4 Clinical Intervention

8/19/2019 4 Clinical Intervention

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Clinical Intervention


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Drug Related Problem

• An event or circumstance involving drug

therapy that actually or potentially interferes

with desired health outcomes


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• Duplication

– Interacting drugs are of the same therapeutic class

Example:

Patient taking two different brands of amiodarone at the

same time

Drug Selection


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Drug Selection

• Drug interaction

– Prescription or non-prescription medicine that

could result in a major interaction if taken with

the concurrent therapy

Example:

Patient asks to purchase an OTC anti-inflammatory when

taking warfarin

Drug Selection


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Drug Selection

• Wrong Drug

– Incorrectly prescribed or incorrectly dispensed

Example:

Doctor prescribes carbimazole 20 mg bid instead of

carbamazepine 200 mg bid

Drug Selection


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Drug Selection

• Incorrect strength

– No details about a drug’s strength or incorrect

details

Example:

Doctor prescribes Irbesartan 150 mg daily but previous

therapy was 300 mg daily

Drug Selection


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Drug Selection

• Inappropriate Dosage Form

– Formulation of the product is inappropriate or

incorrect in terms of the intended use of the

product

Example:

A rectal topical product is prescribed or supplied for an

eye problem

Drug Selection


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Drug Selection

• Contraindication apparent

– Contraindicated due to their medical conditions

Example:

Enalapril for a woman who is 7 months old pregnant

Drug Selection


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Drug Selection

• No indication apparent

– no reason for the drug to be used

Example:

Patient using steroid eye drops over a long term without

current indication

Drug Selection


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Drug Selection

• Other problems

– Out of date or has deteriorated

– Discontinued or out of stock on a long term basis

Example:

Patient presents a prescription for trimethoprim for a

UTI. The drug is out of stock for another 3 weeks, so the

doctor is contacted with a suggestion for an alternative

antibiotic

Drug Selection


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Over or Underdose Prescribed

• Too high

– Total daily dose is too high based on previous

dosage range or reference dosage ranges

– Too high by unintentional error

Example:

A patient is prescribed dexamethasone 50 mg daily (the

prescriber was thinking of prednisolone dose)


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• Too low

– Total daily dose is too low based on previous

dosage range or reference dosage ranges

– Too low by unintentional error

Example:

A 30 kg child is prescribed amoxicillin 125 mg tid

(recommended dose 7.5 – 25 mg/kg tid)


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• Incorrect or unclear dosing instructions

– Specified dosing is not optimal

– Duration is too short or too long

– Incorrect dose titrations

Example:

A patient presents a new prescription for lamotrigine 100

mg bid with no instructions to increase slowly (dose

should start at 25 mg/day for 2 weeks and increase by

maximum of 50 – 100 mg every 1-2 weeks)


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Compliance

• Under-use by consumer

– Uses too little of a medicine as a result of

forgetfulness or lack of understanding

Example:

Patient only takes lercanidipine when his blood pressure is

very high


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Compliance

• Over-use by consumer

– Uses too much of a medicine as a result of

forgetfulness or lack of understanding

Example:

Patient requesting repeat prescription of simvastatin after

two weeks because he was forgetting that he had taken it


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Compliance

• Intentional drug misuse

– Suspected intentional over-use of potentially

abused, product including non-prescription items

Example:

Patient requesting for a second presciption from a

different prescriber for nitrazepam after 1 week, claiming

she dropped the previous supply down the toilet


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Compliance

• Difficulty using dosage form

– Lacks understanding of how to use the dosage

form

– Has a physical problem with the administration of

the dosage form or device

Example:

Patient cannot swallow sustained-release diltiazem

capsules


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Undertreated

• Undertreated

– Symptom or disease that is not being treated

adequately

Example:

Patient frequently requests glyceryl trinitrate spray but is

not being treated with regular anti – angina medication


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Undertreated

• Untreated

– Symptom or disease that is not currently being

treated

Example:

Patient has a fall resulting in a hip fracture but is not on

any medication


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Undertreated

• Preventive therapy required

– Requires additional therapy to prevent a likely

adverse event

Example:

Patient started on a morphine slow-release without

laxative therapy


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Monitoring

• Laboratory Monitoring

– In the absence of any adverse effect, laboratory

monitoring is required

– any laboratory test that is not done within the

consumer’s home, doctor’s surgery or pharmacy

Example:

Patient on warfarin was discharged from hospital 2 weeks

ago and has not yet had a post – discharge INR


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Monitoring

• Non - laboratory Monitoring

– In the absence of any adverse effect, non-

laboratory monitoring is required

Example:

Diabetic patient recently prescribed with insulin is advised

to regularly monitor their blood sugar levels


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Education or Information

• Consumer requests drug information

– Has a reasonable understanding of their

condition, but requests further information about

their medicine

Example:

After starting hormone replacement therapy (HRT), a

consumer requests further printed information about

breast cancer and HRT


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Education or Information

• Consumer requests disease management

advice

– To inform patients of critical aspects of the

management or prevention of a disease orcondition

Example:

Information about fluid restriction is given to a patient

with heart failure


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Not classifiable

• Cannot be classified under another category


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Toxicity or Adverse Reaction

• Toxicity, allergic reaction or adverse effect

present

– Includes situations in which compliance issues

have led to symptoms of toxicity

4 Clinical Intervention

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