Siriraj

Today marked our first of three days at Siriraj hospital. Siriraj hospital is the largest hospital in Thailand, housing over 2200 beds. Our day consisted of getting orientated to the hospital as well as learning about the hospital's ADR monitoring and prevention unit. The hospital has a team of pharmacists dedicated to monitoring and preventing adverse drug reactions. The unit conducts initial evaluations, followups with patients that had ADRs inpatient,investigates historic ADRs and prevents further ADRs. We initially heard a presentation about the unit itself, the objectives they had, and techniques they would use to evaluate, document, and prevent ADRs. One technique that I though was interesting was giving the patient an detailed ADR card on discharge that they could keep on person. This is similar to the med list that we use in the United States but these ADR cards give providers and patients a detailed list of their ADRs. We then proceeded to visiting a patient who required an ADR consult to identify her ADR. The patient was recovering post operation and instead we spoke to her caregiver. Using opened ended questions, the ADR unit was able to identify the ADR as most likely attributed to an NSAID. The next patient the ADR unit saw was a followup with a patient who developed a rash after receiving clindamycin  and ceftriaxone the previous day. The last patient we experienced with the ADR unit was a Thai monk with a suspected case of Steven Johnson Syndrome. The patient was being treated for a opportunistic infection with Bactrim. It was a very good and rare experience to see a case of it first hand. It looked just like all the pictures we saw in class!