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McDerby N, Kosari S, Bail KS, Shield AJ, Thorpe R, Naunton M. Residential care pharmacists: another hole plugged in the Swiss cheese. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Nicole McDerby
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Canberra Australia
| | - Sam Kosari
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Canberra Australia
| | - Kasia S. Bail
- Discipline of Nursing; Faculty of Health; University of Canberra; Canberra Australia
| | - Alison J. Shield
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Canberra Australia
| | - Richard Thorpe
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Canberra Australia
| | - Mark Naunton
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Canberra Australia
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Potentially inappropriate medications according to STOPP-J criteria and risks of hospitalization and mortality in elderly patients receiving home-based medical services. PLoS One 2019; 14:e0211947. [PMID: 30735544 PMCID: PMC6368320 DOI: 10.1371/journal.pone.0211947] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/24/2019] [Indexed: 12/20/2022] Open
Abstract
Background Although potentially inappropriate medications (PIMs) have been linked to poor health outcomes, country-specific PIM criteria have not been compared. Thus, we compared the identification of PIMs between the Screening Tool for Older Person’s Appropriate Prescriptions for Japanese (STOPP-J) and the 2015 American Geriatrics Society Beers Criteria in elderly patients receiving home-based medical services. Methods A 5-year prospective cohort study was conducted with 196 patients receiving home-based medical services. Data were collected using questionnaires and chart reviews and included detailed information on prescription medication. STOPP-J and the Beers Criteria were used to categorize PIM and non-PIM recipients. All-cause mortality and first hospitalization were compared using a multivariate Cox regression model. Results PIMs were detected in 132 patients (67.3%) by STOPP-J and in 141 patients (71.9%) by the Beers Criteria, and the mean numbers of PIMs were 1.3 ± 1.3 and 1.2 ± 1.1, respectively. The three most frequently prescribed STOPP-J PIMs were hypnotics (26.8%), diuretics (25.6%), and NSAIDs (12.6%), compared with proton pump inhibitors (PPIs) (29.8%), hypnotics (26%), and NSAIDs (8.1%) according to the Beers Criteria. STOPP-J PIMs were associated with all-cause mortality (HR 3.01, 95% CI 1.37–6.64) and hospitalization (HR 1.91, 95% CI 1.17–3.09); neither was associated with Beers Criteria PIMs. Using a modified Beers Criteria (excluding PPIs), PIMs were correlated with first hospitalization (HR 1.91, 95% CI 1.17–3.09). Conclusions PIMs categorized by STOPP-J are associated with hospitalization and mortality in Japanese patients receiving home-based medical services. PPIs, commonly used for acid-related diseases, do not seem to have deleterious effects on health outcomes. Country-oriented, medication-specific criteria would be of considerable clinical utility.
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Tucker S, Buck D, Roe B, Hughes J, Challis D. Hospital admissions and place of death of residents of care homes receiving specialist healthcare services: Protocol for a systematic review. J Adv Nurs 2018; 75:443-451. [PMID: 30289570 DOI: 10.1111/jan.13866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022]
Abstract
AIM To synthesize the evidence relating to the ability of specialist care home support services to prevent the hospital admission of older care home residents, including hospital admission at the end-of-life. DESIGN Systematic review and narrative synthesis. METHODS Ten electronic databases will be searched from 2010 - 31 December 2018 using predetermined search terms. All studies of specialist healthcare services to meet care home residents' physical healthcare needs which provide outcome data on hospital admission or place of death compared with usual care will be included. Two reviewers will independently assess studies' eligibility and methodological quality using the Effective Public Health Practice Project Quality Assessment Tool. Data will be extracted by one reviewer and checked by a second according to predetermined categories. Data will be synthesized in evidence tables and narrative. Funder: National Institute for Health Research School for Social Care Research, November 2016. DISCUSSION Care of older people in care home settings is a key aspect of nursing nationally and internationally. This review will increase understanding of the extent to which different models of specialist healthcare support for care homes are associated with key resident outcomes. IMPACT Standard healthcare support for care home residents is often inadequate, resulting in avoidable hospital admissions and lack of resident choice as to place of death. Although a range of specialist healthcare services are emerging, little is known about their relative effectiveness. This paper marshalls evidence of relevance to commissioners investing in healthcare provision to care homes to meet NHS targets.
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Affiliation(s)
- Sue Tucker
- Personal Social Services Research Unit (PSSRU), University of Manchester, Manchester, UK
| | - Deborah Buck
- Personal Social Services Research Unit (PSSRU), University of Manchester, Manchester, UK
| | - Brenda Roe
- Personal Social Services Research Unit (PSSRU), University of Manchester, Manchester, UK.,Evidence-based Practice Research Centre, Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Jane Hughes
- Personal Social Services Research Unit (PSSRU), University of Manchester, Manchester, UK
| | - David Challis
- Personal Social Services Research Unit (PSSRU), University of Manchester, Manchester, UK
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54
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Abdi M, Piri S, Mohammadian R, Asadi M, Khademi E. Factors associated with medication errors in the psychiatric ward of Razi Hospital in Tabriz: Perspectives of nurses. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2018. [DOI: 10.29252/pcnm.8.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Dubé PA, Portelance J, Corbeil O, Tessier M, St-Onge M. Drug Administration to the Wrong Nursing Home Residents Reported to the Québec Poison Center: A Retrospective Study. J Am Med Dir Assoc 2018; 19:891-895. [PMID: 29970296 DOI: 10.1016/j.jamda.2018.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 04/23/2018] [Accepted: 05/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study examined the association between the administration of drugs to the wrong nursing home residents with a need for hospital treatment or as an indicator of mortality. DESIGN A retrospective observational study of medical records from February 1, 2016, to January 31, 2017. SETTING Calls made to the Quebec Poison Center. PARTICIPANTS Nursing home residents aged ≥65 years. INTERVENTION(S) Medication administered to the wrong resident. MAIN OUTCOME MEASURE(S) Death, hospital referral and treatment, number of drugs or type of drug classes. RESULTS Of the 6282 calls received by the Quebec Poison Center concerning medication errors, 494 cases were included in the retrospective study. Half of the patients (51%) received at least 5 different drugs that were not prescribed for them. Most patients (82%) were asymptomatic at the time of the call to the poison center; however, a third (34%) of the exposures were considered potentially toxic and were treated at the hospital. The most prominent drug classes involved include antihypertensives, antiarrhythmics, and antipsychotics. In particular, almost a quarter (23%) of cases of clozapine maladministration resulted in moderate or severe effects. No deaths were reported. CONCLUSIONS/IMPLICATIONS Medication errors in nursing homes are prevalent. The medical provider and probably the poison control center should be consulted as soon as possible when people are aware of administration of medication to the wrong patient, which is considered a medical emergency until proven otherwise. Public policies should seek for better surveillance and prompt intervention. Research should be undertaken to limit errors of drug administration to the wrong nursing home residents.
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Affiliation(s)
- Pierre-André Dubé
- Direction de la santé environnementale et de la toxicologie, Institut national de santé publique du Québec, Québec (Québec), Canada.
| | | | - Olivier Corbeil
- Faculté de pharmacie, Université Laval, Québec (Québec), Canada
| | - Mélanie Tessier
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec (Québec), Canada
| | - Maude St-Onge
- Centre antipoison du Québec, Québec (Québec), Canada
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56
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Parekh N, Ali K, Stevenson JM, Davies JG, Schiff R, Van der Cammen T, Harchowal J, Raftery J, Rajkumar C. Incidence and cost of medication harm in older adults following hospital discharge: a multicentre prospective study in the UK. Br J Clin Pharmacol 2018; 84:1789-1797. [PMID: 29790202 PMCID: PMC6046489 DOI: 10.1111/bcp.13613] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/03/2018] [Accepted: 04/08/2018] [Indexed: 12/21/2022] Open
Abstract
Aims Polypharmacy is increasingly common in older adults, placing them at risk of medication‐related harm (MRH). Patients are particularly vulnerable to problems with their medications in the period following hospital discharge due to medication changes and poor information transfer between hospital and primary care. The aim of the present study was to investigate the incidence, severity, preventability and cost of MRH in older adults in England postdischarge. Methods An observational, multicentre, prospective cohort study recruited 1280 older adults (median age 82 years) from five teaching hospitals in Southern England, UK. Participants were followed up for 8 weeks by senior pharmacists, using three data sources (hospital readmission review, participant telephone interview and primary care records), to identify MRH and associated health service utilization. Results Overall, 413 participants (37%) experienced MRH (556 MRH events per 1000 discharges), of which 336 (81%) cases were serious and 214 (52%) potentially preventable. Four participants experienced fatal MRH. The most common MRH events were gastrointestinal (n = 158, 25%) or neurological (n = 111, 18%). The medicine classes associated with the highest risk of MRH were opiates, antibiotics and benzodiazepines. A total of 328 (79%) participants with MRH sought healthcare over the 8‐week follow‐up. The incidence of MRH‐associated hospital readmission was 78 per 1000 discharges. Postdischarge MRH in older adults is estimated to cost the National Health Service £396 million annually, of which £243 million is potentially preventable. Conclusions MRH is common in older adults following hospital discharge, and results in substantial use of healthcare resources.
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Affiliation(s)
- Nikesh Parekh
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, Sussex, UK.,Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Sussex, UK
| | - Khalid Ali
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, Sussex, UK.,Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Sussex, UK
| | | | - J Graham Davies
- Institute of Pharmaceutical Science, Kings College London, London, UK
| | - Rebekah Schiff
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tischa Van der Cammen
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, Sussex, UK.,Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - James Raftery
- Department of Medicine, University of Southampton, Southampton, UK
| | - Chakravarthi Rajkumar
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, Sussex, UK.,Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Sussex, UK
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Rodrigues MA, Santana RF, Paula RCCD, Silva MTND, Espirito Santo FHD. EXERCÍCIO PROFISSIONAL DE ENFERMAGEM EM INSTITUIÇÕES DE LONGA PERMANÊNCIA PARA IDOSOS: ESTUDO RETROSPECTIVO. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-070720180001700016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: avaliar os resultados da fiscalização ético-profissional de enfermagem em Instituições de Longa Permanência para Idosos. Método: estudo observacional, retrospectivo de análise documental. No período de janeiro de 2010 a dezembro de 2013 realizaram-se 2.650 inspeções fiscalizatórias no Conselho Regional de Enfermagem do Estado do Rio de Janeiro. Dessas, 159 (6%) eram referentes a Instituições de Longa Permanência para Idosos. A amostra final foi composta por 51 processos que atenderam ao critério de possuir, no mínimo, duas fiscalizações para comparações. O instrumento de coleta de dados norteou-se pelos quatro pilares da fiscalização: exercício legal da profissão; dimensionamento de pessoal; sistematização da assistência de enfermagem e legislações afins ao exercício profissional. Para a análise dos dados descritiva e inferencial, utilizaram-se os programas SPSS e Excel 2007. Resultados: das 51 instituições avaliadas, 80,4% eram privadas. O principal motivo das fiscalizações foi cumprir ordens do Ministério Público (56,9%). Houve diferença entre a primeira e a última fiscalização: profissionais de enfermagem com registro no conselho (0,006); classificação de cuidados por dependência (0,008); apresentar escala de profissionais (0,006); não possuir outros profissionais na escala de enfermagem, principalmente cuidadores (0,001); prontuário único (0,039); normas e rotinas de enfermagem (0,000); apresentar protocolos operacionais padrões (0,000); e Processo de Enfermagem (0,001). Conclusão: recomenda-se fortalecer as fiscalizações em consonância com o Ministério Público e a Agência Nacional de Vigilância Sanitária. Deve-se ainda viabilizar o funcionamento conforme as regularidades ético-profissionais incluindo as Instituições de Longa Permanência para Idosos na esfera sociossanitárias, que tem a enfermagem como sua maior classe trabalhadora.
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Fuller AEC, Guirguis LM, Sadowski CA, Makowsky MJ. Electronic Medication Administration Records in Long-Term Care Facilities: A Scoping Review. J Am Geriatr Soc 2018; 66:1428-1436. [PMID: 29684250 DOI: 10.1111/jgs.15384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To map the extent, range, and nature of research on the effectiveness, level of use, and perceptions about electronic medication administration records (eMARs) in long-term care facilities (LTCFs) and identify gaps in current knowledge and priority areas for future research. DESIGN Scoping review of quantitative and qualitative literature. SETTING Literature review. PARTICIPANTS Original research relating to eMAR in LTCF was eligible for inclusion. MEASUREMENTS We systematically searched MEDLINE, CINAHL, Scopus, ProQuest, and the Cochrane Library and performed general and advanced searches of Google to identify grey literature. Two authors independently screened for eligibility of studies. Independent reviewers extracted data regarding country of origin, design, study methods, outcomes studied, and main results in duplicate. RESULTS We identified 694 articles, of which 34 met inclusion criteria. Studies were published between 2006 and 2016 and were mostly from the United States (n=25). Twenty studies (59%) used quantitative methods, including surveys and analysis of eMAR data; 7 (21%) used qualitative methods, including interviews, focus groups, document review, and observation; and 7 (21%) used mixed methods. Three major research areas were explored: medication and medication administration error rates (n=11), eMAR benefits and challenges (n=19), and eMAR prevalence and uptake (n=15). Evidence linking eMAR use and reductions in medication errors is weak because of suboptimal study design and reporting. The majority of studies were descriptive and documented inconsistent benefits and challenges and low levels of eMAR implementation. CONCLUSION Further investigation is required to rigorously evaluate the effect of standalone eMAR systems on medication administration errors and patient safety, the extent of eMAR implementation, pharmacists' perceptions, and cost effectiveness of eMAR systems in LTCF.
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Affiliation(s)
- Andrew E C Fuller
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa M Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl A Sadowski
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Mark J Makowsky
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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Feasibility of Integrating Residential Care Pharmacists into Aged Care Homes to Improve Quality Use of Medicines: Study Protocol for a Non-Randomised Controlled Pilot Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030499. [PMID: 30720779 PMCID: PMC5877044 DOI: 10.3390/ijerph15030499] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/06/2018] [Accepted: 03/09/2018] [Indexed: 12/03/2022]
Abstract
Older adults are particularly susceptible to iatrogenic disease and communicable diseases, such as influenza. Prescribing in the residential aged care population is complex, and requires ongoing review to prevent medication misadventure. Pharmacist-led medication review is effective in reducing medication-related problems; however, current funding arrangements specifically exclude pharmacists from routinely participating in resident care. Integrating an on-site clinical pharmacist into residential care teams is an unexplored opportunity to improve quality use of medicines in this setting. The primary objective of this pilot study is to investigate the feasibility of integrating a residential care pharmacist into the existing care team. Secondary outcomes include incidence of pharmacist-led medication review, and incidence of potential medication problems based on validated prescribing measures. This is a cross-sectional, non-randomised controlled trial with a residential care pharmacist trialled at a single facility, and a parallel control site receiving usual care and services only. The results of this hypothesis-generating pilot study will be used to identify clinical outcomes and direct future larger scale investigations into the implementation of the novel residential care pharmacist model to optimise quality use of medicines in a population at high risk of medication misadventure.
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Schaffler-Schaden D, Pitzer S, Schreier M, Dellinger J, Brandauer-Stickler B, Lainer M, Flamm M, Osterbrink J. Improving medication appropriateness in nursing home residents by enhancing interprofessional cooperation: A study protocol. J Interprof Care 2018. [DOI: 10.1080/13561820.2018.1448372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Dagmar Schaffler-Schaden
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Stefan Pitzer
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Magdalena Schreier
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Johanna Dellinger
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | | | - Miriam Lainer
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
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Willoughby M, Kipsaina C, Ferrah N, Bugeja L, Winbolt M, Ibrahim JE. A greater risk of premature death in residential respite care: a national cohort study. Age Ageing 2018; 47:226-233. [PMID: 29253078 DOI: 10.1093/ageing/afx177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/09/2017] [Indexed: 11/13/2022] Open
Abstract
Background the demand for residential respite care for older persons is high yet little is known about the occurrence of harm, including death in this care setting. Objective to compare the prevalence and nature of deaths among residential respite to permanent nursing home residents. Design retrospective cohort study. Setting australian accredited nursing homes between 1 July 2000 and 30 June 2013. Subjects respite and permanent residents of Australian accredited nursing homes, whose deaths were investigated by Australian coroners. Methods prevalence of deaths of nursing home residents were calculated using routinely generated coronial data stored in the National Coronial Information System. Odds ratios (OR) were calculated to examine residency (respite or permanent) by cause of death. Results of the 21,672 residents who died during the study period, 172 (0.8%) were in respite care. The majority of deaths were due to natural causes. A lower proportion occurred in respite (n = 119, 69.2%) than permanent (n = 18,264, 84.9%) residents. Falls-related deaths in respite as a proportion (n = 41, 23.8%) was almost double that in permanent care (n = 2,638, 12.3%). Deaths from other injury-related causes (such as suicide and choking) were significantly more likely in respite residents (OR = 2.0; 95% confidence interval: 1.1-3.6; P = 0.026). Conclusions this is the first national cohort study examining mortality among respite residents. It established that premature, injury-related deaths do occur during respite care. This is the first step towards better understanding and reducing the risk of harm in respite care.
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Affiliation(s)
- Melissa Willoughby
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Chebi Kipsaina
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Noha Ferrah
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Lyndal Bugeja
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Margaret Winbolt
- La Trobe University, Faculty of Health Sciences, Melbourne, Victoria, Australia
| | - Joseph Elias Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
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62
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Etty-Leal MG. The role of dose administration aids in medication management for older people. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2017. [DOI: 10.1002/jppr.1344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Mary G. Etty-Leal
- Pharmacy Department; Royal Melbourne Hospital; Melbourne Victoria Australia
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