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Currey EM, Falconer N, Isoardi KZ, Barras M. Impact of pharmacists during in-hospital resuscitation or medical emergency response events: A systematic review. Am J Emerg Med 2024; 75:98-110. [PMID: 37939522 DOI: 10.1016/j.ajem.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/11/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND We sought to determine the impact of the presence of a pharmacist on medication and patient related outcomes during the emergency management of critically ill patients requiring resuscitation or medical emergency response team care in a hospital setting. METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of databases from January 1995 to April 2023 was conducted to identify studies of contemporary pharmacist practice. Results were extracted and analysed for included studies, those evaluating the impact of the presence of a pharmacist on medication and patient related outcomes during the emergency management of critically ill hospitalised patients requiring resuscitation or medical emergency response team care. To determine risk of bias, the Newcastle-Ottowa Quality Assessment scale was used for non-randomised studies and the Revised Cochrane risk-of-bias tool for randomised trials. RESULTS Of 1345 studies identified, 54 were selected for full text review, and 30 were included in the final analysis. There were 29 cohort studies and one randomised controlled trial. The studies reported the impact of a pharmacist for a variety of patient presentations. The study team assigned each study to one of eight patient cohorts: acute stroke, cardiac arrest, rapid response calls, S-T segment elevation myocardial infarction, acute haemorrhage, major trauma resuscitation, sepsis and status epilepticus. The most frequently reported outcome, associated with a statistically significant benefit in 23 studies, was time to medication administration. Few studies reported a significant difference in patient outcome measures such as mortality. Only 8 of the 30 studies were assessed to have a low risk of bias. CONCLUSIONS The results of this systematic review provide support for a beneficial impact of a pharmacist presence and intervention during resuscitation or medical emergency response team care, with significant improvements in outcomes such as time to initiation of time-critical medications, medication appropriateness and guideline compliance. However, studies were predominantly small and retrospective and were not powered to detect differences in patient related measures such as length of stay and mortality. Future research should investigate the clinical impacts of the pharmacist in ED resuscitation settings in controlled, prospective studies with robust sampling methods.
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Affiliation(s)
- Elizabeth M Currey
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia.
| | - Nazanin Falconer
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia.
| | - Katherine Z Isoardi
- Emergency Department and Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Newcastle, Newcastle, NSW, Australia.
| | - Michael Barras
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia; School of Medicine, University of Newcastle, Newcastle, NSW, Australia.
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2
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Jang HY, Kim YS, Oh JM. Clinical Effectiveness of Renal Transplant Outpatient Pharmaceutical Care Services in Korea. Healthcare (Basel) 2023; 11:2597. [PMID: 37761794 PMCID: PMC10531252 DOI: 10.3390/healthcare11182597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The necessity and importance of pharmaceutical care services (PCS) are well recognized, yet the concept and scope of PCS have not yet been clearly defined in Korea, particularly in kidney transplantation outpatient clinics. AIM The main purpose of this study is to evaluate whether PCS is effective in the outpatient setting for kidney transplant patients. METHODS For three years, a clinical pharmacist provided PCS to kidney transplant patients in an outpatient setting to evaluate the clinical effectiveness of PCS. RESULTS A total of 302 patients were matched in a 1:1 ratio, with 151 in the PCS group and 151 in the control group. These patients were followed, and a total of 476 interventions were provided to them, including medication reconciliation (n = 113, 23.7%), medication evaluation and management (n = 186, 39.1%), and pharmaceutical care transition (n = 177, 37.2%) services. The estimated glomerular filtration rate (eGFR) exhibited a notable difference between the control and PCS groups when comparing the pre- and post-study periods measurements. In the control group, there was a decline of 7.0 mL/min/1.73 m2 in eGFR. In contrast, the PCS group showed a smaller decline of 2.5 mL/min/1.73 m2 (p = 0.03). The adjusted odds ratio for end stage renal disease development in the PCS group was 0.51 (95% confidence interval: 0.26-0.96), indicating a significantly lower risk compared to the control group. CONCLUSION Our study highlights the promising potential of PCS implementation in kidney transplantation outpatient clinics. Further research is needed to validate and expand upon these findings, especially in diverse clinical settings.
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Affiliation(s)
- Ha Young Jang
- College of Pharmacy, Gachon University, Incheon 21936, Republic of Korea;
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea;
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jung Mi Oh
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
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3
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Viudez‐Martínez A, Ramírez‐López A, López‐Nieto J, Climent‐Grana E, Riera G. Antiparkinsonian Medication Reconciliation as a Strategy to Improve Safety by Preventing Medication Errors. Mov Disord Clin Pract 2023; 10:1090-1098. [PMID: 37476316 PMCID: PMC10354616 DOI: 10.1002/mdc3.13789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 07/22/2023] Open
Abstract
Background About 70% of neurologists report that PD patients do not get their medication properly when hospitalized, and 33% are prescribed contraindicated drugs. Objectives To execute medication reconciliation (MedRec) focused on antiparkinsonian drugs to identify, characterize and, eventually, prevent medication errors, thus promoting therapeutic quality and safety in daily practice. Methods An interventional, single-center, 1 year, prospective study. All the patients who were hospitalized and had, at least, one active prescription containing an antiparkinsonian drug at hospital admission were included. MedRec was performed by following a three-phased check: inpatient electronic prescription validation after assessing the outpatient medication schedule, review of the latest clinical report emitted by the Neurology Department/General Practitioner, and pharmacist-driven interview of the patient and/or caregiver to confirm the information regarding medication gathered. Results A total of 171 admission episodes from 132 patients were registered (February 1, 2021, and January 31, 2022). Of 224 prescription lines involving antiparkinsonian drugs, 179 contained, at least, one medication error (59.8%). Commission errors (91.62%) were more frequent than omitted drugs (8.38%). The most common medication errors were related to timing (41.90%), frequency (21.23%), and dosing (19.55%). The implementation of this program prevented the erroneous administration of 2716 antiparkinsonian doses, 60% of the total number of doses prescribed. Interestingly, a significant relationship between the number of medication errors and having levodopa prescribed was evidenced (P < 0.05). A contraindicated drug was prescribed in almost one-third of the episodes (29.82%). Conclusions Clinical pharmacists' implementation of an antiparkinsonians reconciliation program sharply reduced medication errors and prescription of contraindicated drugs.
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Affiliation(s)
- Adrián Viudez‐Martínez
- Pharmacy DepartmentInstituto Investigación Biomédica y Sanitaria de Alicante (ISABIAL) Hospital General Universitario Dr. BalmisAlicanteSpain
| | - Ana Ramírez‐López
- Pharmacy DepartmentInstituto Investigación Biomédica y Sanitaria de Alicante (ISABIAL) Hospital General Universitario Dr. BalmisAlicanteSpain
| | - Javier López‐Nieto
- Pharmacy DepartmentInstituto Investigación Biomédica y Sanitaria de Alicante (ISABIAL) Hospital General Universitario Dr. BalmisAlicanteSpain
| | - Eduardo Climent‐Grana
- Pharmacy DepartmentInstituto Investigación Biomédica y Sanitaria de Alicante (ISABIAL) Hospital General Universitario Dr. BalmisAlicanteSpain
| | - Gerónima Riera
- Pharmacy DepartmentInstituto Investigación Biomédica y Sanitaria de Alicante (ISABIAL) Hospital General Universitario Dr. BalmisAlicanteSpain
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4
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Ranchon F, Chanoine S, Lambert-Lacroix S, Bosson JL, Moreau-Gaudry A, Bedouch P. Development of artificial intelligence powered apps and tools for clinical pharmacy services: A systematic review. Int J Med Inform 2023; 172:104983. [PMID: 36724730 DOI: 10.1016/j.ijmedinf.2022.104983] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/15/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Artificial Intelligence (AI) offers potential opportunities to optimize clinical pharmacy services in community or hospital settings. The objective of this systematic literature review was to identify and analyse quantitative studies using or integrating AI for clinical pharmacy services. MATERIALS AND METHODS A systematic review was conducted using PubMed/Medline and Web of Science databases, including all articles published from 2000 to December 2021. Included studies had to involve pharmacists in the development or use of AI-powered apps and tools.. RESULTS 19 studies using AI for clinical pharmacy services were included in this review. 12 out of 19 articles (63.1%) were published in 2020 or 2021. Various methodologies of AI were used, mainly machine learning techniques and subsets (natural language processing and deep learning). The datasets used to train the models were mainly extracted from electronic medical records (6 studies, 32%). Among clinical pharmacy services, medication order review was the service most targeted by AI-powered apps and tools (9 studies), followed by health product dispensing (4 studies), pharmaceutical interviews and therapeutic education (2 studies). The development of these tools mainly involved hospital pharmacists (12/19 studies). DISCUSSION AND CONCLUSION The development of AI-powered apps and tools for clinical pharmacy services is just beginning. Pharmacists need to keep abreast of these developments in order to position themselves optimally while maintaining their human relationships with healthcare teams and patients. Significant efforts have to be made, in collaboration with data scientists, to better assess whether AI-powered apps and tools bring value to clinical pharmacy services in real practice.
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Affiliation(s)
- Florence Ranchon
- CNRS, TIMC UMR5525, MESP, Université Grenoble Alpes, F-38041 Grenoble, France; Hospices Civils de Lyon, Hôpital Lyon Sud, unité de pharmacie clinique oncologique, Pierre-Bénite, France; Université Lyon-1, EA 3738 CICLY, Oullins cedex F-69921, France.
| | - Sébastien Chanoine
- CNRS, TIMC UMR5525, MESP, Université Grenoble Alpes, F-38041 Grenoble, France; Pôle Pharmacie, CHU Grenoble Alpes, F-38043 Grenoble, France; Université Grenoble Alpes, Faculté de Pharmacie, F-38041 Grenoble, France
| | | | - Jean-Luc Bosson
- CNRS, TIMC UMR5525, MESP, Université Grenoble Alpes, F-38041 Grenoble, France
| | | | - Pierrick Bedouch
- CNRS, TIMC UMR5525, MESP, Université Grenoble Alpes, F-38041 Grenoble, France; Pôle Pharmacie, CHU Grenoble Alpes, F-38043 Grenoble, France; Université Grenoble Alpes, Faculté de Pharmacie, F-38041 Grenoble, France
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5
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Zhang S, Wu H, Wang L, Zhang G, Rocha LM, Shatkay H, Li L. Translational drug-interaction corpus. Database (Oxford) 2022; 2022:baac031. [PMID: 35616099 PMCID: PMC9216474 DOI: 10.1093/database/baac031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/07/2022] [Accepted: 05/06/2022] [Indexed: 12/01/2022]
Abstract
The discovery of drug-drug interactions (DDIs) that have a translational impact among in vitro pharmacokinetics (PK), in vivo PK and clinical outcomes depends largely on the quality of the annotated corpus available for text mining. We have developed a new DDI corpus based on an annotation scheme that builds upon and extends previous ones, where an abstract is fragmented and each fragment is then annotated along eight dimensions, namely, focus, polarity, certainty, evidence, directionality, study type, interaction type and mechanism. The guideline for defining these dimensions has undergone refinement during the annotation process. Our DDI corpus comprises 900 positive DDI abstracts and 750 that are not directly relevant to DDI. The abstracts in corpus are separated into eight categories of DDI or non-DDI evidence: DDI with pharmacokinetic (PK) mechanism, in vivo DDI PK, DDI clinical, drug-nutrition interaction, single drug, not drug related, in vitro pharmacodynamic (PD) and case report. Seven annotators, three annotators with drug-interaction research experience and four annotators with less drug-interaction research experience independently annotated the DDI corpus, where two researchers independently annotated each abstract. After two rounds of annotations with additional training in between, agreement improved from (0.79, 0.96, 0.86, 0.70, 0.91, 0.65, 0.78, 0.90) to (0.93, 0.99, 0.96, 0.94, 0.95, 0.93, 0.96, 0.97) for focus, certainty, evidence, study type, interaction type, mechanisms, polarity and direction, respectively. The novice-level annotators improved from 0.83 to 0.96, while the expert-level annotators stayed in high performance with some improvement, from 0.90 to 0.96. In summary, we achieved 96% agreement among each pair of annotators with regard to the eight dimensions. The annotated corpus is now available to the community for inclusion in their text-mining pipelines. Database URL https://github.com/zha204/DDI-Corpus-Database/tree/master/DDI%20corpus.
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Affiliation(s)
- Shijun Zhang
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210, USA
| | - Hengyi Wu
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Lei Wang
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210, USA
| | - Gongbo Zhang
- Department of Computer and Information Sciences, University of Delaware, 101 Smith Hall, 18 Amstel Ave, Newark, DE 19716, USA
| | - Luis M Rocha
- School of Informatics & Computing, Indiana University, 919 E 10th St, Bloomington, IN 47408, USA
| | - Hagit Shatkay
- Department of Computer and Information Sciences, University of Delaware, 101 Smith Hall, 18 Amstel Ave, Newark, DE 19716, USA
| | - Lang Li
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210, USA
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6
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Durand A, Gillibert A, Membre S, Mondet L, Lenglet A, Mary A. Acceptance Factors for In-Hospital Pharmacist Interventions in Daily Practice: A Retrospective Study. Front Pharmacol 2022; 13:811289. [PMID: 35401242 PMCID: PMC8984177 DOI: 10.3389/fphar.2022.811289] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/07/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction: Performing pharmacist interventions (PIs) during the medication review helps to improve the quality of care. The acceptance by the physician of these PIs is a good indicator of the quality of this clinical pharmacy activity. The objective of this study was to determine, in the Amiens-Picardie teaching hospital (France), factors of acceptance in a variable environment of activity (central pharmacy, in the care units, computer assisted). Methods: All PIs transcribed by pharmacists on the Act-IP© site between November 2018 and April 2019 were analyzed using a complementary search in patient records. The environment, type, and clinical impact on patient health of each PI was collected. Linear mixed-effects models with a random pharmacist intercept were used to investigate the relationship between PI modalities and their chance of being accepted. Results: A total of 3,100 PIs were traced, of which 2,930 had been followed over time. Of these, 2,930 PIs, 1,504 (51.3%) were performed by a postgraduate pharmacist and 1,426 (48.7%) by a pharmacy resident, 1,623 (55.4%) were performed by verbal exchange, 455 (15.5%) by telephone, 846 (28.9%) by computer software, and 6 (0.2%) by paper. The clinical impact on patient health was major for 976 PIs (33.3%) and vital for 26 PIs (0.9%). According to the Anatomical Therapeutic Chemical Classification (ATC), they were mainly related to anti-infectives (30.3%), the nervous system (18.7%), and blood and blood-forming organs (17.3%). In total, 2,415 PIs (82.4%) were accepted. According to the multivariate model, a PI was more often accepted when it was transmitted orally rather than by software (+27.7%, 95% CI: +23.2 to +32.1%) and when it was transmitted to a medical resident rather than a postgraduate physician (+4.4%, 95% CI: 1.2-7.6%). In these cases, there was a major rather than a moderate clinical impact on patient health (+4.3%, 95% CI: +1.1-+7.6%). Conclusion: This study highlights the importance of the quality of the exchange with the prescriber and the prioritization of high-risk interventions as key points of medication review to improve rate of pharmacist interventions accepted by physician.
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Affiliation(s)
- Amaury Durand
- Department of Pharmacy, Amiens-Picardie Teaching Hospital, Amiens, France.,Department of Pharmacy, Intercommunal Hospital of the Baie de Somme, Saint Valery sur Somme, France
| | - André Gillibert
- Department of Biostatistics, Rouen Teaching Hospital, Rouen, France
| | - Sophie Membre
- Department of Pharmacy, Amiens-Picardie Teaching Hospital, Amiens, France
| | - Lisa Mondet
- Department of Pharmacy, Amiens-Picardie Teaching Hospital, Amiens, France
| | - Aurélie Lenglet
- Department of Pharmacy, Amiens-Picardie Teaching Hospital, Amiens, France
| | - Aurélien Mary
- Department of Pharmacy, Amiens-Picardie Teaching Hospital, Amiens, France
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7
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Hefti E, Wei B, Engelen K. Access to Telepharmacy Services May Reduce Hospital Admissions in Outpatient Populations During the COVID-19 Pandemic. Telemed J E Health 2022; 28:1324-1331. [PMID: 35020478 PMCID: PMC9508445 DOI: 10.1089/tmj.2021.0420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Introduction: Avoidable hospital admissions put increased pressure on already strained health care resources, causing emotional and financial distress for patients and their families while taxing the health system. Pharmacist involvement in patient care has been shown to improve health care outcomes. Telepharmacy allows for personalized interaction and access to pharmacy services in a flexible format. The primary aim of this report is to explore the impact that access to a personalized telepharmacy service has on the hospital admission rate in an outpatient population before and during the COVID-19 pandemic. Materials and Methods: A retrospective, double-arm cohort study was performed. Hospital admission rates were analyzed in two similarly aged groups; one group (n = 2,242) had access to telepharmacy services through their primary care provider and another group did not (n = 1,540), from 2019 to 2020. Statistical analysis was performed to explore hospitalization rates in both groups. Results: An increase in hospitalization rates was observed in both groups of patients from 2019 to 2020. The patient group that had access to the telepharmacy service demonstrated a reduced rise in hospitalization rates versus the group without access to the telepharmacy service (access group +12.9% vs. nonaccess group +40.2%, p < 0.05, Student's t-test). Discussion: The patient group with access to telepharmacy services demonstrated a reduced increase in hospitalizations versus the group without access in 2020. While this represents a preliminary investigation into the potential impacts of telepharmacy on hospitalization rates, telepharmacy services may have a role in improving patient outcomes and cost savings.
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Affiliation(s)
- Erik Hefti
- Department of Pharmaceutical Sciences, Harrisburg University of Science and Technology, Harrisburg, Pennsylvania, USA.,RxLive, Inc., St. Petersburg, Florida, USA
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8
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McGinnis C, Kim C, Qureshi A, Scholle C, Ramanan R. Evaluation and Perception of Clinical Pharmacist Participation in a Rapid Response Team During Cardiopulmonary Resuscitation. Qual Manag Health Care 2022; 31:34-37. [PMID: 34694255 DOI: 10.1097/qmh.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The addition of a pharmacist to rapid response teams (RRT) has been shown to improve adherence to advanced cardiac life support protocols and to decrease mortality. A quality improvement study was initiated at a single center to evaluate the addition of a pharmacist to the RRT during cardiopulmonary arrest. METHODS Data were prospectively collected on pharmacy response time and interventions performed. In addition, a pre- and post-intervention survey of the interprofessional medical emergency response improvement team (MERIT) was performed to assess the perception of pharmacist involvement. RESULTS From April to November 2019, the pharmacists responded to 19 RRT activations for cardiopulmonary arrest. An average of 29.8 minutes were spent at each event and an average of 5.5 interventions per event were made. The most common intervention made by pharmacists was medication procurement (54 interventions), followed by providing drug information (14 interventions). Pharmacists also ensured medication reimbursement (13 interventions). The majority of the MERIT strongly agreed or agreed that the addition of a pharmacist to RRT activations improved teamwork (83.1%), decreased medication turnaround time (84.6%), decreased medication errors (66.7%), and may have prevented a poor outcome (71.8%) in the post-implementation survey. CONCLUSION Overall, pharmacists demonstrated value as a member of the RRT during cardiopulmonary arrest. The addition of a pharmacist was well received by interprofessional members of the MERIT.
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Affiliation(s)
- Cory McGinnis
- UPMC Presbyterian Department of Pharmacy, Pittsburgh, Pennsylvania (Drs McGinnis and Kim); UPMC Presbyterian Department of Critical Care Medicine, Pittsburgh, Pennsylvania (Drs Qureshi and Ramanan); and UPMC Presbyterian Department of Nursing, Pittsburgh, Pennsylvania (Ms Scholle)
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9
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Ortmann MJ, Johnson EG, Jarrell DH, Bilhimer M, Hayes BD, Mishler A, Pugliese RS, Roberson TA, Slocum G, Smith AP, Yabut K, Zimmerman DE. ASHP Guidelines on Emergency Medicine Pharmacist Services. Am J Health Syst Pharm 2021; 78:261-275. [PMID: 33480409 DOI: 10.1093/ajhp/zxaa378] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Daniel H Jarrell
- Department of Pharmacy, Banner - University Medical Center Tucson, Tucson, AZ.,Department of Pharmacy Practice and Science, The University of Arizona, Tucson, AZ
| | - Matt Bilhimer
- Department of Pharmacy, Olathe Medical Center, Olathe, KS
| | - Bryan D Hayes
- Department of Emergency Medicine, Harvard Medical School, Boston, MA.,Department of Pharmacy, Massachusetts General Hospital, Boston, MA
| | - Aimee Mishler
- Department of Pharmacy, Valleywise Health, Phoenix, AZ
| | - Robert S Pugliese
- Department of Pharmacy, Thomas Jefferson University Hospital, Philadelphia, PA.,Department of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | - Taylor A Roberson
- Department of Pharmacy, OhioHealth Grant Medical Center, Columbus, OH
| | - Giles Slocum
- Department of Pharmacy and Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Andrew P Smith
- Department of Pharmacy, Scripps Mercy Hospital, San Diego, CA
| | - Katie Yabut
- Department of Pharmacy, Legacy Mount Hood Medical Center, Portland, OR
| | - David E Zimmerman
- Department of Pharmacy, Duquesne University School of Pharmacy, Pittsburgh, PA.,Department of Pharmacy, UPMC-Mercy, Pittsburgh, PA
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10
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Arredondo E, Udeani G, Horseman M, Hintze TD, Surani S. Role of Clinical Pharmacists in Intensive Care Units. Cureus 2021; 13:e17929. [PMID: 34660121 PMCID: PMC8513498 DOI: 10.7759/cureus.17929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 01/22/2023] Open
Abstract
The cost of health care has been rising in the United States and globally and will continue to increase. Intensive care unit (ICU) care carries a significant portion of the cost for the hospitals. The Institute of Medicine and subsequent studies have suggested that medication errors account for significant morbidity, mortality, and cost, frequently encountered in the ICU. Over the past three decades, clinical pharmacists have emerged from dispensing medication to getting involved in direct patient care and have become an integral part of the multidisciplinary critical care team. Clinical pharmacists play a significant role in reducing medication errors and costs, medication reconciliation, antibiotic stewardship, and patient and health care provider education. This review will discuss the health care and ICU cost, the evolving role of clinical pharmacists in managing critically ill patients, and their contributions in the ICU to mitigate the risks, improve patient outcomes, and decrease health care costs.
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Affiliation(s)
- Enrique Arredondo
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - George Udeani
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - Michael Horseman
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - Trager D Hintze
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - Salim Surani
- Anesthesiology, Mayo Clinic, Rochester, USA
- Medicine, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
- Medicine, University of North Texas, Dallas, USA
- Internal Medicine, Pulmonary Associates, Corpus Christi, USA
- Clinical Medicine, University of Houston, Houston, USA
- Medicine, College of Medicine, Texas A&M Health Science Center, Bryan, USA
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11
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Salsbury LE, Lovering S, Nguyen T, Yung J, Wentzell J. Optimizing Pharmacy Learner Rotations to Improve Clinical Productivity: A Study to Assess 3 Pharmacy Layered Learning Practice Models in an Inpatient Tertiary Care Oncology Unit. Can J Hosp Pharm 2021; 74:282-290. [PMID: 34248169 DOI: 10.4212/cjhp.v74i3.3156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Lauren Ellie Salsbury
- , BSc(Hons), BScPhm, ACPR, was, at the time of this study, with The Ottawa Hospital, Ottawa, Ontario. She is now with the Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Stephanie Lovering
- , BSc(Hons), BScPhm, PharmD, ACPR, is with The Ottawa Hospital, Ottawa, Ontario
| | - Tiffany Nguyen
- , BScPhm, ACPR, BCOP, is with The Ottawa Hospital and the Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Jason Yung
- , BMSc, PharmD, ACPR is with the University Health Network, Toronto, Ontario
| | - Jason Wentzell
- , BScPhm(Hons), ACPR, BCOP, MHM, is with the Ottawa Hospital Research Institute, and Extend Pharmacy, Ottawa, Ontario, and the School of Pharmacy, University of Waterloo, Kitchener, Ontario
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12
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Hilgarth H, Baehr M, Kluge S, König C. [Pharmacological/pharmaceutical counseling in intensive care medicine]. Med Klin Intensivmed Notfmed 2021; 116:173-184. [PMID: 33528630 DOI: 10.1007/s00063-020-00767-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022]
Abstract
Adequate pharmacotherapy in critically ill patients is challenging for many clinicians. Disease-related pathophysiological changes often lead to complex therapy strategies including many intensive care treatments (e.g. invasive ventilation, renal replacement therapy). These measures often influence drug prescribing and dosing. Therefore, in organ dysfunction such as renal and liver impairment reduced drug elimination has to be considered by adapting drug dosing towards elimination rates. Moreover, as intensive care medicine often includes the use of multiple drugs the risk for drug-drug interactions increases. The current article gives an overview about the complexity of individual pharmacotherapy in intensive care units whilst providing information for its clinical implementation.
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Affiliation(s)
- H Hilgarth
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland. .,Klinikapotheke, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - M Baehr
- Klinikapotheke, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - C König
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.,Klinikapotheke, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Shapiro NL, Lin H, Lau AH. Creation and delivery of a clinical pharmacy practice and education program for international participants in the United States. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Nancy L. Shapiro
- Department of Pharmacy Practice University of Illinois at Chicago, College of Pharmacy Chicago Illinois USA
| | - Hsiang‐Wen Lin
- School of Pharmacy and Graduate Institute China Medical University, College of Pharmacy, China Medical University Hospital, Department of Pharmacy Taichung Taiwan
- Department of Pharmacy Systems, Outcomes and Policy University of Illinois at Chicago, College of Pharmacy Chicago Illinois USA
| | - Alan H. Lau
- Department of Pharmacy Practice University of Illinois at Chicago, College of Pharmacy Chicago Illinois USA
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Chen J, Wu G, Michelson A, Vesoulis Z, Bogner J, Corrigan JD, Payne PRO, Li F. Mining reported adverse events induced by potential opioid-drug interactions. JAMIA Open 2020; 3:104-112. [PMID: 32607492 PMCID: PMC7309259 DOI: 10.1093/jamiaopen/ooz073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/17/2019] [Accepted: 03/02/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Opioid-based analgesia is routinely used in clinical practice for the management of pain and alleviation of suffering at the end of life. It is well-known that opioid-based medications can be highly addictive, promoting not only abuse but also life-threatening overdoses. The scope of opioid-related adverse events (AEs) beyond these well-known effects remains poorly described. This exploratory analysis investigates potential AEs from drug-drug interactions between opioid and nonopioid medications (ODIs). MATERIALS AND METHODS In this study, we conduct an initial exploration of the association between ODIs and severe AEs using millions of AE reports available in FDA Adverse Event Reporting System (FAERS). The odds ratio (OR)-based analysis and visualization are proposed for single drugs and pairwise ODIs to identify associations between AEs and ODIs of interest. Moreover, the multilabel (multi-AE) learning models are employed to evaluate the feasibility of AE prediction of polypharmacy. RESULTS The top 12 most prescribed opioids in the FAERS are identified. The OR-based analysis identifies a diverse set of AEs associated with individual opioids. Moreover, the results indicate many ODIs can increase the risk of severe AEs dramatically. The area under the curve values of multilabel learning models of ODIs for oxycodone varied between 0.81 and 0.88 for 5 severe AEs. CONCLUSIONS The proposed data analysis and visualization are useful for mining FAERS data to identify novel polypharmacy associated AEs, as shown for ODIs. This approach was successful in recapitulating known drug interactions and also identified new opioid-specific AEs that could impact prescribing practices.
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Affiliation(s)
- Jinzhao Chen
- Department of Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Gaoyu Wu
- Institute for Informatics (I2), Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Andrew Michelson
- Institute for Informatics (I2), Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Zachary Vesoulis
- Department of Pediatrics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Philip R O Payne
- Institute for Informatics (I2), Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Fuhai Li
- Institute for Informatics (I2), Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Xu P, Hu YY, Yuan HY, Xiang DX, Zhou YG, Cave AJ, Banh HL. The Impact of a Training Program on Clinical Pharmacists on Pharmacy Clinical Services in a Tertiary Hospital in Hunan China. J Multidiscip Healthc 2019; 12:975-980. [PMID: 31819471 PMCID: PMC6885557 DOI: 10.2147/jmdh.s228537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background Prior to 2015, clinical consultation was the only clinical service provided by clinical pharmacists in Changsha Second Hospital. Between 2015 and 2017, a train-the-trainer program was implemented to train clinical pharmacists to provide pharmaceutical care and to conduct clinical research. The objective of the study is to examine the impact on the clinical services provided by pharmacists after the implementation of the train-the-trainer program. Patients and methods Between 2004 and 2014, all completed clinical consultation activities were tallied and summarized. The results from the tallied consultation activities were used as a baseline for clinical activities provided by pharmacists prior to the training. A structured training program was implemented between 2015 and 2017 to train clinical pharmacists to provide pharmaceutical care. After the implementation of the training program was completed, all clinical activities provided by pharmacists between January 2017 and December 2017 were documented in the clinical workload form. The clinical activities completed by each pharmacist were tallied and summarized. Results Between 2004 and 2014, a total of 6569 (average 657 per year) pharmacy consultations were requested and completed from a total of 44 departments. In 2017, a total of 15,078 hrs of clinical activities were logged. The pharmacists completed 3481 consultations in 2017 (an increase of 430%), averaging 316 consultations for each pharmacist and 271.8 hr per pharmacist. Over 2000 hrs (of the 15,078 hrs) were spent on direct patient care by the pharmacists. Conclusion This study shows that there was a 430% increase in clinical pharmacy consultation services provided by the clinical pharmacists after the implementation of the training program. This is directly related to the number of well-trained pharmacists available. After the implementation of the train-the-trainer program, the range of services as well as the number of clinical services and clinical hours spent on providing pharmaceutical care have significantly increased.
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Affiliation(s)
- Ping Xu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Yi Yun Hu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Hai Yan Yuan
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Da Xiong Xiang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Yan Gang Zhou
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Andrew J Cave
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Hoan Linh Banh
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Implementation of clinical pharmacist recommendations and services at a University Hospital in Yemen. Int J Clin Pharm 2019; 42:51-56. [PMID: 31713107 DOI: 10.1007/s11096-019-00936-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
Background Studies have revealed that the inclusion of a clinical pharmacist as a member in multidisciplinary medical team has been associated with improved medication use, reduced adverse drug reaction, reduced cost of treatment, and improved health outcomes. Objective The objectives of this study were to evaluate the implementation of clinical pharmacy recommendations and services, the acceptance rate by the physicians, and the anticipated outcomes of the recommendations at a hospital in Yemen. Methods Different units of the University of Science and Technology Hospital, Sana'a were included in this study. All the recommendations and services provided by the clinical pharmacist during daily activities were documented between June 2013 and November 2015. The provided recommendations were classified based on the type, acceptance rate, and the anticipated outcomes. Main outcome measure Type and quality of clinical pharmacists' recommendations, anticipated impact of the recommendations on health outcomes, and their acceptance rate. Results Throughout the study period, a total of 957 patients in different hospital units were visited and provided with a total of 3307 interventions and services. The most frequent types of clinical pharmacist's interventions were drug discontinuation (23.6%, n = 782), inappropriate dose interval or time (n = 735, 22.2%), and add medication (18.9%, n = 626). Overall, 61.8% (n = 2044) of the provided recommendations were accepted by the physicians. The most anticipated outcomes were improved the effectiveness of therapy (45.1%, n = 1909), avoid adverse drug reactions (29%, n = 1228), and decrease the cost of medications (18.8%, n = 797). Conclusion Clinical pharmacist's recommendations resulted in improving drug therapy and decreasing adverse effects for inpatients at the University of Science and Technology Hospital. This suggests that the implementation of clinical pharmacy services is essential and has a positive outcome on patient care.
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Towards precision medicine: interrogating the human genome to identify drug pathways associated with potentially functional, population-differentiated polymorphisms. THE PHARMACOGENOMICS JOURNAL 2019; 19:516-527. [PMID: 31578463 PMCID: PMC6867962 DOI: 10.1038/s41397-019-0096-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/10/2019] [Accepted: 09/18/2019] [Indexed: 12/24/2022]
Abstract
Drug response variations amongst different individuals/populations are influenced by several factors including allele frequency differences of single nucleotide polymorphisms (SNPs) that functionally affect drug-response genes. Here, we aim to identify drugs that potentially exhibit population differences in response using SNP data mining and analytics. Ninety-one pairwise-comparisons of >22,000,000 SNPs from the 1000 Genomes Project, across 14 different populations, were performed to identify ‘population-differentiated’ SNPs (pdSNPs). Potentially-functional pdSNPs (pf-pdSNPs) were then selected, mapped into genes, and integrated with drug–gene databases to identify ‘population-differentiated’ drugs enriched with genes carrying pf-pdSNPs. 1191 clinically-approved drugs were found to be significantly enriched (Z > 2.58) with genes carrying SNPs that were differentiated in one or more population-pair comparisons. Thirteen drugs were found to be enriched with such differentiated genes across all 91 population-pairs. Notably, 82% of drugs, which were previously reported in the literature to exhibit population differences in response were also found by this method to contain a significant enrichment of population specific differentiated SNPs. Furthermore, drugs with genetic testing labels, or those suspected to cause adverse reactions, contained a significantly larger number (P < 0.01) of population-pairs with enriched pf-pdSNPs compared with those without these labels. This pioneering effort at harnessing big-data pharmacogenomics to identify ‘population differentiated’ drugs could help to facilitate data-driven decision-making for a more personalized medicine.
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Taylor H, Englin EF, Gubbins PO. Development, implementation and perceived benefits of student pharmacist learning experiences in transitions of care. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:1041-1048. [PMID: 31685174 DOI: 10.1016/j.cptl.2019.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/01/2019] [Accepted: 06/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Experiential education designed around transitions of care (TOC) offers student pharmacists a variety of educational activities to build their skills and confidence related to direct patient care, communication, and practice management. The purpose of this paper is to describe the development, implementation, and student perceptions of introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs) that emphasize TOC. EDUCATIONAL ACTIVITY Sixty students (22 IPPE and 38 APPE) completed the learning experience with the oversight of two faculty members in two, separate, large community hospitals providing pharmacy led TOC services. Each educational activity was mapped to the Pharmacists' Patient Care Process, which includes guided electronic medical record review, patient case discussions, and direct patient care (i.e. medication history collection, patient education). Other aspects of the learning experience include the use of layered learning, intention/reflection dialogues, and topic discussions. Evaluation of the learning experience occurred through review of student performance data and feedback. CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY Student performance data demonstrated an increase in the mean score between midpoint and final evaluation of all TOC specific competencies. Students expressed a positive learning experience as demonstrated by an approximately 3.8 overall rating of the learning experience on a 4-point scale for both IPPEs and APPEs. Analysis of open comments from students demonstrated the most beneficial aspects of the learning experience as interprofessional communication, patient communication, and a variety of patient care opportunities.
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Affiliation(s)
- Heather Taylor
- University of Missouri - Kansas City School of Pharmacy, United States
| | - Elizabeth F Englin
- University of Missouri - Kansas City School of Pharmacy, 327 W. Mill St, 4th Floor, Springfield, MO 65806, United States; University of Missouri - Kansas City School of Pharmacy, 327 W. Mill St, 4th Floor, Springfield, MO 65806, United States.
| | - Paul O Gubbins
- University of Missouri - Kansas City School of Pharmacy, United States
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Schulz C, Fischer A, Vogt W, Leichenberg K, Warnke U, Liekweg A, Georgi U, Langebrake C, Hoppe-Tichy T, Dörje F, Knoth H. Clinical pharmacy services in Germany: a national survey. Eur J Hosp Pharm 2019; 28:301-305. [DOI: 10.1136/ejhpharm-2019-001973] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/29/2019] [Accepted: 08/13/2019] [Indexed: 11/04/2022] Open
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Lanier C, Moss J, Tunney R, Baird R, Kelly K. Clinical Pharmacy Practice Patterns Among North Carolina Rural Hospitals. J Pharm Pract 2019; 34:279-286. [PMID: 31422734 DOI: 10.1177/0897190019866325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Rural hospitals are isolated without adequate funding needed to provide for clinical services offered at larger health systems. The purpose of this study is to determine the clinical pharmacy services available and desired by rural hospitals in North Carolina. METHODS This prospective, cross-sectional, survey was distributed to a cohort of rural pharmacy directors and managers at rural hospitals across North Carolina. Data collected pertained to characteristics of the hospital and pharmacy, pharmacy director, clinical services, and responder impressions on their ability to maintain or enhance clinical services. Responses were summarized utilizing descriptive statistics and free-responses were coded for similar themes. RESULTS Seventeen respondents (32.6%) completed the survey. Clinical activities varied, as did characteristics of the hospitals and staff. Improved patient care is the primary reason why hospital pharmacies expand their clinical participation (46.7%). Pharmacy directors believed growth of clinical activities was a long-term goal while reporting regulations, staff, and finances as barriers to growth. CONCLUSION Clinical pharmacy services vary in NC rural hospitals. Directors exhibit a willingness to expand clinical responsibilities. Rural hospital pharmacy directors desire pharmacists to be active clinically in patient care, but face barriers in reaching that goal.
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Affiliation(s)
- Cameron Lanier
- 233484Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA
- 385561Harnett Health System, Dunn, NC, USA
| | - Jason Moss
- 233484Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA
- 385561Harnett Health System, Dunn, NC, USA
| | - Robert Tunney
- 233484Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA
- Vidant Health, Greenville, SC, USA
| | | | - Kim Kelly
- 233484Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA
- 385561Harnett Health System, Dunn, NC, USA
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Consensus recommendations for the role and competencies of the EBMT clinical pharmacist and clinical pharmacologist involved in hematopoietic stem cell transplantation. Bone Marrow Transplant 2019; 55:62-69. [PMID: 31101890 DOI: 10.1038/s41409-019-0538-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 11/09/2022]
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Allenet B, Juste M, Mouchoux C, Collomp R, Pourrat X, Varin R, Honoré S. De la dispensation au plan pharmaceutique personnalisé : vers un modèle intégratif de pharmacie clinique. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.phclin.2018.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sidhu S, Gorman SK, Slavik RS, Ramsey T, Bruchet N, Murray S. Positive and Negative Impacts of a Continuing Professional Development Intervention on Pharmacist Practice: A Balanced Measure Evaluation. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 37:215-222. [PMID: 29140819 DOI: 10.1097/ceh.0000000000000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Evaluations of behavior change interventions aimed at improving professional practice are increasingly focused on impacts at the practice and patient outcome levels. Many of these evaluations assume that if the intended changes occur, the result represents an improvement. However, given the systemic nature of clinical practice, a change in one area can produce changes in other areas as well, some of which may adversely affect the patient. Balancing measures are used to determine whether unintended consequences of an intervention have been introduced into other areas of the system. The aims of this study were to evaluate the impact of behavior change intervention-based continuing professional development (CPD) on pharmacist interventions (resolution of drug therapy problems-DTPs) and resolution of quality indicator DTPs and knowledge change for urinary tract infections (UTI) and pneumonia. As a balancing measure, we aimed to determine whether delivery of behavior change interventions targeting pneumonia and UTI practice results in a negative impact on other important pharmacist interventions, specifically the resolution of heart failure DTPs. METHODS A quasiexperimental study was conducted at a Canadian health authority that evaluated the impacts of an 8-week multifaceted behavior change intervention delivered to 58 ward-based pharmacists. The primary outcome was change in proportion of UTI and pneumonia DTPs resolved from the 6-month preintervention to 6-month postintervention phase. Secondary outcomes were changes in proportion of UTI and pneumonia quality indicator DTPs resolved, knowledge quiz scores, and proportion of quality indicator DTPs resolved for heart failure as a balancing measure. RESULTS A total of 58 pharmacists were targets of the intervention. The proportion of resolved UTI and pneumonia DTPs increased from 17.8 to 27.2% (relative risk increase 52.8%, 95% confidence interval [CI] 42.8-63.6%; P < 0.05). The proportion of resolved UTI and pneumonia quality indicator DTPs increased from 12.2% to 18.2% (relative risk increase 49.9%, 95% CI 34.5-67.0%; P < 0.05). Resolved heart failure DTPs decreased from 14.3 to 8.5% (RRR 40.4%, 95% CI 33.9-46.2%; P < 0.05). Thirty-six pharmacists completed the pre- and post-quiz. Scores increased from 11.3/20 ± 3.2/20 to 14.8/20 ± 2.9/20 (P < 0.05). DISCUSSION CPD using a multifaceted behavior change intervention improved pharmacist behavior and knowledge for UTI and pneumonia. However, these improvements may be offset by reduced interventions for other disease states, such as heart failure. Strategies to mitigate the unintended effects on other professional behaviors should be implemented when delivering CPD focused on changing one aspect of professional behavior.
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Affiliation(s)
- Sukhjinder Sidhu
- Sidhu: Pharmacy Department, Fraser Health Authority, Surrey, British Columbia, Canada. Gorman and Slavik: Interior Health Pharmacy Services, Faculty of Pharmaceutical Sciences, University of British Columbia, Kelowna, British Columbia, Canada. Ramsey: Pharmacy Department, Nova Scotia Health Authority, College of Pharmacy, Dalhousie University, Victoria General Hospital, Halifax, Nova Scotia, Canada. Bruchet: Interior Health Pharmacy Practice Residency Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Kelowna, British Columbia, Canada. Murray: Kelowna General Hospital Pharmacy Department, Kelowna, British Columbia, Canada
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Roy R, Ma J. Impact of a Policy Change on Pharmacists' Reporting of Adverse Drug Reactions. Can J Hosp Pharm 2018; 71:227-233. [PMID: 30185996 PMCID: PMC6118825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Spontaneous reports of adverse drug reactions (ADRs) form an essential component of both drug safety monitoring and patient safety initiatives. Pharmacists are well positioned to report ADRs, but many barriers exist to their doing so. Over the past decade, substantial changes have occurred with regard to drug regulations and medication safety initiatives, and it is possible that knowledge-based interventions may be needed to enhance ADR reporting by pharmacists. OBJECTIVE To determine whether ADR reporting behaviours of pharmacists improved after release of a revised policy on the reporting of medication incidents. METHODS A telephone survey was administered to pharmacists practising in the Canadian Forces Health Services Group. Self-reported behaviours and perceived barriers related to ADR reporting were compared before and 3 months after the updated policy was released. Accuracy in participants' self-assessed ADR reporting was evaluated using independently derived workload statistics. RESULTS During the second survey phase (after release of the revised policy), a greater proportion of respondents reported awareness of institutional policies on ADR reporting and declared that they were able to complete all necessary ADR reports during their assigned work hours. However, the number of ADR reports submitted did not increase. Participants' recall of their ADR reporting behaviour was corroborated by workload data. During the second survey phase, there was a noticeable reduction in the number of free-form comments mentioning lack of staff as a barrier to ADR reporting. CONCLUSIONS Release of a more comprehensive policy was not associated with an increase in the number of ADR reports generated by pharmacists in the study setting. Interventions to strengthen the organization's work processes for detection of ADRs and submission of individual ADR reports should be strongly considered, to reinforce and enhance existing ADR reporting behaviours among pharmacists.
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Affiliation(s)
- Renaud Roy
- , PharmD, MSc, is a Pharmacist with the Hôpital général juif Sir Mortimer B. Davis, Montréal, Quebec
| | - Janice Ma
- , BScPharm, PharmD, is a Drug Use Evaluation Pharmacist with Canadian Forces Health Services Group Headquarters, Ottawa, Ontario
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Lombardi N, Wei L, Ghaleb M, Pasut E, Leschiutta S, Rossi P, Troncon MG. Evaluation of the implementation of a clinical pharmacy service on an acute internal medicine ward in Italy. BMC Health Serv Res 2018; 18:259. [PMID: 29631587 PMCID: PMC5891983 DOI: 10.1186/s12913-018-2988-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Successful implementation of clinical pharmacy services is associated with improvement of appropriateness of prescribing. Both high clinical significance of pharmacist interventions and their high acceptance rate mean that potential harm to patients could be avoided. Evidence shows that low acceptance rate of pharmacist interventions can be associated with lack of communication between pharmacists and the rest of the healthcare team. The objective of this study was to evaluate the effect of a structured communication strategy on acceptance rate of interventions made by a clinical pharmacist implementing a ward-based clinical pharmacy service targeting elderly patients at high risk of drug-related problems. Characteristics of interventions made to improve appropriateness of prescribing, their clinical significance and intervention acceptance rate by doctors were recorded. METHODS A clinical pharmacy intervention study was conducted between September 2013 and December 2013 in an internal medicine ward of a teaching hospital. A trained clinical pharmacist provided pharmaceutical care to 94 patients aged over 70 years. The clinical pharmacist used the following communication and marketing tools to implement the service described: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis; Specific, Measurable, Achievable, Realistic and Timely (SMART) goals; Awareness, Interest, Desire, Action (AIDA) model. RESULTS A total of 740 interventions were made by the clinical pharmacist. The most common drug classes involved in interventions were: antibacterials for systemic use (11.1%) and anti-parkinson drugs (10.8%). The main drug-related problem categories triggering interventions were: no specific problem (15.9%) and prescription writing error (12.0%). A total of 93.2% of interventions were fully accepted by physicians. After assessment by an external panel 63.2% of interventions (96 interventions/ per month) were considered of moderate clinical significance and 23.4% (36 interventions/ per month) of major clinical significance. The most frequent interventions were to educate a healthcare professional (20.4%) and change dose (16.1%). CONCLUSIONS To our knowledge this is the first study evaluating the effect of a structured communication strategy on acceptance rate of pharmacist interventions. Pharmaceutical care delivered by the clinical pharmacist is likely to have had beneficial outcomes. Clinical pharmacy services like the one described should be implemented widely to increase patient safety.
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Affiliation(s)
- Nicola Lombardi
- Department of Pharmacy, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK.
| | - Li Wei
- Department of Pharmacy Practice and Policy, University College London School of Pharmacy, 29-39 Brunswick Square, Bloomsbury, London, WC1N 1AX, UK
| | - Maisoon Ghaleb
- School of Life and Medical Science, Department of Pharmacy, Pharmacology & Postgraduate Medicine, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Enrico Pasut
- Department of Pharmacy, Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330-33100, Udine, Friuli Venezia Giulia, Italy
| | - Silvia Leschiutta
- Department of Pharmacy, Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330-33100, Udine, Friuli Venezia Giulia, Italy
| | - Paolo Rossi
- Division of Internal Medicine, Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330 - 33100, Udine, Friuli Venezia Giulia, Italy
| | - Maria Grazia Troncon
- Department of Pharmacy, Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330-33100, Udine, Friuli Venezia Giulia, Italy
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Effects of multidisciplinary teams and an integrated follow-up electronic system on clinical pharmacist interventions in a cancer hospital. Int J Clin Pharm 2017; 39:1175-1184. [PMID: 28918483 DOI: 10.1007/s11096-017-0530-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
Background The aim of drug therapy is to attain distinct therapeutic effects that not only improve patient's quality of life but also reduce the inherent risks associated with the therapeutic use of drugs. Pharmacists play a key role in reducing these risks by developing appropriate interventions. Whether to accept or reject the intervention made by the pharmacist is a relevant consultant's decision. Objective To evaluate the impact of electronic prompts and follow-up of rejected pharmacy interventions by clinical pharmacists in an in-patient setting. Setting Shaukat Khanum Cancer Hospital & Research Center, Lahore, Pakistan. Method The study was conducted in two phases. Data for 3 months were collected for each phase of the study. Systematic and quantifiable consensus validity was developed for rejected interventions in phase 1, based on patient outcome analyses. Severity rating was assigned to assess the significance of interventions. Electronic prompts for follow-on interventions in phase 2 were then developed and implemented, including daily review via a multidisciplinary team (MDT) approach. Main outcome measure Validity of rejected interventions, acceptance of follow-on interventions before and after re-engineering the pharmacy processes, rejection rate and severity rating of follow-on interventions. Result Of a total of 2649 and 3064 interventions that were implemented during phase 1 and phase 2, 238 (9%) and 307 (10%) were rejected, respectively. Additionally, 133 (56%) were inappropriate rejections during phase 1. The estimated reliability between pharmacists regarding rejected interventions was 0.74 (95% CI of 0.69, 0.79, p 0.000). Prospective data were analysed after implementing electronic alerts and an MDT approach. The acceptance rate of follow-on interventions in phase 2 was 60% (184). Conclusion Electronic prompts for follow-on interventions together with an MDT approach enhance the optimization of pharmacotherapy, increase drug rationality and improve patient care.
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Serag-Bolos ES, Miranda AC, Gelot SR, Dharia SP, Shaeer KM. Assessing students' knowledge regarding the roles and responsibilities of a pharmacist with focus on care transitions through simulation. CURRENTS IN PHARMACY TEACHING & LEARNING 2017; 9:616-625. [PMID: 29233434 DOI: 10.1016/j.cptl.2017.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 12/06/2016] [Accepted: 03/30/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND PURPOSE To evaluate the impact of a pharmacist-focused transitions of care (TOC) simulation on students' perceptions and knowledge of pharmacist roles in the healthcare continuum. Educational Activity and Setting: Two simulations, highlighting pharmacist roles in various practice settings, were conducted within the Pharmaceutical Skills courses in the third-year doctor of pharmacy curriculum. Patient cases were built utilizing electronic medical records (EMR). Students' knowledge was assessed before and after the simulations regarding pharmacist involvement in medication reconciliation, reduction in patient readmissions, reduction of inappropriate medication use, roles and communication on an interprofessional team, and involvement with health information technology (HIT) during care transitions. FINDINGS Fifty-one third-year pharmacy students were anonymously evaluated prior to and following the simulation to assess changes in knowledge and perceptions during the fall semester. Thirty-two (62.7%) students completed the pre-simulation and 21 (41.2%) students completed the post-simulation assessments, respectively. In the spring semester, 40 (80%) students completed the pre-simulation and 23 (46%) students finished the post-simulation assessments. Students predominately had community pharmacy work experience (n=28, 55%). Overall, students enjoyed the variety of pharmacist-led encounters throughout the simulation and assessments demonstrated an increase in knowledge after the simulations. SUMMARY TOC simulations enhance students' understanding of the significant impact that pharmacists have in ensuring continuity of care as members of an interdisciplinary team.
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Affiliation(s)
- Erini S Serag-Bolos
- University of South Florida, College of Pharmacy, Department of Pharmacotherapeutics and Clinical Research, 12901 Bruce B. Downs Blvd, MDC 30, Tampa, FL 3361233612, United States.
| | - Aimon C Miranda
- University of South Florida, College of Pharmacy, Department of Pharmacotherapeutics and Clinical Research, 12901 Bruce B. Downs Blvd, MDC 30, Tampa, FL 3361233612, United States.
| | - Shyam R Gelot
- Lee Memorial Health System, Department of Pharmacy, 636 Del Prado Blvd S, Cape Coral, FL 33991, United States.
| | - Sheetal P Dharia
- Abbvie/Clinical Pharmacokinetics and Pharmacodynamics, 1 North Waukegan Rd, R4PK AP31-3, North Chicago, IL 60064, United States.
| | - Kristy M Shaeer
- University of South Florida, College of Pharmacy, Department of Pharmacotherapeutics and Clinical Research, 12901 Bruce B. Downs Blvd, MDC 30, Tampa, FL 3361233612, United States.
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Ljubojević G, Miljković B, Bućma T, Ćulafić M, Prostran M, Vezmar Kovačević S. Problems, interventions, and their outcomes during the routine work of hospital pharmacists in Bosnia and Herzegovina. Int J Clin Pharm 2017; 39:743-749. [PMID: 28597173 DOI: 10.1007/s11096-017-0491-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
Background In the last 30 years, activities of hospital pharmacists have gone through significant changes. Pharmacists are increasingly involved in patient care. Objectives To explore drug-related and logistic problems, interventions, and their outcomes during routine everyday work of hospital pharmacists. Setting Institute for physical medicine and rehabilitation, Banja Luka, Bosnia and Herzegovina. Methods In the period of January 2013-October 2015 a prospective observational study was performed. Medical doctors, nurses, therapists, and patients addressed pharmacists, face-to-face or by telephone, with drug-related problems (DRPs) and/or logistic issues. Main outcome measure Type of DRP or logistic issue, intervention, outcome, initiator and time spent for solving the problem were documented for each consultation. Results Out of 1515 interventions, 48.8% were aimed at solving DRPs. The most common DRPs were the recommendation of a drug or dose and need for additional information about drugs. Drug price and supply were the most prevalent logistic issues. DRPs were more frequently initiated by medical doctors and required more time to solve the problem compared to logistic issues (Mann-Whitney U test, p ≤ 0.001, respectively). The acceptance rate of interventions to solve DRPs (83.7%) was lower compared to logistic issues (95.2%; p ≤ 0.001). Conclusions Hospital pharmacists were faced with an approximately equal number of DRPs and logistic issues during their routine everyday work. The overall acceptance rate of pharmacists' interventions was high, and the results of our study indicate that there is a need for more involvement of hospital pharmacists in Bosnia and Herzegovina in clinical activities. Impact on practice.
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Affiliation(s)
- Gordana Ljubojević
- Institute for Physical Medicine and Rehabilitation, Dr Miroslav Zotović, Banja Luka, Bosnia and Herzegovina
| | - Branislava Miljković
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, 11000, Serbia
| | - Tatjana Bućma
- Institute for Physical Medicine and Rehabilitation, Dr Miroslav Zotović, Banja Luka, Bosnia and Herzegovina
| | - Milica Ćulafić
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, 11000, Serbia
| | - Milica Prostran
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sandra Vezmar Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, 11000, Serbia.
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Auta A, Strickland-Hodge B, Maz J. Challenges to clinical pharmacy practice in Nigerian hospitals: a qualitative exploration of stakeholders' views. J Eval Clin Pract 2016; 22:699-706. [PMID: 26969559 DOI: 10.1111/jep.12520] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/14/2016] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES In Nigeria, a shift from the traditional pharmacists' role of dispensing and compounding of medications began in the 1980s with the introduction of drug information services and unit dose-dispensing systems in some hospitals. More than three decades after this, clinical pharmacy practice is still underdeveloped. This study was conducted to explore stakeholders' views on the barriers to the development of clinical pharmacy practice in Nigerian hospitals. METHODS Qualitative, semi-structured interviews were conducted with 44 purposefully sampled Nigerian stakeholders including pharmacists, pharmacy technicians, doctors, policymakers and patient group representatives. Transcribed interviews were entered into the QSR (Burlington, MA, USA) NVivo 10 software and analysed thematically. RESULTS Three major themes emerged from the study: pharmacists' professional identity, the structure of pharmacy practice and external barriers. The results revealed an ongoing struggle by Nigerian hospital pharmacists to establish their clinical identities as many non-pharmacy stakeholders viewed pharmacists' roles to be mainly supply based. Barriers to the development of clinical pharmacy practice identified included pharmacists' lack of confidence, shortage of pharmacy staff, underutilisation of pharmacy technicians, lack of specialisation and clinical career structure, medical dominance and opposition and lack of policies that support clinical pharmacy practice. CONCLUSION Several years after its introduction, clinical pharmacy practice is yet to be fully developed in Nigerian hospitals. The barriers identified in this study need to be addressed in order for clinical pharmacy practice to flourish.
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Affiliation(s)
- Asa Auta
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
| | | | - Julia Maz
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Schreiber R, Gregoire JA, Shaha JE, Shaha SH. Think time: A novel approach to analysis of clinicians' behavior after reduction of drug-drug interaction alerts. Int J Med Inform 2016; 97:59-67. [PMID: 27919396 DOI: 10.1016/j.ijmedinf.2016.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/12/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Pharmacologic interaction alerting offers the potential for safer medication prescribing, but research reveals persistent concerns regarding alert fatigue. Research studies have tried various strategies to resolve this problem, with low overall success. We examined the effects of targeted alert reduction on clinician behavior in a resource constrained hospital. METHODS A physician and a pharmacy informaticist reduced alert levels of several drug-drug interactions (DDI) that clinicians almost always overrode with approval from and knowledge of the medical staff. This study evaluated the behavioral changes in prescribers and non-prescribers as measured by "think time", a new metric for evaluating the resolution time for an alert, before and after suppression of selected DDI alerts. RESULTS The user-seen DDI alert rate decreased from 9.98% of all orders to 9.20% (p=0.0001) with an overall volume reduction of 10.3%. There was no statistical difference in the reduction of cancelled (-10.00%) vs. proceed orders (-11.07%). Think time decreased overall by 0.61s (p<0.0001). Think time unexpectedly increased for cancelled orders 1.00s which while not statistically significant (p=0.28) is generally thought to be clinically noteworthy. For overrides, think time decreased 0.67s which was significant (p<0.0001). Think time lowered for both prescribers and non-prescribers. Targeted specialists had shorter think times initially, which shortened more than non-targeted specialists. CONCLUSIONS Targeted DDI alert reductions reduce alert burden overall, and increase net efficiency as measured by think time for all prescribers better than for non-prescribers. Think time may increase when cancelling or changing orders in response to DDI alerts vs. a decision to override an alert.
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Affiliation(s)
- Richard Schreiber
- Clinical Informatics, Chief Medical Informatics Officer, Holy Spirit Hospital-A Geisinger Affiliate, 431 North 21st Street, Suite 101, Camp Hill, PA 17011, United States.
| | - Julia A Gregoire
- Medication Information Systems Manager, Holy Spirit Hospital-A Geisinger Affiliate, 503 North 21st Street, Camp Hill, PA 17011, United States.
| | - Jacob E Shaha
- University of Michigan, Graduate School of Engineering & Computer Science, Ann Arbor, MI, United States.
| | - Steven H Shaha
- Center for Public Policy & Administration, Draper, UT, United States.
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The impact of pharmacist certification on the quality of chemotherapy in Japan. Int J Clin Pharm 2016; 38:1326-35. [PMID: 27573721 DOI: 10.1007/s11096-016-0374-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Abstract
Background In the Japanese healthcare system, board certification not only maintains the quality of daily practice but is also required for hospitals to receive healthcare reimbursement. To date, no data on the effects of the board certification system in Japanese hospitals have been reported. Objective We performed a survey to clarify the impact of pharmacist certification on the quality of chemotherapy. Setting A nationwide mailing survey was conducted in Japan. Method We surveyed oncology pharmacists from 388 cancer designated hospitals (DHs) and 984 randomly selected general hospitals (GHs). Main outcome measure Multivariate analysis of factors for compliance with standard cancer chemotherapy to clarify the impact of pharmacist certification on the quality of chemotherapy. Results The response rate was 70.6 % (274/388) at the DHs and 43.4 % (428/984) at the GHs. Of the 13 different regimens, 66.1 % (181/274) of DHs and 64.7 % (277/428) of GHs reported having experienced either improper doses or intervals of drug administration. The median number of improper regimens was 1 at both the DHs (range 0-15) and GHs (range 0-22). We identified two groups of hospitals, those with two or more improper regimens and those with one improper regimen or less. Univariate analysis showed significant differences in the number of DHs (p < 0.01), performance of more than 10 chemotherapies per day (p < 0.05), presence of more than 400 beds (p < 0.01) and the professional qualifications of oncology pharmacists or medical oncologists. From multivariate analysis, significant differences were observed in certifications from the Japanese Society of Pharmacy Healthcare and Sciences certified Senior Oncology Pharmacist (odds ratio 0.29, p < 0.01) and the Japanese Society of Medical Oncology certified oncologist (odds ratio 0.48, p < 0.01). Conclusion Board certification was more prevalent in the designated (cancer specialist) hospitals than general hospitals and adherence to appropriate therapy was better when the DH was involved. Board certification was shown to be beneficial in terms of adherence to adequate chemotherapy.
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Dupuis S, Martel A, Arfa T, Valma J, Williamson DR, Perreault MM. Factors Influencing Fourth-Year Pharmacy Students' Decisions to Pursue a Hospital Pharmacy Residency. Can J Hosp Pharm 2016; 69:209-15. [PMID: 27403000 DOI: 10.4212/cjhp.v69i3.1557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Canadian Society of Hospital Pharmacists promotes the recruitment of residency-trained pharmacists for work in hospitals and related health care settings. However, Quebec hospitals are still hiring non-residency trained pharmacists, in part because of a severe shortage of hospital pharmacists. To date, no studies have examined the factors influencing the career choices of fourth-year pharmacy students in Canada. OBJECTIVES To identify motivating factors and barriers influencing students' decision to pursue a hospital pharmacy residency. METHODS All 186 fourth-year students in the Faculty of Pharmacy, Université de Montréal, were invited by e-mail to participate in a validated and institutionally approved survey that was available online between March and May 2014. RESULTS Of the 138 respondents who returned a completed survey (74% response rate), 36 (26%) planned to apply for a hospital pharmacy residency. Those planning to apply for a residency were older (p = 0.037) and had more hospital work experience (36% versus 3%, p < 0.001) than those not planning to apply. The most important motivators for pursuing a residency were potential gains in knowledge (reported by 88% of respondents, whether or not they were planning to pursue a residency), experience (80%), and self-confidence (62%). The most frequently reported barriers were recognition that a hospital pharmacy residency is a highly demanding program (65%), having work available upon graduation from the undergraduate program (43%), and financial obligations (34%). Hospital experiential rotations influenced, either positively or negatively, 23 (72%) of the 32 students who changed their decision to pursue or not pursue residency training over the course of their studies. CONCLUSIONS The potential gain in knowledge and experience acquired through residency, the fact that it is considered a highly demanding program, and having work available upon graduation from undergraduate studies were the most influential factors in fourth-year pharmacy students' decision of whether to pursue a hospital pharmacy residency.
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Affiliation(s)
- Sébastien Dupuis
- PharmD, MSc, is with the Faculté de pharmacie, Université de Montréal, and the Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec
| | - Alexis Martel
- PharmD, is with the Pharmacy Vandergoten and Zaccara, Saint-Eustache, Quebec
| | - Taha Arfa
- BPharm, MBA, is with the Faculté de pharmacie, Université de Montréal, Montréal, Quebec
| | - Joannah Valma
- MSc, is with the Faculté de pharmacie, Université de Montréal, Montréal, Quebec
| | - David R Williamson
- BPharm, MSc, PhD, BCPS, is with the Faculté de pharmacie, Université de Montréal, and the Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec
| | - Marc M Perreault
- MSc, PharmD, BCPS, is with the Faculté de pharmacie, Université de Montréal, and the Pharmacy Department, McGill University Health Centre, Montréal, Quebec. He is also an Associate Editor with the Canadian Journal of Hospital Pharmacy
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Suzuki S, Chan A, Nomura H, Johnson PE, Endo K, Saito S. Chemotherapy regimen checks performed by pharmacists contribute to safe administration of chemotherapy. J Oncol Pharm Pract 2016; 23:18-25. [DOI: 10.1177/1078155215614998] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Computerized provider order entry (CPOE) has been developed and implemented within cancer center hospitals nationwide in Japan. To ensure that high-quality services are routinely provided by oncology pharmacists, this study was designed to evaluate the interventions through reviewing the orders that are generated by CPOE. Methods The objective of this retrospective chart review was to evaluate how pharmacists contributed to safe cancer treatment using paper-based pharmacy records. Data were collected from a total of 35,062 chemotherapy regimens for 18,515 outpatients between January and December 2013. Results Of these 35,062 chemotherapy regimens, the rate of pharmacists’ interventions was 1.1% ( n = 408). Among them, 53.1% (217/408) of the chemotherapy prescriptions were modified due to pharmacist interventions. The reasons for interventions included “changes in the chemotherapy regimen were unclear” in 49.5%, “physicians’ prescription errors” (22.0%), “pharmacist suggestions to improve chemotherapy” (15.1%), and “finding differences between physicians’ chemotherapy records and their chemotherapy prescriptions” (13.2%). The top three reasons for the 217 prescription modifications due to pharmacist interventions were “finding prescription errors” (34.5%), “reasons for change in the chemotherapy regimen were unclear” (32.7%), and “finding differences between physicians’ chemotherapy records and their chemotherapy prescriptions” (28.5%). Conclusion The computer could not evaluate chemotherapy protocols or adjust doses of anticancer medicines according to patients’ conditions. Therefore, oncology pharmacists should continue to ensure safe and appropriate administration of cancer chemotherapy.
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Affiliation(s)
- Shinya Suzuki
- Division of Pharmacy, National Cancer Center Hospital East, National Research and Development Agency, Kashiwa, Japan
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
- Oncology Pharmacy, National Cancer Centre Singapore, Singapore
| | - Hisanaga Nomura
- Division of Pharmacy, National Cancer Center Hospital East, National Research and Development Agency, Kashiwa, Japan
| | - Philip E Johnson
- Director of Pharmacy (Retired), Moffitt Cancer Center, Tampa, FL, USA
| | - Kazushi Endo
- Japanese Society of Hospital Pharmacists, Tokyo, Japan
- Department of Drug Safety Management, Meiji Pharmaceutical University, Tokyo, Japan
| | - Shinichiro Saito
- Division of Pharmacy, National Cancer Center Hospital East, National Research and Development Agency, Kashiwa, Japan
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Lo E, Rainkie D, Semchuk WM, Gorman SK, Toombs K, Slavik RS, Forbes D, Meade A, Fernandes O, Spina SP. Measurement of Clinical Pharmacy Key Performance Indicators to Focus and Improve Your Hospital Pharmacy Practice. Can J Hosp Pharm 2016; 69:149-55. [PMID: 27168637 DOI: 10.4212/cjhp.v69i2.1543] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Elaine Lo
- PharmD, is with the University of British Columbia, Vancouver, British Columbia
| | - Daniel Rainkie
- PharmD, was, when this project began, a PharmD student at the University of British Columbia, Vancouver, British Columbia. He is now with the Qatar University College of Pharmacy, Doha, Qatar
| | - William M Semchuk
- PharmD, FCSHP, is with Regina Qu'Appelle Health Region Pharmacy Services, Regina, Saskatchewan, and the University of Saskatchewan, Saskatoon, Saskatchewan
| | - Sean K Gorman
- PharmD, is with Interior Health Pharmacy Services, Kelowna, British Columbia, and the University of British Columbia, Vancouver, British Columbia
| | - Kent Toombs
- BScPharm, is with the Pharmacy Department, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Richard S Slavik
- PharmD, FCSHP, is with Interior Health Pharmacy Services, Kelowna, British Columbia, and the University of British Columbia, Vancouver, British Columbia
| | - David Forbes
- BScPharm, MPA, is with Vancouver Island Health Authority Pharmacy Services, Nanaimo Regional General Hospital, Nanaimo, British Columbia
| | - Andrea Meade
- BScPharm, is with the Pharmacy Department, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Olavo Fernandes
- PharmD, FCSHP, is with the Pharmacy Department, University Health Network, and the University of Toronto, Toronto, Ontario
| | - Sean P Spina
- PharmD, FCSHP, is with Vancouver Island Health Authority Pharmacy Services, Royal Jubilee Hospital, Victoria, British Columbia, and the University of British Columbia, Vancouver, British Columbia
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Leroux A, Guérin A, Bussières JF, Lebel D, Tremblay S, Roy H, Métras ME, Beauchemin M, Bédard P. [Upgrading a pediatric pharmaceutical care service in Quebec]. Arch Pediatr 2016; 23:117-27. [PMID: 26795358 DOI: 10.1016/j.arcped.2015.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 11/13/2015] [Accepted: 11/18/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Clinical pharmacy has developed since the 1960s in North America, with large disparities in the presence of decentralized pharmacists in hospital units between healthcare programs. Decentralized pharmacists have been present in pediatrics since the 1970s. The main objective of this study was to describe the steps used to upgrade the pediatrics department's pharmaceutical care. METHODS A descriptive study was conducted to upgrade the pharmaceutical care provided by two full-time equivalents in two pediatric sectors including 81 beds of a tertiary mother-child hospital. The upgrade includes three steps: a structured literature review, a description of the department, and a description of the practice upgrades proposed by the research team, in consensus with the clinical pharmacy team. RESULTS Out of the 236 articles initially identified, 13 relevant articles were found on the role and impact of pharmacists in pediatrics. Nine pharmaceutical activities were supported by high-quality data. Following the literature review and concerted reflection, 15 improvements were identified as feasible without increasing the staff. CONCLUSION There are data on the impact of pharmacists in pediatrics. This descriptive study illustrates a method that was used to upgrade the pediatrics sector in a university mother-child health center.
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Affiliation(s)
- A Leroux
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - A Guérin
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - J-F Bussières
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada; Faculté de pharmacie, université de Montréal, 2940, chemin de la Polytechnique, H3C 3J7 Montréal, Canada
| | - D Lebel
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - S Tremblay
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - H Roy
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - M-E Métras
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - M Beauchemin
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - P Bédard
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada.
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Langebrake C, Ihbe-Heffinger A, Leichenberg K, Kaden S, Kunkel M, Lueb M, Hilgarth H, Hohmann C. Nationwide evaluation of day-to-day clinical pharmacists' interventions in German hospitals. Pharmacotherapy 2015; 35:370-9. [PMID: 25884525 DOI: 10.1002/phar.1578] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY OBJECTIVE To describe and evaluate the extent and diversity of nationwide data from clinical pharmacists' interventions (PIs) in German hospitals. DESIGN Retrospective analysis. DATA SOURCE The ADKA-DokuPIK German database, a national anonymous self-reported Internet-based documentation system for routine PIs as well as for medication errors reported by German hospital pharmacists. MEASUREMENTS AND MAIN RESULTS Data sets from ADKA-DokuPIK entered between January 2009 and December 2012 were analyzed descriptively. A total of 27,610 PIs were entered, mainly by ward-based clinical pharmacists (82.5%). Most of the PIs were performed on surgical wards (37.8%), followed by anesthesiology/intensive care unit/intermediate care unit and internal medicine. The most prevalent therapeutic subgroup that was the trigger for the PIs was antibacterials for systemic use (13.9%), followed by antithrombotic agents, analgesics, drugs for acid-related disorders, and agents acting on the renin-angiotensin system. About a quarter of interventions (23.4%) were performed due to inappropriate use of drugs, followed by use of a wrong dose or administration interval (22.1%), resulting in the most frequently taken actions of change of dose, change of drug, and drug stopped/paused (withheld). Altogether, the implementation rate of the PIs was 85.5%. Underlying medication errors were predominantly classified as "error, no harm" according to the National Coordinating Council for Medication Error Reporting and Prevention. CONCLUSION For the first time in a European country, our findings show the scope of clinical pharmacist involvement in patient care in daily clinical practice and demonstrate the usefulness and importance of their proactive interventions in the prevention of hazards and risks for hospital inpatients.
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Affiliation(s)
- Claudia Langebrake
- Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ilickovic IM, Jankovic SM, Tomcuk A, Djedovic J. Pharmaceutical care in a long-stay psychiatric hospital. Eur J Hosp Pharm 2015; 23:177-181. [PMID: 31156842 DOI: 10.1136/ejhpharm-2015-000718] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/25/2015] [Accepted: 11/02/2015] [Indexed: 11/04/2022] Open
Abstract
Objectives The aim of this study was to evaluate implementation of services provided by a clinical pharmacist for long-term-hospitalised patients with schizophrenia in a pharmaceutical-care-naive developing country. Method This was a prospective, healthcare-system, interventional, 'before-and-after' study. Long-term (≥6 months) inpatients with schizophrenia were included. A clinical pharmacist reviewed the full patient notes, identified drug-related problems (DRPs), and proposed interventions using a DRP Registration Form (PCNE classification V6.2). Acceptance rate and outcomes of interventions were assessed. Results For 49 patients, 71 DRPs were identified, ranging from one to four problems/patient (1.43±0.68), predominantly related to tolerability and treatment effectiveness. The DRPs were mostly caused (N=184) by inappropriate drug selection (64%) or dose (23.4%): too many drugs for indication (N=33); a non-cost-effective choice (N=29); inappropriate combination (N=27); an inappropriate drug (N=23); lack of therapeutic drug monitoring (N=14); subtherapeutic (N=13) or supratherapeutic (N=11) dosing. Excessive treatment duration was observed for 14 DRPs. The clinical pharmacist proposed 182 interventions (70% at the drug level): discontinuation of medication (N=58); dosage change (N=35); other interventions (monitoring) (N=35); a change of drug (N=18) or instructions for use (N=9); and/or introduction of a new drug (N=7). Physicians accepted 91 interventions and refused 36. Finally, 38 DRPs were solved (25 completely and 13 partially), for 25 a solution was either not needed or not possible, and, for eight, the outcome was not known. Conclusions The study underlines the high potential for pharmaceutical care to improve prescribing practices in developing countries without shared pharmacist-physician decision-making.
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Affiliation(s)
- Ivana M Ilickovic
- Regulatory, Pharmacovigilance and Quality Department, Farmegra Ltd, Podgorica, Montenegro
| | - Slobodan M Jankovic
- Department of Pharmacology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandar Tomcuk
- Specialised Hospital for Psychiatric Diseases, Dobrota, Kotor, Montenegro
| | - Jovo Djedovic
- Specialised Hospital for Psychiatric Diseases, Dobrota, Kotor, Montenegro
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Roblek T, Deticek A, Leskovar B, Suskovic S, Horvat M, Belic A, Mrhar A, Lainscak M. Clinical-pharmacist intervention reduces clinically relevant drug-drug interactions in patients with heart failure: A randomized, double-blind, controlled trial. Int J Cardiol 2015; 203:647-52. [PMID: 26580349 DOI: 10.1016/j.ijcard.2015.10.206] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Incidence of drug-drug interactions (DDIs) increases with complexity of treatment and comorbidities, as in heart failure (HF). This randomized, double-blind study evaluated the intervention of the pharmacist on prevalence of clinically relevant DDIs (NCT01855165). METHODS Patients admitted with HF were screened for clinically relevant DDIs, and randomized to control or intervention. All attending physicians received standard advice about pharmacological therapy; those in the intervention group also received alerts about clinically relevant DDIs. Primary endpoint was DDI at discharge and secondary were re-hospitalization or death during follow-up. RESULTS Of 213 patients, 51 (mean age, 79 ± 6 years; male, 47%) showed 66 clinically relevant DDIs and were randomized. For intervention (n=26) versus control (n=25), the number of patients with and the number of DDIs were significantly lower at discharge: 8 vs. 18 and 10 vs. 31; p=0.003 and 0.0049, respectively. Over a 6 month follow-up period, 11 control and 9 intervention patients were re-hospitalized or died (p>0.2 for all). No significant differences were seen between control and intervention for patients with eGFR <60 mL/min/1.73 m(2) (78%) for re-hospitalization or death (10 vs. 7; p=0.74). CONCLUSIONS Pharmacist intervention significantly reduces the number of patients with clinically relevant DDIs, but not clinical endpoints 6 months from discharge.
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Affiliation(s)
- Tina Roblek
- Faculty of Pharmacy, University of Ljubljana, Askerceva cesta 7, Ljubljana, Slovenia; Lek d.d., Verovskova 57, Ljubljana, Slovenia
| | - Andreja Deticek
- Faculty of Pharmacy, University of Ljubljana, Askerceva cesta 7, Ljubljana, Slovenia
| | - Bostjan Leskovar
- Department of Internal Medicine, General Hospital Trbovlje, Rudarska 9, Trbovlje, Slovenia
| | | | | | - Ales Belic
- Lek d.d., Verovskova 57, Ljubljana, Slovenia
| | - Ales Mrhar
- Faculty of Pharmacy, University of Ljubljana, Askerceva cesta 7, Ljubljana, Slovenia
| | - Mitja Lainscak
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Cardiology, Department of Research and Education, General Hospital Celje, Celje, Slovenia.
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Bolt J, Semchuk W, Loewen P, Bell A, Strugari C. A Canadian Survey of Pharmacist Participation during Cardiopulmonary Resuscitation. Can J Hosp Pharm 2015; 68:290-5. [PMID: 26327702 DOI: 10.4212/cjhp.v68i4.1468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The participation of pharmacists on cardiopulmonary resuscitation (CPR) teams has been associated with improvements in patient outcomes secondary to lower rates of adverse drug events and higher rates of compliance with guidelines for advanced cardiac life support (ACLS). The degree to which Canadian pharmacists participate on CPR teams and the services they provide have not previously been assessed. OBJECTIVES To measure the frequency of pharmacists' involvement on CPR teams in Canadian health care delivery organizations, to characterize the services provided by these pharmacists, to identify positive predictors of participation, and, for health care delivery organizations without pharmacists on CPR teams, to determine the reasons for the lack of involvement. METHODS An electronic survey was distributed to key informants in Canadian health care delivery organizations. The survey consisted of questions about characteristics of the health care delivery organizations, pharmacists' participation and role on the CPR team, training, and barriers to implementation. The primary outcome was the percentage of health care delivery organizations with pharmacists participating on CPR teams in at least one centre within the organization. The secondary outcomes were pharmacists' activities, training, and reasons for not participating on CPR teams. RESULTS Forty-three of 99 key informants responded to the survey. Twenty-nine respondents (67%) indicated that their organization had a CPR team, and 10 (23%) indicated participation by pharmacists on a CPR team. Roles reported to be performed by pharmacists during CPR events were provision of drug information, preparation and administration of medications, record-keeping, and chest compressions. Training for these pharmacists was variable: ACLS training for 4 (40%) of the 10 organizations with pharmacist participation, in-house training for 3 (30%), and no training for 2 (20%); one respondent (10%) did not report the level of training. Reasons for not having pharmacists on CPR teams included inconsistent coverage, lack of training, and staff shortages. CONCLUSIONS This study characterized current pharmacist participation on CPR teams in Canadian health care delivery organizations. As evidence arises showing the impact of this practice on patient outcomes, pharmacist participation on CPR teams may become more common.
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Affiliation(s)
- Jennifer Bolt
- BScPharm, ACPR, PharmD, is Residency and Education Coordinator, Department of Pharmacy Services, Regina Qu'Appelle Health Region, Regina, Saskatchewan
| | - William Semchuk
- MSc, PharmD, FCSHP, is Manager of Clinical Pharmacy Services, Department of Pharmacy Services, Regina Qu'Appelle Health Region, Regina, Saskatchewan
| | - Peter Loewen
- BSc(Pharm), ACPR, PharmD, FCSHP, RPh, is Director of Doctor of Pharmacy Programs and Assistant Professor, Faculty of Pharmaceutical Sciences, The University of British Columbia; Pharmacotherapeutic Specialist (Medicine), Vancouver General Hospital; and Chair, UBC Clinical Research Ethics Board, Vancouver, British Columbia
| | - Ali Bell
- MA, MSc, is a Research Scientist, Department of Research and Health Information Services, Regina Qu'Appelle Health Region, Regina, Saskatchewan
| | - Caitlin Strugari
- BSP, ACPR, was, at the time of the study, a Pharmacy Resident with the Regina Qu'Appelle Health Region, Regina, Saskatchewan. She is now a Pharmacist, Department of Pharmacy Services, in the same organization
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Jackevicius C. [Not Available]. Can J Hosp Pharm 2015; 68:277-278. [PMID: 26327700 PMCID: PMC4552227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Cynthia Jackevicius
- Adresse de correspondance : D Cynthia Jackevicius, College of Pharmacy, Western University of Health Sciences, 309 E Second Street, Pomona CA 909469-5527, Courriel:
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McLeod SE, Lum E, Mitchell C. Value of Medication Reconciliation in Reducing Medication Errors on Admission to Hospital. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2008.tb00837.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Poh EW, Nigro O, Avent ML, Doecke CJ. Pharmaceutical Reforms: Clinical Pharmacy Ward Service versus a Medical Team Model. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2009.tb00448.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Eng Whui Poh
- Clinical Pharmacy and Medicines Information, Royal Adelaide Hospital
| | - Olimpia Nigro
- Specialist Clinical Pharmacist Internal Medicine, Clinical Pharmacy and Medicines Information, Royal Adelaide Hospital
| | - Minyon L Avent
- Clinical Pharmacy and Medicines Information, Royal Adelaide Hospital
| | - Christopher J Doecke
- Royal Adelaide Hospital, North Terrace, and Associate Professor, School of Pharmacy and Medical Sciences; University of South Australia; Adelaide South Australia
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Clinical pharmacy services that influence prescribing in the Western Pacific Region based on the FIP Basel Statements. Int J Clin Pharm 2015; 37:485-96. [DOI: 10.1007/s11096-015-0084-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/11/2015] [Indexed: 11/26/2022]
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Caractéristiques des revues systématiques présentant les interventions de pharmaciens. ANNALES PHARMACEUTIQUES FRANÇAISES 2014; 72:429-39. [DOI: 10.1016/j.pharma.2014.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/13/2014] [Accepted: 05/16/2014] [Indexed: 11/24/2022]
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Penm J, Chaar B, Rose G, Moles R. Pharmacists' influences on prescribing: validating a clinical pharmacy services survey in the Western Pacific Region. Res Social Adm Pharm 2014; 11:63-73. [PMID: 25042568 DOI: 10.1016/j.sapharm.2014.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/02/2014] [Accepted: 04/02/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hospital pharmacists around the world are becoming increasingly involved in promoting the responsible use of medicines through clinical pharmacy services. This is reflected in the Basel Statements developed by the International Pharmaceutical Federation Hospital Pharmacy Section, particularly the theme 'Influences on Prescribing.' Some countries, particularly in Asia, are currently establishing clinical pharmacy services and would benefit from identification of facilitators. OBJECTIVES To validate a survey exploring clinical pharmacy services focusing on pharmacists' influences on prescribing, based on Basel Statements 28-31, and the factors that affect their implementation in the Western Pacific Region (WPR). METHODS Content and face validity of the survey (BS28-31) was established. This resulted in the BS28-31 consisting of 20 questions, which included a Clinical Pharmacy Services Facilitators (CPSF) scale (25 items) to measure respondents' perceptions of facilitators of clinical pharmacy services. The BS28-31 was emailed to hospital pharmacy directors in the WPR. The survey was made available in English, Japanese, Chinese, Vietnamese, Lao, Khmer, French and Mongolian. Principal components and internal consistency analyses were conducted to assess the reliability and construct validity of the CPSF scale. RESULTS The final survey was sent to a total of 2525 hospital pharmacy directors in the WPR of which 726 were returned from 31 nations yielding a response rate of 29%. Two items in the scale were removed due to low communalities (0.22 and 0.16). The resulting 23 item scale produced a parsimonious two-factor solution, divided into internal (e.g. individual pharmacist traits and pharmacy departmental structure/resources) and environmental facilitators (e.g. government support, patient and physician expectations). This two factor solution explained 51.5% of the variance. In addition, the Cronbach's α for the internal and environmental subscales were 0.94 and 0.78 respectively. CONCLUSION The BS28-31 survey was found to be a reliable and valid instrument for assessing hospital pharmacy directors' perceptions of clinical pharmacy services regarding pharmacists' influences on prescribing and their facilitators in the WPR.
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Affiliation(s)
- Jonathan Penm
- Faculty of Pharmacy, World Hospital Pharmacy Research Consortium, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Betty Chaar
- Faculty of Pharmacy, World Hospital Pharmacy Research Consortium, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Grenville Rose
- Aftercare, Rozelle Hospital, Church Street, Lilyfield, NSW, Australia
| | - Rebekah Moles
- Faculty of Pharmacy, World Hospital Pharmacy Research Consortium, The University of Sydney, Camperdown, NSW 2006, Australia
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Guérin A, Caron E, Frève JFO, Lebel D, Bussières JF. [Not Available]. Can J Hosp Pharm 2014; 67:230-239. [PMID: 24970944 PMCID: PMC4071086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Aurélie Guérin
- est candidate au D. Pharm. et assistante de recherche à l'Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec. Elle est aussi interne en pharmacie, Université Paris Sud XI, France
| | - Elaine Caron
- B. Pharm., M. Sc., est pharmacienne au Département de pharmacie, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Johann-François Ouellette Frève
- Pharm. D., M. Sc., est pharmacien au Département de pharmacie, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Denis Lebel
- B. Pharm., M.Sc., FCSHP, est Adjoint, Département de pharmacie et Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Jean-François Bussières
- B. Pharm., M. Sc., FCSHP, est Chef, Département de pharmacie et Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec. Il est aussi professeur titulaire de clinique, Faculté de pharmacie, Université de Montréal, Montréal, Québec
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Phillips AL, Nigro O, Macolino KA, Scarborough KC, Doecke CJ, Angley MT, Shakib S. Hospital admissions caused by adverse drug events: an Australian prospective study. AUST HEALTH REV 2014; 38:51-7. [PMID: 24351707 DOI: 10.1071/ah12027] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 10/08/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the frequency of adverse drug event (ADE)-related admissions (ADE-RAs) during a prospective medical record review of patients admitted to a metropolitan tertiary referral hospital. METHODS Potential ADE-RA cases were identified by examination of case records of randomly selected patients. Cases were assessed by an expert panel to measure study outcomes, which were the frequency (ADEs and ADE-RAs) as well as type, likelihood of causality, severity, avoidability and detection of ADEs. RESULTS Of the 370 subjects, 59 (16.0%) had a confirmed ADE-RA, with 15 (4.1%) of these serious and preventable. The 59 ADE-RAs were a result of 72 discreet ADEs. Adverse drug reactions were the most common type of ADE, followed by non-compliance. Of the 72 discreet ADEs, 31.9% were classified as 'probable' or 'highly probable'. Most ADEs (54.2%) were classified as 'definitely avoidable', 34.7% were classified as 'severe' and 21.8% were classified as both 'definitely avoidable' and 'severe'. Half the ADEs were detected after the patient had been admitted and most were detected by medical practitioners. Antineoplastics followed by antidiabetic agents were most frequently implicated. CONCLUSIONS Implementing a systems approach that involves multiple strategies, such as improving tertiary-to-primary care information transfer and promoting medication adherence through education programs, is necessary to tackle the problem of avoidable ADE-RAs and the associated cost burden. WHAT IS KNOWN ABOUT THE TOPIC? It is estimated that 2-3% of Australian hospital admissions are due to adverse drug events (ADEs), but recent data are lacking. According to the Australian Statistics on Medicines, over 250 million prescriptions were dispensed in 2007, compared with just under 180 million in 1997. This 40% increase in drug utilisation over the 10 years surpasses the Australian population growth of 14% in the same period. An increase in drug use per person indicates that the rate of ADEs and possible ADE-related admissions (ADE-RAs) is likely to have increased. WHAT DOES THIS PAPER ADD? This prospective study was conducted at a large Australian metropolitan teaching hospital and we report that 59 of 370 participants (16.0%) presenting to the Emergency Department had a confirmed ADE-RA, with 15 (4.1%) presenting with a serious and preventable ADE-RA. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? The findings of this study support implementing a systems approach involving multiple strategies to tackle the problem of avoidable ADE-RAs and the associated cost burden. This study reveals that half the ADEs were not detected until after the admission process, which reinforces the importance of focusing efforts towards preventing ADE-RAs and detecting ADE-RAs through measures such as those recommended in the Australian Pharmaceutical Advisory Council guiding principles.
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Affiliation(s)
- Alexandra L Phillips
- Noarlunga Health Service, Alexander Kelly Drive, Noarlunga Centre, SA 5168, Australia
| | - Olimpia Nigro
- Royal Adelaide Hospital, Adelaide, SA 5000, Australia. ; ;
| | | | | | | | - Manya T Angley
- Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia.
| | - Sepehr Shakib
- Royal Adelaide Hospital, Adelaide, SA 5000, Australia. ; ;
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American College of Clinical Pharma , Gubbins PO, Micek ST, Badowski M, Cheng J, Gallagher J, Johnson SG, Karnes JH, Lyons K, Moore KG, Strnad K. Innovation in Clinical Pharmacy Practice and Opportunities for Academic-Practice Partnership. Pharmacotherapy 2014; 34:e45-54. [DOI: 10.1002/phar.1427] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Brook-Barclay L, Delaney CL, Scicchitano M, Quinn S, Spark JI. Pharmacist influence on prescribing in peripheral arterial disease (PIPER). Vasc Med 2014; 19:118-124. [DOI: 10.1177/1358863x14523064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to determine the association between a specialist clinical pharmacist working in collaboration with medical staff and prescribing in peripheral arterial disease (PAD). A retrospective cohort study was conducted comparing the influence of a dedicated clinical pharmacist on two samples of patients admitted to a single vascular surgery unit in either 2007 (control group) prior to implementation of a comprehensive clinical pharmacy service or 2009 (comparison group) post implementation. Data were obtained via review of medical records and electronic reports. A total of 685 patients were identified, resulting in 964 admissions. The patient to pharmacist ratio decreased from 62 to 33 patients per day in 2009. More patients were initiated on an antiplatelet (OR 4.6, 95% CI 2.26 to 9.53, p<0.001) and statin (OR 3.4, 95% CI 1.97 to 6, p<0.001) in 2009 compared to 2007. Risk factor modification increased in 2009, resulting in action being taken more often for HbA1c>7% (OR 3.45, 95% CI 1.64 to 7.27, p=0.001), total cholesterol >4 mmol/L in females (OR 14.5, 95% CI 2.67 to 78.6, p=0.002) and blood pressure above target (OR 1.9, 95% CI 1.01 to 3.73, p=0.05) when a comprehensive clinical pharmacist service was available. There was a non-significant reduction in mortality (18.7% (65) to 14.2% (46), p=0.13) and cardiovascular outcomes (5.5% (19) to 4.3% (14), p=0.44) within 12 months of discharge. In conclusion, prescribing of evidence-based medication for PAD and risk factor modification increased with a comprehensive clinical pharmacist service. This study provides important insight into optimising treatment in this patient group and how a pharmacist can be a helpful addition to the multidisciplinary team.
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Affiliation(s)
- Laura Brook-Barclay
- Flinders Medical Centre, Bedford Park, SA, Australia
- School of Pharmacy, University of South Australia, Adelaide, SA, Australia
| | - Christopher L Delaney
- Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders University, Bedford Park, SA, Australia
| | | | | | - James I Spark
- Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders University, Bedford Park, SA, Australia
- Repatriation General Hospital, Daw Park, SA, Australia
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Paul L, Robinson KM. Capture and documentation of coded data on adverse drug reactions: an overview. Health Inf Manag 2014; 41:27-36. [PMID: 23705134 DOI: 10.1177/183335831204100304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Allergic responses to prescription drugs are largely preventable, and incur significant cost to the community both financially and in terms of healthcare outcomes. The capacity to minimise the effects of repeated events rests predominantly with the reliability of allergy documentation in medical records and computerised physician order entry systems (CPOES) with decision support such as allergy alerts. This paper presents an overview of the nature and extent of adverse drug reactions (ADRs) in Australia and other developed countries, a discussion and evaluation of strategies which have been devised to address this issue, and a commentary on the role of coded data in informing this patient safety issue. It is not concerned with pharmacovigilance systems that monitor ADRs on a global scale. There are conflicting reports regarding the efficacy of these strategies. Although in many cases allergy alerts are effective, lack of sensitivity and contextual relevance can often induce doctors to override alerts. Human factors such as user fatigue and inadequate adverse drug event reporting, including ADRs, are commonplace. The quality of and response to allergy documentation can be enhanced by the participation of nurses and pharmacists, particularly in medication reconciliation. The International Classification of Diseases (ICD) coding of drug allergies potentially yields valuable evidence, but the quality of local and national level coded data is hampered by under-documenting and under-coding.
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Affiliation(s)
- Lindsay Paul
- School of Public Health, Faculty of Health Sciences, La Trobe University, Bundoora VIC 3086, Australia.
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