Authors (including presenting author) :
Cheung WKV(1), Wong KML(1), Tsui WLV(1), Cheng MYG(1), Law KMK(1), Lau SMJ(2)
Affiliation :
(1)Department of Pharmacy, Queen Elizabeth Hospital
(2)Department of Medicine, Queen Elizabeth Hospital
Introduction :
Drug therapy is the mainstay in treating haematological malignancies. Hospitalized patients are especially prone to drug-related problems (DRPs), since treatment can be complicated by fluctuations in clinical status and organ function over the course of hospitalization. Thus, identification of DRPs is the first step to optimize drug therapy and treatment outcome. The incidence of DRP in a haematology ward has been scarcely researched. In 2019, a clinical pharmacy service was launched in Queen Elizabeth Hospital, in which clinical pharmacists followed the progress, reviewed the medication profiles and identified and rectified DRPs in the haematology ward.
Objectives :
This study aimed to identify the incidence, nature and risk factors of DRPs in adult patients with haematological malignancies in a medical haematology ward in a general acute hospital in Hong Kong.
Methodology :
A retrospective study was conducted to collect data from patients with haematological malignancies admitted to the haematology ward in Queen Elizabeth Hospital and whose medication profiles were reviewed by on-site clinical pharmacists, during a 4-month period from December 2019 to March 2020. DRPs were classified by Pharmaceutical Care Network Europe classification system version 8.03. Demographic, clinical variables and drug use patterns were analysed by logistic regression to identify any potential risk factors associated with the incidence of DRPs.
Result & Outcome :
A total of 188 hospitalizations among 107 patients were included in the study and 50 of hospitalizations were identified with at least one DRP. The incidence of DRPs was 26.6% (95% confidence interval 20.4 – 33.5). A total of 58 DRPs were identified during the study period. The most common DRP type was drug choice problem (n = 35, 60.3%), for example omission of usual medications, pre-medications or supportive medications (n = 12, 20.7%), therapeutic duplication when switching antimicrobials (n = 8, 13.8%) and potential drug interaction involving methotrexate and piperacillin-tazobactam (n = 4, 6.90%). Dosing problem accounted for 10.3% of DRPs (n = 6), in which 5 of them involved dose adjustment in changing renal clearance function. More than half of the drugs involved were drugs for infections (42 of 81 drugs, 51.9%), and the most commonly involved were itraconazole, levofloxacin and entecavir (n = 5, 6.25% each). All of pharmacist’s recommendations were accepted by prescriber, 96.6% fully implemented and 3.4% partially implemented. All of the DRPs were totally solved. No statistically significant risk factor was found to be a predictor of DRPs.
To conclude, More than one in four patients with haematological malignancies encountered drug-related problems during hospitalization. It is demonstrated in this study that on-site clinical pharmacists detect drug-related problems over the course of hospitalization and provide prompt recommendations and drug information for prescribers and nurses when needed, thus they have a role in preventing drug-related problems and optimizing drug therapy in medical haematology.
