In many European hospitals, check of medication appropriateness (also called 'clinical validation') is implemented as a liaison between clinical decision support systems (at the moment of prescribing) and bedside clinical pharmacy. This is on the one hand driven by accreditation but on the other hand also the most feasible way to broaden clinical pharmacy services in countries were the budget for bedside clinical pharmacy is restricted. In most programs, electronic medication files are screened by software programs for potential drug-related problems, which are afterwards evaluated by a trained hospital pharmacist. Check of medication appropriateness programs are different from clinical decision support as 1) a patient's treatment is not only validated or checked at the moment of prescribing but at any time during hospitalisation and 2) the check integrates all patient- , disease- and treatment-related characteristics. In this way, check of medication appropriateness is applied to check drug-related biochemical changes, overruled severe drug-drug interactions, antimicrobial stewardship rules etc. The checks are based on recent literature and practice guidelines, and discussed by a multidisciplinary team, often the Pharmacy & Therapeutics Committee, before implementation.
In this workshop, the check of medication appropriateness program used in the University Hospitals Leuven will be presented. First, the participants will be invited to evaluate real-life patient cases with a high risk for drug-related problems based on several flowcharts and algorithms. Second, the participants will be asked to prioritize the needs for specific checks in their own hospital. The feasibility, requirements and rate of success of these checks will be discussed with the moderators of the workshop.
After the session, the participant should be able to:
Understand how a check of medication appropriateness program works based on a case-based approach
Setup a check of medication appropriateness program in his own hospital
Prioritize the clinical rules covered by the check of medication appropriateness programme
Understand how evidence based guidelines can be integrated in a check of medication appropriateness program
Educational need addressed
A hospital pharmacist as a member of multidisciplinary team have a have a key role in studying and creating ways to foster best practices. The main goals of the workshop are describe how to work with evidence in creating guidelines and demonstrate how evidence based guidelines can be integrated in a check of medication appropriateness program.
Keywords: Check of medication appropriateness program, clinical validation, clinical rules, rational therapy, evidence based guidelines.