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Pharmacy
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Medication Use and Patient Safety in Clinical Pharmacy
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Medication Use and Patient Safety in Clinical Pharmacy

A special issue of Pharmacy (ISSN 2226-4787). This special issue belongs to the section "Pharmacy Practice and Practice-Based Research".

Deadline for manuscript submissions: 1 December 2024 | Viewed by 24256

Special Issue Editors

Dr. Mohammed Salahudeen

E-Mail Website
Guest Editor
School of Pharmacy and Pharmacology, University of Tasmania, Private Bag 26, Hobart, TAS 7001, Australia
Interests: geriatric pharmacoepidemiology; dementia; anticholinergic science; evidence-based medicine; quality use of medicines and medication safety
Dr. Daniel Hoyle

E-Mail Website
Guest Editor
School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7005, Australia
Interests: clinical pharmacy; outcomes; pharmacy and pharmacology

Special Issue Information

Dear Colleagues,

The use of medication is a crucial aspect of clinical pharmacy practice, as it is one of the primary ways in which pharmacists contribute to patient care. However, medication use is not without risks, and errors in prescribing, dispensing, and administration can have serious consequences for patient safety.

In recent years, there has been a growing emphasis on improving medication safety in clinical pharmacy practice. This has led to the development of various strategies and tools that aim to minimise the risk of medication errors and adverse drug events. Preventing inappropriate medication use and associated adverse effects is important in the improvement of the health and well-being of patients, especially the elderly.

This Special Issue will consider articles showing the latest research and developments in medication use and patient safety in clinical pharmacy, such as the impact of pharmacist-led interventions on medication-related problems, the role of guideline and clinical decision support systems in improving medication safety, quality use of medicine including high-risk medicines and the challenges and opportunities of implementing medication management programs in various populations. We look forward to your contributions in the form of original research articles, short communication, reviews, case reports or study protocol.

Dr. Mohammed Salahudeen
Dr. Daniel Hoyle
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmacy is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • quality use of medicine
  • medication safety
  • adverse drug event
  • medication error
  • clinical pharmacy
  • adverse drug reaction
  • electronic medication management
  • high-risk medicines
  • medication reconciliation
  • medication-related problems

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Published Papers (10 papers)

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Research

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12 pages, 464 KiB  
Article
Attitudes and Experiences of Patients Regarding Gender-Specific Aspects of Pain Management
by Carolin Alexandra Boldt, Dirk Keiner, Norman Best and Thilo Bertsche
Pharmacy 2024, 12(6), 175; https://doi.org/10.3390/pharmacy12060175 - 22 Nov 2024
Viewed by 248
Abstract
Background: Biological, pharmacological, and socio-cultural aspects influence gender-specific effects in pain management. Methods: Gender-specific aspects of pain management were assessed in a rural outpatient center via semi-structured patient interview: (i) general gender aspects (total population) from 1 = “fully disagree” to 5 = [...] Read more.
Background: Biological, pharmacological, and socio-cultural aspects influence gender-specific effects in pain management. Methods: Gender-specific aspects of pain management were assessed in a rural outpatient center via semi-structured patient interview: (i) general gender aspects (total population) from 1 = “fully disagree” to 5 = “fully agree”; and (ii) individual pain (matched pairs) via numeric analog scale (NAS) from 0 = “no pain” to 10 = “maximum pain”. Patient charts were assessed for pain management (WHO-ladder). Results: In total, 113 patients were enrolled (59.18 [SD: 12.76] years, 46% female, 54% male, 0% diverse), and 42 were matched into female-male pairs. (i) Women and men agreed that men and women should be treated equally despite biological differences (median: 5 [women] vs. 5 [men]; p = 0.789). As a reason for gender-specific aspects, “medication concentration” was reported more frequently by women (p = 0.038) and “no answer” by men (p = 0.014). (ii) Mean value (SD) of pain (NAS) was 4.0 (SD 2.3) for women and 3.3 (SD 2.6) for men (p = 0.215) with a positive correlation between pain management escalation (WHO-ladder) and the pain score (NAS) only in men (r = 0.704, p = 0.001). Women rather reported an influence of adverse drug reactions on treatment contentment than men (p = 0.042). Conclusions: Although patients pleaded for gender-independent equal treatment, gender-specific differences in pain therapy were found. Full article
(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)
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11 pages, 586 KiB  
Article
The Dispensing Error Rate in an App-Based, Semaglutide-Supported Weight-Loss Service: A Retrospective Cohort Study
by Louis Talay and Matt Vickers
Pharmacy 2024, 12(5), 135; https://doi.org/10.3390/pharmacy12050135 - 3 Sep 2024
Cited by 1 | Viewed by 1113
Abstract
Digital weight-loss services (DWLSs) combining pharmacotherapy and health coaching have the potential to make a major contribution to the global struggle against obesity. However, the degree to which DWLSs compromise patient safety through the dispensation of Glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications [...] Read more.
Digital weight-loss services (DWLSs) combining pharmacotherapy and health coaching have the potential to make a major contribution to the global struggle against obesity. However, the degree to which DWLSs compromise patient safety through the dispensation of Glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications is unknown. This study retrospectively analysed the rate at which patients reported GLP-1 RA dispensing errors from patient-selected and partner pharmacies of Australia’s largest DWLS provider over a six-month period. The analysis found that 99 (0.35%) of the 28,165 dispensed semaglutide orders contained an error. Incorrect dose (58.6%) and unreasonable medication expiry window (21.2%) were the two most common error types. Most errors (84.9%) were deemed to have been of medium urgency, with 11.1% being considered high-urgency errors. Incorrect doses (45.5%) and supplies of the wrong medication (36.3%) comprised most errors reported in high-urgency cases. Female patients reported more dispensing errors than male patients (0.41% vs. 0.12%, p < 0.001). Similarly, reported dispensing error rates were highest among patients aged 18 to 29 years (0.6%) and 30 to 39 years (0.5%). This research provides preliminary evidence that GLP-1 RA dispensing errors within comprehensive Australian DWLSs are relatively low. Full article
(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)
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13 pages, 1013 KiB  
Article
Risk Characterization in Patients Using Benzodiazepines While Providing Pharmaceutical Care Dispensing Service
by Daida Alberto Armas, Verónica Hernández García, Yanira Román Castillo, Juan Ramón Santana Ayala, Franc Capdevila Finestres, Arturo Hardisson de la Torre and Carmen Rubio Armendáriz
Pharmacy 2024, 12(4), 120; https://doi.org/10.3390/pharmacy12040120 - 31 Jul 2024
Cited by 1 | Viewed by 1458
Abstract
Background: Tolerance and dependence stand out as the most relevant risks observed during benzodiazepine (BZD) treatments. Objectives: To evaluate the degree of dependence of patients on BZD treatments using the Tyrer test; to define a profile of patients at risk of developing BZD [...] Read more.
Background: Tolerance and dependence stand out as the most relevant risks observed during benzodiazepine (BZD) treatments. Objectives: To evaluate the degree of dependence of patients on BZD treatments using the Tyrer test; to define a profile of patients at risk of developing BZD dependence; and to discuss the role of the pharmaceutical care offered by the community pharmacy during dispensing. Methods: Prospective cross-sectional descriptive observational study (August 2020–February 2021) involving 127 patients using BZD. They voluntarily answered a questionnaire during the dispensing pharmaceutical care service. The study was evaluated and codified (code: DAA-CLO-2020-01) by the Spanish Agency for Drugs and Health Products (AEMPS), and statistical analysis was performed with SPSS 25.0. Results: 19.05% of patients using BZD were suspected of suffering from BZD tolerance, and 77.88% of all patients were identified as being at a high risk of BZD dependence. The Tyrer test for dependence indicated a mean score of 5.59 out of 13 points. An 18-fold increased risk of developing dependence was detected in the case of coexistence of high anxiety or depression. Conclusions: The community pharmacy, through protocolized care practices and supported by tools such as the Tyrer test, can play a decisive role in the detection, prevention, and resolution of the risks associated with BZD treatments. Full article
(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)
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11 pages, 1155 KiB  
Article
Evaluation of Steroid-Induced Osteoporosis Prevention Using Tracing Reports in Collaboration between Hospitals and Community Pharmacists
by Nonoko Ishihara, Shuji Yamashita, Shizuno Seiki, Keito Tsutsui, Hiroko Kato-Hayashi, Shuji Sakurai, Kyoko Niwa, Takuyoshi Kawai, Junko Kai, Akio Suzuki and Hideki Hayashi
Pharmacy 2024, 12(3), 80; https://doi.org/10.3390/pharmacy12030080 - 15 May 2024
Viewed by 1302
Abstract
Glucocorticoid-induced osteoporosis (GIOP) is a side effect of glucocorticoid (GC) treatment; however, despite established prevention guidelines in various countries, a gap persists between these guidelines and clinical practice. To address this gap, we implemented a collaborative intervention between hospitals and community pharmacists, aiming [...] Read more.
Glucocorticoid-induced osteoporosis (GIOP) is a side effect of glucocorticoid (GC) treatment; however, despite established prevention guidelines in various countries, a gap persists between these guidelines and clinical practice. To address this gap, we implemented a collaborative intervention between hospitals and community pharmacists, aiming to assess its effectiveness. Pharmacists recommended to the prescribing doctor osteoporosis treatment for patients who did not undergo osteoporosis treatment with a fracture risk score of ≥3 via tracing reports (TRs), between 15 December 2021, and 21 January 2022. Data were extracted from electronic medical records, including prescriptions, concomitant medications, reasons for not pursuing osteoporosis treatment, and TR contents. Of 391 evaluated patients, 45 were eligible for TRs, with 34 (75.6%) being males. Prednisolone was the most common GCs administered, and urology was the predominant treatment department. Among the 45 patients who received TRs, prescription suggestions were accepted for 19 (42.2%). After undertaking the intervention, guideline adherence significantly increased from 87% to 92.5%. This improvement indicates that TRs effectively bridged the evidence–practice gap in GIOP prevention among GC patients, suggesting their potential utility. Expansion of this initiative is warranted to further prevent GIOP. Full article
(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)
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13 pages, 1714 KiB  
Article
Irrational Use of Medications among Adults with Insomnia: An Observational Study at a Sleep Clinic in Mexico
by Lucelya Carvalho-Silva, Ulises Jiménez-Correa, Rafael Santana-Miranda, Ivo Heyerdahl-Viau, Jonatan Benitez-Morales, Mireya García-Casas and Juan Manuel Martínez-Núñez
Pharmacy 2024, 12(2), 56; https://doi.org/10.3390/pharmacy12020056 - 27 Mar 2024
Viewed by 1897
Abstract
Background: To determine the patterns of irrational use of medications among a sample of adult patients with insomnia. Methods: We included 89 adult patients diagnosed with chronic insomnia who had consumed medications for this disorder during the 12 months prior to admission to [...] Read more.
Background: To determine the patterns of irrational use of medications among a sample of adult patients with insomnia. Methods: We included 89 adult patients diagnosed with chronic insomnia who had consumed medications for this disorder during the 12 months prior to admission to a specialized Sleep Disorders Clinic (SDC) in Mexico City. With a 13-item survey, information was gathered on patterns of medication use and irrational use, considering therapeutic indications, dose, route of administration, and duration of treatment. Results: The participants had taken hypnotics (65%), antidepressants (21%), anticonvulsants (8%), and antipsychotics (6%), and 92% had irrational use of their medication. Irrational use was greatest with benzodiazepines and antipsychotics. There were two main types of irrational use: (1) 47% of participants had consumed a drug unsuitable for their condition, although it was almost always prescribed by a doctor, and (2) 43% had consumed a drug for longer than the maximum time recommended. Conclusion: It is worrisome to find that the irrational use of medications to treat insomnia, especially benzodiazepines and antipsychotics is widespread. Although most participants had acquired their medication by prescription, for many the drug was inappropriate to treat their condition. It should be mandatory that patients with insomnia receive specialized medical attention in primary clinical care. Full article
(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)
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Review

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19 pages, 1616 KiB  
Review
Nexus of Quality Use of Medicines, Pharmacists’ Activities, and the Emergency Department: A Narrative Review
by Tesfay Mehari Atey, Gregory M. Peterson, Mohammed S. Salahudeen and Barbara C. Wimmer
Pharmacy 2024, 12(6), 163; https://doi.org/10.3390/pharmacy12060163 - 1 Nov 2024
Viewed by 789
Abstract
Acute care provided in the hospital’s emergency department (ED) is a key component of the healthcare system that serves as an essential bridge between outpatient and inpatient care. However, due to the emergency-driven nature of presenting problems and the urgency of care required, [...] Read more.
Acute care provided in the hospital’s emergency department (ED) is a key component of the healthcare system that serves as an essential bridge between outpatient and inpatient care. However, due to the emergency-driven nature of presenting problems and the urgency of care required, the ED is more prone to unintended medication regimen changes than other departments. Ensuring quality use of medicines (QUM), defined as “choosing suitable medicines and using them safely and effectively”, remains a challenge in the ED and hence requires special attention. The role of pharmacists in the ED has evolved considerably, transitioning from traditional inventory management to delivering comprehensive clinical pharmacy services, such as medication reconciliation and review. Emerging roles for ED pharmacists now include medication charting and prescribing and active participation in resuscitation efforts. Additionally, ED pharmacists are involved in research and educational initiatives. However, the ED setting is still facing heightened service demands in terms of the number of patients presenting to EDs and longer ED stays. Addressing these challenges necessitates innovation and reform in ED care to effectively manage the complex, rising demand for ED care and to meet government-imposed service quality indicators. An example is redesigning the medication use process, which could necessitate a shift in skill mix or an expansion of the roles of ED pharmacists, particularly in areas such as medication charting and prescribing. Collaborative efforts between pharmacists and physicians have demonstrated positive outcomes and should thus be adopted as the standard practice in improving the quality use of medicines in the ED. Full article
(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)
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9 pages, 233 KiB  
Review
Administration of Levetiracetam via Subcutaneous Infusion for Seizure Control in the Palliative Care Setting: A Narrative Review
by Fern Beschi, Rachel Hughes and Jennifer Schneider
Pharmacy 2024, 12(4), 125; https://doi.org/10.3390/pharmacy12040125 - 16 Aug 2024
Viewed by 1118
Abstract
This narrative review aims to summarise the information available on the use of subcutaneous (SC) levetiracetam (LEV) in the adult palliative care setting using clinical texts, databases, journals, and grey literature. A search strategy utilising Embase, Medline CINALH and Cochrane databases, as well [...] Read more.
This narrative review aims to summarise the information available on the use of subcutaneous (SC) levetiracetam (LEV) in the adult palliative care setting using clinical texts, databases, journals, and grey literature. A search strategy utilising Embase, Medline CINALH and Cochrane databases, as well as Google Scholar, was conducted with the mapped search terms “levetiracetam”, “subcutaneous” and “palliative”. LEV intravenous (IV) proprietary products are used subcutaneously, including as continuous subcutaneous infusions (CSCIs), in the adult palliative care setting. The total LEV daily dose ranged from 250 mg to 5000 mg and LEV was administered with various diluents at varying volumes. The data identified a clinical desire to mix LEV with other medications; however, the current evidence on combination compatibility is observational only and drug stability in combinations is lacking. The majority of information in the literature on SC LEV use is based on case reports and retrospective audits. Case reports, whilst at times offering more clinical detail, represent specific circumstances not necessarily applicable to a larger patient cohort. The findings of retrospective audits are limited by the documentation and detail reported at the time of patient care that may not be designed for data collection. Full article
(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)
11 pages, 506 KiB  
Review
Effectiveness and Safety of Glucosamine in Osteoarthritis: A Systematic Review
by Nam Xuan Vo, Ngan Nguyen Hoang Le, Trinh Dang Phuong Chu, Huong Lai Pham, Khang Xuan An Dinh, Uyen Thi Thuc Che, Thanh Thi Thanh Ngo and Tien Thuy Bui
Pharmacy 2023, 11(4), 117; https://doi.org/10.3390/pharmacy11040117 - 14 Jul 2023
Cited by 4 | Viewed by 12033
Abstract
Knee osteoarthritis is the most popular type of osteoarthritis that causes extreme pain in the elderly. Currently, there is no cure for osteoarthritis. To lessen clinical symptoms, glucosamine was suggested. The primary goal of our systematic review study is to evaluate the effectiveness [...] Read more.
Knee osteoarthritis is the most popular type of osteoarthritis that causes extreme pain in the elderly. Currently, there is no cure for osteoarthritis. To lessen clinical symptoms, glucosamine was suggested. The primary goal of our systematic review study is to evaluate the effectiveness and safety of glucosamine based on recent studies. Electronic databases such as PubMed, Scopus, and Cochrane were used to assess the randomized controlled trial (RCT). From the beginning through March 2023, the papers were checked, and if they fulfilled the inclusion criteria, they were then examined. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and Visual Analog Scale (VAS) scales were considered the main outcome measures. A total of 15 studies were selected. Global pain was significantly decreased in comparison to placebo, as measured by the VAS index, with an overall effect size of standardized mean difference (SMD) of −7.41 ([95% CI] 14.31, 0.51). The WOMAC scale confirmed that pain, stiffness, and physical function had improved, however the effects were insufficient. A statistical update also revealed that there were no reports of serious medication interactions or significant adverse events. To summarize, glucosamine is more effective than a placebo at reducing pain in knee osteoarthritis patients. In long-term treatment, oral glucosamine sulfate 1500 mg/day is believed to be well tolerated. Full article
(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)
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Other

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11 pages, 608 KiB  
Opinion
Decoding Clozapine-Induced Agranulocytosis: Unraveling Interactions and Mitigation Strategies
by Ali Alalawi, Enas Albalawi, Abdullah Aljohani, Abdullah Almutairi, Abdulraouf Alrehili, Areej Albalawi and Ahmed Aldhafiri
Pharmacy 2024, 12(3), 92; https://doi.org/10.3390/pharmacy12030092 - 12 Jun 2024
Cited by 1 | Viewed by 1547
Abstract
Agranulocytosis represents a severe complication associated with the administration of clozapine. Clozapine is an antipsychotic medication that has demonstrated substantial efficacy in remediating refractory schizophrenia and various other psychiatric disorders. Nonetheless, it is crucial to monitor patients for neutropenia regularly during clozapine therapy. [...] Read more.
Agranulocytosis represents a severe complication associated with the administration of clozapine. Clozapine is an antipsychotic medication that has demonstrated substantial efficacy in remediating refractory schizophrenia and various other psychiatric disorders. Nonetheless, it is crucial to monitor patients for neutropenia regularly during clozapine therapy. Therefore, this article aimed to delve into the prevalence of agranulocytosis during clozapine treatment by scrutinizing the extant literature to discern trends and correlations. This review endeavored to explore factors such as drug interactions, dose-related factors, duration of treatment, and genetic predispositions that could potentially influence the likelihood of patients developing agranulocytosis while undergoing clozapine therapy. Moreover, this review enunciates the ramifications of agranulocytosis on both patients and healthcare providers and meticulously evaluates the strategies to mitigate this risk and ensure optimal patient outcomes. Full article
(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)
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8 pages, 470 KiB  
Brief Report
Association of Average Daily Morphine Milligram Equivalents and Falls in Older Adult Chronic Opioid Users
by Stephanie Hwang, Tamera D. Hughes, Joshua Niznik and Stefanie P. Ferreri
Pharmacy 2024, 12(2), 62; https://doi.org/10.3390/pharmacy12020062 - 3 Apr 2024
Cited by 1 | Viewed by 1527
Abstract
Opioids remain commonly prescribed in older adults, despite the known association with falls and fall-related injuries. This retrospective cohort study sought to determine the association of opioid use and falls in older adult opioid users. Using a one-year lookback period in electronic health [...] Read more.
Opioids remain commonly prescribed in older adults, despite the known association with falls and fall-related injuries. This retrospective cohort study sought to determine the association of opioid use and falls in older adult opioid users. Using a one-year lookback period in electronic health records, daily morphine milligram equivalents (MMEs) were calculated using prescription orders. Fall history was based on patient self-reporting. A receiver operating characteristic (ROC) curve was used to identify the threshold of average daily MMEs at which the likelihood of falls was increased. Older opioid users were most often women and White, with 30% having fallen in the prior year. In ROC analyses (n = 590), the threshold where fall risk increased was 37 MMEs (p = 0.07). Older adults prescribed more than 37 MMEs daily may be at increased fall risk and should be targeted for deprescribing interventions. Additionally, analysis on patient characteristics and covariates suggest that sex, age, COPD, sleep apnea, cancer, and psychiatric conditions may indicate an increased risk of falls in older adults taking chronic opioids (p < 0.05). Multifactorial interventions may be needed to modify fall risk beyond medication use alone. Full article
(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)
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