Aging, Hip Fractures, Patient Fall
Conditions
Keywords
Medicine review, Patient handoff, Patient hand over, Intertrochanteric fractures, Trochanteric fractures, Subtrochanteric fractures, Hospital readmission, Hospital readmissions, Injuries, Hip, Hospitalization, Hospitalisation, Hip, Fracture, Femoral fractures, Femoral neck fractures, Medication errors, Medication review, Medication reconciliation
Brief summary
Medication errors represent the most common cause of patient injury and one of the most frequently reported health related deviation in Norway. The addition of a dedicated clinical pharmacist throughout the hip fracture patient pathway (patient pathway pharmacist) is believed to improve patient safety and ensure optimal drug-related patient care. The pharmacist will perform medication reconciliation at admission to hospital, medication review after surgery and assist physicians with discharge summary. Six weeks after discharge the patient pathway pharmacist will perform a second drug reconciliation and medication review. This study will assess the pharmacists' place and specific tasks in the patient pathway, describe areas where the pharmacist contribute to increased quality of care and assess the benefits and/or disadvantages experienced with introducing a patient pathway pharmacist. The estimated number of patients included is 60. Current practice will be determined by investigating the last 50 patients' medical record and a questionnaire to health care professionals involved in treatment of hip fracture patients. Data from medication reconciliation and drug review will be collected and compared to current practice. After the inclusion period, focus group surveys and/or semi-structured interviews will be executed to describe the perceived improvement in the quality of care. Primary endpoints are: 1) Medication reconciliation score at admission 2) Number of inappropriate drugs for elderly 3) Discharge summary score 4) Discharge summaries following procedure. Secondary endpoints are readmissions and mortality after 30 and 90 days. Qualitative endpoints: 1) Health care professionals experience of current drug-related practice 2) Experienced advantages and disadvantages of a patient pathway pharmacist.
Interventions
PROCEDUREPatient Pathway Pharmacist intervention
1. Medication reconciliation at admission to hospital 2. Medication review post surgery 3. Optimised list of drugs in the discharge summary, in accordance with hospital procedures 4. Medication reconciliation, six weeks after discharge 5. Medication review, six weeks after discharge
Sponsors
Hospital Pharmacy Enterprise, South Eastern Norway
Sykehuset i Vestfold HF
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
An intervention group is compared to a cross-sectional retrospective group. A group of 60 patients with hip fracture will get an intervention by a clinical pharmacist who performs medication reconciliation and medication review during hospitalisation, they will receive a discharge summary where the medication part is optimised. After six weeks the patients will be get a follow-up with a second medication reconciliation and - review. This group will be compared with the last 50 patients with hip fracture who did not get the intervention.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Hip fracture patients in Vestfold county, Norway
Exclusion criteria
* Patients under 18 years * Terminally ill * Hip fracture patients who do not follow the standardized patient pathway at Vestfold Regional Hospital * Patients who do not consent to be included in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of inappropriate drugs at discharge | During hospitalisation, after surgery (estimated to be within five days after fracture/inclusion) | After surgery the medication review may reduce the number of inappropriate drugs (on the STOPP-list). |
| Discharge summary score | At discharge (estimated five days after fracture/inclusion) | In the discharge summary, the section describing drugs is scored in accordance with the national patient safety program |
| Admission summary score | At hospital admission (estimated to be within 24 hours after fracture) | In the admission summary, the section describing drugs is scored. The score is adjusted from the discharge summary score to fit the admission note. |
| Discharge summaries written in accordance with procedure | At discharge (estimated five days after fracture/inclusion) | In the discharge summary, the section describing drugs should be in accordance with procedure. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Readmission | 30 days after discharge | Patients who are readmitted to hospital is quantified |
| Death | 30 days after discharge | The number patients who dies is quantified |
Other
| Measure | Time frame | Description |
|---|---|---|
| Experience of current practice | Prior to or during the early start of the intervention | A questionnaire will be distributed to all health care professionals involved in the treatment of hip fracture patients |
| Experience of patient pathway pharmacist | Within three months after last included patient | Focus groups or semi-structured interviews will be performed to assess the advantages and/or disadvantages of introducing a patient pathway pharmacist. |
Countries
Norway
Outcome results
None listed