Incidence, causes, and consequences of preventable adverse drug reactions occurring in inpatients: A systematic review of systematic reviews

The quality of systematic reviews/meta-analyses published in the field of bariatrics: A cross-sectional systematic survey using AMSTAR 2 and ROBIS

High-quality systematic reviews (SR) and meta-analyses (MA) are considered to be reliable sources of information. This study aims to assess the quality of studies published as SR or MA in the field of bariatrics in 2016 and 2017. We identified SR and MA in the field of bariatrics by searching electronic databases (MEDLINE, Embase, and Cochrane Database of Systematic Reviews). Eligible studies were those identified as SR/MA in the title/abstract, which aimed to assess any outcome in patients with morbid obesity undergoing or scheduled to undergo bariatric surgery. Two authors independently reviewed all titles and abstracts, assessed full texts of potentially eligible studies, and assessed the quality of included studies. Any discrepancies were resolved by the third reviewer. We evaluated the quality and risk of bias of each SR/MA using AMSTAR 2 checklist and ROBIS tool, respectively. Seventy-eight of 4236 references met inclusion criteria and were assessed for their quality/risk of bias. The methodological quality of 99% of all papers was classified as "critically low." A total of 6% of the studies were at low risk of bias, and 78% were assessed as being at high risk of bias. The methodological quality of studies published in 2016 and 2017 as SR/MA is highly unsatisfactory.

Artificial intelligence-based conversational agent to support medication prescribing

Objective

This article describes the system architecture, training, initial use, and performance of Watson Assistant (WA), an artificial intelligence-based conversational agent, accessible within Micromedex^®.

Materials and methods

The number and frequency of intents (target of a user’s query) triggered in WA during its initial use were examined; intents triggered over 9 months were compared to the frequency of topics accessed via keyword search of Micromedex. Accuracy of WA intents assigned to 400 queries was compared to assignments by 2 independent subject matter experts (SMEs), with inter-rater reliability measured by Cohen’s kappa.

Results

In over 126 000 conversations with WA, intents most frequently triggered involved dosing (N = 30 239, 23.9%) and administration (N = 14 520, 11.5%). SMEs with substantial inter-rater agreement (kappa = 0.71) agreed with intent mapping in 247 of 400 queries (62%), including 16 queries related to content that WA and SMEs agreed was unavailable in WA. SMEs found 57 (14%) of 400 queries incorrectly mapped by WA; 112 (28%) queries unanswerable by WA included queries that were either ambiguous, contained unrecognized typographical errors, or addressed topics unavailable to WA. Of the queries answerable by WA (288), SMEs determined 231 (80%) were correctly linked to an intent.

Discussion

A conversational agent successfully linked most queries to intents in Micromedex. Ongoing system training seeks to widen the scope of WA and improve matching capabilities.

Conclusion

WA enabled Micromedex users to obtain answers to many medication-related questions using natural language, with the conversational agent facilitating mapping to a broader distribution of topics than standard keyword searches.

The Risks and Outcomes Resulting From Medication Errors Reported in the Finnish Tertiary Care Units:: A Cross-Sectional Retrospective Register Study

Background: Hospital-acquired medication errors (MEs) are common in health care. Although voluntary reporting is criticized for not producing reliable estimates on ME frequency, it provides valuable knowledge on errors occurring in the medication process. Objective: The purpose of this study was to analyze and determine the risks and outcomes resulting from MEs related to the TOP15 medicines in the Finnish tertiary care units from July 2016 to July 2017. Methods: The data consisting of 1,447 ME reports was organized according to ATC classification, after which TOP15 medicines involved in the reports were selected. Inductive content analysis was performed to the reports. After this, the reports were categorized by ME outcome into five categories and further analyzed accordingly. Results: The most common ME outcome in the reports was "omitted medicine" (33.9%). More than a quarter (27.1%) of ME reports were estimated to cause moderate or severe risk to the patient. When compared with each other, none of the outcome groups were more susceptible to high-risk events (p = 0.71). Of the TOP15 medicines, only Norepinephrine had significantly higher risk of being involved in high-risk events (OR 2.43, 95%CI 1.35-4.61). Conclusion: Voluntary reporting has an important role in the development of medication safety and the overall medication process within organizations. Although majority of the TOP15 medicines were involved in MEs resulting in seemingly high-risk outcomes, they were estimated to be insignificant or minor within the reporting unit. In the future, more emphasis will be needed for the assessment and analysis of the reports for more efficient, real-time detection and response to signals from health care units.

Exploring Inpatient Medication Patterns: A Big Data and Multilevel Approach

PURPOSE

Exploratory study to examine inpatient medication administration patterns.

METHODS

Data from multiple sources were utilized for this study. The outcome was time difference between medication schedule and administration. A 3-level hierarchical linear regression approach, both unadjusted and adjusted, was considered for this study where medication administration events are nested within patients nested within nurses or units. Intraclass correlation coefficients (ICCs) were calculated and compared.

RESULTS

On average, medications were delayed by 12 (SD, 48.8) minutes. From the full model, patient ICCs decreased when "unit" replaced "nurse" as the 3rd level (0.541 vs 0.444). Patients who spoke Spanish had a significant 2.3- to 4.2-minute delay in medication administration. Certified nurses significantly give medications earlier compared with noncertified nurses by 1.6 minutes.

DISCUSSION

Optimal medication administration is a multifactorial concern with nurses playing a role. Nursing leaders should also consider patient demographics and unit conditions, such as culture, for medication administration optimization.

Intercycle Unplanned Hospital Admissions Due to Cisplatin-based Chemotherapy Regimen-induced Adverse Reactions: A Retrospective Analysis

BACKGROUND

Cisplatin is a commonly used chemotherapy agent known to induce serious adverse reactions that may require hospital readmission. We aimed to analyze the extent and factors associated with unplanned hospital admissions due to cisplatin-based chemotherapy regimen-induced adverse reactions.

METHODS

Retrospective review of medical records of those patients who received at least one cycle of chemotherapy with cisplatin-based regimen during a six-month period from March to August 2017.

RESULTS

Of the 458 patients who received cisplatin during the study period, 142 patients did not meet inclusion criteria. The remaining 316 patients had a total of 770 episodes of primary admissions for chemotherapy administration. Overall, 187 episodes (24%) of intercycle unplanned hospital admission were recorded of which a major proportion (n=178; 23%) was due to chemotherapy-induced adverse reactions. Underweight patients had higher odds of unplanned admission (OR 1.77, 95% confidence interval [CI] 1.11 to 1.77). Significantly, more number of patients with cancers of head and neck and cancers of musculoskeletal were readmitted (p<0.001). Compared to high-dose cisplatin, low- and intermediate-dose cisplatin had lesser odds of unplanned admission (OR 0.52 and 0.77; 95% CI, 0.31 to 0.88 and 0.41 to 1.45, respectively). Patients without concomitant radiotherapy, drug-drug interaction and initial chemotherapy cycles had lesser odds of unplanned admission (OR 0.38, 0.50 and 0.52; 95% CI, 0.26 to 0.55, 0.25 to 0.99 and 0.32 to 0.84 respectively). Unplanned admissions were mainly due to blood-related (31%) and gastrointestinal (19%) adverse reactions. Among chemotherapy regimens, cisplatin monotherapy (34%) and cisplatin with doxorubicin (20%) regimens resulted in a major proportion of unplanned admissions.

CONCLUSION

These findings highlight risk factors that help identify high-risk patients and suggest that therapy modifications may reduce hospital readmissions due to cisplatin-based chemotherapy-induced adverse reactions.

Medication administration errors and mortality: Incidents reported in England and Wales between 2007 ̶ 2016

BACKGROUND

Medication administration errors may contribute to patient mortality, thus additional understanding of such incidents is required.

OBJECTIVES

To analyse medication administration errors reported in acute care resulting in death, to identify the drugs concerned, and to describe medication administration error characteristics (location of error, error type, patient's age) by drug group.

METHODS

Medication administration errors reported in acute care in 2007 ̶ 2016 (n = 517,384) were obtained from the National Reporting and Learning System for England and Wales. Incidents reported as resulting in death (n = 229) were analysed. Drugs were classified by two researchers using the British National Formulary. Drug categories were described by medication administration errors' year, location, patient age, and error category based on the incidents' original classification.

RESULTS

Errors were most often reported on wards (66.4%, n = 152), and in patients aged over 75 years (41.5%, n = 95). The most common error category was omitted medicine or ingredient (31.4%, n = 72); most common drug groups were cardiovascular (20.1%, n = 46) and nervous system (10.0%, n = 23). Most errors in patients under 12 years concerned drugs to treat infection; cardiovascular drugs were most common among other age groups.

CONCLUSIONS

In order to prevent these most serious of medication administration errors, interventions should focus on avoiding dose omissions, and administration of drugs for patients over 75 years old, as well as safe administration of parenteral anticoagulants and antibacterial drugs.