Analysis of medication administration in relation to food and beverages in inpatients

Proper medication administration in relation to beverage or food is one of the essential tools to achieve the pharmacotherapy goals. It is not known whether this is also considered in the care of inpatients. The aim of this study was to describe and analyse the current practice of medication administration in relation to food and beverages to patients hospitalized in four hospitals in the Czech Republic. This study was conducted based on the results of the first phase of a prospective observation study focused on the safety of medication administration performed by nurses. All data, including the timing of medication administration in relation to food and the data on beverages used, were obtained by the method of direct observation. The team of observersaccompanied the nurse during medication administration. The appropriateness of the medication administration in relationto food/beverages was assessed according to the summary of product characteristics and the published literature. In total, the administration of 5718 oral medications and 198 insulins were analysed. Unproper food timing wasobserved in 15.7% of oral medication administrations and 26.8% of insulin administrations. The highest number ofunproper food timing occurred in the proton pump inhibitors, antihypertensives, and prokinetics. Tea (63.4%) was the most used beverage. Errors with clinically serious impact have been observed in some groups of drugs. The necessity of a systemic approach in management of medication administration is required including interdisciplinary cooperation.

Self-reported medication administration errors in clinical practice of nurses: a descriptive correlation study

BACKGROUND

Medication administration errors (MAE) are a worldwide issue affecting the safety of hospitalized patients. Through the early identification of potential causes, it is possible to increase the safety of medication administration (MA) in clinical nursing. The study aimed to identify potential risk factors affecting drug administration in inpatient wards in the Czech Republic.

MATERIAL AND METHODS

A descriptive correlation study through a non-standardized questionnaire was used. Data were collected from September 29 to October 15, 2021, from nurses in the Czech Republic. For statistical analysis, the authors used SPSS vers. 28 (IBM Corp., Armonk, NY, USA).

RESULTS

The research sample consisted of 1205 nurses. The authors found that there was a statistically significant relationship between nurse education (p = 0.05), interruptions, preparation of medicines outside the patient rooms (p < 0.001), inadequate patient identification (p < 0.01), large numbers of patients assigned per nurse (p < 0.001), use of team nursing care and administration of generic substitution and an MAE.

CONCLUSIONS

The results of the study point to the weaknesses of medication administration in selected clinical departments in hospitals. The authors found that several factors, such as high patient ratio per nurse, lack of patient identification, and interruption during medication preparation of nurses, can increase the prevalence of MAE. Nurses who have completed MSc and PhD education have a lower incidence of MAE. More research is needed to identify other causes of medication administration errors. Improving the safety culture is the most critical challenge for today's healthcare industry. Education for nurses can be an effective way to reduce MAEs by enhancing their knowledge and skills, mainly focusing on increasing adherence to safe medication preparation and administration and a better understanding of medication pharmacodynamics. Med Pr. 2023;74(2):85-92.

Reasons for medication administration errors, barriers to reporting them and the number of reported medication administration errors from the perspective of nurses: A cross-sectional survey

The aim of the study was to identify the reasons for medication administration errors, describe the barriers in their reporting and estimate the number of reported medication administration errors.

BACKGROUND

Providing quality and safe healthcare is a key priority for all health systems. Medication administration error belongs to the more common mistakes committed in nursing practice. Prevention of medication administration errors must therefore be an integral part of nursing education.

DESIGN

A descriptive and cross-sectional design was used for this study.

METHODS

Sociological representative research was carried out using the standardized Medication Administration Error Survey. The research study involved 1205 nurses working in hospitals in the Czech Republic. Field surveys were carried out in September and October 2021. Descriptive statistics, Pearson's and Chi-square automatic interaction detection were used to analyze the data. The STROBE guideline was used.

RESULTS

Among the most frequent causes of medication administration errors belong name (4.1 ± 1.4) and packaging similarity between different drugs (3.7 ± 1.4), the substitution of brand drugs by cheaper generics (3.6 ± 1.5), frequent interruptions during the preparation and administration of drugs (3.6 ± 1.5) and illegible medical records (3.5 ± 1.5). Not all medication administration errors are reported by nurses. The reasons for non-reporting of such errors include fear of being blamed for a decline in patient health (3.5 ± 1.5), fear of negative feelings from patients or family towards the nurse or legal liability (3.5 ± 1.6) and repressive responses by hospital management (3.3 ± 1.5). Most nurses (two-thirds) stated that less than 20 % of medication administration errors were reported. Older nurses reported statistically significantly fewer medication administration errors concerning non-intravenous drugs than younger nurses (p < 0.001). At the same time, nurses with more clinical experience (≥ 21 years) give significantly lower estimates of medication administration errors than nurses with less clinical practice (p < 0.001).

CONCLUSION

Patient safety training should take place at all levels of nursing education. The standardized Medication Administration Error survey is useful for clinical practice managers. It allows for the identification of medication administration error causes and offers preventive and corrective measures that can be implemented. Measures to reduce medication administration errors include developing a non-punitive adverse event reporting system, introducing electronic prescriptions of medicines, involving clinical pharmacists in the pharmacotherapy process and providing nurses with regular comprehensive training.

Vitamin D: sources, physiological role, biokinetics, deficiency, therapeutic use, toxicity, and overview of analytical methods for detection of vitamin D and its metabolites

Vitamin D has a well-known role in the calcium homeostasis associated with the maintenance of healthy bones. It increases the efficiency of the intestinal absorption of dietary calcium, reduces calcium losses in urine, and mobilizes calcium stored in the skeleton. However, vitamin D receptors are present ubiquitously in the human body and indeed, vitamin D has a plethora of non-calcemic functions. In contrast to most vitamins, sufficient vitamin D can be synthesized in human skin. However, its production can be markedly decreased due to factors such as clothing, sunscreens, intentional avoidance of the direct sunlight, or the high latitude of the residence. Indeed, more than one billion people worldwide are vitamin D deficient, and the deficiency is frequently undiagnosed. The chronic deficiency is not only associated with rickets/osteomalacia/osteoporosis but it is also linked to a higher risk of hypertension, type 1 diabetes, multiple sclerosis, or cancer. Supplementation of vitamin D may be hence beneficial, but the intake of vitamin D should be under the supervision of health professionals because overdosing leads to intoxication with severe health consequences. For monitoring vitamin D, several analytical methods are employed, and their advantages and disadvantages are discussed in detail in this review.

Medication adherence terminology - the first consensual translation using the Delphi method

BACKGROUND

The terminology of adherence (or compliance) describing the patients medication taking behavior is often used inconsistently and fragmented in the literature. Therefore, the English original of so-called ABC Taxonomy was developed to classify and unify the terminology. The aim of this paper was to establish the first consensual translation of Czech terminology dealing with the issue of medication taking behavior using Delphi method.

METHODS

In the period from February to May 2021, a three-round anonymous online Delphi questionnaire survey was conducted. The questionnaire contained items for translations of seven terms and their definitions based on the ABC Taxonomy, while the resulting consensus was established by a predefined degree of agreement of the respondents.

RESULTS

Out of 106 contacted panelists representing different healthcare professions, 46 (43.4%) answered in the first round. Sufficient consensus ( 85%) was reached for the translation of two definitions. In the second round, 32 respondents managed to establish a consensus (&gt; 75%) of one term and four definitions and 24 respondents in the third round established a mild (&gt; 50%) to strong (&gt; 95%) consensus for all remaining terms and definitions. The set of terms related to medication taking for the Czech language was as follows: adherence k lé&#269;b&#283;, zahájení lé&#269;by, zavedení lé&#269;by, p&#345;eru&#353;ení lé&#269;by, setrvání na lé&#269;b&#283;, management adherence and obory související s adherencí.

CONCLUSION

The consensual translations of all Czech terms and definitions related to medication adherence can contribute to greater harmonization and comparability of scientific papers as well as to enhance the communication between scientific and clinical community. However, this consensus needs to be confirmed by a larger number of experts dealing with adherence issue, including the involvement of professional societies.

Review of Czech literature focused on terminology of medication adherence

BACKGROUND

Medication taking terminology is often used incorrectly or inconsistently in the world literature and the meaning of the terms is interchanged. The aim of the work was to map the Czech literature and find out whether Czech authors use terminology related to medication adherence and whether they are consistent in defining it.

METHODS

Based on the methodological instructions for the translation of the so-called ABC Taxonomy introduced by International Society for Medication Adherence (ESPACOMP), a search of Czech literature published until September 22nd, 2021 in the databases ProLéka&#345;e.cz, BM&#268;, PubMed, and Solen was prepared. Morphological variants of keywords were used for the search: compliance, adherence, initiation, implementation, discontinuation, persistence, concordance.

RESULTS

A total of 125 Czech publications from 1998 to 2021 were identified, of which 79 defined specific terms. These included: adherence, persistence, compliance, concordance; the terms for compliance and adherence were interchanged in 14 publications. Publications focused on the treatment of specific diseases were the most common. Only five sources dealt with the issue of medication adherence as a theme without relation to a specific nosological unit.

CONCLUSION

Inconsistency in the use of terms related to medication adherence has proven to be a very common phenomenon in the Czech literature. It is, therefore, necessary to establish a consensus on this terminology in order to unify Czech literature.

Pulse check as a tool to raise awareness of atrial fibrillation in pharmacies in the Czech Republic - a pilot project

OBJECTIVE

The aim of the study was to raise the awareness of atrial fibrillation (AF) and the importance of pulse check in Czech pharmacies as well as to point out further possibilities of developing consulting activities in pharmacies.

METHOD

Our project was performed as part of a worldwide campaign during three weeks: Heart Rhythm Week (06/2017) and Atrial Fibrillation Awareness Week (11/2017, 11/2018). Pharmacies actively providing indi-vidual counselling offered manual pulse check to patients aged  40 years without chronic anticoagulant therapy. Whenever high risk of AF was observed, patients were referred to a physician for further evaluation.

RESULTS

Pharmacists undertook pulse checks in 187 patients (mean age 59.0 ± 12.3 years; 70.6% women) in 14 participating pharmacies. The most common symptoms were fatigue (42.2%) and palpitations (20.9%), however, 40.6% of patients were asymptomatic. The mean heart rate was 73.2 ± 11.3 beats per minute (min. 51; max. 135) and irregular pulse was observed in 4.3% patients. The average CHA2DS2-VASc score was 2.0 ± 1.3. Eight (4.3%) patients were referred to a physician and in 5 patients (2.7%) the arrhythmia was diagnosed.

CONCLUSION

Czech pharmacies have successfully adopted this campaign, are interested in continuity of the project and may thus contribute to raise awareness of AF.