Het Nederlands Platform voor Farmaceutisch Onderzoek (NPFO) presenteert onderzoek in de farmaceutische wetenschappen. De nadruk ligt op klinische toepassing zoals medicatieveiligheid, patiëntenzorg, formulering, analyse, farmacologie en casuïstiek.
The effect of a Geriatric Stewardship on drug-related problems after hospital discharge
OBJECTIVE
To assess the effect of a Geriatric Stewardship on drug-related problems (DRPs) reported by patients after discharge.
DESIGN
An implementation study (pre-post design).
METHODS
Hospitalized patients aged ≥ 65 years with polypharmacy and a risk factor for frailty were included from February 2017 until August 2018. The pre-group received usual care (control: no medication review). The post-group received the Geriatric Stewardship intervention. This consisted of an extended medication review based on a (1) review of the medication list and clinical records to draft initial recommendations, (2) consultation with the general practitioner and community pharmacist to discuss the hospital based recommendations, (3) patient interview to assess patient needs, and (4) multidisciplinary evaluation of all the previous steps by a hospital pharmacist and a geriatrician to draft final recommendations.
Two weeks post-discharge, patient-reported DRPs were assessed by telephone using a validated questionnaire. DRPs were classified into: drug-related complaints, practical problems, and questions about medication. The primary outcome was the number and type of DRPs per patient.. Secondary, in the intervention group the number of initial recommendations that were altered after consultations with PCPs and patient interviews was assessed. A poisson regression was used to compare the groups on the primary outcome.
RESULTS
In total, 127 patients were analyzed (control: 74, intervention: 53). Intervention patients reported fewer DRPs compared to control, 2.8 versus 3.3 per patient (RRadjusted = 0.83, 95% CI = 0.66-1.05). The difference was due to a halving in drug-related complaints (P < 0.05). Nearly 30% of the initial recommendations based on the patient’s medication list and clinical records were discarded or modified after consultations with primary care providers and patient interviews.
CONCLUSION
The implementation of a Geriatric Stewardship tends to reduce DRPs after discharge, which provides a good indication for further research. One in three initial medication review recommendations were altered due to PCPs and patient input. This shows that medication reviews should not be based on clinical records only. Patient participation and consultations with primary care providers contributes to a medication review that is tailored to the patient’s individual preferences and medical history.
Effect of a clinical decision support system on reducing drug-drug interactions in the intensive care unit
BACKGROUND
Patients in the intensive care unit (ICU) are at a higher risk of medication-related harm due to potential drug-drug interactions (DDIs). This increased risk is related to the high number of drugs administered. Clinical decision support systems (CDSSs) have the potential to reduce potential DDIs (pDDIs) and improve medication safety.
OBJECTIVE
To evaluate the effect of a CDSS on the incidence of serious pDDIs in the ICU of an academic hospital.
DESIGN and METHODS
This study was conducted at the ICU department of the Amsterdam UMC (location AMC) in the Netherlands. Interrupted time series analysis was used to evaluate the effect of a CDSS. This CDSS generated pDDI alerts during prescribing. Data on medication administrations, pDDIs and pDDI alerts were gathered a year before and a year after implementation of the CDSS from April 2011 till April 2013. The primary outcome was the rate of serious pDDIs per 100 medication administrations. Secondary outcomes were the proportions of overridden pDDI alerts and monitoring actions related to pDDI alerts.
RESULTS
In total 2711 patients having 58.455 drugs administered were included. The rate of serious pDDIs did not significantly change after CDSS implementation (P = 0,098). The mean proportion of overridden pDDI alerts was high: 97% (total: 11.592 alerts). The mean proportion of pDDI alerts followed by a monitoring action varied between alert types (5,8-44,9%).
CONCLUSION
The implementation of a CDSS did not result in a decrease of serious pDDIs at the ICU. Lack of agreement on which pDDIs are clinically relevant for the ICU may explain our findings, since almost all alerts were overridden. Future research should focus on identifying which pDDIs are important in the ICU setting.
Optimal analgesia after laparoscopic segmental colon resections with a focus on intrathecal morphine
BACKGROUND
Analgesia after laparoscopic segmental colon resections remains controversial. Epidural analgesia and systemic opioids per patient-controlled analgesia (PCA) are commonly used methods of analgesia in The Netherlands. A promising method of analgesia is intrathecal morphine because its analgesic properties fit the pain after laparoscopic surgery.
METHODS and RESULTS
Recently, a Dutch randomized controlled trial showed an enhanced recovery with intrathecal morphine when compared to an intravenous loading dose and a PCA pump of piritramide. Furthermore, the patients reported lower pain scores in the intrathecal morphine group. Still, the side effects warrant prophylactic measures for pruritus, nausea and vomiting. Late respiratory depression does not occur when a low dose (< 500 µg) is used and no concomitant sedatives are administered. If one adopts this analgesic technique, one should be cautious of the administered concentration since dilution could lead to dosing errors.