Background A prospective observational study was conducted in 2012 in order to evaluate prescription of potentially inappropriate medicines (PIM) in a geriatric psychiatry unit (GPU) of Lausanne University Hospital.¹ The STOPP/START criteria, an explicit screening tool, were used to detect PIM.² This study showed a high number of PIM. Therefore, introducing a clinical pharmacist in this unit was suggested as a strategy to improve the quality of prescribing by reducing PIM.

Purpose To assess the impact of a clinical pharmacist on PIM by measuring the acceptance rate of the pharmacist’s interventions (PI) in a GPU.

Materials and methods A clinical pharmacy service was implemented in this GPU (16 beds) in order to optimise drug prescription. A clinical pharmacist was integrated in the multidisciplinary team and attended a variety of weekly meetings (pharmacotherapy discussions, new inpatient presentation meeting, nursing staff reports). She performed a daily medicines review (history, conciliation, checking for interaction, consultation of the electronic medical notes, laboratory data, detecting PIM with STOPP/START criteria).

These activities could lead to PI with physicians if drug-related problems were observed. These PI could come from the STOPP/START criteria or after a standard pharmacist appraisal. They were categorised using the Swiss Association of Public Health Administration & Hospital Pharmacists classification [3] and communicated to physicians during meetings, in private discussions or by email. The impact of this activity was measured by the acceptance rate of the PI (number of PI accepted/total number of PI).

Results Data collection started at the end of July 2013. In the last interim analysis dated 11 October, 33 patients were included. 172 PI had been made (117 standard PI and 55 STOPP/START PI) which represents 5.2 PI per patient. Acceptance rate was 85% for standard PI and 47% for STOPP/START PI.

Conclusions This interim analysis shows a good integration of the clinical pharmacist into the healthcare staff with a satisfactory level of acceptance rate. However, a difference in acceptance between standard and STOPP/START PI was observed and needs to be confirmed by further inclusions. This difference may be related to the limitation of this explicit tool in geriatric psychiatry.

References

1. Weibel M-L, et al. http://www.chuv.ch/pha/pha_home/pha-recherche/pha-recherche-contributions/pha-recherche-contributions-travauxdiplomes.htm

2. Gallager, et al. Int J Clin Pharmacol Ther 2008;46(2):72-83

3. http://www.gsasa.ch/pages/activites/activites-cliniques/?oid=1587&lang=FR

No conflict of interest.