1
|
Fatima S, Arshad A, Zafar A, Farrukh S, Rahim A, Nazar S, Zafar H. Journey of medication reconciliation compliance in a lower middle-income country: a retrospective chart review. BMJ Open Qual 2024; 13:e002527. [PMID: 38569666 PMCID: PMC10989168 DOI: 10.1136/bmjoq-2023-002527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 03/23/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE There were three main objectives of the study: to determine the overall compliance of medication reconciliation over 4 years in a tertiary care hospital, to compare the medication reconciliation compliance between paper entry (initial assessment forms) and computerised physician order entry (CPOE), and to identify the discrepancies between the medication history taken by the physician at the time of admission and those collected by the pharmacist within 24 hours of admission. METHODS This study was conducted at a tertiary care hospital in a lower middle-income country. Data were gathered from two different sources. The first source involved retrospective data obtained from the Quality and Patient Safety Department (QPSD) of the hospital, consisting of records from 8776 patients between 2018 and 2021. The second data source was also retrospective from a quality project initiated by pharmacists at the hospital. Pharmacists collected data from 1105 patients between 2020 and 2021, specifically focusing on medication history and identifying any discrepancies compared with the history documented by physicians. The collected data were then analysed using SPSS V.26. RESULTS The QPSD noted an improvement in physician-led medication reconciliation, with a rise from 32.7% in 2018 to 69.4% in 2021 in CPOE. However, pharmacist-led medication reconciliation identified a 25.4% (n=281/1105) overall discrepancy in the medication history of patients admitted from 2020 to 2021, mainly due to incomplete medication records in the initial assessment forms and CPOE. Physicians missed critical drugs in 4.9% of records; pharmacists identified and updated them. CONCLUSION In a lower middle-income nation where hiring pharmacists to conduct medication reconciliation would be an additional cost burden for hospitals, encouraging physicians to record medication history more precisely would be a more workable method. However, in situations where cost is not an issue, it is recommended to adopt evidence-based practices, such as integrating clinical pharmacists to lead medication reconciliation, which is the gold standard worldwide.
Collapse
Affiliation(s)
- Samar Fatima
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Ainan Arshad
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Amara Zafar
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Sana Farrukh
- Department of Community Health Sciences, The Aga Khan University Hospital, Karachi, Pakistan
| | - Anum Rahim
- Department of Community Health Sciences, The Aga Khan University Hospital, Karachi, Pakistan
| | - Saharish Nazar
- Pharmacy, The Aga Khan University Hospital, Karachi, Pakistan
| | - Hasnain Zafar
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
2
|
Alghamdi DS, Alhrasen M, Kassem A, Alwagdani A, Tourkmani AM, Alnowaiser N, Al Barakah Y, Alotaibi YK. Implementation of medication reconciliation at admission and discharge in Ministry of Defense Health Services hospitals: a multicentre study. BMJ Open Qual 2023; 12:bmjoq-2022-002121. [PMID: 37308255 DOI: 10.1136/bmjoq-2022-002121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/25/2023] [Indexed: 06/14/2023] Open
Abstract
There is potential for many medication errors to occur due to the complex medication use process. The medication reconciliation process can significantly lower the incidence of medication errors that may arise from an incomplete or inaccurate medication history as well as reductions in length of hospital stay, patients' readmissions and lower healthcare costs.The quality improvement collaborative project was conducted as a pilot study in two hospitals, then implemented on a broader scale in 18 hospitals in Saudi Arabia. The goal of the project was to reduce the percentage of patients with at least one outstanding unintentional discrepancy at admission by 50%, over 16-month period (July 2020-November 2021). Our interventions were based on the High 5's project medication reconciliation WHO, and Medications at Transitions and Clinical Handoffs toolkit for medication reconciliation by Agency for Healthcare Research and Quality. Improvement teams used the Institute of Healthcare Improvement's (IHI's) Model for improvement as a tool for testing and implementing changes. Collaboration and learning between hospitals were facilitated by conducting learning sessions using the IHI's Collaborative Model for Achieving Breakthrough Improvement. The improvement teams underwent three cycles.By the end of the project significant improvements were observed. The percentage of patients with at least one outstanding unintentional discrepancy at admission showed a 20% reduction (27% before, 7% after; p value <0.05) (Relative Risk (RR) 0.74) with a mean reduction in the number of discrepancies per patient by 0.74. The percentage of patients with at least one outstanding unintentional discrepancy at discharge showed 12% reduction (17% before, 5% after; p value <0.05) (RR 0.71) with a mean reduction in the number of discrepancies per patient by 0.34.Compliance to medication reconciliation documentation within 24 hours of admission and discharge showed significant improvement by an average of 17% and 24%, respectively. Additionally, the implementation of medication reconciliation had a negative correlation with the percentage of patients with at least one outstanding unintentional discrepancy at admission and discharge.
Collapse
Affiliation(s)
- Dalia S Alghamdi
- Continuous Quality Improvement and Patient Safety, Kingdom of Saudi Arabia General Department of Medical Services, Riyadh, Saudi Arabia
| | - Mohammed Alhrasen
- Pharmaceutical Care Department, Kingdom of Saudi Arabia General Department of Medical Services, Riyadh, Saudi Arabia
| | - Ahmed Kassem
- Continuous Quality Improvement and Patient Safety, Kingdom of Saudi Arabia General Department of Medical Services, Riyadh, Saudi Arabia
| | - Alaa Alwagdani
- Continuous Quality Improvement and Patient Safety, Kingdom of Saudi Arabia General Department of Medical Services, Riyadh, Saudi Arabia
| | | | - Noura Alnowaiser
- Quality & Patient Safety, Kingdom of Saudi Arabia General Department of Medical Services, Riyadh, Saudi Arabia
| | - Yasser Al Barakah
- Pharmaceutical Care Department, Kingdom of Saudi Arabia General Department of Medical Services, Riyadh, Saudi Arabia
| | - Yasser K Alotaibi
- Continuous Quality Improvement and Patient Safety, Kingdom of Saudi Arabia General Department of Medical Services, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Alanazi AS, Awwad S, Khan TM, Asdaq SMB, Mohzari Y, Alanazi F, Alrashed A, Alamri AS, Alsanie WF, Alhomrani M, AlMotairi M. Medication reconciliation on discharge in a tertiary care Riyadh Hospital: An observational study. PLoS One 2022; 17:e0265042. [PMID: 35290378 PMCID: PMC8923456 DOI: 10.1371/journal.pone.0265042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to assess the frequency and characteristics of discharge medication discrepancies as identified by pharmacists during discharge medication reconciliation. We also attempted to identify the factors that influence the occurrence of drug discrepancies during medication reconciliation. From June to December 2019, a prospective study was performed at the cardiac center of King Fahad Medical City (KFMC), a tertiary care hospital in Riyadh. The information from discharge prescriptions as compared to the medication administration record (MAR), medication history in the cortex system, and the patient home medication list collected from the medication reconciliation form on admission. The study included all adult patients discharged from KFMC’s cardiac center. These participants comprised 776 patients, 64.6 percent of whom were men and 35.4 percent of whom were women. Medication discrepancies were encountered in 180 patients (23.2%) out of 776 patients. In regards to the number of discharged medications, 651(83.9%) patients had ≥ 5 medications. Around, 174 (73.4%) discrepancies were intentional, and 63 (26.6%) were unintentional discrepancies. The risk of unintentional medication discrepancy was increased with an increasing number of medications (P-value = 0.008). One out of every four cardiac patients discharged from our hospital had at least one medication discrepancy. The number of drugs taken and the number of discrepancies was found to be related. Necessary steps should be taken to reduce these discrepancies and improve the standard of care.
Collapse
Affiliation(s)
- Ahmed S. Alanazi
- Pharmaceutical Service Department, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sameh Awwad
- The Institute of Pharmaceutical Science (IPS) of University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Tahir M. Khan
- The Institute of Pharmaceutical Science (IPS) of University of Veterinary and Animal Sciences, Lahore, Pakistan
| | | | - Yahya Mohzari
- Pharmacy Department, Clinical Pharmacy Section, King Saudi Medical City, Riyadh, Saudi Arabia
| | - Foz Alanazi
- Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Alrashed
- Pharmaceutical Service Department, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulhakeem S. Alamri
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
- Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Taif, Saudi Arabia
| | - Walaa F. Alsanie
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
- Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Taif, Saudi Arabia
| | - Majid Alhomrani
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
- Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Taif, Saudi Arabia
| | - Mohammed AlMotairi
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Alghanem SS, Bayoud T, Taher S, Al-Hazami M, Al-Kandari N, Al-Sharekh M. Introduction of an Ambulatory Care Medication Reconciliation Service in Dialysis Patients: Positive Impact on Medication Prescribing and Economic Benefit. J Patient Saf 2022; 18:e489-e495. [PMID: 34009876 DOI: 10.1097/pts.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to assess the implementation of medication reconciliation (MedRec) and medication-related costs in dialysis-dependent patients. METHODS Completed best possible medication history and reconciliation forms were collected within 6 months from 77 patients' file at the dialysis center. Outcome measures were number and types of medication discrepancies, medication-related problems (MRPs), and their potential to cause harm, in addition to the type and number of interventions conducted during MedRec and the resulted medication costs reduction. RESULTS The mean number of medications was 11 ± 4, which was reduced to 8 ± 3 (P < 0.0001) after MedRec. Medication discrepancies accounted for 55, and MRPs were raised by pharmacists 216 times, and 55% had the potential to cause moderate patient discomfort. Mediations were held in 1.2%, discontinued in 21.2%, and changed in 5.4%, which led to €75.665 (U.S. $85.33) and €459.93 (U.S. $511.979) reduction in medication costs per patient for 1 and 6 months, respectively. CONCLUSIONS Several discrepancies and MRPs were identified in the present study that put patients undergoing dialysis at risk for potential harm and adverse drug events. Regularly performing ambulatory MedRec and involving pharmacists in the model of care can improve the quality of healthcare delivered to dialysis-dependent patients and reduce cost.
Collapse
Affiliation(s)
- Sarah S Alghanem
- From the Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait
| | - Tania Bayoud
- From the Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait
| | - Sameer Taher
- From the Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait
| | - Mai Al-Hazami
- From the Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait
| | - Nasser Al-Kandari
- Nephrology Unit, Department of Medicine, Mubarak Hospital-Ministry of Health, Kuwait City, Kuwait
| | - Monther Al-Sharekh
- Nephrology Unit, Department of Medicine, Mubarak Hospital-Ministry of Health, Kuwait City, Kuwait
| |
Collapse
|
5
|
Exploring Factors That Influence Injured Patients’ Outcomes following Road Traffic Crashes: A Multi-Site Feasibility Study. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Injuries arising from Road Traffic Crashes (RTCs) are a major health problem in Saudi Arabia (SA). The purpose of the study was to determine the feasibility of conducting a multi-center research study to explore factors that influence the mortality of RTC-related trauma patients in SA. Methods: A multi-center observational study was undertaken involving both prospective and retrospective data collected from three hospitals. In-hospital patient mortality thirty days post-crash was the primary outcome variable. The feasibility of the study methods including the quality of data were evaluated and pilot results pertaining to factors predicting mortality were examined. Results: The overall mortality rate (n = 572 RTC victims) was (7.5%). A logistic regression model identified four independent predictors of mortality following an RTC: treatment at a non-trauma center-based hospital, SBP ≤ 90 mmHg, GCS ≤ 8, and ISS ≥ 20. With respect to the assessment of the study method’s feasibility, missing data was problematic, especially for variables pertaining to crash characteristics and prehospital care. Conclusions: Collecting multi-center injury data in SA has logistic challenges, predominantly associated with the comparability and completeness of data sets as well as the need for manual screening and data collection at some institutions. Despite these limitations, this study has demonstrated the feasibility of a method that could be utilized in further large nationwide studies to understand and examine the factors that influence injured patients’ outcomes following RTCs.
Collapse
|
6
|
Anigbogu I, Ugwu A. Evaluation of the pattern and quality of referrals from inpatient wards to hematology department of a tertiary hospital in Nigeria. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_168_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
7
|
Adriano LS, Ibiapina JR, Romero NR, Lima AMA, Ponciano ÂMDS, Fonteles MMDF. Medication errors in critical patients during medication reconciliation: analyses and clinical management. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902020000318587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
8
|
Marques Cavalcante-Santos L, Carvalho Silvestre C, Andrade Macêdo L, Mônica Machado Pimentel D, Dias de Oliveira-Filho A, Manias E, Pereira de Lyra D. Written communication about the use of medications in medical records in a Brazilian hospital. Int J Clin Pract 2021; 75:e14990. [PMID: 34710266 DOI: 10.1111/ijcp.14990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/23/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Effective communication regarding the use of medications in hospital environments is a process that contributes to patient safety. Despite its importance, written communication about the medication use process in medical records remains insufficiently investigated. AIM To describe the documentation in medical records regarding the medication use process by pharmacists, physicians and nurses on admission, during the hospital stay, and at hospital discharge. METHOD A retrospective cross-sectional chart review study was carried out in medical records of patients admitted to a teaching hospital in Northeast Brazil. The study considered all patients admitted between December 2016 and February 2017, aged 18 or older and hospitalised for at least 48 hours. Clinical notes made by pharmacists, physicians and nurses were examined at three transition points of care. Data were collected using a questionnaire relating to the use of medications prior to hospital admission, changes in the prescribed medications during the hospital stay and discharge, as well as prescription non-conformities. Communication failures between the three healthcare professional groups were analysed and classified. The study was authorised by the Hospital's Board of Directors and approved by the Research Ethics Committee of the Federal University of Sergipe. RESULTS This study included 202 medical records of patients with a mean age of 51.48 (SD 6.42, range: 19-97) years. There was no record of a patient or relative interview on allergies and adverse drug reactions in 54 (26.8%) physician notes, 44 (21.9%) nursing notes, and 9 (25.0%) pharmacist notes. Moreover, 1,588 changes in prescriptions were identified during data collection, and 1,198 (75.4%) of these were unjustified. CONCLUSION Medication-related information in medical records was incomplete and inconsistent in the clinical notes of the three studied professions, especially in pharmacists' documentation. Future studies should focus on investigating the consequences of interprofessional communication in patient care.
Collapse
Affiliation(s)
- Lincoln Marques Cavalcante-Santos
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Carina Carvalho Silvestre
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
- Department of Pharmacy, Life Sciences Institute, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Luana Andrade Macêdo
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | | | | | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Divaldo Pereira de Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| |
Collapse
|
9
|
Al Anazi A. Medication reconciliation process: Assessing value, adoption, and the potential of information technology from pharmacists' perspective. Health Informatics J 2021; 27:1460458220987276. [PMID: 33467954 DOI: 10.1177/1460458220987276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Medication Reconciliation (MedRec) process aims to improve patient safety through safe prescription and medication administration. A validated survey was carried out to address aspects related to MedRec process, its obstacles, the role of information technology, and the required functionalities for optimizing the MedRec process. A total of 81% of the survey's respondents acknowledged the roles of EHR (62% of respondents), PHR (41%), and electronic medication registration list (33%) as necessary technology tools for MedRec. Most respondents emphasized the need to compile multiple medications' entries of information technology systems into one application (96.4%), allowing the entries from community pharmacies (90.6%). Further, incorporating information technology into the MedRec process presents a challenge in terms of legal responsibility (92 %) and the ability to integrate medications with other hospitals and community medications (78.6%). Findings affirm the need for a well-designed MedRec process aided with information technology solutions. The external data and user preferences should be considered when redesigning the MedRec process. The study also suggests initiating a policy that mandates sharing data necessary for creating a compiled medication list for each patient. MedRec is an indispensable tool for building a fruitful medication management system in a healthcare organization.
Collapse
Affiliation(s)
- Abdullah Al Anazi
- King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia.,King Abdullah International Medical Research Center, Saudi Arabia.,Ministry of National Guard-Health Affairs, Saudi Arabia
| |
Collapse
|
10
|
Almalki ZS, Alqahtani N, Salway NT, Alharbi MM, Alqahtani A, Alotaibi N, Alotaibi TM, Alshammari T. Evaluation of medication error rates in Saudi Arabia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24956. [PMID: 33655962 PMCID: PMC7939210 DOI: 10.1097/md.0000000000024956] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/04/2020] [Accepted: 02/04/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Due to the diversity of reports and on the rates of medications errors (MEs) in Saudi Arabia, we performed the first meta-analysis to determine the rate of medications errors in Saudi Arabia using meta-analysis in the hospital settings. METHODS We conducted a systematic literature search through August 2019 using PubMed, EMBASE, CINAHL, PsycINFO, and Google Scholar to identify all observational studies conducted in hospital settings in Saudi Arabia that reported the rate of MEs. A random-effects models were used to calculate overall MEs, as well as prescribing, dispensing, and administration error rates. The I2 statistics were used to analyze heterogeneity. RESULTS Sixteen articles were included in this search. The total incidence of MEs in Saudi Arabia hospitals was estimated at 44.4%. Prescribing errors, dispensing errors, and adminstration errors incidents represent 40.2%, 28.2%, and 34.5% out of the total number of reported MEs, respectively. However, between-study heterogeneity was also generally found to be >90% (I-squared statistic). CONCLUSIONS This study demonstrates the MEs common in health facilities. Additional efforts in the field are needed to improve medication management systems in order to prevent patient harm incidents.
Collapse
Affiliation(s)
- Ziyad S. Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj
| | - Nasser Alqahtani
- Drug & Pharmaceutical Affairs, Riyadh First Health Cluster (C1) at Ministry of Health, Riyadh
| | - Najwa Tayeb Salway
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj
| | - Mona Marzoq Alharbi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj
| | - Abdulhadi Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj
| | - Nawaf Alotaibi
- College of Pharmacy, Northern Borders University, Arar, Northern Borders
| | - Tahani M. Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj
| | - Tahani Alshammari
- College of Clinical Pharmacy, Almaarefah University, Riyadh, Saudi Arabia
| |
Collapse
|
11
|
Alsaidan J, Portlock J, Aljadhey HS, Shebl NA, Franklin BD. Systematic review of the safety of medication use in inpatient, outpatient and primary care settings in the Gulf Cooperation Council countries. Saudi Pharm J 2018; 26:977-1011. [PMID: 30416356 PMCID: PMC6218378 DOI: 10.1016/j.jsps.2018.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 05/21/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Errors in medication use are a patient safety concern globally, with different regions reporting differing error rates, causes of errors and proposed solutions. The objectives of this review were to identify, summarise, review and evaluate published studies on medication errors, drug related problems and adverse drug events in the Gulf Cooperation Council (GCC) countries. METHODS A systematic review was carried out using six databases, searching for literature published between January 1990 and August 2016. Research articles focussing on medication errors, drug related problems or adverse drug events within different healthcare settings in the GCC were included. RESULTS Of 2094 records screened, 54 studies met our inclusion criteria. Kuwait was the only GCC country with no studies included. Prescribing errors were reported to be as high as 91% of a sample of primary care prescriptions analysed in one study. Of drug-related admissions evaluated in the emergency department the most common reason was patient non-compliance. In the inpatient care setting, a study of review of patient charts and medication orders identified prescribing errors in 7% of medication orders, another reported prescribing errors present in 56% of medication orders. The majority of drug related problems identified in inpatient paediatric wards were judged to be preventable. Adverse drug events were reported to occur in 8.5-16.9 per 100 admissions with up to 30% judged preventable, with occurrence being highest in the intensive care unit. Dosing errors were common in inpatient, outpatient and primary care settings. Omission of the administered dose as well as omission of prescribed medication at medication reconciliation were common. Studies of pharmacists' interventions in clinical practice reported a varying level of acceptance, ranging from 53% to 98% of pharmacists' recommendations. CONCLUSIONS Studies of medication errors, drug related problems and adverse drug events are increasing in the GCC. However, variation in methods, definitions and denominators preclude calculation of an overall error rate. Research with more robust methodologies and longer follow up periods is now required.
Collapse
Affiliation(s)
- Jamilah Alsaidan
- UCL School of Pharmacy, London, UK
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Nada Atef Shebl
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire, UK
| | | |
Collapse
|
12
|
Mazhar F, Haider N, Ahmed Al-Osaimi Y, Ahmed R, Akram S, Carnovale C. Prevention of medication errors at hospital admission: a single-centre experience in elderly admitted to internal medicine. Int J Clin Pharm 2018; 40:1601-1613. [DOI: 10.1007/s11096-018-0737-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/10/2018] [Indexed: 12/27/2022]
|
13
|
Mashoufi M, Ayatollahi H, Khorasani-Zavareh D. A Review of Data Quality Assessment in Emergency Medical Services. Open Med Inform J 2018; 12:19-32. [PMID: 29997708 PMCID: PMC5997849 DOI: 10.2174/1874431101812010019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/22/2018] [Accepted: 05/15/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Data quality is an important issue in emergency medicine. The unique characteristics of emergency care services, such as high turn-over and the speed of work may increase the possibility of making errors in the related settings. Therefore, regular data quality assessment is necessary to avoid the consequences of low quality data. This study aimed to identify the main dimensions of data quality which had been assessed, the assessment approaches, and generally, the status of data quality in the emergency medical services. METHODS The review was conducted in 2016. Related articles were identified by searching databases, including Scopus, Science Direct, PubMed and Web of Science. All of the review and research papers related to data quality assessment in the emergency care services and published between 2000 and 2015 (n=34) were included in the study. RESULTS The findings showed that the five dimensions of data quality; namely, data completeness, accuracy, consistency, accessibility, and timeliness had been investigated in the field of emergency medical services. Regarding the assessment methods, quantitative research methods were used more than the qualitative or the mixed methods. Overall, the results of these studies showed that data completeness and data accuracy requires more attention to be improved. CONCLUSION In the future studies, choosing a clear and a consistent definition of data quality is required. Moreover, the use of qualitative research methods or the mixed methods is suggested, as data users' perspectives can provide a broader picture of the reasons for poor quality data.
Collapse
Affiliation(s)
- Mehrnaz Mashoufi
- PhD Student of Health Information Management, School of Health Management and Information Sciences, Tehran Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Davoud Khorasani-Zavareh
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Health in Disaster and Emergency, School of HSE, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
14
|
The impact of pharmacist-led medication reconciliation during admission at tertiary care hospital. Int J Clin Pharm 2017; 40:196-201. [PMID: 29248986 DOI: 10.1007/s11096-017-0568-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022]
Abstract
Background Medication errors represent the most common type of error that compromises patient safety, with approximately 20% believed to result in harm. Over 40% of these errors are believed to result from inadequate medication reconciliation during admission, transfer, and discharge of patients and many of these errors could be prevented if adequate medication reconciliation processes were in place. In an effort to minimize adverse events caused during these care transitions, the Joint Commission has stated medication reconciliation as one of its National Patient Safety Goals and health care providers and organizations are encouraged to perform the process at various patient care transitions. Objective Identify the types of medication discrepancy that occurred during medication reconciliation performed by a pharmacist gathering the best possible medication history (BPMH). Estimate the potential for harm with each medication discrepancy using the severity rating methods developed by Cornish et al. (Arch Intern Med 165(4):424-429, 2005). Setting Tertiary care hospital in Jeddah, Saudi Arabia. Method Prospective 3-month study on 286 adult patients, admitted for at least 24 h and regularly taking at least four chronic prescription medications. Medication histories taken by physicians and by a pharmacist gathering the BPMH were compared. Identified discrepancies were reviewed by a panel of clinical pharmacists to assess the potential to cause patient harm with these errors. Main Outcome measure Number and types of medication discrepancies recorded by the pharmacist. Results Total number of medications recorded by physicians was 2548, versus 3085 by the pharmacist. 48.3% of patients had at least one unintended medication discrepancy by physicians. 537 medication discrepancies were reported (17.4% of number of medication discrepancies recorded by pharmacist). Types of medication discrepancies included, omissions (77% of discrepancies), commissions (13%), dosing errors (7%), and frequency errors (3%). 52% of the identified medication discrepancies had the potential to cause moderate to severe patient discomfort. Conclusion Patient medication histories are frequently recorded inaccurately by physicians during admission of patients which results in medication-related errors and compromises patient safety. Medication reconciliation is crucial in reducing these errors. Pharmacists can help in reducing these medication-related errors and the associated risks and complications.
Collapse
|
15
|
Al-Rashoud I, Al-Ammari M, Al-Jadhey H, Alkatheri A, Poff G, Aldebasi T, AbuRuz S, Al-Bekairy A. Medication discrepancies identified during medication reconciliation among medical patients at a tertiary care hospital. Saudi Pharm J 2017; 25:1082-1085. [PMID: 29158719 PMCID: PMC5681327 DOI: 10.1016/j.jsps.2017.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/19/2017] [Indexed: 12/01/2022] Open
Affiliation(s)
- Isra Al-Rashoud
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Maha Al-Ammari
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hisham Al-Jadhey
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmalik Alkatheri
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Gregory Poff
- Saudi Medication Safety Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Tariq Aldebasi
- Division of Ophthalmology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Salah AbuRuz
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,College of Pharmacy, University of Jordan, Amman, Jordan
| | - Abdulkareem Al-Bekairy
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
16
|
Mazhar F, Akram S, Al-Osaimi YA, Haider N. Medication reconciliation errors in a tertiary care hospital in Saudi Arabia: admission discrepancies and risk factors. Pharm Pract (Granada) 2017; 15:864. [PMID: 28503220 PMCID: PMC5386621 DOI: 10.18549/pharmpract.2017.01.864] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/29/2017] [Indexed: 12/03/2022] Open
Abstract
Background: Medication reconciliation is a major component of safe patient care. One of the main problems in the implementation of a medication reconciliation process is the lack of human resources. With limited resources, it is better to target medication reconciliation resources to patients who will derive the most benefit from it. Objective: The primary objective of this study was to determine the frequency and types of medication reconciliation errors identified by pharmacists performing medication reconciliation at admission. Each medication error was rated for its potential to cause patient harm during hospitalization. A secondary objective was to determine risk factors associated with medication reconciliation errors. Methods: This was a prospective, single-center pilot study conducted in the internal medicine and surgical wards of a tertiary care teaching hospital in the Eastern province of Saudi Arabia. A clinical pharmacist took the best possible medication history of patients admitted to medical and surgical services and compared with the medication orders at hospital admission; any identified discrepancies were noted and analyzed for reconciliation errors. Multivariate logistic regression was performed to determine the risk factors related to reconciliation errors. Results: A total of 328 patients (138 in surgical and 198 in medical) were included in the study. For the 1419 medications recorded, 1091 discrepancies were discovered out of which 491 (41.6%) were reconciliation errors. The errors affected 177 patients (54%). The incidence of reconciliation errors in the medical patient group was 25.1% and 32.0% in the surgical group (p<0.001). In both groups, the most frequent reconciliation error was the omission (43.5% and 51.2%). Lipid-lowering (12.4%) and antihypertensive agents were most commonly involved. If undetected, 43.6% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 17.7% were rated as potentially harmful. A multivariate logistic regression model showed that patients aged ≥65 years, polypharmacy, and prescriptions for hypoglycemic drugs and warfarin were more likely associated with reconciliation errors. Conclusion: There is a high failure rate in medication reconciliation process in patients admitted to the medical and surgical department. The reconciliation process proves to be a useful tool since nearly half of avoided reconciliation errors were unintentional and had the potential for harm. This strategy, based on our results and the difficulty of applying the process to all patients should be directed primarily to the patients at increased risk of error.
Collapse
Affiliation(s)
- Faizan Mazhar
- PharmD, MPhil, BCPS. Department of Basic Medical Science, Prince Sultan Military College of Health Sciences, King Fahd Military Medical Complex. Dhahran, (Saudi Arabia).
| | - Shahzad Akram
- PharmD, BCPS. Pharmaceutical Care department, King Abdul-Aziz Medical City, National Guard Health Affairs. Riyadh (Saudi Arabia).
| | - Yousif A Al-Osaimi
- (Pharm.D), Pharmaceutical Care department, King Fahad University Hospital. Khobar (Saudi Arabia).
| | - Nafis Haider
- BPharm, MPharm. Department of Basic Medical Science, Prince Sultan Military College of Health Sciences, King Fahd Military Medical Complex. Dhahran (Saudia Arabia).
| |
Collapse
|
17
|
Mekonnen AB, McLachlan AJ, Brien JAE, Mekonnen D, Abay Z. Medication reconciliation as a medication safety initiative in Ethiopia: a study protocol. BMJ Open 2016; 6:e012322. [PMID: 27884844 PMCID: PMC5168529 DOI: 10.1136/bmjopen-2016-012322] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Medication related adverse events are common, particularly during transitions of care, and have a significant impact on patient outcomes and healthcare costs. Medication reconciliation (MedRec) is an important initiative to achieve the Quality Use of Medicines, and has been adopted as a standard practice in many developed countries. However, the impact of this strategy is rarely described in Ethiopia. The aims of this study are to explore patient safety culture, and to develop, implement and evaluate a theory informed MedRec intervention, with the aim of minimising the incidence of medication errors during hospital admission. METHODS AND ANALYSES The study will be conducted in a resource limited setting. There are three phases to this project. The first phase is a mixed methods study of healthcare professionals' perspectives of patient safety culture and patients' experiences of medication related adverse events. In this phase, the Hospital Survey on Patient Safety Culture will be used along with semi-structured indepth interviews to investigate patient safety culture and experiences of medication related adverse events. The second phase will use a semi-structured interview guide, designed according to the 12 domains of the Theoretical Domains Framework, to explore the barriers and facilitators to medication safety activities delivered by hospital pharmacists. The third phase will be a single centre, before and after study, that will evaluate the impact of pharmacist conducted admission MedRec in an emergency department (ED). The main outcome measure is the incidence and potential clinical severity of medication errors. We will then analyse the differences in the incidence and severity of medication errors before and after initiation of an ED pharmacy service.
Collapse
Affiliation(s)
- Alemayehu B Mekonnen
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Andrew J McLachlan
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Jo-Anne E Brien
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Desalew Mekonnen
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zenahebezu Abay
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
18
|
Abdulrahman SS, Mahmoud MA, Ibrahim A, Aljadhey H. An assessment of the basic medication safety practices in Khartoum State hospitals. Eur J Hosp Pharm 2016; 23:335-338. [PMID: 31156878 DOI: 10.1136/ejhpharm-2016-000885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 01/27/2016] [Accepted: 02/17/2016] [Indexed: 11/03/2022] Open
Abstract
Purpose To assess the presence of medication safety practices in Khartoum State hospitals. Methods A previously used questionnaire was used to evaluate medication safety practices. The main practices evaluated were the presence of a medication safety committee and error-reporting system, look-alike sound-alike (LASA) medications list, control of concentrated electrolyte solutions, care transitions, information technology, drug information and other medication safety practices. The primary investigator visited a stratified sample from all the three cities that comprise Khartoum State and interviewed the pharmacy supervisor of each hospital. Descriptive statistics were performed using SPSS V.22. Results A total of 41 senior pharmacists or pharmacy supervisors from 41 hospitals were interviewed. Only 2% of the hospitals had a list of LASA medications and 5% had a list of error-prone abbreviations. Only 5% of the hospitals had a medication safety committee, and none of the hospitals had a medication safety officer. None of the hospitals involved pharmacists in obtaining medication histories. Concentrated electrolytes were available in the floor stock in 67% of the hospitals. Although 24% of the hospitals used a computer system in their pharmacy to enter prescriptions, none of these hospitals required entry of patient allergies before entering a drug order. Conclusions Most of the hospitals in Khartoum State did not implement basic medication safety practices. Therefore, the Ministry of Health in Sudan should enforce laws and regulations making implementation of medication safety practices mandatory to ensure patient safety.
Collapse
Affiliation(s)
| | | | - Alnada Ibrahim
- Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Hisham Aljadhey
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
19
|
Aljadhey H, Mahmoud MA, Ahmed Y, Sultana R, Zouein S, Alshanawani S, Mayet A, Alshaikh MK, Kalagi N, Al Tawil E, El Kinge AR, Arwadi A, Alyahya M, Murray MD, Bates D. Incidence of adverse drug events in public and private hospitals in Riyadh, Saudi Arabia: the (ADESA) prospective cohort study. BMJ Open 2016; 6:e010831. [PMID: 27406640 PMCID: PMC4947792 DOI: 10.1136/bmjopen-2015-010831] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To determine the incidence of adverse drug events (ADEs) and assess their severity and preventability in four Saudi hospitals. DESIGN Prospective cohort study. SETTING The study included patients admitted to medical, surgical and intensive care units (ICUs) of four hospitals in Saudi Arabia. These hospitals include a 900-bed tertiary teaching hospital, a 400-bed private hospital, a 1400-bed large government hospital and a 350-bed small government hospital. PARTICIPANTS All patients (≥12 years) admitted to the study units over 4 months. PRIMARY AND SECONDARY OUTCOME MEASURES Incidents were collected by pharmacists and reviewed by independent clinicians. Reviewers classified the identified incidents as ADEs, potential ADEs (PADEs) or medication errors and then determined their severity and preventability. RESULTS We followed 4041 patients from admission to discharge. Of these, 3985 patients had complete data for analysis. The mean±SD age of patients in the analysed cohort was 43.4±19.0 years. A total of 1676 ADEs were identified by pharmacists during the medical chart review. Clinician reviewers accepted 1531 (91.4%) of the incidents identified by the pharmacists (245 ADEs, 677 PADEs and 609 medication errors with low risk of causing harm). The incidence of ADEs was 6.1 (95% CI 5.4 to 6.9) per 100 admissions and 7.9 (95% CI 6.9 to 8.9) per 1000 patient-days. The occurrence of ADEs was most common in ICUs (149 (60.8%)) followed by medical (67 (27.3%)) and surgical (29 (11.8%)) units. In terms of severity, 129 (52.7%) of the ADEs were significant, 91 (37.1%) were serious, 22 (9%) were life-threatening and three (1.2%) were fatal. CONCLUSIONS We found that ADEs were common in Saudi hospitals, especially in ICUs, causing significant morbidity and mortality. Future studies should focus on investigating the root causes of ADEs at the prescribing stage, and development and testing of interventions to minimise harm from medications.
Collapse
Affiliation(s)
- Hisham Aljadhey
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mansour A Mahmoud
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Yusuf Ahmed
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Salah Zouein
- Specialized Medical Center, Riyadh, Saudi Arabia
| | | | - Ahmed Mayet
- King Khaled University Hospital, Riyadh, Saudi Arabia
| | | | - Nora Kalagi
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | | | - Michael D Murray
- Purdue University and Regenstrief Institute, Indianapolis, Indiana, USA
| | - David Bates
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
20
|
Oshikoya K, Orji M, Oreagba I. MEDICATION HISTORY DOCUMENTATION IN REFERRAL LETTERS OF CHILDREN PRESENTING AT THE EMERGENCY UNIT OF A TEACHING HOSPITAL IN LAGOS, NIGERIA. Ann Ib Postgrad Med 2016; 14:13-20. [PMID: 27721681 PMCID: PMC5049597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Medical literature has demonstrated that referral hospitals often receive inadequate information about the care and medications their patients received from referring hospitals. OBJECTIVE This study aimed to assess the completeness of referral letters, especially the medication history, for patient presenting at the children emergency room of a teaching hospital in Lagos, Nigeria. METHOD A pro forma form was developed to obtain from the referral letters the demographic information of children referred to the emergency room of the Lagos University Teaching Hospital (LUTH), Idiaraba, over a period of three months. The nature of the referring centre, tentative diagnoses made at the referring centre, duration of illness prior to referral, vital signs and physical examination findings, investigation results, and treatment given were also extracted from the letters. In addition, we extracted from the letters the name, dosage, frequency and duration of use of medicines administered at the referring centres. Parents were also interviewed about the details of medicines used prior to presentation of their child at the referring centres. RESULTS Among those referred with a letter, 100 patients met the inclusion criteria and constituted those evaluated in this study. Most of the patients were referred from general hospitals (31%), another tertiary hospital (29%), and private hospitals/clinics (24%). Gender (30%) and tentative diagnoses (12%) were omitted in the referral letters. However, information about the weight (82%), vital signs (57%), physical examination findings (44%), treatment given (92%), and medication history (71%) were much more omitted in the referral letters. CONCLUSION Medication history as well as many other data points is infrequently reported in referral letters to a tertiary care hospital in Lagos, Nigeria. Standard referral guidelines may be useful to improve documentation of medication history.
Collapse
Affiliation(s)
- K.A. Oshikoya
- Dept. of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - M.U. Orji
- Dept. of Pharmacology, Therapeutics and Toxicology, College of Medicine University of Lagos, Nigeria
| | - I.A. Oreagba
- Dept. of Pharmacology, Therapeutics and Toxicology, College of Medicine University of Lagos, Nigeria
| |
Collapse
|
21
|
Al-Hashar A, Al-Zakwani I, Eriksson T, Al Za’abi M. Whose responsibility is medication reconciliation: Physicians, pharmacists or nurses? A survey in an academic tertiary care hospital. Saudi Pharm J 2015; 25:52-58. [PMID: 28223862 PMCID: PMC5310138 DOI: 10.1016/j.jsps.2015.06.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/28/2015] [Indexed: 11/19/2022] Open
Abstract
Background: Medication errors occur frequently at transitions in care and can result in morbidity and mortality. Medication reconciliation is a recognized hospital accreditation requirement and designed to limit errors in transitions in care. Objectives: To identify beliefs, perceived roles and responsibilities of physicians, pharmacists and nurses prior to the implementation of a standardized medication reconciliation process. Methods: A survey was distributed to the three professions: pharmacists in the pharmacy and physicians and nurses in hospital in-patient units. It contained questions about the current level of medication reconciliation practices, as well as perceived roles and responsibilities of each profession when a standardized process is implemented. Value, barriers to implementing medication reconciliation and the role of information technology were also assessed. Analyses were performed using univariate statistics. Results: There was a lack of clarity of current medication reconciliation practices as well as lack of agreement between the three professions. Physicians and pharmacists considered their professions as the main providers while nurses considered physicians followed by themselves as the main providers with limited roles for pharmacists. The three professions recognize the values and benefits of medication reconciliation yet pharmacists, more than others, stated limited time to implement reconciliation is a major barrier. Obstacles such as unreliable sources of medication history, patient knowledge and lack of coordination and communication between the three professions were expressed. Conclusions: The three health care professions recognize the value of medication reconciliation and want to see it implemented in the hospital, yet there is a lack of agreement with regard to roles and responsibilities of each profession within the process. This needs to be addressed by the hospital administration to design clear procedures and defined roles for each profession within a standardized medication reconciliation process.
Collapse
Affiliation(s)
- Amna Al-Hashar
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
- Corresponding author at: Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 38, Al-Khod, Muscat 123, Oman. Tel.: +968 99351322; fax: +968 24141107.
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Tommy Eriksson
- Department of Clinical Pharmacology, Laboratory Medicine, Lund University, Lund, Sweden
| | - Mohammed Al Za’abi
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| |
Collapse
|
22
|
Aljadhey H, Mahmoud MA, Hassali MA, Alrasheedy A, Alahmad A, Saleem F, Sheikh A, Murray M, Bates DW. Challenges to and the future of medication safety in Saudi Arabia: A qualitative study. Saudi Pharm J 2014; 22:326-32. [PMID: 25161376 PMCID: PMC4142370 DOI: 10.1016/j.jsps.2013.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 08/31/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Medication safety is a global concern among healthcare providers. However, the challenges to and the future of medication safety in Saudi Arabia have not been explored. OBJECTIVES We explored the perspectives of healthcare practitioners on current issues about medication safety in hospitals and community settings in Saudi Arabia in order to identify challenges to improving it and explore the future of medication safety practice. METHODS A total of 65 physicians, pharmacists, academics and nurses attended a one-day meeting in March 2010, designed especially for the purpose of this study. The participants were divided into nine round-table discussion sessions. Three major themes were explored in these sessions, including: major factors contributing to medication safety problems, challenges to improving medication safety practice, and participants' suggestions for improving medication safety. The round-table discussion sessions were videotaped and transcribed verbatim and analyzed by two independent researchers. RESULTS The round-table discussions revealed that major factors contributing to medication safety problems included unrestricted public access to medications from various hospitals and community pharmacies, communication gaps between healthcare institutions, limited use of important technologies such as computerized provider order entry, and the lack of medication safety programs in hospitals. Challenges to current medication safety practice identified by participants included underreporting of medication errors and adverse drug reactions, multilingualism and differing backgrounds of healthcare professionals, lack of communication between healthcare providers and patients, and high workloads. Suggestions for improving medication safety practices in Saudi Arabia included continuous education for healthcare professionals and competency assessment focusing on medication safety, development of a culture that encourages medication error and adverse drug reactions reporting, use of technology proven to decrease medication errors, and promotion and implementation of national patient safety initiatives. CONCLUSIONS Healthcare professionals have identified major challenges and opportunities for medication safety in Saudi Arabia. Policy makers and practitioners should consider these factors when designing future programs aimed at improving the safe use of medications.
Collapse
Affiliation(s)
- Hisham Aljadhey
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mansour Adam Mahmoud
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Descipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mohamed Azmi Hassali
- Descipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Alian Alrasheedy
- Descipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Amjad Alahmad
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Saleem
- Descipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Aziz Sheikh
- Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, UK
| | - Michael Murray
- Purdue University College of Pharmacy and Regenstrief Institute, Indianapolis, IN, USA
| | - David W. Bates
- Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, USA
| |
Collapse
|