Improving medication safety in home enteral nutrition: Uncovering drug-related problems in patients using telepharmacy
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Keywords
medication error, Telepharmacy, Pharmacy Service, Enteral Nutrition, Home Care Services, Medication Errors, Pharmaceutical Services
Abstract
Background: The complexity of drug administration via tube feeding makes home enteral nutrition (HEN) difficult. Telepharmacy was established to provide continuous pharmacological care to assure safety and efficacy of the patients at home care. Objective: To examine drug-related problems (DRPs) in patients receiving HEN, and a pharmacy-led intervention on optimizing medication administration via feeding tubes at home care settings. Methods: This cohort study was conducted between April 2021 and January 2024 involving adult patients on tube feeding who received pharmaceutical care via telepharmacy. Medication review, pharmaceutical consultation, documentation and follow-up planning were performed by pharmacists. During remote consultations, DRPs were identified, and recommendations were made based on current clinical guidelines and evidence-based resources. Results: A total of 90 patients were included, with a mean age of 81.5±14.5 years (63% females). During 153 telepharmacy sessions, pharmacists identified 189 DRPs in 85 patients (94.44%), involving 207 medications. The common drug categories involved in DRPs included gastrointestinal drugs (26.09%), cardiovascular drugs (9.18%), and micronutrients (7.25%). The most frequent DRPs were “failure to receive drugs” (38.10%), improper drug selection (14.28%), untreated indications (8.47%), and drug interactions (8.47%). Telepharmacy-based pharmaceutical counseling and management successfully resolved 134 from 189 DRPs (70.89%). Most issues were addressed through caregiver medication counseling, clarification of drug administration techniques, correction of inappropriate dosage forms, and adjustment of drug regimens in collaboration with physicians. Some problems remained unresolved due to factors beyond immediate pharmacist management, such as unavailable of appropriate dosage forms, or limited authority to modify therapy. Conclusion: These findings highlight the importance of telepharmacy services in optimizing pharmacotherapy and ensuring medication safety among patients receiving HEN.
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