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Background and objective: Warfarin has been a high alert drug due to its narrow therapeutic index. Its use review and feedback may improve the medical staffs’ service quality in efficiency and safety. Objective is to review its use in: justification for use, process indicators, complications and their managements, and outcome indicators in order to develop the institute’s proper warfarin use guideline.Methods: Warfarin use guideline was developed based on the literature review and the experts’ opinion. The drug use review of warfarin in complete medication chart was done in warfarin-using patients in medicine ward, Srinagarind Hospital, who were admitted during January 2004 and December 2007 in Srinagarind Hospital, Khon Kaen, Thailand, comparing with the guideline.Results: In a total of 85 patients, we found that 54.1% of them were female, aged 53.9 ±14.4 year-old. At the time of admission, 68% had been using warfarin, however, their INRs were within optimal range in only 16%. Ninety-five percent of the patients, the use of drug had justified indications. There were lack of necessary laboratory evaluations including hematocrit, platelet count, and ALT/AST in 14%, 16%, and 35%, respectively. There were proper starting and adjusting, when compared to proposed guideline, in 71% and 68%, respectively. There were drug interactions in 27%. On admission, major bleeding and minor bleeding were found in 10% and 9%, respectively. Outcome indicator of warfarin using (INR) met its goal in only 25%.Conclusion: Most of the warfarin use problems that we found in this study could be prevented, if proper guideline is formulated and most of these problems and their related complications could be managed.Keywords : warfarin, guideline
RESUMO
Background: Easy Asthma Clinic (EAC) at Srinagarind Hospital, Khon Kaen University, Thailand was established in February 2004. EAC is an ambulatory asthma clinic which implemented the Global Initiative for Asthma (GINA) guidelines and it has been incorporated into the practice. The goal of EAC is to improve the quality of care for asthmatic patients utilizing multidisciplinary approach involving physicians, nurses and pharmacists; however drug related problems (DRPs) have been still occurred because asthma is a chronic disease which requires long term medication therapy and special technique, these lead to the decrease in effectiveness of therapy. Therefore, pharmacist has an important role in managing these DRPs in order to improve the drug therapy in asthmatic patients. Objective: To study DRPs and pharmacist’s intervention on managing DRPs in EAC. Method: The descriptive and retrospective study design was conducted for patients in EAC, Srinagarind Hospital during 1st July 2005 to 30th June 2007. The selection criteria were patients who have been followed up at least two times. The outcomes of pharmacist’s intervention were evaluated in the following appointment. Result: There were 303 patients recruited, of which 111 (36.6 %) were males and 192 (63.4%) were females with their mean age of 54 years old. Numbers of visits were 906 (3 times per person). There were 225 patients (74.3%) with DRPs, 591 problems in total. The most DRPs were non-compliance (62.9%) and adverse drug reactions (ADRs) (36.2%). In terms of non-compliance, most highly occurred problems were incorrect technique of administrations (62.9%) and under dosage of medication (32.0%). A pharmacist resolved or prevented DRPs by counseling patients (98.7%) and consulting physicians (1.3%). Pharmacist’s interventions improved patient compliance (36.3%) by describing disease and the importance of using medications, teaching appropriate technique of administration (22.8%), counseling on management and prevention of ADRs (20.4%) and educating lifestyle modification (20.6%). Pharmacist’s intervention could resolve the problems (48.1%). Non-compliance was resolved 49.2%, ADRs were resolved 44.9% and other DRPs, which were discussed with the physician, were totally resolved. Conclusion: Pharmacist’s intervention on managing DRPs could resolve DRPs, and help patients to use their medications appropriately.