Drug History Taking and Identification of Drug-Related Problems by Pharmacists: Experience in A Nephrology Ward
Date Issued
2007
Date
2007
Author(s)
Lee, Yi-Ting
DOI
zh-TW
Abstract
Background:
In Taiwan, most patients are not aware about what drugs they are taking and medication safety policies are important. Currently, the prevalence of end-stage renal disease in Taiwan is ranked as the second highest in the world. These patients are at high risk of having drug-related problems (DRPs). Thus, to identify DRPs is an important issue. However, with insufficient human resources, inpatient pharmacists in Taiwan can hardly have time to take drug history and assess the DRPs.
Objective:
To estimate the human resources of pharmacist required for drug history taking, and to evaluate the contribution of identifying DRPs on admission
Method:
All patients in the nephrology ward were included in the study except those who were quarantined. Those who were admitted for primary aldosteronism, belonged to other specialties, had been interviewed by the study pharmacist during last admission, or could not provide drug history were excluded. The patients’ basic and clinical information were recorded on a questionnaire, and used as a guide to interview the patients. After interview, each patient’s DRPs were identified, and the time spent on all the above activities was also recorded. To compare pharmacy records and medical records, the continuous variables were analyzed by Wilcoxon signed rank test or paired t test, and the test of agreement was Kappa test. Predictive factors of DRPs were analyzed with multiple logistic regression.
Results:
During the study period, 207 patients met the inclusive criteria. Among them, 108 were interviewed by pharmacist. There were no significant difference in the demographic data of the patients who were interview and those who were not, except in length of stay, and incidence of renal and cardiovascular disease. We also found that drug histories taken by the pharmacist vary from which taken by physicians, which included histories of allergy/adverse drug reaction, the number of medications prescribed before admission, and their ingredients/dosage/strengths noted, records of self-medications and alternative medications. Sixty-six of 108 patients interviewed, DRPs were assessed. Among these patients and those who DRPs were not assessed, only length of stay was significantly different. The number of DRPs documented by pharmacists and by physicians was 149 and 22 respectively, which were significantly different. The average time spent on recording and interview was 36 minutes, while it took the pharmacist 62 minutes to complete the DRPs assessment and wrote a pharmacy note on the medical record.
In this study, the most common DRPs were improper drug selection (30.9%), adverse drug reactions (18.1%), failure to receive drugs (13.4%), and drug interactions (13.4%). The most common drugs that involved DRPs were psycholeptics (7.4%), diuretics (6.9%), mineral supplement (6.3%), and agents acting on the renin-angiotensin system (5.3%). Pharmacists identified at least 1 DRP in each patient with liver disease, which was overseen by physicians. Pharmacists observed that patients with more medications prescribed before admissions tend to have DRPs. It was also found that patients with liver disease, malignancy, non-metabolic/endocrine disease, and females were more vulnerable to DRPs.
Conclusion:
In this study, pharmacists were able to get more comprehensive drug history from patients in the nephrology ward and to identify DRPs. However, because of time-strait, pharmacist may not be able to take drug history of all inpatients. Drug history may render taken by intern pharmacists and availability of good computerized information. To identify the most DRPs in limited time, we suggest that pharmacists identify DRPs of patients on drugs commonly associated with DRPs, those who receive many drugs before admission, those with liver disease/malignancy, those with non-metabolic/endocrine disease, or female gender.
Subjects
藥品相關問題
藥師
用藥史
住院病患
腎臟科病房
腎臟病
drug-related problems
pharmacist
drug history
inpatient
nephrology ward
renal disease
SDGs
Type
text
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