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Guillén Martínez O, Lucas Mayol MJ, Rodríguez Morote M, Soriano-Irigaray L, Matoses-Chirivella C, Navarro Ruiz A. [Concordance of medication prescription records in the hospitalised surgical patient]. J Healthc Qual Res 2024; 39:163-167. [PMID: 38584085 DOI: 10.1016/j.jhqr.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Electronic prescription is the prescription system that allows healthcare professionals to send medication prescriptions directly to community pharmacies and the outpatient unit of Hospital Pharmacy Services for dispensing. However, there is difficulty in obtaining a reliable pharmacotherapeutic history in chronic patients through electronic prescription upon hospital admission as a critical point for adequate treatment adaptation. Therefore, the pharmacist as a member of the multidisciplinary team must ensure, through medication conciliation, an adequate transition of care through the correct management of the treatment that the chronic patient requires during their hospitalization. OBJECTIVES To evaluate the quality of electronic prescription records for routine chronic treatment by analyzing the concordance of the electronic prescription. MATERIAL AND METHODS Observational, cross-sectional and retrospective study at the General University Hospital of Elche. Hospitalized patients in charge of the Orthopedic Surgery and Traumatology, Urology and Neurosurgery Services in which the responsible doctor requested medication reconciliation by the Pharmacy Service between January 2022 - December 2022 were included. RESULTS 378 patients, 209 (55.3%) women and 169 (44.7%) men, with a mean age±standard deviation of 71.0±11.6 years and 69.0±11.8 years, respectively. The total percentage of patients with discrepancies in the electronic prescription with respect to the usual chronic treatment was 60.6%, reflecting that only 39.4% of the patients had non-discordant electronic prescriptions. CONCLUSIONS More than half of hospitalized surgical patients present discrepancies in the medications prescribed in the home electronic prescription, which justifies the importance of treatment reconciliation upon admission carried out by hospital pharmacists.
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Affiliation(s)
- O Guillén Martínez
- Servicio de Farmacia, Hospital General Universitario de Elche, Elche, Alicante, España.
| | - M J Lucas Mayol
- Servicio de Farmacia, Hospital General Universitario de Elche, Elche, Alicante, España
| | - M Rodríguez Morote
- Servicio de Farmacia, Hospital General Universitario de Elche, Elche, Alicante, España
| | - L Soriano-Irigaray
- Servicio de Farmacia, Hospital General Universitario de Elche, Elche, Alicante, España
| | - C Matoses-Chirivella
- Servicio de Farmacia, Hospital General Universitario de Elche, Elche, Alicante, España
| | - A Navarro Ruiz
- Servicio de Farmacia, Hospital General Universitario de Elche, Elche, Alicante, España
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Wang B, Manskow US. Health professionals' experience and perceived obstacles with managing patients' medication information in Norway: cross-sectional survey. BMC Health Serv Res 2024; 24:68. [PMID: 38218841 PMCID: PMC10790274 DOI: 10.1186/s12913-023-10485-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/15/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Access to correct and up to date medication information is crucial for effective patient treatment. However, persistent discrepancies exist. This study examines the experiences and challenges health professionals encounter while utilizing current digital solutions in the Norwegian healthcare system to manage patients' medication information. METHODS A cross-sectional descriptive analysis using quantitative survey data was conducted to investigate how health professionals managed patients' medication information. Content analysis was used to analyze free-text responses concerning challenges they encountered when transferring medication information and to identify factors deemed necessary for implementing the Shared Medication List in Norway. RESULTS A total of 262 doctors and 244 nurses responded to the survey. A higher percentage of doctors (72.2%) expressed concerns regarding obtaining accurate and updated medication lists than nurses (42.9%), particularly for patients with polypharmacy (35.3%) or transitioning between primary and specialist care services (27.6%). The patient's verbal information was the main source for hospital doctors (17%) to obtain an overview of the patient's medication usage, while general practitioners (19%) and nurses (working in both primary and specialist care services, 28% and 27% respectively) predominantly relied on electronic prescriptions. Doctors, in particular general practitioners, reported carrying excessive responsibilities in coordinating with other health actors (84.8%) and managing patients' medication information. The vast majority of both doctors (84.4%) and nurses (82.0%) were in favor of a Shared Medication List. However, about a third of doctors (36.3%) and nurses (29.8%) expressed the need for a more balanced responsibility in updating and managing patients' medication information, while ensuring compatibility with existing digital systems. CONCLUSIONS Fragmented resources for medication information and unclear responsibilities were prevalent concerns among both professional groups. Doctors voiced more concern than nurses about the accuracy of patients' medication list. While both groups are positive about a shared medication list, successful implementation requires proactive training initiatives and clearer role clarification.
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Affiliation(s)
- Bo Wang
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Sykehusvegen 23, Forskningsparken, Tromsø, Norway.
| | - Unn Sollid Manskow
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Sykehusvegen 23, Forskningsparken, Tromsø, Norway
- Department of Health and Care Sciences, Centre for Care Research, UiT- The Arctic University of Norway, Tromsø, Norway
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Implementation of a shared medication list in primary care - a controlled pre-post study of medication discrepancies. BMC Health Serv Res 2021; 21:1335. [PMID: 34903215 PMCID: PMC8670071 DOI: 10.1186/s12913-021-07346-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
Background Access to medicines information is important when treating patients, yet discrepancies in medication records are common. Many countries are developing shared medication lists across health care providers. These systems can improve information sharing, but little is known about how they affect the need for medication reconciliation. The aim of this study was to investigate whether an electronically Shared Medication List (eSML) reduced discrepancies between medication lists in primary care. Methods In 2018, eSML was tested for patients in home care who received multidose drug dispensing (MDD) in Oslo, Norway. We followed this transition from the current paper-based medication list to an eSML. Medication lists from the GP, home care service and community pharmacy were compared 3 months before the implementation and 18 months after. MDD patients in a neighbouring district in Oslo served as a control group. Results One hundred eighty-nine patients were included (100 intervention; 89 control). Discrepancies were reduced from 389 to 122 (p < 0.001) in the intervention group, and from 521 to 503 in the control group (p = 0.734). After the implementation, the share of mutual prescription items increased from 77 to 94%. Missing prescriptions for psycholeptics, analgesics and dietary supplements was reduced the most. Conclusions The eSML greatly decreases discrepancies between the GP, home care and pharmacy medication lists, but does not eliminate the need for medication reconciliation.
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Automated multi-dose dispensing in persons with and without Alzheimer's disease-impacts on pharmacotherapy. Eur J Clin Pharmacol 2021; 78:513-521. [PMID: 34837494 PMCID: PMC8818643 DOI: 10.1007/s00228-021-03258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
Purpose We investigated the drug use before and after transition to automated multi-dose dispensing (MDD) service among persons with Alzheimer’s disease (AD) and compared whether the changes were similar in persons without AD. Methods The register-based Finnish nationwide MEDALZ cohort includes 70,718 community-dwelling persons diagnosed with AD during 2005–2011. Each person who initiated MDD was matched in both groups with a comparison person without MDD by age, gender and for persons with AD, also time since AD diagnosis at the start of MDD. The study cohort included 15,604 persons with AD in MDD and 15,604 no-MDD, and 5224 persons without AD in MDD and 5224 no-MDD. Point prevalence of drug use was assessed every 3 months, from 1 year before to 2 years after the start of MDD and compared between persons in MDD to those who did not have MDD. Results MDD was started on average 2.9 (SD 2.1) years after AD diagnosis. At the start of MDD, the prevalence of drug use increased especially for antipsychotics, antidepressants, opioids, paracetamol and use of ≥ 10 drugs among persons with and without AD. Prevalence of benzodiazepine use (from 12% 12 months before to 17% at start of MDD), memantine (from 29 to 46%) and ≥ 3 psychotropics (from 3.2 to 6.0%) increased among persons with AD. Decreasing trend was observed for benzodiazepine-related drugs, urinary antispasmodics and non-steroidal anti-inflammatory drugs. Conclusion MDD seems to be initiated when use of psychotropics is initiated and the number of drugs increases. Supplementary information The online version contains supplementary material available at 10.1007/s00228-021-03258-y.
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Vaismoradi M, Jamshed S, Lorenzl S, Paal P. PRN Medicines Management for Older People with Long-Term Mental Health Disorders in Home Care. Risk Manag Healthc Policy 2021; 14:2841-2849. [PMID: 34262371 PMCID: PMC8274703 DOI: 10.2147/rmhp.s316744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/02/2021] [Indexed: 12/21/2022] Open
Abstract
Older people with long-term mental health conditions who receive care in their own home are vulnerable to the inappropriate use of medications and polypharmacy given their underlying health conditions and comorbidities. Inappropriate use of pro re nata (PRN) medications in these older people can enhance their suffering and have negative consequences for their quality of life and well-being, leading to readmission to healthcare settings and the increased cost of health care. This narrative review on published international literature aims at improving our understanding of medicines management in home care and how to improve PRN medication use among older people with long-term health conditions in their own home. Accordingly, the improvement of PRN medicines management for these older people requires the development of an individualised care plan considering ‘reduction of older people’s dependence on PRN medications’, ‘empowerment of family caregivers’, and ‘support by healthcare professionals.’ PRN medication use should be reduced through deprescription and discontinuation strategies. Also, older people and their family caregivers should be encouraged to prioritize the use of non-pharmacologic methods to relieve physical and psychological problems. Besides the empowerment of family caregivers through role development, education and training about PRN medications, and involvement in decision-making, they need support by the multidisciplinary network in terms of supervision, monitoring, and home visits.
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Affiliation(s)
- Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, 8049, Norway
| | - Shazia Jamshed
- Clinical Pharmacy and Practice, Faculty of Pharmacy, University Sultan Zainal Abidin, Terengganu, 22200, Malaysia
| | - Stefan Lorenzl
- Professorship for Palliative Care, Institute of Nursing Science and -Practice, Paracelsus Medical University, Salzburg, 5020, Austria.,Department of Neurology, Klinikum Agatharied, Hausham, 83734, Germany
| | - Piret Paal
- WHO Collaborating Centre at the Institute for Nursing Science and Practice, Paracelsus Medical University, Salzburg, A-5020, Austria
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Chelongar K, Ajami S. Using active information and communication technology for elderly homecare services: A scoping review. Home Health Care Serv Q 2020; 40:93-104. [PMID: 32990180 DOI: 10.1080/01621424.2020.1826381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Nowadays, as life expectancy grows, the healthcare industry faces growing challenges related to corresponding increases in chronic diseases. Home care services (HCS) are the solution to this growing problem. It's a general premise that information and communication technology (ICT) can address these health issues and enhances HCS. The scope of our study was the active managerial and supervisory roles of these technologies within HCS. The study aimed to extract, accumulate, and classify the challenges of using active ICT for elderly HCS. We employed the keywords, their synonyms, and their combinations into the searching areas of title, keywords, and abstract. More than 300 resources were collected, and found those 33 articles of those 33 articles were eligible for our study. Later, a team of experts provided their opinions on our gatherings, which were collected individually. According to the expert team's opinions, researchers classified challenges into; technology, human factors, and management.
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Affiliation(s)
- Kioumars Chelongar
- Department of Management and Health Information Technology, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Sima Ajami
- Department of Management and Health Information Technology, School of Health Management and Information Sciences, Isfahan University of Medical Sciences , Isfahan, Iran
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Aarnio E, Huupponen R, Martikainen JE, Korhonen MJ. First insight to the Finnish nationwide electronic prescription database as a data source for pharmacoepidemiology research. Res Social Adm Pharm 2020; 16:553-559. [DOI: 10.1016/j.sapharm.2019.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/24/2019] [Accepted: 06/20/2019] [Indexed: 11/30/2022]
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Schepel L, Lehtonen L, Airaksinen M, Ojala R, Ahonen J, Lapatto-Reiniluoto O. Medication reconciliation and review for older emergency patients requires improvement in Finland. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2019; 30:19-31. [PMID: 30103352 PMCID: PMC6294607 DOI: 10.3233/jrs-180030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: 10–30% of hospital stays by older patients are drug-related. The admission phase is important for identifying drug-related problems, but taking an incorrect medication history often leads to medication errors. OBJECTIVES: To enhance medication history recording and identify drug-related problems (DRPs) of older patients admitted to emergency departments (EDs). METHODS: DRPs were identified by pharmacists-led medication reconciliation and review procedures in two EDs in Finland; Helsinki University Hospital (HUS), and Kuopio University Hospital (KUH). One-hundred-and-fifty patients aged ≥65-years, living at home and using ≥6 medicines were studied. RESULTS: 100% of patients (N = 75) in HUS and 99% in KUH (N = 75), had discrepancies in their admission-medication chart recorded by the nurse or physician. Associations between admission-diagnosis and drug-related problems were found in 12 patients (16%) in HUS and 22 patients (29%) in KUH. Of these, high-alert medications (e.g. antithrombotics, cytostatics, opioids) were linked to eight patients (11%) in HUS and six patients (8%) in KUH. Other acute DRPs were identified in 19 patients (25%) in HUS and 54 patients (72%) in KUH. Furthermore, 67 patients (89%) in HUS and all patients in KUH had non-acute DRPs. CONCLUSIONS: Medication reconciliation and review at admission of older ED patients requires improvement in Finland.
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Affiliation(s)
- Lotta Schepel
- HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS), Finland.,Specialization Programme of Hospital and Health Centre Pharmacy, Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Lasse Lehtonen
- Helsinki University Hospital and University of Helsinki, Finland
| | - Marja Airaksinen
- Specialization Programme of Hospital and Health Centre Pharmacy, Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland.,Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Raimo Ojala
- KUH Pharmacy, Hospital Pharmacy of Kuopio University Hospital, Finland
| | - Jouni Ahonen
- KUH Pharmacy, Hospital Pharmacy of Kuopio University Hospital, Finland
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Nachar C, Lamy O, Sadeghipour F, Garnier A, Voirol P. Medication reconciliation in a Swiss hospital: methods, benefits and pitfalls. Eur J Hosp Pharm 2018; 26:129-134. [PMID: 31428319 DOI: 10.1136/ejhpharm-2017-001358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/22/2017] [Accepted: 01/02/2018] [Indexed: 11/03/2022] Open
Abstract
Objectives To assess the feasibility and main obstacles to the implementation of a medication reconciliation (MR) process in a Swiss hospital and to develop a standardised method which can be used in similar healthcare systems. Methods For this prospective, observational single-centre and single-ward study, a best possible medication history (BPMH) was established by a clinical pharmacist for 147 patients with heart failure based on two sources and a patient interview for each case. Identified discrepancies with medication histories established during emergency service were conveyed to the ward physician. At the end of each hospital stay, the planned discharge treatments were compared with the BPMHs to identify discrepancies and to propose modifications. After a final validation, the comparative treatment plans were distributed. Results MR was conducted for 120 (82%) patients and the mean time needed was 74 min/patient. At least one discrepancy was identified among 94% of the patients on admission, with 4.1 discrepancies found per patient (mainly omissions). At discharge, 83% of the patients had at least one discrepancy, with 2.3 discrepancies found per patient (mainly unintentional substitutions). The majority (86%) of pharmaceutical interventions to adjust the discharge prescriptions were accepted by the physician. Conclusions A standardised method of MR which offers precise definitions of discrepancies and key tools for the process was developed. This method was applicable to most of our cohort and it effectively identified medication discrepancies. Two potential obstacles for its implementation are the time needed for MR and the questionable impact of pharmaceutical interventions on discrepancies.
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Affiliation(s)
- Carole Nachar
- Service of Pharmacy, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Olivier Lamy
- Service of Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Farshid Sadeghipour
- Service of Pharmacy, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Antoine Garnier
- Service of Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierre Voirol
- Service of Pharmacy, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Lausanne, Lausanne, Switzerland
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The scope of drug-related problems in the home care setting. Int J Clin Pharm 2018; 40:325-334. [DOI: 10.1007/s11096-017-0581-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 12/20/2017] [Indexed: 12/15/2022]
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