Pharmacist’s interventions in anaemia management have been shown to improve clinical and economic outcomes. To determine the outcome of hemoglobin (Hb) level after the implementation of ESA monitoring card and counselling, a prospective, single-blinded randomised controlled study involved patients attending the CAPD clinic in Terengganu tertiary hospital, Malaysia was carried out. Intervention group received ESA injection counselling based on a validated checklist and ESA monitoring card, while the standard care group only received standard care. Result showed a total of 118 eligible patients with 68 of them in the standard care group and 50 patients in the intervention group with an average age of 50.8 (±14.57) and 49.4 (±13.69) years, respectively. Mean Hb showed significant improvement in both standard care and interventional groups with p
Case reports in western populations reported that fenofibrate enhances the anticoagulatory effect of warfarin. We are reporting ten cases of warfarin-fenofibrate interaction among Malaysian patients’ cases that were managed at the anticoagulation clinic of Hospital Kuala Lumpur. Patients taking warfarin and micronized fenofibrate 145mg daily concurrently between the year 2014 to 2018 were identified in May 2018. Ten active patients were included, and the relevant data were retrieved retrospectively. All patients received warfarin for stroke prevention in atrial fibrillation (AF), with a target international normalised ratio (INR) of 2 to 3. No dose adjustment was done upon initiation of fenofibrate. Warfarin doses were adjusted to achieve the targeted range but fenofibrate was not discontinued. Eight patients had INR levels above the target range when INR being reassessed between 20 to 62 days after initiation of fenofibrate. Their weekly warfarin doses were between 17.5mg-46.5mg. Baseline INR ranged between 1.6 -3.1. Percentage of dose reduction ranged between 5%-60%. Four of the patients were on other concurrent interacting medications such as statin and levothyroxine. Only one patient, whose case was with an INR 3.1 before initiation of fenofibrate, required admission for hematoma (INR 12). Two patients had INR within the target range, and INR were assessed at 14 and 21 days after fenofibrate initiation. Their weekly warfarin doses were between 24.5mg and 26.5mg while baseline INR was 2.8 and 1.9 respectively. Interaction between fenofibrate and warfarin may increase INR among Malaysian patients, thus close monitoring of INR is warranted. Empirical warfarin dose reduction may be considered upon initiation of this drug combination for patients with AF. The next INR reassessment date should be arranged not later than three weeks after initiation of fenofibrate.
The coronavirus disease 2019 (COVID-19) pandemic has hugely affected healthcare services, particularly pharmacy services in a COVID-19 hospital. Before the COVID-19 outbreak, clinical pharmacists routinely reviewed patients’ medications upon ward admission, actively participated in ward rounds and partook in transitional care activities focusing on medication reconciliation and patient education in the wards. However, in order to limit contact with COVID patients, hospital pharmacy department reacted promptly by establishing remote clinical pharmacy services in order to sustain the quality of inpatient pharmaceutical care. This commentary describes the challenges faced by clinical pharmacists in a Malaysian hospital as we continue to provide clinical pharmacy services amidst the new norm.
Medication errors are more likely to occur during patient’s transition of care. There was very little information about impact of medication reconciliation activities done for patients with chronic kidney disease (CKD) Stage IV-V during admission stage in Malaysian Primary Hospitals. The objective of this study is to evaluate the impact of clinical pharmacist’s medication reconciliation activities during hospital admission of patients with CKD stage IV-V. This cross-sectional study was carried out in two multidisciplinary wards (male & female ward) in Hospital Raub, Pahang over 12 months with ethical approval. A clinical pharmacist was assigned to enroll potential study subjects in both wards. Patients over 18 years old who had previous history of CKD Stage IV-V were included in the study after obtaining informed consent. Medication reconciliation was carried out by the clinical pharmacist within 24 working hours during the admission of study subjects. All detected medication discrepancies were further classified as “intended” or “unintended” after discussion with the prescribing medical officer. The Severity Level of each unintended medication discrepancy was rated by a visiting medical specialist. Twelve patients with CKD stage V were recruited to the study. A total of 49 medication discrepancies were identified and most (89.8%) were found to be unintended. The most common unintended medication discrepancy identified was omission error. Most of the unintended medication discrepancies (59.1%) was rated as “No potential harm”, while 40.9% were rated as “Potential for monitoring and/or Intervention to preclude harm”. None of the unintended medication discrepancy was rated as “Potential harm”. In conclusion, medication discrepancies were common during admission of patients with late-stage chronic kidney disease in a primary hospital. Medication reconciliation performed by clinical pharmacist during admission has a potential role in preventing potential harms that may arise from unintentional medication discrepancies.
The Pharmacy value-added services (PVAS) has been implemented in Malaysian public hospitals to facilitate the collection of follow-up medications. In specific, PVAS include Integrated Drug Dispensing System, Medicine by Post, Drive-Through Pharmacy, and many more. While past studies examined the satisfaction towards PVAS and its impact on patients’ waiting time, little explored the awareness and the experience of patients towards each type of PVAS. This study aims to explore the patient’s awareness on PVAS, adoption of PVAS, their satisfaction towards PVAS, and willingness to adopt PVAS. This was a cross-sectional study conducted in January 2020. We invited the eligible patients or their family members to participate in the study. Respondents recruited at the Outpatient Pharmacy Department of Miri Hospital using convenient sampling. A questionnaire in the Malay language was developed and content validated to gather information on the demographic data, awareness on PVAS, adoption of PVAS, satisfaction towards PVAS, and willingness to adopt PVAS. A list of PVAS was included for the respondents to select the types they were aware of and used before. Results were presented as frequencies, percentages, mean and standard deviation. A total of 398 respondents participated in the study. Majority of the respondents (70.1%) were aware that PVAS offered in Miri Hospital. However, about a third of the respondents (31.4%) had experience using PVAS. The most commonly used PVAS was Appointment Card Dispensing System (49.6%) and that with the least usage was Local Partial Medication Supply Service (2.4%). The Drive-Through Pharmacy has the greatest satisfaction score, 4.40 (SD=0.70), whereas Call-and-Collect Service was the least satisfied, 3.88 (SD=0.91). Majority of the respondents (86.2%), specifically 95.8% of the experienced PVAS user and 90.1% of inexperienced group, were willing to adopt PVAS to collect their follow-up medications. The Drive-thru Pharmacy, which has the greatest awareness and satisfaction yet low usage, should be further promoted for greater adoption. Besides, such PVAS should be expanded to other healthcare facilities.
Chronic pain has a significant impact on sufferers’ quality of life. Furthermore, treatment inadequacies are often reported in the literatures. This study aims to investigate the prevalence of the different dosing behaviors in analgesics use in chronic, non-cancer pain and their correlation to pain control. This is a cross-sectional study and a convenience sampling method was applied. Brief Pain Inventory- Short Form and Pain Management Index was computed to assess pain control. Statistical analysis was performed with Pearson chi-square test and alpha value was set at 0.05. A total of 127 patients were analyzed. 70.9% of the patients reported inadequate pain control with their prescribed analgesic(s). 88.2% patients only took oral analgesics whenever they felt the pain while 11.8% patients took around-the-clock despite the absence of pain. Among them, 11.8-34.7% of patients did not follow their prescriber’s instruction for oral and topical analgesic use respectively. However, no statistically significant result was found between the dosing behaviors and pain control (p>0.95). It was also reported that 98% of patients were not aware of the maximum daily dose of their prescribed analgesic(s). The prevalence of ‘as needed’ dosing is higher than around-the-clock dosing in the management of chronic, non-cancer pain, with deviation from the prescribed instructions between 11.8-34.7%. However, those differences were not significantly associated with the pain control.