Purpose: In many countries, outpatient and inpatient care are separated. During hospitalization, therefore, switching the outpatient medication to medication of the hospital formulary is required.
Methods: We newly designed a switching algorithm in six switching steps (S0-S5) and conducted a study at Bundeswehr Hospital Hamburg (300 beds, 80% civilians). We performed (i) a medication reconciliation to obtain information on outpatient medications and (ii) a medication review to solve drug-related-problems, e.g., drug-drug interactions. We applied (iii) the algorithm to switch medications to the hospital formulary.
Results: (i) We identified 475 outpatient medications (median per patient: 4; Q25/Q75 2/7) in 100 patients consecutively admitted to hospital (median age: 71; Q25/Q75: 64/80 years). Of 475 medications, the switching algorithm could not be used since product names were missing in 23.9% and strength in 1.7%. In 3.2%, switching was not required since medication was not prescribed during the hospital stay. (ii) Drug-drug interactions were identified in 31 of 79 patients with more than one medication. (iii) Of 475 medications, 18.5% were on the hospital formulary and therefore did not need to be switched (S0), 0.2% were on a substitution-exclusion list not allowing switching (S1), 42.0% were switched to a generic medication of the hospital formulary (S2), 1.7% to a therapeutically equivalent medication (S3), 0.4% were patient-individually switched (S4), and for 8.2% a standardized/patient-individual switching was not possible (S5).
Conclusions: Despite comprehensive medication reconciliation, patient- and medication-related information for switching medications to the hospital formulary was often missing. Once all the necessary information was available, standardized switching could be easily carried out according to a newly developed switching algorithm.
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http://dx.doi.org/10.1007/s00228-024-03682-w | DOI Listing |
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Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Purpose: Gabapentinoids are mainly prescribed for neuropathic pain and certain seizure disorders, but their off-label use has increased significantly. This rise raises concerns about the insufficient evidence supporting some applications, as well as potential risks of misuse, dependence, and adverse effects. The study aims to examine the prescribing patterns and off-label use of gabapentinoids at Dhulikhel Hospital (DH), Nepal, focusing on understanding the extent of off-label practices and patient knowledge regarding their medications.
View Article and Find Full Text PDFBMC Emerg Med
December 2024
Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, USA.
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PEDeus Ltd, Zurich, Switzerland.
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December 2024
GSK, Collegeville, United States
Background: Uncomplicated urinary tract infections (uUTIs) are common bacterial infections.
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J Pharm Pract
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Department of Pharmacy, Aurora St Luke's Medical Center, Milwaukee, WI, USA.
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