Impact of collaborative pharmaceutical care on older inpatients’ medication safety: multicentre stepped-wedge cluster randomised trial (MEDREV Study)
Abstract Background Improving medication safety implies patient-centred multidisciplinary cooperation. During the hospital stay for an acute care episode, the patient needs a comprehensive management to guarantee the best possible outcome. Methods The study was designed as a non-blinded, multicentre...
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2025-07-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-025-06122-1 |
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| author | Géraldine Leguelinel-Blache Sophie Bouvet Pierrick Bedouch Bérengère Bachelet Catherine Chenailler Thomas Dantin Laure Geneletti Alexia Janes Florence Scher Bogdan Cireașă Jean-Marie Kinowski Christel Castelli Clarisse Roux-Marson Working Group “Valorisation of Pharmacist Interventions” of the French Society of Clinical Pharmacy MEDREV working group |
| author_facet | Géraldine Leguelinel-Blache Sophie Bouvet Pierrick Bedouch Bérengère Bachelet Catherine Chenailler Thomas Dantin Laure Geneletti Alexia Janes Florence Scher Bogdan Cireașă Jean-Marie Kinowski Christel Castelli Clarisse Roux-Marson Working Group “Valorisation of Pharmacist Interventions” of the French Society of Clinical Pharmacy MEDREV working group |
| author_sort | Géraldine Leguelinel-Blache |
| collection | DOAJ |
| description | Abstract Background Improving medication safety implies patient-centred multidisciplinary cooperation. During the hospital stay for an acute care episode, the patient needs a comprehensive management to guarantee the best possible outcome. Methods The study was designed as a non-blinded, multicentre stepped-wedge cluster randomised clinical trial, taking place in six French University Hospitals. Each cluster began with the control period in which standard care did not include pharmaceutical intervention. Every 14-day period, one hospital unit was electronically randomised to switch to the intervention period until all cluster groups received the intervention, which consisted of collaborative pharmaceutical care (CPC) associating medication reconciliation at hospital admission, pharmaceutical analysis of the medication order, medication review and collaborative meeting. The primary outcome was assessing the intervention through the rate of patients with at least one medication error (ME) on the admission medication order (such as omission, wrong dose or wrong route of administration), comparing the two periods. Results CPC decreased the rate of patients with at least one ME from 88.9% (n = 243) to 29.2% (n = 267) (p < 0.0001). A total of 1817 MEs were discovered, of which 1121 (61.7%) were in the control period and 696 (38.3%) in the intervention period before resolution by the CPC. After resolving 567 of them, 129 medication errors still remained after CPC. So, a median of 3 MEs [IQR = 1;6] per patient were detected in the control period vs 0 [IQR = 0;1] after CPC in the intervention period (p < 0.0001). Patients were 21-times more likely to avoid a ME with CPC (OR: 20.8 [8.3;52.2], p < 0.0001). The rate of patients with a 2–3 critical ME level decreased from 70.8% to 12.0% in the control vs intervention periods respectively (OR: 18.4 [7.7;43.9], p < 0.0001). Conclusions CPC can prevent the occurrence of MEs and thus can improve inpatients’ medication management and safety. Pharmacists play a key role in combating medication-related harm in healthcare settings. Trial registration This study is registered on ClinicalTrials.gov with the reference number NCT02598115 (2015–11–04). |
| format | Article |
| id | doaj-art-79238ab6c9624e9a94de7f27fbc5957f |
| institution | DOAJ |
| issn | 1471-2318 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Geriatrics |
| spelling | doaj-art-79238ab6c9624e9a94de7f27fbc5957f2025-08-20T03:06:04ZengBMCBMC Geriatrics1471-23182025-07-0125111110.1186/s12877-025-06122-1Impact of collaborative pharmaceutical care on older inpatients’ medication safety: multicentre stepped-wedge cluster randomised trial (MEDREV Study)Géraldine Leguelinel-Blache0Sophie Bouvet1Pierrick Bedouch2Bérengère Bachelet3Catherine Chenailler4Thomas Dantin5Laure Geneletti6Alexia Janes7Florence Scher8Bogdan Cireașă9Jean-Marie Kinowski10Christel Castelli11Clarisse Roux-Marson12Working Group “Valorisation of Pharmacist Interventions” of the French Society of Clinical PharmacyMEDREV working groupPharmacy Department, Nîmes University Hospital, University of MontpellierInstitute Desbrest of Epidemiology and Public Health, University of Montpellier, INSERMUMR 5525, University of Grenoble Alpes, CNRS, Grenoble INP, TIMCPharmacy Department, Toulouse University HospitalPharmacy Department, Rouen University HospitalPharmacy Department, Nice University HospitalPharmacy Department, Grenoble Alpes University Hospital, University of Grenoble AlpesPharmacy Department, Nîmes University Hospital, University of MontpellierPharmacy Department, Strasbourg University HospitalPharmacy Department, Nîmes University Hospital, University of MontpellierPharmacy Department, Nîmes University Hospital, University of MontpellierDepartment of Law and Health Economics, Faculty of Pharmacy, University of MontpellierPharmacy Department, Nîmes University Hospital, University of MontpellierAbstract Background Improving medication safety implies patient-centred multidisciplinary cooperation. During the hospital stay for an acute care episode, the patient needs a comprehensive management to guarantee the best possible outcome. Methods The study was designed as a non-blinded, multicentre stepped-wedge cluster randomised clinical trial, taking place in six French University Hospitals. Each cluster began with the control period in which standard care did not include pharmaceutical intervention. Every 14-day period, one hospital unit was electronically randomised to switch to the intervention period until all cluster groups received the intervention, which consisted of collaborative pharmaceutical care (CPC) associating medication reconciliation at hospital admission, pharmaceutical analysis of the medication order, medication review and collaborative meeting. The primary outcome was assessing the intervention through the rate of patients with at least one medication error (ME) on the admission medication order (such as omission, wrong dose or wrong route of administration), comparing the two periods. Results CPC decreased the rate of patients with at least one ME from 88.9% (n = 243) to 29.2% (n = 267) (p < 0.0001). A total of 1817 MEs were discovered, of which 1121 (61.7%) were in the control period and 696 (38.3%) in the intervention period before resolution by the CPC. After resolving 567 of them, 129 medication errors still remained after CPC. So, a median of 3 MEs [IQR = 1;6] per patient were detected in the control period vs 0 [IQR = 0;1] after CPC in the intervention period (p < 0.0001). Patients were 21-times more likely to avoid a ME with CPC (OR: 20.8 [8.3;52.2], p < 0.0001). The rate of patients with a 2–3 critical ME level decreased from 70.8% to 12.0% in the control vs intervention periods respectively (OR: 18.4 [7.7;43.9], p < 0.0001). Conclusions CPC can prevent the occurrence of MEs and thus can improve inpatients’ medication management and safety. Pharmacists play a key role in combating medication-related harm in healthcare settings. Trial registration This study is registered on ClinicalTrials.gov with the reference number NCT02598115 (2015–11–04).https://doi.org/10.1186/s12877-025-06122-1GeriatricsMedication errorClinical pharmacyCollaborative patient management |
| spellingShingle | Géraldine Leguelinel-Blache Sophie Bouvet Pierrick Bedouch Bérengère Bachelet Catherine Chenailler Thomas Dantin Laure Geneletti Alexia Janes Florence Scher Bogdan Cireașă Jean-Marie Kinowski Christel Castelli Clarisse Roux-Marson Working Group “Valorisation of Pharmacist Interventions” of the French Society of Clinical Pharmacy MEDREV working group Impact of collaborative pharmaceutical care on older inpatients’ medication safety: multicentre stepped-wedge cluster randomised trial (MEDREV Study) BMC Geriatrics Geriatrics Medication error Clinical pharmacy Collaborative patient management |
| title | Impact of collaborative pharmaceutical care on older inpatients’ medication safety: multicentre stepped-wedge cluster randomised trial (MEDREV Study) |
| title_full | Impact of collaborative pharmaceutical care on older inpatients’ medication safety: multicentre stepped-wedge cluster randomised trial (MEDREV Study) |
| title_fullStr | Impact of collaborative pharmaceutical care on older inpatients’ medication safety: multicentre stepped-wedge cluster randomised trial (MEDREV Study) |
| title_full_unstemmed | Impact of collaborative pharmaceutical care on older inpatients’ medication safety: multicentre stepped-wedge cluster randomised trial (MEDREV Study) |
| title_short | Impact of collaborative pharmaceutical care on older inpatients’ medication safety: multicentre stepped-wedge cluster randomised trial (MEDREV Study) |
| title_sort | impact of collaborative pharmaceutical care on older inpatients medication safety multicentre stepped wedge cluster randomised trial medrev study |
| topic | Geriatrics Medication error Clinical pharmacy Collaborative patient management |
| url | https://doi.org/10.1186/s12877-025-06122-1 |
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