The effect of a clinical pharmacist discharge service on medication discrepancies in pat…

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Is deep vein thrombosis prophylaxis appropriate in the medical wards? A clinical pharmacists’ intervention study.

Pharm World Sci. 2010 Oct;32(5):594-600

Authors: Khalili H, Dashti-Khavidaki S, Talasaz AH, Mahmoudi L, Eslami K, Tabeefar H

Venous thromboembolism is a major cause of mortality and morbidity in hospitalized patients. To evaluate physicians’ approach to patients’ thrombosis risk assessment and practice of thromboembolism prophylaxis in a teaching hospital, we designed an interventional prospective study.

PMID: 20623385 [PubMed - indexed for MEDLINE]

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Is deep vein thrombosis prophylaxis appropriate in the medical wards? A clinical pharmacists’ intervention study.

Pharm World Sci. 2010 Oct;32(5):594-600

Authors: Khalili H, Dashti-Khavidaki S, Talasaz AH, Mahmoudi L, Eslami K, Tabeefar H

Venous thromboembolism is a major cause of mortality and morbidity in hospitalized patients. To evaluate physicians’ approach to patients’ thrombosis risk assessment and practice of thromboembolism prophylaxis in a teaching hospital, we designed an interventional prospective study.

PMID: 20623385 [PubMed - indexed for MEDLINE]

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Impact of a computerized physician order entry system on compliance with prescription accuracy requirements.

Pharm World Sci. 2009 Oct;31(5):596-602

Authors: Mir C, Gadri A, Zelger GL, Pichon R, Pannatier A

OBJECTIVE: To assess the change in non-compliant items in prescription orders following the implementation of a computerized physician order entry (CPOE) system named PreDiMed. SETTING: The department of internal medicine (39 and 38 beds) in two regional hospitals in Canton Vaud, Switzerland. METHOD: The prescription lines in 100 pre- and 100 post-implementation patients' files were classified according to three modes of administration (medicines for oral or other non-parenteral uses; medicines administered parenterally or via nasogastric tube; pro re nata (PRN), as needed) and analyzed for a number of relevant variables constitutive of medical prescriptions. MAIN OUTCOME MEASURE: The monitored variables depended on the pharmaceutical category and included mainly name of medicine, pharmaceutical form, posology and route of administration, diluting solution, flow rate and identification of prescriber. RESULTS: In 2,099 prescription lines, the total number of non-compliant items was 2,265 before CPOE implementation, or 1.079 non-compliant items per line. Two-thirds of these were due to missing information, and the remaining third to incomplete information. In 2,074 prescription lines post-CPOE implementation, the number of non-compliant items had decreased to 221, or 0.107 non-compliant item per line, a dramatic 10-fold decrease (chi(2) = 4615; P < 10(-6)). Limitations of the computerized system were the risk for erroneous items in some non-prefilled fields and ambiguity due to a field with doses shown on commercial products. CONCLUSION: The deployment of PreDiMed in two departments of internal medicine has led to a major improvement in formal aspects of physicians' prescriptions. Some limitations of the first version of PreDiMed were unveiled and are being corrected.

PMID: 19554471 [PubMed - indexed for MEDLINE]

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Prescribing errors during hospital inpatient care: factors influencing identification by pharmacists.

Pharm World Sci. 2009 Dec;31(6):682-8

Authors: Tully MP, Buchan IE

OBJECTIVE: To investigate the prevalence of prescribing errors identified by pharmacists in hospital inpatients and the factors influencing error identification rates by pharmacists throughout hospital admission. SETTING: 880-bed university teaching hospital in North-west England. METHODS: Data about prescribing errors identified by pharmacists (median: 9 (range 4-17) collecting data per day) when conducting routine work were prospectively recorded on 38 randomly selected days over 18 months. MAIN OUTCOME MEASURES: Proportion of new medication orders in which an error was identified; predictors of error identification rate, adjusted for workload and seniority of pharmacist, day of week, type of ward or stage of patient admission. RESULTS: 33,012 new medication orders were reviewed for 5,199 patients; 3,455 errors (in 10.5% of orders) were identified for 2,040 patients (39.2%; median 1, range 1-12). Most were problem orders (1,456, 42.1%) or potentially significant errors (1,748, 50.6%); 197 (5.7%) were potentially serious; 1.6% (n = 54) were potentially severe or fatal. Errors were 41% (CI: 28-56%) more likely to be identified at patient’s admission than at other times, independent of confounders. Workload was the strongest predictor of error identification rates, with 40% (33-46%) less errors identified on the busiest days than at other times. Errors identified fell by 1.9% (1.5-2.3%) for every additional chart checked, independent of confounders. CONCLUSIONS: Pharmacists routinely identify errors but increasing workload may reduce identification rates. Where resources are limited, they may be better spent on identifying and addressing errors immediately after admission to hospital.

PMID: 19777366 [PubMed - indexed for MEDLINE]

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Study on the use of drugs in patients with enteral feeding tubes.

Pharm World Sci. 2009 Apr;31(2):145-8

Authors: Heineck I, Bueno D, Heydrich J

OBJECTIVE: To describe the use of drugs in patients using Enteral Feeding Tubes (EFT) at a University Hospital in southern Brazil. METHOD: A total of 315 medical charts of patients that had used EFT were analyzed. Variables of interest were: days the tube was used, number and frequency of drugs administered by the tube, pharmaceutical dosage forms and the number of tube exchanges per patients. RESULTS: The mean of age of the patients was 59 years (SD = 21) and 59% were male. A mean number of drugs prescribed per patient with tube administration were five. Almost all patients (95%) used some drugs in solid pharmaceutical preparations, mostly tablets (72%). About 158 different drugs were prescribed; for 23% of these, the prescription of liquid dosage forms was possible. The chance of changing the enteral tube was greater for patients that used more than five drugs enterally (OR = 4.8, 95% CI 2.8-8.2) and that had more than 13 drug administrations per day (OR = 5.3, 95% CI 3.1-9.3). CONCLUSION: This study provides evidence that patients using more drugs enterally have a greater chance of having their enteral tube exchanged. Furthermore, it suggests a lack of knowledge of the health team with regard to the appropriateness of pharmaceutical preparations for this administration.

PMID: 19031008 [PubMed - indexed for MEDLINE]

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Retrospective assessment of potential interaction between levofloxacin and warfarin.

Pharm World Sci. 2009 Apr;31(2):224-9

Authors: Mercadal Orfila G, Gracia García B, Leiva Badosa E, Perayre Badía M, Reynaldo Martínez C, Jodar Masanés R

OBJECTIVE: There is currently a controversy regarding interactions between levofloxacin and warfarin. The aim of this study was to determine the clinical relevance of this interaction in our setting. SETTING: A university hospital in Barcelona, Spain. METHODS: We carried out a retrospective evaluation of all patients hospitalized in our hospital during the period 2000-2005, selecting all those concomitantly treated with levofloxacin and warfarin for the study. The following data were compiled: demographic information, concomitant medication, comorbid conditions, and relevant analytical parameters, particularly the international normalized ratio (INR), including values taken before, during, and after concomitant administration of the two study drugs. Patients for whom INR values during concomitant administration were not available were excluded. Differences in INR before and during the potential interaction, and before and after the interaction were analyzed with the Wilcoxon t test using SPSS (V12.0). In addition, patients were stratified according to presence or not of toxic habits (smoking/alcohol consumption) to investigate the possible impact of these factors on the interaction under study. RESULTS: Among the 30 patients identified, 9 were excluded because INR data during concomitant administration of warfarin and levofloxacin were not available. Statistical analysis demonstrated significant increase in INR (P = 0.001) following addition of levofloxacin to warfarin therapy. CONCLUSIONS: The results of this study reaffirm the hypothesis that concomitant administration of levofloxacin and warfarin leads to INR increase; hence close monitoring of INR is advisable when patients are prescribed this combination of drugs.

PMID: 19067226 [PubMed - indexed for MEDLINE]

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Incidence of risk factors for developing hyperkalemia when using ACE inhibitors in cardiovascular diseases.

Pharm World Sci. 2009 Jun;31(3):387-93

Authors: Amir O, Hassan Y, Sarriff A, Awaisu A, Abd Aziz N, Ismail O

STUDY OBJECTIVE: To determine the incidence of and the risk factors associated with hyperkalemia, induced by ACEI-drug interactions among cardiac patients. SETTING: Five medical and cardiology wards of a tertiary care center in Malaysia. SUBJECTS: Five hundred cardiac inpatients, who received ACEIs concomitantly with other interacting drugs. METHOD: This was a prospective cohort study of 500 patients with cardiovascular diseases admitted to Penang Hospital between January to August 2006, who received ACEIs concomitantly with other interacting drugs. ACEI-drug interactions of clinical significance were identified using available drug information resources. Drug Interaction Probability Scale (DIPS) was used to assess the causality of association between ACEI-drug interactions and the adverse outcome (hyperkalemia). MAIN OUTCOME MEASURE: Hyperkalemia as an adverse clinical outcome of the interaction was identified from laboratory investigations. RESULTS: Of the 489 patients included in the analysis, 48 (9.8%) had hyperkalemia thought to be associated with ACEI-drug interactions. Univariate analysis using binary logistic regression revealed that advanced age (60 years or more), and taking more than 15 medications were independent risk factors significantly associated with hyperkalemia. However, current and previous smoking history appeared to be a protective factor. Risk factors identified as predictors of hyperkalemia secondary to ACEI-drug interactions by multi-logistic regression were: advanced age (adjusted OR 2.3, CI 1.07-5.01); renal disease (adjusted OR 4.7, CI 2.37-9.39); hepatic disease (adjusted OR 5.2, CI 1.08-25.03); taking 15-20 medications (adjusted OR 4.4, CI 2.08-9.19); and taking 21-26 medications (adjusted OR 9.0, CI 1.64-49.74). CONCLUSION: Cardiac patients receiving ACEIs concomitantly with potentially interacting drugs are at high risk of experiencing hyperkalemia. Old age, renal disease, hepatic disease, and receiving large number of medications are factors that may significantly increase their vulnerability towards this adverse outcome; thus, frequent monitoring is advocated.

PMID: 19255869 [PubMed - indexed for MEDLINE]

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