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Randomized Controlled Trial
. 2025 Jul 11;25(1):516.
doi: 10.1186/s12877-025-06122-1.

Impact of collaborative pharmaceutical care on older inpatients' medication safety: multicentre stepped-wedge cluster randomised trial (MEDREV Study)

Géraldine Leguelinel-Blache  1   2   3 , Sophie Bouvet  4   5 , Pierrick Bedouch  6   7 , Bérengère Bachelet  8 , Catherine Chenailler  9 , Thomas Dantin  10 , Laure Geneletti  7 , Alexia Janes  11 , Florence Scher  12 , Bogdan Cireașă  11 , Jean-Marie Kinowski  11   4 , Christel Castelli  13   14   15 , Clarisse Roux-Marson  11   4 ; Working Group “Valorisation of Pharmacist Interventions” of the French Society of Clinical Pharmacy; MEDREV working group
Collaborators, Affiliations
Randomized Controlled Trial

Impact of collaborative pharmaceutical care on older inpatients' medication safety: multicentre stepped-wedge cluster randomised trial (MEDREV Study)

Géraldine Leguelinel-Blache et al. BMC Geriatr. .

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).

Keywords: Clinical pharmacy; Collaborative patient management; Geriatrics; Medication error.

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Conflict of interest statement

Declarations. Ethics committee approval and consent to participate: The local ethics committee (the Third Southern Mediterranean Protection to Persons Committee) approved the study for all centres (approval number 2015.04.03 bis). All patients included in the study were properly informed regarding their participation and provided written consent at inclusion. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow of participants
See this image and copyright information in PMC

References

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