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4CPS-190 Development of transmural pharmaceutical care in a general hospital
  1. V Vermaut1,2,
  2. S Jabbour2,
  3. S Blondelle2,
  4. P Duez3,
  5. S Patris1,
  6. A Pardo2,3
  1. 1Faculty of Medicine And Pharmacy- University of Mons, Department of Clinical Pharmacy, Mons, Belgium
  2. 2Chr Haute Senne, Department of Pharmacy, Soignies, Belgium
  3. 3Faculty of Medicine and Pharmacy- University of Mons, Laboratory of Therapeutic Chemistry and Pharmacognosy, Mons, Belgium


Background and Importance The transition between different care settings is vulnerable to medication errors. To avoid these errors, information about new medications must be shared between different care providers.

The PACT project, an integrated care project, proposes to carry out medication reconciliation according to a structured methodology using envelopes. At hospital admission, blue envelopes are used. They contain the patient’s medication scheme previously produced by the reference pharmacist in a community pharmacy. At hospital discharge, the new medication scheme and the new prescriptions are placed in a green envelope. This envelope must be given to the reference pharmacist who must explain any changes to the patient.

Aim and objectives • To set up and evaluate the impact of pharmaceutical interventions aiming to implement the PACT medication reconciliation system at hospital discharge.

Material and Methods Two audits, each carried out over a period of 10 days in December 2022, were conducted in three care units on a pre-test group and a test group. The test group was constituted during the period of test which included pharmaceutical interventions (real-time interventions and outreach visits to practitioners).

  • We evaluated the similarity between the two groups in terms of demographic and clinical characteristics and in terms of medication characteristics using Student’s test and the Chi-Squared test (χ2 test).

  • The impact of the pharmaceutical interventions was then evaluated by comparing between the two groups the rate of green envelopes delivered to the patient. Data were analysed using χ2 test.


  • The two groups were similar in terms of demographic and clinical characteristics. Regarding medication characteristics, the analysis confirmed the similarity between groups, except for the number of newly prescribed medicines (p = 0.04) and the number of medicines to be stopped after hospitalisation (p = 0.03).

  • The rate of green envelopes delivered to the patient at the end of hospitalisation was higher in the test group (78%) compared to the pre-test group (33%) (p < 0.001).

Conclusion and Relevance This work highlights the importance of developing the role of integrated care pharmacist coordinator to strengthen the communication on patient medications.

References and/or Acknowledgements 1.


Conflict of Interest No conflict of interest

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