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Möckli N, Simon M, Denhaerynck K, Trutschel D, Martins T, Meyer-Massetti C, Zúñiga F. How external and agency characteristics are related to coordination in homecare - findings of the national multicenter, cross-sectional SPOT nat study. BMC Health Serv Res 2024; 24:367. [PMID: 38519949 PMCID: PMC10960419 DOI: 10.1186/s12913-024-10751-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/19/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Homecare client services are often distributed across several interdependent healthcare providers, making proper care coordination essential. However, as studies exploring care coordination in the homecare setting are scarce, serious knowledge gaps exist regarding how various factors influence coordination in this care sector. To fill such gaps, this study's central aim was to explore how external factors (i.e., financial and regulatory mechanisms) and homecare agency characteristics (i.e., work environment, workforce, and client characteristics) are related to care coordination in homecare. METHODS This analysis was part of a national multicentre, cross-sectional study in the Swiss homecare setting that included a stratified random sample of 88 Swiss homecare agencies. Data were collected between January and September 2021 through agency and employee questionnaires. Using our newly developed care coordination framework, COORA, we modelled our variables to assess the relevant components of care coordination on the structural, process, and outcome levels. We conducted both descriptive and multilevel regression analyses-with the latter adjusting for dependencies within agencies-to explore which key factors are associated with coordination. RESULTS The final sample size consisted of 1450 employees of 71 homecare agencies. We found that one explicit coordination mechanism ("communication and information exchange" (beta = 0.10, p <.001)) and four implicit coordination mechanisms-"knowledge of the health system" (beta = -0.07, p <.01), "role clarity" (beta = 0.07, p <.001), "mutual respect and trust" (beta = 0.07, p <.001), and "accountability, predictability, common perspective" (beta = 0.19, p <.001)-were significantly positively associated with employee-perceived coordination. We also found that the effects of agency characteristics and external factors were mediated through coordination processes. CONCLUSION Implicit coordination mechanisms, which enable and enhance team communication, require closer examination. While developing strategies to strengthen implicit mechanisms, the involvement of the entire care team is vital to create structures (i.e., explicit mechanisms) that enable communication and information exchange. Appropriate coordination processes seem to mitigate the association between staffing and coordination. This suggests that they support coordination even when workload and overtime are higher.
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Affiliation(s)
- Nathalie Möckli
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Michael Simon
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Kris Denhaerynck
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Diana Trutschel
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Tania Martins
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology & Toxicology, Department of General Internal Medicine, Inselspital - University Hospital Bern, CH-3010, Freiburgstrasse, Bern, Switzerland
- Institute for Primary Health Care BIHAM, University of Bern, Mittelstrasse 30, CH-3012, Bern, Switzerland
| | - Franziska Zúñiga
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland.
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Dahmke H, Schelshorn J, Fiumefreddo R, Schuetz P, Salili AR, Cabrera-Diaz F, Meyer-Massetti C, Zaugg C. Evaluation of Triple Whammy Prescriptions After the Implementation of a Drug Safety Algorithm. Drugs Real World Outcomes 2024; 11:125-135. [PMID: 38183571 DOI: 10.1007/s40801-023-00405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The term triple whammy (TW) refers to the concomitant use of non-steroidal anti-inflammatory drugs, diuretics, and angiotensin system inhibitors; this combination significantly increases the risk of acute kidney injury (AKI). To prevent this serious complication, we developed an electronic algorithm that detects TW prescriptions in patients with additional risk factors such as old age and impaired kidney function. The algorithm alerts a clinical pharmacist who then evaluates and forwards the alert to the prescribing physician. METHODS We evaluated the performance of this algorithm in a retrospective observational study of clinical data from all adult patients admitted to the Cantonal Hospital of Aarau in Switzerland in 2021. We identified all patients who received a TW prescription, had a TW alert, or developed AKI during TW therapy. Algorithm performance was evaluated by calculating the sensitivity and specificity as a primary endpoint and determining the acceptance rate among clinical pharmacists and physicians as a secondary endpoint. RESULTS Among 21,332 hospitalized patients, 290 patients had a TW prescription, of which 12 patients experienced AKI. Overall, 216 patients were detected by the alert algorithm, including 11 of 12 patients with AKI; the algorithm sensitivity is 88.3% with a specificity of 99.7%. Physician acceptance was high (77.7%), but clinical pharmacists were reluctant to forward the alerts to prescribers in some cases. CONCLUSION The TW algorithm is highly sensitive and specific in identifying patients with TW therapy at risk for AKI. The algorithm may help to prevent AKI in TW patients in the future.
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Affiliation(s)
- Hendrike Dahmke
- Hospital Pharmacy, Kantonsspital Aarau AG, Aarau, Switzerland.
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
| | - Jana Schelshorn
- Hospital Pharmacy, Kantonsspital Aarau AG, Aarau, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Rico Fiumefreddo
- Medical University Clinic, General Internal and Emergency Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Philipp Schuetz
- Medical University Clinic, General Internal and Emergency Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
| | | | | | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital-University Hospital Bern, Bern, Switzerland
- Institute of Primary Health Care BIHAM, University of Bern, Bern, Switzerland
| | - Claudia Zaugg
- Hospital Pharmacy, Kantonsspital Aarau AG, Aarau, Switzerland
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Schönenberger N, Blanc AL, Hug BL, Haschke M, Goetschi AN, Wernli U, Meyer-Massetti C. Developing indicators for medication-related readmissions based on a Delphi consensus study. Res Social Adm Pharm 2024:S1551-7411(24)00059-7. [PMID: 38433064 DOI: 10.1016/j.sapharm.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Medication-related readmissions challenge healthcare systems by burdening patients, increasing costs and straining resources. However, to date, there has been no consensus study on indicators for medication-related readmissions. OBJECTIVES This Delphi study aimed to develop a consensus-based set of indicators for detecting patients at risk of medication-related readmission. METHODS An expert panel of clinical pharmacists, physicians and nursing experts participated in a two-round Delphi study. In round 1, 31 indicators taken from the literature were rated for relevance on a scale from 1 to 9, with a median rating of 7 or higher suggesting relevance. The RAND/UCLA method was used to determine consensus. In round 2, indicators lacking consensus were re-rated together with a series of new indicators generated by the experts. Additional details were sought for some indicators. The main outcomes were the relevance of, consensus on, and completeness of the proposed indicators for identifying risks of 30-day medication-related readmission. RESULTS Thirty-eight experts participated in round 1. Consensus was found for all the indicators, with 25 included and 6 excluded. Thirty-four experts participated in round 2. Consensus was found for all 5 newly suggested indicators, and 4 were included. The expert panel prioritized the following indicators: (1) insufficient communication between different healthcare providers, (2) polypharmacy (≥7 medications), (3) low rates of medication adherence (twice-weekly mistakes or missing administration), (4) complex medication regimens (≥3 doses, ≥2 dosage forms and ≥2 administration routes per day), and (5) multimorbidity (≥3 chronic conditions). The final set comprised 29 indicators. CONCLUSIONS The indicator set developed for flagging potential medication-related readmissions could guide priorities for clinical pharmacy services at hospital discharge, improving patient outcomes and resource use. A validation study of these indicators is planned.
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Affiliation(s)
- Nicole Schönenberger
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland.
| | - Anne-Laure Blanc
- Pharmacy of the Eastern Vaud Hospitals, 1847, Rennaz, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1205, Geneva, Switzerland
| | - Balthasar L Hug
- Department of Internal Medicine, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland; University of Lucerne, Faculty of Health Sciences and Medicine, 6005, Lucerne, Switzerland
| | - Manuel Haschke
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland
| | - Aljoscha N Goetschi
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Ursina Wernli
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Institute of Primary Healthcare (BIHAM), University of Bern, 3012, Bern, Switzerland
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Schönenberger N, Meyer-Massetti C, Bravo S. Development of a quality assessment tool for pharmacy and therapeutics committees and subsequent pilot testing. Eur J Hosp Pharm 2024; 31:171-174. [PMID: 36241377 PMCID: PMC10895181 DOI: 10.1136/ejhpharm-2022-003365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
Pharmacy and therapeutics committees (PTCs) are multidisciplinary hospital teams responsible for rational medication use. We aimed at developing and piloting an assessment tool for their operating quality.We conducted a scoping literature review in PubMed and Embase to identify potential assessment items. Their relevance was systematically rated and consolidated into the final tool.60 relevant items were included, grouped into eight focus topics: the committee's institutional integration, member characteristics, performance indicators, meeting structure, formulary decision-making and characteristics, strategies to guide medication use and medication use evaluations.In combination with a SWOT (strengths, weaknesses, opportunities and threats) analysis, the tool helped the identification of improvement opportunities for a pilot hospital: adapting the committee's structure, improving the formulary decision-making, implementing strategies to guide formulary medication use and strengthening the committee's recognition within the institution.The tool successfully identified improvement opportunities for a PTC and could therefore be interesting for other hospitals.
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Affiliation(s)
- Nicole Schönenberger
- Department of General Internal Medicine, Clinical Pharmacology and Toxicology, University Hospital of Bern - Inselspital Bern, Bern, Switzerland
| | - Carla Meyer-Massetti
- Department of General Internal Medicine, Clinical Pharmacology and Toxicology, University Hospital of Bern - Inselspital Bern, Bern, Switzerland
- Institute for Primary Healthcare BIHAM, University of Bern, Bern, Switzerland
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Favez L, Zúñiga F, Meyer-Massetti C. Exploring medication safety structures and processes in nursing homes: a cross-sectional study. Int J Clin Pharm 2023; 45:1464-1471. [PMID: 37561370 PMCID: PMC10682270 DOI: 10.1007/s11096-023-01625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/11/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Medication safety is important to limit adverse events for nursing home residents. Several factors, such as interprofessional collaboration with pharmacists and medication reviews, have been shown in the literature to influence medication safety processes. AIM This study had three main objectives: (1) To assess how facility- and unit-level organization and infrastructure are related to medication use processes; (2) To determine the extent of medication safety-relevant processes; and (3) To explore pharmacies' and pharmacists' involvement in nursing homes' medication-related processes. METHOD Cross-sectional multicenter survey data (2018-2019) from a convenience sample of 118 Swiss nursing homes were used. Data were collected on facility and unit characteristics, pharmacy services, as well as medication safety-related structures and processes. Descriptive statistics were used. RESULTS Most of the participating nursing homes (93.2%) had electronic resident health record systems that supported medication safety in various ways (e.g., medication lists, interaction checks). Electronic data exchanges with outside partners such as pharmacies or physicians were available for fewer than half (10.2-46.3%, depending on the partner). Pharmacists collaborating with nursing homes were mainly involved in logistical support. Medication reviews were reportedly conducted regularly in two-thirds of facilities. CONCLUSION A high proportion of Swiss nursing homes have implemented diverse processes and structures that support medication use and safety for residents; however, their collaboration with pharmacists remains relatively limited.
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Affiliation(s)
- Lauriane Favez
- Pflegewissenschaft - Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- School of Engineering and Management Vaud, HES-SO University of Applied Sciences and Arts, Western Switzerland, Yverdon-les-Bains, Switzerland
| | - Franziska Zúñiga
- Pflegewissenschaft - Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
- Institute for Primary Healthcare BIHAM, University of Bern, Bern, Switzerland.
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Clinic for General Internal Medicine, Inselspital - University Hospital of Bern, Bern, Switzerland.
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Schönenberger N, Meyer-Massetti C. Risk factors for medication-related short-term readmissions in adults - a scoping review. BMC Health Serv Res 2023; 23:1037. [PMID: 37770912 PMCID: PMC10536731 DOI: 10.1186/s12913-023-10028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Hospital readmissions due to medication-related problems occur frequently, burdening patients and caregivers emotionally and straining health care systems economically. In times of limited health care resources, interventions to mitigate the risk of medication-related readmissions should be prioritized to patients most likely to benefit. Focusing on general internal medicine patients, this scoping review aims to identify risk factors associated with drug-related 30-day hospital readmissions. METHODS We began by searching the Medline, Embase, and CINAHL databases from their inception dates to May 17, 2022 for studies reporting risk factors for 30-day drug-related readmissions. We included all peer-reviewed studies, while excluding literature reviews, conference abstracts, proceeding papers, editorials, and expert opinions. We also conducted backward citation searches of the included articles. Within the final sample, we analyzed the types and frequencies of risk factors mentioned. RESULTS After deduplication of the initial search results, 1159 titles and abstracts were screened for full-text adjudication. We read 101 full articles, of which we included 37. Thirteen more were collected via backward citation searches, resulting in a final sample of 50 articles. We identified five risk factor categories: (1) patient characteristics, (2) medication groups, (3) medication therapy problems, (4) adverse drug reactions, and (5) readmission diagnoses. The most commonly mentioned risk factors were polypharmacy, prescribing problems-especially underprescribing and suboptimal drug selection-and adherence issues. Medication groups associated with the highest risk of 30-day readmissions (mostly following adverse drug reactions) were antithrombotic agents, insulin, opioid analgesics, and diuretics. Preventable medication-related readmissions most often reflected prescribing problems and/or adherence issues. CONCLUSIONS This study's findings will help care teams prioritize patients for interventions to reduce medication-related hospital readmissions, which should increase patient safety. Further research is needed to analyze surrogate social parameters for the most common drug-related factors and their predictive value regarding medication-related readmissions.
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Affiliation(s)
- N Schönenberger
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - C Meyer-Massetti
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Healthcare (BIHAM), University of Bern, Bern, Switzerland
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Pereira F, Meyer-Massetti C, Del Río Carral M, von Gunten A, Wernli B, Verloo H. Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study. BMJ Open 2023; 13:e072738. [PMID: 37730411 PMCID: PMC10514617 DOI: 10.1136/bmjopen-2023-072738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE This study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs). DESIGN Explanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously. SETTING Hospital and community healthcare in the French-speaking part of Switzerland. PARTICIPANTS The quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge. RESULTS Quantitative results from older adults' profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices. CONCLUSION By linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders' perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.
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Affiliation(s)
- Filipa Pereira
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Clinical of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
- Institute for Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - María Del Río Carral
- Institute of Psychology, Research Center for the Psychology of Health, Aging and Sports Examination (PHASE), University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Boris Wernli
- Swiss Centre of Expertise in the Social Sciences (FORS), University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Möckli N, Simon M, Denhaerynck K, Martins T, Meyer-Massetti C, Fischer R, Zúñiga F. Care coordination in homecare and its relationship with quality of care: A national multicenter cross-sectional study. Int J Nurs Stud 2023; 145:104544. [PMID: 37354791 DOI: 10.1016/j.ijnurstu.2023.104544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION As health care complexity increases, skilled care coordination is becoming increasingly necessary. This is especially true in homecare settings, where services tend to be highly interprofessional. Poor coordination can result in services being provided twice, at the wrong time, unnecessarily or not at all. In addition to risking harm to the client, such confusion leads to unnecessary costs. From the patient's perspective, then, professional coordination should help both to remove barriers limiting quality of care and to minimize costs. To date, though, studies examining the relationship between care coordination and care quality have faced multiple challenges, leading to mixed results. And in homecare contexts, where the clients are highly vulnerable and diverse care interfaces make coordination especially challenging, such studies are rare. OBJECTIVES Therefore, the aim of this study was to explore the relationship, from the perspectives of clients and of homecare professionals, between coordination and quality of care. For both groups, we hypothesized that better coordination would correlate with higher ratings of quality of care. For the clients, we predicted that higher coordination ratings would lead to lower incidence of unplanned health care use, i.e., emergency department (ED) visits, unscheduled urgent medical visits and hospitalizations. DESIGN AND METHODS This study is part of a national multi-center cross-sectional study in the Swiss homecare setting. We recruited 88 homecare agencies and collected data between January and September 2021 through written questionnaires for agencies' managers, employees (n = 3223) and clients (n = 1509). To test our hypotheses, we conducted multilevel analyses. RESULTS Employee-perceived care coordination ratings correlated positively with employee-rated quality of care (OR = 2.78, p < .001); client-perceived care coordination problems correlated inversely with client-reported quality of care (β = -0.55, p < .001). Client-perceived coordination problems also correlated positively with hospitalizations (IRR = 1.20, p < .05) and unscheduled urgent medical visits (IRR = 1.18, p < .05), but not significantly with ED visits. No associations were discernible between employee-perceived coordination quality and either health care service use or client quality-of-care ratings. DISCUSSION While results indicate relationships between coordination and diverse aspects of care quality, various coordination gaps (e.g., poor information flow) also became apparent. The measurement of both care coordination and quality of care remains a challenge. Further research should focus on developing and validating a coordination questionnaire that measures care coordination.
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Affiliation(s)
- Nathalie Möckli
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Michael Simon
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Kris Denhaerynck
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Tania Martins
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology & Toxicology, Department of General Internal Medicine, Inselspital - University Hospital of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Roland Fischer
- Centre for Primary Health Care, University of Basel, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - Franziska Zúñiga
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland.
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Mulder F, Löwinger D, Jenkinson SP, Kaiser E, Scharf T, Maire M, Duss S, Bassetti C, Heinzer R, Auer R, Meyer-Massetti C. Counselling for Chronic Insomnia in Swiss Pharmacies: A Survey Study Based on Case Vignettes. Pharmacy (Basel) 2023; 11:105. [PMID: 37368431 DOI: 10.3390/pharmacy11030105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
(1) Introduction: Chronic insomnia (CI) reduces quality of life and may trigger depression and cardiovascular diseases. The European Sleep Research Society recommends cognitive behavioural therapy (CBT-I) as the first-line treatment. Because a recent study in Switzerland demonstrated that this recommendation was inconsistently followed by primary care physicians, we hypothesised that pharmacists also deviate from these guidelines. The aim of this study is to describe current treatment practices for CI recommended by pharmacists in Switzerland, compare them to guidelines and examine their attitudes towards CBT-I. (2) Methods: A structured survey was sent to all the members of the Swiss Pharmacists Association, containing three clinical vignettes describing typical CI pharmacy clients. Treatments had to be prioritised. The prevalence of CI, and the pharmacists' knowledge and interest in CBT-I were assessed. (3) Results: Of 1523 pharmacies, 123 pharmacists (8%) completed the survey. Despite large variations, valerian (96%), relaxation therapy (94%) and other phytotherapies (85%) were most recommended. Although most pharmacists did not know about CBT-I (72%) and only 10% had recommended it, most were very interested (64%) in education. Missing financial compensation hampers the recommendation of CBT-I. (4) Conclusions: Contrary to existing European guidelines, community pharmacists in Switzerland mostly recommended valerian, relaxation therapy and other phytotherapies for treating CI. This might be connected to the client's expectation of pharmacy services, e.g., medication dispensing. While pharmacists recommend sleep hygiene regularly, most did not know of CBT-I as an overarching concept but were willing to learn. Future studies should test the effects of dedicated training about CI and changes in the financial compensation for counselling for CI in pharmacies.
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Affiliation(s)
- Fanny Mulder
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Graduate School of Health sciences GHS, University of Bern, 3012 Bern, Switzerland
| | - Dimitri Löwinger
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Stephen P Jenkinson
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Estelle Kaiser
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Tamara Scharf
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Graduate School of Health sciences GHS, University of Bern, 3012 Bern, Switzerland
| | - Micheline Maire
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Department of Internal Medicine, Cantonal Hospital of Zug, 6340 Baar, Switzerland
| | - Simone Duss
- Interdisciplinary Sleep-Wake-Epilepsy-Center and Swiss Sleep House Bern, Inselspital-University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Claudio Bassetti
- Interdisciplinary Sleep-Wake-Epilepsy-Center and Swiss Sleep House Bern, Inselspital-University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Raphaël Heinzer
- Service for Pneumology and Sleep Research Center (CIRS), Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Centre for Primary Care and Public Health (Unisanté), 1011 Lausanne, Switzerland
| | - Carla Meyer-Massetti
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital-University Hospital of Bern, 3010 Bern, Switzerland
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Möckli N, Espinosa JA, Simon M, Meyer-Massetti C, Zúñiga F. Clarifying the muddy concept of home healthcare coordination: A comprehensive theoretical framework. Heliyon 2023; 9:e14243. [PMID: 36967915 PMCID: PMC10031358 DOI: 10.1016/j.heliyon.2023.e14243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Effective healthcare coordination is vital when such care is provided as a collaborative effort by many individuals and their task activities are interdependent. Coordination is necessary to ensure that care not only meets the needs of patients, but also avoids negative consequences for them due to omitted, inefficient, unnecessary, or even incorrect treatments. It also helps conserve resources. This has contributed to a rapid increase in articles on this subject. Still, while care coordination topics are gaining the attention of researchers, there are a number of issues experienced, including the delineation of limitations, inconsistent definitions, and problems with measurement. Therefore, the aim of this article is to refine the concept of homecare coordination and provide a comprehensive theoretical framework, illustrated with examples from practice. Focusing on this goal, we have reviewed the extant literature on the subject to develop a theoretical homecare coordination framework. The first intermediary goal was to integrate relevant concepts across multiple theories and frameworks into a unified synthesis. We do so in two parts: (1) analysis of extant coordination frameworks and theories; and (2) the presentation of our newly developed theoretical framework for homecare coordination. The new framework differentiates clearly between coordination as a process-i.e., what people do to coordinate and coordination as an outcome-i.e., the state of coordination. Applying this distinction to both, measurement and interpretation of results helps avoid misleading conclusions. As a research outcome, our framework builds upon the extant coordination literature, considers the complex relationships among the various coordination-related factors and, while focusing on homecare, is applicable to various healthcare settings in general. A nuanced differentiation and explanation of the elements involved enable a more consistent operationalization of the coordination concept. Additionally, as they explicitly address the healthcare system's micro, meso, and macro levels, they can be applied across diverse healthcare settings to investigate homecare coordination.
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Mavragani A, Dixe MDA, Gonçalves Pereira S, Meyer-Massetti C, Verloo H. An Intervention Program to Reduce Medication-Related Problems Among Polymedicated Home-Dwelling Older Adults (OptiMed): Protocol for a Pre-Post, Multisite, Pilot, and Feasibility Study. JMIR Res Protoc 2023; 12:e39130. [PMID: 36696165 PMCID: PMC9909524 DOI: 10.2196/39130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 11/20/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Effective medication management is one of the essential preconditions for enabling polymedicated home-dwelling older adults with multiple chronic conditions to remain at home and preserve their quality of life and autonomy. Lack of effective medication management predisposes older adults to medication-related problems (MRPs) and adverse health outcomes, which can lead to the degradation of a patient's acute clinical condition, physical and cognitive decline, exacerbation of chronic medical conditions, and avoidable health care costs. Nonetheless, it has been shown that MRPs can be prevented or reduced by using well-coordinated, patient-centered, interprofessional primary care interventions. OBJECTIVE This study aimed to explore the feasibility and acceptability of an evidence-based, multicomponent, interprofessional intervention program supported by informal caregivers to decrease MRPs among polymedicated home-dwelling older adults with multiple chronic conditions. METHODS This quasi-experimental, pre-post, multisite pilot, and feasibility study will use an open-label design, with participants knowing the study's objectives and relevant information, and it will take place in primary health care settings in Portugal and Switzerland. The research population will comprise 30 polymedicated, home-dwelling adults, aged ≥65 years at risk of MRPs and receiving community-based health care, along with their informal caregivers and health care professionals. RESULTS Before a projected full-scale study, this pilot and feasibility study will focus on recruiting and ensuring the active collaboration of its participants and on the feasibility of expanding this evidence-based, multicomponent, interprofessional intervention program throughout both study regions. This study will also be essential to projected follow-up research programs on informal caregivers' multiple roles, enhancing their coordination tasks and their own needs. Results are expected at the end of 2024. CONCLUSIONS Designing, establishing, and exploring the feasibility and acceptability of an intervention program to reduce the risks of MRPs among home-dwelling older adults is an underinvestigated issue. Doing so in collaboration with all the different actors involved in that population's medication management and recording the first effects of the intervention will make this pilot and feasibility study's findings very valuable as home care becomes an ever more common solution. TRIAL REGISTRATION Swiss National Clinical Trials Portal 000004654; https://tinyurl.com/mr3yz8t4.
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Affiliation(s)
| | - Maria Dos Anjos Dixe
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
| | | | - Carla Meyer-Massetti
- Institute for Primary Health Care BIHAM, University of Bern, Bern, Switzerland.,Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Henk Verloo
- School of Health Sciences, University of Applied Sciences (HES-SO) Valais/Wallis, Sion, Switzerland.,Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Dixe MDA, Pinho J, Pereira F, Verloo H, Meyer-Massetti C, Pereira SG. Patterns of Medication Management and Associated Medical and Clinical Features among Home-Dwelling Older Adults: A Cross-Sectional Study in Central Portugal. Int J Environ Res Public Health 2023; 20:1701. [PMID: 36767067 PMCID: PMC9914088 DOI: 10.3390/ijerph20031701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
Ageing is frequently associated with multimorbidity and polypharmacy. The present study aimed to identify the current medication management patterns and the profiles of home-dwelling older adults and to find any association with their conditions, including frailty and cognitive impairment. Within the scope of this cross-sectional study, 112 older adults living in the community were assessed via face-to-face structured interviews. Frailty, cognitive status, medication management and clinical and sociodemographic variables were evaluated. Descriptive and inferential statistics were calculated. The mean participant age was 76.6 ± 7.1 years, 53.6% of participants were women, and 40.2% of participants lived alone. More than half were classified as having frailty (58.9%), almost one-fifth (19.6%) presented with a moderate cognitive impairment had more than one disease, and 60.7% were polymedicated. No associations were found between polymedication and medication self-management, the use of over-the-counter medications, living alone, having a poor understanding of pharmacological therapy and/or pathology, or having more than one prescriber. Self-management was associated with age, the number of medications, frailty and cognitive status. Binary logistic regressions showed that cognitive impairment had statistically significant differences with medication management, having a poor understanding of pharmacological therapy and/or pathology, having one prescriber and the use of medications not prescribed by physicians. Interventions to prevent medication-related problems in home-dwelling older adults are recommended.
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Affiliation(s)
- Maria dos Anjos Dixe
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, 2411-901 Leiria, Portugal
- School of Health Sciences, Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Joana Pinho
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, 2411-901 Leiria, Portugal
- School of Health Sciences, Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Filipa Pereira
- School of Health Sciences, HES-SO Valais-Wallis, 2800 Sion, Switzerland
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4099-002 Porto, Portugal
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais-Wallis, 2800 Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology Unit, General Internal Medicine Clinic, University Hospital of Bern (Inselspital), 3010 Bern, Switzerland
- Institute for Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Sónia Gonçalves Pereira
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, 2411-901 Leiria, Portugal
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Wernli U, Dürr F, Jean-Petit-Matile S, Kobleder A, Meyer-Massetti C. Subcutaneous Drugs and Off-label Use in Hospice and Palliative Care: A Scoping Review. J Pain Symptom Manage 2022; 64:e250-e259. [PMID: 35870656 DOI: 10.1016/j.jpainsymman.2022.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Subcutaneous drug administration is an interesting approach for symptom control in hospice and palliative care. However, most drugs have no marketing authorization for subcutaneous administration and are therefore used off-label. In order to meet the requirements of a safe and effective drug therapy, especially in highly vulnerable patients, it is essential to investigate the scope of evidence of these common practices. OBJECTIVES The purpose of this scoping review was to provide an overview of available data on the tolerability and/or effectiveness of subcutaneously administered and off-label used drugs. METHOD We performed a scoping review according to the PRISMA extension to identify data available on the tolerability and/or effectiveness of 17 predefined drugs that are commonly administered subcutaneously in Swiss hospices and hospice-like institutions and that have no marketing authorization (off-label use). RESULTS The scoping review identified 57 studies with most data available on their tolerability (68% local, 54% systemic), clinical effects (82%), details on dosage (96%) and routes of application (100%). Information on pharmacokinetic properties was mostly missing and only available for fentanyl, levetiracetam, midazolam, and ondansetron. For seven drugs, less than five articles were identified and no studies on codeine or clonazepam were available. CONCLUSION This work provides an overview of current evidence on subcutaneous and off-label used drugs in hospice and palliative care. Although both are common practices, evidence on tolerability and effectiveness, particularly pharmacokinetic data, is limited and the identified information gaps need to be closed. This work establishes a basis for further research in this area.
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Affiliation(s)
- Ursina Wernli
- Clinical Pharmacology and Toxicology (U.W., C.M.M.), Inselspital Bern, Switzerland; Graduate School for Health Sciences (U.W.), University of Bern, Switzerland.
| | - Fabienne Dürr
- Institute of Primary Health Care BIHAM (F.D., C.M.M.), University of Bern, Switzerland
| | | | - Andrea Kobleder
- Institute of Applied Nursing Science (A.K.), Eastern Switzerland University of Applied Sciences OST, St Gallen, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology (U.W., C.M.M.), Inselspital Bern, Switzerland; Institute of Primary Health Care BIHAM (F.D., C.M.M.), University of Bern, Switzerland
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Wernli U, Hischier D, Meier CR, Jean-Petit-Matile S, Panchaud A, Kobleder A, Meyer-Massetti C. Prescription Trends in Hospice Care: A Longitudinal Retrospective and Descriptive Medication Analysis. Am J Hosp Palliat Care 2022:10499091221130758. [PMID: 36168963 DOI: 10.1177/10499091221130758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In hospice and palliative care, drug therapy is essential for symptom control. However, drug regimens are complex and prone to drug-related problems. Drug regimens must be simplified to improve quality of life and reduce risks associated with drug-related problems, particularly at end-of-life. To support clinical guidance towards a safe and effective drug therapy in hospice care, it is important to understand prescription trends. OBJECTIVES To explore prescription trends and describe changes to drug regimens in inpatient hospice care. DESIGN We performed a retrospective longitudinal and descriptive analysis of prescriptions for regular and as-needed (PRN) medication at three timepoints in deceased patients of one Swiss hospice. SETTING/SUBJECTS Prescription records of all patients (≥ 18 years) with an inpatient stay of three days and longer (admission and time of death in 2020) were considered eligible for inclusion. RESULTS Prescription records of 58 inpatients (average age 71.7 ± 12.8 [37-95] years) were analyzed. The medication analysis showed that polypharmacy prevalence decreased from 74.1% at admission to 13.8% on the day of death. For regular medication, overall numbers of prescriptions decreased over the patient stay while PRN medication decreased after the first consultation by the attending physician and increased slightly towards death. CONCLUSIONS Prescription records at admission revealed high initial rates of polypharmacy that were reduced steadily until time of death. These findings emphasize the importance of deprescribing at end-of-life and suggest pursuing further research on the contribution of clinical guidance towards optimizing drug therapy and deprescribing in inpatient hospice care.
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Affiliation(s)
- Ursina Wernli
- Clinical Pharmacology and Toxicology, 27252Inselspital University Hospital Bern, Bern, Switzerland.,Graduate School for Health Sciences, 27210University of Bern, Bern, Switzerland
| | - Désirée Hischier
- Clinical Pharmacy and Pharmacoepidemiology, 27209University of Basel, Basel, Switzerland
| | - Christoph R Meier
- Clinical Pharmacy and Pharmacoepidemiology, 27209University of Basel, Basel, Switzerland
| | | | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), 27210University of Bern, Bern, Switzerland
| | - Andrea Kobleder
- Institute of Applied Nursing Science, 112888Eastern Switzerland University of Applied SciencesOST, St Gallen, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, 27252Inselspital University Hospital Bern, Bern, Switzerland.,Clinical Pharmacy and Pharmacoepidemiology, 27209University of Basel, Basel, Switzerland
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Pereira F, Verloo H, von Gunten A, Del Río Carral M, Meyer-Massetti C, Martins MM, Wernli B. Unplanned nursing home admission among discharged polymedicated older inpatients: a single-centre, registry-based study in Switzerland. BMJ Open 2022; 12:e057444. [PMID: 35246423 PMCID: PMC8900032 DOI: 10.1136/bmjopen-2021-057444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate patient characteristics and the available health and drug data associated with unplanned nursing home admission following an acute hospital admission or readmission. DESIGN A population-based hospital registry study. SETTING A public hospital in southern Switzerland (Valais Hospital). PARTICIPANTS We explored a population-based longitudinal dataset of 14 705 hospital admissions from 2015 to 2018. OUTCOME MEASURES Sociodemographic, health and drug data, and their interactions predicting the risk of unplanned nursing home admission. RESULTS The mean prevalence of unplanned nursing home admission after hospital discharge was 6.1% (n=903/N=14 705). Our predictive analysis revealed that the oldest adults (OR=1.07 for each additional year of age; 95% CI 1.05 to 1.08) presenting with impaired functional mobility (OR=3.22; 95% CI 2.67 to 3.87), dependency in the activities of daily living (OR=4.62; 95% CI 3.76 to 5.67), cognitive impairment (OR=3.75; 95% CI 3.06 to 4.59) and traumatic injuries (OR=1.58; 95% CI 1.25 to 2.01) had a higher probability of unplanned nursing home admission. The number of International Classification of Diseases, 10th version diagnoses had no significant impact on nursing home admissions, contrarily to the number of prescribed drugs (OR=1.17; 95% CI 1.15 to 1.19). Antiemetics/antinauseants (OR=2.53; 95% CI 1.21 to 5.30), digestives (OR=1.78; 95% CI 1.09 to 2.90), psycholeptics (OR=1.76; 95% CI 1.60 to 1.93), antiepileptics (OR=1.49; 95% CI 1.25 to 1.79) and anti-Parkinson's drugs (OR=1.40; 95% CI 1.12 to 1.75) were strongly linked to unplanned nursing home admission. CONCLUSIONS Numerous risk factors for unplanned nursing home admission were identified. To prevent the adverse health outcomes that precipitate acute hospitalisations and unplanned nursing home admissions, ambulatory care providers should consider these risk factors in their care planning for older adults before they reach a state requiring hospitalisation.
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Affiliation(s)
- Filipa Pereira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- School of Health Sciences, HES-SO Valais Wallis, Sion, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais Wallis, Sion, Switzerland
- Département de Psychiatrie, Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | - Armin von Gunten
- Département de Psychiatrie, Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | - María Del Río Carral
- Institute of Psychology, Research Center for the Psychology of Health, Aging and Sports Examination, University of Lausanne, Lausanne, Switzerland
| | - Carla Meyer-Massetti
- Institute for Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Clinical Pharmacology and Toxicology, Clinical of General Internal Medicine, Inselspital - University Hospital of Bern, Bern, Switzerland
| | | | - Boris Wernli
- FORS, Swiss Centre of Expertise in the Social Sciences, University of Lausanne, Lausanne, Switzerland
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Zerah L, Henrard S, Thevelin S, Feller M, Meyer-Massetti C, Knol W, Wilting I, O’Mahony D, Crowley E, Dalleur O, Spinewine A. Erratum to: Performance of a trigger tool for detecting drug-related hospital admissions in older people: analysis from the OPERAM trial. Age Ageing 2022; 51:6544239. [PMID: 35263429 DOI: 10.1093/ageing/afac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/07/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lorène Zerah
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
| | - Séverine Henrard
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Stefanie Thevelin
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
| | - Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ingeborg Wilting
- Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O’Mahony
- School of Medicine, Geriatric Medicine, University College Cork, Cork, Ireland
| | - Erin Crowley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
- Pharmacy, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
- Pharmacy Department, Université Catholique de Louvain, CHU UCLNamur, Yvoir, Belgium
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Zerah L, Henrard S, Thevelin S, Feller M, Meyer-Massetti C, Knol W, Wilting I, O’Mahony D, Crowley E, Dalleur O, Spinewine A. Performance of a trigger tool for detecting drug-related hospital admissions in older people: analysis from the OPERAM trial. Age Ageing 2022; 51:6430101. [PMID: 34794171 DOI: 10.1093/ageing/afab196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/07/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND identifying drug-related hospital admissions (DRAs) in older people is difficult. A standardised chart review procedure has recently been developed. It includes an adjudication team (physician and pharmacist) screening using 26 triggers and then performing causality assessment to determine whether an adverse drug event (ADE) occurred (secondary to an adverse drug reaction, overuse, misuse or underuse) and whether the ADE contributed to hospital admission (DRA). OBJECTIVE to assess the performance of those triggers in detecting DRA. DESIGN retrospective study using data from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people) trial. SETTINGS four European medical centres. SUBJECTS multimorbid (≥ 3 chronic medical conditions) older (≥ 70 years) inpatients with polypharmacy (≥ 5 chronic medications) were enrolled in the OPERAM trial (N = 2,008) and followed for 12 months. We included patients with ≥1 adjudicated hospitalisation during the follow-up. METHODS the positive predictive value (PPV; number of DRAs identified by trigger/number of triggers) was calculated for each trigger and for the tool as a whole. RESULTS of 1,235 hospitalisations adjudicated for 832 patients, 716 (58%) had at least one trigger; an ADE was identified in 673 (54%) and 518 (42%) were adjudicated as DRAs. The overall PPV of the trigger tool for detecting DRAs was 0.66 [0.62-0.69]. CONCLUSIONS this tool performs well for identifying DRAs in older people. Based on our results, a revised version of the tool was proposed but will require external validation before it can be incorporated into research and clinical practice.
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Affiliation(s)
- Lorène Zerah
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
| | - Séverine Henrard
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Stefanie Thevelin
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
| | - Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ingeborg Wilting
- Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O’Mahony
- School of Medicine, Geriatric Medicine, University College Cork, Cork, Ireland
| | - Erin Crowley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
- Pharmacy, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
- Pharmacy Department, Université Catholique de Louvain, CHU UCLNamur, Yvoir, Belgium
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Pereira F, Verloo H, Zhivko T, Di Giovanni S, Meyer-Massetti C, von Gunten A, Martins MM, Wernli B. Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study. BMJ Open 2021; 11:e052755. [PMID: 34261693 PMCID: PMC8281082 DOI: 10.1136/bmjopen-2021-052755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The present study analysed 4 years of a hospital register (2015-2018) to determine the risk of 30-day hospital readmission associated with the medical conditions and drug regimens of polymedicated, older inpatients discharged home. DESIGN Registry-based cohort study. SETTING Valais Hospital-a public general hospital centre in the French-speaking part of Switzerland. PARTICIPANTS We explored the electronic records of 20 422 inpatient stays by polymedicated, home-dwelling older adults held in the hospital's patient register. We identified 13 802 hospital readmissions involving 8878 separate patients over 64 years old. OUTCOME MEASURES Sociodemographic characteristics, medical conditions and drug regimen data associated with risk of readmission within 30 days of discharge. RESULTS The overall 30-day hospital readmission rate was 7.8%. Adjusted multivariate analyses revealed increased risk of hospital readmission for patients with longer hospital length of stay (OR=1.014 per additional day; 95% CI 1.006 to 1.021), impaired mobility (OR=1.218; 95% CI 1.039 to 1.427), multimorbidity (OR=1.419 per additional International Classification of Diseases, 10th Revision condition; 95% CI 1.282 to 1.572), tumorous disease (OR=2.538; 95% CI 2.089 to 3.082), polypharmacy (OR=1.043 per additional drug prescribed; 95% CI 1.028 to 1.058), and certain specific drugs, including antiemetics and antinauseants (OR=3.216 per additional drug unit taken; 95% CI 1.842 to 5.617), antihypertensives (OR=1.771; 95% CI 1.287 to 2.438), drugs for functional gastrointestinal disorders (OR=1.424; 95% CI 1.166 to 1.739), systemic hormonal preparations (OR=1.207; 95% CI 1.052 to 1.385) and vitamins (OR=1.201; 95% CI 1.049 to 1.374), as well as concurrent use of beta-blocking agents and drugs for acid-related disorders (OR=1.367; 95% CI 1.046 to 1.788). CONCLUSIONS Thirty-day hospital readmission risk was associated with longer hospital length of stay, health disorders, polypharmacy and drug regimens. The drug regimen patterns increasing the risk of hospital readmission were very heterogeneous. Further research is needed to explore hospital readmissions caused solely by specific drugs and drug-drug interactions.
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Affiliation(s)
- Filipa Pereira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Sion, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Taushanov Zhivko
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Saviana Di Giovanni
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Sion, Switzerland
- Pharmacy Benu Tavil-Chatton, Morges, Switzerland
| | | | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Maria Manuela Martins
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- Porto Higher School of Nursing, Porto, Portugal
| | - Boris Wernli
- FORS, Swiss Centre of Expertise in the Social Sciences, University of Lausanne, Lausanne, Switzerland
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Möckli N, Simon M, Meyer-Massetti C, Pihet S, Fischer R, Wächter M, Serdaly C, Zúñiga F. Factors associated with homecare coordination and quality of care: a research protocol for a national multi-center cross-sectional study. BMC Health Serv Res 2021; 21:306. [PMID: 33823850 PMCID: PMC8025374 DOI: 10.1186/s12913-021-06294-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The persistent fragmentation of home healthcare reflects inadequate coordination between care providers. Still, while factors at the system (e.g., regulations) and organisational (e.g., work environment) levels crucially influence homecare organisation, coordination and ultimately quality, knowledge of these factors and their relationships in homecare settings remains limited. OBJECTIVES This study has three aims: [1] to explore how system-level regulations lead to disparities between homecare agencies' structures, processes and work environments; [2] to explore how system- and organisation-level factors affect agency-level homecare coordination; and [3] to explore how agency-level care coordination is related to patient-level quality of care. DESIGN AND METHODS This study focuses on a national multi-center cross-sectional survey in Swiss homecare settings. It will target 100 homecare agencies, their employees and clients for recruitment, with data collection period planned from January to June 2021. We will assess regulations and financing mechanisms (via public records), agency characteristics (via agency questionnaire data) and homecare employees' working environments and coordination activities, as well as staff- and patient-level perceptions of coordination and quality of care (via questionnaires for homecare employees, clients and informal caregivers). All collected data will be subjected to descriptive and multi-level analyses. DISCUSSION The first results are expected by December 2021. Knowledge of factors linked to quality of care is essential to plan and implement quality improvement strategies. This study will help to identify modifiable factors at multiple health system levels that might serve as access points to improve coordination and quality of care.
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Affiliation(s)
- Nathalie Möckli
- Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Michael Simon
- Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, CH-4056, Basel, Switzerland.,Nursing Research Unit, Inselspital Bern, Freiburgstrasse 18, CH-3010, Bern, Switzerland
| | - Carla Meyer-Massetti
- Department of Pharmaceutical Sciences, Clinical Pharmacy & Epidemiology, c/o University Hospital Basel, Spitalstrasse 26, CH-4031, Basel, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, CH-3012, Bern, Switzerland
| | - Sandrine Pihet
- University of Applied Sciences and Arts of Western Switzerland, School of Nursing, Route des Arsenaux 16a, CH-1700, Fribourg, Switzerland
| | - Roland Fischer
- Centre for Primary Health Care, University of Basel, Rheinstrasse 26, CH-4410, Liestal, Switzerland
| | - Matthias Wächter
- Institute for Business and Regional Economics IBR, Lucerne University, Zentralstrasse 9, CH-6002, Luzern, Switzerland
| | - Christine Serdaly
- serdaly&ankers snc, Route de Florissant 210, CH-1231, Conches, Switzerland
| | - Franziska Zúñiga
- Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, CH-4056, Basel, Switzerland.
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Meyer-Massetti C, Hofstetter V, Hedinger-Grogg B, Meier CR, Guglielmo BJ. Medication-related problems during transfer from hospital to home care: baseline data from Switzerland. Int J Clin Pharm 2018; 40:1614-1620. [PMID: 30291577 DOI: 10.1007/s11096-018-0728-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 09/25/2018] [Indexed: 11/26/2022]
Abstract
Background The shift from inpatient to ambulatory care has resulted in an increase in home care patients. Little is known regarding medication safety associated with patient transfer from hospital to home care. Objective To evaluate medication-related problems in patients transferring from hospital to home care in Switzerland. Setting A non-for-profit home care organization in the city of Lucerne/Switzerland. Methods We conducted a prospective observational study, including patients aged ≥ 64 years and receiving ≥ 4 medications at hospital discharge. Two structured questionnaires assessing the transfer process were completed by home care nurses. Prescription quality was assessed using a PCNE Type 2b Medication Review. Main outcome measures The quality of the transfer process was measured comparing agreed-upon with reported parameters. Prescription quality was analyzed assessing the unambiguity of the prescription. Potentially inappropriate medications (Priscus® list), contraindications, duplications and interactions, and clinical pharmacist-identified potential medication-related problems were collected. Results Study patients (n = 100) received 8.6 ± 3.5 regularly administered medications. Only 5/100 patients had a complete set of written discharge information. At the time of the first visit, 13/100 patients had no written medication information available. Discharge medication prescriptions were clear to nurses in 62% of patients. In 20 patients, the required medications were unavailable, resulting in 19 medication errors. Assessment by a clinical pharmacist revealed only 33/100 patients had a clear discharge prescription. Of a total of 984 prescribed drugs, 16% were considered to be ambiguous, 22 (2.2%) were potentially inappropriate. 7/984 drugs were contraindicated, 8 were duplicates. Conclusion In addition to the known risk factors in patients transferring from hospital to home care (age, polymedication, multiple providers), 3 major problems impacted upon medication safety: fragmented communication, unreliable medication availability and a poor prescription quality. Clinical pharmacists are an important option to improve medication safety ass.
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Affiliation(s)
- Carla Meyer-Massetti
- Clincal Pharmacy & Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
- Hospital Pharmacy, University Hospital of Basel, Spitalstrasse 26, 4031, Basel, Switzerland.
| | - Vera Hofstetter
- Clincal Pharmacy & Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | | | - Christoph R Meier
- Clincal Pharmacy & Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Hospital Pharmacy, University Hospital of Basel, Spitalstrasse 26, 4031, Basel, Switzerland
| | - B Joseph Guglielmo
- School of Pharmacy, University of California San Francisco, San Francisco, USA
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Huckels-Baumgart S, Niederberger M, Manser T, Meier CR, Meyer-Massetti C. A combined intervention to reduce interruptions during medication preparation and double-checking: a pilot-study evaluating the impact of staff training and safety vests. J Nurs Manag 2017; 25:539-548. [PMID: 28675553 DOI: 10.1111/jonm.12491] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 11/26/2022]
Abstract
AIM The aim was to evaluate the impact of staff training and wearing safety vests as a combined intervention on interruptions during medication preparation and double-checking. BACKGROUND Interruptions and errors during the medication process are common and an important issue for patient safety in the hospital setting. METHODS We performed a pre- and post-intervention pilot-study using direct structured observation of 26 nurses preparing and double-checking 431 medication doses (225 pre-intervention and 206 post-intervention) for 36 patients (21 pre-intervention and 15 post-intervention). RESULTS With staff training and the introduction of safety vests, the interruption rate during medication preparation was reduced from 36.8 to 28.3 interruptions per hour and during double-checking from 27.5 to 15 interruptions per hour. CONCLUSION This pilot-study showed that the frequency of interruptions decreased during the critical tasks of medication preparation and double-checking after the introduction of staff training and wearing safety vests as part of a quality improvement process. IMPLICATIONS FOR NURSING MANAGEMENT Nursing management should acknowledge interruptions as an important factor potentially influencing medication safety. Unnecessary interruptions can be successfully reduced by considering human and system factors and increasing both staff and nursing managers' awareness of 'interruptive communication practices' and implementing physical barriers. This is the first pilot-study specifically evaluating the impact of staff training and wearing safety vests on the reduction of interruptions during medication preparation and double-checking.
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Affiliation(s)
- Saskia Huckels-Baumgart
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany.,Quality Management and Patient Safety, University Hospital Zürich, Zürich, Switzerland
| | - Milena Niederberger
- Clinical Pharmacy & Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Center for Hospital Pharmacy, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Tanja Manser
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Christoph R Meier
- Clinical Pharmacy & Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacy & Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
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Meyer-Massetti C, Krummenacher E, Hedinger-Grogg B, Luterbacher S, Hersberger KE. Medication safety in the home care setting: Development and piloting of a Critical Incident Reporting System. Pflege 2016; 29:247-255. [PMID: 27377359 DOI: 10.1024/1012-5302/a000498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: While drug-related problems are among the most frequent adverse events in health care, little is known about their type and prevalence in home care in the current literature. The use of a Critical Incident Reporting System (CIRS), known as an economic and efficient tool to record medication errors for subsequent analysis, is widely implemented in inpatient care, but less established in ambulatory care. Recommendations on a possible format are scarce. A manual CIRS was developed based on the literature and subsequently piloted and implemented in a Swiss home care organization. Aim: The aim of this work was to implement a critical incident reporting system specifically for medication safety in home care. Results: The final CIRS form was well accepted among staff. Requiring limited resources, it allowed preliminary identification and trending of medication errors in home care. The most frequent error reports addressed medication preparation at the patients’ home, encompassing the following errors: omission (30 %), wrong dose (17.5 %) and wrong time (15 %). The most frequent underlying causes were related to working conditions (37.9 %), lacking attention (68.2 %), time pressure (22.7 %) and interruptions by patients (9.1 %). Conclusions: A manual CIRS allowed efficient data collection and subsequent analysis of medication errors in order to plan future interventions for improvement of medication safety. The development of an electronic CIRS would allow a reduction of the expenditure of time regarding data collection and analysis. In addition, it would favour the development of a national CIRS network among home care institutions.
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Affiliation(s)
- Carla Meyer-Massetti
- 1 Klinische Pharmazie & Epidemiologie, Departement Pharmazeutische Wissenschaften, Universität Basel, Schweiz
| | - Evelyne Krummenacher
- 2 Pharmaceutical Care Research Group, Departement Pharmazeutische Wissenschaften, Universität Basel, Schweiz
| | | | - Stephan Luterbacher
- 4 Dienststelle Gesundheit, Gesundheitsdepartement des Kantons Luzern, Schweiz
| | - Kurt E Hersberger
- 2 Pharmaceutical Care Research Group, Departement Pharmazeutische Wissenschaften, Universität Basel, Schweiz
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Meyer-Massetti C, Kaiser E, Hedinger-Grogg B, Luterbacher S, Hersberger K. [Medication safety in the home care setting: error-prone process steps]. Pflege 2012; 25:261-9. [PMID: 22811293 DOI: 10.1024/1012-5302/a000214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
So far, little is known about drug-related problems in the homecare setting. It is estimated that up to 30% of homecare patients experience a potential medication error, most frequently happening during preparation and administration of drugs. In order to identify error-prone process steps in a Swiss homecare organisation caring for 1854 patients per year, direct observation of the medication use process, including the analysis of 10% of all prescriptions, was executed. Three complimentary methods were combined for the assessment of qualitative aspects of the medication use process: the analysis of a critical incident reporting system, a survey among homecare nurses, and a failure, mode and effects analysis. The medication use process is complex, consisting of 20 individual steps. Patients are prescribed an average of 7.5 ± 3.5 drugs per day, including 1 to 9 doses not suitable for deblistering into weekly dispensing systems. Of 84 reported errors, 74% happened during drug preparation. Communication with physicians, patients interrupting drug preparation and not transmitted changes of the drug regimen were considered the most critical process steps.
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Affiliation(s)
- C Meyer-Massetti
- Departement für Pharmazeutische Wissenschaften, Universität Basel und Stiftung für Patientensicherheit, Zürich.
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Abstract
Medication errors are responsible for up to 50% of errors in healthcare. Therefore, they are an important target for the improvement of patient safety. The application of evidence-based methods for the analysis of institution-specific medication safety hotspots is crucial. Recommended methods for the identification of medication safety problems have individual strengths and weaknesses, but there is little overlap. Consequently, a combination of methods is recommended. While the analysis of critical incident reporting systems preferentially identifies serious medication errors, trigger tool represents an effective and cost-efficient approach. Evidence-based data for improvement methods is limited. However, the implementation of clinical pharmacy services, IT tools (electronic prescribing, barcoding) and standardized double-check showed a significant impact on error reduction. In addition, the support of institutional leadership is an important prerequisite.
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Meyer-Massetti C, Locatelli E, Meier CR. Indicator development for the assessment of pain management: a practical approach. Eur J Hosp Pharm 2012. [DOI: 10.1136/ejhpharm-2011-000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Meyer-Massetti C, Cheng CM, Schwappach DLB, Paulsen L, Ide B, Meier CR, Guglielmo BJ. Systematic review of medication safety assessment methods. Am J Health Syst Pharm 2011; 68:227-40. [DOI: 10.2146/ajhp100019] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Carla Meyer-Massetti
- Medication Safety And Drug Event Monitoring, Swiss Patient Safety Foundation (SPSF), Zurich, Switzerland, and Junior Specialist, Medication Outcomes Center, Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco (UCSF), San Francisco
| | - Christine M. Cheng
- Medication Outcomes Center, Department of Clinical Pharmacy, School of Pharmacy, UCSF
| | - David L. B. Schwappach
- Division of Social and Behavioral Health Research, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Brigid Ide
- Patient Safety and Quality Services, UCSF Medical Center
| | - Christoph R. Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland, and Director of Pharmaceutical Services, Hospital Pharmacy, University Hospital Basel, Basel
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Meyer-Massetti C, Cheng CM, Sharpe BA, Meier CR, Guglielmo BJ. The FDA extended warning for intravenous haloperidol and torsades de pointes: how should institutions respond? J Hosp Med 2010; 5:E8-16. [PMID: 20394022 DOI: 10.1002/jhm.691] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In September 2007, the Food and Drug Administration (FDA) strengthened label warnings for intravenous (IV) haloperidol regarding QT prolongation (QTP) and torsades de pointes (TdP) in response to adverse event reports. Considering the widespread use of IV haloperidol in the management of acute delirium, the specific FDA recommendation of continuous electrocardiogram (ECG) monitoring in this setting has been associated with some controversy. We reviewed the evidence for the FDA warning and provide a potential medical center response to this warning. METHODS Cases of intravenous haloperidol-related QTP/TdP were identified by searching PubMed, EMBASE, and Scopus databases (January 1823 to April 2009) and all FDA MedWatch reports of haloperidol-associated adverse events (November 1997 to April 2008). RESULTS A total of 70 of IV haloperidol-associated QTP and/or TdP were identified. There were 54 reports of TdP; 42 of these events were reportedly preceded by QTP. When post-event QTc data were reported, QTc was prolonged >450 msec in 96% of cases. Three patients experienced sudden cardiac arrest. Sixty-eight patients (97%) had additional risk factors for TdP/prolonged QT, most commonly receipt of concomitant proarrhythmic agents. Patients experiencing TdP received a cumulative dose of 5 mg to 645 mg, patients with QTP alone received a cumulative dose of 2 mg to 1540 mg. CONCLUSIONS While administration of IV haloperidol can be associated with QTP/TdP, this complication most often took place in the setting of concomitant risk factors. Importantly, the available data suggest that a total cumulative dose of IV haloperidol of <2 mg can safely be administered without ongoing electrocardiographic monitoring in patients without concomitant risk factors.
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Affiliation(s)
- Carla Meyer-Massetti
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, Medication Outcomes Center, San Francisco, California, USA.
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Cheng CM, Meyer-Massetti C, Kayser SR. A review of three stand-alone topical thrombins for surgical hemostasis. Clin Ther 2009; 31:32-41. [DOI: 10.1016/j.clinthera.2009.01.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2008] [Indexed: 11/26/2022]
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Swoboda S, Meyer-Massetti C, Hoppe-Tichy T. [Interaction between an antiinfective agent and an immunosuppressant after liver transplantation]. Med Monatsschr Pharm 2006; 29:179-82. [PMID: 16719261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Interactions between immunosuppressants and antiinfectives are most important in pharmacotherapy. Patients receiving this drug combination must be monitored carefully. Individual dose adaptation and therapeutic drug monitoring (TDM) according to the SOAP scheme (subjective data, objective data, analysis, plan) are exemplified by the case report of a 47-year-old patient who had undergone a liver transplantation.
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Affiliation(s)
- Stefanie Swoboda
- Universitatsklinikums Heidelberg, Im Neuenheimer Feld 670, 69120 Heidelberg.
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