Category: Federal Forum Posters
Purpose: In accordance with the Drug utilization review program developed by Korea Ministry of Food and Drug Safety(MFDS) in 2004, a single tertiary general hospital has been conducting prescription control through a computer program for drugs prohibited to be used in combination since 2006. However, in order to treat certain patients, it is inevitable to use the drugs together. Yet, follow-up studies are lacking. Therefore, this study was conducted for the purpose of guiding safe drug use by analyzing the status of prescription including incidence of personal injury and monitoring performance rate which was selectively allowed.
Methods: This study was conducted for patients who received medications that are not recommended to use together during the hospitalization period from August 1, 2016 to July 31, 2017 in a single tertiary general hospital in Korea. The cases were not administered together and the emergency situations such as cardiopulmonary resuscitation were excluded. In order to analyze the prescription status, we collected data on the combination of medicines, reasons to avoid combined prescription, number of days together, and reasons for requesting cancellation of control. For safety evaluation, data on monitoring performance, interaction rate, and number of days of hospital stay were collected. The data were retrospectively collected using medical records and analyzed using IBM SPSS Statistics ver. 23.0(IBM Co., Armonk, NY, USA).
Results: Among the prohibited drug combinations announced by the MFDS, there were 17 kinds of combinations prescribed in the hospital for the past one year and the total number of cases was 306. Of the total prescriptions, the actual follow-up monitoring rate was 110 cases (35.9%) and the incidence of adverse events was 42 cases (13.7%). However, 176 cases (57.5%) were not identified because monitoring was not performed. In addition, the prescription rate for children under 18 years old and geriatrics aged 65 years or older who required careful use of medications due to relatively high risk of adverse drug reactions were 117 cases (38.2%) and 37 cases (12.1%) respectively, accounting for 50.3%. The combination of drugs that are not recommended to use together announced by MFDS is highly likely to cause harm to patients. Although follow-up monitoring should be accompanied, a low monitoring rate was observed in this study. Therefore, additional measures are needed, such as follow-up check by the pharmacist, to increase it. In particular, it is necessary to concentrate on children and the elderly.
Conclusion: Drugs that are not recommended to use together are highly risky and should be considered in conjunction with the patient's clinical situation, taking risks and benefits into consideration. In addition, patients should be monitored continuously for the prescriptions. In particular, it is necessary to focus on children and the elderly who are relatively vulnerable to adverse drug reactions. This study has significance in analyzing not only prescription status but also post-management status such as monitoring performance rate and symptom incidence. This will serve as the basis for safer drug use. Further multi center studies are needed for more comprehensive studies.
Kyunga Lee– Department of pharmacy / Pharmacist, Yonsei University Healthcare System, Seodaemun-gu, Seoul-t'ukpyolsi, Republic of Korea