Background
Methods
Study design and setting
Description of the recommendation process used by the clinical pharmacists
Data collection and extraction
Assessment and classification of DRPs
Data analysis
Results
Patients’ characteristics
Characteristics | Frequency (n, %)a |
---|---|
Sex | |
Male | 274 (56.1) |
Female | 214 (43.9) |
Age (y), mean ± SD | 52.0 ± 15.0 |
18–64 | 371 (76.0) |
≥ 65 | 117 (24.0) |
Diagnosis at admissionb | |
Malignant neoplasms of lip, oral cavity or pharynx (2B60-2B68, 2B6A) | 163 (33.4) |
Diseases or disorders of orofacial complex (DA01, DA04-DA07) | 144 (29.5) |
Benign non-mesenchymal neoplasms (2E90-2E91) | 117 (24.0) |
Benign mesenchymal neoplasms (2E80-2E83) | 35 (7.2) |
In situ neoplasms, except of lymphoid, hematopoietic, central nervous system or related tissues (2E60) | 17 (3.5) |
Others | 12 (2.5) |
Number of patients taking chronic medications | 195 (40.0) |
Number of chronic medication categories | |
1 | 54 (11.1) |
2 | 40 (8.2) |
3 | 33 (6.8) |
4 | 22 (4.5) |
≥ 5 | 46 (9.4) |
Most common chronic medications | |
Nifedipine | 43 (8.8) |
Amlodipine | 35 (7.2) |
Metformin | 34 (7.0) |
Number of patients having comorbidities | 192 (39.3) |
Number of comorbidity categories | |
1 | 84 (17.2) |
2 | 59 (12.1) |
≥3 | 49 (10.0) |
Most common comorbidities | |
Hypertension | 140 (28.7) |
Diabetes | 64 (13.1) |
Dyslipidemia | 47 (9.6) |
Allergies | |
No known drug allergy | 409 (83.8) |
Yes (to one or more medications) | 79 (16.2) |
Details on the DRPs
Code
|
Detailed classification
a
|
Total
|
Perioperative DRPs
|
Nonperioperative DRPs
|
---|---|---|---|---|
n (%)
|
n (%)
|
n (%)
| ||
Problems
|
254 (100)
|
144 (100)
|
110 (100)
| |
P1 | Treatment effectiveness | 78 (30.7) | 20 (13.9) | 58 (52.7) |
P1.1 | No effect of drug treatment despite correct use | 1 (0.4) | - | 1 (0.9) |
P1.2 | Effect of drug treatment not optimal | 64 (25.2) | 20 (13.9) | 44 (40.0) |
P1.3 | Untreated symptoms or indication | 13 (5.1) | - | 13 (11.8) |
P2 | Treatment safety | 170 (66.9) | 124 (86.1) | 46 (41.8) |
P2.1 | Adverse drug event (possibly) occurring | 170 (66.9) | 124 (86.1) | 46 (41.8) |
P3 | Other | 6 (2.4) | - | 6 (5.5) |
P3.1 | Unnecessary drug-treatment | 6 (2.4) | - | 6 (5.5) |
Interventions
|
292 (100)
|
154 (100)
|
138 (100)
| |
I1 | At prescriber level | 165 (56.5) | 143 (92.9) | 22 (15.9) |
I1.3 | Intervention proposed to prescriber | 144 (49.3) | 132 (85.7) | 12 (8.7) |
I1.4 | Intervention discussed with prescriber | 21 (7.2) | 11 (7.1) | 10 (7.2) |
I2 | At patient level | 110 (37.7) | 11 (7.1) | 99 (71.7) |
I2.1 | Patient (drug) counselling | 43 (14.7) | 11 (7.1) | 32 (23.2) |
I2.2 | Written information provided (only) | 24 (8.2) | - | 24 (17.4) |
I2.3 | Patient referred to prescriber | 43 (14.7) | - | 43 (31.2) |
I3 | At drug level | 16 (5.5) | - | 16 (11.6) |
I3.4 | Instructions for use changed to … | 9 (3.1) | - | 9 (6.5) |
I3.5 | Drug paused or stopped | 7 (2.4) | - | 7 (5.1) |
I4 | Other intervention or activity | 1 (0.3) | - | 1 (0.7) |
I4.2 | Side effect reported to authorities | 1 (0.3) | - | 1 (0.7) |
Acceptance
|
292 (100)
|
154 (100)
|
138 (100)
| |
A1 | Intervention accepted | 285 (97.6) | 154 (100) | 131 (94.9) |
A1.1 | Intervention accepted and fully implemented | 209 (71.6) | 143 (92.9) | 66 (47.8) |
A1.2 | Intervention accepted, partially implemented | 1 (0.3) | - | 1 (0.7) |
A1.3 | Intervention accepted but not implemented | 10 (3.4) | - | 10 (7.2) |
A1.4 | Intervention accepted, implementation unknown | 65 (22.2) | 11 (7.1) | 54 (39.1) |
A2 | Intervention not accepted | 7 (2.4) | - | 7 (5.1) |
A2.2 | Intervention not accepted: no agreement | 7 (2.4) | - | 7 (5.1) |
Causes of DRPs
Code
|
Detailed classification
a
|
Perioperative DRPs
|
Nonperioperative DRPs
| ||
---|---|---|---|---|---|
n
= 144
|
n
= 124
| ||||
n (%)
|
Example (n)
|
n (%)
|
Example (n)
| ||
C1 | Drug selection | 105 (72.9) | 57 (46.0) | ||
C1.1 | Inappropriate drug according to guidelines/formulary | 105 (72.9) | Taking ACEI/ARB increased the hypotension risk during the perioperative period (75) | 21 (16.9) | Irrational self-medication with herbal products (7) |
C1.2 | No indication for drug | - | - | 6 (4.8) | Taking aspirin as a supplement for health protection (4) |
C1.3 | Inappropriate combination of drugs, or drugs and herbal medications, or drugs and dietary supplements | - | - | 1 (0.8) | The combination of zopiclone and estazolam for insomnia in a 63-year-old patient (1) |
C1.5 | No or incomplete drug treatment in spite of existing indication | - | - | 29 (23.4) | The unknown presence of or incompletely treated diabetes before admission (14) |
C2 | Drug form | 28 (19.4) | - | ||
C2.1 | Inappropriate drug form/formulation (for this patient) | 28 (19.4) | Taking nifedipine controlled-release tablets that are unsuitable for nasogastric tube administration (18) | - | - |
C7 | Patient related | 11 (7.6) | 63 (50.8) | ||
C7.1 | Patient intentionally uses/takes less drug than prescribed or does not take the drug at all for whatever reason | 11 (7.6) | Self-discontinuation of chronic medications before admission for fear of affecting the surgery and preoperative examinations (11) | 25 (20.2) | Poor adherence due to forgetfulness or fear of adverse drug reactions (23) |
C7.5 | Patient takes food that interacts | - | - | 1 (0.8) | Drinking a lot of porridge every day which leads to poor glucose control (1) |
C7.6 | Patient stores drug inappropriately | - | - | 8 (6.5) | Keeping the in-use insulin pen along with the needle refrigerated (2 to 8 °C) (8) |
C7.7 | Inappropriate timing or dosing intervals | - | - | 18 (14.5) | Inappropriate time of taking diabetes medications (9) |
C7.8 | Patient unintentionally administers/uses the drug in a wrong way | - | - | 10 (8.1) | No resuspending before using the premixed insulin pen (1). |
C7.9 | Patient physically unable to use drug/form as directed | - | - | 1 (0.8) | Cannot split the small tablets of medications in half (1). |
C9 | Other | - | 4 (3.2) | ||
C9.1 | No or inappropriate outcome monitoring (incl. TDM) | - | - | 4 (3.2) | The self-monitoring of blood glucose not including a postprandial 2 h glucose (1) |
Interventions and acceptance
Outcomes of the interventions
Perioperative risks | Total DRPs | Totally solved | Partially solved |
---|---|---|---|
n
|
n (%)
|
n (%)
| |
Hypertension/hypotension | 96 | 94 (97.9)a | 2 (2.1) |
Hyperglycemia/hypoglycemia | 23 | 23 (100)a | - |
Hemorrhagic/thrombotic | 21 | 14 (66.7)a | 7 (33.3) |
Gastrointestinal discomfort | 2 | 2 (100)a | - |
Dyslipidemia | 2 | - | 2 (100) |
Total
|
144
|
133 (92.4)
a
|
11 (7.6)
|
DRPs classification
|
Total
|
Totally resolved
|
Partially resolved
|
Not solved, lack of cooperation of the patient
|
Status unknown
|
---|---|---|---|---|---|
n
|
n (%)
|
n (%)
|
n (%)
|
n (%)
| |
No effect of drug treatment | 1 | 1 (100) | - | - | - |
Effect of drug treatment not optimal | 44 | 12 (27.3) | 15 (34.1) | 2 (4.5) | 15 (34.1) |
Untreated symptoms or indication | 13 | 4 (30.8) | - | - | 9 (69.2) |
Adverse drug event possibly occurringa | 44 | 21 (47.7) | 6 (13.6) | 6 (13.6) | 11 (25.0) |
Adverse drug event occurring | 2 | 1 (50.0) | - | - | 1 (50.0) |
Unnecessary drug-treatment | 6 | 3 (50.0) | 1 (16.7) | 2 (33.3) | - |
Total
|
110
|
42 (38.2)
|
22 (20.0)
|
10 (9.1)
|
36 (32.7)
|
Potential risk factors for the occurrence of DRPs
Factors
|
Univariate
|
Multivariate
| ||
---|---|---|---|---|
OR (95% CI)
|
P
value
|
OR (95% CI)
|
P
value
| |
Sex | 1.294 (0.873–1.918) | 0.199 | - | - |
Age | 1.060 (1.044–1.077) | < 0.001 | - | - |
Number of comorbidities | 6.998 (4.965–9.865) | < 0.001 | 3.815 (2.297–6.337) | < 0.001 |
Number of chronic medications (per active increase) | 3.035 (2.471–3.729) | < 0.001 | 1.539 (1.153–2.055) | 0.003 |