NP-004 Implementation of clinical pharmacy services in long-term care wards

Background Age-related physiological changes and frailty increase the individual variability of drug responses in the elderly. Moreover, a large majority of the elderly population deals with numerous medical conditions, managed by multiple medications often initiated by more than one prescriber. Polypharmacy (concurrent use of more than five chronic drugs) can substantially increase the risk of adverse events and interactions. Long-term care of patients was observed in two departments. The first was a unit of 200 beds, where clinical pharmacy services were launched in 2015. The second, 400-bed ward had no previous history of the presence of clinical pharmacists. Purpose The aim of this study was to compare the detected incidence of drug-related problems (DRPs) between the wards. Methods Medication therapies of 46 patients from the Ward #1 and 60 patients from Ward #2 were assessed. DRPs were classified based on the PCNE V8.01 algorithm. The analysis was carried out by using Microsoft Excel. Results The mean age was slightly above 80 years in both groups (83 years vs. 84 years, respectively). The average number of concurrent medications was 5.5 and 5.8 per patient in the two observed wards, both qualifying as polypharmacy. Based on PCNE, DRPs at both sites derived from the possibly occurring adverse drug events (P2.1) and any failure of the optimal effect of drug treatment (P1.2). The possible reasons for these problems include inappropriate combination s of drugs or drugs and herbal medication (C1.4) and wrong drug, strength or dosage advised (C5.3). Fifty-four interventions were made by the pharmacist in Ward #1, whereas 69 possible, theoretical interventions were noted in Ward #2. A remarkable proportion of these interventions were related to drugs affecting the central nervous system. Conclusions Clinical pharmacists can take the lead in the follow-up, optimisation and continuous re-evaluation of drug therapies for the elderly. Based on the current findings, well-established clinical pharmacy services can potentially play a fundamental role in improving patient safety and the quality of life for the ageing population. References and/or acknowledgements Pharmaceutical Care Network Europe: https://www.pcne.org/upload/files/215_PCNE_classification_V8-01.pdf