[Evaluation of professional practices: Implication of hospital pharmacist in improving care for vulnerable patients]

As drug delivery activity to outpatients in precarious situation is rising continuously, the goal of this work was to perform an assessment of the professional practices of the care pathway of these patients, called PASS in France (permanence d'accès aux soins de santé). At first, two pharmacists did an audit of this care pathway. Then, options for improvement were suggested and established after a multidisciplinary work with pharmacists, physicians and social workers of the relevant services. Finally, after six months, those actions and their impact were evaluated. Over a three-year period, the audit showed an increase by a factor of 1.77 of the average number of prescriptions provided per year. Over the same period, the number of dispensed lines was increased by 2.2 and the annual costs were multiplied per 1.82. The pharmacy department suggested several corrective actions: at first, initiating new schedules suited to the activity; then, making adjustments in the reception zone; but also, establishing two new specific prescriptions and 89 helps cards about the most frequently delivered medications. As a result, the time dedicated to drug delivery has been cut in half while the number of pharmaceutical actions remained constant. This assessment of the professional practices showed how hard it is to formalize a transversal circuit as the PASS in hospital. The actions established had improved the organization and the drug delivery activity in the pharmacy department.