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Forstner J, Litke N, Weis A, Straßner C, Szecsenyi J, Wensing M. How to fall into a new routine: factors influencing the implementation of an admission and discharge programme in hospitals and general practices. BMC Health Serv Res 2022; 22:1289. [PMID: 36284324 PMCID: PMC9598008 DOI: 10.1186/s12913-022-08644-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The VESPEERA programme is a multifaceted programme to enhance information transfer between general practice and hospital across the process of hospital admission, stay and discharge. It was implemented in 7 hospitals and 72 general practices in Southern Germany. Uptake was heterogeneous and overall low. A process evaluation aimed at identifying factors associated with the implementation of the VESPEERA programme. METHODS This was a qualitative study using semi-structured interviews in a purposeful sample of health workers in hospitals and general practices in the VESPEERA programme. Qualitative framework analysis using the Consolidated Framework for Implementation Research was performed and revealed the topic of previous and new routines to be protruding. Inductive content analysis was used for in-depth examination of stages in the process of staying in a previous or falling into a new routines. RESULTS Thirty-six interviews were conducted with 17 participants from general practices and 19 participants from hospitals. The interviewees were in different stages of the implementation process at the time of the interviews. Four stages were identified: Stage 1,'Previous routine and tension for change', describes the situation in which VESPEERA was to be implemented and the factors leading to the decision to participate. In stage 2,'Adoption of the VESPEERA programme', factors that influenced whether individuals decided to employ the innovation are relevant. Stage 3 comprises 'Determinants for falling into and staying in the new VESPEERA-routine' relates to actual implementation and finally, in stage 4, the participants reflect on the success of the implementation. CONCLUSIONS The individuals and organisations participating in the VESPEERA programme were in different stages of a process from the previous to the new routine, which were characterised by different determinants of implementation. In all stages, organisational factors were main determinants of implementation, but different factors emerged in different implementation stages. A low distinction between decision-making power and executive, as well as available resources, were beneficial for the implementation of the innovation. TRIAL REGISTRATION DRKS00015183 on DRKS / Universal Trial Number (UTN): U1111-1218-0992.
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Affiliation(s)
- Johanna Forstner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Marsilius Arkaden, Turm West, D-69120 Heidelberg, Heidelberg, 69120 Germany
| | - Nicola Litke
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Marsilius Arkaden, Turm West, D-69120 Heidelberg, Heidelberg, 69120 Germany
| | - Aline Weis
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Marsilius Arkaden, Turm West, D-69120 Heidelberg, Heidelberg, 69120 Germany
| | - Cornelia Straßner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Marsilius Arkaden, Turm West, D-69120 Heidelberg, Heidelberg, 69120 Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Marsilius Arkaden, Turm West, D-69120 Heidelberg, Heidelberg, 69120 Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Marsilius Arkaden, Turm West, D-69120 Heidelberg, Heidelberg, 69120 Germany
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En‐nasery‐de Heer S, Uitvlugt EB, Bet PM, Bemt BJF, Alai A, Bemt PMLA, Swart EL, Karapinar‐Çarkit F, Hugtenburg JG. Implementation of a pharmacist‐led transitional pharmaceutical care programme: Process evaluation of Medication Actions to Reduce hospital admissions through a collaboration between Community and Hospital pharmacists (MARCH). J Clin Pharm Ther 2022; 47:1049-1069. [PMID: 35306683 PMCID: PMC9544789 DOI: 10.1111/jcpt.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/03/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
What is known and objective The recently conducted Medication Actions to Reduce hospital admissions through a collaboration between Community and Hospital pharmacists (MARCH) transitional care programme, which aimed to test the effectiveness of a transitional care programme on the occurrence of ADEs post‐discharge, did not show a significant effect. To clarify whether this non‐significant effect was due to poor implementation or due to ineffectiveness of the intervention as such, a process evaluation was conducted. The aim of the study was to gain more insight into the implementation fidelity of MARCH. Methods A mixed methods design and the modified Conceptual Framework for Implementation Fidelity was used. For evaluation, the implementation fidelity and moderating factors of four key MARCH intervention components (teach‐back, the pharmaceutical discharge letter, the post‐discharge home‐visit and the transitional medication review) were assessed. Quantitative data were collected during and after the intervention. Qualitative data were collected using semi‐structured interviews with MARCH healthcare professionals (community pharmacists, clinical pharmacists, pharmacy assistants and pharmaceutical consultants) and analysed using thematic analysis. Results and Discussion Not all key intervention components were implemented as intended. Teach‐back was not always performed. Moreover, 63% of the pharmaceutical discharge letters, 35% of the post‐discharge home‐visits and 44% of the transitional medication reviews were not conducted within their planned time frames. Training sessions, structured manuals and protocols with detailed descriptions facilitated implementation. Intervention complexity, time constraints and the multidisciplinary coordination were identified as barriers for the implementation. What is new and Conclusion Overall, the implementation fidelity was considered to be moderate. Not all key intervention components were carried out as planned. Therefore, the non‐significant results of the MARCH programme on ADEs may at least partly be explained by poor implementation of the programme. To successfully implement transitional care programmes, healthcare professionals require full integration of these programmes in the standard work‐flow including IT improvements as well as compensation for the time investment.
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Affiliation(s)
| | | | - Pierre M. Bet
- Department of Clinical Pharmacology and Pharmacy Amsterdam UMC Amsterdam The Netherlands
| | - Bart J. F. Bemt
- Department of Pharmacy Sint Maartenskliniek Nijmegen The Netherlands
- Department of Pharmacy Radboud University Medical Centre Nijmegen The Netherlands
| | - Aida Alai
- Department of Clinical Pharmacology and Pharmacy Amsterdam UMC Amsterdam The Netherlands
| | - Patricia M. L. A. Bemt
- Department of Clinical Pharmacy and Pharmacology University Medical Center Groningen Groningen The Netherlands
| | - Eleonora L. Swart
- Department of Clinical Pharmacology and Pharmacy Amsterdam UMC Amsterdam The Netherlands
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Amalberti R, Staines A, Vincent C. Embracing Multiple Aims in Healthcare Improvement and Innovation. Int J Qual Health Care 2022; 34:6530228. [DOI: 10.1093/intqhc/mzac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/08/2022] [Accepted: 02/16/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Healthcare and other industries have to manage and coordinate a number of different aims and longer-term ambitions. They must maintain quality, manage costs, support and retain the workforce, manage regulatory demands, and consider wider societal objectives. These aims are all legitimate, but they are not necessarily aligned, neither in their timeframe nor in their nature. Conflicts between aims have a profound influence on the implementation of safety and quality improvement and wider innovation system change. Healthcare leaders understand that these aims may conflict, but the extent and nature of such conflicts have been underestimated. This paper aims to support medical and nursing leadership and executives in the complex task of managing multiple aims in relation to improvement and innovation.
Methods
We drew on our experience and the wider industrial and healthcare literature to find examples of studies and improvement projects with multiple aims and examples of innovation and change in which conflicting aims were apparent. We sought to identify principles which would enable the management of parallel aims and practical strategies that might facilitate implementation.
Results
We argue that almost all improvement and innovation in healthcare should address parallel aims, actively seek to articulate these aims, and manage potential conflicts between them. We propose four underlying principles to support a more productive approach to the identification and management of parallel aims: embrace multiple aims, consider both short- and long-term aims and ambitions, consider the wider societal context, and appreciate that all change takes place within an evolving, dynamic context. In terms of practical actions, we identified five key strategies: (i) identify and monitor the parallel aims and accept that some will conflict; (ii) slow down to accommodate the natural flexibility of the system; (iii) think both short and long term; (iv) expect and endeavour to anticipate some unintended consequences; and (v) resist downgrading the project to partial implementation.
Conclusions
We have argued that most improvement and innovation, unlike controlled trials, should consider multiple aims. We set out some broad principles and practices to reduce conflict and suggest avenues to manage conflicts and support positive synergies. We suggest that if this is not done, conflicts are much more likely to arise, which will be detrimental to the change process. Articulating the multiple aims and actively seeking to manage them in parallel will promote a more flexible and productive approach to innovation and change.
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Affiliation(s)
- Rene Amalberti
- Public Foundation for Industrial Safety Culture, FONCSI, 6 Allée Emile Monso, Toulouse 31000, France
| | - Anthony Staines
- Patient Safety program director, Hospital Federation of Vaud, Bois de Cery, Prilly 1008, Switzerland
- IFROSS Institute, University of Lyon 3, 18 Rue Chevreul, Lyon 69007, France
| | - Charles Vincent
- Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, Oxfordshire OX2 6GG, UK
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Falconer N, Snoswell C, Morris C, Barras M. The right time and place: the need for seven‐day pharmacist service models. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Nazanin Falconer
- School of Pharmacy Pharmacy Australia Centre of Excellence The University of Queensland Brisbane Australia
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
- Centre for Health Services Research Faculty of Medicine The University of Queensland The University of Queensland Brisbane Australia
| | - Centaine Snoswell
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
- Centre for Health Services Research Faculty of Medicine The University of Queensland The University of Queensland Brisbane Australia
| | - Christopher Morris
- Department of Internal Medicine Princess Alexandra Hospital Metro South Health Brisbane Australia
| | - Michael Barras
- School of Pharmacy Pharmacy Australia Centre of Excellence The University of Queensland Brisbane Australia
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
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Ng YK, Mohamed Shah N, Loong LS, Pee LT, Chong WW. Barriers and facilitators to patient-centred care in pharmacy consultations: A qualitative study with Malaysian hospital pharmacists and patients. PLoS One 2021; 16:e0258249. [PMID: 34618863 PMCID: PMC8496827 DOI: 10.1371/journal.pone.0258249] [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: 10/31/2020] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patient-centred care (PCC) has been suggested to provide benefits such as improved patient-healthcare provider communication and better disease self-management to patients. The practice of PCC should involve all healthcare professionals, including pharmacists who are well-positioned in providing pharmaceutical care to patients. However, a better understanding of the factors that can affect the practice of PCC in pharmacists' consultations is needed. OBJECTIVE To explore the perceptions of Malaysian hospital pharmacists and patients on the barriers and facilitators of a PCC approach in pharmacist consultations. DESIGN This study employed a qualitative, explorative semi-structured interview design. SETTING AND PARTICIPANTS Interviews were conducted with 17 patients and 18 pharmacists from three tertiary hospitals in Malaysia. The interviews were audiotaped and transcribed verbatim. Emerging themes were developed through a constant comparative approach and thematic analysis. RESULTS Three themes were identified in this study: (i) patient-related factors (knowledge, role expectations, and sociocultural characteristics), (ii) pharmacist-related factors (personalities and communication), and (iii) healthcare institutional and system-related factors (resources, continuity of care, and interprofessional collaboration). Pharmacists and patients mentioned that factors such as patients' knowledge and attitudes and pharmacists' personality traits and communication styles can affect patients' engagement in the consultation. Long waiting time and insufficient manpower were perceived as barriers to the practice of PCC. Continuity of care and interprofessional collaboration were viewed as crucial in providing supportive and tailored care to patients. CONCLUSION The study findings outlined the potential factors of PCC that may influence its implementation in pharmacist consultations. Strategic approaches can be undertaken by policymakers, healthcare institutions, and pharmacists themselves to address the identified barriers to more fully support the implementation of PCC in the pharmacy setting.
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Affiliation(s)
- Yew Keong Ng
- Faculty of Pharmacy, Centre of Quality Management of Medicines, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Faculty of Pharmacy, Centre of Quality Management of Medicines, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Ly Sia Loong
- Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Lay Ting Pee
- Department of Pharmacy, Hospital Kuala Lumpur, Ministry of Health, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Wei Wen Chong
- Faculty of Pharmacy, Centre of Quality Management of Medicines, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
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Cousins J, Parameswaran Nair N, Curtain C, Bereznicki B, Wilson K, Adamczewski B, Barratt A, Webber L, Simpson T, McKenzie D, Connolly M, Bereznicki L. Preventing Adverse Drug Reactions After Hospital Discharge (PADR-AD): Protocol for a randomised-controlled trial in older people. Res Social Adm Pharm 2021; 18:3284-3289. [PMID: 34593344 DOI: 10.1016/j.sapharm.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Adverse drug reactions (ADRs) and adverse drug events (ADEs) in older people contribute to a significant proportion of hospital admissions and are common following discharge. Effective interventions are therefore required to combat the growing burden of preventable ADRs. The Prediction of Hospitalisation due to Adverse Drug Reactions in Elderly Community Dwelling Patients (PADR-EC) score is a validated risk score developed to assess the risk of ADRs in people aged 65 years and older and has the potential to be utilised as part of an intervention to reduce ADRs. OBJECTIVES This trial was designed to investigate the effectiveness of an intervention to reduce ADR incidence in older people and to obtain further information about ADRs and ADEs in the 12-24 months following hospital discharge. METHODS The study is an open-label randomised-controlled trial to be conducted at the Royal Hobart Hospital, a 500-bed public hospital in Tasmania, Australia. Community-dwelling patients aged 65 years and older with an unplanned overnight admission to a general medical ward will be recruited. Following admission, the PADR-EC ADR score will be calculated by a research pharmacist, with the risk communicated to clinicians and discussed with participants. Following discharge, nominated general practitioners and community pharmacists will receive the risk score and related medication management advice to guide their ongoing care of the patient. Follow-up with participants will occur at 3 and 12 and 18 and 24 months to identify ADRs and ADEs. The primary outcome is moderate-severe ADRs at 12 months post-discharge, and will be analysed using the cumulative incidence proportion, survival analysis and Poisson regression. SUMMARY It is hypothesised that the trial will reduce ADRs and ADEs in the intervention population. The study will also provide valuable data on post-discharge ADRs and ADEs up to 24 months post-discharge.
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Affiliation(s)
- Justin Cousins
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia.
| | - Nibu Parameswaran Nair
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia.
| | - Colin Curtain
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia.
| | - Bonnie Bereznicki
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Private Bag 34, Hobart, Tasmania, 7001, Australia.
| | - Kiara Wilson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia.
| | - Blair Adamczewski
- Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia.
| | - Annette Barratt
- Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia.
| | - Liz Webber
- Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia.
| | - Tom Simpson
- Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia.
| | - Duncan McKenzie
- Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia.
| | - Michael Connolly
- Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia.
| | - Luke Bereznicki
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia.
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Tomlinson J, Marques I, Silcock J, Fylan B, Dyson J. Supporting medicines management for older people at care transitions - a theory-based analysis of a systematic review of 24 interventions. BMC Health Serv Res 2021; 21:890. [PMID: 34461892 PMCID: PMC8404335 DOI: 10.1186/s12913-021-06890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 08/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Older patients are at severe risk of harm from medicines following a hospital to home transition. Interventions aiming to support successful care transitions by improving medicines management have been implemented. This study aimed to explore which behavioural constructs have previously been targeted by interventions, which individual behaviour change techniques have been included, and which are yet to be trialled. METHOD This study mapped the behaviour change techniques used in 24 randomised controlled trials to the Behaviour Change Technique Taxonomy. Once elicited, techniques were further mapped to the Theoretical Domains Framework to explore which determinants of behaviour change had been targeted, and what gaps, if any existed. RESULTS Common behaviour change techniques used were: goals and planning; feedback and monitoring; social support; instruction on behaviour performance; and prompts/cues. These may be valuable when combined in a complex intervention. Interventions mostly mapped to between eight and 10 domains of the Theoretical Domains Framework. Environmental context and resources was an underrepresented domain, which should be considered within future interventions. CONCLUSION This study has identified behaviour change techniques that could be valuable when combined within a complex intervention aiming to support post-discharge medicines management for older people. Whilst many interventions mapped to eight or more determinants of behaviour change, as identified within the Theoretical Domains Framework, careful assessment of the barriers to behaviour change should be conducted prior to intervention design to ensure all appropriate domains are targeted.
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Affiliation(s)
- Justine Tomlinson
- Medicines Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK.
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Iuri Marques
- Medicines Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Jonathan Silcock
- Medicines Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Beth Fylan
- Medicines Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Judith Dyson
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
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Uitvlugt EB, Heer SEND, van den Bemt BJF, Bet PM, Sombogaard F, Hugtenburg JG, van den Bemt PMLA, Karapinar-Çarkit F. The effect of a transitional pharmaceutical care program on the occurrence of ADEs after discharge from hospital in patients with polypharmacy. Res Social Adm Pharm 2021; 18:2651-2658. [PMID: 34049802 DOI: 10.1016/j.sapharm.2021.05.009] [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] [Received: 09/11/2020] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Transitional care programs (i.e. interventions delivered both in hospital and in primary care), could increase continuity and consequently quality of care. However, limited studies on the effect of these programs on Adverse Drug Events (ADEs) post-discharge are available. Therefore, the aim of this study was to investigate the effect of a transitional pharmaceutical care program on the occurrence of ADEs 4 weeks post-discharge. METHODS A multicentre prospective before-after study was performed in a general teaching hospital, a university hospital and 49 community pharmacies. The transitional pharmaceutical care program consisted of: teach-back to the patient at discharge, a pharmaceutical discharge letter, a home visit by a community pharmacist and a clinical medication review by both the community and the clinical pharmacist, on top of usual care. Usual care consisted of medication reconciliation at admission and discharge by pharmacy teams. The primary outcome was the proportion of patients who reported at least 1 ADE 4 weeks post-discharge. Multivariable logistic regression was used to adjust for potential confounders. RESULTS In total, 369 patients were included (control: n = 195, intervention: n = 174). The proportion of patients with at least 1 ADE did not statistically significant differ between the intervention and control group (general teaching hospital: 59% vs. 67%, ORadj 0.70 [95% CI 0.38-1.31], university hospital: 63% vs 50%, OR adj 1.76 [95% CI 0.75-4.13]). CONCLUSION The transitional pharmaceutical care program did not decrease the proportion of patients with ADEs after discharge. ADEs after discharge were common and more than 50% of patients reported at least 1 ADE. A process evaluation is needed to gain insight into how a transitional pharmaceutical care program could diminish those ADEs.
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Affiliation(s)
- Elien B Uitvlugt
- Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands.
| | - Selma En-Nasery-de Heer
- Department of Clinical Pharmacology and Pharmacy, De Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands.
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands. Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, De Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands.
| | - Ferdi Sombogaard
- Department of Clinical Pharmacology and Pharmacy, De Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands.
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, De Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands.
| | - Patricia M L A van den Bemt
- University Medical Center Rotterdam, Department of Hospital Pharmacy. University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, the Netherlands.
| | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands.
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Fylan B, Ismail H, Hartley S, Gale CP, Farrin AJ, Gardner P, Silcock J, Alldred DP. A non-randomised feasibility study of an intervention to optimise medicines at transitions of care for patients with heart failure. Pilot Feasibility Stud 2021; 7:85. [PMID: 33766141 PMCID: PMC7995719 DOI: 10.1186/s40814-021-00819-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/09/2021] [Indexed: 12/15/2022] Open
Abstract
Background Heart failure affects 26 million people globally, and the optimal management of medicines is crucial for patients, particularly when their care is transferred between hospital and the community. Optimising clinical outcomes requires well-calibrated cross-organisational processes with staff and patients responding and adapting to medicines changes. The aim of this study was to assess the feasibility of implementing a complex intervention (the Medicines at Transitions Intervention; MaTI) co-designed by patients and healthcare staff. The purpose of the intervention was to optimise medicines management across the gaps between secondary and primary care when hospitals handover care. The study objectives were to (1) assess feasibility through meeting specified progression criteria to proceed to the trial, (2) assess if the intervention was acceptable to staff and patients, and (3) determine whether amendment or refinement would be needed to enhance the MaTI. Methods The feasibility of the MaTI was tested in three healthcare areas in the North of England between July and October 2017. Feasibility was measured and assessed through four agreed progression to trial criteria: (1) patient recruitment, (2) patient receipt of a medicines toolkit, (3) transfer of discharge information to community pharmacy, and (4) offer of a community pharmacy medicines review/discussion or medicines reconciliation. From the cardiology wards at each of the three NHS Acute Trusts (sites), 10 patients (aged ≥ 18 years) were recruited and introduced to the ‘My Medicines Toolkit’ (MMT). Patients were asked to identify their usual community pharmacy or nominate a pharmacy. Discharge information was transferred to the community pharmacy; pharmacists were asked to reconcile medicines and invited patients for a medicines use review (MUR) or discussion. At 1 month following discharge, all patients were sent three questionnaire sets: quality-of-life, healthcare utilisation, and a patient experience survey. In a purposive sample, 20 patients were invited to participate in a semi-structured interview about their experiences of the MaTI. Staff from hospital and primary care settings involved in patients’ care were invited to participate in a semi-structured interview. Patient and staff interviews were analysed using Framework Analysis. Questionnaire completion rates were recorded and data were descriptively analysed. Results Thirty-one patients were recruited across three sites. Eighteen staff and 18 patients took part in interviews, and 19 patients returned questionnaire sets. All four progression to trial criteria were met. We identified barriers to patient engagement with the intervention in hospital, which were compounded by patients’ focus on returning home. Some patients described not engaging in discussions with staff about medicines and lacking motivation to do so because they were preoccupied with returning home. Some patients were unable or unwilling to attend a community pharmacy in person for a medicines review. Roles and responsibilities for delivering the MaTI were different in the three sites, and staff reported variations in time spent on MaTI activities. Staff reported some work pressures and staff absences that limited the time they could spend talking to patients about their medicines. Clinical teams reported that recording a target dose for heart failure medicines in patient-held documentation was difficult as they did not always know the ideal or tolerable dose. The majority of patients reported receiving the patient-held documentation. More than two-thirds reported being offered a MUR by their community pharmacists. Conclusions Delivery of the Medicines at Transitions Intervention (MaTI) was feasible at all three sites, and progression to trial criteria were met. Refinements were found to be necessary to overcome identified barriers and strengthen delivery of all steps of the intervention. Necessary changes to the MaTI were identified along with amendments to the implementation plan for the subsequent trial. Future implementation needs to take into account the complexity of medicines management and adaptation to local context.
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Affiliation(s)
- Beth Fylan
- School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK. .,NIHR Yorkshire and Humber Patient Safety Translational Research Centre. Bradford Institute for Health Research, Temple Bank House, Bradford, BD9 6RJ, UK. .,Wolfson Centre for Applied Health Research, Bradford, BD9 6RJ, UK.
| | - Hanif Ismail
- School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.,Wolfson Centre for Applied Health Research, Bradford, BD9 6RJ, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Peter Gardner
- School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.,Wolfson Centre for Applied Health Research, Bradford, BD9 6RJ, UK
| | - Jonathan Silcock
- School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.,Wolfson Centre for Applied Health Research, Bradford, BD9 6RJ, UK
| | - David P Alldred
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre. Bradford Institute for Health Research, Temple Bank House, Bradford, BD9 6RJ, UK.,School of Healthcare, University of Leeds, Leeds, LS2 9JT, UK
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Rognan SE, Kälvemark Sporrong S, Bengtsson K, Lie HB, Andersson Y, Mowé M, Mathiesen L. Discharge processes and medicines communication from the patient perspective: A qualitative study at an internal medicines ward in Norway. Health Expect 2021; 24:892-904. [PMID: 33761170 PMCID: PMC8235877 DOI: 10.1111/hex.13232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients are expected to participate in the hospital discharge process, assume self-management after discharge and communicate relevant information to their general practitioner; however, patients report that they are not being sufficiently empowered to take on these responsibilities. The aim of this study was to explore and understand the discharge process with a focus on medicines communication, from the patient perspective. METHODS Patients were included at a hospital ward, observed during health-care personnel encounters on the day of discharge and interviewed 1-2 weeks after discharge. A process analysis was performed, and a content analysis combined data from observations and data from patient interviews focusing on medicines communication in the discharge process. RESULTS A total of 9 patients were observed on the day of discharge, equalling 67.5 hours of observations. The analysis resulted in the following themes: (a) the observed discharge process; (b) patient initiatives; and (c) the patient role. The medicines communication in the discharge process appeared unstructured. Various patient preferences and needs were revealed. The elements of the best practice structured discharge conversation were observed; however, some patients did not have a discharge conversation at all. CONCLUSIONS The study contributes to a broader understanding of the discharge process, how patients experience it, including their role. It is evident that the discharge process is not always tailored to meet the patients' needs. More focus on early patient involvement and communication, in order to better prepare patients for self-management of their medications, is important for their health outcomes.
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Affiliation(s)
- Stine Eidhammer Rognan
- Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Oslo, Norway.,Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
| | | | | | | | - Yvonne Andersson
- Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
| | - Morten Mowé
- Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Mathiesen
- Department of Pharmacy, University of Oslo, Oslo, Norway
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11
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Williams M, Jordan A, Scott J, Jones M. A systematic review examining the characteristics of users of NHS patient medicines helpline services, and the types of enquiries they make. Eur J Hosp Pharm 2020; 27:323-329. [PMID: 33097614 PMCID: PMC7856156 DOI: 10.1136/ejhpharm-2019-002001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/03/2019] [Accepted: 10/14/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Patient medicines helpline services (PMHS) are available from some National Health Service Trusts in the UK to support patients following their discharge from hospital. The aim of this systematic review was to examine the available evidence regarding the characteristics of enquirers and enquiries to PMHS, in order to develop recommendations for service improvement. METHODS Searches were conducted using Medline, Embase, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Web of Science, on 4 June 2019. Forward and backward citation searches were conducted, and grey literature was searched. Studies were included if they reported any characteristics of enquirers who use PMHS, and/or enquiries received. Study quality was assessed using the Axis tool. A narrative synthesis was conducted, and where appropriate, weighted means (WMs) were calculated. Where possible, outcomes were compared with Hospital Episode Statistics (HES) data for England, to establish whether the profile of helpline users may differ to that of hospital patients. RESULTS Nineteen studies were included (~4362 enquiries). Risk of bias from assessed studies was 71%. Enquirers were predominantly female (WM=53%; HES mean=57%), elderly (WM=69 years; HES mean=53 years) and enquired regarding themselves (WM=72%). Out of inpatient and outpatient enquirers, 50% were inpatients and 50% were outpatients (WM). Six of 15 studies reported adverse effects as the main enquiry reason. Two of four studies reported antimicrobial drugs as the main enquiry drug class. From two studies, the main clinical origin of enquiries were general surgery and cardiology. Across six studies, 27% (WM) of enquiries concerned medicines-related errors. CONCLUSIONS Our findings show that PMHS are often used by elderly patients, which is important since this group may be particularly vulnerable to experiencing medicines-related issues following hospital discharge. Over a quarter of enquiries to PMHS may concern medicines-related errors, suggesting that addressing such errors is an important function of this service. However, our study findings may be limited by a high risk of bias within included studies. Further research could provide a more detailed profile of helpline users (eg, ethnicity, average number of medicines consumed), and we encourage helpline providers to use their enquiry data to conduct local projects to improve hospital services (eg, reducing errors). PROSPERO REGISTRATION NUMBER CRD42018116276.
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Affiliation(s)
- Matt Williams
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
| | - Jenny Scott
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Matthew Jones
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
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12
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Mardani A, Griffiths P, Vaismoradi M. The Role of the Nurse in the Management of Medicines During Transitional Care: A Systematic Review. J Multidiscip Healthc 2020; 13:1347-1361. [PMID: 33154651 PMCID: PMC7608001 DOI: 10.2147/jmdh.s276061] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/04/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To synthesise knowledge and to explore the role of the nurse in medicines management during transitional care. METHODS An integrative systematic review was conducted. Electronic databases such as PubMed [including Medline], Web of Knowledge, Scopus, and Cinahl from January 2010 to April 2020 were searched. Original qualitative and quantitative studies written in English that focused on the role of the nurse in medicines management during transitional care, which included movement between short-term, long-term, and community healthcare settings were included. RESULTS The search process led to the retrieval of 10 studies, which were published in English from 2014 to 2020. They focused on the role of the nurse in patients' medicines management during transitional care in various healthcare settings. Given variations in the aims and methods of selected studies, the review findings were presented narratively utilizing three categories developed by the authors. In the first category as 'medication reconciliation process' the nurse participated in obtaining medication history, performing medication review, identifying medication discrepancies, joint medication reconciliation and adjustment. The second category as 'collaboration with other healthcare providers' highlighted the nurses' role in clarifying medicines' concerns, interdisciplinary communication and consultation, discharge planning and monitoring. In the third category as 'provision of support to healthcare recipients', the nurse was responsible for interpersonal communication with patients, education about medicines, and simplification of medication regimens, and symptoms management during transitional care. CONCLUSION Nurses play a crucial role in the safety of medicines management during transitional care. Therefore, they should be empowered and more involved in medicines management initiatives in the healthcare system. Patient safety and avoidance of medication errors during transitional care require that medicines management becomes a multidisciplinary collaboration with effective communication between healthcare providers.
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Affiliation(s)
- Abbas Mardani
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Pauline Griffiths
- Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, Wales, UK
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13
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Tomlinson J, Silcock J, Smith H, Karban K, Fylan B. Post-discharge medicines management: the experiences, perceptions and roles of older people and their family carers. Health Expect 2020; 23:1603-1613. [PMID: 33063445 PMCID: PMC7752204 DOI: 10.1111/hex.13145] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/14/2020] [Accepted: 09/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background Multiple changes are made to older patients’ medicines during hospital admission, which can sometimes cause confusion and anxiety. This results in problems with post‐discharge medicines management, for example medicines taken incorrectly, which can lead to harm, hospital readmission and reduced quality of life. Aim To explore the experiences of older patients and their family carers as they enacted post‐discharge medicines management. Design Semi‐structured interviews took place in participants’ homes, approximately two weeks after hospital discharge. Data analysis used the Framework method. Setting and participants Recruitment took place during admission to one of two large teaching hospitals in North England. Twenty‐seven participants aged 75 plus who lived with long‐term conditions and polypharmacy, and nine family carers, were interviewed. Findings Three core themes emerged: impact of the transition, safety strategies and medicines management role. Conversations between participants and health‐care professionals about medicines changes often lacked detail, which disrupted some participants’ knowledge and medicines management capabilities. Participants used multiple strategies to support post‐discharge medicines management, such as creating administration checklists, seeking advice or supporting primary care through prompts to ensure medicines were supplied on time. The level to which they engaged with these activities varied. Discussion and conclusion Participants experienced gaps in their post‐discharge medicines management, which they had to bridge through implementing their own strategies or by enlisting support from others. Areas for improvement were identified, mainly through better communication about medicines changes and wider involvement of patients and family carers in their medicines‐related care during the hospital‐to‐home transition.
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Affiliation(s)
- Justine Tomlinson
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK.,Medicine Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jonathan Silcock
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Heather Smith
- Medicine Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kate Karban
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Beth Fylan
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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14
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Affiliation(s)
- Karen Cardwell
- Queen's University Belfast - Northern Ireland Centre for Pharmacy Learning and Development, United Kingdom of Great Britain and Northern Ireland, Belfast, Belfast
- Royal College of Surgeons in Ireland - General Practice, Dublin, Ireland
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15
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Tomlinson J, Cheong VL, Fylan B, Silcock J, Smith H, Karban K, Blenkinsopp A. Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity. Age Ageing 2020; 49:558-569. [PMID: 32043116 PMCID: PMC7331096 DOI: 10.1093/ageing/afaa002] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 10/18/2019] [Accepted: 01/07/2019] [Indexed: 11/14/2022] Open
Abstract
Background medication-related problems occur frequently when older patients are discharged from hospital. Interventions to support medication use have been developed; however, their effectiveness in older populations are unknown. This review evaluates interventions that support successful transitions of care through enhanced medication continuity. Methods a database search for randomised controlled trials was conducted. Selection criteria included mean participant age of 65 years and older, intervention delivered during hospital stay or following recent discharge and including activities that support medication continuity. Primary outcome of interest was hospital readmission. Secondary outcomes related to the safe use of medication and quality of life. Outcomes were pooled by random-effects meta-analysis where possible. Results twenty-four studies (total participants = 17,664) describing activities delivered at multiple time points were included. Interventions that bridged the transition for up to 90 days were more likely to support successful transitions. The meta-analysis, stratified by intervention component, demonstrated that self-management activities (RR 0.81 [0.74, 0.89]), telephone follow-up (RR 0.84 [0.73, 0.97]) and medication reconciliation (RR 0.88 [0.81, 0.96]) were statistically associated with reduced hospital readmissions. Conclusion our results suggest that interventions that best support older patients’ medication continuity are those that bridge transitions; these also have the greatest impact on reducing hospital readmission. Interventions that included self-management, telephone follow-up and medication reconciliation activities were most likely to be effective; however, further research needs to identify how to meaningfully engage with patients and caregivers to best support post-discharge medication continuity. Limitations included high subjectivity of intervention coding, study heterogeneity and resource restrictions.
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Affiliation(s)
- Justine Tomlinson
- School of Pharmacy and Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford BD7 1DP, UK
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds LS9 7TF, UK
| | - V-Lin Cheong
- Pharmacy Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - Beth Fylan
- School of Pharmacy and Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford BD7 1DP, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ, UK
| | - Jonathan Silcock
- School of Pharmacy and Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford BD7 1DP, UK
| | - Heather Smith
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds LS9 7TF, UK
| | - Kate Karban
- Faculty of Life Sciences, University of Bradford, Bradford BD7 1DP, UK
| | - Alison Blenkinsopp
- School of Pharmacy and Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford BD7 1DP, UK
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16
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Brühwiler LD, Beeler PE, Böni F, Giger R, Wiedemeier PG, Hersberger KE, Lutters M. A RCT evaluating a pragmatic in-hospital service to increase the quality of discharge prescriptions. Int J Qual Health Care 2020; 31:G74-G80. [PMID: 31087065 DOI: 10.1093/intqhc/mzz043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/04/2019] [Accepted: 04/25/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To improve discharge prescription quality and information transfer to improve post-hospital care with a pragmatic in-hospital service. DESIGN A single-centre, randomized controlled trial. SETTING Internal medicine wards in a Swiss teaching hospital. PARTICIPANTS Adult patients discharged to their homes, 76 each in the intervention and control group. INTERVENTION Medication reconciliation at discharge by a clinical pharmacist, a prescription check for formal flaws, interactions and missing therapy durations. Important information was annotated on the prescription. MAIN OUTCOME MEASURES At the time of medication dispensing, community pharmacy documented their pharmaceutical interventions when filling the prescription. A Poisson regression model was used to compare the number of interventions (primary outcome). The significance of the pharmaceutical interventions was categorized by the study team. Comparative analysis was used for the significance of interventions (secondary outcome). RESULTS The community pharmacy staff performed 183 interventions in the control group, and 169 in the intervention group. The regression model revealed a relative risk for an intervention of 0.78 (95% CI 0.62-0.99, p = 0.04) in the intervention group. The rate of clinically significant interventions was lower in the intervention group than in the control group (72 of 169 (42%) vs. 108 of 183 (59%), p < 0.01), but more economically significant interventions were performed (98, 58% vs. 80, 44%, p < 0.01). CONCLUSIONS The pragmatic in-hospital service increased the quality of prescriptions. The intervention group had a lower risk for the need for pharmaceutical interventions, and clinically significant interventions were less frequent. Overall, our pragmatic approach showed promising results to optimize post-discharge care.
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Affiliation(s)
- Lea D Brühwiler
- Clinical Pharmacy, Cantonal Hospital of Baden, Switzerland.,Pharmaceutical Care Research Group, University of Basel, Switzerland
| | - Patrick E Beeler
- Department of Internal Medicine & Center of Competence Multimorbidity & University Research Priority Program 'Dynamics of Healthy Aging', University Hospital Zurich & University of Zurich, Switzerland
| | - Fabienne Böni
- Pharmaceutical Care Research Group, University of Basel, Switzerland
| | - Rebekka Giger
- Department of Internal Medicine, Cantonal Hospital of Baden, Switzerland
| | | | - Kurt E Hersberger
- Pharmaceutical Care Research Group, University of Basel, Switzerland
| | - Monika Lutters
- Clinical Pharmacy, Cantonal Hospital of Baden, Switzerland
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17
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Ozavci G, Bucknall T, Woodward-Kron R, Hughes C, Jorm C, Joseph K, Manias E. A systematic review of older patients' experiences and perceptions of communication about managing medication across transitions of care. Res Social Adm Pharm 2020; 17:273-291. [PMID: 32299684 DOI: 10.1016/j.sapharm.2020.03.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Communication about managing medications may be difficult when older people move across transitions of care. Communication breakdowns may result in medication discrepancies or incidents. OBJECTIVE The aim of this systematic review was to explore older patients' experiences and perceptions of communication about managing medications across transitions of care. DESIGN A systematic review. METHODS A comprehensive review was conducted of qualitative, quantitative and mixed method studies using CINAHL Complete, MEDLINE, Embase and PsycINFO, Web of Science, INFORMIT and Scopus. These databases were searched from inception to 14.12.2018. Key article cross-checking and hand searching of reference lists of included papers were also undertaken. INCLUSION CRITERIA studies of the medication management perspectives of people aged 65 or older who transferred between care settings. These settings comprised patients' homes, residential aged care and acute and subacute care. Only English language studies were included. Comments, case reports, systematic reviews, letters, editorials were excluded. Thematic analysis was undertaken by synthesising qualitative data, whereas quantitative data were summarised descriptively. Methodological quality was assessed with the Mixed Methods Appraisal Tool. RESULTS The final review comprised 33 studies: 12 qualitative, 17 quantitative and 4 mixed methods studies. Twenty studies addressed the link between communication and medication discrepancies; ten studies identified facilitators of self-care through older patient engagement; 18 studies included older patients' experiences with health professionals about their medication regimen; and, 13 studies included strategies for communication about medications with older patients. Poor communication between primary and secondary care settings was reported as a reason for medication discrepancy before discharge. Older patients expected ongoing and tailored communication with providers and timely, accurate and written information about their medications before discharge or available for the post-discharge period. CONCLUSIONS Communication about medications was often found to be ineffective. Most emphasis was placed on older patients' perspectives at discharge and in the post-discharge period. There was little exploration of older patients' views of communication about medication management on admission, during hospitalisation, or transfer between settings.
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Affiliation(s)
- Guncag Ozavci
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Tracey Bucknall
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria, 3125, Australia; Deakin-Alfred Health Nursing Research Centre, Alfred Health, 55 Commercial Rd, Melbourne, VIC 3004 Australia.
| | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Grattan Street Parkville, 3052, Victoria, Australia.
| | - Carmel Hughes
- Queen's University Belfast, School of Pharmacy, 97 Lisburn Road Belfast BT9 7BL, UK, Northern Ireland, UK.
| | - Christine Jorm
- NSW Regional Health Partners, Wisteria House, James Fletcher Hospital, 72 Watt St, Newcastle, 2300, NSW, Australia.
| | - Kathryn Joseph
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Elizabeth Manias
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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18
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The Patient-Held Active Record of Medication Status (PHARMS) study: a mixed-methods feasibility analysis. Br J Gen Pract 2020; 69:e345-e355. [PMID: 31015221 DOI: 10.3399/bjgp19x702413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/21/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Medication errors frequently occur as patients transition between hospital and the community, and may result in patient harm. Novel methods are required to address this issue. AIM To assess the feasibility of introducing an electronic patient-held active record of medication status device (PHARMS) at the primary-secondary care interface at the time of hospital discharge. DESIGN AND SETTING A mixed-methods study (non-randomised controlled intervention, and a process evaluation of qualitative interviews and non-participant observation) among patients >60 years in an urban hospital and general practices in Cork, Ireland. METHOD The number and clinical significance of errors were compared between discharge prescriptions of the intervention (issued with a PHARMS device) and control (usual care, handwritten discharge prescription) groups. Semi-structured interviews were conducted with patients, junior doctors, GPs, and IT professionals, in addition to direct observation of the implementation process. RESULTS In all, 102 patients were included in the final analysis (intervention n = 41, control n = 61). Total error number was lower in the intervention group (median 1, interquartile range [IQR] 0-3) than in the control group (median 8, IQR (4-13.5, P<0.001), with the clinical significance score in the intervention group also being lower than the control group (median 2, IQR 0-4 versus median 11, IQR 5-20, P<0.001). The PHARMS device was found to be technically implementable using existing information technology infrastructure, and acceptable to all key stakeholders. CONCLUSION The results suggest that using PHARMS devices within existing systems in general practice and hospitals is feasible and acceptable to both patients and doctors, and may reduce medication error.
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19
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Marien S, Legrand D, Ramdoyal R, Nsenga J, Ospina G, Ramon V, Boland B, Spinewine A. A web application to involve patients in the medication reconciliation process: a user-centered usability and usefulness study. J Am Med Inform Assoc 2019; 25:1488-1500. [PMID: 30137331 DOI: 10.1093/jamia/ocy107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 07/27/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Medication reconciliation (MedRec) can improve patient safety by resolving medication discrepancies. Because information technology (IT) and patient engagement are promising approaches to optimizing MedRec, the SEAMPAT project aims to develop a MedRec IT platform based on two applications: the "patient app" and the "MedRec app." This study evaluates three dimensions of the usability (efficiency, satisfaction, and effectiveness) and usefulness of the patient app. Methods We performed a four-month user-centered observational study. Quantitative and qualitative data were collected. Participants completed the system usability scale (SUS) questionnaire and a second questionnaire on usefulness. Effectiveness was assessed by measuring the completeness of the medication list generated by the patient application and its correctness (ie medication discrepancies between the patient list and the best possible medication history). Qualitative data were collected from semi-structured interviews, observations and comments, and questions raised by patients. Results Forty-two patients completed the study. Sixty-nine percent of patients considered the patient app to be acceptable (SUS Score ≥ 70) and usefulness was high. The medication list was complete for a quarter of the patients (7/28) and there was a discrepancy for 21.7% of medications (21/97). The qualitative data enabled the identification of several barriers (related to functional and non-functional aspects) to the optimization of usability and usefulness. Conclusions Our findings highlight the importance and value of user-centered usability testing of a patient application implemented in "real-world" conditions. To achieve adoption and sustained use by patients, the app should meet patients' needs while also efficiently improving the quality of MedRec.
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Affiliation(s)
- Sophie Marien
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université catholique de Louvain, Brussels, Belgium.,Geriatric Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Delphine Legrand
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université catholique de Louvain, Brussels, Belgium
| | - Ravi Ramdoyal
- Centre d'Excellence en Technologies de l'Information et de la Communication (CETIC), Charleroi, Belgium
| | - Jimmy Nsenga
- Centre d'Excellence en Technologies de l'Information et de la Communication (CETIC), Charleroi, Belgium
| | - Gustavo Ospina
- Centre d'Excellence en Technologies de l'Information et de la Communication (CETIC), Charleroi, Belgium
| | - Valéry Ramon
- Centre d'Excellence en Technologies de l'Information et de la Communication (CETIC), Charleroi, Belgium
| | - Benoit Boland
- Geriatric Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Anne Spinewine
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université catholique de Louvain, Brussels, Belgium.,Pharmacy Department, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
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20
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Weetman K, Dale J, Scott E, Schnurr S. The Discharge Communication Study: research protocol for a mixed methods study to investigate and triangulate discharge communication experiences of patients, GPs, and hospital professionals, alongside a corresponding discharge letter sample. BMC Health Serv Res 2019; 19:825. [PMID: 31711500 PMCID: PMC6849198 DOI: 10.1186/s12913-019-4612-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Discharge letters are crucial during care transitions from hospital to home. Research indicates a need for improvement to increase quality of care and decrease adverse outcomes. These letters are often sent from the hospital discharging physician to the referring clinician, typically the patient's General Practitioner (GP) in the UK, and patients may or may not be copied into them. Relatively little is known about the barriers and enablers to sending patients discharge letters. Hence, the aim of this study was to investigate from GP, hospital professional (HP) and patient perspectives how to improve processes of patients receiving letters and increase quality of discharge letters. The study has a particular focus on the impacts of receiving or not receiving letters on patient experiences and quality of care. METHODS The setting was a region in the West Midlands of England, UK. The research aimed to recruit a minimum of 30 GPs, 30 patients and 30 HPs in order to capture 90 experiences of discharge communication. Participating GPs initially screened and selected a range of recent discharge letters which they assessed to be successful and unsuccessful exemplars. These letters identified potential participants who were invited to take part: the HP letter writer, GP recipient and patient. Participant viewpoints are collected through interviews, focus groups and surveys and will be "matched" to the discharge letter sample, so forming multiple-perspective "quartet" cases. These "quartets" allow direct comparisons between different discharge experiences within the same communicative event. The methods for analysis draw on techniques from the fields of Applied Linguistics and Health Sciences, including: corpus linguistics; inferential statistics; content analysis. DISCUSSION This mixed-methods study is novel in attempting to triangulate views of patients, GPs and HPs in relation to specific discharge letters. Patient and practitioner involvement will inform design decisions and interpretation of findings. Recommendations for improving discharge letters and the process of patients receiving letters will be made, with the intention of informing guidelines on discharge communication. Ethics approval was granted in July 2017 by the UK Health Research Authority. Findings will be disseminated in peer-reviewed journals, reports and newsletters, and presentations.
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Affiliation(s)
- Katharine Weetman
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Jeremy Dale
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Emma Scott
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Stephanie Schnurr
- Centre for Applied Linguistics, University of Warwick, Coventry, CV4 7AL UK
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21
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Foulon V, Wuyts J, Desplenter F, Spinewine A, Lacour V, Paulus D, De Lepeleire J. Problems in continuity of medication management upon transition between primary and secondary care: patients' and professionals' experiences. Acta Clin Belg 2019; 74:263-271. [PMID: 29932849 DOI: 10.1080/17843286.2018.1483561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients often experience drug-related problems at admission or after discharge from hospital. The objective of this study was to identify the main problems in medication management at transition between settings of care, as experienced by health care professionals (HCPs) and patients. METHODS Focus group discussions were organised between December 2009 and February 2010; nine focus groups with primary and secondary care HCPs and patients and two with stakeholders. Focus group discussions were audiotaped and observation files were constructed. For the analysis, a thematic framework approach was used. Between November 2015 and April 2016, 19 additional interviews and 1 focus group were performed with general practitioners (GP) and community pharmacists (CP). RESULTS This qualitative study provided a long list of problems that could be summarised in five clusters: (1) problems at admission, e.g. incomplete list of medication, absence of information in case of emergency admission; (2) problems at discharge, e.g. lack of communication with GP, insufficient supplies of medication for the weekend; (3) problems as to professions, e.g. GP's opinion different to that of the medical specialist; (4) problems as to patients and family, e.g. failure to understand treatment; (5) problems as to processes, e.g. medication substitutions. CONCLUSION HCPs and patients experience many problems in medication management at transition between settings of care. The fact that these problems occur at different stages and persist over time stresses the necessity for multilevel solutions.
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Affiliation(s)
- Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven , Leuven, Belgium
| | - Joke Wuyts
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven , Leuven, Belgium
| | - Franciska Desplenter
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven , Leuven, Belgium
- Universitair Psychiatrisch Centrum KU Leuven – Z.org KU Leuven , Kortenberg, Belgium
| | - Anne Spinewine
- Faculté de pharmacie et des sciences biomédicales, Louvain Drug Research Institute, Université catholique de Louvain , Brussels, Belgium
| | - Valérie Lacour
- Faculté de pharmacie et des sciences biomédicales, Louvain Drug Research Institute, Université catholique de Louvain , Brussels, Belgium
| | | | - Jan De Lepeleire
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven , Leuven, Belgium
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22
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Bucknall T, Digby R, Fossum M, Hutchinson AM, Considine J, Dunning T, Hughes L, Weir-Phyland J, Manias E. Exploring patient preferences for involvement in medication management in hospitals. J Adv Nurs 2019; 75:2189-2199. [PMID: 31162718 DOI: 10.1111/jan.14087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/11/2019] [Accepted: 04/02/2019] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to identify patient preferences for involvement in medication management during hospitalization. DESIGN A qualitative descriptive study. METHODS This is a study of 20 inpatients in two medical and two surgical wards at an academic health science centre in Melbourne, Australia. Semi-structured interviews were recorded and analysed using content analysis. FINDINGS Three themes were identified: (a) 'understanding the medication' established large variation in participants' understanding of their pre-admission medication and current medication; (b) 'ownership of medication administration' showed that few patients had considered an alternative to their current regimen; only some were interested in taking more control; and (c) 'supporting discharge from hospital' showed that most patients desired written medication instructions to be explained by a health professional. Family involvement was important for many. CONCLUSION There was significant diversity of opinion from participants about their involvement in medication management in hospital. Patient preferences for inclusion need to be identified on admission where appropriate. Education about roles and responsibilities of medication management is required for health professionals, patients and families to increase inclusion and engagement across the health continuum and support transition to discharge. IMPACT STATEMENT Little is known about patient preferences for participation in medication administration and hospital discharge planning. Individual patient understanding of and interest in participation in medication administration varies. In accordance with individual patient preferences, patients need to be included more effectively and consistently in their own medication management when in hospital.
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Affiliation(s)
- Tracey Bucknall
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia.,Nursing, Alfred Health, Melbourne, Victoria, Australia
| | - Robin Digby
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia
| | - Mariann Fossum
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia.,Nursing, Alfred Health, Melbourne, Victoria, Australia.,Centre for Caring Research, Grimstad, Norway
| | - Alison M Hutchinson
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia.,Nursing, Monash Health, Melbourne, Victoria, Australia
| | - Julie Considine
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia.,Nursing, Eastern Health, Melbourne, Victoria, Australia
| | - Trisha Dunning
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia.,Nursing, Barwon Health, Geelong, Victoria, Australia
| | - Lee Hughes
- Nursing, Alfred Health, Melbourne, Victoria, Australia
| | | | - Elizabeth Manias
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia
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23
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Pharmacy-supported interventions at transitions of care: an umbrella review. Int J Clin Pharm 2019; 41:831-852. [DOI: 10.1007/s11096-019-00833-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/10/2019] [Indexed: 11/25/2022]
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24
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Walroth TA, Dossett HA, Doolin M, McMichael D, Reddan JG, Degnan D, Fuller J. Standardizing concentrations of adult drug infusions in Indiana. Am J Health Syst Pharm 2019; 74:491-497. [PMID: 28336759 DOI: 10.2146/ajhp151018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A multidisciplinary, consensus-driven initiative to promote the use of standardized medication concentrations for adult drug infusions across the state of Indiana is described. METHODS To accomplish development of the Indiana Standard Concentrations of Adult Drug Infusions List ("the Indiana List"), several available lists of i.v. concentrations were compiled, consolidated, and compared. Lists of adult standardized i.v. concentrations were primarily drawn from Indiana regional patient safety coalitions, published literature, and publicly available lists of recommended i.v. concentrations. The standardization project, which expanded initial work completed by the Indianapolis Coalition for Patient Safety, was conducted in conjunction with Purdue University's Center for Medication Safety Advancement, the Indiana Hospital Association, and the 11 regional patient safety coalitions across the state. RESULTS After a review of 9 existing lists of standard i.v. concentrations, an initial list of 69 concentrations representing a total of 37 medications was derived; 34 of those concentrations were represented on at least 1 of the 3 evaluated Indiana regional patient safety coalition lists. A statewide interdisciplinary work group of representatives of regional patient safety coalitions and 9 health systems representing a total of 81 hospitals ranging from academic medical centers to critical access hospitals assembled to develop consensus on a final list of standard medication concentrations for adult i.v. infusions. CONCLUSION A final list of 28 concentrations of 26 medications was identified for the recommended Indiana List by an interdisciplinary work group. A checklist of considerations for implementation was also developed.
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Affiliation(s)
| | | | | | | | - Jennifer G Reddan
- Center for Medication Management, Indiana University Health, Indianapolis, IN
| | - Dan Degnan
- Center for Medication Safety Advancement, Purdue College of Pharmacy, Fishers, IN
| | - James Fuller
- Indianapolis Coalition for Patient Safety, Inc., Indianapolis, IN
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25
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Forstner J, Straßner C, Kunz A, Uhlmann L, Freund T, Peters-Klimm F, Wensing M, Kümmel S, El-Kurd N, Rück R, Handlos B, Szecsenyi J. Improving continuity of patient care across sectors: study protocol of a quasi-experimental multi-centre study regarding an admission and discharge model in Germany (VESPEERA). BMC Health Serv Res 2019; 19:206. [PMID: 30925879 PMCID: PMC6441227 DOI: 10.1186/s12913-019-4022-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitalisations are a critical event in the care process. Insufficient communication and uncoordinated follow-up care often impede the recovery process of the patient resulting in a high number of rehospitalisations and increased health care costs. The overall aim of this study is the development, implementation and evaluation of a structured programme (VESPEERA) to improve the admission and discharge process. METHODS We will conduct an open quasi-experimental multi-centre study with four intervention arms. A cohort selected from insurance claims data will serve as a control group reflecting usual care. The intervention will be implemented in 25 hospital departments and 115 general practices in 9 districts in Baden-Wurttemberg. Eligibility criteria for patients are: age > 18 years, hospital admission or hospitalisation, insurance at the sickness fund "AOK Baden-Wurttemberg", enrolment in general practice-centred care contract. Each study arm will receive different intervention components based on the point of study enrolment and the patient's medical need. The interventions comprise a) a structured assessment in the general practice prior to admission resulting in an admission letter b) a discharge conversation by phone between hospital and general practice, c) a structured assessment and care plan post-discharge and d) telephone monitoring for patients with a high risk of rehospitalisation. The assessments are supported by a software tool ("CareCockpit"), originally developed for structured case management programmes. The primary outcome (rehospitalisation due to the same indication within 90 days) and a range of secondary outcomes (rehospitalisation due to the same indication within 30 days; hospitalisations due to ambulatory care-sensitive conditions; delayed prescription of medication and medical products/ devices and referral to other health practitioner/s after discharge; utilisation of emergency or rescue services within 3 months; average care cost per year and patient participating in the VESPEERA programme) and quality indicators will be determined based on insurance claims data and CareCockpit data. Additionally, a patient survey on satisfaction with cross-sectoral care and health related quality of life will be conducted. DISCUSSION Based on the results, area-wide implementation in usual care is well sought. This study will contribute to an improvement of cross-sectoral care during the admission and discharge process. TRIAL REGISTRATION DRKS00014294 on DRKS / Universal Trial Number (UTN): U1111-1210-9657, Date of registration 12/06/2018.
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Affiliation(s)
- Johanna Forstner
- Department for General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Cornelia Straßner
- Department for General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Aline Kunz
- Department for General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Lorenz Uhlmann
- Department for Medical Biometry, University Hospital of Heidelberg, Institute for Medical Biometry and Informatics, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Tobias Freund
- Department for General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Frank Peters-Klimm
- Department for General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department for General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Stephanie Kümmel
- aQua -Institute GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | - Nadja El-Kurd
- AOK Baden-Württemberg, Presselstraße19, 70191, Stuttgart, Germany
| | - Ronja Rück
- HÄVG Hausärztliche Vertragsgemeinschaft Aktiengesellschaft Regionaldirektion Süd, Kölner Str. 18, 70376, Stuttgart, Germany
| | - Bärbel Handlos
- Gesundheitstreffpunkt Mannheim, Max-Joseph-Str. 1, 68167, Mannheim, Germany
| | - Joachim Szecsenyi
- Department for General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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26
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Redmond P, Grimes TC, McDonnell R, Boland F, Hughes C, Fahey T. Impact of medication reconciliation for improving transitions of care. Cochrane Database Syst Rev 2018; 8:CD010791. [PMID: 30136718 PMCID: PMC6513651 DOI: 10.1002/14651858.cd010791.pub2] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Transitional care provides for the continuity of care as patients move between different stages and settings of care. Medication discrepancies arising at care transitions have been reported as prevalent and are linked with adverse drug events (ADEs) (e.g. rehospitalisation).Medication reconciliation is a process to prevent medication errors at transitions. Reconciliation involves building a complete list of a person's medications, checking them for accuracy, reconciling and documenting any changes. Despite reconciliation being recognised as a key aspect of patient safety, there remains a lack of consensus and evidence about the most effective methods of implementing reconciliation and calls have been made to strengthen the evidence base prior to widespread adoption. OBJECTIVES To assess the effect of medication reconciliation on medication discrepancies, patient-related outcomes and healthcare utilisation in people receiving this intervention during care transitions compared to people not receiving medication reconciliation. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, seven other databases and two trials registers on 18 January 2018 together with reference checking, citation searching, grey literature searches and contact with study authors to identify additional studies. SELECTION CRITERIA We included only randomised trials. Eligible studies described interventions fulfilling the Institute for Healthcare Improvement definition of medication reconciliation aimed at all patients experiencing a transition of care as compared to standard care in that institution. Included studies had to report on medication discrepancies as an outcome. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts, assessed studies for eligibility, assessed risk of bias and extracted data. Study-specific estimates were pooled, using a random-effects model to yield summary estimates of effect and 95% confidence intervals (CI). We used the GRADE approach to assess the overall certainty of evidence for each pooled outcome. MAIN RESULTS We identified 25 randomised trials involving 6995 participants. All studies were conducted in hospital or immediately related settings in eight countries. Twenty-three studies were provider orientated (pharmacist mediated) and two were structural (an electronic reconciliation tool and medical record changes). A pooled result of 20 studies comparing medication reconciliation interventions to standard care of participants with at least one medication discrepancy showed a risk ratio (RR) of 0.53 (95% CI 0.42 to 0.67; 4629 participants). The certainty of the evidence on this outcome was very low and therefore the effect of medication reconciliation to reduce discrepancies was uncertain. Similarly, reconciliation's effect on the number of reported discrepancies per participant was also uncertain (mean difference (MD) -1.18, 95% CI -2.58 to 0.23; 4 studies; 1963 participants), as well as its effect on the number of medication discrepancies per participant medication (RR 0.13, 95% CI 0.01 to 1.29; 2 studies; 3595 participants) as the certainty of the evidence for both outcomes was very low.Reconciliation may also have had little or no effect on preventable adverse drug events (PADEs) due to the very low certainty of the available evidence (RR 0.37. 95% CI 0.09 to 1.57; 3 studies; 1253 participants), with again uncertainty on its effect on ADE (RR 1.09, 95% CI 0.91 to 1.30; 4 studies; 1363 participants; low-certainty evidence). Evidence of the effect of the interventions on healthcare utilisation was conflicting; it probably made little or no difference on unplanned rehospitalisation when reported alone (RR 0.72, 95% CI 0.44 to 1.18; 5 studies; 1206 participants; moderate-certainty evidence), and had an uncertain effect on a composite measure of hospital utilisation (emergency department, rehospitalisation RR 0.78, 95% CI 0.50 to 1.22; 4 studies; 597 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS The impact of medication reconciliation interventions, in particular pharmacist-mediated interventions, on medication discrepancies is uncertain due to the certainty of the evidence being very low. There was also no certainty of the effect of the interventions on the secondary clinical outcomes of ADEs, PADEs and healthcare utilisation.
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Affiliation(s)
- Patrick Redmond
- Department of General Practice, Royal College of Surgeons in IrelandHRB Centre for Primary Care ResearchBeaux Lane HouseBow LaneDublin 2Ireland
- University of CambridgeTHIS Institute (The Healthcare Improvement Studies Institute)CambridgeUK
| | - Tamasine C Grimes
- Trinity College DublinSchool of Pharmacy and Pharmaceutical SciencesSchool of Pharmacy and Pharmaceutical SciencesPanoz Institute, Trinity College, Dublin 2DublinDublinIrelandD2
| | - Ronan McDonnell
- Department of General Practice, Royal College of Surgeons in IrelandHRB Centre for Primary Care ResearchBeaux Lane HouseBow LaneDublin 2Ireland
| | - Fiona Boland
- Department of General Practice, Royal College of Surgeons in IrelandHRB Centre for Primary Care ResearchBeaux Lane HouseBow LaneDublin 2Ireland
| | - Carmel Hughes
- Queen's University BelfastSchool of Pharmacy97 Lisburn RoadBelfastNorthern IrelandUKBT9 7BL
| | - Tom Fahey
- Department of General Practice, Royal College of Surgeons in IrelandHRB Centre for Primary Care ResearchBeaux Lane HouseBow LaneDublin 2Ireland
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27
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Holdhus H, Bøvre K, Mathiesen L, Bjelke B, Bjerknes K. Limited effect of structured medication report as the only intervention at discharge from hospital. Eur J Hosp Pharm 2018; 26:101-105. [PMID: 31157108 PMCID: PMC6452344 DOI: 10.1136/ejhpharm-2017-001371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 11/04/2022] Open
Abstract
Objective To investigate whether a structured medication report at discharge from the hospital could reduce the number of medication discrepancies in primary care. Method The study was performed as an open, randomised controlled study including patients transferred from one hospital in Norway to nursing home or home care. Both groups received epicrisis on discharge. In addition, the intervention group received a structured medication report. After discharge, the medication list in primary care service was compared with the list at discharge and medication discrepancies identified. In addition, these medication lists were retrospectively compared with the lists prior to admission to the hospital and at admission to hospital. A questionnaire on time spent and quality of the medication information was filled in by nurses in primary care. Results Medication discrepancies were found for 72% (26) of the patients in the intervention group and 76% (42) in the control group (P=0.918). Most common was drugs omitted or committed to the medication lists in primary care service. Typically, the committed drugs in primary care were omitted drugs after admission to the hospital. Nurses used significantly less time (66%) obtaining medication information in the intervention group (P=0.041). Conclusions Structured medication report as the only intervention did not reduce the medication discrepancies after discharge from hospital. There is a need for reconciliation at admission to ensure the quality of the medication report. Structured medication report resulted in the nurses spending less time on collecting medication information in primary care service.
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Affiliation(s)
- Hanne Holdhus
- Hospital Pharmacy Enterprices, South Eastern Norway, Oslo, Norway
| | - Katrine Bøvre
- Hospital Pharmacy Enterprices, South Eastern Norway, Oslo, Norway
| | - Liv Mathiesen
- Hospital Pharmacy Enterprices, South Eastern Norway, Oslo, Norway.,Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Börje Bjelke
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Kathrin Bjerknes
- Hospital Pharmacy Enterprices, South Eastern Norway, Oslo, Norway
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28
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BrÜhwiler LD, Hersberger K, Lutters M. Authors' reply. Pharm Pract (Granada) 2018; 15:1148. [PMID: 29317928 PMCID: PMC5742005 DOI: 10.18549/pharmpract.2017.04.1148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Lea D BrÜhwiler
- Clinical Pharmacy, Cantonal Hospital of Baden. Baden (Switzerland).
| | - Kurt Hersberger
- Pharmaceutical Care Research Group, University of Basel. Basel (Switzerland).
| | - Monika Lutters
- Pharmaceutical Care Research Group, University of Basel. Basel (Switzerland).
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29
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Towne SD, Fair K, Smith ML, Dowdy DM, Ahn S, Nwaiwu O, Ory MG. Multilevel Comparisons of Hospital Discharge among Older Adults with a Fall-Related Hospitalization. Health Serv Res 2017; 53:2227-2248. [PMID: 28857156 DOI: 10.1111/1475-6773.12763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We examined multilevel factors associated with hospital discharge status among older adults suffering a fall-related hospitalization. DATA SOURCES The 2011-2013 (n = 131,978) Texas Inpatient Hospital Discharge Public-Use File was used. STUDY DESIGN/METHODS Multilevel logistic regression analyses estimated the likelihood of being discharged to institutional settings versus home. PRINCIPAL FINDINGS Factors associated with a greater likelihood of being discharged to institutional settings versus home/self-care included being female, white, older, having greater risk of mortality, receiving care in a non-teaching hospital, having Medicare (versus Private) coverage, and being admitted from a non-health care facility (versus clinical referral). CONCLUSIONS Understanding risk factors for costly discharges to institutional settings enables targeted fall-prevention interventions with identification of at-risk groups and allows for identifying policy-related factors associated with discharge status.
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Affiliation(s)
- Samuel D Towne
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX
| | - Kayla Fair
- Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew Lee Smith
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX.,Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA
| | - Diane M Dowdy
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX
| | - SangNam Ahn
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX.,Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, TN
| | - Obioma Nwaiwu
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M University, School of Public Health, College Station, TX
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30
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Rodrigues CR, Harrington AR, Murdock N, Holmes JT, Borzadek EZ, Calabro K, Martin J, Slack MK. Effect of Pharmacy-Supported Transition-of-Care Interventions on 30-Day Readmissions: A Systematic Review and Meta-analysis. Ann Pharmacother 2017; 51:866-889. [DOI: 10.1177/1060028017712725] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To describe pharmacy-supported transition-of-care (TOC) interventions and determine their effect on 30-day all-cause readmissions. Data Sources: MEDLINE/PubMed, EMBASE, International Pharmaceutical Abstracts, ABI Inform Complete, PsychINFO, Web of Science, Academic Search Complete, CINHAL, Cochrane library, OIASTER, ProQuest Dissertations & Theses, ClinicalTrials.gov , and relevant websites were searched from January 1, 1995, to December 31, 2015. Study Selection and Data Extraction: PICOS+E criteria were utilized. Eligible studies reported pharmacy-supported TOC interventions compared with usual care in adult patients discharged to home within the United States. Studies were required to evaluate postdischarge outcomes (eg, rate of readmissions, hospital utilization). Randomized controlled trials, cohort studies, or controlled before-and-after studies were included. Two reviewers independently extracted data and evaluated study quality. Data Synthesis: A total of 56 articles were included in the systematic review (n = 61 858), of which 32 reported 30-day all-cause readmissions and were included in the meta-analysis. A taxonomy was developed to categorize targeted patients, intervention types, and pharmacy personnel as sole intervener. The meta-analysis demonstrated about a 32% reduction in the odds of readmission (odds ratio [OR] = 0.68; 95% CI = 0.61 to 0.75) observed for pharmacy-supported TOC interventions compared with usual care. Heterogeneity was identified ( I2 = 55%; P < 0.001). A stratified meta-analysis showed that interventions with patient-centered follow-up reduced 30-day readmissions relative to studies without follow-up (OR = 0.70; CI = 0.63 to 0.78). Conclusions: Pharmacy-supported TOC programs were associated with a significant reduction in the odds of 30-day readmissions.
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31
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Elson R, Cook H, Blenkinsopp A. Patients' knowledge of new medicines after discharge from hospital: What are the effects of hospital-based discharge counseling and community-based medicines use reviews (MURs)? Res Social Adm Pharm 2017; 13:628-633. [DOI: 10.1016/j.sapharm.2016.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/03/2016] [Indexed: 11/30/2022]
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Jain K. Use of failure mode effect analysis (FMEA) to improve medication management process. Int J Health Care Qual Assur 2017; 30:175-186. [DOI: 10.1108/ijhcqa-09-2015-0113] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Medication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety.
Design/methodology/approach
The study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored.
Findings
The percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes.
Research limitations/implications
FMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing FMEA but also for implementing the corrective actions.
Practical implications
FMEA is an effective proactive risk-assessment tool and is a continuous process which can be continued in phases. The corrective actions taken resulted in reduction in RPN, subjected to further evaluation and usage by others depending on the facility type.
Originality/value
The application of the tool helped the hospital in identifying failures in medication management process, thereby prioritising and correcting them leading to improvement.
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Manias E, Gerdtz M, Williams A, McGuiness J, Dooley M. Communicating about the management of medications as patients move across transition points of care: an observation and interview study. J Eval Clin Pract 2016; 22:635-43. [PMID: 26762967 DOI: 10.1111/jep.12507] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES As patients move across transition points, effective medication management is critical for patient safety. The aims of this study were to examine how health professionals, patients and family members communicate about managing medications as patients moved across transition points of care and to identify possible sources of communication failure. METHOD A descriptive approach was used involving observations and interviews. The emergency departments and medical wards of two hospitals were involved. Observations focused on how health professionals managed medications during interactions with other health professionals, patients and family members, as patients moved across clinical settings. Follow-up interviews with participants were also undertaken. Thematic analysis was completed of transcribed data, and descriptive statistics were used to analyse characteristics of communication failure. RESULTS Three key themes were identified: environmental challenges, interprofessional relationships, and patient and family beliefs and responsibilities. As patients moved between environments, insufficient tracking occurred about medication changes. Before hospital admission, patients participated in self-care medication activities, which did not always involve exemplary behaviours or match the medications that doctors prescribed. During observations, 432 instances of communication failure (42.8%) were detected, which related to purpose, content, audience and occasion of the communication. CONCLUSIONS Extensive challenges exist involving the management of medications at transition points of care. Bedside handovers and ward rounds can be utilized as patient counselling opportunities about changes in the medication regimen. Greater attention is needed on how patients in the community make medication-related decisions.
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Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia. .,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia. .,Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
| | - Marie Gerdtz
- Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Emergency Department, The Royal Melbourne Hospital, Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison Williams
- Monash Nursing Academy, Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Josephine McGuiness
- Pharmacy Department, The Alfred, Prahran, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Michael Dooley
- Pharmacy Department, The Alfred, Prahran, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
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Almanasreh E, Moles R, Chen TF. The medication reconciliation process and classification of discrepancies: a systematic review. Br J Clin Pharmacol 2016; 82:645-58. [PMID: 27198753 PMCID: PMC5338112 DOI: 10.1111/bcp.13017] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022] Open
Abstract
AIMS Medication reconciliation is a part of the medication management process and facilitates improved patient safety during care transitions. The aims of the study were to evaluate how medication reconciliation has been conducted and how medication discrepancies have been classified. METHODS We searched MEDLINE, EMBASE, CINAHL, PubMed, International Pharmaceutical Abstracts (IPA), and Web of Science (WOS), in accordance with the PRISMA statement up to April 2016. Studies were eligible for inclusion if they evaluated the types of medication discrepancy found through the medication reconciliation process and contained a classification system for discrepancies. Data were extracted by one author based on a predefined table, and 10% of included studies were verified by two authors. RESULTS Ninety-five studies met the inclusion criteria. Approximately one-third of included studies (n = 35, 36.8%) utilized a 'gold' standard medication list. The majority of studies (n = 57, 60%) used an empirical classification system and the number of classification terms ranged from 2 to 50 terms. Whilst we identified three taxonomies, only eight studies utilized these tools to categorize discrepancies, and 11.6% of included studies used different patient safety related terms rather than discrepancy to describe the disagreement between the medication lists. CONCLUSIONS We suggest that clear and consistent information on prevalence, types, causes and contributory factors of medication discrepancy are required to develop suitable strategies to reduce the risk of adverse consequences on patient safety. Therefore, to obtain that information, we need a well-designed taxonomy to be able to accurately measure, report and classify medication discrepancies in clinical practice.
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Affiliation(s)
- Enas Almanasreh
- Faculty of Pharmacy, Pharmacy and Bank Building A15, The University of Sydney, NSW, 2006, Australia
| | - Rebekah Moles
- Faculty of Pharmacy, Pharmacy and Bank Building A15, The University of Sydney, NSW, 2006, Australia
| | - Timothy F Chen
- Faculty of Pharmacy, Pharmacy and Bank Building A15, The University of Sydney, NSW, 2006, Australia
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Eassey D, Smith L, Krass I, McLAchlan A, Brien JA. Consumer perspectives of medication-related problems following discharge from hospital in Australia: a quantitative study. Int J Qual Health Care 2016; 28:391-7. [DOI: 10.1093/intqhc/mzw047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 01/19/2023] Open
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Drancourt P, Atkinson S, Lebel D, Bussières JF. [Assessment of perception about medication reconciliation among healthcare professionals at Saint-Justine hospital]. ANNALES PHARMACEUTIQUES FRANÇAISES 2016; 74:304-16. [PMID: 26739918 DOI: 10.1016/j.pharma.2015.11.004] [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: 06/22/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Our main objective is to assess nurses and doctors perception about medication reconciliation. METHODS This is a descriptive and cross-sectional study. We have created three surveys, one for each health worker (nurses, doctors, resident, pharmacists). Each survey consists of single or multi-choice closed questions. A four-point Likert scale was used to collect the perception. Descriptive statistics have been calculated. RESULTS A total of 114 nurses, 98 doctors and residents and 26 pharmacists from all care services, replied to the survey. The majority of doctors (58%), pharmacists (60%) and nurses (52%) recognized the relevance and utility of medication reconciliation in healthcare safety. However, few healthcare professionals (6% of doctors, 13% of nurses et 46% of pharmacists) know that medication reconciliation is a required organizational practice. Only 25% of doctors always consult the best possible medication history after a patient admission while the majority do not use it because of unreliability issues. So, there have been some major changes to optimize medication reconciliation process in our hospital. CONCLUSION This study shows a increasing interest to medication reconciliation by healthcare professionals. However, the use of medication reconciliation remains marginal.
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Affiliation(s)
- P Drancourt
- Unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, QC, Canada
| | - S Atkinson
- Unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, QC, Canada
| | - D Lebel
- Unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, QC, Canada
| | - J-F Bussières
- Unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, QC, Canada; Faculté de pharmacie, université de Montréal, CP 6128, succursale Centre-ville, H3C 3J7 Montréal, QC, Canada.
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Bartlett Ellis RJ, Carmon AF, Pike C. A review of immediacy and implications for provider-patient relationships to support medication management. Patient Prefer Adherence 2016; 10:9-18. [PMID: 26792985 PMCID: PMC4710167 DOI: 10.2147/ppa.s95163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES This review is intended to 1) describe the construct of immediacy by analyzing how immediacy is used in social relational research and 2) discuss how immediacy behaviors can be incorporated into patient-provider interventions aimed at supporting patients' medication management. METHODS A literature search was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, OVID, PubMed, and Education Resource Information Center (ERIC) EBSCO with the keyword "immediacy". The literature was reviewed and used to describe historical conceptualizations, identify attributes, examine boundaries, and identify antecedents and consequences of immediacy. RESULTS In total, 149 articles were reviewed, and six attributes of immediacy were identified. Immediacy is 1) reciprocal in nature and 2) reflected in the communicator's attitude toward the receiver and the message, 3) conveys approachability, 4) respectfulness, 5) and connectedness between communicators, and 6) promotes receiver engagement. Immediacy is associated with affective learning, cognitive learning, greater recall, enhanced relationships, satisfaction, motivation, sharing, and perceptions of mutual value in social relationships. CONCLUSION Immediacy should be further investigated as an intervention component of patient-provider relationships and shared decision making in medication management. PRACTICE IMPLICATIONS In behavioral interventions involving relational interactions between interveners and participants, such as in medication management, the effects of communication behaviors and immediacy during intervention delivery should be investigated as an intervention component.
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Affiliation(s)
- Rebecca J Bartlett Ellis
- Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
- Correspondence: Rebecca J Bartlett Ellis, Science of Nursing Care Department, Indiana University School of Nursing, 1111 Middle Drive, E423, Indianapolis, IN 46202, USA, Tel +1 317 274 0047, Fax +1 317 278 2021, Email
| | - Anna F Carmon
- Communication Studies, Indiana University Purdue University Columbus, Columbus, IN, USA
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Johnson A, Guirguis E, Grace Y. Preventing medication errors in transitions of care: A patient case approach. J Am Pharm Assoc (2003) 2015; 55:e264-74; quiz e275-6. [PMID: 25749270 DOI: 10.1331/japha.2015.15509] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To discuss common causes of medication errors occurring upon transitions of care and review key interventions that should be implemented to ensure effective communication and accurate completion of medication reconciliation. DATA SOURCES MEDLINE (1946 to November 2014) using MeSH terms medication errors, medication reconciliation, and nursing homes in addition to conventional text words, including transitions of care and medication safety; Agency for Healthcare Research and Quality Patient Safety Network using search terms transitions of care, medication errors, and medication reconciliation; and relevant websites of national organizations pertaining to transitions of care and medication reconciliation. STUDY SELECTION Limited to English-language journals with no limitation set on the year of publication for clinical trials, meta-analyses, and reviews. DATA EXTRACTION At the authors' discretion, preference was given to references focusing on pharmacists' role in transitions of care and medication reconciliation. RESULTS Most medication errors stem from a lack of effective communication between health care providers during transitions of care. Part of successful communication and correct patient hand-off is completing accurate medication reconciliation. A patient case highlights a life-threatening medication error that occurred during a transition of care due to ineffective communication between a pharmacist and nurse while transferring medication information. CONCLUSION To provide patients with accurate medication information, pharmacists should perform medication reconciliation upon transitions of care using The Joint Commission's five-step process. Pharmacists can conduct numerous interventions to prevent medication errors during transitions of care and ensure patient safety. Pharmacists are integral to evaluating the appropriateness of medication use, ensuring information is updated in the health record, and verbally communicating accurate information to other health professionals.
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Belche JL, Berrewaerts MA, Ketterer F, Henrard G, Vanmeerbeek M, Giet D. [From chronic disease to multimorbidity: Which impact on organization of health care]. Presse Med 2015; 44:1146-54. [PMID: 26358669 DOI: 10.1016/j.lpm.2015.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/14/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022] Open
Abstract
Healthcare systems are concerned with the growing prevalence of chronic diseases. Single disease approach, based on the Chronic Care Model, is known to improve specific indicators for the targeted disease. However, the co-existence of several chronic disease, or multimorbidity, within a same patient is the most frequent situation. The fragmentation of care, as consequence of the single disease approach, has negative impact on the patient and healthcare professionals. A person centred approach is a method addressing the combination of health issues of each patient. The coordination and synthesis role is key to ensure continuity of care for the patient within a network of healthcare professionals from several settings of care. This function is the main characteristic of an organized first level of care.
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Affiliation(s)
- Jean-Luc Belche
- Université de Liège, département de médecine générale, Liège, Belgique.
| | | | - Frédéric Ketterer
- Université de Liège, département de médecine générale, Liège, Belgique
| | - Gilles Henrard
- Université de Liège, département de médecine générale, Liège, Belgique
| | - Marc Vanmeerbeek
- Université de Liège, département de médecine générale, Liège, Belgique
| | - Didier Giet
- Université de Liège, département de médecine générale, Liège, Belgique
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Effectiveness of an electronic tool for medication reconciliation in a general surgery department. Int J Clin Pharm 2015; 37:159-67. [PMID: 25557203 DOI: 10.1007/s11096-014-0057-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Medication reconciliation is a key tool in the prevention of adverse drug events. OBJECTIVE To assess the impact of an electronic reconciliation tool in decreasing unintended discrepancies between medications prescribed after surgery and the patient's usual treatment. SETTING General Surgery Department of Gregorio Marañón's University General Hospital, Madrid. METHOD A pre-post intervention study with no equivalent control group was carried out between June 2009 and December 2010. Patients hospitalized in the General Surgery Department for 24 h or more, and whose prescriptions prior to admission included three or more drugs were included in the study. Patients were interviewed to gather information about their usual treatment drugs. Discrepancies between the latter and the drugs prescribed after surgery were assessed before and after the medication reconciliation electronic tool was implemented. MAIN OUTCOME MEASURE Proportion of patients with at least one unintended discrepancy. RESULTS A total of 107 patients in the pre-intervention phase and 84 patients in the post-intervention phase were included. We detected 1,678 discrepancies, 167 were found to be unintended. The number of patients with at least one unintended discrepancy was 43 (40.2 %) in the pre-intervention phase, and 38 (38.1 %) in the post-intervention phase, p = 0.885. The percentage of unintended discrepancies over the total amount of drugs reconciled was lower in the post-intervention phase than in the pre-intervention phase (6.6 vs. 10.6 %), p = 0.002. Regarding unintended discrepancies 79.2 % were grade C severity (the error reached the patient but caused no harm), 13.6 % grade D (the error reached the patient and required monitoring or intervention to preclude harm) and 7.1 % grade E (the error may have contributed to or resulted in temporary harm to the patient and required intervention). CONCLUSION Implementation of an electronic tool facilitated the process of medication reconciliation in a general surgery unit. The proportion of unintended discrepancies over the total amount of drugs reconciled was reduced after the implementation of the reconciliation programme. However, we could not demonstrate a more significant impact due to some methodological limitations.
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Claeys C, Foulon V, de Winter S, Spinewine A. Initiatives promoting seamless care in medication management: an international review of the grey literature. Int J Clin Pharm 2014; 35:1040-52. [PMID: 24022724 DOI: 10.1007/s11096-013-9844-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 08/26/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patients' transition between hospital and community is a high-risk period for the occurrence of medication-related problems. AIM OF THE REVIEW The objective was to review initiatives, implemented at national and regional levels in seven selected countries, aiming at improving continuity in medication management upon admission and hospital discharge. METHOD We performed a structured search of grey literature, mainly through relevant websites (scientific, professional and governmental organizations). Regional or national initiatives were selected. For each initiative data on the characteristics, impact, success factors and barriers were extracted. National experts were asked to validate the initiatives identified and the data extracted. RESULTS Most initiatives have been implemented since the early 2000 and are still ongoing. The principal actions include: development and implementation of guidelines for healthcare professionals, national information campaigns, education of healthcare professionals and development of information technologies to share data across settings of care. Positive results have been partially reported in terms of intake into practice or process measures. Critical success factors identified included: leadership and commitment to convey national and local forces, tailoring to local settings, development of a regulatory framework and information technology support. Barriers identified included: lack of human and financial resources, questions relative to responsibility and accountability, lack of training and lack of agreement on privacy issues. CONCLUSION Although not all initiatives are applicable as such to a particular healthcare setting, most of them convey very interesting data that should be used when drawing recommendations and implementing approaches to optimize continuity of care.
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