Clinical pharmaceutical screening in critical situations in a radioiodine therapy management service

Radioiodine therapy can be used in differentiated thyroid carcinoma and requires extensive evaluation to ensure effectiveness and safety. Therefore, it is necessary to evaluate all health problems and medications used in the pre-radioiodine therapy period and comprehensive medication managementservices can serve as a screening tool in this context. The present study aims to describe critical clinical situations identified during the initial assessments of a comprehensive medication management service offered to differentiated thyroid carcinoma patients pre-radioiodine therapy, and the pharmaceutical interventions performed to solve them. A descriptive study with regard to the initial ten months of a comprehensive medication management service was carried out in a large oncology hospital (Rio de Janeiro, Brazil). Descriptive analysis was used to describe the critical clinical situations identified, as well as the correspondent drug therapy problems and the type, acceptability, and outcomes of the pharmaceutical interventions performed to solve them. Thirty patients with an average of 45.8 years and 5.1 medications were evaluated. Five critical clinical situations were identified; corresponding to drug therapy problems two(needs additional drug therapy – n = 4) and drug therapy problems four (dosage too low – n = 1). All pharmaceutical interventions were accepted. The comprehensive medication management service provision pre-radioiodine therapy is feasible and represents an important screening strategy.

Reporting Medication Errors and Drug Therapy Problems Through the Egyptian National Electronic Reporting System in 56 Governmental Hospitals during 2019

Introduction Several countries have adopted national reporting systems of medication errors such as in the UK and the USA. Egypt has a new national reporting system of medication error (MEs) & drug therapy problems (DTPs), the NO HARMe (the National Office for Handling And Reduction of Medication errors) since October 2017. Objectives To determine the most common types of MEs and DTPs encountered by clinical pharmacists as the NO HARMe users in governmental hospitals. Methodology We conducted a cross-sectional survey using a self-administered online questionnaire in fifty-six governmental hospitals where clinical pharmacists use the NO HARMe, from October to December 2019. Results Most (96%) of the 206 participating clinical pharmacists were females with a mean age of 32.8 years (SD 4.32). The most common departments where participants worked are adult ICU (32.5%), neonatal ICU (14.6%), pediatric ICU (7%), and internal medicine (5%). The most common types of DTPs & MEs reported by clinical pharmacists were inappropriate doses or dosing intervals (38.3%), drugs with no valid indications (25.2%), antibiotics without indication (17.5%), and inappropriate selection of an antibiotic (13.6%). Conclusion Medication errors in drug dosing are prevalent in the hospitals included in this study. Also, drugs that are prescribed without need, while errors in antibiotics were very common in many hospitals either prescribed for no need or selected inappropriately.

A survey of pharmacists' knowledge, attitudes and barriers in pharmaceutical care concept in Poland

Background The major goals of pharmaceutical care (PC) are to improve the patient’s quality of life and ensure safety of pharmacotherapy. Inclusion of a pharmacist in the multidisciplinary team caring for the patient and integration of state-of-the-art pharmaceutical services with medical care and nursing are some of the most important challenges that the health care system in Poland is facing. Objectives To evaluate the pharmacists attitudes towards practice in, and knowledge of PC in Poland and to identify the barriers in PC provision. Methods The study was designed as a multicenter study, conducted among Polish pharmacists. Random sampling technique was employed to select the study group. Face-to-face questionnaire method was used to interview the pharmacists, upon obtaining their prior verbal consent to participate in the study. The study was conducted between January 2017 and September 2019. Results Only 15% of the pharmacists have ever attended a training on PC. 72% believed PC provision was necessary to ensure pharmacotherapy safety. Only 63% of the pharmacists believed that preventing and solving health-related and drug therapy problems for patients were their responsibilities. The main reason for non-provision of PC by the pharmacists was the lack of time for such activities, lack of legal regulations, lack of organizational facilities. Conclusion This study indicates that implementation of PC is expected in Poland. Educational programs in this respect are urgently needed. PC provision should be included in the curricula of academic pharmaceutical courses.

Impact of medication therapy management service on selected clinical and humanistic outcomes in the ambulatory diabetes patients of Tikur Anbessa Specialist Hospital, Addis Ababa, Ethiopia

Background Diabetes mellitus (DM) patients are at increased risk of developing drug therapy problems (DTPs). The patients had a variety of comorbidities and complications, and they were given multiple medications. Medication therapy management (MTM) is a distinct service or group of services that optimize therapeutic outcomes for individual patients. The study assessed the impact of provision of MTM service on selected clinical and humanistic outcomes of diabetes patients at the diabetes mellitus clinic of Tikur Anbessa Specialized Hospital (TASH). Methods A pre-post interventional study design was carried out at DM clinic from July 2018 to April 2019. The intervention package included identifying and resolving drug therapy problems, counseling patients in person at the clinic or through telephone calls, and providing educational materials for six months. This was followed by four months of post-intervention assessment of clinical outcomes, DTPs, and treatment satisfaction. The interventions were provided by pharmacist in collaboration with physician and nurse. The study included all adult patients who had been diagnosed for diabetes (both type I & II) and had been taking anti-diabetes medications for at least three months. Patients with gestational diabetes, those who decided to change their follow-up clinic, and those who refused to participate in the study were excluded. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Descriptive statistics, t-test, and logistic regressions were performed for data analyses. Results Of the 423 enrolled patients, 409 fulfilled the criteria and included in the final data analysis. The intervention showed a decrease in average hemoglobin A1c (HbA1c), fasting blood sugar (FBS), and systolic blood pressure (SBP) by 0.92%, 25.04 mg/dl, and 6.62 mmHg, respectively (p<0.05). The prevalence of DTPs in the pre- and post-intervention of MTM services was found to be 72.9% and 26.2%, respectively (p<0.001). The overall mean score of treatment satisfaction was 90.1(SD, 11.04). Diabetes patients of age below 40 years (92.84 (SD, 9.54)), type-I DM (93.04 (SD, 9.75)) & being on one medication regimen (93.13(SD, 9.17)) had higher satisfaction score (p<0.05). Conclusion Provision of MTM service had a potential to reduce DTPs, improve the clinical parameters, and treatment satisfaction in the post-intervention compared to the pre-intervention phase.

Frequency of polypharmacy and drug interactions in inpatients in the emergency department, Southwest of Iran

This study aimed to evaluate the polypharmacy extent and the frequency and severity of drug interactions by evaluating inpatients in the emergency department. In this epidemiologicaldescriptive study, data were collected retrospectively by reviewing medical records of 92 hospitalized patients in the emergency department with a stay over 48 hours. Out of the study population, 54.3% and 45.7% were respectively male and female, with a mean age of 59.09. In terms of hospitalization, 27.2% and 16.3% were hospitalized due to heart problems and trauma, respectively and the mean length of hospitalization was 3.91 with a standard deviation of 2.57 days. The mean drug received was 8.48, with a standard deviation of 4.48. Of the patients, 81.5% received more than 5 drugs; in addition, the observed amounts of drug interactions of A, B, C, D, and X were 2.5%, 17%, 59.3%, 19.5%, and 1.9%, respectively. The drug interaction prevalence in inpatients in the emergency department was high. The presence of a pharmacist is necessary to identify drug interactions and reduce drug-therapy problems to provide quality services.

Assessment of knowledge, attitude and practice among hypertension patients at tertiary care hospital on drugs

Drug therapy problems are significant for the pharmaceutical care practitioner. The evaluation of drug therapy problems is the target of the assessment and shows the major decisions made in that step of the patient care process. Although drug therapy problem evaluation is technically part of the assessment procedure, it performs the very particular input made by pharmaceutical care practitioners. The prospective observational study was conducted at the Cardiology department with 450 hypertension patient based on Inclusion and exclusion criteria. The data collection form was administered after getting the Consent form. The data were analyzed by using SPSS software. A total of 450 HTN patients were included in the study & only 402 patients of them enrolled in the study as per the inclusion & Exclusion criteria stated in the protocol. In this study, 452 Interventions were performed & documented for both drug therapy 35.84% (n=162) & health education 64.15% (n=290). These interventions were equally distributed among the patients. Drug therapy-related intervention was solved amid adjustment of medication chart in HTN patients. The study sealed that pharmaceutical care Intervention is a basic device to enhance BP management in HTN patients. The role of Clinical pharmacist is essential to improve the knowledge of patient for better treatment outcome.