Professor Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore-570 015. India Mysuru, India
Background: High-risk medications (HRMs) are medications that have a high potential for harm if used improperly or inappropriately. While the special population may require HRMs to manage their conditions, they are also at increased risk of experiencing drug-related problems (DRPs).
Objectives: To determine the rate, pattern, and predictors of DRPs associated with the use of HRMs
Methods: A hospital-based Cohort study was carried out in the departments of general medicine, general surgery, pediatrics, and obstetrics and gynecology for a period of six months. Patients of either gender receiving at least one HRM were included in the study. Institute of Safe Medication Practices (ISMP) list of HRMs was adopted. Eligible patients were reviewed on daily basis and followed till their discharge to identify any DRP occurrence. Predictors for DRP occurrence were evaluated using an odds ratio at a 95% confidence Interval.
Results: A total of 328 eligible patients were identified. A total of 545 DRPs were identified with an incidence of 70.12%. DRPs associated with the use of HRM were found to be 44.22%. The prominent DRP was Drug-Drug Interactions (DDI) [285 (52.22%)] followed by alternate dosage form [68 (12.47%)] and Adverse Drug Reactions (ADR) [52 (9.54%)]. Most of the DDI reported were between a Non-HRM - Non-HRM [107 (37.5%)], followed by an HRM - Non-HRM [56 (19.6%)], and by an HRM - HRM [22 (7.71%)]. Most of the DDI reported were of ‘moderate’ in significance [171(63.5%)]. A total of 52 ADRs were reported among the study cohort, of which [37 (71.15%)] in the geriatric cohort. Insulin-induced hypoglycemia was the most reported ADR [18 (36.61%)]. The causality of most ADRs reported were “probable” [36 (69.2%)]. The severity of most reported ADRs was “Moderate-Level 3". As a corrective measure, the suspected drug in most cases was withdrawn [36 (69.23%], followed by dose alteration [11 (21.15%)]. All the ADRs were uneventful. Cessation of drug [128 (23.4%)] was the most common pharmacist’s intervention, followed by a change in dosage form [65 (11.90%)] and the addition of drug [57 (10.40%)]. Most of the pharmacist’s interventions [365 (66.97%)] were moderate in clinical significance. In 94.1% of the incidence, the clinical pharmacist’s interventions were accepted, however, only 83% resulted in a change of prescription occurred. Hyper-polypharmacy [OR= 1.354; p=0.002], Geriatric population [OR= 2.982; p= 0.012] and use of the HRM [OR= 2.536; p= < 0.001] were found to be significant predictors for DRP occurrence.
Conclusions: The incidence of DRPs associated with the use of HRM was high. By implementing appropriate interventions, healthcare providers can improve medication safety and ultimately improve patient outcomes.
