Impact of the Intervention of Pharmacists and Geriatrician on Drug Prescription in Elderly Patients in a Surgical ICU (IATROAGE)

Impact of the Intervention of Pharmacists and Geriatrician on Drug Prescription in Critically Ill Elderly Patients Admitted in Surgical ICU

In order to optimize drug prescription and to reduce potentially inappropriate medications, a pharmaceutical analysis activity is conducted in our establishment for several years. Medical prescriptions are reviewed daily by pharmacists. This activity is developed in approximatively 84% of the hospital wards of the institution, and especially in the geriatric department. Drug induced adverse effects are frequently encountered in elderly people and ICU environment causes a high risk of iatrogenic events because of the complexity of care and of the severity of illness. The hypothesis of the study is that the intervention of pharmacists and geriatricians could improve the medical prescription in elderly patients by reducing avoidable drug interactions and thus by decreasing the risk of drug induced adverse effects.

The primary objective of this study is to evaluate the impact of the intervention of pharmacists and geriatricians on medical prescription and on iatrogenic risk in elderly critically ill patients admitted in surgical ICU. The secondary objectives are (i) to describe the elderly patients population in surgical ICU, (ii) to analyze the impact of the ICU stay on medical prescription, (iii) to analyze the opportunities suggested by the pharmacists to optimize drug therapies and (iv) to assess the impact of drug prescription in the ICU on long-term disability.

A prospective, observational, before-after study will be conducted from august 1, 2018 to February 1, 2020, in the surgical ICU of the hospital. Patients older than 70 years and admitted to surgical ICU will be eligible. This study will be conducted in 2 successive steps: (1) first step: without any intervention of pharmacists or and geriatricians (Baseline), (2) second step: all drug prescription during the ICU and the hospital stay will be analyzed by a pharmacist and a geriatrician, to decrease drug interaction and risk of drug related adverse effect. During each step, the demographic and medical data will be recorded. Medical prescriptions will be reviewed at ICU admission, at 96 hours after ICU admission and then every 4 days until discharge from the ICU. For each patient, the impact of the intervention on mid-term and long-term disability will be assessed during a geriatric evaluation by using adequate specific scale at hospital discharge and at 3 months after hospital discharge. All iatrogenic events will be collected and analyzed.

Study Overview

• Status: Completed
• Conditions: Critical Care; Aged

Detailed Description

The aim of this study is to evaluate the impact of the intervention of pharmacists and geriatricians on medical prescription and on the iatrogenic risk in elderly critically ill patients admitted in surgical ICU. This study is before-after prospective study, carried out in 2 steps.

Step 1 data collection from August 1, 2018 to February 1, 2019

This step is a prospective analysis without any intervention of the pharmacist and of the geriatrician.

• The sociodemographic, and medical (comorbidities, reason for ICU admission, SAPS II (Simplified Acute Physiology Score) and SOFA (Sepsis-related Organ Failure Assessment) scores, laboratory data, invasive procedures data will be collected from ICU medical record.
• A geriatric evaluation and disability evaluation will be performed by using the ADL (Activity of Daily Living), Charlson, and SEGA (Short Emergency Geriatric Assessment) scales.
• The medical prescriptions will be reviewed at the first day and at 96 hours after admission in the ICU, and every 4 days during ICU stay. The pharmacist will analyse the medical prescriptions by using a standardized tool (Micromedex®, Theriaque®, Vidal®), to identify inappropriate prescription, and to assess the iatrogenic risks. These interventions will be quantified by using the SFPC Scale (French Society of clinical pharmacy).
• Iatrogenic events will be reported and analyzed.
• Drug prescription and patient outcome at discharge from the ICU and at discharge from the hospital will be collected.
• At 3 months from discharge from the hospital, a new geriatric evaluation will be conducted (patient's outcome and medical prescription).

Step 2, from March 1, 2019 to March, 2020.

This step is a prospective analysis with the intervention of the pharmacist and of the geriatrician.

The same data that step 1 will be collected. During this step, the pharmacist carries individualized interventions that will be discuss with the physician in charge of the patient to improve the safety of drug prescription. The physician will be allowed to accept or to refuse these interventions.

At 3 months from discharge from the hospital, a consultation with geriatrician will be proposed to the elderly patient. The geriatric evaluation and disability assessment will be conducted during this consultation.

• Study Type: Observational
• Enrollment (Actual): 230

Contacts and Locations

Study Locations

• France
  • Besançon, France, 25000
    • CHU de Besancon

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 70 years and older (OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

70 years or older patient admitted to surgical ICU of university affiliated hospital of Besançon

Description

Inclusion Criteria:

• patients 70 years or older
• admitted to surgical ICU

Exclusion Criteria:

• patients refusing data collection

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Before; Elderly patients > = 70 in ICU without any intervention of the pharmacists and of the geriatricians
After; Elderly patients > = 70 in ICU with individualized intervention of the pharmacists and of the geriatricians

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Impact of geriatric and pharmacist's intervention	Difference between iatrogenic risks before/after pharmaceutical intervention on the elderly's prescription. The iatrogenic risk is evaluated with the iatrogenic events rates and the inappropriate prescriptions rates.	Hospital stay until 3 months after

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Describe the medical characteristics of elderly patients population in surgical intensive care with the Charlson Comorbidities Index (CCI)	Charlson Comorbidities Index Three grades of severity: mild, with CCI scores of 1-2; moderate, with CCI scores of 3-4; severe, with CCI scores ≥5	During hospital stay up to 3 months after discharge
Describe the medical characteristics of elderly patients population in surgical intensive care	Rates of hospitalization's causes: surgical emergency causes, elective surgery causes, medical emergency causes, elective medical causes	During hospital stay up to 3 months after discharge
Describe the demographic elderly patients population in surgical intensive care	age, sex	During hospital stay up to 3 months after discharge
Impact of a stay surgical intensive care on medical prescription change	number of new treatment, number of new interaction, number of iatrogenic event, before/after surgical intensive care	During Hospital stay in ICU (Day 0, 4, 8, 12, 16) and 3 months after discharge
Evaluate the intervention's impact on the disability and geriatric evaluation with ADL scale	Evolution of disability and geriatric evaluation before/after intervention: - ADL (Activity Daily Living evolution of the different geriatrics scores) 0 : dependance, 6 autonomy	3 months after hospital discharge
Evaluate the intervention's impact on the disability and geriatric evaluation with SEGA scale	Evolution of disability and geriatric evaluation before/after intervention: - SEGA (Short Emergency Geriatric Assessment): 0-26 < or = 8 : Low fragility, 9-11: fragility, > or = 12 Very fragile person	3 months after hospital discharge
Analyse the opportunities suggested by the pharmacist for optimization of drug therapies	rates of kind opportunities suggested by the pharmacist (dosage adjustment, galenic form change, inappropriate medication ...)	During Hospital stay ICU (Day 0, 4, 8, 12, 16)

Collaborators and Investigators

• Sponsor: Centre Hospitalier Universitaire de Besancon
• Investigators: Principal Investigator: Anne Laure CLAIRET, CHU de Besancon

Study record dates

Study Major Dates

• Study Start (ACTUAL): August 1, 2018
• Primary Completion (ACTUAL): March 23, 2020
• Study Completion (ACTUAL): July 1, 2020

Study Registration Dates

• First Submitted: August 16, 2018
• First Submitted That Met QC Criteria: October 12, 2018
• First Posted (ACTUAL): October 15, 2018

Study Record Updates

• Last Update Posted (ACTUAL): March 9, 2021
• Last Update Submitted That Met QC Criteria: March 5, 2021
• Last Verified: December 1, 2019

More Information

Terms related to this study

• Keywords: quality of life; disability; iatrogenic; surgery ICU; inappropriate medications
• Other Study ID Numbers: IATROAGE

Drug and device information, study documents

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