INTRODUCTION:

Medication is a powerful tool that can be used to cure or prevent disease when used as directed. They have the potential to hurt users significantly if taken improperly. Any medicine may have these unwanted side effects, often known as adverse reactions. To reduce the risk of harm to the patient, healthcare teams, which include doctors, chemists, and other healthcare providers, must weigh the potential risks against the desired benefit of each medication when deciding whether to use a particular medication to treat a specific patient¹.

In all sorts of patient care settings, from neighbourhood pharmacies to hospitals and long-term care institutions, pharmacists collaborate with patient's other healthcare providers as vital members of the healthcare team. Pharmacists consistently perform key tasks that enhance patient safety in each of these contexts. To become a chemist in the United States, one must complete six to eight years of formal study, which includes courses on illnesses and the drugs used to prevent and treat them².

There is a dearth of research that critically evaluates the viewpoints of professors who are on the "front lines" of curricular change despite rising interest in patient safety curricular innovation. Although there have been more tools for teaching patient safety, much of the early work was restricted to theoretical frameworks and curriculum guidelines, such as WHO's Multi-professional Patient Safety Curriculum Guide and Patient Safety Curriculum Guide for Medical Schools³. Recent empirical studies have looked at the effects of curricular interventions, such as incident reporting and error disclosure, inside particular institutions, or professional groups. According to our research, learning about patient safety appears to be hindered by the culture of the clinical training environments where we educate and acclimatize new HP. In the current study, we present teaching faculty viewpoints from the medical, nursing, and pharmacy fields addressing the elements that affect the integration of curricula and the training of safe practitioners. It has been demonstrated that patients provide more accurate information about their medications to chemists than to doctors⁴.

Fig.1- Improving patient safety

PHARMACIST ACTION TO IMPROVE PATIENT SAFETY:

Pharmacists contribute to improved patient safety by:

· Increasing medication compliance: Assisting individuals in taking their prescriptions as directed by their medical professionals.

· Providing services for health and wellbeing: Delivering essential patient care services intended to enhance patients' health.

· Helping for medication management: Reviewing all patient's prescriptions in detail, making sure that they will interact with one another without causing issues, and creating a successful, well-thought-out treatment plan to treat or prevent disease⁵.

· Evaluating the health of patients: Determining a patient's present condition to offer treatment suggestions and evaluate the success of drug therapy.

· Managing care transitions: Assisting patients with care coordination and medication management coordination as they move between care settings.

· Determining if a drug is necessary: Providing knowledge to patients and their carers to enable safe and efficient drug administration⁶.

MEASURING IMPACTS:

While there are many possible beneficial outcomes that emerge from pharmacists’ efforts, the scenarios in this book chosen to demonstrate each of the eight patient safety measures will emphasize the following potential impacts⁷:

· Achieved patient treatment goals

· Avoided adverse effects

· Decreased length of time patient spends in hospital or rehabilitation facility

· Decreased number of visits for emergency care

· Enhanced patient quality of life

· Improved medication adherence

· Improved patient satisfaction

· Prevented medication errors

· Reduced cost to the patient and/or health care system

· Reduced time to reach patient treatment goals

Safety measured by Pharmacist using following methods:

· Promoting Access to Medicine: The role of a chemist is to ensure that patients have access to the medications they need and to help them in negotiating insurance coverage, looking for ways to save costs, and finding the best solutions when necessary.

· Information Delivery Regarding Medication: To help patients and their guardians understand and use medications safely and efficiently, chemists share important information with them. They educate patients about dose, probable side effects, drug selling, and protection, enabling them to make well-informed decisions⁸.

· Determining the Appropriateness of Medication: Pharmacists evaluate each prescription to determine the most suitable, efficient, and secure alternative for each patient. To maximize therapeutic results, they consider elements including the patient's medical history, allergies, concurrent medications, and other pertinent circumstances.

· Improving Medication Compliance: Pharmacists actively assist patients in following their recommended treatment plans. To increase patient compliance and medical effectiveness, they make sure counselling is provided, provide reminders and tools to promote adherence, identify problems or hurdles, and track progress⁹.

· Providing medical and healthcare services: To improve overall wellbeing, chemists offer extra patient care helpers. These might involve giving vaccinations, giving smoking cessation advice, conducting health exams, and providing infection prevention training.

· Providing Medication Management Services: All medications a patient takes are thoroughly examined by chemists to ensure they interact well with one another and reduce potential problems. They create thoughtful treatment programmes that consider the patient's particular needs and circumstances to efficiently organise and avoid diseases¹⁰.

ENSURING MEDICATION ACCESS:

Ensuring medication access is a critical aspect of patient safety in healthcare. Lack of access to necessary medications can lead to serious health risks and adverse outcomes. Here are some key strategies to ensure medication access and promote patient safety:

· Reconciliation of medication: This entails compiling and keeping up-to-date records on a patient's current medications, including prescription, over-the-counter, and nutritional supplements. At every stage of the care transition, including admission, transfer, and discharge, reconciliation should take place.

· Programmes for Medication Assistance: Financial constraints may prevent many people from receiving medicine. Hospitals and health systems can help patients apply for pharmaceutical assistance programmes, which help eligible people pay for prescription medications¹¹.

· Optimising drug formularies and health insurance: Access to medications is significantly influenced by health insurance coverage. To guarantee that the patient's plan covers the recommended prescriptions, healthcare professionals should cooperate with insurers. Furthermore, healthcare institutions can create formularies that direct physicians in choosing drugs that are both efficient and affordable.

· Services from pharmacies: In healthcare settings, comprehensive pharmacy services can aid in ensuring prompt access to pharmaceuticals. This includes on-site pharmacies, medicine delivery services, and pharmacists who can respond to inquiries and impart knowledge on the appropriate use of medications.

· Electronic prescribing and telehealth: By providing virtual consultations with medical professionals who may electronically prescribe pharmaceuticals to patients, telehealth can enhance patient access to medication. By delivering prescriptions directly to the patient's preferred pharmacy, e-prescribing systems can also aid in reducing mistakes and enhancing patient access to medications¹².

· Monitoring medication adherence: To assist patients in sticking to their recommended medication schedules, use technology and treatments including medication adherence apps, reminders, and feedback systems.

· Reporting and Feedback Systems: To quickly detect and address problems, encourage healthcare personnel and patients to submit medication-related mistakes or difficulties to a reporting system¹³.

Fig.2- Ensuring safe and appropriate medication management

SUPPLYING MEDICATION INFORMATION:

To ensure that patients receive the proper prescriptions in the appropriate amounts and are aware of how to take them safely, it is essential to provide medication information in patient safety. Providing pharmaceutical information in the interest of patient safety should consider the following:

· Clarity of Expression: Healthcare professionals should clearly and intelligibly provide drug facts in a language that the patient can comprehend. Use simple language and stay away from medical jargon. Written directions should be readable and legible¹⁴.

· Reconciliation of Medication: Ensure an accurate list of all medications the patient is taking, including prescription, over-the-counter, and supplements. This helps prevent drug interactions and duplicate therapy.

· Education of the Patient: Inform patients on their drugs, including the brand name, generic name, dose, and any adverse effects. Inform them of the proper times to take their prescriptions. Both vocally and through written sources, this is possible.

· Drug Labelling: Clear labels containing the patient's name, the medicine name, dose instructions, and any cautions should be included on pharmaceutical containers. Labels must to be simple to read and comprehend¹⁵.

Fig.3-Medication information by Pharmacist.

· Adherence Assistance: Help patients remember to take their prescriptions as directed by providing them with information and assistance. This might involve using alarm clocks, pill organisers, or reminder applications.

· Allergies and negative effects: Make sure the patient's allergies are noted and that they are aware of the significance of telling their doctor about any negative side effects.

· Advising a patient: Encourage patients to inquire about their drugs, and be prepared to address any concerns they may have. Make sure they understand how to contact you if they have any queries or problems.

· Medication Retention: Inform patients on the right way to keep their drugs. While some prescriptions should be stored at room temperature, others may need to be refrigerated. The efficacy of a drug can be impacted by improper storage¹⁶.

· Disposal of Medication: To prevent accidental consumption or environmental contamination, instruct patients on how to properly dispose of expired or unused prescriptions.

· Reviews of medications: Make sure a patient's pharmaceutical regimen is still suitable for their requirements by periodically reviewing it. Patients who are taking various drugs should pay particular attention to this.

IMPROVING MEDICATION ADHERENCE:

Medication adherence refers to the extent to which patients take their medications as prescribed. Not taking medications as prescribed can cause patient harm, including adverse effects or costly hospitalizations. One of the most common reasons for medication nonadherence is simply forgetting to take a medication or forgetting to get it refilled in time. Other reasons that have been reported include younger age, medication adverse effects, poor communication with the health care team, memory loss, and confusion¹⁷. Pharmacists are often the only members of the health care team with a complete list of a patient’s medications. As a result, pharmacists can lead the process of assessing and improving medication adherence in collaboration with the patient’s healthcare team. If nonadherence is suspected or documented, pharmacists are trained to work with patients to find ways for them to take their medications appropriately.

The degree to which individuals take their prescriptions as directed is known as medication adherence. Patients who do not take their prescriptions as prescribed may experience negative side effects or expensive hospital stays. Forgetting to take a prescription or to receive a refill on time is one of the most frequent causes of pharmaceutical nonadherence. There have also been reports of younger age, negative pharmaceutical effects, poor communication with the medical staff, confusion, and memory loss. Oftentimes, chemists are the only medical professionals who have a comprehensive record of a patient's prescriptions. Consequently, in coordination with the patient's medical team, chemists can take the lead in evaluating and enhancing medication adherence. Pharmacists are educated to collaborate with patients to discover solutions for them to take their prescriptions as prescribed if nonadherence is suspected or confirmed¹⁸.

Evaluating medication Appropriateness:

A crucial component of healthcare is determining if a patient is receiving the safest and most effective medications for their circumstances. When determining whether a drug is suitable, healthcare professionals such as physicians, chemists, and nurses consider a variety of factors. The following are some important aspects to consider when considering if a medicine is appropriate:

· Diagnosis: Verifying the patient's diagnosis is the first stage in determining if a medicine is appropriate. The prescription drug needs to be appropriate for the illness or symptom the patient is dealing with²⁸.

· Factors Unique to the Patient: The patient's age, gender, weight, allergies, medical history, and any comorbidities should all be considered by healthcare professionals. These elements may have an impact on medicine selection, dosage, and possible interactions¹⁹.

· Efficacy: Analyse how well the drug treats the patient's ailment. To decide if the treatment is known to be successful for the condition, consider the existing clinical data and recommendations.

· Safety: Determine the patient's medication's safety. Think about any possible side effects, restrictions, and drug interactions. The possible hazards of the medicine must be weighed against its potential advantages.

· Administration & Dosage: The dose and administration guidelines should be suitable for the patient's age, weight, and condition. Make sure the patient can follow the recommended dose schedule.

· Monitoring: Determine whether monitoring is necessary to follow the medication's efficacy and catch any side effects, such as laboratory testing or clinical evaluations.

· Alternative Medicine: Alternative therapies or treatments should be considered since they can be more suitable or secure for the patient. Non-pharmacological therapies or alterations to one's lifestyle may be preferred in some circumstances²⁰.

· Patient Preferences: Shared decision-making should be used to learn about the patient's preferences and worries surrounding the medicine. Better treatment adherence and results may result from this.

· Pricing and Access: As financial restrictions might affect treatment adherence, consider if the patient can afford and obtain the prescribed prescription.

· Review and Revaluation: Review the medication's suitability on a regular basis, especially for chronic diseases, and make any necessary modifications depending on the patient's reaction and any evolving circumstances.

· Documentation: Keep meticulous records of the reasons for the medicine selection, the dose, and any pertinent conversations with the patient. For the continuation of patient treatment and for legal requirements, this documentation is crucial²¹.

PROVIDING HEALTH AND WELLNESS SERVICES:

Pharmacists are trained to provide a variety of health and wellness services, including blood pressure, blood glucose, and cholesterol screenings; immunization screening and administration; smoking cessation programs; and disease state education. All these services ultimately improve individual patient health as well as the health of the communities in which they live²². Some of these services may be provided in collaboration with other members of the healthcare team. Health and wellness services are an important part of patient safety. For example, immunizations protect patients from diseases that can often be severe and life-threatening, and smoking cessation programs help patients avoid the long-term consequences of tobacco use. In addition, these services may prevent patients and the healthcare system from incurring costs related to treating diseases that could have been prevented²³.

Pharmacists are qualified to offer a range of health and wellness services, such as cholesterol, blood sugar, and blood pressure checks; immunisation delivery and screening; smoking cessation programmes; and disease state information. In the end, each of these services enhances the health of the patient as well as the communities in which they reside. A number of these services might be given in conjunction with other members of the medical staff. Services related to health and wellness play a significant role in patient safety²⁴. For instance, vaccinations shield patients from illnesses that frequently pose a serious risk to their lives, and programmes to assist patients quit smoking help them avoid the long-term effects of tobacco use. These services may also save patients and the healthcare system money by avoiding the need to treat diseases that could have been avoided²⁵.

PERFORMING MEDICATION MANAGEMENT SERVICES:

Pharmacists in every practice setting use their expertise to help patients manage medications and solve medication-related problems. Medication management services can vary in complexity and include everything from identifying which medication may be causing an adverse effect to reviewing a long list of the patient’s medications and making necessary adjustments²⁶. Pharmacists may identify opportunities to simplify a patient’s medication regimen, making it easier for patients to take their medications correctly. In other cases, pharmacists may identify that a patient is not reaching his or her treatment goals, and can recommend changing a medication dose, or adding or changing medications. When such opportunities are identified, pharmacists work with other members of the patient’s health care team to optimize therapy. In every practise context, chemists use their knowledge and skills to assist patients with drug management and medication-related issues.

Fig. 4. Medication Management.

The intricacy of medication management services can vary, ranging from determining which medicine may be having a bad effect to going over a lengthy list of the patient's prescriptions and making the required changes. Pharmacists can spot chances to streamline a patient's prescription schedule, which will help patients take their meds as directed. In other situations, chemists may notice that a patient is not meeting their treatment objectives and may suggest adding, adjusting, or modifying medicine. Pharmacists collaborate with other members of the patient's healthcare team to maximise therapy when such opportunities are found²⁷.

ASSESSING PATIENTS’ HEALTH STATUS:

Pharmacists are trained on how to assess the health status of patients, and, if necessary, refer patients for follow-up treatment with another health care provider. Pharmacists can perform several basic assessments, including monitoring blood pressure and heart rate, evaluating pain, checking for complications of certain diseases such as diabetes, and others²⁷. In some cases, pharmacists may use laboratory tests to assess health status or to determine whether a medication is working safely and effectively for a particular patient. Depending on the result of the health status assessment, the pharmacist may recommend medication adjustments or lifestyle changes such as diet and exercise. Pharmacists are educated to evaluate patients' health and, if required, recommend patients to another healthcare professional for additional treatment. A variety of fundamental examinations can be carried out by chemists, including as measuring blood pressure and heart rate, assessing pain, looking for signs of illness complications like diabetes, and more. When assessing a patient's health or determining if a medicine is doing its job safely and effectively, chemists may occasionally employ laboratory testing. The chemist may suggest dietary and exercise modifications or medication adjustments based on the findings of the health status evaluation²⁸.

Fig.5-Patient’s assessment

In addition to evaluating your patient's physical and mental health, you will also be required to evaluate the following:

· Temperature

· Heart rate and pulse.

· Respiration.

· Oxygen saturation.

· BP, or blood pressure.

· Neurologic condition.

COORDINATING CARE TRANSITIONS:

As patients move through the health care system, they receive care in a variety of settings and from many members of the health care team. Some examples of care transitions include a patient moving from a home setting to the hospital or from the hospital to a nursing home. Care transitions also can occur within a particular setting (e.g., from the emergency department to an intensive care unit, to surgery, to a general medicine service)²⁹. Any time a patient is transferred from one care setting to another, there is a potential for medication-related errors to occur. Factors such as poor communication among the healthcare team and low access to patient records often result in high rates of avoidable medication-related problems. Common errors during care transitions include a medication accidentally being discontinued or more than one medication being prescribed to treat the same condition. Pharmacists are often the only members of the health care team with access to the patient’s complete medication list³⁰.

As a result, they are uniquely positioned in the health care system to impact patient safety by managing care transitions. Reducing mistakes is one possible outcome of getting patients ready and interested for new ambulatory care appointments³¹.

· Boost the involvement of patients.

· Take steps to guarantee that patients receive the information they require.

· Boost your coordination.

· Improve the patient experience.

· Improve communications.

ROLE OF THE PHARMACIST:

While medication dispensing is the best-known function of the pharmacist, pharmacists—through counselling, medication therapy management (MTM), disease-state management, and other means—can play a pivotal role in patient care. There are opportunities in every type of pharmacy practice to improve patient’s adherence and therapeutic outcomes, and pharmacists must embrace and act on them.

With the new health care reform laws—the Patient Protection and Affordable Care Act, in particular—there may be reimbursement for such activities. The patient-centred medical home model of health care delivery will allow the pharmacist to be part of a physician- or nurse practitioner–led health care team. Pharmacists will be compensated for delivering MTM services to their patients³².

Many factors dictate a patient’s medication adherence, and each patient is unique. The pharmacist must approach each patient individually to determine the level of adherence and what barriers may exist that are preventing the patient from taking his or her medication appropriately.

Education, while helpful, is usually not enough to persuade the patient to comply with the physician’s drug orders. Information must be presented in clear, easy-to-understand language, and the patient must understand not only the benefits of adherence, but the repercussions of nonadherence. Also, positive reinforcement goes a long way; patients who feel empowered and cared for are more apt to play an active role in their treatment.

Dosing simplification and minimization of adverse effects are extremely successful strategies for improving adherence. When filling a prescription, the pharmacist should do a quick review to see whether the dosing schedule is as simple as possible. The pharmacist should inquire frequently about any adverse effects the patient is experiencing and then consult the physician regarding suggested alternatives.

Preparing a dosing card containing only the most essential elements of the patient’s medications can be highly beneficial. Including the name of the pill, an image (if possible), the condition it is for, and time of day taken can be extremely helpful for patients who take many medications or who have cognitive barriers³³.

CONCLUSION:

These actual patient stories show just a small portion of the patients and how they were safer when a chemist was involved in their care. Concern that over 300, 000 chemists worldwide Every day, the United States provides. Almost every situation, the activities of chemists intended to enhance Patient safety had a favourable effect on both to the patient and the medical system. Many repercussions are shown in some of the cases where listed, but in others, just a few. However, even one influence has a cascading effect, and the distinction is better medical treatment. For example, enhanced Adherence to medication doesn't end with a patient not forgetting to take their prescription. The fact that patient can then better manage their illness. and, ideally, doing so will make it less likely to require emergency care or hospitalization, enhance life quality, and see a reduction in overall healthcare expenses. It is significant to remember that, frequently, when patients participate, the results are better. in their own handling. Patients may participate in their care by offering comprehensive details to medical professionals such as chemists. The medical staff will benefit from this knowledge. In choosing the appropriate course of action for patient’s medicines and treatment objectives.

REFERENCES:

1. Cronenwett L, Sherwood G, Barnsteiner J, et al. Quality and Safety Education for Nurses. Outlook. 2007; 55:122–31.

2. Croskerry P, Wears RL, Binder LS. We are setting the educational agenda and curriculum for error prevention in emergency medicine. Acad Emerg Med. 2000; 7:1194–200.

3. Walton M, Woodward H, Staalduinen SV, et al. The WHO patient safety curriculum guide for medical schools. Qual Safe Health Care. 2010; 19: 542–6.

4. World Health Organization. Multi-professional Patient Safety Curriculum Guide. WHO Press, 2011.

5. Gurwich EL. Comparison of medication histories acquired by pharmacists and physicians. Am J Hosp Pharm. 1983; 40: 1541-2.

6. Pharmacists’ Impact on Patient Safety. American Pharmacists Association website. https://pharmacist.com/Portals/0/PD FS/Practice/Pharmacists Impact on Patient Safety. November 18. 2019.

7. Agency for Healthcare Research and Quality. (2016, December 9). AHRQ Tools To Reduce Hospital-Acquired Conditions. Retrieved from

8. Centers for Medicare & Medicaid Services. CMS Quality Reporting and Value-Based Programs & Initiatives. May 2022. Accessed June 28, 2022

9. Centers for Medicare & Medicaid Services. Hospital-Acquired Condition Reduction Program (HACRP). Accessed June 28, 2022

10. Dellit TH, Owens RC, McGowan Jr JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007; 44(2):159-77

11. Davey P, Marwick CA, Scott CL, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. The Cochrane Database of Systematic Reviews. 2017; 2: Cd003543.

12. Karanika S, Paudel S, Grigoras C, Kalbasi A, Mylonakis E. Systematic Review and Metaanalysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs. Antimicrobial Agents and Chemotherapy. 2016 Aug; 60(8):4840-52.

13. Salter C. Compliance and concordance during domiciliary medication review involving pharmacists and older people. Sociol Health Illn. 2010; 32: 21-36.

14. Schedlbauer A, Davies P, Fahey T. Interventions to improve adherence to lipid lowering medication. Cochrane Database Syst Rev. 2010; 3: CD004371.

15. Saini SD, Schoenfeld P, Kaulback K, Dubinsky MC. Effect of medication dosing on adherence in chronic diseases. Am J Manag Care. 2009.

16. Kripalani S, Yao X, Haynes RB. Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med. 2007; 167: 540-550.

17. Vermeire E, Wens J, Van Royen P, et al. Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005; 2: CD003638.

18. Carter BL, Foppe van Mil JL. Comparative effectiveness research: evaluating pharmacist interventions and strategies to improve medication adherence. Am J Hypertens. 2010; 23: 949-955.

19. Ma A, Chen DM, Chau FM, Saberi P. Improving adherence and clinical outcomes through an HIV pharmacist’s interventions. AIDS Care. 2010; 22: 1189-1194.

20. Touchette D. Improving adherence in the community and clinic pharmacy settings: an emerging opportunity. Pharmacotherapy. 2010; 30:425-427.

21. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008; 10: 348-354.

22. Tsiantou V, Pantzou P, Pavi E, et al. Factors affecting adherence to antihypertensive medication in Greece: results from a qualitative study. Patient Prefer Adherence. 2010; 4: 335-343.

23. Ahmad A, Hugtenburg J, Welschen LM, et al. Effect of medication review and cognitive behavior treatment by community pharmacists of patients discharged from the hospital on drug-related problems and compliance: design of a randomized control trial. BMC Public Health. 2010; 10: 133.

24. Kripalani S, Robertson R, Love-Ghaffari MH, et al. Development of an illustrated medication schedule as a low-literacy patient education tool. Patient Educ Couns. 2007; 66: 368-377.

25. Chisholm-Burns MA, Kim Lee J, Spivey CA, et al. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Medical Care. 2010; 48:923-933. Morgado MP, Morgado SR, Mendes LC, et al. Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: review and meta-analysis. Am J Health Syst Pharm. 2011; 68: 241-253.

26. Thompson CA. New healthcare laws will bring changes for pharmacists. Am J Health Syst Pharm. 2010; 67:690-695.

27. Altmiller G. The role of constructive feedback in patient safety and continuous quality improvement. Nurs Clin North Am. 2012; 47(3): 365-74.

28. Karanika S, Paudel S, Grigoras C, Kalbasi A, Mylonakis E. Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs. Antimicrobial agents and chemotherapy. 2016; 60(8): 4840-52. doi: 10.1128/AAC.00825-16.

29. Harkness, Turna L. MSN, RN, LGBC. Effective care coordination and transition management for older adults. Nursing Made Incredibly Easy. 2020; 18(5): 26-32.

30. National Transitions of Care Coalition Measures Work Group, (Transitions of Care Measures) Washington DC: National Transitions of Care Coalition; 2008.

31. Saleh SS, Freire C, Morris‐Dickinson G, Shannon T. An Effectiveness and Cost‐Benefit Analysis of a Hospital‐Based Discharge Transition Program for Elderly Medicare Recipients. Journal of the American Geriatrics Society. 2012.

32. Karanika S, Paudel S, Grigoras C, Kalbasi A, Mylonakis E. Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs. Antimicrobial Agents and Chemotherapy. 2016.

33. Baur D, Gladstone BP, Burkert F, et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. The Lancet Infectious Diseases. 2017.

Received on 07.11.2023 Modified on 06.12.2023

Asian J. Pharm. Tech. 2024; 14(1):87-94.

DOI: 10.52711/2231-5713.2024.00016