jagomart
digital resources
picture1_Pharmacy Pdf 152192 | Original8


 135x       Filetype PDF       File size 0.12 MB       Source: scielo.isciii.es


File: Pharmacy Pdf 152192 | Original8
mekonnen ab yesuf ea odegard ps wega ss implementing ward based clinical pharmacy services in an ethiopian university hospital pharmacy practice 2013 jan mar 11 1 51 57 original research ...

icon picture PDF Filetype PDF | Posted on 16 Jan 2023 | 2 years ago
Partial capture of text on file.
                                    Mekonnen AB, Yesuf EA, Odegard PS, Wega SS. Implementing ward based clinical pharmacy services in an 
                                    Ethiopian University Hospital. Pharmacy Practice 2013 Jan-Mar;11(1):51-57. 
                                                                                            Original Research 
                                Implementing ward based clinical pharmacy 
                                 services in an Ethiopian University Hospital 
                                               Alemayehu B. MEKONNEN, Elias A. YESUF, Peggy S. ODEGARD, Sultan S. WEGA. 
                                                                          Received (first version):   25-Sep-2012               Accepted: 8-Mar-2013 
                                                    *
                                 ABSTRACT                                                                                be generalized to other health care settings in the 
                                 Background: Clinical pharmacy practice has                                              country to improve medication outcomes. 
                                 developed internationally to expand the role of a                                        
                                 pharmacist well beyond the traditional roles of                                         Keywords: Medication Errors; Inpatients; 
                                 compounding, dispensing and supplying drugs to                                          Pharmaceutical Services; Professional Practice; 
                                 roles more directly in caring for patients. Studies on                                  Ethiopia 
                                 the activities of the clinical pharmacist in an                                          
                                 inpatient ward in resource constrained settings are                                     IMPLANTACIÓN DE SERVICIOS DE 
                                 scarce, however.                                                                        FARMACIA CLÍNICA EN LOS 
                                 Objective: To assess ward based clinical pharmacy                                       DEPARTAMENTOS DE UN HOSPITAL 
                                 services in an internal medicine ward of Jimma                                          UNIVERSITARIO ETÍOPE 
                                 University Specialized Hospital.                                                         
                                 Methods: The study was carried out in the internal                                      RESUMEN 
                                 medicine ward from March to April, 2011 at Jimma                                        Antecedentes: El ejercicio de la farmacia clínica se 
                                 University Specialized Hospital. The study design                                       ha desarrollado internacionalmente para expandir el 
                                 was a prospective observational study where                                             papel del farmacéutico más allá de los papeles 
                                 pharmaceutical care services provided by clinical                                       tradicionales de formulación, dispensación y 
                                 pharmacists for inpatients were documented over a                                       distribución de medicamentos a papeles más 
                                 period of two months. Interventions like optimization                                   directamente relacionados con los cuidados de los 
                                 of rational drug use and physician acceptance of                                        pacientes. Sin embargo, son escasos los estudios de 
                                 these recommendations were documented. Clinical                                         las actividades del farmacéutico clínico en los 
                                 significance of interventions was evaluated by an                                       departamentos en establecimientos de recursos 
                                 independent team (1 internist, 1 clinical                                               escasos. 
                                 pharmacologist) using a standardized method for                                         Objetivo: Evaluar los servicios de farmacia clínica 
                                 categorizing drug related problems (DRPs).                                              en un departamento de medicina interna del 
                                 Results: A total of 149 drug related interventions                                      hospital universitario especializado de Jimma. 
                                 conducted for 48 patients were documented; among                                        Métodos: El estudio fue realizado en el 
                                 which 133(89.3%) were clinical pharmacists initiated                                    departamento de medicina interna desde marzo a 
                                 interventions and 16(10.7%) interventions were                                          abril de 2011 en el hospital Universitario 
                                 initiated by other health care professionals. The                                       especializado de Jimma. El diseño del estudio fue 
                                 most frequent DRPs underlying interventions were                                        observacional prospectivo donde se documentaron 
                                 unnecessary drug therapy, 36(24.2%); needs                                              los servicios de atención farmacéutica 
                                 additional drug therapy, 34(22.8%) and                                                  proporcionados por un farmacéutico clínico a 
                                 noncompliance, 29(19.5%). The most frequent                                             pacientes internados durante un periodo de dos 
                                 intervention type was change of dosage/instruction                                      meses. Se documentaron intervenciones como la 
                                 for use, 23(15.4%). Acceptance rate by physicians                                       optimización del uso racional y la aceptación de los 
                                 was 68.4%. Among the interventions that were                                            médicos de estas recomendaciones. Un equipo 
                                 rated as clinically significant, 46(48.9%) and                                          independiente (1 internista y 1 farmacólogo clínico) 
                                 25(26.6%) had major and moderate clinical                                               evaluó la significación clínica de estas 
                                 importance respectively.                                                                intervenciones usando un método estandarizado de 
                                 Conclusion: Involving trained clinical pharmacists                                      clasificar los problemas relacionados con 
                                 in the healthcare team leads to clinically relevant                                     medicamentos (PRM). 
                                 and well accepted optimization of medicine use in a                                     Resultados: Se realizó un otal de 149 
                                 resource limited settings. This approach can likely                                     intervenciones para 48 pacientes.; de ellos, 133 
                                                                                                                         (83,9%) fueron intervenciones iniciadas por el 
                                                                                                                         farmacéutico clínico y 16 (10,7%) fueron iniciadas 
                                 *Alemayehu B. MEKONNEN. BPharm, MSc. Lecturer of                                        por otros profesionales de la salud. Los PRM más 
                                 Pharmacotherapy. School of Pharmacy, University of                                      frecuentes subyacentes a cada intervención fueron 
                                 Gondar. Gondar (Ethiopia).                                                              medicación innecesaria 36 (24,2%); necesidad de 
                                 Elias A. YESUF. MD. Department of Health Services                                       medicación adicional 34 (22,8%); e incumplimiento 
                                 Planning and Management, Jimma University. Jimma                                        29 (19,5%). El tipo de intervención más frecuente 
                                 (Ethiopia).                                                                             fue el cambio de dosis/instrucciones de uso 
                                 Peggy S. ODEGARD. PharmD, CDE. Professor of                                             23(15.4%). La tasa de aceptación por médicos fue 
                                 Pharmacy. School of Pharmacy, University of Washington.                                 del 68,4%. Entre las intervenciones que fueron 
                                 Seattle, WA (United States).                                                            calificadas de clínicamente significativas, 46 
                                 Sultan S. WEGA. MSc, PhD fellow. School of Pharmacy, 
                                 Jimma University. Jimma (Ethiopia). 
                                                                              www.pharmacypractice.org (ISSN: 1886-3655)                                                                              51
                     Mekonnen AB, Yesuf EA, Odegard PS, Wega SS. Implementing ward based clinical pharmacy services in an 
                     Ethiopian University Hospital. Pharmacy Practice 2013 Jan-Mar;11(1):51-57. 
                   (48,9%) y 25 (26,6%) tuvieron grande y moderada             revised national curricula of the country in March 
                   importancia clínica, respectivamente.                       2009. Jimma University took the lead in clinical 
                   Conclusión: Envolver a un farmacéutico clínico en           pharmacy in Ethiopia because of its unique 
                   el equipo de salud lleva a la optimización                  experiential learning practice sites and its 
                   clínicamente relevante y aceptada del uso de                community-based approach to learning, which 
                   medicamentos en un establecimiento de recursos              allows students to train in the university’s teaching 
                   limitados. Este abordaje puede, probablemente,              hospital and local training health centers. The 
                   generalizarse a otros establecimientos en el país           graduate program is accompanied by a one year 
                   para mejorar los resultados de la medicación.               clinical internship program for which ward based 
                                                                               clinical pharmacy services are the primary focus. 
                   Palabras clave: Errores de Medicación; Pacientes            Therefore, the purpose of this study was to assess 
                   Internos; Servicios Farmacéuticos; Práctica                 the development, implementation and initial 
                   Profesional; Etiopia                                        outcomes of ward based clinical pharmacy service 
                                                                               in the internal medicine ward of Jimma University 
                                                                               Specialized Hospital (JUSH). 
                   INTRODUCTION                                                 
                   The role of pharmacists as members of the health            METHODS  
                   care team has expanded beyond conventional                  This prospective observational study was conducted 
                   medication dispensing. Recently, pharmacists                at JUSH, located in Jimma city of Oromia regional 
                   entered doctor’s clinics as clinical pharmacists to         state which is located at a distance of 350 Km 
                   perform direct patient care services.1 According to         southwest of Addis Ababa. It provides specialized 
                   Barber2, clinical pharmacy services (CPS) are               health services through its 9 medical and other 
                   patient oriented services developed to promote the          clinical and diagnostic departments for 
                   rational use of medicines and more specifically to          approximately 9000 inpatients and 80,000 
                   maximize therapeutic effect, minimize risk, minimize        outpatients each year with bed capacity of 450 and 
                   cost and respect patient choice.1 To achieve this,          a total of more than 550 staff. The study was carried 
                   clinical pharmacists are trained in therapeutics and        out at the internal medicine ward of JUSH over a 
                   provide comprehensive drug management to                    period of 2 months from March 1 to April 30, 2011. 
                   patients and health care providers (clinical                The internal medicine ward has three subsections: 
                   pharmacists). Interacting with the health care team         medical A, B, and C with total bed occupancy of 60. 
                   in patient rounds, interviewing patients and                Three hundred patients were admitted during the 
                   conducting medication histories; providing  study observation period. All in-patients in the 
                   recommendations on drug selection and follow-up             internal medicine ward whose medicine chart or 
                   all resulted in improved outcomes2,3 Murray et al.4         prescription led to an intervention were enrolled in 
                   reported the effect of pharmacist interventions in          the study based on their consent. Critically ill 
                   outpatients with cardiovascular disease reduced the         patients requiring intensive care unit (ICU) 
                   risk of adverse drug events by 34% compared with            admission and patients with length of stay less than 
                   the control group. . The positive impact of CPS (or         48 hours were excluded from the study. 
                   pharmaceutical care services) on clinical, economic         Data Collection Procedure 
                   and humanistic outcomes has been demonstrated 
                   in numerous studies in the North America and                Normally, patients are under the care of one 
                   United Kingdom (UK).5-8 Despite this, there is much         attending physician and two internal medicine 
                   inter-country and intra-country variability in the          residents in each ward of internal medicine, JUSH. 
                   practice and implementation of clinical pharmacy            Standard practice at the ward includes daily medical 
                   (CP) and CP is still in its early stages, even in most      rounds by the resident in charge. Students and 
                   European countries.9 CP is new to many developing           interns also participate in daily clinical rounds. The 
                   countries including Ethiopia.                               internist/resident assessed the patients and made 
                   The importance of pharmaceutical care services in           recommendations and the resident/intern would 
                   saving lives and protecting public health is                made changes to the prescriptions respectively. 
                   particularly relevant in resource-limited settings with     In this study, the graduate level clinical pharmacists 
                   a high prevalence of major medicine-treatable               completing their one year internship and training of 
                   diseases.10 Ethiopia is an Eastern African country of       trainers pharmaceutical care course were involved 
                   approximately 80 million persons with a gross               in ward rounds in the internal medicine inpatient 
                   domestic product of USD900 per capita, classifying          settings to give pharmaceutical care services 
                   it as a low-income country.11 In addition to policy         according to the standards of practice. This practice 
                   and resource related challenges, the effect of              process involves three major steps including 
                   limited number and quality of pharmacy personnel            assessment, development of a care plan and follow-
                   on the provision of health care in Ethiopia is              up evaluation. Specifically, eight clinical 
                   prominent.12,13 To tackle these and similar problems        pharmacists, two for two weeks, were assigned in 
                   in the country, the School of Pharmacy of Jimma             the internal medicine ward for 2 months and 
                   University launched the country’s first graduate            participated in medical and multidisciplinary team 
                   program in clinical pharmacy with an objective of           two days per week. Ward rounds usually took place 
                   training patient centered pharmacy practitioners as         from 10:00 am to 12:00 am. At each visit, the 
                   well as training faculty members for the new                clinical pharmacist used all relevant information 
                   undergraduate clinical pharmacy courses in the new          about each patient which was systematically 
                                                  www.pharmacypractice.org (ISSN: 1886-3655)                                        52
                       Mekonnen AB, Yesuf EA, Odegard PS, Wega SS. Implementing ward based clinical pharmacy services in an 
                       Ethiopian University Hospital. Pharmacy Practice 2013 Jan-Mar;11(1):51-57. 
                     collected in the medical record: the results of         pharmaceutical care patient record. Data were 
                     examinations and laboratory results, the medical        checked for completeness daily with appropriate 
                     history, clinical factors, diseases, symptoms and       follow-up and editing if needed. Data were then 
                     medication history. We recognized that undertaking      cleaned and analyzed, using SPSS version-16. The 
                     this activity for as many patients as possible          data were summarized and described using cross 
                     represents a significant use of time and needs          tabulation. Descriptive statistics was used to 
                     commitment. Likewise, recording all interventions to    characterize interventions, drug related problems 
                     treatment takes time. So, for the sake of this study;   and physicians acceptance of interventions. 
                     pharmaceutical care interventions were  The following operational definitions were used: 
                     documented in only those patients with DRPs. 
                     Participation with a multidisciplinary team was part      Acceptance of pharmaceutical care 
                     of the project. Interventions made were                    interventions: the doctor approves the proposal 
                     communicated with the concerned health care                made by the pharmacist for the prevention or 
                     professionals. All clinical pharmacists’ interventions     resolution of the DRP. 
                     were documented in the pharmaceutical care                 Clinical importance of interventions: a rating of 
                     patient record, which was already incorporated as          the intervention’s significance or impact with 
                     patient care in the patient chart. With the data           regard to patent’s outcomes. Significance was 
                     collected, the pharmacist evaluated appropriateness        classified as extreme - life saving, deleterious; 
                     of medical therapy, identified any other DRPs and          major - intervention may prevent serious 
                     communicated interventions to the internist/resident.      morbidity, including readmission, serious organ 
                     Written information to support the need for the            dysfunction, serious adverse drug event; 
                     intervention was then provided by the clinical             moderate - no benefit or minor benefit, 
                     pharmacist to the provider and the intervention            depending on professional interpretation; mild - 
                     documented. At discharge, the clinical pharmacists         recommendation that brings care to a more 
                     provided treatment update information to the patient       acceptable and appropriate level of practice or 
                     or caregiver and the general practitioner for              that may prevent an adverse drug event of 
                     continuity of care and communication. A written plan       moderate importance. 
                     (including names of drugs, indications, dosages and 
                     forms, frequency and time of administration,            Ethical Consideration 
                     modalities of administration, list of drugs 
                     discontinued and reason) was given to the patient       Letter of ethical clearance was obtained from the 
                     or caregiver, together with oral explanations. The      Ethical Review Board of Jimma University. Privacy 
                     further follow-up of the decisions on subsequent        and confidentiality was ensured during the 
                     days or after the patient’s discharge from the          pharmaceutical care services. Thus, name and 
                     hospital was not a part of the study.                   address of the patient was not recorded in the DRP 
                     Drug related problems (DRPs) identified, resolved       data collectionformat. From the pharmaceutical care 
                     and prevented were recorded through DRP                 service, DRPs were identified and 
                     registration format. A drug-related problem is          resolved/prevented so that health and economic 
                     defined by Strand et al.14 as ‘an undesirable patient   outcome was ensured. 
                     experience that involves drug therapy and that           
                     actually or potentially interferes with the desired     RESULTS  
                     patient outcome’. Different pharmaceutical care         Clinical pharmacists were present in the internal 
                     researchers have employed different kinds of DRP        medicine ward for 16 days during the study period. 
                     classification categories. However, many of the         A total of 149 drug related interventions were 
                     DRP categories are adapted from the Cipolle-
                     Morley-Strand classification.15-17 In our study, DRPs   documented for 48 of the 300 patients admitted 
                     were categorized according to this classification       during the study period. Among them, 133 (89.3%) 
                     scheme.18 It consisted of seven DRP categories:         interventions were initiated by the clinical 
                     unnecessary drug therapy, needs additional drug         pharmacists and 16 (10.7%) by another health care 
                     therapy, ineffective drug therapy, dosage too low,      professional (i.e. interventions were already handled 
                     adverse drug reaction, dosage too high and              by another health care professional). Mean average 
                     noncompliance. A definition for each DRP is             age of the patients was 38 (SD=17.6) (range 18-
                     available which is adapted from Cipolle et al.18        80), majority of patients 32 (66.7%) were females 
                     Thus, clinical pharmacists identified and  and mean average DRPs identified per patient was 
                     documented DRPs accordingly. DRPs documented            3.83 (SD=2.43).  
                     were validated by a senior pharmacist. Types of         Medication use for all patients was evaluated for 
                     interventions made and their acceptance were            potential DRPs. DRPs identified were documented. 
                     recorded from the pharmaceutical care patient           These are summarized in Table 1. Unnecessary 
                     record. To judge the relevance of interventions, an     dug therapy was the most common drug related 
                     independent panel comprised of one internist and        problem identified accounting for a quarter of all 
                     one clinical pharmacologist rated DRPs according        documented drug related interventions. Of the 36 
                     to their significance. Disagreements between the        DRPs classified as unnecessary, 18 (50%) were 
                     ratings were provided for discussion to the clinical    because there was no valid medical indication at 
                     pharmacist adjudication team for deliberation and       that time, 9 (25%) were due to alcohol use or 
                     confirmation of the DRP. Data collection was            smoking and 7 (19.4%) were due to duplication of 
                     completed by junior pharmacists that were properly      therapy. “Needs additional drug therapy” was also a 
                     trained on the extraction of data from 
                                                  www.pharmacypractice.org (ISSN: 1886-3655)                                  53
                      Mekonnen AB, Yesuf EA, Odegard PS, Wega SS. Implementing ward based clinical pharmacy services in an 
                      Ethiopian University Hospital. Pharmacy Practice 2013 Jan-Mar;11(1):51-57. 
                    Table 1. Characteristics of interventions documented by      (14.3%) and drug discontinuation 16 (12%) (Table 
                    clinical pharmacists, JUSH, Ethiopia, March-April 2011.      3). 
                    Drug related problem category*        Interventions,         A total of 68.4% of the interventions were fully 
                                                              n (%) 
                    Unnecessary drug therapy               36(24.2%)             accepted and 2.3% were partially accepted by 
                    Additional drug therapy                34(22.8%)             physicians. All of the health education interventions 
                    Ineffective drug                        4(2.7%)              that were made were accepted by the patients and 
                    Dosage too low                         18(12.1%)             implemented by the multidisciplinary team. An 
                    Adverse drug reaction                  16(10.7%)             independent clinical panel assessed the clinical 
                    Dosage too high                          12(8%)              significance of 94 interventions made by clinical 
                    Noncompliance 29(19.5%) 
                                                                                 pharmacists. The panel reviewed only those 
                    Total 149(100%) 
                    *A classification scheme by Cipolle et al, 2004              interventions which were considered fully and 
                                                                                 partially accepted. The panel and the intervening 
                   common problem identified 34 (22.8%). For 17                  pharmacist were deemed to be in agreement if both 
                   (50%) of the subjects, a medical condition indicated          assessed the same change (increase/decrease) 
                   the need for initiation of drug therapy, with 12              and the same magnitude of change. Individual 
                   (35.3%) requiring preventive drug therapy to                  ratings were different for some of the interventions 
                   prevent development of a new condition. The third             and level of agreement was determined between 
                   most frequently identified drug related problem was            the independent panels and the intervening clinical 
                   noncompliance, 29 (19.5%) including unavailability            pharmacists after discussion and consensus was 
                   of drug product 18 (62.1%) and the patient prefers            reached. On the basis of clinical importance, 46 
                   not to take the medications 9 (31%).                          (48.9%); 25 (26.6%); 18 (19.2%) and 5 (5.3%) 
                   Analysis of drug classes involved in interventions of         interventions were rated as major, moderate, mild, 
                   all types showed iron, calcium, vitamins and other            and extreme respectively. 
                   supplements, 30 (20.1%), were the most frequent                
                   classes involved in DRPs, followed by antibiotics,            DISCUSSION 
                   22 (14.8%) (Table 2). The frequencies of classes of           The clinical pharmacist contributes to the general 
                   drugs with each particular drug therapy problem               health outcomes by improvement of the drug 
                   demonstrated; - the most predominant were                     therapy. This study provided evidence for the 
                   antibiotics as ‘unnecessary drug therapy’ and                 benefit of a patient to a more appropriate (effective 
                   ‘adverse drug reaction’ categories; digoxin from the          and safe) medication use as a result of clinical 
                   ‘ineffective drug therapy’ category; iron, calcium,           pharmacist initiated interventions. A number of 
                   vitamins and other supplements from the ‘needs                studies reported that involvement of clinical 
                   additional drug therapy’ and ‘dosage too low’                 pharmacists in patient care in the inpatient hospital 
                   categories and anticoagulants, antihyperlipidimics            settings resulted in safer and more effective 
                   from the ‘dosage too high’ and ‘noncompliance’                medication use through identification, resolution and 
                   categories.                                                   prevention of drug therapy problems.19-24 To our 
                   Clinical pharmacists working in an internal medicine          knowledge, this is the first study to report results of 
                   ward during the study period were providers of                the ward based clinical pharmacy services in an 
                   pharmaceutical care resulting in 133 initiated                African hospital setting. We found that clinical 
                   interventions. Among those interventions they acted           pharmacists through the provision of 
                   up on, dosage/instruction for use changed and                 pharmaceutical care were able to propose a lot of 
                   consulting the health care professionals each                 interventions to a wide variety of DRPs and drugs. 
                   accounting for 23 (17.3%) were the most common                The most common drug related problem in our 
                   interventions made followed by new drug started 19            patients was unnecessary drug therapy (24%) with 
                  Table 2. Classes of drugs involved in interventions of all     the most common reason being no valid medical 
                  types, JUSH, Ethiopia, March – April 2011.                     indication (50%) and much of the share was to 
                                  Drug class                      N (%)          antibiotics. A study in Indonesia showed antibiotics 
                  Iron, calcium, vitamins and other                              are the third most common agents involved in 
                                                                30 (20.1%)                                   25
                  supplements *                                                  unnecessary drug therapy  but the cost incurred on 
                                                                                 them is the highest. . Unnecessary drug use has 
                  Antibiotics 22 (14.8%) 
                  Anticoagulants, antihyperlipidimics           17 (11.4%)       two implications according to this result. On the one 
                  Diuretics 16 (10.7%) 
                                                                                 hand, antibiotic use without indication and over 
                  Antacids, antiulcers                          11 (7.4%)        prescription has its own effect on the emergency of 
                  Analgesics 10 (6.7%) 
                                                                                 resistance to particular bacterial strains. On the 
                  Antiretrovirals 7 (4.7%) 
                                                                                 other hand, in this era of inflation drug therapy costs 
                  ACEIs 6 (4.0%) 
                                                                                 are on the rise. This is cumbersome for developing 
                  Digoxine 6 (4.0%) 
                                                                                 nations. Prevention of unnecessary drug therapy 
                  Antifungals 5 (3.4%) 
                                                                                 will contribute in cost saving among hospitalized 
                  Antituberculars 4 (2.7%) 
                                                                                 patients. Numerous US studies have demonstrated 
                  BBs 3 (2.0%) 
                                                                                 cost reductions when pharmaceutical care is 
                  Bronchodilators 2 (1.3%) 
                                                                                 provided.23,24 In Australia the value of clinical 
                  others† 9 (6.7%) 
                                                                                 pharmacists in reducing costs of treatment and 
                                    Total 149 (100%)                                                                                26
                  ACEIs=angiotensin converting enzyme inhibitors; BBs=beta-      shortened hospital stays has been reported.  A 
                    blockers                                                     study done in Sweden has showed the addition of 
                  *other supplements include potassium, multivitamins            pharmacists to health care teams would lead to 
                  †antihelminthics, antiviral, sedative hypnotics 
                                                   www.pharmacypractice.org (ISSN: 1886-3655)                                          54
The words contained in this file might help you see if this file matches what you are looking for:

...Mekonnen ab yesuf ea odegard ps wega ss implementing ward based clinical pharmacy services in an ethiopian university hospital practice jan mar original research alemayehu b elias a peggy s sultan received first version sep accepted abstract be generalized to other health care settings the background has country improve medication outcomes developed internationally expand role of pharmacist well beyond traditional roles keywords errors inpatients compounding dispensing and supplying drugs pharmaceutical professional more directly caring for patients studies on ethiopia activities inpatient resource constrained are implantacion de servicios scarce however farmacia clinica en los objective assess departamentos un internal medicine jimma universitario etiope specialized methods study was carried out resumen from march april at antecedentes el ejercicio la se design ha desarrollado internacionalmente para expandir prospective observational where papel del farmaceutico mas alla papeles prov...

no reviews yet
Please Login to review.