Linked to EAHP Statements:
Section 1: Introductory Statements and Governance
Section 4: Clinical Pharmacy Services
Section 5: Patient safety and Quality Assurance
Section 6: Education and Research
ACPE UAN: 0475-0000-16-010-L04-P. A knowledge based activity.
Hospital pharmacists and other healthcare professionals perform medicines optimisation in the best interest of the patient. What are the benefits of this clinical service and how can they be evaluated? Do the outcomes depend on which tools are used for medicines optimisation? Or do the outcomes depend on who performs medicines optimisation? How can pharmacists work together with other healthcare professionals to benefit the patient?
Medicines optimisation starts with medication reconciliation (MR). How can MR be performed? Which tools can be used? How frequently are medication discrepancies identified? Which medication discrepancies are most frequently identified? Do some patients benefit more than others? Does it matter whether a pharmacist completes an MR? Pharmacists spend far less time performing MRs than nurses. What's more, physicians may agree more often to act upon medication discrepancies identified by pharmacists than by nurses.
Clinical medication review is an integral part of medicines optimisation. How can the impact of a clinical medication review performed by a pharmacist be evaluated? What are the advantages and disadvantages of the tools available for measuring appropriateness of prescribing? How well do they capture the impact of an intervention performed by a clinical pharmacist? A comprehensive clinical pharmacist intervention has been shown to reduce hospital readmission rates for patients aged 80 years or older onto an acute internal medicine ward. The quality of prescribing has been improved for the patients in the intervention group during the hospital stay, as measured using three validated tools for prescribing appropriateness: MAI, STOPP and START. However, when the link between the tools and clinical outcome was explored, no strong association between a high level of inappropriate prescribing (according to the tools) and a higher number of hospital readmissions was found.
• To discuss the effects of medicines optimisation and how to measure these effects;
• To show the advantages and disadvantages of applying these different tools.