4CPS-194 Clinical impact of a pharmacist-led discharge medication review service: an analysis of prevalence and acceptance of interventions (original) (raw)
2022, Section 4: Clinical pharmacy services
scored CR technical feasibility (no, hardly, easily, very easily-feasible). 'Very relevant' and 'easily feasible' CR were retained if average criticality score was 'high' when applicable for different specialties (assessed by numerous experts) or 'extreme' when applicable for a specific specialty (assessed by only one expert). Results Fifty-six CR potentially relevant for children were selected from the literature and divided into five risk classes: drug contraindicated (34%), medication and abnormal laboratory value (27%), drug-drug interaction (19%), inadequate administration mode (11%) and prescription omission (9%). Twenty-four CR were retained after expert assessment, 8 (33.3%) concerned both groups, 14 (58.3%) were specific for group A and 2 (8.3%) for group B. The three most critical CR involved prescribing potassium and hyperkalaemia, glucose-lowering drugs and hypoglycaemia, and vancomycin not adjusted to renal function. Development in CDSS was assessed as 'very easily' feasible for 5 CR (21%) including 3 CR (12.5%) concerning both groups. We identified 24 CR in five risk classes that could be monitored using our CDSS. Assessment based on expert opinion according to risk (criticality), clinical practice (relevance) and technical consideration (feasibility) allowed CR prioritisation to be developed. One-fifth of CR would be immediately implementable with some likely to cover the entire paediatric department since they are common to both groups. A pilot study using these CR will assess the workload associated with this new practice.
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