Identification and resolution of drug-related problems in a tertiary hospital respiratory unit in China

Abstract Background The prevalence of drug-related problems in patients hospitalized at respiratory care units is unknown in mainland China. Objective To identify and categorize drug-related problems in a respiratory care unit in China. Setting Respiratory care unit in a tertiary university hospital in China. Methods Clinical pharmacy services were introduced and documented during an 18-months study period. The problems were categorized using the Pharmaceutical Care Network Europe DRP classification tool V8.02. Main outcome measures Problems and causes of drug-related problems, interventions proposed, and outcome of pharmacy recommendations. Results A total of 474 patients were reviewed, 164 patients had DRPs (34.6%). Total 410 problems were identified, an average of 2.5 per patient. Treatment effectiveness was the major type of problem detected (219; 53.4%) followed by treatment safety (140; 34.1%). The most common causes of the problems were patient-related (25.8%), drug selection (24.0%), and drug use process (23.4%). Pharmacist made 773 interventions; average 1.9 per drug-related problem. A total of 96.2% of these interventions were accepted leading to solving 81.9% of the identified problems. Conclusion There is a high prevalence of drug-related problems in patients hospitalized at the respiratory unit of this clinic. Clinical pharmacists should focus on improving prescribing practice and patient counseling.

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The role of the pharmacist in the multidisciplinary approach to the prevention and resolution of drug-related problems in cancer chemotherapy

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155218786048 ◽

2018 ◽

Vol 25 (6) ◽

pp. 1312-1320 ◽

Cited By ~ 8

Author(s):

Ahmet S Boşnak ◽

Nevzat Birand ◽

Ömer Diker ◽

Abdikarim Abdi ◽

Bilgen Başgut

Keyword(s):

Clinical Pharmacy ◽

Treatment Effectiveness ◽

University Hospital ◽

Major Type ◽

Cancer Type ◽

Pharmacy Services ◽

Drug Related Problems ◽

Clinical Pharmacy Services ◽

Treatment Safety

Background Clinical pharmacists have important roles in implementing scientifically valid knowledge and advice on safe, reasonable use of pharmaceuticals. Clinical pharmacy services were introduced and evaluated in oncology clinic in a tertiary university hospital. Methods A prospective interventional study was conducted from November 2017 to March 2018. Drug-related problems were classified using the Pharmaceutical Care Network Europe drug-related problem classification tool v8.01. The main outcome measure is the proposed interventions aimed at identification of the drug-related problems, the role of the pharmacists in the resolution, and the rate of acceptance of these recommendations by physicians. Results A total of 102 patients were included in the study, who were treated with at least two cycles of any cancer type and stage. A total of 55 (53.9%) patients had 251 drug-related problems. Drug-related problems mainly involved antihypertensive (31.6%), antidiabetic (17.8%), and herbal agents (31.6%). Treatment effectiveness was the major type of drug-related problems (50.2%) followed by treatment safety (29.1%). A total of 211 (100%) interventions were accepted and regarded as clinically relevant. Prescriber informed only were the most common types of intervention at the prescriber level. Eighty-six point four percent identified drug-related problems were solved, 9.8% of the problems were partially solved, 2.3% problems were unsolved. Conclusion Clinical pharmacy services may have optimized therapy effectiveness, prevent adverse effects and unclear/compliant problems. The pharmacist interventions were highly acknowledged by oncologists and patients; this may indicate the presence of a great convenience and need to implement Clinical pharmacy services in alternative hospitals in Northern Cyprus.

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Identification and solution of drug-related problems in the neurology unit of a tertiary hospital in China

BMC Pharmacology and Toxicology ◽

10.1186/s40360-021-00530-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Pengpeng Liu ◽

Guangyao Li ◽

Mei Han ◽

Chao Zhang

Keyword(s):

Tertiary Care ◽

Patient Treatment ◽

Major Type ◽

Drug Related Problems ◽

Dose Selection ◽

Nasogastric Feeding ◽

Factors Associated ◽

Clinical Pharmacists ◽

Medication Therapy ◽

Medication Error Reporting

Abstract Background The prevalence and characteristics of drug-related problems (DRPs) and factors associated with the occurrence of DRPs in the neurology unit in China remain unknown. This study aimed to determine the prevalence, characteristics and severity ratings of DRPs and identify factors associated with the occurrence of DRPs in the neurology unit of a tertiary care and academic teaching hospital in China. Methods A retrospective study of DRPs and pharmacists’ interventions for neurology patients was performed during a non-consecutive 24-month study period. Patient demographics and clinical characteristics, and pharmacist’s intervention records were collected. The characteristics and severity ratings of DRPs were categorized using the Pharmaceutical Care Network Europe (PCNE) DRP classification tool V9.00 and the National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP) classification respectively. Results A total of 242 DRPs were detected for 974 admitted patients, an average of 0.25 DRPs per patient. Treatment safety was the major type of DRPs (106;43.8%) followed by treatment effectiveness (78;32.2%). The primary causes of DRPs were drug selection (124;44.1%) and dose selection (92;32.7%). Clinical pharmacists provided 525 interventions, and most interventions occurred at the prescriber level (241;45.9%). A total of 91.4% of these interventions were accepted, contributing to solving 93.0% of the identified problems. The majority of DRPs (210;86.8%) were rated at severity categories B to D (causing no patient harm). Multiple logistic regression showed that creatinine clearance, number of medications used, nasogastric feeding, diabetes, and infectious diseases were associated with more frequent DRPs (p < 0.05). Conclusions DRPs are relatively common in the neurology unit in China, with primary causes of drug and dose selection, and clinical pharmacists can effectively reduce and prevent DRPs to optimize medication therapy.

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Drug-related problems among hospitalized patients with COPD in mainland China

International Journal of Clinical Pharmacy ◽

10.1007/s11096-019-00913-4 ◽

2019 ◽

Vol 41 (6) ◽

pp. 1507-1515 ◽

Cited By ~ 2

Author(s):

Qin Li ◽

Hui Jun Qu ◽

Dan Lv ◽

Ming-Kung Yeh ◽

Shusen Sun ◽

...

Keyword(s):

Mainland China ◽

Hospitalized Patients ◽

Drug Related Problems ◽

Dose Selection ◽

Patient Demographics ◽

Copd Patients ◽

Common Causes ◽

Academic Teaching Hospital ◽

Treatment Safety ◽

Exacerbation Of Copd

Abstract Background Data are lacking about the extent of drug-related problems in hospitalized patients with COPD in China. Objective Identify types and causes of drug-related problems and assess interventions performed by pharmacists. Setting Study was conducted in an academic teaching hospital in Shanghai, China. Method Between June 2017 and July 2018, 393 patients admitted to hospital for acute exacerbation of COPD hospitalized were enrolled. Patient demographics and clinical characteristics were collected. The drug-related problems and interventions were recorded and analyzed based on the Pharmaceutical Care Network Europe (PCNE)-DRP V 8.02 classification. Main outcome measures The number, types, causes, interventions, and outcomes of the problems were analyzed. Results A total of 640 DRPs, with 763 corresponding causes, were identified for 393 patients. “Treatment safety P2” was the most common type of problem (54.2%; 347/640), and the most common causes were “drug selection C1” (24.2%; 185/763), “dose selection C3” (21.5%; 164/763) and “treatment duration C4” (17.7%; 135/763). Antibiotics, corticosteroids, and proton pump inhibitors were the three primary medication classes associated with DRPs. Patients, hospitalized for more than eight days, taking ten or more drugs or having renal dysfunctions were more likely to have drug-related problems. Pharmacists totally proposed 1557 interventions to address the problems. Most interventions (91.0%; 1418/1557) were accepted, and 91.6% of the problems were solved. Conclusion The prevalence of drug-related problems among the studied COPD patients was high. Pharmacists can have an important role in addressing the problems and optimizing the safety and effectiveness of therapies for hospitalized COPD patients.

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Incidence, types and acceptability of pharmaceutical interventions about drug related problems in a general hospital: an open prospective cohort

BMJ Open ◽

10.1136/bmjopen-2019-035848 ◽

2020 ◽

Vol 10 (4) ◽

pp. e035848

Author(s):

Valdjane Saldanha ◽

Rand Randall Martins ◽

Sara Iasmin Vieira Cunha Lima ◽

Ivonete Batista de Araujo ◽

Antonio Gouveia Oliveira

Keyword(s):

Prospective Cohort ◽

Primary Outcome ◽

Treatment Effectiveness ◽

Significant Proportion ◽

Treatment Costs ◽

University Hospital ◽

Medical Team ◽

Medication Order ◽

Drug Related Problems ◽

Pharmaceutical Interventions

ObjectivesTo evaluate the incidence and types of drug-related problems (DRP) in a general teaching hospital and to evaluate the acceptability of pharmaceutical interventions by the medical team.DesignProspective cohort study during 2 years.SettingConducted in a Brazilian University Hospital.ParticipantsThe patient cohort consisted of 9303 patients with a total of 12 286 hospitalisation episodes.Primary outcome measuresDRP detected by pharmacists’ review of 100% medication orders using Pharmaceutical Care Network Europe 6.2 classification.ResultsPatients with a mean age of 52.6±17.7 years and 50.9% females. A total of 3373 DRP in 1903 hospital episodes were identified, corresponding to a cumulative incidence of 15.5%. ‘Treatment ineffectiveness’ (11.5%) and ‘Treatment costs’ (5.90%) were the most common DRP and ‘Drug use process’ (18.4%) and ‘Treatment duration’ (31.0%) the main causes of DRP. The medicines involved most often involved in DRP were anti-infectives (36.0%), mainly cephalosporins (20.2%), antiulcer (38.6%), analgesics/antipyretics (61.2%), propulsives (51.2%), opioids (38.5%) and antiemetics (57.4%). From 1939 pharmaceutical interventions, at least, 21.4% were not approved by the medical team.ConclusionDRP detected by 100% medication order review by hospital pharmacists occur in a significant proportion of hospital episodes, the most frequent being related to treatment effectiveness and treatment costs. The medications mostly involved were cephalosporins, penicillins, antidyspeptics, analgesics, antipyretics, opioids and antiemetics. Pharmaceutical interventions had low acceptability by the medical staff.

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Postoperative opioids and risk of respiratory depression – A cross-sectional evaluation of routines for administration and monitoring in a tertiary hospital

Scandinavian Journal of Pain ◽

10.1515/sjpain-2020-0060 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Karoline Kolås Andersen ◽

Gunnvald Kvarstein

Keyword(s):

Respiratory Depression ◽

Patient Monitoring ◽

Current Practice ◽

Tertiary Hospital ◽

University Hospital ◽

Post Anesthesia Care Unit ◽

Cross Sectional ◽

Routes Of Administration ◽

Surgical Ward ◽

Cross Sectional Design

AbstractObjectivesOpioids are the most potent analgesics in the treatment of postoperative pain. Respiratory depression is, however, a serious side effect. The aims of this study were to evaluate current practice and routines for post-operative administration of opioids in a Norwegian university hospital and to evaluate whether the clinical safeguards adequately protected patients’ safety regarding risk of respiratory depression.MethodsThe study had a retrospective cross-sectional design and included 200 patients, treated with opioids postoperatively. The patients were treated in a post-anesthesia care unit (PACU) before transferal to a surgical ward. Relevant data such as opioid dosages, routes of administration, sedation and respiratory function, routines for patient monitoring, and numbers of patients with opioid induced respiratory depression was collected.ResultsTwo patients (1%) developed respiratory depression that needed naloxone to reverse the effect, and 32 patients (16%) had a respiratory rate (RR) <10/min, which may have been caused by opioids. In the PACU, the patient’s RR was evaluated on a routine base, but after transferal to a surgical ward RR documented in only 7% of the patients.ConclusionsThe lack of routines for patient monitoring, especially RR, represented a risk of not detecting opioid induced respiratory depression.

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Analysis of the interventions in antineoplastic therapy by a clinical pharmacy service at a tertiary hospital in Brazil

Journal of Oncology Pharmacy Practice ◽

10.1177/10781552211017650 ◽

2021 ◽

pp. 107815522110176

Author(s):

Camile da Rocha ◽

Juliane Carlotto ◽

Jose Zanis Neto

Keyword(s):

Monoclonal Antibodies ◽

Antineoplastic Therapy ◽

Clinical Significance ◽

Clinical Pharmacy ◽

Tertiary Hospital ◽

Clinical Pharmacy Service ◽

Drug Related Problems ◽

Lack Of Information ◽

Clinically Significant ◽

Pharmaceutical Interventions

Background Medication errors are avoidable occurrences that can assume clinically significant dimensions and impose relevant costs to the health system, especially in the context of antineoplastic therapy. Objective Assess the clinical significance and economic impacts of a clinical pharmaceutical service. This retrospective study consists of an analysis of pharmacy interventions and drug-related problems found in a review of electronic prescriptions referring to antineoplastic therapy of a public teaching tertiary hospital in Brazil. Method Retrospective descriptive study obtained from electronic records of drug-related problems and pharmaceutical interventions related to antineoplastic therapy for oncological and hematological diseases, obtained through the pharmacotherapy review service. The accepted interventions were analyzed for the financial impact generated, evaluating your direct costs. The perception of clinical significance of a random sample of interventions was ascertained by the experts' opinion, using the Delphi method. Results The most frequent problem was a “lack of information to professionals” (25.06%), “problems as to the frequency and interval of doses” (22.90%), and “medication underdosing” (16.20%). Dose adjustment (31.50%) and clarifications (30.90%) were the most frequent pharmaceutical interventions. In the second round of Delphi, experts rated 77.77% of interventions as extremely significant and very significant. The main drugs reported in the interventions were cyclophosphamide, carboplatin, methotrexate, folinic acid, and monoclonal antibodies. The savings amounted to US$1,193,970.18 and involved mainly bortezomib, dactinomycin, and monoclonal antibodies. Conclusion Clinical pharmacy services contributed to the rational use of medicines presenting clinical significance and avoiding waste of financial resources.

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Spectrum of childhood interstitial and diffuse lung diseases at a tertiary hospital in Egypt

ERJ Open Research ◽

10.1183/23120541.00880-2020 ◽

2021 ◽

pp. 00880-2020

Author(s):

Salma G. Abdelhady ◽

Eman M. Fouda ◽

Malak A. Shaheen ◽

Faten A. Ghazal ◽

Ahmed M. Mostafa ◽

...

Keyword(s):

Interstitial Lung Disease ◽

Lung Disease ◽

Lung Diseases ◽

Demographic Data ◽

Tertiary Hospital ◽

University Hospital ◽

Systematic Evaluation ◽

Pulmonary Hemosiderosis ◽

Diffuse Lung Diseases ◽

Diffuse Lung

BackgroundChildhood interstitial and diffuse lung diseases (chILD) encompass a broad spectrum of rare pulmonary disorders. In most developing middle eastern countries, chILD is still underdiagnosed. Objective: To describe and investigate patients diagnosed with chILD in a tertiary university hospital in Egypt.MethodsWe analyzed data of consecutive subjects (<18 years) referred for further evaluation at the Children's Hospital, Ain Shams University. Diagnosis of chILD was made in accordance with the chILD-EU criteria. The following information was obtained: demographic data, clinical characteristics, chest CT findings, laboratory studies, spirometry, BAL and histopathology findings.Results22 subjects were enrolled over 24 months. Median age at diagnosis was 7 years (range 3.5–14 years). The most common manifestations were dyspnea (100%), cough (90.9%), clubbing (95.5%) and tachypnea (90.9%). Systematic evaluation led to the following diagnoses: hypersensitivity pneumonitis (n=3), idiopathic interstitial pneumonias (n=4), chILD related to chronic granulomatous disease (n=3), chILD related to small airway disease (n=3), postinfectious chILD (n=2), Langerhans cell histiocytosis (n=2), Idiopathic pulmonary hemosiderosis (n=2), granulomatous lymphocytic interstitial lung disease (n=1), systemic sclerosis (n=1), familial interstitial lung disease (n=1). Among the subjects who completed the diagnostic evaluation (n=19), treatment was changed in 13 (68.4%) subjects.ConclusionSystematic evaluation and multidisciplinary peer review of chILD patients at our tertiary hospital led to changes in management in 68% of the patients. This study also highlights the need for an Egyptian chILD network with genetic testing, as well as the value of collaborating with international groups in improving health care for children with chILD.

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Prediction of Prognosis in Adult Patients With Carbapenem-Resistant Klebsiella pneumoniae Infection

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.818308 ◽

2022 ◽

Vol 11 ◽

Author(s):

Jihui Chen ◽

Yu Yang ◽

Huimin Yao ◽

Shuhong Bu ◽

Lixia Li ◽

...

Keyword(s):

High Risk ◽

Klebsiella Pneumoniae ◽

Treatment Effectiveness ◽

Risk Group ◽

Clinical Information ◽

Tertiary Hospital ◽

High Risk Group ◽

Adult Patients ◽

Carbapenem Resistant ◽

Prediction Of Prognosis

ObjectiveCarbapenem-resistant Klebsiella pneumoniae (CRKP) infections are associated with poor patient outcomes. We aimed to analyze the clinical information of adult patients with CRKP infection in order to establish a nomogram for mortality risk as well as to determine the treatment effectiveness of different antimicrobial regimens.MethodsAdult patients diagnosed with CRKP infection in a tertiary hospital in Shanghai between September 2019 and March 2021 were included. The clinical characteristics and clinical outcomes of these patients were analyzed.ResultsA total of 199 cases of CRKP infection were examined. Five factors, namely age ≥65 years, respiratory failure, Sequential Organ Failure Assessment score, serum procalcitonin ≥5 ng/mL, and appropriate treatments in 3 days, were found to be associated with 30-day mortality. Upon incorporating these factors, the nomogram achieved good concordance indexes of 0.85 (95% confidence interval [CI]: 0.80–0.90) and well-fitted calibration curves. Receiver-operating characteristic curves for 7-, 15-, and 30-day survival had areas under the curve of 0.90, 0.87, and 0.88, respectively. Three-drug combination therapy was observed to be associated with lower mortality in the high-risk group (adjusted hazard ratio = 0.24, 95% CI: 0.06–0.99) but not in the low-risk group. Ceftazidime–avibactam, fosfomycin, and amikacin were effective against infections caused by CRKP. Tigecycline improved the treatment efficiency in 7 days, but a trend toward increased mortality was seen (HR, 1.69; 95% CI: 0.98–2.94; P = 0.061).ConclusionThe antimicrobial regimen efficacy data and the predictive nomogram established in this study can help clinicians in identifying high-risk adult patients with CRKP infection, improving the therapeutic effect, and reducing mortality.

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Comparing the first and second waves of COVID-19 in a tertiary university hospital in Barcelona

F1000Research ◽

10.12688/f1000research.73988.1 ◽

2021 ◽

Vol 10 ◽

pp. 1197

Author(s):

Yolima Cossio ◽

Marta-Beatriz Aller ◽

Maria José Abadias ◽

Jose-Manuel Domínguez ◽

Maria-Soledad Romea ◽

...

Keyword(s):

Tertiary Hospital ◽

Healthcare Systems ◽

University Hospital ◽

Emergency Rooms ◽

Daily Number ◽

Patient Demographics ◽

Significant Difference ◽

The University ◽

Hospital Wards ◽

Second Wave

Background: Hospitals have constituted the limiting resource of the healthcare systems for the management of the COVID-19 pandemic. As the pandemic progressed, knowledge of the disease improved, and healthcare systems were expected to be more adapted to provide a more efficient response. The objective of this research was to compare the flow of COVID-19 patients in emergency rooms and hospital wards, between the pandemic's first and second waves at the University Hospital of Vall d’Hebron (Barcelona, Spain), and to compare the profiles, severity and mortality of COVID-19 patients between the two waves. Methods: A retrospective observational analysis of COVID-19 patients attending the hospital from February 24 to April 26, 2020 (first wave) and from July 24, 2020, to May 18, 2021 (second wave) was carried out. We analysed the data of the electronic medical records on patient demographics, comorbidity, severity, and mortality. Results: The daily number of COVID-19 patients entering the emergency rooms (ER) dropped by 65% during the second wave compared to the first wave. During the second wave, patients entering the ER were significantly younger (61 against 63 years old p<0.001) and less severely affected (39% against 48% with a triage level of resuscitation or emergency; p<0.001). ER mortality declined during the second wave (1% against 2%; p<0.000). The daily number of hospitalised COVID-19 patients dropped by 75% during the second wave. Those hospitalised during the second wave were more severely affected (20% against 10%; p<0.001) and were referred to the intensive care unit (ICU) more frequently (21% against 15%; p<0.001). Inpatient mortality showed no significant difference between the two waves. Conclusions: Changes in the flow, severity and mortality of COVID-19 patients entering this tertiary hospital during the two waves may reflect a better adaptation of the health care system and the improvement of knowledge on the disease.

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DRUG-RELATED PROBLEMS IN CHRONIC KIDNEYS DISEASE PATIENTS IN AN INDONESIAN HOSPITAL: DO THE PROBLEMS REALLY MATTER?

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2016v8i12.15193 ◽

2016 ◽

Vol 8 (12) ◽

pp. 298 ◽

Cited By ~ 2

Author(s):

Hesty U. Ramadaniati ◽

Yusi Anggriani ◽

Vonny M. Wowor ◽

Alvina Rianti

Keyword(s):

Treatment Effectiveness ◽

Demographic Data ◽

Descriptive Analysis ◽

Electrolyte Imbalance ◽

Drug Related Problems ◽

Patient Interview ◽

Major Teaching Hospital ◽

Medical Wards ◽

Stage Renal Disease ◽

End Stage

Objective: To identify and evaluate drug-related problems (DRPs) in patients with chronic kidney disease (CKD).Methods: A prospective observational three-month study was conducted in adult patients with CKD hospitalized in five general medical wards and one intensive cardiac care unit in a major teaching hospital in Indonesia. Principal researcher (pharmacist) identified the occurrence of DRPs through the direct patient interview, discussion with nurses and assessment of patients’ medication charts and medical records. The identified DRPs were validated by a senior pharmacist and classified using Pharmaceutical Care Network Europe/PCNE classification scheme for DRP V6.2. Descriptive analysis was applied for demographic data, drug utilization and DRP profiles.Results: There were 105 patients who met the inclusion criteria and 80% of these patients had end-stage renal disease. A total of 2404 medication orders were reviewed and 1026 DRPs were identified. Potential DRPs accounted for around two-thirds of the cases. The rate of overall DRPs was 42.7 DRPs per 100 medication orders and each patient in the study experienced approximately ten DRPs during their hospitalization. Treatment effectiveness and adverse reaction domains contributed to the majority of DRPs primary domains for problems. Drugs for cardiovascular diseases and drugs for correcting electrolyte imbalance were most commonly implicated in DRP incidence.Conclusion: This study uncovered higher rate of DRPs experienced by each patient compared to other CKD studies. There were variations of DRP types when comparing with similar studies. Pharmacists’ competencies to identify, prevent and resolve DRPs are vital measures to improve clinical outcomes in CKD patients.

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