An audit of the impact of a clinical pharmacist on rational drug use at Kenyatta National Hospital
The management and use of drugs has clinical, economic, arid environmental implications. Irrational use of drugs has been recognized not only as a cause of poor health outcomes but also an important factor of increased health care costs. Furthermore, irrational drug use also increases ~ risks of medication errors, adverse drug reactions and events. World Health Organization (WHO) and the First International Conference on Improving Use of Medicines (ICIUM), held in Thailand in 1997, recommended regular drug use audits since detection of problems is the first step in evaluating the underlying causes before taking remedial action. A preliminary report of a baseline audit on rational drug use (RDD) carried out at Kenyatta National Hospital (KNH) between January and February 2009 using the WHOIDAP manual 'How to investigate drug use in health facilities' showed high incidences of irrational drug use in all the clinical areas. As part ofthe various strategies to combat irrational and inappropriate drug use, the department of pharmacy medicine and information centre, in collaboration with the clinical pharmacist, made medication interventions and repeated the audit to assess the impact on rational drug use. The audit utilized a cross-sectional study design with pre-intervention and post-intervention study arms. The clinical pharmacist took part in medical ward round on alternate days in the intervention wards and in the course of provision of "pharmaceutical care" made medication interventions which were classified using a scheme adapted from Hatoum et al,. The outcomes and the reason for the intervention were also recorded. One hundred and fifty six interventions were made in a period of one month. Interventions pertaining to unavailability of prescribed drugs were most frequent at 29.5%. Other interventions included; Clarification of treatment in cases where prescription was illegible (16.7%), Dose ,frequency and duration of treatment (14.1 %), Choice of treatment (11.5%), Adverse drug reaction or interaction (8.3%), Recommendation of alternative therapy (8.3%), Transcription error (5.1 %), Administration or formulation or route (4.5%) and cost (2.6%). Only 1.3% of the interventions were rejected. xi The most important reason for intervention was unavailability of prescribed drugs (41 %). Other reasons were safety and effectiveness of prescribed drugs at 22.4% and 19.9% respectively. Cost as a reason accounted for 5.8% while the rest of the interventions (10.9%) had shared reasons. A comparison ofRDU parameters in the intervention wards at baseline and after intervention showed significant improvement in the average proportion of drugs prescribed in generic names; at 72.4%, after intervention compared to at 57.7% at baseline (P<0.001). There was an insignificant increase, in percentage of drugs actually dispensed from 82.8 % at baseline to 86.6% after intervention (p= 0.454). The results of this audit showed that the interventions led to an improvement in rational drug use in the targeted wards.