1
|
Pettoello-Mantovani M, Ferarra P, Bali D, Giardino I, Vural M, Pop TL, Pastore M, Buonocore G. The Importance of Medication Review and Pharmacological Reconciliation in Pediatrics. J Pediatr 2024; 273:114187. [PMID: 38986927 DOI: 10.1016/j.jpeds.2024.114187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/07/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Massimo Pettoello-Mantovani
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Italian Academy of Pediatrics, Milan, Italy; Institute for Scientific Research «Casa Sollievo», Residency Course of Pediatrics, University of Foggia, Foggia, Italy.
| | - Pietro Ferarra
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Italian Academy of Pediatrics, Milan, Italy; Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy
| | - Donjeta Bali
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Albanian Society of Pediatrics, Tirana, Albania
| | - Ida Giardino
- Department of Clinical and experimental Sciences, University of Foggia, Foggia, Italy
| | - Mehmet Vural
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Turkish Pediatric Association, Istanbul, Turkey
| | - Tudor Lucian Pop
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Department of Mother and Child, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj, Romania; Romanian Society of Social Pediatrics, Cluj, Romania
| | - Maria Pastore
- Institute for Scientific Research «Casa Sollievo», Residency Course of Pediatrics, University of Foggia, Foggia, Italy
| | - Giuseppe Buonocore
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Italian Academy of Pediatrics, Milan, Italy; Mother and Child Department, University of Siena, Siena, Italy
| |
Collapse
|
2
|
Iturgoyen Fuentes DP, Meneses Mangas C, Cuervas Mons Vendrell M. Criteria for the selection of paediatric patients susceptible to reconciliation error. Eur J Hosp Pharm 2024; 31:234-239. [PMID: 36180176 DOI: 10.1136/ejhpharm-2022-003468] [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: 07/13/2022] [Accepted: 09/21/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Many medication errors occur during care transitions, which are critical points for patient safety. There is strong evidence in favour of medication reconciliation as a strategy to avoid errors in adults, though few studies have been made in the paediatric setting. Likewise, no recommendations have been established for the selection and/or prioritisation of paediatric patients amenable to reconciliation. METHODS A retrospective study was conducted involving patients subjected to reconciliation by a pharmacist on admission to hospital and who experienced at least one reconciliation error between January and November 2018. Univariable and multivariable analyses were performed to identify possible factors associated with reconciliation error, using a logistic regression model to determine the odds ratio (OR) with the corresponding 95% confidence interval (95% CI). RESULTS The group of patients with at least one reconciliation error included 334 patients, compared with the group of patients without reconciliation errors, which included 1426 patients. It was determined that schoolchildren and adolescent patients had a risk of presenting a reconciliation error on hospital admission that was more than double for younger patients (OR 2.32, 95% CI 1.26 to 4.25, and OR 2.68, 95% CI 1.44 to 4.99, respectively). This risk was multiplied by five if we compared polymedicated patients versus non-polymedicated patients (OR 4.48, 95% CI 3.35 to 5.99). Patients with a neurological or onco-haematological underlying disease had a 12 and 10 times higher risk of presenting a reconciliation error compared with patients with other types of underlying diseases (OR 11.97, 95% CI 7.57 to 18.92, and OR 9.96, 95% CI 6.09 to 16.28, respectively). Finally, patients with narrow therapeutic index medicines in their usual treatment had an almost three times greater risk of presenting a reconciliation error when admitted to the hospital, although this last factor was not determined as an independent risk factor as for the others (OR 2.98, 95% CI 2.22 to 3.99). CONCLUSIONS The paediatric population is characterised by a number of risk factors for reconciliation error. Knowledge of these factors can allow the prioritisation of medication reconciliation in a concrete group of patients. In order to generalise the results obtained in this study, they must be confirmed in other paediatric care settings involving larger samples and different types of patients.
Collapse
|
3
|
Avvaru D, Reddy MS, Ms SA, Wali S, Patil MV, Bhandari R, Ganachari MS. Assessment of medication discrepancy, medication appropriateness, and cost analysis among patients with pediatric nephrotic syndrome: An ambispective cohort observational study. Arch Pediatr 2024; 31:106-111. [PMID: 38262858 DOI: 10.1016/j.arcped.2023.09.015] [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: 04/29/2022] [Revised: 09/15/2023] [Accepted: 09/23/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Nephrotic syndrome (NS) is a commonly encountered chronic kidney disease in pediatric populations, with South Asian children being at high risk and requiring long-term pharmacological management. Thus, identifying medication discrepancies and evaluating the appropriateness of therapy and its economic burden are vital for inpatient management. The aim of the study was to assess medication reconciliation, medication appropriateness, and cost analysis in NS cases. METHODS An ambispective cohort observational study was carried out with 150 NS patients where medication discrepancies were identified retrospectively and prospectively using the best possible medication history and following up patients correspondingly. Further, the Medication Appropriateness Index and cost variation analysis were used to assess the prescribed therapy and cost analysis, respectively. RESULTS Out of 150 patients with NS included, 67.3% were male and the mean age was 7.2 years. In total, 36.7% medication discrepancies were found at baseline and 6% discrepancies at follow-up. The majority of discrepancies were unintentional and due to dosing error both at baseline and follow-up. Further, in only 2% of the patients was there inappropriately prescribed medication, and the majority of patients spent between INR (Indian Rupees) 500 and 1000. CONCLUSION Chronic conditions like NS require continuous monitoring by the specialist pediatric clinical pharmacist, who can contribute significantly by minimizing the medication discrepancies, by assessing the appropriateness of therapy, and lessening the economic burden.
Collapse
Affiliation(s)
- Deepthi Avvaru
- Department of Pharmacy Practice, KLE College of Pharmacy Belagavi, KLE Academy of Higher Education and Research (KAHER), Nehru Nagar, Belagavi, Karnataka, India
| | - M Santhosh Reddy
- Department of Pharmacy Practice, KLE College of Pharmacy Belagavi, KLE Academy of Higher Education and Research (KAHER), Nehru Nagar, Belagavi, Karnataka, India
| | - Shinaj Azar Ms
- Department of Pharmacy Practice, KLE College of Pharmacy Belagavi, KLE Academy of Higher Education and Research (KAHER), Nehru Nagar, Belagavi, Karnataka, India
| | - Shashikala Wali
- Department of Pharmacy Practice, KLE College of Pharmacy Belagavi, KLE Academy of Higher Education and Research (KAHER), Nehru Nagar, Belagavi, Karnataka, India.
| | - Mahantesh V Patil
- Department of Pediatrics, J N Medical College, A Constituent Unit of KLE Academy of Higher Education and Research (KAHER), Belagavi, Karnataka, India
| | - Ramesh Bhandari
- Department of Pharmacy Practice, KLE College of Pharmacy Belagavi, KLE Academy of Higher Education and Research (KAHER), Nehru Nagar, Belagavi, Karnataka, India
| | - M S Ganachari
- Department of Pharmacy Practice, KLE College of Pharmacy Belagavi, KLE Academy of Higher Education and Research (KAHER), Nehru Nagar, Belagavi, Karnataka, India
| |
Collapse
|
4
|
Cuervas-Mons Vendrell M, Iturgoyen Fuentes DP, Arrojo Suárez J, Jimenez Lozano I, Fernandez-Llamazares CM, Tristancho-Perez A, Yunquera Romero L, Martínez Roca C, Otero Villalustre C, García Robles A, Garrido Corro B, Rodríguez Marrodán B. Medication reconciliation on admission in paediatric chronic patients: A multicentre study. An Pediatr (Barc) 2023; 99:376-384. [PMID: 38036314 DOI: 10.1016/j.anpede.2023.11.008] [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: 07/18/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Medication reconciliation (MC) is one of the main strategies to reduce medication errors in care transitions. In Spain, several guidelines have been published with recommendations for the implementation and development of MC aimed at the adult population, although paediatric patients are not included. In 2018, a study was carried out that led to the subsequent publication of a document with criteria for selecting paediatric patients in whom CM should be prioritised. OBJECTIVES To describe the characteristics of paediatric patients most likely to suffer from errors of reconciliation (EC), to confirm whether the results of a previous study can be extrapolated. METHODOLOGY Prospective, multicentre study of paediatric inpatients. We analysed the CE detected during the performance of the CM on admission. The best possible pharmacotherapeutic history of the patient was obtained using different sources of information and confirmed by an interview with the patient/caregiver. RESULTS 1043 discrepancies were detected, 544 were identified as CD, affecting 317 patients (43%). Omission of a drug was the most common error (51%). The majority of CD were associated with drugs in groups A (31%), N (23%) and R (11%) of the ATC classification. Polymedication and onco-haematological based disease were the risk factors associated with the presence of CD with statistical significance. CONCLUSIONS The findings of this study allow prioritisation of CM in a specific group of paediatric patients, favouring the efficiency of the process. Onco-haematological patients and polymedication are confirmed as the main risk factors for the appearance of CD in the paediatric population.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ana García Robles
- Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | |
Collapse
|
5
|
ENVER C, ERTÜRK ŞENGEL B, SANCAR M, KORTEN V, OKUYAN B. Medication Reconciliation Service in Hospitalized Patients with Infectious Diseases During Coronavirus Disease-2019 Pandemic: An Observational Study. Turk J Pharm Sci 2023; 20:210-217. [PMID: 37605897 PMCID: PMC10445224 DOI: 10.4274/tjps.galenos.2022.08455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
Objectives To determine the prevalence and type of medication discrepancies and factors associated with unintentional discrepancies and identify the rate of hospital readmission and emergency service visit within 30 days after discharge among hospitalized patients with infectious diseases and receiving clinical pharmacist-led medication reconciliation during the coronavirus disease-2019 (COVID-19) pandemic. Materials and Methods This observational study was conducted in the internal medicine and infectious diseases wards of a tertiary university hospital between July 2020 and February 2021 among hospitalized adult patients with infectious diseases. Medication reconciliation service (including patient counseling) was provided in person or by telephone. The number and type of medication discrepancies detected during the medication reconciliation services, the acceptance rate of pharmacists' recommendation, and factors associated with having at least one unintentional medication discrepancy at admission were evaluated. At follow-up, hospital readmission and emergency service visit within 30 days after discharge were assessed by telephone. Results Among 146 patients, 84 (57.5%) had at least one unintentional discrepancy at admission. Only three unintentional discrepancies were determined in three patients at hospital discharge. All the pharmacists' recommendations for medication discrepancies were accepted by the physicians. Having COVID-19 [odds ratio (OR): 2.25, 95% confidence interval (CI): 1.15-4.40; p<0.05], being at a high risk for medication error (OR: 2.01, 95% CI: 1.03-3.92; p<0.05), and higher number of medications used at home (OR: 1.41, 95% CI: 1.23-1.61; p<0.001) were associated with having at least one unintentional discrepancy at admission. The rates of 30 day hospital readmission and admission to the emergency medical service were 12.3% and 15.8%, respectively. Conclusion Medication reconciliation service provided by in-person or by telephone was useful for detecting and solving unintentional medication discrepancies during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Cüneyd ENVER
- Marmara University, Faculty of Pharmacy, Department of Clinical Pharmacy, İstanbul, Türkiye
| | - Buket ERTÜRK ŞENGEL
- Marmara University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Türkiye
| | - Mesut SANCAR
- Marmara University, Faculty of Pharmacy, Department of Clinical Pharmacy, İstanbul, Türkiye
| | - Volkan KORTEN
- Marmara University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Türkiye
| | - Betül OKUYAN
- Marmara University, Faculty of Pharmacy, Department of Clinical Pharmacy, İstanbul, Türkiye
| |
Collapse
|
6
|
Hovey SW, Cho HJ, Kain C, Sauer HE, Smith CJ, Thomas CA. Pharmacist-Led Discharge Transitions of Care Interventions for Pediatric Patients: A Narrative Review. J Pediatr Pharmacol Ther 2023; 28:180-191. [PMID: 37303760 PMCID: PMC10249976 DOI: 10.5863/1551-6776-28.3.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/28/2022] [Indexed: 06/13/2023]
Abstract
Transitions of care (TOC) before, during, and after hospital discharge are an opportune setting to optimize medication management. The quality standards for pediatric care transitions, however, are lacking, leading to reduced health outcomes in children. This narrative review characterizes the pediatric populations that would benefit from focused, TOC interventions. Different types of medication-focused TOC interventions during hospital discharge are described, including medication reconciliation, education, access, and adherence tools. Various TOC intervention delivery models following hospital discharge are also reviewed. The goal of this narrative review is to help pediatric pharmacists and pharmacy leaders better understand TOC interventions and integrate them into the hospital discharge process for children and their caregivers.
Collapse
Affiliation(s)
- Sara W. Hovey
- Department of Pharmacy Practice (SWH), University of Illinois at Chicago, College of Pharmacy, Chicago, IL
| | - Hae Jin Cho
- Department of Pharmacotherapy (HJC), College of Pharmacy, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX
| | - Courtney Kain
- Department of Pharmacy (CK), Nemours Children's Hospital, Wilmington, DE
| | - Hannah E. Sauer
- Department of Pharmacy (HES), Texas Children's Hospital, Houston, TX
| | - Christina J. Smith
- Department of Pharmacy (CJS), Loma Linda University Children's Hospital, Loma Linda, CA
| | | |
Collapse
|
7
|
Hovey SW, Click KW, Jacobson JL. Effect of a Pharmacist Admission Medication Reconciliation Service at a Children's Hospital. J Pediatr Pharmacol Ther 2023; 28:36-40. [PMID: 36777983 PMCID: PMC9901323 DOI: 10.5863/1551-6776-28.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/16/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the clinical effect and estimate cost avoidance attributed to a pharmacist-led admission medication reconciliation service at a children's hospital. METHODS This was a prospective observational cohort study that measured pharmacist interventions for pediatric patients over a 90-day period. Pharmacists logged all interventions identified during medication reconciliation in real time. Patient demographic data were collected retrospectively. Cost avoidance from prevented adverse drug events (ADEs) was estimated based on previously published literature. RESULTS Pharmacists completed 283 admission medication reconciliations during the study period. Of those, 69% of medication reconciliations required intervention. Interventions affected care during the hospital admission in 21.9% of patients and 8 medication reconciliations resulted in prevention of a major ADE. This pharmacist-led service resulted in an estimated cost avoidance of $46,746.65 in the 3-month period. CONCLUSIONS Implementation of a pharmacist-led admission medication reconciliation service for pediatric patients improved medication safety and resulted in significant cost avoidance, which justifies investment in these pharmacist resources.
Collapse
Affiliation(s)
- Sara W Hovey
- Department of Pharmacy Practice (SWH), University of Illinois at Chicago, College of Pharmacy, University of Illinois Hospital & Health Sciences System, Chicago, IL
| | - Kristen W Click
- Department of Pharmacy (KWC, JLJ), Rush University Medical Center, Rush Children's Hospital, Chicago, IL
| | - Jessica L Jacobson
- Department of Pharmacy (KWC, JLJ), Rush University Medical Center, Rush Children's Hospital, Chicago, IL
| |
Collapse
|
8
|
Gebrye DB, Wudu MA, Hailu MK. Magnitude and Predictors of Medication Administration Errors Among Nurses in Public Hospitals in Northeastern Ethiopia. SAGE Open Nurs 2023; 9:23779608231201466. [PMID: 37705732 PMCID: PMC10496468 DOI: 10.1177/23779608231201466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
Introduction Currently, patient safety and quality of care have become a public health concern. However, medication administration errors are common in global medical settings and may cause problems ranging from the subtle to the fatal. Objective To assess the Magnitude and determinant factors of Medication Administration Errors among nurses working in the public hospitals in the Eastern Amhara region, Northeastern Ethiopia, 2022. Methods A multicenter hospital-based cross-sectional study design was used in South Wollo Zone public hospitals from February-March 2022, with 423 nurses selected using a simple random method. Data were collected using a pretested questionnaire, entered, and analyzed using EpiData 4.6.0 and SPSS 26. Predictors of medication administration errors were identified by multivariate logistic regression. Result Magnitude of Medication Administration Errors in the study areas was 229 (55%), 95% CI [0.501, 0.599]. Service provision to ≥ 11 patients per day (AOR: 2.52, 95% CI [1.187, 6.78]), interruption (AOR: 4.943, 95% CI [2.088, 11.712]), lack of training (AOR: 6.35, 95% CI [3.340, 7.053]), ≥ 4 years and 5-9 years of experience respectively (AOR: 3.802, 95% CI [1.343, 10.763]), (AOR: 2.804, 95% CI [1.062, 7.424]) were factors associated with Medication Error. likewise, shortage of time (AOR: 5.637, 95% CI [2.575, 12.337]), lack of guidelines (AOR: 2.418, 95% CI [1.556, 5.086]), workload (AOR: 7.32, 95% CI [3.146, 17.032]) and stress (AOR: 12.061, 95% CI [33.624, 53.737]) were determinant factors for Medication Administration Errors. Conclusion and recommendation In the current study, medication administration errors were common. Patient load, interruption, nurse's service experience, time deficit, stress, a lack of training, and the absence of guidelines were associated with medication administration errors. Therefore, ongoing training, the availability of guidelines, the presence of a good working environment, and the retention of experienced nurses can all be critical steps in improving patient safety.
Collapse
Affiliation(s)
- Dagne Belete Gebrye
- Department of Maternity and Reproductive Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Muluken Amare Wudu
- Department of Maternity and Reproductive Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Molla Kassa Hailu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
9
|
Costa E Silva T, Dias P, Alves E Cunha C, Feio J, Lavrador M, Oliveira J, Figueiredo IV, Rocha MJ, Castel-Branco M. [Medication Reconciliation During Admission to an Internal Medicine Department: A Pilot Study]. ACTA MEDICA PORT 2022; 35:798-806. [PMID: 35245429 DOI: 10.20344/amp.16892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of medication reconciliation is to promote patient safety by reducing medication errors and adverse events due to medication discrepancies in transition of care. The aim of this pilot study of medication reconciliation at the time of hospital admission was to identify the necessary resources for its implementation in clinical practice. MATERIAL AND METHODS Pilot study with 100 patients admitted to an Internal Medicine department between October and December 2019, aged 18 and over, and chronically taking at least one medicine. The best possible medication history was obtained systematically, with subsequent identification, classification and resolution of the discrepancies. RESULTS The study sample, in general characterized by polypharmacy and by having multiple long-term conditions, presented a mean age of 77.04 ± 13.74 years, being 67.0% male. Overall, 791 discrepancies were identified. Intentional discrepancies were 95.7% and 50.9% of them were documented. The difficulties encountered were mainly related with the access and quality of therapeutic information and communication problems between different healthcare professionals. The key priority resources that were identified were related with the process, tools, and personnel categories. CONCLUSION The data revealed weaknesses in the clinical records available at the primary/hospital care interface. Optimization of data sources, standardization and informatization of the process, multidisciplinary approach and definition of priority groups were identified as opportunities for optimization.
Collapse
Affiliation(s)
- Thaís Costa E Silva
- Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra.Portugal
| | - Patrícia Dias
- Serviço de Medicina Interna. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Catarina Alves E Cunha
- Unidade de Farmacologia Clínica. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - José Feio
- Serviços Farmacêuticos. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Marta Lavrador
- Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra. Instituto de Investigação Clínica e Biomédica de Coimbra. Coimbra. Portugal
| | - Joelizy Oliveira
- Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra. Fundação Capes. Ministério da Educação. Brasília. Brasil. Centro de Documentação e Informação em Educação Superior. Ministério da Educação Superior e Pesquisa do Governo do Grão-Ducado de Luxemburgo. Luxemburgo
| | - Isabel Vitória Figueiredo
- Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra. Instituto de Investigação Clínica e Biomédica de Coimbra. Coimbra. Portugal
| | - Marília João Rocha
- Serviços Farmacêuticos. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Margarida Castel-Branco
- Laboratório de Farmacologia e Cuidados Farmacêuticos. Faculdade de Farmácia. Universidade de Coimbra. Coimbra. Instituto de Investigação Clínica e Biomédica de Coimbra. Coimbra. Portugal
| |
Collapse
|
10
|
Abu Hammour K, Abu Farha R, Ya’acoub R, Salman Z, Basheti I. Impact of Pharmacist-Directed Medication Reconciliation in Reducing Medication Discrepancies: A Randomized Controlled Trial. Can J Hosp Pharm 2022; 75:169-177. [PMID: 35847464 PMCID: PMC9245405 DOI: 10.4212/cjhp.3143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background In hospital surgical wards, patients are at higher risk for medication errors, in part because physicians may not consider themselves sufficiently trained to prescribe medications. Hence, collaborative teamwork involving the pharmacist is needed. Objectives To assess the impact of medication reconciliation directed by pharmacists on decreasing medication discrepancies after discharge from the surgical ward. Methods Patients admitted to the surgical unit at a tertiary teaching hospital in Amman, Jordan, between July 2017 and July 2018 were selected and randomly assigned to either the control or the intervention group. Upon admission, the number and kinds of unintentional medication discrepancies were determined for both groups. Medication reconciliation was then provided to patients in the intervention group. The number of unintentional discrepancies was re-evaluated upon discharge for both groups. To assess differences between the control and intervention groups, the χ2 or Fisher exact test was used for categorical variables and an independent-sample t test for continuous data. A paired t test was conducted to determine whether the number of medication discrepancies was reduced as a result of pharmacists' recommendations. Results A total of 123 patients met the inclusion criteria, 61 in the intervention group and 62 in the control group. Discrepancies of omission and wrong dose constituted 41 (77%) of the 53 discrepancies in the intervention group and 25 (76%) of the 33 discrepancies in the control group. The number of unintentional discrepancies was significantly reduced from admission to discharge in both the intervention group (p = 0.002) and the control group (p = 0.007). Of 53 recommendations made by pharmacists, 20 (38%) were accepted by the treating physician, and all of these discrepancies were resolved. Conclusions This study sheds light on the existence of unintentional medication discrepancies upon admission for surgical patients, which may expose the patients to potential harm upon discharge from hospital. Additional studies with a larger sample size are needed to gain further insights on pharmacists' role in implementing medication reconciliation for surgical patients.
Collapse
|
11
|
OUP accepted manuscript. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:420-426. [DOI: 10.1093/ijpp/riac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/01/2022] [Indexed: 11/12/2022]
|
12
|
Keuler N, Bouwer A, Coetzee R. Pharmacists' Approach to Optimise Safe Medication Use in Paediatric Patients. PHARMACY 2021; 9:pharmacy9040180. [PMID: 34842828 PMCID: PMC8628964 DOI: 10.3390/pharmacy9040180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/02/2021] [Accepted: 10/09/2021] [Indexed: 11/22/2022] Open
Abstract
Paediatric patients are unique, yet challenging patients to care for by pharmacists. Paediatric medicine use requires special consideration. Pharmacists play an important role in educating and counselling patients, carers, and healthcare workers. Further, pharmacists have the necessary knowledge and skills to optimise safe medicine use in paediatric patients. This article provides basic principles for safe practices in paediatric medicine by following the nine rights of medication administration.
Collapse
Affiliation(s)
- Nicole Keuler
- School of Pharmacy, University of the Western Cape, Cape Town 7535, South Africa;
- Correspondence:
| | - Annatjie Bouwer
- Centralized Monitoring Solutions, IQVIA, Bloemfontein 9301, South Africa;
| | - Renier Coetzee
- School of Pharmacy, University of the Western Cape, Cape Town 7535, South Africa;
| |
Collapse
|
13
|
Maffre I, Leguelinel-Blache G, Soulairol I. A systematic review of clinical pharmacy services in pediatric inpatients. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00845-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
14
|
van der Nat DJ, Taks M, Huiskes VJB, van den Bemt BJF, van Onzenoort HAW. A comparison between medication reconciliation by a pharmacy technician and the use of an online personal health record by patients for identifying medication discrepancies in patients' drug lists prior to elective admissions. Int J Med Inform 2020; 147:104370. [PMID: 33421688 DOI: 10.1016/j.ijmedinf.2020.104370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/16/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
AIM Medication discrepancies (MDs), defined as unexplained differences among medication regimens, cause important public health problems with clinical and economic consequences. Medication reconciliation (MR) reduces the risk of MDs, but is time consuming and its success relies on the quality of different information sources. Online personalized health records (PHRs) may overcome these drawbacks. Therefore, the aim of this study is to determine the level of agreement of identified MDs between traditional MR and an online PHR and the correctness of the identified MDs with a PHR. METHODS A prospective cohort study was conducted at the cardiology, neurology, internal medicine and pulmonary department of the Amphia Hospital, the Netherlands. Two weeks prior to a planned admission all patients received an invitation from a PHR to update their medication file derived from the Nationwide Medication Record System (NMRS). At admission MR was performed with all by a pharmacy technician, who created the best possible medication history (BPMH) based on the NMRS data and an interview. MDs were determined as discrepancies between the available information from the NMRS and the input and alterations patients or pharmacy technician made. The number, correctness of patients' alterations, type and severity of identified MDs were analysed. RESULTS Of 488 patients approached, 155 (31.8 %) patients who both used the PHR and had received MR were included. The mean number of MDs identified with MR and PHR was 6.2 (SD 4.3) and 4.7 (SD 3.7), respectively. 82.1 % of the drug information noted by the patient in the PHR was correct compared to the BPMH and 98.6 % had no clinically relevant differences between the lists. CONCLUSION Patients who used an online PHR can relatively accurately record a list of their medication. Further research is required to explore the level of agreement and the correctness of a PHR in other (larger) hospital(departments).
Collapse
Affiliation(s)
| | - Margot Taks
- Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands
| | | | - Bart J F van den Bemt
- Department of Pharmacy, St. Maartenskliniek, Nijmegen, the Netherlands; Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Hein A W van Onzenoort
- Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands; Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands.
| |
Collapse
|
15
|
Prevalence of medication discrepancies in pediatric patients transferred between hospital wards. Int J Clin Pharm 2020; 43:909-917. [PMID: 33175294 DOI: 10.1007/s11096-020-01196-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/04/2020] [Indexed: 01/24/2023]
Abstract
Background Children are more susceptible to harm from medication errors and adverse drug reactions when compared to adults. Such events may occur from medication discrepancies while transitioning patients throughout the healthcare system. Contributing factors include medication discontinuity and lack of information by the healthcare team. Objective To analyze the prevalence of medication discrepancies in transition points of care in a pediatric department. Setting Pediatric department of a public hospital in Northeast Brazil. Method A cross-sectional study was carried out from August 2017 to March 2018. Data collection consisted of the following steps: collection of sociodemographic data, clinical interview with the patient's caregiver, registration of patient prescriptions, and evaluation of medical records. Medication discrepancies were classified as intentional and unintentional. The unintentional medication discrepancies were classified as omission of medication, therapeutic duplicity, and differences in dose, frequency, or route of administration. Main outcomes measure Discrepancy profile identified at admission, internal transfer and hospital discharge. Results Among the 114 patients included in the study, 85 (74.5%) patients had at least one unintentional medication discrepancy, of which 16 (14.0%) patients presented medication discrepancies at hospital admission, 42 (36.8%) patients at internal transfer, and 52 (45.6%) patients during discharge. Omission of medication represented 20 (74.1%) errors at admission, 26 (37.7%) errors at internal transfer, and 80 (100.0%) errors at hospital discharge. Conclusions The main transition points of care where unintentional discrepancies occurred in the studied pediatric department were at internal transfer and hospital discharge, with omission being the most common type of unintentional discrepancy.
Collapse
|
16
|
Ramadanov N, Klein R, Schumann U, Aguilar ADV, Behringer W. Factors, influencing medication errors in prehospital care: A retrospective observational study. Medicine (Baltimore) 2019; 98:e18200. [PMID: 31804342 PMCID: PMC6919435 DOI: 10.1097/md.0000000000018200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the frequency of medication errors in prehospital care and to investigate the influencing factors - diagnostic agreement (DA), the medical educational status, the specialty, the approval for emergency medicine of the prehospital emergency physician, the patient age and sex and the time of deployment.We retrospectively reviewed 708 patients from 2013 to 2015, treated by the prehospital emergency physicians of the emergency medical service center Bad Belzig, Germany. The medication appropriateness was determined by a systematic comparison of the administered medication in prehospital deployments with the discharge diagnosis, according to current guidelines. The influencing factors were examined by univariate analysis of medication appropriateness (MA), using the χ, the Mann-Whtiney U and the Welch tests. We calculated a cut-off value with the Youden index to predict absent MA, according to patients age. The significance level was P = .05.MA was absent in 220 of 708 patients (31.1%). In the case of present DA, MA was absent in 103 of 491 patients (20.9%). In the case of absent DA, MA was absent in 117 of 217 patients (53.9%) (P = .01). MA was absent in 82 of 227 patients (36.1%), treated by specialist and in 138 of 481 patients (28.7%), treated by resident physicians (P = .04). The calculated cut-off value to predict absent MA was 75.5 years. MA was absent in 100 of 375 patients (26.7%) of the younger patient age group (≤75.5 years), MA was absent 120 of 333 patients (36.0%) of the older patient age group (>75.5 years) (P = .01). Absent MA showed peak values (46.7%-60%) at night from 3 to 6 AM (P = .01) The other investigated factors had no influence on MA.The correctness of medication as a quality feature in prehospital care shows a necessity for improvement with a proportion of 31.1% medication errors. The correct diagnosis by the prehospital emergency physician and his rapid accumulation of experience had an impact on the correctness of medication in prehospital care. Elderly patients (75+ years) and nighttime prehospital deployments (3-6 AM) were identified as high risk for medication errors by the emergency physicians.
Collapse
Affiliation(s)
- Nikolai Ramadanov
- Center for Emergency Medicine, University Hospital Jena, Friedrich Schiller
| | | | - Urs Schumann
- Center for Internal Medicine, Clinic for Endocrinology and Diabetology Niemegker Str. Bad Belzig, Germany
| | | | - Wilhelm Behringer
- Center for Emergency Medicine, University Hospital Jena, Friedrich Schiller
| |
Collapse
|
17
|
Ramadanov N, Klein R, Aguilar Valdez AD, Behringer W. Medication Appropriateness in Prehospital Care. Emerg Med Int 2019; 2019:6947698. [PMID: 31565440 PMCID: PMC6745092 DOI: 10.1155/2019/6947698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/30/2019] [Accepted: 08/05/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of the present study was to determine the medication appropriateness (MA) in prehospital emergency physician deployments according to the hospital discharge diagnosis and to investigate the factors influencing the MA. METHODS The MA was determined by a systematic comparison of the administered medication in prehospital emergency physician deployments with the discharge diagnosis in a period of 24 months at the emergency medical services in Bad Belzig. Categorial variables for the specialty, medical educational status, and approval for emergency medicine of prehospital emergency physicians were examined univariate for relations with the MA, using the χ2 test with the significance level of p=0.05. RESULTS The MA was present in 69% (n = 488) cases. The MA was present in 64% of cases by specialists and in 71% by resident physicians (p=0.04). The specialty and the approval for emergency medicine of the prehospital emergency physician did not show significant results. MA was present in 46% (n = 100) of cases with incorrect diagnoses, and it was present in 79% (n = 388) of cases with correct diagnoses by the prehospital emergency physician (p=0.01). In cases of missing MA, 224 drugs and 23 different drugs were administered by the prehospital emergency physician. CONCLUSIONS The MA in prehospital emergency physician deployments shows a necessity for improvement with 31% medication errors. Incorrect diagnoses by the prehospital emergency physician seem to lead to medication errors in prehospital emergency physician deployments. The necessary standards and guidelines for administration of drugs should be taken into account in educational courses. The wide-ranging emergency medical training and the rapid accumulation of operational experience seem to play a crucial role for correct administration of medication in the prehospital emergency physician deployments.
Collapse
Affiliation(s)
- Nikolai Ramadanov
- Center for Emergency Medicine, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany
| | - Roman Klein
- Orthopaedics, Trauma Surgery and Sports Traumatology, Marienhaus Hospital Hetzelstift, Stiftstr. 10, 67434 Neustadt, Germany
| | - Abner Daniel Aguilar Valdez
- Center for Internal Medicine, Clinic for Endocrinology and Diabetology, Ernst von Bergmann Hospital Bad Belzig, Niemegker Str. 45, 14806 Bad Belzig, Germany
| | - Wilhelm Behringer
- Center for Emergency Medicine, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany
| |
Collapse
|