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The Impact of a clinical pharmacist in the Emergency Department of an Academic Hospital in the Kingdom of Saudi Arabia

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Journal of Pharmacy and Pharmacology 2018年第8期6卷 752-759页

作者： Waad H. Al-Kathiri Hossam A. H. Abdelrazek Hisham S. Al-Jadhey Department of clinical Pharmacy Services King Saud University Medical City King Saud University Riyadh 11472 Saudi Arabia clinical Pharmacy Department College of Pharmacy King Saud University Riyadh 11472 Saudi Arabia Department of Emergency Medicine College of Medicine King Saud University Riyadh 11472 Saudi Arabia Saudi Food and Drug Authority Riyadh 13312 Saudi Arabia

Introduction： The department of emergency medicine （DEM） has a high-risk environment due to its unique and complex workflow. Many high-risk medications are ordered and administered at patients’ bedsides without being checked by a pharmacist first, which may lead to an increase in the incidence of patient medication errors （MEs）. Objective： The current study evaluated the needs of the clinical pharmacy service in the DEM at King Saud University Medical City （KSUMC）, Riyadh, Saudi Arabia. Methods： A cross-sectional retrospective study was conducted between Jan 2016 to Dec 2017 and the documentation of clinical pharmacist interventions was extracted from Esihi database. Results： A total of 2,255 interventions for 862 patients were documented. The recommended interventions were as follows： 645 （dose adjustments）, 108 （therapeutic substitutions）, and 354 interventions （initiating drug therapy）. Adverse drug reactions （ADRs） were reported in 16 patients, and drug interactions were managed in 26 patients. The DEM responded to 713 information inquires and 290 pharmacokinetic consultations. Drug discontinuations included 39 incidents （where unjustified drug prescription occurred）, 37 （where contraindications were involved）, and 19 （where duplicate therapy was involved）. The most common interventions were related to the following drugs： antibiotics （34%）, anticoagulants （15%）, and anticonvulsants （10%）. The acceptance rates for the EM clinical pharmacist recommendations increased from 93.9% in 2016 to 99% in 2017. The most common outcome for interventions was to optimize the therapeutic effects of the drugs that were administered （73%）. Reconciliation was done in 796 patients. Conclusions： The clinical pharmacy service plays a critical role in the management of patients in the emergency department （ED）.

关键词： ED clinical pharmacist interventions pharmacy services.

Participation of clinical pharmacist specialized in oncology in the treatment of a patient with advanced esophageal carcinoma complicated with hypertension: one case report

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Journal of Chinese Pharmaceutical Sciences 2014年第5期23卷 330-334页

作者：王增丁海樱袁梅琴林能明浙江省肿瘤医院药剂科浙江杭州310022 浙江省肿瘤医院化疗中心浙江杭州310022 杭州市第一人民医院个体化医学研究所浙江杭州310006

clinical pharmacists specialized in oncology contributed to the safe and effective chemotherapy treatment for advanced esophageal carcinoma patients complicated with hypertension by participating in medication practice. Optimal therapeutic regimen was proposed, and pharmaceutical care and health education were provided based on the condition of each patient. By providing pharmaceutical care for cancer patients with their pharmacy knowledge, clinical pharmacists specialized in oncology can not only reduce the potential risks of chemotherapy, but also take into account of other accompanying diseases, thus improving the comprehensive treatment of patients. Furthermore, it deepened the understanding of the role of clinical pharmacy practice by patients and other medical workers. Involvement of clinical pharmacist in therapeutic practice could improve the outcome of pharmacotherapy.

关键词： Advanced esophageal cancer Hypertension clinical pharmacist Chemotherapy

Analysis of the status of clinical pharmacist pilot training in Chinese hospitals

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Journal of Chinese Pharmaceutical Sciences 2011年第4期20卷 410-414页

作者：包宁疆邵宏聂小燕吴永佩颜青李喜西杨巍王宁郑凯魏艳红史录文北京大学医学部药学院药事管理与临床药学系北京100191 中国医院协会药事管理专业委员会北京100035

A total of 626 questionnaires were collected and analyzed to study the current status of clinical pharmacist Pilot Training（CPPT）in Chinese *** training satisfaction of the training hospitals,trainees,and the trainee providing hospitals are all very high,among which the satisfaction of the training hospital is the *** to the results of the questionnaire, the most important training mode in the training hospitals＇ opinion is different from that in the trainees＇ *** prefer more initiative,practical,and participatory training and hope to learn from the wards round process,while the training hospitals are more inclined to group discussion and ***＇s necessary to increase the number of eligible training hospitals, to implement one on one mentoring strategy in hospital pharmacist training,and to increase active learning in the training program. The result of this research would help to build more effective and efficient pharmacist training programs in Chinese hospitals.

关键词： CPPT project clinical pharmacist Satisfaction Hospital pharmacist training system

Individualized anti-thrombotic therapy for acute myocardial infarction complicated with left ventricular thrombus: A case report

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World Journal of clinical Cases 2024年第4期12卷 835-841页

作者： Yan Song Hua Li Xia Zhang Lei Wang Hong-Yan Xu Zhi-Chao Lu Xiao-Gang Wang Bo Liu Department of clinical Pharmacy Zibo Municipal HospitalZibo 255400Shandong ProvinceChina Department of Cardiology Zibo Municipal HospitalZibo 255400Shandong ProvinceChina Department of Pharmacy Zibo Municipal HospitalZibo 255400Shandong ProvinceChina Department of Imaging Zibo Municipal HospitalZibo 255400Shandong ProvinceChina Department of Pulmonary and Critical Care Medicine Department of Clinical MicrobiologyZibo City Key Laboratory of Respiratory Infection and Clinical MicrobiologyZibo City Engineering Technology Research Center of Etiology Molecular DiagnosisZibo Municipal HospitalZibo 255400Shandong ProvinceChina

BACKGROUND Presently,there is no established standard anti-blood clot therapy for patients facing acute myocardial infarction(AMI)complicated by left ventricular thrombus(LVT).While vitamin K antagonists are the preferred choice for oral blood thinning,determining the best course of blood-thinning medication remains *** is unclear if non-vitamin K antagonist oral blood thinners have different effectiveness in treating *** study significantly contributes to the medical *** SUMMARY The blood-thinning treatment of a patient with AMI and LVT was *** blood-thinning therapy included daily enteric-coated aspirin tablets at 0.1 g,daily clopidogrel hydrogen sulfate at 75 mg,and dabigatran etexilate at 110 mg twice *** 15 d,the patient’s LVT did not decrease but instead *** pharmacists comprehensively analyzed the cases from the perspective of the patient’s disease status and drug *** drug regimen was reformulated for the patient,replacing dabigatran etexilate with warfarin,and was administered for six *** clinical pharmacist provided the patient with professional and standardized pharmaceutical *** patient’s condition was discharged after meeting the international normalized ratio value(2-3)*** patient fully complied with the follow-up,and the time in the therapeutic range was 78.57%,with no serious adverse effects during pharmaceutical *** Warfarin proves to be an effective drug for patients with AMI complicated by LVT,and its blood-thinning course lasts for six months.

关键词： Myocardial infarction Left ventricular thrombus Dabigatran etexilate Warfarin clinical pharmacist Case report

Optimizing hepatitis C virus treatment through pharmacist interventions: Identification and management of drug-drug interactions

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World Journal of Gastroenterology 2017年第9期23卷 1618-1626页

作者： Jacob A Langness Matthew Nguyen Amanda Wieland Gregory T Everson Jennifer J Kiser Hepatology and Transplant Clinic University of Colorado Hospital Department of Pharmacy University of Colorado Hospital University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Department of Gastroenterology School of MedicineUniversity of Colorado

To quantify drug-drug-interactions (DDIs) encountered in patients prescribed hepatitis C virus (HCV) treatment, the interventions made, and the time spent in this *** standard of care, a clinical pharmacist screened for DDIs in patients prescribed direct acting antiviral (DAA) HCV treatment between November 2013 and July 2015 at the University of Colorado Hepatology Clinic. HCV regimens prescribed included ledipasvir/sofosbuvir (LDV/SOF), paritaprevir/ritonavir/ombitasvir/dasabuvir (OBV/PTV/r + DSV), simeprevir/sofosbuvir (SIM/SOF), and sofosbuvir/ribavirin (SOF/RBV). This retrospective analysis reviewed the work completed by the clinical pharmacist in order to measure the aims identified for the study. The number and type of DDIs identified were summarized with descriptive *** hundred and sixty four patients (83.4% Caucasian, 57% male, average 56.7 years old) were identified; 369 for LDV/SOF, 48 for OBV/PTV/r + DSV, 114 for SIM/SOF, and 133 for SOF/RBV. Fifty-one point five per cent of patients were cirrhotic. Overall, 5217 medications were reviewed (7.86 medications per patient) and 781 interactions identified (1.18 interactions per patient). The number of interactions were fewest for SOF/RBV (0.17 interactions per patient) and highest for OBV/PTV/r + DSV (2.48 interactions per patient). LDV/SOF and SIM/SOF had similar number of interactions (1.28 and 1.48 interactions per patient, respectively). Gastric acid modifiers and vitamin/herbal supplements commonly caused interactions with LDV/SOF. Hypertensive agents, analgesics, and psychiatric medications frequently caused interactions with OBV/PTV/r + DSV and SIM/SOF. To manage these interactions, the pharmacists most often recommended discontinuing the medication (28.9%), increasing monitoring for toxicities (24.1%), or separating administration times (18.2%). The pharmacist chart review for each patient usually took approximately 30 min, with additional time for more complex patients

关键词： clinical pharmacist Drug-drug interaction Hepatitis C virus treatment

Pharmacological Monitoring of Capecitabine in a Gastric Cancer Patient with Hyperbilirubinemia

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Journal of Biosciences and Medicines 2023年第3期11卷 120-126页

作者： Yanting Gu Qinghua Lang Dongmei Chen Jianying Zhang Zheng Liu Ling Gao Department of Pharmacy China Aerospace Science & Industry Corporation 731 Hospital Beijing China Department of Nursing Liupanshui Municipal People’s Hospital Liupanshui China Department of Nursing Zhongshan People’s Hospital of Guangdong Province Zhongshan China

Objective: To examine therapeutic drug monitoring in managing hyperbilirubinemia caused by capecitabine in patients with gastric adenocarcinoma with extensive liver metastases. Results: The initial liver function tests showed an elevation of transaminases (aspartate amino transferase 615 UI/l, alanine aminotransferase 385.9 UI/l), hyperbilirubinemia (total bilirubin at 246.1 μmol/l), and alkaline phosphatase at 694.6 UI/l. We initiated capecitabine based combination chemotherapy, and the clinical pharmacist conducted a full-course medication monitoring of the patient’s treatment including design of individualized dosing regimens and monitoring of bilirubin, infection, cancer pain, parenteral nutrition support and adverse events. After 21 days of supervision by clinical pharmacist and clinicians, the patient’s bilirubin and transaminase decreased progressively, with aspartate aminotransferase, total bilirubin and alkaline phosphatase falling back to 57 UI/l, 69.8 μmol/l, 307.2 UI/l, respectively. The patient’s condition improved significantly at the time of discharge, with the jaundice subsided, and the bloating relieved. Conclusion: Due to adverse reactions, capecitabine requires medication monitoring during use. The relationship between effectiveness and adverse effects is controversial. Adverse reactions should not be the sole criterion for the use of drugs. clinical pharmacists can improve the safety and effectiveness of patients’ medications and promote rational drug use by monitoring patients, which may be useful to help the doctors identify the high-risk patients for taking efficient treatment strategy decisions.

关键词： clinical pharmacist Capecitabine Gastric Cancer Hyperbilirubinemia Therapeutic Drug Monitoring

Pharmacological monitoring and literature analysis of dagliflozin in patients with hypovolemia

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Journal of Chinese Pharmaceutical Sciences 2022年第9期31卷 718-722页

作者： Ye Yuan Bo Yu Zhenzhen Yang Weichong Dong Xiuling Yang The Second Hospital of Hebei Medical University Shijiazhuang 050000China

In the present study,we aimed to explore the timing of dosing with dapagliflozin(DAPA)in patients with hypovolemia and the role of the clinical pharmacist in pharmacological *** clinical pharmacist was involved in the dosing regimen of two patients with hypovolemia using DAPA and advising patients with insufficient blood volume to withhold the use of the *** reviewed the relevant literature to provide a theoretical basis for clinicians and the role of clinical pharmacists in pharmacy *** considering patients with hypovolemia,the clinical pharmacist can promptly identify that DAPA can reduce blood volume and provide rational advice and rationale for the patient‟s medication that is adopted by the clinician,resulting in an individualized dosing regimen for the *** pharmacists are advised to pay attention to the dosing adjustments of DAPA when patients are in hypovolemia and to be more alert to the adverse effects that can result from its use.

关键词： Dagliflozin Hypovolemia Pharmacological monitoring Literature analysis clinical pharmacist