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– Out of date or has deteriorated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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Over or Underdose Prescribed
• 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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Over or Underdose Prescribed
• 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