Prevention Of Drug-related Problems Research Articles

Automation in Pharmacovigilance

The term “pharmacovigilance,” first proposed in the1970s, has gradually gained traction to become one of the two common terms of art for the overall discipline, the other, older term being “drug safety.” “World Health Organization (WHO)” as “the science and activities relating to the detection, assessment, understanding and prevention of drug-related problems”. The information about suspect product is collected from healthcare providers and patients to detect and prevent abnormalities associated with it. Therefore, PV deals with adverse effects of drug, poly-pharmacy, paradoxical reactions, and severe adverse events. Automation in pharmacovigilance entails using cognitive technologies such as machine learning (ML) and advanced analytics to transform legacy data compilation processes and information gathering for regulatory approval. Automation technologies have strong potential to automate routine work and balance resource use across safety risk management and other pharmacovigilance activities. This article provides an overview of automation in pharmacovigilance.

Outcomes of Pharmacist-Led Pharmaceutical Care Interventions Within Community Pharmacies: Narrative Review.

Pharmaceutical care (PhC) services interventions led by pharmacists within community pharmacies (CPs) are essential in achieving optimal medication use outcomes. PhC is a concept related to medication use goals optimization through the reduction and prevention of drug-related problems (DRPs). This review paper summarized the literature on pharmacist-led PhC interventions within CPs. PubMed and Google Scholar publications were searched, identified, and summarized. Results showed that some studies handled community pharmacists' roles, and some talked about PhC interventions. However, some studies reviewed the use of medicines, adherence, and follow-up, while other groups were on counseling, patient education, and health promotion. Pharmacists integrated some studies concerning diagnosis and disease screening into community pharmacy services. Besides these studies, there were studies on system design and installation of PhC service models. Most of the identified research results showed pharmacist-led intervention benefits for patients. These benefits include reduced DRPs, clinical, economical, humane, education and knowledge, disease prevention and immunization, identification of practice process problems, and the need for current practice redesigning. In conclusion, pharmacists can help patients achieve optimal outcomes through pharmacist-led interventions. Despite mentioned results, We recommend researching comprehensively applied PhC services provision models within CPs for more pharmacists-led interventions and role activation.

Drug-related problems among transfusion-dependent thalassemia patients: A real-world evidence study.

Introduction: Thalassemia is among the most common genetic disorders globally and many patients suffer from iron overload (IOL) complications that mainly affect the heart, liver and endocrine system. These events may be further complicated by drug-related problems (DRP), an inherent issue among patients with chronic diseases. Objective: The study aimed to evaluate the burden, associated factors and impacts of DRP in transfusion-dependent thalassemia (TDT) patients. Method: Eligible TDT patients under follow-up in a tertiary hospital between 01 March 2020 to 30 April 2021 were interviewed and their medical records were reviewed retrospectively to identify any DRP. DRPs were classified using the Pharmaceutical Care Network Europe (PCNE) classification version 9.1. The incidence and preventability of DRP were assessed and the associated risk factors were estimated by univariate and multivariate logistic regression. Results: A total of 200 patients were enrolled with a median (interquartile range: IQR) age of 28years at enrolment. Approximately 1 in 2 patients were observed to suffer from thalassemia-related complications. Throughout the study period, 308 DRPs were identified among 150 (75%) participants, with a median DRP per participant of 2.0 (IQR 1.0-3.0). Of the three DRP dimensions, treatment effectiveness was the most common DRP (55.8%) followed by treatment safety (39.6%) and other DRP (4.6%). The median serum ferritin level was statistically higher in patients with DRP compared with patients without DRP (3833.02 vs. 1104.98μg/L, p < 0.001). Three risk factors were found to be significantly associated with the presence of DRP. Patients with frequent blood transfusion, moderate to high Medication Complexity Index (MRCI) and of Malay ethnicity were associated with higher odds of having a DRP (AOR 4.09, 95% CI: 1.83, 9.15; AOR 4.50, 95% CI: 1.89, 10.75; and AOR 3.26, 95% CI: 1.43, 7.43, respectively). Conclusion: The prevalence of DRP was relatively high amongst TDT patients. Increased medication complexity, more severe form of the disease and Malay patients were more likely to experience DRP. Hence, more viable interventions targeted to these groups of patients should be undertaken to mitigate the risk of DRP and achieve better treatment outcomes.

Management of Drug Related Problems in the Elderly - A Review

Drug Related Problems (DRPs) also known as Medication Related Problems (MRPs) are the problems that occur because of the drugs when a person is undergoing a treatment. Older patients are particularly vulnerable to ADRs because of age-related changes in pharmacokinetics and pharmacodynamics, such as reduced hepatic and renal function, prolonged elimination half-life, and increased sensitivity to drugs, which have been shown to be associated with an increased risk of ADRs. This may (in most cases) interfere with the desired outcome of the therapy. This in turn, reduces the quality of life of a person. DRPs may be life-threatening in some and this poses the importance of identification of DRPs. The DRPs can be identified and can be categorized as whether it is preventable or not. It can also be classified into different classes- Adverse Drug Reaction (ADR) and Drug Interaction being the most common causes for the incidence of DRP. The pharmacist can play a key role in identification, categorization and prevention of DRPs. The aim of this review is for the better understanding of DRPs and to shine light on the causes of DRPs that is often left unseen or under-estimated. This review also aims to show the big role that can be played by pharmacist in identifying, preventing DRPs and thereby improving the quality of life of patients. Keywords: Drug related problems, Quality of life, Pharmacist’s role

Characteristics of drug-related problems and pharmacist’s interventions in hospitalized patients in Thailand: a prospective observational study

Drug-related problems (DRPs) are a major health concern. A better understanding of the characteristics of DRPs throughout the hospital stay may help to tailor pharmaceutical care services (PCS). This study aims to describe the characteristics of DRPs and to compare DRP pattern in different stages of hospital stay. DRPs were identified by clinical pharmacists as part of their routine services. Pharmacist assessed causality, severity and preventability of DRP. A total of 316 preventable DRPs occurred in 257 patients with the median of 1 (rang 1–3) DRPs per patient. 46.8% of DRPs occurred at discharge than at other stages. The most frequent cause of DRP was no drug treatment in spite of existing indication, accounting for 32.3% of all DRPs. No drug treatment with existing indication was detected frequently at discharge (56.1%) compared with other stages (p-value < 0.001). The common intervention to physician was starting a drug (34.0%) and the acceptance rate was 95.8%. DRPs in hospitalized patients occur at any stage of the hospital stay. Systematic identification of DRP characteristics enables pharmacists to tailor optimal type of PCS required and hence improve patient safety.

Chronic Kidney Disease: Clinical and Epidemiological Scenario of Patients in Hemodialysis

OBJECTIVE: To describe the clinical and epidemiological scenario of patients with chronic kidney disease undergoing hemodialysis.&#x0D; &#x0D; METHOD: Retrospective study with secondary data collected from the medical records of patients over 18 years of age on hemodialysis from January 2016 to December 2018.&#x0D; &#x0D; RESULTS: 507 patients underwent ambulatory and/or hospital hemodialysis during the study period. From these, 494 participants were included, comprising 383 who were still under treatment at the end of the study period and 111 who died during the study period. The majority of hemodialysis patients were male, with a mean age of 56.6 years, non-white (77.4%), in a stable relationship (51.6%), retired (54.9%), and with low education (73.9%). Most participants started hemodialysis with the use of a central venous catheter (83.3%), which was maintained for 43.8% of the treatment time. Participants used an average of 18.91 medications daily. More than half of the deaths occurred during the first two years of treatment, with 30.6% of these occurring in the first 12 months of hemodialysis. Evaluation of the results of the clinical outcome of death demonstrated a relationship between age (p= 0.003), number of comorbidities (p = 0.009), time using a central venous catheter (p = 0.025), and white ethnicity (p = 0.021). Septic shock was the main cause of death (56.8%). &#x0D; &#x0D; CONCLUSION: Some factors related to the prognosis of the disease cannot be changed, such as age and white ethnicity. However, greater attention to the management and adequate monitoring of comorbidities is necessary, as well as a reduction in the time spent using a central venous catheter. Due to polymedication, pharmacotherapeutic monitoring is indicated, both for the prevention of drug related problems and for discussions concerning drug discontinuation.

Effectiveness of Clinical Pharmacist Service on Drug-Related Problems and Patient Outcomes for Hospitalized Patients with Chronic Kidney Disease: A Randomized Controlled Trial.

(1) Background: The study aimed to analyze the effectiveness of clinical pharmacist services on drug-related problems (DRPs) and patient outcomes in inpatients with chronic kidney disease (CKD). (2) Methods: In a randomized controlled trial, the participants in the intervention group received pharmacist services, including medication reconciliation, medication evaluation and management, and discharge pharmaceutical care transition services. Participants in the control group received usual care. The primary outcome was the number of DRPs per patient at discharge. (3) Results: The baseline characteristics of 100 participants included the following: mean age, 52.5 years; median eGFR, 9.2 mL/min/1.73 m2. The number of DRPs in the intervention group during hospitalization increased significantly with decreasing eGFR (PR, 0.970; 95% CI, 0.951–0.989) and an increasing number of unintentional medication discrepancies at admission (PR, 1.294; 95% CI, 1.034–1.620). At discharge, the number of DRPs per patient was 0.94 ± 1.03 and 1.96 ± 1.25 in the intervention and control groups, respectively (p < 0.001). The service had a significant effect on the reduction of the unintentional discrepancies at discharge (p < 0.001). (4) Conclusion: Hospital pharmacists play an important role in the prevention of DRPs at discharge and unintentional medication discrepancies in inpatients with CKD.

Drug-related problems in Ethiopian public healthcare settings: Systematic review and meta-analysis.

Identification and prevention of drug-related problems have become the central role of patient-centered pharmacy practitioners. After the initiation of patient-oriented pharmacy service, many studies evaluating magnitude of drug-related problems at facility level in Ethiopia have been conducted, though the extent of the problem at a national level remains unknown. Hence, this systematic review and meta-analysis is undertaken with the aim of quantifying the prevalence of drug-related problems in Ethiopian public healthcare settings using Cipolle/Strand classification system. Electronic databases were searched including PubMed, EMBASE, Web of Science, MEDLINE and HINARI, Google Scholar and ResearchGate for both published and unpublished works. Data on study characteristics and outcomes were extracted using the format developed on Microsoft Excel. The primary measure was the pooled prevalence of drug-related problems. The meta-analysis was conducted using OpenMeta[Analyst].A total of 17 studies were included in this systematic review and meta-analysis. The pooled prevalence of drug-related problems of patients who experienced at least one drug-related problem during their therapy was found to be 69.4% (95% confidence interval: 61.5–77.4). The most frequently reported types of drug-related problems were “need for additional drug and “noncompliance,” together accounting for more than half of the drug-related problems. The most frequently reported factors associated with drug-related problems were patients’ age, polypharmacy, comorbidities and the number days of hospital stay.The prevalence of drug-related problems in Ethiopian public healthcare settings was found to be high. Inconsistent reporting of drug-related problems was observed across the studies. It is imperative to design and implement interventions aimed at reducing drug-related problems. Responsible stakeholders should adopt uniform drug-related problem classification approach to ensure uniform reporting of drug-related problems in Ethiopian healthcare settings

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

BackgroundPharmacists play a key role in ensuring the safe use of injectable antineoplastics, which are considered as high-alert medications. Pharmaceutical analysis of injectable antineoplastic prescriptions aims to detect and prevent drug related problems by proposing pharmacist interventions (PI). The impact of this activity for patients, healthcare facilities and other health professionals is not completely known. This study aimed at describing the clinical, economic, and organizational impacts of PIs performed by pharmacists in a chemotherapy preparation unit.MethodsA prospective 10-week study was conducted on PIs involving injectable antineoplastic prescriptions. Each PI was assessed by one of the four multidisciplinary expert committees using a multidimensional tool with three independent dimensions: clinical, economic and organizational. An ancillary quantitative evaluation of drug cost savings was conducted.ResultsOverall, 185 patients were included (mean age: 63.5 ± 13.7 years; 54.1% were male) and 237 PIs concerning 10.1% prescriptions were recorded. Twenty one PIs (8.9%) had major clinical impact (ie: prevented hospitalization or permanent disability), 49 PIs (20.7%) had moderate clinical impact (ie: prevented harm that would have required further monitoring/treatment), 62 PIs (26.2%) had minor clinical impact, 95 PIs (40.0%) had no clinical impact, and 9 PIs (3.8%) had a negative clinical impact. For one PI (0.4%) the clinical impact was not determined due to insufficient information. Regarding organizational impact, 67.5% PIs had a positive impact on patient management from the healthcare providers’ perspective. A positive economic impact was observed for 105 PIs (44.3%), leading to a saving in direct drug costs of 15,096 €; 38 PIs (16.0%) had a negative economic impact, increasing the direct drug cost by 11,878 €. Overall cost saving was 3218€.ConclusionsPIs are associated with positive clinical, economic and organizational impacts. This study confirms the benefit of pharmacist analysis of injectable antineoplastic prescriptions for patient safety with an overall benefit to the healthcare system.

Medication follow-up in newborns with extremely low birth-weight.

Objective:The medication follow-up in infants with extremely low birth-weight in a neonatal intensive care unit is described, identifying drug-related problems (DRP), drug-related negative outcomes, and the relationship between the occurrence of DRP and birth-weight of newborns and their impact on pharmacotherapy and length of hospital stay.Methods:A descriptive and exploratory study was performed in which medication follow-up of a population of infants with extremely low birth-weight admitted to the neonatal intensive care unit of a government-run maternity hospital was carried out by clinical pharmacists. Monitoring comprised assessment of patients’ pharmacotherapy needs through visits to the neonatal unit, evaluation of prescriptions and information on medical records, identification of issues associated with pharmacotherapy and follow-up of the newborns’ clinical evolution to determine whether desired results were achieved.Results:The subjects were 33 infants characterized by extremely low weight at birth. Analysis of patients’ pharmacotherapy showed that 39.4% (n=13) of the neonates presented some type of DRP, totaling 37 DRPs and a mean of 2.8 problems/patient. Fourteen drugs were identified with the occurrence of DRP. Vancomycin and cefepime were the most prevalent, with 18.9% (n=7). Occurrence of DRPs and several clinical characteristics of newborns and their pharmacotherapy were compared. The most prevalent drug-related negative outcomes identified were “untreated health problem” (40%, n=10) and “quantitative ineffectiveness” (32%, n=8). Pharmaceutical interventions were performed for all problems associated with pharmacotherapy, with a prevalence of “treatment day count correction” and “dose correction”, both with 21.6% (n=8), and “correction of dosage” (16.2%, n=6).Conclusion:The research evidenced the role of the clinical pharmacist in the solution and prevention of drug-related problems, contributing with the multidisciplinary team to obtain a safe and effective pharmacotherapy. Further, current study confirmed that there is an association between the characteristics of the newborns under analysis (eg. birth-weight, pharmacotherapy) and the occurrence of drug-related problems.

Influence of Pharmacist Recommendations for Chemotherapy-Related Problems in Diabetic Cancer Patients

Drug related-problems pose additional worse outcomes in cancer patients treated with chemotherapy. A vital role of the clinical pharmacist is the detection and prevention of drugrelated problems. The provision of patient education is an important step to reduce and prevent drug-related problems during chemotherapy administration. The objective of this study was to assess the occurrence of drug-related problems and the importance of effective provision of patient education and appropriate recommendations by the clinical pharmacist in reducing and solving of these problems in diabetic patients suffering from cancer. A prospective study carried out on 50 diabetic patients as a single group with new diagnosis of diverse cancer types eligible for chemotherapy adminitration recruited between September 2014 and April 2015 at the oncology unit in one of the Teaching and Research Hospital (Istanbul-Turkey). Drug-related problems were evaluated, and proper patient education alongside pharmacist recommendation regarding chemotherapy was provided during the required chemotherapy protocol schedule. (n=65) of the drug-related problems were contributed to inappropriate IV fluid selection; (n=33) were attributed to low drug dose prescribed, and (n=30) to high drug dose prescribed. Drug-related problems totally solved due to clinical pharmacist recommendations were 69.57% (n=80). There was a significant increase in the occurrence of paleness (P=0.0001); urinary frequency (P=0.003); loss of appetite (P=0.0001), nausea (P=0.0001), vomiting (P=0.0001); and numbness (P=0.0001). A significant decrease in the occurrence and severity of chemotherapy-related adverse effects was observed as a mild urinary frequency (P=0.0001) and mild vomiting (P=0.0001) after the clinical pharmacist recommendations and provision of patient education. Results of this study revealed that diabetic cancer patients are definitly prone to the occurrence of drug-related problems and adverse drug reactions. Clinical pharmacist is expected to provide a well-defined education and care to those patients and the outcomes of pharmacist recommendations may diminish and prevent many drug-related problems and adverse drug reactions and by this, influence patients’ desire to complete the course of chemotherapy.

ASSESSMENT OF DRUG RELATED PROBLEMS IN A TERTIARY CARE TEACHING HOSPITAL, INDIA

ABSTRACTObjective: Drug related problems (DRPs) are frequent in hospitalization where multiple changes in patient’s medication regimen and lack of continuity of care may be accompanied. The aim of present research was to identify drug related problems, drug classes involved in DRPs as well as associated factors with the occurrence of DRPs and to assess the pharmacist interventions in a tertiary care teaching hospital.Methods: A prospective observational study was carried out in a tertiary care teaching hospital, over a period of six months from November 2015 to April 2016. All the in patients admitted to all departments of hospital, who satisfied the selection criteria, were included in this study. Necessary demographic and clinical data was collected from the case records. The Pharmaceutical Care Network Europe Classification Version (PCNE) 5.01 was used to classify DRPs. The treatment data was analyzed to determine the rate, pattern, clinical significance, and outcomes of DRPs.Results: A total of 300 patient case sheets were reviewed during the study period, out of which 143 drug related problems were identified from 93 patients. Male (%) predominance was noted over females (%). The most common DRP was drug Interactions 47.55% (68) followed by drug use problems 19.58% (28), drug choice problems 14.68% (21), others 11.88% (17), dosing problems 4.89% (7), and adverse reaction 1.39% (2) were identified.Conclusion: Drug related problems are common among the wards of hospital. Clinical pharmacist’s role in identification, resolution and prevention of drug related problems helps in achieving better therapeutic outcomes and improved patient healthcare.Keywords: DRP’s, Adverse Drug Reactions, Drug Interactions (DI), Drug choice problems, Dosing problem, Drug use problems, Paediatric, Medicine, PCNE

Availability of information on renal function in Dutch community pharmacies.

Background Early detection and monitoring of impaired renal function may prevent drug related problems. Objective To assess the availability of information on patient's renal function in Dutch community pharmacies, for patients using medication that might need monitoring in case of renal impairment. Methods Per pharmacy, 25 patients aged ≥65years using at least one drug that requires monitoring, were randomly selected from the pharmacy information system. For these patients, information on renal function [estimated glomerular filtration rate (eGFR)], was obtained from the pharmacy information system. When absent, this information was obtained from the general practitioner (GP). Results Data were collected for 1632 patients. For 1201 patients (74%) eGFR values were not directly available in the pharmacy, for another 194 patients (12%) the eGFR value was not up-to-date. For 1082 patients information could be obtained from the GP, resulting in 942 additional recent eGFR values. Finally, recent information on renal function was available for 72% (n=1179) of selected patients. Conclusion In patients using drugs that require renal monitoring, information on renal function is often unknown in the pharmacy. For the majority of patients this information can be retrieved from the GP.

Assessment of clinical pharmacist interventions in drug therapy in patients with diabetes mellitus in a tertiary care teaching hospital

AimTo assess the impact of clinical pharmacist interventions in drug therapy in hospitalized patients with diabetes mellitus. MethodsA Prospective interventional study was carried out in the medicine wards of a tertiary care teaching hospital over a period of 10 months from September 2013 to June 2014. The drug therapy details of the patients were collected from inpatient case records in the respective clinical wards. Clinical pharmacist reviewed the drug therapy, identified the drug related problems during ward rounds and discussed with the physicians and suitable suggestions was provided which had been documented. ResultsA total of 189 drug therapy problems were identified from 151 patient case records. The number of drug related problems was found to more in males than females. Drug related problems were commonly seen in patients aged between 61 and 70 years of age. The most common drug related problems was found to be drug use without indication (17.98%) followed by improper drug selection (16.40%). The most frequent suggestions by the clinical pharmacist were on cessation of drug (30.68%). The acceptance rate of suggestions and the changes in drug therapy was found to be high (58.20%). The majority of the level of significance of drug related problems was seen to have moderate significance in grade. ConclusionInvolvement of clinical pharmacist as a member of healthcare team during ward rounds in hospitalized patients with diabetes mellitus helps in identification and prevention of drug related problems which will helps to rationalize drug therapy, achieve better therapeutic outcomes and improved patient care.

A PROSPECTIVE OBSERVATIONAL STUDY ON POLYPHARMACY LEADING TO ADVERSE DRUG REACTIONS IN A DEPARTMENT OF MEDICINE

Poly pharmacy significantly raises the likelihood of adverse reac tions to drugs, risk of hospitalization and medical errors related to drugs. It depends on the number of drugs, the diseases, and patient related factors . Poly pharmacy is a risk factor for severe adverse drug reactions (ADRs) and is associated with an inc reased risk of mortality. The main aim of the study was to assess the poly pharmacy leading to adverse drug reaction. This is a prospective observational study conducted at Basaveshwara Medical College Hospital and Research Center (BMCH and RC), Chitradurg a , India for the period of 4 months in the department of Medicine. In this study 601 patients of both genders were included. The identified ADRs are reported to the phy sician and causality assessment of adverse drug reactions (ADR’s) was done by using the Naranjo’s scale and Modified Hartwig Seigle scale. About 601 patients screened among them 315 patients were males and 286 were females and average drugs per prescription were 6.17. There are 356 (59.23 %) patients with major poly pharmacy ( ≥ 6 drugs) and 2 45 (40.76 %) with minor poly pharmacy (3 - 5 drugs). During the study 32 ADRs were identified and reported to the Physicians; in this 28 ADRs were accepted. The prevalence of ADRs seen during the study was 5.32 % and in this 3.49 % (n = 21) were seen patien ts who had major poly pharmacy. Our study showed that females were more prone to develop ADRs compared to the males i.e., 53.12 % (n = 17) of ADRs were identified in female gender and 46.87 % (n = 15) in male gender. Out of 32 ADRs 21 (65.62 %) were identi fied in patients with major poly pharmacy and 11 (34.37 %) with minor poly pharmacy. There were more ADRs associated with major poly pharmacy and female gender. It is necessary to create the awareness to curb irrational prescription of poly pharmacy which helps in prevention of drug related problems like ADRs.

Costs and Length of Stay of Drug-Related Hospital Admissions in Cancer Patients

BackgroundMost previous studies of the incidence and economic impact of drug-related hospital admissions were not cancer specific, despite the fact that drug-related problems (DRPs) are of particular concern in oncology. ObjectiveThe goals of this study were to assess the economic impact, particularly the length of stay (LOS) and direct medical costs (DMC), of drug-related hospital admissions and the associated factors in cancer patients in Singapore. MethodsA prospective study was conducted over a 5-month period in 2 oncology wards at the largest acute tertiary hospital in Singapore. Drug-related admissions were identified from all oncology admissions to these wards, and the demographic, clinical, and cost data of these drug-related admissions were collected. The association between LOS and DMC as well as their associations with age, severity, and preventability of DRPs were examined. A nationwide estimation was made to determine the overall DMC of drug-related hospital admissions among cancer patients. ResultsA total of 151 drug-related admissions that occurred among 137 cancer patients were identified. The mean DMC (in Singapore dollars [SGD]) and LOS per drug-related admission were SGD $4747 and 6.1 days, respectively. A nationwide extrapolation estimated an annual total DMC of SGD $16.2 million. Longer LOS was found to be correlated with higher DMC (rs = 0.86, P < 0.001) and preventable DRPs (P = 0.02). ConclusionsDrug-related hospitalization among cancer patients is costly; therefore, more attention is warranted to develop and improve strategies for preventing drug-related morbidity and mortality in cancer patients.

Characteristics of unplanned hospital admissions due to drug-related problems in cancer patients

Studies have examined drug-related problems (DRPs) that have led to hospital admissions in the general population. However, there is a lack of information on the characteristics of DRPs in the cancer population. The objective of this study was to investigate the type, causality, severity, and preventability of DRPs that result in unplanned hospitalizations among cancer patients. This was a prospective, cohort study conducted in two oncology wards between July and December 2012. All patients who were diagnosed with solid tumor or lymphoma and required unplanned hospitalization were included. The incidence of DRPs among hospital admissions was captured, and the nature of the DRPs (causality, severity, and preventability) was characterized. There were 1,299 admissions and 1,275 were eligible for analysis. Among the 1,275 eligible admissions, 158 (12.4%) were considered to be associated with a DRP. In the 158 admissions associated with DRPs, 164 DRPs were found. The majority of the DRP-related admissions were adverse drug reactions (ADRs) (n=155/164, 94.5%), probable (n=98, 59.8%), moderately severe (n=155, 94.5%), and probably or definitely preventable (n=86, 52.4%). Most patients with DRPs recovered and were discharged. Febrile neutropenia was the most common adverse drug reaction, and drug combinations involving antihypertensives and long-term corticosteroids raised the risks for potential drug-drug interactions among patients with cancer. The incidence of DRP-induced unplanned hospital admissions was 12.4% among cancer patients. Approximately half of these were preventable events.

Results from a project to develop systematic patient focused clinical pharmacy services. The Lund Integrated Medicines Management model

As people get older, polypharmacy increases and there is an increased risk of adverse drug events, drug interactions, low medication adherence, increasing economic burden, hospital admissions and even drug-related deaths.1...

Drug related problems and pharmacist interventions in a geriatric unit employing electronic prescribing

Computerised physician order entry (CPOE) and the integration of a pharmacist in clinical wards have been shown to prevent drug related problems (DRPs). The primary objective was to make an inventory of the DRPs and resident pharmacist on-ward interventions (PIs) identified in a geriatric acute care unit using CPOE system. The secondary objective was to evaluate the physicians' acceptance of the proposed interventions. A 26-bed geriatric ward of a 1,300-bed teaching hospital. A 6-month descriptive study with prescription analysis and recommendations to physicians by a resident pharmacist during five half days a week. Patients' characteristics, number of prescribed drugs per patient, nature and frequency of DRPs and PIs, physicians' acceptance and drugs questioned. Resident pharmacist reviewed 311 patients and identified 241 DRPs. One hundred and fifty-two patients (49 %) had at least one DRP (mean ± SD age 87 ± 6 years, mean ± SD number of prescribed drugs 10.7 ± 3.4). Most frequent DRPs were: untreated indication (n = 58, 24.1 %), dose too high (n = 46, 19.1 %), improper administration (n = 31, 12.9 %) and drug interactions (n = 23, 9.5 %). The rate of physicians' acceptance was 90.0 % (7.5 % refusals, 2.5 % not assessable). DRPs related to CPOE system misuse (n = 35, 14.5 %) appeared as a worrying phenomenon (e.g., errors in selecting dosage or unit, or duplication of therapy). A resident pharmacist detected various DRPs. Most PIs were accepted. DRPs related to the misuse of the CPOE system appeared potentially dangerous and need particular attention by healthcare professionals. The description of the DRPs is an essential step for implementation of targeted clinical pharmacy services in order to optimize pharmacists' job time.

Consistency Matters: The Practice of Clinical Pharmacy

or almost 20 years, I have practised as a clinical pharmacist, trained to deliver pharmaceutical care through the identifi- cation, resolution, and prevention of drug-related problems, to improve medication use, and to optimize individual therapeutic outcomes. As I refined my skills as a clinician and built on the training of the many great mentors I had during my early career, I developed a consistent, systematic process of patient care. However, despite establishing a level of comfort in my own process and approach, I have often observed inconsistencies in the manner in which we, as a profession, provide care. This is not to suggest that my process is right or better than those of others, but only that there have been differences and inconsis - tencies in the manner in which our profession has approached