ABSTRACT
Introduction: Drug-related problems (DRP) are events or circumstances in which drug therapy does or could interfere with desired health outcomes. In December 2019, a new coronavirus, SARS-CoV-2, appeared. Little knowledge about this type of infection resulted in the administration of various drugs with limited use in other pathologies. Evidence about DRP in patients with COVID-19 is lacking. Objective: The aim of the present study is to describe identified cases of DRP and those drugs involved in the first wave of patients with COVID-19, and evaluate associated risk factors. Material and methods: Observational, retrospective study performed in a tertiary university hospital between 14th March 2020 and 31 May 2020 (corresponding to the first COVID-19 wave). We recruited patients admitted during the study period. Exclusion criteria included age < 18 years; admission to critically ill units; and care received either in the emergency room, at-home hospitalization or a healthcare center. Results: A total of 817 patients were included. The mean age was 62.5 years (SD 16.4) (range 18-97), and 453 (55.4%) were male. A total of 516 DRP were detected. Among the patients, 271 (33.2%) presented at least one DRP. The mean DRP per patient with an identified case was 1.9. The prevailing DRPs among those observed were: incorrect dosage (over or underdosage) in 145 patients (28.2%); wrong drug combination in 131 (25.5%); prescriptions not in adherence to the then COVID-19 treatment protocol in 73 (14.1%); prescription errors due to the wrong use of the computerized physician order entry in 47 (9.2%); and incorrect dosage due to renal function in 36 (7%). The logistic regression analysis showed that patients who received only prescriptions of antibacterials for systemic use (J01 ATC group) faced a higher likelihood of experiencing a DRP (OR 2.408 (1.071-5.411), p = 0.033). Conclusion: We identified several factors associated with an increased risk of DRPs, similar to those reported in other pre-pandemic studies, including a prolonged length of stay, higher number of prescribed drugs and antimicrobial administration. The relevance of pharmacists and tools like pharmacy warning systems can help prevent, identify and resolve DRP efficiently.
ABSTRACT
Introduction: Drug-related problems (DRP) are events or circumstances in which drug therapy does or could interfere with desired health outcomes. In December 2019, a new coronavirus, SARS-CoV-2, appeared. Little knowledge about this type of infection resulted in the administration of various drugs with limited use in other pathologies. Evidence about DRP in patients with COVID-19 is lacking. Objective: The aim of the present study is to describe identified cases of DRP and those drugs involved in the first wave of patients with COVID-19, and evaluate associated risk factors. Material and methods: Observational, retrospective study performed in a tertiary university hospital between 14th March 2020 and 31 May 2020 (corresponding to the first COVID-19 wave). We recruited patients admitted during the study period. Exclusion criteria included age < 18 years;admission to critically ill units;and care received either in the emergency room, at-home hospitalization or a healthcare center. Results: A total of 817 patients were included. The mean age was 62.5 years (SD 16.4) (range 18–97), and 453 (55.4%) were male. A total of 516 DRP were detected. Among the patients, 271 (33.2%) presented at least one DRP. The mean DRP per patient with an identified case was 1.9. The prevailing DRPs among those observed were: incorrect dosage (over or underdosage) in 145 patients (28.2%);wrong drug combination in 131 (25.5%);prescriptions not in adherence to the then COVID-19 treatment protocol in 73 (14.1%);prescription errors due to the wrong use of the computerized physician order entry in 47 (9.2%);and incorrect dosage due to renal function in 36 (7%). The logistic regression analysis showed that patients who received only prescriptions of antibacterials for systemic use (J01 ATC group) faced a higher likelihood of experiencing a DRP (OR 2.408 (1.071–5.411), p = 0.033). Conclusion: We identified several factors associated with an increased risk of DRPs, similar to those reported in other pre-pandemic studies, including a prolonged length of stay, higher number of prescribed drugs and antimicrobial administration. The relevance of pharmacists and tools like pharmacy warning systems can help prevent, identify and resolve DRP efficiently.
ABSTRACT
Background and importance Drug related problems (DRP) are common among hospitalised patients. During the COVID-19 pandemic, the number of inpatients increased and the pattern of drug use was varied which could lead to a higher number of potential DRP. Aim and objectives To describe DRP in patients admitted to COVID-19 wards during the COVID-19 pandemic peak. Material and methods A retrospective observational study was performed in a tertiary university hospital from 21 March to 30 April 2020. Patients included were those admitted to a COVID-19 ward and presenting a DRP (excluding emergency department and critical care units). Computerised physician order entry (CPOE) operates for all hospital beds. Medical prescriptions were revised daily by clinical pharmacists. When a potential DRP was detected, an annotation with a recommendation was made in the patient's medical record. DRP were classified according to the Pharmaceutical Care Network Europe classification. Data collected were demographic, the drug class involved (anatomical chemical therapeutic (ATC)), DRP detected and degree of recommendation acceptance. Results Total patients with DRP: 291 (23.3%). Identified DRP: 393 (1.4 DRP/patient). 58.3% were men and median age was 63 (15.7) years. Conclusion and relevance Almost 25% of all patients had a DRP, presenting an incidence of 1.4 DRP/patient, higher than reported in previous series. 83% of evaluable recommendations were accepted. One-third of the recommendations were derived from a wrong dosage, and 15% from drug interactions. Hydroxychloroquine was the most frequently involved drug, probably because of the limited experience and wide spectrum of interactions, followed by antimicrobials such as ceftriaxone and azithromycin, used widely in respiratory tract infections.
ABSTRACT
4CPS-384 Table 1PRM Wrong dosage Overdose 90 (22.9) Underdose 38 (9.7) Out of protocol 78(19.8) Interactions Adverse event potentiation 34 (8.7) Induction/inhibition 15 (3.8) Bioavailability alteration 12 (3.1) Prescription error by incorrect use of CPOE 41 (16.1) Renal impairment 25 (6.4) Indication Inexistent drug 16 (4.1) Unnecessary drug 9 (2.3) Other 35 (8.9) Recommendation Acceptance rate Accepted 284 (72.2) Non-accepted 60 (15.2) Non-evaluable 49 (12.5) Drug involved P Hydroxychloroquine 90 (22.9) J Ceftriaxone 65 (16.5) Azithromycin 27 (6.9) Lopinavir/ritonavir 6 (1.5) Dolutegravir 1 (0.02) Other 14 (3.6) A Calcifediol 34 (8.6) Vitamin B 2 (0.5) Saccharomyces boulardii 9 (2.3) Calcium carbonate 4 (1.0) Potassium 4 (1.0) H Dexamethasone 25 (6.4) Methylprednisolone 4 (1.0) B Enoxaparin 15 (3.8) AAS 2 (0.05) Apixaban 2 (0.05) Acenocumarol 1 (0.02) R Respiratory system 13 (3.3) C Lipid modifying agents 10 (2.5) Diuretics 7 (1.8) N Psychoanaleptics 7 (1.8) V Various 8 (2.0) Other 43 (10.9) Conclusion and relevanceAlmost 25% of all patients had a DRP, presenting an incidence of 1.4 DRP/patient, higher than reported in previous series. 83% of evaluable recommendations were accepted. One- third of the recommendations were derived from a wrong dosage, and 15% from drug interactions. Hydroxychloroquine was the most frequently involved drug, probably because of the limited experience and wide spectrum of interactions, followed by antimicrobials such as ceftriaxone and azithromycin, used widely in respiratory tract infections.References and/or acknowledgementsConflict of interestNo conflict of interest