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Maleki S, Gu G, Buntine P, Zamani M, Zhu V, Chan K, Martin C, Goulopoulos A. The effect of an extended-hours ED clinical pharmacy service on admission medication prescribing errors. Emerg Med Australas 2024. [PMID: 38686457 DOI: 10.1111/1742-6723.14415] [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: 10/05/2023] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The aim of this study was to determine the effect of a 7-day extended-hours clinical pharmacy service in the ED on medication prescribing errors upon hospital admission and time to medication reconciliation. METHODS In this retrospective observational study, high-needs patients reviewed by ED pharmacists were compared against those not reviewed, to determine if the service was associated with reduction in admission medication errors. The primary outcome was the rate of medication errors. Errors were independently rated by two senior clinicians using a risk-probability matrix. Secondary outcomes included service's impact on time to best possible medication history (BPMH) and medication reconciliation. RESULTS There were 242 patients who met the inclusion criteria: 105 intervention vs 137 control. In the intervention arm, 74 patients had at least 1 medication error compared with 113 in the control arm (total errors 206 vs 407). The error rate per 10 medications (interquartile range) was 1.4 (0, 2.9) in the intervention arm compared with 2.7 (1.2, 4.3) in the control arm (risk ratio 0.66 [95% confidence interval: 0.56-0.78]; P < 0.001). There were 33 moderate-risk and no high-risk errors (intervention), compared with 84 moderate-risk and 3 high-risk errors (control). Percent agreement was 98.98% (weighted kappa: 0.62). Time to BPMH and medication reconciliation were reduced from 40.5 and 45.0 h to 7.8 and 40.0 h, respectively. CONCLUSIONS The 7-day extended-hours ED clinical pharmacy service was associated with a reduction in medication prescribing errors in high-needs patients and improved time to BPMH and medication reconciliation.
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Affiliation(s)
- Sam Maleki
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Galahad Gu
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Paul Buntine
- Department of Emergency Medicine, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Mazdak Zamani
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Violet Zhu
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Kayin Chan
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Catherine Martin
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne Goulopoulos
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
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Jackson AB, Lewis M, Meek R, Kim-Blackmore J, Khan I, Deng Y, Vallejo J, Egerton-Warburton D. Regular Medications in the Emergency Department Short Stay Unit (ReMedIES): Can Prescribing be Improved Without Increasing Resources? Hosp Pharm 2024; 59:110-117. [PMID: 38223859 PMCID: PMC10786055 DOI: 10.1177/00185787231194999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Background: Hospital medication errors are frequent and may result in adverse events. Data on non-prescription of regular medications to emergency department short stay unit patients is lacking. In response to local reports of regular medication omissions, a multi-disciplinary team was tasked to introduce corrective emergency department (ED) process changes, but with no additional financing or resources. Aim: To reduce the rate of non-prescription of regular medications for patients admitted to the ED Short Stay Unit (SSU), through process change within existing resource constraints. Methods: A pre- and post-intervention observational study compared regular medication omission rates for patients admitted to the ED SSU. Included patients were those who usually took regular home medications at 08:00 or 20:00. Omissions were classified as clinically significant medications (CSMs) or non-clinically significant medications (non-CSMs). The intervention included reinforcement that the initially treating acute ED doctor was responsible for prescription completion, formal checking of prescription presence at SSU handover rounds, double-checking of prescription completeness by the overnight SSU lead nurse and junior doctor, and ED pharmacist medication reconciliation for those still identified as having regular medication non-prescription at 07:30. Results: For the 110 and 106 patients in the pre- and post-intervention periods, there was a non-significant reduction in the CSM omission rate of -11% (95% CI: -23 to 2), from 41% (95% CI: 32-50) to 30% (95% CI: 21-39). Conclusion: Non-prescription of regular CSMs for SSU patients was not significantly reduced by institution of work practice changes within existing resource constraints.
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Affiliation(s)
- Aidan B. Jackson
- St Vincent’s Hospital Melbourne, Fitzroy, Melbourne, VIC, Australia
| | - Mark Lewis
- Monash Health, Melbourne, VIC, Australia
| | - Robert Meek
- Monash Health, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | | | - Irim Khan
- Monash Health, Melbourne, VIC, Australia
| | - Yong Deng
- Monash Health, Melbourne, VIC, Australia
- University of Melbourne, Parkville, VIC, Australia
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Spinks J, Violette R, Boyle DI, Petrie D, Fanning L, Hall KK, Kelly F, Wheeler AJ, Ware RS, Byrnes J, Chen E, Donald A, Ellis N, DelDot M, Nissen L. Activating pharmacists to reduce the frequency of medication-related problems (ACTMed): a stepped wedge cluster randomised trial. Med J Aust 2023; 219:325-331. [PMID: 37586750 DOI: 10.5694/mja2.52073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Medicines are the most frequent health care intervention type; their safe use provides significant benefits, but inappropriate use can cause harm. Systemic primary care approaches can manage serious medication-related problems in a timely manner. OBJECTIVES ACTMed (ACTivating primary care for MEDicine safety) uses information technology and financial incentives to encourage pharmacists to work more closely with general practitioners to reduce the risk of harm, improve patients' experience of care, streamline workflows, and increase the efficiency of medical care. METHODS AND ANALYSIS The stepped wedge cluster randomised trial in 42 Queensland primary care practices will assess the effectiveness of the ACTMed intervention. The primary outcome will be the proportion of people at risk of serious medication-related problems - patients with atrial fibrillation, heart failure, cardiovascular disease, type 2 diabetes, or asthma or chronic obstructive pulmonary disease - who experience such problems. We will also estimate the cost per averted serious medication-related problem and the cost per averted potentially preventable medication-related hospitalisation. ETHICS APPROVAL The University of Queensland Human Research Ethics Committee approved the pilot (2021/HE002189) and trial phases of the ACTMed study (2022/HE002136). Access to Patron data was granted by the Patron Data Governance Committee (PAT052ACTMed). Access to linked hospitalisations and deaths data are subject to Public Health Act approval (pending). DISSEMINATION OF FINDINGS A comprehensive dissemination plan will be co-developed by the researchers, the ACTMed steering committee and consumer advisory group, project partners, and trial site representatives. Aboriginal and Torres Strait Islander communities will be supported in leading community-level dissemination. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (pilot: ACTRN12622000595718; 21 April 2022; full trial: ACTRN12622000574741; 14 April 2022).
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Affiliation(s)
- Jean Spinks
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
| | - Richard Violette
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
- Griffith University, Gold Coast, QLD
| | - Douglas Ir Boyle
- HaBIC Research Information Technology Unit, the University of Melbourne, Melbourne, VIC
| | - Dennis Petrie
- Centre for Health Economics, Monash University, Melbourne, VIC
| | - Laura Fanning
- Centre for Health Economics, Monash University, Melbourne, VIC
- Box Hill Hospital, Melbourne, VIC
| | | | | | - Amanda J Wheeler
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD
- The University of Auckland, Auckland, New Zealand
| | - Robert S Ware
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD
| | - Esa Chen
- Centre for Health Economics, Monash University, Melbourne, VIC
| | | | | | - Megan DelDot
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
| | - Lisa Nissen
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
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4
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Costello J, Barras M, Foot H, Cottrell N. The impact of hospital-based post-discharge pharmacist medication review on patient clinical outcomes: A systematic review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100305. [PMID: 37655116 PMCID: PMC10466898 DOI: 10.1016/j.rcsop.2023.100305] [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: 09/28/2022] [Revised: 06/20/2023] [Accepted: 07/08/2023] [Indexed: 09/02/2023] Open
Abstract
Background Clinical pharmacists have been shown to identify and resolve medication related problems post-discharge, however the impact on patient clinical outcomes is unclear. Aims To undertake a systematic review to identify, critically appraise and present the evidence on post-discharge hospital clinics that provide clinical pharmacist medication review; report the patient clinical outcomes measured; and describe the activities of the clinical pharmacist. Methods Published studies evaluating a patient clinical outcome following a post-discharge hospital clinic pharmacy service were included. All studies needed a comparative design (intervention vs control or comparator). Pubmed, Embase, CINAHL, PsycnINFO, Web of Science, IPA and APAIS-Health databases were searched to identify studies. The type of clinic and the clinical pharmacist activities were linked to patient clinical outcomes. Results Fifty-seven studies were included in the final analysis, 14 randomised controlled trials and 43 non-randomised studies. Three key clinic types were identified: post-discharge pharmacist review alone, inpatient care plus post-discharge review and post-discharge collaborative clinics. The three main outcome metrics identified were hospital readmission and/or representation, adverse events and improved disease state metrics. There was often a mix of these outcomes reported as primary and secondary outcomes. High heterogeneity of interventions and clinical pharmacist activities reported meant it was difficult to link clinical pharmacist activities with the outcomes reported. Conclusions A post-discharge clinic pharmacist may improve patient clinical outcomes such as hospital readmission and representation rates. Future research needs to provide a clearer description of the clinical pharmacist activities provided in both arms of comparative studies.
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Affiliation(s)
- Jaclyn Costello
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Redcliffe Hospital, Metro North Health, Brisbane, QLD, Australia
| | - Michael Barras
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
| | - Holly Foot
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Neil Cottrell
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
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5
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Kobayashi S, Sugama N, Nagano H, Takahashi M, Kushiyama A. Renally inappropriate medications in elderly outpatients and inpatients with an impaired renal function. Hosp Pract (1995) 2023; 51:76-81. [PMID: 36695817 DOI: 10.1080/21548331.2023.2173412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS The purpose of this study was to investigate differences in the frequency of renally inappropriate medications (RIMs) in outpatient and inpatient among three institutions. METHODS We collected prescription and renal function data for patients over 65 years of age from the drug department system. We selected 50 kinds of the most frequently used medicines which require dose adjustment according to a patient's renal function. RESULTS Outpatient RIM was seen in 611 cases (6.17%), and inpatient prescription RIM was seen in 317 cases (5.29%), showing a significant difference between the groups (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.02-1.35). However, in a multivariate analysis, when the renal function was included, that difference between outpatients and inpatients became insignificant (OR 1.16, 95% CI 0.98-1.37). The distribution of prescription with or without RIM in outpatient and inpatient settings depended on the CKD stage. Outpatients with a better CKD stage (stage 1-3) had a higher rate of RIM than inpatients, while patients with a worse CKD stage (stage 4 or 5) had a higher rate of RIM than outpatients. CONCLUSION The rate of RIM in outpatients tends to be high, and attention should be paid to RIM in inpatients with a severe CKD stage.
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Affiliation(s)
- Shotaro Kobayashi
- Department of Pharmacy, Sonoda Daiichi Hospital, Tokyo, Japan.,Department of Pharmacotherapy, Meiji Pharmaceutical University, Kiyose City, Japan
| | - Norio Sugama
- Department of Pharmacy, Sonoda Daiichi Hospital, Tokyo, Japan
| | - Hiroyuki Nagano
- Department of Pharmacotherapy, Meiji Pharmaceutical University, Kiyose City, Japan.,Department of Pharmacy, Saitama Medical University Hospital, Saitama, Japan
| | - Masahiro Takahashi
- Department of Pharmacotherapy, Meiji Pharmaceutical University, Kiyose City, Japan
| | - Akifumi Kushiyama
- Department of Pharmacotherapy, Meiji Pharmaceutical University, Kiyose City, Japan
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Lim R, Ellett LMK, Semple S, Roughead EE. The Extent of Medication-Related Hospital Admissions in Australia: A Review from 1988 to 2021. Drug Saf 2022; 45:249-257. [PMID: 35089582 PMCID: PMC8933367 DOI: 10.1007/s40264-021-01144-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/29/2022]
Abstract
Introduction Medication-related problems often lead to patient harm. This paper aims to review the Australian literature to determine the overall incidence, severity and preventability of medication-related hospital admissions, as well as providing a national estimate on their extent and cost. Methods The first part of the paper includes a literature search to identify studies that provided estimates of medication-related problems that caused hospital admissions. Incidence of medication-related hospital admissions, type of medication-related problem contributing to admission (e.g. adverse medicine reaction) and method used to estimate incidence (e.g. chart review) were extracted. Data on severity and preventability of the admissions were extracted where available. The second part of the paper involves use of methodological triangulation to estimate the extent and cost of medication-related hospital admission. Median estimates used to assess medication-related hospital admissions and the 2019–2020 national hospital admissions data were used to calculate the national estimate on the extent of medication-related hospital admission. Costs were also estimated. Results Seventeen studies provided estimates on the extent of medication-related hospital admissions as assessed using medication chart review. The median incidence of 2.5% (interquartile range [IQR] 0.6%) as a proportion of all hospital admissions suggests 275,000 hospital admissions annually in Australia are medication related. The median incidence of 9% (IQR 3.9%) of emergency admissions suggests that 270,000 admissions annually are medication related. Eight studies provided estimates of the extent of medication-related hospital admissions identified from administrative health data; the median incidence of 1.7% with an under-reporting rate of 82% suggests 280,000 hospital admissions annually are medication related. Triangulation of results suggests that at least 250,000 hospital admissions annually in Australia are medication related, with an estimated cost of 1.4 billion Australian dollars (AUD$). Five studies assessed severity, and nine studies assessed preventability. Preventability estimates suggest two-thirds of medication-related hospital admissions are potentially preventable. Conclusions We estimated that 250,000 hospital admissions in Australia are medication related, with an annual cost of AUD$1.4 billion to the healthcare system. Two-thirds of medication-related hospital admissions are potentially preventable. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01144-1.
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Affiliation(s)
- Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
| | - Lisa M Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Susan Semple
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
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7
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Wojt IR, Cairns R, Gillooly I, Patanwala AE, Tan ECK. Clinical factors associated with increased length of stay and readmission in patients with medication-related hospital admissions: a retrospective study. Res Social Adm Pharm 2021; 18:3184-3190. [PMID: 34556433 DOI: 10.1016/j.sapharm.2021.09.003] [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: 01/29/2021] [Revised: 08/23/2021] [Accepted: 09/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adverse drug events (ADEs) remain a key contributor to hospitalisations, resulting in long hospital stays and readmissions. Information pertaining to the specific medications and clinical factors associated with these outcomes is limited. Hence, a better understanding of these factors and their relationship to ADEs is required. OBJECTIVES To investigate medications involved, clinical manifestations of ADE-related hospitalisations, and their association with length of stay and readmission. METHODS A retrospective medical record review of patients admitted to a major, tertiary referral hospital in NSW, Australia, from January 2019 to August 2020 was conducted. ADEs were identified using Australian Refined Diagnosis Related Group (AR-DRG) codes: X40, X61, X62 and X64. Medications were classified per the Anatomical Therapeutic Chemical (ATC) classification system and clinical symptoms were classified per the International Classification of Disease (ICD) 9-CM. Logistic regression was performed to assess the relationship between medication and presentation classes with length of stay (≥2 days vs <2 days) and readmission. RESULTS There were 125 patients who met inclusion criteria (median age = 64 [interquartile range, 45-75] years; 53.6% male). Anti-thrombotic agents, opioids, antidepressants, antipsychotics, insulins and NSAIDs were the most implicated pharmacological classes. Neurological medications and falls were associated with a length of stay ≥2 days (adjusted odds ratio [aOR] 3.92, 95% confidence interval [CI] 1.48-10.33 and aOR 3.24, 95% CI 1.05-10.06, respectively). Neurological medications and neurological and cognitive disorders were associated with an increased likelihood of 90-day readmission (aOR 2.63, 95% CI 1.05-6.57 and aOR 3.20, 95% CI 1.17-8.75, respectively). CONCLUSION This study identified neurological medications as high-risk for increased length of stay and readmission in those hospitalised due to ADEs. This highlights the need for judicious prescribing and monitoring of these medications.
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Affiliation(s)
- Ilsa R Wojt
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia
| | - Rose Cairns
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia; NSW Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Isabelle Gillooly
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia
| | - Asad E Patanwala
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia; Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Edwin C K Tan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia; Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
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Criddle DT, Devine B, Murray K, Budgeon CA, Sanfilippo FM, Gupta S, Davidson A, Etherton-Beer C, Clifford R. Developing PHarmacie-R: A bedside risk prediction tool with a medicines management focus to identify risk of hospital readmission. Res Social Adm Pharm 2021; 18:3137-3148. [PMID: 34556434 DOI: 10.1016/j.sapharm.2021.08.014] [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: 11/15/2020] [Revised: 08/18/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The imperative to identify patients at risk of medication-related harm has never been greater. Hospital clinicians cannot easily predict risk of readmission or harm. Candidate variables associated with medication-related harm derived from the literature or significantly represented in a complex patient cohort have been previously described by PHarmacie-4. With a focus on polypharmacy and high-risk medicines in vulnerable patient cohorts, PHarmacie-4 was easy to use and highlighted risks. However it over-estimated risk, reducing its usefulness in stratifying risk of readmission. OBJECTIVE Develop a risk prediction tool built into a smart phone app, enabling clinicians to identify and refer high-risk patients for an early post-discharge medicines review. Demonstrate usability, real world application and validity in an independent dataset. METHODS A retrospective, observational study was conducted with 1201 randomly selected patients admitted to Sir Charles Gairdner Hospital between June 1, 2016 to December 31, 2016. Patient characteristics and outcomes of interest were reported, including unplanned hospital utilisation at 30, 60 and 90 days post-discharge. Using multivariable logistic regression modelling, an algorithm was developed, built into a smart phone app and used and validated in an independent dataset. RESULTS 738 patients (61%) were included in the derivation sample. The best predictive performance was achieved by PHarmacie-R (C-statistic 0.72, 95% CI 0.68-0.75) which included PHarmacie-4 risk variables, a non-linear effect of age, unplanned hospital utilisation in the preceding six months and gender. The independent validation dataset had a C-statistic of 0.64 (95% CI 0.56-0.72). CONCLUSION PHarmacie-R is the first readmission risk prediction tool, built into a smart phone app, focussing on polypharmacy and high-risk medicines in vulnerable patients. It can assist clinical pharmacists to identify medical inpatients who may benefit from early post-discharge medication management services. External validation is needed to enable application in other clinical settings.
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Affiliation(s)
- Deirdre T Criddle
- Pharmacy Department, Sir Charles Gairdner Hospital, Perth, 6009, Australia; Complex Needs Coordination Team, South Metropolitan Health Service, Murdoch Drive, Perth, 6150, Australia; Medicines Solutions, Dianella, 6059, Australia.
| | - Benjamin Devine
- Complex Needs Coordination Team, South Metropolitan Health Service, Murdoch Drive, Perth, 6150, Australia
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, 6009, Australia
| | - Charley A Budgeon
- School of Population and Global Health, University of Western Australia, Perth, 6009, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, University of Western Australia, Perth, 6009, Australia
| | - Shetaal Gupta
- Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, 6009, Australia
| | | | | | - Rhonda Clifford
- Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, 6009, Australia
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Cofie NSA, Anum P, Afriyie DK, Amponsah SK. A five-year retrospective assessment of prescription errors and adverse drug events at a regional hospital in Accra, Ghana. SCIENTIFIC AFRICAN 2021. [DOI: 10.1016/j.sciaf.2021.e00849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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10
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The Effective Strategies to Avoid Medication Errors and Improving Reporting Systems. MEDICINES 2021; 8:medicines8090046. [PMID: 34564088 PMCID: PMC8468915 DOI: 10.3390/medicines8090046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
Background: Population-based studies from several countries have constantly shown excessively high rates of medication errors and avoidable deaths. An efficient medication error reporting system is the backbone of reliable practice and a measure of progress towards achieving safety. Improvement efforts and system changes of medication error reporting systems should be targeted towards reductions in the likelihood of injury to future patients. However, the aim of this review is to provide a summary of medication errors reporting culture, incidence reporting systems, creating effective reporting methods, analysis of medication error reports, and recommendations to improve medication errors reporting systems. Methods: Electronic databases (PubMed, Ovid, EBSCOhost, EMBASE, and ProQuest) were examined from 1 January 1998 to 30 June 2020. 180 articles were found and 60 papers were ultimately included in the review. Data were mined by two reviewers and verified by two other reviewers. The search yielded 684 articles, which were then reduced to 60 after the deletion of duplicates via vetting of titles, abstracts, and full-text papers. Results: Studies were principally from the United States of America and the United Kingdom. Limited studies were from Canada, Australia, New Zealand, Korea, Japan, Greece, France, Saudi Arabia, and Egypt. Detection, measurement, and analysis of medication errors require an active rather than a passive approach. Efforts are needed to encourage medication error reporting, including involving staff in opportunities for improvement and the determination of root cause(s). The National Coordinating Council for Medication Error Reporting and Prevention taxonomy is a classification system to describe and analyze the details around individual medication error events. Conclusion: A successful medication error reporting program should be safe for the reporter, result in constructive and useful recommendations and effective changes while being inclusive of everyone and supported with required resources. Health organizations need to adopt an effectual reporting environment for the medication use process in order to advance into a sounder practice.
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11
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Urquhart A, Yardley S, Thomas E, Donaldson L, Carson-Stevens A. Learning from patient safety incidents involving acutely sick adults in hospital assessment units in England and Wales: a mixed methods analysis for quality improvement. J R Soc Med 2021; 114:563-574. [PMID: 34348052 DOI: 10.1177/01410768211032589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Six per cent of hospital patients experience a patient safety incident, of which 12% result in severe/fatal outcomes. Acutely sick patients are at heightened risk. Our aim was to identify the most frequently reported incidents in acute medical units and their characteristics. DESIGN Retrospective mixed methods methodology: (1) an a priori coding process, applying a multi-axial coding framework to incident reports; and, (2) a thematic interpretative analysis of reports. SETTING Patient safety incident reports (10 years, 2005-2015) collected from the National Reporting and Learning System, which receives reports from hospitals and other care settings across England and Wales. PARTICIPANTS Reports describing severe harm/death in acute medical unit were identified. MAIN OUTCOME MEASURES Incident type, contributory factors, outcomes and level of harm were identified in the included reports. During thematic analysis, themes and metathemes were synthesised to inform priorities for quality improvement. RESULTS A total of 377 reports of severe harm or death were confirmed. The most common incident types were diagnostic errors (n = 79), medication-related errors (n = 61), and failures monitoring patients (n = 57). Incidents commonly stemmed from lack of active decision-making during patient admissions and communication failures between teams. Patients were at heightened risk of unsafe care during handovers and transfers of care. Metathemes included the necessity of patient self-advocacy and a lack of care coordination. CONCLUSION This 10-year national analysis of incident reports provides recommendations to improve patient safety including: introduction of electronic prescribing and monitoring systems; forcing checklists to reduce diagnostic errors; and increased senior presence overnight and at weekends.
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Affiliation(s)
- Alexandra Urquhart
- Division of Population Medicine, Cardiff University, Cardiff CF14 4YU, UK
| | - Sarah Yardley
- Central and North West London NHS Foundation Trust, London NW1 3AX, UK.,Marie Curie Palliative Care Research Department, University College London, London WC1E 6BT, UK
| | - Elin Thomas
- Division of Population Medicine, Cardiff University, Cardiff CF14 4YU, UK
| | - Liam Donaldson
- Division of Population Medicine, Cardiff University, Cardiff CF14 4YU, UK.,London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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12
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Li R, Curtis K, Zaidi STR, Van C, Thomson A, Castelino R. Prevalence, characteristics, and reporting of adverse drug reactions in an Australian hospital: a retrospective review of hospital admissions due to adverse drug reactions. Expert Opin Drug Saf 2021; 20:1267-1274. [PMID: 34077311 DOI: 10.1080/14740338.2021.1938539] [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] [Indexed: 10/21/2022]
Abstract
Background: Adverse drug reaction (ADR) related hospitalizations is a major cause of morbidity and mortality in Australia. This study investigated the prevalence, characteristics, and reporting of ADR related hospitalizations at a tertiary hospital in Australia.Research design and methods: A retrospective review of all ADR related hospitalizations from October to December 2019 was conducted using eMedical Records. They were classified by medicine class, ADR type, preventability, and the strength of causal relationship. ADRs were searched within the regulator's safety database to verify whether it was reported.Results: A total of 496 ADR related hospitalizations were identified from 5521 records (9.0%). Nervous system agents (32.3%) were responsible for most ADR hospitalizations and were more likely to cause psychiatric disorders (RR 9.71, 95%CI 4.98-18.87). They were also more likely to cause preventable ADRs (HR 1.62, 95%CI 1.46-1.81). Patient age (OR 1.04, 95%CI 1.03-1.05) and the number of medicines (OR 1.13, 95%CI 1.11-1.15) were associated with ADR related hospitalizations. Under-reporting to the national regulator was over 99%.Conclusions: ADR under-reporting is highly prevalent in Australian hospitals. Further research into identifying specific barriers toward reporting ADRs are needed to inform strategies with a focus on healthcare professionals involved in prescribing, dispensing, and administrating nervous system agents.
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Affiliation(s)
- Raymond Li
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Kate Curtis
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Syed Tabish Razi Zaidi
- Faculty of Medicine and Health, University of Leeds, Leeds, UK.,National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre, West Yorkshire, UK
| | - Connie Van
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Amy Thomson
- NSW Poisons Information Centre, Sydney Children's Hospital Network, Camperdown, NSW, Australia
| | - Ronald Castelino
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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Ayele Y, Tesfaye ZT. Drug-related problems in Ethiopian public healthcare settings: Systematic review and meta-analysis. SAGE Open Med 2021; 9:20503121211009728. [PMID: 33948177 PMCID: PMC8053755 DOI: 10.1177/20503121211009728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 03/21/2021] [Indexed: 11/16/2022] Open
Abstract
Identification and prevention of drug-related problems have become the central role of patient-centered pharmacy practitioners. After the initiation of patient-oriented pharmacy service, many studies evaluating magnitude of drug-related problems at facility level in Ethiopia have been conducted, though the extent of the problem at a national level remains unknown. Hence, this systematic review and meta-analysis is undertaken with the aim of quantifying the prevalence of drug-related problems in Ethiopian public healthcare settings using Cipolle/Strand classification system. Electronic databases were searched including PubMed, EMBASE, Web of Science, MEDLINE and HINARI, Google Scholar and ResearchGate for both published and unpublished works. Data on study characteristics and outcomes were extracted using the format developed on Microsoft Excel. The primary measure was the pooled prevalence of drug-related problems. The meta-analysis was conducted using OpenMeta[Analyst].A total of 17 studies were included in this systematic review and meta-analysis. The pooled prevalence of drug-related problems of patients who experienced at least one drug-related problem during their therapy was found to be 69.4% (95% confidence interval: 61.5-77.4). The most frequently reported types of drug-related problems were "need for additional drug and "noncompliance," together accounting for more than half of the drug-related problems. The most frequently reported factors associated with drug-related problems were patients' age, polypharmacy, comorbidities and the number days of hospital stay.The prevalence of drug-related problems in Ethiopian public healthcare settings was found to be high. Inconsistent reporting of drug-related problems was observed across the studies. It is imperative to design and implement interventions aimed at reducing drug-related problems. Responsible stakeholders should adopt uniform drug-related problem classification approach to ensure uniform reporting of drug-related problems in Ethiopian healthcare settings.
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Affiliation(s)
- Yohanes Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Medical and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Zelalem Tilahun Tesfaye
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Isaacs AN, Ch'ng K, Delhiwale N, Taylor K, Kent B, Raymond A. Hospital medication errors: a cross-sectional study. Int J Qual Health Care 2021; 33:5925732. [PMID: 33064797 DOI: 10.1093/intqhc/mzaa136] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Medication errors (MEs) are among the most common types of incidents reported in Australian and international hospitals. There is no uniform method of reporting and reducing these errors. This study aims to identify the incidence, time trends, types and factors associated with MEs in a large regional hospital in Australia. METHODS A 5-year cross-sectional study. RESULTS The incidence of MEs was 1.05 per 100 admitted patients. The highest frequency of errors was observed during the colder months of May-August. When distributed by day of the week, Mondays and Tuesdays had the highest frequency of errors. When distributed by hour of the day, time intervals from 7 am to 8 am and from 7 pm to 8 pm showed a sharp increase in the frequency of errors. One thousand and eighty-eight (57.8%) MEs belonged to incidence severity rating (ISR) level 4 and 787 (41.8%) belonged to ISR level 3. There were six incidents of ISR level 2 and only one incident of ISR level 1 reported during the five-year period 2014-2018. Administration-only errors were the most common accounting for 1070 (56.8%) followed by prescribing-only errors (433, 23%). High-risk medications were associated with half the number of errors, the most common of which were narcotics (17.9%) and antimicrobials (13.2%). CONCLUSIONS MEs continue to be a problem faced by international hospitals. Inexperience of health professionals and nurse-patient ratios might be the fundamental challenges to overcome. Specific training of junior staff in prescribing and administering medication and nurse workload management could be possible solutions to reducing MEs in hospitals.
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Affiliation(s)
- Anton N Isaacs
- Monash University, School of Rural Health, Traralgon, VIC 3844, Australia
| | - Kenneth Ch'ng
- Latrobe Regional Hospital, Traralgon, VIC 3844, Australia
| | - Naaz Delhiwale
- Latrobe Regional Hospital, Traralgon, VIC 3844, Australia
| | | | - Bethany Kent
- Latrobe Regional Hospital, Traralgon, VIC 3844, Australia
| | - Anita Raymond
- Latrobe Regional Hospital, Traralgon, VIC 3844, Australia
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Cheluvappa R, Selvendran S. Medical negligence - Key cases and application of legislation. Ann Med Surg (Lond) 2020; 57:205-211. [PMID: 32793340 PMCID: PMC7413923 DOI: 10.1016/j.amsu.2020.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/25/2020] [Accepted: 07/11/2020] [Indexed: 11/18/2022] Open
Abstract
Background Law entails precedent-based common law and parliamentary-legislation-based statutory law. Australian courts recognise civil wrongs, called torts. The most common tort worldwide is negligence. The first aim of the paper is to educate the Australian nursing community about medicolegal issues, statutes, important cases, legal applications, and negligence statistics pertaining to clinical practice. The second aim is to determine whether medicolegal negligence claim-numbers are commensurate with recorded statistics on adverse events. The third aim is to determine and discuss preventative approaches to minimise culpability. Materials and methods Relevant searches were done using Pubmed, Google Scholar, and Austlii. Data, negligence legislation, key cases, and law processes were collated and analysed based on court decision citations, legal impact, and relationships between legislation application and case law. Although New South Wales legislation was used throughout this paper, parallel statutes exist across Australian jurisdictions. Results The basics of the civil tort offence of negligence are explained with step-by-step explanations. Key judgments and application of legislation in key medical negligence cases are discussed. Relevant medicolegal issues and negligence statistics are discussed. The civil tort of negligence is elaborately discussed, step-by-step, with relevant Common Law and legislation relevant to NSW. The watershed cases of Hadiza Bawa-Garba and Nurse Amaro are summarised with the ramifications for doctors and nurses. Expedient strategies to assist doctors and nurses in minimising unlawful action are discussed. Conclusions Adverse medical events are high in Australia. However, new claims are decreasing. Negligence claim-numbers are disproportionate to statistics on adverse events. The Hadiza Bawa-Garba and Nurse Amaro cases have opened a legal can of worms with manifold negative ramifications for the nursing community. For a negligent breach of expected standard of care:Inexperience is irrelevant All procedural risks must be divulged prior to patient consent (Roger v Whitaker principle) No liability if a standard of care is one of many non-consensus standards widely accepted by peers
Key medicolegal issues and negligence statistics:High prevalence of adverse events and medication errors (Australia) Decreasing negligence claims are disproportionate to increasing numbers of recorded adverse events and medication errors
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Affiliation(s)
- Rajkumar Cheluvappa
- Australian Catholic University, Watson, ACT, 2602, Australia
- Corresponding author. Australian Catholic University, Watson, ACT, 2602, Australia.
| | - Selwyn Selvendran
- Department of Surgery, St George Hospital, Kogarah, NSW, 2217, Australia
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Lim R, Bereznicki L, Corlis M, Kalisch Ellett LM, Kang AC, Merlin T, Parfitt G, Pratt NL, Rowett D, Torode S, Whitehouse J, Andrade AQ, Bilton R, Cousins J, Kelly L, Schubert C, Williams M, Roughead EE. Reducing medicine-induced deterioration and adverse reactions (ReMInDAR) trial: study protocol for a randomised controlled trial in residential aged-care facilities assessing frailty as the primary outcome. BMJ Open 2020; 10:e032851. [PMID: 32327474 PMCID: PMC7204916 DOI: 10.1136/bmjopen-2019-032851] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/04/2020] [Accepted: 03/30/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Many medicines have adverse effects which are difficult to detect and frequently go unrecognised. Pharmacist monitoring of changes in signs and symptoms of these adverse effects, which we describe as medicine-induced deterioration, may reduce the risk of developing frailty. The aim of this trial is to determine the effectiveness of a 12-month pharmacist service compared with usual care in reducing medicine-induced deterioration, frailty and adverse reactions in older people living in aged-care facilities in Australia. METHODS AND ANALYSIS The reducing medicine-induced deterioration and adverse reactions trial is a multicentre, open-label randomised controlled trial. Participants will be recruited from 39 facilities in South Australia and Tasmania. Residents will be included if they are using four or more medicines at the time of recruitment, or taking more than one medicine with anticholinergic or sedative properties. The intervention group will receive a pharmacist assessment which occurs every 8 weeks. The pharmacists will liaise with the participants' general practitioners when medicine-induced deterioration is evident or adverse events are considered serious. The primary outcome is a reduction in medicine-induced deterioration from baseline to 6 and 12 months, as measured by change in frailty index. The secondary outcomes are changes in cognition scores, 24-hour movement behaviour, grip strength, weight, percentage robust, pre-frail and frail classification, rate of adverse medicine events, health-related quality of life and health resource use. The statistical analysis will use mixed-models adjusted for baseline to account for repeated outcome measures. A health economic evaluation will be conducted following trial completion using data collected during the trial. ETHICS AND DISSEMINATION Ethics approvals have been obtained from the Human Research Ethics Committee of University of South Australia (ID:0000036440) and University of Tasmania (ID:H0017022). A copy of the final report will be provided to the Australian Government Department of Health. TRIAL REGISTRATION NUMBER Australian and New Zealand Trials Registry ACTRN12618000766213.
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Affiliation(s)
- Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Luke Bereznicki
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Megan Corlis
- Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Lisa M Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Ai Choo Kang
- Southern Cross Care (SA&NT), Adelaide, South Australia, Australia
| | - Tracy Merlin
- Discipline of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Gaynor Parfitt
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Debra Rowett
- UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Stacey Torode
- Southern Cross Care (SA&NT), Adelaide, South Australia, Australia
| | - Joseph Whitehouse
- Pharmacy Improvement Centre Ltd, Welland, South Australia, Australia
| | - Andre Q Andrade
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Rebecca Bilton
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Justin Cousins
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Lan Kelly
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Camille Schubert
- Discipline of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Elizabeth Ellen Roughead
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Urquhart A, Carson-Stevens A, Yardley S, Thomas E. Patient safety incidents involving acutely sick adults in hospital assessment units in England and Wales: a mixed methods analysis. Future Healthc J 2020; 7:s78-s79. [PMID: 32455304 PMCID: PMC7241148 DOI: 10.7861/fhj.7.1.s78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Sarah Yardley
- Central and North West London NHS Foundation Trust, London, UK
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18
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Panduwal CA, Bilaut EC. The Effectiveness of Interventions to Reduce the Nurses’ Distractions during Medication Administration: A Systematic Review. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Nurses constitute the largest group of health professionals who work in the hospital setting and most of the medications in the setting are administered by nurses. Errors related to medication conducted by a nurse frequently occur during medication administration. Interruptions or distractions during medication administration have been identified as significant contributory factors to medication administration errors (MAEs).Methods: This systematic review critically reviewed the evidence of the effectiveness of the interventions that aim to reduce nurse interruptions or distractions during medication administration. The search for the relevant literature was conducted in August 2018 using three databases; Medline, Cinahl and Embase.Results: Nineteen full text articles were retrieved and reviewed, and 7 articles were included in this review. Five of these studies showed evidence of a reduction in the interruption or distraction rates in post-intervention measurements, while 4 studies reported a statistically significant reduction in the interruption or distraction rates, with p values between 0.0005 and 0.002.Conclusion: There was limited evidence available to support the effectiveness of the interventions in terms of either reducing the interruptions or distractions of the nurses during the medication administration or in terms of reducing the medication administration error rates.
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Knowledge, attitude and practice regarding nursing interruptions among Chinese nurses: A nationwide cross-sectional survey. Int J Nurs Sci 2019; 7:66-73. [PMID: 32099862 PMCID: PMC7031111 DOI: 10.1016/j.ijnss.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 11/26/2019] [Accepted: 12/10/2019] [Indexed: 11/20/2022] Open
Abstract
Objectives To explore the knowledge, attitude and practice of Chinese nurses regarding nursing interruptions and related factors. Methods A total of 6,400 nurses from 31 hospitals in China were investigated by using the Knowledge, Attitude and Practice (KAP) Questionnaire of Nursing Interruptions. The questionnaire consists of three dimensions, knowledge, attitude and practice, containing 10, 9 and 7 items, with full score of 50, 45 and 28, respectively. Results The mean overall KAP score regarding nursing interruptions of Chinese nurses was 74.05 ± 16.65 (range: 26–123), with scores for the knowledge, attitude, and practice component being 21.74 ± 9.80, 34.83 ± 6.98, and 17.49 ± 4.97, respectively. Among the nurses, 70.8% of them experienced an average level of KAP toward nursing interruptions while 15.5% were at a poor level. The knowledge, attitude, and practice of nursing interruptions were better in chief nurses, managers, nurses with a master degree or above, nurses ever received training, and nurses with a strong agreement to leadership compared to nurses in other groups (P < 0.05). In addition, employment type, professional title, position, standardized training and leaders’ attention were predictors of KAP in nurses. Conclusion Chinese nurses have a moderate level of KAP regarding nursing interruptions. Leaders’ attention, standardized training, position, professional title and employment type could predict nurses’ KAP state of nursing interruptions. Thus, a targeted training program should be implemented for clinical nurses by nursing leaders, with a particular focus on feasibility and professionalism.
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Dang CPL, Toh LS, Cooling N, Jackson S, Curtain C, Thompson A, Peterson G. Updating and validating quality prescribing indicators for use in Australian general practice. Aust J Prim Health 2019; 26:31-42. [PMID: 31864426 DOI: 10.1071/py19060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/18/2019] [Indexed: 11/23/2022]
Abstract
This study aims to update and validate quality prescribing indicators (QPIs) for Australian general practice. The study comprised two phases: (1) developing preliminary potential QPIs based on the 2006 National Prescribing Service (NPS) MedicineWise indicators, published literature, international indicators and guidelines, and through qualitative focus group discussions; and (2) validating the proposed QPIs through a two-round online survey using the Delphi technique. The Delphi panel included four GPs, four pharmacists and two clinical pharmacologists. The Delphi panel rated the potential QPIs for their validity, importance and feasibility using a 1-10 Likert scale. In round one, all proposed QPIs presented as 'prescribing rules' achieved high scores regarding validity, importance and feasibility No rule was eliminated and three new rules were introduced. Rules were reworded into 'prescribing indicators' for round two, which resulted in 35 indicators being accepted and two indicators being eliminated. The final QPIs also include seven drug-drug interactions, which received high scores in round one. In conclusion, 42 QPIs were nominated for use in Australian general practice, based on their validity, importance and feasibility. If implemented, these QPIs have the potential to assist in efforts to improve the quality and safety of medicines management.
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Affiliation(s)
- Cuu Phuong Linh Dang
- Division of Pharmacy, School of Medicine, University of Tasmania, Private Bag 26, Hobart, Tas. 7001, Australia; and Corresponding author
| | - Li Shean Toh
- Division of Pharmacy, School of Medicine, University of Tasmania, Private Bag 26, Hobart, Tas. 7001, Australia; and Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham NG9 2RD, UK
| | - Nick Cooling
- Division of Medicine, School of Medicine, University of Tasmania, Private Bag 34, Hobart, Tas. 7001, Australia
| | - Shane Jackson
- Division of Pharmacy, School of Medicine, University of Tasmania, Private Bag 26, Hobart, Tas. 7001, Australia
| | - Colin Curtain
- Division of Pharmacy, School of Medicine, University of Tasmania, Private Bag 26, Hobart, Tas. 7001, Australia
| | - Angus Thompson
- Division of Pharmacy, School of Medicine, University of Tasmania, Private Bag 26, Hobart, Tas. 7001, Australia
| | - Gregory Peterson
- Division of Pharmacy, School of Medicine, University of Tasmania, Private Bag 26, Hobart, Tas. 7001, Australia
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Hay P, Wilton K, Barker J, Mortley J, Cumerlato M. The importance of clinical documentation improvement for Australian hospitals. HEALTH INF MANAG J 2019; 49:69-73. [DOI: 10.1177/1833358319854185] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Clinical documentation improvement (CDI) is a recent initiative gaining increased momentum in Australia. The benefits surrounding its success internationally include improved quality and patient safety outcomes and increased reimbursement. The premise of CDI is simple: engage clinicians to improve the clinical documentation in the medical record in “real time” so that it is fit for reporting, analysis and reimbursement. Every country has differing healthcare systems and this article has focused on validating the relevancy of CDI for the Australian healthcare environment.
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Affiliation(s)
| | | | | | | | - Megan Cumerlato
- Health Information Management Consultant, Australia
- NCCH, University of Sydney, Australia
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Hattingh L, Sim TF, Sunderland B, Czarniak P. Successful implementation and provision of enhanced and extended pharmacy services. Res Social Adm Pharm 2019; 16:464-474. [PMID: 31272922 DOI: 10.1016/j.sapharm.2019.06.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Careful planning is important for successful implementation and ongoing provision of enhanced and extended pharmacy services. OBJECTIVE To explore the factors that contributed to the successful implementation and ongoing provision of enhanced and extended services in Western Australian community pharmacies. METHODS In-depth semi-structured telephone interviews were conducted with purposively selected pharmacists from various practice settings. Interviews explored experiences and perspectives on the provision of enhanced and extended professional services and continued until saturation was achieved. Analysis focused on prior investigation before implementation of services, perceptions of the impact of the services and factors to be considered. The COM-B (Capability, Opportunity, Motivation and Behaviour) model was applied post hoc to the thematic analysis to explore whether there was an overlap between themes and the model. RESULTS In total 26 pharmacists (16 males, 10 females) participated in semi-structured interviews during October 2017 and February 2018. They classified as 20 community, 13 accredited and 7 specialist pharmacists and 11 pharmacist immunisers (some classified as more than one). Interview duration was 55 min (minimum 22, maximum 91 min). Responses regarding prior investigation/research conducted varied in approach followed and level of enquiry. Opinions about services were overall positive such as enhanced collaboration with other healthcare professionals, positive patient outcomes, increased staff satisfaction and acceptance of pharmacists as primary care providers. New services did not always provide direct financial benefit. Three major themes emerged as factors that impacted on provision of services: 1) pharmacist characteristics, 2) local needs, structures and support, and 3) an enabling practice framework. CONCLUSIONS Pharmacists who were successful in the implementation and maintenance of new professional services were familiar with local needs. Both pharmacy and pharmacist aspects should be considered during implementation and maintenance of new professional services. An enabling practice framework is crucial in facilitating new pharmacy services.
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Affiliation(s)
- Laetitia Hattingh
- Gold Coast Health, Gold Coast, Queensland, 4215, Australia; School of Pharmacy and Pharmacology, Griffith University, Gold Coast, Queensland 4222, Australia.
| | - Tin Fei Sim
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, 6102, Australia.
| | - Bruce Sunderland
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, 6102, Australia.
| | - Petra Czarniak
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, 6102, Australia.
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Borja VA, Galbraith K. Medication-related issues associated with the documentation and administration of long-acting injectable antipsychotics. Int J Clin Pharm 2019; 41:623-629. [DOI: 10.1007/s11096-019-00814-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
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Daliri S, Hugtenburg JG, ter Riet G, van den Bemt BJF, Buurman BM, Scholte op Reimer WJM, van Buul-Gast MC, Karapinar-Çarkit F. The effect of a pharmacy-led transitional care program on medication-related problems post-discharge: A before-After prospective study. PLoS One 2019; 14:e0213593. [PMID: 30861042 PMCID: PMC6413946 DOI: 10.1371/journal.pone.0213593] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/25/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Medication-related problems are common after hospitalization, for example when changes in patients' medication regimens are accompanied by insufficient patient education, poor information transfer between healthcare providers, and inadequate follow-up post-discharge. We investigated the effect of a pharmacy-led transitional care program on the occurrence of medication-related problems four weeks post-discharge. METHODS A prospective multi-center before-after study was conducted in six departments in total of two hospitals and 50 community pharmacies in the Netherlands. We tested a pharmacy-led program incorporating (i) usual care (medication reconciliation at hospital admission and discharge) combined with, (ii) teach-back at hospital discharge, (iii) improved transfer of medication information to primary healthcare providers and (iv) post-discharge home visit by the patient's own community pharmacist, compared with usual care alone. The difference in medication-related problems four weeks post-discharge, measured by means of a validated telephone-interview protocol, was the primary outcome. Multiple logistic regression analysis was used, adjusting for potential confounders after multiple imputation to deal with missing data. RESULTS We included 234 (January-April 2016) and 222 (July-November 2016) patients in the usual care and intervention group, respectively. Complete data on the primary outcome was available for 400 patients. The proportion of patients with any medication-related problem was 65.9% (211/400) in the usual care group compared to 52.4% (189/400) in the intervention group (p = 0.01). After multiple imputation, the proportion of patients with any medication-related problem remained lower in the intervention group (unadjusted odds ratio 0.57; 95% CI 0.38-0.86, adjusted odds ratio 0.50; 95% CI 0.31-0.79). CONCLUSIONS A pharmacy-led transitional care program reduced medication-related problems after discharge. Implementation research is needed to determine how best to embed these interventions in existing processes.
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Affiliation(s)
- Sara Daliri
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands
- Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail: (SD); (FKÇ)
| | - Jacqueline G. Hugtenburg
- Department of Clinical Pharmacology & Pharmacy, VU University Medical Center, Amsterdam, the Netherlands
- Community Pharmacy Westwijk, Amsterdam, the Netherlands
| | - Gerben ter Riet
- Department of General Practice, Academic Medical Center, Amsterdam, the Netherlands
| | - Bart J. F. van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Pharmacy, University Medical Centre Maastricht, the Netherlands
| | - Bianca M. Buurman
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Wilma J. M. Scholte op Reimer
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands
- * E-mail: (SD); (FKÇ)
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Rao WW, Zeng LN, Zhang JW, Zong QQ, An FR, Ng CH, Ungvari GS, Yang FY, Zhang J, Peng KZ, Xiang YT. Worldwide prevalence of falls in older adults with psychiatric disorders: A meta-analysis of observational studies. Psychiatry Res 2019; 273:114-120. [PMID: 30641340 DOI: 10.1016/j.psychres.2018.12.165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 11/05/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
Falls are common in older adults with psychiatric disorders, but the epidemiological findings have been inconsistent. This meta-analysis examined the prevalence of falls in older psychiatric patients and its moderating factors. PubMed, EMBASE, Web of Science and PsycINFO databases were independently searched by three investigators from their inception date to Nov 31, 2017. The random effects meta-analysis was used to synthesize the prevalence of falls, while meta-regression and subgroup analyses were conducted to explore the moderating factors. Sixteen of the 2061 potentially relevant papers met the entry criteria for the meta-analysis. The pooled lifetime prevalence of falls was 17.25% (95% confidence interval: 13.14%-21.35%). Neither univariate and nor multivariate meta-regression analyses revealed any moderating effects of the study region, duration, sample size, and quality on the prevalence of falls (P values > 0.05). Falls in older adults with psychiatric disorders are common.
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Affiliation(s)
- Wen-Wang Rao
- Faculty of Health Sciences, Unit of Psychiatry, Institute of Translational Medicine, University of Macau, 3/F, Building E12, Macao SAR, China
| | - Liang-Nan Zeng
- Faculty of Health Sciences, Unit of Psychiatry, Institute of Translational Medicine, University of Macau, 3/F, Building E12, Macao SAR, China; Department of Neurosurgery, the Affiliated Hospital of Southwest Medical University, Sichuan province, China
| | - Ji-Wen Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Qian-Qian Zong
- School of Nursing, Capital Medical University, Beijing, China; The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China.
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S Ungvari
- The University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
| | - Fang-Yu Yang
- School of Nursing, Capital Medical University, Beijing, China
| | - Juan Zhang
- Faculty of Education, University of Macau, Macao SAR, China
| | - Kelly Z Peng
- Department of Business Administration, Hong Kong Shue Yan University, Hong Kong, China
| | - Yu-Tao Xiang
- Faculty of Health Sciences, Unit of Psychiatry, Institute of Translational Medicine, University of Macau, 3/F, Building E12, Macao SAR, China.
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Awareness and use of medication management services in relation to medication adherence prior to hospitalisation among older adults in Regional Australia. Int J Clin Pharm 2018; 41:189-197. [DOI: 10.1007/s11096-018-0765-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022]
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Jedwab RM, Hutchinson AM, Redley B. Magnesium sulphate replacement therapy in cardiac surgery patients: A systematic review. Aust Crit Care 2018; 32:421-433. [PMID: 30501993 DOI: 10.1016/j.aucc.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 09/06/2018] [Accepted: 09/24/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this review was to identify evidence to inform clinical practice guidelines for magnesium sulphate (MgSO4) replacement therapy for postoperative cardiac surgery patients. DATA SOURCES Three databases were systematically searched: CINAHL Complete, MEDLINE Complete, and EmBase. REVIEW METHOD USED A systematic literature review method was used to locate, appraise, and synthesise available evidence for each step of the medication management cycle (indication, prescription, preparation, administration, and monitoring) for MgSO4 replacement therapy. Database searches used combinations of synonyms for postoperation or surgery, cardiac, heart, arrhythmia, atrial fibrillation, and magnesium sulphate. Search results were independently screened for inclusion by two researchers at title, abstract, and full-text stages with good statistical agreement (kappa scores of 0.99, 0.87, and 1.00, respectively). RESULTS Twenty-four included studies reported varying methodologies, data collected, and medication management practices. Of these, 23 studies (95.8%) excluded patients with comorbidities commonly observed in clinical practice. This review identified low-level evidence for two practice recommendations: (i) concurrent administration of MgSO4 with medications recommended as the best practice for prevention of postoperative atrial fibrillation and (ii) clinical and laboratory monitoring of magnesium blood serum levels, vital signs, and electrocardiography should be performed during MgSO4 replacement therapy. Evidence to inform MgSO4 replacement therapy for each medication management cycle step was limited; therefore, a guideline could not be developed. CONCLUSIONS Although MgSO4 is routinely administered to prevent hypomagnesaemia in postoperative cardiac surgery patients, there was insufficient evidence to guide critical care nurses in each medication management cycle step for MgSO4 replacement therapy. These findings precluded the development of comprehensive recommendations to standardise this practice. Poor standardisation can increase the risk for patient harm related to variation in clinical processes and procedural errors. In light of this evidence gap, consensus of expert opinion should be used as a strategy to guide MgSO4 medication management.
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Affiliation(s)
- Rebecca M Jedwab
- Centre for Quality and Patient Safety Research - Monash Health Partnership, 246 Clayton Road, Clayton, Victoria, 3168, Australia; Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
| | - Alison M Hutchinson
- Centre for Quality and Patient Safety Research - Monash Health Partnership, 246 Clayton Road, Clayton, Victoria, 3168, Australia; Deakin University, School of Nursing and Midwifery, Geelong, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Bernice Redley
- Centre for Quality and Patient Safety Research - Monash Health Partnership, 246 Clayton Road, Clayton, Victoria, 3168, Australia; Deakin University, School of Nursing and Midwifery, Geelong, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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Wheeler AJ, Spinks J, Kelly F, Ware RS, Vowles E, Stephens M, Scuffham PA, Miller A. Protocol for a feasibility study of an Indigenous Medication Review Service (IMeRSe) in Australia. BMJ Open 2018; 8:e026462. [PMID: 30391923 PMCID: PMC6231589 DOI: 10.1136/bmjopen-2018-026462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The age-adjusted rate of potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people is almost five times the rate of other Australians. Quality use of medicines has an important role in alleviating these differences. This requires strengthening existing medication reviewing services through collaboration between community pharmacists and health workers, and ensuring services are culturally appropriate. This Indigenous Medication Review Service (IMeRSe) study aims to develop and evaluate the feasibility of a culturally appropriate medication management service delivered by community pharmacists in collaboration with Aboriginal health workers. METHODS AND ANALYSIS This study will be conducted in nine Aboriginal health services (AHSs) and their associated community pharmacies in three Australian states over 12 months. Community pharmacists will be trained to improve their awareness and understanding of Indigenous health and cultural issues, to communicate the quality use of medicines effectively, and to strengthen interprofessional relationships with AHSs and their staff. Sixty consumers (with a chronic condition/pregnant/within 2 years post partum and at risk of medication-related problems (MRPs) per site will be recruited, with data collection at baseline and 6 months. The primary outcome is the difference in cumulative incidence of serious MRPs in the 6 months after IMeRSe introduction compared with the 6 months prior. Secondary outcomes include potentially preventable medication-related hospitalisations, medication adherence, total MRPs, psychological and social empowerment, beliefs about medication, treatment satisfaction and health expenditure. ETHICS AND DISSEMINATION The protocol received approval from Griffith University (HREC/2018/251), Queensland Health Metro South (HREC/18/QPAH/109), Aboriginal Health and Medical Research Council of New South Wales (1381/18), Far North Queensland (HREC/18/QCH/86-1256) and the Central Australian HREC (CA-18-3090). Dissemination to Indigenous people and communities will be a priority. Results will be available on the Australian Sixth Community Pharmacy Agreement website and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12618000188235; Pre-results.
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Affiliation(s)
- Amanda J Wheeler
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Faculty of Medical and Health Sciences, Auckland University, Auckland, New Zealand
| | - Jean Spinks
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Fiona Kelly
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Pharmacy and Pharmacology, Griffith University, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Erica Vowles
- The Pharmacy Guild of Australia, National Secretariat, Canberra, Australian Capital Territory, Australia
| | - Mike Stephens
- National Aboriginal Community Controlled Health Organisation, Canberra, Australian Capital Territory, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Adrian Miller
- Office of the Pro Vice-Chancellor Indigenous Engagement, CQ University, Townsville, Queensland, Australia
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Reducing adverse medication events in mental health: Australian National Survey. INT J EVID-BASED HEA 2018; 18:108-115. [PMID: 30239356 DOI: 10.1097/xeb.0000000000000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM To determine the extent to which evidence-based medication safety practices have been implemented in public and private mental health inpatient units across Australia. METHODS The Reducing Adverse Medication Events in Mental Health survey was piloted in Victoria, Australia, in 2015, and rolled out nationally in 2016. In total, 235 mental health inpatient units from all States and Territories in Australia were invited to participate. The survey included questions about the demographics of the mental health unit, evidence-based strategies to improve prescription writing, the administration and dispensing of medicines and pharmacy-led interventions, and also questions relating to consumer engagement in medication management and shared decision-making. RESULTS The response rate was 45% (N = 106 units). Overall, the survey found that 57% of the mental health units had fully or partially implemented evidence-based medication safety practices. High levels of implementation (80%) were reported for the use of standardized medication charts such as the National Inpatient Medication Chart as a way to improve medication prescription writing. Most (71%) of the units were using standardized forms for recording medication histories, and 56% were using designated forms for Medication Management Plans. However, less than one-fifth of the units had implemented electronic medication management systems, and the majority of units still relied on paper-based documentation systems.Interventions to improve medicine administration and dispensing were not highly utilized. Individual patient-based medication distribution systems were fully implemented in only 9% of the units, with a high reliance (81%) on ward stock or imprest systems. Tall Man lettering for labelling was implemented in only one-third of the units.Pharmacy services were well represented in mental health units, with 80% having access to onsite pharmacist services providing assessments of current medications and clinical review services, adverse drug reaction reporting and management services, patient and carer education and counselling, and medicines information services. However, pharmacists were involved in only half of medical reconciliations. Their involvement in post-discharge follow-up was limited to 4% of units. CONCLUSIONS Gaps in medication safety practices included limited use of individual patient supply systems for medication distribution, a high reliance on ward stock systems and high reliance on paper-based systems for medication prescribing and administration. With regards to service provision, clinical pharmacist involvement in medical reconciliation services, therapeutic drug monitoring and interdisciplinary ward rounds should be increased. Discharge and post-discharge services were major gaps in service provision.
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Buss VH, Shield A, Kosari S, Naunton M. The impact of clinical services provided by community pharmacies on the Australian healthcare system: a review of the literature. J Pharm Policy Pract 2018. [DOI: 10.1186/s40545-018-0149-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wang KN, Bell JS, Chen EYH, Gilmartin-Thomas JFM, Ilomäki J. Medications and Prescribing Patterns as Factors Associated with Hospitalizations from Long-Term Care Facilities: A Systematic Review. Drugs Aging 2018; 35:423-457. [PMID: 29582403 DOI: 10.1007/s40266-018-0537-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Residents of long-term care facilities (LTCFs) are at high risk of hospitalization. Medications are a potentially modifiable risk factor for hospitalizations. OBJECTIVE Our objective was to systematically review the association between medications or prescribing patterns and hospitalizations from LTCFs. METHODS We searched MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and International Pharmaceutical Abstracts (IPA) from inception to August 2017 for longitudinal studies reporting associations between medications or prescribing patterns and hospitalizations. Two independent investigators completed the study selection, data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Tools. RESULTS Three randomized controlled trials (RCTs), 22 cohort studies, five case-control studies, one case-time-control study and one case-crossover study, investigating 13 different medication classes and two prescribing patterns were included. An RCT demonstrated that high-dose influenza vaccination reduced all-cause hospitalization compared with standard-dose vaccination (risk ratio [RR] 0.93; 95% confidence interval [CI] 0.88-0.98). Another RCT found no difference in hospitalization rates between oseltamivir as influenza treatment and oseltamivir as treatment plus prophylaxis (treatment = 4.7%, treatment and prophylaxis = 3.5%; p = 0.7). The third RCT found no difference between multivitamin/mineral supplementation and hospitalization (odds ratio [OR] 0.94; 95% CI 0.74-1.20) or emergency department visits (OR 1.05; 95% CI 0.76-1.47). Two cohort studies demonstrated influenza vaccination reduced hospitalization. Four studies suggested polypharmacy and potentially inappropriate medications (PIMs) increased all-cause hospitalization. However, associations between polypharmacy (two studies), PIMs (one study) and fall-related hospitalizations were inconsistent. Inconsistent associations were found between psychotropic medications with all-cause and cause-specific hospitalizations (11 studies). Warfarin, nonsteroidal anti-inflammatory drugs, pantoprazole and vinpocetine but not long-term acetylsalicylic acid (aspirin), statins, trimetazidine, digoxin or β-blockers were associated with all-cause or cause-specific hospitalizations in single studies of specific resident populations. Most cohort studies assessed prevalent rather than incident medication exposure, and no studies considered time-varying medication use. CONCLUSION High-quality evidence suggests influenza vaccination reduces hospitalization. Polypharmacy and PIMs are consistently associated with increased all-cause hospitalization.
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Affiliation(s)
- Kate N Wang
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia.
| | - J Simon Bell
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Esa Y H Chen
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
| | - Julia F M Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - Jenni Ilomäki
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Caughey GE, Hillen JB, Bacon S, Bullock N, Bullock V, Kalisch Ellett L. Implementation of medication-related indicators of potentially preventable hospitalizations in a national chronic disease management program for older patients with multimorbidity. Int J Qual Health Care 2018; 31:133-139. [DOI: 10.1093/intqhc/mzy133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 04/23/2018] [Accepted: 06/06/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Gillian E Caughey
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Jodie B Hillen
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | | | | | | | - Lisa Kalisch Ellett
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
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Falconer N, Barras M, Cottrell N. Systematic review of predictive risk models for adverse drug events in hospitalized patients. Br J Clin Pharmacol 2018; 84:846-864. [PMID: 29337387 PMCID: PMC5903258 DOI: 10.1111/bcp.13514] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/21/2017] [Accepted: 01/03/2018] [Indexed: 12/23/2022] Open
Abstract
AIM An emerging approach to reducing hospital adverse drug events is the use of predictive risk scores. The aim of this systematic review was to critically appraise models developed for predicting adverse drug event risk in inpatients. METHODS Embase, PubMed, CINAHL and Scopus databases were used to identify studies of predictive risk models for hospitalized adult inpatients. Studies had to have used multivariable logistic regression for model development, resulting in a score or rule with two or more variables, to predict the likelihood of inpatient adverse drug events. The Checklist for the critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) was used to critically appraise eligible studies. RESULTS Eleven studies met the inclusion criteria and were included in the review. Ten described the development of a new model, whilst one study revalidated and updated an existing score. Studies used different definitions for outcome but were synonymous with or closely related to adverse drug events. Four studies undertook external validation, five internally validated and two studies did not validate their model. No studies evaluated impact of risk scores on patient outcomes. CONCLUSION Adverse drug event risk prediction is a complex endeavour but could help to improve patient safety and hospital resource management. Studies in this review had some limitations in their methods for model development, reporting and validation. Two studies, the BADRI and Trivalle's risk scores, used better model development and validation methods and reported reasonable performance, and so could be considered for further research.
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Affiliation(s)
- Nazanin Falconer
- School of Pharmacy, Pharmacy Australia Centre of ExcellenceThe University of QueenslandBrisbaneQLD4102Australia
| | - Michael Barras
- School of Pharmacy, Pharmacy Australia Centre of ExcellenceThe University of QueenslandBrisbaneQLD4102Australia
- Princess Alexandra HospitalMetro South Health199 Ipswich Road, WoolloongabbaBrisbaneQLD4102Australia
| | - Neil Cottrell
- School of Pharmacy, Pharmacy Australia Centre of ExcellenceThe University of QueenslandBrisbaneQLD4102Australia
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Ng J, Scahill S, Harrison J. Stakeholder views do matter: a conceptual framework for medication safety measurement. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jerome Ng
- School of Pharmacy; University of Auckland; Auckland New Zealand
- Institute for Innovation and Improvement; Waitemata District Health Board; New Zealand
| | - Shane Scahill
- School of Pharmacy; University of Auckland; Auckland New Zealand
- School of Management; Massey University; Auckland New Zealand
| | - Jeff Harrison
- School of Pharmacy; University of Auckland; Auckland New Zealand
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Changes in medicine prescription following a medication review in older high-risk patients with polypharmacy. Int J Clin Pharm 2018; 40:480-487. [PMID: 29453677 PMCID: PMC5918522 DOI: 10.1007/s11096-018-0602-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/01/2018] [Indexed: 12/02/2022]
Abstract
Background The more (inappropriate) drugs a patient uses, the higher the risk of drug related problems. To reduce these risks, medication reviews can be performed. Objective To report changes in the prescribed number of (potentially inappropriate) drugs before and after performing a medication review in high-risk polypharmacy patients. A secondary objective was to study reasons for continuing potentially inappropriate drugs (PIDs). Setting Dutch community pharmacy and general medical practice. Methods A retrospective longitudinal intervention study with a pre-test/post-test design and follow-up of 1 week and 3 months was performed. The study population consisted of 126 patients with polypharmacy and with additional risk for drug related problems that underwent a medication review in five community pharmacies. The medication review was performed by the pharmacist in close cooperation with the general practitioner of each corresponding patient. Main outcome measure Number of (potentially inappropriate) drugs, and appropriateness of prescribed medicines. Results The average number of drugs a patient used 1 day before the review was 8.7 (SD = 2.9), which decreased (p < 0.05) to 8.3 (SD = 2.7) 1 week after the review, and to 8.4 (SD = 2.6) 3 months after the review. The average number of PIDs was initially 0.6 (SD = 0.8) per patient and decreased to 0.4 (SD = 0.6, p < 0.05). Twenty-two of the 241 initial drug changes (9%) were deprescribed during follow-up. Registered reasons for continuing PIDs are clinical or patients’ preferences. Conclusions Performing medication reviews in polypharmacy patients seems useful to continue at least in high-risk patients in The Netherlands. The time-consuming reviews could be limited to patients who are willing to change their medication.
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Drug-related problems among community-dwelling older adults in mainland China. Int J Clin Pharm 2018; 40:368-375. [PMID: 29340850 DOI: 10.1007/s11096-017-0587-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
Background Little is known about the extent of drug-related problems (DRPs) in community-dwelling older adult patients with chronic diseases in mainland China. Setting A medication therapy review service at a community health center in Chongqing, China. Objective To identify and categorize DRPs along with pharmacists' recommendations in addressing the DRPs identified. Method The study was conducted between May 2015 and July 2016. A total of 102 community-dwelling older adults were included. MTR was carried out by clinical pharmacists. DRPs and pharmacotherapy recommendations were recorded and analyzed. Main outcome measure The number of drug-related problems and main problem categories. Results The average age of patients was 69.4 years. Patients took an average of 6.3 medications. A total of 489 DRPs were identified (mean of 4.8 per patient). The most common category was under-treated (27.8%) followed by over- or under-dose (18.8%) and monitoring (17.8%). The number of medications taken was the significant associated factor for DRPs. Pharmacists made 526 recommendations to address the DRPs (mean of 1.1 recommendations per DRP). Primary care providers accepted 68.1% of these recommendations, and implemented 60.9% of them. Conclusion The prevalence of DRPs among studied patient population was high. Pharmacists may play a vital role in addressing the DRPs and optimize pharmacotherapy through MTR service located in community health centers.
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Fossum M, Hughes L, Manias E, Bennett P, Dunning T, Hutchinson A, Considine J, Botti M, Duke MM, Bucknall T. Comparison of medication policies to guide nursing practice across seven Victorian health services. AUST HEALTH REV 2018; 40:526-532. [PMID: 26803689 DOI: 10.1071/ah15202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 11/24/2015] [Indexed: 11/23/2022]
Abstract
Objectives The objective of this paper is to review and compare the content of medication management policies across seven Australian health services located in the state of Victoria. Methods The medication management policies for health professionals involved in administering medications were obtained from seven health services under one jurisdiction. Analysis focused on policy content, including the health service requirements and regulations governing practice. Results and Conclusions The policies of the seven health services contained standard information about staff authorisation, controlled medications and poisons, labelling injections and infusions, patient self-administration, documentation and managing medication errors. However, policy related to individual health professional responsibilities, single- and double-checking medications, telephone orders and expected staff competencies varied across the seven health services. Some inconsistencies in health professionals' responsibilities among medication management policies were identified. What is known about the topic? Medication errors are recognised as the single most preventable cause of patient harm in hospitals and occur most frequently during administration. Medication management is a complex process involving several management and treatment decisions. Policies are developed to assist health professionals to safely manage medications and standardise practice; however, co-occurring activities and interruptions increase the risk of medication errors. What does this paper add? In the present policy analysis, we identified some variation in the content of medication management policies across seven Victorian health services. Policies varied in relation to medications that require single- and double-checking, as well as by whom, nurse-initiated medications, administration rights, telephone orders and competencies required to check medications. What are the implications for practitioners? Variation in medication management policies across organisations is highlighted and raises concerns regarding consistency in governance and practice related to medication management. Lack of practice standardisation has previously been implicated in medication errors. Lack of intrajurisdictional concordance should be addressed to increase consistency. Inconsistency in expectations between healthcare services may lead to confusion about expectations among health professionals moving from one healthcare service to another, and possibly lead to increased risk of medication errors.
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Affiliation(s)
- Mariann Fossum
- Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Vic. 3125, Australia. ; ; ; ; ; ;
| | - Lee Hughes
- Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Vic. 3125, Australia. ; ; ; ; ; ;
| | - Elizabeth Manias
- Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Vic. 3125, Australia. ; ; ; ; ; ;
| | - Paul Bennett
- Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Vic. 3125, Australia. ; ; ; ; ; ;
| | - Trisha Dunning
- Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Vic. 3125, Australia. ; ; ; ; ; ;
| | - Alison Hutchinson
- Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Vic. 3125, Australia. ; ; ; ; ; ;
| | - Julie Considine
- Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Vic. 3125, Australia. ; ; ; ; ; ;
| | - Mari Botti
- Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Vic. 3125, Australia. ; ; ; ; ; ;
| | - Maxine M Duke
- Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Vic. 3125, Australia. ; ; ; ; ; ;
| | - Tracey Bucknall
- Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Vic. 3125, Australia. ; ; ; ; ; ;
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da Cruz HL, Mota FKDC, Araújo LU, Bodevan EC, Seixas SRS, Santos DF. The utility of the records medical: factors associated with the medication errors in chronic disease. Rev Lat Am Enfermagem 2017; 25:e2967. [PMID: 29236841 PMCID: PMC5738858 DOI: 10.1590/1518-8345.2406.2967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/22/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study describes the development of the medication history of the medical records to measure factors associated with medication errors among chronic diseases patients in Diamantina, Minas Gerais. METHODS retrospective, descriptive observational study of secondary data, through the review of medical records of hypertensive and diabetic patients, from March to October 2016. RESULTS The patients the mean age of patient was 62.1 ± 14.3 years. The number of basic nursing care (95.5%) prevailed and physician consultations were 82.6%. Polypharmacy was recorded in 54% of sample, and review of the medication lists by a pharmacist revealed that 67.0% drug included at least one risk. The most common risks were: drug-drug interaction (57.8%), renal risk (29.8%), risk of falling (12.9%) and duplicate therapies (11.9%). Factors associated with medications errors history were chronic diseases and polypharmacy, that persisted in multivariate analysis, with adjusted RP chronic diseases, diabetes RP 1.55 (95%IC 1.04-1.94), diabetes/hypertension RP 1.6 (95%CI 1.09-1.23) and polypharmacy RP 1.61 (95%IC 1.41-1.85), respectively. CONCLUSION Medication errors are known to compromise patient safety. This has led to the suggestion that medication reconciliation an entry point into the systems health, ongoing care coordination and a person focused approach for people and their families.
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Affiliation(s)
- Hellen Lilliane da Cruz
- Graduated, Pharmacy, MSc, Departamento de Farmácia, Universidade Federal
dos Vales Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Flávia Karla da Cruz Mota
- Especialist, Nursing and Family Health Especialization, Secretaria
Municipal de Saúde, Prefeitura de Diamantina, Diamantina, MG, Brazil
| | - Lorena Ulhôa Araújo
- Doctor, Pharmaceutical Sciences, Professor, Departamento de farmácia,
Universidade Federal dos Vales Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Emerson Cotta Bodevan
- PhD, Estatistic, Professor, Departamento de Matemática, Universidade
Federal dos Vales Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Sérgio Ricardo Stuckert Seixas
- PhD, Farmacology, Professor, Departamento de Farmácia, Universidade
Federal dos Vales Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Delba Fonseca Santos
- PhD, Collective Health, Professor, Departamento de Farmácia,
Universidade Federal dos Vales Jequitinhonha e Mucuri, Diamantina, MG, Brazil
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Mekonnen AB, Alhawassi TM, McLachlan AJ, Brien JAE. Adverse Drug Events and Medication Errors in African Hospitals: A Systematic Review. Drugs Real World Outcomes 2017; 5:1-24. [PMID: 29138993 PMCID: PMC5825388 DOI: 10.1007/s40801-017-0125-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Medication errors and adverse drug events are universal problems contributing to patient harm but the magnitude of these problems in Africa remains unclear. Objective The objective of this study was to systematically investigate the literature on the extent of medication errors and adverse drug events, and the factors contributing to medication errors in African hospitals. Methods We searched PubMed, MEDLINE, EMBASE, Web of Science and Global Health databases from inception to 31 August, 2017 and hand searched the reference lists of included studies. Original research studies of any design published in English that investigated adverse drug events and/or medication errors in any patient population in the hospital setting in Africa were included. Descriptive statistics including median and interquartile range were presented. Results Fifty-one studies were included; of these, 33 focused on medication errors, 15 on adverse drug events, and three studies focused on medication errors and adverse drug events. These studies were conducted in nine (of the 54) African countries. In any patient population, the median (interquartile range) percentage of patients reported to have experienced any suspected adverse drug event at hospital admission was 8.4% (4.5–20.1%), while adverse drug events causing admission were reported in 2.8% (0.7–6.4%) of patients but it was reported that a median of 43.5% (20.0–47.0%) of the adverse drug events were deemed preventable. Similarly, the median mortality rate attributed to adverse drug events was reported to be 0.1% (interquartile range 0.0–0.3%). The most commonly reported types of medication errors were prescribing errors, occurring in a median of 57.4% (interquartile range 22.8–72.8%) of all prescriptions and a median of 15.5% (interquartile range 7.5–50.6%) of the prescriptions evaluated had dosing problems. Major contributing factors for medication errors reported in these studies were individual practitioner factors (e.g. fatigue and inadequate knowledge/training) and environmental factors, such as workplace distraction and high workload. Conclusion Medication errors in the African healthcare setting are relatively common, and the impact of adverse drug events is substantial but many are preventable. This review supports the design and implementation of preventative strategies targeting the most likely contributing factors. Electronic supplementary material The online version of this article (10.1007/s40801-017-0125-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alemayehu B Mekonnen
- Faculty of Pharmacy, University of Sydney, S114, Pharmacy Building A15, Sydney, NSW, 2006, Australia.
- School of Pharmacy, University of Gondar, Gondar, Ethiopia.
| | - Tariq M Alhawassi
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Andrew J McLachlan
- Faculty of Pharmacy, University of Sydney, S114, Pharmacy Building A15, Sydney, NSW, 2006, Australia
- Centre for Education and Research on Ageing, Concord Hospital, Sydney, NSW, Australia
| | - Jo-Anne E Brien
- Faculty of Pharmacy, University of Sydney, S114, Pharmacy Building A15, Sydney, NSW, 2006, Australia
- Faculty of Medicine, St Vincent's Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia
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Van de Vreede M, de Clifford J, McGrath A. Staff experience and perceptions of the safety and risks of electronic medication management systems in Victorian public hospitals. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2017. [DOI: 10.1002/jppr.1327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Jan de Clifford
- Frankston Hospital Pharmacy Department; Peninsula Health; Frankston Australia
| | - Anne McGrath
- Pharmacy Department; Austin Health; Heidelberg Australia
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Illing PT, Purcell AW, McCluskey J. The role of HLA genes in pharmacogenomics: unravelling HLA associated adverse drug reactions. Immunogenetics 2017; 69:617-630. [DOI: 10.1007/s00251-017-1007-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/29/2017] [Indexed: 12/17/2022]
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Bull ER, Mason C, Junior FD, Santos LV, Scott A, Ademokun D, Simião Z, Oliver WM, Joaquim FF, Cavanagh SM. Developing nurse medication safety training in a health partnership in Mozambique using behavioural science. Global Health 2017; 13:45. [PMID: 28676121 PMCID: PMC5496247 DOI: 10.1186/s12992-017-0265-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/18/2017] [Indexed: 11/29/2022] Open
Abstract
Background Globally, safe and effective medication administration relies on nurses being able to apply strong drug calculation skills in their real-life practice, in the face of stressors and distractions. These may be especially prevalent for nurses in low-income countries such as Mozambique and Continuing Professional Development post-registration may be important. This study aimed to 1) explore the initial impact of an international health partnership’s work to develop a drug calculation workshop for nurses in Beira, Mozambique and 2) reflect upon the role of health psychologists in helping educators apply behavioural science to the training content and evaluation. Methods In phase one, partners developed a training package, which was delivered to 87 Portuguese-speaking nurses. The partnership’s health psychologists coded the training’s behaviour change content and recommended enhancements to content and delivery. In phase two, the refined training, including an educational game, was delivered to 36 nurses in Mozambique and recoded by the health psychologists. Measures of participant confidence and intentions to make changes to healthcare practice were collected, as well as qualitative data through post-training questions and 12 short follow-up participant interviews. Results In phase one six BCTs were used during the didactic presentation. Most techniques targeted participants’ capability to calculate drug doses accurately; recommendations aimed to increase participants’ motivation and perceived opportunity, two other drivers of practice change. Phase two training included an extra seven BCTs, such as action planning and further skills practice. Participants reported high confidence before and after the training (p = 0.25); intentions to use calculators to check drug calculations significantly increased (p = 0.031). Qualitative data suggested the training was acceptable, enjoyable and led to practice changes, through improved capability, opportunity and motivation. Opportunity barriers to medication safety were highlighted. Conclusions Reporting and measuring medication errors and related outcomes is a complex challenge affecting global efforts to improve medication safety. Through strong partnership working, a multi-disciplinary team of health professionals including health psychologists developed, refined and begin to evaluate a locally-led drug calculation CPD workshop for nurses in a low-resource setting. Applying behavioural science helped to collect feasible evaluation data and hopefully improved impact and sustainability.
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Affiliation(s)
| | | | | | | | - Abigail Scott
- East Anglia Medicines Information Service, Ipswich Hospital NHS Trust, Ipswich, UK
| | | | | | | | | | - Sarah M Cavanagh
- East Anglia Medicines Information Service, Ipswich Hospital NHS Trust, Ipswich, UK.,University of Suffolk, Ipswich, UK
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Hayes C, Jackson D, Davidson PM, Daly J, Power T. Calm to chaos: Engaging undergraduate nursing students with the complex nature of interruptions during medication administration. J Clin Nurs 2017; 26:4839-4847. [PMID: 28445621 DOI: 10.1111/jocn.13866] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe undergraduate student nurse responses to a simulated role-play experience focussing on managing interruptions during medication administration. BACKGROUND Improving patient safety requires that we find creative and innovative methods of teaching medication administration to undergraduate nurses in real-world conditions. Nurses are responsible for the majority of medication administrations in health care. Incidents and errors associated with medications are a significant patient safety issue and often occur as a result of interruptions. Undergraduate nursing students are generally taught medication administration skills in a calm and uninterrupted simulated environment. However, in the clinical environment medication administration is challenged by multiple interruptions. DESIGN/METHODS A qualitative study using convenience sampling was used to examine student perceptions of a simulated role-play experience. Data were collected from 451 of a possible 528 student written reflective responses and subject to thematic analysis. RESULTS Students reported an increased understanding of the impacts of interruptions while administering medications and an improved awareness of how to manage disruptions. This study reports on one of three emergent themes: "Calm to chaos: engaging with the complex nature of clinical practice." CONCLUSIONS Interrupting medication administration in realistic and safe settings facilitates awareness, allows for students to begin to develop management strategies in relation to interruption and increases their confidence. Students were given the opportunity to consolidate and integrate prior and new knowledge and skills through this role-play simulation.
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Affiliation(s)
- Carolyn Hayes
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia.,Faculty of Health & Life Sciences, Oxford Brookes University, Oxford, UK.,Faculty of Health, Head, WHO UTS Collaborating Centre for Nursing, Midwifery & Health Development, University of Technology Sydney, Broadway, NSW, Australia
| | | | - John Daly
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia.,Faculty of Health, Head, WHO UTS Collaborating Centre for Nursing, Midwifery & Health Development, University of Technology Sydney, Broadway, NSW, Australia
| | - Tamara Power
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
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Prevalence of multiple antipsychotic use and associated adverse effects in Australians with mental illness. INT J EVID-BASED HEA 2017; 14:104-12. [PMID: 27213238 DOI: 10.1097/xeb.0000000000000082] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM This article analyzes the prevalence of use of concurrent multiple antipsychotics and high dosage treatment in people with mental illness, to assess the burden of antipsychotic drug-related side-effects associated with multiple use, and to identify strategies shown to reduce antipsychotic polypharmacy. METHODS Literature reviewed was sourced from MEDLINE, Embase, CINAHL, InformIT, PsycINFO, International Pharmaceutical Abstracts, Cochrane Library database and Joanna Briggs Institute databases to identify Australian studies published between January 2000 and February 2015. Studies that reported prevalence of multiple antipsychotic use or addressed the issue of antipsychotic drug-related side-effects were included. Systematic reviews, randomized controlled trials, and observational pre-post studies of Australian and international interventions aiming to reduce multiple antipsychotic use in mental health settings were also identified. RESULTS Nineteen studies reporting prevalence of multiple antipsychotic use were identified. The proportion of patients taking more than one antipsychotic ranged from 5 to 61%. Of the studies assessing dosages used, between one-third and one-half of all patients taking multiple antipsychotics received doses higher than recommended. Data from one national study reported that people taking multiple antipsychotics were more likely to experience at least one side-effect in comparison to consumers taking a single antipsychotic (90 verses 80%).International evidence of direct trials of conversion from treatment regimens involving multiple antipsychotics to those based on monotherapy show that between 50 and 75% of people with serious mental illness could be successfully converted to single-agent treatment, with up to 25% obtaining an improvement in health and the remaining 50% staying well managed. CONCLUSION Use of multiple antipsychotics is common among Australian people with mental illness, despite guidelines recommending that only one antipsychotic should be used in most cases. People taking more than one antipsychotic at a time are more likely to experience side-effects, and to receive higher than recommended antipsychotic doses. Direct trials that aimed to reduce multiple antipsychotic use suggest it is possible to effectively reduce therapy in the majority of people without worsening outcomes. Simple educational programmes targeting health professionals have not been found to be effective; however, complex multifaceted programmes and quality improvement programmes have demonstrated effect.
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Paradissis C, Coombes ID, Donovan P, Doran E, McKean M, Barras MA. The type and incidence of adverse drug events in ageing medical inpatients and their effect on length of hospital stay. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2017. [DOI: 10.1002/jppr.1255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Ian D. Coombes
- School of Pharmacy; University of Queensland; Brisbane Australia
- Pharmacy Department; Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Peter Donovan
- Department of Internal Medicine; Royal Brisbane and Women's Hospital; Brisbane Australia
- School of Medicine and Biosciences; University of Queensland; Brisbane Australia
| | - Elizabeth Doran
- Pharmacy Department; Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Mitchell McKean
- Department of Internal Medicine; Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Michael A. Barras
- School of Pharmacy; University of Queensland; Brisbane Australia
- Pharmacy Department; Royal Brisbane and Women's Hospital; Brisbane Australia
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Moyle W, El Saifi N, Draper B, Jones C, Beattie E, Shum D, Thalib L, Mervin C, O’Dwyer S. Pharmacotherapy of Persons with Dementia in Long-Term Care in Australia: A Descriptive Audit of Central Nervous System Medications. Curr Drug Saf 2017; 12:CDS-EPUB-81651. [PMID: 28183240 PMCID: PMC5543562 DOI: 10.2174/1574886312666170209113203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/09/2017] [Accepted: 01/31/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms of dementia are often treated through the prescription of one or more psychotropic medications. However, limited efficacy and potential harmful side-effects has resulted in efforts to reduce the use of psychotropic medication in this population, particularly for those living in long-term care. OBJECTIVES This study sought to describe the pattern of central nervous system medication usage in older adults with dementia living in long-term care; assess the appropriateness of prescribing against Beers criteria; and detect potential drug interactions from co-administered medications. METHODS A retrospective descriptive audit of the medical records of n=415 residents, aged >60 years with a diagnosis of dementia, from 28 long-term care facilities in Queensland, Australia. Information extracted included the types and usage of regular and Pro Re Nata central nervous system medications. RESULTS Of those taking medication (n=317), 68% were prescribed at least one potentially inappropriate medication, and there was a significant positive correlation between the number of medications prescribed and the number of potentially inappropriate medications. Two-hundred potential interactions with variable severity were identified from 130 residents on ≥1 medication - 38% were potentially severe interactions, 46% were moderate. CONCLUSIONS This medication audit raises concerns that prescription of medications may still be the first resort to treat behavioural and psychological symptoms of dementia. There is a need for effective and sustainable person-centred interventions that address barriers for appropriate prescribing practice, and involve the collaboration of all healthcare professionals to optimise prescribing and improve the quality use of medicines in older people with dementia.
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Affiliation(s)
- Wendy Moyle
- Menzies Health Institute QLD, Griffith University, Nathan, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Brisbane, Queensland, Australia
| | - Najwan El Saifi
- Menzies Health Institute QLD, Griffith University, Nathan, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Brisbane, Queensland, Australia
| | - Brian Draper
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Cindy Jones
- Menzies Health Institute QLD, Griffith University, Nathan, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Brisbane, Queensland, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia
| | - David Shum
- Menzies Health Institute QLD, Griffith University, Nathan, Brisbane, Queensland, Australia
- School of Applied Psychology, Mt Gravatt Campus, Griffith University, Brisbane, Queensland, Australia
| | - Lukman Thalib
- Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar
| | - Cindy Mervin
- Menzies Health Institute QLD, Griffith University, Nathan, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine, Nathan Campus, Griffith University, Nathan, Brisbane, Queensland, Australia
| | - Siobhan O’Dwyer
- Menzies Health Institute QLD, Griffith University, Nathan, Brisbane, Queensland, Australia
- Medical School, University of Exeter, Exeter, United Kingdom
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Mekonnen AB, McLachlan AJ, Brien JAE, Mekonnen D, Abay Z. Medication reconciliation as a medication safety initiative in Ethiopia: a study protocol. BMJ Open 2016; 6:e012322. [PMID: 27884844 PMCID: PMC5168529 DOI: 10.1136/bmjopen-2016-012322] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Medication related adverse events are common, particularly during transitions of care, and have a significant impact on patient outcomes and healthcare costs. Medication reconciliation (MedRec) is an important initiative to achieve the Quality Use of Medicines, and has been adopted as a standard practice in many developed countries. However, the impact of this strategy is rarely described in Ethiopia. The aims of this study are to explore patient safety culture, and to develop, implement and evaluate a theory informed MedRec intervention, with the aim of minimising the incidence of medication errors during hospital admission. METHODS AND ANALYSES The study will be conducted in a resource limited setting. There are three phases to this project. The first phase is a mixed methods study of healthcare professionals' perspectives of patient safety culture and patients' experiences of medication related adverse events. In this phase, the Hospital Survey on Patient Safety Culture will be used along with semi-structured indepth interviews to investigate patient safety culture and experiences of medication related adverse events. The second phase will use a semi-structured interview guide, designed according to the 12 domains of the Theoretical Domains Framework, to explore the barriers and facilitators to medication safety activities delivered by hospital pharmacists. The third phase will be a single centre, before and after study, that will evaluate the impact of pharmacist conducted admission MedRec in an emergency department (ED). The main outcome measure is the incidence and potential clinical severity of medication errors. We will then analyse the differences in the incidence and severity of medication errors before and after initiation of an ED pharmacy service.
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Affiliation(s)
- Alemayehu B Mekonnen
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Andrew J McLachlan
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Jo-Anne E Brien
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Desalew Mekonnen
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zenahebezu Abay
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
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Cerqueira Santos S, Boaventura TC, Rocha KSS, de Oliveira Filho AD, Onozato T, de Lyra DP. Can we document the practice of dispensing? A systematic review. J Clin Pharm Ther 2016; 41:634-644. [PMID: 27671224 DOI: 10.1111/jcpt.12462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/05/2016] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN Documentation is a process indicator utilized to evaluate quality clinical pharmacist services. In this framework, documentation of dispensing, besides supporting patient care, allows evaluation of the impact of counselling. OBJECTIVE To identify and assess studies of documentation by pharmacists in the dispensing process. METHOD A systematic review was carried out according to the following steps: (i) identification of studies in the following databases: PubMed/Medline, Web of Science, Scopus and Lilacs, using the descriptors 'counselling', 'dispensing', 'community pharmacy services', 'pharmacies' and 'pharmacists' in different combinations; (ii) evaluation of studies, in which the title, abstract and full text of the studies, and the evaluation of the methodological quality of the selected studies were analysed. RESULTS In total, 26 articles met the specific criteria. Few studies addressed documentation as part of the dispensing working process (3), and 16 articles reported documentation using non-electronic systems. The main variables documented were patient information, drug therapy problems and clinical interventions. Furthermore, 20 studies showed the effects of documentation in the dispensing process and 23 studies included statistical evidence. Eight articles met between 42% and 75% of the 28 items recommended by the STROBE initiative, and two articles met approximately 60% of the 36 items recommended by the CONSORT initiative. WHAT IS NEW AND CONCLUSION Few studies address documentation as part of the dispensing working process. Thus, researchers should be concerned with standardizing documentation and implementing more robust designs and multicenter studies.
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Affiliation(s)
- S Cerqueira Santos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - T C Boaventura
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - K S S Rocha
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - A D de Oliveira Filho
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - T Onozato
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - D P de Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil.
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Feasibility Study of Interventions to Reduce Medication Omissions Without Documentation: Recall and Check Study. J Nurs Care Qual 2016; 32:E8-E16. [PMID: 27607850 DOI: 10.1097/ncq.0000000000000229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We conducted a feasibility study to test an intervention to reduce medication omissions without documentation using nurse-initiated recall cards and medication chart checking at handover. No significant difference in the omission rate per 100 medications was found, although after adjusting for hospital and patient age, a significant effect occurred in the intervention group (n = 262 patients) compared with the control group (n = 272). This intervention may reduce medication omissions without documentation, requiring further study within larger samples.
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The extent of medication errors and adverse drug reactions throughout the patient journey in acute care in Australia. INT J EVID-BASED HEA 2016; 14:113-22. [DOI: 10.1097/xeb.0000000000000075] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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