Le dossier pharmaceutique dans un service d’accueil des urgences : évaluation de son accessibilité et de son impact sur le niveau de connaissance du traitement du patient

[Contribution of the pharmaceutical record in the analysis of drug interactions during retrocession in a centre for cancer research]

OBJECTIVES

To implement the pharmaceutical record in retrocession, to evaluate its contribution to the analysis of drug interactions and to estimate the sustainability of this approach.

METHODS

This prospective, descriptive, monocentric study was conducted over five months. All patients presenting at the retrocession were eligible. After having offered them the pharmaceutical record and having completed it, drug interactions were sought. If the impact was considered significant, a pharmaceutical intervention was transmitted to the referring physician of the institution and recorded in the computerized patient record.

RESULTS

The pharmaceutical record was offered to 497 patients, i.e., 87 % of eligible patients. At the first meeting, 7 % of patients (n=34) were aware of it and 72 % had one open. In total, 395 pharmaceutical records were filled in at least once, 41 of which we created. Only 25 patients (5 %) refused the process and 90 % of the existing records were filled by the pharmacy. In total, 419 prescriptions were analysed for 330 patients: the pharmaceutical record was therefore a useful tool for 66 % of patients. For 17 % (n=57) of them, or 11 % of included patients, 99 drug interactions with a high risk of clinical impact were detected with the retroceded drug. On average, the presentation, creation and feeding of the drug record took one minute each and the analysis of interactions 14minutes.

CONCLUSIONS

Easy to implement, the pharmaceutical record is a useful tool to search for drug interactions with retroceded drugs. It helps to optimize patient follow-up, despite the limited information available.

The Electronic Pharmaceutical Record: A new method for medication reconciliation

RATIONALE, AIM, AND OBJECTIVE

There are several ways to establish an accurate medication list in the hospital admission medication reconciliation (MedRec). The challenge for MedRec lies in the availability, reliability, and completeness of the data used. In France, the Electronic Pharmaceutical Record (ePR) was developed to register each medication taken by ambulatory patients, primarily to make dispensation in community pharmacies safe. We evaluated the suitability of this tool in the MedRec when patients were admitted to the hospital.

METHOD

We conducted a 6-month pilot study of 249 MedRec files from a hospital diabetology department. The analysis was supplemented by the ePR for any patient for whom this information was recorded. The study evaluated the ePR as a new MedRec tool, as well as the clinical impact (CI) of the new data collected.

RESULTS

The ePR was contributory for 28% of the patients. Discrepancies were associated with polypharmacy, most of which had a CI = 1. Medication omission was the most frequently found discrepancy (72%), but self-medication (8%) and lack of medication adherence (9%) were also observed.

CONCLUSION

This tool provided added value for reconciliation, as it quickly identifies regular medications, adherence, and self-medication behaviour. The ePR is essential for conducting a thorough MedRec.

[Pharmaceutical record's use in drugs sales service: Analysis of five months of experimentation]

OBJECTIVE

The pharmaceutical record integrated in the health insurance card is now exploitable by hospital pharmacists. The aim of this study is to assess the impact of pharmaceutical record's use in hospital drugs sales service and the relevance of this tool to secure the ambulatory dispensing of drugs.

METHOD

All patients admitted in hospital drugs sales service between June and October 2016 were included. With the patient's consent, pharmaceutical record was created and/or consulted and implemented. When it included the city pharmacy's treatment, a pharmaceutical analysis was carried out to research drug interaction with hospital drugs sales service's treatment. If a contraindicated or not recommended association was detected, a pharmaceutical intervention was sent to the general practitioner, by secured mail. Each stage was timed.

RESULTS

For the 183 included patients, 40 pharmaceutical records have been created and 74 completed. For the 69 remaining patients, pharmaceutical record could not be used. At the end of these 5 months, 86 pharmaceutical records included city pharmacy's and hospital treatments. The pharmaceutical analysis performed have shown 24 drugs interactions related to hospital treatment; seven inappropriate associations were transmitted to the general practitioner. Five minutes were required for both the use and the analysis of pharmaceutical record.

CONCLUSION

Now, the pharmaceutical record is systematically used in the hospital drugs sales service, and its content is systematically analyzed. It represents one of the tool improving communication between town-hospital networks, and helps secure the ambulatory drugs dispensation.