Patient Pathway Pharmacist - Optimal Drug-related Care

NCT03695081 | Completed

• 1 other identifier: 59475
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Medication errors represent the most common cause of patient injury and one of the most frequently reported health related deviation in Norway. The addition of a dedicated clinical pharmacist throughout the hip fracture patient pathway (patient pathway pharmacist) is believed to improve patient safety and ensure optimal drug-related patient care. The pharmacist will perform medication reconciliation at admission to hospital, medication review after surgery and assist physicians with discharge summary. Six weeks after discharge the patient pathway pharmacist will perform a second drug reconciliation and medication review. This study will assess the pharmacists' place and specific tasks in the patient pathway, describe areas where the pharmacist contribute to increased quality of care and assess the benefits and/or disadvantages experienced with introducing a patient pathway pharmacist. The estimated number of patients included is 60. Current practice will be determined by investigating the last 50 patients' medical record and a questionnaire to health care professionals involved in treatment of hip fracture patients. Data from medication reconciliation and drug review will be collected and compared to current practice. After the inclusion period, focus group surveys and/or semi-structured interviews will be executed to describe the perceived improvement in the quality of care. Primary endpoints are: 1) Medication reconciliation score at admission 2) Number of inappropriate drugs for elderly 3) Discharge summary score 4) Discharge summaries following procedure. Secondary endpoints are readmissions and mortality after 30 and 90 days. Qualitative endpoints: 1) Health care professionals experience of current drug-related practice 2) Experienced advantages and disadvantages of a patient pathway pharmacist.

Conditions

Hip Fractures; Aging; Patient Fall

Keywords

Medicine review; Patient handoff; Patient hand over; Intertrochanteric fractures; Trochanteric fractures; Subtrochanteric fractures; Hospital readmission; Hospital readmissions; Injuries, Hip; Hospitalization; Hospitalisation; Hip; Fracture; Femoral fractures; Femoral neck fractures; Medication errors; Medication review; Medication reconciliation

Outcome Measures

Primary Outcomes (4)

• Discharge summary score

  In the discharge summary, the section describing drugs is scored in accordance with the national patient safety program

  At discharge (estimated five days after fracture/inclusion)

• Admission summary score

  In the admission summary, the section describing drugs is scored. The score is adjusted from the discharge summary score to fit the admission note.

  At hospital admission (estimated to be within 24 hours after fracture)

• Discharge summaries written in accordance with procedure

  In the discharge summary, the section describing drugs should be in accordance with procedure.

  At discharge (estimated five days after fracture/inclusion)

• Number of inappropriate drugs at discharge

  After surgery the medication review may reduce the number of inappropriate drugs (on the STOPP-list).

  During hospitalisation, after surgery (estimated to be within five days after fracture/inclusion)

Secondary Outcomes (4)

• Readmission

  30 days after discharge

• Readmission

  90 days after discharge

• Death

  30 days after discharge

• Death

  90 days after discharge

Other Outcomes (2)

• Experience of current practice

  Prior to or during the early start of the intervention

• Experience of patient pathway pharmacist

  Within three months after last included patient

Study Arms (2)

Patient Pathway Pharmacist intervention

EXPERIMENTAL

1. Medication reconciliation at admission to hospital 2. Medication review post surgery 3. Optimised list of drugs in the discharge summary, in accordance with hospital procedures 4. Medication reconciliation, six weeks after discharge 5. Medication review, six weeks after discharge

Procedure: Patient Pathway Pharmacist intervention

No intervention

NO INTERVENTION

Business as usual. The Patient Pathway Pharmacist is not involved and the nurses and physicians are responsible for medicine reconciliation, -review and section in the discharge summary.

Interventions

Patient Pathway Pharmacist intervention PROCEDURE

1. Medication reconciliation at admission to hospital 2. Medication review post surgery 3. Optimised list of drugs in the discharge summary, in accordance with hospital procedures 4. Medication reconciliation, six weeks after discharge 5. Medication review, six weeks after discharge

Patient Pathway Pharmacist intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Hip fracture patients in Vestfold county, Norway

You may not qualify if:

• Patients under 18 years
• Terminally ill
• Hip fracture patients who do not follow the standardized patient pathway at Vestfold Regional Hospital
• Patients who do not consent to be included in the study

Sponsors & Collaborators

• Sykehuset i Vestfold HF: lead
• Hospital Pharmacy Enterprise, South Eastern Norway: collaborator

Study Sites (1)

Vestfold Hospital Trust

Tønsberg, Norway

Location

Related Publications (1)

• Henriksen BT, Krogseth M, Andersen RD, Davies MN, Nguyen CT, Mathiesen L, Andersson Y. Clinical pharmacist intervention to improve medication safety for hip fracture patients through secondary and primary care settings: a nonrandomised controlled trial. J Orthop Surg Res. 2023 Jun 13;18(1):434. doi: 10.1186/s13018-023-03906-2.

  PMID: 37312222 DERIVED

Related Links

• Score of the drug section in discharge summaries - The Norwegian Patient Safety Programme: In Safe Hands

MeSH Terms

Conditions

Hip Fractures; Hip Injuries; Fractures, Bone; Femoral Fractures; Femoral Neck Fractures

Condition Hierarchy (Ancestors)

Wounds and Injuries; Leg Injuries

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Clinical Pharmacist

Model Details: An intervention group is compared to a cross-sectional retrospective group. A group of 60 patients with hip fracture will get an intervention by a clinical pharmacist who performs medication reconciliation and medication review during hospitalisation, they will receive a discharge summary where the medication part is optimised. After six weeks the patients will be get a follow-up with a second medication reconciliation and - review. This group will be compared with the last 50 patients with hip fracture who did not get the intervention.

Study Record Dates

• First Submitted: September 11, 2018
• First Posted: October 3, 2018
• Study Start: September 3, 2018
• Primary Completion: June 15, 2019
• Study Completion: June 28, 2023
• Last Updated: June 29, 2023

Record last verified: 2023-06

Data Sharing

• IPD Sharing: Will not share

Locations

NO (1)