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1.
J Oncol Pharm Pract ; 26(1): 29-35, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30832556

RESUMO

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.


Assuntos
Drogas em Investigação/efeitos adversos , Erros de Medicação/prevenção & controle , Neoplasias/tratamento farmacológico , Farmacêuticos , Serviço de Farmácia Hospitalar/métodos , Papel Profissional , Feminino , Humanos , Masculino , Neoplasias/epidemiologia , Farmacêuticos/tendências , Serviço de Farmácia Hospitalar/tendências , República da Coreia/epidemiologia , Estudos Retrospectivos
2.
J Oncol Pharm Pract ; 26(1): 51-59, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30866715

RESUMO

BACKGROUND: Different international organizations recommend safety measures for the use of vincristine to prevent wrong route administrations. A central recommendation is to use infusion bags instead of syringes to prevent confusion with intrathecal chemotherapy. This study aimed to investigate the implementation of safety measures for vincristine and intrathecal chemotherapies in Switzerland. METHOD: We conducted a written survey among hospital pharmacies of all general care and pediatric hospitals in Switzerland (n = 102). A responsible person of each hospital pharmacy was invited by email to participate in the online survey in May 2018. RESULTS: Of 66 responding hospitals (response rate 65%), 27 have a hospital pharmacy preparing parenteral chemotherapy. All of these hospitals prepared vincristine in 2017, while 21 also prepared intrathecal chemotherapy. Of these 21, 16 hospitals prepared vincristine as syringes, with small volume syringes being the most widely distributed dosage form. A switch from syringes to infusion bags was discussed in seven hospitals, and discussions led to plans for switch in two. The most prevalent safety measures were labeling for vincristine and special delivery for intrathecal drugs. Of hospitals preparing both vincristine syringes and intrathecal chemotherapy, four reported to have no safety measures implemented neither for vincristine nor for intrathecal chemotherapy. CONCLUSION: International recommendations are not widely implemented in Swiss hospitals. Syringes are still in use and other safety measures are sparsely disseminated. Thus, Swiss vincristine patients are still at an increased risk for wrong route application. Recommendations have to be further disseminated and implementation could be enhanced.


Assuntos
Antineoplásicos Fitogênicos/administração & dosagem , Erros de Medicação/prevenção & controle , Serviço de Farmácia Hospitalar/normas , Inquéritos e Questionários , Vincristina/administração & dosagem , Antineoplásicos Fitogênicos/efeitos adversos , Vias de Administração de Medicamentos , Feminino , Humanos , Masculino , Serviço de Farmácia Hospitalar/métodos , Suíça/epidemiologia , Seringas/normas , Vincristina/efeitos adversos
3.
Farm. hosp ; 43(4): 128-133, jul.-ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183899

RESUMO

Objetivo: Describir un programa de farmacovigilancia llevado a cabo por un servicio de farmacia y analizar las sospechas de reacciones adversas a medicamentos recogidas. Método: Estudio observacional, longitudinal, de nueve años de duración (2008-2016). El programa de farmacovigilancia está liderado por el servicio de farmacia, que realiza farmacovigilancia prospectiva, retrospectiva, intensiva y voluntaria en el paciente hospitalizado y ambulatorio (urgencias, hospital de día, consultas externas y centros sociosanitarios). Las reacciones adversas se incorporan en la historia clínica electrónica del paciente y se añade una alerta que indica su presencia. Resultados: Se recogieron 2.631 reacciones adversas a medicamentos en 2.436 pacientes (52% varones) con una media [rango] de edad de 63,3 [0-98] años. El 92,8% de las reacciones fueron notificadas por el farmacéutico y el 7,2% por médicos, enfermería y técnicos. El 63,7% se notificaron en hospitalización, el 19,2% en urgencias, el 10,6% en consultas externas, el 6,2% en hospital de día y el 0,3% en radiología. Se observó un incremento de notificación por farmacovigilancia prospectiva e intensiva. Los grupos terapéuticos mayoritariamente implicados fueron: antineoplásicos (21,3%), antibacterianos (12,3%), antitrombóticos (7,7%), analgésicos (6,7%), corticosteroides (5,2%), psicolépticos (5,2%), diuréticos (4,9%), antivirales (4,9%), antiinflamatorios y antirreumáticos (4,2%) e inmunosupresores (3,3%). Las reacciones adversas detectadas afectaron mayoritariamente a la piel y anejos (19,7%) y al tracto gastrointestinal (19,1%). Respecto a su gravedad, el 38,7% fueron leves, el 30,8% graves y el 30,5% moderadas. El 60,9% de los pacientes se recuperaron de las reacciones adversas y el 31,7% se encontraban en proceso de recuperación. Se interrumpió el tratamiento en el 65% de los casos y el 56% de los pacientes recibieron tratamiento específico. Conclusiones: La incorporación del programa de farmacovigilancia en la rutina diaria del farmacéutico de hospital aporta un valor añadido a la seguridad de la farmacoterapia del paciente


Objective: To describe our pharmacovigilance program and to analyze the reported adverse drug reactions. Method: Observational longitudinal study conducted from 2008 to 2016. The Pharmacy Department leads the pharmacovigilance program and performs prospective, retrospective, intensive, and spontaneous reporting of inpatients and outpatients (emergencies, day hospital, external consultations, and nursing homes). Each adverse drug reaction is incorporated in the electronic health record of the patient along with an alert. Results: A total of 2,631 adverse drug reactions were reported in 2,436 patients. Of these patients, 52% were men with a mean age of 63.3 [0-98] years. A total of 92.8% drug events were reported by the pharmacists and 7.2% by doctors, nurses, and technicians. A total of 63.7% were reported in inpatients, 19.2% in emergencies, 10.6% in external consultations, 6.2% in the day hospital, and 0.3% in diagnostic radiology. There was an increase in adverse drug reactions detected by prospective and intensive pharmacovigilance. Principal therapeutic groups involved in adverse drug events were antineoplastic agents (21.3%), antibacterials (12.3%), antithrombotics (7.7%), analgesics (6.7%), corticosteroids (5.2%), psycholeptics (5.2%), diuretics (4.9%), anti virals (4.9%), antiinflammatories and antirheumatics (4.2%), and immunosupressants (3.3%). Adverse drug reactions mainly affected the skin and appendages (19.7%) and gastrointestinal tract (19.1%). Adverse drug reactions were mild (38.7%), severe (30.8%), and moderate (30.5%). In total, 60.9% of patients recovered from drug events and 31.7% were in recovery. The most frequent response was treatment interruption in 65% of cases and the patients received additional specific treatment in 56% of cases. Conclusions: The incorporation of the pharmacovigilance program within the daily routine of the hospital pharmacist provides added value to the safety and pharmacotherapy of the patient


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Serviço de Farmácia Hospitalar/métodos , Serviço de Farmácia Hospitalar/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Antibacterianos , Fibrinolíticos , Antineoplásicos , Hospitalização/estatística & dados numéricos , Emergências/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Corticosteroides , Diuréticos
4.
Farm. hosp ; 43(4): 134-139, jul.-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183900

RESUMO

Objetivo: Los objetivos del estudio fueron cuantificar la adherencia, determinar los factores predictivos y conocer las consecuencias de una menor adherencia, en la práctica clínica diaria, en pacientes con artropatías inflamatorias crónicas tratados con terapias biológicas. Método: Estudio descriptivo, observacional y retrospectivo. Se incluyeron pacientes con artritis reumatoide, espondilitis anquilosante y artritis psoriásica que iniciaron una terapia biológica entre el 1 de enero de 2009 y el 31 de diciembre de 2016. Se recogieron variables sociodemográficas, relacionadas con la enfermedad, sobre las terapias biológicas y los recursos hospitalarios. La adherencia se calculó mediante la ratio media de posesión. Resultados: Se incluyeron 362 pacientes y 423 líneas de terapia biológica. La media de edad ± desviación estándar fue de 50,3 ± 13,9 años; 228 (53,9%) fueron mujeres. El porcentaje de adherentes fue de 187 de 216 (87%) en artritis reumatoide, 91 de 107 (85%) en espondilitis anquilosante y 84 de 100 (84%) en artritis psoriásica. La adherencia se relacionó con acudir con más frecuencia a la consulta del servicio de farmacia (odds ratio de 1,2; intervalo de confianza 95%: 1,1-1,3 [p < 0,001]) e inversamente con no acudir a las consultas de reumatología en la fecha prevista (odds ratio de 0,2; intervalo de confianza 95%: 0,1-0,9 [p = 0,030]) No hubo diferencias en el número de recursos hospitalarios utilizados por pacientes adherentes y no adherentes. Conclusiones: La adherencia a las terapias biológicas entre las artropatías inflamatorias crónicas es similar. Dicha adherencia se correlaciona con la frecuentación a consultas externas, pero no implica un aumento del consumo de recursos


Introduction: The aims of the study were to quantify adherence, determine the factors that can predict adherence and identify the consequences of poorer adherence in patients with chronic inflammatory arthropathies treated with biological therapies in daily clinical practice. Method: A descriptive, observational and retrospective study was carried out. Patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who started a biologic therapy between 1 January 2009 and 31 December 2016 were included. Variables related to socioeconomic status, the disease, the biological therapy and hospital resources were included. Adherence was calculated by using the medication possession ratio. Results: Three hundred and sixty-two patients and 423 lines of biological therapy were included. Mean age ± standard deviation was 50.3 ± 13.9 years, and 228 (53.9%) were women. The percentage of adherent patients was 187 out of 216 (87%) in rheumatoid arthritis, 91 out of 107 (85%) in ankylosing spondylitis and 84 out of 100 (84%) in psoriatic arthritis. Greater adherence was associated with more frequent visits to the pharmacy service (odds ratio 1.2, 95% confidence interval: 1.1-1.3 [p < 0.001]) and poorer adherence with a failure to attend scheduled appointments at the rheumatology clinic (odds ratio 0.2, 95% confidence interval: 0.1-0.9 [p = 0.030]). There were no differences between adherent and non-adherent patients in terms of the number of hospital resources used. Conclusions: There are no differences in adherence to biological therapies among patients with chronic inflammatory arthropathies. Adherence correlates with attendance at outpatient appointments, but this does not imply an increase in the use of hospital resources


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Cooperação e Adesão ao Tratamento , Terapia Biológica/métodos , Artropatias/terapia , Estudos Retrospectivos , Artrite Reumatoide/terapia , Espondilite Anquilosante/terapia , Artrite Psoriásica/terapia , Serviço de Farmácia Hospitalar/métodos , Intervalos de Confiança , Razão de Chances
5.
Am J Health Syst Pharm ; 76(9): 591-598, 2019 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-31361828

RESUMO

PURPOSE: The surface contamination levels of 5 commonly used hazardous drugs in hospital pharmacies are summarized, identifying practice patterns associated with contamination. METHODS: Contamination testing data were compiled to evaluate surface contaminants of 5 hazardous drugs (docetaxel, paclitaxel, cyclophosphamide, ifosfamide, and 5-fluorourcil). Data from 5,842 wipes over 6 years were collected from 338 hospital pharmacies. The contamination level for each drug was categorized as nondetectable (ND; ≤10 ng/ft2), low (between 10 and ≤100 ng/ft2), medium (between 100 and ≤1,000 ng/ft2) or high (>1,000 ng/ft2). Surface exposures for each drug were summarized based on location, contamination at first and subsequent wipe events, and the use of a closed system transfer device (CSTD). RESULTS: The majority of contamination results corresponded to locations at or near hazardous drug preparation, but also occurred in areas where hazardous drugs were not prepared. There was a higher incidence of contamination levels (high, medium, and low, respectively) at first wipe event (10.2%, 17.4%, and 17.7%) compared to subsequent wipe events (5.8%, 12.2%, and 13.6%) (p < 0.0001). There was a lower incidence of contamination levels at institutions that used CSTDs (6.3%, 12.8%, and 14.4%) compared to institutions that did not use CSTDs (14.2%, 17.9%, and 17.3%) (p < 0.0001). CONCLUSIONS: The majority of highest contamination levels corresponded to locations where hazardous drugs were prepared. While the rate of contamination was lower at subsequent wipe events and at institutions that used CSTDs, contamination was not completely eliminated in either scenario.


Assuntos
Antineoplásicos/análise , Contaminação de Equipamentos/prevenção & controle , Substâncias Perigosas/análise , Serviço de Farmácia Hospitalar/normas , Composição de Medicamentos/métodos , Composição de Medicamentos/normas , Monitoramento Ambiental/métodos , Equipamentos e Provisões Hospitalares/normas , Humanos , Serviço de Farmácia Hospitalar/métodos
6.
Int J Clin Pharm ; 41(4): 981-992, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31240551

RESUMO

Background Adverse drug reactions (ADRs) monitoring in cancer patients is important to ensure early detection, effective management and possible prevention subsequently. Objectives This study was conducted to detect and monitor ADRs to anti-cancer agents, and to assess impact of clinical pharmacists (CPs)' interventions in minimizing ADRs to anti-cancer agents. Setting Private, specialty oncology care hospital in South India. Methods CPs prospectively followed cancer patients admitted to inpatient wards and treated at ambulatory care in order to identify ADRs, for a period of 3 years. Identified/reported ADRs were discussed with concerned oncologists and/or nurses, documented electronically and assessed further for their causality, severity, preventability and grading. Based on study findings during year 1, interventions (educational, therapeutic and system based) were developed by CPs and implemented in order to minimize preventable ADRs. Impact of CPs' interventions was studied during year 2 and year 3. Main outcome measure(s) Preventable factors contributing to ADRs and percentage of preventable ADRs before and after CPs' interventions. Results A total of 1279 ADRs were reported in 1133 patients from a cohort of 1328 patients. Vomiting (23.22%), alopecia (9.53%), diarrhoea (8.67%) and myelosuppression (7.42%) were the common ADRs reported. Inappropriate administration frequency and regimen of anti-emetics (22%), lack of/suboptimal supportive care (18%) and administration errors (16%) were identified as common contributing (preventable) factors for ADRs in year 1. Percentage of preventable ADRs was 81% during year 1 (pre-intervention), and 45% and 34% in year 2 and year 3 respectively (post-interventions). Conclusion Interventions by CPs helped to minimize preventable ADRs to anti-cancer agents.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Segurança do Paciente , Serviço de Farmácia Hospitalar/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
7.
Pharm. pract. (Granada, Internet) ; 17(2): 0-0, abr.-jun. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184675

RESUMO

Background: Lack of benefit and potential harm of early parenteral nutrition (PN) initiation in critically ill children was highlighted in the 2016 published results of a large multicenter, randomized controlled trial. Objectives: The purpose of this project was to implement a process to delay PN initiation for up to five days after admission to our pediatric intensive care unit (PICU). Methods: Patients greater than thirty days of age, admitted to the PICU beginning July 1, 2016 were included in the analysis of the healthcare improvement initiative to decrease early PN initiation. A meeting was held with PICU fellows, attending physicians, dietitians, and pharmacists to reach a consensus to delay initiation of parenteral nutrition until PICU day five. The dietitian, with pharmacist support, reiterated recommendations on rounds and in formal notes. Results: A total of 2333 patients were identified in the pre-intervention group and a total of 2491 patients in the post-intervention group. The percentage of patients receiving PN prior to day five within the PICU was 5.5% in the pre-intervention group versus 3.1% in the delayed PN group (p<0.001). PICU patients receiving PN less than or equal to three days decreased from 2.6% pre-intervention to 1.5% post-intervention (p=0.01). For the subset of patients who were initiated on PN after admission to the PICU, median PICU length of stay was 7 days versus 6 days in the pre-intervention versus post-intervention group (p=0.26). Conclusions: Decrease in PN utilization was seen in the pre and post-intervention groups as assessed by percentage of patients initiated on PN prior to day five of PICU admission. Consensus among practitioners with consistent recommendations from the frontline dietitian and pharmacist, with nutrition support team collaboration, contributed to the evidence based quality initiative results. Delaying PN did not adversely affect length of stay pre versus post-intervention


No disponible


Assuntos
Humanos , Nutrição Enteral/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Cuidados Críticos/métodos , Tempo de Internação/estatística & dados numéricos , Serviço de Farmácia Hospitalar/métodos , Estudos Retrospectivos , Equipe de Assistência ao Paciente/organização & administração
8.
Crit Care Clin ; 35(3): 519-533, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076051

RESUMO

As more specialized care gets centralized in centers of excellence, patients admitted to rural hospitals may be at a disadvantage at the time of accessing expertise or receiving advanced care. In this setting, telemedicine models provide a justification to equalize care across different levels. The diversity in telemedicine services is vast and is expanding. Even with all the subsets of telemedicine, including telepharmacy, telestroke, teledialysis, and tele-emergency medicine, the reasons for providing services and associated limitations are similar. However, there is a lack of empirical research including best practices and resultant outcomes for these subsets of telemedicine models.


Assuntos
Diálise/métodos , Serviço Hospitalar de Emergência , Serviço de Farmácia Hospitalar , Acidente Vascular Cerebral/terapia , Telemedicina , Humanos , Serviço de Farmácia Hospitalar/métodos , Serviço de Farmácia Hospitalar/organização & administração , Telemedicina/métodos , Telemedicina/organização & administração
9.
Int J Clin Pharm ; 41(3): 820-824, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31028594

RESUMO

Background The poor quality of discharge summaries following admission to hospital, especially in relation to information on medication changes, is well documented. Hospital pharmacists can record changes to medications in the electronic discharge note to improve the quality of this information for primary care. Objective To audit the pharmacist-completed notes describing changes to admission medication, and to identify improvement opportunities. Setting 750-bed teaching district general hospital in England. Methods An evaluation of pharmacist written notes was conducted at a 750-bed teaching district general hospital in England. A sample of notes was analysed in three consecutive years, 2016-2018. Analyses were performed using descriptive statistics. Main outcome measure The number of discrepancies in the note compared to the discharge summary medication list. Results Notes were analysed for 125, 120 and 120 patients in 2016-2018 respectively. We saw an overall improvement in the accuracy of our notes from 12% of patients having an inaccurate note in 2016 to 4.2% in 2017 and 5.8% in 2018. The percentage of discharge medicines affected by these discrepancies reduced from 1.7% (2016) to 0.6% (2017) and 0.9% (2018). Conclusion Discrepancies were due to changes in the patient's medicines journey not being fully captured and documented. The overall reduction of discrepancies over the three consecutive audits was felt to be largely due to formalisation of the discharge medicines reconciliation process and reminding staff on how to complete a note. We are planning to utilise informatics surveillance tools along with system developments to sustain this elimination of out of date notes being transmitted to primary care.


Assuntos
Registros Eletrônicos de Saúde/normas , Reconciliação de Medicamentos/normas , Sumários de Alta do Paciente Hospitalar/normas , Farmacêuticos/normas , Atenção Primária à Saúde/normas , Cuidado Transicional/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Reconciliação de Medicamentos/métodos , Pessoa de Meia-Idade , Alta do Paciente/normas , Serviço de Farmácia Hospitalar/métodos , Serviço de Farmácia Hospitalar/normas , Atenção Primária à Saúde/métodos , Estudos Retrospectivos , Adulto Jovem
10.
Int J Clin Pharm ; 41(3): 728-733, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30937695

RESUMO

Background In Sweden there has been limited work investigating the integration and nature of collaborative relationships between pharmacists and other healthcare practitioners. Objective To explore the working relationships of physicians, nurses and ward-based pharmacists in a rural hospital after the introduction of a clinical pharmacy service. Setting General medical ward in a rural hospital in northern Sweden. Method Mixed methods involving face-to-face semi-structured interviews with nurses, physicians and pharmacists, and a physician survey using the Physician-Pharmacist Collaboration Index to measure the extent of physician-reported collaborative working relationships. Main outcome measure Perceptions about collaborative working relationships between physician, nurses and pharmacists. Results All physicians (n = 9) who interacted with the clinical pharmacists completed the survey. The mean total score was 78.6 ± 4.7, total 92 (higher scores represent a more advanced relationship). Mean domain scores were highest for relationship initiation (13.0 ± 1.3, total 15), and trustworthiness (38.9 ± 3.4, total 42), followed by role specification (26.3 ± 2.6, total 30). The interviews (with nurses and physicians), showed how communication, collaboration and joint knowledge-exchange in the intervention changed and developed over time. Conclusion This study provides new insights into collaborative working relationships from the perspectives of physicians and nurses. The Physician-Pharmacist Collaboration Index scores suggest that physicians felt that clinical pharmacists were active in providing patient care; could be trusted to follow up on recommendations; and were credible. The interviews suggest that the team-based intervention provided good conditions for creating new ways to work to achieve commitment to professional working relationships.


Assuntos
Atitude do Pessoal de Saúde , Relações Interprofissionais , Enfermeiras e Enfermeiros/psicologia , Equipe de Assistência ao Paciente , Farmacêuticos/psicologia , Médicos/psicologia , Feminino , Hospitais Rurais/normas , Humanos , Masculino , Enfermeiras e Enfermeiros/normas , Equipe de Assistência ao Paciente/normas , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/métodos , Serviço de Farmácia Hospitalar/normas , Médicos/normas , Papel Profissional/psicologia , Suécia/epidemiologia
11.
Clin Interv Aging ; 14: 587-600, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30962679

RESUMO

Purpose: Aging increases the prevalence of diseases. The elderly population is consequently often exposed to complex medication regimens. Increased drug use is one of the main reasons for drug-related problems (DRPs). The primary objective of this study was to define and classify DRPs, pharmacist interventions, and frequently prescribed medications in relation to possible DRPs in patients admitted to the geriatric ward of a teaching hospital in Turkey. Patients and methods: Pharmacist medication review reports for 200 orders of 91 patients (mean age: 80.33±0.46) were analyzed retrospectively. Results: A total of 1,632 medications were assessed and 329 interventions were proposed for possible DRPs in 156 orders. A total of 87.5% of the patients used five or more drugs (mean: 8.17±0.23). The number of DRPs per order was higher when polypharmacy was present (1.04±0.15 vs 1.66±0.11, P<0.05). In 71.31% of the cases, adverse drug events were recognized as the problem. The principal cause of possible DRPs was determined as drug interactions (40.12%). Only 22 potentially inappropriate medications were prescribed. The most common interventions included monitoring drug therapy (31.0%), stopping the drug (20.06%), and changing dosage (13.98%). The acceptance rate of pharmacist interventions by treating geriatrician was 85.41%. The most frequently prescribed drugs were for the nervous system, alimentary tract and metabolism, and cardiovascular system (n=358, 314, and 304, respectively). The pharmaceutical forms of 23 drugs were deemed inappropriate by pharmacists. Conclusion: Clinical pharmacy services are still not properly implemented in Turkey. The study highlights ways in which clinical pharmacy services can be instrumental in a geriatric ward. The high acceptance rates of pharmacist recommendations concerning a wide variety of DRPs and different classes of drugs indicate that advanced collaboration among geriatricians and pharmacists is possible in interdisciplinary geriatric assessment teams in Turkey.


Assuntos
Prescrição Inadequada , Farmacêuticos/normas , Serviço de Farmácia Hospitalar , Idoso de 80 Anos ou mais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Feminino , Serviços de Saúde para Idosos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Prescrição Inadequada/efeitos adversos , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/estatística & dados numéricos , Masculino , Conduta do Tratamento Medicamentoso/organização & administração , Determinação de Necessidades de Cuidados de Saúde , Serviço de Farmácia Hospitalar/métodos , Serviço de Farmácia Hospitalar/normas , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Polimedicação , Prevalência , Estudos Retrospectivos , Turquia/epidemiologia
12.
Int J Clin Pharm ; 41(3): 667-671, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30953272

RESUMO

Background Emergency medicine (EM) pharmacists are increasingly recognized as integral team members in the care of emergency department (ED) patients but there is variability in the scope of direct patient care services. Objectives The primary objective was to categorize direct patient care activities and drug therapy recommendations. The secondary objectives were to categorize recommendations based on drug class and to determine the proportion of recommendations associated with Institute for Safe Medication Practices (ISMP) high-alert medications. Methods This retrospective, single-center, chart review was conducted in an academic ED with 65,000 annual visits. EM pharmacists documented direct patient care activities in the electronic health record. Documented activities from 1/1/2015 through 3/31/2015 were abstracted electronically for analysis by a trained reviewer. Results There were 3567 interventions and direct patient care activities documented. The most common activities were facilitation of medication histories (n = 1300) and drug therapy recommendations (n = 1165). Of 1165 drug therapy recommendations, 986 were linked to a drug class such as antimicrobial agents (31.9%), cardiovascular agents (16.6%), and analgesic agents (13.2%) and 20% of these interventions were associated with ISMP high-alert medications. Conclusion EM pharmacists documented several types of direct patient care activities with the majority being drug therapy recommendations and medication histories.


Assuntos
Medicina de Emergência/métodos , Erros de Medicação/prevenção & controle , Assistência ao Paciente/métodos , Farmacêuticos , Serviço de Farmácia Hospitalar/métodos , Papel Profissional , Medicina de Emergência/normas , Humanos , Assistência ao Paciente/normas , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/normas , Estudos Retrospectivos
13.
J Clin Pharm Ther ; 44(4): 603-610, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30883843

RESUMO

WHAT IS KNOWN AND OBJECTIVE: The roles of pharmacists in medication management for transplant recipients have received limited attention. This study comprehensively assessed the impact of pharmacist-led post-transplant medication management. METHODS: A retrospective pre- and post-intervention study was conducted in the urology ward in a general hospital. Patients receiving kidney transplants from May 2015 to April 2017 were enrolled. Eligible subjects were assigned into two groups (pre-intervention group and post-intervention group) according to the date (1 May 2016) when the pharmacist commenced participation in the post-transplant management for kidney transplant recipients. The outcomes included intervention analysis, cost-saving effect, outcomes of immunosuppressive drug level monitoring, antibiotic outcomes, safety outcomes, and blood pressure (BP) and plasma glucose (PG) outcomes. RESULTS AND DISCUSSION: A total of 299 patients were admitted to our hospital for kidney transplantation. Two hundred and four patients met inclusion criteria for this study (84 patients were in pre-intervention group, and 120 patients were in post-intervention group). Out of 630 pharmacist interventions in the medication order, 97.1% were accepted by the physicians. The average cost of medications per patient decreased from 4661.64 Ren Min Bi (RMB) to 3051.33 RMB. The percentage of patients who maintained tacrolimus (TAC) levels within the target concentration range was higher in the post-intervention group on post-operative day (POD) 7 (75.00% vs 87.50%, P = 0.021). There was a significant decrease in antibiotic use density (AUD) and duration of antibiotic treatment in the post-intervention group. Post-intervention group showed lower levels in systolic blood pressure (SBP) (141.55 ± 14.62 vs 136.04 ± 13.17, P = 0.01) with higher BP control rate (67.50% vs 90.70%, P = 0.00) on discharge day compared to pre-intervention group. WHAT IS NEW AND CONCLUSION: Pharmacists played a comprehensive role in the management of kidney transplant recipients in the inpatient setting, with some evidence of enhanced clinical outcomes.


Assuntos
Conduta do Tratamento Medicamentoso , Serviço de Farmácia Hospitalar/métodos , Adulto , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/métodos , Masculino , Equipe de Assistência ao Paciente , Farmacêuticos , Estudos Retrospectivos , Tacrolimo/uso terapêutico , Transplantados
14.
Am J Health Syst Pharm ; 76(4): 225-235, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30715186

RESUMO

Purpose: The purpose of this project was to develop a set of valid and feasible quality indicators used to track opioid stewardship efforts in hospital and emergency department settings. Methods: Candidate quality indicators were extracted from published literature. Feasibility screening excluded quality indicators that cannot be reliably extracted from the electronic health record or that are irrelevant to pain management in the hospital and emergency department settings. Validity screening used an electronic survey of key stakeholders including pharmacists, nurses, physicians, administrators, and researchers. Stakeholders used a 9-point Likert scale to rate the validity of each quality indicator based on predefined criteria. During expert panel discussions, stakeholders revised quality indicator wording, added new quality indicators, and voted to include or exclude each quality indicator. Priority ranking used a second electronic survey and a 9-point Likert scale to prioritize the included quality indicators. Results: Literature search yielded 76 unique quality indicators. Feasibility screening excluded 9 quality indicators. The validity survey was completed by 46 (20%) of 228 stakeholders. Expert panel discussions yielded 19 valid and feasible quality indicators. The top 5 quality indicators by priority were: the proportion of patients with (1) naloxone administrations, (2) as needed opioids with duplicate indications, and (3) long acting or extended release opioids if opioid-naïve, (4) the average dose of morphine milligram equivalents administered per day, and (5) the proportion of opioid discharge prescriptions exceeding 7 days. Conclusion: Multi-professional stakeholders across a health system participated in this consensus process and developed a set of 19 valid and feasible quality indicators for opioid stewardship interventions in the hospital and emergency department settings.


Assuntos
Analgésicos Opioides/uso terapêutico , Revisão de Uso de Medicamentos/normas , Serviço Hospitalar de Emergência/normas , Pessoal de Saúde/normas , Serviço de Farmácia Hospitalar/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Analgésicos Opioides/efeitos adversos , Revisão de Uso de Medicamentos/métodos , Humanos , Serviço de Farmácia Hospitalar/métodos , Inquéritos e Questionários/normas
15.
Eur J Pharm Sci ; 130: 181-185, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30710619

RESUMO

BACKGROUND: Compounding of cytostatic drugs requires strict aseptic procedures, while exposure to toxic drugs and repetitive manual movements should be minimized. Furthermore, reuse of vials is desirable to lower the costs. To assess if all this might be safely achieved with a robot, this study aimed at qualifying the aseptic preparation process with the robotic system APOTECAchemo. METHODS: The aseptic compounding of patient-individual cytostatic solutions was simulated with media fill simulation tests to qualify the performance according to European GMP Annex 1. The contamination in the environment was measured in critical places using settle plates, contact plates, active air sampling and particle counting. Media-fill simulation tests were prepared in 3 production batches. The second part of the study evaluated the microbiological shelf-life of commercial drug vials after repeated puncturing. On six days, fifty syringes of 15 ml media were prepared from the same 50 vials with the robot. After each preparation, vials were covered with an IVA seal upon unloading from the robot to protect them from microbiological contamination. RESULTS: No microbiological contamination was found in any of the 96 media fill preparations, nor in any of the 300 syringes that were prepared with repeated puncturing. The compounding area met class A limits, while class A criteria were not fulfilled by the contact plates and settle plates placed on the right side of the loading area. There, the average colony forming units (cfu) were 3 and 1.17, respectively, meeting class B criteria. CONCLUSIONS: Robotical compounding of cytostatic drugs with APOTECAchemo meets the microbiological requirements of the European GMP. In addition, the robot can reuse vials repeatedly and safely, thereby enabling extended usage.


Assuntos
Assepsia/métodos , Citostáticos/síntese química , Composição de Medicamentos/métodos , Contaminação de Medicamentos/prevenção & controle , Serviço de Farmácia Hospitalar/métodos , Robótica/métodos , Assepsia/instrumentação , Composição de Medicamentos/instrumentação , Fenômenos Microbiológicos , Robótica/instrumentação
16.
Br J Clin Pharmacol ; 85(3): 616-625, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30675742

RESUMO

AIMS: To implement pharmacist-led, postdischarge telephone follow-up (TFU) intervention and to evaluate its impact on rehospitalization parameters in polypharmacy patients, via comparison with a well-matched control group. METHOD: Pragmatic, prospective, quasi-experimental study. Intervention patients were matched by propensity score techniques with a control group. Guided by results from a pilot study, clinical pharmacists implemented TFU intervention, added to routine integrated medicines management service. RESULTS: Using an intention to treat approach, reductions in 30- and 90-day readmission rates for intervention patients compared with controls were 9.9% [odds ratio = 0.57; 95% confidence interval (CI): 0.36-0.90; P < 0.001] and 15.2% (odds ratio = 0.53; 95% CI: 0.36-0.79; P = 0.021) respectively. Marginal mean time to readmission was 70.9 days (95% CI: 66.9-74.9) for intervention group compared with 60.1 days (95% CI: 55.4-64.7) for controls. Mean length of hospital stay compared with control was (8.3 days vs. 6.7 days; P < 0.001). Benefit: cost ratio for 30-day readmissions was 29.62, and 23.58 for 90-day interval. Per protocol analyses gave more marked improvements. In intervention patients, mean concern scale score, using Beliefs about Medicine Questionnaire, was reduced 3.2 (95% CI: -4.22 to -2.27; P < 0.001). Mean difference in Medication Adherence Report Scale was 1.4 (22.7 vs. 24.1; P < 0.001). Most patients (83.8%) reported having better control of their medicines after the intervention. CONCLUSIONS: Pharmacist-led postdischarge structured TFU intervention can reduce 30- and 90-day readmission rates. Positive impacts were noted on time to readmission, length of hospital stay upon readmission, healthcare costs, patient beliefs about medicines, patient self-reported adherence and satisfaction.


Assuntos
Assistência ao Convalescente/métodos , Continuidade da Assistência ao Paciente/organização & administração , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/métodos , Adulto , Assistência ao Convalescente/organização & administração , Idoso , Feminino , Seguimentos , Implementação de Plano de Saúde , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Serviço de Farmácia Hospitalar/organização & administração , Polimedicação , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Telefone
18.
Int J Clin Pharm ; 41(1): 65-73, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30610543

RESUMO

Background Medication communication and prescribing on the post-take ward round following patient admission to hospital can be suboptimal leading to worse patient outcomes. Objective To evaluate the impact of clinical pharmacist participation on the post-take ward round on the appropriateness of medication prescribing, medication communication, and overall patient health care outcomes. Setting Tertiary referral teaching hospital, Brisbane, Australia. Method A pre-post intervention study was undertaken that compared the addition of a senior clinical pharmacist attending the post-take ward was compared to usual wardbase pharmacist service, with no pharmacist present of the post-take ward round. We assessed the proportion of patients with an improvement in medication appropriateness from admission to discharge, using the START/STOPP checklists. Medication communication was assessed by the mean number of brief and in-depth discussions, with health care outcomes measured by comparing length of stay and 28-day readmission rates. Main outcome measures: Medication appropriateness according to the START/STOPP list, number and type of discussions with team members and length of stay and readmission rate. Results Two hundred and sixty patients were recruited (130 pre- and 130-post-intervention), across 23 and 20 post-take ward rounds, respectively. Post-intervention, there was increase in the proportion of patients who had an improvement medication appropriateness (pre-intervention 25.4%, post-intervention 36.9%; p = 0.004), the number of in-depth discussions about patients' medication (1.9 ± 1.7 per patient pre-intervention, 2.7 ± 1.7 per patient post-, p < 0.001), and the number relating to high-risk medications (0.71 ± 1.1 per patient pre-intervention, to 1.2 ± 1.2 per patient post-, p < 0.05). Length of stay and 28-day mortality were unchanged. Conclusion Clinical pharmacist participation on the post-take ward round leads to improved medication-related communication and improved medication appropriateness but did not significantly improve health care outcomes.


Assuntos
Prescrições de Medicamentos/normas , Equipe de Assistência ao Paciente/normas , Farmacêuticos/normas , Lista de Medicamentos Potencialmente Inapropriados/normas , Papel Profissional , Visitas com Preceptor/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Erros de Medicação/prevenção & controle , Pessoa de Meia-Idade , Admissão do Paciente/normas , Serviço de Farmácia Hospitalar/métodos , Serviço de Farmácia Hospitalar/normas , Visitas com Preceptor/métodos
19.
Am J Health Syst Pharm ; 76(3): 148-152, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30689747

RESUMO

Purpose: This study aims to show the feasibility and sustainability of technician barcode scanning verification as an alternative to pharmacist visual verification of first dose medications in an acute care setting. Methods: A two-phase, noninferiority, single-center study was conducted to compare the accuracy of technician barcode scanning verification to pharmacist visual verification of pre-packaged first dose medications within a large acute care medical center. In phase 1, a pharmacy technician utilized barcode scanning as a means of verification. These preparations were then re-verified for accuracy by pharmacist visual verification. In phase 2, the verification order was reversed, starting with pharmacist visual verification of first doses, which were subsequently re-verified by a technician utilizing barcode scanning. Accuracy and efficiency (first dose processing time) of each phase was analyzed via error logs and retrospective dose tracking. Results: A total of 12,328 first dose preparations were included in the analysis and showed no difference between technician barcode scanning verification and pharmacist visual verification. Retrospective time study showed a 4-minute decrease in processing time when doses were verified by technician barcode scanning. Based on initial study outcomes, a variance was granted to pilot first dose tech-check-tech by the Wisconsin State Board of Pharmacy. Conclusion: This study determined that there is no difference in verification accuracy between technician barcode scanning verification and pharmacist visual verification of first doses in an acute care setting. Through leveraging technology and skill mix, Froedtert Hospital was able to provide the same level of patient safety while decreasing pharmacy processing time, developing our technician workforce, and reallocating pharmacist staff from distributive roles in central pharmacy to decentralized clinical activities.


Assuntos
Sistemas de Registro de Ordens Médicas/normas , Sistemas de Medicação no Hospital/normas , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/normas , Técnicos em Farmácia/normas , Papel Profissional , Humanos , Serviço de Farmácia Hospitalar/métodos
20.
J Pharm Pract ; 32(5): 488-492, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29534629

RESUMO

BACKGROUND: Medication reconciliation is a major patient safety concern, and the impact of a structured process to evaluate anti-infective agents at hospital discharge warrants further review. OBJECTIVE: The aim of this study was to (1) describe a structured, multidisciplinary approach to review anti-infectives at discharge and (2) measure the impact of a stewardship-initiated antimicrobial review process in identifying and preventing anti-infective-related medication errors (MEs) at discharge. METHODS: A prospective study to evaluate adult patients discharged on anti-infectives was conducted from October 2013 to May 2014. The antimicrobial stewardship program (ASP) classified interventions on anti-infective regimens into predefined ME categories. RESULTS: Forty-five patients who were discharged on 59 anti-infective prescriptions were included in the study. The most common indications for anti-infective regimens at discharge were pneumonia (22%, n = 10), bacteremia (18%, n = 8), and skin and soft tissue infections (16%, n = 7). An ME was identified in 42% (n = 19/45) of anti-infective regimens. Seventy percentage of ASP team recommendations were accepted which resulted in an avoidance of MEs in 68% (n = 13/19) of patients with an ME prior to discharge. CONCLUSION: This study describes the outcomes of a stewardship-initiated review process in preventing MEs at discharge. Developing a systematic process for a multidisciplinary ASP team to review all anti-infectives can be a valuable tool in preventing MEs at hospital discharge.


Assuntos
Anti-Infecciosos , Gestão de Antimicrobianos/tendências , Erros de Medicação/tendências , Reconciliação de Medicamentos/tendências , Alta do Paciente/tendências , Serviço de Farmácia Hospitalar/tendências , Adulto , Idoso , Anti-Infecciosos/efeitos adversos , Gestão de Antimicrobianos/métodos , Feminino , Humanos , Masculino , Erros de Medicação/prevenção & controle , Reconciliação de Medicamentos/métodos , Pessoa de Meia-Idade , Serviço de Farmácia Hospitalar/métodos , Estudos Prospectivos
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