Bedside check of medication appropriateness (BED-CMA) as a risk-based tool for bedside clinical pharmacy services: A proof-of-concept study at the trauma surgery ward

Greet Van De Sijpe; Wencke Hublou; Peter Declercq; Willem-Jan Metsemakers; An Sermon; Minne Casteels; Veerle Foulon; Charlotte Quintens; Isabel Spriet

doi:10.1016/j.csbj.2023.10.017

Bedside check of medication appropriateness (BED-CMA) as a risk-based tool for bedside clinical pharmacy services: A proof-of-concept study at the trauma surgery ward

Comput Struct Biotechnol J. 2023 Oct 21:22:58-65. doi: 10.1016/j.csbj.2023.10.017. eCollection 2023.

Authors

Greet Van De Sijpe^{1

2}, Wencke Hublou¹, Peter Declercq^{1

2}, Willem-Jan Metsemakers³, An Sermon³, Minne Casteels², Veerle Foulon², Charlotte Quintens^{1

2}, Isabel Spriet^{1

2}

Affiliations

¹ Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.
² Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
³ Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium.

Abstract

Background: Bedside clinical pharmacy prevents drug-related problems, but is not feasible in many countries due to limited resources. Hence, clinical rules using structural information in the electronic health record can help identifying potentially inappropriate prescriptions (PIPs). We aimed to develop and implement a risk-based clinical pharmacy service and evaluate its impact on prescribing at the trauma surgery ward.

Methods: The proportion of residual PIPs per day, i.e. the number of PIPs that persisted up to 24 h after pharmacist intervention divided by the number of PIPs at T0, was evaluated before and after implementation of the intervention in an interrupted time series analysis. The pre-intervention cohort received usual pharmacy services, i.e. a 0.3 FTE clinical pharmacist trainee. Fifteen clinical rules, targeting antimicrobial, anticoagulant and analgesic therapy were implemented in the post-intervention period. The pre-intervention period was compared to two post-intervention scenarios: A) clinical rule alerts reviewed by a 0.3 FTE clinical pharmacist trainee; and B) clinical rule alerts reviewed daily for approximately 1 h by a clinical pharmacist trainee.

Results: Pre-intervention, a median proportion of 67% (range 0%-100%) residual PIPs per day was observed. Scenario A showed an immediate relative reduction of 14% (p = 0.72) and scenario B a significant immediate relative reduction of 85% (p = 0.0015) in residual PIPs per day. In scenario A, recommendations were provided for 19% of clinical rule alerts, of which 67% was accepted by the surgeon within 24 h. In scenario B, recommendations were given for 56% of alerts, of which 84% was accepted.

Conclusions: Using clinical rules is an effective approach to organize bedside clinical pharmacy services and improves prescribing at the trauma surgery ward. Advanced training and daily follow-up of the clinical rules are two requirements to be considered.

Keywords: Algorithms; Bedside clinical pharmacy; Clinical rules; Potential inappropriate prescriptions; Trauma surgery.