Optimising drug therapy and patient safety in patients with ileostomy: development and evaluation of a structured medication analysis approach

OBJECTIVES: Published descriptions of medication analysis procedures are often insufficiently detailed to ensure reproducibility. This limitation is particularly relevant for patient populations with specific clinical conditions, such as patients with ileostomy, in whom physiological changes can substantially alter drug absorption. Our study aimed to develop and evaluate a structured medication analysis approach tailored to the needs of patients with ileostomies. The approach was designed to support pharmacists in systematically detecting stoma-specific drug-related problems (DRPs) and implementing suitable pharmaceutical interventions. METHODS: This study was a single centred, multiphase mixed-methods study carried out at a tertiary-care teaching hospital. A structured medication analysis approach for patients with ileostomy was developed using a modified Delphi process with an interprofessional expert panel and piloted in an exploratory evaluation of retrospective medication case records from 25 patients. Subsequently, a controlled intervention study was performed using a standardised ileostomy patient case distributed to 40 pharmacists, who were assigned to an intervention group (using the structured approach) or a control group (standard practice). Pharmacists identified DRPs and proposed interventions, which were evaluated using a predefined scoring system. RESULTS: The final approach, organised into six key domains, was based on the (patho)physiological changes following ileostomy creation and designed as a decision-tree tool to guide systematic medication analysis. A total of 36 pharmacists from 20 institutions completed the case study. The intervention group achieved significantly higher total scores than the control group (mean 11.4 vs 7.3, p<0.001), driven primarily by improved detection of stoma-specific DRPs (6.6 vs 1.6 out of 8, p<0.001). CONCLUSION: The structured medication analysis approach substantially improved the recognition of stoma-specific DRPs and facilitated appropriate pharmaceutical interventions. It offers a reproducible, practice-oriented framework to optimise drug therapy and improve patient safety in individuals with ileostomy, particularly benefiting pharmacists with limited prior experience in this specialised area.