Background Pharmaceutical care is a patient-centred practice designed to meet drug-related needs by identifying, resolving and preventing drug treatment problems. Due to the complexity of their pharmacotherapy, haematological patients were the target population with a high risk of drug-related problems (DRPs).
Purpose To develop a pharmaceutical care programme in a bone marrow transplantation unit (BMTU), for severely immunosuppressed patients after bone marrow transplantation or intense chemotherapy.
Materials and methods Prospective study performed from June to September 2011 including patients admitted to the BMTU for whom severe aplasia was anticipated. The pharmacist within the healthcare team collected information after contact with physicians, nurses and patients, on a special data collection sheet. The information collected included demographic data, health problems, laboratory data and drug treatment. Data were evaluated to detect and classify DRPs. Interventions were made if needed.
Results Six patients (66.7% men) were followed for a mean period of 20 days. Twenty-two DRPs were detected before they reached the patient. In accordance with the Third Granada Consensus, DRPs were classified into the following categories: 45.5% a drug adverse event was probable, 4.5% interactions, 9.1% duplications, 4.5% a drug was administered wrongly, 18.2% a health problem was insufficiently treated and 18.2% the dose, dosage schedule and/or duration was inappropriate. Therapeutic groups mainly involved were: anti-infectives for systemic use (35.3%), antineoplastic and immunomodulating agents (17.6%), alimentary tract and metabolism (11.8%) and respiratory system (11.8%) medicines. Fourteen interventions were made with a 71.4% acceptance rate. Eight DRPs were detected by both physician and pharmacist and thus required no pharmacist intervention. The attending pharmacist detected 175% more DRPs than the physician.
Conclusions Direct interaction of a clinical pharmacist with both the healthcare team and the patient improves patient outcomes, preventing DRPs and solving them before harm is caused. Because of the high-risk drugs involved, preventing DRPs is vital in this specialised unit. DRP detection rates increased when a clinical pharmacist was present.
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