1
|
Chen Q, Wang Q, Zhang Y. Clinical Intervention Increases Rational Use of Proton Pump Inhibitors in the General Surgery Department. Front Pharmacol 2022; 13:864081. [PMID: 35548351 PMCID: PMC9083545 DOI: 10.3389/fphar.2022.864081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
This study aimed to evaluate the role of the clinical pharmacist in the rational use of proton pump inhibitors (PPIs) in a general surgery department. All enrolled patients had attended the general surgery department of a tertiary hospital. This single-center prospective study compared differences in the overall rate of rational PPI use, proportion of unindicated PPI use, utilization rate, average defined daily dose (DDD), drug costs, PPI costs, and cost-effectiveness of clinical pharmacist intervention between the intervention (538 cases) and control (536 cases) groups. In the intervention group, Pareto and fishbone diagram analyses were combined with the Plan-Do-Check-Act cycle; Statistical Package for the Social Sciences was used for analyzing all data. The overall rate of rational PPI use was significantly higher in the intervention group than in the control group (p < 0.01). The proportion of unindicated PPI use, utilization rate, average DDD, drug costs, and PPI costs were significantly lower in the intervention group than in the control group (p < 0.05). Cost-effectiveness analysis for the overall rate of rational PPI use indicated a positive impact of intervention, with economic benefits in the intervention group. Clinical pharmacist intervention for rational use of PPIs in general surgery departments could significantly increase the overall rate of rational PPI use; it could also reduce the proportion of unindicated PPI use, utilization rates, average DDDs, drug costs, and PPIs costs. Pharmacist intervention also offers economic benefits by improving the overall rate of rational PPI use.
Collapse
Affiliation(s)
- Qiying Chen
- Department of Pharmacy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Qiaohong Wang
- Department of Pharmacy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Department of Pharmacy, QuanZhou Women's and Children's Hospital, Quanzhou, China
| | - Yin Zhang
- Department of Pharmacy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| |
Collapse
|
2
|
Moukafih B, Abahssain H, Mrabti H, Errihani H, Rahali Y, Taoufik J, Chaibi A. Impact of clinical pharmacy services in a hematology/oncology ward in Morocco. J Oncol Pharm Pract 2020; 27:305-311. [PMID: 32326873 DOI: 10.1177/1078155220919169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Clinical pharmacists are contributing to safe medication use by providing comprehensive management to patients and medical staff. The aim of this study is to document and evaluate the role of clinical pharmacy services in oncology department. PATIENTS AND METHODS A prospective, descriptive, observational study was carried out from July 2018 through June 2019 at the Department of Medical Oncology at the National Institute of Oncology, Morocco. Medication reviews concerning hospitalized adult cancer patients were performed every day by the clinical pharmacist assigned to the department. RESULTS A total of 3542 prescriptions of 526 adult cancer patients were analyzed. The pharmacist identified 450 drug-related problems (12.7% of the prescriptions) primarily related to the analgesics (31.5%). Medication problems included mostly untreated indications (31.3%), overdosing (17.1%), drug-drug interactions (12.4%), underdosing (11.1%), administration omissions (6.7%), drug not indicated (6.0%), and contraindication (5.3%). Interventions (n = 450) led to drug additions (30.7%), drug dosing adjustments (27.1%), treatment discontinuations (20.0%), recall of the treatment (6.2%), replacement of a drug with another one (5.1%), administration optimization (4.0%), therapeutic drug monitoring (3.1%), alternate routes of administration (2.5%), and extension of treatment duration (1.3%). Most (98%) of the interventions were accepted and implemented by the medical staff-172 (38.2%) having a significant clinical impact on the patient, 88 (19.6%) as having a very significant clinical impact, and 71(15.8%) as having a potential vital impact. CONCLUSION This work highlights the positive clinical relevance of pharmacists' interventions in oncology and the importance of medicopharmaceutical collaboration to prevent medication error.
Collapse
Affiliation(s)
- Badreddine Moukafih
- Department of Medical Oncology, National Institute of Oncology, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Halima Abahssain
- Department of Medical Oncology, National Institute of Oncology, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Hind Mrabti
- Department of Medical Oncology, National Institute of Oncology, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Hassan Errihani
- Department of Medical Oncology, National Institute of Oncology, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Younes Rahali
- Pharmacy Department, National Institute of Oncology, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Jamal Taoufik
- Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Aicha Chaibi
- Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| |
Collapse
|
3
|
Duarte NC, Barbosa CR, Tavares MGR, Dias LP, Souza RN, Moriel P. Clinical oncology pharmacist: Effective contribution to patient safety. J Oncol Pharm Pract 2018; 25:1665-1674. [DOI: 10.1177/1078155218807748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Management and prevention of problems related to oncology drugs are particularly important due to the excessive cost, high toxicity, and narrow therapeutic index of the antineoplastic drugs, in addition to the patients' state of health. Therefore, the presence of the pharmacist as a member of the multidisciplinary team is essential to contribute to patient safety. In this work, the interventions performed were identified, quantified, and classified to characterize the work of the clinical oncology pharmacist. This is a prospective and quantitative study, conducted over a period of six months in the outpatient oncology and chemotherapy clinic of the University Hospital of the University of Campinas, Brazil. A total of 3526 medical prescriptions were evaluated for the 780 patients seen and, among these prescriptions, 220 (6.24%) contained errors, representing 6.24% of the total number. The most common error was dose-related with 79 (22.83%) cases of overdosing. Wrong-patient medication error was the least reported (0.29%). Thirty drugs were involved in the pharmaceutical interventions, Carboplatin and Ondansetron being the most frequent. Thirteen types of potential errors were evaluated according to the method proposed by Cardinal and Fernandes. Two (15.38%) included interventions of indication, contraindication, and therapeutic efficacy of a drug. Five of them (38.46%) are related to the treatment regimen, and two (15.38%) were related to prevention of potential adverse events. Four interventions (30.77%) concerned technical interventions in injectable drugs such as dilution, compatibility, and administration time. Of the 346 interventions performed, 1 (0.29%) was classified as potentially lethal, 114 as serious (32.95%), 140 as significant (40.46%), and 91 as minor (26.30%).
Collapse
Affiliation(s)
| | - Cristina R Barbosa
- Hospital das Clínicas of University of Campinas (HC-UNICAMP), Campinas, Brazil
| | - Mariane GR Tavares
- Hospital das Clínicas of University of Campinas (HC-UNICAMP), Campinas, Brazil
| | - Lara P Dias
- Hospital das Clínicas of University of Campinas (HC-UNICAMP), Campinas, Brazil
| | - Rafael N Souza
- Faculty of Pharmaceutical Sciences (FCF-UNICAMP), Campinas, Brazil
| | - Patricia Moriel
- Faculty of Pharmaceutical Sciences (FCF-UNICAMP), Campinas, Brazil
| |
Collapse
|
4
|
Malfará M, Pernassi M, Aragon D, Carlotti A. Impact of the clinical pharmacist interventions on prevention of pharmacotherapy related problems in the paediatric intensive care unit. Int J Clin Pharm 2018; 40:513-519. [PMID: 29603074 DOI: 10.1007/s11096-018-0632-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
Background Problems related to pharmacotherapy are common in patients admitted to the paediatric intensive care unit (PICU) and are associated with increased healthcare costs. Data on the impact of clinical pharmacist interventions to prevent pharmacotherapy-related problems and to minimize costs in the PICU are limited. Objectives To evaluate the number and type of clinical pharmacist interventions in the PICU and to determine cost savings associated with them. Setting a ten bed PICU of a tertiary-care university hospital in Brazil. Method This was a prospective, observational study conducted over 1-year. The Failure Mode and Effects Analysis (FMEA) tool was applied at the beginning of the study to assess drug-related risks in the PICU and to guide clinical pharmacist interventions. Main outcome measure Number and type of clinical pharmacist interventions and healthcare-related costs. Results One hundred sixty-two children were followed-up by the clinical pharmacist and 1586 prescriptions were evaluated; pharmacotherapy-related problems were identified in 12.4% of them. Sixteen of 75 failure modes identified by FMEA were potentially reduced by the clinical pharmacist interventions. There were 197 interventions with a cost saving of R$ 15,118.73 (US$ 4828.00). Clinical pharmacist interventions were related to drug interaction and therapeutic monitoring (34.5%), drug selection (22.3%), dosing and frequency (16.8%), prescription (13.2%) and administration (13.2%). Ninety-seven per cent of the clinical pharmacist interventions were accepted by the medical team. The interventions with larger cost savings were related to administration (39%). Conclusion The clinical pharmacist interventions minimized the risks of pharmacotherapy-related problems and contributed to the reduction of costs associated with medical prescription.
Collapse
Affiliation(s)
- Márcia Malfará
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Maria Pernassi
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Davi Aragon
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Ana Carlotti
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
| |
Collapse
|
5
|
Fideles GMA, de Alcântara-Neto JM, Peixoto Júnior AA, de Souza-Neto PJ, Tonete TL, da Silva JEG, Neri EDR. Pharmacist recommendations in an intensive care unit: three-year clinical activities. Rev Bras Ter Intensiva 2016; 27:149-54. [PMID: 26340155 PMCID: PMC4489783 DOI: 10.5935/0103-507x.20150026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/16/2015] [Indexed: 11/20/2022] Open
Abstract
Objective To analyze the clinical activities performed and the accepted pharmacist
recommendations made by a pharmacist as a part of his/her daily routine in an
adult clinical intensive care unit over a period of three years. Methods A cross-sectional, descriptive, and exploratory study was conducted at a tertiary
university hospital from June 2010 to May 2013, in which pharmacist
recommendations were categorized and analyzed. Results A total of 834 pharmacist recommendations (278 per year, on average) were analyzed
and distributed across 21 categories. The recommendations were mainly made to
physicians (n = 699; 83.8%) and concerned management of dilutions (n = 120;
14.4%), dose adjustment (n = 100; 12.0%), and adverse drug reactions (n = 91;
10.9%). A comparison per period demonstrated an increase in pharmacist
recommendations with larger clinical content and a reduction of recommendations
related to logistic aspects, such as drug supply, over time. The recommendations
concerned 948 medications, particularly including systemic anti-infectious
agents. Conclusion The role that the pharmacist played in the intensive care unit of the institution
where the study was performed evolved, shifting from reactive actions related to
logistic aspects to effective clinical participation with the multi-professional
staff (proactive actions).
Collapse
Affiliation(s)
| | | | | | | | - Taís Luana Tonete
- Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil
| | | | | |
Collapse
|
6
|
Okumura LM, da Silva DM, Comarella L. Relation between safe use of medicines and Clinical Pharmacy Services at Pediatric Intensive Care Units. REVISTA PAULISTA DE PEDIATRIA (ENGLISH EDITION) 2016. [PMID: 27578187 PMCID: PMC5176057 DOI: 10.1016/j.rppede.2016.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: Clinical Pharmacy Services (CPS) are considered standard of care and is endorsed
by the Joint Commission International, the American Academy of Pediatrics, and the
American College of Clinical Pharmacy. In Brazil, single experiences have been
discreetly arising and the importance of these services to children and
adolescents care has led to interesting results, but certainly are under reported.
This short report aims to discuss the effect of implementing a bedside CPS at a
Brazilian Pediatric Intensive Care Unit (PICU). Methods: This is a cross-sectional study conducted in a 12 bed PICU community hospital,
from Campo Largo/Brazil. Subjects with<18 years old admitted to PICU were
included for descriptive analysis if received a CPS intervention. Results: Of 53 patients accompanied, we detected 141 preventable drug-related problems
(DRPs) which were solved within clinicians (89% acceptance of all interventions).
The most common interventions performed to improve drug therapy included:
preventing incompatible intravenous solutions (21%) and a composite of inadequate
doses (17% due to low, high and non-optimized doses). Among the top ten
medications associated with DRPs, five were antimicrobials. By analyzing the
correlation between DRPs and PICU length of stay, we found that 74% of all
variations on length of stay were associated with the number of DRPs. Conclusions: Adverse drug reactions due to avoidable DRPs can be prevented by CPS in a
multifaceted collaboration with other health care professionals, who should
attempt to use active and evidence-based strategies to reduce morbidity related to
medications.
Collapse
|
7
|
Okumura LM, Silva DMD, Comarella L. Relation between safe use of medicines and Clinical Pharmacy Services at Pediatric Intensive Care Units. REVISTA PAULISTA DE PEDIATRIA 2016; 34:397-402. [PMID: 27578187 DOI: 10.1016/j.rpped.2016.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/11/2016] [Accepted: 03/17/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Clinical Pharmacy Services (CPS) are considered standard of care and they are endorsed by the Joint Commission International, the American Academy of Pediatrics, and the American College of Clinical Pharmacy. In Brazil, single experiences have been discreetly arising and the importance of these services to children and adolescents care has led to interesting results, but certainly are under reported. This short report aims to discuss the effect of implementing a bedside CPS at a Brazilian Pediatric Intensive Care Unit (PICU). METHODS This is a cross-sectional study conducted in a 12 bed PICU community hospital, from Campo Largo/Brazil. Subjects with<18 years old admitted to PICU were included for descriptive analysis if received a CPS intervention. RESULTS Of 53 patients accompanied, we detected 141 preventable drug-related problems (DRPs) which were solved within clinicians (89% acceptance of all interventions). The most common interventions performed to improve drug therapy included: preventing incompatible intravenous solutions (21%) and a composite of inadequate doses (17% due to low, high and non-optimized doses). Among the top ten medications associated with DRPs, five were antimicrobials. By analyzing the correlation between DRPs and PICU length of stay, we found that 74% of all variations on length of stay were associated with the number of DRPs. CONCLUSIONS Adverse drug reactions due to avoidable DRPs can be prevented by CPS in a multifaceted collaboration with other health care professionals, who should attempt to use active and evidence-based strategies to reduce morbidity related to medications.
Collapse
|
8
|
Haga CS, Mancio CM, Pioner MDC, Alves FADL, Lira AR, Silva JSD, Ferracini FT, Borges Filho WM, Guerra JCDC, Laselva CR. Implementation of vertical clinical pharmacist service on venous thromboembolism prophylaxis in hospitalized medical patients. EINSTEIN-SAO PAULO 2014; 12:27-30. [PMID: 24728242 PMCID: PMC4898235 DOI: 10.1590/s1679-45082014ao2526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 02/03/2014] [Indexed: 11/28/2022] Open
Abstract
Objective: To describe the vertical clinical pharmacist service's interventions in prevention of venous thromboembolism. Methods: This prospective study was done at a private hospital. From January to May 2012, the clinical pharmacist evaluated medical patients without prophylaxis for thromboembolism. If the patient fulfilled criteria for thromboembolism and did not have contraindications, the clinical pharmacist suggested inclusion of pharmacologic agents and/or mechanical methods for venous thromboembolism prevention. In addition, the appropriate dose, route of administration, duplicity and replacement of the drug were suggested. Results: We evaluated 9,000 hospitalized medical patients and carried out 77 pharmaceutical interventions. A total of 71 cases (92.21%) adhered to treatment so that non-adherence occurred in 6 cases (7.79%). In 25 cases pharmacologic agents were included and in 20 cases mechanical prophylaxis. Dose adjustments, route, frequency, duplicity and replacement made up 32 cases. Conclusion: The vertical clinical pharmacist service included the prophylaxis for venous thromboembolism and promotion of appropriate use of medicines in the hospital.
Collapse
|