CLINICAL INTERVENTIONS UNDERTAKEN BY FINAL YEAR STUDENT PHARMACISTS ON ROUNDING TEAMS IN NIGERIA: A 3-YEAR CROSS-SECTIONAL EVALUATION
Objective: The aim of this study was to assess the interventions of final year pharmacy students of University of Nigeria Nsukka (UNN) during clinical ward rounds in a secondary and a tertiary hospital in Enugu State, Nigeria.
Methods: Students were instructed at the start of their clerkship by pharmacist preceptors on how to appropriately document clinical interventions across the hospitals. A pharmacist reviewed each intervention entered by the students for appropriateness. All data collected were entered into the IBM Statistical Products and Service Solutions (SPSS) for Windows, Version 21.0 for analysis. Descriptive statistics, including mean and percentages, were used to analyze data obtained. Ethical approval was obtained from the Health Research and Ethics committee of the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State.
Results: The students documented interventions for three hundred and eight (308) patients. There were more females among the patients (157) and most were aged 19-35 y (92). The common types of interventions performed were drug-drug interactions (14%), therapeutic duplication (11%), and patient and family education (11.7%). The most common additional laboratory test recommended was Serum-Electrolyte-Urea-Creatinine (SEUCr) (30.77%). The most common form of patient education rendered was on dietary and lifestyle modifications in ulcer (1.9%). No characteristic of the patients had a statistically significant relationship with the types and frequency of clinical interventions.
Conclusion: Final year pharmacy students of UNN demonstrated competencies in experiential education. They were able to make valid clinical interventions that contributed to patient care in the two hospitals during their clinical clerkship.
2. World Health Organization. The Rational Use of Drugs. Geneva; 1985. Available from: http://apps.who.int/medicinedocs/ documents/s17054e/s17054e.pdf. [Last accessed on 31 Dec 2017].
3. Ofori-Asenso R, Agyeman AA. Irrational use of a medicines-a summary of key concepts. Pharm (Basel, Switzerland); 2016. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28970408. [Last accessed on 31 Dec 2017].
4. World Health Organization. Problems of irrational drug use session guide problems of irrational drug use session guide purpose and content; 2004. Available from: http://new.paho.org/hq/dmdocuments/2010/3_IrrationalSG.pdf. [Last accessed on 31 Dec 2017]
5. Alfa J, Adigwe OP. Rational use of medicines in nigeria: a critical review. J Biol; 2014. Available from: http://www.iiste.org/Journals/index.php/JBAH/article/viewFile/14487/14797. [Last accessed on 31 Dec 2017]
6. Leisinger KM, Garabedian LF, Wagner AK. Improving access to medicines in low and middle income countries: corporate responsibilities in context. South Med Rev 2012;5:3â€“8.
7. World Health Organization. WHO Medicines Strategy: Countries at the core. Geneva; 2004. Available from: http://www.who.int/management/background_4a.pdf. [Last accessed on 31 Dec 2017]
8. Ajemigbitse AA, Omole MK, Erhun WO. Medication prescribing errors in a tertiary hospital in nigeria: types, prevalence and clinical significance. West Afr J Pharm; 2013. Available from: http://www.academix.ng/search/paper.html?idd=3300016347. [Last accessed on 31 Dec 2017]
9. Arulogun OS, Oluwole SK, Titiloye MA. Prescription errors prevalent in four units of a university teaching hospital in nigeria. J Public Heal Epidemiol 2011;3:513â€“9.
10. Ogunleye OO, Oreagba IA, Falade C, Isah A, Enwere O, Olayemi S, et al. Medication errors among health professionals in Nigeria: a national survey. Int J Risk Saf Med 2016;28:77â€“91.
11. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279:1200â€“5.
12. Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE prevention study group. JAMA 1995;274:29â€“34.
13. Senst B, Achusim L, Genest R, Cosentino L, Ford C, Little J, et al. Practical approach to determining costs and frequency of adverse drug events in a health care network. Am J Heal Pharm 2001;58. Available from: http://www.ajhp.org/content/ 58/12/1126?sso-checked=true. [Last accessed on 31 Dec 2017].
14. Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA 1999;282:267â€“70.
15. Eldh AC, Almost J, DeCorby-Watson K, Gifford W, Harvey G, Hasson H, et al. Clinical interventions, implementation interventions, and the potential greyness in the between-a discussion paper. BMC Health Serv Res 2017;17:16.
16. Smith WE. Role of a pharmacist in improving rational drug therapy as part of the patient care team. Ann Pharmacother 2007;41:330â€“5.
17. Avalere Health. Exploring Pharmacistsâ€™ Role in a Changing Healthcare Environment; 2014. p. 1â€“30.
18. Oliveira De Melo D, Lusitana L, De Castro C. Pharmacistâ€™s contribution to the promotion of access and rational use of essential medicines in SUS. Cien Saude Colet 2017;22:235â€“44.
19. Swiatek D, Dally C. Not just dispensing: the unique role of pharmacists in an outpatient research pharmacy. Pharm Times 2016. Available from: http://www.pharmacytimes.com/publications/career/2016/pharmacycareers_may2016/the-unique-role-of-pharmacists-in-an-outpatient-research-pharmacy. [Last accessed on 22 Dec 2017]
20. National Universities Commision. Benchmark and Minimum Academic Standardâ€“Pharmaceutical Sciences. Abuja: National Universities Commission; 2005. Available from: http://www.pcn.gov.ng/files/BMS.pdf. [Last accessed on 31 Dec 2017]
21. Shogbon AO, Lundquist LM. Student pharmacistsâ€™ clinical interventions in advanced pharmacy practice experiences at a nonteaching community hospital. Am J Pharm Educ 2014;78:50.
22. Mersfelder TL, Bouthillier MJ. Value of the student pharmacist to experiential practice sites: a review of the literature. Ann Pharmacother 2012;46:541â€“8.
23. Campbell AR, Nelson LA, Elliott E, Hieber R, Sommi RW. Analysis of cost avoidance from pharmacy studentsâ€™ clinical interventions at a psychiatric hospital. Am J Pharm Educ 2011;75:8.
24. Pound MW, Miller SM. Written versus oral recommendations made by pharmacy students during internal medicine rotations. Ann Pharmacother 2007;41:772â€“6.
25. Lundquist LM, Moye PM. Resident physiciansâ€™ acceptance of pharmacy studentsâ€™ pharmacotherapy recommendations during ambulatory care advanced pharmacy practice experience. Am J Pharm Educ 2009;73:145. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20221338. [Last accessed on 31 Dec 2017]
26. Condren ME, Haase MR, Luedtke SA, Gaylor AS. Clinical activities of an academic pediatric pharmacy team. Ann Pharmacother 2004;38:574â€“8.
27. Stevenson TL, Fox BI, Andrus M, Carroll D. Implementation of a school-wide clinical intervention documentation system. Am J Pharm Educ 2011;75:90.
28. Pham DQ. Evaluating the impact of clinical interventions by PharmD students on internal medicine clerkships: the results of a 3 y study. Ann Pharmacother 2006;40:1541â€“5.
29. Slaughter RL, Erickson SR, Thomson PA. Clinical interventions provided by doctor of pharmacy students. Ann Pharmacother 1994;28:665â€“70.
30. Taylor CT, Church CO, Byrd DC. Documentation of clinical interventions by pharmacy faculty, residents, and students. Ann Pharmacother 2000;34:843â€“7.
31. Divall MV, Zikaras B, Copeland D, Gonyeau M. School-wide clinical intervention system to document pharmacy studentsâ€™ impact on patient care. Am J Pharm Educ 2010;74:14.
32. Kucukarslan SN, Peters M, Mlynarek M, Nafziger DA. Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units. Arch Intern Med 2003;163:2014.
33. Nour AH, Khan M, Sulaiman AZ, Batool T, Nour AH, Khan MM, et al. In vitro anti-acetylcholinesterase and antioxidant activity of selected Malaysian plants. Asian J Pharm Clin Res 2014;8:271â€“3.
34. Bosma L, Jansman FGA, Franken AM, Harting JW, Bemt PMLA. Evaluation of pharmacist clinical interventions in a Dutch hospital setting. Pharm World Sci 2007;30:31â€“8.
35. Mukherjee S, Bhattacharyya A, Biswanath Sharma Sarkar B, Goswami DN, Ghosh S, Samanta A. Knowledge and practice of standard precautions and awareness regarding post-exposure prophylaxis for HIV among interns of a medical college in West Bengal, India. Oman Med J 2013;28:141â€“5.
36. Al Rahbi HAM, Al-Sabri RM, Chitme HR. Interventions by pharmacists in out-patient pharmaceutical care. Saudi Pharm J 2014;22:101â€“6.
37. Alderman CP, Farmer C. A brief analysis of clinical pharmacy interventions undertaken in an Australian teaching hospital. J Qual Clin Pract 2001;21:99â€“103.
38. S NE, R SK, MS NV. Review on clinically developing antibiotics. Int J Appl Pharm 2018;10:13â€“8.
39. Fahimi F. Implementation of a clinical pharmacy education program in a teaching hospital: resident-oriented documentation and intervention. Iran J Pharm Res 2010;9:297â€“302.
40. McGettigan P, Golden J, Fryer J, Chan R, Feely J. Prescribers prefer people: The sources of information used by doctors for prescribing suggest that the medium is more important than the message. Br J Clin Pharmacol 2001;51:184â€“9.