Medication Reconciliation Led by Clinical Pharmacist as an Effective Strategy in Preventing and Reducing Adverse Drug Reactions
Author(s): Yerni Kumar B*, Chakravarthy Guntapalli, Koteswar rao GSN, Kishore Kumar K and Rajsekar A
Background and objectives: Alarming statistics of adverse drug reactions round the world is urging the health care professionals to focus on managing them in the best possible way. Although previous studies had focused on reporting the incidents and measured the severity of adr’s of most of the drugs. In contrast, our study is aimed to prove that implementing a few important strategies would prevent the adverse drug reactions and if occurred what efforts to be put in place in order to curb the incidence and severity. Preventing an adr would certainly imply the affirmation rendered to the patient by the clinical pharmacist and allied health care professionals.
Aim: The main purpose of this study is to assess the outcome of ADRs upon execution of medication reconciliation and robust training to the nurses in a tertiary care centre. Focus is on to prevent and reduce adverse drug reactions.
Methods: Medication reconciliation form was prepared in-order and approved the drugs and committee, started to document the past medical history of the patients, which also records the drug allergy status. The clinical pharmacist in collaboration with the nursing supervisors trained all the nursing staff based on the training calendar scheduled. Bed side and class room training attendance was recorded to ensure the training occurred. Evaluation is done after every training session. Going further, the practice of giving parenteral chlorpheniramine (anti-histamine) or hydrocortisone is initiated to prevent any allergic reactions of an antibiotic which is usually administered to the patient before starting the surgical procedure.
Results: It was found that, of 410 patients observed in this study, 9 adverse drug reactions were evidenced ranging from mild to moderate and rest of the patients had no reactions. Statistical analyses tool was used to assess the data. Among the 12 adrs occurred it is antibiotics and snake venom that caused most of the adrs 4 adrs were seen in the patients admitted in general medicine department, 3 in the department of orthopaedics, 1 in critical care and anesthesia department, also 1 in pulmonology. The total adr figure has dropped from 17 to 9 post training, evaluation, post start of administering single shot of an antihistamine or hydrocortisone as well, implementation of the other strategies. 17 adverse drug reactions were reported before the implementation of the above strategies discussed. As a routine review and follow up, these adr’s were observed. As “human life is priceless” even a single adr must be considered serious as it can potentially affect the patient. The credit goes to the introduction of previous medication history collecting form as well consistent practice of giving a test dose is another key factor which contributed to insignificant and less severe adr’s recorded.
Conclusion: Medication reconciliation and In patient medication review done by clinical pharmacists, training offered by them to the nurses at all levels and administering a single dose of an antihistamine before the surgical procedure has shown remarkable decline in the outcome of number of adrs as well their intensity also. Preventing an adverse drug reaction in the hospital setting which means improving the quality of life of the patients.