Page 127 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP4.4 Clinical Safety and Quality Service II 16:15 Room 221

Joint Pharmacist-nurse Round in Medical Extended Care Unit to Reduce Polypharmacy — Physicians’ Monday, 18 May

Acceptance Rate and Clinical Significance of Interventions
Mak WC 1, Cheng PPP 2, Lau NY 1, Mo KKL 3
1Pharmacy Department, 2Central Nursing Division, 3Department of Medicine, Yan Chai Hospital, Hong Kong

Introduction

Medication-related problems in older adults are common, costly, and may lead to poor outcomes. However, many geriatric
patients have the problem of polypharmacy, from which they exposed to unnecessary drugs and avoidable adverse drug
events.

Objectives

(1) To reduce polypharmacy and improve patient outcomes by a multidisciplinary approach; (2) to determine physicians’
acceptance rate to interventions; and (3) to determine clinical significance of interventions.

Methodology

A weekly joint pharmacist-nurse round including clinical pharmacists and senior nurses (Nurse Consultant and/or Advanced
Practice Nurses) was established in the Medical Extended Care Unit. All interventions were documented on standard
intervention forms and attached to the patients’ drug charts. Physicians would decide whether to accept or reject the
interventions. All accepted interventions were evaluated for clinical significance by an expert panel which is independent of
our hospital, and composed of one senior geriatrician, one nursing school professor, and two pharmacy school lecturers.

Results

From March to November 2014, 395 patients and 3,123 drug items were reviewed. The mean age of patients was 78.9
years old. The number of intervention documented was 319 which involved 42 drug classes. The top three categories of
interventions were polypharmacy (51.41%), drug regimen (26.96%) and drug selection (18.50%). Physicians’ acceptance rate
to interventions was 87.78%. The number of drug discontinued was 186. Drug dosage reduction was resulted in 38 cases.
Besides, physicians changed to better drug alternatives in 44 cases. The net decrease in number of drug administration
frequency was 445. Given that the average length of stay of patients in the involved wards was 25.4 days, the estimated
total number of drug administration frequency reduced was 11,303. The percentage of accepted interventions being rated
as significant, very significant, and extremely significant by the senior geriatrician, nursing professor, and two pharmacy
lecturers was 97.4%, 67.5%, 91.1% and 80.8% respectively. There was a substantial agreement between panel members
as the Intraclass Correlation Coefficient was 0.693. By the concerted effort of physicians, clinical pharmacists and nurses,
better patient care plans were devised during the joint round. This service model provides a new direction to improve patient
outcomes and should be promoted in similar healthcare settings.

HOSPITAL AUTHORITY CONVENTION 2015

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