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.