Patient Pathway Pharmacist - Optimal Drug-related Care

Patient Pathway Pharmacist: Drug Optimisation for Hip Fracture Patients - Facilitating a Safe Patient Handover: a Descriptive Study

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.

Study Overview

• Status: Completed
• Conditions: Aging; Hip Fractures; Patient Fall
• Intervention / Treatment: Procedure: Patient Pathway Pharmacist intervention

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Norway
  • Tønsberg, Norway
    • Vestfold Hospital Trust

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Hip fracture patients in Vestfold county, Norway

Exclusion Criteria:

• 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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Patient Pathway Pharmacist intervention; Medication reconciliation at admission to hospital; Medication review post surgery; Optimised list of drugs in the discharge summary, in accordance with hospital procedures; Medication reconciliation, six weeks after discharge; Medication review, six weeks after discharge	Procedure: Patient Pathway Pharmacist intervention; Medication reconciliation at admission to hospital; Medication review post surgery; Optimised list of drugs in the discharge summary, in accordance with hospital procedures; Medication reconciliation, six weeks after discharge; Medication review, six weeks after discharge
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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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 Outcome Measures

Outcome Measure	Measure Description	Time Frame
Readmission	Patients who are readmitted to hospital is quantified	30 days after discharge
Readmission	Patients who are readmitted to hospital is quantified	90 days after discharge
Death	The number patients who dies is quantified	30 days after discharge
Death	The number of patients who dies is quantified	90 days after discharge

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Experience of current practice	A questionnaire will be distributed to all health care professionals involved in the treatment of hip fracture patients	Prior to or during the early start of the intervention
Experience of patient pathway pharmacist	Focus groups or semi-structured interviews will be performed to assess the advantages and/or disadvantages of introducing a patient pathway pharmacist.	Within three months after last included patient

Collaborators and Investigators

• Sponsor: Sykehuset i Vestfold HF
• Collaborators: Hospital Pharmacy Enterprise, South Eastern Norway

Publications and helpful links

Helpful Links

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

Study record dates

Study Major Dates

• Study Start (Actual): September 3, 2018
• Primary Completion (Actual): June 15, 2019
• Study Completion (Actual): June 28, 2023

Study Registration Dates

• First Submitted: September 11, 2018
• First Submitted That Met QC Criteria: October 2, 2018
• First Posted (Actual): October 3, 2018

Study Record Updates

• Last Update Posted (Actual): June 29, 2023
• Last Update Submitted That Met QC Criteria: June 28, 2023
• Last Verified: June 1, 2023

More Information

Terms related to this study

• Keywords: Hospital readmissions; Hospitalisation; Hip; Fracture; Medication errors; Hospitalization; Femoral neck fractures; Medication review; Intertrochanteric fractures; Medication reconciliation; Hospital readmission; Medicine review; Patient handoff; Patient hand over; Trochanteric fractures; Subtrochanteric fractures; Injuries, Hip; Femoral fractures
• Additional Relevant MeSH Terms: Wounds and Injuries; Leg Injuries; Femoral Fractures; Hip Injuries; Fractures, Bone; Hip Fractures
• Other Study ID Numbers: 59475

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No