International Journal of Hospital Pharmacy

  • Patient Problem Solving and Preventive Care

    Medications are powerful tools that, if used correctly, can prevent or treat disease. If used incorrectly, there is potential to cause great harm to people who take them. These unintended effects, called adverse effects, can occur from any medication. As health care teams, which include physicians, pharmacists, and other health care providers, are making decisions about using specific medications to treat an individual patient, they must weigh the potential risks against the desired benefit of each medication to minimize the chance of harm to the patient. As important members of the health care team, pharmacists work collaboratively with patients’ other health care providers in all types of patient care settings ranging from community pharmacies to hospitals and long-term care facilities. Across these settings, pharmacists take specific actions that regularly contribute to improving patient safety. In addition to training on medications, pharmacist education and training includes assessing health status of patients, providing education and counseling, managing diseases, and using health care technologies. Pharmacists use this education and training to prevent medication errors, drug interactions, and other adverse medication events from reaching patients. With the expanding number and complexity of medications, pharmacists’ roles and responsibilities have expanded broadly beyond medication distribution. Pharmacists are providing patient care in almost all health care settings to help people of all ages get the most from the medications that are prescribed to them. Examples of pharmacists’ patient care services include providing health and wellness screenings, managing chronic diseases, assisting patients with medication management, administering immunizations, and working with hospitals and health systems to improve patient care and reduce the number of patients who are readmitted to the hospital following their hospital stay.

  • Framework for Patient Safety

    Medication errors are common in general practice and in hospitals. Both errors in the act of writing (prescription/dispensing/administration errors) and prescribing faults due to erroneous medical decisions can result in harm to patients. Any step in the prescribing process can generate errors. Slips, lapses, or mistakes are sources of errors, as in unintended omissions in the transcription of drugs. Faults in dose selection, omitted transcription, and poor handwriting are common. Inadequate knowledge or competence and incomplete information about clinical characteristics and previous treatment of individual patients can result in prescribing faults, including the use of potentially inappropriate medications. An unsafe working environment, complex or undefined procedures, and inadequate communication among health-care personnel, particularly between doctors and nurses, have been identified as important underlying factors that contribute to prescription errors and prescribing faults. Active interventions aimed at reducing prescription errors and prescribing faults are strongly recommended. These should be focused on the education and training of prescribers and the use of on-line aids. The complexity of the prescribing procedure should be reduced by introducing automated systems or uniform prescribing charts, in order to avoid transcription and omission errors. Feedback control systems and immediate review of prescriptions, which can be performed with the assistance of a hospital pharmacist, are also helpful. Audits should be performed periodically.

  • ARTS AND SCIENCE OF PRESCRIBING

    Prescribing patient is a mammoth task. It is recommended that healthcare professionals who prescribe medications exercise critical thinking skills to ensure the safe and effective use of therapeutic agents. It should be endowed with communication skills, diagnostic skills, knowledge of medicines, an understanding of the principles of clinical methodology, consecutive risk and uncertainty. In fact, clinicians prescribe in varied situations, often in the absence of patient, and rational prescribing decisions must be based on knowledge interpreted in the light of many other factors. Purpose of the study: Discussion and projection of drug prescribing among patients of both acute and chronic care. The pharmacists have a vital role to play which is thoroughly discussed. Findings: Prescribing is not just a piece giving patient a piece of paper and advising him to follow instructions. Many factors and necessary considerations are lying beneath. Materials and Methods: Research conducted a comprehensive year-round literature search, which included books, technical newsletters, newspapers, journals, and many other sources. Medicine and technical experts, pharma company executives and representatives were interviewed. Projections were based on estimates such as drug end users, providers or prescribers, general theories of rational use, implication and types of different prescribing methods. Research limitations: Very few articles found in matters regarding along with a very less interest paid by general people to talk about medicine use, prescription, pharmacists in counseling therapy, ADRs and their management. It was very difficult to bring out facts of irrational prescribing or different prescribing policy by the providers cause prescription holding patients rarely co-operates in this. Practical Implication: A good prescribing is the soul of patient compliance and safety along with well-being after a period of illness. Along with students, researchers and professionals of different background and disciplines, e.g. Pharmacists, doctors, nurses, hospital authorities, public representatives, policy makers and regulatory…

  • The practice of counseling in Pharmacy: Patients’ perspectives

    Aim: The objective of the study was to assess pharmacists’ counseling practices from the patient perspective using the United States Pharmacopeia (USP) Medication Counseling Behavior Guidelines (MCBG) questionnaire. Methods: This was a cross-sectional study conducted over 4 months in the outpatients section of the pharmacy department in two tertiary care hospitals: King Abdulaziz Medical City, Riyadh, and King Fahad Medical City. Participants were randomly selected to complete the USP-MCBG questionnaire, and gave their full consent to the data collector. USP-MCBG questionnaire is an interactive approach between the patient and the pharmacist, which takes into account the patient’s special needs, beliefs and perceptions about medication use .The questionnaire included 33 items with a two-point response scale. The questionnaire was divided into four sections corresponding to the four stages of the medication counseling process. Results: During the study period, 520 subjects were enrolled and of these, 486 responded to our questionnaire (response rate: 93%). The study population was gender balanced; most respondents (88%) were Saudi nationals, and 49% reported having at least high school education. There were no differences between the socio-demographic profiles of participants at the two study sites. The overall mean USP-MCBG score of satisfaction was 3.18 ± 0.11 (highest score is 5). Within subsections of the questionnaire, ‘Management of treatment’ scored the highest (1.14 ± 0.05) and ‘Communication’ scored the lowest (0.35 ± 0.03). In terms of medication counseling, more than >80% of patients had a positive perception and were satisfied with the performance of outpatient pharmacists. At almost all stages of the counseling process, there was a slightly inversely proportional relationship between patient age and satisfaction with pharmacist performance.Conclusion: Using the USP-MCB guidelines, patients’ perception of and satisfaction with pharmacists counseling in the outpatient setting was positive. Greater effort is needed to ensure effective counseling services in particular…

  • Art (Anti Retroviral Therapy) Induced Buffalo Hump: Case Report

    INTRODUCTION- Anti-retroviral therapy is used for the treatment of patients with HIV. This therapy may also lead to some of the adverse drug reactions among which Zidovudine induced Buffalo Hump is an uncommon adverse drug reaction. CASE REPORT- In this present study a 38 year old women diagnosed with HIV disease in November 2008 and on ZLN therapy. By 2017 December she developed Buffalo Hump in her dorsal cervical area which was not associated with pain and erythema but discomfort is being observed. Patients was suggested for surgical removal of buffalo hump adipose tissue, but she refused to that. Later after six months of follow up the stabilization of fat in cervical region was observed. CONCLUSION- Protease inhibitors induced Buffalo hump is common but Ziduvudine induced Buffalo hump is uncommon. Treatment options include surgical removal of fat and exercise in order to maintain body fat.

  • Assessment of risk factors for diabetic foot ulcer

    Diabetes mellitus is a group of metabolic disorders of fat, carbohydrate, and protein metabolism that results from defects in insulin secretion, insulin action, or both. Ulceration of foot in diabetes is common, clinical presentations are variable and management requires early expert assessment. 73 years old patient, an old case of type 2 diabetes mellitus, smoker and on irregular medical treatment was admitted with history of diabetic feet bilateral. Patient also had foul smelling discharge from left foot and had auto amputation of 2nd to 4th toe left foot due to gangrene. On examination patient was restless. General condition was poor. Local examination of left foot revealed gangrene of heel, sole and auto amputation of 3rd and 4th toe. Right foot had superficial ulcers over dorsum of 2nd and 3rd toe. Patient was investigated and broad spectrum antibiotics started after wound debridement and dressing. Blood sugar levels varied between fasting 150mg% to 1701mg% and post prandial up to 234 mg%. Patient was advised aerobic exercises of upper limbs, diabetic diet and oral hypoglycemic agents and has improved.

  • Self-medication and role of pharmacist in patient education

    Introduction:Pharmacy is the art, science and practice of preparing, preserving, compounding and dispensing of drugs and it also includes modern services related to health care including clinical services, reviewing medications for safety and efficacy, and providing drug information. The pharmacy services provided in India seem to be mainly product-sale focused and traditionally practiced with very minimum or negligible focus on the trending or modern clinical services such as patient education on prescribed medication and also over the counter medications which may be taken by the patient. Therefore, strategies are to be implemented and health system reforms need to be introduced to follow the trending clinical services in order to improve the quality of pharmacy services with the main aim of optimizing the patient care. Objective: Assess self-medication and role of pharmacist in patient education in the Department of Pharmacy, Dr. B.R. Ambedkar Medical College and Hospital, Bengaluru. Methodology: This was a Hospital based observational study, in which data collection was carried out over a period of 6 months from the outpatient pharmacy. Data was collected after obtaining consent from the patients. A self-designed questionnaire for assessing knowledge on self-medication and patient satisfaction were used for data collection. Then follow-up was made to assess improvement in medication adherence. The data collected was then analyzed using suitable statistical methods. Result: A total of 250 patients were enrolled from the patients visiting out-patient pharmacy. Out of which, 60.8% were females and 39.2% were males. Among both genders females (60.80%) showed more interest in participating in our study. The mean age of the study subjects was found to be 37.86±17.99 years. In our study which involved 250 patients, 42% (n=105) were found to be on self-medication. Out of 42%, 17.20% (n=43) were males and 24.80% (n=62) were females. The age group ranging between 40-59years,…

  • Utilization Evaluation of Drugs Used in Dialysis Patients

    You cannot live without having your blood cleaned properly. So, when the kidneys have failed completely, a treatment called dialysis can take over the job of filtering and cleaning the blood. A 67 year’s old male diabetic with End Stage Renal Disease (ESRD) admitted to the hospital with the symptoms of decreased balance, loss of sensation, fear of falling, and decreased endurance during daily activities. In April 2011 due to extreme illness and diagnosed with kidney failure. Patient reports progression of his disease to ESRD in 2016. Patient has been receiving dialysis treatment since ESRD diagnosis 3 days per week.

  • Assessment of Antihypertensives Drug Class in Type 2 Diabetes and It’s Complications

    Background: Hypertension and Diabetes are now serious public and worldwide health challenge as by 2025 it has been estimated that 1.56 billion world population will suffer from hypertension and diabetes is the 8th leading cause of death. Objectives:Primary objective is assessment of antihypertensive drug classes used in type 2 diabetes & it’s complications and Secondary objectives are , is to assess the prescribing pattern of diabetic drugs, and to assess the incidence of complications in diabetes mellitus. Methods & Materials: This was a prospective observational study carried out at Dr. B.R. Ambedkar Medical College and Hospital. Data collection form was prepared and study was carried out in Patients with inclusion criterias after they were briefed about the study and oral consent was obtained from them. Results: 150 patients were included in the study, with females 66.67%. The average age of patients included in the study was 57.97±9.90, belonging to the age group 55-64 years. Out of 150 patients 105 had diabetic complications. Patients with Diabetic Nephropathy CCB 38.71% and the combination of ARB with diuretic 22.58% were prescribed, In patients with cardiovascular diseases they were mostly prescribed with CCB 34.29% followed by Beta-Blockers 20.00%, in patients with cerebrovascular diseases combinations of ARB with Diuretic 30.77% were most prescribed and in diabetic foot CCB 45.83% were prescribed. Managing diabetes, Metformin was the most prescribed as mono-therapy in 24.49% patients and as the combination with Glimepiride was used in 56.46% patients. Conclusion: This study revealed that CCB as monotherapy and ARB with diuretics as dual therapy were the most commonly used agents with diabetic complications like diabetic neuropathy, cardiovascular diseases and diabetic foot. A larger sample size may be necessary to reach a conclusion on the benefits of particular classes of drug in different diabetes complication so as to slower their progression.

  • Case Report on Drug Induced Cushing Syndrome

    Corticoids are 21 carbon compounds having cyclopentanohydrophenanthrene nucleus. They are synthesised in adrenal Cortisol cells in the cholesterol. Corticoids are given exogenously to regulate various body functions like in the maintainenece of fluid electrolyte balance, cardiovascular and energy substrate homeostasis and functional status of skeletal muscles and nervous system.They help withstand body with the outside stimuli and noxious particles and stress during a diseased state. They mimic the action of the body’s Natural hormone Cortisol Taking too much of exogenous Cortisol when given in medication form of gluco-corticosteriod leads to exogenous Cushing syndrome. A condition that occurs from the exposure to high Cortisol levels for a longer period of time. Symptoms of Cushing Syndrome include: Moon face, Slow growth rate in children, Weight gain in fat accumulation, Skin Infection, Thin skin with easy bruising. Lab test conducted to Verify Cushing Syndrome are: Blood Cortisol Levels, Blood sugar levels, Dexamethasone suppression test, 24hr urine Cortisol and Creatinine levels, ACTH stimulation test. OBJECTIVE: To describe a case of Drug induced Cushing syndrome in a 40 year old female patient who was on the treatment of skin rashes under methyl prednisolone continuously for a period of one month.