Analysis of drug-related problems in three departments of a German University hospital.
BACKGROUND
During the last decades, pharmaceutical care services have been developed and implemented to optimize drug therapies and ensure medication safety. To investigate the need for pharmaceutical care services, drug-related problems can be measured.


OBJECTIVE
Thus, the aim of this study was to analyse number, type and occurrence of drug-related problems in different clinical departments.


METHODS
A pharmaceutical care service was established on general wards in Urology, Neurology and Gastroenterology at the University Hospital RWTH Aachen, Germany.


METHODS
For each of a total of 306 patients, a pharmacist conducted an extended medication history, performed medication reconciliation, conducted medication safety checks and if drug-related problems were discovered, gave valid recommendations to the attending healthcare team. Drug-related problems were classified using the APS-Doc system. For statistical analyses, SAS(®) 9.1.3, SAS Institute, Cary NC, USA was applied. The project was approved by the local ethics committee.


METHODS
Type, occurrence and frequency of DRP in different medical departments.


RESULTS
On average, 2.3 drug-related problems per patient were documented for all three departments. Drug-related problems were found in each category of the APS-Doc system. The most pronounced drug-related problems found were drug-drug interactions (34.6 %). 37 % of the identified drug-related problems occurred before hospital admission, 27 % during transitional care, and 36 % on the ward. Subgroup analysis revealed specific drug-related problem patterns for each clinical department. The number of drug-related problems was found to be associated with the number of drugs and age.


CONCLUSIONS
Drug-related problems frequently occur in all investigated clinical departments. A holistic pharmaceutical care service could be an option to address this issue. In case of limited resources, individual drug-related problem patterns can be used as a basis for a tailored pharmaceutical care service. As number of drugs and age have been shown to be significant risk factors, it is crucial that the healthcare team including the pharmacist pays special attention to elderly patients and those with polymedication.
Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany. rlenssen@ukaachen.de.|Department of Urology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany. rlenssen@ukaachen.de.|Institute of Pharmacy, Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany. rlenssen@ukaachen.de.
Rebekka
R
Lenssen
Department of Urology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
Axel
A
Heidenreich
Department of Neurology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
Jörg B
JB
Schulz
Department of Internal Medicine III, Gastroenterology, Metabolic Disorders and Internal Intensive Medicine, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
Christian
C
Trautwein
Department of Medical Statistics, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
Christina
C
Fitzner
Institute of Pharmacy, Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany.
Ulrich
U
Jaehde
Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany.
Albrecht
A
Eisert
D016907:Adverse Drug Reaction Reporting Systems; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005762:Gastroenterology; D005858:Germany / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D033183:Interdisciplinary Communication; D008297:Male; D059065:Medication Reconciliation; D054539:Medication Therapy Management; D008875:Middle Aged; D009462:Neurology; D010348:Patient Care Team; D061214:Patient Safety; D010607:Pharmacy Service, Hospital; D019338:Polypharmacy; D018570:Risk Assessment; D012307:Risk Factors; D014573:Urology Department, Hospital
Drug-related problems; Gastroenterology; Germany; Medication safety; Neurology; Pharmaceutical care; Urology; Ward-based pharmacist