Drug-Related Problems on a Palliative Care Unit

Rémi, Constanze; Bauer, Dominik; Krumm, Lisa; Bausewein, Claudia

doi:10.1080/15360288.2021.1943596

Cited by 6 publications

(9 citation statements)

References 25 publications

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“…Nevertheless, characteristics of the medication regimens and aspects of medication safety identified here are consistent with those revealed in other studies. 2,7,8,20,21 Both the complexity of patients' drug regimens observed at admission and the progression of their medication therapies support the general assumption in palliative care that regular medications decrease steadily towards death, while the need for PRN medications increases.…”

Section: Strengths and Limitationsmentioning

confidence: 87%

“…19 The problem of complex drug regimens in palliative care has been investigated and described in several studies. 2,7,20,21 However, studies investigating whether drug regimens in hospice care are associated with similar levels of complexity remain low in number. Most of the available studies only assess medication cross-sectionally at one timepoint only, usually on the day of death.…”

Section: Introductionmentioning

confidence: 99%

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Prescription Trends in Hospice Care: A Longitudinal Retrospective and Descriptive Medication Analysis

Wernli

Hischier

Meier

et al. 2022

Am J Hosp Palliat Care

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Background In hospice and palliative care, drug therapy is essential for symptom control. However, drug regimens are complex and prone to drug-related problems. Drug regimens must be simplified to improve quality of life and reduce risks associated with drug-related problems, particularly at end-of-life. To support clinical guidance towards a safe and effective drug therapy in hospice care, it is important to understand prescription trends. Objectives To explore prescription trends and describe changes to drug regimens in inpatient hospice care. Design We performed a retrospective longitudinal and descriptive analysis of prescriptions for regular and as-needed (PRN) medication at three timepoints in deceased patients of one Swiss hospice. Setting/subjects Prescription records of all patients ([Formula: see text] 18 years) with an inpatient stay of three days and longer (admission and time of death in 2020) were considered eligible for inclusion. Results Prescription records of 58 inpatients (average age 71.7 ± 12.8 [37-95] years) were analyzed. The medication analysis showed that polypharmacy prevalence decreased from 74.1% at admission to 13.8% on the day of death. For regular medication, overall numbers of prescriptions decreased over the patient stay while PRN medication decreased after the first consultation by the attending physician and increased slightly towards death. Conclusions Prescription records at admission revealed high initial rates of polypharmacy that were reduced steadily until time of death. These findings emphasize the importance of deprescribing at end-of-life and suggest pursuing further research on the contribution of clinical guidance towards optimizing drug therapy and deprescribing in inpatient hospice care.

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Section: Strengths and Limitationsmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Prescription Trends in Hospice Care: A Longitudinal Retrospective and Descriptive Medication Analysis

Wernli

Hischier

Meier

et al. 2022

Am J Hosp Palliat Care

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“…DRP, type of interventions (written and oral), and results of these interventions were coded patient-specifically using the Pharmaceutical Care Network Europe (PCNE) Questionnaire on Drug-Related Problems V 8.0 [15]. The PCNE defines a DRP as an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes [6]. The coded data were documented in a project-specific Access database and analyzed descriptively.…”

Section: Measurement Of the Primary Endpointmentioning

confidence: 99%

“…The latter play an important role in palliative care and can have an impact on patient morbidity and mortality. Distinguishing between adverse effects of prescribed medications and symptoms of progressive disease is, however, difficult and probably often ambiguous [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Drug Therapy Safety in Palliative Care—Pharmaceutical Analysis of Medication Processes in Palliative Care

Krumm,

Bausewein,

Rémi

2023

Pharmacy

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Pharmacotherapy plays a crucial role in symptom management in palliative care and is associated with risks potentially leading to drug-related problems (DRP). Pharmacists can identify DRPs and advise prescribers on optimizing drug therapy. The aim of this study was to identify DRP in a palliative care unit (PCU) and evaluate corresponding pharmaceutical interventions. A non-randomized before-and-after study in a PCU starts with a control phase, an interphase, and an intervention phase. Primary endpoint: DRP, including pharmaceutical interventions and their acceptance. The medication of all inpatients was recorded at set time points, assessed for potential and manifest DRP, and categorized. In the control phase, the ward pharmacist did not interfere with the clinical team. In the intervention phase, the pharmacist could intervene when a DRP was identified and give recommendations. During the 12-month period, 284 patients were included (control phase n = 138; intervention phase n = 146) and 1079 DRPs were identified (control phase n = 634; intervention phase n = 445). The number of DRPs/patient was significantly reduced by the pharmacist’s interventions between the control and intervention phases (4 vs. 3 DRPs, p = 0.001). Overall acceptance of pharmaceutical interventions by prescribers was very high (227/256; 88%). DRPs are hardly preventable. With a clinical pharmacist as a member of the palliative care team, it is possible to reduce the number of DRPs and identify potential problems earlier.

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“…They must be knowledgeably aware of the character or nature of their patient's medical condition, particularly the illnesses which acquire immediate medical attention or examination. In addition to that, they must have the skills to identify, prevent, and resolve the actual or potential drug-related problems (DRP) [7]. Moreover, they should aware of their patient's drugrelated needs [8].…”

Section: Introductionmentioning

confidence: 99%

STARZ-DRP: An Advance Nursing Approach for Palliative Home Care Services

Nordin¹

2023

Nursing - New Insights for Clinical Care

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Nurses perform a significant role as professional practitioners in the healthcare system, particularly providing the Palliative Home Care Services (PHCS). PHCS is a continuum of medical and social services which support the needs of patients living with chronic medical conditions or severe disabilities. Most of the time, they shall engage with patients and their family members in the absence of physicians or pharmacists. They shall assist them to go through their daily routines with physical help and support. Foremost, they shall help their patients to consume medications as being prescribed. For that reason, they need an advanced approach to assist them to provide a quality and excellent PHCS. Therefore, this article shall highlight a tool is known as STARZ-DRP as a potential modus operandi to maneuver them to make an accurate and quick triaging-decision as well as identify the actual or potential drug-related problems. It is to be hoped that the tool shall enhance the image of nurses as healthcare providers.

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Drug-Related Problems on a Palliative Care Unit

Cited by 6 publications

References 25 publications

Prescription Trends in Hospice Care: A Longitudinal Retrospective and Descriptive Medication Analysis

Prescription Trends in Hospice Care: A Longitudinal Retrospective and Descriptive Medication Analysis

Drug Therapy Safety in Palliative Care—Pharmaceutical Analysis of Medication Processes in Palliative Care

STARZ-DRP: An Advance Nursing Approach for Palliative Home Care Services

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