In this review of a random sample of patients who underwent elective total joint arthroplasty in a large Canadian health region, the majority of patients had at least one drug-related problem. Most of the problems identified were related to home medications, and over half were deemed potentially harmful. Patients 65 years of age or older had more potentially harmful drug-related problems; they also had many problems involving a potential indication for drug therapy.
These findings suggest that when pharmacists are screening patients for drug-related problems, they should focus on prescriptions for home medications, patients 65 years of age or older, the total number of home medications for patients with specific comorbidities, and patients with comorbid conditions. These priorities will help pharmacists to have the greatest possible impact on patient care.
Although there are limited data evaluating drug-related problems in patients undergoing total joint arthroplasty, the findings of the current study are consistent with those of a study conducted at the University Health Network in Toronto, Ontario. In that earlier study, Kwan and others evaluated pharmacists’ medication assessments in a surgical preadmission clinic. In particular, they compared drug-related problems between a standard group of patients (with no pharmacist involvement) and an intervention group (with pharmacist involvement). The majority of postoperative problems were related to home medications (70.1% in the intervention arm and 78.6% in the standard care arm), and 37.2% of patients had at least one postoperative problem related to home medications. These findings are similar to the results in the current study, in which 65.5% of problems identified were related to home medications; however, a greater proportion of the patients in the current study (60.3%) had at least one drug- related problem involving home medications. This difference could be attributable to differences in the study designs, as the study by Kwan and others included communication between the health care team and the patient, which would have allowed for clarification of intentional and unintentional medication discrepancies. Alternatively, the classification of drug-related problems might have differed between the 2 studies, which might have accounted for the differing results.
Kwan and others5 found that the most common postoperative problem related to home medications was omission of medications (46.4%), and the most common problems related to postoperative orders involved incorrect dose and frequency. Similarly, the most common types of drug-related problems in the current study were omission of medications, illegible drug orders, inappropriate dose frequencies, and drug—allergy interactions. Thus, a focus on preventing these specific types of medication errors could result in fewer drug-related problems and fewer consequences for the patient. kamagra tablets
Cornish and others studied unintended discrepancies between the physician’s medication orders on admission and a comprehensive medication history obtained at the time of hospital admission for patients admitted to general internal medicine clinical teaching units. They found that 53.6% of patients had at least one unintended discrepancy, and the most common error (46.4% of errors) was the omission of regularly used medications. In addition, 38.6% of the drug-related problems identified had the potential to cause moderate to severe discomfort or clinical deterioration (as determined by consensus among evaluators). Likewise, we found that 60.3% of patients had at least one problem relating to home medication orders, with 43.3% of these problems deemed potentially harmful.