Clinical pharmacists' role in identification of drug related problems in a teritiary care teaching hospital (original) (raw)
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International Journal of Pharmacy and Pharmaceutical Sciences, 2015
Objective: To identify various drug related problems in patients admitted to the general ward of a tertiary care hospital and to make suitable drug therapy recommendations. Methods: A prospective observational study was conducted in the Annex General ward in B Block of Amrita Institute of Medical Sciences, Kochi for a period of 6 months. All the patients admitted to the general ward on particular day of each week and who satisfied the selection criteria were included in this study. Results: During the study period, a total of 598 drug related problems were identified of which 55.51% were due to prescribing of interacting drugs followed by drug choice problems (12.71%). Three hundred and thirty two drug interactions were observed in 224 patients. Thirty nine adverse drug reactions were observed in the study patients and cardiac drugs were the main class of drugs involved. Eighty seven drug interventions were done in 224 patients. It took an average of 25-35 minutes per intervention. Out of the total 87 interventions made, 41.4% (36) were at the prescriber level followed by 30% (27) at drug administration level. 23% of drug interventions were made at the patient level. 88.5% of the interventions were accepted and 11.5% were rejected. Conclusion: This study shows the positive impact of clinical pharmacists in identification and resolution of drug related problems in a tertiary care hospital.
Identification of Drug-Related Problems: A Prospective Study in Two General Hospitals
Current Clinical Pharmacology, 2012
Drug-related problems (DRPs) can reduce the potential clinical benefits of treatment with medicines and waste valuable resources. No previous studies were published to examine the nature and frequency of drug related problems among hospitalized patients in Palestinian hospitals. Methodology: Prospective observational study was conducted to report and record the natural and frequency of drug related problems in two general hospitals. Results: The study included 212 patients, 54.4 % female, with a mean age 62.2 (±10.6 SD). 88% of the patients were reported with one or more DRPs, with an average of 1.9 DRPs per patient were found. The most prevalent DRP was incorrect dosing regimen which was represented by (22.2%), followed by drug-drug interaction (19.4%), drugs need laboratory tests (15.2%). Ceftriaxone, warfarin, enoxapirin and dogixin were the drugs causing most frequent DRPs. The drug groups causing most DRPs were anti-infective agents, anti-thrombotic agents and non-steroidal anti-inflammatory agents. Once discovered, the majority of DRPs (71.6%) were accepted by the physicians and solved immediately, while 11.5 % of pharmacist advice was not approved. Multiple regression analysis indicated that the number of medications (RR 1.99; 95% CI 1.31-3.76) and the number of medical conditions (RR 1.81; 95% CI 1.11-3.13) independently predicted the number of DRPs. Conclusion: DRPs in general hospitals are frequent, serious and predictable. Most of the problems identified as DRPs by the pharmacists were accepted by the physicians and solved. Pharmacists in the hospital setting are well suited to identify and resolve DRPs.
Drug related problems are considered as a major problem associated with hospitals. Many studies have been conducted in past in evaluating the role of clinical pharmacist in reducing this prevailed problem, however only few have assessed the impact of clinical pharmacist intervention in addressing this issue. The objective of this study was to evaluate the impact of clinical pharmacists in reducing drug related problems in Pakistan A prospective, observational and interventional study was conducted in a teaching based hospital to identity drug related problems and their causes. Interventions were also designed to address these issues. Classification of drug related problem was done on the basis of PCNE system. Data were then entered into Microsoft excel (2010) for descriptive analysis. A total of 373 profiles were reviewed in which 184 profiles had drug related issues. A total of 147 drug related problems were identified in which major issue was related to adverse drug reaction (n=61, 41.5%). The total number of causes which lead to these problems were 161, of which dosing error was found to be more prevalent (n=68, 42.2%). Out of 161 recommendations given by clinical pharmacists, 86.33% (n=139) were successful in solving the problem while 6.83% of recommendations were termed ineffective as they failed to address their respective issues. The clinical pharmacists play an important role in healthcare settings by reducing the burden of drug related problems effectively. Their contribution has promoted positive changes in healthcare setup of Pakistan.
Journal of basic and clinical pharmacy, 2014
To evaluate prevalence, types, and severity of potential adverse drug-drug interaction in medicine out-patient department. A single-point, prospective, and observational study was carried out in medicine OPD. Study began after obtaining approval Institutional Ethics Committee. Data were collected and potential drug-drug interactions (pDDIs) were identified using medscape drug interaction checker and were analyzed. A total of 350 prescriptions with mean age 52.45 ± 14.49 years were collected over a period of 5 months. A total of 2066 pDDIs were recorded with mean of 5.90 ± 6.0. The prevalence of pDDI was 83.42%. Aspirin was most frequently prescribed drug in 185 (10.15%) out of total of 1821 drugs It was also the most frequent drug implicated in pDDI i.e. in 48.16%. The most common pDDI identified was metoprolol with aspirin in 126 (6.09%). Mechanism of interactions was pharmacokinetic in 553 (26.76%), pharmacodynamic in 1424 (68.92%) and 89 (4.30%) having an unknown mechanism. Out o...
Journal of Pharmaceutical Research International, 2021
The present study was carried out to determine the incidence of Adverse Drug Reactions (ADRs) in general medicine department and to assess and analyze the causality, severity, and preventability of ADRs. A prospective observational study was conducted in the general medicine department for six months. All patients receiving drug therapy are considered and are selected based on the inclusion criteria. Patient demographic details like age, gender, diagnosis, past medical history, concomitant medications, etc., are recorded from the patient data gathering form. The causality assessment is accomplished using Naranjo and WHO scales. The severity is carried out using the Modified Hartwig and Siegel scale. The preventability evaluation is accomplished using the Modified Schmock and Thornton scale. The study included 385 patients were between the age group of 18 years and, out of which 34 patients developed adverse drug effects including female and male. Patients between the age group of 40...
International Journal of Pharmacy and Pharmaceutical Sciences, 2021
Objective: The present study aims at implementing the doctor of pharmacy services in the identification and reporting of drug-related problems in the in-patient units of cardiology and pulmonary medicine departments of ESI Hospital, Bangalore. Methods: A prospective interventional study was conducted from September 2018 to March 2019. Determination and categorization of drugrelated problems (DRPs) were performed by the pharmacist using the PCNE classification scheme for drug-related problems V5.01. The DRPs identified by the pharmacist were reported and interventions made were subsequently recorded. Results: 180 drug-related problems were identified in the study, among which the major problems were drug-drug interactions (13.88%), followed by generic substitution (10%). The mean drug-related problem per patient was found to be 1.06. A total of 196 interventions were made by the clinical pharmacists among which, 109 (55.61%), 56 (28.57%), 17 (8.67%) interventions were at the prescriber, drug, patient levels, and 14 (7.14%) cases were the rest of interventions or activities. Distributions based on type and degree of acceptance of interventions showed that among 56 drug regimen change interventions proposed by the pharmacist, only 55.35% were accepted. The results further indicated that out of 68 monitoring required interventions made by the pharmacist, and among 17 cases that required counseling by the pharmacist in verbal, 77.94% and 88.36% of cases were accepted, respectively. Also, regarding the cases that required communication between the pharmacists and other healthcare professionals, 85.36% of a total of 41 samples and all of 14 adverse drug reporting cases made in a formal note form were accepted. Conclusion: The clinical pharmacist's/doctor of pharmacy professional's timely interventions in the patient's drug therapy is required to prevent or minimize the occurrence and the risk of DRP. Rational drug therapy and optimal medication safety can be achieved by clinical pharmacy services.
Risk Management and Healthcare Policy
Patients and Methods: This retrospective study was conducted among inpatients at Ministry of Health hospital in Jazan, a region in southwestern Saudi Arabia. We collected data for a 2-year period (from 2016 to 2017). For any detected DRP of the ordered medications for dispensing, the inpatient pharmacist is sending report for that particular DRP with recommendation to the medical team which in turn might accept or reject such recommendation. Serious drug-drug interactions, as part of DRP, were assessed by utilizing three different online DDI checkers, including Lexi-Comp, Medscape, and Drugs.com. Results: The most common type of DRP was serious drug-drug interactions (49%). Over the study period, most incidences of DRPs were decreased. Of the DRPs in 2016 and 2017, antibiotics were the most commonly involved (51% and 69.5%) of cases, respectively, followed by proton pump inhibitors (25.3% and 14.1%) and statins (12.9% and 9.4%). Interestingly, of the 241 interventions for DRPs in 2016, 199 (82.5%) were accepted, resulting in a change in drug therapy (p=0.006). In 2017, 90 (70.3%) interventions out of 128 were accepted by the physician and the drug therapy changed (p=0.029). Conclusion: Pharmacist interventions appear to decrease the incidence of DRPs, which emphasize the importance of an optimal pharmaceutical care plan for clinical care settings.
Asian Journal of Pharmaceutical and Clinical Research Journal, 2022
Objective: The objective of the study was to analyze the pattern and risk factors of adverse drug reactions (ADR) in a tertiary care hospital. Methods: In this retrospective study, all the suspected ADRs reported to ADR monitoring center were analyzed for the demographic details, its temporal association, status of recovery, seriousness and outcome of reaction, details of the suspected and concomitant medications. Data on various predisposing factors responsible for an ADR, such as presence of co-morbidities, use of Fixed Dose Combinations (FDC), improper monitoring, presence of drug interactions, and presence of polypharmacy were also collected. Descriptive statistics and Chi-square were used for data analysis. A p value of <0.05 was taken as level of significance. Results: Out of the total 233ADRs, 48.9% were reported among geriatric patients. The study showed a female preponderance with 51.9%. The highest number of ADRs was reported from the therapeutic class of antimicrobials 18.9%. The skin and appendages constituted the most common organ system affected with 33.5%. Out of 106 serious ADRs, majority required prolonged hospitalization 62.3%. About 78.1 % of reactions were found to be predictable and 72.5% preventable. A positive association was found between ADR and co-exiting co-morbidity (60%), polypharmacy (66.5%), and use of FDC (18.45%). ADRs secondary to inadequate monitoring was 7.7% and those due to drug-drug interaction was 6.5%. Conclusion: Female population, age >60 years, and presence of concomitant co-morbidities were the patient related risk factors and polypharmacy, drug-drug interactions, and inadequate monitoring were the drug related risk factors for development of ADRs.
Assessment of Drug Related Problems in a Tertiary Care Teaching Hospital, India
Asian Journal of Pharmaceutical and Clinical Research, 2017
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.Res...
Background: Drug-Drug Interactions (DDIs) contribute to increased rate of morbidity and mortality increasing the need for intense monitoring of patient safety which can be achieved by detecting and preventing morbidities associated with DDIs. Objective and Methodology: The present work was a prospective study carried out for a period of six months, to assess the incidence of DDIs in patients admitted to the Department of General Medicine at a tertiary care hospital. Results: Prescriptions of 411 patients were analysed, out of which 165 (40.15%) prescriptions were identified with potential DDIs whereas clinical manifestations of actual DDIs were observed and reported in 23 (5.6%). A total of 657 DDIs were observed of which 6 (0.9%), 240 (36.5%), 374 (56.9%) and 33 (5.6%) were of contra indicated, major, moderate and minor severity respectively. Based on the mechanism 310 (47.2%) of the identified DDIs were pharmacodynamic and 243 (36.9%) were pharmacokinetic interactions. There was a positive correlation between the number of DDIs and risk factors such as length of hospital stay, number of drugs prescribed and co-morbidities. Conclusion: This study concludes that awareness on the most prevalent DDIs can help the practitioners to prescribe drugs with a low risk for DDIs and prevent the concomitant use of dangerous drug combinations.