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Abstract Background Since December 2010, a nationwide real-time medication surveillance program has been implemented in Korea to prevent potential adverse drug reactions. Our goal was to evaluate physicians’ and pharmacists’ satisfaction and clinical needs for the medication surveillance program in Korea. Methods Both web- and paper-based surveys were conducted using a structured questionnaire among 1164 physicians and pharmacists from May 23, 2014 to August 11, 2014. The survey consisted of questions about the participant’s satisfaction with the medication surveillance program, clinical usefulness, clinical need for the medication surveillance program, and sociodemographic characteristics. Multivariate ordinal logistic regression was performed to investigate the factors influencing satisfaction levels with the medication surveillance program. Results We analyzed data from 1120 respondents, including 503 physicians and 617 pharmacists. Overall, 63.1% of the respondents were satisfied with the medication surveillance program. Pharmacists were more satisfied with the program than were physicians (69.1% vs. 55.6%; adjusted odds ratio, 2.13; 95% confidence interval, 1.65–2.76). Among the respondents, 77.8% cited a decrease in therapeutic duplication to be a major improvement resulting from the medication surveillance program, 82.6% considered the drug–drug interaction information useful, and 48.7% suggested that the program should include information on liver or kidney disease–drug interaction. Conclusions Overall, 63.0% of physicians and pharmacists were satisfied, and a decrease in therapeutic duplication was regarded as the most beneficial component. Further improvements by considering clinical needs of physicians and pharmacists will be needed to increase satisfaction.

Abstract Background To improve medication surveillance and provide pharmacotherapeutic support in University Hospitals Leuven, a back-office clinical service, called “Check of Medication Appropriateness” (CMA), was developed, consisting of clinical rule based screening for medication inappropriateness. The aim of this study is twofold: 1) describing the development of CMA and 2) evaluating the preliminary results, more specifically the number of clinical rule alerts, number of actions on the alerts and acceptance rate by physicians. Methods CMA focuses on patients at risk for potentially inappropriate medication and involves the daily checking by a pharmacist of high-risk prescriptions generated by advanced clinical rules integrating patient specific characteristics with details on medication. Pharmacists’ actions are performed by adding an electronic note in the patients’ medical record or by contacting the physician by phone. A retrospective observational study was performed to evaluate the primary outcomes during an 18-month study period. Results 39,481 clinical rule alerts were checked by pharmacists for which 2568 (7%) electronic notes were sent and 637 (1.6%) phone calls were performed. 37,782 (96%) alerts were checked within four pharmacotherapeutic categories: drug use in renal insufficiency (25%), QTc interval prolonging drugs (11%), drugs with a restricted indication or dosing (14%) and overruled very severe drug-drug interactions (50%). The emergency department was a frequently involved ward and anticoagulants are the drug class for which actions are most frequently carried out. From the 458 actions performed for the four abovementioned categories, 69% were accepted by physicians. Conclusions These results demonstrate the added value of CMA to support medication surveillance in synergy with already integrated basic clinical decision support and bedside clinical pharmacy. Otherwise, the study also highlighted a number of limitations, allowing improvement of the service.

Background Lung cancer patients have a high risk for drug–drug interactions, as they use numerous types of concomitant medicines including antineoplastic agents, cancer treatment co-medication, and medicines aimed at several types of comorbidities. Objective The primary objective of this study is to determine the incidence and the clinical relevance of the drug–drug interactions between antineoplastic agents and regular medication used by lung cancer patients. Secondary objectives are (i) to determine the effectiveness of the medication review by the hospital pharmacists concerned, (ii) to establish which patients are most at risk of drug–drug interactions and (iii) to determine whether physicians comply with advice given by hospital pharmacists. Setting This prospective study was undertaken in a Dutch hospital pharmacy, at Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam. Methods All lung cancer patients receiving one or more cytotoxic agents during the period 21 June 2010 till 2 December 2014 at OLVG were included. The medication list of the patients was obtained electronically from the community pharmacy and checked for interactions by a hospital pharmacist. Interactions that required intervention according to the national database were the only ones taken into account. Interventions were recorded in the patients’ electronic charts. All medication reviews were cross-checked and analyzed by an independent pharmacist at the end of the study period. Main outcome measure Prevalence and clinical relevance of drug–drug interactions between antineoplastic agents and other types of medication in lung cancer patients. Results A total of 298 lung cancer patients were included in this study. In 53 patients (18%), a total of 73 interactions with potential clinical relevance were found. The most frequent interaction was between cytostatics and coumarins while the most relevant one was between cisplatin and furosemide. According to statistical analysis, gender as well as the number of drugs prescribed were significant predictors for drug–drug interactions. Eighty-four percent of the interactions were discovered by pharmacists during daily routine. In 92% of the cases, the pulmonary physicians complied with the advice of the pharmacist. Conclusion Eighteen percent of lung cancer patients treated with cytotoxic therapy had one or more relevant drug–drug interactions. This study shows that medication surveillance by a hospital pharmacist is necessary to prevent possible negative drug–drug interactions. Further research should focus on the clinical outcome of the interactions as well as on interactions between cytostatics and alternative medicines and/or over-the-counter medicines. [ABSTRACT FROM AUTHOR]

Background Hospital pharmacists and pharmacy technicians play a major role in detecting prescribing errors by medication surveillance. At present the frequency of detected and correctly handled prescribing errors is unclear, as are factors associated with correct handling. Objective To examine the frequency of detection of prescribing errors and the frequency of correct handling, as well as factors associated with correct handling of prescribing errors by hospital pharmacists and pharmacy technicians. Setting This study was conducted in 57 Dutch hospital pharmacies. Method Prospective observational study with test patients, using a case–control design to identify factors associated with correct handling. A questionnaire was used to collect the potential factors. Test patients containing prescribing errors were developed by an expert panel of hospital pharmacists (a total of 40 errors in nine medication records divided among three test patients; each test patient was used in 3 rounds; on average 4.5 prescribing error per patient per round). Prescribing errors were defined as dosing errors or therapeutic errors (contra-indication, drug–drug interaction, (pseudo)duplicate medication). The errors were selected on relevance and unequivocalness. The panel also defined how the errors should be handled in practice using national guidelines and this was defined as ‘correct handling’. The test patients had to be treated as real patients while conducting medication surveillance. The pharmacists and technicians were asked to report detected errors to the investigator. Main outcome measure The percentages of detected and correctly handled prescribing errors were the main outcome measures. Factors associated with correct handling were determined, using multivariate logistic regression analysis. Results Fifty-nine percent of the total number of intentionally added prescribing errors were detected and 57 % were handled correctly by the hospital pharmacists and technicians. The use of a computer system for medication surveillance compared to no computer system was independently associated with correct handling [odds ratio (OR) 15.39 (95 % confidence interval (CI) 3.62–65.50] for computerized physician order entry system; OR 15.40 (95 % CI 3.61–65.70) for order entry by pharmacy technicians), but because the reference category contained only one hospital these results can’t be interpreted. Furthermore, manual screening of dosages in children with or without computerized surveillance compared to no dosage checks for children [OR 2.02 (95 % CI 1.06–3.84)], qualified pharmacy technicians compared to no qualified pharmacy technicians [OR 1.32 (95 % CI 1.03–1.67)] and pharmacy technicians using protocols compared to ones not using protocols [OR 1.30 (95 % CI 1.04–1.61)] were independently associated with correct handling. Conclusion This study showed that the quality of medication surveillance in Dutch hospital pharmacies can be subject to improvement and the identified factors may give direction to such improvements. [ABSTRACT FROM AUTHOR]

Background Medication surveillance is not commonly performed for cytotoxic agents. Cytotoxic agents generally have a narrow therapeutic range and therefore it might be necessary to adjust the dose. Interactions may not only cause supratherapeutic ranges, but can also lead to subtherapeutic levels. Up till now, only a few studies have demonstrated the value and importance of medication surveillance in ambulatory cancer patients. Objective The objective of this study is to determine the prevalence and relevance of interactions with cytotoxic agents in ambulant cancer patients receiving one or more intravenous cytotoxic administrations. Setting This retrospective study was undertaken in the Orbis Medical Centre in Sittard, the Netherlands. Methods All ambulatory cancer patients receiving one or more intravenous cytotoxic treatments during the period October 2008 to April 2010 were included. Cytotoxic agent related information was determined using the hospital information system and medication history was determined using the Electronic Prescribing System (EPS) and an open care information system. Medication was entered into the EPS and medication surveillance was performed electronically using the G-standard. All alerts were generated retrospectively. Main outcome measure The prevalence and relevance of interactions between cytotoxic agents and other drugs in ambulatory cancer patients. Results A total of 527 ambulatory cancer patients was enrolled. The mean age of the patients was 63.6 years and 303 were female (55 %). In 24 patients a total of 58 cytotoxic agent-related interactions was detected of whom five were clinically relevant. The most frequent cytotoxic agent-related interaction was with acenocoumarol; the most relevant interactions were with antiepileptic drugs. Conclusion A total of 58 potential cytotoxic agent-related interactions was found. This corresponds to 11 cytotoxic agent-related interactions per 100 ambulatory cancer patients, of which one was indicated clinically relevant and should have required an intervention. The most frequently involved drug was acenocoumarol. Most drug-related interactions with cytotoxic agents are manageable and can be monitored. Prospective studies are needed to confirm the relevance of medication surveillance on cytotoxic agents. [ABSTRACT FROM AUTHOR]

This article reviews the implementation of patient education as a new task in Dutch Community pharmacy. A search of the literature, including ‘grey’ (not-scientific) literature was done to find indications for the implementation of patient education. The little data available show that patient education activities are not carried out as a routine task and are therefore not implemented, despite the development of interventions on educational and pharmacy practice level. In addition, barriers were found that relate to the organisation of patient education. More sound research is necessary on criteria for implementation, on the level and amount of communication with clients and on the experienced barriers for organising and practising patient education. The opportunities for designing an intervention on the organisational level should be assessed. [Copyright &y& Elsevier]

Aim of study: The role of pharmacists in today's healthcare is changing rapidly. As they are close to the prescribing process, pharmacists are in the position to identify and adjust prescribing errors before dispensing. The objective of this study was to identify relevant determinants of interventions directly linked to prescription processing in community pharmacy. Methods: As part of a yearly continuing education programme, all community pharmacies in the region of 'Zeeland' (N=23) in the south west of The Netherlands kept detailed records of all interventions directly linked to prescription processing during one week in May 1998. For every patient involved in an intervention, a control patient was matched on pharmacy practice, date, gender and age. Results: A total of 39,357 prescriptions were evaluated by the 23 pharmacies during the one week intervention programme. Out of these, one out of 10 resulted into an intervention. Being a first prescription in a new treatment episode was found to be a significant determinant (OR 1.75, 95 CI% 1.18 2.33). Variables reflecting drug therapy complexity (> 3 prescribers, > 15 prescriptions in 3 months before, > 3 different medications) showed all ORs higher than 1.00, but not significant. When looking at the individual drug categories, anti infectives, respiratory drugs and cardiovascular medicines came out as important drug classes for intervention risk. We could not find any association between the number of signals per pharmacy and the number of interventions. Conclusion: The 'whistle blower' model of pharmacy based interventions is a valid one but needs a targeted and integral way of implemented thinking and use of information technology. In such an environment, interventions are a logical step of in process quality control in the drug usage system. [ABSTRACT FROM AUTHOR]

This article tries to develop an ethical reasoning that can be applied to (the practice of) pharmacy. Only general principles, based on accepted values in western society, lead to guidelines for ethical behaviour. Such essential values are personal autonomy, democracy and solidarity.The principle of nonmaleficence can be derived from these. Results of this analysis can be applied to health care and pharmacy practice. Subchapters deal with questions such as budget limitations and the autonomy of the patient versus that of the care provider. It concludes that protocols are important tools for ethical behaviour in every day practice. The ethical problem appears to be the unequal access to the health care system.An analysis of pharmaceutical care in the light of ethics can help to formulate the pharmacist's responsibilities. The principle of nonmaleficence is strongly connected to the pharmacy profession. Pharmacists should focus more on possible negative outcomes of pharmacotherapy. Monitoring the patient's medication, identification and prevention of possible adverse effects, medication surveillance, proper communication and information about the use of medicines are therefore priority items within our profession. A definition of target groups for pharmaceutical care will facilitate this task.A suggestion for a general code of ethics for pharmacists is proposed and compared with the code of ethics as currently accepted by the International Pharmaceutical Federation (FIP) council. [ABSTRACT FROM AUTHOR]

Background: To improve medication surveillance and provide pharmacotherapeutic support in University Hospitals Leuven, a back-office clinical service, called "Check of Medication Appropriateness" (CMA), was developed, consisting of clinical rule based screening for medication inappropriateness. The aim of this study is twofold: 1) describing the development of CMA and 2) evaluating the preliminary results, more specifically the number of clinical rule alerts, number of actions on the alerts and acceptance rate by physicians.Methods: CMA focuses on patients at risk for potentially inappropriate medication and involves the daily checking by a pharmacist of high-risk prescriptions generated by advanced clinical rules integrating patient specific characteristics with details on medication. Pharmacists' actions are performed by adding an electronic note in the patients' medical record or by contacting the physician by phone. A retrospective observational study was performed to evaluate the primary outcomes during an 18-month study period.Results: 39,481 clinical rule alerts were checked by pharmacists for which 2568 (7%) electronic notes were sent and 637 (1.6%) phone calls were performed. 37,782 (96%) alerts were checked within four pharmacotherapeutic categories: drug use in renal insufficiency (25%), QTc interval prolonging drugs (11%), drugs with a restricted indication or dosing (14%) and overruled very severe drug-drug interactions (50%). The emergency department was a frequently involved ward and anticoagulants are the drug class for which actions are most frequently carried out. From the 458 actions performed for the four abovementioned categories, 69% were accepted by physicians.Conclusions: These results demonstrate the added value of CMA to support medication surveillance in synergy with already integrated basic clinical decision support and bedside clinical pharmacy. Otherwise, the study also highlighted a number of limitations, allowing improvement of the service. [ABSTRACT FROM AUTHOR]