DRUG-RELATED PROBLEMS AMONG ELECTIVE SURGICAL PATIENTS

Main Article Content

Dr Sameer Kumar
Dr Vineet Verma

Keywords

elective surgical patients

Abstract

Objectives:

The aim of this study was to assess drug-related problems and determinants among elective surgical patients .


Methods:

A hospital-based prospective observational study was conducted. Data were collected through patients’ interview and physicians’ medication orders and charts review using pre-tested questionnaire and data abstraction formats. Drug-related problems were assessed for each patient using drug-related problem classification tool. Data were analyzed using Statistical Package for Social Science for windows; version 21.0. The predictors of drug-related problems were determined by multivariable logistic regression analysis. A p-value of less than or equal to 0.05 was considered to be statistically significant.


Results:

Of the total 141 participants, 98 (69.5%) of them had at least one drug-related problem during their hospital stay. A total of 152 drug-related problems were identified among 141 elective surgical patients. The most common identified drug-related problems were indication-related problems (39%) followed by effectiveness-related problems (21%) and safety-related problems (21%). The presence of complication (adjusted odds ratio = 2.90, 95% confidence interval (1.302, 3.460)), American Society of Anesthesiologists Physical Status ⩾ 2 (adjusted odds ratio = 6.01, 95% confidence interval (1.0011, 9.500)), and postoperative antibiotics (adjusted odds ratio = 6.027, 95% confidence interval (1.594, 22.792)) were independent predictors of drug-related problems.


Conclusion:

The prevalence of drug-related problems is high among elective surgical patients. The indication-related problems were the most common category of drug-related problem identified among elective surgical patients. The presence of complication, American Society of Anesthesiologists Physical Status ⩾ 2, and postoperative antibiotics were the independent predictors of drug-related problems.

Abstract 45 | pdf Downloads 23

References

1. Bos JM, van den Bemt PM, Kievit W, et al. A multifaceted intervention to reduce drug-related complications in surgical patients. Br J Clin Pharmacol 2017; 83(3): 664–677. [PMC free article] [PubMed] [Google Scholar]
2. Pharmaceutical Care Network Europe: PCNE Classification for drug related problems, V 5.01, 2006. http://www.pcne.org.
3. Cipolle RJ, Strand LMMP. Pharmaceutical care practice: the patient-centered approach to medication management services. 3rd ed., 2012. www.acesspharmacy.com
4. Boeker EB, Boer M, De Kiewiet JJS, et al. Occurrence and preventability of adverse drug events in surgical patients: a systematic review of literature occurrence and preventability of adverse drug events in surgical patients: a systematic review of literature. BMC Health Serv Res 2013; 13(1): 1. [PMC free article] [PubMed] [Google Scholar]
5. Surgery and Pharmacy in Liaison (SUREPILL) Study Group. Effect of a ward-based pharmacy team on preventable adverse drug events in surgical patients (SUREPILL study). Br J Surg 2015; 102(10): 1204–1212. [PubMed] [Google Scholar]
6. Almeida D, Pereira C, Couto PS, et al. Management of chronic medication therapies in the perioperative period: a literature review. J Anesth Clin Res 2017; 8: 9. [Google Scholar]
7. Lee JS, Gonzales R, Vittinghoff E, et al. Appropriate reconciliation of cardiovascular medications after elective surgery and postdischarge acute hospital and ambulatory visits. J Hosp Med 2017; 12(9): 723–730. [PubMed] [Google Scholar]
8. Tefera GM, Zeleke AZ, Jima YM, et al. Drug therapy problems and the role of clinical pharmacist in surgery ward: prospective observational and interventional study. Drug Healthc Patient Saf 2020; 12: 71–83. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210033/ [PMC free article] [PubMed] [Google Scholar]
9. Dipiro JT, Talbert RL, Yee GC, et al. Pharmacotherapy: a pathophysiologic approach. 10th ed. New York: McGraw-Hill Education. [Google Scholar]
10. Brunicardi F, Andersen DK, Bliarr TR, et al. Pollock Schwartz’s principles of surgery. In: Chen CL, Cooper MA, Shapiro ML, et al. (eds) Patient safety. New York: The McGraw-Hill Companies, 2014, pp.365–393. [Google Scholar]
11. Food, Medicine and Healthcare Administration and Control Authority. Standard treatment guidelines for general hospital. 3rd ed. Addis Ababa, Ethiopia: Food, Medicine and Healthcare Administration and Control, 2014. [Google Scholar]
12. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30(2): 239–245. [PubMed] [Google Scholar]
13. Neville HL, Chevalier B, Daley C, et al. Clinical benefits and economic impact of post-surgical care provided by pharmacists in a Canadian hospital. Int J Pharm Pract 2014; 22(3): 216–222. [PubMed] [Google Scholar]
14. Haley M, Raymond C, Nishi C, et al. Drug-Related Problems in Patients Arthroplasty of the Hip or Knee. CJHP 2009; 62(5): 360–366. [PMC free article] [PubMed] [Google Scholar]
15. Zaman Huri H, Hui Xin C, Sulaiman CZ. Drug-related problems in patients with benign prostatic hyperplasia: a cross sectional retrospective study. Plos One 2014; 9(1): e86215–14. [PMC free article] [PubMed] [Google Scholar]
16. Paranaguá TT, Bezerra AL, dos Santos AL, et al. Prevalence and factors associated with incidents related to medication in surgical patients. Rev Esc Enferm USP 2014; 48(1): 41–48. [PubMed] [Google Scholar]
17. Wood D, Lightfoot N. An audit of regular medication compliance prior to presentation for elective surgery. N Z Med J 2018; 131(1480): 75–80. [PubMed] [Google Scholar]
18. Yonca Y. Preoperative medication management: continue, discontinue or temporary alteration. Res Rev JHCP 2017; 3(1): 1–2. [Google Scholar]
19. Nanji KC, Patel A, Shaikh S, et al. Evaluation of perioperative medication errors and adverse drug events. Anesthesiology 2016; 124(1): 25–34. [PMC free article] [PubMed] [Google Scholar]
20. Bratzler DW, Hunt DR. The surgical infection prevention and surgical care improvement projects : national initiatives to improve outcomes for patients having surgery. CID 2006; 43: 322–330. [PubMed] [Google Scholar]