Detection of Drug-Related Problems Associated with High-Risk Medications in a Clinical Setting – A Prospective Study

Ameena Kadar K A; Sreeja P A; Soumya P V; Dawn V J; Surabhi Mohan K; Irene V R

doi:10.31632/ijalsr.2025.v08i03.015

Ameena Kadar K A Department of Pharmacy Practice, Grace College of Pharmacy, Affiliated to Kerala University of Health Sciences, Palakkad, 678004, Kerala, India https://orcid.org/0009-0008-1804-3195
Sreeja P A Department of Pharmacy Practice, Dr. M.G.R Educational and Research Institute, Velappanchavadi, Chennai, 600077, Tamil Nadu, India. https://orcid.org/0009-0000-9297-0757
Soumya P V Department of Pharmacy Practice, Sanjo College of Pharmaceutical Studies, Affiliated to Kerala University of Health Sciences, Palakkad, 678702, Kerala, India. https://orcid.org/0009-0005-6678-9459
Dawn V J Department of Pharmacy Practice, Sanjo College of Pharmaceutical Studies, Affiliated to Kerala University of Health Sciences, Palakkad, 678702, Kerala, India. https://orcid.org/0000-0003-1043-2096
Surabhi Mohan K Department of Pharmacy Practice, Sanjo College of Pharmaceutical Studies, Affiliated to Kerala University of Health Sciences, Palakkad, 678702, Kerala, India. https://orcid.org/0009-0006-2871-0057
Irene V R Department of Pharmacy Practice, Sanjo College of Pharmaceutical Studies, Affiliated to Kerala University of Health Sciences, Palakkad, 678702, Kerala, India. https://orcid.org/0000-0001-9527-372X

DOI https://doi.org/10.31632/ijalsr.2025.v08i03.015

Abstract

Background: Drug-Related Problems (DRPs) associated with High-Risk Medications (HRMs) present significant challenges in clinical practice, particularly among older adults with multiple comorbidities. This study aimed to identify, classify, and address DRPs in patients prescribed HRMs at a tertiary care hospital in Kerala. Methods: A prospective interventional study was conducted over ten months, enrolling 201 patients aged 18 years and above, of whom 193 completed the protocol. Prescriptions involving HRMs from the cardiology, neurology, general medicine, and psychiatry departments were reviewed using the APS-Doc framework to classify DRPs. Pharmacist-led interventions were implemented to resolve identified issues, including dosage adjustments, drug substitutions, and enhanced patient monitoring. Results: A total of 233 DRPs were identified, with potential drug-drug interactions (61.8%) being the most prevalent, followed by actual interactions (17.6%). Ten Adverse Drug Reactions (ADRs) were reported, with Verapamil causing the most frequent reaction (peripheral oedema). Overall, 198 interventions (85%) were accepted by physicians and implemented, contributing to improved medication safety and therapeutic outcomes. Conclusion: The study highlighted the critical need for systematic prescription review, interdisciplinary collaboration, and proactive clinical pharmacist involvement to enhance the safety of HRMs. The APS-Doc framework proved effective in identifying and addressing DRPs, emphasising its potential for broader adoption in similar clinical settings. Future multicentre research is needed to validate these findings across diverse patient populations.

Keywords: Adverse Drug Reactions (ADRs), APS-Doc System, Drug-Related Problems (DRPs), High-Risk Medications (HRMs)

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