Garnier, A.

Lamy, O.

Nachar, C.

Sadeghipour, F.

Voirol, P.

English

Serveur académique lausannois

 P989Discharge plan for patient with heart failure: it is worth to have aclinical pharmacist in the team C. Nachar1, P. Voirol1, F. Sadeghipour1, O. Lamy2, A. Garnier21Pharmacy Service, 2Internal Medicine Service, University Hospital of Lausanne (CHUV), Lausanne,Switzerland Objective: A study on the effectiveness of a multidisciplinary discharge plan (DP) to lower earlyreadmission of patients with heart failure is running in the Internal Medicine Service of our tertiary carehospital (LEAR-HF study). The DP team includes a physician, a nurse and a clinical pharmacist (CP).The goal of the present sub-analysis is to highlight the targets of the CP's intervention aimed atpreventing drug-related problems after hospital discharge and improving continuity of care. Methods: For each patient, CP provides medication reconciliation: - patient's interview on medication knowledge and adherence, - check for discrepancies between admission record and home medication, - check for discrepancies between discharge order and home medication, - medication plan for the patient, his general practitioner and community pharmacy. We documented discrepancies (type, number), CP's recommendations and time of intervention. Results: Within the first 2 months of study, the DP has been achieved for 26 patients. Only 19 (73%)got complete CP's intervention. Mean intervention time per patient was 71 min. We found 49discrepancies (1.9/patient) on admission record and 47 (1.8/patient) on discharge order (table 1). Over55 CP's recommendations, 49 (89%) have been followed by physician in charge. Conclusion: CP's intervention is useful and easily accepted by physician, despite necessitatingsubstantial work. Medication reconciliation is a key contribution to the DP. Main challenge resides indifficulty to perform medication reconciliation if the patient is rushly or unexpectedly discharged, leading toincomplete intervention and waste of time for the DP team. [table 1]

Discharge plan for patient with heart failure: it is worth to have a clinical pharmacist in the team

https://serval.unil.ch/resource/serval:BIB_885FA0CEE21C.P001/REF.pdf

Discharge plan for patient with heart failure: it is worth to have a clinical pharmacist in the team

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