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Trutwin-Bornhöft S, Schumacher J, Döring I, Hennen D. [Drug Therapy Safety in Outpatient Care Services]. DAS GESUNDHEITSWESEN 2023; 85:427-434. [PMID: 35213897 PMCID: PMC11248391 DOI: 10.1055/a-1727-5672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Due to frequent multi-medication, older people are particularly vulnerable to adverse drug reactions (ADRs), which increase hospitalisation and mortality rates. If specially trained pharmacists and nursing staff assume more responsibility in the use of medicines by the elderly, risks can be avoided. METHODS A voluntary survey was conducted with care managers of ambulatory care services using a predefined survey questionnaire, and the medicines stored and provided were examined. RESULTS Medicines were stored in 76% of the 104 ambulatory care services surveyed. In 63% of these, medicines in stock were examined, and in 55% a comparison was made between prescribed and provided medicines. Deficiencies were found in about half of the inspected boxes and dosettes. On average, 1.5 errors were found per checked unit; 40% of the nursing services left the medicines in the vehicle for 3 to 6 hours when transporting them to the client. Regular meetings with doctors' practices or pharmacies were conducted by less than 35% of the these services. In 41 out of the 104 services surveyed, investigators monitoring therapy rated the performance of the nursing staff positively. CONCLUSIONS Therapy monitoring and cooperation of ambulatory care services with other health professionals, especially with pharmacists, needs to be improved. More care and control (e. g., through the four-eyes principle) should be exercised, especially in the provision of medicines. In future, further precisely conducted and representative surveys on medication processes in outpatient care need to be carried out. Analogous to existing studies, there were indications of quality and communication problems as well as weaknesses in therapy monitoring in ambulatory care services. Sources of error were mainly found in storage and transport of medicines. Errors were also evident in the provision of medicines. Due to the lack of participation obligations, the results of the study are limited.
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Affiliation(s)
| | | | - Inge Döring
- Gesundheitsamt Kreis Heinsberg, Heinsberg, Germany
| | - Desirée Hennen
- Arzneimittelversorgung, Apotheke an der Voltmannstraße, Bielefeld, Germany
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De Baetselier E, Dilles T, Feyen H, Haegdorens F, Mortelmans L, Van Rompaey B. Nurses' responsibilities and tasks in pharmaceutical care: A scoping review. Nurs Open 2021; 9:2562-2571. [PMID: 34268910 PMCID: PMC9584497 DOI: 10.1002/nop2.984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/27/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022] Open
Abstract
Aim To provide an overview of responsibilities and tasks of nurses in pharmaceutical care. Design Scoping review. Methods Two databases were systematically searched (MEDLINE and Scopus) for recent original research papers concerning nurses’ responsibilities and tasks in pharmaceutical care. The definition of responsibility was based on literature, moral and ethical discussions. Existing responsibilities and tasks beyond preparation and administration of medication were collected and synthesized. This main study outcome was extracted from titles and abstracts only. Results were reported in accordance with PRISMA‐ScR guidelines. Results Of the 3,805 titles and abstracts reviewed, 453 abstracts were included. A total of seven responsibilities were identified: (a) management of therapeutic and adverse effects of medication, (b) management of medication adherence, (c) management of patient medication self‐management, (d) management of patient education and information about medication, (e) prescription management, (f) medication safety management and (g) (transition of) care coordination. Within these responsibilities, all tasks performed by nurses were described.
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Affiliation(s)
- Elyne De Baetselier
- Department of Nursing and Midwifery Science, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tinne Dilles
- Department of Nursing and Midwifery Science, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hilde Feyen
- Department of Nursing and Midwifery Science, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Filip Haegdorens
- Department of Nursing and Midwifery Science, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Laura Mortelmans
- Department of Nursing and Midwifery Science, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Bart Van Rompaey
- Department of Nursing and Midwifery Science, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Logan V, Keeley S, Akerman K, De Baetselier E, Dilles T, Griffin N, Matthews L, Van Rompaey B, Jordan S. Did we do everything we could have? Nurses' contributions to medicines optimization: A mixed-methods study. Nurs Open 2021; 8:592-606. [PMID: 33570308 PMCID: PMC7877145 DOI: 10.1002/nop2.664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/24/2020] [Accepted: 10/07/2020] [Indexed: 12/17/2022] Open
Abstract
AIM To explore UK professionals' interpretations of medicines optimization and expansion of nurses' roles. DESIGN This mixed-methods study sought professionals' views on nurses' involvement, competency and engagement in monitoring patients for adverse effects of medicines, monitoring adherence, prescribing and patient education. METHOD An online survey and interviews were undertaken with nurses, doctors and pharmacists in Wales and England, May 2018 to July 2019. RESULTS In all, 220 nurses, 17 doctors and 62 pharmacists responded to the online survey, and 24 professionals were interviewed. Nurses were divided over extending their roles, with 123/220 (55.9%) wishing to extend roles in monitoring patients for possible adverse drug reactions (ADRs), 111/220 (50.5%) in adherence monitoring, 121/220 (55.0%) in prescribing and 122/220 (55.4%) in patient education. The best-qualified nurses were the most willing to increase involvement in monitoring patients for ADRs (aOR 13.00, 1.56-108.01). Interviews revealed that both nurses and doctors assumed the other profession was undertaking this monitoring. Respondents agreed that increasing nurses' involvement in medicines optimization would improve patient care, but expressed reservations about nurses' competencies. Collaboration between nurses and doctors was suboptimal (rated 7/10 at best) and between nurses and pharmacists even more so (6/10 at best). CONCLUSION Juxtaposition of datasets identified problems with medicines optimization: although most respondents agreed that increasing nurses' involvement would positively impact practice, their educational preparation was a barrier. Only ~50% of nurses were willing to expand their roles to fill the hiatus in care identified and ensure that at least one profession was taking responsibility for ADR monitoring. IMPACT To improve multiprofessional team working and promote patient safety, nurse leaders should ensure patients are monitored for possible ADRs by at least one profession. Initiatives expanding nurses' roles in medicines optimization and prescribing might be best targeted towards the more educated nurses, who have multidisciplinary support.
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Affiliation(s)
- Vera Logan
- Department of NursingSwansea UniversitySwanseaUnited Kingdom
| | | | - Kevin Akerman
- Department of NursingSwansea UniversitySwanseaUnited Kingdom
| | - Elyne De Baetselier
- Faculty of Medicine and Health SciencesCRIC (Center of Research and Innovation in Care)NuPhaCUniversity of AntwerpAntwerpenBelgium
| | - Tinne Dilles
- Faculty of Medicine and Health SciencesCRIC (Center of Research and Innovation in Care)NuPhaCUniversity of AntwerpAntwerpenBelgium
| | - Nia Griffin
- Department of NursingSwansea UniversitySwanseaUnited Kingdom
| | - Lisa Matthews
- Department of NursingSwansea UniversitySwanseaUnited Kingdom
| | - Bart Van Rompaey
- Faculty of Medicine and Health SciencesCRIC (Center of Research and Innovation in Care)NuPhaCUniversity of AntwerpAntwerpenBelgium
| | - Sue Jordan
- Department of NursingSwansea UniversitySwanseaUnited Kingdom
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Jordan S, Prout H, Carter N, Dicomidis J, Hayes J, Round J, Carson-Stevens A. Nobody ever questions-Polypharmacy in care homes: A mixed methods evaluation of a multidisciplinary medicines optimisation initiative. PLoS One 2021; 16:e0244519. [PMID: 33411824 PMCID: PMC7790299 DOI: 10.1371/journal.pone.0244519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/10/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Nurse-led monitoring of patients for signs and symptoms associated with documented 'undesirable effects' of medicines has potential to prevent avoidable harm, and optimise prescribing. INTERVENTION The Adverse Drug Reaction Profile for polypharmacy (ADRe-p) identifies and documents putative adverse effects of medicines commonly prescribed in primary care. Nurses address some problems, before passing ADRe-p to pharmacists and prescribers for review, in conjunction with prescriptions. OBJECTIVES We investigated changes in: the number and nature of residents' problems as recorded on ADRe-p; prescription regimens; medicines optimisation: and healthcare costs. We explored aetiologies of problems identified and stakeholders' perspectives. SETTING AND PARTICIPANTS In three UK care homes, 19 residents completed the study, December 2018 to May 2019. Two service users, three pharmacists, six nurses gave interviews. METHODS This mixed-method process evaluation integrated data from residents' ADRe-ps and medicines charts, at the study's start and 5-10 weeks later. RESULTS We recruited three of 27 homes approached and 26 of 45 eligible residents; 19 completed ADRe-p at least twice. Clinical gains were identified for 17/19 residents (mean number of symptoms 3 SD 1.67, range 0-7). Examples included management of: pain (six residents), seizures (three), dyspnoea (one), diarrhoea (laxatives reduced, two), falls (two of five able to stand). One or more medicine was de-prescribed or dose reduced for 12/19 residents. ADRe administration and review cost ~£30 in staff time. ADRe-p helped carers and nurses bring residents' problems to the attention of prescribers. IMPLICATIONS ADRe-p relieved unnecessary suffering. It supported carers and nurses by providing a tool to engage with pharmacists and prescribers, and was the only observable strategy for multidisciplinary team working around medicines optimisation. ADRe-p improved care by: a) regular systematic checks and problem documentation; b) information transfer from care home staff to prescribers and pharmacists; c) recording changes. REGISTRATION NLM Identifier NCT03955133; ClinicalTrials.gov.
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Affiliation(s)
- Sue Jordan
- Faculty of Health and Life Science, Swansea University, Swansea, United Kingdom
| | - Hayley Prout
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Neil Carter
- Faculty of Health and Life Science, Swansea University, Swansea, United Kingdom
| | - John Dicomidis
- Care Home Governance and National Lead Pharmacy Informatics, Pontypool, Wales, United Kingdom
| | - Jamie Hayes
- School of Pharmacy and Pharmaceutical Sciences, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Jeffrey Round
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
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Looking for the "Little Things": A Multi-Disciplinary Approach to Medicines Monitoring for Older People Using the ADRe Resource. Geriatrics (Basel) 2020; 5:geriatrics5040079. [PMID: 33086499 PMCID: PMC7709700 DOI: 10.3390/geriatrics5040079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 01/29/2023] Open
Abstract
Advances in medicines have increased the effectiveness of treatments and the social and cultural authority of doctors. However, as prescribing has become the dominant modality of treatment, the “pharmaceuticalization” of medical practice has often resulted in treatment “at a distance”, with doctors having limited contact with patients. Older and poorer people, who are socially distanced from medical prescribers, suffer more adverse drug reactions (ADRs) than the general population. A team approach to checking patients systematically for ADRs, as detailed in manufacturers’ literature, can minimise medication errors, but regular review is rare. This paper explains the benefits of medicines monitoring to protect older patients from iatrogenic harm, such as over-sedation, falls, or drug-induced Parkinsonism. We show how multidisciplinary initiatives to optimise prescribing can be supported by using a recognised resource—the adverse drug reaction profile (ADRe). The profile identifies and documents patients’ signs and symptoms of putative ADRs. Better monitoring allows professionals to adjust prescribing and respond to identified problems with agility. Implementation of systematic monitoring will require changes to the regulatory regime and better inter-professional cooperation. Providing carers, nurses and pharmacists with a structured system to monitor patients would democratise relevant medical knowledge and help address ageism and the socio-economic health divide.
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The Current Status of Genes and Genetic Testing in Emergency Medicine: A Narrative Review. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2020; 4:e10. [PMID: 31938779 PMCID: PMC6955026 DOI: 10.22114/ajem.v0i0.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Context: An emergency is any medical problem that could cause death or permanent injury if not treated quickly. In some occasions, the kind of urgent intervention depends on patient’s exact genetic background. Unfortunately, the importance of genes in medical emergencies has been forgotten in recent decades. Evidence acquisition: In order to find relevant articles, we searched two databases of Pubmed and Embase. The exact words of “genes”, “genetics”, “epigenetics”, “DNA”, and “emergency” were used alone and in combination. All studies like randomized clinical trials (RCT), case/controls, case series, case reports, and review articles were studied to find the related data. No time limitation was considered for the studies. Results: Several aspects of genetic testing are newly considered in emergency departments including cell-free DNA (cfDNA) for disease diagnosis, pharmacogenetics for decreasing the adverse drug effects, and personalized medicine for exact emergency interventions in diseases like Vascular Ehlers-Danlos syndrome (vEDS). Data from genetic testing and genome wide association studies have yielded promising results to make medical emergency interventions more beneficial in the near future. Conclusion: Taking everything into consideration, several advanced genetic and epigenetic alteration technologies can change emergency medicine for the better. Personalized genetic data of patients can turn emergency medicine to personalized medicine.
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Jordan S, Banner T, Gabe-Walters M, Mikhail JM, Panes G, Round J, Snelgrove S, Storey M, Hughes D. Nurse-led medicines' monitoring in care homes, implementing the Adverse Drug Reaction (ADRe) Profile improvement initiative for mental health medicines: An observational and interview study. PLoS One 2019; 14:e0220885. [PMID: 31509537 PMCID: PMC6738583 DOI: 10.1371/journal.pone.0220885] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/25/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Preventable adverse effects of medicines often pass unnoticed, but lead to real harm. Intervention Nurse-led monitoring using the structured Adverse Drug Reaction (ADRe) Profile identifies and addresses adverse effects of mental health medicines. Objectives This study investigated the implementation and clinical impact of ADRe, and barriers to and facilitators of sustained utilisation in routine practice. Methods Administration of ADRe was observed for 30 residents prescribed mental health medicines in ten care homes. The study pharmacist reviewed completed ADRes against medication records. Policy context was explored in 30 interviews with service users, nurse managers and strategic leads in Wales. Results Residents were aged 60–95, and prescribed 1–17 (median 9 [interquartile range (IQR) 7–13]) medicines. ADRe identified a median of 18 [IQR 11.5–23] problems per resident and nurses made 2 [1–2] changes to care per resident. For example: falls were reported for 9 residents, and care was modified for 5; pain was identified in 8 residents, and alleviated for 7; all 6 residents recognised as dyspnoeic were referred to prescribers. Nurses referred 17 of 30 residents to prescribers. Pharmacists recommended review for all 30. Doubts about administering ADRe, sometimes expressed by people who had not yet used it, diminished as it became familiar. ADRe was needed to bridge communication between resident, nurses and prescribers. When barriers of time, complacency, and doctors’ non-availability were overcome, reporting with ADRe made prescribers more likely to heed nurses’ concerns regarding residents’ welfare. Clinical gains were facilitated by one-to-one time, staff-resident relationships, and unification of documentation. Implications To our knowledge, ADRe is the only instrument that brings a full account of patients’ problems to medication reviews. This juxtaposition of signs and symptoms against prescriptions facilitates dose adjustments and de-prescribing and leads to: reduced pain and sedation; early identification of problems linked to ADRs, such as falls; and timely medication reviews e.g. for dyspnoea.
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Affiliation(s)
- Sue Jordan
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- * E-mail:
| | - Timothy Banner
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- Cardiff and Vale University Health Board, Wales, United Kingdom
| | | | - Jane M. Mikhail
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Gerwyn Panes
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Jeff Round
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Sherrill Snelgrove
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Mel Storey
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- Hywel Dda University Health Board, Wales, United Kingdom
| | - David Hughes
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
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Johansson-Pajala RM, Martin L, Jorsäter Blomgren K. Registered nurses' use of computerised decision support in medication reviews. Int J Health Care Qual Assur 2018; 31:531-544. [PMID: 29954263 DOI: 10.1108/ijhcqa-01-2017-0009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to explore the implications of registered nurses' (RNs) use of a computerized decision support system (CDSS) in medication reviews. Design/methodology/approach The paper employs a quasi-experimental, one-group pre-test/post-test design with three- and six-month follow-ups subsequent to the introduction of a CDSS. In total, 11 RNs initiated and prepared a total of 54 medication reviews. The outcome measures were the number of drug-related problems (DRPs) as reported by the CDSS and the RNs, respectively, the RNs' views on the CDSS, and changes in the quality of drug treatment. Findings The CDSS significantly indicated more DRPs than the RNs did, such as potential adverse drug reactions (ADRs). The RNs detected additional problems, outside the scope of the CDSS, such as lack of adherence. They considered the CDSS beneficial and wanted to continue using it. Only minor changes were found in the quality of drug treatments, with no significant changes in the drug-specific quality indicators (e.g. inappropriate drugs). However, the use of renally excreted drugs in reduced renal function decreased. Practical implications The RNs' use of a CDSS in medication reviews is of value in detecting potential ADRs and interactions. Yet, in order to have an impact on outcomes in the quality of drug treatment, further measures are needed. These may involve development of inter-professional collaboration, such as established procedures for the implementation of medication reviews, including the use of CDSS. Originality/value This is, to the best of the authors' knowledge, the first study to explore the implications of medication reviews, initiated and prepared by RNs who use a CDSS. The paper adds further insight into the RNs' role in relation to quality of drug treatments.
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Jordan S, Banner T, Gabe-Walters M, Mikhail JM, Round J, Snelgrove S, Storey M, Wilson D, Hughes D. Nurse-led medicines' monitoring in care homes study protocol: a process evaluation of the impact and sustainability of the adverse drug reaction (ADRe) profile for mental health medicines. BMJ Open 2018; 8:e023377. [PMID: 30269073 PMCID: PMC6169755 DOI: 10.1136/bmjopen-2018-023377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/02/2018] [Accepted: 08/07/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Improved medicines' management could lead to real and sustainable improvements to the care of older adults. The overuse of mental health medicines has featured in many reports, and insufficient patient monitoring has been identified as an important cause of medicine-related harms. Nurse-led monitoring using the structured adverse drug reaction (ADRe) profile identifies and addresses the adverse effects of mental health medicines. Our study investigates clinical impact and what is needed to sustain utilisation in routine practice in care homes. METHODS AND ANALYSIS This process evaluation will use interviews and observations with the participants of all five homes involved in earlier research, and five newly recruited homes caring for people prescribed mental health medicines. The ADRe profile is implemented by nurses, within existing resources, to check for signs and symptoms of ADRs, initiate amelioration and share findings with pharmacists and prescribers for medication review. Outcome measures are the numbers and nature of problems addressed and understanding of changes needed to optimise clinical gain and sustain implementation. Data will be collected by 30 observations and 30 semistructured interviews. Clinical gains will be described and narrated. Interview analysis will be based on the constant comparative method. ETHICS AND DISSEMINATION Ethical approval was conferred by the National Health Service Wales Research Ethics Committee. If the ADRe profile can be sustained in routine practice, it has potential to (1) improve the lives of patients, for example, by reducing pain and sedation, and (2) assist in early identification of problems caused by ADRs. Therefore, in addition to peer-reviewed publications and conferences, we shall communicate our findings to healthcare professionals, policy-makers and sector regulators. TRIAL REGISTRATION NUMBER NCT03110471.
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Affiliation(s)
- Sue Jordan
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Timothy Banner
- Welsh School of Pharmacy, Cardiff University, Cardiff, UK
| | | | - Jane M Mikhail
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Jeff Round
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Mel Storey
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Douglas Wilson
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - David Hughes
- College of Human and Health Sciences, Swansea University, Swansea, UK
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Jordan S, Logan PA, Panes G, Vaismoradi M, Hughes D. Adverse Drug Reactions, Power, Harm Reduction, Regulation and the ADRe Profiles. PHARMACY 2018; 6:E102. [PMID: 30231573 PMCID: PMC6165166 DOI: 10.3390/pharmacy6030102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 12/15/2022] Open
Abstract
The power and influence of healthcare systems comes largely from the ability to prescribe efficacious medicine. However, medicine can sometimes cause harm rather than bring benefits. Systematically checking patients for the adverse effects of medicines, as listed in manufacturers' literature, would protect patients from iatrogenic harm, but this is rarely undertaken. We argue for the benefits of this approach using the example of the prescription of antipsychotics to older adults. Prescribing antipsychotics to control challenging behaviours associated with dementia is a controversial matter, and regulatory intervention is under discussion. Improved regulatory systems could protect against iatrogenic harm, such as over-sedation, falls, tremor, or drug-induced Parkinsonism. However, measuring the impact and outcomes of regulatory interventions has proved difficult, not least because there are rarely systematic records of all adverse effects of medicines. We indicate how regulatory initiatives to reduce antipsychotic prescribing can be supported by systematic monitoring and documentation of patients' signs and symptoms of putative adverse drug reactions. Monitoring documentation then provides the rationale and support for professionals' responses to identified problems. Longitudinal monitoring records would improve understanding of the impact and outcomes of adverse drug reactions (ADRs) on health and wellbeing, and the many costs of ADRs.
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Affiliation(s)
- Sue Jordan
- College of Human and Health Sciences, Swansea University, Swansea SA2 8PP, UK.
| | - Patricia A Logan
- Faculty of Science, Charles Sturt University, Bathurst Campus, NSW 2795, Australia.
| | - Gerwyn Panes
- College of Human and Health Sciences, Swansea University, Swansea SA2 8PP, UK.
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway.
| | - David Hughes
- College of Human and Health Sciences, Swansea University, Swansea SA2 8PP, UK.
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Soerensen AL, Lisby M, Nielsen LP, Poulsen BK, Mainz J. Improving Medication Safety in Psychiatry - A Controlled Intervention Study of Nurse Involvement in Avoidance of Potentially Inappropriate Prescriptions. Basic Clin Pharmacol Toxicol 2018; 123:174-181. [DOI: 10.1111/bcpt.12989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/12/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Ann L. Soerensen
- Danish Center for Healthcare Improvements; Faculty of Social Science; Aalborg University; Aalborg Denmark
- University College of Northern Denmark; Aalborg Denmark
| | - Marianne Lisby
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus Denmark
| | - Lars P. Nielsen
- Department of Clinical Pharmacology; Aarhus University Hospital; Aarhus Denmark
| | - Birgitte K. Poulsen
- Department of Clinical Pharmacology; Aarhus University Hospital; Aarhus Denmark
| | - Jan Mainz
- Department of Psychiatry; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Faculty of Health; Aalborg University; Aalborg Denmark
- Department of Community Mental Health; The University of Haifa; Haifa Israel
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Angelis AD, Pancani L, Steca P, Colaceci S, Giusti A, Tibaldi L, Alvaro R, Ausili D, Vellone E. Testing an explanatory model of nurses' intention to report adverse drug reactions in hospital settings. J Nurs Manag 2017; 25:307-317. [PMID: 28127821 DOI: 10.1111/jonm.12467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/01/2022]
Abstract
AIM To test an explanatory model of nurses' intention to report adverse drug reactions in hospital settings, based on the theory of planned behaviour. BACKGROUND Under-reporting of adverse drug reactions is an important problem among nurses. METHODS A cross-sectional design was used. Data were collected with the adverse drug reporting nurses' questionnaire. Confirmatory factor analysis was performed to test the factor validity of the adverse drug reporting nurses' questionnaire, and structural equation modelling was used to test the explanatory model. RESULTS The convenience sample comprised 500 Italian hospital nurses (mean age = 43.52). Confirmatory factor analysis supported the factor validity of the adverse drug reporting nurses' questionnaire. The structural equation modelling showed a good fit with the data. Nurses' intention to report adverse drug reactions was significantly predicted by attitudes, subjective norms and perceived behavioural control (R² = 0.16). CONCLUSIONS The theory of planned behaviour effectively explained the mechanisms behind nurses' intention to report adverse drug reactions, showing how several factors come into play. IMPLICATIONS FOR NURSING MANAGEMENT In a scenario of organisational empowerment towards adverse drug reaction reporting, the major predictors of the intention to report are support for the decision to report adverse drug reactions from other health care practitioners, perceptions about the value of adverse drug reaction reporting and nurses' favourable self-assessment of their adverse drug reaction reporting skills.
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Affiliation(s)
- Alessia De Angelis
- Department of Nursing, Local Health Authority Roma 4, Civitavecchia, Rome, Italy
| | - Luca Pancani
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Patrizia Steca
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Sofia Colaceci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Angela Giusti
- National Center of Epidemiology, Surveillance and Health Promotion National Institute of Health, Rome, Italy
| | - Laura Tibaldi
- Department of Nursing, Local Health Authority Roma 4, Civitavecchia, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Johansson-Pajala RM, Gustafsson LK, Jorsäter Blomgren K, Fastbom J, Martin L. Nurses' use of computerised decision support systems affects drug monitoring in nursing homes. J Nurs Manag 2016; 25:56-64. [DOI: 10.1111/jonm.12430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 01/23/2023]
Affiliation(s)
| | | | | | - Johan Fastbom
- Aging Research Center; Karolinska Institutet and Stockholm University; Stockholm Sweden
| | - Lene Martin
- School of Health; Care and Social Welfare; Mälardalen University; Eskilstuna Sweden
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Vaismoradi M, Griffiths P, Turunen H, Jordan S. Transformational leadership in nursing and medication safety education: a discussion paper. J Nurs Manag 2016; 24:970-980. [DOI: 10.1111/jonm.12387] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Pauline Griffiths
- College of Human and Health Sciences; Swansea University; Swansea UK
| | - Hannele Turunen
- Department of Nursing Science; University of Eastern Finland; Kuopio University Hospital; Kuopio Finland
| | - Sue Jordan
- College of Human and Health Sciences; Swansea University; Swansea UK
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Johansson-Pajala RM, Jorsäter Blomgren K, Bastholm-Rahmner P, Fastbom J, Martin L. Nurses in municipal care of the elderly act as pharmacovigilant intermediaries: a qualitative study of medication management. Scand J Prim Health Care 2016; 34:37-45. [PMID: 26846298 PMCID: PMC4911024 DOI: 10.3109/02813432.2015.1132891] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore registered nurses' experience of medication management in municipal care of the elderly in Sweden, with a focus on their pharmacovigilant activities. DESIGN A qualitative approach using focus-group discussions was chosen in order to provide in-depth information. Data were analysed by qualitative content analysis. SETTING Five focus groups in five different long-term care settings in two regions in Sweden. SUBJECT A total of 21 registered nurses (RNs), four men and 17 women, aged 27-65 years, with 4-34 years of nursing experience. RESULTS The findings reveal that RNs in municipal long-term care settings can be regarded as "vigilant intermediaries" in the patients' drug treatments. They continuously control the work of staff and physicians and mediate between them, and also compensate for existing shortcomings, both organizational and in the work of health care professionals. RNs depend on other health care professionals to be able to monitor drug treatments and ensure medication safety. They assume expanded responsibilities, sometimes exceeding their formal competence, and try to cover for deficiencies in competence, experience, accessibility, and responsibility-taking. CONCLUSION The RNs play a central but also complex role as "vigilant intermediaries" in the medication monitoring process, including the issue of responsibility. Improving RNs' possibility to monitor their patients' drug treatments would enable them to prevent adverse drug events in their daily practice. New strategies are justified to facilitate RNs' pharmacovigilant activities. KEY POINTS This study contributes to the understanding of registered nurses' (RNs') role in medication management in municipal care of the elderly (i.e. detecting, assessing, and preventing adverse drug events or any drug-related problems). RNs can be considered to be "vigilant intermediaries" in elderly patients' drug treatments, working at a distance from staff, physicians, and patients. RNs occasionally take on responsibilities that exceed their formal competence, with the patients' best interests in mind. In order to prevent adverse drug events in municipal care of the elderly, new strategies are justified to facilitate RNs' pharmacovigilant activities.
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Affiliation(s)
- Rose-Marie Johansson-Pajala
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
- CONTACT Rose-Marie Johansson-Pajala Mälardalen University, School of Health, Care and Social Welfare, PO Box 325, SE-631 05 Eskilstuna, Sweden
| | | | - Pia Bastholm-Rahmner
- Medical Management Centre, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Jordan S, Gabe-Walters ME, Watkins A, Humphreys I, Newson L, Snelgrove S, Dennis MS. Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial. PLoS One 2015; 10:e0140203. [PMID: 26461064 PMCID: PMC4603896 DOI: 10.1371/journal.pone.0140203] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/21/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND People with dementia are susceptible to adverse drug reactions (ADRs). However, they are not always closely monitored for potential problems relating to their medicines: structured nurse-led ADR Profiles have the potential to address this care gap. We aimed to assess the number and nature of clinical problems identified and addressed and changes in prescribing following introduction of nurse-led medicines' monitoring. DESIGN Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care. SETTING Five UK private sector care homes. PARTICIPANTS 41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine. INTERVENTION Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step. OUTCOMES Problems addressed and changes in medicines prescribed. DATA COLLECTION AND ANALYSIS Information was collected from participants' notes before randomisation and after each of five monthly trial steps. The impact of the Profile on problems found, actions taken and reduction in mental health medicines was explored in multivariate analyses, accounting for data collection step and site. RESULTS Five of 10 sites and 43 of 49 service users approached participated. Profile administration increased the number of problems addressed from a mean of 6.02 [SD 2.92] to 9.86 [4.48], effect size 3.84, 95% CI 2.57-4.11, P <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78-8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80-235.90] and 5.12 [1.45-18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15-17.22). CONCLUSION The WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines. TRIAL REGISTRATION ISRCTN 48133332.
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Affiliation(s)
- Susan Jordan
- College of Human and Health Sciences, Swansea University, Swansea, Wales
| | | | - Alan Watkins
- College of Medicine, Swansea University, Swansea, Wales
| | - Ioan Humphreys
- College of Human and Health Sciences, Swansea University, Swansea, Wales
| | - Louise Newson
- College of Human and Health Sciences, Swansea University, Swansea, Wales
| | - Sherrill Snelgrove
- College of Human and Health Sciences, Swansea University, Swansea, Wales
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De Angelis A, Colaceci S, Giusti A, Vellone E, Alvaro R. Factors that condition the spontaneous reporting of adverse drug reactions among nurses: an integrative review. J Nurs Manag 2015; 24:151-63. [PMID: 25974355 DOI: 10.1111/jonm.12310] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 11/28/2022]
Abstract
AIM To describe and synthesise previous research on factors conditioning the spontaneous reporting of adverse drug reactions among nurses. BACKGROUND Spontaneous reports of adverse drug reactions by health-care providers, are a main instrument for the continuous evaluation of the risk-benefit ratio of every drug. Under-reporting of adverse drug reactions by all health-care providers, in particular by nurses, is a major limitation to this system. EVALUATION An integrated review of the literature was conducted using MEDLINE, CINAHL, Embase, Scopus databases and Google Scholar. After evaluation for appropriateness related to inclusion/exclusion criteria, 16 studies were included in the final analysis and synthesis. KEY ISSUES Two factors emerged from the study: (1) intrinsic factors related to nurses' knowledge and attitudes; (2) extrinsic factors related to nurses' interaction with health-care organisations and to the relationship between nurses and physicians. Nurses' attitudes that hinder reporting include ignorance, insecurity, fear and lethargy. CONCLUSIONS Nurses are not fully aware of their role in adverse drug reaction reporting. Nurses must acquire greater knowledge to implement specific skills into their daily clinical practice. IMPLICATIONS FOR NURSING MANAGEMENT To improve nurses' reporting of adverse drug reactions, it is necessary to develop management approaches that modify both intrinsic and extrinsic factors.
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Affiliation(s)
- Alessia De Angelis
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Sofia Colaceci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Angela Giusti
- National Centre of Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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18
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Johansson-Pajala RM, Martin L, Fastbom J, Jorsäter Blomgren K. Nurses' self-reported medication competence in relation to their pharmacovigilant activities in clinical practice. J Eval Clin Pract 2015; 21:145-52. [PMID: 25327625 DOI: 10.1111/jep.12263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Adverse drug reactions (ADRs) represent a major health problem and previous studies show that nurses can have an active role in promoting medication safety. The aim of this study was to describe and evaluate nurses' self-reported competence and pharmacovigilant activities in clinical practice and also to explore the impact of age, education, workplace and nursing experience on these matters. METHODS This cross-sectional study was based on a questionnaire covering areas related to nurses' medication competence, including knowledge, assessment and information retrieval, and pharmacovigilant activities within these areas, for example, the detection and assessment of ADRs. A 45-item questionnaire was 2013 sent out to 296 nurses in different settings and counties in Sweden. They were selected on the basis of having applied to a university course including pharmacovigilance during 2008-2011. One hundred twenty-four had participated in the courses (exposed) and 172 had applied to the courses but not participated (unexposed). RESULTS Completed questionnaires were obtained from 75 exposed (60%) and 93 unexposed (54%) nurses. Overall nurses rated themselves high in medication competence but low in pharmacovigilant activities. Significant (P ≤ 0.001) differences between groups were observed regarding medication competence. The exposure of completed dedicated courses in pharmacovigilance was the strongest factor for self-reported medication competence when adjusted for age, other education, workplace and experience. No significant differences between the groups were found regarding the number of pharmacovigilant activities during the 6 months prior to answering the questionnaire. CONCLUSION Dedicated university courses improved nurses' self-reported competence in pharmacovigilance but did not increase the number of related activities. Education per se seems to be not sufficient to generate pharmacovigilant activities among nurses.
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Medication monitoring in a nurse-led respiratory outpatient clinic: pragmatic randomised trial of the West Wales Adverse Drug Reaction Profile. PLoS One 2014; 9:e96682. [PMID: 24798210 PMCID: PMC4010491 DOI: 10.1371/journal.pone.0096682] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 04/04/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the clinical effect of medication monitoring using the West Wales Adverse Drug Reaction (ADR) Profile for Respiratory Medicine. Design Single-site parallel-arm pragmatic trial using stratified randomisation. Setting Nurse-led respiratory outpatient clinic in general hospital in South Wales. Participants 54 patients with chronic respiratory disease receiving bronchodilators, corticosteroids or leukotriene receptor antagonists. Intervention Following initial observation of usual nursing care, we allocated participants at random to receive at follow up: either the West Wales ADR Profile for Respiratory Medicine in addition to usual care (‘intervention arm’ with 26 participants); or usual care alone (‘control arm’ with 28 participants). Main Outcome Measures Problems reported and actions taken. Results We followed up all randomised participants, and analysed data in accordance with treatment allocated. The increase in numbers of problems per participant identified at follow up was significantly higher in the intervention arm, where the median increase was 20.5 [inter-quartile range (IQR) 13–26], while that in the control arm was −1 [−3 to +2] [Mann-Whitney U test: z = 6.28, p<0.001]. The increase in numbers of actions per participant taken at follow up was also significantly higher in the intervention arm, where the median increase was 2.5 [1]–[4] while that in the control arm was 0 [−1.75 to +1] [Mann-Whitney U test: z = 4.40, p<0.001]. Conclusion When added to usual nursing care, the West Wales ADR Profile identified more problems and prompted more nursing actions. Our ADR Profile warrants further investigation as a strategy to optimise medication management. Trial Registration Controlled-trials.com ISRCTN10386209
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20
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Jordan S, Kyriacos U. Medicines' management: a public health problem on nursing's agenda. J Nurs Manag 2014; 22:271-5. [DOI: 10.1111/jonm.12238] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sue Jordan
- College of Human and Health Sciences/ Coleg y Gwyddorau Dynol a Iechyd; Swansea University/ Prifysgol Abertawe; Swansea/Abertawe UK
| | - Una Kyriacos
- Division of Nursing & Midwifery; Faculty of Health Sciences; University of Cape Town; Cape Town South Africa
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21
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Smeulers M, Onderwater AT, van Zwieten MCB, Vermeulen H. Nurses' experiences and perspectives on medication safety practices: an explorative qualitative study. J Nurs Manag 2014; 22:276-85. [DOI: 10.1111/jonm.12225] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Marian Smeulers
- Department of Quality and Process Innovation (KPI); Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - Astrid T. Onderwater
- Department of Quality and Process Innovation (KPI); Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - Myra C. B. van Zwieten
- Department of General Practice/Medical Ethics; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - Hester Vermeulen
- Department of Quality and Process Innovation (KPI); Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
- Amsterdam School
of Health Professions; Amsterdam The Netherlands
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Hajibabaee F, Joolaee S, Peyravi H, Alijany-Renany H, Bahrani N, Haghani H. Medication error reporting in Tehran: a survey. J Nurs Manag 2014; 22:304-10. [PMID: 24612424 DOI: 10.1111/jonm.12226] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 11/28/2022]
Abstract
AIM The purpose of this study was to evaluate nurses' reporting of medication errors. BACKGROUND Improvement in medication error reporting is one of the major challenges in today's health care environments. METHODS This was a descriptive survey of nurses working in medical, surgery, orthopaedic, gynaecology and obstetric wards in hospitals affiliated to Iran University of Medical Sciences, using stratified multistage sampling. Data were collected between November 2008 and May 2009 using a researcher-designed questionnaire. Data were described and explored using Kruskal-Wallis, one-way analysis of variance and Mann-Whitney's test. RESULTS The response rate was 93% (n = 286).The mean number of medication errors 'reported' per nurse during 3 months was 1.33 [standard deviation (SD) = 4.18, median = 0, interquartile range (IQR) = 0-0, range = 70-0]. The mean number of errors made was 19.5 (SD = 30.27, median = 10, IQR = 1-25, range = 181-0). None of the individual and organisational characteristics reported were significantly related to reporting of medication errors. Failure to record vital signs (e.g. pulse, blood pressure etc.) before and after administering certain medicines was the most frequently reported medication error. CONCLUSION More errors were made than were reported and this requires further investigation. IMPLICATIONS FOR NURSING MANAGEMENT The reporting of medication errors is a problem in health care systems worldwide, including Iran. Considering the significant difference between the nurses' actual and reported medication errors, managers should monitor medication errors. Educational initiatives are needed to improve understanding of the importance of medication administration.
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Affiliation(s)
- F Hajibabaee
- School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Hemingway S, Clifton A, Stephenson J, Edward KL. Facilitating knowledge of mental health nurses to undertake physical health interventions: a pre-test/post-test evaluation. J Nurs Manag 2014; 22:383-93. [DOI: 10.1111/jonm.12220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Steve Hemingway
- School of Human and Health Sciences; Centre for Health and Social Care Research; University of Huddersfield; Queensgate Huddersfield UK
| | - Andrew Clifton
- School of Human and Health Sciences; Centre for Health and Social Care Research; University of Huddersfield; Queensgate Huddersfield UK
| | - John Stephenson
- School of Human and Health Sciences; Centre for Health and Social Care Research; University of Huddersfield; Queensgate Huddersfield UK
| | - Karen-Leigh Edward
- Faculty of Health Sciences; Australian Catholic University; Melbourne Vic. Australia
- Nursing Research Unit; St Vincent's Private Hospital; Melbourne Vic. Australia
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Jordan S, Gabe M, Newson L, Snelgrove S, Panes G, Picek A, Russell IT, Dennis M. Medication monitoring for people with dementia in care homes: the feasibility and clinical impact of nurse-led monitoring. ScientificWorldJournal 2014; 2014:843621. [PMID: 24707218 PMCID: PMC3951004 DOI: 10.1155/2014/843621] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/06/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES People with dementia are susceptible to adverse effects of medicines. However, they are not always closely monitored. We explored (1) feasibility and (2) clinical impact of nurse-led medication monitoring. DESIGN Feasibility "before-and-after" intervention study. SETTING Three care homes in Wales. PARTICIPANTS Eleven service users diagnosed with dementia, taking at least one antipsychotic, antidepressant, or antiepileptic medicine. INTERVENTION West Wales Adverse Drug Reaction (ADR) Profile for Mental Health Medicines. OUTCOME MEASURES (1) Feasibility: recruitment, retention, and implementation. (2) Clinical impact: previously undocumented problems identified and ameliorated, as recorded in participants' records before and after introduction of the profile, and one month later. RESULTS Nurses recruited and retained 11 of 29 eligible service users. The profile took 20-25 minutes to implement, caused no harm, and supplemented usual care. Initially, the profile identified previously undocumented problems for all participants (mean 12.7 (SD 4.7)). One month later, some problems had been ameliorated (mean 4.9 (3.6)). Clinical gains included new prescriptions to manage pain (2 participants), psoriasis (1), Parkinsonian symptoms (1), rash (1), dose reduction of benzodiazepines (1), new care plans for oral hygiene, skin problems, and constipation. CONCLUSIONS Participants benefited from structured nurse-led medication monitoring. Clinical trials of our ADR Profile are feasible and necessary.
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Affiliation(s)
- Sue Jordan
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Marie Gabe
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Louise Newson
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Sherrill Snelgrove
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Gerwyn Panes
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Aldo Picek
- Fieldbay Ltd., Chestnut House, Tawe Business Village, Swansea Enterprise Park, Swansea SA7 9LA, UK
| | - Ian T. Russell
- The College of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Michael Dennis
- The College of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, UK
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25
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Vogelsmeier A. Identifying medication order discrepancies during medication reconciliation: perceptions of nursing home leaders and staff. J Nurs Manag 2013; 22:362-72. [PMID: 24373069 DOI: 10.1111/jonm.12165] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2013] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this qualitative study was to explore nursing home leader and staff nurse perceptions about the process of medication reconciliation, with a specific focus on identifying medication order discrepancies. BACKGROUND Medication order discrepancies and harmful discrepancy-related adverse drug events can occur when residents make the transition to nursing homes, yet little is known about how discrepancies are identified in this setting. METHOD Interviews of 18 leaders and focus groups of 13 registered nurses and 28 licensed practical nurses from eight mid-western United States nursing homes were conducted. RESULT Three themes emerged from the data: (1) nurses believe nursing home physicians rely on them to know, (2) active vs. passive information-seeking, and (3) nurses making sense of medication orders to identify discrepancies. CONCLUSION This study provides evidence about the role of nursing home nurses in medication reconciliation and how nurses engage in cognitive processes, such as 'sensemaking', when identifying discrepancies. IMPLICATIONS FOR NURSING MANAGEMENT Nursing leaders and managers must acknowledge that medication reconciliation is a complex cognitive process that requires the right nurse be assigned to the role, taking into account education and experience. Additionally, systems to support collaboration between physicians, nurses and pharmacists should be in place to ensure that potentially harmful discrepancies are identified and resolved.
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Affiliation(s)
- Amy Vogelsmeier
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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26
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Gabe ME, Jordan SE. Development and clinical gains of nurse-led medication monitoring profiles. J Nurs Manag 2013; 22:331-49. [PMID: 23701013 DOI: 10.1111/jonm.12067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 11/29/2022]
Abstract
AIM This paper reports on the development of an instrument for nurse-led medication monitoring, the West Wales Adverse Drug Reaction profile for respiratory medicines, as part of a strategy to reduce avoidable adverse drug reactions. BACKGROUND Preventable adverse drug reactions account for 3.7% hospital admissions. Nurse-led medication monitoring may reduce drug-related harm. However, development of medication monitoring strategies is not reported elsewhere. METHODS The profile was developed by: (1) cognitive interviews (n = 4), (2) the content validity index (n = 10) involving academics, clinicians and service users prescribed respiratory medicines, (3) inter-rater reliability (n = 48) and clinical gains in a nurse-led outpatient clinic. RESULTS Cognitive interviews prompted more profile changes than either the content validity index or inter-rater reliability testing. Cohen's κ for inter-rater reliability for each item ranged from 0.73-1.00 (good to complete agreement). The profile identified previously unsuspected problems in all participants, including muscular weakness, skin and mouth problems. CONCLUSIONS The West Wales Adverse Drug Reaction profile was valid and reliable, and helped to detect and ameliorate drug-related harm. IMPLICATIONS FOR NURSING MANAGEMENT The West Wales Adverse Drug Reaction profile offers opportunities to improve care. Medication monitoring provides the structure to concurrently monitor known adverse drug reactions. Practice-based adverse drug reaction profiles benefit from cognitive, content validity and inter-rater reliability testing.
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Affiliation(s)
- Marie E Gabe
- Research Capacity Building Collaboration (RCBC) Wales, Swansea University, Swansea, UK
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