Context: The appropriate description of corticosteroids is an important issue in hospitals because this is a widely used drug. Clinical pharmacists’ interventions can help improve the rational ...prescription of corticosteroids. Aims: To evaluate clinical pharmacists’ interventions on appropriate prescription of corticosteroids at a medical center in Vietnam from 2022 to 2023. Methods: An interventional and cross-sectional descriptive study was conducted from January 1, 2022, to June 30, 2023. Results: There were 726 patients (363 patients before intervention and 363 patients after intervention) and 22 doctors included in this study. The proportion of appropriate prescriptions of corticosteroids increased from 89% in pre-intervention to 96.4% in post-intervention. The portion of appropriate prescriptions of corticosteroids regarding contraindications went up from 62.5% in pre-intervention to 83.2% in post-intervention. The percentage of appropriate prescriptions of corticosteroids in terms of dosage and usage rose from 69.1% in pre-intervention to 85.7% in post-intervention. The general rationality grew from 46.3% to 81.3%. Doctors aged less than 30 years old with a bachelor’s degree, 2-5 years of working experience, and not participating in training were more likely to prescribe corticosteroids inappropriately than other groups (p<0.05). Conclusions: Clinical pharmacists' interventions have increased the rate of appropriate corticosteroid prescriptions at a medical center in Vietnam. Effective clinical pharmacists’ interventions help improve the percentage of appropriate use of corticosteroids, so they need to be concerned in the future.
Celiac disease, an immune reaction to gluten causing nutrient malabsorption, and long-term glucocorticoid therapy adversely affect bone metabolism and increase fracture risk.
A patient with ...long-standing celiac disease on a strict gluten-free diet and long-term glucocorticoid therapy status post kidney transplant for Sjögren syndrome–induced interstitial nephritis presented for management of osteoporosis. Initial evaluation was notable for secondary hyperparathyroidism, which resolved after switching to a gluten-free calcium citrate supplement. Given normal serum total alkaline phosphatase (ALP) and parathyroid hormone (PTH), she began treatment of osteoporosis with abaloparatide. Two months later, she reported abrupt onset of diarrhea with significant weight loss. Biochemical investigation revealed a threefold increase in serum ALP level. As a precaution, abaloparatide was suspended, yet symptoms persisted with elevated ALP and PTH levels. Endoscopy revealed a celiac flare. The clinic-based pharmacist found that her pharmacy had inadvertently dispensed prednisone tablets containing wheat starch. A switch to a gluten-free formulation led to rapid resolution of the diarrhea with weight regain. Serum ALP and PTH levels normalized, and abaloparatide was resumed without biochemical abnormalities.
An unintended switch to a gluten-containing prednisone formulation resulted in uncontrolled celiac disease causing calcium malabsorption, secondary hyperparathyroidism, elevated ALP levels, and an interruption in osteoporosis therapy. Common supplements and drugs can be a hidden source of gluten. Collaboration with a clinic-based pharmacist enhances the detection and prevention of medication-induced adverse reactions.
This case highlights the importance of a careful review of gluten-containing medications and supplements in patients with celiac disease.
Introduction: Medication errors (MEs) are considered preventable errors that may occur frequently during the treatment process with or without patient harm in addition to their economic consequence. ...MEs occur during prescribing, dose calculation, dispensing, or administration of medicine which could be made by any healthcare professional as a physician, pharmacist or nurse, or by the patient himself. Objective: To detect and report MEs in pediatric inpatients’ medical records and potentially preventing these MEs by making recommendations/suggestions for healthcare professionals about the proper action needed to be taken. Methods: This was a prospective observational study, in which the medical records of admitted pediatric patients to Ibn Al-Atheer Teaching Hospital, Nineveh were reviewed to detect, report, and prevent MEs between the 1st of January and the 30th of June 2019. Results: Out of 6964 medical records reviewed by clinical pharmacists during the study period, 119 MEs were reported to healthcare professionals and prevented. 83% of detected MEs were dosing errors. The results of the Chi-square analysis showed that the highest percentage of dosing errors were associated with antibiotics (p=0.0493). Furthermore, the results of Chi-square analysis showed that the highest percentage of dosing errors were seen in infants and toddlers (p=0.011). Conclusion: This study highlighted the role of clinical pharmacists in recognizing, reporting and preventing MEs which are still occurring in every medical setting. Dosing errors were the most commonly occurring errors and antibiotics were the most frequent group of medicines involved in MEs.
The 2021 Surviving Sepsis Campaign Guidelines recommend administration of antimicrobials within the first hour of recognition of sepsis. Over the last decade, several studies have demonstrated ...improved time-to-antibiotic administration and antibiotic appropriateness when a pharmacist was involved in the care of patients with sepsis. To our knowledge, no studies evaluating the appropriate use of antibiotics in sepsis driven entirely by an Emergency Medicine (EM) Clinical Pharmacist Practitioner (CPP) have been published. The purpose of this study is to evaluate the impact of an EM CPP-driven protocol on antimicrobial interventions in patients with sepsis in the emergency department (ED).
This was a retrospective comparison of patients with sepsis for whom antimicrobials were ordered in the ED without pharmacist intervention to patients whose antimicrobials were ordered by an EM CPP via a sepsis consult to pharmacy. An EM CPP reviewed individual patient profiles for pertinent historical admissions, culture data, and allergy profiles to guide antimicrobial selection for the suspected source of infection and entered orders under their scope of practice with formal documentation in the electronic medical record (EMR). The primary objective of this study was to compare the rates of appropriate empiric antibiotic utilization in septic patients admitted from the ED pre- and post-protocol implementation. Secondary endpoints included the following, broadening of ED-initiated empiric antibiotics on hospital admission, time-to-antibiotic administration, in-hospital mortality, Rapid Emergency Medicine Score (REMS) association with in-hospital mortality, and hospital length of stay.
A total of 144 patients were included: 80 patients prescribed antibiotics without pharmacist intervention and 64 prescribed antibiotics by an EM CPP. Appropriate empiric antibiotic selection in the ED improved from 57.5% (46/80) to 86% (55/64) with EM CPP intervention (difference 28.5%; p < 0.01). Time-to-first antibiotic administration decreased by 64 min (p < 0.01). Administration of antibiotics within 60 min, broadening of antibiotics on admission, hospital length of stay, and in-hospital mortality did not significantly differ across groups.
In this small, single-center study, an EM Clinical Pharmacist Practitioner-driven protocol for patients with sepsis in the emergency department improved the rate of appropriate empiric antimicrobial selection and time-to-antibiotic administration.
Hospitalized patients in intensive care units (ICUs) frequently suffer from drug-related problems (DRPs). Clinical pharmacists may help to prevent, detect, and manage DRPs to improve drug safety and ...efficacy in multidisciplinary teams. This study aims to evaluate drug-related problems and clinical pharmacists' recommendations in the ICU of a university hospital in Turkey.
This study was carried out between January–February 2023 (2 months) in the ICU of a university hospital. All patients hospitalized in the ICUs were evaluated in the study, and patients with one or more clinical pharmacists were included. During the study period, the clinical pharmacists' interventions and responses to requests from physicians were recorded. DRPs were classified according to the Pharmaceutical Care Network Europe Drug Related Problem Classification V.9.1.
At least one recommendation was made for a total of 71 patients. The mean age of the patients was 59.8 ± 21.22 years, and 41% (n = 29) were women. One hundred twenty-nine different recommendations were proposed by clinical pharmacists. Of these, 16 (12.4%) were in response to the questions requests from physicians and 113 (87.6%) of them were related to the DRPs detected by the pharmacists during their daily ward rounds. 98.4% (n = 127) of the recommendations were accepted and 79.5% (n = 101) were implemented. Recommendations were most frequently made about meropenem (n = 28, 21.7%), enoxaparin (n = 10, 7.8%) and colistin (n = 9, 7.0%). 103 (91.1%) DRPs were probable and 10 (8.9%) DRPs were existing problems. The classification of drug-related problems and recommendations is given in Table 1.
The importance of the clinical pharmacists' interventions in the determination and management of DRPs was emphasized in this study. In our study, most DRPs were caused by drug doses, and most interventions were accepted.
1. Arredondo E, Udeani G, Horseman M, Hintze TD, Surani S. Role of Clinical Pharmacists in Intensive Care Units. Cureus. 2021 Sep 13;13(9):e17929.
2. Chiang LH, Huang YL, Tsai TC. Clinical pharmacy interventions in intensive care unit patients. J Clin Pharm Ther. 2021;46(1):128–133.
Drug-related problems (DRPs) are a common problem in clinics that can have a negative impact on patients' treatment outcomes, cost of care and morbidity/mortality rates. The involvement of clinical ...pharmacist on patient care provides benefits to prevent and/or to manage those DRPs. This study aimed to determine the DRPs in the third-step intensive care unit (ICU) and to show the contributions of the clinical pharmacist to the management of these problems.
This study was carried out prospectively between May 1st, 2021 and July 31st, 2022 in anesthesiology and reanimation ICUs of a university hospital. ICU patients were monitored daily by a clinical pharmacist and during the wards, consultancy services and interventions were provided to the ICU team on drug selection, drug doses, drug administration routes, drug-indication appropriateness, drug side effects, drug-drug interactions, drug-food/nutritional solution interactions, techniques of administration of drugs through the enteral feeding tube, and drug incompatibility. The final decision on whether to make a change in the treatment was made by the attending physician.
A total of 75 patients were included in the study. The median age of the patients (minimum-maximum) was 74 (21–98) years, and 49 (65.33%) of these patients were male. The number of drugs per patient (mean ± standard deviation) was 10.27 ± 5.12. Total of 379 DRPs were observed and 74 of those DRPs did not require any recommendations. Clinical pharmacist's recommendations on 287 (94.1%) DRPS were accepted out of 305 recommendations by the physicians and applied into practice. Among the recommendations, 121 (39.7%) were related to drug dose adjustment (Table 1) and antibiotics constitute the drug group with the highest dose adjustment recommendation (n = 103, 85.1%) (Table)
Clinical pharmacist plays an active role in detection and management of DRPs, therefore involvement of clinical pharmacist in multidisciplinary healthcare teams especially in ICUs is important to improve optimum patient treatment.
Background
Patients with acute coronary syndrome (ACS) often have associated problems either as a reason or as a corollary of the disease and drug‐related problems (DRPs) are more likely to ...precipitate despite the presence of standard guidelines. This research is intended to evaluate the nature and extent of DRPs and examine their clinical significance in the presence of a clinical pharmacist.
Methods
A clinical pharmacist‐initiated cross‐sectional study was carried out in the Department of Cardiology unit in a tertiary care teaching hospital for a year. The patient's medications were audited for DRPs using PCNE V 8.0.1 and drug‐interactions by Micromedex. Descriptive and inferential statistics were applied whenever required by using SPSS v 25.0.
Results
A total of 1120 patients screened, 432 patients were enrolled in the study by obtaining consent. The majority were in the age group 41–60 years of whom (294 (68.05 %)) were males. DRPs (367) were identified in (225 (52%)) patients of which (243 (66.13%) were due to problems in prescription, 27 (1.90%) treatment duration, followed by dispensing 43 (11.71%), drug use process 41 (11.17%) and patient‐related 38 (10.35%)). The overall incidence of DRPs was 51.85%. Most risk factors were associated with DRPs (p < 0.0001).
Conclusion
Drug‐related problems are common in patients with acute coronary syndrome due to comorbidities and its related polypharmacy. Physician and clinical pharmacist collaboration can help in the early detection of DRPs, and alleviate the adversities emphasising optimal pharmacotherapeutic management.
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