Table 3.
Prevalence and Examples of MRPs Identified During the Study Period
| n (%) Patients With ≥ 1 MRP* | n (%) Instances of MRPs | n (%) Instances of High‐Risk MRPs | Examples of High‐Risk MRPs | ||
|---|---|---|---|---|---|
| Nonadherence | 38 (66.7%) | 118 (31.5%) | 57 (48.3%) | ||
| Intentional | 28 (49.1%) | 77 (65.3%) | 39 (50.6%) | Nonadherence with diuretics in a patient with large volume ascites due to urinary urgency | |
| Unintentional | 14 (24.6%) | 22 (18.6%) | 9 (40.9%) | Nonadherence with spontaneous bacterial peritonitis prophylaxis as the patient assumed antibiotics would cease after course completed | |
| Other † | 12 (21.1%) | 19 (16.1%) | 9 (47.4%) | Financial circumstance impacting adherence with lactulose in a patient with HE | |
| Adverse drug reaction | 18 (31.6%) | 21 (5.6%) | 12 (57.1%) | Irritability and mood disturbances (on a background of depression and anxiety) while taking prednisolone prescribed for alcoholic hepatitis | |
| Drug interactions | 19 (33.3%) | 24 (6.4%) | 21 (87.5%) | ||
| Drug–drug | 5 (8.8%) | 5 (20.8%) | 3 (60.0%) | High‐dose tramadol and sertraline coadministration causing tremors, agitation, and sweating | |
| Drug–disease | 16 (28.1%) | 19 (79.2%) | 18 (94.7%) | Use of NSAIDs by a patient with a history of ascites and renal impairment | |
| Indication | 47 (82.5%) | 109 (29.1%) | 34 (31.2%) | ||
| Wrong drug | 14 (24.6%) | 16 (14.7%) | 12 (75.0%) | Opioid‐naive patient prescribed a fentanyl patch for chronic pain by general practitioner | |
| Unnecessary drug | 15 (26.3%) | 21 (19.3%) | 3 (14.3%) | Ongoing insulin use by a patient with hypoglycemia (previously started for elevated blood sugar levels while taking prednisolone) | |
| Untreated indication | 40 (70.2%) | 72 (67.9%) | 19 (26.4%) | Constipation in a patient at risk of encephalopathy not prescribed lactulose or an alternative aperient | |
| Suboptimal dose | 31 (54.4%) | 62 (16.5%) | 41 (66.1%) | ||
| Dose too high | 19 (33.3%) | 30 (48.4%) | 18 (60.0%) | Significant diarrhea associated with high lactulose dose in a patient with a history of encephalopathy | |
| Dose too low | 23 (40.4%) | 32 (51.6%) | 23 (71.9%) | Patient with moderate volume ascites intended to increase diuretics following prior review; however, dose change not made in Webster‐Pak | |
| Monitoring issues | 30 (52.6%) | 41 (10.9%) | 15 (36.6%) | Pathology not requested for a patient restarted on diuretics for ascites, following recent hyponatremia and acute kidney injury |
*Patients may have had an MRP in ≥1 subtype;
†nonadherence due to financial or social circumstance.