Pharmacological awareness benefits patients
Whereas the tool of the surgeon is the scalpel, internists cure, or at least treat, with medication. However, in the past decade our toolbox has grown so rapidly that it is becoming more and more difficult to handle. The result: adverse drug events (ADE). In a meta-analysis by Hakkarainen et al., it was demonstrated that in an outpatient population up to 2% of all admissions or emergency visits are due to ADE, many of which were potentially preventable. The most important risk factor for ADE in hospitalised patients is the number of drugs they use and the start of a new drug during admission. Patients on cancer treatment sometimes start three new drugs during admission just to treat their nausea. In the current issue, Schoffelen et al. explain how various drugs given in cancer therapy may interact with each other.
Prescription errors and drug-drug interactions are potentially preventable as a cause of ADE. Computerised prescriber order entry may help in prevention but depends on adherence and completeness. We need to do better. In the current issue of the journal, Bosma et al. demonstrated that adding a pharmacologist to the team present during rounds on the intensive care unit leads to further improvement in medication care for patients and on top of this to a decrease in costs.
Luckily most patients admitted do not end up in the ICU unit, but also on general wards and in the outpatient clinic patients might benefit from better pharmacological awareness. Apart from drug interactions, knowledge on pharmacokinetics and pharmacodynamics is becoming more and more important especially in a patient population that is gradually ageing. As Ross and Maxwell stated: ‘Good prescribing requires a sound understanding of the principles of clinical pharmacology, knowledge of medicines, appreciation of uncertainty and good judgement, ideally based on experience’. Intensifying training in pharmacology ultimately will lead to better patient care.