Nesligül ÖZDEMİR, Ayce CELİKER, Bulent Barıs KUSKONMAZ, Fatma Visal OKUR, Duygu UCKAN CETİNKAYA

Evaluation of Drug-Related Problems in a Pediatric Bone Marrow Transplantation Unit Identified by a Clinical Pharmacist in-training in a 7-Month Period

Objective: This cross sectional study was performed to demonstrate the importance of clinical pharmacists’ participation in pediatric hematopoietic stem cell transplantation patient management with regards to the detection, prevention, and management of drug-related problems.Methods: The study was carried out from 1st October 2015 to 1st May 2016 in a pediatric bone marrow transplantation unit of a tertiary care hospital. The inpatients and outpatients between 0 to 18 years of age were included and the patients were monitored and evaluated for drug-related problems (interactions, side effects, preparation, and administration). A clinical pharmacist-in-training made recommendations to the physicians and the nurses on the problems that were identified.Results: Twenty inpatients and twenty-two outpatients were monitored during the study. In total, 245 problems were identified in the inpatients, 37.14 % of which were drug-related; 33 % of the drug-related problems were the side effects of cyclosporine. Eleven recommendations on drug-related problems were made to the physicians and six of them were for the problems identified in the inpatient services with regards to drug dosing and administration. Five recommendations regarding total parenteral nutrition, drug incompatibility, drug administration from the feeding tube, and drug side effects were made to the nurses. Twenty-nine information on the dosing, side effects, incompatibilities, administration, and preparation of the drugs, were given by the pharmacist to the physicians and the nurses.Conclusion: Clinical pharmacists’ participation will improve the detection and the management of drug-related problems in pediatric hematopoietic stem cell transplantation units in Turkey.

Keywords:

clinical pharmacist, pediatric hematopoietic stem cell transplantation patients, drug related problems,

PDF

___

1. European Society for Blood and Marrow Transplantation, Annual Report 2017. 2018. https://www.ebmt.org/ebmt/documents/ebmt-annual-report-2017. Accessed 2 Jan 2019.
2. Hatzimichael E, Tuthill M. Hematopoietic stem cell transplantation. Stem Cells Cloning 2010;3:105–17.
3. Yeşilipek MA. Hematopoetic stem cell transplantation in children. Turk Pediatri Ars 2014;49:91–8.
4. Applebaum FR. The current status of hematopoietic cell transplantation. Annu Rev Med 2003;54:491-512
5. Ghaleb MA, Barber N, Franklin BD, Yeung VWS, Khaki ZF, Wong IC. Systematic review of medication errors in pediatric patients. The Annals of Pharmacotherapy 2006;40:1766-76.
6. Prot-Labarthe S, Therrien R, Demanche C, Larocque D, Bussières JF. Pharmaceutical care in an inpatient pediatric hematopoietic stem cell transplant service. J Oncol Pharm Pract 2008;14:147-52.
7. Lu H, Rosenbaum S. Developmental pharmacokinetics in pediatric populations. J Pediatr Pharmacol Ther 2014;19:262–76.
8. Barfield RC, Kasow KA, Hale GA. Advances in pediatric hematopoietic stem cell transplantation. Cancer Biol Ther 2008;7:1533-39.
9. Ratko TA, Belinson SE, Brown HM, Noorani HZ, Chopra RD, Marbella A, et al. Hematopoietic stem-cell transplantation in the pediatric population. Agency for Healthcare Research and Quality 2012.
10. Ferranti J, Horvath MM, Cozart H, Whitehurst J, Eckstrand J. Reevaluating the safety profile of pediatrics: a comparison of computerized adverse drug event surveillance and voluntary reporting in the pediatric environment. Pediatrics 2008; https://doi.org/10.1542/18450863
11. Hematopoietic Cellular Therapy Accreditation Manual, 7th edition, JACIE/FACT. 2018. https://www.ebmt.org/jacie-standards/7th-edition-effective-june-1st-2018. Accessed 2 Jan, 2019.
12. Turkey Stem Cell Coordination Center (TURKOK), Statistics. 2018. https://turkok.saglik.gov.tr/TR,21122/istatistikler.html . Accessed 2 Jan, 2019.
13. Glotzbecker B, Duncan C, Alyea E, Campbell B, Soiffer R. Important drug interactions in hematopoietic stem cell transplantation: what every physician should know. Biol Blood Marrow Transplant 2012;18:989-1006.
14. Deeg HJ. Optimization of transplant regimens for patients with myelodysplastic syndrome (MDS). Hematology Am Soc Hematol Educ Program 2005;167-173.
15. Chaudhry HM, Bruce AJ, Wolf RC, Litzow MR, Hogan WJ, Patnaik MS, et al. The incidence and severity of oral mucositis among allogeneic hematopoietic stem cell transplantation patients: a systematic review. Biol Blood Marrow Transplant 2016;22:605-16.
16. Griffith ML, Savani BN, Boord JB. Dyslipidemia after allogeneic hematopoietic stem cell transplantation: evaluation and management. Blood 2010;116:1197-204.
17. Törlén J, Ringdén O, Garming-Legert K, Ljungman P, Winiarski J, Remes K, et al. A prospective randomized trial comparing cyclosporine/methotrexate and tacrolimus/sirolimus as graft-versus-host diseaseprophylaxis after allogeneic hematopoietic stem cell transplantation. Haematologica 2016;101:1417-25.
18. Mehdizadeh M, Hajifathali A, Tafazoli A. Drug utilization evaluation of cyclosporine in allogeneic hematopoietic stem cell transplantation. Exp Clin Transplant 2015;13:461-66.
19. Robert N, Wong GW, Wright JM. Effect of cyclosporine on blood pressure. Cochrane Database Syst Rev 2010; https://doi: 10.1002/14651858
20. Kishi Y, Murashige N, Kami M, Miyakoshi S, Shibagaki Y, Hamaki T, et al. Optimal initial dose of oral cyclosporine in relation to its toxicities for graft-versus-host disease prophylaxis following reduced-intensity stem cell transplantation in Japanese patients. Bone Marrow Transplant 2005;35:1079-82.
21. Jenssen T, Hartmann A. Emerging treatments for post-transplantation diabetes mellitus. Nat Rev Nephrol 2015;11:465-77.
22. Fuji S, Rovó A, Ohashi K, Griffith M, Einsele H, Kapp M, et al. How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT. Bone Marrow Transplant 2016;51:1041-49.
23. Komanduri KV. Pharmacists and physicians in hematopoietic stem cell transplantation: advances and opportunities to use collaborative practice agreements to improve care. Biol Blood Marrow Transplant 2013;19:505-8.
24. Ho L, Akada K, Messner H, Kuruvilla J, Wright J, Seki JT. Pharmacist's Role in Improving Medication Safety for Patients in an Allogeneic Hematopoietic Cell Transplant Ambulatory Clinic. Can J Hosp Pharm 2013;66:110-7.
25. Kelly DV, Bishop L, Young S, Hawboldt J, Phillips L, Keough TM. Pharmacist and physician views on collaborative practice: Findings from the community pharmaceutical care project. Can Pharm J (Ott) 2013;146:218-26.
26. Berhane A, Ali E, Odegard P, Suleman S. Physicians’ expectations of clinical pharmacists’ roles in Jimma University SpecializedHospital, South west Ethiopia. International Journal of Pharmacy Teaching & Practices 2013;4:571-4.
27. Westbrook JI, Rob MI, Woods A, Parry D. Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ Qual Saf 2011;20:1027-34.
28. Ghaleb MA, Barber N, Franklin BD, Wong IC. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child 2010;95:113-8.