Journal of Pharmaceutical Care
Volume:1 Issue: 4, Autumn 2013

It has been more than two decades since Luciane Leape and co authors published the results of Harvard Medical Practice Study which attracted the attention of clinicians around the world on the subject of patient safety in the medical care environment (1-2). Since then the issue of errors in medicine has been highlighted in different healthcare settings. From the reports published since then, it seems that medical errors have become epidemic throughout the world and no one country is immune from it.

Since albumin imposes a relatively high cost to a healthcare system, drug use evaluation for this drug is much more important. This study wants to evaluate pattern of albumin use in a large university affiliated hospital in Tehran, Iran. A concurrent, cross-sectional study was performed in “Shaheed Rajaei” Cardiovascular, Medical and Research Center. All inpatient adults that were prescribed albumin during the study period were evaluated to register the indications for albumin usage according to the evidence-based guidelines. Only for five patients (4%) the albumin prescriptions were justifiable. Of these cases, intractable edema was the leading cause of albumin misuse (73 patients; 60.8%). The total 1468 vials of Albumin were prescribed for 120 patients during the study period. The most common reasons to prescribe albumin were acute normovolemic (34%), cardiac failure (0.83%), resistance edema with Albumin>2g/dL (61%), nephrotic syndrome (0.83%), plasmapheresis (1.67%), ascetic (1.67%). These data, together with previous national studies highly suggest a mandatory need for educational measures for practicing physicians along with strict regulations for prescription strategies regarding expensive drugs such as albumin.

In-depth knowledge of antibiotic principles is widely considered a necessary condition for appropriate prescribing of antibiotics. The study aimed at determining the impact of healthcare providers’ level of knowledge in bacteriology and principles of antibiotic prescribing on their abilities to prescribe antibiotics appropriately. A structured questionnaire survey targeting all doctors, nurses and healthcare providers within Health Service Areas abounding and including five selected public hospitals in Lesotho was carried out. The questionnaire tested respondents’ knowledge in bacteriology of infections and principles of antibiotic prescribing. Relevant data on antibiotic prescriptions were also collected concurrently with the survey. Data were analysed to establish respondents’ level of knowledge and the influence of same on their abilities to prescribe antibiotics appropriately. In inpatient and outpatient departments, 53.3% and 62.5% of respondents demonstrated inadequate levels of knowledge in the bacteriology and treatment of infections, respectively. Of the prescriptions analysed, 57.0% in the inpatient department and 19.1% in the outpatient department were classified as inappropriate. Appropriateness of antibiotic prescriptions was positively associated with healthcare providers’ level of knowledge in inpatient but not outpatient settings. A majority of healthcare providers appear to lack sufficient knowledge in bacteriology of infections and principles of antibiotic prescribing. In respect to antibiotic prescribing among inpatients but not outpatients the study demonstrated a positive correlation between healthcare providers’ knowledge and their abilities to prescribe antibiotics appropriately.

Drug Utilization Evaluation (DUE) studies are designed to evaluate and improve the rational use of medications. DUEs have focused on drugs used in high risk patients such as critically ill cases in this study. Carbapenems are beta-lactam type antibiotics with broad-spectrum of activity which cover Gram-positive, Gram-negative and anaerobic bacteria. The heavy use of carbapenems (imipenem or meropenm) could increase the risk of multi-drug resistant (MDR) pathogens. This study was a prospective and cross sectional study performed at three intensive care units (ICUs) of Shariati hospital, affiliated with Tehran University of Medical Sciences. The study was conducted from April 2012 to May 2013. All of the patients were on imipenem or meropenem as an empiric treatment or based upon microbiology culture results included in the study. Total of 68 patients in three ICU wards evaluated. The most common diagnosis was Central Nervous System (CNS) infections and meningitis (36.8%). The most common microorganism derived from the patient’s specimen was Acinetobacter spp. (28%). Overall initial treatment for thirty five patients (51.4%) was justified versus nineteen cases (27.9%) of unjustified. For 14 patients (20.5%) empiric treatment was justified, but continuation of treatment was unjustified. The result of the study showed that empiric therapy was justified in most cases (72%), but according to the culture results, continuation of treatment in several cases was unjustified (47%).

Adverse Drug Reactions (ADRs) are one of the leading causes of morbidity and mortality and contribute to excessive health care costs. Detection and reporting of ADRs could decrease these consequences. The present study was designed to assess the Knowledge, Attitude and Practice (KAP) of pharmacy students towards ADRs monitoring and reporting. A questionnaire was prepared to investigate the Knowledge, Attitude and Practice (KAP) of pharmacy students regarding ADR reporting. The questionnaire consisting of 17 questions (7 questions on knowledge, 5 on attitudes and 5 on practice) were given to pharmacy students randomly. A total of 71 respondents participated in the study. 70% of participants had favorable general knowledge about ADRs but more than 60% of their professional knowledge was not satisfying. 60% of respondent believed that educational intervention will improve participating of health care professional in ADRs reporting. 63% of respondent observed ADRs cases but about 95% of them had never reported an ADR. In overall, pharmacy students have poor knowledge, attitude and practice towards ADRs reporting and pharmacovigilance. This suggests the need of suitable changes in the undergraduate teaching curriculum and additional training among the students regarding ADRs.

Inappropriate use of vancomycin not only increase health care costs but also contribute to the emergence of resistant organisms. Higher trough serum vancomycin concentrations (>10mg/L) has been recommended for avoidance of development of resistance. We aim to compare the administered dose with recommended doses based on guideline-recommended weight-based dosing. In a cross sectional study, all patients who received vancomycin between July and October 2013, in infectious disease, internal medicine wards and emergency department of a teaching hospital in Tehran, Iran were entered to the study. Indication of vancomycin and necessary data for dose calculation including height and serum creatinine were recorded. Prescribed doses were compared with recommended doses in guidelines and calculated Glomerular filtration rate (GFR) for each patient. One hundred and four patients (45 females and 59 males) recruited in the study. Our results indicated that, from all administered doses of vancomycin, 64.4% and 88.8% differs significantly (more than 20%) based on American Pharmacist Association (AphA) vancomycin monograph and guideline-recommended, weight-based vancomycin dosing (for adults), respectively. Underdosing of vancomycin is a major risk factor for developing resistance of gram positive organisms to this glycopeptide. Our results showed that more than half of patients receiving vancomycin are in the risk of low drug levels based on guidelines. So, having a comprehensive plan for the proper use of this drug especially designing effective internal guidelines can prevent emergence of resistance to vancomycin in future.

In recent decades, by increasing complexity of drug therapy, pharmacists considered as health-care members who can help optimizing drug therapy. We know that medicines do not have the anticipated effects all the times and a vast variability may exist in their behaviors in the body. So, it is very crucial to individualize treatment for every single patient. Nowadays, optimizing drug therapy in patients needs a collaborative interdisciplinary approach to patients care and treatment. Specifically when drug therapy is considered for a condition, pharmacists can enroll as a valuable professional to help for modification of therapy along with other clinicians. Abundant number of studies and reports exist in the literatures which address usefulness of pharmacist engagement in patient care. In this review we have presented some valuable evidences supporting pharmacist role in different clinical settings.