Presence Of Clinical Pharmacist Research Articles

Evaluation of Medication Errors in Preparation and Administration of Intravenous Medicines in Intensive Care Units in Imam Reza and Shohada Hospitals in Tabriz

Background: Studies have shown that medication errors and adverse drug reactions are among the main causes of adverse events in hospitals leading to disability and death. Errors occur in the process of drug prescribing, dispensing, and administration. errors are most often made on the patient care units with various risk factors. The aim of the study was to evaluate medication errors in preparation and administration of intravenous medications in two Intensive Care Units of two university hospitals in Tabriz.
 Methods: An observational and single-blinded study was carried out in the pulmonary ICU of Imam Reza hospital and the ICU of Shohada hospital using general and mono-drug checklists of error-prone situations. 14 different error categories were studied.
 Results: Total of 367 administrations for 26 different drugs were observed. among 4558 opportunities for errors, 640 errors were identified. Error rate of 15.99 % and 10.96 % were reported in Imam Reza and Shohada hospital, respectively. Wrong rate error and controls during administration had the highest rate of errors in Imam Reza and Shohada hospitals, respectively. Streptokinase in Imam Reza hospital and ceftazidime in Shohada hospital were the drugs with highest error rate. Midnight and 10 PM administration rounds had the highest error rate in Imam Reza and Shohada hospitals, respectively. Error rate in Imam Reza hospital was significantly higher.
 Conclusion: It is concluded that medication errors occur in all stages like preparation and administration mostly related to rate of administration and controls needed while administration; Strict controlling, training programs, and presence of clinical pharmacists are highly recommended.

Analysis on Clinical pharmacy services provided by pharmacists for promoting elderly patients care

Clinical pharmacy services are the services provided by the pharmacists to promote patient care, optimizes medication therapy, promote health and disease prevention. This prospective cross sectional study was conducted in tertiary care hospital over a period of 6 months. This collected data is checked for their appropriateness of any prescription related errors and DRPs were identified. Results obtained were assessed to determine the influence of Clinical pharmacist services. Majority of the prescriptions were with 5-9(62.5%) drugs. The majority of co-morbidities among 125 enrolled patients in age group of 60-70, 55 patients were with 3-4 co-morbidities. Among 125 prescriptions around 12 prescriptions were identified with 622 drug interactions. Among 125 patients 2 (0.277) adverse drug reactions were observed and according to Naranjo's probability assessment scale these adverse drug reactions were mild and 15(2.08%) dispensing errors, 10(1.386%) prescription errors where majority of prescription errors are due to missed written frequencies in the prescriptions. 5(0.693%) administration errors, 5 (0.693%)untreated indications were observed. Presence of clinical pharmacist in hospital settings can reduce drug related problems and they can assist other staff in improving patient care.

A survey of therapeutic drug monitoring in a teaching hospital.

ObjectivesTherapeutic drug monitoring (TDM) is one of the tools that aim to improve and ensure the best therapeutic effects while avoiding drug toxicity. This study aimed to identify the clinical utilization and application of TDM at a major teaching hospital in Jeddah.MethodsA cross sectional survey of the clinical utilization and application of TDM at King Abdulaziz University Teaching Hospital across nurses in medical, surgical, pediatric, and intensive care units. The sample size (n = 130) represented 30% of the nursing population. The collection of questionnaires started on the 31st of January 2019 and was completed by the 10th of March 2019.ResultsThe indication to use TDM was well-known to respondents. However, only 64% of respondents reported collection and measuring of the correct drug levels at a precise sampling time with no specific protocols being followed for each drug. Moreover, only 53% reported that the drug levels were being re-measured and adequately monitored for the right indication and proper sampling time. Regarding the presence of clinical pharmacists, 70% of the respondents indicated that no clinical pharmacist worked in their department.ConclusionResults demonstrate that appropriate sampling time was not used for the majority of monitored drugs. In the absence of a TDM request form, this finding probably indicates the lack of national or local TDM guidelines. In conclusion, TDM services, which include standardized forms, references, and an active clinical pharmacist will likely improve the application of TDM.

STUDY OF POTENTIAL DRUG INTERACTIONS AMONG EIGHT MAJOR DEPARTMENTS-GENERAL MEDICINE, ORTHOPEDICS, GYNECOLOGY, PULMONOLOGY, GENERAL SURGERY, PSYCHIATRY, OTOLARYNGOLOGY AND DERMATOLOGY OF A TERTIARY CARE TEACHING HOSPITAL IN SOUTHERN INDIA

Objective: To identify frequency, type, severity and predictors of potential drug-drug interactions(pDDIs), potential drug-food interactions(pDFIs), potential drug-alcohol interactions(pDAIs) and potential drug-tobacco interactions(pDTIs) and most frequently interacting drug combination pairs in hospitalized patients from departments(depts) of General Medicine(GM), Orthopedic(Ortho), Gynecology(OBG), Pulmonology(Pulmo), General Surgery (GS), Psychiatry (Psych), Otolaryngology(ENT) and Dermatology (Derm) of study population.
 Methods: A Prospective Observational Study was conducted in eight major dept's of a tertiary care teaching hospital for a period of 6 mo. A sample size of 650 prescriptions reflecting admission no's for each department were used.
 Results: A total of 650 patients were included in the study. Among them, 282(43.4%) were males and 368(56.6%) were females. The mean age of the study population was 39.67±15.23. A total of 487 pDDIs, 734 pDFIs, 586 pDAIs and 159 pDTIs were found out of 650 hospitalized episodes. OBG showed the highest pDDIs and pDAIs. Highest pDFIs and pDTIs were seen in Pulmo. The majority of DDIs were minor, DFIs and DAIs were moderate and DTIs were of major in severity. Pharmacokinetic types of interactions were seen in the majority of the depts. Logistic regression analysis showed that Polypharmacy was associated with the occurrence of DIs. Most of the DIs repeated several times in particular depts and a list of these combinations was prepared.
 Conclusion: With the high occurrence of overall DIs and characteristic patterns of DIs combination pairs among different departments of the hospital, the presence of clinical pharmacists in hospitals can play a great role, especially in developing nations like India where their role in hospitalized settings is always controversial.

Evaluation of Clinical Pharmacy Services in the Intensive Care Unit of a Tertiary University Hospital in the Northwest of Iran.

Objective:Current literature indicates that the presence of clinical pharmacists in hospitals results in improved patient care, rational drug therapy, and treatment costs. This study assessed the clinical pharmacy services in the intensive care unit (ICU) of a tertiary hospital at Tabriz University of Medical Sciences, Iran.Methods:During a 9-month cross-sectional study (2014–2015), the clinical pharmacy interventions in 27 sessions and educational activities for patients and health-care professionals were randomly assessed based on the Australian guideline and standard of practice for clinical pharmacy. The interventions of clinical pharmacist were evaluated in terms of their clinical importance.Findings:In this study, a total of 832 interventions on 242 patients were performed by the clinical pharmacist, and approximately 93.6% of the interventions were approved by the attending physician. Most interventions concerned adding a new medication to a drug regimen or switching to a needed new medication. Each patient received an average of three interventions. The clinical pharmacist provided drug information to employees and medical staff in 108 of the total 832 interventions (13%). Medical residents who were surveyed indicated that the quality of education, research, and patient care was improved by the attendance of a clinical pharmacist.Conclusion:The results of this study show that the collaboration of a clinical pharmacist with the medical staff of an ICU can improve pharmacotherapy approach and increase the quality of education.

Role of the Clinical Pharmacist in Reducing Preventable Adverse Drug Events

According to so many previous studies, lack of sufficient information during prescribing steps may lead to medication errors. Thus, the presence of the clinical pharmacist during routine rounding process in the ward with intervention of patient care plan may reduce the probability of adverse drug events (ADEs).This study evaluate role of the clinical pharmacists, as a member of medical team with the physician, on ADEs and report their interventions in the internal medicine unit. This study was designed to compare between two groups of patients, those receiving care from a rounding team (physician, nurse, and clinical pharmacist) (study or intervention group with 51 patient); and those receiving care from a rounding team (physician and nurse, but without any pharmacist) (control group with 49 patient). The primary outcome measure was preventable ADEs and secondary one involves the time of staying in the hospital and onset of response to therapy. Patients were randomly selected, followed a single-blind design, and evaluated by a senior physicians and clinical pharmacists who document their medical interventions.Specialist physicians accepted (60) of (77) recommendations (i.e. do modifications in drug therapy depending on clinical pharmacist interventions). The most common intervention was recommending dosage or frequency of medication (32.4%), followed by addition of medication (19.5%).The rate of preventable ordering ADEs in the study unit was 77% lower than in the control unit (P<0.05). There was no significant difference (p>0.05) in the cost of drug therapy between patient groups. Patients with ADEs in the control group had an average of 1.5 day longer staying period at the hospital; which was not differ significantly (p>0.05) from the study group.In summary, presence of clinical pharmacist during tour as a full member of the patient care team in internal medicine ward was associated with a substantially lowered rate of ADEs which caused by prescribing errors. Types of errors indicate the need for activation of the clinical pharmacist's interventions.
 Key words: adverse drug events (ADEs), clinical pharmacist.

Implementation of a Clinical Pharmacy Training Program in Iraqi Teaching Hospitals : Review Article

Pharmaceutical care is a patient-centered, outcomes oriented practice that requires the pharmacist to work in concert with the patient and the patient’s other healthcare providers to promote health, to prevent disease, and to assess, monitor, initiate, and modify medication use to assure that drug therapy regimens are safe and effective. In addition, the presence of clinical pharmacists has led to a higher quality of patient education and provision of complete detailed information for patients. In developed countries Pharm D has become the professional degree for practice of Pharmacy. The graduates will be enrolled in a pharmacy residency program; admission to the residency programs is available to Pharm D graduates of an accredited College of Pharmacy. The residency is also designed to prepare the residents to become Board Certified Specialists in their field. In many developing countries three new pharmaceutical education programs have currently been established to serve the pharmaceutical care development. Firstly, a six-year curriculum leading to the doctor of pharmacy (Pharm. D) degree as the sole professional degree. Secondly, Pharmacy Residency and Fellowship Training Program have been developed to provide intensive training in pharmaceutical care practice to the pharmacists. Lastly, the continuing pharmaceutical education program (CPE) has been adopted to ensure the competency of all pharmacists to deliver the best knowledge and skills in pharmaceutical sciences in their specialties. In our opinion we lack for most of these programs, even the program of clinical pharmacy in ministry of health is not residency program and it is short and not subspecialized apart from being not recognized by academic institutes and references. In conclusion, pharmacy profession has to change towards the more responsibility on patient care. New training program has to be adopted by medical education institutes to provide clinical pharmacists as a profession and to prepare board certified clinical pharmacists as specialists to cope with the advances in all medical fields.
 Key words: clinical pharmacy, board certification.

Infectious Disease Pharmaceutical Care: The Role of the Clinical Pharmacists to Improve Clinical Outcomes 2017

Today more than past we need to improve clinical outcomes in the management of infectious disease related to patient in critical conditions (septic shock, sepsis, MOF, invasive fungal infections, HIV, peritonitis, meningitis, endocarditis, osteomyelitis, pneumonia, severe UTI, proteases infections and other). The same way we can see the high efficacy of some new drugs in eradicate severe infectious (as CEPAT), saving cost for transplant. This condition needs today an active role and permanent presence of clinical pharmacist in medical team because these therapies highly involved in patient’s health. The objective of this work is to analyze the role of clinical pharmacist in infectious disease medical team observing some in our opinion relevant publication and the positive effect on clinical outcomes. Infectious disease needs today new management systems to contain the increase of antimicrobial resistance in an era of few new and innovative drug discovered by pharmaceutical industries. Clinical pharmacist can give to the physicians a great help in this field to improve clinical outcomes, reducing toxicity, containing costs but also to preserve the antimicrobial potential of the antimicrobials (as safe-life drugs). These are only some of the many reason to apply the clinical pharmacist competence in patient medical team.

Effects of Organizational Characteristics on Outcomes and Resource Use in Patients With Cancer Admitted to Intensive Care Units.

To investigate the impact of organizational characteristics and processes of care on hospital mortality and resource use in patients with cancer admitted to intensive care units (ICUs). We performed a retrospective cohort study of 9,946 patients with cancer (solid, n = 8,956; hematologic, n = 990) admitted to 70 ICUs (51 located in general hospitals and 19 in cancer centers) during 2013. We retrieved patients' clinical and outcome data from an electronic ICU quality registry. We surveyed ICUs regarding structure, organization, staffing patterns, and processes of care. We used mixed multivariable logistic regression analysis to identify characteristics associated with hospital mortality and efficient resource use in the ICU. Median number of patients with cancer per center was 110 (interquartile range, 58 to 154), corresponding to 17.9% of all ICU admissions. ICU and hospital mortality rates were 15.9% and 25.4%, respectively. After adjusting for relevant patient characteristics, presence of clinical pharmacists in the ICU (odds ratio [OR], 0.67; 95% CI, 0.49 to 0.90), number of protocols (OR, 0.92; 95% CI, 0.87 to 0.98), and daily meetings between oncologists and intensivists for care planning (OR, 0.69; 95% CI, 0.52 to 0.91) were associated with lower mortality. Implementation of protocols (OR, 1.52; 95% CI, 1.11 to 2.07) and meetings between oncologists and intensivists (OR, 4.70; 95% CI, 1.15 to 19.22) were also independently associated with more efficient resource use. Neither admission to ICUs in cancer centers compared with general hospitals nor annual case volume had an impact on mortality or resource use. Organizational aspects, namely the implementation of protocols and presence of clinical pharmacists in the ICU, and close collaboration between oncologists and ICU teams are targets to improve mortality and resource use in critically ill patients with cancer.

The Effect of Medication Administration Associated Factors on Anxiety and Depression of Hospitalized Patients

Context: Hospital anxiety and depression can lead to higher length of stay in hospitals. Aims: The aim of this study was to evaluate the relationship between drug administration associated factors and anxiety and depression of hospitalized patients in infectious ward and also to evaluate the impacts of clinical pharmacist interventions on anxiety and depression of hospitalized patients in infectious ward through administering medications. Settings and Design: This study conducted in the infectious ward of Afzalipour Hospital affiliated to Kerman Medical University and had two parts. The first part was a cross-sectional study and the second part was a randomized clinical trial. Subjects and Methods: Patients on the 3rd or 4th day of hospitalization, who were between 16 and 85-year-old were included in this study. To measure anxiety and depression in patients, we used the Hospital Anxiety and Depression Scale. Statistical Analysis used: We used Spearman rank test, Mann–Whitney U-test, Kruskal–Wallis one-way analysis of variance, and Chi-square test. Results: In the first part, 156 patients participated. It was found that the number of medication and frequency of medication administration had a direct correlation with both anxiety and depression. In the second part, 104 patients enrolled. It was found that the presence of clinical pharmacist did not have any significant effect on anxiety, depression, frequency of medications administration, and the number of medications. Conclusions: It was concluded that drugs associated factors had a significant effect on anxiety and depression of hospitalized patients.

An evaluation of clinical pharmacist service on a neurology care unit.

Medications used to treat neurological diseases may result in adverse effects. Research is needed to demonstrate pharmacist value and their roles in patient care. To categorize the types and severities of the prescribing errors intercepted and to describe clinical activities conducted by neurology ward pharmacists. Pharmacists prospectively reviewed medication orders over an 18-month period with inventions documented and categorized. A total of 341 prescribing errors in 1183 patients were intercepted. The most common error types were dosing frequency (35.8 %) and medication selection (21.5 %). The top five most detected error medications were those indicated for hyperhomocysteinemia (22.0 %), stress ulcer prophylaxis (12.3 %), poor circulation (10.9 %), hyperglycemia (6.5 %), and infections (5.9 %). Although 67.5 % of the detected errors having the potential causing no harm, 26.4 % of the errors may require intervention, and 6.2 % may increase the length of stay. The number of errors decreased from 19 to 10 per month during the study period. Clinical pharmacists also actively engaged in medication use evaluation, clinical decision support system optimization, and education to patients and providers. Presence of clinical pharmacists at the neurology unit may help in early detection of prescribing errors with increased patient safety.

Prescribing Pattern in an Intensive Car Unit in a Tertiary Care Teaching Hospital, Bangalore, South India

INTRODUCTION: Critical care presents with a major patient safety challenges and requires fast-paced, complex and urgent high-risk decisionmaking, by physicians with varying levels of critical care training. In Intensive Care Unit (ICU) settings, the rate of preventable and potential Adverse Drug Events (ADEs) is even higher, being almost twice as high as in non-ICUs.Many studies states that, the presence of clinical pharmacists in ICUs has reduced the number of adverse events, improved cost savings and medications, stay, and shortened the duration of ICU admission. AIM : To study the prescribing pattern in an Intensive Care Unit (ICU). METHOD : A prospective - observational study on prescription pattern was done in the ICU Department of a tertiary care teaching hospital in Bangalore for a period of 6 months. All patients admitted in the ICU above 18 years were included in the study and patients who were admitted in ICU for less than 24 hours were excluded. Patients satisfying Inclusion criteria were enrolled after obtaining Informed Consent (IC) and their medication orders were observed for Prescription Pattern and analysed. RESULTS and DISCUSSION : A total of 120 cases were observed and analysed in which 45% were females and 55% were males. Majority of the patients belong to the age category of above 50 years. A total of 1165 drugs were prescribed out of which 20% were antibiotics followed by broncho dilators (9.2%), anti-hypertensives (9.4%), corticosteroids and analgesics (7.4%) each, anti-diabetics (5.6%), antidotes (1.6 %) and others (38.8%). Antibiotics were the uppermost class prescribed, among which Ceftriaxone or Cefaperazone -Sulbactum combination was widely found. Atropine (52.6%) was the most commonly prescribed antidote. Among bronchodilators, combination of anti-cholinergics and beta blockers was prescribed more (49%). Short acting glucocorticoid and para- aminophenol derivatives with 81.6% and 85% respectively, were the most prescribed corticosteroid and analgesics. CONCLUSION : The results of the study highlights areas that need improvement among which most importantly, there is a need to implement local antibiotic management program or infectious disease specialist consultation which could lead to marked reductions in antibiotic consumption. There are considerable variations in the practice of emergency medications by various professionals in the ICU, hence preparation and implementation of emergency medication practice guidelines may bridge the variations among practitioners and continually improve the quality of care to the patients.

Medication errors in an emergency department in a large teaching hospital in tehran.

Medication errors have important effects on increased length of hospitalization, increased mortality and costs. We assessed the incidence of medication errors and characterize the error types in an emergency department in a large teaching hospital in Tehran. We also investigated the effect of Emergency Department pharmacists on patient safety with regard to recovery of potentially harmful medication errors. The study was conducted in the 24 bed emergency department from February to March, 2010 at a 600-bed teaching hospital. Two hospital pharmacists and two clinical pharmacy residents observed care provision and collected data on medication errors. Demographic data, type of medication error, the recorded stage of error, date and time of occurrence and report, who made the error, probability of error were recorded from medical records. We used chi-squared and independent sample t- tests for analyzing the data. We recorded 203 medication errors during 180 hours. The incidence of medication errors was 50.5% at various levels in the emergency department. Significant difference in age means was seen between the patients with and without medication errors. Seventy four point nine percent of errors were recorded as definitely an error. Most recorded errors were made by nurses (44.5%) and occurred in administrating stage (63.6%). Given that the rate of the errors was relatively high, it seems that the presence of clinical pharmacist can be beneficial.

Comparative assessment of drug interactions in pediatrics at private and public sector hospitals of Sargodha and Faisalabad

The present study was performed in the cities of Faisalabad and Sargodha, and pediatric in-patient prescriptions were collected from four private and D.H.Q hospitals of these two cities. The collected data of 1420 prescriptions was analyzed for drug interactions by using the software developed by the Medical Letter. The drug interactions found were divided into severe, moderate and mild depending on the type of effect produced. The results showed that the public sector showed 820 drug interactions, that is 74.55%; on the other hand, the private sector showed 130 drug interactions, that is 40.63%. The private sector hospital of Faisalabad showed only 40 drug interactions, that is 20%; while 90 drug interactions, that is 75% were found in private sector hospital of Sargodha. The public sector hospital of Sargodha showed 390 drug interactions, 92.86% and 430 drug interactions, that is 63.24% were found in public sector hospital of Faisalabad. The results showed that the frequency of drug interactions was much less in private hospitals as compared to the public sector hospitals. The possible reason was the presence of clinical pharmacists in more numbers in the private hospitals as compared to the public sector hospitals. It is therefore required that the role of pharmacist should be increased in the hospitals.

Evaluation of the role of the critical care pharmacist in identifying and avoiding or minimizing significant drug-drug interactions in medical intensive care patients

Study Objective The aim of the study was to evaluate the impact of prospective review of significant drug-drug interactions (DDIs) occurring in medical intensive care unit (MICU) patients by the critical care pharmacist participating in patient care rounds on improvement of safer and more efficacious medication use. Study Design A prospective consecutive 10-week study was conducted in the MICU, St Luke's/Roosevelt Hospital Center (St Luke's site), New York, NY. This study compared baseline period when clinical pharmacist services were not provided with the period when each patient's profile was reviewed daily during MICU rounds and interactions were minimized. The study examined whether the presence of critical care pharmacist would decrease the number of significant DDIs in the MICU. Impact of decreasing presence of severe DDIs on length of stay (LOS) and discharge status was also evaluated. Results Having a pharmacist on rounds resulted in statistically significant decrease in number of clinically important interactions requiring therapy modification, rated D-X (Poisson regression B = −1.036; 95% confidence interval, −1.318 to −0.753; P < .01). The coefficient (−1.036) indicates the incidence rate ratio of 0.35, meaning that the presence of clinical pharmacist in MICU rounds decreased DDI rate by 65%. According to the multiple linear regression, lower number of DDIs was associated with shorter LOS ( P < .01). Inpatient mortality rate was lower in the intervention group compared with the preintervention group. Number of DDIs was not significantly associated with mortality based on simple regression ( P = .45) or multiple regression analysis ( P = .09). Conclusion Implementing a DDI screening procedure results in significantly lower number of important DDI in the MICU and shortens LOS.

Clinical and economic outcomes of involving pharmacists in the direct care of critically ill patients with infections*

To determine whether the absence or presence of clinical pharmacists in intensive care units (ICUs) results in differences in mortality rates, length of ICU stay, and ICU charges for Medicare patients with nosocomial-acquired infections, community-acquired infections, and sepsis. The type and level of pharmacy services provided to ICUs were obtained from a 2004 national survey. Clinical pharmacy services were defined as having at least a partial pharmacist full-time equivalent specifically devoted to the ICU for the purpose of direct involvement in patient care. Infections were defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes. ICU outcome data were drawn from the 2004 modified Medicare provider analysis and review. Depending on the infection studied, the involvement of clinical pharmacists was evaluated in 8,927-54,042 patients from 265 to 276 hospitals. None. Mortality rates, length of ICU stay, Medicare charges, drug charges, and laboratory charges for each of the infections categorized according to the absence or presence of clinical pharmacists. Compared to ICUs with clinical pharmacists, mortality rates in ICUs that did not have clinical pharmacists were higher by 23.6% (p < 0.001, 386 extra deaths), 16.2% (p = 0.008, 74 extra deaths), and 4.8% (p = 0.008, 211 extra deaths) for nosocomial-acquired infections, community-acquired infections, and sepsis, respectively. Similarly, ICU length of stay was longer by 7.9% (p < 0.001, 14,248 extra days), 5.9% (p = 0.03, 2855 extra days), and 8.1% (p < 0.001, 19,215 extra days) for nosocomial-acquired infections, community-acquired infections, and sepsis, respectively. ICUs that did not have clinical pharmacists had greater total Medicare billings of 12% (p < 0.001, $132,978,807 extra billing charges), 11.9% (p < 0.001, $32,240,378 extra billing charges), and 12.9% (p < 0.001, $224,694,784 extra billing charges) for nosocomial-acquired infections, community-acquired infections, and sepsis, respectively. Similar findings were observed for Medicare drug charges and laboratory charges. The involvement of clinical pharmacists in the care of critically ill Medicare patients with infections is associated with improved clinical and economic outcomes. Hospitals should consider employing clinical ICU pharmacists.