[Retrocession, a risk area in care pathway]

Abstract

Objectives: Medication errors are common at transitions points in care pathway. The pharmacist can secure patient care in "retrocession" (dispensing specific drugs by hospital pharmacy to outpatient) due to his prescription analysis (both regulatory and pharmacotherapeutic). The "retrocession" is a risk area in care pathway. The objective of this study is to evaluate iatrogenic and economic risks in "retrocession" dispense by identifying pharmaceutical interventions.

Material and methods: This is a prospective monocentric study performed during 8months in university hospital. All the prescriptions have been analyzed and divided into 3 categories: "first prescription" (a new prescription for a new treatment or a new patient), continued therapy with new prescription and prescription renewal. Therapeutic optimizations and regulatory pharmaceutical interventions performed have been systematically recorded.

Results: Among 7166 prescriptions analyzed, 161 pharmaceutical interventions (2.2%) are done. The highest rate of therapeutic optimizations and regulatory pharmaceutical interventions concern the "first prescription" category (9.3%). The most involved drugs in medication errors on a "first prescription" are cancer drugs (36%) and anti-infectives (24%).

Conclusion: The first dispensation in "retrocession" is the riskiest step, especially with pharmacotherapeutic intervention. Thanks to pharmacist counseling sessions, especially in oncology, this risk is better controlled. This study demonstrates the interest of developing pharmacist counseling sessions for the treatment's introduction regardless of therapeutic class.

Keywords: Analyse des prescriptions; Care pathway; Interventions pharmaceutiques réglementaires; Optimisations thérapeutiques; Parcours de soins; Prescription analysis; Regulatory pharmaceutical intervention; Rétrocessions; Therapeutic optimization; “Retrocessions”.