The majority of hospitalised patients have drug-related problems: results from a prospective study in general hospitals.

OBJECTIVE: To describe the frequency and types of drug-related problems (DRPs) in hospitalised patients, and to identify risk factors for DRPs and the drugs most frequently causing them. METHODS: From May to December 2002, 827 patients from six internal medicine and two rheumatology departments in five hospitals in Norway were included in this study. We recorded demographic data, drugs used, relevant medical history, laboratory data and clinical/pharmacological risk factors, i.e. reduced renal function, reduced liver function, heart failure, diabetes, compliance problems, drugs with a narrow therapeutic index and drug allergy. DRPs were documented after reviewing medical records and participation in multidisciplinary team discussions. An independent quality assessment team retrospectively assessed the DRPs in a randomly selected number of the study population. RESULTS: Of the patients, 81% had DRPs, and an average of 2.1 clinically relevant DRPs was recorded per patient. The DRPs most frequently recorded were dose-related problems (35.1% of the patients) followed by need for laboratory tests (21.6%), non-optimal drugs (21.4%), need for additional drugs (19.7%), unnecessary drugs (16.7%) and medical chart errors (16.3%). The patients used an average of 4.6 drugs at admission. A multivariate analysis showed that the number of drugs at admission and the number of clinical/pharmacological risk factors were both independent risk factors for the occurrence of DRPs, whereas age and gender were not. The drugs most frequently causing a DRP were warfarin, digitoxin and prednisolone, with calculated risk ratios 0.48, 0.42 and 0.26, respectively. The drug groups causing most DRPs were B01A-antithrombotic agents, M01A-non-steroidal anti-inflammatory agents, N02A-opioids and C09A-angiotensin converting enzyme inhibitors, with risk ratios of 0.22, 0.49, 0.21 and 0.35, respectively. CONCLUSIONS: The majority of hospitalised patients in our study had DRPs. The number of drugs used and the number of clinical/pharmacological risk factors significantly and independently influenced the risk for DRPs. Procedures for identification of, and intervention on, actual and potential DRPs, along with awareness of drugs carrying a high risk for DRPs, are important elements of drug therapy and may contribute to diminishing drug-related morbidity and mortality.

[Clinical pharmacist improves the use of drugs in hospital]. / Klinisk farmasøyt forbedrer legemiddelbruken i sykehus.

BACKGROUND: We investigated how a clinical pharmacist can contribute to quality assurance of the use of drugs for inpatients in a respiratory ward. MATERIAL AND METHODS: Up to twice a week over two periods (43 meetings, 31 in the first and 12 in the second period), a clinical pharmacist sat in on the morning meetings regarding patients. Various drug-related problems were identified and discussed. RESULTS: The clinical pharmacist took part in discussions of 232 (70%) of a total of 332 patients. On average, 0.71 drug-related problems per patient resulting in a prescription change were identified. This included 239 drug-related problems: lack of use of drugs (25), unnecessary use (18) or wrong use (1); too low dose (16), too high dose (30); adverse effects (29); compliance (10) and miscellaneous problems (110). The average number of prescription changes suggested by the clinical pharmacist went down from 0.81 per patient in the first period to 0.57 in the second (p < 0.001). INTERPRETATION: We conclude that many drug-related problems were identified and the quality of drug use was improved by including a clinical pharmacist in the medical team.

Comparison of drug-related problems in different patient groups.

BACKGROUND: There is a lack of knowledge concerning how drug-related problems (DRPs) vary in different patient groups. Possible dissimilarities need to be taken into consideration when guidelines for detecting and preventing DRPs are compiled. OBJECTIVE: To characterize and compare the frequency and categories of DRPs in different groups of hospitalized patients. METHODS: Patients admitted to 4 different types of departments at 5 hospitals in Norway were included consecutively. Medical records and information acquired at multidisciplinary morning meetings were sources for assessing the patients' DRPs. RESULTS: A total of 827 patients were included. Mean age was 70.8 years, 58.6% were female, and 81% had at least one DRP. An average of 1.9, 2.0, 2.1, and 2.3 DRPs per patient were found in the departments of cardiology, geriatrics, respiratory medicine, and rheumatology, respectively. Significant differences in the type of DRPs between the patient groups were found. The most frequent DRPs and the patient group in which they most often occurred were nonoptimal dose (cardiology, respiratory, geriatric) and need for additional drug (rheumatology). CONCLUSIONS: DRPs occurred in the majority of the patients in all departments. The type of DRP differed markedly between the patient groups. Knowledge of these differences is clinically valuable by enabling us to guide efforts toward prevention of DRPs. Antithrombotic agents, loop diuretics, angiotensin-converting enzyme inhibitors, penicillins, antiinflammatory drugs, and opioid analgesics commonly caused DRPs, even in departments where knowledge of these drugs is assumed to be extensive.