Evaluation of drug‐related problems and subsequent clinical pharmacists’ interventions at a Swiss university hospital

Abstract

What is known and objective: The evaluation of clinical pharmacy services is essential for their further development and establishment. We analysed drug-related problems (DRPs) and subsequent clinical pharmacists' interventions (PIs) at a Swiss university hospital. Method:We conducted a retrospective analysis of DRPs and subsequent PIs that were identified and implemented during interdisciplinary ward rounds in internal medicine at the University Hospital Basel, Switzerland, between 2015 and 2017. We estimated the potential clinical and economic impact of PIs using a validated evaluation tool (CLEO de ). Results and discussion:Based on medication reviews of 5441 patients, clinical pharmacists identified 5024 DRPs, of which 2892 DRPs (57.6%) were followed by a PI that was directly accepted and implemented by the physician in charge and included in the present analysis. The leading cause and type of PIs were inappropriate dose and dose adjustment, respectively. Overall, 97.8% of DRPs were followed by PIs with an expected clinical benefit for the patients (major: 11.1%; moderate: 27.6%; minor: 59.1%). The drugs most often involved in PIs of major clinical impact were antithrombotics, acid blockers and cardiovascular drugs. With regard to the economic impact, 40.7% of DRPs implied PIs resulting in an increase of immediate therapy costs, whereas 39.3% implied PIs resulting in a decrease of immediate therapy costs. The remaining PIs were cost-neutral. What is new and conclusion:This study emphasizes that clinical pharmacists may help improve the effectiveness and safety of pharmacotherapy on acute care medical wards. K E Y W O R D S clinical pharmacy, drug-related problems, hospital, internal medicine, medication review, pharmacist intervention 1 | WHAT IS K NOWN AND OBJEC TIVE Drug-related problems (DRPs) are defined as events or circumstances involving drug therapy that actually or potentially interfere with desired health outcomes. Underlying causes can be related to the selection of a drug, drug form or dose, treatment duration, the logistics of the prescribing and dispensing process, drug administration, patient behaviour or outcome monitoring. 1 DRPs are common in Swiss hospitals. For instance, on two internal medicine wards at the University Hospital Geneva, a clinical | 925 REINAU Et Al.

Drug-related problems identified during pharmacy intervention and consultation: Implementation of an intensive care unit pharmaceutical care model

“…(1) The incidence rates of interventions is 12.1 cases per 100 patient admissions, being similar to the rate of preventable ordering adverse drug events as 14.7 per 100 patients in previous report [10]. (2) ADE occurring (31.1%) was the most frequently detected DRPs and more than four fifths of DRPs were due to drug selection, dose selection and treatment duration, being in line with an evaluation of pharmacists' interventions in a Swiss study [8]. 3Drugs that most frequently caused DRPs during intervention were antibiotics, showing a similar composition but with a higher percentage than that of previous studies [8,31,32].…”

“…Previous studies have shown that critical care pharmacists can play an essential role in promoting the delivery of pharmaceutical care (PC) and improve the overall quality of healthcare by offering individualized recommendations in complicated drug regimens, reducing the incidence rate of DRPs and decreasing preventable ADEs [6][7][8]. However, the development of PC in the ICU is currently facing three major challenges worldwide.…”

Drug-Related Problems Identified During Pharmacy Intervention and Consultation: Implementation of an Intensive Care Unit Pharmaceutical Care Model

“…(1) The incidence rates of interventions is 12.1 cases per 100 patient admissions, being similar to the rate of preventable ordering adverse drug events as 14.7 per 100 patients in previous report (Leape et al, 1999). (2) ADE occurring (31.1%) was the most frequently detected DRPs and more than four fifths of DRPs were due to drug selection, dose selection, and treatment duration, being in line with an evaluation of pharmacists' interventions in a Swiss study (Reinau et al, 2019). (3) Drugs that most frequently caused DRPs during intervention were antibiotics, showing a similar composition but with a higher percentage than that of previous studies (Klopotowska et al, 2010;Johansen et al, 2016;Reinau et al, 2019).…”

“…ICU physicians might feel pressure when they held different opinions on treatment plans, and unnecessary medication orders could be carried out in this way. These situations bring great opportunities for pharmacists to get involved, communicate with both sides and ensure medication safety (Rudis and Brandl, 2000;Kane et al, 2003;Penm et al, 2014a;Tasaka et al, 2018;Reinau et al, 2019).…”

“…Patients admitted to the intensive care unit (ICU) are at higher risk for developing DRPs, from 2.1/1,000 to 804.5/1,000 patients days (Garrouste-Orgeas et al, 2010;Garrouste-Orgeas et al, 2015;Garrouste-Orgeas et al, 2016), primarily cause by their critical diseases status or complications, the use of various high alert medications, and the rapid changing pharmacotherapies (Kari et al, 2018). Previous studies have shown that critical care pharmacists can play an essential role in promoting the delivery of pharmaceutical care (PC) and improve the overall quality of health care by offering individualized recommendations in complicated drug regimens, reducing the incidence rate of DRPs, and decreasing preventable ADEs (Tasaka et al, 2018;Lee et al, 2019;Reinau et al, 2019). However, the development of PC in the ICU is currently facing three major challenges worldwide.…”