1. Identification and Characterization of Drug Related Problems
in Orthopedic Patients after Femur Neck Fractures in an Orthopedic Ward
Olga Brodskiy PharmD1,4*, Alina Amitai PharmD1,4*, Suzy Kovatz MD2,
Mira Maram Edry MD3
1Division of Clinical Pharmacy, Pharmacy Services , 2Senior Internal Consultant to the Surgical
Department, 3Medical Management Department; all at Meir Medical Center, Kfar Saba, Israel,
affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 4Division of
Clinical Pharmacy, School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem, Israel
*equal contribution
Conclusions
Introduction
References:
1
Cipolle RJ, Strand LM. Pharmaceutical Care Practice: The clinician’s guide, 2nd ed. New York, NY:McGraw Hill. 2004:178-9NY:McGraw Hill. 2004:178-9
2
Naranjo CA, Busto U, Sellers EM, et al. Clin Pharmacol Ther 1981;30:239-45
3
Horn JR, Hansten PD, Chan LN. Ann Pharmacother 2007;41:674-80
4
Hartwig SC, Siegel J, Schneider PJ. Am J Hosp Pharm 1992;49:2229-32
Additional Results
Identification and characterization of drug related problems (DRPs)
among elderly patients with femoral neck fractures.
Methods
Prospective, open label, convenience sample study.
Patient characteristics included advanced age, multiple co-morbidities
and polypharmacy.
• DRPs classification - the Cipolle and Strand Scale1
• Adverse drug reactions (ADRs) - Naranjo Adverse Drug Reaction Prob
ability Scale2
• Drug interactions (DIs) – the Hansten and Horn scale3
• Severity of ADRs/DIs – the Hartwig and Siegel scale4
• Overall DRP evaluation – guidelines and published literature
Results
Average patient age was 83.2 ± 7.5 years. At least one DRP was identified
in 69% (72/104) of the study population. A total of 145 DRPs were found
and 96 recommendations were given to 63% (45/72) of patients with DRPs.
Most DRPs analyzed in the study pertained to Safety (34%) and
Indication (32%).
*Ten percent of all DRPs were related to an adverse drug event
Most of the recommendations pertained to adding or discontinuing a
medication, which may imply that the study population is characterized
by over- or under-treatment
DRPs were mainly associated with cardiovascular, gastrointestinal,
neurological and hematological drug groups. This is partly due to the use of
these medications in elderly patients, who tend to suffer from multi-morbidity
and polypharmacy
• A correlation was found between the number of chronic medications and the number of DRPs (P = 0.001). A large increase in the number of DRPs
was observed in patients taking 10 or more medications.
• 76% (55/72) of patients with DRPs were women. Gender was found to be a statistically significant risk factor (p< 0.05)
• The underlying characteristics of the study population define it as a high-risk patient group. Most DRPs
identified were related to safety or indication and stemmed from over- or under-treatment.
• This underscores the importance of a comprehensive medication review.
• Based on the study results, a clinical pharmacist was added to the multi-disciplinary team of the Orthopedic Ward.
Association between DRP Category and Type of Recommendation
CP-020
Authors’ contact information:
olgabr3@clalit.org.il
alina.amitai@clalit.org.il
Recommendation
DRP Category
Indication Effectiveness Safety
Add medication 48% - -
Discontinue
medication
26% 50% 62%
Change dose - 50% 38%
Other 26% - -
Indication
Effectivenenn
Safty
Adherence
Monitoring
Documentation
21%
4%
32%
7%
34%
1%
Distribution of DRPs by category
N=145