Pharmaceutical care during COVID-19 pandemic: challenges and perspectives

Abstract COVID-19 (SARS-CoV-2) pandemic is raising many questions about the future of face-to-face interactions. The possible changes on healthcare delivery may provoke a long term disruption on pharmaceutical assistance requiring new approaches to provide pharmaceutical services. The proposal of pharmaceutical care is patient oriented, and its activities include different forms of interaction. The emergence of COVID-19 puts to the test all the efforts to reposition pharmaceutical care in the set of clinical activities. Now, the pharmaceutical consultations and group activities, which played a fundamental role in the reformulation of pharmacy practices, must be revised in order to reduce the risk of patient agglomeration and contamination. Several researchers suggest technology use to intermediate health care assistance. However, few studies had rigorously analyzed the effectiveness of virtual health care on the pharmaceutical field. Innovating the pharmacy workflow, during the course of a crisis like COVID-19, is the current challenge addressed to all pharmacists. This unforeseen situation requires us to reconsider our plans and actions. It will be necessary resilience, courage and creativity to achieve a consistent attitude, which provides a quick response to the health care needs in this time of crisis.

Impact of clinical pharmacy in oncology and hematology centers: A systematic review.

BACKGROUND: Oncology and hematology is a complex and specific area that requires monitoring by a multidisciplinary team capable of personalizing the treatment of each patient. Clinical pharmacy services have the potential to contribute significantly to the effective and economical care of cancer patients. OBJECTIVE: To evaluate, synthesize and critically present the available evidence on the impact of the Clinical Pharmacy in the treatment of patients with hematological cancer. METHOD: A review was carried out on the bases PubMed/MEDLINE, LILACS and Google Scholar. The included studies were: studies that evaluated the effects of pharmaceutical interventions in clinical in oncology and hematology services and having as a population patient with hematological cancer. RESULTS: 17 studies were selected among 745 identified. 4.771 patients were included, with an average follow-up time of 15.3 months. Patients affected by some type of hematological cancer, undergoing chemotherapy treatment, showed better adherence and continuity when accompanied by a clinical pharmacist, added to this professional in carrying out interventions, provides control of symptoms such as cancer pain, nausea and constipation and, thus, contributes to decrease the length of hospital stay. CONCLUSION: The implementation of a Clinical Pharmacy service in oncology and hematology centers contributes significantly to the effectiveness of pharmacotherapeutic treatment, treatment costs reduction, safety increase in the use of medications and the patient's quality of life.

Análise das características e tendências do mercado da formação de farmacêuticos no Brasil / Analisys of the characteristics and trends of pharmacist training market in Brazil

A presente pesquisa tem como foco a graduação do farmacêutico. Com o intuito de estudar o mercado educacional do curso de Farmácia, buscou-se analisar a oferta de cursos e vagas desta profissão, a legislação pertinente ao ensino superior do Brasil e do ensino em farmácia, além da atualização da DCN pertencentes a este curso. As justificativas para realização deste estudo estão baseadas em quatro argumentos interligados, como a importância da formação de recursos humanos para saúde, as mudanças ocorridas no perfil curricular desse curso nos últimos anos, o papel das instituições de ensino privado e o aparecimento e crescimento da modalidade EAD, sendo observadas as tendências para o mercado de formação dessa categoria profissional. Trata-se de estudo descritivo e exploratório utilizando uma abordagem quali-quantitativa com associação de duas estratégias metodológicas: a combinação de pesquisa bibliográfica e narrativa sobre as características e tendências da formação do farmacêutico em nosso país, e a coleta de dados através do site do e-MEC. Os resultados da pesquisa junto ao site do e-MEC evidenciaram um total de 811 cursos de Farmácia divididos em 752 presenciais tanto em instituições públicas quanto privadas; já na modalidade EAD, foram encontrados 59, todos em instituições privadas. Em janeiro de 2021 foram ofertadas 107.786 vagas na modalidade presencial e 194.433 EAD, totalizando 302.219 vagas. Considerando a organização acadêmica dos cursos presenciais, a pesquisa encontrou a maior parte em faculdades totalizando 273; O mercado educacional para o curso de farmácia teve sua expansão durante os anos 1930 juntamente com políticas voltadas para o crescimento do setor farmo-químico no país. Nos últimos anos, ocorreram inúmeras mudanças nas políticas de ensino superior, como o crescimento da oferta de vagas em IES privadas com incentivos do governo federal como o FIES e o PROUNI. Este período foi marcado pelo crescimento acelerado do número de cursos, vagas, modalidades de ensino e matrículas, além da diversidade de instituições que pertencem ao sistema de ensino superior do Brasil. O ensino à distância ganhou visibilidade com o avançar da globalização e a criação de novas tecnologias voltadas para a educação. As mudanças no setor educacional permitiram mostrar a importância de pesquisar a formação de recursos humanos, a necessidade de políticas, diretrizes e estratégias que atendam à população e aos serviços de saúde, evitando assim a escassez de recursos humanos para o setor saúde, garantindo o acesso universal e integral como proposto na Lei no 8.080. A pandemia do COVID-19 destacou a importância do farmacêutico em relação ao uso racional de medicamentos e de uma formação qualificada que possa garantir a assistência farmacêutica.

The focus of this study is on pharmacist graduation. To analyze the educational market for the Pharmacy course, we looked at the supply of courses and places in this field, as well as the regulations governing higher education in Brazil and pharmacy education, as well as the DCN for this degree. The study's justifications are based on four interconnected arguments, including the importance of human resources training for health, changes in the curricular profile of this course in recent years, the role of private educational institutions, and the emergence and growth of distance education, as well as trends in the training market for this professional category. This is a descriptive and exploratory study that uses a quali-quantitative approach and combines two methodological strategies: a combination of bibliographic and narrative research on the characteristics and trends of pharmacist education in our country, as well as data collection through the e-MEC website. The survey found a total of 811 Pharmacy courses, divided into 752 face-to-face courses in both public and private institutions, and 59 distance learning courses, all in private institutions, on the e-MEC website. In January 2021, 107,786 on-site places and 194,433 distance learning vacancies were available, amounting 302,219 places. During the 1930s, the educational market for pharmacy courses grew in line with policies aimed at expanding the pharmochemical sector in the country. There have been several changes in higher education regulations in recent years, such as the increase of vacancies in private HEIs with federal government incentives like FIES and PROUNI. The number of courses, vacancies, education modalities, and enrollments increased rapidly throughout this period, as did the diversity of institutions that make up Brazil's higher education system. With the advancement of globalization and the introduction of new educational technology, distance learning has become more visible. The changes in the educational sector highlight the importance of studying human resource formation, as well as the need for policies, guidelines, and strategies that benefit the population and health services, avoiding a human resource shortage in the health sector and ensuring universal and integral access, as proposed in Law 8.080. The COVID-19 pandemic underscored the necessity of pharmacists in terms of medication rationalization and specialized training that can ensure pharmaceutical assistance.

Automated compounding technology and workflow solutions for the preparation of chemotherapy: a systematic review.

OBJECTIVES: The current systematic review (SR) was undertaken to summarise the published literature reporting the clinical and economic value of automation for chemotherapy preparation management to include compounding workflow software and robotic compounding systems. METHODS: Literature searches were conducted in MEDLINE, Embase and the Cochrane Library on 16 November 2017 to identify publications investigating chemotherapy compounding workflow software solutions used in a hospital pharmacy for the preparation of chemotherapy. RESULTS: 5175 publications were screened by title and abstract and 18 of 72 full publications screened were included. Grey literature searching identified an additional seven publications. The SR identified 25 publications relating to commercial technologies for compounding (Robotic compounding systems: APOTECAchemo (n=12), CytoCare (n=5) and RIVA (n=1); Workflow software: Cato (n=6) and Diana (n=1)). The studies demonstrate that compounding technologies improved accuracy in dose preparations and reduced dose errors compared with manual compounding. Comparable levels of contamination were reported for technologies compared with manual compounding. The compounding technologies were associated with reductions in annual costs compared with manual compounding, but the impact on compounding times was not consistent and was dependent on the type of compounding technology. CONCLUSIONS: The published evidence suggests that the implementation of chemotherapy compounding automation solutions may reduce compounding errors and reduce costs; however, this is highly variable depending on the form of automation. In addition, the available evidence is heterogeneous, sparse and inconsistently reported. A key finding from the current SR is a 'call to action' to encourage pharmacists to publish data following implementation of chemotherapy compounding technologies in their hospital, which would allow for evidence-based recommendations on the benefits of chemotherapy compounding technologies.

Women in oncology pharmacy leadership: A white paper.

Gender disparity exists in leadership roles within healthcare. While the majority of the healthcare workforce is comprised of women, significantly fewer women occupy leadership positions, particularly at executive and board levels. As the field of oncology pharmacy continues to rapidly expand and evolve, an assessment of the current state of women in oncology pharmacy leadership roles is vital to the growth and development of the profession. In the fall of 2017, the Hematology/Oncology Pharmacy Association (HOPA) hosted a summit to explore leadership issues facing women in oncology pharmacy which have the potential to affect our membership and our profession. This meeting included invited participants from across the fields of oncology and pharmacy and was part of HOPA's strategic leadership initiative developed through the work of the HOPA Leadership Development Committee in 2016. This promotes a primary goal of HOPA, which is to support oncology pharmacists as they assume leadership roles within their practices and within healthcare to assure oncology pharmacy is integrated into cancer care. The purpose of this white paper is to (1) summarize key issues that were identified through a membership survey; (2) review ongoing efforts to address the needs of female oncology pharmacists in leadership development; (3) serve as a call to action for individuals and professional organizations to assist with and disseminate these efforts and highlight available resources, and (4) to provide practical steps to meet the needs of individuals, training programs, and institutions/employers.

Front-line use of tyrosine kinase inhibitors in chronic phase chronic myeloid leukemia: Practice considerations.

The development of BCR-ABL-targeting tyrosine kinase inhibitors has transformed chronic phase chronic myeloid leukemia (CP CML) from a disease with a terminal prognosis to a treatable chronic illness. Long-term treatment with tyrosine kinase inhibitors means that patients have to be clinically managed and monitored over extended periods of time, thus a patient-centered, medically integrated, and multidisciplinary oncology healthcare team is required to support patients through their journey. Pharmacists work with patients, physicians, and the wider support team to select the optimum therapy plan for a given patient. These decisions are based on risk factors, comorbidities, concomitant medications, and personal circumstances and pharmacists advise on the efficacy and safety of different treatment options. Additionally, pharmacists are a key point-of-contact and resource for monitoring patient response to treatment, identifying and managing adverse events and drug-drug interactions, any subsequent therapy plan modifications, and, potentially, treatment-free remission. Pharmacists also assist with patient education, medication adherence, and financial discussions with patients throughout the long course of the disease. This review provides an overview of BCR-ABL tyrosine kinase inhibitors, discusses the role of the medically integrated pharmacy team, and suggests strategies that pharmacists can use in patient management and clinical decision-making to optimize the treatment of CP CML.

Implementing screening interventions in community pharmacy to promote interprofessional coordination of primary care - A mixed methods evaluation.

BACKGROUND: Screening is a critical component of efforts to reduce the population burden of cardiovascular disease (CVD), by facilitating early use of cost-effective prevention and treatment strategies. While international evidence suggests that screening in community pharmacies improves screening access and identifies at-risk individuals, concerns from medical organisations about the absence of interdisciplinary coordination and related lack of continuity of care with general practice have significantly contributed to reluctance from some stakeholders to endorse, and engage with, pharmacy-based screening initiatives. The Cardiovascular Absolute Risk Screening (CARS) study was designed to address these challenges and promote an interprofessional approach to screening for cardiovascular disease risk by pharmacists. This study describes the impact of the CARS implementation model on interdisciplinary coordination and continuity of care. METHODS: In addition to clinical training, pharmacists at eleven participating pharmacies were provided with implementation training, resources and support to promote interprofessional coordination. Completion of training and pharmacy implementation plans, both of which highlighted GP engagement strategies, were pre-requisites for screening commencement. Using mixed methods approaches, data were analyzed from screening records (n = 388), researcher interviews with patients at 6-10 weeks post-screening (n = 248, 64%), and pharmacist interviews (n = 10). RESULTS: Screening records suggested that 94% of screened individuals were advised to seek formal GP assessment, and 98% consented to sharing of results. Among interviewed participants, 81% recalled direct pharmacist action to facilitate GP engagement. Among interviewees who had seen their GP already (n = 70), 79% reported that their GP was aware of the results (another 16% were uncertain). Pharmacists reported positive GP feedback stemming from efforts at early engagement, but an absence of ongoing collaboration. CONCLUSIONS: Use of implementation planning by pharmacists, alongside clinical training, can effectively promote an interdisciplinary coordination focus by pharmacists.

Pharmacist-led patient education and adverse event management in patients with non-small cell lung cancer receiving afatinib in a community-based, real-world clinical setting.

PURPOSE: To describe the outcomes of a pharmacist-led multi-center, collaborative patient education and proactive adverse event management program in a community-based oncology setting. METHODS: Patients with EGFR mutation-positive (EGFRm+) non-small cell lung cancer, newly prescribed with oral afatinib, and monitored as part of the Florida Cancer Specialists patient management program, were included in a retrospective, observational analysis. During follow-up, data were collected on adverse event frequency, and changes in afatinib dosing. Data analyses were descriptive and exploratory in nature. RESULTS: The mean age of the 123 patients included in the analysis was 69 years, and 78% were female. At the time of the analysis, 3 patients had discontinued before receiving treatment, 89 patients had discontinued afatinib treatment, and 31 patients were continuing to receive afatinib treatment. The most common afatinib-related adverse events were diarrhea (85%), rash/skin reactions (58%), stomatitis/mucositis (19%), and paronychia (16%). Overall, 13% of patients discontinued due to afatinib-related adverse events. The median duration of treatment was 4 months in patients who discontinued due to adverse events, 6 months in those who discontinued for other reasons, and 18 months in those who were continuing to receive therapy. Afatinib dose-reductions were more frequent in patients continuing treatment versus those who discontinued due to adverse events (77% vs. 42%, respectively). CONCLUSIONS: Findings suggest that adverse events in patients with EGFRm + non-small cell lung cancer receiving afatinib can be successfully managed in a community-based, real-world setting with the help of collaborative pharmacist-led patient education, adverse event monitoring, and continuous support.

Effects of pharmacist interventions on reducing prescribing errors of investigational drugs in oncology clinical trials.

OBJECTIVES: This study aimed to investigate the effectiveness of pharmacist intervention in reducing and preventing prescribing errors of investigational drugs for cancer patients. MATERIALS AND METHODS: A retrospective study was conducted during two periods: a baseline period from December 2015 to June 2016 and an intervention period from July 2016 to February 2017. The investigational drug service (IDS) pharmacists performed active interventions during the intervention period. RESULTS: Among 12,387 investigational drug orders, 395 (6.1%) prescribing errors were detected in 6477 orders at the baseline period, and 278 errors (4.7%) were detected in 5,910 orders at the intervention period. To identify factors that affect prescribing errors, three models were constructed for the multivariate analysis. Among factors affecting prescribing errors, sponsor initiated trial (SIT) was the strongest factor (AOR: 4.16, 95% CI: 3.31-5.23). Pharmacist intervention reduced prescribing errors by at least 25% in all constructed models after adjusting for confounding variables. Prescribing errors were 1.3 times higher when dealing with intravenous medications than when dealing with oral medications. There were 60% fewer prescribing errors in the blinded study than in the open study. SIT and multi-center/multi-nation studies had 4.2 and 2.4 times more frequent prescribing errors than in investigator-initiated trials (IIT) and single-center/single-nation studies, respectively. Fewer errors occurred in phase 2 and trials covering both phase 1 and phase 2 (phase 1/2) than in phase 3 trials. CONCLUSIONS: The IDS pharmacist intervention in cancer clinical trials was associated with significant reductions in prescribing errors and may lead to increased medication safety.

Work overload is related to increased risk of error during chemotherapy preparation.

PURPOSE: Chemotherapy preparation units face peaks in activity leading to high workloads and increased stress. The present study evaluated the impact of work overloads on the safety and accuracy of manual preparations. METHOD: Simulating overwork, operators were asked to produce increasing numbers of syringes (8, 16, and 24), with markers (phenylephrine or lidocaine), within 1 h, in an isolator, under aseptic conditions. Results were analyzed using qualitative and quantitative criteria. Concentration deviations of < 5%, 5%-10%, 10%-30%, and >30% from the expected concentration were considered as accurate, weakly accurate, inaccurate, and wrong concentrations, respectively. RESULTS: Twenty-one pharmacy technicians and pharmacists carried out 63 preparation sessions (n = 1007 syringes). A statistically significant decrease in the manufacturing time for one syringe was observed when workload increased (p < 0.0001). Thirty-nine preparation errors were recorded: 30 wrong concentrations (deviation > 30%), 6 mislabeling, 2 wrong diluents, and 1 wrong drug. There was no statistically significant difference in the mean concentration accuracy of final preparations across the three workloads. The overall error rate increased with the number of preparations made in 1 h: 1.8% for 8 preparations, 2.7% for 16 preparations, and 5.4% for 24 preparations (p < 0.05). CONCLUSION: Although pharmacy technicians and pharmacists were able to increase production speeds with no effect on mean concentration accuracy under stressful conditions, there were greater probability errors being made. These results should encourage actions to spread workloads out over the day to avoid peaks in activity.

Multidisciplinary intervention to improve medication safety in nursing home residents: protocol of a cluster randomised controlled trial (HIOPP-3-iTBX study).

BACKGROUND: Medication safety is an important health issue for nursing home residents (NHR). They usually experience polypharmacy and often take potentially inappropriate medications (PIM) and antipsychotics. This, coupled with a frail health state, makes NHR particularly vulnerable to adverse drug events (ADE). The value of systematic medication reviews and interprofessional co-operation for improving medication quality in NHR has been recognized. Yet the evidence of a positive effect on NHR' health and wellbeing is inconclusive at this stage. This study investigates the effects of pharmacists' medication reviews linked with measures to strengthen interprofessional co-operation on NHR' medication quality, health status and health care use. METHODS: Pragmatic cluster randomised controlled trial in nursing homes in four regions of Germany. A total of 760 NHR will be recruited. Inclusion: NHR aged 65 years and over with an estimated life expectancy of at least six months. Intervention with four elements: i) introduction of a pharmacist's medication review combined with a communication pathway to the prescribing general practitioners (GPs) and nursing home staff, ii) facilitation of change in the interprofessional cooperation, iii) educational training and iv) a "toolbox" to facilitate implementation in daily practice. ANALYSIS: primary outcome - proportion of residents receiving PIM and ≥ 2 antipsychotics at six months follow-up. Secondary outcomes - cognitive function, falls, quality of life, medical emergency contacts, hospital admissions, and health care costs. DISCUSSION: The trial assesses the effects of a structured interprofessional medication management for NHR in Germany. It follows the participatory action research approach and closely involves the three professional groups (nursing staff, GPs, pharmacists) engaged in the medication management. A handbook based on the experiences of the trial in nursing homes will be produced for a rollout into routine practice in Germany. TRIAL REGISTRATION: Registered in the German register of clinical studies (DRKS, study ID DRKS00013588 , primary register) and in the WHO International Clinical Trials Registry Platform (secondary register), both on 25th January 2018.

Current models of support from community pharmacies for patients on oral anticancer medicines.

Administration of chemotherapy is moving into the community as more and more therapies to treat cancer are being developed as oral medications. Patients taking these oral medications still require support, as many of these agents can be toxic. This support could be simple side effect management, compliance issues or even reassurance with regards to their diagnosis as examples. Community pharmacies are ideally placed within the community to help these patients. The purpose of this review is to determine what support community pharmacies are currently providing for patients taking oral anticancer medication and if there is a model that can be adopted or adapted to be used elsewhere. Searches were undertaken using two databases, Medline and Embase. Other evidence-based articles were discovered from other sources. The different services currently available from community pharmacies were largely varied. There are some key aspects to each which could be used in the development of a new model. Further research is required to determine the views of the patients, carers and community pharmacy staff.

Pharmacists' Impact on Secondary Stroke Prevention.

BACKGROUND: Patients admitted to our institution with a cerebrovascular accident (stroke) or transient ischemic attack (TIA) are referred to the pharmacist-run stroke prevention clinic (SPC) for medication and risk factor management. OBJECTIVE: The objective was to determine if patients receiving care from the SPC have better outcomes than patients who received usual care. METHODS: This was a retrospective chart review of patients referred to the SPC. At the time of stroke/TIA, before initial visit, and after last SPC visit, risk factor data was collected. Hospital readmissions were reviewed for secondary stroke/TIA, myocardial infarction (MI), and new or incidental peripheral artery disease (PAD). For patients that did not attend SPC visits, data was used as a control. RESULTS: Patients referred to the SPC from October 2012 to December 2014 were reviewed. 455 records were reviewed. The primary composite end point of readmission for stroke/TIA, myocardial infarction, and new or incidental PAD was statistically significantly lower in the SPC group than the control group (P = .013). All surrogate markers, including blood pressure, Low Density Lipoprotein, Hemoglobin A1c, and smoking status, improved in the SPC group. CONCLUSION: Pharmacists can play a role in reducing risk factors for secondary stroke/TIA and prevent future hospital admissions.

A systematic review of the impact of outpatient clinical pharmacy services on medication-related outcomes in patients receiving anticancer therapies.

BACKGROUND: Patients receiving anticancer therapies are frequently prescribed complex and high-risk medication regimens, which at times can result in medication misadventures. The objective of this review was to assess the effect of outpatient clinical pharmacy services on medication-related outcomes in patients receiving anticancer therapies, including patients undergoing radiotherapy. METHODS: A systematic review of original publications indexed in EMBASE, MEDLINE and Cochrane Library from June 2007 to June 2017. Eligible studies evaluated outpatient pharmacy clinic services for cancer patients and reported at least one medication-related quantitative outcome measure. Two authors independently reviewed full-text articles for inclusion, then extracted data and performed quality and risk of bias assessments. RESULTS: Of 908 identified publications, 13 met predefined eligibility criteria; 1 randomised control trial, 2 controlled cohort studies and 10 uncontrolled before-after studies. Many excluded studies described outpatient pharmacy services but lacked medication-related outcomes. All included studies had informative practice model designs, with interventions for drug-related problems including drug dose optimisation ( n = 8), reduced drug interaction ( n = 6) and adverse drug reaction reporting ( n = 3). Most studies ( n = 11) reported on symptom improvement, commonly nausea ( n = 7) and pain ( n = 5). Of four studies in radiotherapy cohorts, pharmacist involvement was associated with improved symptoms, satisfaction and wellbeing scores. CONCLUSION: Few studies have objectively assessed outpatient pharmacy cancer services, even fewer in the radiotherapy settings. Although the results support these services, significant heterogeneity and bias in the study designs prohibit robust conclusions and further controlled trials are required.

Awareness and use of medication management services in relation to medication adherence prior to hospitalisation among older adults in Regional Australia.

Background Ageing is associated with changes in physiology, functional ability, declined in cognition and multiple co-morbidities. Alterations in pharmacodynamic and pharmacokinetic aspects also occur. Medications can improve the quality of life in people with multiple co-morbidities; polypharmacy and ageing could increase risks of medication misadventures and adverse events leading to hospital admissions. Medication management services (MedsCheck, Diabetes MedsCheck and Home Medication Review) were implemented in Australia to: increase patients' knowledge about their medicines, increase patients' confidence in using their medicines, and reduce avoidable hospital admissions. Objective This study aims to investigate patients' awareness, understanding and uptake of medication management services in relation to medication adherence. Setting Study was conducted at the Maryborough hospital, Queensland, Australia. Method This was a questionnaire based prospective study. A questionnaire was developed based on the questions used in the evaluation of the MedsCheck and Diabetes MedsCheck pilot program. Main outcome/Result We identified 243 participants of which 198 patients agreed to participate. Of the participants, 68.1% were taking more than five different medications a day and 34.3% of participants were taking more than 10 different medications a day. Those that consumed five or more doses of medication a day constitutes 72%. Only 3% had accessed medication management services prior to hospital admission. Many of participants (76.3%) noted that they had issues with different generics/brands of medication and only 23.2% of participants stated that they had a good understanding of drug-drug interactions. Conclusion Hospitalised patients are unaware of medication management services that could reduce frequency of re-hospitalisation. Community and hospital pharmacists can play a major role increasing patients' awareness of the availability of these services.

Clinical oncology pharmacist: Effective contribution to patient safety.

Management and prevention of problems related to oncology drugs are particularly important due to the excessive cost, high toxicity, and narrow therapeutic index of the antineoplastic drugs, in addition to the patients' state of health. Therefore, the presence of the pharmacist as a member of the multidisciplinary team is essential to contribute to patient safety. In this work, the interventions performed were identified, quantified, and classified to characterize the work of the clinical oncology pharmacist. This is a prospective and quantitative study, conducted over a period of six months in the outpatient oncology and chemotherapy clinic of the University Hospital of the University of Campinas, Brazil. A total of 3526 medical prescriptions were evaluated for the 780 patients seen and, among these prescriptions, 220 (6.24%) contained errors, representing 6.24% of the total number. The most common error was dose-related with 79 (22.83%) cases of overdosing. Wrong-patient medication error was the least reported (0.29%). Thirty drugs were involved in the pharmaceutical interventions, Carboplatin and Ondansetron being the most frequent. Thirteen types of potential errors were evaluated according to the method proposed by Cardinal and Fernandes. Two (15.38%) included interventions of indication, contraindication, and therapeutic efficacy of a drug. Five of them (38.46%) are related to the treatment regimen, and two (15.38%) were related to prevention of potential adverse events. Four interventions (30.77%) concerned technical interventions in injectable drugs such as dilution, compatibility, and administration time. Of the 346 interventions performed, 1 (0.29%) was classified as potentially lethal, 114 as serious (32.95%), 140 as significant (40.46%), and 91 as minor (26.30%).

Exploring the current and future role of the pharmacists in osteoporosis screening and management in Malaysia.

Background Several studies have found that pharmacists can assist in screening and prevention of osteoporosis by referring patients for bone mineral density scans and counselling on lifestyle changes. In Malaysia, screening osteoporosis in all elderly women is not mandatory due to its cost. One approach to address this gap is to develop a pharmacist-led osteoporosis screening and prevention program. However, there is a paucity of data on the perspectives of Malaysian pharmacists in this area. Objective To explore the perspective of stakeholders (policy makers, doctors, pharmacists, nurses and patients) towards the role of pharmacists in osteoporosis screening and management. Setting A primary care clinic located within a teaching hospital in Kuala Lumpur, Malaysia. Method Patients (n = 20), nurses (n = 10), pharmacists (n = 11), doctors (n = 10) and policy makers (n = 5) were individually interviewed using a semi-structured topic guide. Purposive sampling was used. Interviews were transcribed verbatim and analysed using thematic analysis. Main outcome measure Perspective of stakeholders on the current and future role of pharmacists. Results All participants perceived pharmacists to be suppliers of medication, although there was some recognition of roles in providing medication advice. Nonetheless, these stakeholders were eager for pharmacists to expand their non-dispensing roles towards counselling, creating awareness and screening of osteoporosis. Interviewed pharmacists referred to their current role as 'robotic dispensers' and unanimously agreed to spread out to osteoporosis management role. Conclusion Under stakeholders there is a willingness to expand the role of pharmacists in Malaysia to non-dispensing roles, particularly in osteoporosis screening and management.

Drug related problems identified by clinical pharmacist at the Internal Medicine Ward in Turkey.

Background Drug-related problems (DRPs) interfere with patient optimal therapeutic outcomes and may be associated with higher morbidity, mortality and healthcare expenditures. Objective This study aimed to identify DRPs and their causes in a Turkish hospital. Setting Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Internal Medicine Ward, Istanbul, Turkey. Method Cross-sectional study included a total of 100 patients. Patient demographics, medications, and history were evaluated. Data regarding recent medications were analyzed by two clinical pharmacists and an Internal Medicine physician. The DRPs were identified via V7.0 PCNE classification. Lexicomp® was used to assess the drug-drug interactions. UpToDate® recommendations and national guidelines were applied in the assessment of compliance with approved medication procedures. Main outcome measures Number and causes of the potential DRPs. Results At least one potential DRP was seen in 80% of the patients and 163 potential DRPs were identified (average = 1.6 DRPs/patient). The most common causes of DRPs were errors in drug selection (44.78%), dose selection (27.61%) and medication procedures (21.47%). There were significant correlations (p < 0.05) between DRPs and age (r = 0.4), number of drugs used (r = 0.32), duration of hospitalization (r = 0.25), renal impairment (r = - 0.34) and inflammation (r = 0.31). Conclusion The majority of the patients had DRPs. Patients with renal impairment, inflammation, polypharmacy or an extended hospital stay had a much higher chance of developing DRPs.

Development and validation of a transitions-of-care pharmacist tool to predict potentially avoidable 30-day readmissions.

PURPOSE: A practical tool for predicting the risk of 30-day readmissions using data readily available to pharmacists before hospital discharge is described. METHODS: A retrospective cohort study to identify predictors of potentially avoidable 30-day readmissions was conducted using transitions-of-care pharmacy notes and electronic medical record data from a large health system. Through univariate and multivariable logistic regression analyses of factors associated with unplanned readmissions in the study cohort (n = 690) over a 22-month period, a risk prediction tool was developed. The tool's discriminative ability was assessed using the C statistic; its calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test. RESULTS: Three factors predictive of readmission risk were identified; these variables-medication count, comobidity count, and health insurance status at discharge-form the 3-predictor MEDCOINS score. Among patients identified as being at high risk for readmission using the MEDCOINS tool, the estimated readmission risk was 22.5%, as compared with an observed readmission rate of 21.9%. The discriminatory performance of MEDCOINS scoring was fair (C statistic = 0.65 [95% confidence interval, 0.60-0.70]), with good calibration (Hosmer-Lemeshow p = 0.99). CONCLUSION: Among a cohort of patients who were seen by a transitions-of-care pharmacist during an inpatient hospitalization, comorbidity burden, number of medications, and health insurance coverage were most predictive of 30-day readmission. The MEDCOINS tool was found to have fair discriminative ability and good calibration.