Evaluation of the Appropriateness of Albumin Usage in a Teaching Hospital in Iran: The Impact of Clinical Pharmacist Intervention

Background: Albumin is a colloidal protein medication in which has a limited availability in market and it has a high cost. Albumin must be used in such approved indications as, large volume paracentesis, plasmapheresis, spontaneous bacterial peritonitis and hepato-renal syndrome. Objectives: The aim of this study was to evaluate the appropriateness of albumin utilization in a teaching hospital in Iran before and after guideline implementation. Methods: In this prospective study, a total of 100 patients were enrolled into the study in Loghman Hakim Teaching Hospital. The medical records of patients were reviewed and some information such as demographic parameters, albumin indication, albumin therapy duration, appropriateness of indication, nutrition type were recorded in pre-intervention phase. Then in post-intervention phase, albumin was administered after clinical pharmacist teaching and guideline implementation. After post-intervention period, demographic parameters, albumin indication, albumin therapy duration, appropriateness of indication were recorded again. Results: In phase 1, albumin was mostly prescribed in inappropriate indications and internist physicians were the most physicians who ordered albumin and wound healing also was the most frequent indication for albumin therapy. This improvement also was significant (P < 0.05). Data showed that albumin indication in post-intervention was different from that in the pre-intervention phase. After clinical pharmacist intervention most of indications were appropriately. Conclusions: This study demonstrated that in this hospital, albumin was prescribed inappropriately in most cases based on hospital guideline. This rate improved after clinical pharmacist intervention and resulted in significant reduction in albumin irrational utilization. It is advisable that albumin prescription must be monitored carefully by clinical pharmacists.