The evaluation and classification of drug-related problems by a clinical pharmacist in an internal diseases intensive care unit: A prospective cohort 7-month study

Year 2024, , 1 - 11, 30.04.2024

Mefküre Durmuş , Zeynep Ülkü Gün , Hacı Bayram Berktaş

https://doi.org/10.26650/IstanbulJPharm.2024.1327194

Abstract

Background and Aims: Drug-related problems can cause morbidity and mortality as well as increase health-care costs. Clinical pharmacists provide many benefits to healthcare systems by detecting, decreasing, and preventing drug-related problems. It was aimed to determine and classify drug-related problems and determine risk factors for drug-related problems.

Methods: Drug-related problems were evaluated prospectively between August 16, 2021, and March 16, 2022, in 257 patients during their hospital stay who were hospitalized in the internal diseases intensive care unit and took at least one drug. Patients who were not administered any drug or who were younger than 18 were excluded from the study. The Pharmacetical Care Network Europe v.9 method was utilized to classify these problems. Clinical and demographic characteristics of patients with and without drug-related problems were compared by statistical analysis. Risk factors of drug-related problems were determined by logistic regression analysis.

Results: At least one drug-related problem was detected in 157 of the 257 patients and a total of 399 drug-related problems were recorded. 399 recommendations were made, and 349 (87.5%) of these were accepted and 50 (12.5%) were not accepted. Drug selection (C1) was the most common cause of drug-related problems at 42.2%, and dose selection (C3) followed this by 41.5%. The results of regression analysis showed that atrial fibrillation (OR: 2.985, CI: 1.158-7.692), hematopoietic stem cell transplantation (OR: 3.883, CI: 1.256-11.999), antibacterial drugs (OR: 3.285, CI: 1.563-6.904), or polypharmacy (OR: 3.955, CI:1.207- 11.071) were risk factors of drug-related problems.

Conclusion: The most common drug-related problem category was found as treatment safety and the causes of them were found as drug selection and dose selection. Clinicians should pay attention when prescribing new drugs to patients with atrial fibrillation and a history of hematopoietic stem cell transplantation. Furthermore, clinicians and clinical pharmacists should pay attention if polypharmacy and antibacterial drugs are present in medical therapies.

Keywords

Clinical pharmacy, drug-related problem, intensive care unit

References

• Albayrak, A., Başgut, B., Bıkmaz, G, A., & Karahalil, B. (2022). Clin-ical pharmacist assessment of drug-related problems among inten-sive care unit patients in a Turkish university hospital. BMC Health ServiceResearch, 22(1), 1-7. https://doi.org/10.1186/s12913-022-07494-5 google scholar
• Aljbouri, T. M., Alkhawaldeh, M. S., Abu-Rumman, K.,Hasan, T. A., Khattar, H. M., & Abu- Oliem, A. S. (2013). Im-pact of clinical pharmacist on cost of drug therapy in the ICU. Saudi Pharmaceutical Journal, 21(4), 371-374. https://doi.org/10.1016/j.jsps.2012.12.004 google scholar
• Al-azzam, S. I., Shara, M., Alzoubi, K. H., Almahasneh, F. A., & Iflaifel, M. H. (2013). Implementation of clinical phar-macy services at a university hospital in Jordan. The In-ternational Journal of Pharmacy Practice, 21(5), 337-340. https://doi.org/10.1111/ypp.12009 google scholar
• Al-Jazairi, A. S., Al-Agil, A. A., Asiri, Y. A.,Al-Kholi, T. A., Akhras, N. S., & Horanieh, B. K. (2008).The impact of clinical pharmacist in a cardiac-surgery intensive care unit. Saudi Medical Journal, 29(2), 277-81. google scholar
• Ayhan, Y. E., Karakurt, S., & Sancar, M. (2022). The effect of the clinical pharmacist in minimizing drug-related problems and re-lated costs in the intensive care unit in Turkey: A non- randomized controlled study. Journal of Clinical Pharmacy and Therapeutics, 47(11), 1867- 1874. https://doi.org/10.1111/jcpt.13784 google scholar
• Bourne, R. S., Choo, C. L., & Dorward, B. J. (2014). Proactive clinical pharmacist interventions in critical care: effect of unit speciality and other factors. The International Journal of Pharmacy Prac-tice, 22(2), 146-154. https://doi.org/10.1111/ypp.12046 google scholar
• Clemmons, A. (2020). The Hematopoietic Cell Transplant Pharmacist: A Call to Action. Pharmacy, 8(1), 1-7. https://doi.org/10.3390/pharmacy8010003 google scholar
• Greeshma, M., Lincy, S., Maheswari, E., Tharanath, S., & Viswam, S. (2018). Identification of drug related problems by clinical phar-macist in prescriptions with polypharmacy: A prospective inter-ventional study. Journal of Young Pharmacists, 10(4), 460-465. https://doi.org/10.5530/jyp.2018.10.100 google scholar
• Horvat, N., & Kos, M. (2016). Development and validation of the Slovenian drug-related problem classification system based on the PCNE classification V 6.2. International Journal of Clinical Pharmacy, 38(4), 950-959. https://doi.org/10.1007/s11096-016-0320-7 google scholar
• Jiang, S-P., Chen, J., Zhang, X-G., Lu, X-Y., & Zhao, Q-W. (2014). Implementation of pharmacists’ interventions and assessment of medication errors in an intensive care unit of a Chinese tertiary hospital. Therapeutics and Clinical Risk Management, 10, 861866. https://doi.org/10.2147/TCRM.S69585 google scholar
• Johansen, E. T., Haustreis, S. M., Mowinckel, A. S., & Ytreb0, L. M. (2016). Effects of implementing a clinical pharmacist service in a mixed Norwegian ICU. European Journal of Hospital Pharmacy, 23(4), 197-202. https://doi.org/10.1136/ejhpharm-2015-000751 google scholar
• Kubas, M. A., & Halboup, A. M. (2020). Implementation of clinical pharmacist recommendations and services at a University Hospital in Yemen. International Journal of Clinical Pharmacy, 42(1), 5156. https://doi.org/10.1007/s11096-019-00936-x google scholar
• Kaufmann, C. P., Stampfli, D., Hersberger, K. E., &Lampert, M. L. (2015). Determination of risk factors for drug-related problems: A multidisciplinary triangulation process. BMJ Open,5(3), e006376-82. https://doi.org/10.1136/bmjopen-2014-006376 google scholar
• Lee, H., Ryu, K., Sohn, Y.,Kim, J., Suh, G. Y., &Kim, E. Y. (2019). Impact on patient outcomes of pharmacist participa-tion in multidisciplinary critical care teams: A systematic review and meta-analysis. Critical Care Medicine, 47(9), 1243-1250. https://doi.org/10.1097/CCM.0000000000003830 google scholar
• Lenssen, R., Heidenreich, A., Schulz, J. B., Trautwein, C., Fitzner, C., Jaehde, U., & Eisert, A. (2016). Analysis of drug-related problems in three departments of a German University hospi-tal. International Journal of Clinical Pharmacy, 38(1), 119-126. https://doi.org/10.1007/s11096-015-0213-1 google scholar
• Li, X-x., Zheng, S-q., Gu, J-h., Huang, T., Liu, F., Ge, Q-g., . . . Shi, L-w. (2020). Drug-related problems identified during pharmacy intervention and consultation: Implementation of an intensive care unit pharmaceutical care model. Frontiers in Pharmacology. 11, 1-13 (571906). https://doi.org/10.3389/fphar.2020.571906 google scholar
• Martins, R. R., Silva, L. T., & Lopes, F. M. (2019). Impact of medica-tion therapy management on pharmacotherapy safety in an inten-sive care unit. International Journal of Clinical Pharmacy, 41(1), 179-188. https://doi.org/10.1007/s11096-018-0763-0 google scholar
• Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatrics, 17(230), 1-10. https://doi.org/10.1186/s12877-017-0621-2 google scholar
• Napier, K., Lim, D., Thomas, E., Boyd, J., Chakera, A., Williamson, J., . . . Robinson, S. (2022). Impact of routine reporting of estimated glomerularfiltration rate using the European Kidney Function Consortium and Chronic Kidney Disease Epidemiology Collabo-ration equations in a Western Australian community population. Nephrology, 27(10), 823-833. https://doi.org/10.1111/nep.14083 google scholar
• Ozdemir, N., Celiker, A., Kuskonmaz, B. B., Okur, F. V., & Cetinkaya, D. U. (2019). Evaluation of Drug-Related Prob-lems in a Pediatric Bone Marrow Transplantation Unit Iden-tified by a Clinical Pharmacist in-training in a 7-Month Pe-riod. Clinical and Experimental Health Sciences, 10(1), 21-26. https://doi.org/10.33808/clinexphealthsci.590213 google scholar
• Pharmaceutical Care Network Europe Asso-ciation. (20.04.2023). Accessed address: https://www.pcne.org/upload/files/410_PCNE_classification_V9-0m.pdf. google scholar
• Reinau, D., Furrer, C., Stampfli, D.,Bornand, D., & Meier, C. R. (2019). Evaluation of drug- related problems and subsequent clinical pharmacists’ interventions at a Swiss university hospital. Journal of Clinical Pharmacy and Therapeutics, 44(6), 924-931. https://doi.org/10.1111/jcpt.13017 google scholar
• Ritchie, L. A., Penson, P. E., Akpan, A. A., Lip, G. Y. H., & Lane, D. A. (2022) Integrated Care for Atrial Fibrillation Management: The Role of the Pharmacist. The American Journal of Medicine, 135(12), 1410-1426. https://doi.org/10.1016/j.amjmed.2022.07.014 google scholar
• Ruths, S., Viktil, K. K., &Blix, H. S. (2007). Classification of drug-related problems. The Journal of the Norwegian Medical Associ-ation,127, 3073-3076. google scholar
• Tasaka, Y., Tanaka, A., Yasunaga, D.,Asakawa, T., Araki, H., &Tanaka, M. (2018). Potential drug-related problems detected by routine pharmaceutical interventions: Safety and economic contributions made by hospital pharmacists in Japan. Jour-nal of Pharmaceutical Health Care and Sciences, 4(33), 1-11. https://doi.org/10.1186/s40780-018-0125-z google scholar
• Tharanon, V., Putthipokin, K., &Sakthong, P. (2022). Drug-related problems identified during pharmaceutical care interventions in an intensive care unit at a tertiary university hospital. SAGE Open Medicine, 10, 1-10. https://doi.org/10.1177/20503121221090881 google scholar
• Toukhy, A., Fayed, S., Sabry, N., & Shawki M. (2021). The Impact of an Established Pharmaceutical Care Pathway on Drug Related Problems in an Intensive Care Unit. The American Journal of Medical Sciences, 362(2), 143-153. https://doi.org/10.1016/j.amjms.2021.03.007 google scholar
• Viktil, K. K., & Blix, H. S. (2008). The impact of clinical phar-macists on drug-related problems and clinical outcomes. Ba-sic & Clinical Pharmacology & Toxicology,102(3), 275-280. https://doi.org/10.1111/j.1742-7843.2007.00206.x google scholar
• Zaidi, S. T. R., Hassan, Y., Postma, M. J., & Seiw Hain, N. (2003). Impact of pharmacist recommendations on the cost of drug therapy in ICU patients at a Malaysian hospital. Pharmacy World and Science, 25(6), 299-302. https://doi.org/10.1023/B:PHAR.0000006524.52076.2f google scholar