[Results of integrating pharmaceutical care in an Acute Geriatric Unit].

Objective: To evaluate whether the integration of pharmaceutical care in an acute geriatric unit can promote the detection of potentially inappropriate drug prescriptions (PIP) and adverse drug events (ADE), and if this can improve patient and caregiver information at hospital discharge.

Method: Descriptive prospective study in older patients admitted for acute care in the Geriatric Department of a university hospital. On admission, a pharmacist recorded a comprehensive drug history from the patient, caregiver and other available sources, and reviewed preadmission treatments in order to detect adverse drug events (using the 3(rd) Granada consensus criteria) and potentially inappropriate prescriptions (using STOPP-START criteria). At hospital discharge, the pharmacist informed patients and caregivers about the treatment and gave them computer generated written information for all drugs prescribed.

Results: In a 9 month period 189 patients (84.7% of all admissions) were included in the pharmaceutical care program (71.9% women, mean age 87.2±5.5 years). After analysing 1523 prescriptions (mean drugs/patient 8.1±3.3), 356 (23.4%) potentially inappropriate prescriptions and 580 (38.1%) adverse drug events were detected (1.9 PIP and 3.2 ADE per patient). Almost three-quarters (74.2%) of the patients had at least one PIP: STOPP (48.9%) and START (26.9%). The most frequent adverse drug event was an untreated health problem. The pharmacist offered verbal and written information to 74.7% of the discharged patients.

Conclusion: Adding pharmaceutical care to the multidisciplinary activity of an acute geriatric care unit enables a great number of potentially inappropriate prescriptions and adverse drug events to be detected, and increases patient and caregiver information at hospital discharge.