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.

Economic Impact and Cost Benefit of the Inpatient Clinical Pharmacist Interventions in Cancer Care Units

Background: Clinical pharmacists play a key role in ensuring the optimum use of cancer medicines. Yet, the economic benefit of this role has never been assessed in Qatar. Aim: To evaluate the overall economic impact of clinical pharmacist interventions in the main cancer care setting in Qatar. Methods: From the public healthcare perspective, this was an analysis of the total economic benefit and a cost-benefit analysis of the clinical pharmacy interventions. As a study sample size, patient records in March 2018, July/August 2018, and January 2019 were retrospectively reviewed at the National Center for Cancer Care & Research (NCCCR), Qatar. The total benefit from interventions was the total of the cost avoidance due to preventable adverse drug events (ADEs) plus the cost savings associated with therapeutic interventions. The interventions cost was based on salary and increased cost due to therapeutic interventions. The cost-benefit analysis results were presented via net benefit and benefit‐to‐cost ratio measures. Results : Total of 1,352 interventions occurred during the 3-month follow-up period. The total benefit was QAR 196,010,360 (USD53,834,206), constituting cost avoidance of QAR 194,764,534 (USD 53,492,040) and cost savings of QAR 1,245,826 (USD 342,166), mostly due to recommending additional medications and the medication dose reduction. The benefit-to-cost ratio was 174:1 and the annual net benefit was QAR 779,539,440 (USD 214,100,351). Sensitivity analyses confirmed the robustness of results. Conclusion: The clinical pharmacist intervention is a cost-beneficial practice in the NCCCR setting, associated with ADEs prevention and substantial economic benefits, including relative to the interventions cost.

A Randomized, Single Centered, Parallel and Open labelled Interventional Study on Effectiveness of Clinical Pharmacists on Adverse Event Following Immunization (AEFI) in Pediatric Population

Background: Adverse events are a major threat to any immunization programs, which in turn have proven to be a boon for developing nations like India. Hindering factors, such as inadequate knowledge, inappropriate attitude, incorrect practices, etc., of the guardian affect the vaccination rate. Aim: This study aims to assess the effectiveness of clinical pharmacist intervention on an adverse event following immunization in the pediatric population receiving immunization. Materials and Methods: Pediatric subjects <5 yrs of both genders receiving immunization in a tertiary care hospital during the period of 8 months were considered. Subjects were randomized into control and interventional groups. Pharmaceutical intervention was done in interventional group in the form of patient counselling, and a patient information leaflet. Adverse event following immunization was recorded and analysed for both groups along with Knowledge, Attitude, and Practice scores of guardians’ pre and post intervention through customized data collection forms. Microsoft excel and statistical software SPSS IBM version 22 was used to analyse the data. Results: The study was conducted on a total of 88 subjects (n) in which 79 were <2 years, 1 and 8 were between 2-4 years and 4-5 years respectively. Forty-ninesubjects (55.69%) were female, while 39 were male (44.31%) with a response and completion rate of 91.66%. 97.7% subjects received Bacillus Calmette-Guerin vaccination (majority), while 8.88% received pneumococcal special vaccine (minority). Adverse event following immunization was recorded in 31(35.22%) cases. Knowledge, Attitude and Practice scores increased by 42.17%, 52% and 12.67%, respectively in guardians after clinical pharmacist intervention. Conclusion: This studydemonstrates that educational inputs, awareness programs, and proper medical professional intervention can act as a helping factor to fight against AEFI and towards the success of an immunization program.

A pilot study about methods to reduce prescription errors in a chemotherapy day unit – Aspects to consider in pharmacist verification process

Introduction Prescribing errors can happen unintentionally during the prescribing process, or when choosing a treatment therapy. Prescribing errors have the highest prevalence amongst common error types related to chemotherapy medication in outpatient settings. According to the Joint Commission International (JCI), prescriptions should be reviewed for appropriateness by someone else than the prescriber or practitioner to prevent medication errors. Aim The study was aimed to map out the existing type and amount of occurring deviations in prescribing and to clarify the current chemotherapy prescribing practices at the Comprehensive Cancer Center at Helsinki University Hospital. Similar research has not been published in Finland before. Methods and patients The researcher selected patients randomly from the daily outpatient attendance list following a predetermined numerical order. Data was collected by conducting a medication verification review in line with the JCI guidance by a clinical pharmacist the day before the patient's clinic appointment using the available medical documentation. A clinical pharmacist evaluated findings from prescriptions and contacted an oncologist if the findings were considered clinically significant. Results A clinical pharmacist verified prescriptions from 101 patients for appropriateness and found discrepancies in four percent of the prescriptions ( n = 4/101). The oncologist approved 50 percent of the suggested amendments by the pharmacist as clinically significant ( n = 2/4). The study revealed that patient’s regular home medications were not always correctly recorded into the database, so verification of medicine interactions could not be trusted as completely accurate. It took on average 16 min per patient to perform a medication verification review. The process was slowed down by the lack of detailed enough protocols for this purpose and the current patient care record system not having structural formatting of data entry. Conclusions Verification of prescriptions provides a tool to identify prescribing discrepancies and to prevent unintended medication errors affecting patients. The development of detailed protocols and guidelines, as well as an appropriate training program, would support pharmacists in compiling clinical medication reviews for chemotherapy patients. More research is needed to further develop the operating model in Finland. Information gathered from this study can be used for identifying training requirements.

Impact of Clinical Pharmacist Mediated Discharge Counseling and SMS Reminders Service on Medication Adherence in Chronic Disorders

Aims: This study aimed to assess the effect of discharge counseling with SMS reminders on medication adherence in chronic disorders. Study Design: Prospective randomized open-label trial Place and Duration of Study: The study was conducted at the dispensing department of a secondary care referral charity hospital located in a small village. The study was conducted for a period of six months from October 2018 to April 2019. Methodology: Upon consent, a total of 364 patients were enrolled in this study and randomized into two groups viz., intervention group (n=182) and control group (n=182) respectively, with and without discharge counseling and SMS reminder on medication usage by the clinical pharmacist. The level of medication adherence was measured using a pill count and visual analog scale (VAS) methods at two follow-up visits includes baseline and final follow-up visit (gap of two months). A two-sample Wilcoxon rank‑sum (Mann–Whitney) was used to compare the statistical mean difference of medication adherence levels between two groups at each follow‑up visit. Results: The mean age of intervention and control groups were 57.1±8.55 and 58.5±8.53; most of the subjects were >60 years of age and were typically suffering from hypertension (30.2%) and diabetes (34.8%). Initially, at baseline, the values of medication adherence level (pill-count method) were closer in both intervention (82.4±7.3) and control group (81.35±6.4), whereas at follow up visits, the levels of the intervention group (93.2±6.0, 95.6±2.25) were significantly increased (p<0.0001) as compared to the control group (81.2±8.5, 80.6±8.1). Conclusion: Thus, the statistical significance infers that the clinical pharmacist-mediated discharge counseling with SMS reminders would increase medication adherence levels in chronic disorders.

Impact of Clinical Pharmacist Interventions in Management of Diabetes in Primary Care in Saudi Arabia

The study aimed to identify the impact and effectiveness of clinical pharmacist intervention on the management and overall quality of life of diabetic patients. Two cross-sectional studies using SF36 Health Survey, involving physicians and pharmacists at the Ambulatory Care Department in Riyadh, Saudi Arabia. Diabetic patients showed significant improvements in their QoL in terms of general health, energy and fatigue, pain scores, and social, emotional, and physical functions. Moreover, PC was found to have a significant impact on diabetes related QoL along with various outcome indicators, such as HbA1c, random blood sugar, and lipid profile in such patients. Additionally, satisfactory knowledge, good practice in identifying prescription errors were found among pharmacists. This study reveals that clinical pharmacists are valuable members of interdisciplinary primary care teams in ambulatory care. This can positively impact glycemic control in patients with type 2 diabetes and improve their quality of life. Also, the current study presented that a satisfactory extent of pharmaceutical care by an ambulatory clinical pharmacist was effective in improving HbA1c in patients with diabetes. A clinical pharmacist in ambulatory care was found to be eminent and of an added value to the patients, physicians, and healthcare team.