Évaluation des répercussions des nouvelles activités de la Loi 41 sur le processus de soins au CHU Sainte-Justine

Resume Objectif : Presenter les repercussions sur le processus de soins pharmaceutiques des sept nouvelles activites que la Loi 41 a accordees aux pharmaciens quebecois et qui ont ete implantees en decembre 2017 dans le cadre d’un projet pilote en obstetrique-gynecologie au CHU Sainte-Justine. Description de la problematique : L’implantation et l’evaluation des activites de la Loi 41 tardent en milieu hospitalier, et les etablissements de sante quebecois ne disposent d’aucune methode preetablie pour evaluer ces activites. Resolution de la problematique : Du 11 decembre 2017 au 18 mai 2018, 200 activites nouvellement autorisees ont ete effectuees par les pharmaciennes et les etudiants en pharmacie du departement d’obstetrique-gynecologie : 45 % concernaient des ajustements medicamenteux, 25 % des prescriptions sans diagnostic, 24 % des prolongations d’ordonnances et 4,5 % des analyses de laboratoire. Outre le recensement des activites des pharmaciens, les investigateurs ont effectue un sondage aupres des infirmieres et des medecins, qui ont ete majoritairement favorables au projet. Ils ont aussi ete en mesure d’evaluer l’impact clinique des activites selon l’echelle Overhage et coll. : 81 % d’entre elles ont ete jugees significatives alors qu’aucune activite n’a ete deletere. Conclusion : L’implantation des activites reservees decoulant de la Loi 41 a ete reussie dans le cadre des activites du departement d’obstetrique-gynecologie du CHU Sainte-Justine. La demarche decrite comporte non seulement la description des activites, mais egalement une demarche evaluative qui permet de confirmer les retombees de la Loi 41. A notre connaissance, il s’agit d’une premiere au Quebec en milieu hospitalier. Abstract Objective: To describe the impact of the pharmaceutical care process for the seven new activities granted to Quebec pharmacists by Bill 41, which were implemented at the CHU Sainte-Justine in December 2017 as part of an obstetrics/gynecology pilot project. Problem description: The implementation and evaluation of the activities set out in Bill 41 has been a long time coming in hospitals, and Quebec’s health-care institutions do not have a preestablished method for evaluating these activities. Problem resolution: From December 11, 2017 to May 18, 2018, there were 200 instances in which the newly authorized activities were performed by the pharmacists and pharmacy students in the Department of Obstetrics and Gynecology: 45% involved medication adjustments, 25% prescriptions with no diagnosis, 24% prescription extensions and 4.5% laboratory tests. In addition to the inventory of the pharmacists’ activities, the investigators conducted a survey among the nurses and physicians, most of whom were in favour of the project. They were also able to assess the clinical impact of the activities using Overhage et al.’s scale: 81% of them were considered significant, and no activity was deleterious. Conclusion: The reserved activities set out in Bill 41 have been successfully implemented within the framework of the activities of the CHUSJ’s Department of Obstetrics and Gynecology. The approach described involves not only a description of the activities, but also an evaluative approach that can be used to confirm the repercussions of Bill 41. To our knowledge, this is a first in a Quebec hospital.