Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany

L Cortejoso,1 RA Dietz,2 G Hofmann,1 M Gosch,2 A Sattler1 1Department of Pharmacy, 2Department of Geriatrics, Hospital Nuremberg, Paracelsus Medical Private University Nuremberg, Nuremberg, Germany Background: Inappropriate pharmacotherapy among older adults remains a critical issue in our health...

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Autores principales:	Cortejoso L, Dietz RA, Hofmann G, Gosch M, Sattler A
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	older adults medication errors pharmacist interventions Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/9ec2b47ebf4643478fdccb7c6893b1ef
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spelling	oai:doaj.org-article:9ec2b47ebf4643478fdccb7c6893b1ef2021-12-02T07:35:25ZImpact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany1178-1998https://doaj.org/article/9ec2b47ebf4643478fdccb7c6893b1ef2016-09-01T00:00:00Zhttps://www.dovepress.com/impact-of-pharmacist-interventions-in-older-patients-a-prospective-stu-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998L Cortejoso,1 RA Dietz,2 G Hofmann,1 M Gosch,2 A Sattler1 1Department of Pharmacy, 2Department of Geriatrics, Hospital Nuremberg, Paracelsus Medical Private University Nuremberg, Nuremberg, Germany Background: Inappropriate pharmacotherapy among older adults remains a critical issue in our health care systems. Besides polypharmacy and multiple comorbidities, the age-related pharmacokinetic and pharmacodynamic changes may increase the risk of adverse drug reactions and medication errors.Objective: The main target of this study was to describe the characteristics of pharmaceutical interventions in two geriatric wards (orthogeriatric ward and geriatric day unit) of a general teaching hospital and to evaluate the clinical significance of the detected medication errors.Materials and methods: The study was conducted between August 2014 and October 2015 and was based on a triple approach that included validation of medical orders, medication reconciliation at patients’ admission, and a predischarge planning appointment with the patient. The validation of medical orders was based on analyzing the suitability of the drugs prescribed, the drug dose depending on the patient’s characteristics, the presence of contraindications and interactions between drugs, and the proposal of alternative drugs included in the hospital formulary.Results: A total of 2,307 interventions associated to a medication error in 15,282 medical orders for 1,859 older patients were recorded. The greater part of the interventions carried out on the orthogeriatric ward at admission and at discharge were due to omission of a drug in the medical order (20.0%) and clinically significant interactions requiring monitoring (30.4%), respectively. The main factor triggering pharmacist’s recommendations on the geriatric day unit was clinically significant interactions (21.1%). With regard to the clinical severity of the detected errors, 68.1% were considered significant, 24.8% were of minor significance, and 7.2% were clinically serious.Conclusion: Our findings show the importance of clinical pharmacist involvement in the optimization of pharmacotherapy in older adults, ensuring that they receive effective, safe, and efficient drug therapy. Keywords: older adults, medication errors, pharmacist interventionsCortejoso LDietz RAHofmann GGosch MSattler ADove Medical Pressarticleolder adultsmedication errorspharmacist interventionsGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 11, Pp 1343-1350 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	older adults medication errors pharmacist interventions Geriatrics RC952-954.6
spellingShingle	older adults medication errors pharmacist interventions Geriatrics RC952-954.6 Cortejoso L Dietz RA Hofmann G Gosch M Sattler A Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany
description	L Cortejoso,1 RA Dietz,2 G Hofmann,1 M Gosch,2 A Sattler1 1Department of Pharmacy, 2Department of Geriatrics, Hospital Nuremberg, Paracelsus Medical Private University Nuremberg, Nuremberg, Germany Background: Inappropriate pharmacotherapy among older adults remains a critical issue in our health care systems. Besides polypharmacy and multiple comorbidities, the age-related pharmacokinetic and pharmacodynamic changes may increase the risk of adverse drug reactions and medication errors.Objective: The main target of this study was to describe the characteristics of pharmaceutical interventions in two geriatric wards (orthogeriatric ward and geriatric day unit) of a general teaching hospital and to evaluate the clinical significance of the detected medication errors.Materials and methods: The study was conducted between August 2014 and October 2015 and was based on a triple approach that included validation of medical orders, medication reconciliation at patients’ admission, and a predischarge planning appointment with the patient. The validation of medical orders was based on analyzing the suitability of the drugs prescribed, the drug dose depending on the patient’s characteristics, the presence of contraindications and interactions between drugs, and the proposal of alternative drugs included in the hospital formulary.Results: A total of 2,307 interventions associated to a medication error in 15,282 medical orders for 1,859 older patients were recorded. The greater part of the interventions carried out on the orthogeriatric ward at admission and at discharge were due to omission of a drug in the medical order (20.0%) and clinically significant interactions requiring monitoring (30.4%), respectively. The main factor triggering pharmacist’s recommendations on the geriatric day unit was clinically significant interactions (21.1%). With regard to the clinical severity of the detected errors, 68.1% were considered significant, 24.8% were of minor significance, and 7.2% were clinically serious.Conclusion: Our findings show the importance of clinical pharmacist involvement in the optimization of pharmacotherapy in older adults, ensuring that they receive effective, safe, and efficient drug therapy. Keywords: older adults, medication errors, pharmacist interventions
format	article
author	Cortejoso L Dietz RA Hofmann G Gosch M Sattler A
author_facet	Cortejoso L Dietz RA Hofmann G Gosch M Sattler A
author_sort	Cortejoso L
title	Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany
title_short	Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany
title_full	Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany
title_fullStr	Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany
title_full_unstemmed	Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany
title_sort	impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in germany
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/9ec2b47ebf4643478fdccb7c6893b1ef
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Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany

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