INTRODUCTION
In December 2019, a new coronavirus, now identified as SARS-COV-2, was discovered in Wuhan, China, in cases of acute respiratory illness [1]. Since then it has spread worldwide and the World Health Organization (WHO) officially declared the disease caused by this virus (COVID-19) as a pandemic. During the “first wave” of infections, the virus caused 3,175,207 infections and 224,172 deaths worldwide; in France it resulted in 128,121 infections and 24,342 deaths [2].
Older people are at a higher risk of severe illness (respiratory distress, cardiovascular accident) due to their advanced age and comorbidities [3-5]. In France as of May 18, 2020, 75% of those who have died of COVID-19 are over 75 years of age [6].
To cope with this pandemic several COVID-specific units have been set up in our University Hospital in Angers, France. Since March 19th, the geriatric acute care unit, for patients over 75 years, has been separated into two wards: one for positive or suspect patients (17 beds) and one for “non-COVID” patients (20 beds).
This unit benefits from a continued pharmaceutical presence. A major task for the clinical pharmacy team is the analysis of the patients’ prescriptions within this unit. Pharmacists can highlight the problematics of inappropriate prescriptions and provide therapeutic advice. These Pharmacist Interventions (PIs) prevent a risk of medicinal error and encourage optimal prescriptions, especially for frail elderly inpatients who are at higher risk of iatrogenic event due to their natural vulnerability and their polypharmacy [7,8].
The value of working with clinical pharmacists for the prevention of drug-related iatrogenic events and the optimisation of therapeutics, especially in a geriatric unit, has been demonstrated in several previous studies [9-12].
During this state of health emergency linked to the emergence of the COVID-19 pandemic, an unusual and less typical form of medical care was expected for the infected patients with the use of specific protocols or drugs uncommon in geriatric standard practice. Therefore the pharmaceutical analysis of prescriptions by the clinical pharmacists in this unit may be a valuable support for the medical team.
With this work we wanted to assess the activity of pharmaceutical analysis in the geriatric acute care unit during the first wave of COVID-19 pandemic and its potential impact on drug management. To do so, we chose to compare the PIs carried out by the clinical pharmacy team during the analysis of the patients’ prescriptions in this period with PIs carried out prior to the pandemic, over the same time-scale.
The main objective was to compare the number of PIs between the two periods.
The secondary objectives were (i) to compare the drug class managed by the PIs, (ii) to compare Drug Related Problems (DRP) identified and the pharmacists’ therapeutic advice given, (iii) to compare the clinical impact of our PIs and (iiii) to compare the acceptance rate of our PIs by the geriatricians.