ROLE OF A PHARMACIST IN ROLE OF A PHARMACIST IN IMPROVING THE QUALITY OFIMPROVING THE QUALITY OF

TREATMENT IN INPATIENTSTREATMENT IN INPATIENTS

Sabina FarooqSabina Farooq* Dr Shobarani R H , Dr Venugopal Reddy, Geetha * Dr Shobarani R H , Dr Venugopal Reddy, Geetha pradeep, Soumya k.L .pradeep, Soumya k.L .

Pharmacy practice Pharmacy practice Al-ameen college of pharmacy.bangalore. Al-ameen college of pharmacy.bangalore.

INTRODUCTIONINTRODUCTION

Clinical pharmacy is defined as an umbrella of services aimed at maximizing the pharmacotherapeutic effect and minimizing the risk of developing adverse drug effects for the health care system.

The fundamental responsibility of a pharmacist is to ensure that every patient receives the most appropriate treatment in the most convenient and cost effective form.

Drug use is a complex process and there are many drug related challenges at various levels involving prescriber, pharmacist and patients. (1)

(1) Schwartzberg E , Livny S, Sterenberg A, Troista A, Oren M, Shani S. Evaluation of the impact of a clinical pharmacist on the quality and cost of pharmacotherapy in a general surgical department, the Hillel- Yaffe Medical Center. Harefuah 2003; 142(1):5-9

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Addition of a clinical pharmacist to the health care team attending ward rounds in hospital settings helps:

Assisting physician in pharmacotherapy decision making and providing pharmacokinetic consultation.

Monitoring patient for drug efficacy and safety Detecting medication error and drug-drug / drug-food

interaction. Improved patient care. Reduced length of hospital stay and health care cost.

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The basic aim of this project was to test whether inclusion of the clinical pharmacist improved pharmaceutical care of patients and how the pharmacist could truly contribute to patient care.

OBJECTIVES:OBJECTIVES:

To identify the medication errors.

Detection of Adverse Drug Reaction.

To detect Drug-Drug interaction.

Correlation between treatment and indication.

Irregularities in laboratory investigations.

METHODOLOGY:METHODOLOGY:

Data was obtained from prospective series of patients who were admitted to the medicine ward in St Martha’s hospital and Victoria hospital in Bangalore from 15th September 2006 to 28th October 2006.

Inclusion criteria: Patients taking five or more medications Patients suffering from acute or severe illness. Patients with symptoms suggestive of an adverse drug

reaction

Exclusion criteria:

•The following categories of patient were excluded from the study.•Short stay or acute medical admissions.•Those admitted for overnight observation.•Patients with whom communication was not possible.

Based on inclusion and exclusion criteria 76 patients were enrolled in the study, of which 30 were from Victoria hospital and 46 were from St Martha’s hospital

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From the pts case file the following information was collected.

Presenting complaints Complete history of the patient Laboratory reports Diagnosis Treatment Discharge summary

Medication Review

Patient Name: ___________________________________

File number: ____________________________________

Date of review: __________________________________

  Medication(including strength & frequency prescribed)

Actual dose/frequency taken by patient

Indication Medication issue(e.g. none, duplication, compliance, adverse event etc)

Action Taken(e.g. reduce/increase dose, cease medication, counsel patient etc)

1          

2          

3          

4          

5    

A total of 76 patients were enrolled in the study of which 30 patients were from Victoria hospital and 45 patients were from St Martha’s hospital. A thorough review of each case was done, with aim to know the relevance of the medications with the diagnosis.

RESULTS

In 76 cases the problems that were identified were:In 76 cases the problems that were identified were:

PROBLEMS No.of casesLab investigation not done 29

A total of 76 patients were enrolled in the study of which 30 patients were from Victoria hospital and 45 patients were from St Martha’s hospital. A thorough review of each case was done, with aim to know the relevance of the medications with the diagnosis.

RESULTS

In 76 cases the problems that were identified were:In 76 cases the problems that were identified were:

PROBLEMS No.of casesLab investigation not done 29

Appropriate Treatment not given

28

A total of 76 patients were enrolled in the study of which 30 patients were from Victoria hospital and 45 patients were from St Martha’s hospital. A thorough review of each case was done, with aim to know the relevance of the medications with the diagnosis.

RESULTS

In 76 cases the problems that were identified were:In 76 cases the problems that were identified were:

PROBLEMS No.of casesLab investigation not done 29

Appropriate Treatment not given

28

Dose & Duration incorrect 22

A total of 76 patients were enrolled in the study of which 30 patients were from Victoria hospital and 45 patients were from St Martha’s hospital. A thorough review of each case was done, with aim to know the relevance of the medications with the diagnosis.

RESULTS

In 76 cases the problems that were identified were:In 76 cases the problems that were identified were:

PROBLEMS No.of casesLab investigation not done 29

Appropriate Treatment not given

28

Dose & Duration incorrect 22

Drug - Drug Interaction 21

A total of 76 patients were enrolled in the study of which 30 patients were from Victoria hospital and 45 patients were from St Martha’s hospital. A thorough review of each case was done, with aim to know the relevance of the medications with the diagnosis.

RESULTS

In 76 cases the problems that were identified were:In 76 cases the problems that were identified were:

PROBLEMS No.of casesLab investigation not done 29

Appropriate Treatment not given

28

Dose & Duration incorrect 22

Drug - Drug Interaction 21

Missed Drug 29

A total of 76 patients were enrolled in the study of which 30 patients were from Victoria hospital and 45 patients were from St Martha’s hospital. A thorough review of each case was done, with aim to know the relevance of the medications with the diagnosis.

RESULTS

In 76 cases the problems that were identified were:In 76 cases the problems that were identified were:

PROBLEMS No.of casesLab investigation not done 29

Appropriate Treatment not given

28

Dose & Duration incorrect 22

Drug - Drug Interaction 21

Missed Drug 29

Extra Drug 33

A total of 76 patients were enrolled in the study of which 30 patients were from Victoria hospital and 45 patients were from St Martha’s hospital. A thorough review of each case was done, with aim to know the relevance of the medications with the diagnosis.

RESULTS

In 76 cases the problems that were identified were:In 76 cases the problems that were identified were:

PROBLEMS No.of casesLab investigation not done 29

Appropriate Treatment not given

28

Dose & Duration incorrect 22

Drug - Drug Interaction 21

Missed Drug 29

Extra Drug 33

ADR’s 13

A total of 76 patients were enrolled in the study of which 30 patients were from Victoria hospital and 45 patients were from St Martha’s hospital. A thorough review of each case was done, with aim to know the relevance of the medications with the diagnosis.

RESULTS

In 76 cases the problems that were identified were:In 76 cases the problems that were identified were:

PROBLEMS No.of casesLab investigation not done 29

Appropriate Treatment not given

28

Dose & Duration incorrect 22

Drug - Drug Interaction 21

Missed Drug 29

Extra Drug 33

ADR’s 13

Discharge Summary 11

A total of 76 patients were enrolled in the study of which 30 patients were from Victoria hospital and 45 patients were from St Martha’s hospital. A thorough review of each case was done, with aim to know the relevance of the medications with the diagnosis.

RESULTS

In 76 cases the problems that were identified were:In 76 cases the problems that were identified were:

Lab Investigation

Yes62%

No38%

Dose & Duration

Yes71%

No29%

Drug - Drug Interaction

NO72%

YES28%

Missed Drugs

No62%

Yes38%

Extra Drugs

No57%

Yes43%

Adverse Drug Reactions

NO83%

YES17%

Discharge Summary

Yes86%

No14%

CONCLUSIONCONCLUSION

From the above study I observed that medical decision making is particularly prone to errors due to the urgency, complexity and uncertainty in clinical situations.

Thus medication review by a pharmacist can reduce the number of inappropriate drugs prescribed and thus pharmacist can play an important role in improving the quality of treatment of inpatients.

A study was conducted by the Department of Health Policy and Management, Harvard School of Public Health, USA ( 1993-94)

to measure the effect of pharmacist participation on medical rounds and the rate of preventable adverse drug events (ADEs).

Preventable ADEs were identified by review of medical records of the randomly selected patients during both preintervention and postintervention phases.

The pharmacist made 366 recommendations related to drug ordering, of which 362 (99%) were accepted by physicians.

ReferencesReferences

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Thomson Micromedex Medclik AFHS CIMS Internal Medicine by Harrison Current Consult Medicine Internet