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THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Abdul-Jabbar Sumayah1, Bates Ian2, Davies Graham1, Shulman Robert3

1Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH

2University College London School of Pharmacy, University of London, Russell Square, London WC1B 5EA

3Department of Pharmacy, University College Hospital, NHS foundation Trust, 235 Euston Road, London NW1 2BU

Email: sumayah_aj@yahoo.com

Purpose

To evaluate the daily drug cost of critically ill patients and investigate this in terms of severity of illness and mortality. This is via designing a patient specific and reproducible method that accommodates for the diversity of critically ill patients.

Methods

The study was conducted at a London Teaching Hospital Critical Care Unit. Data were collected for patients who were either discharged or died during September 2011 and stayed longer than 48 hours. The drug-cost was based on 150 drugs which equated to 97% of the total drug expenditure for the study month. This cost was then related to patient's acuity and outcome.

Results

There were 85 patients evaluated in total. Patients that had significantly high daily drug cost (median £403) had a higher mortality rates, more dependence on mechanical ventilation and more requirements for higher level of care. Patients with haematological malignancy had a daily drug cost 24 times (median £561) more than those without (median £23). The method design permitted the determination of drug expenditure by therapeutic class. Antifungals were the major contributors' whereby they accounted for 30% of drug expenditure. A regression analysis on the following aspects: haematological malignancy, deterioration, number of anti-infectives and day 2 drug cost (patient's diversity) explained 93% of the variance in the daily drug cost.

Conclusions

The median daily drug cost was just under £30. This cost escalated significantly with patient acuity and in haematological malignancy. Therefore, it is necessary to appreciate the diversity and heterogeneity of the patients in cost comparison. A patient specific reference method has been designed for an in-depth evaluation of daily drug cost. We invite others to compare their Unit's cost in this way; facilitating the potential for comparisons of clinical efficiency in the treatment of comparable patients.

CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Appleton C Sarah1 and Payne A Rupert2

1University of Cambridge Medical School, Addenbrookes Hospital, Cambridge

2Primary Care Unit, University of Cambridge, Forvie Site, Cambridge

Email: sa490@cam.ac.uk

Objective

Polypharmacy is often considered to be undesirable, but is common in the context of cardiovascular disease management. This study aimed to establish whether cardiovascular polypharmacy was associated with adverse clinical outcomes, by assessing the relationship between the number of prescribed cardiovascular medicines and non-cardiovascular unplanned hospital admissions.

Methods

A retrospective cohort study of 180,647 patients aged 20 years or above. Routine clinical data was collected from 40 Scottish GP practices, linked to national hospital discharge data. All patients registered were followed up for one year, and the main outcome measures of occurrence of non-cardiovascular emergency admission and non-cardiovascular potentially preventable emergency admission were recorded.

Results

25.3% of patients were prescribed one or more cardiovascular medicine; 5.9% had 5 or more cardiovascular medicines. At least one non-cardiovascular emergency admission or potentially preventable admission was experienced by 4.2% and 0.9% of patients respectively. For patients prescribed 1 or 2 cardiovascular medicines the odds ratio for emergency and potentially preventable admission was 0.93 (0.86 to 1.01) and 1.02 (0.87 to 1.20) respectively, compared with those prescribed no cardiovascular medicines; for patients prescribed 7 or more cardiovascular medicines the odds ratio were 0.79 (0.66 to 0.94) and 0.92 (0.69 to 1.23) respectively.

Conclusions

There was no evidence of an association between increasing cardiovascular medicines and potentially preventable non-cardiovascular admissions. A decreased risk of emergency admission is associated with increasing cardiovascular medicine use. Assumptions that polypharmacy is hazardous and represents poor care should be tempered in the context of cardiovascular medicines, where it may actually reflect a higher standard of disease management more general.

DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Barnett Nina L, Parmar Paresh, Christine Ward North West London Hospitals Trust (NWLHT), London, UK.

Email: nina.barnett@nhs.net

The community pharmacy New Medicines Service (NMS) was introduced in 2011 to promote medication adherence, in patients newly commenced on certain medicines, through medication –related consultations. Hospitals are able to refer patients to the service, but hospital referral processes are inconsistent and uptake appears very low1. The service could offer medicines optimisation to manage polypharmacy in stroke patients, who may have new disabilities with new long-term medication, including anticoagulant or antiplatelet drugs.

Aim

To develop an effective NMS referral process from an acute hospital and quantify uptake.

Method and Results

The study was conducted on the Stroke unit within Northwick Park Hospital(NWLHT) and consisted of 2 Plan Do Study Act cycles2.

Cycle 1 - Hospital pharmacists discussed new medicines with patients near discharge. Patients were also given a pre-printed NMS referral letter and advised to contact their community pharmacist within 2 weeks of discharge. 65 patients were seen between 10th January and 8th February 2012. The community pharmacists nominated by patients were subsequently contacted by phone to determine uptake of NMS, or patients were contacted if no community pharmacist contact was available. Four weeks post-discharge 1 hospital-referred NMS had been conducted. Conversations with local community pharmacists revealed that many were unaware that hospital referral was possible for the NMS and they would value direct hospital contact. Of the patients contacted, none knew about hospital-referred NMS despite the verbal and written hospital support.

Cycle 2 – In addition to Cycle 1 activities, the hospital pharmacist obtained patient consent to share medicines discharge information with the patient's chosen community pharmacy and also for that community pharmacy to telephone the patient 1 week after discharge. 28 patients received this service between 2nd July and 31st July 2012. At follow-up 4 weeks post-discharge, 9 patients had accessed the NMS (with a further 3 in the fifth week post discharge). Hospital pharmacists reported that this intervention had a minimal impact on their time. Community pharmacists highlighted the benefits of discharge information for their pharmacy medication records and having a phone contact number for both the patient and the hospital pharmacist.

Discussion

This study is a small scale, single hospital intervention in stroke patients which limits generalisability. However, the study suggests that the addition of a telephone referral process to inpatient written and verbal NMS information is an effective way to increase the number of patients accessing the NMS after hospital discharge.

References

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Corlett SA1,Dodds L J2 and Rodgers RM1.

1 Medway School of Pharmacy, Universities of Kent and Greenwich at Medway, Chatham Maritime

2 Medway School of Pharmacy and East and South East England Specialist Pharmacy Services, West Kent PCT

Email: S.A.Corlett@kent.ac.uk

Background

Patient views of medicine-related support services, such as Medicine Use Reviews, have demonstrated that these services are regarded positively by patients and that pharmacists providing these services are perceived to be knowledgeable about medicines1. This study explored the general publics' experience of medicine support services and their perception of the community pharmacists' role in providing these new clinical services.

Method

Following ethical approval, focus group discussions were held with members of the public in Medway who used, or cared for someone who used, regular medicines. Participants were recruited via displayed posters. Health care professionals were excluded. Participants were asked what they would like to support them with their medicine taking, about the resources they used for resolution of medicines-related problems or identified needs, and about the experience that they had had with community pharmacists relating to support provided for medicines. Focus groups were digitally recorded, transcribed and thematically analysed.

Results

17 volunteers (7 female) participated, in two focus groups. Participants expressed a desire for information, knowledge and better understanding of their medicines. They recognised that the pharmacist was knowledgeable about medicines but were dissuaded from discussing issues with their medicines by the perceived business of the pharmacist, and concerns about a lack of co-ordination of pharmacist advice with that of their general practitioner. They were frustrated by supply issues. The participants' experiences of the clinical services suggested that these were perceived as something of being of greater importance to the pharmacist than to them as a patient, and that their participation was often something they did to oblige the pharmacist, rather than a clinical service to improve their care. Some of the participants were however very positive about their pharmacist, who they regarded as a trusted friend.

Conclusion

The general public do not fully recognise the potential for pharmacists to address their medicine-related needs. This may be, in part, due to the language and behaviour adopted by pharmacists when recruiting to, and providing these services.

  • 1
    Krska J, Nesbit J, Baylie K, O'Kane A. Patient Views on the MUR service. Int J Pharm Pract 2009;17 (Suppl 1):A41-2

STOPPING MEDICATION AND DECISION-MAKING BIASES

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Donyai P, Ibrahim K, Almutairi S

Reading School of Pharmacy, University of Reading, Berkshire, RG6 6AP

Email: p.donyai@reading.ac.uk

Objectives

Polypharmacy can be beneficial, but risk from iatrogenic disease can outweigh benefits especially with unnecessary overtreatment, which is not exclusive to polypharmacy. Single medicines can also expose patients to unacceptable risks, especially with continued use. For example, methylphenidate in children with attention-deficit hyperactivity disorder and antipsychotics in dementia need not be prescribed longterm1,2. Medical decisions, including whether to stop patients' medication, can rely on heuristics (shortcuts), which can lead to cognitive biases (erroneous reasoning)3. The aim was to examine interviews with health professionals to unlock heuristics and biases in continued prescribing decisions.

Methods

Transcripts from qualitative, semi-structured, face-to-face interviews carried out in 2012 with Child and Adolescent Mental Health Services consultants (n = 7) recruited from six clinics in Berkshire, general practitioners (n = 6, methylphenidate; n = 4, antipsychotics) recruited from West and East Berkshire Primary Care Trusts, and old-age psychiatrists (n = 5) and geriatricians (n = 3) recruited from Berkshire Healthcare NHS Foundation Trust (BHFT) were examined using thematic analysis, which resulted in the emergence of a number of potential heuristics and biases reported here. Approvals were received from the University of Reading Research Ethics Committee, BHFT R&D office and the Thames Valley Primary Care Research Partnership.

Results

There was evidence of ‘aggregate bias’, non-compliance with guidelines because individual patients are thought to fall outside standard guideline parameters. Thus, for example, some questioned the necessity of methylphenidate ‘drug holidays’ for their patients, despite guidelines recommending consideration of periodic withdrawal every two years. There was also evidence of ‘multiple alternative bias’, being overwhelmed by alternative choices. For example with antipsychotics, professionals lacked sufficient knowledge and confidence about effective alternatives with the uncertainty resulting in adherence to the status quo. A final finding was a ‘visceral bias’, emotional involvement leading to a ‘value bias’, believing in a stronger likelihood for a desired positive outcome. For example with methylphenidate, parents' ability to cope with children on medication and better schooling took precedence over iatrogenic impact. Similarly, with antipsychotics, doctors thought continued prescribing was genuinely useful to their patients.

Conclusion

Doctors have a range of beliefs about medication and need for continued prescribing, which can influence their behaviour and impact on whether or not patients' medicines are stopped. Evidence that cognitive biases could be informing decision-making in relation to stopping potentially unnecessary treatment provides hope for tools that enable ‘de-biasing’.

References

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX
  • 1
    National Institute for Health and Clinical Excellence (2008) Attention Deficit Hyperactivity Disorder: Diagnosis and management of ADHD in children, young people and adults. National Clinical Practice Guideline Number 72. London: National Institute for Health and Clinical Excellence.
  • 2
    Banerjee S. The use of antipsychotic medication for people with dementia: Time for action. Department of Health report. November 2009
  • 3
    Croskerry P. Achieving Quality in Clinical Decision Making: Cognitive Strategies and Detection of Bias. Academic Emergency Medicine. 2004;9(11):1184204.

ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Fairbrother K, Senior Real World Evidence Analyst (AstraZeneca UK)

Blak B, Real World Evidence Analyst (AstraZeneca UK)

Findley S, GP (Bishopgate Medical Centre, Bishop Auckland)

Holmes P, GP (Felix House Surgery, Darlington)

Fuat A, GP (Carmel Medical Practice, Darlington)

Email: Karen.Fairbrother@astrazeneca.com

Objectives

National Institute of Clinical Excellence (NICE) guidelines currently specify simvastatin 40mg for treatment of dyslipidaemia. Alternative therapy should only be used if required, with consideration of statin monotherapy options ahead of others. The aim of this analysis was to use existing audit data to look at real world use of statin monotherapy options that may be prescribed following simvastatin 40mg for reasons other than to achieve greater cholesterol lowering (atorvastatin 10mg, fluvastatin 20-80mg, pravastatin 10-40mg, rosuvastatin 5mg and simvastatin 10-20mg).

Methods

Previously extracted and anonymised data were collated from 44 consenting UK practices that had participated in a statin audit provided as a service to medicine by AstraZeneca between 01 January 2008 and 01 April 2011. The analysis looked at all patients prescribed simvastatin 40mg monotherapy followed by an alternative statin treatment option since January 2003 until the day of audit. Patients with relevant total cholesterol (TC) levels (and without concomitant fibrate, cholesterol resin or nicotinic acid derivative) were eligible for inclusion.

Results

23,036 patients had received simvastatin 40mg monotherapy of which 6157(27%) switched to an alternative treatment option. 2548(41%) of the patients who switched changed to a statin option of similar or lesser efficacy than simvastatin 40mg of which 808 had relevant TC levels. Analyses were not performed for treatment groups where n < 10. Results are shown as mean percentage change in TC (with 95% CI) from baseline (on simvastatin 40mg) to on the alternative treatment option.

Compared to treatment with simvastatin 40mg:

  • Mean percentage TC levels were similar for treatment groups atorvastatin 10mg (−1.9%;CI-4.7%to + 0.8%,n = 208,baseline TC = 4.81mmol/L) and rosuvastatin 5mg (−0.8%;CI-9.2%to + 7.5%,n = 66,baseline TC = 5.13mmol/L).
  • Mean percentage TC levels were higher for treatment groups pravastatin 20mg (+10.7%;CI + 1.1%to + 20.2%,n = 30,baseline TC = 4.78mmol/L), pravastatin 40mg (+8.9%;CI + 3.5% to + 14.3%,n = 75,baseline TC = 4.63mmol/L), simvastatin 10mg (+11. 9%;CI + 3.72%to + 20.1%,n = 45,baseline TC = 4.25mmol/L) and simvastatin 20mg (+7.7%;CI + 5.7%to + 9.7%,n = 370,baseline TC = 4.22mmol/L).

Conclusions

For patients requiring a change of therapy from simvastatin 40mg for reasons other than to achieve greater cholesterol lowering, then atorvastatin 10mg and rosuvastatin 5mg may provide alternatives without compromising the level of cholesterol control achieved with simvastatin 40mg. When cytochrome P4503A4 drug interactions are a consideration rosuvastatin 5mg could be prescribed.

Based on these results, changing to pravastatin 20-40mg or simvastatin 10-20mg may not achieve the same level of cholesterol control as simvastatin 40mg with a potential resultant negative effect on cardiovascular risk.

MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Poly Pharmacy not superior Quality Indicator

Authors

Flood, Bernadette MPSI [PhD student] & Henman, Dr. Martin. School of Pharmacy & Pharmaceutical Sciences, TCD, Dublin.

Email: beflood@tcd.ie

Introduction

PAWID are vulnerable in healthcare. Medication use is the main therapeutic intervention in the population ageing with intellectual disability. The medication use process for PAWID and behaviour disorders is extraordinarily complex. The aim of this project was to develop Quality Indicators for medication use in PAWID and behaviour disorders.

Methodology

As the first step in a Modified Delphi Technique a literature and guideline review identified 38 candidate Quality Indicators[QIs], one of which was ‘Poly—Pharmacy’. A multidisciplinary panel with 28 members rated each candidate QI, on a 9 point likert scale against key criteria - importance, scientific soundness and feasibility.

Results

Following a two round Modified Delphi Technique panel members identified 6 superior QIs which did not include ‘Poly-pharmacy’. The superior QIs identified were, rated as important by more than 90% of panel. These were Medication Review, General Health Review, Restrictive Practice, Excessive Dose Anti-Psychotics, Gradual Dose Reduction and Dementia & Anti-Psychotic Medication. The candidate ‘Poly-Pharmacy’ QI was rated by [1]88.9% of the panel to be important [2] 85.2% as scientifically important and [3] 70.4% to be feasible.

Discussion

PAWID have a different pattern of morbidity and mortality than the general population. Clinical guidelines may contribute to health inequities experienced by disadvantaged groups such as PAWID. Caution is required in using Potentially Inappropriate Medication [PIM] tools developed for use in the general population in PAWID as these tools relate to only one aspect of quality ie appropriateness. ‘Poly Pharmacy’ was not identified in this project as a superior indicator of quality care in this population group. This reflects the position where PAWID have a high prevalence of chronic diseases, such as epilepsy and psychiatric disorders and are commonly multiple medication users. PIMs should be used with caution unless they are validated in this vulnerable population group as multiple medication use may be absolutely necessary for the proper treatment of many PAWID and behaviour disorders.

CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

J. Gallagher 1, S. Byrne 1, D. Lynch2, S. Mc Carthy1,2

1University College Cork (UCC), and 2 Cork University Hospital, Cork Ireland

Email: j.e.gallagher@umail.ucc.ie

Background

Clinical pharmacists are instrumental in optimising the efficiency, effectiveness and safe delivery of pharmaceutical care [1]. Pharmacist interventions are actions which aim to improve a patient's pharmaceutical care. Comprehensive evidence exists to support both the clinical and economic benefits of pharmacy interventions in both hospital and community settings [2]. The objective of this study was to determine the areas of prescribing and medicine administration which most frequently required interventions from clinical pharmacists.

Method

Ethical approval was obtained from the Clinical Research Ethics Committee of UCC. This was a retrospective study, reviewing interventions made by the team of clinical pharmacists at Cork University Hospital, Ireland. Interventions were documented using a paper-based system. These interventions were then collated and entered on the eClinical Pharmacy Suite software, which facilitates analysis of the intervention data. Interventions were classified as belonging to one of the following categories: drug, date/time, dose, frequency, duration, route/formulation. The drug category pertained to the following types of interventions: omissions, requests to review suitability of therapy, interactions, chemical duplication, notification of discontinuation and cost benefit interventions. Interventions from the time period of 01/01/2010 - 31/08/2012 were included in this study.

Results

A total of 4265 prescribing and administration interventions were identified. Medication omissions were the most frequent intervention highlighted by pharmacists in this study (50.2% of overall interventions). (Table 1).

Table 1 Categorisation of interventions

Category of interventionN (%)
1. Drug (Total)3028 (70.7%)
- Potential medication omissions2141 (70.7% of drug category)
- Review drug therapy389 (12.8% of drug category)
- Drug interactions100 (3.3% of drug category)
- Other398 (13.1% of drug category)
2. Doses728 (17.1%)
3. Frequencies326 (7.6%)
4. Routes121 (2.8%)
5. Duration36 (0.8%)
6. Date/Time21 (0.5%)
7. Rates5 (0.1%)

Conclusion

The most frequent category of intervention made by clinical pharmacists in this study was the identification of potential prescribing omissions of patient's regular medications from their hospital Kardex. Further investigation of medical records will be required in the future to ascertain whether these suggested interventions were enacted. The categorisation of the interventions could also be refined by additional information from patient's medical records and a review by senior clinical staff. This study highlights the utility of pharmacist led medicines reconciliation on admission.

References

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Gammie, Shivaun1 and Donn, Jane2

1 Medway School of Pharmacy, Universities of Kent and Greenwich, Chatham Maritime

2 Maidstone & Tunbridge Wells NHS Trust, Hermitage Lane, Maidstone

Email: S.M.Gammie@kent.ac.uk

Background

The National Patient Safety Agency1 identified the need to reduce the risks from omitted medicines which included requirements to review incident reports and undertake audits of omitted medicines. The objective of this study was to investigate whether doses of medicines which were omitted without a documented reason (defined as “missed dose medication errors”) were reported within one Trust.

Method

Following an analysis of the Trust incident reporting system 7 wards, including high and low reporters of missed dose medication errors and a range of specialties, were included in this study. Each ward was visited on one day and all medication charts were scrutinised by an independent investigator for doses of medication that had been missed. Any dose missed without a documented reason was recorded on a data collection tool designed for this project. This study was part of a larger study into missed dose medication errors which had NHS Ethics Approval.

Results

131 medication charts were analysed; 29 (22%) contained at least one missed dose medication error and 79 individual missed doses were recorded. Three of the 7 wards had no missed dose medication errors, one ward (identified as a low reporter) had 49 (62%) missed dose medication errors with the remaining 3 wards having 13 (16%), 12 (15%) and 5 (6%) of the missed dose medication errors. One patient had 10 missed dose medication errors and a second patient had 9 missed dose medication errors. The 3 most common groups of drugs were CNS (22 missed dose medication errors, 28%), cardiovascular (17, 22%) and endocrine (12, 15%). The most commonly omitted drug was paracetamol (n = 14). The low molecular weight heparin, Fragmin®, was omitted on 10 occasions.

None of the 79 reported missed dose medication errors identified in this study were reported and recorded on the Trust incident database two or eight weeks after the observation period.

Conclusion

The results of this study indicate that missed dose medication errors are under-reported. The unintentional omission of drugs, such as low molecular heparins, has the potential to adversely affect patient care.

Reference

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX
  • 1
    National Patient Safety Agency. Rapid Response Report. Reducing harm from omitted and delayed medicines in hospital. National Patient Safety Agency. February 2010.

PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Authors

Brian Godman1,2, Andrew Martin3, Jeanette Tilstone3, Nigget Saleem3

1Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden

2Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK

3NHS Bury, 21 Silver Street, Bury BL9 0EN, UK.

Email: Brian.Godman@ki.se

Introduction

There have been active initiatives throughout the UK to improve prescribing efficiency. These include programmes to lower generic prices such as the ‘M’ and ‘W’ scheme, resulting in certain generics as low as 2% to 3% of pre-patent loss originator prices, and prescribing of generics versus originators and patented products in a class or related class such as training of doctors to prescribe by INN name, Better Care Better Value indicators and financial incentive schemes. The availability of generic losartan and its listing in Category ‘M’ in July 2010 provided an opportunity to enhance ARB prescribing efficiency. Initially, there was limited activity in NHS Bury to enhance the utilisation of losartan versus other ARBs. This changed in March 2011 with active switch programmes, practice based financial incentive schemes and other measures instigated by pharmacists working for NHS Bury.

Objective

Principally, assess the impact of multiple measures instigated in March 2011 on the subsequent utilisation of losartan, its price as well as overall ARB expenditure. In addition, estimate the cost of implementing the programme alongside the savings.

Methodology

Principally an interrupted time series analysis of ARB utilisation before and after the availability of generic losartan as well as before and after the instigation of multiple demand side measures in March 2011. Utilisation measured in prescription items, which is typically 28 days.

Results

There was no immediate change in losartan utilisation following the availability of generics. This changed significantly after initiating the multiple programme, with losartan 65% of all single ARB items dispensed by October 2011. ARB expenditure by October 2011 was 59% below expenditure prior to the availability of generic losartan, helped by a 92% reduction in expenditure/ item for generic losartan vs. pre-patent loss prices. Annual net savings from the programme are estimated at over GB£290,000 per year for the 186,000 population, over eight times the cost of implementation.

Conclusion

Active programmes are needed to improve prescribing efficiency with no apparent spill over between classes. The results demonstrate that Medicine Management technicians can action switch programmes under guidance to appreciably enhance prescribing efficiency.

ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

B. Hodgson1, M. Wilcock1, Matthews S1, N Gibson2

1Pharmacy Department, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, TR1 3LJ, and 2NHS Cornwall & IoS PCT GP Prescribing Lead

Email: Mike.Wilcock@rcht.cornwall.nhs.uk

Objectives

The majority of hospital admissions caused by adverse drug reactions (ADRs) are viewed as preventable1 though there is no clear strategy to encouraging prescribers to learn from these opportunities for prevention.2

Method

The study was conducted in a 700 bed teaching hospital over a 3 month period in 2012 during which patient records containing the ICD-10 diagnostic code Y40-Y59 (Drugs, medicaments and biological substances causing adverse effects in therapeutic use) were scrutinised. Details of the suspected ADR, the suspected causative drug, and patient demographics were noted. The ADR was categorised from the GP's perspective as:- commonly known (known knowns e.g. ACEI and angioedema); an ADR that a GP could recall if prompted (known unknown e.g. hyponatraemia and SSRI); or one that the average GP would unlikely be aware of (unknown unknowns e.g. mirtazapine and neutropenic sepsis).

Results

Data were obtained for 46 patients. Seven were excluded as the associated drug had been given in hospital but caused an admission once the patient was home e.g. chemotherapy induced neutropenia. Of the 39 patients, 12 were male and average age was 71 (range 28 to 99); 61 drugs were implicated (for some patients more than one drug was deemed the possible cause). The types of drug implicated and the ADR ‘Rumsfeld’ categorisation are shown below. Overall 21 of 39 ADR instances were thought to be possibly preventable.

image
BNF section and number of drugs 
Diuretics - 11Antiplatelet - 3
Drugs affecting the renin-angiotensin system - 10Anticoagulants - 3
Opioid analgesic - 6Other - 23
Antidepressants - 5 

Conclusion

In this small study, most of the ADRs thought to be causing hospital admission were well recognised, and theoretically preventable, though some common ADRs were not (e.g. 5 cases of angioedema due to a renin drug). A number of scenarios require reinforcement back to primary care eg acute kidney injury with ACE-I and diuretic, GI bleed in an elderly patient on aspirin but no covering PPI, opioid-induced constipation. We intend to highlight and discuss a few of these instances with approximately 60 GPs over a series of 3 meetings to ascertain if they agree that there are general key principles to be learnt; wish to receive this type of general feedback on an ongoing manner, either at meetings or via some other medium; or wish to receive specific individual patient level feedback for their own patients for reflective purposes.

References

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Vanaja Kenchappa1, 2, Priyanka N1, Jahurul Haq G1, Samira Khadadoostan1, Iran Nasri1

1Department of Pharmacy Practice, Visveswarapura Institute of Pharmaceutical Sciences, Bangalore, India. 2 Institute of Physiology, Eberhard Karls Universität Tübingen, Gmelinstrasse 5, Tübingen 72076, Germany

Email: vanaja_ceutics@yahoo.com

Introduction

Malaria is a tropical disease caused by five Plasmodium species including P.falciparum, P.vivax, P.ovale, P.malariae and more recently P.knowlesi. In India, it is one of the major public health problems, with the major Indian states being malaria-prone1.

India's official figure for malaria stood at 1,023 in 2010 and 430 in 2011. The correct use of anti-malarial drugs is the key not only to therapeutic success but also to determine the spread of drug resistance. Malaria and drug utilization studies will ensure that the healthcare providers are working in concert with National strategy. Hence, we aimed at studying the utilization pattern of anti-malarial drugs at a tertiary care hospital in Bangalore, India.

Methods

A retrospective study was conducted in the department of medicine in a tertiary care hospital and research center, Bangalore after obtaining Ethical clearance from Human Ethics committee Board of VIPS. Retrospective data was extracted from the medical records from January 2004 to December 2011 (n =350) and examined which included age, sex, weight and monthly income of the patients; symptoms presented at the time of admission; complications associated with the disease and duration of stay at the hospital. The WHO core prescribing indicators were used to evaluate the drug utilization at the hospital and statistical methods were used for data analysis

Results

The yearly trend of malaria occurrence data showed that the prevalence of P.falciparum infection (52.6%) was more when compared to P.vivax (47.4%) infection. The number of medicines per prescription was found to be 6.7 ± 1.0 with 16.6 ± 2.4% prescribed as generics. Most of the drugs (94.6%) were prescribed from the National Essential List of Medicines India 2011.

65% of patients were on combination therapy and 35% of patients were on monotherapy. Among which 49.1% of patients received monotherapy for P.falciparum infection, 50.9% for P. vivax infection. Whereas combination therapy was prescribed to 62.5% of the patient population having P. falciparum infection and for 37.5% of patients having P. vivax infection.

Among the total patient population (N = 350), 75% received Artesunate, 15% received Primaquine and 10% received Chloroquine during monotherapy. In combination therapy, majority of the patient population (65%) received Artesunate + Primaquine, whereas, Artesunate with other combinations were prescribed to a lesser extent.

Conclusion

The anti malarial drugs prescribed in the hospital complied with the National Essential Drug List 2011 (NEDL), India.

DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Vanaja Kenchappa1, 2, Bency Verghese1,

1Department of Pharmacy Practice, Visveswarapura Institute of Pharmaceutical Sciences, Bangalore, India. 2Institute of Physiology, Eberhard Karls Universität Tübingen, Gmelinstrasse 5, Tübingen 72076, Germany

Email: vanaja_ceutics@yahoo.com

The aim of the study was to evaluate drug usage pattern in a teaching tertiary care hospital in Bangalore, India at the Department of OBG for a period of 9 months.

The medication use pattern was evaluated in 250 women attending antenatal clinics from inpatients and out-patients. Women were interviewed in different gestational ages using a pre-designed structured questionnaire. Medications were classified according to the US FDA risk classification and medication by pharmacological class. Drug details (generic and brand name of the drug, dose, dosage frequency and route of administration) collected were including prescribed medications, OTC medications, herbal treatment and self medication during the current pregnancy.

The mean age of the pregnant women was found to be 24.51 ± 3.81years. 52% of the total participants had school level of education with majority of them (91.2%) being housewives residing in urban areas (92.8%).

Results

The prenatal visits of 39.6% of study participants was between 12–25 weeks of pregnancy. Majority of the participants (76.8%) were reported to have no history of abortion with 44% 1st gravida; 85.6% in the 3rd trimester. 23.5% of the participants had high blood pressure in the 1st trimester and 42.2% showed a decrease in haemoglobin level in the 2nd trimester. 10.5% of the women had a high level of random blood sugar and a low level of thyroid stimulating hormone in their 2nd trimester.

Category A drugs constituted 39.1%, 4.3% and 56.5%, category B drugs constituted 28.5%, 14.2% and 57.1% and category C drugs constituted 23%, 15.3% and 61.5% during the 1st, 2nd and 3rd trimesters respectively. However, category D constituting about 71.4% of drugs was used in 3rd trimester. Category X drugs constituted 75% in the 1st trimester and 25% in the 3rd trimester. Cardiovascular drugs were the most highly used category of drugs followed by progesterone and anti-diabetics.

Data during lactation period (1st week post-partum) from 174 study participants revealed that a large proportion of women were dispensed at least one drug before delivery, including a considerable number who were exposed to drugs with pregnancy risk designations D and X.

Conclusion: Education on self medication and the use of drugs during pregnancy can reduce the ill-effects of drugs on the baby.

STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Krska, Janeta; Chaipichit, Natapornb; Chumworathayi, Pansuc; Jarernsiripornkul, Narumolb*

a- Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, UK

b- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand

c- Department of Pharmacy Service, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand

Email: narumol@kku.ac.th

Background

In Thailand, drug allergy constitutes 16.2% of all ADRs in hospitalized patients. Inadequate documentation and communication between health service providers, use of English medication names and lack of patient-friendly patient information leaflets contribute to recurrent drug allergy.

Objectives

To evaluate the effectiveness of strategies in improving knowledge and understanding of drug allergy and key behaviours in relation to drug allergy cards in patients with history of drug allergy, and to explore factors influencing these outcomes.

Methods

This study was conducted in Srinagarind hospital, an 800-bed tertiary teaching hospital in North East Thailand. Questionnaires were distributed to patients with history of drug allergy before and after receiving interventions: brochure only (Group 1) or pharmacist counselling with brochure (Group 2). Knowledge scores were compared between patient groups at baseline and one month later. Baseline responses were analysed for factors associated with knowledge and behavioural outcomes.

Results

Baseline questionnaires were completed by 299 and 100 patients in Group 1 and Group 2 respectively, of whom 179 and 96 completed follow-up questionnaires. At baseline, mean total knowledge scores between groups were not significantly different (p = 0.05), however, mean follow-up knowledge score in Group 2 was significantly higher than Group 1 (p < 0.01). Self-reported always carrying and presenting drug allergy cards was also higher in Group 2 than Group 1 (p < 0.05 and p < 0.01). Higher baseline knowledge scores were associated with having at least secondary school education or previously receiving drug allergy cards. Patients with two or more drug allergies were significantly more likely to report carrying drug allergy cards than those with allergy to only one drug.

Conclusion

Pharmacist counselling with brochures was found to be more effective than brochures alone for improving patients' knowledge and understanding of drug allergies and drug allergy cards and in promoting drug allergy card carrying behaviour.

PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Krska, Janeta; Chaipichit, Natapornb; Uchaipichat, Verawanb; Pratiparnwat, Thongchaic; Jarernsiripornkul, Narumolb*

a- Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, UK

b- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand

c- Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand

Email: narumol@kku.ac.th

Objectives

To determine the prevalence of Statin-induced adverse reactions by patient self-reporting and to evaluate factors associated with the accuracy of these adverse drug reaction (ADR) reports.

Methods

This cross-sectional study was performed in Srinagarind hospital, an 800- bed tertiary teaching hospital, in Thailand. Patients who were prescribed Statins received self-reporting ADR questionnaires directly from the pharmacist or by post. The questionnaire collected patients' demographic characteristics and incorporated a previously validated checklist of symptoms which could be adverse effects. Medical records were reviewed to confirm medication, medical history, and laboratory tests. All symptoms were evaluated for causal relationship to the statin, based on predefined criteria which considered concomitant drugs and diseases.

Results

A total of 1388 questionnaires were distributed to patients who then completed 717 (51.6%) valid questionnaires suitable for analysis. More than 76.0% of the respondents reported at least one symptom and the prevalence of reported symptoms for the three Statins ranged between 74.9 - 76.6%. Muscle pain was reported in 23.4%, 19.2%, and 26.8% of respondents taking simvastatin, atorvastatin, and rosuvastatin, respectively. The accuracy of reported symptoms was less in patients who had reported higher numbers of symptoms (OR = 0.399; 95%CI 0.174, 0.917; P < 0.030), whereas age, gender, number of concomitant diseases and medicines, duration and indication of Statin therapy, and education were not significantly associated with symptom accuracy. More atorvastatin users reported symptoms accurately than simvastatin and rosuvastatin users (71.6%, 43.2%, and 36.6%, respectively; p < 0.001).

Conclusions

Patients were willing to report adverse reactions related to statins using the standardised questionnaire. Overall the proportion of patients reporting any suspected ADR was high, with muscle pain occurring frequently with all three drugs. In line with previous studies which have used this checklist, the number of symptoms reported was the most important factor associated with symptom attribution accuracy.

PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Manning, L. University Hospitals of Leicester, Department of Medicine for the Elderly

Conroy, S. University Hospitals of Leicester, Department of Medicine for the Elderly

Email: lmanning@doctors.org.uk

Background

Within an ageing population, multiple co-morbidities leading to polypharmacy and potentially inappropriate prescribing, contribute significantly to poorer health and hospital admissions. Our hospital introduced the STOPP (Screening Tool of Older Person's Prescriptions) / START (Screening Tool to Alert doctors to Right Treatment) tool to encourage safe prescribing. Our audit cycles have shown that it is possible to reduce potentially inappropriate prescribing (1). Additional work is still required to improve prescribing in older people. Our objective was to identify predictors of inappropriate prescribing to allow us to target our efforts.

Methods

Annual audits were undertaken from 2009–2011 in people aged 70+ in medial wards across three hospitals. Appropriateness of prescribing was assessed against the STOPP/START criteria. We performed a logistic regression analysis on the data, to identify predictors of inappropriate prescribing.

Findings

Data was collected on 586 patients. 60% of patients were female. 32.5% were on geriatric wards and 68.5% on other medical wards. 49.5% were confused. Other demographics are shown below:

VariableMean
Age83.8 years
Number of Co-morbidities3.6
Number of Geriatric Syndromes1.8
Number of Medications7.2

There were no significant differences in baseline characteristics between patients on geriatric compared to non-geriatric wards. 36.86% were on one or more inappropriate drugs (STOPP). 39% had one or more drug omissions. Results of a multivariate regression analysis for STOPP and START compliance are shown in table 2 (95% Confidence Interval in brackets).

VariableSTOPP Odds RatioSTART Odds Ratio
Geriatric Ward0.5 (0.4 – 0.8)0.7 (0.5 – 1.1)
Male Gender1.2 (0.8 – 1.8)1.2 (0.8 – 1.7)
Co morbidities1.1 (0.9-2.0)1.1 (1.2 – 1.5)
Geriatric Syndromes1.1 (0.2 – 1.3)1.2 (1.0 – 1.4)
Confusion1.0 (0.6 – 1.6)0.9 (0.6 – 1.5)
Number of medications1.2 (1.1 – 1.3)1.0 (1.0 – 1.3)
Age (≥85 years)1.0 (0.8 – 1.7)1.0 (0.7 – 1.5)

Conclusions

The significant predictors of being on one or more inappropriate medications were ward type (associated with a halving in STOPP risk) and number of medications (associated with a modest increase in STOPP risk). Patient demographics on geriatric and non geriatric wards were very similar in terms of mean age, number of co morbidities and number of medications. For patients on non-geriatric wards, a focus on those with high levels of poly pharmacy using interventions such as STOPP/START might improve prescribing.

Reference

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Kate Marsden1, Tony Avery1, Richard Knox1, Gill Gookey1, Ndeshi Salema2, Mindy Bassi3

1 University of Nottingham, School of Community Health Sciences, Division of Primary Care, Nottingham, UK

2 University of Nottingham, School of Pharmacy, Nottingham, UK

3 NHS Nottingham City Clinical Commissioning Group, Nottingham, UK

Email: Kate.Marsden@nottingham.ac.uk

Background

The recent GMC funded study on the nature and causes of prescribing errors in general practice (PRACtICe) identified a number of potential interventions that might help improve the safety of prescribing in general practice. We are now undertaking a qualitative research project to explore the views of GPs and other relevant stakeholders on our findings and proposed interventions.

Design and Participants

This study, which is due to finish in May 2013 has planned to use ten focus groups whose members are to be recruited from GP practices, GP Trainers, GP trainees, Pharmacists and members of the public. At the time of writing this abstract, four focus groups had taken place including 2 GP practices, Pharmacy advisers and GP Trainees. These focus groups were recorded, professional transcribed and then analysed thematically.

Recent Results

The analysis is still in its initial stages but the following issues are emerging:

  • GP computer systems need to be improved to provide better support for prescribers without over alerting them
  • Effective methods need to be devised for minimising interruptions to clinicians when prescribing
  • Greater attention is needed in prescribing in GP training and a number of suggestions have been made including e-learning packages, analysis and feedback on prescriptions, and greater prominence to prescribing in the GP curriculum
  • There is considerable potential for pharmacists to expand their roles in general practices in order to help improve the safety of prescribing
  • General practices need to find more effective ways of undertaking medication reviews for complex patients taking multiple medications

Conclusion

The findings so far demonstrate that the focus groups are a valuable source of ideas for identifying potentially feasible interventions that might be undertaken to reduce prescribing errors in general practice.

PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Vanessa Marvin, Georgia Woodfield, Shirley Kuo, Sharon Donnellan and Iñaki Bovill.

Members of the NIHR for NW London CLAHRC (Collaboration for Leadership in Applied Health Research and Care) STOPIT (Screening Tool for Older People's Inappropriate Treatment) project team at Chelsea & Westminster Hospital NHS Foundation Trust.

Email: Vanessa.Marvin@chelwest.nhs.uk

Background

A project team of hospital doctors and pharmacy staff was set up to reduce unnecessary prescribing of potentially harmful or inappropriate medicines in older people. The team works in collaboration with another NW London CLAHRC project (ImpE) in improving prescribing in the elderly (aged 70 years and over).

Medication-related problems contribute to illness in the elderly1,2. Nearly 5% of emergency admissions are due to preventable adverse drug events which account for 4% of hospital bed days and annual costs of £380-£466m.3–5 Patients on 6 or more medicines have increased risk6. Reducing medication burden through evidence based review could help improve health and prevent readmissions.

Local audit showed that two-thirds of older patients are on 6 or more medicines. Anecdotally anti-hypertensives and benzodiazepines are, for example seen in drug histories of falls patients. Local focus groups suggested that junior doctors feel uncomfortable stopping medicines that more senior doctors started. Indications for medicines are frequently unavailable to the admitting team, current medication lists not up-to-date and GPs are not informed of reasons for hospital-initiated medicines. These factors may contribute to unnecessary continuation of previous prescriptions.

Method

We adapted the validated STOPP tool6 producing a proforma and procedure to ‘qualify’ admitted patients for review of potentially inappropriate medicines. Qualifying patients are identified by pharmacy staff and highlighted through documentation in the electronic prescribing system. The team doctors review accordingly at a clinically appropriate time. Changes made (dose reductions or discontinuations) are similarly documented electronically allowing transcription onto the discharge summary.

The tool was presented at junior doctor teaching, medicine directorate meetings and the Trust Patient Experience Group and then piloted for 3 months from July 2012. Data was entered into the weekly web reporting tool. Plan-Do-Study-Act cycles and feedback from weekly project team meetings led to improvements before settling on the final version named the STOPIT tool.

Results

Data is available on over 100 patients; their reason for admission, number and category of medicines they were on pre and post review. Analysis of pilot findings revealed that although 73% of older patients were on 6 or more medicines, only 46% qualified for a medication review using the draft STOPIT tool. We expanded the inclusion criteria to those on 6 or more irrespective of drug category and the re-design increased the number of patients who qualify. The tool is now finalised will be made intranet accessible as we hope to embed it into routine practice and further analyse the impact in the full project.

Discussion

Many patients aged 70 and over are using potentially inappropriate medication.

We have produced a tool that aids prescribers in their review and rationalisation of older patients' medicines. Piloting the new process was time consuming but invaluable and using a multidisciplinary approach with effective communications is essential.

The re-designed proforma has addressed the problem of potentially missing ‘at risk’ patients by qualifying all patients age 70 and over, on specified medications or polypharmacy even if asymptomatic. Some qualifying patients were being discharged before there was an opportunity for review. We now note this on the patient's discharge summary, requesting the GP to consider appropriately.

Conclusion

Polypharmacy in the elderly is common despite good intentions of prescribers. Review of medications is simplified using the STOPIT tool. It encourages appropriate prescribing, which might be expected to optimise patient safety.

References

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX
  • 1
    Juurlink DN, Mamdami M, Kopp A et al. Drug-drug inter-actions among elderly patients hospitalised for drug toxicity. JAMA 2003; 289:1652.
  • 2
    Goldberg RM, Mabee J, Chan L, Wong S. Drug-drug and drug-disease interactions in the emergency department: analysis of a high-risk population. Am J Emerg Med 1996; 14: 44750.
  • 3
    Bates DW, Cullen DJ, Laird N et al (for the ADE Prevention Study Group). Incidence of adverse drug events and potential adverse drug events. Implications for prevention. JAMA 1995;274:2934.
  • 4
    Beijer HJ, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta analysis of observational studies. Pharmacy World and Science 2002;24:4654.
  • 5
    Wiffen PJ, Gill M, Edwards J, Moore A. Adverse drug reactions in hospital patients: a systematic review of the prospective and retrospective studies. Bandolier Extra June 2002.
  • 6
    Gallagher P, O'Mahony D. STOPP (Screening Tool of Older Persons potentially inappropriate Prescriptions) application to acutely ill elderly patients and comparison with Beers criteria. Age Ageing 2008;37:673679.

WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Miller, Gavin; Jetha, Hema; Devlin, Niamh; Rafferty, Aisling; Gavin, Ciara; Birdi, Depinder; Franklin, Bryony Dean

Imperial College Healthcare NHS Trust, London

Email: Gavin.Miller@imperial.nhs.uk

Introduction

The National Patient Safety Agency (NPSA) issued a report detailing the harmful consequences of omitted or delayed doses, highlighting that omitted doses could lead to fatalities and that leaving administration boxes blank is unacceptable1. Subsequently our Trust produced a list of critical medicines which should not be omitted or delayed, ward stock lists were reviewed and we raised awareness around accessing medicines. An audit was then conducted to investigate the reasons why administration boxes were left blank or medicines are documented as unavailable.

Objectives

To identify:

  1. Drug charts with a documented unavailable dose or blank administration box.
  2. The reasons for the unavailable dose or blank administration box.

Method

Data were collected by three pre-registration pharmacists over five days using a data collection proforma. Drug charts were selected at random from a range of specialities across the trust. If there was a blank administration box or a dose documented as unavailable on the drug chart, this was investigated further on the ward.

Results

The main reasons for the 57 doses documented as being unavailable are:

  • Medication not yet ordered or delivered by pharmacy (18 doses, 32%).
  • Newly prescribed medication not stocked on the ward and not yet requested from pharmacy (21%, 12 doses).
  • Drug available on ward but not found (18%, 10 doses)

The main reason for the 41 blank administration boxes was nurses forgetting to sign the drug chart (39 doses, 95%).

Conclusion

There were a number of reasons why drugs were documented as being unavailable on the ward. The majority related to medication that either needed to be ordered from pharmacy or delivered to the ward by pharmacy. To overcome this, the timings of ward pharmacy visits should be reviewed to see if they can match the doctors' ward rounds; greater awareness is needed by the multidisciplinary team to ensure medication is ordered in a timely manner.

The importance of nursing staff always remembering to document drug administration on drug charts needs to be highlighted through education.

This study shows the importance of exploring the reasons for dose omissions as well as auditing their prevalence.

References

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX
  • 1
    NPSA (2010). RRR009: Reducing harm from omitted and delayed medicines in hospital.

PATIENT COUNSELLING – A DYING ART?

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Nabhani S, Olszewska A, Singh J and Kayyali R

School of Pharmacy and Chemistry, Kingston University, London

Email: S.Nabhani@kingston.ac.uk

Background

One of the key roles of pharmacists defined in the document “A vision for Pharmacy in the new NHS”, is ‘to advise patients on the safe and effective use of medicines’1. This is supported by a recent study which identified a significant correlation existing between correct medication knowledge and medication counselling2. Moreover, several studies revealed that pharmacists' counselling had a significant impact on patient self efficacy and disease outcomes and was considered important to patients. 3–5 Despite this documented benefit, not all hospital pharmacists are engaged in face to face interaction with patients.

The aim of this study was to investigate the cancer patient counselling process in a large teaching hospital in the UK.

Methods

This was a qualitative study that was undertaken in two phases.

Phase 1 was an observational study whereby patients receiving capecitabine were shadowed throughout their patient counselling sessions.

Phase 2 entailed semi-structured interviews with 12 cancer patients receiving capecitabine. Patients were recruited as they presented to the medical day unit over a period of 1 month. Interviews were conducted jointly by the pharmacist and a pharmacy research student. The interviews were voice-recorded and transcribed. The themes were deduced using inductive content analysis based on a systematic coding process.6 This study was approved by the ethics committee at the hospital.

Results

In total, 9 counselling sessions were observed of which 3 patients were capecitabine naive and 7 were on cycle 2 and beyond. All the naive patients were counselled by a consultant regarding the administration and expected side effects. All patients were counselled by pharmacy technicians regarding the proper handling and storage of capecitabine. Pharmacists were not involved in the observed counselling sessions.

In the interview analysis, the following themes emerged relating to patient counselling: (1) need for individualised counselling, (2) the amount of the ADRs presented to the patient orally and in written format is overwhelming, (3) absence of the role of the pharmacist in the patient counselling journey, (4) need for pharmacists' input in counselling to cover all patients' counselling needs

Conclusion

There is scope for improvement of the counselling sessions and the format of information provided to patients. Furthermore, pharmacists' involvement in cancer patient counselling needs to be enhanced especially with patients who suffer from other co morbidities

References

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Patterson SM1, Bradley MC2, Kerse N3, Cardwell CR4, Hughes CM2

1Health and Social Care Board, 12–22 Linenhall Street, Belfast BT2 8BS; 2School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL; 3Department of General Practice and Primary Health Care, University of Auckland, New Zealand; 4 Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ

Email: Susan.Patterson@hscni.net

Introduction

Inappropriate polypharmacy1 is a particular concern in older people. It is associated with a range of negative health outcomes,2 hence choosing the best interventions to improve appropriate polypharmacy is a priority. The aim of this review3 was to determine which interventions, alone or in combination, are effective in improving appropriate polypharmacy and reducing medication-related problems.

Methods

The literature was systematically searched for eligible studies which described interventions in those over 65 years. The primary outcomes were medication appropriateness, measured by a validated instrument, e.g. Beers criteria, Medication Appropriateness Index (MAI) and hospital admissions. Secondary outcomes were medication-related problems, adherence and quality of life. Study-specific estimates were pooled, using a random effects model to yield summary estimates of effect size.

Results

From 2200 potentially relevant abstracts, 139 studies were assessed in detail and 10 studies fitting the inclusion criteria were included in the review. Nine studies examined complex, multifaceted interventions of pharmaceutical care conducted in a variety of settings and one examined computerised decision support (CDS) in general practice. A reduction in inappropriate medication use was demonstrated. The summated MAI score post-intervention pooled data (n = 5) showed a mean reduction of −3.88 (95% CI: -5.40, -2.35) in the intervention group. There was a mean difference of −6.78 (95% CI; -12.34, -1.22) in the change in MAI score in favour of the intervention group (n = 4) and a mean reduction of −0.10 (95% CI; -0.28, 0.09) in the number of Beers drugs per patient (n = 2). Evidence of the effect on hospital admissions (n = 4) was conflicting. Analysis of medication-related problems, reported as adverse drug events (n = 3), found a significant reduction of 35% in the number of adverse drug events. One study reported a 15% increase in adherence and two studies reported no change in quality of life.

Conclusion

Interventions to improve appropriate polypharmacy, such as pharmaceutical care, appear to be beneficial in terms of reducing inappropriate prescribing and reducing some medication related problems. Evidence for changes in hospitalisations, adherence and quality of life was inconclusive.

References

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX
  • 1
    Montamat SC, Cusack B. Overcoming problems with polypharmacy and drug misuse in the elderly. Clinics in Geriatric Medicine 1992; 8:14358
  • 2
    Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. American Journal of Geriatric Psychiatry 2007; 5(4):34551.
  • 3
    Patterson SM, Hughes C, Kerse N, Cardwell CR, Bradley MC. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD008165. DOI:10.1002/14651858.CD008165.pub2.

AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Rajgor Sapna, Langran Catherine, Grant Daniel

University of Reading – Reading School of Pharmacy

Email: sapna_rajgor@hotmail.com

Background

The appropriate use of antimicrobials before vascular surgery can be considered lifesaving. However, unnecessary overuse can precipitate health-care associated infections and can lead to the development of antimicrobial resistance ultimately increasing costs for the health care system. An audit of compliance with antibacterial guidelines for prophylaxis is therefore vital to ensure that 100% of patients receive the right drug at the right dose at the right time and for the right duration.

Method

University ethical approval was gained. Data was collected on patients undergoing adult vascular surgery once weekly between January and March 2012 at the John Radcliffe Hospital. Data was collected on parameters such as the surgical procedure conducted, antibiotics given, timing of administration in relation to surgical incision, dose, route, patient weight, patient allergies and documented reasons (if applicable) for any deviations from the guidelines. Data was retrieved from patient prescription charts, theatre notes and medical notes using an audit data collection form. Analysis of the findings explored potential areas for improvement in terms of health care delivery and patient outcomes.

Key Findings

38 patients were audited during the data collection period. Of the 38 patients only 20 (53%) were considered fully compliant, the remaining 18 (47%) patients were considered non-compliant for various reasons. These include incorrect doses of gentamicin (n = 11), unclear documentation of antibiotic administration time (n = 5), no documented weight for gentamicin dosing (n = 6) and deviations from the guidelines without documentation (n = 4). Fortunately, there were no cases of surgical site infections; however one patient did go onto developing a Clostridium difficile infection.

Conclusion

Overall, only half of the prescribed antimicrobial prophylaxis in adult vascular surgery at the John Radcliffe Hospital followed the local guidelines. Significant under-doses and overdoses of Gentamicin were observed, despite a gentamicin dosing table in the guidelines. Additionally there is an issue with the quality of information recorded in patients' medical notes. Action should be taken to improve guideline adherence and documentation. Changes to documentation sheets have been recommended which aim to improve documentation of antibiotic timing with respect to the procedure and the reasoning for deviation from antibiotic guidelines.

MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Emanuel Raschi1, Elisabetta Poluzzi1, Brian Godman2, Ariola Koci1, Christian Berg3, Iain Bishop4, Marija Kalaba5, Ott Laius6, Ugo Moretti7, Manuela Schmitzer8, Catherine Sermet9, Bjorn Wettermark1, Miriam Sturkenboom10 and Fabrizio De Ponti1.

1Department of Medical and Surgical Services, Pharmacology Unit, Alma Mater Studiorum - University of Bologna, Bologna, Italy; 2Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden, SE-141 86; 3Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway; 4Information Services Division, National Services Scotland, Scotland, United Kingdom; 5Republic Institute for Health Insurance, Belgrade, Serbia; 6State Agency of Medicines, Tartu, Estonia; 7Clinical Pharmacology Unit, University of Verona, Verona, Italy; 8HVB, Vienna, Austria; 9IRDES, Paris, France and 10Erasmus University Medical Centre, Rotterdam, Netherlands.

Email: Brian.Godman@ki.se

Background and objectives

This pilot study, within the ARITMO project, evaluated the pro-arrhythmic risk of antipsychotic drugs (APs: ATC group N05A, excluding lithium) by analyzing the FDA Database (FDA_AERS) and European drug utilization data (15 countries).

Methods

Cases of QT prolongation and Torsades de Pointes (TdP) associated with APs were retrieved from the FDA_AERS (2004–2010). APs with unexpected signals were defined by disproportionality (Reporting Odds Ratio, ROR, with 95%CI > 1, cases > 3) and checking in Arizona_CERT (www.azcert.org). Consumption data (2006–2010) were provided from administrative databases of 15 European countries through health authority, health insurance personnel and EuroDURG members. Data were expressed as DDDs/TID (Thousand inhabitants per day). Utilisation data were re-validated with data providers to enhance its accuracy.

Results

Thirty-one APs were reported in 1,467 cases of TdP/QT prolongation: 21 generated disproportionality, with 10 unexpected signals: amisulpride (ROR = 17.9; 95%CI = 11.9-26.9), aripiprazole (1.4; 1.1-1.9), bromperidol (88.5; 37.3-210.0) chlorprothixene (9.4; 3.5-25.5), cyamemazine (6.3; 3.5-11.4), fluphenazine (7.0; 3.5-14.1), levomepromazine (4.6; 2.1-10.4), olanzapine (3.7; 3.2-4.2), prothipendyl (5.5; 6.8-35.5) and zuclopenthixol (12.2; 5.4-27.8). In all countries, AP use was stable or increased, i.e. from only +0.11 DDD/TID (Norway) to +24.08 (Serbia). Except in Serbia, the atypical/typical ratio increased. There was variable utilization in 2010, from 5.60 (Lithuania) to 20.17 (Serbia). The mean use of APs with unexpected signals ranged from 1.72 (Estonia) to 5.45 (Slovenia). Olanzapine was stable, but peaked 2.9 in Norway. Aripiprazole increased, but no use in Serbia. Fluphenazine was substantially used only in Serbia (3.77 in 2010).

Conclusions

Differences in AP use among countries imply different levels of risk; however less variability in overall utilisation than seen with PPIs and statins. The use of atypical APs is generally growing among the countries. Aripiprazole should be closely monitored by regulators, due to its steadily increasing utilisation in most countries; fluphenazine is a specific concern in Serbia. The study also demonstrates the synergy between drug utilisation and adverse event databases to alert health policy personnel of potential future activities to reduce ADRs especially from drugs with unexpected signals.

DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Reynolds, Matthew1,2, Hickson, Mary1,2, Franklin, Bryony Dean2,3

1Imperial College, London; 2Imperial College Healthcare NHS Trust, London; 3UCL School of Pharmacy

Email: Matthew.Reynolds@imperial.nhs.uk

Introduction and Objectives

Adverse drug reactions, poor patient adherence and errors, here collectively referred to as medication-related harm (MRH), cause 2.7-10.1% of UK hospital admissions. Communication gaps between successive providers of care are known to exist, but little is known about how MRH is documented and communicated in inpatients' medical records. Our objectives were to describe the presence and quality of MRH documentation within the medical records for patients admitted to hospital due to MRH, at a London teaching hospital. Additionally, the international classification of disease (ICD) codes attributed to confirmed MRH-related admissions were studied to explore the appropriateness of using ICD codes to identify these patients.

Method

Admissions ward pharmacists identified patients admitted due to MRH. Six different data points in their medical record (accident and emergency (A&E) triage, A&E clerking, post-take ward round (PTWR), written medical notes on the day of PTWR, written medical notes at ward transfer, and discharge summary) were subsequently examined and the presence of MRH-related information recorded. Each data point was examined for the presence of statements of the MRH symptom and diagnosis, identification of the causative agent, and a statement of the plan or action taken with respect to the causative agent. Statements were categorised as ‘explicit’ if they were unambiguous or ‘implicit’ if ambiguous and open to interpretation. The ICD codes attributed to diagnosed MRH cases were recorded.

Results

In total, 84 patients were identified over 141 data collection days; 75 of these met our inclusion criteria. MRH documentation was usually present (855 of 1307 opportunities; 65%), and was usually explicit (705 of 855 opportunities; 82%). The causative agent had the lowest proportion of explicit statements (139 of 201; 69%). We identified two patients where the causal agent was not identified on the discharge summary, but was documented in their inpatient medical record. Of the 59 admissions with an explicit or implicit MRH diagnosis on their discharge summary, only six (10%) had a MRH-related ICD code associated with that admission.

Conclusion

Availability of information in the inpatient medical record was generally good, although there were instances when MRH-related information in the inpatient notes was not transferred to the discharge summary or was written ambiguously. MRH-related admissions were found to be rarely coded as such; therefore any admission rate calculated using ICD codes is likely to greatly underestimate their true occurrence. The communication of MRH can be improved by using clear statements, and by documenting reasons for changing medications.

POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Richardson, Kathrynab; Kenny, Rose Anne abc; Bennett, Kathleend

a The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Ireland

b Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland

c Trinity College Institute of Neuroscience, St James's Hospital, Dublin, Ireland

d Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St. James' Hospital, Dublin, Ireland

Email: richarkj@tcd.ie

Objective

Eligibility for public healthcare coverage in Ireland is means tested for adults aged under 70 years enabling free GP visits and prescription medications at minimal cost. As differing access to healthcare has implications for public health, we examined the rates of polypharmacy (5+ medications) and use of fifteen common medication classes in those with public versus private healthcare coverage whilst adjusting for underlying health status using both multivariable logistic regression and propensity score techniques.

Methods

Self-reported regular medication use, history of doctor diagnosed health conditions, disability, and socio-demographics, and objective measures of depression and anxiety for adults aged 50–69 years (N = 5,796) were ascertained from the population representative The Irish Longitudinal study on Ageing (TILDA). Objective measures of frailty, cognition, hypertension and body mass index were also assessed for 4,241 participants. These confounders were used to estimate a score representing the propensity for public healthcare coverage. Poisson regression was used to estimate relative risks (RR) by adjusting for all confounders in a multivariable regression and separately adjusting for the propensity score. RRs were additionally adjusted for the potential mediator of frequency of contact with medical professionals (annual number of GP and hospital outpatient and inpatient visits).

Results

Polypharmacy was reported by 22% and 7% of the 1,932 and 3,864 public and private health system users. When accounting for differences in sociodemographics and health variables, the adjusted RR of polypharmacy for public compared to private health system use was 1.26 (95% CI 1.02-1.54) using multivariable regression and 1.25 (95% CI 1.00-1.57) when adjusted for the propensity score. Only agents acting on the renin-angiotensin system were identified as significantly more commonly used among public patients. However, there were no significant associations after adjustment for the frequency of contact with medical professionals.

Conclusions

Findings suggest the additional polypharmacy observed in the public versus private healthcare system in Ireland are due to differences in underlying sociodemographics, health and healthcare access. We could not assess ‘appropriate’ prescribing, but cost barriers to GP visits may have resulted in restricted preventative medication use for patients without public healthcare coverage. Alternatively findings could represent over-prescribing to public patients due to additional GP visits. Associations were similar using propensity scores and multivariable regression, and were only attenuated slightly by additionally adjusting for objective measures of health.

NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Philippa Roe1, Dr Rachel Howard1, Dr Paul Howard2 and Cathy Goddard2

1School of Pharmacy, University of Reading, Reading 2. Duchess of Kent House, Reading

Email: rachel.howard@reading.ac.uk

Objectives

In order for inpatient Specialist Palliative Care Units (SPCUs) to be considered truly " specialised" a clinical pharmacist should be part of the team, yet there are no published evaluations of the services they perform. Therefore, the aims were to assess the pharmacy services currently offered in SPCUs across Great Britain, and highlight future services that palliative care pharmacists could provide.

Methods

A list of 267 inpatient SPCUs was obtained from the UK Palliative Care Directory. Three copies of a short questionnaire enquiring about the SPCU structure and pharmacy contract, working hours, pharmacist qualifications, services currently provided and those wanted in the future were sent to each address. A pharmacist, medical director or ward sister from each unit were invited to complete the survey. The responses were entered into Microsoft Office Excel 2007® and reported as percentages and median (interquartile range (IQR)) as appropriate. The evaluation received ethical approval from the University of Reading.

Results

Ninety-four SPCUs (35.2%) returned 122 questionnaires (23 SPCUs returned multiple responses, with 4 units returning all 3 questionnaires). Charitable independents were the major funders (46/94; 49%), with one-fifth relying solely upon the NHS for funding. Most pharmacy services were provided by hospital pharmacists (64/94; 68.1%) rather than community or SPCU; 15 units received no pharmacist visits. The median pharmacist visit time was 0.4 hr/bed/wk (IQR 0.1, 1.2). General interventions were the commonest services (66/94; 70.2%) followed by specialist interventions (60; 63.8%), staff training (54; 57.4%) and medicines management (50; 53.2%). Patient counselling was low at 37.2% (35/94), and frequently requested for the future (15/68; 17.4%). The multiple responders gave a relatively consistent lack of awareness of pharmacist working hours, with some discrepancies in qualifications and services performed.

Conclusions

Variation within unit structures and pharmacy contracts produce vast differences in the services that patients are able to receive. Other healthcare workers within SPCUs do not fully appreciate the pharmacists' roles. The major barrier to introducing further services or strengthening current ones is limited working hours. Therefore, there is need for heightened awareness of pharmacists' valuable role within SPCUs so that the necessary funds can become available to increase contracted hours and pharmacy services in the future.

PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

Warren A. Pharmacy, NHS Highland

Email: alyson.warren@nhs.net

Objective

To implement Polypharmacy: guidance for prescribing in frail adults1 through collaboration with a pharmacist and GP in general practice, reviewing the medicines of patients resident in nursing homes.

Method

Referring to the guideline the pharmacist conducted a medication review of the patients' medical notes. For each medicine, the pharmacist considered if there was a valid and current indication, tolerability in frail patients, contribution to a high-risk drug combination and efficacy (referring to the number needed to treat per annum to achieve specific outcomes). The pharmacist discussed the review with the patient's GP before visiting the care home to discuss medication with the patient (where appropriate) and their carer/nurse. Agreed changes were documented and repeat prescription records amended.

Results

65 patients received a polypharmacy review. Of these, 37 (57%) had a medicine stopped and 25 (38%) had their medicines changed. A total of 80 medicines were stopped and 33 changed. The number of changes made to a patients' repeat prescription ranged from zero (23% of patients) to 5 (3% of patients).

Cardiovascular drugs (n = 37) were most likely to be modified, followed by gastrointestinal drugs (n = 22). This was mainly due to discontinuation of aspirin (n = 8) and simvastatin (n = 8).

Antihypertensives were discontinued or reduced in 10 patients all of whom had a blood pressure adequately controlled below recommended targets. 2 patients prescribed an ACE inhibitor for secondary prevention following a cardiovascular event with normal left ventricular function had this discontinued.

Modifications (n = 19) to the central nervous system medicines mainly involved dose reductions, aiming to gradually withdraw therapy, e.g. amisulpride for agitation and gabapentin for postherpetic neuralgia.

Diabetes medication was discontinued in 2 patients, whose HbA1c levels were controlled to 6% and 6.4%.

Conclusion

Referring to the polypharmacy guideline helped the pharmacist conduct a constructive medication review with both the GP and the frail patient. The review considered the potential for adverse events such as falls when discontinuing antihypertensive medication and the possibility that tight HbA1c control could increase the patient's risk of mortality. Discontinuing or reducing unnecessary medicines, or those with little long-term efficacy was well received by patients and carers. The systematic approach and therapeutic principles in the guideline will become more significant as our ageing population suffering from multiple long-term conditions treated to a number of clinical guidelines increases the prevalence of polypharmacy.

References

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX

AUTHOR INDEX

  1. Top of page
  2. THE ANALYSIS OF DAILY DRUG COST OF ADULT CRITICALLY ILL PATIENTS IN TERMS OF ACUTE ILLNESS AND MORBIDITY
  3. CARDIOVASCULAR POLYPHARMACY IS NOT ASSOCIATED WITH UNPLANNED HOSPITALISATION
  4. DEVELOPMENT AND EVALUATION OF HOSPITAL REFERRALS FOR THE NEW MEDICINES SERVICE
  5. AS PHARMACISTS EXPAND THEIR CLINICAL ROLES DO THE GENERAL PUBLIC RECOGNISE WHAT THEY CAN OFFER?
  6. STOPPING MEDICATION AND DECISION-MAKING BIASES
  7. ALTERNATIVE STATIN TREATMENT OPTIONS PRESCRIBED IN UK GENERAL PRACTICE FOLLOWING SIMVASTATIN 40MG MONOTHERAPY
  8. MULTIPLE - MEDICATION USE IN PEOPLE AGEING WITH INTELLECTUAL DISABILITY [PAWID] AND BEHAVIOUR DISORDERS
  9. CATEGORISATION OF INTERVENTIONS MADE BY CLINICAL PHARMACISTS IN AN IRISH HOSPITAL SETTING
  10. ARE UNINTENTIONAL MISSED DOSES OF MEDICATIONS REPORTED?
  11. PHARMACISTS APPRECIABLY IMPROVING SARTAN PRESCRIBING EFFICIENCY IN THE UK: IMPLICATIONS FOR OTHER CLASSES AND COUNTRIES
  12. ADVERSE DRUG REACTIONS CAUSING HOSPITAL ADMISSIONS – CAN DONALD RUMSFELD HELP WITH THE SHARED LEARNING?
  13. DRUG UTILIZATION STUDY OF ANTIMALARIAL DRUGS IN A TERTIARY TEACHING INSTITUTION
  14. DRUG USAGE PATTERN DURING PREGNANCY AT A TERTIARY CARE TEACHING HOSPITAL
  15. STRATEGIES TO IMPROVE PATIENTS' KNOWLEDGE AND UNDERSTANDING OF DRUG ALLERGY AND BEHAVIOUR IN RELATION TO DRUG ALLERGY CARDS IN THAILAND
  16. PATIENT PARTICIPATION IN THE REPORTING OF ADVERSE REACTIONS TO STATINS
  17. PRESCRIBING HABITS IN OLDER PATIENTS: CAN WE PREDICT THOSE AT RISK OF POTENTIALLY INAPPROPRIATE PRESCRIBING?
  18. FOCUS GROUP STUDY TO EXPLORE IDEAS ON POTENTIAL INTERVENTIONS FOR REDUCING PRESCRIBING ERRORS IN GENERAL PRACTICE
  19. PILOT STUDY OF THE USE OF A MEDICATON REVIEW TOOL AS AN AID TO STOPPING UNNECESSARY MEDICINES IN OLDER HOSPITAL PATIENTS
  20. WHY ARE MEDICATION DOSES DOCUMENTED AS UNAVAILABLE OR LEFT BLANK ON DRUG CHARTS
  21. References
  22. PATIENT COUNSELLING – A DYING ART?
  23. INTERVENTIONS TO IMPROVE THE APPROPRIATE USE OF POLYPHARMACY FOR OLDER PEOPLE: A COCHRANE SYSTEMATIC REVIEW
  24. AN AUDIT OF COMPLIANCE WITH THE OXFORD UNIVERSITY HOSPITALS (OUH) ANTIBACTERIAL GUIDELINES FOR SURGERY PROPHYLAXIS – VASCULAR SURGERY
  25. MAPPING THE PRO-ARRHYTHMIC RISK OF ANTIPSYCHOTICS: COMBINING ADVERSE DRUG REACTIONS WITH DRUG UTILIZATION DATA ACROSS EUROPE
  26. DOCUMENTATION OF MEDICATION-RELATED HOSPITAL ADMISSIONS
  27. POLYPHARMACY IN ADULTS AGED 50–69 YEARS IN THE IRISH LONGITUDINAL STUDY ON AGEING VARIED BY HEALTH SYSTEM USE
  28. NATIONAL EVALUATION OF PHARMACY SERVICES IN SPECIALIST PALLIATIVE CARE UNITS
  29. PHARMACIST INVOLVEMENT IN TACKLING POLYPHARMACY IN FRAIL ADULTS
  30. AUTHOR INDEX
  • Abdul-Jabbar, S
  • Appleton, S
  • Barnett, N
  • Corlett, S
  • Donyai, P
  • Fairbrother, K
  • Flood, B
  • Gallagher, J
  • Gammie, S
  • Godman, B
  • Hodgson, B
  • Kenchappa, V
  • Kenchappa, V
  • Krska, J
  • Krska, J
  • Manning, L
  • Marsden, K
  • Marvin, V
  • Miller, G
  • Nabhani, S
  • Patterson, S
  • Rajgor, S
  • Raschi, E
  • Reynolds, M
  • Richardson, K
  • Roe, P
  • Warren, A