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Light J, Ruh C, Ott M, Banker C, Meaney D, Doloresco F, Noyes K. The Effect of Pharmacy-Led Medication Reconciliation on Odds of Psychiatric Relapse at a Community Hospital. J Pharm Pract 2024; 37:391-398. [PMID: 36314582 DOI: 10.1177/08971900221137100] [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] [Indexed: 02/16/2024]
Abstract
Purpose: Individuals with psychiatric disorders are at increased risk for treatment non-adherence and related complications, especially during transitions of care. Medication reconciliation is now a standard process during hospital admissions that is uniformly recommended by international organizations to aid in safe and effective care transitions. Pharmacy-led medication reconciliation (PMR) practices are poised to represent a standardized method of reconciliation attempt within this underserved population with complex medication histories. Methods: A retrospective cross-sectional study using medical chart review was conducted for all adults admitted to the inpatient psychiatric service at a community hospital in Buffalo, NY, during 2 months in 2018. Outcomes were 30- and 180-day psychiatric readmission rates, 30- and 180-day visit rates to the outpatient comprehensive psychiatric emergency program (CPEP), and composite 30- and 180-day relapse. Receipt of pharmacy-led medication reconciliation was identified from pharmacy documentation in the electronic medical record. Results: 78% of patient's medication lists on admission were reconciled, with 49% of reconciliations made by the inpatient pharmacy. Presence of a PMR did not alter the odds of inpatient readmission alone, however patients without a PMR were found to have 2.13 times higher odds of visiting the hospital's outpatient CPEP within 30-days (P = .012) and 1.9 times higher odds of any composite psychiatric relapse within 30-days (P = .024). Conclusions: Implementation of hospital-wide pharmacy-led medication reconciliation on admission may help reduce psychiatric relapse across multiple care settings.
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Affiliation(s)
- Jamie Light
- Erie County Medical Center, Buffalo, NY, USA
| | | | - Michael Ott
- Erie County Medical Center, Buffalo, NY, USA
| | - Christopher Banker
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Drake Meaney
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Fred Doloresco
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Katia Noyes
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
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2
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Aghighi N, Aryankhesal A, Raeissi P, Najafpour Z. Frequency and influential factors on occurrence of medical errors: A three-year cross-sectional study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 12:422. [PMID: 38464657 PMCID: PMC10920663 DOI: 10.4103/jehp.jehp_1726_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/10/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Despite efforts to improve patient safety, medical errors (MEs) continue to recur. Proper utilization of reported MEs can be effective in preventing their recurrence. This study investigated the errors reported in 3 years and examined the factors affecting them. MATERIALS AND METHODS This descriptive analytical study was conducted using the errors reported in 20 hospitals under the auspices of one of Iran's medical universities from 2018 to 2020. All reported errors were investigated by an expert panel. RESULTS In total, 6584 reported errors were grouped into four main categories based on the type of error. The highest reported errors were related to the management and treatment procedures. Analyses of the factors influencing medical errors revealed that 15 factors affected the occurrence of errors. An increasing trend of error was found in 9 of the 15 identified factors. Incorrect documenting of the physician's order in the nursing Kardex and noncompliance with the patient identification guide were the highest with 16.03 and 15.47%, respectively. CONCLUSION The most identified factor was the incorrect registration of the physician's prescription on the nursing card; therefore, it seems that the use of computerized physician order entry should be considered. Furthermore, the mere existence and training of patient safety guides cannot help prevent errors. Not only should the underlying causes of errors be carefully identified and investigated but it also requires serious determination to follow the patient's safety instructions from the highest to the lowest levels of the health system.
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Affiliation(s)
- Negar Aghighi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Aryankhesal
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Pouran Raeissi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Zhila Najafpour
- Department of Health Care Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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3
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Zahl-Holmstad B, Garcia BH, Svendsen K, Johnsgård T, Holis RV, Ofstad EH, Risør T, Lehnbom EC, Wisløff T, Chan M, Elenjord R. Completeness of medication information in admission notes from emergency departments. BMC Health Serv Res 2023; 23:1425. [PMID: 38104071 PMCID: PMC10724918 DOI: 10.1186/s12913-023-10371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Medication lists prepared in the emergency department (ED) form the basis for diagnosing and treating patients during hospitalization. Since incomplete medication information may lead to patient harm, it is crucial to obtain a correct and complete medication list at hospital admission. In this cross-sectional retrospective study we wanted to explore medication information completeness in admission notes from Norwegian EDs and investigate which factors were associated with level of completeness. METHODS Medication information was assessed for completeness by applying five evaluation criteria; generic name, formulation, dose, frequency, and indication for use. A medication completeness score in percent was calculated per medication, per admission note and per criterion. Quantile regression analysis was applied to investigate which variables were associated with medication information completeness. RESULTS Admission notes for patients admitted between October 2018 and September 2019 and using at least one medication were included. A total of 1,080 admission notes, containing 8,604 medication orders, were assessed. The individual medications had a mean medication completeness score of 88.1% (SD 16.4), while admission notes had a mean medication completeness score of 86.3% (SD 16.2). Over 90% of all individual medications had information about generic name, formulation, dose and frequency stated, while indication for use was only present in 60%. The use of an electronic tool to prepare medication information had a significantly strong positive association with completeness. Hospital visit within the last 30 days, the patient's living situation, number of medications in use, and which hospital the patient was admitted to, were also associated with information completeness. CONCLUSIONS Medication information completeness in admission notes was high, but potential for improvement regarding documentation of indication for use was identified. Applying an electronic tool when preparing admission notes in EDs seems crucial to safeguard completeness of medication information.
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Affiliation(s)
- Birgitte Zahl-Holmstad
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway.
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway.
| | - Beate H Garcia
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Kristian Svendsen
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Tine Johnsgård
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Renata V Holis
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
| | - Eirik H Ofstad
- Department of Medicine, Nordland Hospital Trust, Parkveien 95, Bodø, 8005, Norway
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Torsten Risør
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1014, Denmark
| | - Elin C Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar, 392 31, Sweden
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Sykehusveien 25, Nordbyhagen, Lørenskog, 1478, Norway
| | - Macty Chan
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Renate Elenjord
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
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Gebremariam SN, Sema FD, Jara AG, Mekonen BT, Mekonnen GA. Medication error and associated factors among adults admitted to emergency ward at the university of Gondar comprehensive specialized hospital, North-West Ethiopia: a cross-sectional study, 2022. J Pharm Policy Pract 2023; 16:148. [PMID: 37978391 PMCID: PMC10655288 DOI: 10.1186/s40545-023-00616-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/16/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Medication errors are the most common cause of preventable adverse drug events at the emergency ward. OBJECTIVES This study assessed medication errors and associated factors among adult patients admitted to the emergency ward at the University of Gondar Comprehensive Specialized Hospital, North-West Ethiopia. METHODS A cross-sectional study was conducted from June 1, 2022, to August 30, 2022. Data were entered into EpiData Manager 4.6.0.0 for clearing and exported to SPSS version 24 for analysis. Descriptive statistics such as frequencies, medians with an interquartile range and inferential statistics like binary logistic regression were used for data analysis. The level of significance was declared at a p value less than 0.05 with a 95% confidence interval. RESULTS From 422 study participants, medication errors were found in three-fourths (74.4%) of study participants. The most frequent type of medication error was omitted dose (26.27%). From a total of 491 medication errors, 97.75% were not prevented before reaching patients. More than one-third (38.9%) of medication errors had potentially moderate harmful outcomes. More than half (55.15%) of possible causes of medication errors committed by staff are due to behavioral factors. Physicians accepted 99.16% and nurses accepted 98.71% of clinical pharmacist intervention. Hospital stay ≥ 6 days (AOR: 3.00 95% CI 1.65-5.45, p < 0.001), polypharmacy (AOR: 5.47, 95% CI 2.77-10.81 p < 0.001), and Charlson comorbidity index ≥ 3 (AOR: 1.94, 95% CI (1.02-3.68), p < 0.04) significantly associated with medication error. CONCLUSIONS About three-fourths of adult patients admitted to the emergency ward experienced medication errors. A considerable amount of medication errors were potentially moderately harmful. Most medication errors were due to behavioral factors. Most clinical pharmacists' interventions were accepted by physicians and nurses. Patients who stayed longer at the emergency ward, had a Charlson comorbidity index value of ≥ 3, and were on polypharmacy were at high risk of medication error. The hospital should strive to reduce medication errors at the emergency ward.
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Affiliation(s)
- Saron Naji Gebremariam
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Fasiel Dula Sema
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abdisa Gemedi Jara
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Banchamlak Teferi Mekonen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gizework Alemnew Mekonnen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Routly M, Gettis M, Thomas A, Macias J, Cherven B. Transferring critical pediatric patients from emergency department to intensive care: A quality improvement initiative. J Pediatr Nurs 2023; 72:e47-e52. [PMID: 37330276 DOI: 10.1016/j.pedn.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/30/2023] [Accepted: 06/04/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Transfer of care, moving hospitalized patients between care areas, is a critical point of vulnerability for healthcare organizations. Patient information handoff is an essential activity occurring frequently in hospital environments. Poor communication has been linked with adverse events and poor patient outcomes. This evidence-based quality project aimed to enhance the handoff process between the Emergency Department (ED) and Pediatric Intensive Care Unit (PICU) by standardizing transfer of care steps. This was accomplished through customizing a reporting tool to contain all the information the receiving department deemed necessary for safe patient care. METHODS A customized situation, background, assessment, recommendation (SBAR) form handoff tool was developed for ED to PICU transfers. This SBAR tool included information that PICU nurses identified as critical to transfer of care. Nurse perceptions were surveyed pre- and post-implementation. Patient safety event reports were tracked to evaluate events related to transfer of care before and after the practice change. FINDINGS An increased number of PICU nurses agreed the customized handoff tool was complete and organized. Additionally, more nurses agreed that handoff gave all information needed to safely care for critically ill patients transferred from the ED. Lastly, bedside patient checks increased, and patient safety events related to transfer of care decreased. DISCUSSION This project demonstrated that implementation of a standardized transfer of care process coupled with a customized handoff tool increased PICU nurse perceptions that handoff was organized, and all information needed to safely care for critically ill patients was conveyed. APPLICATION TO PRACTICE Transfer of care processes between the ED and PICU should be standardized. The use of customized tools may improve information exchange between nurses and ensure that all vital patient information is communicated.
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Affiliation(s)
- Maia Routly
- Children's Healthcare of Atlanta, Atlanta, GA, United States of America.
| | - Margaret Gettis
- Children's Healthcare of Atlanta, Atlanta, GA, United States of America; Nursing Research & Evidence Based Practice Department at Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Amy Thomas
- Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Jennifer Macias
- Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Brooke Cherven
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, United States of America; Nursing Research & Evidence Based Practice Department at Children's Healthcare of Atlanta, Atlanta, GA, United States of America; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
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6
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DiConti-Gibbs A, Chen KY, Coffey CE. Polypharmacy in the Hospitalized Older Adult. Clin Geriatr Med 2022; 38:667-684. [DOI: 10.1016/j.cger.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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7
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Operationalizing Whole-Person Postpartum Care: Health Care Provider-Level Strategies. Clin Obstet Gynecol 2022; 65:611-631. [PMID: 35894737 DOI: 10.1097/grf.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postpartum mothers report feeling unsupported and unprepared by their health care providers to meet the challenges of the postpartum period. This gap perpetuates a cycle of disappointment with and disengagement from postpartum care services. The need to revamp postpartum care has been recognized at the population level but implementing changes at the health care provider level is challenging without practical guidance. The needs of new mothers are broad in scope and variable between individuals, requiring a whole-person care approach that is comprehensive yet nimble. Presented here are provider-level strategies to promote care that both elicits and is responsive to the unique care goals of this population.
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Sudari F, Priskilla I, Febiola M, Sinuraya RK. Strategies to improve the vaccine distribution and community awareness of taking COVID-19 vaccine in rural areas in Indonesia. PHARMACIA 2022. [DOI: 10.3897/pharmacia.69.e81525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
COVID-19 has spread worldwide, and several governments, including Indonesia, are actively vaccinating. However, numerous factors may contribute to decreased vaccination administration, including hesitation, a lack of information, and demographic considerations. Therefore, this review provides insights on maximizing vaccine distribution and raising community awareness about COVID-19 vaccination in rural regions with difficulty in transportation access, a lack of health care workers, and limited vaccine storage facilities. It was discovered that numerous potential methods, such as the Internet of Things (IoT), bio-tracking and bio-detect, P-median, and Vehicle Routing Problem (VRP), can monitor vaccination delivery in rural parts of Indonesia. The correct vaccine distribution system can monitor situations during distribution by combining IoT technology with bio-tracking and bio-detect in airborne transportation. Besides enhancing vaccine distribution technologies, healthcare professionals play a critical role in maintaining vaccine quality and improving community awareness of diseases. In particular, as a healthcare professional, a pharmacist has an essential role in ensuring the quality of the vaccine until it is administered to the patient and improving patients’ awareness of COVID-19 and the vaccinations. Pharmacists can collaborate with other healthcare professionals to educate the community to identify important information related to wrong perceptions about COVID-19 and vaccinations.
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Adams SC, Gura KM, Seres DS, Kovacevich D, Maguire A, Herlitz J, Canada TW, Nishikawa R, Boullata J. Safe care transitions for patients receiving parenteral nutrition. Nutr Clin Pract 2022; 37:493-508. [PMID: 35587169 DOI: 10.1002/ncp.10861] [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: 06/17/2021] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 01/14/2023] Open
Abstract
Transitions of care require coordination between inpatient healthcare providers, care managers, outpatient/ambulatory providers, and the patient/caregiver and family members. Poor communication during transitions of care can affect health outcomes and economic costs for patients/caregivers, healthcare providers, and healthcare systems. The goal of this paper is to identify risk-prone processes in the transition of care for patients requiring parenteral nutrition (PN) between healthcare environments, including the hospital, home, skilled nursing facility, and long-term acute care hospital settings. To facilitate the evaluation of the transition, a sequential series of steps in the transition process were identified: initial notification, assessment in preparation for transfer, identifying the receiving organization, identifying accountable providers at each sending/receiving organization, communicating the nutrition care plan, implementing the plan and additional considerations regarding PN preparation and readmissions. Safety concerns with risk-prone processes are identified and recommended best practices are proposed for improving processes at each step of the transition. Pediatric considerations are included in the evaluation of the various steps in the transition of care. This paper was approved by the American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors.
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Affiliation(s)
- Stephen C Adams
- Geisinger Home Infusion Services, Danville, Pennyslvania, USA
| | - Kathleen M Gura
- Boston Children's Hospital Boston, Boston, Massachusetts, USA
| | - David S Seres
- Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York, USA
| | - Debbie Kovacevich
- Home Care Services Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Jean Herlitz
- University of Chicago Medical Center, Chicago, Iillinois, USA
| | - Todd W Canada
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | | | - Joseph Boullata
- JBoullata, PharmD Consulting Services, Philadelphia, Pennsylvania, USA
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10
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Syed F, Sajid Mithani M, Abu Mostafa F, Alfattani A, Al Messharawi J, Al Ghammas H, Al Amri D, Binzaid AA, Almustanyir S. Prevalence of Aggressive Behavior Toward Fellows, Residents, and Nurses at a Tertiary Care Hospital in Riyadh, Saudi Arabia. Cureus 2022; 14:e24142. [PMID: 35582558 PMCID: PMC9107312 DOI: 10.7759/cureus.24142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/05/2022] Open
Abstract
Background Workplace bullying (WPB) is a form of mistreatment toward an individual manifested by physical, verbal, or indirect aggression. Affected victims display a wide range of signs and symptoms that impact their health. This study aimed to investigate the prevalence of aggressive behavior toward healthcare workers and its effects on job satisfaction, general health, and mental health. Methodology An online survey comprising a revised version of the Negative Acts Questionnaire-Revised (NAQ-R) was distributed to the fellows, residents, and nurses working in a tertiary care hospital. The survey collected information regarding the group's demographics and their exposure to WPB encountered in the work environment while maintaining confidentiality. Survey results were analyzed using SPSS Statistics version 25 (IBM Corp., Armonk, NY, USA). Results Among the 339 participants who filled the survey, 53% of healthcare practitioners in different services had experienced some form of WPB. Among the targeted group, it was noted that female gender (50%), age between 31 and 41 years (57.03%), nurses (51.98%), non-Saudi practitioners (41.94%), and those working in inpatient settings (49.74%) were the most commonly affected individuals in the medical facility. Furthermore, higher bullying prevalence was correlated with lower job satisfaction and mental health levels. Conclusions Age, gender, job, and nationality were factors associated with increased susceptibility to WPB. WPB in any facility is an unfortunate event, especially in a healthcare setting. It affects health practitioners by decreasing job satisfaction, jeopardizing health, and increasing the risk of harm to patients. WPB will eventually have a negative impact on the medical facility and the healthcare sector. Hence, hospital administrations should be alarmed about the rise in WPB, and adequate measures must be taken to deal with the root cause of the problem.
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Affiliation(s)
- Faaezuddin Syed
- College of Medicine, Alfaisal University College of Medicine, Riyadh, SAU
| | | | - Fadwa Abu Mostafa
- Quality Department, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Areej Alfattani
- Biostatistics and Epidemiology Department, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Joumana Al Messharawi
- Quality Department, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Hanan Al Ghammas
- Quality Department, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Dhafer Al Amri
- Quality Department, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Abdulaziz A Binzaid
- Adult Cardiology Department, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Sami Almustanyir
- Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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11
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Shope CJ, Bruno M, Ruby CM, Naumovski J, Iasella CJ, Aspinall M. Evaluating the Effects of a Medication Adherence Packaging Program on Outcomes in Older People. Sr Care Pharm 2022; 37:73-81. [PMID: 35082012 DOI: 10.4140/tcp.n.2022.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective To determine the impact of an adherence packaging and medication synchronization program on hospital visits for older people living independently in the community. Design A retrospective pre-post study that evaluated patient outcomes over a 24-month period was conducted. Patient-specific socio-demographic, medical, and hospital visit-related data were collected for 12 months before and after patient enrollment in the adherence packaging program. Setting The study was conducted at Rx Partners LTC, LLC, a University of Pittsburgh Medical Center (UPMC) pharmacy in Pittsburgh, Pennsylvania. Participants Patients 65 years of age or older, of any gender, with UPMC Health Plan insurance coverage, who enrolled in the adherence packaging program between July 2019 and December 2019. Intervention Enrollment in the adherence packaging program included medication synchronization and packaging in prefilled medication sets delivered to the patient's home monthly. Monthly medication reconciliation and review by clinical pharmacists was an included value-added service. Results Of the 92 patients included in the analysis, 60 had hospital visits during their pre-enrollment period for a total of 146 visits, compared with 54 patients in the postenrollment period totaling 126 visits; however, the mean rate of hospital visits was not statistically significant (1.59 versus 1.37; P = 0.48). Pharmacists prevented 1.87 medication errors/patient in the postenrollment setting. Conclusion Enrollment in the program was associated with fewer hospital visits, though not statistically significant, and pharmacists had abundant opportunity to prevent medication errors and optimize regimens. Further evaluation is warranted in a larger cohort.
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Affiliation(s)
- Cori J Shope
- 1 University of Pittsburgh Medical Center Presbyterian-Shadyside, Pittsburgh, Pennsylvania
| | | | - Christine M Ruby
- 1 University of Pittsburgh Medical Center Presbyterian-Shadyside, Pittsburgh, Pennsylvania
| | - John Naumovski
- 1 University of Pittsburgh Medical Center Presbyterian-Shadyside, Pittsburgh, Pennsylvania
| | - Carlo J Iasella
- 1 University of Pittsburgh Medical Center Presbyterian-Shadyside, Pittsburgh, Pennsylvania
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Dionisi S, Di Simone E, Liquori G, De Leo A, Di Muzio M, Giannetta N. Medication errors' causes analysis in home care setting: A systematic review. Public Health Nurs 2021; 39:876-897. [PMID: 34967458 DOI: 10.1111/phn.13037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Abstract
Many studies analyze the medication errors in the hospital setting, but the literature involving the home care setting seems scarce. The aim of this study is to identify the main risk factors that affect the genesis of medication errors and the possible solutions to reduce the phenomenon in the home care setting. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The critical analysis of the literature shows that medication errors in home care occur mainly during transitional care. The main risk factors related to transitional care are poor interprofessional communication, lack of a standardized process for medication reconciliation, the widespread use of computerized tools, and the inadequate integration of the pharmacist into the care team. The strategies to reduce the risk of errors from therapy at home are the implementation of the pharmacist in the health team to ensure accurate medication reconciliation and the use of computerized tools to improve communication between professionals and to reduce the dispersion of information.
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Affiliation(s)
- Sara Dionisi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Emanuele Di Simone
- Nursing, Technical, Rehabilitation, Assistance and Research Departement, IRCCS Istituti Fisioterapici Ospitalieri, IFO, Rome, Italy
| | - Gloria Liquori
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Aurora De Leo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Sewell J, McDaniel CC, Harris SM, Chou C. Implementation of a pharmacist-led transitions of care program in an indigent care clinic: A randomized controlled trial. J Am Pharm Assoc (2003) 2021; 61:276-283.e1. [PMID: 33536154 DOI: 10.1016/j.japh.2021.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/25/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Pharmacists' involvement in the transitions of care has shown the potential to decrease readmissions and increase access to care in many populations; however, the uninsured patient populations have not been studied. The evidence for the feasibility of implementing transitions of care services in indigent care clinics with limited resources also remains limited. The objectives were to implement a pharmacist-led transitions of care program in an indigent care clinic, to demonstrate the feasibility of its implementation, and to evaluate its impact on readmissions and emergency department (ED) visit rates among an uninsured population. METHODS The study was a single-blind, parallel, randomized controlled trial implemented in an indigent care clinic in the Southeast region of the United States from October 2018 to July 2019. Eligible patients were those older than 18 years, uninsured, English-speaking, diagnosed with any condition, and recently discharged from a local community hospital within the past 16 days. The primary outcome was the hospital readmission rate at 30 days after discharge. The secondary outcomes included 60- and 90-day readmission rates in addition to 30-, 60-, and 90-day ED visit rates. RESULTS A total of 88 participants were recruited. The intervention was successfully implemented in the clinic, but patient-level barriers to follow-ups included transportation, accessibility, financial burdens, inconsistent telephone communication, and a lack of knowledge about the importance of follow-ups. At 30 days postdischarge, 13.64% of the patients in the usual care group experienced readmissions compared with 9.30% of the patients in the intervention group. The relative change in the 30-day readmission rates between the usual care and the intervention groups was 1.7 (rate ratio [RR] 1.69 [95% CI 0.47-6.08]). The RRs were insignificant for the 30-, 60-, and 90-day readmission and ED visit rates. CONCLUSION This study demonstrated the feasibility of implementing transitions of care services in a clinic with limited resources by pharmacists. The intervention showed promising results by reducing readmission rates.
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Joseph T, Hale GM, Moreau C. Training pharmacy residents as transitions of care specialists: a United States perspective. Int J Clin Pharm 2021; 43:756-758. [PMID: 33439425 DOI: 10.1007/s11096-021-01231-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/05/2021] [Indexed: 11/29/2022]
Abstract
Transitions of care has emerged as a point of vulnerability in global health care systems, which can lead to potential avoidable medical errors. In the United States, pharmacist-led transitions of care programs are increasing in number, with many hospitals offering discharge prescription services. However, the required training for these positions remains unclear. With the lack of accreditation standards by the American Society of Health-System Pharmacists for transitions of care as a post-graduate year 2 specialty, this leads to the unanswered question: Which pharmacists are qualified for the growing number of transitions of care positions? Whether trained in a formal transitions of care specialty residency or not, pharmacists as a profession should reassess the proper qualifications needed to provide transitions of care services. One central message remains clear in that having a pharmacist on any interdisciplinary team who is knowledgeable about inpatient and community settings and administrative tasks involved in transitions of care while understanding optimal evidence-based recommendations would appear to be an important piece to the puzzle.
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Affiliation(s)
- Tina Joseph
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA
| | - Genevieve M Hale
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA.
| | - Cynthia Moreau
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA
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Looman N, Fluit C, van Wijngaarden M, de Groot E, Dielissen P, van Asselt D, de Graaf J, Scherpbier‐de Haan N. Chances for learning intraprofessional collaboration between residents in hospitals. MEDICAL EDUCATION 2020; 54:1109-1119. [PMID: 32564390 PMCID: PMC7754101 DOI: 10.1111/medu.14279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 05/13/2023]
Abstract
CONTEXT Intraprofessional collaboration (intraPC) between primary care (PC) doctors and medical specialists (MSs) is becoming increasingly important. Patient safety issues are often related to intraPC. In order to equip doctors well for their task of providing good quality and continuity of care, intraPC needs explicit attention, starting in postgraduate training. Worldwide, PC residents undertake a hospital placement during their postgraduate training, where they work in proximity with MS residents. This placement offers the opportunity to learn intraPC. It is yet unknown whether and how residents learn intraPC and what barriers to and opportunities for exist in learning intraPC during hospital placements. METHODS We performed an ethnographic non-participatory observational study in three emergency departments and three geriatric departments of five hospitals in the Netherlands. This was followed by 42 in-depth interviews with the observed residents and supervisors. The observations were used to feed the questions for the in-depth interviews. We analysed the interviews iteratively following the data collection using template analysis. RESULTS Hospital wards are rich in opportunities for learning intraPC. These opportunities, however, are seldom exploited for various reasons: intraPC receives limited attention when formulating placement goals, so purposeful learning of intraPC hardly takes place; residents lack awareness of the learning of intraPC; MS residents are not accustomed to searching for expertise from PC residents; PC residents adapt to the MS role and they contribute very little of their PC knowledge, and power dynamics in the hospital department negatively influence the learning of intraPC. Therefore, improvements in mindset, professional identity and power dynamics are crucial to facilitate and promote intraPC. CONCLUSIONS Intraprofessional collaboration is not learned spontaneously during hospital placements. To benefit from the abundant opportunities to learn intraPC, adjustments to the set-up of these placements are necessary. Learning intraPC is promoted when there is a collaborative culture, hierarchy is limited, and there is dedicated time for intraPC and support from the supervisor.
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Affiliation(s)
- Natasja Looman
- Department of Primary and Community CareRadboudumcNijmegenthe Netherlands
| | - Cornelia Fluit
- Department for Research in Learning and EducationRadboudumc Health AcademyNijmegenthe Netherlands
| | - Marielle van Wijngaarden
- Department of Primary and Community CareRadboudumcNijmegenthe Netherlands
- Department of Geriatric MedicineRadboudumcNijmegenthe Netherlands
| | - Esther de Groot
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Patrick Dielissen
- Department of Primary and Community CareRadboudumcNijmegenthe Netherlands
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Kushner DS, Strasser DC. Stroke Inpatient Rehabilitation Team Conferences: Leadership and Structure Improve Patient Outcomes. J Stroke Cerebrovasc Dis 2020; 29:104622. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/27/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022] Open
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17
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Guo Q, Guo H, Song J, Yin D, Song Y, Wang S, Li X, Duan J. The role of clinical pharmacist trainees in medication reconciliation process at hospital admission. Int J Clin Pharm 2020; 42:796-804. [PMID: 32221824 DOI: 10.1007/s11096-020-01015-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/14/2020] [Indexed: 12/01/2022]
Abstract
Background Medication discrepancies are a common occurrence following hospital admission and carry the potential for causing harm. However, little is known about the prevalence and potential risk factors involved in medication discrepancies in China. Objective To determine the frequency of medication discrepancies and the associated risk factors and evaluate the potential harmsof errors prevented by pharmacist trainees performing medication reconciliation process. Setting A tertiary hospital in Shanxi, China. Method Medication reconciliation was conducted at admission to four clinical departments including cardiology, nephrology, endocrinology and pneumology department between 2019 Feb 1st and 2019 Aug 31st by clinical pharmacist trainees. All unintentional medication discrepancies were presented to the expert panel to evaluate. Associations between unintentional medication discrepancies and various factors were examined. Main outcome measure The primary outcome was the prevalence of unintentional medication discrepancies as well as the associated risk factors. Results Overall, 331 patients were included (mean age 59.7 ± 15.2 years; 176 men). The reconciliation process identified 511 drug discrepancies, 98 of which were unintentional medication discrepancies; these occurred in 74 patients. The most common unintentional medication discrepancies type was omission (40.8%), followed by incorrect dose (25.5%), and 73.5% could have caused patients moderate to significant harm and complications. 5 or more drugs and 2 or more chronic diseases at admission associated with unintentional medication discrepancies in a logistic regression analysis. Conclusion Medication reconciliation performed by pharmacist trainees upon admission can reduce unintentional medication discrepancies. Patients taking 5 or more drugs and experiencing more than two chronic diseases were found to be particularly at risk.
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Affiliation(s)
- Qian Guo
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No.382, Wuyi Road, Taiyuan, Shanxi, China
| | - Hui Guo
- Department of Pharmacy, Shanxi Cardiovascular Disease Hospital, Taiyuan, China
| | - Junli Song
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No.382, Wuyi Road, Taiyuan, Shanxi, China
| | - Donghong Yin
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No.382, Wuyi Road, Taiyuan, Shanxi, China
| | - Yan Song
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No.382, Wuyi Road, Taiyuan, Shanxi, China
| | - Shuyun Wang
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No.382, Wuyi Road, Taiyuan, Shanxi, China
| | - Xiaoxia Li
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No.382, Wuyi Road, Taiyuan, Shanxi, China
| | - Jinju Duan
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No.382, Wuyi Road, Taiyuan, Shanxi, China.
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Rogers KC, Neu DW, Jaeger MC, Shah R, Finks SW. An Underappreciated and Prolonged Drug Interaction Leads to Ineffective Anticoagulation. South Med J 2019; 112:125-129. [DOI: 10.14423/smj.0000000000000926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Use of Nonpalliative Medications Following Burdensome Health Care Transitions in Hospice Patients. Med Care 2019; 57:13-20. [DOI: 10.1097/mlr.0000000000001008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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Santos GRDSD, Barros FDM, Broca PV, Silva RCD. COMMUNICATION NOISE DURING THE NURSING TEAM HANDOVER IN THE INTENSIVE CARE UNIT. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2018-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to describe the communication process among the professionals of the intensive care nursing team during the handover, analyzing the existence of noise and its repercussions on patient safety. Method: qualitative and exploratory study, in the light of Berlo, carried out at the intensive care unit of a federal hospital with 42 nursing professionals participating in the handover and/or acting in direct patient care. An audio recording of the handover was performed, as well as its systematic observation and the care practices of the nursing team. The audios were transcribed for an instrument and analyzed through descriptive statistics regarding the presence, completeness and correction of the information. The observation data were submitted to thick description. Results: the noises were related to the absence/incompleteness of information about the patient, with focus on the communication about intercurrences and clinical evolution of the last 24 hours and little valuation of the data on evaluation, care plan and clinical condition of the patient; in addition to late arrivals, speaking with a low tone of voice, parallel conversations, and the use of cell phones. Such noises have caused unnecessary, wrong procedures or prevented procedures from being performed. Conclusion: noise in the communication process negatively affects nursing and patient safety.
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21
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DeCherrie LV, Wajnberg A, Soones T, Escobar C, Catalan E, Lubetsky S, Leff B, Federman A, Siu A. Hospital at Home-Plus: A Platform of Facility-Based Care. J Am Geriatr Soc 2018; 67:596-602. [PMID: 30481382 DOI: 10.1111/jgs.15653] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/23/2018] [Accepted: 09/15/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe the evolution of a hospital at home (HaH) program to a HaH with a 30-day posthospitalization transition period (HaH-Plus) and results of a retrospective review of cases. DESIGN After launching HaH-Plus, we used the same interdisciplinary clinical team to provide acute home-based care for a broader range of home-based acute-level services than originally conceived in the Hospital at Home model. These included a palliative care unit at home (PCUaH), an observation unit at home (OUaH), a post-acute care rehabilitation at home (RaH), and a program for the hospital averse - those patients needing to be in the hospital but who refuse. SETTING Urban health system. PARTICIPANTS Individuals 18 years or older residing in specified catchment area with Medicare fee-for-service or accepted Medicare/Medicaid Advantage plans requiring facility-based care. INTERVENTION Provision of facility-based acute-level care at home to 685 participants. MEASUREMENTS Length of stay, readmission, and mortality. RESULTS HaH-Plus cared for 685 individuals. The PCUaH had the oldest participants (mean age 87), and all groups were predominantly female and dually eligible for Medicare and Medicaid. Diagnoses and length of stay were similar in all groups except that those in RaH had a larger group of diagnoses, than those accepted in to HaH-Plus and those in OUaH had a shorter stay. Rate of readmission was highest for RaH (19%). Mortality during the active treatment episode was highest for PCUaH and hospital averse as compared to HaH-Plus, OUaH and RaH. CONCLUSION Providing a broader range of facility-based care in the home has significant advantages for patients and increases the scalability of HaH. Developing a spectrum of services was possible by leveraging a robust, 24-hour HaH team. Community- and home-based care could become a greater part of the U.S. healthcare system if a platform of HaH services along with advances in technology and payment models were developed. J Am Geriatr Soc 67:596-602, 2019.
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Affiliation(s)
- Linda V DeCherrie
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ania Wajnberg
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tacara Soones
- Department of General Internal Medicine, MD Anderson Cancer Center, Houston, Texas
| | - Christian Escobar
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elisse Catalan
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sara Lubetsky
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bruce Leff
- Division of Geriatrics, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Alex Federman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Albert Siu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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22
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Åhsberg E. Discharge from hospital – a national survey of transition to out‐patient care. Scand J Caring Sci 2018; 33:329-335. [DOI: 10.1111/scs.12625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 09/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Elizabeth Åhsberg
- Department of Knowledge Based Policy and Guidance The National Board of Health and Welfare Stockholm Sweden
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23
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Caleres G, Bondesson Å, Midlöv P, Modig S. Elderly at risk in care transitions When discharge summaries are poorly transferred and used -a descriptive study. BMC Health Serv Res 2018; 18:770. [PMID: 30305104 PMCID: PMC6180642 DOI: 10.1186/s12913-018-3581-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Discharge summary with medication report effectively counteracts drug-related problems among elderly patients due to insufficient information transfer in care transitions. However, this requires optimal transfer and use of the discharge summaries. This study aimed to examine information transfer with discharge summaries from hospital to primary care. Methods A descriptive study with data consisting of discharge summaries of 115 patients, 75 years or older, using five or more drugs, collected during one week from 28 different hospital wards in Skåne county, Sweden. Two weeks after discharge, information transfer was examined via review of primary care medical records. It was noted whether the discharge summary was received (i.e. scanned to the primary care medical records), if the medication list was updated with drug changes and if a patient chart entry regarding medication or its follow-up was made in the primary care medical records. An electronic survey, which was sent to 151 primary care units in Skåne county, was used to examine experiences of the information transfer. Results Out of 115 discharge summaries, 47 (41%) were found in the primary care medical records. Patient chart entries regarding medication or its follow-up were seen in 53 (46%) cases. Drug changes during hospitalisation were seen in 51 out of 76 patients without multidose drug dispensing. In 16 (31%) out of these cases, medication lists were updated in primary care medical records. In the electronic survey, 22 (21%) out of the 107 responding primary care units reported the discharge summary was often received on the day of discharge, while 71 (66%) respondents indicated the discharge summary was always/often received but later. Medication list updates and patient chart entries in the primary care medical records were always/often done upon receipt of the discharge summary according to 61 (57%) respondents. Conclusion The transfer of information was often deficient and the discharge summaries were insufficiently used. Many discharge summaries were lost, an insufficient proportion of medication lists were updated and patient chart entries were often lacking. These findings may increase the risk of medication errors and drug-related problems for elderly in care transitions.
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Affiliation(s)
- Gabriella Caleres
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Box 50332, SE-20213, Malmö, Sweden.
| | - Åsa Bondesson
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Box 50332, SE-20213, Malmö, Sweden.,Department of Medicines Management and Informatics in Skåne County, Malmö, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Box 50332, SE-20213, Malmö, Sweden
| | - Sara Modig
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Box 50332, SE-20213, Malmö, Sweden.,Department of Medicines Management and Informatics in Skåne County, Malmö, Sweden
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24
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Lau ETL, Steadman KJ, Cichero JAY, Nissen LM. Dosage form modification and oral drug delivery in older people. Adv Drug Deliv Rev 2018; 135:75-84. [PMID: 29660383 DOI: 10.1016/j.addr.2018.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 02/15/2018] [Accepted: 04/12/2018] [Indexed: 11/29/2022]
Abstract
Many people cannot swallow whole tablets and capsules. The cause ranges from difficulties overriding the natural instinct to chew solids/foodstuff before swallowing, to a complex disorder of swallowing function affecting the ability to manage all food and fluid intake. Older people can experience swallowing difficulties because of co-morbidities, age-related physiological changes, and polypharmacy. To make medicines easier to swallow, many people will modify the medication dosage form e.g. split or crush tablets, and open capsules. Some of the challenges associated with administering medicines to older people, and issues with dosage form modification will be reviewed. Novel dosage forms in development are promising and may help overcome some of the issues. However, until these are more readily available, effective interdisciplinary teams, and improving patient health literacy will help reduce the risk of medication misadventures in older people.
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Affiliation(s)
- Esther T L Lau
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Julie A Y Cichero
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Lisa M Nissen
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
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25
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An assessment of critical care capacity in the Gambia. J Crit Care 2018; 47:245-253. [PMID: 30059869 DOI: 10.1016/j.jcrc.2018.07.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/30/2018] [Accepted: 07/20/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Critical illnesses are a major cause of morbidity and mortality in The Gambia, yet national data on critical care capacity is lacking. MATERIALS AND METHODS We surveyed eight of the eleven government-owned health facilities providing secondary and tertiary care in The Gambia's public health sector. At each hospital, a designated respondent completed a questionnaire reporting information on the presence of an intensive care unit, the number of critical care beds where available, monitoring equipment, and the ability to provide basic critical care services at their respective hospitals. RESULTS The response rate was 88% (7/8 hospitals). Only one hospital had a dedicated intensive care unit with eight ICU beds, resulting in an estimated 0.4 ICU beds/100,000 population in the country. All hospitals reported treating more than 50 critically ill patients a month, with trauma, obstetric emergencies, hypertensive emergencies and stroke accounting for the leading causes of admission respectively. The country lacks any trained specialists and resources to diagnose and treat critically ill patients. CONCLUSIONS The Gambia has a very low ICU bed capacity and lacks the human resources and equipment necessary to diagnose and treat the large number of critically ill patients admitted to public hospitals in the country.
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Santos GRDSD, Campos JF, Silva RCD. Handoff communication in intensive care: links with patient safety. ESCOLA ANNA NERY 2018. [DOI: 10.1590/2177-9465-ean-2017-0268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: To gather scientific evidence about ICU handoff practices and their implications on the safety of communication among team members about hospitalized patients. Method: This was an integrative review conducted in the Medline, PubMed, Cinahl and Scopus databases with the descriptors patient handoff, communication, patient safety, critical care, health communication and intensive care unit. The adopted criteria were: full text, in Portuguese or English, in the last 10 years, with level of evidence over IV and compliance to the study question. Fifteen articles were submitted to a structured tool and analysis. Results: There is evidence of incompleteness, absence or errors in handoff information, caused by the lack of standardization and preparation for this activity, generating delayed, incorrect or non-performed procedures. The use of tools reduces the amount of omitted information, side talks, and errors, improving team satisfaction. Final considerations: It is necessary to promote safe communication in handoff, implementing practices that ensure care continuity.
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Foged S, Nørholm V, Andersen O, Petersen HV. Nurses' perspectives on how an e-message system supports cross-sectoral communication in relation to medication administration: A qualitative study. J Clin Nurs 2017; 27:795-806. [PMID: 29048777 DOI: 10.1111/jocn.14109] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 12/22/2022]
Abstract
AIMS AND OBJECTIVES To describe nurses' perspectives on how an e-message system supports communication between hospital and home care nurses in relation to medication administration. BACKGROUND Medication administration is a complex process involving a high risk of error. Unclear communication and lack of updated information about medication have been identified as the leading cause of medication errors during care transitions. E-message systems are progressively being used to improve information exchange across sectors, yet little is known about their usage for exchange of medication information between nurses. DESIGN A qualitative design using content analysis. METHODS Focus group interviews were conducted with nurses from eight hospital wards and six municipalities (n = 79). Participant observations were conducted in three hospital wards and in three municipalities (165 hr). RESULTS The e-message system did not provide the information needed by the home care nurses to ensure safe medication administration after discharge due to (1) limitations of the system, (2) hospital nurses' lack of knowledge about home care nurses' information needs and (3) hospital nurses' lack of access to medication information. Due the home care nurses' perception of responsibility, they bypassed the e-message system to get the information. CONCLUSIONS The home care nurses perceived themselves as the last link in the safety chain. As such, access to adequate information was essential for the nurses to ensure safe medication administration; however, the e-message system did not support exchange of the information needed. RELEVANCE TO CLINICAL PRACTICE E-message systems must meet home care nurses' need for information to ensure that safe medication administration does not depend on the knowledge of the individual nurse. Moreover, other system factors that influence interprofessional collaboration and nurses' cross-sectoral communication must be addressed.
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Affiliation(s)
- Signe Foged
- Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
| | - Vibeke Nørholm
- Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ove Andersen
- Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
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Hahn M, Roll SC, Klein J. [Drug therapy safety at the transition from hospital to community medicine]. DER NERVENARZT 2017; 89:796-800. [PMID: 28871317 DOI: 10.1007/s00115-017-0412-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We evaluated the qualitative and quantitative changes of medications during the stay on a geriatric-psychiatric ward where the medication was optimized by a clinical pharmacist, and after discharge. The goal of the study was to analyze the continuity of the medication at the transfer from hospital to ambulatory care. METHODS We interviewed 41 patients on the phone about their drug regimen 4 and 12 weeks after discharge. Medications were compared to their discharge medication. The number of medications from the PRISCUS list of inappropriate medications for the elderly as well as the number of drug interactions was documented. The drug interaction database MediQ was used to identify and classify the drug-drug interactions. RESULTS During the hospitalization of the patients, 101 interventions of the clinical pharmacist were recommended and accepted. In cooperation with the physicians, the number of drug interactions decreased by 44% and the number of PRISCUS list medications by 42%. Only 4 weeks after discharge, 54 drugs for 27 patients (66%) had already been changed. During the following 8 weeks, another 44 medications were changed in 14 patients (35%). The total number of drugs after discharge did not change. The number of moderate drug interactions (p = 0.17) of medications from the PRISCUS list increased (p = 0.77), but not significantly. CONCLUSION While the interventions of a clinical pharmacist can lead to a reduction in drug interactions and inappropriate medication for the elderly during the hospitalization, the medication was changed after discharge in numerous cases. In a detailed analysis it was found that some of the changes increased the number of drug interactions as well as the number of potentially inappropriate medications for the elderly. A drug interaction check after discharge could prevent drug interactions and medication errors. Also the nationwide medication plan can help to prevent medication errors by the prescribing physician as well as by the patient.
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Affiliation(s)
- M Hahn
- Vitos Klinik Eichberg, Kloster-Eberbach-Str.4, 65346, Eltville, Deutschland.
| | - S C Roll
- Vitos Klinik Eichberg, Kloster-Eberbach-Str.4, 65346, Eltville, Deutschland
| | - J Klein
- Pharmakologie für Naturwissenschaftler, FB 14, Goethe-Universität Frankfurt, Max-von-Laue Str. 9, 60438, Frankfurt, Deutschland
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An In-home Advanced Robotic System to Manage Elderly Home-care Patients' Medications: A Pilot Safety and Usability Study. Clin Ther 2017; 39:1054-1061. [PMID: 28433400 DOI: 10.1016/j.clinthera.2017.03.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/17/2017] [Accepted: 03/22/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE We examined the safety profile and usability of an integrated advanced robotic device and telecare system to promote medication adherence for elderly home-care patients. METHODS There were two phases. Phase I aimed to verify under controlled conditions in a single nursing home (n = 17 patients) that no robotic malfunctions would hinder the device's safe use. Phase II involved home-care patients from 3 sites (n = 27) who were on long-term medication. On-time dispensing and missed doses were recorded by the robotic system. Patients' and nurses' experiences were assessed with structured interviews. FINDINGS The 17 nursing home patients had 457 total days using the device (Phase I; mean, 26.9 per patient). On-time sachet retrieval occurred with 97.7% of the alerts, and no medication doses were missed. At baseline, Phase II home-dwelling patients reported difficulty remembering to take their medicines (23%), and 18% missed at least 2 doses per week. Most Phase II patients (78%) lived alone. The device delivered and patients retrieved medicine sachets for 99% of the alerts. All patients and 96% of nurses reported the device was easy to use. IMPLICATIONS This trial demonstrated the safety profile and usability of an in-home advanced robotic device and telecare system and its acceptability to patients and nurses. It supports individualized patient dosing schedules, patient-provider communications, and on-time, in-home medication delivery to promote adherence. Real time dose-by-dose monitoring and communication with providers if a dose is missed provide oversight generally not seen in home care.
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Nguyen KA, Haggstrom DA, Ofner S, Perkins SM, French DD, Myers LJ, Rosenman M, Weiner M, Dixon BE, Zillich AJ. Medication Use among Veterans across Health Care Systems. Appl Clin Inform 2017; 8:235-249. [PMID: 28271121 DOI: 10.4338/aci-2016-10-ra-0184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/06/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Dual healthcare system use can create gaps and fragments of information for patient care. The Department of Veteran Affairs is implementing a health information exchange (HIE) program called the Virtual Lifetime Electronic Record (VLER), which allows providers to access and share information across healthcare systems. HIE has the potential to improve the safety of medication use. However, data regarding the pattern of outpatient medication use across systems of care is largely unknown. Therefore, the objective of this study is to describe the prevalence of medication dispensing across VA and non-VA health care systems among a cohort Veteran population. METHODS This study included all Veterans who had two outpatient visits or one inpatient visit at the Indianapolis VA during a 1-year period prior to VLER enrollment. Source of medication data was assessed at the subject level, and categorized as VA, INPC (non-VA), or both. The primary target was identification of sources for medication data. Then, we compared the mean number of prescriptions, as well as overall and pairwise differences in medication dispensing. RESULTS Out of 52,444 Veterans, 17.4% of subjects had medication data available in a regional HIE. On average, 40 prescriptions per year were prescribed for Veterans who used both sources compared to 29 prescriptions per year from VA only and 25 prescriptions per year from INPC only sources. The annualized prescription rate of Veterans in the dual use group was 36% higher than those who had only VA data available and 61% higher than those who had only INPC data available. CONCLUSIONS Our data demonstrated that 17.4% of subjects had medication use identified from non-VA sources, including prescriptions for antibiotics, antineoplastics, and anticoagulants. These data support the need for HIE programs to improve coordination of information, with the potential to reduce adverse medication interactions and improve medication safety.
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Affiliation(s)
- Khoa A Nguyen
- Khoa A Nguyen, Pharm.D, Medical Informatics Postdoctoral Fellow, VA HSR&D-CHIC, D6004-2, 1481 West 10th Street, Indianapolis, IN 46202, USA, , Phone: (317) 988-4409
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Nicholls J, MacKenzie C, Braund R. Preventing drug-related adverse events following hospital discharge: the role of the pharmacist. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2017; 6:61-69. [PMID: 29354552 PMCID: PMC5774326 DOI: 10.2147/iprp.s104639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Transition of care (ToC) points, and in particular hospital admission and discharge, can be associated with an increased risk of adverse drug events (ADEs) and other drug-related problems (DRPs). The growing recognition of the pharmacist as an expert in medication management, patient education and communication makes them well placed to intervene. There is evidence to indicate that the inclusion of pharmacists in the health care team at ToC points reduces ADEs and DRPs and improves patient outcomes. The objectives of this paper are to outline the following using current literature: 1) the increased risk of medication-related problems at ToC points; 2) to highlight some strategies that have been successful in reducing these problems; and 3) to illustrate how the role of the pharmacist across all facets of care can contribute to the reduction of ADEs, particularly for patients at ToC points.
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Affiliation(s)
| | | | - Rhiannon Braund
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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Munshi MN, Florez H, Huang ES, Kalyani RR, Mupanomunda M, Pandya N, Swift CS, Taveira TH, Haas LB. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association. Diabetes Care 2016; 39:308-18. [PMID: 26798150 PMCID: PMC5317234 DOI: 10.2337/dc15-2512] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life.
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Affiliation(s)
- Medha N Munshi
- Beth Israel Deaconess Medical Center and Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Hermes Florez
- Geriatric Research Education and Clinical Centers, Miami Veterans Affairs Healthcare System and University of Miami, Miami, FL
| | - Elbert S Huang
- Section of General Internal Medicine, The University of Chicago, Chicago, IL
| | - Rita R Kalyani
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Naushira Pandya
- Department of Geriatrics, Nova Southeastern University College of Osteopathic Medicine, Ft. Lauderdale, FL
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