Medication Reviews by a Clinical Pharmacist at an Irish University Teaching Hospital
2.3. Data Collection
2.4. Classification of the PIs
2.5. Assessment of Potential Clinical Harm
2.6. Data Analysis
2.7. Ethical Approval
3.1. Patient Characteristics
3.2. PI Prevalence
3.3. Types of PIs
3.4. Medicine Types Associated with PIs
3.5. Patient Characteristics Associated with PIs
3.6. Potential for Adverse Drug Events
Conflicts of Interest
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|Probability of ADE Occurring||Probability Score||Example|
|No harm expected||0||Pharmacist suggests changing a person from esomeprazole to omeprazole exclusively for economic reasons|
|Very low||0.01||Patient regularly takes a bisphosphonate, but medication omitted from hospital kardex|
|Low||0.1||Patient takes an antibiotic twice daily, when recommended dose would be three times daily|
|Medium||0.4||Metformin dose not reduced despite patient demonstrating renal impairment|
|High||0.6||Patient prescribed amiodarone while taking digoxin without any reduction in digoxin dose|
|Demographic||Description||Patients with PI(s)||Patients with no PI(s)|
|n = 213||n = 1003|
|Gender (n)||Male||80 (37.6%)||458 (45.7%)|
|Female||133 (62.4%)||545 (54.3%)|
|Specialty (n)||Medicine||191 (89.7%)||820 (78.2%)|
|Surgery||22 (10.3%)||229 (21.8%)|
|≥65 years||n = 164 (77.0%)||n = 521 (51.9%)|
|Length of hospital stay (days)||Median||10.4||4.7|
|Type of PI||No. of PIs (%)|
|Co-prescribe same drug class||45 (14.38%)|
|Co-prescribe same drug||42 (13.42%)|
|Poor Prescribing Practice||41 (13.1%)|
|Frequency of administration unclear||24 (7.67%)|
|Dose charted unclear||13 (4.15%)|
|Drug charted unclear||4 (1.28%)|
|Frequency 1||38 (12.14%)|
|More than approved normal frequency||21 (6.71%)|
|Less than approved normal frequency||17 (5.43%)|
|Dose 1||33 (10.54%)|
|More than approved normal dose||25 (7.99%)|
|Less than approved normal dose||8 (2.56%)|
|Interaction 1||32 (10.22%)|
|Timing 1,2||27 (8.63%)|
|Review Therapy||23 (7.35%)|
|Omission 3||12 (3.83%)|
|Other 4||13 (4.15%)|
|Likelihood of an ADE Occurring||Number (%) of PIs 1||Example|
|Zero (no harm expected)||1 (0.32%)||Omeprazole prescribed as a PRN medicine with no doctor‘s signature|
|Very low||11 (3.51%)||Thiamine prescribed 200 mg OD as a regular medicine and two administration times circled|
|Low||111 (35.46%)||Combivent® 2 and Tiotropium both prescribed as regular medicines|
|Medium||169 (53.99%)||Solpadol® 3 II QDS prescribed as a regular medicine and Paracetamol 1 g QDS prescribed as a PRN medicine|
|High||21 (6.71%)||Enoxaparin and Rivaroxaban both prescribed as regular medicines|
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Kearney, A.; Halleran, C.; Walsh, E.; Byrne, D.; Haugh, J.; Sahm, L.J. Medication Reviews by a Clinical Pharmacist at an Irish University Teaching Hospital. Pharmacy 2017, 5, 60. https://doi.org/10.3390/pharmacy5040060
Kearney A, Halleran C, Walsh E, Byrne D, Haugh J, Sahm LJ. Medication Reviews by a Clinical Pharmacist at an Irish University Teaching Hospital. Pharmacy. 2017; 5(4):60. https://doi.org/10.3390/pharmacy5040060Chicago/Turabian Style
Kearney, Alan, Ciaran Halleran, Elaine Walsh, Derina Byrne, Jennifer Haugh, and Laura J. Sahm. 2017. "Medication Reviews by a Clinical Pharmacist at an Irish University Teaching Hospital" Pharmacy 5, no. 4: 60. https://doi.org/10.3390/pharmacy5040060