Patient Pathway Pharmacist - Optimal Drug-related Care

• Readmission[ Time Frame: 30 days after discharge ]
  Patients who are readmitted to hospital is quantified
• Readmission[ Time Frame: 90 days after discharge ]
  Patients who are readmitted to hospital is quantified
• Death[ Time Frame: 30 days after discharge ]
  The number patients who dies is quantified
• Death[ Time Frame: 90 days after discharge ]
  The number of patients who dies is quantified

Medication errors represent the most common cause of patient injury and one of the most frequently reported health related deviation in Norway. The addition of a dedicated clinical pharmacist throughout the hip fracture patient pathway (patient pathway pharmacist) is believed to improve patient safety and ensure optimal drug-related patient care. The pharmacist will perform medication reconciliation at admission to hospital, medication review after surgery and assist physicians with discharge summary. Six weeks after discharge the patient pathway pharmacist will perform a second drug reconciliation and medication review. This study will assess the pharmacists' place and specific tasks in the patient pathway, describe areas where the pharmacist contribute to increased quality of care and assess the benefits and/or disadvantages experienced with introducing a patient pathway pharmacist. The estimated number of patients included is 60. Current practice will be determined by investigating the last 50 patients' medical record and a questionnaire to health care professionals involved in treatment of hip fracture patients. Data from medication reconciliation and drug review will be collected and compared to current practice. After the inclusion period, focus group surveys and/or semi-structured interviews will be executed to describe the perceived improvement in the quality of care. Primary endpoints are: 1) Medication reconciliation score at admission 2) Number of inappropriate drugs for elderly 3) Discharge summary score 4) Discharge summaries following procedure. Secondary endpoints are readmissions and mortality after 30 and 90 days. Qualitative endpoints: 1) Health care professionals experience of current drug-related practice 2) Experienced advantages and disadvantages of a patient pathway pharmacist.

• Procedure: Patient Pathway Pharmacist intervention
  Medication reconciliation at admission to hospital Medication review post surgery Optimised list of drugs in the discharge summary, in accordance with hospital procedures Medication reconciliation, six weeks after discharge Medication review, six weeks after discharge

• Experimental: Patient Pathway Pharmacist intervention
  Medication reconciliation at admission to hospital Medication review post surgery Optimised list of drugs in the discharge summary, in accordance with hospital procedures Medication reconciliation, six weeks after discharge Medication review, six weeks after discharge
• No Intervention: No intervention
  Business as usual. The Patient Pathway Pharmacist is not involved and the nurses and physicians are responsible for medicine reconciliation, -review and section in the discharge summary.