Predictive factors for clinically significant pharmacist interventions at hospital admission.

Pharmaceutical care activities at hospital admission have a significant impact on patient safety. The objective of this study was to identify predictive factors for clinically significant pharmacist interventions (PIs) performed during medication reconciliation and medication review at patient hospital admission.A 4-week prospective study was conducted in 4 medicine wards. At hospital admission, medication reconciliation and medication review were conducted and PIs were performed by the pharmaceutical team. The clinical impact of PIs was determined using the clinical economic and organizational (CLEO) tool. Clinical characteristics, laboratory results, and medication data for each patient were collected and analyzed as potential predictive factors of clinically significant PIs. Univariate and multivariate binary logistic regression were subsequently used to identify independent predictive factors for clinically relevant PIs.Among 265 patients admitted, 150 patients were included. Among 170 PIs performed at hospital admission, 71 were related to unintentional discrepancies (41.8%) during medication reconciliation, and 99 were related to drug-related problems (DRPs) (58.8%) during medication review. Overall, 115 PIs (67.7%) were considered to have a clinical impact. By multivariate analysis, number of medications ≥5 (P = .01) based on the best possible medication history, and Charlson comorbidity index score ≥2 (P < .01) were found to be independent predictive factors of clinically significant PIs at hospital admission.Identifying predictive factors of clinically significant PIs is valuable to optimize clinical pharmacist practices at hospital admission during both medication reconciliation and medication review. These 2 steps of the pharmaceutical care process improve medication safety at hospital admission.

Aseptic simulation test challenged with microorganisms for validation of pharmacy operators.

PURPOSE: Aseptic technique of pharmacy operators was assessed using simulated media-fill tests challenged with microorganisms. METHODS: Simulation of the process was done in accordance with multiple transfer steps using tryptone soya broth. All stoppers of broth medium vials were deliberately contaminated with a challenge micro-organism (Enterococcus faecalis). Each final preparation (vials, syringes, and minibags), including the culture medium, was incubated for 14 days at 32 °C. Vials, syringes, and bags were held in front of light daily for 14 days to detect any visual turbidity. At the end of the 14-day period, all clear culture media were filtered via a 0.45-µm sterile filter, which was then incubated at 32 °C on a tryptone soya agar plate. Bags and vials not subjected to manipulation were incubated simultaneously and served as controls. Visual observation by a pharmacist was conducted during the media-fill test, and finger dabs were taken at the end of the media-fill test to test for contamination. RESULTS: Ten operators previously trained in aseptic technique were assessed. The overall operator failure rate was 40%, and 2.3% of the 300 preparations were contaminated. Similarly, 10 of 60 finger dabs were found to be contaminated with E. faecalis, the challenge microorganism. There was no association between operators' years of experience and media-fill test results. CONCLUSION: Optimized media-fill tests allowed for the detection of minor deviances from standard protocol and helped to provide evidence of improper aseptic technique used by pharmacy operators.