Analysis of drug-related problems in general practitioners office II. Author: Šárka Sperottová Supervisor of the thesis: PharmDr. Martin Doseděl, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Background: A Drug-Related Problem - DRP - is according to Pharmaceutical Care Network Europe - PCNE - an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. We can encounter DRP in every general practitioner's - GPs - office all around the world. But with proper cooperation between practitioners and pharmacists we could reduce the number of problems. That would be big benefit for patients and health system as well. This thesis is focused on anticoagulant drugs, mainly on DOAC group - direct oral anticoagulants - and their DRP in it's theoretical part. Practical part of thesis is analysis of DRP in GPs office itself. Aim: Theoretical part - describe the process of haemostasis and the possibilities of influencing this process by drugs. Discuss DRP of anticoagulants, especially oral anticoagulants and heparins. Practical part - identify and describe DRP. Sort them by PCNE Classification for DRP V5.01. Analyse and describe the most frequent drug-related problems occurring in general...

Analysis of drug-related problems in a health facility IV. Author: Linda Šubrtová Tutor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction: Increasing use of drugs leads to a growing risk of occurence of drug-related problems. These problems can often endanger patient's health and increase the economic cost of the treatment. However, many of these problems can be prevented by controls and collaboration of all health care subjects. Objective: The aim of this work was to carry out a revision of pharmacotherapy in a rehabilitation health facility and to analyse acquired drug-related problems. Methodology: The collection of data took place from 13 to 15 February 2017 in health facility in the Czech Republic. The review of pharmacotherapy was performed by a three-member team (clinical pharmacist, pharmacist, work researcher). The data obtained from the provided medical records were recorded into the database, which was prepared for the purpose of the pharmacotherapy review. Recorded were: the patient's age and sex, allergic, family, work, social and personal history, physical and laboratory examinations and complete pharmacotherapy, which included over-the-counter drugs and dietary supplements, including dosage...

Objetivos: Um dos objetivos deste estudo é avaliar as intervenções farmacêuticas realizadas durante o primeiro ano de atuação de farmacêutico junto a equipe multidisciplinar de uma unidade de terapia intensiva (UTI) de hospital de pronto-socorro, público, localizado em Porto Alegre, RS. O estudo se propôs, ainda, a estabelecer uma metodologia para a priorização do cuidado farmacêutico aos pacientes críticos desse hospital. Métodos: Foi realizado um estudo transversal retrospectivo para avaliar as intervenções farmacêuticas no período de maio de 2013 a abril de 2014, a partir de um banco de dados do Serviço de Farmácia. Para estabelecer uma ordem de prioridade para o acompanhamento farmacoterapêutico foi avaliada, prospectivamente, a complexidade da farmacoterapia dos pacientes, através de uma ferramenta chamada Índice de Complexidade da Farmacoterapia adaptado para paciente crítico (ICFT PC), verificando seu grau de associação com o Escore Fisiológico Agudo Simplificado (SAPS3), utilizado como índice prognóstico pela equipe médica. Resultados: No período avaliado retrospectivamente, 426 pacientes internaram na UTI, sendo que 70,6% deles (301) tiveram pelo menos uma intervenção do farmacêutico na sua terapia medicamentosa. Das 602 intervenções realizadas, 53,5% foram relativas à situações qualificadas como erro de medicação. 77,7% do total de intervenções realizadas foram aceitas, sendo o percentual de aceitação superior para as intervenções realizadas devido à erros de medicação (83,2%). Com relação à complexidade da farmacoterapia, 160 pacientes foram avaliados, dos quais 57% eram homens. O ICFT PC dos pacientes variou de 77 a 499, sendo a mediana igual a 164,5. A correlação entre o SAPS3 e o ICFT PC foi de 0,204. Conclusões: O acompanhamento farmacoterapêutico de pacientes críticos permite não apenas a detecção e correção de potenciais erros de medicação, como também a otimização dos resultados terapêuticos e o uso racional de medicamentos. A utilização de uma metodologia para organização deste cuidado farmacêutico e priorização do atendimento à pacientes com maior risco associado à complexidade da farmacoterapia é uma maneira de proporcionar uma assistência mais efetiva, segura e de qualidade aos pacientes do Sistema Único de Saúde. / Objectives: One of the goals of this study is evaluating pharmaceutical interventions done during the first year of pharmaceutical action together with a multidisciplinary team on an intensive care unit (ICU) inside of a public emergency hospital, located in Porto Alegre, Rio Grande do Sul, Brazil. This study is also proposing to establish a methodology to prioritize the pharmaceutical care for critical patients in that hospital. Methods: It was done a retrospective transversal study to evaluate pharmaceutical interventions from May, 2013 to April, 2014, based on a database offered by the Pharmacy Service. To establish a priority order for the pharmacist monitoring, the complexity of patient’s pharmacotherapy was valued, prospectively, through a tool called Pharmacotherapy Complexity Index, which was adapted for critical patients (Medication Regimen Complexity Index for critical patient – MRCI CP). Thus it was possible to verify its level of association with Simplified Acute Physiologic Score (SAPS3) that is used as prognostic index by medical team. Results: On the period evaluated, 426 patients were hospitalized at ICU, 70.6% of them (301) needed at least one pharmaceutical intervention on their drug therapy. Out of the 602 completed interventions, 53.5% were related to situations of medication error. 77.7% of the interventions were accepted; the acceptance percentage was higher for interventions that were done due to medication errors (83.2%). In relation to complexity of pharmacotherapy, 160 patients were evaluated and 57% of them were men. The patients MRCI CP had a range of 77 to 499, being the median 164.5. The correlation between SAPS3 and MRCI CP was 0.204. Conclusions: The pharmacist monitoring of critical patients allows detection and correction of potential medication errors, besides optimization of therapeutic results and rational use of medicines. The use of a methodology to organize this pharmaceutical care and to prioritize the treatment of patients with increased risk associated to complexity of pharmacotherapy is a way of supply an effective, secure and qualified assistance for patients of Unique Health System.

Abstract Medicines are substances used to prevent, alleviate or cure diseases which is an important part of health care. The role of the pharmacist in the healthcare chain is important because they are the patients last contact with healthcare professionals. After this contact they must assume responsibility over their own treatment. The pharmacist's responsibility is to make sure that the patient has received essential information about their drugs and to check that the prescribed dose is correct. The increased digitalization of society brings an opportunity for the patients to increase participation and understanding of their drug treatment. Decision support systems are different methods used to obtain a basis for decision making. Pharmacists use these systems to check if prescriptions are correct, for example by ensuring that the right medication, in the correct dose, has been prescribed to the right patient at the right time. In Sweden there is a decision support system called elektroniskt expertstöd (EES). This system offers pharmacy customers further drug control in addition to other controls that are available through the pharmacy's other systems. The benefit of this system is that the pharmacist has better support in detecting incorrect doses, interactions, duplicate medications and if the drug is inappropriate for the patient's gender or age. When the system alerts, the pharmacist makes an assessment which may be discussed with the patient or the physician if needed. Purpose The purpose of this survey study was to investigate what the pharmacy customers knows about EES and the pharmacists use of the system. Method Before the study started, approval from the southeast ethic committee was obtained which said that there were no ethical barriers for the performance of the study. The surveys were handed out to anyone who would receive prescriptions at different pharmacies in Luleå, Grängesberg, Värnamo, Kalmar and Torsås. The common goal was to spend 20 hours of handing out surveys per student. The results were put together and analyzed in IBM SPSS Statistics with descriptive statistics.  Results and discussion The results show that most of the respondents did not know about EES and did not know if the pharmacists are using this support system. The results also show that most of the respondents had not given their consent to EES and did not know if EES could support the pharmacists work. More than half of the survey population answered “do not know” on a question asking if they wanted the pharmacist to use EES when dispensing drugs. Almost a quarter of the total population wanted the pharmacist to use EES and close to three quarters of the total population had no knowledge of the system. This could mean that the customers who have knowledge wants the system to be used. A reason for wanting the system to be used without having knowledge of it could be that customers trust it is beneficial for themselves and for the pharmacists. Building trust and showing care in each customer meeting is important to make the customer susceptible to information. Sufficient information can lead to better compliance in drug treatments. Before the pharmacist can use EES for the first time the customer must consent. Although it was a few years since the introduction of EES into pharmacies, some pharmacists find it difficult to connect customers to the system. It is a relatively new way of working with drug analysis at the pharmacies in Sweden. More practice in the system could provide increased use of it and help the pharmacists decision making.   Conclusion Only a small proportion of the pharmacy customers have knowledge of EES. But even so, one fourth of them wanted the system to be used to analyze their medication which is considered positive.

Abstract Background and Objective: An accurate medication history list is an integral part of the patient assessment at hospital admission. The objective of the study was to describe the frequency, type, and predictors of unintentional medication errors and to evaluate the quality of the clinical pharmacy services focusing on the acceptance of the recommendations made by the clinical pharmacist. Setting and methods: A descriptive study was conducted at two internal medicine wards at Baghdad Teaching Hospital in Iraq using Lund Integrated Medicines Management (LIMM)-based medication reconciliation. The study pharmacist conducted medication interviews for patients shortly after hospital admission to obtain the most accurate pre-admission medication history list. This list was compared with the medication list in the patient’s medical chart. Intended addition, withdrawal of a drug, or changes to the dose/ dosage form in the patient’s medical list was considered as medication discrepancies. However, medication discrepancies were considered as medication errors based on no identified clinical reason. Results: A total of 114 patients were included in this study. Over two-thirds of the study patients (73.7%) experienced 215 medication errors identified by a clinical pharmacist conducting medication reconciliation. Most errors were omission (87.9%). Cardiovascular agents followed by NSAID were commonly in error (53%) and (10.2%) respectively. In a logistic regression model, age (odds ratio (OR), 1.055: 95% confidence interval (CI) 1.010 - 1.102), female gender (OR, 3.468: 95% CI 1.232- 9.761) and number of medications at admission (OR, 0.810: 95% CI 0.681-0.963) were predictors for medication history errors at admission. Conclusions: Medication errors at the time of hospital admission are common and undetected.  A structured approach like the LIMM-based medication reconciliation at Iraqi hospital is needed to detect these errors.

Objetivos: Um dos objetivos deste estudo é avaliar as intervenções farmacêuticas realizadas durante o primeiro ano de atuação de farmacêutico junto a equipe multidisciplinar de uma unidade de terapia intensiva (UTI) de hospital de pronto-socorro, público, localizado em Porto Alegre, RS. O estudo se propôs, ainda, a estabelecer uma metodologia para a priorização do cuidado farmacêutico aos pacientes críticos desse hospital. Métodos: Foi realizado um estudo transversal retrospectivo para avaliar as intervenções farmacêuticas no período de maio de 2013 a abril de 2014, a partir de um banco de dados do Serviço de Farmácia. Para estabelecer uma ordem de prioridade para o acompanhamento farmacoterapêutico foi avaliada, prospectivamente, a complexidade da farmacoterapia dos pacientes, através de uma ferramenta chamada Índice de Complexidade da Farmacoterapia adaptado para paciente crítico (ICFT PC), verificando seu grau de associação com o Escore Fisiológico Agudo Simplificado (SAPS3), utilizado como índice prognóstico pela equipe médica. Resultados: No período avaliado retrospectivamente, 426 pacientes internaram na UTI, sendo que 70,6% deles (301) tiveram pelo menos uma intervenção do farmacêutico na sua terapia medicamentosa. Das 602 intervenções realizadas, 53,5% foram relativas à situações qualificadas como erro de medicação. 77,7% do total de intervenções realizadas foram aceitas, sendo o percentual de aceitação superior para as intervenções realizadas devido à erros de medicação (83,2%). Com relação à complexidade da farmacoterapia, 160 pacientes foram avaliados, dos quais 57% eram homens. O ICFT PC dos pacientes variou de 77 a 499, sendo a mediana igual a 164,5. A correlação entre o SAPS3 e o ICFT PC foi de 0,204. Conclusões: O acompanhamento farmacoterapêutico de pacientes críticos permite não apenas a detecção e correção de potenciais erros de medicação, como também a otimização dos resultados terapêuticos e o uso racional de medicamentos. A utilização de uma metodologia para organização deste cuidado farmacêutico e priorização do atendimento à pacientes com maior risco associado à complexidade da farmacoterapia é uma maneira de proporcionar uma assistência mais efetiva, segura e de qualidade aos pacientes do Sistema Único de Saúde. / Objectives: One of the goals of this study is evaluating pharmaceutical interventions done during the first year of pharmaceutical action together with a multidisciplinary team on an intensive care unit (ICU) inside of a public emergency hospital, located in Porto Alegre, Rio Grande do Sul, Brazil. This study is also proposing to establish a methodology to prioritize the pharmaceutical care for critical patients in that hospital. Methods: It was done a retrospective transversal study to evaluate pharmaceutical interventions from May, 2013 to April, 2014, based on a database offered by the Pharmacy Service. To establish a priority order for the pharmacist monitoring, the complexity of patient’s pharmacotherapy was valued, prospectively, through a tool called Pharmacotherapy Complexity Index, which was adapted for critical patients (Medication Regimen Complexity Index for critical patient – MRCI CP). Thus it was possible to verify its level of association with Simplified Acute Physiologic Score (SAPS3) that is used as prognostic index by medical team. Results: On the period evaluated, 426 patients were hospitalized at ICU, 70.6% of them (301) needed at least one pharmaceutical intervention on their drug therapy. Out of the 602 completed interventions, 53.5% were related to situations of medication error. 77.7% of the interventions were accepted; the acceptance percentage was higher for interventions that were done due to medication errors (83.2%). In relation to complexity of pharmacotherapy, 160 patients were evaluated and 57% of them were men. The patients MRCI CP had a range of 77 to 499, being the median 164.5. The correlation between SAPS3 and MRCI CP was 0.204. Conclusions: The pharmacist monitoring of critical patients allows detection and correction of potential medication errors, besides optimization of therapeutic results and rational use of medicines. The use of a methodology to organize this pharmaceutical care and to prioritize the treatment of patients with increased risk associated to complexity of pharmacotherapy is a way of supply an effective, secure and qualified assistance for patients of Unique Health System.

Problemas relacionados a medicamentos (PRMs) compreendem erros de medicação (EMs) e reações adversas a medicamentos (RAMs). Este estudo teve por objetivo analisar, classificar, quantificar e intervir nos PRMs ocorridos em pacientes idosos internados. Este estudo prospectivo descritivo de uma série de casos clínicos abrangeu 28 pacientes e 100 prescrições aleatórias a eles destinadas. A identificação dos PRMs se deu por métodos de farmacovigilância ativa e as intervenções farmacêuticas (IFs) foram realizadas diretamente junto à equipe médica. Medicamentos de uso potencialmente inapropriado para idosos foram utilizados por 21,4% dos pacientes; 19% das prescrições possuíam rasuras. Foram encontrados 924 PRMs, sendo 920 EMs e 4 possíveis RAMs, sendo uma delas confirmada. A maioria dos EMs foi classificada como sem prejuízo ao paciente. Foram realizadas 143 IFs em 73 prescrições de 92,9% dos pacientes, sendo a maioria (77,6%) acatada pela equipe médica. Apesar das limitações, demonstrou-se a importância do farmacêutico na investigação, prevenção e solução de PRMs. / Drug related problems (DRPs) include medication errors (MEs) and adverse drug reactions (ADRs). The objective of this study was to analyze, classify, quantify and intervene in DRPs occurred in hospitalized elderly patients. This prospective descriptive study of a case series included 28 patients and 100 random prescriptions to them addressed. The identification of DRPs was carry out by methods of active pharmacovigilance and the pharmaceutical interventions (PIs) were performed directly with the medical staff. Drugs potentially inappropriate for the elderly were used by 21.4% of the patients; 19% of the prescriptions had rasures. There were 924 DRPs, with 920 MEs and 4 possible ADRs 4, one of which confirmed. The majority of MEs was classified as \"without harm to the patient\". Were carried out 143 PIs on 73 prescriptions of 92.9% of the patients, being the majority (77.6%) fully embraced by the medical staff. Despite the limitations, it was possible to demonstrate the pharmacist importance in research, prevention and resolution of DRPs.

INTRODUÇÃO: O tema segurança do paciente ganhou importância a partir da publicação dos Estudos Harvard I e II, e dimensão pública a partir do livro To Error is Human pelo Institute of Medicine em 1999, onde são apresentados números alarmantes sobre erros durante o processo do cuidado em saúde. Esses estudos demonstram que os erros com medicamentos são a causa mais frequente de incidentes em pacientes internados. O Institute for Safe Medication Practices (ISMP), uma organização que se dedica à prevenção de erros de medicação e ao uso seguro dos medicamentos publicou em 1989 a primeira lista de medicamentos reconhecidos como perigosos. Em 1995, o ISMP avaliou os erros notificados com medicamentos quanto à gravidade e os danos causados no Medication Error Reporting and Prevention (MERP). Após este estudo, o termo \"High Alert Medication\" foi adotado para designar um grupo de medicamentos mais relacionados a danos graves ou fatais quando ocorre alguma falha no seu processo de utilização. No Brasil estes medicamentos são conhecidos como Medicamentos de Alto Risco, Medicamentos de Alta Vigilância (MAV) ou Medicamentos Potencialmente Perigosos (MPP). OBJETIVOS: Avaliar a ocorrência de incidentes com medicamentos de acordo com a classificação MPP e suas variáveis no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP - USP), nos anos de 2013 e 2015. MÉTODOS: Estudo transversal descritivo retrospectivo com abordagem quantitativa dos incidentes notificados ao Núcleo de Segurança do Paciente relacionados aos MPP. RESULTADOS: Durante o ano de 2013, foram notificados 28% de incidentes envolvendo MPP na unidade Campus e 37,5% na Unidade de Emergência (UE). Os medicamentos quimioterápicos foram os mais notificados e com as maiores Taxas de Incidência (TI) na unidade Campus; o cloreto de potássio foi o mais notificado e com a maior TI na UE. A etapa de prescrição foi a mais notificada nas duas unidades. Utilizando a classificação ATC, os subgrupos terapêuticos que mais atingiram o paciente foram Análogos da Purina, Análogos do Ácido Fólico e Nutrição Parenteral (Campus); Insulina e Análogos Injetáveis, Outras Preparações Cardíacas foram os mais notificados na UE. Em 2015, os percentuais de notificações com MPP foram 8,8% (Campus) e 31,7% (UE). Nesse ano, os medicamentos mais notificados foram o cloridrato de tramadol e a enoxaparina nas duas unidades. Na unidade Campus a etapa de dispensação foi a mais notificada, e etapa de administração na UE. Os subgrupos com maiores TI foram Agentes Alquilantes, Anti Histamínico para Uso Sistêmico e Agente com Ação no Músculo Liso Arteriolar (Campus); na UE, Antiarrítmico, Classe III e Analgésico Opióide. CONCLUSÃO: A classificação MPP pode padronizar a atuação do farmacêutico clínico, além de prover indicadores clínico-gerenciais que auxiliem no desenho de processos proativos de prevenção de erros de medicação. / INTRODUCTION: The patient safety issue gained importance from the publication of Harvard Studies I and II, and public dimension from the book To Error is Human by the Institute of Medicine in 1999, which presents the alarming dates about errors during the process of healthcare. These studies demonstrate that the errors with medications are the most common cause of incidents in hospitalized patients. The Institute for Safe Medication Practices (ISMP), an organization dedicated to the prevention of medication errors and the safe use of medication published in 1989 the first list of recognized dangerous drugs. In 1995, the ISMP evaluated the reports of drugs errors according the severity and damage to the Medication Error Reporting and Prevention (MERP). After this study, the term \"High Alert Medication\" was adopted to designate a group of drugs more related to serious injury or death occurs when a fault in its usage. In Brazil, these drugs are known as high-risk drugs, high alert medications or potentially dangerous drugs. OBJECTIVES: Analyze the occurrence of reported incidents involving the high alert medication and its variables at the Hospital of Ribeirão Preto Medical School, University of São Paulo (HCFMRP - USP) in the years 2013 and 2015. METHODS: Retrospective descriptive cross-sectional study with a quantitative approach of the reported incidents to the Patient Safety Center related to high alert medication. RESULTS: During the year 2013 it was reported 28% of incidents involving high alert medication in the Campus Unit (CU) and 37.5% at the Emergency Unit (EU). Chemotherapeutic drugs were the most reported and with the highest Incidence Rates (IR) (CU) and 19.1% potassium chloride was the most commonly reported and the largest IR in the EU. Prescription stage was the most reported in both units. Using the ATC classification, therapeutic subgroups most reached the patient were Purine Analogues, Folic Acid Analogues and Parenteral Nutrition (CU), Insulin and Analogs for Injections and Other Cardiac Preparations (EU). In 2015, the percentage of notifications with high alert medication was 8.8% (CU) and 31.7% (EU). The most reported drugs were tramadol hydrochloride and enoxaparin in both units. On CU dispensing stage was the most notified and administration stage in the EU. Subgroups with higher IR were Alkylating Agents, Antihistamine for Systemic Use and Arteriolar Smooth Muscle, Agent Action On (CU) and Antiarrhythmic, Class III and Analgesic Opioid (EU). CONCLUSION: The MPP classification can standardize the performance of the clinical pharmacist, and provide clinical and management indicators to assist in the proactive process design to prevent medication errors.

No description available.

(english) ANALYSIS OF DRUG-RELATED PROBLEMS IN HEALTHCARE FACILITY IV. Author: Vanesa Gajdošová Supervisor: PharmDr. Martin Doseděl, Ph.D. Introduction Drug-Related Problems (DRPs) occure in lots of clinical areas.1 They are defined as pharmacotherapy related events, which actually or prospectively interfere with a therapeutic purpose.2 Aims The goal of the teoretical part of the work is to become familiar with the problem of DRPs and analyze in detail the problems of benzodiazepines and atipsychotics. The practical part of the work is focused on obtaining and evaluating of DRPs in the specific healthcare facility. Methods The data was obtained in Hamzova odborná léčebna pro děti a dospělé (Luže-Košumberk) which is the important center of rehabilitation in the Czech Republic. The audit was taking place from February 13, 2017 to February 16, 2017. The data of 94 patients from the three departments of the rehabilitation center was analyzed. The all necessary information was obtained from the medical documentation. The data was collected using the special online application and finally was statistically evaluated by the descriptive statistic. The most occurred DRPs were discussed with physicians. Results Patients used together 672 drugs (i.e. 7.15 drugs per patient). Overall, 272 DRPs were registered...