Department of Pharmacy Practice, Visveswarapura Institute of Pharmaceutical Sciences, Rajiv Gandhi University of Health Sciences.
Department of Pharmacy Practice, Kempegowda Institute of Medical Sciences Hospital and Research Centre, Bangalore, India.
Eur J Gastroenterol Hepatol. 2019 Dec;31(12):1569-1576. doi: 10.1097/MEG.0000000000001492.
Characteristics of drug-related problems and related patient harm has not been evaluated in critically ill patients with decompensated cirrhosis. Our objectives were to identify characteristics and incidence rate of drug-related problems and related preventable harm in critically ill patients with decompensated liver cirrhosis.
A prospective observational study was conducted from February 2018 to January 2019 in 10-bed medical intensive care unit of a tertiary care hospital. Medication charts of 78 patients diagnosed with decompensated cirrhosis were reviewed by the clinical pharmacist. Pharmaceutical care-related standard tools were applied for classification of drug-related problems and their severity of outcomes.
A total of 394 drug-related problems with an incidence rate of 298.48 per 1000 patient medical intensive care unit-day were identified. Most common drug-related problems were drug-drug interaction (48.7%) followed by guideline nonconformity (15.5%), inappropriate drug form (11.9%), and contraindication (9.6%). Approximately 27% of drug-related problems induced preventable harm, which included temporary harm (19.8%), permanent harm (5.8%), and death (0.8%). The incidence rate of preventable harm was found to be 78.78 per 1000 patient medical intensive care unit-day. Nonsteroidal anti-inflammatory drugs were the most common medications involved in drug-drug interaction, guideline nonconformity, and contraindication which led to gastrointestinal bleeding (24%) and worsening of renal function (11.5%).
Drug-related problems occurred commonly in critically ill patients with decompensated liver cirrhosis and induced preventable harm which jeopardized the safety of these vulnerable patients. Clinical pharmacist's intervention is essential for identification of drug-related problems and related preventable harm among these patients.
尚未评估失代偿性肝硬化危重症患者的药物相关问题特征及其相关的患者伤害。我们的目的是确定失代偿性肝硬化危重症患者的药物相关问题及其可预防伤害的特征和发生率。
本前瞻性观察研究于 2018 年 2 月至 2019 年 1 月在一家三级护理医院的 10 张病床的内科重症监护病房进行。临床药师审查了诊断为失代偿性肝硬化的 78 名患者的用药图表。应用药物相关标准工具对药物相关问题及其结果的严重程度进行分类。
共发现 394 例药物相关问题，发生率为每 1000 个患者重症监护病房日 298.48 例。最常见的药物相关问题是药物-药物相互作用（48.7%），其次是不符合指南（15.5%）、药物剂型不当（11.9%）和禁忌证（9.6%）。大约 27%的药物相关问题导致可预防的伤害，包括暂时伤害（19.8%）、永久伤害（5.8%）和死亡（0.8%）。可预防伤害的发生率为每 1000 个患者重症监护病房日 78.78 例。导致药物-药物相互作用、不符合指南和禁忌证导致胃肠道出血（24%）和肾功能恶化（11.5%）的最常见药物是非甾体抗炎药。
药物相关问题在失代偿性肝硬化危重症患者中很常见，并导致可预防的伤害，危及这些脆弱患者的安全。临床药师的干预对于识别这些患者的药物相关问题和相关的可预防伤害至关重要。
