Finished Projects Abstracts

Finished Projects Abstracts

Drug Prescription Pattern in Pediatric Epileptic Patients in a Tertiary Care Referral  Hospital

ABSTRACT

The  study  on “Drug Prescription Pattern in Pediatric Epileptic Patients in a Tertiary Care Referral Hospital”  was a  prospective observational study  carried  out  at  Al-Shifa  Hospital’ Perinthalmanna, for  eight months . The aim was to evaluate the pattern of prescription of antiepileptic drugs in pediatric patients. The prescription data of 91 patients of seizures from pediatric in patient department was analyzed. Demographic details of the patients, types of Epilepsy, the patients has been diagnosed with, number of AED’s prescribed, dose and duration, were recorded. The study focused on children aged up to 12 years. Out of 91 patients52 (57.1%) were male and 39(42.9%) were females. The most common epilepsy was Febrile seizure 36(39.6%) followed by Generalized seizure 20(22%) and Simple partial Seizures 19(20.90%) respectively. The most frequently used therapy in febrile seizure was monotherapy while dualtherapy was used in generalized seizure .The average number of AEDs prescribed per patient was 1.8. Most commonly prescribed drug was Fosphenytoin which accounts for 50(29.8%) in both the genders, followed by Lorazepam 37(22%) and Clobazam usage was 32(19%). Mono therapy was the type of therapy most frequently used in all types of seizures. For Febrile seizures, Fosphenytoin(62%),Generalized seizures clobazam(37.5%), Simple partial seizures Lorazepam (29.8%) was commonly prescribed AEDs . In this study relative frequency of utilization of first generation AEDs were 83(49.4%) and benzodiazepines 85(50.4%). The study suggests that there is immense scope of improvement in prescribing in this department. Proper implementation of rational use of drugs will result in better community health care.

 Development of hospital formulary for a tertiary care referral hospital

This was a prospective study carried out in five phases over a period of one year in Al Shifa Hospital. The study aims to design and develop second edition of Formulary in the hospital, to compare it with National Essential Drug List 2011, WHO model list 2011, first edition of Al Shifa formulary and National Formulary of India 2011 and to implement the prepared hospital formulary. The selected drugs were classified according to the BNF in to 16 therapeutic categories. Monographs were prepared for all the drugs in the hospital pharmacy. Prepared formulary consisted of 414 generic drugs among these about 49.48% drugs were available in single brand, 32% in two brands and there was about 118 FDCs in the prepared formulary, There were only 85 drugs safe to use in pregnancy. About 179 drugs recommended by the essential list were not present in the prepared formulary absence of oncology department in the hospital is considered as the reason for this deviation. Addition and deletion of drugs had done in every therapeutic class of drugs. During the surveillance of pharmacy it was found that out of 417 drugs, 25 drugs were those that were not present in pharmacy but were included in the formulary, about 34 drugs were present in the pharmacy but not included in the formulary. Study suggests that formulary management process is very important to give current and updated knowledge about the drugs and their availability to the healthcare providers to promote rational drug use. The prepared formulary will be published in a book format and distributed to all physicians to support their prescription and to promote rational drug use in the hospital.

Drug use evaluation of antihypertensive drugs and impact of patient counseling using pictogram in hypertension

Hypertension is a chronic illness associated with high morbidity & mortality. The present study aims to conduct DUE of antihypertensive drugs and to measure impact of patient counseling using pictograms. The study was carried out in inpatients of a tertiary care referral hospital. 150 hypertensive patients were included in the study. Patients Data were collected from inpatients case sheets and laboratory reports. The 150 were randomly distributed into two groups, control and test. The control group receives only verbal counseling and normal text based instruction at discharge, were as the test group receives the pictogram based counseling and pictogram based instructions at discharge. Standard USP pictograms were used and some cultural specific pictograms were also developed. The patient medication adherence was compared in two groups. Medication adherence was measured by using a validated questionnaire. The data were analyzed using SPSS 17.0 for Windows version.  After analyzing the patient demographic details, females were in majority with 56% compared to males 44%, majority of the patients were suffered from stage-II hypertension. This study revealed that high proportion of hypertensive patient had co-morbid diabetes mellitus. The most widely prescribed class were ARBs followed by CCBs, β-blockers respectively. In this study it was found that test group shows a higher adherence than control group and the medication adherence progressed with time in the test group. The study shows that clinical pharmacist can play a key role to promote rational prescribing and improve the adherence.

Development of paediatric formulary for a tertiary care referral hospital

                         The objectives of the study were to design and develop a questionnaire to evaluate the need of Paediatric Formulary, to collect the existing Paediatric Drug list from the chief pharmacist, and to prepare monographs for the Paediatric Formulary. This was a prospective study to design and develop Paediatric Formulary for a tertiary care hospital with an aim to provide updated drug information to healthcare professionals to promote rational drug use. This study was conducted over a period of one year and carried out in tertiary care Al Shifa hospital. Statistical analysis was done by using SPSS 17.0 for Windows version. The prepared Paediatric Formulary consists of 152 drug monographs excluding fixed drug combinations. Information on Generic name, Therapeutic category, Pharmacokinetics, Indications, Contra-indications, Precautions, Adverse reactions, Dosage, Administration, Pregnancy, Breast feeding, Drug interactions, Poisoning, Brands available, Drug Price were  present in prepared Paediatric Formulary. In the prepared Al Shifa Paediatric Formulary, about 80 (41.67%) drugs were available in single brand, 68 (35.42%) in two brands, 30 (15.63%) as three brands, while 14 (7.29%) as four brands. The Prepared Paediatric Formulary contains 40 (20.80%) numbers of FDCs (Fixed Drug Combinations), 19 (9.89%) numbers of Vaccines out of total 192 drugs. The study found that the number of drugs and combinations were more in the prepared Paediatric Formulary than IAP Paediatric Formulary. The percentages of vaccines included in the prepared Paediatric Formulary were more than that of WHO and IAP Essential Drug List.

Role of clinical pharmacist in adverse drug reaction monitoring and effect of patient education in reducing adverse drug reaction incidence rate

This study was carried out in a 350 bedded tertiary care referral hospital located. The aim of this study was firstly to assess perceptions of adverse drug reaction amongst hospitalized patients and to educate them ,To detect the incidence rate of adverse drug reaction in a tertiary care referral hospital.

Ethics approval was obtained before initiation of study. A prospective observational study was conducted. During study period total 60 ADRs were reported from various departments. Majority of patients reported more than one ADRs.  Maximum numbers of ADRs were reported from the General medicine department 19(31.7%). Statistical analysis shown that high significant association exist between the education level and knowledge on medication which contributes to create awareness about ADR reporting among patients. Male 39 (65%) predominated over females 21(35%) in ADR occurrence. Skin 19(31.7%) was the mostly affected organ system by the adverse drug reactions. Type B- 34 (56.70%) was common reactions. The major predisposing factor contributing to ADR was Multiple Drug Therapy (31.7%). 45(75%) of cases the suspected drug was withdrawn. Of the reported ADRs moderate reactions accounted about 33(55%). As per Naranjo scale, 32(53.30%) were probable. Analysis of results showed that 54(90%) of the ADRs were predictable. Study revealed that 35(58.30%) of the ADRs were definitely preventable. In conclusion study suggests the need for rational use of medication at right dose, at right time at right intervals to control the overall ADR incidence rate .

STUDY ON MEDICATION ERROR IN PEDIATRIC AND GERIATRIC DEPARTMENT OF A TERITARY CARE   HOSPITAL

The study was conducted over a period of 1 year  and carried out in multi-specialty referral hospital. categorize medication error  according to NCCMERP(National coordinating council for medication error reporting and prevention)and ASHP (American society of health system pharmacist).The statistical analysis of the study was done using SPSS 17.0 for windows version

During the study period Medication errors were observed in 117 in-patients were male (57.3%) and female (42.7%).Geriatrics are proportionately more in inpatients due to existence of inter current diseases, more susceptibility to infection, inefficient immune system etc.  According to ASHP categorization prescription errors (54.7.%) were the most frequently occurring type of error. It was followed by administration errors (29.1%), dispensing errors (16.2%). Drug interaction, patient errors and other type of errors collectively contributed to the remaining portion. Based on the extent of harm NCC MERP classified medication errors as follows, No error 10.3%), Error, no harm (70.9%), Error; Harm (18.8%), Error, death (0.0%). In   department wise distribution of the study more number of medication errors were in geriatric population. In pediatric department more number of medication errors were found in pediatric2(10.3%),Pediatric1(6.8%), pediatric3(6%).Geriatric populations are more to produce medication errors self-medication is the main problem in elderly.

The study helps to assess the incidence of medication error and to categorize medication error based on NCCMERP and ASHP guidelines .In the study prescribing errors were more frequent followed by administering errors and dispensing errors.

A PROSPECTIVE SURVEILLANCE STUDY ON THE PREVALENCE AND INFLUENTIAL DETERMINANTS OF POLYPHARMACY IN HOSPITALIZED GERIATRIC PATIENTS

Polypharmacy is the use of multiple medications by a patient (i.e,5 to9 drugs), especially when more drugs are prescribed than is clinically warranted or more dosage forms are prescribed. This study entitled “A prospective surveillance study on the prevalence and influential determinants of polypharmacy in hospitalized geriatric patients” aims to reduce overall prevalence of polypharmacy. This prospective study, carried out in Al shifa hospital, Perinthalmanna, was conducted in 2 phases, each extending for 5 months, focusing 7 major departments of the hospital. Out of 145 patients in phase 1, 64.8% patients had polypharmacy and the remaining 35.2% patients were deprived of it. Eventually, certain remedial measures to minimize the percentage of polypharmacy were suggested to doctors at the end of phase 1. As a result, the rate of polypharmacy has been reduced to 55% during phase 2. The influential determinants of polypharmacy were identified as age, length of hospital stay and co morbidities. The most common off-label prescribed drugs were found to be Pantoprazole, Cefoperazone+sulbactum and Atorvastatin. Interventions to reduce polypharmacy and high level polypharmacy during hospital stays should focus on patients who have co morbidities, increasing age and hospitalized for > 10 days. The campaign for rational drug use in the elderly population should promote the prescribing of Pantoprazole, Cefoperazone+sulbactum and Atorvastatin in accordance with their indications.

A PROSPECTIVE OBSERVATIONAL STUDY OF DRUG-DRUG INTERACTION IN GENERAL MEDICINE DEPARTMENTS OF A TERTIARY CARE HOSPITAL

Drug interaction are said to occur when pharmacologic activity of a drug altered by the concomitant use of another drug or food, drinks, or environmental chemicals. Drug interactions may have potentially life-threatening consequences in older adults, who may take several drugs at once for multiple conditions. This study aims to carry out a prospective study of drug-drug interactions in general medicine departments of Al Shifa Hospital and estimate the risk associated with drug interactions. The number of drugs prescribed and the duration of hospital stay was analyzed. All the drug interactions were analyzed based on their mechanism, severity, and significance. The data were analyzed using SPSS 17.0. The total number of male patients in the study was 36 accounting for 46% while females accounted for the remaining 55% of the cases within 44 patients. The average number of drugs prescribed per patient in the study population was 7.51. 33.47% of the drug-drug interactions were pharmacokinetic while 40.24% were pharmacodynamic, 26.29% of the interactions mechanism was not specified. Interactions of minor severity accounted for 34.66% while those of moderate and major severity accounted for 47.01% and 17.93% respectively. It was seen that interaction belonging to suspected were most common at 37.5% while possible interaction were least common at 5%. The average duration of hospital stay of the patients in the study population is calculated to be 7.05 days. A successful DDIs evaluation will have a positive impact on the medication use system to improve the quality of patient care.

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