DRUG RELATED
PROBLEMS
Ratna Kurnia Illahi
Departemen Farmasi Komunitas
Jurusan Farmasi FKUB
Definition
• Drug related problem (DRP) is defined as
an event that may potentially affect the
health outcomes in the patients.
Bemt Pvd, Egberts T. Drug Related Problems: definitions and classification.
EJHP Practice. 2007; Vol. 13(1):62-4.
• A Drug-Related Problem is an event or
circumstance involving drug therapy that
actually or potentially interferes with
desired health outcomes.
Pharmaceutical Care Network Europe. DRP-classification V5.1. Available from:
http://www.pcne.org/
• DRP can occur at all stages of medication:
- Prescribing
- Dispensing
- Lack of follow-up or reassessment of the
disease
DRP Classifications
American Society of Hospital Pharmacist (ASHP)
Classifications 1996
• DRP was defined as “…an event or
circumstance involving medication therapy that
actually or potentially interferes with an optimum
outcome for a specific patient.”
• One of the most used today.
DRP Classifications
• Classifications:
i. Medication with no indication
ii. Condition for which no drug is prescribed
iii. Medication prescribed inappropriately for a
particular condition
iv. Inappropriate dose, dosage form, schedule,
route of administration, or method of
administration
v. Therapeutic duplication
DRP Classifications
• Classifications:
vi. Prescribing of medication to which the patient
is allergic
vii. Actual and potential adverse drug events
viii. Actual and potential drug–drug, drug–
disease, drug–nutrient, and drug–laboratory
test interactions that are clinically significant
ix. Interference with medical therapy by social or
recreational drug use
DRP Classifications
• Classifications:
x. Failure to receive the full benefit of prescribed
therapy
xi. Problems are arising from the financial
impact of therapy
xii. Lack of understanding of the medication
xiii. Failure of the patient to adhere to the
regimen.
DRP Classifications
Cipolle/Morley/Strand Classification
• Using “drug-therapy problem” rather than DRP.
• Widely used in community pharmacies in the US
to assess the daily activities of the pharmacists
in practice.
• The term did not include potential DRPs, and
only applied when the actual ADR events
appear.
DRP Classifications
• Classifications:
i. Need for additional therapy
ii. Unnecessary therapy
iii. Wrong drug
iv. Dosage is too low
v. Adverse drug reaction
vi. Dose is too high
vii. Adherence problem
DRP Classifications
• Granada consensus
• Hanlon approach
• Hepler-Strand classifications
• Krska et al. system
• Mackie classifications
• etc
DRP Classifications
• Most classifications only have problem and
intervention sections, while it is also important to
identify the cause of the problem arose.
• Need another system that categorised the
problem, cause, and intervention.
DRP Classifications
• PCNE (Pharmaceutical Care Network Europe)
classification for Drug Related Problems
• This hierarchical system comprises separate
codes for problems, causes, and interventions
and is hierarchically structured.
• It is currently in use in projects conducted in
Sweden and the UK.
DRP Classifications
• The basic classification has 6 primary domains
for problems, 6 primary domains for causes and
5 primary domains for interventions; with sub
domains that can be regarded as explanatory for
the principal domains.
DRP Classifications
• The problems
DRP Classifications
• The problems
DRP Classifications
• The problems
DRP Classifications
• The causes
DRP Classifications
• The causes
DRP Classifications
• The causes
DRP Classifications
• The causes
DRP Classifications
• The causes
DRP Classifications
• The interventions
DRP Classifications
• The interventions
DRP Classifications
• The interventions
DRP Classifications
• Outcome of the interventions
Adverse drug reaction (ADR)
Symptoms
Drug therapy related to disease
or therapy
Human or
Medication errors systematic Medication errors
no morbidity error with morbidity
Adverse drug reaction (ADR)
• ADR define as an appreciably harmful or
unpleasant reaction, consequential from an
intervention associated to the use of a medicinal
product, that prognosticate risk from future
administration and warrants prevention or
particular treatment, or modification of the
dosage regimen, or withdrawal of the product
(Aronson, 2000).
• Also known as intrinsic toxicity
• Type A and Type B
Medication Error
• Extrinsic toxicity
• Prescribing Error
Administrative and procedural errors
• general (e.g. readability)
• patient data (e.g. patient mix-up)
• ward data and prescriber data
• drug name
• dosage form and route of administration
Medication Error
• Prescribing Error
Dosage errors
• strength
• frequency
• dosage too high/low
• no maximum dosage in “at need” prescription
• length of therapy
• directions for use
Medication Error
• Prescribing Error
Therapeutic errors
• indication
• contra-indication
• monitoring
• drug-drug interaction
• incorrect monotherapy
• (pseudo) duplicate therapy (duplicate therapy would be
e.g.inderal [contains propranolol] and propranolol;
pseudo duplicate therapy would be e.g. omeprazol and
pantoprazol [two drugs from same therapeutic category])
Medication Error
Dispensing Error
• for wrong patient or for wrong ward
• wrong drug
• wrong dosage form
• wrong strength
• wrong time
Medication Error
Administration error
• omission (drug not administered)
• unordered
• wrong preparation
• wrong dosage form
• wrong route of administration
• wrong administration technique
• wrong dosage
• wrong time (at least 60 minutes early/late)
• compliance/adherence
Medication Error
Medication error in class of seriousness
• A
An error has been made, but the medication did not
reach the patient
• B
An error has been made, and the medication reaches
the patient, but no harm is done
B1
medication not administered
B2
medication administered but no harm
Medication Error
Medication error in class of seriousness
• C
An error has been made which results in an increased
frequency of monitoring, but no harm is done
• D
An error has been made, and harm is done
D1 temporary damage necessitating treatment
D2 temporary damage resulting in an increased length of
hospital stay
D3 permanent damage
D4 patient nearly dies
• E
An error has been made which results in the death of the
patient
DRP in elderly patients
Accountable for more than 1/3 of DRP’s
Most common DRP’s:
- Not taking medication appropriately
- No indication
- Medication therapy needed
- Drug interaction
- Taking too much of correct medication
Pharmacist’s management of DRP
A. Reason for Pharmacist review
• Are patients with these characteristics predisposed
to specific diseases which may require drug
treatment?
• Do they have alterations in drug efficacy
(pharmacokinetic, pharmacodynamic) which may
require alterations in drug choices?
• Are they predisposed to drug toxicity which may
require altered doses or drug choices?
• Are they predisposed to factors which may affect
their compliance or drug taking behaviour (eg.
memory deficits, certain cultural backgrounds)?
Pharmacist’s management of DRP
B. Allergies and intolerances
C. Present drug therapy and medical
problems/disorders
D. Past drug therapy and immunisation history
E. Social history
Tobbaco use and alcohol use
F. Family history
G. Compliance history
H. Review of system organs
Pharmacist’s management of DRP
Identification of drug related problems
List and prioritised actual or potential drug
related problems
Therapeutic plan, therapeutic plan
endpoint, monitoring plan
Documentation
Tugas untuk Diskusi
Membagi diri menjadi 8 kelompok
Mengambil satu kasus penyakit, bisa
menggunakan kasus dari resep apotek,
atau kasus di RS
Identifikasi DRP, ADR, Medication Error
(baik yang aktual maupun potensial)
Presentasi dan diskusi
