Browsing by Author "Kähkönen, Asta"

According to international studies, medication records are often incomplete in hospitals' patient information system. Medication reconciliation is an effective method to prevent medication errors and improve medication safety. A medication review is a useful tool in the assessment of drug-related problems (DRPs). DRPs can cause severe patient harm and even cause death. Approximately one third of Finnish people are diagnosed with cancer during their lifetime. About 16 000 patients receive cancer treatments in the Helsinki University Central Hospital Cancer Centre (HUCHCC). There are no clinical pharmacy services in the division of the solid tumors of HUCHCC. Internationally clinical pharmacy services in oncology are patient oriented and often include medication reconciliations and reviews. The clinical pharmacy services have increased patient safety also in the oncological specialty. The aim of this study was to find out the accuracy of the medication charts and identify the DRPs among 70-80-year-old patients with 6 or more medicines in uro-oncological outpatient clinic of HUCHCC. Accuracy of the medication charts was assessed by pharmacist-led medication reconciliation with patient interview. Information concerning patient's medication was also searched from the national electronical prescription centre and from the records of previous hospital visits. DRPs, such as drug-drug interactions, adverse drug reactions and overlapping medications, were identified with the pharmacist-led medication review. Special attention was paid to renal insuffiency, high-alert medications and potentially inappropriate medication for patients over 75 years old. Pharmacist discussed the DRPs with the oncology specialist. The theoretical framework of this study was the theory of human error, where patient safety hazards can be prevented by using safety defences such as medication reconciliation and medication review. Altogether 30 patients with urological cancer were included in this study. On average, they were 74.3 years old and used 12.4 medications. On average, there were 6.8 discrepancies per patient in the hospital medication chart. Only one patient had the accurate medication chart. The discrepancies were most commonly related to paracetamol (n = 10), vitamin-D (n = 9) and the combination of calcium and vitamin-D (n = 8). The most common discrepancies of high-alert medications were related to enoxaparin (n=6) and oxycodone (n=6). Of the potentially inappropriate medications for over 75 years old, the most common discrepancies were related magnesium (n=8) and metoclopramide (n=5). In the medication review process, 4 acute and 44 non-acute DRPs were identified with 22 patients (2,2 per patient). 60 % of these were regarded clinically relevant and lead to actions by the oncology specialist. Reconsidering the need or efficacy of the medication was recommended 19 times and inappropriate dose or medication with renal insufficiency were identified six times in medication reviews. DRPs were usually related to non-oncological medications such as pantoprazol (n=8), the combination of calcium and vitamin-D (n=4) ja bisoprolol (n=3). The medication reconciliation process should be developed in the urology-oncology outpatient clinic. Multiprofessional medication review can be used to detect and resolve DRPs of patients with urological cancer. The results of this study can be exploited when clinical pharmacy services will be created and developed in HUCHCC.