Browsing by Author "Lynch, C."

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Case report: Opportunities for Medication Review and Reconciliation by a Clinical Pharmacist to Prevent Drug-Related Hospital Re-Admissions: Evidence from a Case Series in Sri Lanka
(Pharmaceutical Journal of Sri Lanka, 2018) Shanika, L.G.T.; Wijekoon, C.N.; Jayamanne, S.; Coombes, J.; Perera, D.; Pathiraja, V.M.; Mamunuwa, N.; Mohamed, F.; Coombes, I.; Lynch, C.; de Silva, H.A.; Dawson, A.H.
ABSTRACT: Medication review by a clinical pharmacist improves quality use of medicines in patients by identifying, reducing and preventing drug related problems and hospital re-admissions. This service is new to Sri Lanka. We present two cases from a non-randomized controlled trial conducted in a tertiary care hospital in Sri Lanka. The first case is from the control group where no clinical pharmacist was engaged and the next case is from the intervention group. The first case was a drug related hospital re-admission because of missing medicines in the discharge prescription and the second case was a re-admission which was prevented by the intervention of a ward pharmacist by performing a clinical medication review of the prescription.
A clinic-based pharmacy counselling service to improve medication adherence among diabetes out-patients
(Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2016) Mamunuwa, N.; Jayamanne, S.; Coombes, J.; de Silva, A.; Lynch, C.; Wickramasinghe, D.
The burden of diabetes is increasing with the rising prevalence of the disease and its complications. Medication adherence is a significant factor in the management of diabetes. Pharmacists’ role in the improvement of medication adherence is well-studied in the world. Despite the high and rising prevalence of diabetes in Sri Lanka, this is the first study to evaluate a pharmacy counselling service in a Sri Lankan diabetes population. To assess how a clinic-based pharmacy counselling service may affect patient medication adherence. 400 consecutive patients with diabetes mellitus attending outpatient medical clinics at Colombo North Teaching Hospital were randomized into either intervention group (IG) or control group (CG). Patients in the IG received pharmacist counselling (verbal and written) for four consecutive monthly visits in addition to standard care at the clinic, while patients in the CG received standard care only. Adherence for both groups was measured at baseline and post intervention using ©Morisky Medication Adherence Scale (8-Items). Mean age of the participants was 61.79 ± 9.06 and 67% were female. The IG had a median score of 4 out of 8 (IQR 5-3) at baseline which increased to 7 (IQR 8-6) after intervention. The median score of the CG was not significantly changed; 5 (IQR 7-4) at baseline and 5 (IQR 7- 6.5) after intervention period. Patients in the IG had a statistically significant improvement in adherence compared to the CG, using the Mann-Whitney U test (P<0.005). The IG had a 74.15% improvement in adherence whereas the CG had an improvement of 1.78%. Pharmacist counselling in outpatient clinics can improve medication adherence of the patients with diabetes.
Drug related problems among patients with diabetes; a descriptive analysis of data from an urban hospital in Sri Lanka
(Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2016) Mamunuwa, N.; Jayamanne, S.; Coombes, J.; de Silva, A.; Lynch, C.; Wickramasinghe, D.
Drug related problems (DRPs) result in reduced quality of care and even morbidity and mortality. The aim of this study is to assess the frequency and nature of DRPs and their causes among patients with diabetes attending an outpatient clinic. The prospective study was conducted in medical clinics of Colombo North teaching hospital and included 400 outpatients with diabetes. The identified DRPs were classified according to Pharmaceutical Care Network Europe tool (PCNE V6.2). A total of 151 DRPs were detected. The highest number of DRPs (61.58%) related to treatment effectiveness while 21.19% related to treatment costs, 9.93% related to adverse effects and 7.28% related to other non-classified problems. The most common DRP identified was ‘effect of drug treatment not optimal’ (39.73%) followed by ‘unnecessary drug treatment’ (16.55%) and ‘untreated indication’ (12.58%). Half (50.33%) of the DRPs detected were caused by the way patients use the medicines, in spite of proper prescribing and instructions. This included ‘deliberate under-use of the drug’ (61.84%), ‘drug not taken at all’ (15.78%), ‘inability to use the drug as directed’ (9.21%) and ‘drug overuse’ (6.57%). 31.12% of the DRPs were related to selection of drugs including ‘inappropriate drug’ (40.42%), ‘drug required not given’ (23.4%) and ‘duplications’ (21.27%). DRPs are frequent among diabetes outpatients. Early detection and addressing the causes of the actual and potential DRPs may improve the quality use of medicines and ensure safe, appropriate and cost-effective out-patient care.
Duplication errors due to brand name confusion; It is not always the name-Short case series
(John Wiley & Sons, 2023) Mamunuwa, N.; Jayamanne, S.; Wijekoon, N.; Coombes, J.; Perera, D.; Shanika, T.; Mohamed, F.; Lynch, C.; de Silva, A.; Dawson, A.
Confusion of drug names has been identified as a leading cause of medication errors and potential iatrogenic harm. Most of these errors occur because of look-alike or sound-alike drugs. This case series gives examples of duplication errors due to brand confusion, where there are no similarities in the names.
Opportunities for pharmacists to optimise quality use of medicines in a Sri Lankan hospital: An observational, prospective, cohort study
(Wiley-Blackwell, 2017) Perera, D.M.P.; Coombes, J.A.; Shanika, L.G.T.; Dawson, A.; Lynch, C.; Mohamed, F.; Kalupahana, N.; de Silva, H.A.; Jayamanne, S.F.; Peters, N.B.; Myers, B.; Coombes, I.D.
BACKGROUND: Quality use of medicines (QUM) has been identified as a priority in Sri Lanka. Aim: To identify opportunities to optimise QUM, and evaluate medication appropriateness and medication information exchanged with patients and carers on discharge in a Sri Lankan tertiary care hospital. METHODS: An observational, prospective, cohort study of patients systematically sampled from two medical wards. A research pharmacist determined their pre-admission medication regimen via interview at time of discharge. Issues of poor adherence and discrepancies between the pre- and post-admission medication regimens were recorded. Drug-related problems were categorised into opportunities to optimise drug therapy. The appropriateness of discharge medications was evaluated using a validated tool. The patient or carer was interviewed after discharge regarding the quality of medicine information exchanged in hospital. RESULTS: The 578 recruited patients were taking 1756 medications prior to admission, and 657 (37.4%) of these medications were not continued during admission. Opportunities to optimise drug therapy were identified on 1496 occasions during admission (median, 2.0 opportunities/patient), 215 opportunities, (14.4%) were resolved spontaneously by the medical team prior to discharge. The median score for appropriateness of medications on discharge was 1.5 per patient (interquartile range, 0.0–3.5). Of 427 patients surveyed after discharge, 52% recalled being asked about their medications on admission to hospital, 75% about previous adverse medication reactions and 39% recalled being informed about changes to their medications on discharge. CONCLUSION: Significant opportunities exist for pharmacists to enhance quality use of medicines for patients in the current hospitalbased healthcare system in Sri Lanka. © 2017 The Society of Hospital Pharmacists of Australia.