Development of the Pharmaceutical Care Model for Patients with Renal Impairment at Medical Ward in Suwannaphum Hospital, Roi-Et

Abstract

Objective: To develop a pharmaceutical care model for patients with impaired renal function in the internal medicine ward of Suwannaphum Hospital, Roi-Et. Methods: This study was an action research with 3 phases. Phase 1 was a study of drug related problems in 300 patients with impaired renal function using data from electronic medical records between October 1, 2016 and September 30, 2017. Phase 2 was the development of the manual on dosage adjustment in patients with impaired renal function, and the development of a pharmaceutical care model. Phase 3 was the full implementation of pharmaceutical care in 40 patients. Results: Phase 1 found 254 drug-related problems including 1) 77 problems on receiving the appropriate drugs, but with too high dose, 2) 75 problems on drug interactions, 3) 56 problems on untreated indications, 4) 34 problems on improper drug selections, 5) 7 problems on adverse drug reactions, and 6) 5 problems on receiving the appropriate drugs, but with too low dose. Phase 2 of the study led to the development of the manual on dosage adjustment according to renal function, and the full implementation of pharmaceutical care model in the ward. Phase 3 identified a total of 42 drug-related problems including 1) 16 drug interactions, 2) 10 problems on receiving the appropriate drugs, but with too high dose, 3) 5 problems on untreated indications, 4) 5 problems on medication noncompliance, 5) 3 problems on improper drug selections, and 6) 3 problems on a verse drug reactions. All 42 problems were resolved and monitored by the pharmacist throughout the hospital stay. Physicians or patients accepted and followed 61.90% of pharmacists’ recommendations. Physicians or patients accepted, but with some modifications, 38.10% of pharmacists’ recommendations leading to the reduction of the problems. Conclusion: Pharmaceutical care provided by pharmacists could lead to the identification and resolution of drug-related problems leading to drug safety and maximum benefit of drug use.