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Manias E, Hughes C, Woodward-Kron R, Ozavci G, Jorm C, Bucknall T. Decision-making about changing medications across transitions of care: Opportunities for enhanced patient and family engagement. Res Social Adm Pharm 2024; 20:520-530. [PMID: 38403571 DOI: 10.1016/j.sapharm.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 12/19/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Older patients often have complex medication regimens, which change as they move across transitions of care. Engagement of older patients and families in making medication decisions across transitions of care is important for safe and high-quality medication management. AIMS To explore decision-making between health professionals, older patients and families about medication changes across transitions of care, and to examine how patient and family engagement is enacted in the process of decision-making in relation to these medication changes. METHODS A focused ethnographic design was undertaken with semi-structured interviews, observations, and reflective focus groups or interviews. Reflexive thematic analysis was conducted on transcribed data. The study was undertaken at a public teaching acute care hospital and a public teaching community hospital in Australia. RESULTS In all, 182 older patients, 44 family members and 94 health professionals participated. Four themes were conceptualised from the data: different customs and routines, medication challenges, health professional interactions, and patient and family involvement. Environments had differences in their customs and routines, which increased the potential for medication delays or the substitution of unintended medications. Medication challenges included health professionals assuming that patients and families did not need information about regularly prescribed medications. Patients and families were informed about new medications after health professionals had already made decisions to prescribe these medications. Health professionals tended to work in disciplinary silos, and they had views about their role in interacting with patients and families. Patients and families were expected to take the initiative to participate in decision-making about medication changes. CONCLUSIONS Patient movements across transitions of care can create complex and chaotic medication management situations, which lacks transparency, especially for older patients and their families. A greater focus on pre-emptive and planned discussions about medication changes will contribute to improving patient and family involvement in medication decision-making.
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Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia; Alfred Health, 55 Commercial Road Melbourne, Victoria, 3004, Australia; School of Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, Victoria, 3800, Australia.
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, University Road, Belfast, Northern Ireland, BT9 7BL, United Kingdom.
| | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia.
| | - Guncag Ozavci
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia; Alfred Health, 55 Commercial Road Melbourne, Victoria, 3004, Australia.
| | - Christine Jorm
- School of Public Health, The University of Sydney, Castlereagh Street, Camperdown, New South Wales, 2006, Australia.
| | - Tracey Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia; Alfred Health, 55 Commercial Road Melbourne, Victoria, 3004, Australia.
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Stevens EL, Hulme A, Goode N, Coventon L, Read G, Salmon PM. Understanding complexity in a safety critical setting: A systems approach to medication administration. APPLIED ERGONOMICS 2023; 110:104000. [PMID: 36958252 DOI: 10.1016/j.apergo.2023.104000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
'Medication errors' are a significant concern and are associated with a higher incidence of adverse events and unintentional patient harm than any other aspect of healthcare. While much research has focused on adverse medication errors, limited studies have specifically examined 'normal' medication delivery performance and the interactions between tasks, agents, and information within the medication administration system. This article describes a study that applied the Event Analysis of Systemic Teamwork (EAST) model to study the hospital medication administration system to identify opportunities to optimise performance and patient safety. Key findings of this study demonstrate that this is a highly complex system, comprising many social agents and a relatively closely linked series of tasks and information. However, most of the workload relies on a small proportion of healthcare professionals. Significantly, the patient has a minimal role in the medication administration system during their hospital stay. The research has shown that this approach enables mapping networks and their interdependencies to optimise the system as a whole rather than its parts in isolation.
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Affiliation(s)
- Erin L Stevens
- Centre for Human Factors and Sociotechnical Systems, School of Law and Society, University of the Sunshine Coast, Sippy Downs, 4558, Queensland, Australia.
| | - Adam Hulme
- Southern Queensland Rural Health, Faculty of Health and Behavioural Sciences, The University of Queensland, Toowoomba, 4350, Queensland, Australia
| | | | - Lauren Coventon
- Centre for Human Factors and Sociotechnical Systems, School of Law and Society, University of the Sunshine Coast, Sippy Downs, 4558, Queensland, Australia
| | - Gemma Read
- Centre for Human Factors and Sociotechnical Systems, School of Law and Society, University of the Sunshine Coast, Sippy Downs, 4558, Queensland, Australia
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, School of Law and Society, University of the Sunshine Coast, Sippy Downs, 4558, Queensland, Australia
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Zahl-Holmstad B, Garcia BH, Johnsgård T, Ofstad EH, Lehnbom EC, Svendsen K, Risør T, Holis RV, Elenjord R. Patient perceptions and experiences with medication-related activities in the emergency department: a qualitative study. BMJ Open Qual 2023; 12:bmjoq-2022-002239. [PMID: 37217242 DOI: 10.1136/bmjoq-2022-002239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Emergency department (ED) pharmacists reduce medication errors and improve quality of medication use. Patient perceptions and experiences with ED pharmacists have not been studied. The aim of this study was to explore patients' perceptions of and experiences with medication-related activities in the ED, with and without an ED pharmacist present. METHODS We conducted 24 semistructured individual interviews with patients admitted to one ED in Norway, 12 before and 12 during an intervention, where pharmacists performed medication-related tasks close to patients and in collaboration with ED staff. Interviews were transcribed and analysed applying thematic analysis. RESULTS From our five developed themes, we identified that: (1) Our informants had low awareness and few expectations of the ED pharmacist, both with and without the pharmacist present. However, they were positive to the ED pharmacist. (2) Our informants expressed a variation of trust in the healthcare system, healthcare professionals and electronic systems, though the majority expressed a high level of trust. They believed that their medication list was automatically updated and assumed to get the correct medication. (3) Some informants felt responsible to have an overview of their medication use, while others expressed low interest in taking responsibility regarding their medication. (4) Some informants did not want involvement from healthcare professionals in medication administration, while others expressed no problems with giving up control. (5) Medication information was important for all informants to feel confident in medication use, but the need for information differed. CONCLUSION Despite being positive to pharmacists, it did not seem important to our informants who performed the medication-related tasks, as long as they received the help they needed. The degree of trust, responsibility, control and information varied among ED patients. These dimensions can be applied by healthcare professionals to tailor medication-related activities to patients' individual needs.
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Affiliation(s)
- Birgitte Zahl-Holmstad
- Hospital Pharmacy of North Norway Trust, Tromsø, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
| | - Beate Hennie Garcia
- Hospital Pharmacy of North Norway Trust, Tromsø, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tine Johnsgård
- Hospital Pharmacy of North Norway Trust, Tromsø, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
| | - Eirik Hugaas Ofstad
- Department of Medicine, Nordland Hospital Trust, Bodø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Elin Christina Lehnbom
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Kristian Svendsen
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
| | - Torsten Risør
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Public Health, University of Copenhagen, København, Denmark
| | | | - Renate Elenjord
- Hospital Pharmacy of North Norway Trust, Tromsø, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
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Basger BJ, Moles RJ, Chen TF. Uptake of pharmacist recommendations by patients after discharge: Implementation study of a patient-centered medicines review service. BMC Geriatr 2023; 23:183. [PMID: 36991378 PMCID: PMC10061906 DOI: 10.1186/s12877-023-03921-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medicine use is common in older people, resulting in harm increased by lack of patient-centred care. Hospital clinical pharmacy services may reduce such harm, particularly prevalent at transitions of care. An implementation program to achieve such services can be a complex long-term process. OBJECTIVES To describe an implementation program and discuss its application in the development of a patient-centred discharge medicine review service; to assess service impact on older patients and their caregivers. METHOD An implementation program was begun in 2006. To assess program effectiveness, 100 patients were recruited for follow-up after discharge from a private hospital between July 2019 and March 2020. There were no exclusion criteria other than age less than 65 years. Medicine review and education were provided for each patient/caregiver by a clinical pharmacist, including recommendations for future management, written in lay language. Patients were asked to consult their general practitioner to discuss those recommendations important to them. Patients were followed-up after discharge. RESULTS Of 368 recommendations made, 351 (95%) were actioned by patients, resulting in 284 (77% of those actioned) being implemented, and 206 regularly taken medicines (19.7 % of all regular medicines) deprescribed. CONCLUSION Implementation of a patient-centred medicine review discharge service resulted in patient-reported reduction in potentially inappropriate medicine use and hospital funding of this service. This study was registered retrospectively on 12th July 2022 with the ISRCTN registry, ISRCTN21156862, https://www.isrctn.com/ISRCTN21156862 .
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Affiliation(s)
- Benjamin Joseph Basger
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia.
- Wolper Jewish Hospital, 8 Trelawney Street, Woollahra, Sydney, NSW, 2025, Australia.
| | - Rebekah Jane Moles
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia
| | - Timothy Frank Chen
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia
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Park J, Han AY. Medication safety education in nursing research: Text network analysis and topic modeling. NURSE EDUCATION TODAY 2023; 121:105674. [PMID: 36481524 DOI: 10.1016/j.nedt.2022.105674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study aimed to identify the knowledge structure of medication safety nursing education literature by developing schematic diagrams of the relationship between keywords from a macro perspective. This study also identifies the research topics and trends over time. DESIGN This quantitative content study used text network analysis to explore keywords and research topics using topic modeling within the medication safety nursing education literature. DATA SOURCES PubMed, EMBASE, and Cochrane databases were used to search for the medication safety nursing education literature published until December 2021. METHODS Keywords from 2085 articles were examined using text network analysis and topic modeling with NetMiner 4.4.3. RESULTS The keywords with the most frequency and the highest networking degree in centrality were "patient," "medication," "program," "nurse," and "care." The emerging keywords assessed by time periods were identified; the first phase ("heart failure," "insulin," "chemotherapy," and "infusion"), the second phase ("medication errors," "staff," and "information"), the third phase ("program," "management," and "data"). The results of topic modeling were as follows: safe medication administration, safe medication reconciliation process, medication education for patients, medication errors in nursing practice, and multidisciplinary teamwork for medication safety. CONCLUSION These findings will help nursing researchers and educators to understand the trends and insights for medication safety education and educate future nurses to provide safer nursing care.
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Affiliation(s)
- Jinkyung Park
- College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Republic of Korea
| | - A Young Han
- Department of Nursing, College of Life Science and Industry, Sunchon National University, 255, Jungang-ro, Suncheon-Si, Jeollanam-do 57922, Republic of Korea.
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Ozavci G, Bucknall T, Woodward‐Kron R, Hughes C, Jorm C, Manias E. Towards patient-centred communication in the management of older patients' medications across transitions of care: A focused ethnographic study. J Clin Nurs 2022; 31:3235-3249. [PMID: 34873761 PMCID: PMC9786755 DOI: 10.1111/jocn.16162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/08/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Communication about managing medications during transitions of care can be a challenging process for older patients since they often have complex medication regimens. Previous studies highlighted that links between communication breakdowns and medication incidents in older patients occur mainly at discharge or in the post-discharge period. Little attention has been paid to exploring communication strategies facilitating patient-centred medication communication at transitions of care from a discourse-analytic perspective. OBJECTIVES To explore, through a discursive lens, strategies that enable patient-centred medication communication at transitions of care. DESIGN A focused ethnographic study was employed for this study. The study was reported according to the COREQ checklist. METHODS Interviews, observations and focus groups were analysed utilising Critical Discourse Analysis and the Medication Communication Model following thematic analysis. Data collection was undertaken in eight wards across two metropolitan hospitals in Australia. RESULTS Patient preferences and beliefs about medications were identified as important characteristics of patient-centred communication. Strategies included empathetic talk prioritising patients' medication needs and preferences for medications; informative talk clarifying patients' concerns; and encouraging talk for enhancing shared decision-making with older patients. Challenges relating to the use of these strategies included patients' hearing, speech or cognitive impairments, language barriers and absence of interpreters or family members during care transitions. RELEVANCE TO CLINICAL PRACTICE To enhance medication communication, nurses, doctors and pharmacists should incorporate older patients' preferences, previous experiences and beliefs, and consider the challenges faced by patients across transitions. Strategies encouraging patients' contribution to decision-making processes are crucial to patient-centeredness in medication communication. Nurses need to engage in informative talk more frequently when administering the medications to ensure older patients' understanding of medications prescribed or altered in hospital settings.
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Affiliation(s)
- Guncag Ozavci
- Centre for Quality and Patient Safety ResearchThe School of Nursing and MidwiferyInstitute for Health TransformationAlfred HealthDeakin UniversityBurwoodVic.Australia
| | - Tracey Bucknall
- Centre for Quality and Patient Safety ResearchThe School of Nursing and MidwiferyInstitute for Health TransformationAlfred HealthDeakin UniversityBurwoodVic.Australia
| | - Robyn Woodward‐Kron
- Department of Medical EducationMelbourne Medical SchoolThe University of MelbourneParkvilleVic.Australia
| | - Carmel Hughes
- School of PharmacyQueen's University BelfastBelfastUK
| | - Christine Jorm
- School of Public HealthThe University of SydneyCamperdownNSWAustralia
| | - Elizabeth Manias
- Centre for Quality and Patient Safety ResearchThe School of Nursing and MidwiferyInstitute for Health TransformationAlfred HealthDeakin UniversityBurwoodVic.Australia
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Ozavci G, Bucknall T, Woodward-Kron R, Hughes C, Jorm C, Joseph K, Manias E. Knowledge and Power Relations in Older Patients' Communication About Medications Across Transitions of Care. QUALITATIVE HEALTH RESEARCH 2021; 31:2678-2691. [PMID: 34657517 DOI: 10.1177/10497323211043494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Communicating about medications across transitions of care is a challenging process for older patients. In this article, we examined communication processes between older patients, family members, and health professionals about managing medications across transitions of care, focusing on older patients' experiences. A focused ethnographic design was employed across two metropolitan hospitals. Data collection methods included interviews, observations, and focus groups. Following thematic analysis, data were analyzed using Fairclough's Critical Discourse Analysis and Medication Communication Model. Older patients' medication knowledge and family members' advocacy challenged unequal power relations between clinicians and patients and families. Doctors' use of authoritative discourse impeded older patients' participation in the medication communication. Older patients perceived that nurses' involvement in medication communication was limited due to their task-related routines. To reduce the unequal power relations, health professionals should be more proactive in sharing information about medications with older patients across transitions of care.
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Affiliation(s)
- Guncag Ozavci
- Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Australia
| | - Tracey Bucknall
- Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Australia
| | | | - Carmel Hughes
- Queen's University Belfast, Belfast, Northern Ireland
| | - Christine Jorm
- NSW Regional Health Partners, Newcastle, New South Wales, Australia
| | - Kathryn Joseph
- Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Australia
| | - Elizabeth Manias
- Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Australia
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Syyrilä T, Vehviläinen-Julkunen K, Härkänen M. Healthcare professionals' perceptions on medication communication challenges and solutions - text mining and manual content analysis - cross-sectional study. BMC Health Serv Res 2021; 21:1226. [PMID: 34774044 PMCID: PMC8590289 DOI: 10.1186/s12913-021-07227-0] [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: 11/27/2020] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Communication challenges contribute to medication incidents in hospitals, but it is unclear how communication can be improved. The aims of this study were threefold: firstly, to describe the most common communication challenges related to medication incidents as perceived by healthcare professionals across specialized hospitals for adult patients; secondly, to consider suggestions from healthcare professionals with regard to improving medication communication; and thirdly, to explore how text mining compares to manual analysis when analyzing the free-text content of survey data. METHODS This was a cross-sectional, descriptive study. A digital survey was sent to professionals in two university hospital districts in Finland from November 1, 2019, to January 31, 2020. In total, 223 professionals answered the open-ended questions; respondents were primarily registered nurses (77.7 %), physicians (8.6 %), and pharmacists (7.3 %). Text mining and manual inductive content analysis were employed for qualitative data analysis. RESULTS The communication challenges were: (1) inconsistent documentation of prescribed and administered medication; (2) failure to document orally given prescriptions; (3) nurses' unawareness of prescriptions (given outside of ward rounds) due to a lack of oral communication from the prescribers; (4) breaks in communication during care transitions to non-communicable software; (5) incomplete home medication reconciliation at admission and discharge; (6) medication lists not being updated during the inpatient period due to a lack of clarity regarding the responsible professional; and (7) work/environmental factors during medication dispensation and the receipt of verbal prescriptions. Suggestions for communication enhancements included: (1) structured digital prescriptions; (2) guidelines and training on how to use documentation systems; (3) timely documentation of verbal prescriptions and digital documentation of administered medication; (4) communicable software within and between organizations; (5) standardized responsibilities for updating inpatients' medication lists; (6) nomination of a responsible person for home medication reconciliation at admission and discharge; and (7) distraction-free work environment for medication communication. Text mining and manual analysis extracted similar primary results. CONCLUSIONS Non-communicable software, non-standardized medication communication processes, lack of training on standardized documentation, and unclear responsibilities compromise medication safety in hospitals. Clarification is needed regarding interdisciplinary medication communication processes, techniques, and responsibilities. Text mining shows promise for free-text analysis.
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Affiliation(s)
- Tiina Syyrilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), Yliopistonranta 1c, P.O. Box 1627, 70211, Kuopio, Finland.
- University of Helsinki, Helsinki University Hospital (HUS), Meilahti Tower Hospital, building 1, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, HUS, Finland.
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), Yliopistonranta 1c, P.O. Box 1627, 70211, Kuopio, Finland
- Kuopio University Hospital (KUH), Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Marja Härkänen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), Yliopistonranta 1c, P.O. Box 1627, 70211, Kuopio, Finland
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Kukreja JB, Schroeck FR, Lotan Y, Gore JL, Ullman R, Lipman RR, Murray MBB, Chisolm S, Smith AB. Discomfort and relieving factors among patients with bladder cancer undergoing office-based cystoscopy. Urol Oncol 2021; 40:9.e19-9.e27. [PMID: 34162499 DOI: 10.1016/j.urolonc.2021.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/13/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the degree of discomfort among patients with bladder cancer undergoing office-based cystoscopy and identify factors and interventions that influence discomfort and anxiety. METHODS We conducted a survey of the Bladder Cancer Advocacy Network Patient Survey Network (BCAN PSN) to investigate the degree of discomfort associated with office-based cystoscopy and prevalence of interventions used to reduce discomfort. All patients had undergone at least one previous cystoscopy. Bivariable and multivariable logistic regression were used to identify factors associated with moderate-to-severe cystoscopy discomfort. RESULTS Among 488 BCAN PSN respondents (50% response rate), 392 responded with demographic data and discomfort score. Cystoscopy was associated with moderate-to-severe discomfort in 52% of patients. Respondents who reported moderate-to-severe discomfort were more likely to describe their most recent cystoscopy discomfort as worse than prior (P<0.001) and to be interested in planning discomfort mitigation for cystoscopy (P<0.001). On multivariable analysis, gender was the only factor independently associated with discomfort, with women reporting less discomfort than men (OR 0.59, 95%CI 0.37-0.95,P=0.03). Patients reported a wide variety of cystoscopy-specific interventions with differing perceived effectiveness, the most common being intraurethral lidocaine. CONCLUSIONS Over half of patients undergoing office-based cystoscopy for bladder cancer report moderate-to-severe discomfort, constituting a substantial problem among patients undergoing the procedure. Future large pragmatic comparative effectiveness trials are needed to better understand which interventions work most effectively to reduce discomfort associated with cystoscopy.
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Affiliation(s)
| | - Florian R Schroeck
- Section of Urology and VA Outcomes Group, White River Junction VA Medical Center, Vermont; Section of Urology, Norris Cotton Cancer Center, and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - John L Gore
- Department of Urology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Ralph Ullman
- Bladder Cancer Advocacy Network, Research Patient Advocate
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- Bladder Cancer Advocacy Network, Research Patient Advocate
| | - Angela B Smith
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Urology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Vaismoradi M, Jordan S, Vizcaya-Moreno F, Friedl I, Glarcher M. PRN Medicines Optimization and Nurse Education. PHARMACY 2020; 8:E201. [PMID: 33114731 PMCID: PMC7712763 DOI: 10.3390/pharmacy8040201] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022] Open
Abstract
Medicines management is a high-risk and error prone process in healthcare settings, where nurses play an important role to preserve patient safety. In order to create a safe healthcare environment, nurses should recognize challenges that they face in this process, understand factors leading to medication errors, identify errors and systematically address them to prevent their future occurrence. ''Pro re nata'' (PRN, as needed) medicine administration is a relatively neglected area of medicines management in nursing practice, yet has a high potential for medication errors. Currently, the international literature indicates a lack of knowledge of both the competencies required for PRN medicines management and the optimum educational strategies to prepare students for PRN medicines management. To address this deficiency in the literature, the authors have presented a discussion on nurses' roles in medication safety and the significance and purpose of PRN medications, and suggest a model for preparing nursing students in safe PRN medicines management. The discussion takes into account patient participation and nurse competencies required to safeguard PRN medication practice, providing a background for further research on how to improve the safety of PRN medicines management in clinical practice.
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Affiliation(s)
- Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway
| | - Sue Jordan
- Department of Nursing, Swansea University, Swansea SA2 8PP, UK;
| | - Flores Vizcaya-Moreno
- Nursing Department, Faculty of Health Sciences, University of Alicante, 03080 Alicante, Spain;
| | - Ingrid Friedl
- Hospital Graz II, A Regional Hospital of the Health Care Company of Styria, 8020 Graz, Austria;
| | - Manela Glarcher
- Institute of Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria;
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11
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Härkänen M, Franklin BD, Murrells T, Rafferty AM, Vehviläinen-Julkunen K. Factors contributing to reported medication administration incidents in patients' homes - A text mining analysis. J Adv Nurs 2020; 76:3573-3583. [PMID: 33048380 PMCID: PMC7702090 DOI: 10.1111/jan.14532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/03/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
AIMS To describe the characteristics of medication administration (MA) incidents reported to have occurred in patients' own homes (reporters' profession, incident types, contributing factors, patient consequence, and most common medications involved) and to identify the connection terms related to the most common contributing factors based on free text descriptions. DESIGN A retrospective study using descriptive statistical analysis and text mining. METHODS Medication administration incidents (N = 19,725) reported to have occurred in patients' homes between 2013-2018 in one district in Finland were analysed, describing the data by the reporters' occupation, incident type, contributing factors, and patient consequence. SAS® Text Miner was used to analyse free text descriptions of the MA incidents to understand contributing factors, using concept linking. RESULTS Most MA incidents were reported by practical (lower level) nurses (77.8%, N = 15,349). The most common category of harm was 'mild harm' (40.1%, N = 7,915) and the most common error type was omissions of drug doses (47.4%, N = 9,343). The medications most commonly described were Marevan [warfarin] (N = 2,668), insulin (N = 811), Furesis [furosemide] (N = 590), antibiotic (N = 446), and Panadol [paracetamol] (N = 416). The contributing factors most commonly reported were 'communication and flow of information' (25.5%, N = 5,038), 'patient and relatives' (22.6%, N = 4,451), 'practices' (9.9%, N = 1,959), 'education and training' (4.8%, N = 949), and 'work environment and resources' (3.0%, N = 598). CONCLUSION There is need for effective communication and clear responsibilities between home care patients and their relatives and health providers, about MA and its challenges in home environments. Knowledge and skills relating to safe MA are also essential. IMPACT These findings about MA incidents that have occurred in patients' homes and have been reported by home care professionals demonstrate the need for medication safety improvement in home care.
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Affiliation(s)
- Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College London Healthcare NHS Trust, London, UK.,UCL School of Pharmacy, London, UK
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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Considine J, Berry D, Sprogis SK, Newnham E, Fox K, Darzins P, Rawson H, Street M. Understanding the patient experience of early unplanned hospital readmission following acute care discharge: a qualitative descriptive study. BMJ Open 2020; 10:e034728. [PMID: 32439693 PMCID: PMC7247374 DOI: 10.1136/bmjopen-2019-034728] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To understand from a patient and carer perspective: (1) what features of the discharge process could be improved to avoid early unplanned hospital readmission (within 72 hours of acute care discharge) and (2) what elements of discharge planning could have enhanced the discharge experience. DESIGN A qualitative descriptive design was used. Study data were collected using semi-structured interviews that were transcribed verbatim and analysed using inductive thematic analysis. Data related to participant characteristic were collected by medical record audit and summarised using descriptive statistics. SETTING Three acute care hospitals from one health service in Australia. PARTICIPANTS Patients who had an early unplanned hospital readmission and/or their carers, if present during the interviews and willing to participate, with patient permission. FINDINGS Thirty interviews were conducted (23 patients only; 6 patient and carer dyads; 1 carer only). Five themes were constructed: 'experiences of care', 'hearing and being heard', 'what's wrong with me', 'not just about me' and 'all about going home'. There was considerable variability in patients' and carers' experiences of hospital care, discharge processes and early unplanned hospital readmission. Features of the discharge process that could be improved to potentially avoid early unplanned hospital readmission were better communication, optimal clinical care including ensuring readiness for discharge and shared decision-making regarding discharge timing and goals on returning home. The discharge experience could have been enhanced by improved communication between patients (and carers) and the healthcare team, not rushing the discharge process and a more coordinated approach to patient transport home from hospital. CONCLUSIONS The study findings highlight the complexities of the discharge process and the importance of effective communication, shared decision-making and carer engagement in optimising hospital discharge and reducing early unplanned hospital readmissions.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety-Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Debra Berry
- Centre for Quality and Patient Safety-Eastern Health Partnership, Box Hill, Victoria, Australia
- School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Stephanie K Sprogis
- School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Evan Newnham
- Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Karen Fox
- Eastern Health, Box Hill, Victoria, Australia
| | - Peteris Darzins
- Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Helen Rawson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety-Monash Health Partnership, Clayton, Victoria, Australia
| | - Maryann Street
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety-Eastern Health Partnership, Box Hill, Victoria, Australia
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