The Role of Clinical Pharmacist in Monitoring Drug Therapy in the Cardiovascular and Coronary Care Units in Libya

Main Article Content

Asmaa S.H. Alhomri
Ahmed . A. Battah
Ahmed A. Elberry
Eman K.A. Abdelall
Raghda Hussein

Keywords

monitoring drugs, cardiovascular diseases, coronary care units, ccu patients, role of clinical pharmacist

Abstract

Background: In hospitals, medication errors are common and potentially harmful resulting in unintentional discrepancies. The study’s central goal is to assess the clinical pharmacy services’ role in cardiovascular disease inpatients. Methods: The current study was a prospective study conducted on one hundred patients admitted to the CVU and CCU in Libya. The patients were classified - into two main groups (I - and II), where the guidelines of clinical pharmacy - were applied only in Group II. Each group is subdivided - into three subgroups with equal numbers of patients. As follows: (Gp a: ten outpatients, Gp b: twenty-five inpatients, Gp c: fifteen patients admitted to CCU. Results: By using clinical pharmacy guidelines, the patients in group I were 28 (56%) had angina pectoris, 28 (56%) responded to treatment, 20 (40%) had complications, and 8 (16%) died; while the patients in group II were 15 (30%) had angina pectoris, 43 (86%) respond to treatment, 7 (14%) had complications and 1 (2%) died. So, the results reported a dramatic decrease in the morbidity rates in all groups that undergo guidelines of clinical pharmacy. Conclusion: The application of clinical aspects of clinical pharmacy is outstanding in CVU and CCU in Libya.

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References

1. Maedeh Amini, Farid Zayeri, and Masoud Salehi. Trend analysis of cardiovascular disease mortality, incidence, and mortalityto-incidence ratio: results from global burden of disease study 2017. Published: BMC Public Health .2021;21(1):401.https://doi.org/10.1186/s12889-021-10429-0
2. Coronary Artery Disease (CAD) - risk factors and causes: In Libyan patients
3. Noncommunicable diseases in Libya; Health Organization data (WHO) 2023; https://www.emro.who.int/lby/programmes/noncommunicable-diseases.html
4. Country report Libya - April 2018, Omar Msalam. http://who.int/gho/mortality_burden_disease/en
5. World Health Rankings, 2020. https://www.worldlifeexpectancy.com/libya-coronary-heart-disease
6. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, UnitedStates: Institute for Health Metrics and Evaluation (IHME), 2021.
7. Prachi Bhatnagar, Kremlin Wickramasinghe, Elizabeth Wilkins, Nick Townsend. Trends in the epidemiology of cardiovascular disease in the UK. 2016;102(24):1945-52. https://doi.org/10.1136/heartjnl-2016-309573
8. Athansios TsiosCCU, Evagelismos Hosp, Athens. Admissions to the Coronary Care Unit (CCU): Comparison With International Data. https://doi.org/10.2015/hc.v3i4.293
9. Vina AS, Anton B, Retnosari A. Evaluation of a Clinical Pharmacist Intervention on Clinical and Drug-Related Problems Among Coronary Heart Disease Inpatients A pre-experimental prospective study at a general hospital in Indonesia. SQU Med J. 2018;18:81-7.
10. Osama Bheleel, Alaa Abdulhamid, Ibtisam Alhadi, Hanaa Grash, Hajer almuaket, Mohamed Hadi Mohamed Abdelhamid. Coronary Artery Disease (CAD) - risk factors and causes: In Libyan patients. https://doi.org/10.1101/2021.11.18.21266513
11. Urbina O, Ferrandez O, Luque S, Grau S, Mojal S, Pellicer R, et al. Patient risk factors for developing a drug-related problem in a cardiology ward. Ther Clin Risk Manag 2014;11:9-15. https://doi.org/10.2147/tcrm.s71749
12. Abraham RR. Drug related problems and reactive pharmacist interventions for inpatients receiving cardiovascular drugs. Int J Basic Med Sci Pharm 2013;3:42-8.
13. Elliott RA’ Putman KD, Franklin M, Annemans L, Verhaeghe N, Eden M, et al. Cost Effectiveness of a Pharmacist-Led Information Technology Intervention for Reducing Rates of Clinically Important Errors in Medicines Management in General Practices
(PINCER), Pharmacoeconomics. 2014;32:573-90. https://doi.org/10.1007/s40273-014-0148-8
14. Tarride JE, Lim M, DesMeules M, Luo W, Burke N, O’Reilly D, et al. A review of the cost of cardiovascular disease. Can J Cardiol.2009;25:195-202.
15. Aljadhey H, Mahmoud MA, Mayet A, Alshaikh M, Ahmed Y, Michael D, et al. Incidence of adverse drug events in an academic
hospital: a prospective cohort study. International Journal for Quality in Health Care. 2013;25:648-55. https://doi.org/10.1093/intqhc/mzt075
16. Robert L. McNamara, Kevin F. Kennedy, David J. Cohen, Deborah B. Diercks, Mauro Moscucci, Stephen Ramee, et al.Predicting In-Hospital Mortality in Patients With Acute Myocardial Infarction, 2016;68(6):626-35. https://doi.org/10.1016/j.jacc.2016.05.049
17. Logoyda L, Korobko D, Ivanusa Iryna, Serhii Kovalenko. “Development of the methodology of the chromatographic determinationof nifedipine in medicines. Development. 2017;10(3).
18. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006;166:955-64. https://doi.org/10.1001/archinte.166.9.955
19. George PP, Molina JA, Cheah J, Chan SC, Lim BP. The evolving role of the community pharmacist in chronic disease management- a literature review. Ann Acad Med Singapore. 2010;39:861-7.
20. Jong GP, Chang MH, Tien L, Li SY, Liou YS, Lung CH, et al. Antihypertensive drugs and new-onset diabetes: a retrospective longitudinal cohort study. Cardiovasc Ther. 2009;27:159-63. https://doi.org/10.1111/j.1755-5922.2009.00092.x
21. Green Conaway DL, Enriquez JR, Barberena JE, Jones PG, O’Keefe JH, Jr, Spertus JA. Assessment of and physician response to glycemic control in diabetic patients presenting with an acute coronary syndrome. Am Heart J. 2006;152:1022-7. https://doi.org/10.1016/j.ahj.2006.06.013
22. Eppley M and Serr G. Hyperglycemia management in the hospital: the pharmacist’s role. Hosp Pharm. 2009;44:594-603.
23. Charrois TL, Zolezzi M, Koshman SL, Pearson G, Makowsky M, Durec T, et al. A systematic review of the evidence for pharmacist care of patients with dyslipidemia. Pharmacotherapy. 2012;32:222-33. https://doi.org/10.1002/j.1875-9114.2012.01022.x
24. Abdulaziz A, Ceri JP, Deborah F. A systemic review of the clinical and economic effectiveness of clinical pharmacist intervention in secondary prevention of cardiovascular disease. J Manag Care Pharm. 2013;19(5):408-16. https://doi.org/10.18553/jmcp.2013.19.5.408
25. John L, Tauqir P, Brad S. Sutton, Lorrel E, Peter J, et al. The Cardiovascular Intensive Care Unit-An Evolving Model for Health Care Delivery. Journal of Intensive Care Medicine. 2017;32(2):116-23. https://doi.org/10.1177/0885066615624664
26. Luisetto M, Ghulam Rasool Mashori. Intensive Care Units (ICU): The clinical pharmacist role to improve clinical outcomes and reduce mortality rate 2017; J Pharma Pharma Sci: JPPS-144.
27. LaPointe NM, Jollis JG. Medication errors in hospitalized cardiovascular patients. Arch Intern Med. 2003;163:1461-6.28. Azita Hajhossein, Talasaz. The Potential Role of Clinical Pharmacy Services in Patients with Cardiovascular Diseases. Published
online. 2012;7(2):41-6. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3466897/
29. https://www.acc.org/Guidelines.
30. https://www.medscape.com/.
31. https://www.webmd.com/.
32. https://www.drugs.com/.
33. Richard S. Bourne, Rob Shulman, Mark Tomlin, Mark Borthwick, Will Berry, Gary H. Mills. Reliability of clinical impact grading by healthcare professionals of common prescribing error and optimisation cases in critical care patients. International Journal for Quality in Health Care. 2017; 29(2,1):250-5. https://doi.org/10.1093/intqhc/mzx003
34. Chung JS, Lee KK, Tomlinson B, Lee VW. Clinical and economic impact of clinical pharmacy service on hyperlipidemic management in Hong Kong. J Cardiovasc Pharmacol Ther. 2011;16:43-52. https://doi.org/10.1177/1074248410380207
35. Moyen E, Camiré E, Stelfox HT. Clinical review: Medication errors in critical care. Crit Care. 2008;12:208. https://doi.org/10.1186/cc6813
36. Chen B, Huang JJ, Chen HF, Xu BM. Clinical pharmacy service practice in a Chinese tertiary hospital. Drug Metab Pers Ther.2015;30(4):215-30. https://doi.org/10.1515/dmpt-2015-0009
37. O’Dell KM and Kucukarslan SN. Impact of the clinical pharmacist on readmission in patients with acute coronary syndrome.Ann Pharmacother. 2005;39(9):1423-7. https://doi.org/10.1345/aph.1e640
38. Al-Somai N, Al-Muhur M, Quteimat O, Hamzah N. The impact of clinical pharmacist and ID intervention in rationalization of antimicrobial use. Saudi Pharm J. 2014;22(6):516-21. https://doi.org/10.1016/j.jsps.2014.02.003
39. AbuRuz ME, Alaloul F, Saifan A, Masa’deh R, Abusalem S. Quality of Life for Saudi patients with heart failure: A cross-sectional correlational study. Glob J Health Sci. 2016;8(3):49-58. https://doi.org/10.5539/gjhs.v8n3p49
40. Shareef J, Sandeep B, Shastry CS. Assessment of drug related problems in patients with cardiovascular diseases in a tertiary care teaching hospital. J Pharm Care. 2014;2(2):70-6.
41. Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, et al. Pharmacist participation on physician rounds andadverse drug events in the intensive care unit. JAMA. 1999;282(3):267-70. Erratum in: JAMA 2000;283(10):1293. https://doi.org/10.1001/jama.282.3.267
42. Talasaz AH. The potential role of clinical pharmacy services in patients with cardiovascular diseases. J Teh Univ Heart Ctr. 2012;7(2):41-6. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3466897/
43. Altowaijri A, Phillips CJ, Fitzsimmons D. A systematic review of the clinical and economic effectiveness of clinical pharmacist intervention in secondary prevention of cardiovascular disease. J Manag Care Pharm. 2013;19:408-16. https://doi.org/10.18553/jmcp.2013.19.5.408
44. Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med. 2010;362(7):590-9. https://doi.org/10.1056/nejmoa0907355
45. Carey, Szkiladz AK, Ackerbauer K, Heelon M, Friderici J, Kopcza K. Impact of pharmacy student and resident-led discharge counseling on heart failure patients. J Pharm Pract. 2013;26:574-9. https://doi.org/10.1177/0897190013491768
46. Henry Dargie, Heart failure post-myocardial infarction: a review of the issues. 2005; Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK.
47. Koshman SH, Charrois TL, Simpson SH, McAlister FA, Tsuyuki RT. Pharmacist care of patients with heart failure, a systematic review of randomized trials. Arch Intern Med. 2008;168(7):687-694. https://doi.org/10.1001/archinte.168.7.687
48. Yu DSF, Thompson DR, Lee DTF. Disease management programs for older people with heart failure: crucial characteristics which improve post-discharge outcomes. Eur J Heart Fail. 2006;27:596-612. https://doi.org/10.1093/eurheartj/ehi656
49. Keith AA Fox, Philippe Gabriel Steg, Kim A Eagle, Shaun G, Frederick A, Christopher B, et al. Decline in Rates of Death and Heart Failure in Acute Coronary Syndromes, 1999-2006. JAMA. 2007;297(17): 1892-1900. https://doi.org/10.1001/jama.297.17.1892
50. Pei-Xi Zhao1, Chao Wang1, Li Qin2, Ming Yuan3, Qian Xiao4, Ying-Hua Guo5, et al. Effect of clinical pharmacist’s pharmaceutical care intervention to control hypertensive outpatients in China. 2011; 6. https://doi.org/10.5897/AJPP11.633
51. Schnipper, J, Kirwin, J, Cotungo M. Role of pharmacist counseling in preventing adverse drug events after hospitalization. ArchIntern Med. 2006;166:565-71. https://doi.org/10.1001/archinte.166.5.565
52. Warrington L, Ayers P, Baldwin AM, Virginia W, Krista D, Saulters R, et al. Implementation of a pharmacist-led, multidisciplinary diabetes management team. Am J Health Syst Pharm 2012;69:1240-5. https://doi.org/10.2146/ajhp110297
53. Preslaski CR, Lat I, MacLaren R, Poston J. Pharmacist contributions as members of the multidisciplinary ICU team. Chest. 2013;144:1687-95. https://doi.org/10.1378/chest.12-1615
54. Eric D. Peterson, Matthew TR, Mulgund J, Elizabeth RD, Barbara L, Ralph G, et al. Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA. 2006;295(16):1912-20. https://doi.org/10.1001/jama.295.16.191
55. Nicole M. Gasbarro, Kristin H. Eginger, Connie Street. Impact of Clinical Pharmacist Interventions on 30-Day Readmission Rate in Hospitalized Patients With Acute Myocardial Infarction. First Published 2014;31(2):64-8 https://doi.org/10.1177/875512251455175656. Xiao-Bo Zhai, Zhi-Chun Gu, Xiao-Yan Liu . Clinical pharmacist intervention reduces mortality in patients with acute myocardial infarction: a propensity score matched analysis. published online 2018;26(5):248-52 https://doi.org/10.1136/ejhpharm-2017-001344
57. Bond CA, Raehl CL, Franke T. Clinical pharmacy services and hospital mortality rates. Pharmacotherapy. 1999;19:556-64.https://doi.org/10.1592/phco.19.8.556.31531