The intervention of a pharmacist reduced the incidence of delayed CINV and improved medication adherence.
With tyrosine kinase inhibitors (TKI), chronic myeloid leukemia (CML) patients are achieving similar rates of survival to the general population and some treatment aspects such as adherence and drug-to-drug interactions (DDI) are becoming increasingly important. Our aim was to investigate the frequency and real clinical consequences of DDI between TKI and concurrent medications in CML. We performed a retrospective multicenter study including 105 patients receiving 134 TKI treatments. Sixty-three patients (60%) had at least one potential DDI. The mean number of concomitant medications was 4.8 (0-19). The mean number of DDI by TKI treatment was 1.2 (0-8); it increased with the number of concomitant medications and age in a significant manner. A total of 159 DDI were detected, involving 55 different drugs. The most common drug classes involved were proton pump inhibitors, statins, and antidepressants. A DDI-related clinical effect (toxicity and/or lack of efficacy) was suspected during the common course of patient follow-up in only five patients (4.7%). This number increased to 20% when data were centrally reviewed. Most of the adverse events (AE) attributed to DDIs were mild. The most common were diarrhea, vomiting, edema, cramps, and transaminitis. Nilotinib and dasatinib showed a tendency towards a higher risk of DDI compared with imatinib. There were no significant differences in AE frequency or in treatment response between patients with or without DDI. Due to their frequency, and their potential to cause clinically relevant effects, DDI are an important aspect of CML management.
Our study confirms low adherence with both local and international recommendations for antiemetic prescriptions. However, we could not prove that adherence involves a CINV reduction. Adherence did not seem to be influenced by the doctor's perception of the patient's risk of emesis.
Background Computerized provider-order-entry (CPOE) system is known to improve quality, increase efficiency, and reduce medication errors. The pharmacist, through the electronic validation, can provide improvements to the patient pharmacotherapy. However, not all hospitals follow the same method to make such proposals. Purpose To analyse the type of interventions made in our hospital. To validate process intervention. Materials and Methods Pharmacists interventions were studied over a period of one year (June 2011–May 2012). Both prescription and validation are performed in the computer programme Farmatools®. The pharmacist used to write a warning on the patient treatment. Alerts were reviewed the following day and we checked if the recommendation was accepted or not by the physician. Interventions were classified according to the type of recommendation, the drug and whether it was accepted. Results A total of 788 interventions were analysed (2.2 per day). The most frequent (27%) was dose adjustment for renal failure, followed by switching from intravenous to oral route (16%), change of dose (13%) and indication (12%). Other interventions were medication reconciliation, duplicity, therapeutic equivalent and adverse reaction. The most frequent drugs were enoxaparin (24%), pantoprazole (12%), paracetamol (5%), insulin (5%), digoxin (4%), amoxicilin-clavulanic (4%) and levofloxacin (4%). Only 72% of the recommendations were reviewed. From this, 54% were accepted. Conclusions Although 788 interventions have been studied, there are many who have not been registered in the programme, so it could not be analysed. We observed that the dose adjustment for renal failure, especially enoxaparin, is recorded systematically, but this does not occur with other types of interventions. Acceptance is lower than those reported in literature, so we can conclude that the method of communication with the clinician is inadequate and should be strengthened with verbal communication. No conflict of interest.
Background In Spain wards usually order medicines electronically. Urgent or restricted medicines can be handwritten and are dispensed immediately. Purpose To measure the time taken for technicians to dispense medicines in the pharmacy and to analyse handwritten prescriptions for drugs. Materials and methods The study was conducted in a tertiary hospital. All handwritten orders were collected for 2 weeks from 8:00 to 15:00. This data was recorded: department, number of medicines, order arrival time, time taken to prepare the medicine, time of collection, whether or not a pharmacist consultation was necessary and the reason and whether it was justified as urgent. Results 178 orders were received (18 a day) averaging 1.5 ± 1.0 drugs each (range: 1–6). Most orders were received on Tuesday and Friday and from 13:00 to 14:00, followed by 9:00 -10:00. Departments with more orders were ICU, Paediatrics, Emergency and Psychiatry. The time taken to prepare the medicines was 10 min (range: 0–125: 65% of them <10 min). 48% needed a pharmacist consultation before being dispensed, mainly due to restricted-use drugs (54%). Other reasons were: medicines not stocked in our hospital and compounding required for individual patients. Once prepared, the orderly took on average 9 min (from 0 min to more than 24 h) to pick up the medicines. Finally we found that 57% were not justified as urgent handwritten orders. 7% of the orders were not dispensed. Conclusions By ISMP Medication Safety Self-Assessment for Hospitals 2007 standards, most orders were dispensed in a short time (<10 min). Although many of them were collected on the spot, others were not collected that day. It is noteworthy that about half of the orders were not justified as urgent, with the consequent disadvantage for the Department’s organisation. The most common causes of delay in preparation were that the orderly did not let the technician know the order had arrived and the high number of orders that needed a pharmacist consultation. No conflict of interest.
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