Assessment of effects and challenges of implementing individualised dispensing on medication related problems at Kenyatta National hospital

Abstract

Background: Medication related problems are said to occur when the outcome of medicine use is not optimal resulting to a significant strain on the health delivery system and contributing to mortality, morbidity and escalation of healthcare costs. Potential and actual medication related problems can occur at any stage of the medicine use process. Objectives: The objective of the study was to identify the challenges faced in the implementation of the individualized dispensing system at the medical wards of Kenyatta National Hospital. Further the effect of the change on medication related problems were determined. Methods: A pre-post design was utilized to study effects. A systematic random sample of 236 patient files was picked for before study arm and 207 patient files for the after study arm. A cross section study was used for challenges faced study. A convenience sample of 25 that included nurses, pharmacists and pharmaceutical technologist were recruited and interviewed for the survey on challenges faced. Descriptive and inferential data analysis was performed. Results: The main challenges faced during the implementation phase were inadequate medicine storage facilities, patient management software anomalies, delay in ordering patient medicines and increased workload. There was a high prevalence of medication related problem (97.5 % vs.95.7%) with prescribing errors (16.1 % vs. 15.8%), drug interaction (80.9 % vs. 69.9 %) and non adherence (80.9 % vs.91.3%) being most common. No robust mechanism for resolving medication related problems exist. Conclusion: The study recommends the formation of multi-disciplinary teams involving pharmacists to identify and resolve medication related problems at the medical wards and to provide adequate resources for medicine storage facilities, requisite staff mix and effective patient management software.