How a Patient Personalised Clinical Pharmacy Programme Can Secure Therapeutic Care in an Orthogeriatric Care Pathway (5P Project)?

Marine Barral,1,* Julie Martin,1,* Emmanuelle Carre,2 Audrey Janoly-Dumenil,3– 5 Florence Ranchon,2,4,6 Stéphanie Parat,2 Catherine Rioufol,2,4,6 Sylvain Goutelle,4,7,8 Laurent Bourguignon,4,7,8 Teddy Novais,4,9,10 Sebastien Doh,11 Matthieu Malatray,12 Philippe Chaudier,13 Jerome Gauthier,14 Christine Pivot,3 Christelle Mouchoux,4,9,15 Delphine Hoegy1,4,5 On behalf of 5P Study Group1Pharmacie, Hospices Civils de Lyon, Lyon, France; 2Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; 3Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; 4Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France; 5 6-EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France; 6EA3738, CICLY Centre pour l’Innovation en cancérologie de Lyon, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France; 7Pharmacie Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France; 8CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Villeurbanne, France; 9Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France; 10Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; 11Service de Gériatrie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; 12Service de Chirurgie Orthopédique Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; 13Service de Chirurgie Orthopédique Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; 14Service d’anesthésie et réanimation Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; 15Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, Lyon, France*These authors contributed equally to this work.Correspondence: Delphine HoegyHôpital Edouard Herriot, Groupement Hospitalier Centre, Hospices Civils de Lyon, 5 Place d’Arsonval, Lyon, 69003, FranceTel +33 4 72 11 91 82Fax +33 4 72 11 78 76Email delphine.hoegy@chu-lyon.frBackground: A new model was developed for integrating a personalised clinical pharmacy programme (5P project) into the orthogeriatric care pathway.Objective: To secure the therapeutic care of orthogeriatric patients.Design and Setting: Prospective descriptive study in a multisite teaching hospital from June 2019 to January 2020.Subjects: Patients aged ≥ 75 years admitted for hip fracture.Methods: A prescription review was performed for all patients at inclusion. Other clinical pharmacy activities (additional prescription review, pharmaceutical interviews, medication reconciliation) were dedicated to “high-risk” patients. Potential medication errors (ME), either pharmaceutical interventions (PI) or unintentional discrepancies (UID), were recorded. The potential clinical impact of PI was evaluated by a pluriprofessional expert panel using a validated tool.Results: In the 455 patients included, 955 potential ME were detected, that is ≥ 1 potential ME for 324/455 (71%) patients. In acute care, 561 PI were formulated during prescription review for 440/455 (97%) patients and 348/561 (62%) were accepted by physicians. Medication reconciliation was performed for 213 patients, 316 UID were identified. In rehabilitation units, a second prescription review was performed for 112/122 (92%) “high-risk” patients, leading to 61 PI. The clinical impact was evaluated for 519/622 (83%) PI. A consensus was obtained for 310/519 (60%) PI: 147/310 (47%) were rated as having minor clinical impact, 138/310 (45%) moderate, 22/310 (7%) major, 2/310 (0.6%) vital, and 1/310 (0.3%) null.Conclusion: The 5P project secured the orthogeriatric care pathway by detecting a great number of potential ME, including PI mostly considered as having a significant clinical impact.Keywords: hip fracture, frail elderly, pharmaceutical services, medication errors, clinical relevance