Background The Institutionalised Patient Care Unit (IPCU) aims to humanise and optimise the care of the institutionalised older patients in the Emergency Department (ED), promoting their early functional recovery. Likewise, this unit promotes multidisciplinary team-working to achieve decisions swiftly in order to reduce the average stay in the ED and to reduce unnecessary tests and hospitalisations.
Purpose To describe the role of the hospital pharmacist in the IPCU.
Material and methods The IPCU began its activity in October 2016. The incorporation of the pharmacist was done on a part-time basis. The pharmaceutical intervention focused on medication reconciliation, review and optimisation, and, in addition, on the coordination, together with the nurses, of continuity of care and of the dispensing of parenteral antibiotics to nursing homes.
Results From October 2016 to May 2017, 2236 patients were treated at the IPCU, with an average stay time of 18 hour 6 min (53.4% were discharged, 31.3% admitted, 15.3% transferred to another hospital). In that period, the pharmacist performed medication reconciliation to 511 patients (22.8% of the total patients attended) (64.7% females; mean age: 85.5±8.1 years; 9.4±3.6 chronic drugs per patient). Of the 511 patients, 407 (79.6%) required some type of pharmaceutical intervention. The number of interventions was 884 (2.2 interventions per patient, on average). The most frequent interventions (79) were collected in a document according to the drug or therapeutic group involved in order to streamline and standardise the pharmaceutical intervention in the future. The errors of greatest clinical impact detected were those related to anticoagulants, digoxin, antiepileptics, opioids, antiparkinsonians and beta-blockers. Regarding the dispensing of parenteral antibiotics to the nursing homes, we gave intravenous treatment to 25 patients: eight (36%) amoxicillin/clavulanate; five (20%) ertapenem, 4 (16%) piperacillin/tazobactam; 4four (16%) ceftriaxone; and four (16%) other. In addition, written information was developed to ensure the correct administration of the medication.
Conclusion The development of the pharmaceutical care process in the IPCU contributes to improving safety and quality of urgent healthcare and helps to optimise the therapy at discharge from the ED. Coordination with the IPCU team facilitates the dispensation of medication to institutionalised patients, and highlights the requirement for the pharmacist in the management of avoidable hospitalisations.
No conflict of interest
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