Pharmacy Practice is a free full-text journal with a scope on the practice of pharmacy. Pharmacy Practice covers pharmaceutical care, social pharmacy, pharmacy education, process and outcome research, health promotion and education, health informatics, pharmacoepidemiology

Background: In Thailand, pharmacists are responsible for all activities to ensure access to medicines throughout pharmaceutical supply chain. Competency framework (CF) is an important guidance for professional development and workforce planning. Objective: This study aimed to explore needs for pharmacy services in pharmaceutical supply chain and competencies of pharmacists to serve those needs. It was the first step for developing evidence-based pharmacy CF within the context of Thailand in 2026. Methods: A qualitative method using in-depth interviews to gain rich data from practitioners and leaders in all area of practices. 99 key informants from 56 workplaces in Thailand were interviewed during January and March 2016. Data was transcribed verbatim, and thematic analysis was used. Competencies were extracted, followed by several rounds of group discussion among team members to develop an initial framework. The competencies and CF were presented, and recommendations were gained from professional leaders for refining the findings. Results: The key informants agreed that pharmacist’s works and responsibilities have gradually been drifted to support changes in healthcare and pharmaceutical systems. The upcoming pharmaceutical services call for higher standards of practice, larger number of personnel, and skillful pharmacists who have strong foundation in pharmaceutical knowledge as well as an ability to integrate knowledge into practices. Two sets of CFs were established. The general CF comprises five core domains: product focus, patient focus, healthcare system focus, community focus, and personal focus for self-improvement. These general competencies allow practitioners to perform basic professional tasks, including providing information, dispensing, and compounding. The service-specific competency is the integration of general competencies tailored into specific area of practice. Conclusions: Regarding the professional goal to evolve pharmacists from generalists to specialists for providing higher quality of professional services, the pharmacists are required to demonstrate general competencies and service-specific competencies. The findings serve as the need-based evidence for developing a national CF for pharmacists in Thailand.

Background: Look-alike/sound-alike (LASA) drugs substantially contribute to global healthcare challenges and patient harm, necessitating a comprehensive understanding of LASA medication errors. Objective: The current study explored the prevalence and characteristics of medication errors related to LASA in a 200-bed general hospital. Methods: A mixed-methods approach was employed. The quantitative component analyzed the LASA drug error data using the hospital database. For the qualitative component, in-depth interviews with pharmacists and pharmacy staff were undertaken to gain insights into stakeholder perceptions and management of LASA-related issues. Results: Quantitative analysis highlighted three types of LASA medication errors: confusion due to similar drug names, appearance, and packaging. Drug name confusion accounted for most errors (64.62%), demonstrating the considerable risk associated with similar medication names. Packaging confusion accounted for 24.61% of errors, indicating the importance of a unique packaging design. Overall, 10.77% of errors were attributed to similar appearance, indicating that the visual resemblance of medications played a considerable role in LASA errors. Forty-six LASA drug pairs were identified, the most frequent being simvastatin 10 mg and simvastatin 20 mg. The errors were divided into two categories: Category A, with two pairs related to name and packaging similarities, and Category B, with 44 pairs involving all types of similarities. The differentiation between these categories underscores the complex nature of LASA errors. Semi-structured interviews revealed that anticipatory errors often occurred during busy periods, which could result in crucial details, such as drug strengths, being overlooked. Proposed solutions for reducing LASA errors included implementing Tall Man lettering, developing movable LASA signage, and improving workforce allocation. Root-cause analysis identified several factors, including drug similarities and staffing issues, as notable contributors to LASA errors, highlighting the need for a multipronged approach. Conclusion: LASA medication errors, particularly those attributed to drug name similarities, pose a considerable risk and persist despite existing safeguards. Implementing tailored strategies, such as Tall Man letters, movable LASA signage, and careful management of high-risk medication pairs, could aid in addressing these issues.

Objective: This study aimed to assess the diversity of extemporaneous preparations, identify the prevalent formulations, and highlight the challenges and opportunities for standardization and improvement of extemporaneous preparation practices. Methods: A survey was conducted among 88 Thai hospitals representing the public and private sectors. The questionnaire gathered information on general hospital characteristics, detailed aspects of extemporaneous compounding, and the specific extemporaneous formulations used. Results: The survey revealed significant variations in extemporaneous preparations among Thai hospitals, with oral liquids, semisolids, and eye preparations commonly employed. The primary oral liquid formulations used were suspensions, syrups, and solutions. Specific medications frequently used in extemporaneous preparations were also identified. The challenges encompassed space, personnel, skills, raw materials, equipment, standardized formula information, preparation process information, funding, and other factors. Conclusion: A survey among Thai hospitals revealed significant variations in extemporaneous preparations in 88 participating hospitals. Common formulations used in extemporaneous compounding include oral liquid preparations, such as suspensions, syrups, solutions, semisolid preparations, and eye preparations. Stakeholder involvement, implementation of standardized operating procedures, resource allocation, comprehensive training programs, and collaboration among hospitals, pharmaceutical companies, and regulatory agencies are recommended to enhance extemporaneous compounding practices.

Drug name confusion or similar product packaging and labeling, also known as “look-alike, sound-alike” (LASA) medication error, is one of the most problematic causes of prescribing and dispensing errors. Therefore, this study aimed to compare the similarity of registered brand name drugs of tablets and capsules that are commercially available in Thailand to estimate the magnitude of LASA medication errors. Analogous comparisons of brand names using similarity in orthography (written forms with identical letters) were analyzed retrospectively. Tablets and capsules commercially available in Thailand and registered with the Bureau of Drug Administration, Food and Drug Administration (FDA) in 2012 as “dangerous drugs” and “specially controlled drugs” for humans and animals were included in this study. Descriptive statistics, including frequencies and percentages, were used in this study. The analogous comparison of brand name orthography was scrutinized, and the results revealed 1,668 brand names, which were categorized into three genres as follows: 1) Single brand names from a single manufacturer having the same active pharmaceutical ingredient (API) with numerous registration numbers (1,049 names, 62.89% of the total similarity results) 2) Single brand names from different manufacturers having the same API and possessing several registration numbers (615 names, 36.87% of the total similarity results) 3) Single brand names from different manufacturers with diverse APIs (four brand names, 0.24% of the total similarity results). Analogous results revealed that numerous identical brand names could be derived from the same manufacturers, APIs, dosage strengths, or otherwise. The results of this study recommend improvement on product registration to better ensure patient safety in the future.

Purpose/Background: Clozapine-induced hypersalivation is one of the most common bothersome adverse reactions of clozapine. The management strategies for this condition remain inadequately studied and understood. The objective of the study is to compare the effectiveness and tolerability of (1) trihexyphenidyl 5 mg/d, (2) clonidine 0.15 mg/d, or (3) a reduction of clozapine dosage by 25 to 50 mg/d for managing clozapine-induced hypersalivation Methods/Procedures: A randomized, open-label, non–placebo-controlled clinical trial was conducted from December 2023 to May 2024. Eligible patients were randomly assigned to 1 of 3 groups. Primary outcomes were assessed using the Drooling Severity and Frequency Scale (DSFS) and the Nocturnal Hypersalivation Rating Scale (NHRS) at baseline, week 4, and week 8. Quality of life assessed using the pharmaceutical therapy for quality of life short version and adverse drug reactions were recorded as secondary outcomes. Findings/Results: A total of 67 patients were randomly assigned to 1 of 3 treatment groups. By week 8, significant reductions in DSFS and NHRS scores were observed in all groups, with clonidine showing the greatest improvement. Trihexyphenidyl was also effective, whereas reducing clozapine dose resulted in more modest improvements. Quality of life improved significantly across all groups, with the greatest improvement observed in the clonidine group. The most common adverse effects were dry mouth, constipation, drowsiness, and dizziness. Implications/Conclusions: Clonidine and trihexyphenidyl appear to be more effective options for managing clozapine-induced hypersalivation compared to clozapine dose reduction.