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Maurin C, Atkinson S, Hamouche L, Bussières JF. Ratios d’incidents et d’accidents totaux et médicamenteux par 1000 jours-présence en établissement de santé au Québec: une étude exploratoire. Can J Hosp Pharm 2024; 77:e3497. [PMID: 38601131 PMCID: PMC10984257 DOI: 10.4212/cjhp.3497] [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: 05/01/2023] [Accepted: 09/16/2023] [Indexed: 04/12/2024]
Abstract
Background Since 2022, it has been mandatory in Québec to report all incidents and accidents (I&As) occurring in health-care facilities. Since 2011, a summary report of these I&As has been published each year. However, it is difficult to compare health facilities given that no denominator is specified and ratios are not calculated. Objective The primary objective was to calculate the ratios of total I&As and medication-related I&As per 1000 inpatient-days per type of facility for all health-care facilities in Québec. Methods This retrospective descriptive study was based on data from the period of April 1, 2016, to March 31, 2021. Data were extracted from the National Register of Incidents and Accidents Occurring during the Provision of Health Care and Social Services in Québec (Registre national des incidents et accidents survenus lors de la prestation des soins et services de santé au Québec) and financial reports. The ratios of total I&As/1000 inpatient-days and medication-related I&As/1000 inpatient-days, expressed as the mean ± standard deviation and median [minimum; maximum], were calculated. Results A total of 85 health-care facilities had usable data, specifically 33 acute-care facilities, 45 long-term care facilities, and 7 rehabilitation facilities. The mean ratio for total I&As/1000 inpatient-days varied from 33 ± 19 to 38 ± 22 in acute-care facilities, from 14 ± 5 to 16 ± 7 in long-term care facilities, and from 99 ± 39 to 147 ± 55 in rehabilitation facilities. The mean ratio for medication-related I&As/1000 inpatient-days varied from 11 ± 7 to 12 ± 7 in acute care facilities, from 3 ± 2 to 4 ± 3 in long-term care facilities, and from 24 ± 10 to 40 ± 21 in rehabilitation facilities. Conclusions This exploratory study demonstrated the feasibility of calculating I&A ratios from the National Register of Incidents and Accidents Occurring during the Provision of Health Care and Social Services in Québec. These ratios facilitate discussion of the reporting culture of I&As within the health-care system. It is hoped that these ratios will be added to future annual reports from the Québec I&A register.
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Affiliation(s)
- Charlotte Maurin
- , candidate au D. Pharm., est assistante de recherche à l'Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, Montréal (Québec)
| | - Suzanne Atkinson
- , B. Pharm., M. Sc., chef-adjointe aux services pharmaceutiques, unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, Montréal (Québec)
| | - Linda Hamouche
- , B.S.N., M. Sc., conseillère, gestion des risques, direction de la qualité, évaluation, performance et éthique, CHU Sainte-Justine, Montréal (Québec)
| | - Jean-François Bussières
- , B. Pharm., M. Sc., M.B.A., F.C.S.H.P., F.O.P.Q., responsable, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine; professeur titulaire de clinique, Faculté de pharmacie, Université de Montréal, Montréal (Québec)
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Heier L, Schellenberger B, Schippers A, Nies S, Geiser F, Ernstmann N. Interprofessional communication skills training to improve medical students' and nursing trainees' error communication - quasi-experimental pilot study. BMC MEDICAL EDUCATION 2024; 24:10. [PMID: 38172793 PMCID: PMC10765820 DOI: 10.1186/s12909-023-04997-5] [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: 09/14/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Interprofessional communication is of extraordinary importance for patient safety. To improve interprofessional communication, joint training of the different healthcare professions is required in order to achieve the goal of effective teamwork and interprofessional care. The aim of this pilot study was to develop and evaluate a joint training concept for nursing trainees and medical students in Germany to improve medication error communication. METHODS We used a mixed-methods, quasi-experimental study with a pre-post design and two study arms. This study compares medical students (3rd year) and nursing trainees (2nd year) who received an interprofessional communication skills training with simulation persons (intervention group, IG) with a control group (CG). Both cohorts completed identical pre- and post-training surveys using the German Interprofessional Attitudes Scale (G-IPAS) and a self-developed interprofessional error communication scale. Descriptive statistics, Mann-Whitney-U-test and Wilcoxon-test were performed to explore changes in interprofessional error communication. RESULTS A total of 154 were medical students, and 67 were nursing trainees (IG: 66 medical students, 28 nursing trainees / CG: 88 medical students, 39 nursing trainees). After training, there were significant improvements observed in the "interprofessional error communication" scale (p < .001) and the "teamwork, roles, and responsibilities" subscale (p = .012). Median scores of the subscale "patient-centeredness" were similar in both groups and remained unchanged after training (median = 4.0 in IG and CG). CONCLUSIONS Future studies are needed to find out whether the training sustainably improves interprofessional teamwork regarding error communication in acute care.
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Affiliation(s)
- Lina Heier
- Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.
- Chair of Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands.
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, The Netherlands.
| | - Barbara Schellenberger
- Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Chair of Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Schippers
- Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Sebastian Nies
- Centrum für Aus- & Weiterbildung, University Hospital Bonn, Bonn, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Chair of Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Mesgarpour B, Sadeghirad B. Cochrane in CORR® : Reducing Medication Errors for Adults in Hospital Settings. Clin Orthop Relat Res 2023; 481:17-24. [PMID: 36473112 PMCID: PMC9750574 DOI: 10.1097/corr.0000000000002497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Bita Mesgarpour
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Sadeghirad
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Mohammed M, Bayissa B, Getachew M, Adem F. Drug-related problems and determinants among elective surgical patients: A prospective observational study. SAGE Open Med 2022; 10:20503121221122438. [PMID: 36093421 PMCID: PMC9459467 DOI: 10.1177/20503121221122438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 08/05/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives The aim of this study was to assess drug-related problems and determinants among elective surgical patients admitted to Jimma University Medical Center. Methods A hospital-based prospective observational study was conducted at Jimma University Medical Center, from April 10 to July 10, 2018. Data were collected through patients' interview and physicians' medication orders and charts review using pre-tested questionnaire and data abstraction formats. Drug-related problems were assessed for each patient using drug-related problem classification tool. Data were analyzed using Statistical Package for Social Science for windows; version 21.0. The predictors of drug-related problems were determined by multivariable logistic regression analysis. A p-value of less than or equal to 0.05 was considered to be statistically significant. Results Of the total 141 participants, 98 (69.5%) of them had at least one drug-related problem during their hospital stay. A total of 152 drug-related problems were identified among 141 elective surgical patients. The most common identified drug-related problems were indication-related problems (39%) followed by effectiveness-related problems (21%) and safety-related problems (21%). The presence of complication (adjusted odds ratio = 2.90, 95% confidence interval (1.302, 3.460)), American Society of Anesthesiologists Physical Status ⩾ 2 (adjusted odds ratio = 6.01, 95% confidence interval (1.0011, 9.500)), and postoperative antibiotics (adjusted odds ratio = 6.027, 95% confidence interval (1.594, 22.792)) were independent predictors of drug-related problems. Conclusion The prevalence of drug-related problems is high among elective surgical patients. The indication-related problems were the most common category of drug-related problem identified among elective surgical patients. The presence of complication, American Society of Anesthesiologists Physical Status ⩾ 2, and postoperative antibiotics were the independent predictors of drug-related problems.
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Affiliation(s)
- Mesud Mohammed
- Department of Pharmacy, School of Medicine, Madda Walabu University, Goba, Ethiopia
| | - Bodena Bayissa
- School of Pharmacy, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Mestawet Getachew
- School of Pharmacy, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Fuad Adem
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
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Jarošová D, Zeleníková R, Plevová I, Mynaříková E, Kachlová M. Differences in the Incidence of Adverse Events in Acute Care Hospitals: Results of a Multicentre Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095238. [PMID: 35564632 PMCID: PMC9105439 DOI: 10.3390/ijerph19095238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022]
Abstract
Background: Adverse events are indicators of patient safety and quality of care. Adverse events clearly have negative impacts on healthcare system costs. Organizational and unit characteristics are not very often studied in relation to adverse events. The aim of the study was to find the differences in the incidence of adverse events and healthcare-associated infections in hospitalized patients in Czech acute care hospitals according to type of hospital and type of unit. Methods: This cross-sectional multicentre study was conducted in 105 acute care medical and surgical units located in 14 acute care hospitals throughout the Czech Republic. The data on adverse events and healthcare-associated infections were reported monthly by nurse researchers. The data were collected from June 2020 to October 2020. Results: The incidence of healthcare-associated infections, pressure ulcers, and medication errors was significantly lower in large hospitals. Statistically significant differences have been further found between the incidence of pressure ulcers (<0.001), falls without injury (<0.001), and falls with injury (<0.001) in surgical and medical units. More pressure ulcers, falls without injury, and falls with injury have been reported in surgical units. Conclusion: The type of hospital and type of unit affected the incidence of adverse events at acute care hospitals. To reduce adverse events, a systematic adverse event measurement and reporting system should be promoted.
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Affiliation(s)
- Darja Jarošová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic; (D.J.); (I.P.); (M.K.)
| | - Renáta Zeleníková
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic; (D.J.); (I.P.); (M.K.)
- Correspondence:
| | - Ilona Plevová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic; (D.J.); (I.P.); (M.K.)
| | - Eva Mynaříková
- Department of Nursing Care, University Hospital Ostrava, 708 00 Ostrava, Czech Republic;
| | - Miroslava Kachlová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic; (D.J.); (I.P.); (M.K.)
- Department of Nursing Care, University Hospital Ostrava, 708 00 Ostrava, Czech Republic;
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Patel TK, Patel PB, Bhalla HL, Kishore S. Drug-related deaths among inpatients: a meta-analysis. Eur J Clin Pharmacol 2021; 78:267-278. [PMID: 34661726 DOI: 10.1007/s00228-021-03214-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To estimate the prevalence of drug-related deaths with regard to total hospital mortality and to explore the heterogeneity in its estimation through subgroup analysis, univariate and multivariate analysis. METHODS Two investigators independently searched the PubMed and Google Scholar databases with appropriate key terms to identify observational and randomised studies assessing drug-related problems. The prevalence of drug-related deaths was estimated using a double arcsine method. The heterogeneity was explored through subgroup and univariate analysis for the following study characteristics: study design, age group, study ward, study region, types of drug-related problems, study duration, sample size and study period. The study variables showing significant effects were further explored through a multivariable regression model. The percentage of preventable drug-related deaths was explored as a secondary objective. RESULTS Of the 480 full-text articles assessed, 23 studies satisfying the selection criteria were included. The mean percentage of drug-related deaths was 5.6% (95% CI: 3.8-7.6%; I2 = 96%). The univariable analysis showed study design (regression coefficient: 4.31) and study wards (regression coefficient: - 6.37) as heterogeneity modifiers. In the multivariable model, only the study ward was considered a significant predictor of drug-related deaths (regression coefficient: - 5.78; p = 0.04). The mean percentage of preventable drug-related deaths was 45.2% (95% CI: 33.6-57.0%; I2 = 60%). CONCLUSION Drug-related problems are an important cause of mortality. The variability in its estimation could be explained by admission wards.
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Affiliation(s)
- Tejas K Patel
- Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, Uttar Pradesh, 273008, India.
| | - Parvati B Patel
- Department of Pharmacology, GMERS Medical College, Gotri, Vadodara, Gujarat, 390021, India
| | - Hira Lal Bhalla
- Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, Uttar Pradesh, 273008, India
| | - Surekha Kishore
- All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, Uttar Pradesh, 273008, India
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Pardo-Cabello AJ, Manzano-Gamero V, Luna JDD. The impact of PIPs on mortality and readmissions in older adults: a retrospective cohort study. Eur J Clin Pharmacol 2021; 78:139-145. [PMID: 34529111 DOI: 10.1007/s00228-021-03217-7] [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: 03/20/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Our aim was to determine the impact of potentially inappropriate prescriptions (PIP), according to "Screening Tool of Older Persons' Prescriptions" criteria version 2 (STOPP-2), on mortality and hospital admissions. METHODS Monocentric retrospective cohort study. Patients over 65 years of age and who were consecutively discharged from internal medicine at a Spanish university hospital in 2016 were included. The mortality and hospital admissions of the cohort of patients were analysed using their electronic health records within two years from the time of discharge. Analysis was done based on the type and number of STOPP-2 criteria as well as taking into account the total number of medications. The subdistribution hazard ratios (SHR) were estimated through a competing proportional hazards model. RESULTS A total of 270 patients with a median age of 82 years (interquartile range/IQR 76-86 years), and 152 (56.3%) women were studied. It was found out that 28.3% of patients with PIP died compared to 17.2% of patients without it. Digoxin (B1 STOPP-2 criterion) with a subdistribution hazard ratio (SHR) 2.40 (95% CI 0.63-9.18), selective serotonin re-uptake inhibitors/SSRIs (D4) with a SHR 1.76 (95% CI 0.52-5.96) and neuroleptic drugs (K2) with a SHR 2.01 (95% CI 0.82-4.95) non-significantly increased the risk of death. Dementia (SHR 5.45; 95% CI 2.76-10.78) was then the only statistically significant risk factor for death. Sixty percent of patients with a PIP had shown at least one hospital admission compared to 51% of patients without it. The number of drugs at discharge (SHR 1.03; 95% CI 1.01-1.05) and having 1-2 STOPP-2 criteria (SHR 1.17; 95% CI 1.02-1.35) significantly increased the risk of hospital admission. CONCLUSION The number of drugs at discharge and having any STOPP criteria significantly increased the risk of hospital admission in this cohort. PIP, only according to some specific STOPP-2 criteria involving digoxin, neuroleptics and SSRIs, might associate with a statistically non-significantly higher risk on mortality.
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Affiliation(s)
| | - Victoria Manzano-Gamero
- Department of Internal Medicine, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Juan de Dios Luna
- Department of Biostatistics, School of Medicine, University of Granada, Granada, Spain
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Hamilton J, Kushner B, Holden S, Holden T. Age-Related Risk Factors in Ventral Hernia Repairs: A Review and Call to Action. J Surg Res 2021; 266:180-191. [PMID: 34015515 DOI: 10.1016/j.jss.2021.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND As the population ages, the incidence of ventral hernias in older adults is increasing. Ventral hernia repairs (VHR) should not be considered low risk operations, particularly in older adults who are disproportionately affected by multiple age-related factors that can complicate surgery and adversely affect outcomes. Although age-related risk factors have been well established in other surgical fields, there is currently little data describing their impact on VHR. METHODS We performed a systematic review of the literature to identify studies that examine the effects of age-related risk factors on VHR outcomes. This was conducted using Cochrane Library, Embase, PubMed (Medline), and Google Scholar databases, all updated through June 2020. We selected relevant studies using the keywords, multimorbidity, comorbidities, polypharmacy, functional dependence, functional status, frailty, cognitive impairment, dementia, sarcopenia, and malnutrition. Primary outcomes include mortality and overall complications following VHR. RESULTS We summarize the evidence basis for the significance of age-related risk factors in elective surgery and discuss how these factors increase the risk of adverse outcomes following VHR. In particular, we explore the impact of the following risk factors: multimorbidity, polypharmacy, functional dependence, frailty, cognitive impairment, sarcopenia, and malnutrition. As opposed to chronological age itself, age-related risk factors are more clinically relevant in determining VHR outcomes. CONCLUSIONS Given the increasing complexity of VHR, addressing age-related risk factors pre-operatively has the potential to improve surgical outcomes in older adults. Preoperative risk assessment and individualized prehabilitation programs aimed at improving patient-centered outcomes may be particularly useful in this population.
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Affiliation(s)
- Julia Hamilton
- Department of Surgery, Washington University School of Medicine. St. Louis, Missouri.
| | - Bradley Kushner
- Department of Surgery, Washington University School of Medicine. St. Louis, Missouri
| | - Sara Holden
- Department of Surgery, Washington University School of Medicine. St. Louis, Missouri
| | - Timothy Holden
- Department of Medicine, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, Missouri
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Rodríguez LM, Posada M, Acuña J. Instrumentador Quirúrgico: eventos adversos intraoperatorios. REPERTORIO DE MEDICINA Y CIRUGÍA 2019. [DOI: 10.31260/repertmedcir.v28.n2.2019.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introducción: el instrumentador quirúrgico cumple un papel importante en la atención del paciente quirúrgico, involucrándose en la manipulación de medicamentos que pueden generar incidentes y eventos adversos (EA). El presente estudio describe los EA publicados que ocurrieron durante la atención intraoperatoria. Materiales y métodos: revisión de la literatura en las plataformas Cochrane, MEDLINE, Embase y bases de datos de literatura de salud Pubmed, OVID, UptoDate y Scielo entre 2006 y 2017. Resultados: se localizaron 1.747 documentos eliminándose 1.697 por no cumplir con criterios de inclusión y de los 50 restantes se descartaron 41 por no contar con información de interés para el presente estudio. Conclusiones: aunque en los quirófanos los EA asociados con la manipulación de medicamentos no es infrecuente, se requieren más estudios con alto nivel de evidencia que permitan asociar la práctica asistencial del instrumentador quirúrgico con dichos EA intraoperatorios.
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Wolfe D, Yazdi F, Kanji S, Burry L, Beck A, Butler C, Esmaeilisaraji L, Hamel C, Hersi M, Skidmore B, Moher D, Hutton B. Incidence, causes, and consequences of preventable adverse drug reactions occurring in inpatients: A systematic review of systematic reviews. PLoS One 2018; 13:e0205426. [PMID: 30308067 PMCID: PMC6181371 DOI: 10.1371/journal.pone.0205426] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/25/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Preventable adverse drug reactions (PADRs) in inpatients are associated with harm, including increased length of stay and potential loss of life, and result in elevated costs of care. We conducted an overview of reviews (i.e., a systematic review of systematic reviews) to determine the incidence of PADRs experienced by inpatients. Secondary review objectives were related to assessment of the effects of patient age, setting, and clinical specialty on PADR incidence. METHODS The protocol was registered in PROSPERO (CRD42016043220). We performed a search of Medline, Embase, and the Cochrane Library, limiting languages of publication to English and French. We included published systematic reviews that reported quantitative data on the incidence of PADRs in patients receiving acute or ambulatory care in a hospital setting. The full texts of all primary studies for which PADR data were reported in the included reviews were obtained and data relevant to review objectives were extracted. Quality of the included reviews was assessed using the AMSTAR-2 tool. Both narrative summaries of findings and meta-analyses of primary study data were undertaken. RESULTS Thirteen systematic reviews encompassing 37 unique primary studies were included. Across primary studies, the PADR incidence was highly varied, ranging from 0.006 to 13.3 PADRs per 100 patients, with a pooled incidence estimate of 0.59 PADRs per 100 patients. Substantial heterogeneity was present across both reviews and primary studies with respect to review/study objectives, patient age, hospital setting, medical discipline, definitions and assessment tools used, event detection methods, endpoints of interest, and units of measure. Thirteen primary studies used prospective event detection methods and had a pooled PADR incidence of 3.13 (2.87-3.38) PADRs per 100 patients; however, extreme statistical heterogeneity (I2 = 97%) indicated this finding should be considered with caution. Subgroup meta-analyses demonstrated that PADR incidence varied significantly with event detection method (prospective > retrospective > voluntary reporting methods), hospital setting (ICU > wards), and medical discipline (medical > surgical). High statistical heterogeneity (I2 > 80%) was present across all analyses, indicating results should be interpreted with caution. Effects of patient age could not be assessed due to poor reporting of age groups used in primary studies. DISCUSSION The method of event detection appeared to significantly influence PADR incidence, with prospective methods having the highest reported PADR rate. This finding is in agreement with the background literature. High methodological and statistical heterogeneity across primary studies evaluating adverse drug events reduces the validity of the overall PADR incidence derived from the meta-analyses of the pooled data. Data pooled from studies using only prospective methods of event detection should provide an overall estimate closest to the true PADR incidence; however, our estimate should be considered with caution due to the statistical heterogeneity found in this group of studies. Future studies should employ prospective methods of detection. This review demonstrates that the true overall incidence of PADRs is likely much greater than the overall pooled incidence estimate of 0.59 PADRs per 100 patients obtained when event detection method was not taken into consideration.
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Affiliation(s)
- Dianna Wolfe
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Fatemeh Yazdi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Salmaan Kanji
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lisa Burry
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Beck
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Claire Butler
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Leila Esmaeilisaraji
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Candyce Hamel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mona Hersi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Roy R, Ma J. Impact of a Policy Change on Pharmacists' Reporting of Adverse Drug Reactions. Can J Hosp Pharm 2018; 71:227-233. [PMID: 30185996 PMCID: PMC6118825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Spontaneous reports of adverse drug reactions (ADRs) form an essential component of both drug safety monitoring and patient safety initiatives. Pharmacists are well positioned to report ADRs, but many barriers exist to their doing so. Over the past decade, substantial changes have occurred with regard to drug regulations and medication safety initiatives, and it is possible that knowledge-based interventions may be needed to enhance ADR reporting by pharmacists. OBJECTIVE To determine whether ADR reporting behaviours of pharmacists improved after release of a revised policy on the reporting of medication incidents. METHODS A telephone survey was administered to pharmacists practising in the Canadian Forces Health Services Group. Self-reported behaviours and perceived barriers related to ADR reporting were compared before and 3 months after the updated policy was released. Accuracy in participants' self-assessed ADR reporting was evaluated using independently derived workload statistics. RESULTS During the second survey phase (after release of the revised policy), a greater proportion of respondents reported awareness of institutional policies on ADR reporting and declared that they were able to complete all necessary ADR reports during their assigned work hours. However, the number of ADR reports submitted did not increase. Participants' recall of their ADR reporting behaviour was corroborated by workload data. During the second survey phase, there was a noticeable reduction in the number of free-form comments mentioning lack of staff as a barrier to ADR reporting. CONCLUSIONS Release of a more comprehensive policy was not associated with an increase in the number of ADR reports generated by pharmacists in the study setting. Interventions to strengthen the organization's work processes for detection of ADRs and submission of individual ADR reports should be strongly considered, to reinforce and enhance existing ADR reporting behaviours among pharmacists.
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Affiliation(s)
- Renaud Roy
- , PharmD, MSc, is a Pharmacist with the Hôpital général juif Sir Mortimer B. Davis, Montréal, Quebec
| | - Janice Ma
- , BScPharm, PharmD, is a Drug Use Evaluation Pharmacist with Canadian Forces Health Services Group Headquarters, Ottawa, Ontario
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Bos JM, van den Bemt PMLA, Kievit W, Pot JLW, Nagtegaal JE, Wieringa A, van der Westerlaken MML, van der Wilt GJ, de Smet PAGM, Kramers C. A multifaceted intervention to reduce drug-related complications in surgical patients. Br J Clin Pharmacol 2016; 83:664-677. [PMID: 27670813 DOI: 10.1111/bcp.13141] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/31/2016] [Accepted: 09/21/2016] [Indexed: 12/14/2022] Open
Abstract
AIM The P-REVIEW study was a prospective, multicenter, open intervention study, designed to determine whether a multifaceted intervention of educating the prescriber combined with medication review and pharmaceutical visits to the ward by the hospital pharmacist could lead to a reduction in drug-related complications among surgical patients. METHODS A total of 6780 admissions of 5940 patients to surgical, urological and orthopaedic wards during the usual care period and 6484 admissions of 5711 patients during the intervention period were included. An educational programme covering pain management, antithrombotics, fluid and electrolyte management, prescription in case of renal insufficiency and antibiotics was developed. National and local hospital guidelines were included. Hospital pharmacists performed medication safety consultations, combining medication review of high-risk patients and a visit to the physician on the ward. RESULTS A significantly lower proportion of admissions with one or more clinically relevant, potentially preventable, drug-related problems (including death, temporary or sustained disability, increased length of hospital stay or readmission within 30 days) occurred in the intervention period (1.1% (73/6484) compared to the usual care period [1.6% (106/6780)] (P = 0.029). The relative risk (RR) was 0.72 (95% CI 0.53-0.97). Several types of drug-related problems occurred less frequently. Costs incurred as result of time spent on study-related activities were not different before and after the intervention. CONCLUSIONS The P-REVIEW study shows that education and support of the prescribing physician with respect to high-risk patients in surgical departments leads to a significant, clinically relevant benefit for patients without generating additional costs.
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Affiliation(s)
- Jacqueline M Bos
- Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | | | - Wietske Kievit
- Department of Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Johan L W Pot
- Department of Clinical Pharmacy, Meander Medical Centre, Amersfoort, the Netherlands
| | - J Elsbeth Nagtegaal
- Department of Clinical Pharmacy, Meander Medical Centre, Amersfoort, the Netherlands
| | - André Wieringa
- Department of Clinical Pharmacy, Isala Hospital, Zwolle, the Netherlands
| | | | - Gert Jan van der Wilt
- Department of Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Peter A G M de Smet
- Department Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Cornelis Kramers
- Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.,Department of Clinical Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, the Netherlands
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Drug-related mortality among inpatients: a retrospective observational study. Eur J Clin Pharmacol 2016; 72:731-6. [DOI: 10.1007/s00228-016-2026-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/10/2016] [Indexed: 11/28/2022]
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Patel N, Desai S. Profile of adverse drug reactions in patients admitted to general surgical wards of a rural tertiary-care hospital in India. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0231-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Effect of a ward-based pharmacy team on preventable adverse drug events in surgical patients (SUREPILL study). Br J Surg 2015; 102:1204-12. [DOI: 10.1002/bjs.9876] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/25/2015] [Accepted: 05/18/2015] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Surgical patients are at risk of adverse drug events (ADEs) causing morbidity and mortality. Much harm is preventable. Ward-based pharmacy interventions to reduce medication-related harm have not been evaluated in surgical patients.
Methods
This multicentre prospective clinical trial evaluated a protocolled, ward-based pharmacy method compared with standard pharmaceutical care in surgical patients. Allocation of study group was done by one-time randomization at ward level. Consecutive patients admitted for elective surgery with an expected hospital stay longer than 48 h were included. Pharmacy practitioners performed bedside medication reconciliation at admission and discharge, and hospital pharmacists undertook regular medication reviews in the study wards. Preventable ADEs and clinical outcomes were assessed.
Results
A total of 1094 surgical patients were studied. Some 880 specific interventions were made by the hospital pharmacist to improve pharmacotherapy in 309 of 547 patients on study wards. A further 547 patients were included on control wards. A crude non-significant reduction in incidence of preventable ADEs was seen on intervention wards in comparison with control wards (2·74 versus 3·84 preventable ADEs per 100 admissions; incidence rate ratio 0·71, 95 per cent c.i. 0·37 to 1·39; P = 0·324). After adjustment for differences in treatment groups and for potential confounding, the incidence rate ratio remained non-significant (0·82, 0·39 to 1·72; P = 0·598). No differences were seen for other outcomes, such as duration of hospital stay, number of complications and quality of life.
Conclusion
The present prospective controlled trial showed no significant reduction in medication-related harm or changes in clinical outcomes when surgical patients received protocolled ward-based pharmacy interventions.
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von Klüchtzner W, Grandt D. Influence of hospitalization on prescribing safety across the continuum of care: an exploratory study. BMC Health Serv Res 2015; 15:197. [PMID: 25962594 PMCID: PMC4494641 DOI: 10.1186/s12913-015-0844-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 04/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transitions between different levels of healthcare, such as hospital admission and discharge, pose a considerable threat to the quality and continuity of drug therapy. This study aims to further explore the current role of hospitalization in prescribing error exposure and medication-related communication as patients are transferred from and back to ambulatory care. METHODS Assisted by electronic decision support, pre-admission and discharge medication regimens of 187 adult patients in a German university hospital were comparatively screened for clinically relevant categories of potentially inadequate prescribing. Binary logistic regression analyses were conducted to identify risk factors predisposing individuals to prescribing errors as a result of hospitalization. Additionally, it was established to what extent medication changes and potentially inappropriate prescribing decisions originating from inpatient treatment were communicated in discharge letters. RESULTS 94.7% of the patients are subjected to differences between pre-admission and discharge prescriptions occurring at a rate of 461 per 100 hospitalizations. However, these modifications in drug therapy do not have a significant effect on the total number of potential prescribing errors per patient (p = 0.135) even though a large potential for improvement exists throughout the care continuum. For instance, almost a quarter of study participants with impaired kidney function lacks appropriate dose adjustment for one or more drugs before onset and at the end of inpatient treatment alike (22.5% [95% CI: 13.5%-34.0%] vs. 22.8% [95% CI: 14.1%-33.6%]). Overall, the probability of error exposure following hospitalization rises with an increasing number of prescribed drugs per patient, while individuals treated on surgical wards are four times more likely to be discharged with a prescribing-related safety hazard than their counterparts from medical departments (OR: 4.069 [95% CI: 1.126-14.703]; p = 0.032). In the study population's discharge summaries only 14.8% of medication changes and none of the potentially inappropriate prescribing decisions made during inpatient care are addressed, despite the latter occurring at a rate of 91 per 100 hospitalizations. CONCLUSIONS There is urgent need for standardized and evidence-based measures contributing to patient safety across sectorial interfaces of drug therapy. Our findings provide useful orientation for the targeted and rational design of such improvement strategies.
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de Boer M, Ramrattan MA, Boeker EB, Kuks PFM, Boermeester MA, Lie-A-Huen L. Quality of pharmaceutical care in surgical patients. PLoS One 2014; 9:e101573. [PMID: 25006676 PMCID: PMC4090008 DOI: 10.1371/journal.pone.0101573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/07/2014] [Indexed: 11/26/2022] Open
Abstract
Background Surgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements. Objective To assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements. Methods For this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients. Results Thirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and ‘sensitivity to change’. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%). Conclusions This quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced.
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Affiliation(s)
- Monica de Boer
- Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
- * E-mail:
| | - Maya A. Ramrattan
- Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
| | - Eveline B. Boeker
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Paul F. M. Kuks
- Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Loraine Lie-A-Huen
- Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
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