Effect of the Utilization of Pharmaceutical Care Tools developed to Manage Preventable Adverse Drug Events in General Surgical Patients

Abstract

Objective: To compare the incidence of (preventable adverse drug events; pADEs) before and after implementation of tools developed for pharmaceutical care in general surgical patients. Methods: Subjects were all male patients admitted to male general surgical ward at Songkhla hospital with a hospital stay at least 24 hours. Prior to the development of tools for pharmaceutical care, the researchers prospectively collected the data to detect pADEs by reviewing medical records, interviewing patients and health care professionals, observing on the ward, and reviewing voluntary incident reports by health care professionals. Two reviewers including a physician and a clinical pharmacist independently judged whether identified incidents were pADEs. Subsequently the researchers analyzed the information on pADEs, developed pharmaceutical care tools accordingly and implemented them in practice. The tools developed during implementation of pharmaceutical care tool period were implemented along with pharmaceutical care service. The data collection after implementation of the tools was done in the same way as that of pre-tool development phase. Primary outcome was the incidence of pADEs. Results: In the phases of pre and post implementation of the tools, there were 247 patients with 1,628 patient-days and 231 patients with 1,298 patient-days, respectively. The developed tools included warfarin protocol, warfarin dosing chart, warfarin monitoring sheet, warfarin note, medication reconciliation (MR) order form, MR sticker and potassium chloride elixir pre-printed sticker. The incidence rates of pADEs decreased from 3.07 per 1,000 patient-days in the pre-tool implementation phase to 0 in the post tool implementation phase (P = 0.030). Most of the pADEs identified during pre-tool implementation phase were in the category E. Conclusion: The analysis of identified pADEs and corresponding tools development to resolve the problems at system level were effective to decrease the incidence of pADEs.