Background

In the strained actual economic context, all clinical pharmacy activities cannot be achieved for all patients of all care pathways. So finding a way to prioritize moments and patients needing those activities is essential. This is the challenge of the “5P project” (Patient personalized clinical pharmacy program integrated into care pathway).

Objective

To present adverse event (AE) risk management approach applied to develop clinical pharmacy programs integrated into care pathway, using two methods.

Method

Used as a priori AE risk management approach, the Delphi method and inductive approach analysis of semi-directed interviews were realized from April 1st to October 3rd^, 2019, respectively in orthogeriatric (OG) and pediatric kidney transplantation (PKT) care pathways. Complementarily to bibliographic research, participants were medical and paramedical healthcare providers involved in the concerned care pathway. They have been interrogated regarding AE risks to identify the clinical pharmacy activities required, the patients who need them, and the appropriate steps of the care pathway.

Results

The Delphi method for OG care pathway has revealed: 1/. Patients were prioritized by the presence of at least 2 among the following 4 criteria: age ≥90 years old, cardiovascular diseases, prescribed potentially inappropriate medication for elderly patients, obesity or diabetes; priority steps were the post-operative and rehabilitation care steps. 2/. Prescription reviews, medication reconciliation and targeted pharmaceutical informative interview about oral anticoagulants were required.

Nine semi-directed interviews used for PKT care pathway has revealed: 1/. Clinical pharmacy activities were carried out for all patients. Priority steps were pre-transplantation, immediate post-operative, and post-transplantation. 2/. Prescription reviews and educative interviews were required.

Conclusions

The two presented methods can be used to both develop patient prioritization and targeting steps for clinical pharmacy activities, and integrate it into care pathway. Today, those two developed programs have been executed in our teaching hospital.

中文翻译：

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利用不良事件风险开发临床药学项目并整合到患者护理路径中

背景

在紧张的实际经济背景下，不可能为所有护理途径的所有患者实现所有临床药学活动。因此，找到一种方法来优先考虑需要这些活动的时刻和患者是至关重要的。这就是“5P 项目” （患者个性化临床药学计划融入护理路径）的挑战。

客观的

介绍不良事件 (AE) 风险管理方法，使用两种方法开发整合到护理路径中的临床药学项目。

方法

作为先验AE 风险管理方法，半定向访谈的德尔菲法和归纳法分析分别于 2019 年4 月 1 日至 10 月 3^{日在正畸 (OG) 和小儿肾移植 (PKT) 护理路径中实现。}作为书目研究的补充，参与者是参与相关护理途径的医疗和辅助医疗保健提供者。他们接受了关于 AE 风险的询问，以确定所需的临床药学活动、需要这些活动的患者以及护理途径的适当步骤。

结果

OG 护理路径的 Delphi 方法揭示了： 1/。患者优先考虑以下 4 项标准中的至少 2 项：年龄≥90 岁、心血管疾病、为老年患者开具可能不适当的药物、肥胖或糖尿病；优先步骤是术后和康复护理步骤。2/。需要对口服抗凝剂进行处方审查、药物调整和有针对性的药物信息访谈。

用于 PKT 护理途径的九个半定向访谈显示：1/。对所有患者进行临床药学活动。优先步骤是移植前、术后即刻和移植后。2/。需要进行处方审查和教育性访谈。

结论

这两种方法可用于制定临床药学活动的患者优先级和目标步骤，并将其整合到护理路径中。今天，这两个开发项目已经在我们教学医院执行。