Clinical pharmacist intervention (original) (raw)
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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.
DRPs identified by European community pharmacists in patients discharged from hospital
International Journal of Clinical Pharmacy
Drug related problems identified by European community pharmacists in patients discharged from hospital • E m a I . P a u l i n o , M a r c e l L . B o u v y, M i g u e l A . G a s t e l u r r u t i a , M a r a G u e r r e i r o a n d H e n k B u u r m a f o r t h e E S C P -S I R R e j k j a v i k C o m m u n i t y P h a r m a c y R e s e a r c h G r o u p *
Retrospective Assessment of the Clinical Pharmacist Sheets among a Few Iraqi General Hospitals
The Journal of communicable diseases, 2021
Background: Clinical pharmacist sheet is an essential part of the medical record; it highlights the pharmacist's role during hospitalisation through the concept of pharmaceutical care and specific pharmacist collaboration with a patient and other health care teams. Objective: To assess the documentation completeness level of the clinical pharmacist sheet, pharmacist intervention, type and prevalence of Drug-Related Problems. Methodology: A retrospective observational study that included revised 3900 clinical pharmacist sheets from Baghdad and Thiqar Hospitals for 2018, 2019, and 2020. The forms from four departments of the hospitals (internal medicine, surgery, paediatrics, gynaecology and obstetrics). In addition, assessment completeness of the pharmacist documentation level in the clinical pharmacist sheets, and Pharmacist interventions. Results: The overall documentation completeness level in the clinical pharmacist sheets was generally poor (less than 50% of the sheet items were filled in). The best documentation level was presented in the surgery ward (52.34%). A total of 3900 clinical pharmacist sheets were analysed within multi-ward hospitals that revealed variable percentages of DRPs (10%, 8.55%, 12.44%, and 7.42%) in internal medicine, surgery, gynaecology and obstetrics, and paediatric respectively. Findings also revealed a significant decline in pharmacist interventions over the last three years. Conclusion: There was poorn documentation completeness level and pharmacist interventions over the last 3 years among clinical pharmacist sheets. Drug selection, dosing, and substituting unavailable drugs with an alternative were the commonest causes of DRPs.
Objective To evaluate the drug related problems in which it occurs mostly in both IP and OP. To examine the nature, frequency and to estimate the risks associated with drug related problems in a General Medicine Department. Methodology A prospective observational study was carried out at a 750 bedded teaching hospital for a period of 6 months. Patients were enrolled on the basis of inclusion and exclusion criteria. The inclusion criterion involves patients in multiple drug therapy with a minimum of two drugs and patients of both sexes. Results A total of 508 cases were collected during the study period. Among them 165 cases due to the infectious diseases. The most common DRP is possible drug-drug interaction in part of patients i.e.219.Based on severity level, moderate drug-drug interactions were found to be maximum (48.8%) followed by minor (28.4%) and major 22.8%. Adverse drug reactions (ADRs) are the second major DRP found in 34 cases. Poly pharmacy is found to be the most important cause of DRPs followed by in appropriate drug choices, poor medication adherence risk. Statistical analysis was performed using spearman's correlation test and it was found a significant difference (P=0.0001) between the drug related problems of inpatient and outpatient department. Conclusion Clinical pharmacist as a member of the health care team can contribute significantly to the improved patient outcomes by monitoring drug therapy and can also promote rational use of drugs. Keywords: Drug related problems (DRP), adverse drug reactions (ADR), possible drug-drug interactions (pDDI), Polypharmacy.
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.
Clinical pharmacist service in the acute ward
International Journal of Clinical Pharmacy, 2013
Background The majority of hospitalised patients have drug-related problems. Clinical pharmacist services including medication history, medication reconciliation and medication review may reduce the number of drug-related problems. Acute and emergency hospital services have changed considerably during the past decade in Denmark, and the new fast-paced workflows pose new challenges for the provision of clinical pharmacist service. Objective To describe and evaluate a method for a clinical pharmacist service that is relevant and fit the workflow of the medical care in the acute ward. Setting Acute wards at three Danish hospitals. Methods The clinical pharmacist intervention comprised medication history, medication reconciliation, medication review, medical record entries and entry of prescription templates into the electronic medication module. Drug-related problems were categorised using The PCNE Classification V6.2. Inter-rater agreement analysis was used to validate the tool. Acceptance rates were measured as the physicians' approval of prescription templates and according to outcome in the PCNE classification. Main outcome measure Acceptance rate of the clinical pharmacists' interventions through the described method and inter-rater agreement using the PCNE classification for drug-related problems. Results During 17 months, 188 patients were included in this study (average age 72 years and 55 % women). The clinical pharmacists found drug-related problems in 85 % of the patients. In the 1,724 prescriptions, 538 drug-related problems were identified. The overall acceptance rate by the physicians for the proposed interventions was 76 % (95 % CI 74-78 %). There was a substantial inter-rater agreement when using the PCNE classification system. Conclusion The methods for a clinical pharmacist service in the acute ward in this study have been demonstrated to be relevant and timely. The method received a high acceptance rate, regardless of no need for oral communication, and a substantial inter-rater agreement when classifying the drug-related problems. Keywords Acceptance rate Á Acute ward Á Clinical pharmacy Á Denmark Á DRP classification Á Drugrelated problems Á Electronic prescription template Á Medication history Á Medication reconciliation Á Medication review Impacts on practice • Clinical pharmacist services in the acute ward need to fit the high-paced workflow to benefit the health care professional teams and thereby the patients. • The method for a clinical pharmacist service in the acute ward described here fits an intensive workflow, identifies multiple drug-related problems and yields a
Drug-related problems in medical wards with a computerized physician order entry system
Journal of Clinical Pharmacy and Therapeutics, 2009
Identification and estimation, by clinical pharmacists participating in routine medical rounds, of drug-related problems (DRPs), arising despite the use of a computerized physician order entry (CPOE) system. Methods: An 18-month prospective study of DRPs through a CPOE was conducted by seven clinical pharmacists participating in ward activity. DRPs were identified by two independent pharmacists using a structured order review (French Society of Clinical Pharmacy instrument). Results: A total of 29 016 medication orders relating to 8152 patients were analysed, and 2669 DRPs, involving 1564 patients (56% female; mean age 72AE6 years), were identified representing 33 DRPs per 100 admissions. The most commonly identified DRPs were non-conformity to guidelines or contra-indication (29AE5%), improper administration (19AE6%), drug interaction (16AE7%) and overdosage (12AE8%). There were 429 different drugs associated with these DRPs. Cardiovascular drugs were the most frequently implicated (22AE2%), followed by antibiotics/antiinfectives (13AE3%) and analgesics/antiinflammatory drugs (11AE3%). Different types of DRPs were closely associated with specific classes of drugs. Conclusions: Drug-related problems are common even after implementation of CPOE. In this context, routine participation of clinical pharmacists in clinical medical rounds may facilitate identification of DRPs. Pharmacists should be able to enhance patient safety through such involvement.
An-Evaluation-Of-Interventions-By-Clinical-Pharmacists-In-A-Tertiary-Hospital
Malaysian Journal of Pharmacy, 2021
Introduction: Problems with medication therapy are a major concern in health care because of the associated increase in morbidity, mortality and increased cost of treatment. Clinical pharmacy services are well established in developed countries such as the United States and have been reported to reduce adverse drug events, medication errors, patient's length of stay, mortality rates and costs. Clinical pharmacists proactively ensure rational medication use, avoiding medication errors at point of prescribing. They participate in ward rounds, communicate with the team in the wards, interview patients, perform medication reconciliation, provide counselling, therapeutic drug monitoring, antibiotic stewardship, discharge screening and follow ups. Any discrepancy or problems detected will be conveyed to the relevant team member for correction. Objective: To describe and evaluate the interventions performed by clinical pharmacists in a tertiary teaching hospital in Malaysia. Method: A clinical pharmacy observational retrospective study was conducted between January and December 2019. Fourteen clinical pharmacists were assigned to respective wards in the medical, surgery and intensive care units to provide pharmaceutical care. All interventions performed in the wards were documented systematically. Result: A total of 3345 interventions were recorded. The most frequent interventions were on rational drug therapy (n = 1456, 43.5%), followed by corrections made on prescription (n = 1349, 40.3%) and changes in dosage and frequency (n = 540, 16.2%). The majority of suggestions (n = 3264, 97.6%) have been accepted. Conclusion: To our knowledge, this is the first study reporting clinical pharmacist interventions in a teaching hospital in Malaysia. The involvement of clinical pharmacist in the wards contributed to the optimisation of pharmacotherapy, safety and better patients' outcomes. There was good inter-professional collaboration at the ward level.