Clinical pharmacist assessment of drug-related problems among intensive care unit patients in a Turkish university hospital

Background Critically ill patients treated in the intensive care units (ICUs) often suffer from side effects and drug-related problems (DRPs) that can be life-threatening. A way to prevent DRPs and improve drug safety and efficacy is to include clinical pharmacists in the clinical team. This study aims to evaluate the classification of drug-related problems and the implementation of clinical pharmacy services by a clinical pharmacist in the ICU of a university hospital in Turkey. Methods This study was carried out prospectively between December 2020 and July 2021 in Gazi University Medical Faculty Hospital Internal Diseases ICU. All patients hospitalized in the intensive care unit for more than 24 h were included in the study. During the study, the clinical pharmacist's interventions and other clinical services for patients were recorded. DRPs were classed according to the Pharmaceutical Care Network Europe V.8.02. Results A total of 151 patients were included during the study period corresponding to 2264 patient-days. Patients with DRPs had a longer hospital stay and a higher mortality rate (p < 0.05). 108 patients had at least one DRP and the total number of DRPs was 206. There was an average of 1.36 DRPs per patient, 71.5% of patients experienced DRP and 89.22 DRPs per 1000 patient-days. A total of 35 ADEs were observed in 32 patients. ADE incidence was per 1000 patient-days 15.45. ADEs were caused by nephrotoxicity (48.57%), electrolyte disorders (17.14%), drug-induced thrombocytopenia (17.14%), liver enzyme increase (8.57%) and other causes (8.57%). Drug selection (40.29%) and dose selection (54.36%) constituted most of the causes of DRPs. Dose change was the highest percentage of planned interventions with a rate of 56.79%. Intervention was accepted at a rate of 90.8% and it was fully implemented. Conclusion In this study, the importance of the clinical pharmacist in the determination and analysis of DRPs was emphasized. Clinical pharmacy services like the one described should be implemented widely to increase patient safety.

Polypharmacy and Hyperpolypharmacy in Older Individuals with Parkinson’s Disease: A Systematic Review and Meta-Analysis

<b><i>Background and Aim:</i></b> Polypharmacy (concomitant use of 5–9 medicines) and hyperpolypharmacy (concomitant use of over 10 medicines) were observed to be more frequent in older adults (≥65 years) and associated with adverse outcomes. Their prevalence and risk in older patients with Parkinson’s disease (PD) remain unknown. We aimed to synthesize the extant evidence on the prevalence and risk of polypharmacy and hyperpolypharmacy in older adults with PD. <b><i>Methods:</i></b> A systematic literature search was performed in PubMed/MEDLINE, Scopus, and Embase databases to identify pertinent studies published from 2000 to July 2021. Observational studies reporting the prevalence and association with disease of polypharmacy/hyperpolypharmacy in older adults with PD were meta-analyzed. Pooled prevalence and odds ratio (OR) with 95% confidence intervals (CIs) were calculated. <b><i>Results:</i></b> Out of the total 499 studies identified, 6 fulfilled the inclusion criteria and comprised 7,171 participants. The overall prevalence of polypharmacy and hyperpolypharmacy was 40% (95% CI: 37–44) and 18% (95% CI: 13–23), respectively. A meta-analysis of 4 studies indicated a significant association between polypharmacy (OR: 1.94, 95% CI: 1.26–2.62; <i>p</i> &#x3c; 0.001) and PD. Hyperpolypharmacy was also strongly associated with PD (OR: 3.11, 95% CI: 2.08–4.14; <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> Polypharmacy (40%) and hyperpolypharmacy (18%) are highly prevalent and eventually increase the risk of drug-related problems in older adults with PD. Therefore, interventions that ensure rational geriatric pharmacotherapy are of critical importance for the older population with neurogenerative disorders.

Clinical and Organizational Impacts of Medical Ordering Settings on Patient Pathway and Community Pharmacy Dispensing Process: The Prospective ORDHOSPIVILLE Study

During the dispensing process of medical orders (MOs), community pharmacists (CPs) can manage drug-related problems (DRPs) by performing pharmacist interventions (PIs). There is little evidence that the PI rate is higher with MOs from hospitals (MOHs) than ambulatory (MOAs) settings, and their impact on the patient and community pharmacy is unknown. The primary objective of this study was to compare the MOH and MOA PI rates. The secondary objective was to describe PIs and their clinical and organizational impacts on patient and community pharmacy workflow. A total of 120 CPs participated in a prospective study. Each CP included 10 MOH and 10 MOA between January and June 2020. DRP and PI description and clinical and organizational impacts between MOH and MOA were assessed and compared. We analyzed 2325 MOs. PIs were significantly more frequent in MOH than in MOA (9.7% versus 4.7%; p < 0.001). The most reported PI was the difficulty of contacting hospital prescribers (n = 45; 52.2%). MOHs were associated with a longer dispensing process time and a greater impact on patient pathway and community pharmacy workflow than MOAs. Lack of communication between hospital and primary care settings partly explains the results. Implementation of clinical pharmacy activities at patient discharge could alleviate these impacts.

Prescription audit of antihypertensive drugs used in stroke patients in a tertiary care teaching hospital

Background: Stroke is considered as one of the important reasons of death and disability worldwide. A rational use of medications is needed to prevent the recurrence and the disease related complications.Methods: The current study is a prospective observational study. All stroke cases, with patients above the age of 25 and treated with antihypertensive agents were included in the study. A total of 189 patients were found suitable for inclusion in the study. Using a suitably designed data collection form, all pertinent data such as patient demographics, prescribed medicines, drug interactions and adverse drug reactions were collected from the patient’s case file, nurses’ charts, and medication charts. Prescription pattern of antihypertensive drugs were obtained. The causality of the ADR was assessed using the Naranjo causality assessment scale and reported in the institution where the study was conducted.Results: Majority of patients included in the study were in the age group of 61-70 years. The incidence of stroke in this study was more in males than in the females. Ischemic stroke (72%) was more prevalent when compared to Hemorrhagic stroke. Among the antihypertensive agents, calcium channel blockers (32%) were the most commonly prescribed class of drugs. In our audit, drug related problems were observed in 27% of the cases which included cases with improper dose (3 cases), contraindications (4 cases), major drug interactions (20 cases), and adverse drug reactions (17 cases). Most of the prescriptions were legible. Drug related problems had a great impact on the overall stroketherapy.Conclusions: The drug related problems are a relevant aspect to be considered when treating patients with stroke and it can arise irrespective of adherence to guidelines.

Pharmaceutical Care Network Europe (PCNE) Drug-Related Problems Classification Version 9.1: First Implementation in Sudan

Background: Clinical pharmacy services are an emerging specialty in Sudan. Many tools exist to document drug-related problems (DRP), such as the Pharmaceutical Care Network Europe (PCNE) classification. However, none has been attempted and published in Sudan. Objectives: The study aimed to identify the DRP and its characteristics in real hospital setting using non-modified version of PCNE. Method: Prospective study of clinical pharmacists' interventions during the routine care work of reviewing patients over a period from December 2020 to February 2021 at the wards of National Cancer Institute, University of Gezira, Sudan. Main outcome measure Using non-modified PCNE version 9.1 to identify the number, types, causes of the DRP, clinical pharmacists' interventions, acceptance, and outcomes. Results: Five minutes (range, 3-15 minutes) was the median time spent for evaluation and intervention by the clinical pharmacists, a total of 51 DRP were discovered among 40 patients with an average of 1.3 DRP per patient, an adverse drug event (possibly) occurring (29.4%) was the main problem, no or incomplete drug treatment (27.5%) was the main causes, above one-third of the clinical pharmacists' interventions were proposed to the prescriber, these interventions were accepted in 96% and fully implemented among 72.5% of the cases. At the end of the process, the majority of DRP (72.5%) were totally solved. Conclusion: Non-modified PCNE version 9.1 provides a suitable tool for the DRP process for Sudanese clinical pharmacists during routine work in the oncology setting. It hence can be considered as an optimal tool for further quality and policymaking.

Pharmacotherapy of Different Tuberculosis Patients its Analysis and Outcomes: A Retrospective Cohort Study

This study aim was to evaluate the prescribed therapies and to identify various drug-related problems as well as their causes in different TB patients admitted at the Pulmonology Department, Northwest General Hospital and Research Centre, Hayatabad, Peshawar, Pakistan. A 5-month retrospective study was conducted in which a total of 525 patients’ medical records were collected using predesigned standard data collection proforma. Among them, 25 patients having incomplete medical records were excluded and the rest of 500 cases were involved and analyzed accordingly. In all these cases, the causative agent was Mycobacterium tuberculosis. Overall 14 drugs of 133 different therapeutic classes were used in which the most frequently prescribed drugs to these patients were Anti-Tuberculosis drugs (100%), Antibiotic (100%), Multivitamins (78%), GIT drugs (55%) and Antihistamines (55%) followed by other drugs listed in the present study. Out of 500 cases, a total of 179 (35.8%) patients were identified had Drug-related problems, among them 23 (4.6%) cases were in untreated condition, in 12 (2.4%) cases drugs without indication problems were found, in 43 (8.6%) cases there were adverse drug reactions problems noted, in 75 (15%) cases total drug interactions problems were identified, while in 26 (5.2%) cases polypharmacy problems were found. The prescribed pharmacotherapy in all 500 cases meets with the standard pharmacotherapy. However, the discrepancies observed in the present study were due to lack of proper knowledge about the pharmacology of the drugs, overburden on doctors and proper lack of patient counseling. To better understand the proper management and reduction of these problems other health care professionals and proper clinical pharmacists are required to cooperate for the sake of improving the outcomes of the pharmacotherapy.

Assessment of the potential impact of resolving drug-related problems by clinical pharmacists in Japan: a retrospective observational study

Background Clinical pharmacists play a role in limiting the disadvantages of pharmacotherapy for patients by detecting and resolving drug-related problems (DRPs) through medication reviews. Although their contributions to patient care have been analyzed and understood in various countries, the role of Japanese clinical pharmacists in this context remains to be clearly elucidated. Thus, in this study, we aimed to elucidate the detection of DRPs by clinical pharmacists and determine the potential impact of pharmacist interventions in Japan. Methods This study was conducted in a 273-bed hospital and targeted hospitalized patients over a period of 6 months. DRPs detected by clinical pharmacists during the study period were investigated and classified into 10 types. Furthermore, medications were categorized according to the Anatomical Therapeutic Chemical classification. A review committee consisting of two pharmacists independently reviewed the pharmacist interventions on a six-point scale (extremely significant, very significant, significant, somewhat significant, no significance, adverse significance) according to the potential impact on patient care. Results During the study period, 1711 patients (mean age: 71.2 years, 54.1% male) were included, and 2149 DRPs were detected (1.26 DRPs/patient). Pharmacists intervened in all the DRPs detected. The most common DRP was supratherapeutic dosage (19.3%), followed by untreated indication (18.1%). The most common medication classification causing DRPs was “Antiinfectives for Systemic Use” (25.1%), followed by “Alimentary Tract and Metabolism” (19.9%). Most of the pharmacist interventions (99.6%) were rated “somewhat significant” or more significant, of which 1.1% were rated “extremely significant,” and none were rated as “adverse significance.” Conclusions Our results show that in Japan, as in other countries, clinical pharmacists detect and resolve DRPs in hospitalized patients through medication review. Our findings also show that clinical pharmacists have a positive impact on patient care and suggest the need for their involvement.

Assessment of Drug related problems Encountered in Patients with Psychiatric disorders in a Secondary Care Hospital.

Introduction: Patients with psychiatric disorders receives multiple medications associated with their comorbid conditions and mental illness increasing the risk of drug related problems leading to frequent hospitalization, healthcare expenditure and reduced quality of life. Aim/Objective: To assess and evaluate the Drug Related Problems (DRPs) encountered in patients with psychiatric disorders in a Secondary Care Hospital in Ras Al-Khaimah. Methodology: A prospective observational study was carried out for a period of six months in the department of psychiatry of a secondary care teaching hospital. All the necessary details including the demographics, drug therapy and laboratory parameters were collected from the patient case records. The patient medication orders were reviewed and screened for any DRPs. The identified DRPs were documented and later evaluated to identify the types, frequency, class of drugs involved and for the level of clinical significance by using the descriptive statistics. Results: A total of 61 DRPs were identified from 50 patients. Male predominance was noted over females. DRPs were commonly seen in patients aged between 21-40 years of age. Schizophrenia (42%) was the most common psychiatric illness identified in the study. The most common DRPs was found to be drug-drug interaction (36.06%) followed by adverse drug reaction (27.86%) and medication non-adherence (24.59%). The level of significance of DRPs was found to be ‘minor’ significance in the grade. Conclusion: The study identifies the DRPs in patients with psychiatric illness and necessitates the need for a regular medication review which will help to rationalize the drug therapy, achieve better therapeutic outcomes and improved quality of patient care.