Medication therapy management and collaborative drug therapy management

An interventional study on intensive care unit drug therapy assessment in a rural district hospital in India

Background:

Intensive care unit is a potential area for drug-related problems. As many of the patients treated are complex patients, clinical pharmacy intervention could find drug therapy problems.

Materials and Methods:

Drug information liaisons daily attended ward rounds with intensivists and screened the patient for drug therapy assessment using the American Society for Health-System Pharmacists clinical skills competition DTA format. This was a prospective study done for 6 months from August 2012 to January 2013. Simple statistics were used to tabulate the drug-related problems assessed.

Results:

A total of 72 patients were screened for drug therapy problems, for which 947 drug doses were prescribed in the study period. The total number of prescriptions was 148. The average number of drugs per prescription was 6.39 and the average number of drugs per patient was 13.15. A total of 243 problems were identified; on an average, 1.67 problems were present per prescription. The total number of drug interactions identified was N = 192 (78.2%); majority of them (61.4%) were of type C (not serious). So, 55.73% of them were monitored and not stopped or substituted. The second type of problem was a correlation between drug therapy and medical problem (7.4%). Appropriate drug selection and drug regimen was the third problem, and the adverse drug reactions and therapeutic duplications accounted for approximately 2% of the drug-related problems identified.

Conclusion:

Drug interactions constituted the major problem of ICUs, but not many were serious or significant. Consensus in assessment of drug-related problems and convincing intensivists with good quality evidences are required for better acceptance of interventions.

Identifying Physical Assessment Skills and Their Relative Importance in Faculty-Based Pharmacy Practice Settings within the Same Region

Background:

As pharmacy educators, it is the responsibility of the faculty to prepare student pharmacists, through education, for the variety of opportunities that will be available to them after graduation. This education can be provided by incorporating standards set forth by the Accreditation Council on Pharmacy Education (ACPE), as well as by working with fellow educators at other schools of pharmacy within the region or across the country. This article summarizes data collected regarding physical assessment skills from pharmacy practice faculty within the Northeast region.

Objective:

To identify how often physical assessment skills are applied and their importance to pharmacy practice faculty practicing in various pharmacy settings, to use the data collected from pharmacy practice faculty to standardize which physical assessment skills should be used for training student pharmacists, and to use the collected data to assist in the development of guidelines that highlight core competencies in physical assessment that are in accordance with ACPE Accreditation Standards and Guidelines and that student pharmacists should be able to perform upon graduation.

Methods:

A physical assessment survey was mailed to pharmacy practice faculty at schools of pharmacy in the Northeast region. The survey asked faculty members to rate 2 parameters for each skill: how often a skill is used at their own practice site, and the importance of that skill to teach student pharmacists to use in the future.

Results:

A total of 238 surveys were mailed to pharmacy practice faculty in the Northeast region; 81 surveys were returned to the primary investigator. The data collected indicated a wide spread of opinions among faculty members regarding physical assessment.

Conclusions:

Although physical assessment skill is a required competency set forth by the ACPE Accreditation Standards and Guidelines, there is a wide variety of skills that pharmacy practice faculty feel are important to teach student pharmacists.