International Journal of Clinical Pharmacy

, Volume 39, Issue 6, pp 1201–1210 | Cite as

Clinical impact of an interdisciplinary patient safety program for managing drug-related problems in a long-term care hospital

  • Oreto Ruiz-MilloEmail author
  • Mónica Climente-Martí
  • Ana María Galbis-Bernácer
  • José Ramón Navarro-Sanz
Research Article


Background Medication reviews intended to identify drug-related problems (DRPs) have been researched in primary care, acute care and nursing homes rather than in long-term care hospitals (LTCHs). Objectives To assess the clinical impact of an interdisciplinary pharmacotherapy quality improvement and patient safety program in elderly patients with polypharmacy admitted to an LTCH. Setting An interventional, longitudinal, prospective study was conducted in a Spanish LTCH Method A total of 162 elderly (≥ 70 years) patients with polypharmacy (≥ 5 medications) were included. Pharmacist conducted the pharmacotherapy follow-up of patients (reconciliation, pharmacotherapeutic optimization, educational interviews) from admission to discharge. Demographic, clinical and treatment-related variables were recorded. Main outcome measured Clinical impact of the program by DRP-based effectiveness and drug-related morbidity (DRM)-based safety indicators. Results 895 DRPs (median of 5 (1–23)) were identified in 153 (94.4%) patients. The most common DRPs were unnecessary drug (25.3%), dosage too high (24.9%) and a need for additional drug (24.8%). The most frequent pharmacotherapy recommendations were individualizing the dosage regimen (29.6%) and stopping (27.3%) or starting (21.9%) a drug. The mean implementation rate of pharmacotherapy recommendations was 90.9%. The effectiveness indicator revealed a 94.9% of prevented or resolved DRPs. The safety indicator showed an 89.3% of prevented or resolved DRM. Therefore, the program prevented or resolved 92.5% of adverse effects and 91.7% of suboptimal responses or therapeutic failures. Conclusion This interdisciplinary patient safety program seems to be a valuable approach to identify, prevent and resolve the high number of DRPs and potential DRM that elderly patients with polypharmacy admitted to an LTCH present.


Drug-related problem Elderly Interdisciplinary care Long-term care Pharmacotherapy Quality improvement Patient safety Spain 



The authors would like to thank MD PhD Jose Luis Górriz for his suggestions for the preparation of the manuscript.



Conflicts of interest

The authors have no conflicts of interest to declare.

Supplementary material

11096_2017_548_MOESM1_ESM.doc (40 kb)
Supplementary material 1 (DOC 40 kb)


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Pharmacy DepartmentDoctor Peset University HospitalValenciaSpain
  2. 2.Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO)Doctor Peset University HospitalValenciaSpain
  3. 3.Comprehensive Medical UnitPare Jofre HospitalValenciaSpain

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