Potential Drug-related Problems Research Articles

IDENTIFIKASI DRUG RELATED PROBLEMS (DRPs) PADA PASIEN ANAK DEMAM BERDARAH DENGUE (DBD) DI INSTALASI RAWAT INAP RSUD UNDATA PALU TAHUN 2011

Drug Related Problems (DRPs) is an unexpected incident patients experience consequences or unforeseen consequences could potentially interfere with drug therapy to therapy outcomes. Dengue Hemorrhagic Fever (DHF) is one of diseases that occur in children and have a great chance to be the occurrence of DRPs. This study aims to find out the extent of potential DRPs in the incidence of DHF in children patients at the RSUD (public hospital) Undata Palu. This research was non experimental study using a descriptive retrospective study. The research was conducted by collecting data from the medical records of children patient (1-12 years old) undiagnosed DHF at RSUD Undata Palu. The data analyzed includes unnecessary drug therapy, wrong medicine, subtherapy dose and overdose. Based on the results of the study, we obtained that from 103 patients who met the criteria there were total of around 171 cases of DRPs cases, i.e. 103 cases (57.89%) was clasified as unnecessary drug therapy category, 25 cases (14,62%) was categorised as wrong medicine, 39 cases (22,81%) was over dose categories, and 8 cases (4,68%) was subtherapy dose category. The most often DRPs incidents occurs in this study were unnecessary drug therapy should be as large as 57,89 % of the total cases of DRPs.

Ambulatory clinical pharmacy specialty services: the Kaiser Permanente Colorado experience.

Health care in the United States is increasingly being delivered during ambulatory care visits.1 As new investment in health care shifts from the inpatient to outpatient setting, the role of ambulatory clinical pharmacists (CP) are expanding. While dispensing pharmacists provide clinical screening and patient education for potential drugrelated problems, CPs provide services that complement the care provided by dispensing pharmacists by directly advising and educating other health care providers and patients on appropriate pharmaceutical use and dosing.

CP-056 Evaluation of pharmaceutical interventions in a general medical and a geriatric units

Background At Lamentin Hospital Centre in Martinique, prescriptions are analysed by pharmacists in two clinical units, twice a week. This routine analysis leads to pharmaceutical interventions (PIs) defined by the...

CP-112 Beneficial effects of pharmaceutical follow-up in long-term geriatric units

BackgroundImproving the quality of medicines prescribing is one of the first steps to ensuring patient safety in hospital wards. Every day, in the geriatric department of Toulouse University Hospital, pharmacists...

Completeness of medication reviews provided by community pharmacists

Little is known about the ability of community pharmacists who are inexperienced in medication review to identify drug-related problems (DRPs). The objective of our study was to investigate the completeness of DRPs in terms of number, type and clinical relevance identified by community pharmacists when performing home medication reviews (HMRs). This is a cross-sectional study within the intervention arm of a randomized controlled trial among community-dwelling patients (≥65years, ≥5 drugs) in ten Dutch community pharmacies. Community pharmacists, who were inexperienced in medication review, received 2-day training in medication review. These pharmacists interviewed patients at home about their medicines, identified potential DRPs and made recommendations in combination with medication and clinical records. Expert reviewers completed the number of potential DRPs and recommendations by reviewing all available information, including patient interview reports. In 155 patients, community pharmacists identified a mean of 3·6 (SD 2·8) potential DRPs per patient and expert reviewers added 6·5 (SD 3·2) DRPs. Community pharmacists formulated 2·6 (SD 2·3) recommendations per patient and reviewers added 7·5 (SD 3·3) recommendations. Community pharmacists identified a higher proportion of clinically relevant DRPs compared with expert reviewers, as assessed by DRPs with high priority [OR=1·8 (95% CI 1·4-2·2)], DRPs associated with recommendations for drug change [OR=1·9 (95% CI 1·5-2·3)] and implemented recommendations for drug change [OR=2·1 (95% CI 1·6-2·7)]. This study shows that the completeness of medication reviews by inexperienced community pharmacists with limited training could be improved, although they identified a higher proportion of potentially clinically relevant DRPs compared with expert reviewers. The results suggest that community pharmacists with limited experience in medication review may need more intensive post-graduate training.

Retrospective evaluation of cotrimoxazole use as preventive therapy in people living with HIV/AIDS in Boru Meda Hospital

BackgroundDrug use evaluation is a performance improvement method that focuses on evaluating and improving drug use process to achieve optimal patient outcomes. Drug use evaluation helps in identifying, preventing or resolving actual and potential drug related problems. The objective of the study was to evaluate the use of cotrimoxazole as preventive therapy in people living with HIV/AIDS in Boru Meda Hospital, Northeast Ethiopia.MethodsA retrospective drug use evaluation was conducted on patients’ medical history records based on a validated drug use evaluation criteria according to the national guideline. Medical history records of 248 patients were selected using systematic sampling method.ResultsThe result showed that 49.6% of the patients were at WHO clinical stage III at the start of cotrimoxazole preventive therapy. In this study, the use of cotrimoxazole preventive therapy was consistent with the guideline in the rationale for indication (97.98%), dose (96.77%), and its use despite the presence of contraindications (91.93%). Problems regarding drug-drug interaction were identified in 49.59% of cases, and 20.97% of patients discontinued cotrimoxazole preventive therapy due to different reasons.ConclusionsIn most patients cotrimoxazole preventive therapy was consistent with the national guideline regarding the rationale for indication, dose, discontinuation and its use in the presence of contraindications.

Identification of drug-related problems of elderly patients discharged from hospital

BackgroundDrug-related problems (DRP) following hospital discharge are common among elderly patients using multiple drugs for the treatment of chronic diseases. The aim of this study was to investigate the occurrence of DRP in these patients using a specific tool for the identification of DRP by community pharmacists.MethodsAn observational study involving 340 patients aged over 60 years using at least five prescription drugs and discharged from hospital. The occurrence of DRP was assessed by means of an identification tool specifically developed for use by community pharmacists, including a semistructured patient interview and a checklist of common DRP.ResultsIn total, 992 potential DRP were observed in the 340 patients (mean 2.9 ± 1.7). No drug prescribed but clear indication, an unnecessarily long duration of treatment, dose too low, and incorrect drug selection were the DRP most commonly observed. Ten percent of DRP occurring in 71 patients were drug–drug interactions. The number of DRP was related to the number of drugs prescribed. Frequently occurring DRP found using the patient interview were fear of side effects and no or insufficient knowledge of drug use. Medication of patients discharged from the pulmonary department and of those with type 2 diabetes was particularly associated with occurrence of DRP.ConclusionFollowing hospital discharge, DRP occur frequently among elderly patients using five or more drugs for the treatment of chronic disease. The number of DRP increased with the number of drugs used. An important task for community pharmacists is to identify, resolve, and prevent the occurrence of DRP among this patient group. Since DRP are associated with an increased risk of hospital readmissions, morbidity, and mortality, it is very important to develop intervention strategies to resolve and prevent DRP.

Impact of outpatient interventions made at an ambulatory cancer centre oncology pharmacy in Singapore

To evaluate the clinical significance of interventions made by pharmacists in an oncology pharmacy in Singapore and their acceptance rate and to identify common drug-related problems and workflow-related interventions. A two-month prospective intervention study was conducted at National Cancer Centre Singapore. During the study, pharmacists documented the reason for intervening and its related drug(s). Each intervention was evaluated for its clinical significance by an expert panel: two oncologists and a pharmacist using a five-point scale. The Kendall's test of concordance and Cohen's weighted kappa were employed for analysis of agreement among the respondents. Other variables were analysed using descriptive statistics. A total of 331 interventions were recorded: 147 cases were due to missing chemotherapy orders while 184 cases had potential drug-related problems. Among the 184 cases, 60 cases were related to clarification of orders, while the others had drug-related problems. The Kendall's concordance coefficient was calculated to be 0.612 (p < 0.001) while weighted kappa test results showed fair agreement across the evaluators. Acceptance rate of interventions was 93%. Most commonly documented drugs requiring interventions were carboplatin, trastuzumab and capecitabine. About half of the documented interventions by pharmacists were evaluated as clinically 'significant' or 'very significant'.

Description of a systematic pharmaceutical care approach intended to increase the appropriateness of medication use by elderly patients.

Background & AimsThe pharmaceutical care practice represents a model of responsible pharmacist involvement in the pharmacotherapy optimization of various population groups, including the elderly, known to be at risk for drug-related problems. Romanian pharmacists could use validated pharmaceutical care experiences to confirm their role as health-care professionals.This descriptive research presents the application in two real and different environments of practice of a structured pharmaceutical care approach conceived as the basis for a medication review activity and aiming at the identification and resolution of the drug related problems in the elderlyPatients and methodsTwo patients with similar degree of disease-burden complexity, receiving care in different health-care environments (The Geriatric Ward of the Royal Victoria Hospital from the McGill University Health Centre in Montréal, Québec, Canada, in November 2010, and an urban nursing-home facility in Cluj-Napoca, Romania, in March 2011), were chosen for the analysis. One clinical pharmacist suggested solutions for the management of each of the active drug-related problems identified, using the systematic pharmaceutical care approach and specific published geriatric pharmacotherapy recommendations. The number of the drug-related problems identified and the degree of the care-team acceptance of the pharmacists’ solutions were noted for each patient.ResultsThe pharmacist found 6 active drug-related problems for the hospitalized patient (72 year-old, Chronic Disease Score 9) and 7 potential ones for the nursing-home resident (79 year-old, Chronic Disease Score 8), involving misuse, underuse and overuse of medications. Each patient had 3 geriatric syndromes at baseline. The therapy changes suggested by the pharmacist were implemented for the hospitalized patient, through collaboration with the health-care team. For the nursing home resident, the pharmacist identified the need for additional 6 medications and safety and efficacy arguments to cease 7 initial therapies, simplifying the therapeutic daily schedule (from 24 daily doses to 15).ConclusionThe pharmacist’s potential contribution to the optimization of the Romanian elderly patients’ pharmacotherapy needs further exploration, as potential drug related problems reported as characteristic for this population were easily identified. The presented structured and validated model of pharmaceutical care approach could be used to this end. Its dissemination and use could be encouraged along with the enhancement of pharmacotherapy information and care team collaboration skills.

Impact of a Clinical Pharmacist in the General Hospital: An Egyptian Trial

Medication review aims at optimizing the impact of medications while minimizing their related problems. Drug-related problems have never been properly addressed in Egyptian hospitals. The purpose of this paper is to record and compare the prevalence and types of medication related problems, the interventions provided by the clinical pharmacists and how physicians responded along with making recommendations for error prevention. This prospective study was conducted between June 2012 and December 2012, at an Egyptian general hospital. Five trained pharmacists recorded patient-specific medication related recommendations and completed quality-of-care interventions. The average number of audited doses was 81% of those prescribed. The most prevalent medication problem was prescribing errors followed by administration errors. A total of 20 patients experienced adverse drug events. The greatest error rates across the seven months were observed in the ICU and cardiology units. Numbers of interventions offered by the pharmacists ranged from 241, to 519 per month. Nurses accepted all the interventions introduced by the pharmacists aimed at reducing administration errors while physicians’ resistance rates had an average of 21%. This study showed a positive influence of the pharmacist-led medication review in reducing potential drug-related problems in an Egyptian secondary care where the hospital under study implemented new measures to minimize drug related problems according to the findings of the trained pharmacists.

A Comparison of Prescribing Criteria When Applied to Older Community-Based Patients

Studies have compared prescribing criteria for older people in general terms, reporting the findings without true side-by-side comparisons of the frequency and type of potential drug-related problems (DRPs). The aim of this study was to compare the frequency and type of DRPs identified by several prescribing criteria. Additionally, original pharmacist DRP findings were compared with DRPs identified using the prescribing criteria. Three prescribing criteria were automated: Beers 2012 (Beers), Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START), and Prescribing Indicators in Elderly Australians (PIEA). The criteria were applied to medication reviews of 570 ambulatory older Australian patients. DRPs identified by each set of criteria were recorded. Each DRP was assigned a descriptive term which highlighted mainly drug classes and/or diagnoses to provide a meaningful common language for comparison between recorded DRPs. Descriptive terms were used to compare the frequency and type of DRP identified by each set of criteria, as well as against original pharmacists' findings. Beers identified 399 DRPs via 21 different descriptive terms, STOPP/START identified 1,032 DRPs via 42 terms, and PIEA identified 1,492 DRPs via 33 terms. The various types of DRPs identified by all of the three prescribing criteria were represented by 53 different terms. When constrained to the same 53 different terms, pharmacists identified 862 DRPs. Each set of criteria displayed relevance through mutual agreement of known high-risk medication classes in older people. The number and scope of DRPs identified by pharmacists was best represented by STOPP/START. The application of STOPP/START may be further augmented with relevant criteria from PIEA and Beers.

Identification of drug-related problems by a clinical pharmacist in addition to computerized alerts

Both clinical pharmacists and computerized physician order entry systems with clinical decision support (CPOE/CDSS) can reduce drug-related problems (DRPs). However, the contribution of a clinical pharmacist in addition to CPOE/CDSS has not been established in a prospective study. To determine which DRPs can be identified by a clinical pharmacist in a setting with routine use of CPOE/CDSS. Two surgical and two neurological wards in St. Elisabeth hospital, a 600-bed teaching hospital in the Netherlands. In this observational prospective follow-up study a clinical pharmacist reviewed the pharmacotherapy of patients admitted to surgical and neurological wards to identify DRPs (i.e. medication errors and adverse drug events) and discussed the relevance of identified problems and interventions to resolve these with the responsible physician. Acceptance of the proposed interventions and the presence of alerts in CPOE/CDSS were assessed. Primary outcome was the proportion of DRPs identified by the clinical pharmacist that also triggered a CPOE/CDSS alert. Differences between the DRPs that generated an alert and those that did not were expressed as relative risks or analyzed with Chi square statistics or Mann-Whitney U tests. The proportion of drug-related problems identified by the clinical pharmacist that also generated an alert in the CPOE/CDSS. During 1206 medication reviews, 442 potential DRPs were identified; 286 (65 %) DRPs were considered relevant and 247 (56 %) of the proposed interventions were accepted. A CPOE/CDSS alert was generated for 35 (8 %) of the DRPs the clinical pharmacist identified. The only difference between problems that triggered an alert and those that did not was the class of the DRP (indication 23 vs. 36 %, effectiveness 23 vs. 13 %, safety 23 vs. 10 % and pharmaceutical care issues 31 vs. 42 %, p = 0.02). CPOE/CDSS triggered 623 additional alerts that were handled during routine pharmacy service. As most DRPs identified by a clinical pharmacist were not detected in daily clinical practice by CPOE/CDSS, a clinical pharmacist contributes to reducing DRPs. The sensitivity of CPOE/CDSS to detect certain classes of problems should be optimized.

An investigation into drug-related problems identifiable by commercial

Accredited pharmacists conduct home medicines reviews (HMRs) to detect and resolve potential drug-related problems (DRPs). A commercial expert system, Medscope Review Mentor (MRM), has been developed to assist pharmacists in the detection and resolution of potential DRPs. This study compares types of DRPs identified with the commercial system which uses multiple classification ripple down rules (MCRDR) with the findings of pharmacists. HMR data from 570 reviews collected from accredited pharmacists was entered into MRM and the DRPs were identified. A list of themes describing the main concept of each DRP identified by MRM was developed to allow comparison with pharmacists. Theme types, frequencies, similarity and dissimilarity were explored. The expert system was capable of detecting a wide range of potential DRPs: 2854 themes; compared to pharmacists: 1680 themes. The system identified the same problems as pharmacists in many patient cases. Ninety of 119 types of themes identifiable by pharmacists were also identifiable by software. MRM could identify the same problems in the same patients as pharmacists for 389 problems, resulting in a low overlap of similarity with an averaged Jaccard Index of 0.09. MRM found significantly more potential DRPs than pharmacists. MRM identified a wide scope of DRPs approaching the range of DRPs that were identified by pharmacists. Differences may be associated with system consistency and perhaps human oversight or human selective prioritisation. DRPs identified by the system were still considered relevant even though the system identified a larger number of problems.

GRP-139 Pharmacist Interventions in the Emergency Room of a Tertiary-Level Hospital

BackgroundThe presence of a full-time pharmacist in the ER is well established and acknowledged in many institutions to be of great value.PurposeTo analyse and assess the clinical impact of the...

Recognition of drug related problems by home healthcare employees: A Dutch observational study with self reports

Background: In the Netherlands, the majority (80%) of the older people (age&gt;65) do use prescribed drugs. 82% of the patients who receive home healthcare are 65 years of age or older. Because of natural changes in age-related drug metabolism, these older home healthcare patients are particularly vulnerable to drug - related problems. Purpose: To describe how home healthcare Nurse Assistants (NA), home healthcare Licensed Practical Nurses (LPN) and home healthcare Registered Nurses (RN) rate their knowledge, monitoring skills and ability to recognize adverse drug reactions and drug interactions of the most commonly used medication in older people, aged 75 or older, in the Netherlands. Methods: A survey design was conducted with the use of a questionnaire in a home care organization in the Netherlands. Results: Home healthcare workers most easily recognize side-effects of confusion, drowsiness and fatigue more easily than gastrointestinal disorders and dizziness. In addition, home healthcare Registered Nurses and home healthcare Licensed Practical Nurses were more likely than home healthcare assistants to recognize and report symptoms due to side- effects. Conclusion: There are differences between RN, LPN and NA in the knowledge and their skills to recognize adverse drug reactions and interactions in home care. Consequently, the allocation of clients to RNs, LPNs or NAs should be arranged well. Home healthcare workers are well positioned to act preventatively and alertly to potential drug related problems, if they have adequate access to information on side effects and interactions of medication.

Characteristics of potential drug-related problems among oncology patients

Oncology patients are more at risk for drug related problems because of treatment with (combinations of) anticancer drugs, as they have a higher risk for organ failure or altered metabolism with progression of their disease. The aim of this study was to characterize and to evaluate the frequency of potential drug related problems (pDRPs) among oncology patients. Outpatient- and day-care centres for Internal and Pulmonary Medicine at the Deventer Hospital, Deventer, The Netherlands. A prospective, descriptive, observational study was carried out from March 2010 to March 2011 at the Deventer Hospital, Deventer, The Netherlands. All patients older than 18 years receiving anticancer drugs prescribed by an internal medicineoncologist or pulmonologist-oncologist were included. The primary outcome was the number and type of pDRPs according to Dutch guidelines. Among 546 patients with cancer, 952 pDRPs were identified, of which 474 were oncology-related. These were mainly drug interactions (IA) (246 IA in 157 patients) and potential contraindications (pCI) (201 pCI in 143 patients). Most identified pDRPs in cancer patients were IAs and pCIs and involved corticosteroids. The most frequently occurring oncology-related IAs were classified as minor or moderate levels of severity.

Evaluation of clinical pharmacist recommendations in the geriatric ward of a Belgian university hospital

ObjectiveTo evaluate the type, acceptance rate, and clinical relevance of clinical pharmacist recommendations at the geriatric ward of the Ghent university hospital.MethodsThe clinical pharmacist evaluated drug use during a weekly 2-hour visit for a period of 4 months and, if needed, made recommendations to the prescribing physician. The recommendations were classified according to type, acceptance by the physician, prescribed medication, and underlying drug-related problem. Appropriateness of prescribing was assessed using the Medication Appropriateness Index (MAI) before and after the recommendations were made. Two clinical pharmacologists and two clinical pharmacists independently and retrospectively evaluated the clinical relevance of the recommendations and rated their own acceptance of them.ResultsThe clinical pharmacist recommended 304 drug therapy changes for 100 patients taking a total of 1137 drugs. The most common underlying drug-related problems concerned incorrect dose, drug–drug interaction, and adverse drug reaction, which appeared most frequently for cardiovascular drugs, drugs for the central nervous system, and drugs for the gastrointestinal tract. The most common type of recommendation concerned adapting the dose, and stopping or changing a drug. In total, 59.7% of the recommendations were accepted by the treating physician. The acceptance rate by the evaluators ranged between 92.4% and 97.0%. The mean clinical relevance of the recommendations was assessed as possibly important (53.4%), possibly low relevance (38.1%), and possibly very important (4.2%). A low interrater agreement concerning clinical relevance between the evaluators was found: kappa values ranged between 0.15 and 0.25. Summated MAI scores significantly improved after the pharmacist recommendations, with mean values decreasing from 9.3 to 6.2 (P < 0.001).ConclusionIn this study, the clinical pharmacist identified a high number of potential drug-related problems in older patients; however, the acceptance of the pharmacotherapy recommendations by the treating physician was lower than by a panel of evaluators. This panel, however, rated most recommendations as possibly important and as possibly having low relevance, with low interrater reliability. As the appropriateness of prescribing seemed to improve with decreased MAI scores, clinical pharmacy services may contribute to the optimization of drug therapy in older inpatients.

The contribution of patient interviews to the identification of drug-related problems in home medication review

To determine to what extent patient interviews contribute to the identification of drug-related problems (DRPs) in home medication reviews, in terms of number, type and clinical relevance. We performed a cross-sectional study within the intervention arm of a randomized controlled trial. Patients were recruited from 10 Dutch community pharmacies. Patients were eligible if they were home-dwelling, aged 65 years and over and used five or more different drugs, including at least one cardiovascular or antidiabetic drug. The community pharmacist interviewed the patient at home about the medicines and identified potential DRPs in combination with medication and clinical records. This medication review was assessed and modified by an independent pharmacist reviewers' panel. Outcomes were the number and type of DRPs and recommendations and percentage of clinical relevant DRPs. Clinical relevance of DRPs was assessed by DRPs assigned a high priority, DRPs followed by recommendations for drug change and DRPs followed by implemented recommendations for drug change. A total of 1565 potential DRPs and recommendations (10 per patient).were identified for 155 patients (median age, 76 years; 54% women). Fifty-eight per cent of all recommendations involved a drug change; 27% of all DRPs were identified during patient interviews and 74% from medication and clinical records. Compared to DRPs identified from patient medication and clinical records, DRPs identified during patient interviews were more frequently assigned a high priority (OR = 1.8 [1.4-2.2]), were more frequently associated with recommendations for drug change (OR = 2.4 [1.9-3.1]) and were implemented recommendations for drug change (OR = 2.8 [2.1-3.7]). This study shows that more than a quarter of all DRPs were identified during patient interviews. DRPs identified during patient interviews were more frequently assigned a higher clinical relevance.

Assessment of inappropriate drug prescription in older people through a screening tool

BackgroundComorbidity and polypharmacy in conjunction with physiological changes in older people contribute to the well-documented problem of inappropriate drug prescription, a risk associated with an age group.PurposeTo find out to...

Healthcare providers’ experiences with adverse drug reactions and adherence challenges in antiretroviral therapy of HIV patients in the Eastern Cape Province, South Africa

To gain insight into the experiences and handling of adverse drug reactions (ADRs) by the staffs of public primary healthcare (PHC) clinics in Eastern Cape Province, South Africa, as well as their perceptions of related adherence challenges in the treatment and follow-up of human immunodeficiency virus (HIV)-positive patients. Healthcare providers working at the PHC level in the public sector in the study area were approached and asked to participate in focus group discussions (FGDs). Seven FGDs were conducted with 32 healthcare providers (9 nurses, 23 auxiliary staff). Questions introduced by the moderator of each FGD were freely discussed by the participants. Discussions were audio-recorded and subjected to thematic content analysis. Several challenges in the treatment and follow-up of patients on ART were identified. These include: (1) lack of training of healthcare providers in PHC clinics to confidently identify, manage and treat the ADRs HIV-positive patients receiving ART; (2) patients' difficulty in communicating information on ADRS; (3) insufficient pharmacovigilance; (4) role of poverty. Both nurses and auxiliary staff expressed lack of knowledge and confidence regarding ADRs in HIV patients and management of this. More emphasis is warranted on training the healthcare providers to identify ADRs and provide adequate advice for continued treatment of patients experiencing potential drug related problems.