Medication use quality and safety in older adults: 2020 update

Exploring medication safety structures and processes in nursing homes: a cross-sectional study

BACKGROUND

Medication safety is important to limit adverse events for nursing home residents. Several factors, such as interprofessional collaboration with pharmacists and medication reviews, have been shown in the literature to influence medication safety processes.

AIM

This study had three main objectives: (1) To assess how facility- and unit-level organization and infrastructure are related to medication use processes; (2) To determine the extent of medication safety-relevant processes; and (3) To explore pharmacies' and pharmacists' involvement in nursing homes' medication-related processes.

METHOD

Cross-sectional multicenter survey data (2018-2019) from a convenience sample of 118 Swiss nursing homes were used. Data were collected on facility and unit characteristics, pharmacy services, as well as medication safety-related structures and processes. Descriptive statistics were used.

RESULTS

Most of the participating nursing homes (93.2%) had electronic resident health record systems that supported medication safety in various ways (e.g., medication lists, interaction checks). Electronic data exchanges with outside partners such as pharmacies or physicians were available for fewer than half (10.2-46.3%, depending on the partner). Pharmacists collaborating with nursing homes were mainly involved in logistical support. Medication reviews were reportedly conducted regularly in two-thirds of facilities.

CONCLUSION

A high proportion of Swiss nursing homes have implemented diverse processes and structures that support medication use and safety for residents; however, their collaboration with pharmacists remains relatively limited.

Research status and hotspots of medication safety in older adults: A bibliometric analysis

Background

Medication safety is a significant concern in healthcare. Research on medication safety for older adults has taken a broad approach, resulting in a range of proposals. At this juncture, it is necessary to identify the main contributors and establish the current developmental status of the principal research topics.

Objective

This study sets out to summarize the state-of-the-art in medication safety for older adults, identifying significant achievements, key topics, and emerging trends.

Methods

The Web of Science Core Collection (WOSCC) database was searched for relevant documentation over the interval 1st January 2000 to 31st December 2021. Annual outputs and citations were identified from the WOS citation reports. CiteSpace and VOSviewer were adopted for bibliometric analysis and visualization that included the distribution of countries/regions, organizations, authors and journals, and an analysis of co-cited references and keywords.

Results

A total of 1,638 documents were retrieved for bibliometric analysis, yielding 34.29 citations per document. Publications have increased over the past two decades, reaching 177 outputs in 2019. Our database encompasses 71 countries/regions, 2,347 organizations, and 7,040 authors. The United States ranks first in terms of scientific activity with 604 publications (36.87%). We have identified the University of Sydney as the most prolific organization (53 publications). J. T. Hanlon, J. H. Gurwitz, D. O'Mahony, and G. Onder are the most influential researchers in terms of publications and citations. The Journal of the American Geriatrics Society ranks first with 89 (5.43%) papers. In terms of major research directions, three topics have been identified from co-cited reference and keyword analysis: (1) estimation of the prevalence and variables associated with polypharmacy and potentially inappropriate medication; (2) analysis of interventions involving pharmacists and the associated impact; (3) patient experience and perception associated with medication use or pharmaceutical care.

Conclusion

Research on medication safety for older adults has progressed significantly over the past two decades. The United States, in particular, has made important contributions to this field. Polypharmacy and potentially inappropriate medication use, interventions involving pharmacists, patient experience and perception represent the current focus of research. Our findings suggest that these directions will continue as research hotspots in the future.

In vitro Efficacy Evaluation of Leading Brands of Ciprofloxacin Tablets Found in Bishoftu City Against Salmonella Isolates, Central Ethiopia

Purpose

Salmonella Enteritidis (SE) and Salmonella Typhimurium (STM) are the serovars most frequently associated with human illness. Ciprofloxacin is most widely used to manage cases in adults. The present study aimed to evaluate the in vitro antibacterial activity of leading brands of ciprofloxacin (tablets) marketed in Bishoftu city against SE and STM serovars, and field isolates of Salmonella (non-serotyped) from dairy milk in central Ethiopia.

Methods

Five most widely prescribed ciprofloxacin brands (A-E) were subjected to in vitro efficacy evaluation against Salmonella isolates by using the disc diffusion method. The zone of inhibition (ZI) of the tested brands was compared with the standard disc and interpreted as susceptible, intermediate, and resistant.

Results

Out of 27 replicates (SE, STM, and field Salmonella isolates each = 9) tested for efficacy, the result revealed the mean ZI of the brands varies for all tested isolates (p < 0.05). The highest mean was recorded for Brand E (24.7±0.71, 24.3±0.50, and 19.5±2.69) and lowest for Brand A (22.0±0.87, 21.0±0.87, and 10.7±1.4) for field Salmonella isolates, STM and SE, respectively. All SE were resistant to four brands (Brand A-D) whereas 67% and 33% of them were resistant and intermediate to Brand E, respectively. Similarly, 33% of STM were resistant to Brand A while all the STM were intermediate to other brands. Furthermore, all non-serotyped field isolates of Salmonella were intermediate to all five tested ciprofloxacin brands with variable ranges of mean of ZI (p<0.05).

Conclusion

The study revealed that Brand E was found to have relatively better efficacy against SE than other brands. The current study warrants a need for periodic surveillance of both the quality and efficacy of antibiotics to improve patient well-being and minimize the risk of antimicrobial resistance.