PHP271 - Pharmacotherapy Consultations By Clinical Pharmacists To Improve Quality And Safe Use Of Medicines: An Experience From Tertiary Care Teaching Hospital

Abstract

This study was conducted to assess the impact of pharmacotherapy consultations provided by clinical pharmacists (CPs) on improving quality and safe use of medicines. Clinicians from various specialties referred the patients to clinical pharmacy department for consultation. All the consultation requests received by the department were categorized based on its purpose; detection & management of adverse drug reactions (ADRs); individualized drug therapy; medication counseling; assessment of drug interactions; others. CPs attended all the referred requests and provided their opinion(s) to respective clinicians. They were documented electronically and analyzed further to assess its impact on patient care. A total of 784 referral requests were made during 12 months period. Majority of patients were referred by dermatologist (41.5%) followed by surgeons (15%), pulmonologists (14.5%), physicians (11%) and pediatricians (7.14%). Patients were referred for assessment of suspected drug reactions (48%), individualized drug therapy and dose calculations (20%), receiving medication counseling (18%), assessment of drug-drug interactions (8%), safe use of drugs in pregnancy (4%), selection of drug therapy for high risk conditions (3%). From CPs’ consultation, 340 ADRs were detected, from which 56 patients were given alert card and 104 patients were discontinued with current medications to reduce the severity of ADRs. Ongoing therapy of the 156 patients was modified in terms of drug, dose and frequency to improvise the therapeutic benefits and patient safety. 141 patients with chronic diseases and polypharmacy were educated for appropriate use of drugs and devices. Medication orders were changed for 54 patients due to significant drug-drug interactions. Nearly for 28 patients safer drugs were suggested considering their pregnancy and lactation stage. Around 96% of the opinions given were implemented by clinicians to enhance the patient care. Implementation of Pharmacotherapy referral service by CPs was beneficial in improving rational drug use and was appreciated by clinicians.