Risk factors for drug-related problems in a general hospital: A large prospective cohort

Saldanha, Valdjane; Araújo, Ivonete Batista de; Lima, Sara Iasmin Vieira Cunha; Martins, Rand Randall; Oliveira, António Gouveia

doi:10.1371/journal.pone.0230215

Cited by 19 publications

(24 citation statements)

References 36 publications

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“…When DRPs are not recognized and/or resolved, patients may experience treatment failure, adverse events, sub-optimal quality of life, and facing new medical conditions as well as mortality [ 3 , 6 , 7 ]. Furthermore, problems involving medication are associated with emergency department visits, extended hospitalizations, additional visits to the physician’s office, and additional prescriptions [ 8 , 9 ]. Overall, medication-related morbidity accounts for 7.0% of hospitalizations and has led to unnecessary health care expenditures in billions of dollars [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Drug-related problems and its determinant among hospitalized neonates with sepsis at Jimma University Medical Center, Ethiopia: a prospective observational study

Yizengaw

Melaku

Beshir

2021

J Pharm Health Care Sci

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Background Neonatal populations are quite susceptible to drug-related problems (DRPs) because of clinical heterogeneity and clinical practice trends. However, studies reporting DRPs in the neonatal population are quite limited. Objective This study aimed to assess the magnitude and types of DRPs and determinant factors among neonates admitted with neonatal sepsis at the Neonatal Intensive Care Unit (NICU) of the Jimma University Medical Center (JUMC), Ethiopia. Methods A hospital-based prospective observational study was conducted involving 201 neonates with sepsis admitted to the NICU from May to August 30, 2018. DRPs were classified using Cipolle’s classification method. Statistical Package for Social Science Version 22 was employed for data analysis. Logistical regression was carried out to determine the determinants of DRPs. A p-value < 0.05 was considered to be statistically significant. Results Of 201 neonates with sepsis included in this study, 125 (62.2%) were males and the median age of the neonate was 5 days. The mean (±standard deviation) number of medications taking during their hospital stay was 2.6 ± 0.7. DRPs were identified in 98 neonates, at a rate of 48.8% (95% CI, 41.7–55.9). Dose too high (42, 35.8%) and need additional drug therapy (40, 34.1%) were the commonly identified DRPs. Taking antibiotics plus other medications (Adjusted Odds Ratio (AOR) =5.2, 95%CI [1.2–22.0], p = 0.02) was a determinant factor for the occurrence of DRPs. Conclusion The burdens of DRPs occurrence were high in hospitalized neonates with sepsis. The most common DRPs identified were dose too high and need additional drug therapy. Combined use of other medicines with antibiotics was a predictor of DRP occurrence. The innovative way to tackle the occurrence of DRPs, such as the incorporation of clinical pharmacy service provider into the neonatal care team, which will prevent, detect and/or minimize the occurrence of DRPs, is highly recommended.

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Section: Introductionmentioning

confidence: 99%

Drug-related problems and its determinant among hospitalized neonates with sepsis at Jimma University Medical Center, Ethiopia: a prospective observational study

Yizengaw

Melaku

Beshir

2021

J Pharm Health Care Sci

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“…This is consistent with the results of the previous studies that CKD severity and medication errors are associated with medication-related problems [ 30 , 31 ]. However, well-known risk factors for DRPs, such as polypharmacy and comorbidity, were not significantly associated with DRPs in this study, possibly owing to the relatively small sample size and the propensity of bias towards patients with CKD stage 5 with high medication burdens and complicated comorbidity conditions [ 32 , 33 ]. The present study demonstrated that clinical pharmacist interventions significantly reduced the number of DRPs at discharge compared with usual care.…”

Section: Discussionmentioning

confidence: 98%

Effectiveness of Clinical Pharmacist Service on Drug-Related Problems and Patient Outcomes for Hospitalized Patients with Chronic Kidney Disease: A Randomized Controlled Trial

Song

Jeong

Han

et al. 2021

JCM

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(1) Background: The study aimed to analyze the effectiveness of clinical pharmacist services on drug-related problems (DRPs) and patient outcomes in inpatients with chronic kidney disease (CKD). (2) Methods: In a randomized controlled trial, the participants in the intervention group received pharmacist services, including medication reconciliation, medication evaluation and management, and discharge pharmaceutical care transition services. Participants in the control group received usual care. The primary outcome was the number of DRPs per patient at discharge. (3) Results: The baseline characteristics of 100 participants included the following: mean age, 52.5 years; median eGFR, 9.2 mL/min/1.73 m2. The number of DRPs in the intervention group during hospitalization increased significantly with decreasing eGFR (PR, 0.970; 95% CI, 0.951–0.989) and an increasing number of unintentional medication discrepancies at admission (PR, 1.294; 95% CI, 1.034–1.620). At discharge, the number of DRPs per patient was 0.94 ± 1.03 and 1.96 ± 1.25 in the intervention and control groups, respectively (p < 0.001). The service had a significant effect on the reduction of the unintentional discrepancies at discharge (p < 0.001). (4) Conclusion: Hospital pharmacists play an important role in the prevention of DRPs at discharge and unintentional medication discrepancies in inpatients with CKD.

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“…As expected, our findings highlighted that home-dwelling geriatric inpatients do not always return home after hospital discharge. This can be interpreted not only via the progression of the pathological processes leading to hospitalization but also through shared risk factors that lead to a downward spiral of accumulated adverse events and irreversible health outcomes in hospital [ 11 , 13 ]. In a previous study examining the same population, we explored institutionalization after hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…Geriatric inpatients are susceptible to greater functional decline and adverse health events which are not directly related to the illness for which they were hospitalized [ 11 , 14 , 15 ]. Additionally, they are at risk of not being able to return to their homes [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hospitalizations, especially if repeated and prolonged, may produce adverse events and irreversible health outcomes, precipitating geriatric syndromes, functional impairment, institutionalization, and even early death [ 8 , 9 , 10 ]. Older inpatients are at a greater risk of declining functional status, frailty, delirium, falls, medication toxicity, nosocomial infections, malnutrition, dehydration, immobilization, and pressure sores while hospitalized [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Functional Status among Polymedicated Geriatric Inpatients at Discharge: A Population-Based Hospital Register Analysis

et al. 2021

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This study explored and compared the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge. We used a cross-sectional registry of geriatric patients’ hospital records from a multi-site public hospital center in Switzerland. The analysis included all inpatients aged 65 years old or more admitted between 1 January 2015 and 31 December 2017 (n = 53,690), of whom 67.5% were polymedicated at hospital discharge, 52.1% were women (n = 18,909), and 42.7% were 75–84 years old (n = 15,485). On average, the polymedicated patients’ hospital lengths of stay were six days longer, they presented with more than three comorbidities, and they were prescribed more than nine medications at hospital discharge (p < 0.001). They showed more frequent general mobility decline (43.2% vs. 41.9%), gait disorders (46.2% vs. 43%), fatigue (48.6% vs. 43.4%) and dependence on lower-body care (49.7% vs. 47.6%), and presented a higher malnutrition risk (OR = 1.411; 95%CI 1.263–1.577; p < 0.001). However, the non-polymedicated inpatients had proportionally more physical and cognitive impairments. The comparison of the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge is important for clinicians trying to identify and monitor those who are most vulnerable to functional decline, and to design targeted strategies for the prevention of functional impairment and related adverse health outcomes.

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Risk factors for drug-related problems in a general hospital: A large prospective cohort

Abstract: Objective To identify risk factors for potential Drug-Related Problems (DRP) at admission in hospitalized patients.

Cited by 19 publications

References 36 publications

Drug-related problems and its determinant among hospitalized neonates with sepsis at Jimma University Medical Center, Ethiopia: a prospective observational study

Drug-related problems and its determinant among hospitalized neonates with sepsis at Jimma University Medical Center, Ethiopia: a prospective observational study

Effectiveness of Clinical Pharmacist Service on Drug-Related Problems and Patient Outcomes for Hospitalized Patients with Chronic Kidney Disease: A Randomized Controlled Trial

Functional Status among Polymedicated Geriatric Inpatients at Discharge: A Population-Based Hospital Register Analysis

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