CP-095 Continuity of clinical pharmacy activities from admission to hospital discharge: which impacts during hospital stay of patients?

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BackgroundThe teaching hospital in this study is a reference centre for the management of patients with bone and joint infections. In this dedicated unit, a pharmacist is present on a daily basis.PurposeThe aim of this study was to assess the value and complementarity of different missions of the pharmacist.Material and methodsPharmaceutical activity is organised into three steps: medication reconciliation at patient admission, analysis of the first hospital prescription and daily analysis of prescriptions during hospitalisation. For each step, pharmaceutical time was estimated. Pharmaceutical interventions (PI) carried out were recorded and classified according to the pharmaceutical validation step and the ATC (Anatomical Therapeutic Chemical) classification of the drug.ResultsThe study was performed on 52 patients hospitalised in the trauma unit between November 2015 and January 2016. On average, 1 PI per hour was proposed during the reconciliation step, 3.46 PI per hour during the first analysis and 3.59 PI per hour during daily analysis of prescriptions. Most of the PI were proposed when analysing the prescriptions, whatever this was the first or a follow-up. Nevertheless, they were feasible only when reconciliation had already been made so as to establish a ‘medical check-up’ and to facilitate subsequent analysis. PI made during reconciliation concerned, in 55% of cases, cardiovascular and respiratory medicinal products. PI made during the first prescription analysis and during daily analysis of prescriptions concerned, respectively, in 60% and 56% of cases, anti-infectives and analgesics. Reconciliation primarily targets chronic treatments. It is complementary to the third level of prescription analysis which targets treatments introduced during hospitalisation. The large number of PI carried out during hospitalisation begs the question as to whether therapeutic protocols proposed by prescription software, widely used in the unit, can be a source of error due to lack of personalisation of drug management.ConclusionAll pharmaceutical activity steps are complementary and essential to patient care. A global pharmaceutical management system from hospital admission to hospital discharge must be considered.References and/or acknowledgementsThanks to the trauma unit team.No conflict of interest

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