The clinical pharmacist governed periodic monitoring of high alert medications in a tertiary care hospital: A drug utilization evaluation study

Introduction: Patient medication compliance is an essential component that determines treatment outcome. Discrepancies in therapy would generate adverse effects that can have inter-personal variability. In a hospital setting, high alert medications are usually administered under physician's supervision and require special considerations. Hence, there is a need to evaluate the drug utilization of such medications in the tertiary care hospitals. Materials & Methods: A six month retro-prospective observational study composed of three phases; first phase was scheduled for planning and setting of high alert medications’ rational usage criteria, second phase included data collection according to generated requirements. In phase 3, analysis of data and feedback of results. Results: One hundred and fifty four patients’ medical information was retrieved and had total of 229 prescribed high alert medications. Anti-thrombotic and anticoagulants (n = 89, 57.80%; enoxaparin sodium, n = 64, 71.9%) were highly utilized, followed by insulin (n = 30, 19.50%). Eighty six percent (n = 133) was complying with countersign and independent double checks concerning high alert medication and 89% (n = 137) patients were appropriately monitored. The drug utilization evaluation identified (n = 24) 15.6% transcription and documentation errors and few adverse drug reactions (infusion related, n = 3, 1.9%; drug related, n = 1). The subjects between the age group of 71 to 80 years (P-value < 0.05) and those with administration error (P-value < 0.01) had to stay longer in the hospital (> 9 days). Discussions: The pharmacist mediated patient review had sorted out few medication errors and adverse drug reactions. However, rapid high alert medication feedback system generated by the clinical pharmacist served the physicians to better manage the patient before it is late and without causing any fatal events. Conclusion: Training the medical professionals on proper handling and administration of high alert medications can reduce potential patient harm.