Lovisenberg Diakonale Hospital Pharmacy

Oslo, Norway

Lovisenberg Diakonale Hospital Pharmacy

Oslo, Norway
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Blix H.S.,Lovisenberg Diakonale Hospital Pharmacy | Blix H.S.,Norwegian Institute of Public Health | Viktil K.K.,University of Oslo | Moger T.A.,University of Oslo | Reikvam A.,University of Oslo
Pharmacy Practice | Year: 2010

Drugs with narrow therapeutic index (NTI-drugs) are drugs with small differences between therapeutic and toxic doses. The pattern of drug-related problems (DRPs) associated with these drugs has not been explored. Objective: To investigate how, and to what extent drugs, with a narrow therapeutic index (NTI-drugs), as compared with other drugs, relate to different types of drug-related problems (DRPs) in hospitalised patients. Methods: Patients from internal medicine and rheumatology departments in five Norwegian hospitals were prospectively included in 2002. Clinical pharmacists recorded demographic data, drugs used, medical history and laboratory data. Patients who used NTI-drugs (aminoglycosides, ciclosporin, carbamazepine, digoxin, digitoxin, flecainide, lithium, phenytoin, phenobarbital, rifampicin, theophylline, warfarin) were compared with patients not using NTI-drugs. Occurrences of eight different types of DRPs were registered after reviews of medical records and assessment by multidisciplinary hospital teams. The drug risk ratio, defined as number of DRPs divided by number of times the drug was used, was calculated for the various drugs. Results: Of the 827 patients included, 292 patients (35%) used NTI-drugs. The NTI-drugs were significantly more often associated with DRPs than the non-NTI-drugs, 40% versus 19% of the times they were used. The drug risk ratio was 0.50 for NTI-drugs and 0.20 for non-NTI-drugs. Three categories of DRPs were significantly more frequently found for NTI-drugs: non-optimal dose, drug interaction, and need for monitoring. Conclusion: DRPs were more frequently associated with NTI-drugs than with non-NTI-drugs, but the excess occurrence was solely related to three of the eight DRP categories recorded. The drug risk ratio is a well-suited tool for characterising the risk attributed to various drugs.Results:Results are given for the whole group of patients without separate data for Tegretol and other NTI-drugs. More NTI-users (80%) than non-NTI-users (67%) had at least 1 DRP. Use of NTI-drugs, number of drugs at admission, number of drugs introduced in hospital and presence of renal failure were independent risk factors. Other risk factors were diabetes and heart failure. DRPs were remarkably more often connected to NTI-drugs than to non-NTI-drugs, with a drug risk ratio of 0.50, compared to 0.20. 3 categories of DRPs (non-optimal dose, drug interaction, and need for monitoring) were more frequently found for NTI-drugs. The most frequent DRP associated with NTI-drugs, need for monitoring, was noted in 23% of the instances the NTI-drugs were used, while the corresponding figure was 2% for non-NTI-drugs. NTI-drugs were connected to drug interactions and non-optimal dose in 14% and 8% of the times they were used, while the figures for non-NTI-drugs were 2% and 5%. The drug risk ratios for different NTI-drugs were high and markedly higher than the ratios for the most frequently used drugs. Some non-NTI-drugs, most of them with relatively low use, also had high drug risk ratios, as a result of relatively high frequencies of a wide range of DRPs. They did not exhibit a specific DRP pattern corresponding to that found for NTI-drugs.AdverseEffects:No adverse events were mentioned.AuthorsConclusions:DRPs were more frequently associated with NTI-drugs than with non-NTI-drugs, but the excess occurrence was solely related to three of the eight DRP categories recorded. The drug risk ratio is a well-suited tool for characterising the risk attributed to various drugs.Patients:827 inpatients, 485 females and 342 males, age range 15-98 years (mean age 70.8 years); 292 (156 females and 136 males, mean age 75.2 years) were on NTI-drugs (aminoglycosides, ciclosporin, Tegretol, digoxin, digitoxin, flecainide, lithium, phenytoin, phenobarbital, rifampicin, theophylline, warfarin; 217 had one NTI-drug, 69 on 2 and 6 on 3 NTI-drugs) and 535 (329 females and 206 males, mean age 68.4 years) were not on NTI-drugs.TypeofStudy:An open, prospective study investigating how, and to what extent drugs, with a narrow therapeutic index (NTI-drugs; including Tegretol), as compared with other drugs, relate to different types of drug-related problems (DRPs) in hospitalized patients.DosageDuration:Dosage and duration not stated.FreeText:The pharmacist identified DRPs among the patients and thereafter discussed the findings with the multidisciplinary teams lead by physicians. Occurrences of 8 different types of DRPs [need for an additional drug, unnecessary drug, non-optimal drug, non-optimal dose, no further need of drug, drug interaction, need for monitoring and adverse drug reaction (ADR)] were registered after reviews of medical records and assessment by multidisciplinary hospital teams. The drug risk ratio, defined as number of DRPs divided by number of times the drug was used, was calculated for the various drugs.


Willoch K.,Lovisenberg Diakonale Hospital Pharmacy | Blix H.S.,Lovisenberg Diakonale Hospital Pharmacy | Blix H.S.,Norwegian Institute of Public Health | Pedersen-Bjergaard A.M.,Lovisenberg Diakonale Hospital Pharmacy | And 2 more authors.
International Journal of Clinical Pharmacy | Year: 2012

Background Drug-related problems (DRPs) have been found to be associated with increased morbidity, mortality, and health costs. Objective To investigate whether the inclusion of pharmacists in a rehabilitation team influences the handling of DRPs in the ward and whether an intervention in hospital affects drug use after discharge. Setting The rehabilitation ward of a general hospital in Oslo, Norway. Methods Patients were randomized into an intervention group (IG) or a usual care group (CG). The IG patients were followed prospectively by a pharmacist, who reviewed the patients' drug therapies using information from their medical records and patient interviews. The pharmacist identified DRPs and suggested solutions during multidisciplinary team meetings. The IG patients received targeted drug counselling from the pharmacist before discharge. The drug therapy in the CG, for the period from study randomization to discharge, was assessed retrospectively by the pharmacist, who identified DRPs and recorded how they were acted upon. Three months after discharge, pharmacists who were blinded to the patient randomization, visited the patients at home and interviewed them about their medication. Main outcome measures: Types and frequencies of DRPs in the IG and CG were compared at hospital admission, at discharge, and 3 months after discharge. Results Of the 77 patients included, 40 belonged to the IG and 37 to the CG. Patient characteristics (IG vs CG) were as follows: age 73.5 versus 76.8 years; female 58 versus 68%; mean number of drugs at admission 8.3 versus 7.8; and mean number of drugs at discharge 8.5 versus 7.7. At admission, 4.4 DRPs per patient were recorded in the IG and 4.2 in the CG. Significantly more DRPs were acted upon and resolved in the IG; at discharge, the IG had 1.2 DRPs per patient and the CG had 4.0 (P < 0.01). At the home visit, a significant difference between the groups was found: 1.63 versus 2.62 DRPs (P = 0.02) for the IG and the CG, respectively. Conclusion Involvement of a pharmacist in drug-therapy management, including participation in multidisciplinary team discussions, markedly improved the identification and resolution of DRPs during a hospital stay. The benefit persisted after discharge. © 2011 CARS.


PubMed | Lovisenberg Diakonale Hospital Pharmacy
Type: Journal Article | Journal: International journal of clinical pharmacy | Year: 2012

Drug-related problems (DRPs) have been found to be associated with increased morbidity, mortality, and health costs.To investigate whether the inclusion of pharmacists in a rehabilitation team influences the handling of DRPs in the ward and whether an intervention in hospital affects drug use after discharge.The rehabilitation ward of a general hospital in Oslo, Norway.Patients were randomized into an intervention group (IG) or a usual care group (CG). The IG patients were followed prospectively by a pharmacist, who reviewed the patients drug therapies using information from their medical records and patient interviews. The pharmacist identified DRPs and suggested solutions during multidisciplinary team meetings. The IG patients received targeted drug counselling from the pharmacist before discharge. The drug therapy in the CG, for the period from study randomization to discharge, was assessed retrospectively by the pharmacist, who identified DRPs and recorded how they were acted upon. Three months after discharge, pharmacists who were blinded to the patient randomization, visited the patients at home and interviewed them about their medication.Types and frequencies of DRPs in the IG and CG were compared at hospital admission, at discharge, and 3 months after discharge.Of the 77 patients included, 40 belonged to the IG and 37 to the CG. Patient characteristics (IG vs CG) were as follows: age 73.5 versus 76.8 years; female 58 versus 68%; mean number of drugs at admission 8.3 versus 7.8; and mean number of drugs at discharge 8.5 versus 7.7. At admission, 4.4 DRPs per patient were recorded in the IG and 4.2 in the CG. Significantly more DRPs were acted upon and resolved in the IG; at discharge, the IG had 1.2 DRPs per patient and the CG had 4.0 (P < 0.01). At the home visit, a significant difference between the groups was found: 1.63 versus 2.62 DRPs (P = 0.02) for the IG and the CG, respectively.Involvement of a pharmacist in drug-therapy management, including participation in multidisciplinary team discussions, markedly improved the identification and resolution of DRPs during a hospital stay. The benefit persisted after discharge.

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