Clinical Intervention

Drug Related Problem

An event or circumstance involving drug
therapy that actually or potentially interferes
with desired health outcomes

Drug Selection
Duplication
Interacting drugs are of the same therapeutic class

Example:
Patient taking two different brands of amiodarone at the
same time

Drug
DrugSelection
Selection
Drug interaction
Prescription or non-prescription medicine that
could result in a major interaction if taken with
the concurrent therapy
Example:
Patient asks to purchase an OTC anti-inflammatory when
taking warfarin

Drug
DrugSelection
Selection
Wrong Drug
Incorrectly prescribed or incorrectly dispensed

Example:
Doctor prescribes carbimazole 20 mg bid instead of
carbamazepine 200 mg bid

Drug
DrugSelection
Selection
Incorrect strength
No details about a drugs strength or incorrect
details
Example:
Doctor prescribes Irbesartan 150 mg daily but previous
therapy was 300 mg daily

Drug
DrugSelection
Selection
Inappropriate Dosage Form
Formulation of the product is inappropriate or
incorrect in terms of the intended use of the
product
Example:
A rectal topical product is prescribed or supplied for an
eye problem

Drug
DrugSelection
Selection
Contraindication apparent
Contraindicated due to their medical conditions

Example:
Enalapril for a woman who is 7 months old pregnant

Drug
DrugSelection
Selection
No indication apparent
no reason for the drug to be used

Example:
Patient using steroid eye drops over a long term without
current indication

Drug
DrugSelection
Selection
Other problems
Out of date or has deteriorated
Discontinued or out of stock on a long term basis
Example:
Patient presents a prescription for trimethoprim for a
UTI. The drug is out of stock for another 3 weeks, so the
doctor is contacted with a suggestion for an alternative
antibiotic

Over or Underdose Prescribed

Too high
Total daily dose is too high based on previous
dosage range or reference dosage ranges
Too high by unintentional error
Example:
A patient is prescribed dexamethasone 50 mg daily (the
prescriber was thinking of prednisolone dose)

Over or Underdose Prescribed

Too low
Total daily dose is too low based on previous
dosage range or reference dosage ranges
Too low by unintentional error
Example:
A 30 kg child is prescribed amoxicillin 125 mg tid
(recommended dose 7.5 25 mg/kg tid)

Over or Underdose Prescribed

Incorrect or unclear dosing instructions
Specified dosing is not optimal
Duration is too short or too long
Incorrect dose titrations
Example:
A patient presents a new prescription for lamotrigine 100
mg bid with no instructions to increase slowly (dose
should start at 25 mg/day for 2 weeks and increase by
maximum of 50 100 mg every 1-2 weeks)

Compliance
Under-use by consumer
Uses too little of a medicine as a result of
forgetfulness or lack of understanding

Example:
Patient only takes lercanidipine when his blood pressure is
very high

Compliance
Over-use by consumer
Uses too much of a medicine as a result of
forgetfulness or lack of understanding

Example:
Patient requesting repeat prescription of simvastatin after
two weeks because he was forgetting that he had taken it

Compliance
Intentional drug misuse
Suspected intentional over-use of potentially
abused, product including non-prescription items

Example:
Patient requesting for a second presciption from a
different prescriber for nitrazepam after 1 week, claiming
she dropped the previous supply down the toilet

Compliance
Difficulty using dosage form
Lacks understanding of how to use the dosage
form
Has a physical problem with the administration of
the dosage form or device
Example:

Patient cannot swallow sustained-release diltiazem

capsules

Undertreated
Undertreated
Symptom or disease that is not being treated
adequately

Example:

Patient frequently requests glyceryl trinitrate spray but is

not being treated with regular anti angina medication

Undertreated
Untreated
Symptom or disease that is not currently being
treated

Example:

Patient has a fall resulting in a hip fracture but is not on

any medication

Undertreated
Preventive therapy required
Requires additional therapy to prevent a likely
adverse event

Example:

Patient started on a morphine slow-release without

laxative therapy

Monitoring
Laboratory Monitoring
In the absence of any adverse effect, laboratory
monitoring is required
any laboratory test that is not done within the
consumers home, doctors surgery or pharmacy
Example:

Patient on warfarin was discharged from hospital 2 weeks

ago and has not yet had a post discharge INR

Monitoring
Non - laboratory Monitoring
In the absence of any adverse effect, nonlaboratory monitoring is required

Example:

Diabetic patient recently prescribed with insulin is advised

to regularly monitor their blood sugar levels

Education or Information
Consumer requests drug information
Has a reasonable understanding of their
condition, but requests further information about
their medicine

Example:

After starting hormone replacement therapy (HRT), a

consumer requests further printed information about
breast cancer and HRT

Education or Information
Consumer requests disease management
advice
To inform patients of critical aspects of the
management or prevention of a disease or
condition
Example:
Information about fluid restriction is given to a patient
with heart failure

Not classifiable
Cannot be classified under another category

Toxicity or Adverse Reaction

Toxicity, allergic reaction or adverse effect
present
Includes situations in which compliance issues
have led to symptoms of toxicity