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4CPS-204 Pharmaceutical intervention and education for the discharge of inpatients: experiences in a teaching hospital in taiwan
  1. YN Hsu,
  2. SE Wu,
  3. SC Wu,
  4. LC Chen
  1. Taipei City Hospital, Pharmacy, Taipei, Taiwan R.O.C


Background Discharge medication consultation is to provide a seamless pharmaceutical care to the patient discharged from the hospital to the community, to empower the patient with the correct drug use information which hopefully would reduce or even eliminate the occurrences of re-hospitalisation or emergency visits caused by incorrect drug uses.

Purpose The present study was to reveal the pharmaceutical intervention and education for the discharge of inpatients.

Material and methods The study was conducted from July 2015 to November 2016 and included patients who were offered medication consultation from the pharmacist upon hospital discharge in a teaching hospital in Taiwan. A pharmacist visit recording sheet was used to record all the relevant patient demographic information and intervention provided for further analysis.

Results A total of 748 patients were included: 447 were males (59.8%) and 301 were females (40.2%). Ninety per cent of the patients were 60 or older, 9% were between 40 and 59 years’ old and 1% were less than 40 years’ old. There were 252 patients where pharmacists needed to provide clinical interventions. Concerning the causes of interventions, 200 interventions were related to NG tube uses (79.5%), 24 cases were related to antibiotic use (9.5%), 11 cases were related to interactions (including drug-drug and drug-food interactions), 15 cases were related to unusual dosing instructions and adverse drug reactions (6%), and dosage adjustment and unique dosage form each contributed one case (03%). Of all interventions provided, 30 cases required contacting doctors for prescription changes, 19 cases were related to the use of NG tube, four cases were interaction-related and seven cases were related to antibiotic use.

Conclusion In summary, the majority of patients who had referrals for the pharmacist discharge consultation service were patients over 60-years-old and had a NG tube installed. Most patients included in this study are bed-ridden and incapable of managing on their own. The care-aids are often foreign maids who may have language barriers, hence, pharmacist should pay more attention to ensure that all the information provided is well understood by the care-aids in order to ensure the effectiveness and safety of the drug therapies.

References and/or Acknowledgements Acknowledge all the pharmacists providing pharmaceutical intervention and education for the discharge patients.

No conflict of interest

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