Authors (including presenting author) :
Chung YSA(1), Fong TS(1), Lee WY(2), Wah SH(3)
Affiliation :
(1)Department of Pharmacy, (2)Infirmary Service, (3)Department of Medicine, Haven of Hope Hospital
Introduction :
Haven of Hope Hospital (HHH) is an extended-care hospital. The service spectrum includes infirmary wards for patients with chronic conditions requiring continuous medical and nursing care. Over half of these patients are elderly with dysphagia relying on enteral feeding tubes for nutrition and drug administration. Many of these patients also have challenging decubitus ulcers or chronic slow-healing wounds, which delay their discharge to community. The optimisation of drug absorption, safety and efficacy for patients’ metabolic control, together with assessment of patients’ nutritional status, could have positive impact on wound healing. Hence, multidisciplinary management is warranted, leading to the introduction of Infirmary Service Multidisciplinary Case Conference in HHH in February 2016.
Objectives :
To rationalise infirmary ward patients’ medication use, minimise polypharmacy and drug-drug interference, optimise nutrition and promote wound healing in a holistic approach with balanced utilisation of available resources.
Methodology :
A case conference was held every 1-2 months in one of the four infirmary wards in turns. Each patient would receive comprehensive case review every 4 months. The multidisciplinary team comprised physicians, nurses and pharmacists, with dietitians’ support outside the conference on as-needed basis. Patients’ medical records, drug history, current medication profiles, laboratory results, vital signs, diet and fluid status were reviewed jointly in the conference. Patients’ disease entities-therapeutics and fluid-caloric-nutrition-related problems were addressed with cross-disciplinary discussion and treatment modifications. Patients’ wound conditions were also reviewed by the team.
Result & Outcome :
From February 2016 to August 2018, 15 multidisciplinary case conferences were held in infirmary wards. In total, 417 cases (251 patients) were reviewed with a mean age of 78±14.4 and the majority being females (n=262, 62.8%). There were 257 types of follow-up investigations ordered for monitoring patients’ progress. A total of 811 therapeutic modifications were made during and after the conferences, the two most common categories being medication discontinuation (n=316, 39.0%) and adjustment of dosing regimen (n=194, 23.9%). There were 105 (12.9%) therapeutic modifications offering more efficacious drug or enteral feeding regime for optimising fluid and nutritional balance. The multidisciplinary team also reviewed 159 wounds in 108 (43.0% of 251) patients. The implementation of Infirmary Service Multidisciplinary Case Conference was effective in enhancing pharmaceutical care, nutrition support and wound management in infirmary ward patients.
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