Drug-related problems and factors influencing acceptance of clinical pharmacologists` alerts in a large cohort of neurology inpatients.
OBJECTIVE
Data regarding the prevalence and types of drug-related problems (DRPs) among neurology inpatients is sparse. The objective of this study was to characterise the types of DRPs seen among neurology inpatients and furthermore to study factors affecting the acceptance of clinical pharmacologists' and pharmacists' recommendations for improving drug safety.


METHODS
1,263 consecutive inpatient cases in a Swiss university hospital neurology unit were assessed for the presence of DRPs over 12 months. Treating neurologists' acceptance of the resulting recommendations was also recorded. Primary outcome measures were types of DRP, recommendations made by clinical pharmacologists and number of recommendations accepted. Factors potentially associated with acceptance were studied using univariate and multivariate generalised estimating equation modelling.


RESULTS
Twenty-nine percent of cases demonstrated one or more DRPs. DRPs were the cause of admission in 10 cases (0.8%). In total 494 DRPs were identified and 467 recommendations given, of which 62% were accepted. Factors associated with an increased likelihood of acceptance were prescriptions involving regularly administered drugs (odds ratio [OR] 2.57 95% confidence interval [CI] 1.73-3.80), adverse drug events (OR 2.5; 95% CI 1.29-5.06), known drug side-effect (OR 1.85; 95% CI 1.06-3.22), high-risk drug-drug interactions (OR 3.22; 95% CI 1.07-9.69) and interventions involving changing a drug (OR 2.71; 95% CI 1.17-6.25).


CONCLUSIONS
Clinical pharmacologists and pharmacists can play an important role in identifying DRPs among neurology inpatients. Their recommendations for optimising medication-safety are most likely to be accepted for regular prescriptions, prescriptions associated with an adverse drug event and high-risk drug combinations.
Department of Clinical Pharmacology and Toxicology, University Hospital Basel, Switzerland. ataegtmeyer@uhbs.ch
Anne B
AB
Taegtmeyer
Ivanka
I
Curkovic
Natascia
N
Corti
Christoph
C
Rosen
Marco
M
Egbring
Stefan
S
Russmann
Andreas R
AR
Gantenbein
Michael
M
Weller
Gerd A
GA
Kullak-Ublick
D015331:Cohort Studies; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions; D055695:Electronic Prescribing; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008505:Medical Staff, Hospital; D008508:Medication Errors / Q000517:prevention & control*; D009422:Nervous System Diseases / Q000188:drug therapy*; D004364:Pharmaceutical Preparations / Q000145:classification; D010601:Pharmacology, Clinical; D017010:Reminder Systems
D004364:Pharmaceutical Preparations