International journal of clinical pharmacy
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Observational Study
Interdisciplinary collaboration in the provision of a pharmacist-led discharge medication reconciliation service at an Irish teaching hospital.
Medication reconciliation is a basic principle of good medicines management. With the establishment of the National Acute Medicines Programme in Ireland, medication reconciliation has been mandated for all patients at all transitions of care. The clinical pharmacist is widely credited as the healthcare professional that plays the most critical role in the provision of medication reconciliation services. ⋯ This study demonstrates how interdisciplinary collaboration, between the clinical pharmacist and hospital doctor, can improve the completeness and accuracy of discharge prescriptions through the provision of a pharmacist led discharge medication reconciliation service at an Irish teaching hospital.
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Observational Study
Drug-related problems in institutionalized, polymedicated elderly patients: opportunities for pharmacist intervention.
An aging population and the increasing prevalence of chronic diseases have led to the increased use of medicines. Portugal is one of the European countries where more medicines are consumed and the associated expense is higher. Medicines are associated with enormous health benefits but also with the potential to cause illness and death. A drug related problem (DRP) is an "an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes". In the U.S., they represent the 4th-6th leading cause of death and have an estimated cost of 130 billion dollars. Moreover, many of these DRP can be avoided. Elderly are at increased risk of DRP due to multiple factors: pluripathology and consequent polypharmacy, complex dosing regimens, pharmacokinetic/pharmacodynamic and functional/cognitive changes. Therefore, this population would be the one who would benefit most from the prevention, detection and control of DRP. The role of the pharmacist as an integral element of health care has been recognized by various international and European organizations. Providing pharmaceutical care as a patient-centered activity, focusing on their needs related to pharmacotherapy, contributes to guarantee that drug expenditure is a good investment, with benefits that outweigh potential risks. ⋯ These results reinforce the need for the implementation of pharmaceutical care services to institutionalized elderly, necessary to improve medicines efficacy and safety, better clinical outcomes and cost reduction.
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Observational Study
Role of an electronic antimicrobial alert system in intensive care in dosing errors and pharmacist workload.
Critically ill patients are vulnerable to dosing errors. We developed an electronic Antimicrobial Dose alert based upon Creatinine clearance (ADC-alert), which gives daily antimicrobial dosing advice based upon the 24-h creatinine clearance (CLcr). ⋯ We developed and evaluated an electronic alert system to generate dynamic antimicrobial dose adaptation based on the daily calculation of the 24-h CLcr of ICU patients. Its use led to substantial time savings for clinical pharmacists. However, the alert advice suffered from some developmental and other flaws. Despite resolving some of these shortcomings, bedside interpretation of the results and clinical judgement remain necessary.