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Lertsakulbunlue S, Kantiwong A. Development and validation of immediate self-feedback very short answer questions for medical students: practical implementation of generalizability theory to estimate reliability in formative examination designs. BMC MEDICAL EDUCATION 2024; 24:572. [PMID: 38789958 PMCID: PMC11127299 DOI: 10.1186/s12909-024-05569-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Very Short Answer Questions (VSAQs) reduce cueing and simulate better real-clinical practice compared with multiple-choice questions (MCQs). While integrating them into formative exams has potential, addressing marking time and ideal occasions and items is crucial. This study gathers validity evidence of novel immediate self-feedback VSAQ (ISF-VSAQ) format and determines the optimal number of items and occasions for reliable assessment. METHODS Ninety-four third-year pre-clinical students took two ten-item ISF-VSAQ exams on cardiovascular drugs. Each question comprised two sections: (1) Questions with space for student responses and (2) a list of possible correct answers offering partial-credit scores ranging from 0.00 to 1.00, along with self-marking and self-feedback options to indicate whether they fully, partially, or did not understand the possible answers. Messick's validity framework guided the collection of validity evidence. RESULTS Validity evidence included five sources: (1) Content: The expert reviewed the ISF-VSAQ format, and the question was aligned with a standard examination blueprint. (2) Response process: Before starting, students received an example and guide to the ISF-VSAQ, and the teacher detailed the steps in the initial session to aid self-assessment. Unexpected answers were comprehensively reviewed by experts. (3) Internal structure: The Cronbach alphas are good for both occasions (≥ 0.70). A generalizability study revealed Phi-coefficients of 0.60, 0.71, 0.76, and 0.79 for one to four occasions with ten items, respectively. One occasion requires twenty-five items for acceptable reliability (Phi-coefficient = 0.72). (4) Relations to other variables: Inter-rater reliability between self-marking and teacher is excellent for each item (rs(186) = 0.87-0.98,p = 0.001). (5) Consequences: Path analysis revealed that the self-reflected understanding score in the second attempt directly affected the final MCQ score (β = 0.25,p = 0.033). However, the VSAQ score did not. Regarding perceptions, over 80% of students strongly agreed/agreed that the ISF-VSAQ format enhances problem analysis, presents realistic scenarios, develops knowledge, offers feedback, and supports electronic usability. CONCLUSION Electronic ISF-VSAQs enhanced understanding elevates learning outcomes, rendering them suitable for formative assessments with clinical scenarios. Increasing the number of occasions effectively enhances reliability. While self-marking is reliable and may reduce grading efforts, instructors should review answers to identify common student errors.
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Affiliation(s)
| | - Anupong Kantiwong
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.
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Alipour J, Payandeh A, Hashemi A, Aliabadi A, Karimi A. Physicians' Perspectives with the E-prescribing System in Five Teaching Hospitals. Appl Clin Inform 2024; 15:428-436. [PMID: 38810656 PMCID: PMC11136528 DOI: 10.1055/s-0044-1786872] [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: 12/14/2023] [Accepted: 03/24/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVES Despite the evidence suggesting the potential of electronic prescribing (e-prescribing), this system also faces challenges that can lead to inefficiency and even failure. This study aimed to evaluate physicians' perspectives on the efficiency, effectiveness, opportunities, and challenges associated with the e-prescribing system. METHODS In 2023, a descriptive analytics cross-sectional study was carried out. Due to the finite population size, all the physicians from five studied hospitals who agreed to participate in the study were included through the census method (n = 195). Data collection was conducted using a validated questionnaire. Data were analyzed using descriptive (mean, standard deviation, and frequency) and analytical (Pearson's correlation coefficient, two-sample t-test, one-way analysis of variance (ANOVA), and linear multiple regression model) statistics. RESULTS The mean scores of efficiency and effectiveness were 47.47 ± 14.46 and 36.09 ± 10.67 out of 95 and 65, respectively. Removing the illegibility of the prescriptions (n = 22) was the most frequent opportunity and internet connectivity problem (n = 37) was the most frequent challenge associated with the e-prescribing system. There was a strong positive significant correlation between efficiency and effectiveness (r = 0.850, p < 0.01). Moreover, age was found to have a significant negative correlation with efficiency (B = -7.261, p = 0.004) and effectiveness (B = - 5.784, p = 0.002). CONCLUSION Physicians believe that e-prescribing enhances the efficiency and effectiveness of their work. There are many opportunity and challenges to the use of e-prescription. Assessing the needs of physicians, actively participating and training them in the stages of design and implementation, and conducting regular evaluations of the e-prescribing system are crucial to overcome the challenges. Our finding offers insightful information about how doctors see the e-prescribing system at teaching hospitals and provide a basis for managers and policy makers at the local and national levels to support the implementation of this system and plan for improvement of its shortcomings.
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Affiliation(s)
- Jahanpour Alipour
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abolfazl Payandeh
- Genetics of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Aida Hashemi
- Department of Health Information Technology, School of Paramedical, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Aliabadi
- Department of Health Information Technology, School of Paramedical, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Afsaneh Karimi
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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3
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El Abdouni S, Kalfsvel LS, Rietdijk WJR, Van der Kuy H, van Rosse F. Differences in prescribing errors between electronic prescribing and traditional prescribing among medical students: A randomized pilot study. Br J Clin Pharmacol 2024. [PMID: 38520277 DOI: 10.1111/bcp.16053] [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: 11/21/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/25/2024] Open
Abstract
AIMS This randomized controlled pilot study aimed to assess the differences in the frequency, type and severity of prescribing errors made by medical students when assessed in an electronic (e-)prescribing system compared to a traditional prescribing method (e.g., typing out a prescription). METHODS Fourth year medical students in the period of 1 November to 31 July 2023, were asked to participate in this single-centre prospective, randomized, controlled intervention study. Participants performed a prescribing assessment in either an e-prescribing system (intervention group) or in a more traditional prescribing platform (control group). The prescriptions were checked for errors, graded and categorized. Differences in prescribing errors, error categories and severity were analysed. RESULTS Out of 334 students, 84 participated in the study. Nearly all participants (98.8%) made 1 or more prescribing errors, primarily involving inadequate information errors. In the intervention group, more participants made prescribing errors involving the prescribed amount (71.4 vs. 19.0%; P < .01), but fewer involving administrative errors (2.4 vs. 19.0%; P = .03). Prescribing-method-specific errors were identified in 4.8 and 40.5% of the intervention and control group, respectively, with significant differences in overlapping errors as well. CONCLUSION This pilot study shows the importance of training e-prescribing competencies in medical curricula, in addition to traditional prescribing methods. It identifies prescribing-method-specific prescribing errors and emphasizes the need for further research to define e-prescribing competencies. Additionally, the need for an accessible real-life-like e-prescribing environment tailored to educators and students is essential for effective learning and incorporation of e-prescribing into medical curricula.
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Affiliation(s)
- Samir El Abdouni
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Laura S Kalfsvel
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Wim J R Rietdijk
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hugo Van der Kuy
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Floor van Rosse
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Donker EM, Spitaleri Timpone P, Brinkman DJ, Richir MC, Papaioannidou P, Likic R, Sanz EJ, Christiaens T, Costa JN, De Ponti F, Gatti M, Böttiger Y, Kramers C, Pandit R, van Agtmael MA, Tichelaar J. The European List of Key Medicines for Medical Education: A Modified Delphi Study. Clin Pharmacol Ther 2024; 115:515-524. [PMID: 38062784 DOI: 10.1002/cpt.3132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Abstract
Rational prescribing is essential for the quality of health care. However, many final-year medical students and junior doctors lack prescribing competence to perform this task. The availability of a list of medicines that a junior doctor working in Europe should be able to independently prescribe safely and effectively without supervision could support and harmonize teaching and training in clinical pharmacology and therapeutics (CPT) in Europe. Therefore, our aim was to achieve consensus on such a list of medicines that are widely accessible in Europe. For this, we used a modified Delphi study method consisting of three parts. In part one, we created an initial list based on a literature search. In part two, a group of 64 coordinators in CPT education, selected via the Network of Teachers in Pharmacotherapy of the European Association for Clinical Pharmacology and Therapeutics, evaluated the accessibility of each medicine in his or her country, and provided a diverse group of experts willing to participate in the Delphi part. In part three, 463 experts from 24 European countries were invited to participate in a 2-round Delphi study. In total, 187 experts (40%) from 24 countries completed both rounds and evaluated 416 medicines, 98 of which were included in the final list. The top three Anatomical Therapeutic Chemical code groups were (1) cardiovascular system (n = 23), (2) anti-infective (n = 21), and (3) musculoskeletal system (n = 11). This European List of Key Medicines for Medical Education could be a starting point for country-specific lists and could be used for the training and assessment of CPT.
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Affiliation(s)
- Erik M Donker
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Pietro Spitaleri Timpone
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - David J Brinkman
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Milan C Richir
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paraskevi Papaioannidou
- Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert Likic
- Unit of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb and University of Zagreb School of Medicine, Zagreb, Croatia
| | - Emilio J Sanz
- School of Health Science, Universidad de La Laguna, and Hospital Universitario de Canarias (SCS), Santa Cruz de Tenerife, Spain
| | - Thierry Christiaens
- Unit of Clinical Pharmacology, Department of Fundamental and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - João N Costa
- Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon, Lisbon, Portugal
- Instituto de Medicina Molecular, Lisbon, Portugal
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Milo Gatti
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Ylva Böttiger
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Cornelis Kramers
- Department of Clinical Pharmacy, CWZ, Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University, Nijmegen, The Netherlands
| | - Rahul Pandit
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel A van Agtmael
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
- Interprofessional Collaboration and Medication Safety at the Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
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Ravenel K, Guegan H, Gastebois A, Bouchara JP, Gangneux JP, Giraud S. Fungal Colonization of the Airways of Patients with Cystic Fibrosis: the Role of the Environmental Reservoirs. Mycopathologia 2024; 189:19. [PMID: 38407729 DOI: 10.1007/s11046-023-00818-x] [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: 09/25/2023] [Accepted: 11/23/2023] [Indexed: 02/27/2024]
Abstract
Filamentous fungi frequently colonize the airways of patients with cystic fibrosis and may cause severe diseases, such as the allergic bronchopulmonary aspergillosis. The most common filamentous fungi capable to chronically colonize the respiratory tract of the patients are Aspergillus fumigatus and Scedosporium species. Defining the treatment strategy may be challenging, the number of available drugs being limited and some of the causative agents being multiresistant microorganisms. The knowledge of the fungal niches in the outdoor and indoor environment is needed for understanding the origin of the contamination of the patients. In light of the abundance of some of the causative molds in compost, agricultural and flower fields, occupational activities related to such environments should be discouraged for patients with cystic fibrosis (CF). In addition, the microbiological monitoring of their indoor environment, including analysis of air and dust on surfaces, is essential to propose preventive measures aiming to reduce the exposure to environmental molds. Nevertheless, some specific niches were also identified in the indoor environment, in relation with humidity which favors the growth of thermotolerant molds. Potted plants were reported as indoor reservoirs for Scedosporium species. Likewise, Exophiala dermatitidis may be spread in the kitchen via dishwashers. However, genotype studies are still required to establish the link between dishwashers and colonization of the airways of CF patients by this black yeast. Moreover, as nothing is known regarding the other filamentous fungi associated with CF, further studies should be conducted to identify other potential specific niches in the habitat.
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Affiliation(s)
- Kévin Ravenel
- IRF (Infections Respiratoires Fongiques), SFR ICAT 4208, Univ Angers, Univ Brest, Angers, France
| | - Hélène Guegan
- EHESP, IRSET (Institut de Recherche en Santé Environnement et Travail), UMR_S 1085, CHU Rennes, INSERM, Univ Rennes, 35000, Rennes, France
| | - Amandine Gastebois
- IRF (Infections Respiratoires Fongiques), SFR ICAT 4208, Univ Angers, Univ Brest, Angers, France
| | - Jean-Philippe Bouchara
- IRF (Infections Respiratoires Fongiques), SFR ICAT 4208, Univ Angers, Univ Brest, Angers, France
| | - Jean-Pierre Gangneux
- EHESP, IRSET (Institut de Recherche en Santé Environnement et Travail), UMR_S 1085, CHU Rennes, INSERM, Univ Rennes, 35000, Rennes, France
| | - Sandrine Giraud
- IRF (Infections Respiratoires Fongiques), SFR ICAT 4208, Univ Angers, Univ Brest, Angers, France.
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Alanzi MA, Tully MP, Lewis PJ. Exploring the challenges faced by foundation doctors when prescribing high risk medicines safely during the on-call period: A qualitative study. Br J Clin Pharmacol 2024; 90:548-556. [PMID: 37872107 DOI: 10.1111/bcp.15928] [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: 04/11/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023] Open
Abstract
AIMS Errors with prescribing high-risk medicines (HRMs) have a greater propensity to cause harm than with non-HRMs. Prescribing errors arise due to multiple factors and it can be particularly challenging for junior doctors to prescribe safely during the on-call period. Knowledge regarding the challenges of prescribing HRM during the on-call period would be useful to target preventative interventions. The aim of this study was to explore the challenges encountered by foundation doctors (doctors who have graduated medical school within the last 2 years) when prescribing specific HRMs (anticoagulants, insulin and opioids) safely during the on-call period. METHODS Six focus groups exploring the challenges of prescribing HRMs safely during the on-call period were conducted, 3 with foundation year 1 and 3 with foundation year 2 doctors from across 3 different hospitals. A thematic framework analysis based on the London Protocol was conducted. RESULTS Doctors described multiple challenges to prescribing HRMs safely during the on-call period including a lack of prescribing support, nursing pressure, complex prescribing tasks, unknown patients as well as individual factors such as lack of knowledge and tiredness. Many of these factors exist to some extent during the day, yet the nature of the on-call period as a fast-paced environment heightened the challenges that prescribers faced. CONCLUSION There are multiple challenges experienced by foundation doctors when prescribing HRMs during the on-call period. The potentially devastating consequences of errors with HRMs means that closer attention and more concern from healthcare professionals, researchers and policymakers is required to improve safe prescribing of HRMs in hospitals.
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Affiliation(s)
- Mahdi A Alanzi
- Department of Pharmaceutical Services, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Mary P Tully
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Penny J Lewis
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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7
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Magavern EF, Hitchings A, Bollington L, Wilson K, Hepburn D, Westacott RJ, Sam AH, Caulfield MJ, Maxwell S. UK Prescribing Safety Assessment (PSA): The development, implementation and outcomes of a national online prescribing assessment. Br J Clin Pharmacol 2024; 90:493-503. [PMID: 37793701 DOI: 10.1111/bcp.15919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
AIMS The United Kingdom (UK) Prescribing Safety Assessment (PSA) is a 2-h online assessment of basic competence to prescribe and supervise the use of medicines. It has been undertaken by students and doctors in UK medical and foundation schools for the past decade. This study describes the academic characteristics and performance of the assessment; longitudinal performance of candidates and schools; stakeholder feedback; and surrogate markers of prescribing safety in UK healthcare practice. METHODS We reviewed the performance data generated by over 70 000 medical students and 3700 foundation doctors who have participated in the PSA since its inception in 2013. These data were supplemented by Likert scale and free text feedback from candidates and a variety of stakeholder groups. Further data on medication incidents, collected by national reporting systems and the regulatory body, are reported, with permission. RESULTS We demonstrate the feasibility, high quality and reliability of an online prescribing assessment, uniquely providing a measure of prescribing competence against a national standard. Over 90% of candidates pass the PSA on their first attempt, while a minority are identified for further training and assessment. The pass rate shows some variation between different institutions and between undergraduate and foundation cohorts. Most responders to a national survey agreed that the PSA is a useful instrument for assessing prescribing competence, and an independent review has recommended adding the PSA to the Medical Licensing Assessment. Surrogate markers suggest there has been improvement in prescribing safety in practice, temporally associated with the introduction of the PSA but other factors could be influential too. CONCLUSIONS The PSA is a practical and cost-effective way of delivering a reliable national assessment of prescribing competence that has educational impact and is supported by the majority of stakeholders. There is a need to develop national systems to identify and report prescribing errors and the harm they cause, enabling the impact of educational interventions to be measured.
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Affiliation(s)
- Emma F Magavern
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Lynne Bollington
- UK Prescribing Safety Assessment Partnership, c/o British Pharmacological Society, Medical Schools Council-British Pharmacological Society, London, UK
| | - Kurt Wilson
- The University of Manchester, Manchester, UK
| | - David Hepburn
- Hull York Medical School, Allam Medical Building, University of Hull, Hull, UK
| | - Rachel J Westacott
- Birmingham Medical School, Institute of Clinical Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Amir H Sam
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Mark J Caulfield
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Simon Maxwell
- Clinical Pharmacology Unit, Medical Education Centre, Western General Hospital, University of Edinburgh, Edinburgh, UK
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8
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Stuhec M, Batinic B. Clinical pharmacist interventions in the transition of care in a mental health hospital: case reports focused on the medication reconciliation process. Front Psychiatry 2023; 14:1263464. [PMID: 38205081 PMCID: PMC10777203 DOI: 10.3389/fpsyt.2023.1263464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024] Open
Abstract
The transition of care represents a key point in the hospital admission and discharge process. A comprehensive transition could lead to fewer medication-related problems. The hospital clinical pharmacist could help in the transition of care process with a comprehensive medication reconciliation process, which has been poorly described in mental health hospitals. This study presents two clinical cases in which hospital clinical pharmacists identified omitted medications and other medication-related issues, including medication errors, during the transition of care in a mental health hospital. These positive experiences may encourage other countries to establish similar collaborations with hospital clinical pharmacists in mental health hospitals.
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Affiliation(s)
- Matej Stuhec
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ormoz, Slovenia
| | - Borjanka Batinic
- Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
- Clinic of Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
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9
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Donker EM, Osmani H, Brinkman DJ, van Rosse F, Janssen B, Knol W, Dumont G, Jorens PG, Dupont A, Christiaens T, van Smeden J, de Waard-Siebinga I, Peeters LEJ, Goorden R, Hessel M, Lissenberg-Witte BI, Richir MC, van Agtmael MA, Kramers C, Tichelaar J. The impact of a summative national prescribing assessment and curriculum type on the development of the prescribing competence of junior doctors. Eur J Clin Pharmacol 2023; 79:1613-1621. [PMID: 37737911 PMCID: PMC10663181 DOI: 10.1007/s00228-023-03567-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE The primary aim of this study was to investigate the effect of including the Dutch National Pharmacotherapy Assessment (DNPA) in the medical curriculum on the level and development of prescribing knowledge and skills of junior doctors. The secondary aim was to evaluate the relationship between the curriculum type and the prescribing competence of junior doctors. METHODS We re-analysed the data of a longitudinal study conducted in 2016 involving recently graduated junior doctors from 11 medical schools across the Netherlands and Belgium. Participants completed three assessments during the first year after graduation (around graduation (+ / - 4 weeks), and 6 months, and 1 year after graduation), each of which contained 35 multiple choice questions (MCQs) assessing knowledge and three clinical case scenarios assessing skills. Only one medical school used the DNPA in its medical curriculum; the other medical schools used conventional means to assess prescribing knowledge and skills. Five medical schools were classified as providing solely theoretical clinical pharmacology and therapeutics (CPT) education; the others provided both theoretical and practical CPT education (mixed curriculum). RESULTS Of the 1584 invited junior doctors, 556 (35.1%) participated, 326 (58.6%) completed the MCQs and 325 (58.5%) the clinical case scenarios in all three assessments. Junior doctors whose medical curriculum included the DNPA had higher knowledge scores than other junior doctors (76.7% [SD 12.5] vs. 67.8% [SD 12.6], 81.8% [SD 11.1] vs. 76.1% [SD 11.1], 77.0% [12.1] vs. 70.6% [SD 14.0], p < 0.05 for all three assessments, respectively). There was no difference in skills scores at the moment of graduation (p = 0.110), but after 6 and 12 months junior doctors whose medical curriculum included the DNPA had higher skills scores (both p < 0.001). Junior doctors educated with a mixed curriculum had significantly higher scores for both knowledge and skills than did junior doctors educated with a theoretical curriculum (p < 0.05 in all assessments). CONCLUSION Our findings suggest that the inclusion of the knowledge focused DNPA in the medical curriculum improves the prescribing knowledge, but not the skills, of junior doctors at the moment of graduation. However, after 6 and 12 months, both the knowledge and skills were higher in the junior doctors whose medical curriculum included the DNPA. A curriculum that provides both theoretical and practical education seems to improve both prescribing knowledge and skills relative to a solely theoretical curriculum.
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Affiliation(s)
- Erik M Donker
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.
| | - Hayaudin Osmani
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - David J Brinkman
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Floor van Rosse
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ben Janssen
- Department of Pharmacology and Toxicology, Maastricht University, Maastricht, The Netherlands
| | - Wilma Knol
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Glenn Dumont
- Department of Hospital Pharmacy and Clinical Pharmacology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Philippe G Jorens
- Department Pharmacotherapy, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Alain Dupont
- Department of Clinical Pharmacology, Free University of Brussels (VUB), Brussels, Belgium
| | - Thierry Christiaens
- Clinical Pharmacology, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Jeroen van Smeden
- Department of Education, Centre for Human Drug Research, Leiden, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Itte de Waard-Siebinga
- Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura E J Peeters
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ronald Goorden
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marleen Hessel
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Milan C Richir
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel A van Agtmael
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Cornelis Kramers
- Pharmacology-Toxicology and Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jelle Tichelaar
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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10
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Shawaqfeh MS, Alangari D, Aldamegh G, Almotairi J, Bin Orayer L, Albekairy NA, Abdel-Razaq W, Mardawi G, Almuqbil F, Aldebasi TM, Albekairy AM. Unveiling medication errors in liver transplant patients towards enhancing the imperative patient safety. Saudi Pharm J 2023; 31:101789. [PMID: 37799574 PMCID: PMC10550402 DOI: 10.1016/j.jsps.2023.101789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
Background Medication errors (MEs) are a significant healthcare problem that can harm patients and increase healthcare expenses. Being immunocompromised, liver-transplant patients are at high risk for complications if MEs inflict harmful or damaging effects. The present study reviewed and analyzed all MEs reported in Liver Transplant Patients. Methods All MEs in the Liver Transplant Patients admitted between January 2016 to August 2022 were retrieved through the computerized physician order entry system, which two expert pharmacists classified according to the type and severity risk index. Results A total of 314 records containing 407 MEs were committed by at least 71 physicians. Most of these errors involved drugs unrelated to managing liver-transplant-related issues. Antibiotic prescriptions had the highest mistake rate (17.0%), whereas immunosuppressants, routinely used in liver transplant patients, rank second with fewer than 14% of the identified MEs. The most often reported MEs (43.2%) are type-C errors, which, despite reaching patients, did not cause patient harm. Subgroup analysis revealed several factors associated with a statistically significant great incidence of MEs among physicians treating liver transplant patients. Conclusion Although a substantial number of MEs occurred with liver transplant patients, the majority are not related to liver-transplant medications, which mainly belonged to type-C errors. This could be attributed to polypharmacy of transplant patients or the heavy workload on health care practitioners. Improving patient safety requires adopting regulations and strategies to promptly identify MEs and address potential errors.
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Affiliation(s)
- Mohammad S. Shawaqfeh
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia
| | - Dalal Alangari
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Ghaliah Aldamegh
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Jumana Almotairi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Luluh Bin Orayer
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Nataleen A. Albekairy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Wesam Abdel-Razaq
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia
| | - Ghada Mardawi
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi Arabia
| | - Faisal Almuqbil
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Tariq M. Aldebasi
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Abdulkareem M. Albekairy
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia
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11
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Garrod M, Fox A, Rutter P. Automated search methods for identifying wrong patient order entry-a scoping review. JAMIA Open 2023; 6:ooad057. [PMID: 37545981 PMCID: PMC10397536 DOI: 10.1093/jamiaopen/ooad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/31/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023] Open
Abstract
Objective To investigate: (1) what automated search methods are used to identify wrong-patient order entry (WPOE), (2) what data are being captured and how they are being used, (3) the causes of WPOE, and (4) how providers identify their own errors. Materials and Methods A systematic scoping review of the empirical literature was performed using the databases CINAHL, Embase, and MEDLINE, covering the period from database inception until 2021. Search terms were related to the use of automated searches for WPOE when using an electronic prescribing system. Data were extracted and thematic analysis was performed to identify patterns or themes within the data. Results Fifteen papers were included in the review. Several automated search methods were identified, with the retract-and-reorder (RAR) method and the Void Alert Tool (VAT) the most prevalent. Included studies used automated search methods to identify background error rates in isolation, or in the context of an intervention. Risk factors for WPOE were identified, with technological factors and interruptions deemed the biggest risks. Minimal data on how providers identify their own errors were identified. Discussion RAR is the most widely used method to identify WPOE, with a good positive predictive value (PPV) of 76.2%. However, it will not currently identify other error types. The VAT is nonspecific for WPOE, with a mean PPV of 78%-93.1%, but the voiding reason accuracy varies considerably. Conclusion Automated search methods are powerful tools to identify WPOE that would otherwise go unnoticed. Further research is required around self-identification of errors.
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Affiliation(s)
- Mathew Garrod
- Corresponding Author: Mathew Garrod, MPharm, Department of Pharmacy, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD, UK;
| | - Andy Fox
- Department of Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul Rutter
- School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, UK
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12
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Roberts J, Jaam M, Paudyal V, Hadi MA. Minimizing prescribing errors: A phenomenological exploration of the views and experiences of independent prescribing pharmacists. Br J Clin Pharmacol 2023; 89:2747-2756. [PMID: 37105534 DOI: 10.1111/bcp.15758] [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: 11/02/2022] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 04/29/2023] Open
Abstract
AIMS This study aims to explore the views and experiences of independent prescribing (IP) pharmacists regarding prescribing errors and strategies to mitigate errors in practice. METHODS One-to-one online semi-structured interviews were conducted with IP pharmacists across the United Kingdom. Verbatim transcripts of the interview were generated and coded using NVivo® 12 software for thematic analysis. A mixed inductive and deductive approach was used to generate themes and sub-themes which were then mapped onto the framework of factors that influence clinical practice proposed by Vincent et al. RESULTS: A total of 14 interviews were conducted. Participants linked the risk-averse nature of a pharmacist, self-perception of their roles as medicines experts, and previous experience of keeping checks on doctors' prescriptions as a dispenser often made them feel confident in prescribing. However, lacking adequate diagnostic skills, inadequate prescribing training programmes, and dealing with complex patients often made them feel vulnerable to committing errors. Organizational and system-related factors such as work interruptions and increased workload were identified as other factors linked to prescribing errors. CONCLUSIONS Independent prescribing pharmacists use a variety of strategies to reduce the risk of prescribing errors. Promoting diagnostic competency in their area of practice, strengthening undergraduate and prescribing curricula, and addressing known organizational and system-related factors linked to prescribing errors can minimize errors and promote patient safety.
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Affiliation(s)
- Joshua Roberts
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Myriam Jaam
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Vibhu Paudyal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Muhammad Abdul Hadi
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
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13
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Kalfsvel L, Wilkes S, van der Kuy H, van den Broek W, Zaal R, van Rosse F, Versmissen J. Do junior doctors make more prescribing errors than experienced doctors when prescribing electronically using a computerised physician order entry system combined with a clinical decision support system? A cross-sectional study. Eur J Hosp Pharm 2023:ejhpharm-2023-003859. [PMID: 37652663 DOI: 10.1136/ejhpharm-2023-003859] [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: 05/31/2023] [Accepted: 08/08/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES Prescribing errors can lead to inconvenience, morbidity and mortality. It is therefore crucial to educate doctors to prescribe safely, efficiently and effectively. To create an effective educational programme, it is essential to understand which errors are made and by whom. The aim of this study is to explore if the experience level of the doctor influences how many and which prescribing errors are made in a European academic teaching hospital, where a computerised physician order entry system (CPOE) with a clinical decision support system (CDSS) is exclusively used. METHODS Prescriptions for all inpatients in an academic teaching hospital were collected in June 2021. All prescriptions with an alert generated by the CDSS which could not be handled by a pharmacy technician according to local protocol were checked for errors. Identified errors were categorised by type and severity. RESULTS A total of 130 538 prescriptions were newly made or altered by doctors. Of these prescriptions, 1914 (1.5%) were retained for a check by the pharmacist. These contained 430 prescribing errors (0.3% of total prescriptions). Doctors not in specialty training and those in specialty training made more prescribing errors than consultants (0.5% and 0.5% vs 0.1%; p<0.001). Doctors in specialty training made relatively more drug-drug interaction errors than consultants (n=31 (16%) vs n=3 (3%), p<0.05). No significant difference was found regarding the severity of the errors. CONCLUSIONS Doctors not in specialty training and doctors in specialty training, who are the less experienced doctors, make more prescribing errors than consultants, even with the use of a CPOE combined with CDSS. The type of errors differ between doctors of different experience levels. This finding provides a solid basis for specific additional education to medical students, doctors not in specialty training and doctors in specialty training.
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Affiliation(s)
| | - Sarah Wilkes
- Hospital Pharmacy, Erasmus MC, Rotterdam, Netherlands
| | | | | | - Rianne Zaal
- Hospital Pharmacy, Erasmus MC, Rotterdam, Netherlands
| | | | - Jorie Versmissen
- Hospital Pharmacy, Erasmus MC, Rotterdam, Netherlands
- Internal Medicine, Erasmus MC, Rotterdam, Netherlands
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14
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Karthik K, Lakshmi JT, Taran RU, Sarva K. Clinical Audits to Identify Medication Errors in a Healthcare Facility. MAEDICA 2023; 18:299-306. [PMID: 37588823 PMCID: PMC10427082 DOI: 10.26574/maedica.2023.18.2.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background: Medication errors have serious effects on patient care and it is important to detect them instantly in order to reduce clinical practice errors and prevent their adverse outcomes. Even though error reporting techniques are less expensive, there may be considerable impediments for a nurse to notify an error due to the obvious possibility of negative repercussions. Study aims: The present study was undertaken to determine the incidence of medication errors, with identifying their common types, and the effect of clinical audits. Materials and methods: Records are maintained by the hospital quality assurance department, according to National Accreditation Board of Hospitals (NABH) standards, from January 2018 to December 2019. This data was collected by the authors and analyzed for the percentage of medication errors which included prescription errors and medicine dispensing errors. Results:In this study, the incidence of medication errors was 2.82, 1.43, 2.09, 1.70, 4.97, 3.96, 1.38, 1.53, 1.71, 1.80, 1.41, and 0.54 in January, February, March, April, May, June, July, August, September, October, November, and December 2018, respectively, versus 2.64, 0.91, 0, 0.81, 1.11, 1.20, 2.50, 2.75, 1.91, 1.44, 1.14 and 1.91 during the same months of 2019, respectively. Conclusion:Although medication errors occur frequently, they are rarely reported. In order to accurately assess the contributing factors and take preventative action to make sure they do not recur in the future, reporting is essential.
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Affiliation(s)
| | - Jyothi T Lakshmi
- Department of Microbiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad Metropolitan Region, India
| | | | - Kamlakar Sarva
- Department of Microbiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad Metropolitan Region, India
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15
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Vittery ER, Bayliss E, Heed A, Fagan C, Thomas M, Tse Y. Reducing prescribing errors: making electronic prescribing work for cystic fibrosis inpatients. Arch Dis Child Educ Pract Ed 2023; 108:112-114. [PMID: 35264442 DOI: 10.1136/archdischild-2021-322446] [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: 05/12/2021] [Accepted: 02/11/2022] [Indexed: 11/04/2022]
Abstract
Children admitted to our hospital with cystic fibrosis had frequent medication errors due to polypharmacy and addition of specialist and high-risk medications despite an electronic prescribing and medicines administration system in place. We describe a multidisciplinary quality improvement project that combined a computerised order entry system (CPOE) with human factor process changes. Over 12 months, our run chart showed a 43% reduction in prescription errors. For medications prescribable via the CPOE, errors reaching the patient reduced from 50% to 29%. Electronic prescribing can be seen by clinicians as a fixed unalterable system contributing to rather than ameliorating errors. Improving safety requires whole team engagement and working closely with programmers to adapt function and influence human factors.
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Affiliation(s)
| | - Emily Bayliss
- Department of Paediatric Pharmacy, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - Andrew Heed
- Department of Clinical Informatics Pharmacy, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - Claire Fagan
- Department of Respiratory Paediatrics, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Matthew Thomas
- Department of Respiratory Paediatrics, Great North Children's Hospital, Newcastle Upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Yincent Tse
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle Upon Tyne, UK
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16
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Donker EM, Pandit R, Poleij MCS, Brinkman DJ, van Agtmael MA, van Rosse F, Dumont G, Kramers C, Atiqi R, Richir MC, van Smeden J, Hessel MHM, Janssen BJ, Knol W, Tichelaar J. The Dutch list of essential drugs for undergraduate medical education: A modified Delphi study. Br J Clin Pharmacol 2023; 89:1431-1451. [PMID: 36403122 DOI: 10.1111/bcp.15606] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022] Open
Abstract
AIMS Prescribing errors among junior doctors are common in clinical practice because many lack prescribing competence after graduation. This is in part due to inadequate education in clinical pharmacology and therapeutics (CP&T) in the undergraduate medical curriculum. To support CP&T education, it is important to determine which drugs medical undergraduates should be able to prescribe safely and effectively without direct supervision by the time they graduate. Currently, there is no such list with broad-based consensus. Therefore, the aim was to reach consensus on a list of essential drugs for undergraduate medical education in the Netherlands. METHODS A two-round modified Delphi study was conducted among pharmacists, medical specialists, junior doctors and pharmacotherapy teachers from all eight Dutch academic hospitals. Participants were asked to indicate whether it was essential that medical graduates could prescribe specific drugs included on a preliminary list. Drugs for which ≥80% of all respondents agreed or strongly agreed were included in the final list. RESULTS In all, 42 (65%) participants completed the two Delphi rounds. A total of 132 drugs (39%) from the preliminary list and two (3%) newly proposed drugs were included. CONCLUSIONS This is the first Delphi consensus study to identify the drugs that Dutch junior doctors should be able to prescribe safely and effectively without direct supervision. This list can be used to harmonize and support the teaching and assessment of CP&T. Moreover, this study shows that a Delphi method is suitable to reach consensus on such a list, and could be used for a European list.
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Affiliation(s)
- Erik M Donker
- Department of Internal Medicine, Unit Pharmacotherapy, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Rahul Pandit
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Merel C S Poleij
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - David J Brinkman
- Department of Internal Medicine, Unit Pharmacotherapy, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Unit Pharmacotherapy, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Floor van Rosse
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Glenn Dumont
- Department of Clinical Pharmacology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis Kramers
- Department of Pharmacology and Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Clinical Pharmacy, CWZ, Nijmegen, The Netherlands
| | - Roya Atiqi
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Milan C Richir
- Department of Internal Medicine, Unit Pharmacotherapy, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen van Smeden
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands.,Leiden Academic Centre for Drug Research, University of Leiden, Leiden, The Netherlands
| | - Marleen H M Hessel
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ben J Janssen
- Department of Pharmacology and Toxicology, Maastricht University, Maastricht, The Netherlands
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, Unit Pharmacotherapy, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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17
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van den Hanenberg F, Ozturk E, van Haastrecht M, Tichelaar J, van Goor H, van Agtmael MA, Keijsers CJPW. A comparison of the clinical pharmacotherapy knowledge of medical and surgical residents and consultants. Eur J Clin Pharmacol 2023; 79:671-677. [PMID: 37004542 DOI: 10.1007/s00228-023-03481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/18/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Knowledge of clinical pharmacotherapy is essential for all who prescribe medication. The aims of this study were to investigate differences in the pharmacotherapy and polypharmacy knowledge of medical and surgical residents and consultants and whether this knowledge can be improved by following an online course. METHODS Design: A before-and-after-measurement. SETTING An online course available for Dutch residents and consultants working in hospitals. STUDY POPULATION Dutch residents and consultants from different disciplines who voluntarily followed an online course on geriatric care. INTERVENTION An online 6-week course on geriatric care, with 1 week dedicated to clinical pharmacotherapy and polypharmacy. Variables, such as medical vs surgical specialty, consultant vs resident, age, and sex, that could predict the level of knowledge. The effects of the online course were studied using repeated measures ANOVA. The study was approved by the National Ethics Review Board of Medical Education (NERB dossier number 996). RESULTS A total of 394 residents and 270 consultants, 220 from surgical and 444 from medical specialties, completed the online course in 2016 and 2017. Residents had higher test scores than consultants for pharmacotherapy (73% vs 70%, p < 0.02) and polypharmacy (75% vs 72%, p < 0.02). The learning effect did not differ. Medical residents/consultants had a better knowledge of pharmacotherapy (74% vs 68%, p < 0.001) and polypharmacy (77% vs 66%, p < 0.001) than surgical residents/consultants, but the learning effect was the same. CONCLUSIONS Residents and consultants had a similar learning curve for acquiring knowledge, but residents outperformed consultants on all measures. In addition, surgical and medical residents/consultants had similar learning curves, but medical residents/consultants had higher test scores on all measures.
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Affiliation(s)
- Floor van den Hanenberg
- Department of Geriatric Medicine, Medical Centre OLVG, Postbus , 9243, 1006 AE, Amsterdam, The Netherlands.
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.
| | - Ekin Ozturk
- Department of Surgery, Nijmegen University Medical Center, Nijmegen, The Netherlands
| | - Mariska van Haastrecht
- Department of Geriatric Medicine, Medical Centre OLVG, Postbus , 9243, 1006 AE, Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, Amsterdam Universities Medical Centers, VU University, Section Pharmacotherapy, Amsterdam, The Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Harry van Goor
- Department of Surgery, Nijmegen University Medical Center, Nijmegen, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Amsterdam Universities Medical Centers, VU University, Section Pharmacotherapy, Amsterdam, The Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Carolina J P W Keijsers
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's , Hertogenbosch, The Netherlands
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18
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Valladales-Restrepo LF, Gaviria-Mendoza A, Londoño-Serna MJ, Ospina-Cano JA, Giraldo-Giraldo C, Machado-Duque ME, Machado-Alba JE. Prescription of transdermal patches in Colombia: A real-world evidence study. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2023; 34:325-335. [PMID: 36776078 DOI: 10.3233/jrs-220027] [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: 02/12/2023]
Abstract
BACKGROUND Transdermal drug delivery has contributed positively to medical practice. However, prescriptions that do not meet minimum quality criteria and medication errors are common. OBJECTIVE The objective was to determine how transdermal patches are being prescribed to a group of patients in Colombia, the compliance with established requirements of such prescriptions and the comparisons between correct and incorrect prescriptions. METHODS This was a cross-sectional study of prescriptions for transdermal patches using data from a population-based drug dispensing database between December 1 and 31, 2019. Medical prescriptions were randomly reviewed, establishing whether the drugs were appropriately prescribed by the manufacturer's indications or national regulations. Descriptive and bivariate analysis was performed. RESULTS A total of 415 prescriptions were reviewed; the prescription was provided to 412 patients with a median age of 76.9 years, and 63.3% were women. Rivastigmine was the most prescribed transdermal patch (57.8%). 66.3% of all prescriptions did not meet the minimum appropriate prescribing standards, especially those for rivastigmine (97.1%). The 7.0% of all prescriptions had posology errors, especially prescriptions for buprenorphine (43.8%). Older patients (84.4% vs 52.5%), from the Pacific region (34.4% vs 23.7%), with manual formulations (22.1% vs 0.8%), dementia (49.0% vs 6.8%), and in management with lipid-lowering drugs (41.8% vs 30.5%), presented incorrect transdermal patch formulations more frequently (p < 0.05). CONCLUSION The high proportion of inappropriately prescribed transdermal patches should draw the attention of those responsible for health care to improve the training of physicians and create prescription quality verification systems.
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Affiliation(s)
- Luis Fernando Valladales-Restrepo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Andrés Gaviria-Mendoza
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - María José Londoño-Serna
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia
| | - Juan Alberto Ospina-Cano
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia
| | - Claudia Giraldo-Giraldo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia
| | - Manuel Enrique Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia
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19
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Grimes TC, Guinan EM. Interprofessional education focused on medication safety: a systematic review. J Interprof Care 2023; 37:131-149. [PMID: 35050843 DOI: 10.1080/13561820.2021.2015301] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Safe medication use necessitates interprofessional working, with calls to enhance interprofessional education (IPE) focusing on medication safety (MS) in healthcare professional (HCP) curricula. Little is known about the design, delivery or evaluation of such activities. This systematic literature review describes MS-focused IPE activities in pre-qualification HCP programmes. MedLine, EMBASE, CINAHL and ERIC were searched, relevant studies identified and data extracted. The McGill Mixed Methods Appraisal Tool was employed. The 3P (presage-process-product) theory structured deductive analysis. Thirty-one studies were included, reporting on 30 activities, mostly undertaken in North America or United Kingdom. Presage/Design: Most reported activities involved pharmacy, nursing, medical or physician assistant students learning with one or more other HCP group. Few studies matched student groups' skills or experiences. Few studies reported theoretical underpinnings. Process/Delivery: Multiple pedagogical approaches were employed, mostly social construction, and low- and high-fidelity simulation-based learning. Few studies reported learning outcomes or summative assessment, more reported formative assessment. Product/evaluation: Outcomes measured were learners' opinions, satisfaction or attitudes toward interprofessional working and findings were generally positive. Few studies reported on student development or outcomes specific to medication safety. Lack of integration of qualitative/quantitative components of mixed methods studies and limited outcome measurements' validity or reliability weakened study quality. MS-focused IPE for pre-qualification HCPs is well received by students. Design of future activities could be enhanced by employing theory and ensuring matching of students' and groups' skills, professional identity and learner attributes to enhance learning in an interprofessional setting. Future delivery should embed MS-focused IPE into the standard curricula to optimize constructive alignment, learner engagement, quality and drive development. The required skillset in pre-qualification HCP programmes to facilitate future safe medication practice, together with the associated learning outcomes and assessment approaches, should be defined. The quality of scholarly studies examining these activities needs improvement.
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Affiliation(s)
- T C Grimes
- School of Pharmacy and Pharmaceutical Sciences, Panoz Institute, Trinity College Dublin, Dublin 2, Ireland
| | - E M Guinan
- School of Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
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20
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Chu A, Kumar A, Depoorter G, Franklin BD, McLeod M. Learning from electronic prescribing errors: a mixed methods study of junior doctors' perceptions of training and individualised feedback data. BMJ Open 2022; 12:e056221. [PMID: 36549720 PMCID: PMC9772675 DOI: 10.1136/bmjopen-2021-056221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To explore the views of junior doctors towards (1) electronic prescribing (EP) training and feedback, (2) readiness for receiving individualised feedback data about EP errors and (3) preferences for receiving and learning from EP feedback. DESIGN Explanatory sequential mixed methods study comprising quantitative survey (phase 1), followed by interviews and focus group discussions (phase 2). SETTING Three acute hospitals of a large English National Health Service organisation. PARTICIPANTS 25 of 89 foundation year 1 and 2 doctors completed the phase 1 survey; 5 participated in semi-structured interviews and 7 in a focus group in phase 2. RESULTS Foundation doctors in this mixed methods study reported that current feedback provision on EP errors was lacking or informal, and that existing EP training and resources were underused. They believed feedback about prescribing errors to be important and were keen to receive real-time, individualised EP feedback data. Feedback needed to be in manageable amounts, motivational and clearly signposting how to learn or improve. Participants wanted feedback and better training on the EP system to prevent repeating errors. In addition to individualised EP error data, they were positive about learning from general prescribing errors and aggregated EP data. However, there was a lack of consensus about how best to learn from statistical data. Potential limitations identified by participants included concern about how the data would be collected and whether it would be truly reflective of their performance. CONCLUSIONS Junior doctors would value feedback on their prescribing, and are keen to learn from EP errors, develop their clinical prescribing skills and use the EP interface effectively. We identified preferences for EP technology to enable provision of real-time data in combination with feedback to support learning and potentially reduce prescribing errors.
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Affiliation(s)
- Ann Chu
- Faculty Education Office, Imperial College London, London, UK
| | - Arika Kumar
- Department of Pharmacy, Imperial College Healthcare NHS Trust, London, UK
- UCL School of Pharmacy, London, UK
| | | | - Bryony Dean Franklin
- Department of Pharmacy, Imperial College Healthcare NHS Trust, London, UK
- UCL School of Pharmacy, London, UK
| | - Monsey McLeod
- Department of Pharmacy, Imperial College Healthcare NHS Trust, London, UK
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21
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Kalfsvel L, Hoek K, Bethlehem C, van der Kuy H, van den Broek WW, Versmissen J, van Rosse F. How would final-year medical students perform if their skill-based prescription assessment was real life? Br J Clin Pharmacol 2022; 88:5202-5217. [PMID: 35653185 PMCID: PMC9796372 DOI: 10.1111/bcp.15427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 01/01/2023] Open
Abstract
AIMS Prescribing errors occur frequently, especially among junior doctors. Our aim was to investigate prescribing errors made by final-year medical students. Information on these errors can help to improve education on and assessment of clinical pharmacotherapy (CPT). METHODS This was a retrospective cohort study amongst final-year medical students at Erasmus Medical Centre, The Netherlands. Errors made in the final prescribing assessment were analysed. Errors were categorized by type, possible consequence and possibility of reaching the patient in real life. RESULTS A total of 381 students wrote 1502 analysable prescriptions. Forty per cent of these contained at least one error, and 54% of errors were of the inadequate information type. The rating of prescriptions for children was lower than for other question categories (P = <.001). Fifty per cent of errors were classified as "would have reached the patient but would not have had the potential to cause harm". In total, 253 (29%) errors would not have been intercepted by an electronic prescribing system or a pharmacist. Ten (4%) of these would probably have caused harm in the patient. CONCLUSIONS There is a high rate of errors in prescriptions written by final-year medical students. Most errors were of the inadequate information type, indicating that students had difficulties determining the content and amount of information needed to make treatment successful. Prescriptions for children contained most errors. Curricula could be improved by offering more case-based CPT education, focusing on the practical issues of prescribing, especially for paediatric cases, and offering more practice time for prescribing during clerkships.
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Affiliation(s)
- Laura Kalfsvel
- Erasmus Medical CentreUniversity Medical Center Rotterdam, Hospital PharmacyRotterdamThe Netherlands
| | - Kirsten Hoek
- Erasmus Medical CentreUniversity Medical Center Rotterdam, Hospital PharmacyRotterdamThe Netherlands
| | - Corine Bethlehem
- Erasmus Medical CentreUniversity Medical Center Rotterdam, Hospital PharmacyRotterdamThe Netherlands
| | - Hugo van der Kuy
- Erasmus Medical CentreUniversity Medical Center Rotterdam, Hospital PharmacyRotterdamThe Netherlands
| | - Walter W. van den Broek
- Erasmus Medical CentreUniversity Medical Center Rotterdam, Institute of Medical Education Research RotterdamRotterdamThe Netherlands
| | - Jorie Versmissen
- Erasmus Medical CentreUniversity Medical Center Rotterdam, Hospital PharmacyRotterdamThe Netherlands,Erasmus Medical CentreUniversity Medical Center Rotterdam, Department of Internal MedicineRotterdamThe Netherlands
| | - Floor van Rosse
- Erasmus Medical CentreUniversity Medical Center Rotterdam, Hospital PharmacyRotterdamThe Netherlands
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22
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Donker EM, Brinkman DJ, van Rosse F, Janssen B, Knol W, Dumont G, Jorens PG, Dupont A, Christiaens T, van Smeden J, de Waard‐Siebinga I, Peeters LEJ, Goorden R, Hessel M, Lissenberg‐Witte B, Richir M, van Agtmael MA, Kramers C, Tichelaar J. Do we become better prescribers after graduation: A 1-year international follow-up study among junior doctors. Br J Clin Pharmacol 2022; 88:5218-5226. [PMID: 35716366 PMCID: PMC9796721 DOI: 10.1111/bcp.15443] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 01/07/2023] Open
Abstract
AIM The aim of this study was to investigate how the prescribing knowledge and skills of junior doctors in the Netherlands and Belgium develop in the year after graduation. We also analysed differences in knowledge and skills between surgical and nonsurgical junior doctors. METHODS This international, multicentre (n = 11), longitudinal study analysed the learning curves of junior doctors working in various specialties via three validated assessments at about the time of graduation, and 6 months and 1 year after graduation. Each assessment contained 35 multiple choice questions (MCQs) on medication safety (passing grade ≥85%) and three clinical scenarios. RESULTS In total, 556 junior doctors participated, 326 (58.6%) of whom completed the MCQs and 325 (58.5%) the clinical case scenarios of all three assessments. Mean prescribing knowledge was stable in the year after graduation, with 69% (SD 13) correctly answering questions at assessment 1 and 71% (SD 14) at assessment 3, whereas prescribing skills decreased: 63% of treatment plans were considered adequate at assessment 1 but only 40% at assessment 3 (P < .001). While nonsurgical doctors had similar learning curves for knowledge and skills as surgical doctors (P = .53 and P = .56 respectively), their overall level was higher at all three assessments (all P < .05). CONCLUSION These results show that junior doctors' prescribing knowledge and skills did not improve while they were working in clinical practice. Moreover, their level was under the predefined passing grade. As this might adversely affect patient safety, educational interventions should be introduced to improve the prescribing competence of junior doctors.
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Affiliation(s)
- Erik M. Donker
- Department of Internal Medicine, Section PharmacotherapyAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands,Research and Expertise Centre in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
| | - David J. Brinkman
- Department of Internal Medicine, Section PharmacotherapyAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands,Research and Expertise Centre in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
| | - Floor van Rosse
- Department of Hospital PharmacyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Ben Janssen
- Department of Pharmacology and ToxicologyMaastricht UniversityMaastrichtThe Netherlands
| | - Wilma Knol
- University Medical Center Utrecht, Department of Geriatric MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Glenn Dumont
- Department of Hospital Pharmacy and Clinical PharmacologyAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Philippe G. Jorens
- Antwerp University Hospital, Department of PharmacotherapyUniversity of AntwerpAntwerpBelgium
| | - Alain Dupont
- Department of Clinical PharmacologyFree University of BrusselsBrusselsBelgium
| | - Thierry Christiaens
- Clinical Pharmacology, Department of Basic and Applied Medical SciencesGhent UniversityGhentBelgium
| | - Jeroen van Smeden
- Department of EducationCentre for Human Drug ResearchLeidenThe Netherlands,Leiden University Medical CenterLeidenThe Netherlands
| | - Itte de Waard‐Siebinga
- Department of Clinical Pharmacy and Pharmacology GroningenUniversity Medical Center GroningenThe Netherlands
| | - Laura E. J. Peeters
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands,Department of Internal MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Ronald Goorden
- Radboud University Medical CenterNijmegenThe Netherlands
| | | | - Birgit Lissenberg‐Witte
- Department of Epidemiology and Data ScienceAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Milan Richir
- Department of Internal Medicine, Section PharmacotherapyAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands,Research and Expertise Centre in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands,Department of SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Michiel A. van Agtmael
- Department of Internal Medicine, Section PharmacotherapyAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands,Research and Expertise Centre in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
| | - Cornelis Kramers
- Pharmacology‐Toxicology and Internal Medicine NijmegenRadboud University Medical CenterThe Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, Section PharmacotherapyAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands,Research and Expertise Centre in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
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23
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Soliman AM, Al-Zakwani I, Younos IH, Al Zadjali S, Al Za’abi M. A Snapshot of Potentially Inappropriate Prescriptions upon Pediatric Discharge in Oman. PHARMACY 2022; 10:pharmacy10050121. [PMID: 36287442 PMCID: PMC9607182 DOI: 10.3390/pharmacy10050121] [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: 08/21/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Identifying and quantifying potentially inappropriate prescribing (PIP) practices remains a time-consuming and challenging task, particularly among the pediatric population. In recent years, several valuable tools have been developed and validated for assessing PIP. This study aimed to determine the prevalence of PIP and related risk factors in pediatric patients at a tertiary care hospital in Oman. Materials and Methods: A retrospective study was conducted by reviewing the medical records of pediatric patients (<18 years) from 1 October to 31 December 2019. Potentially inappropriate medication (PIM) and potential prescribing omission (PPO) were assessed using an internationally validated pediatric omission of prescriptions and inappropriate prescriptions (POPI) tool. Results: A total of 685 patients were included; 57.5% were male, and 30.5% had at least one comorbidity. Polypharmacy was identified in 70.2% of these patients, with a median of 2 (1−3) medications. PIM was observed in 20.4% of the cohort, with the highest in ENT-pulmonary disease (30.5%), followed by dermatological disorders (28.6%). PPO was identified in 6.9% of the patients with digestive and neuropsychiatric disorders, with the highest rate of 54% and 24%, respectively. Age (p = 0.006), number of medications (p = 0.034), and prescriber rank (p = 0.006) were identified as significant predictors of PIM, whereas age (p = 0.044) was the only significant predictor for PPO. Conclusions: The rates of PIM and PPO were high in this study population. In light of these findings, educational and interventional activities and programs are needed.
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Affiliation(s)
- Alaa M. Soliman
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat PC 123, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat PC 123, Oman
| | - Ibrahim H. Younos
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat PC 123, Oman
- Department of Clinical Pharmacology, College of Medicine, Menoufia University, Shebin El Koum 51132, Egypt
- Physician Assistant Program, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA
| | - Shireen Al Zadjali
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Mohammed Al Za’abi
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat PC 123, Oman
- Correspondence: ; Tel.: +968-2414-3431
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24
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Wuyts SCM, Scheyltjens S, Hubloue I, Dupont AG, Cornu P. Interdisciplinary knowledge gaps on intravenous fluid management in adult patients: Survey among physicians and nurses of a university hospital. J Eval Clin Pract 2022; 28:599-606. [PMID: 35080261 DOI: 10.1111/jep.13663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
Abstract
RATIONALE Intravenous (IV) fluids are frequently involved in iatrogenic complications in hospitalized patients. Knowledge of IV fluids seems inadequate and is not covered sufficiently in standard medical education. METHODS Two surveys were developed, based on the 2016 British National Institute for Health and Care Excellence guideline 'IV fluid therapy in adults in hospital', to provide insight on the learning needs and expectations of physicians and nurses. Each survey focused on profession-specific practice and consisted of three parts: demographics, knowledge questions and evaluation of current habits. Physicians and nurses practicing in a Belgian university hospital were invited to complete the survey electronically, respectively, in January and May 2018. RESULTS A total of 103 physicians (19%) and 259 nurses (24%) participated. Although every indication for fluid therapy may require a specific fluid and electrolyte mixture, and hence, knowledge of their exact composition, most physicians and nurses did not know the composition of commonly prescribed solutions for IV infusion. Senior physicians did not score better than juniors did on questions concerning the daily needs of a nil-by-mouth patient. The availability of an IV fluid on the ward guides physicians to prescribe IV fluids (17%). Nurses (56%) feel they share responsibility in fluid management as they frequently intervene in urgent situations. More than half of participants (70% of physicians, 79% of nurses) indicated a need for additional information. CONCLUSIONS A clear need for more structured information on IV fluids was identified. Both physicians and nurses struggle with fluid therapy. Continuing education on IV fluid management, emphasizing multidisciplinary collaboration, and monitoring evidence-based practice is essential to support the clinical decision process in daily practice.
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Affiliation(s)
- Stephanie C M Wuyts
- Research Group Clinical Pharmacology and Clinical Pharmacy, Centre for Pharmaceutical Research, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Pharmacy Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Simon Scheyltjens
- Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ives Hubloue
- Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Group in Emergency and Disaster Medicine, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Alain G Dupont
- Research Group Clinical Pharmacology and Clinical Pharmacy, Centre for Pharmaceutical Research, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Pieter Cornu
- Research Group Clinical Pharmacology and Clinical Pharmacy, Centre for Pharmaceutical Research, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Information and Communication Technologies, Universitair Ziekenhuis Brussel, Brussels, Belgium
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25
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Nurses’ and patients’ perceptions on interruptions on admission processes at an acute public hospital using cross-sectional survey. Collegian 2022. [DOI: 10.1016/j.colegn.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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26
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The Effect of CFTR Modulators on Airway Infection in Cystic Fibrosis. Int J Mol Sci 2022; 23:ijms23073513. [PMID: 35408875 PMCID: PMC8998472 DOI: 10.3390/ijms23073513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 02/08/2023] Open
Abstract
The advent of Cystic fibrosis transmembrane receptor (CFTR) modulators in 2012 was a critical event in the history of cystic fibrosis (CF) treatment. Unlike traditional therapies that target downstream effects of CFTR dysfunction, CFTR modulators aim to correct the underlying defect at the protein level. These genotype-specific therapies are now available for an increasing number of CF patients, transforming the way we view the condition from a life-limiting disease to one that can be effectively managed. Several studies have demonstrated the vast improvement CFTR modulators have on normalization of sweat chloride, CFTR function, clinical endpoints, and frequency of pulmonary exacerbation. However, their impact on other aspects of the disease, such as pathogenic burden and airway infection, remain under explored. Frequent airway infections as a result of increased susceptibility and impaired innate immune response are a serious problem within CF, often leading to accelerated decline in lung function and disease progression. Current evidence suggests that CFTR modulators are unable to eradicate pathogenic organisms in those with already established lung disease. However, this may not be the case for those with relatively low levels of disease progression and conserved microbial diversity, such as young patients. Furthermore, it remains unknown whether the restorative effects exerted by CFTR modulators extend to immune cells, such as phagocytes, which have the potential to modulate the response of people with CF (pwCF) to infection. Throughout this review, we look at the potential impact of CFTR modulators on airway infection in CF and their ability to shape impaired pulmonary defences to pathogens.
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27
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Donker EM, Brinkman DJ, Richir MC, Papaioannidou P, Likic R, Sanz EJ, Christiaens T, Costa JN, De Ponti F, Böttiger Y, Kramers C, van Agtmael MA, Tichelaar J. The European Prescribing Exam: assessing whether European medical students can prescribe rationally and safely. Eur J Clin Pharmacol 2022; 78:1049-1051. [PMID: 35243516 PMCID: PMC9107449 DOI: 10.1007/s00228-022-03301-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Erik M Donker
- Section Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.
| | - David J Brinkman
- Section Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Milan C Richir
- Section Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Paraskevi Papaioannidou
- 1st Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert Likic
- Unit of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb and University of Zagreb School of Medicine, Zagreb, Croatia
| | - Emilio J Sanz
- School of Health Science, Universidad de La Laguna, San Cristobal de La Laguna, Tenerife, Spain.,Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | | | - João N Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Ylva Böttiger
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Cornelis Kramers
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel A van Agtmael
- Section Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Section Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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28
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Slikkerveer M, van de Plas A, Driessen JHM, Wijngaard R, de Vries F, Olie R, Meertens N, van den Bemt P. Prescribing Errors With Low-Molecular-Weight Heparins. J Patient Saf 2021; 17:e587-e592. [PMID: 28858001 DOI: 10.1097/pts.0000000000000417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Low-molecular-weight heparins (LMWHs) are used in the prevention and treatment of venous thromboembolism (VTE). Bleeding is the primary major complication of LMWH therapy, which is associated with dose. The administration of appropriate dosages of LMWHs depends on the patient's risk of VTE, risk of bleeding, bodyweight, and renal function. Therefore, LMWH prescribing is prone to errors. However, no earlier study has explored the frequency of prescribing errors with LMWH. PURPOSE The aim of the study was to determine the frequency and determinants of in-hospital LMWH-prescribing errors. METHODS A cross-sectional study was conducted to examine the frequency and determinants of LMWH prescribing errors between April and August 2014. We randomly selected 500 patients 18 years and older with at least one LMWH prescription during inpatient hospitalization. A prescribing error was a deviation from the internal hospital guidelines. Logistic regression estimated determinants of prescribing error. RESULTS A prescribing error was present with 34% of all LMWH users. The most frequently recorded error was a dose that was not adjusted to body weight and/or renal function (85%). Prophylactic LMWH prescribing in medical wards was associated with a higher risk of prescribing error as compared with surgical wards. CONCLUSIONS The frequency of prescribing errors was 34% in a tertiary care hospital. Being a patient with prophylactic LMWH use on a medical ward is a determinant for LMWH prescribing error. Interventions that will lead to better electronic recording of body weight and more awareness among medical doctors may reduce the total number of prescribing errors.
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Affiliation(s)
- Marielle Slikkerveer
- From the Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center
| | - Afke van de Plas
- From the Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center
| | | | - Robin Wijngaard
- From the Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center
| | | | | | - Nathalie Meertens
- Thrombosis Expertise Center, Maastricht University Medical Center+, Maastricht
| | - Patricia van den Bemt
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
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Ross SL, Bhushan Y, Davey P, Grant S. Improving documentation of prescriptions for as-required medications in hospital inpatients. BMJ Open Qual 2021; 10:bmjoq-2020-001277. [PMID: 34544692 PMCID: PMC8454436 DOI: 10.1136/bmjoq-2020-001277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 09/10/2021] [Indexed: 11/04/2022] Open
Abstract
It is estimated that 1 in 10 hospital inpatients in Scotland have experienced a medication error. In our unit, an audit in 2019 identified documentation of as-required prescriptions on drug Kardexes as an important target for improvement. This project aimed to reduce the percentage of these errors to <5% in the ward in 6 months.Weekly point prevalence surveys were used to measure medication error rates over a 12-week baseline period. Errors in route, frequency of dose and maximum dose accounted for >80% of all prescribing errors. The intervention was a poster reminder about the three most common errors linked to standards for prescribing pain medication. Barriers to change were identified through inductive thematic analysis of semistructured interviews with five ward doctors and two staff nurses.In the 6 weeks after intervention, our run chart showed a shift in maximum dose errors per patient, which fell from 75% to 26%. However, route and frequency errors remained high at >70% per patient. Most of these errors were due to use of abbreviations, and qualitative interviews revealed that senior doctors and nurses believed that these abbreviations were safe. We found some evidence from national guidelines to support these beliefs.Overall, the intervention was associated with decreased prevalence of patients without a maximum dose written on their prescription, but lack of space on drug prescriptions was identified as a key barrier to further improvement in both maximum dose and abbreviation errors.
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Affiliation(s)
| | | | - Peter Davey
- School of Medicine, University of Dundee, Dundee, UK.,Clinical Quality Improvement, University of Dundee, Dundee, UK
| | - Suzanne Grant
- School of Medicine, University of Dundee, Dundee, UK
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30
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Valladales-Restrepo LF, Constain-Mosquera CA, Álvarez-Amaya V, Machado-Alba JE. Study of prescription-indication of tetracyclines in a population in Colombia. Fundam Clin Pharmacol 2021; 36:390-396. [PMID: 34481423 DOI: 10.1111/fcp.12724] [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: 06/15/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022]
Abstract
The inappropriate use of antibiotics is associated with increased antimicrobial resistance, adverse reactions, medical care costs, and worse clinical outcomes. The objective of this study is to determine the prescription patterns and approved and unapproved indications for tetracyclines in a group of patients in Colombia. This was a cross-sectional study, based on a database of medication dispensing of approximately 8.5 million people affiliated with the Colombian Health System, of the indications for the use of tetracyclines in outpatients. Sociodemographic, pharmacological, and comorbidity variables were considered. A total of 20 699 patients with a prescription of tetracyclines were identified, with a median age of 26.1 years; 65.0% were women. The most prescribed tetracycline was doxycycline (95.1%), especially for the treatment of acne (55.3%). A total of 23.5% of the prescriptions was used for unapproved indications, for example, vaginitis-vulvitis-vulvovaginitis (8.1%). Increasing age, prescriptions of doxycycline made by general physician, and woman attended by general physician were associated with a greater probability that a tetracycline was used for unapproved indications. Residing in Bogota-Cundinamarca Region and woman that residing in Bogota-Cundinamarca reduced this risk. A high proportion of patients received tetracyclines for dermatological conditions, with a lower proportion of use for gynecological and respiratory infections. For approximately one quarter of the cases, tetracyclines were prescribed for indications not approved by regulatory agencies, especially in those over 18 years and when the prescriptions of doxycycline was made by a general practitioners.
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Affiliation(s)
- Luis Fernando Valladales-Restrepo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S. A., Pereira, Risaralda, Colombia.,Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Camilo Alexander Constain-Mosquera
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - Valeria Álvarez-Amaya
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S. A., Pereira, Risaralda, Colombia
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Hamill LM, Bonnett J, Baxter MF, Kreutz M, Denny KJ, Keijzers G. Antimicrobial Prescribing in the Emergency Department; Who Is Calling the Shots? Antibiotics (Basel) 2021; 10:antibiotics10070843. [PMID: 34356764 PMCID: PMC8300735 DOI: 10.3390/antibiotics10070843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Inappropriate antimicrobial prescribing in the emergency department (ED) can lead to poor outcomes. It is unknown how often the prescribing clinician is guided by others, and whether prescriber factors affect appropriateness of prescribing. This study aims to describe decision making, confidence in, and appropriateness of antimicrobial prescribing in the ED. Methods: Descriptive study in two Australian EDs using both questionnaire and medical record review. Participants were clinicians who prescribed antimicrobials to patients in the ED. Outcomes of interest were level of decision-making (self or directed), confidence in indication for prescribing and appropriateness (5-point Likert scale, 5 most confident). Appropriateness assessment of the prescribing event was by blinded review using the National Antibiotic Prescribing Survey appropriateness assessment tool. All analyses were descriptive. Results: Data on 88 prescribers were included, with 61% making prescribing decisions themselves. The 39% directed by other clinicians were primarily guided by more senior ED and surgical subspecialty clinicians. Confidence that antibiotics were indicated (Likert score: 4.20, 4.35 and 4.35) and appropriate (Likert score: 4.07, 4.23 and 4.29) was similar for juniors, mid-level and senior prescribers, respectively. Eighty-five percent of prescriptions were assessed as appropriate, with no differences in appropriateness by seniority, decision-making or confidence. Conclusions: Over one-third of prescribing was guided by senior ED clinicians or based on specialty advice, primarily surgical specialties. Prescriber confidence was high regardless of seniority or decision-maker. Overall appropriateness of prescribing was good, but with room for improvement. Future qualitative research may provide further insight into the intricacies of prescribing decision-making.
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Affiliation(s)
- Laura M. Hamill
- Department of Emergency Medicine, Christchurch Hospital, Canterbury DHB, Christchurch 8011, New Zealand;
| | - Julia Bonnett
- School of Medicine, Griffith University, Gold Coast, QLD 4215, Australia; (J.B.); (M.F.B.); (M.K.)
| | - Megan F. Baxter
- School of Medicine, Griffith University, Gold Coast, QLD 4215, Australia; (J.B.); (M.F.B.); (M.K.)
| | - Melina Kreutz
- School of Medicine, Griffith University, Gold Coast, QLD 4215, Australia; (J.B.); (M.F.B.); (M.K.)
| | - Kerina J. Denny
- Department of Intensive Care, Gold Coast University Hospital, Gold Coast, QLD 4215, Australia;
| | - Gerben Keijzers
- School of Medicine, Griffith University, Gold Coast, QLD 4215, Australia; (J.B.); (M.F.B.); (M.K.)
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD 4215, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4215, Australia
- Correspondence:
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Parthasarathi A, Puvvada R, Patel H, Bhandari P, Nagpal S. Evaluation of Medication Errors in a Tertiary Care Hospital of a Low- to Middle-Income Country. Cureus 2021; 13:e16769. [PMID: 34354894 PMCID: PMC8328840 DOI: 10.7759/cureus.16769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Medication errors (MEs) are a major public health concern as they are detrimental to patient safety, compromise patients' confidence in the healthcare system, increase healthcare costs, and adversely affect the patient's quality of life. This is especially true in low to middle-income countries where the significance of MEs is largely undervalued. This study aims to investigate the prevalence of MEs and analyze the causes, medicines involved, reporting, and severity of MEs in a tertiary care setting. Methods A prospective observational study was conducted from March 2020 to February 2021 in a tertiary care teaching hospital in South India. The data was collected after reviewing patient medical records, by interviewing patients and healthcare professionals. National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index was used to evaluate MEs. Results A total of 557 MEs were identified from 3798 patients with a prevalence of 14.6%. Prescribing errors were the most commonly observed ME followed by errors related to documentation of medical records, administration-related errors, and dispensing errors. Lack of time for documentation of medication records, shift change and work overload were common causes of MEs. The majority of MEs were category A and B of the NCC MERP severity index. Conclusion Antibiotics and proton pump inhibitors were the most common medicines involved in MEs. Prescribing and documentation errors were most prevalent. Implementation of systems like strict adherence to treatment guidelines, computerized provider order entry (CPOE), barcode medication administration, and closed-loop electronic medication management systems may greatly help reduce MEs. All healthcare institutions should undertake routine audits to determine the prevalence and causes of medication errors.
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Affiliation(s)
| | - Rahul Puvvada
- Physiology, Anatomy, and Microbiology, College of Science, Health and Engineering, La Trobe University, Melbourne, AUS
| | - Himanshu Patel
- Pharmacology and Therapeutics, International Society of Oncology Pharmacy Practitioners, North Vancouver, CAN
| | - Pooja Bhandari
- Public Health, Madhavnagar Government Hospital, Ujjain, IND
| | - Sagar Nagpal
- Internal Medicine, Erie County Medical Center, Buffalo, USA
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Donker E, Brinkman D, Richir M, Papaioannidou P, Likic R, Sanz EJ, Christiaens T, Costa J, De Ponti F, Gatti M, Böttiger Y, Kramers C, Garner S, Pandit R, van Agtmael M, Tichelaar J. European List of Essential Medicines for Medical Education: a protocol for a modified Delphi study. BMJ Open 2021; 11:e045635. [PMID: 33947736 PMCID: PMC8098946 DOI: 10.1136/bmjopen-2020-045635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Junior doctors are responsible for a substantial number of prescribing errors, and final-year medical students lack sufficient prescribing knowledge and skills just before they graduate. Various national and international projects have been initiated to reform the teaching of clinical pharmacology and therapeutics (CP&T) during undergraduate medical training. However, there is as yet no list of commonly prescribed and available medicines that European doctors should be able to independently prescribe safely and effectively without direct supervision. Such a list could form the basis for a European Prescribing Exam and would harmonise European CP&T education. Therefore, the aim of this study is to reach consensus on a list of widely prescribed medicines, available in most European countries, that European junior doctors should be able to independently prescribe safely and effectively without direct supervision: the European List of Essential Medicines for Medical Education. METHODS AND ANALYSIS This modified Delphi study will recruit European CP&T teachers (expert group). Two Delphi rounds will be carried out to enable a list to be drawn up of medicines that are available in ≥80% of European countries, which are considered standard prescribing practice, and which junior doctors should be able to prescribe safely and effectively without supervision. ETHICS AND DISSEMINATION The study has been approved by the Medical Ethics Review Committee of VU University Medical Center (no. 2020.335) and by the Ethical Review Board of the Netherlands Association for Medical Education (approved project no. NVMO-ERB 2020.4.8). The European List of Essential Medicines for Medical Education will be presented at national and international conferences and will be submitted to international peer-reviewed journals. It will also be used to develop and implement the European Prescribing Exam.
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Affiliation(s)
- Erik Donker
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - David Brinkman
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Milan Richir
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Paraskevi Papaioannidou
- Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert Likic
- University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Internal Medicine, Unit of Clinical Pharmacology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Emilio J Sanz
- School of Health Science, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | | | - João Costa
- Department of Pharmacology and Clinical Pharmacology, University of Lisbon, Lisbon, Portugal
| | - Fabrizio De Ponti
- Department of Medical and Surgical Sciences, Pharmacology Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Milo Gatti
- Department of Medical and Surgical Sciences, Pharmacology Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Ylva Böttiger
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Cornelis Kramers
- Department of Internal Medicine and Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sarah Garner
- Health Technologies and Pharmaceuticals Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Rahul Pandit
- Department of Translational Neuroscience, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands
| | - Michiel van Agtmael
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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Rao D, Shiyanbola OO. Best practices for conducting and writing mixed methods research in social pharmacy. Res Social Adm Pharm 2021; 18:2184-2192. [PMID: 33975778 DOI: 10.1016/j.sapharm.2021.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/03/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
Mixed method approaches are increasingly being used in social pharmacy research due to its potential to uncover insights that are not possible with separate quantitative and qualitative studies. Despite their increasing use, there are some limitations in these publications. Typically, specific mixed method designs are not chosen, quantitative and qualitative data are not systematically integrated, and the credibility or validity of the approach is not addressed. In this paper, we discuss mixed method designs and their applications in social pharmacy. Different integration techniques and legitimation types are detailed. We describe new methodological developments and provide examples from recent mixed method studies in social pharmacy. Finally, we also provide recommendations for planning, conducting, reporting, and evaluating mixed method studies. We suggest that researchers interested in conducting mixed method studies follow recommended guidelines and obtain training in mixed methods to ensure that rigorous mixed method studies are conducted in social and administrative pharmacy.
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Affiliation(s)
- Deepika Rao
- Social and Administrative Sciences, School of Pharmacy University of Wisconsin-Madison, USA.
| | - Olayinka O Shiyanbola
- Social and Administrative Sciences, School of Pharmacy University of Wisconsin-Madison, USA
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Alwadie AF, Naeem A, Almazmomi MA, Baswaid MA, Alzahrani YA, Alzahrani AM. A Methodological Assessment of Pharmacist Therapeutic Intervention Documentation (TID) in a Single Tertiary Care Hospital in Jeddah, Kingdom of Saudi Arabia. PHARMACY 2021; 9:pharmacy9020097. [PMID: 33924922 PMCID: PMC8167559 DOI: 10.3390/pharmacy9020097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022] Open
Abstract
Pharmacist intervention has valuable input to the healthcare system by reducing medication errors, costs of treatment and improving therapeutic outcomes. This study aimed to analyze pharmacists’ interventions during the verification of computerized physician order entry and to determine the association between prescribers’ level and type of prescribing errors. In this cross-sectional, observational study, data collection was carried out over three months starting from 1 January 2020 to 31 March 2020. Included were 2405 interventions documented by 52 different pharmacists. The prevalence of prescribing order entry errors was 9.1%. The most identifiable type of intervention was incorrect dilution (40.2%) followed by dose substitution (27.7%). The drug category associated with a high percentage of interventions was perfusion solutions (41%), followed by antibacterial (35%). The number of junior physician orders that required pharmacist intervention was higher than other prescribers (45.2%), followed by specialist and senior physicians, (31.4% and 15.5%, respectively). Prescriber ordering time and types of prescribing errors were shown to have a significant (p < 0.05) association. Internal medicine physicians entered the highest percentage of prescribing errors, representing 22.7%. The current study concluded that TID has significant potential to reduce drug-related problems; TID fatigue is a real problem that might be under-reported and addressing this point in future studies would be of great value.
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Affiliation(s)
- Ali F. Alwadie
- Pharmaceutical Care Department, Ministry of National Guard—Health Affairs, Jeddah 22384, Saudi Arabia; (A.F.A.); (A.N.); (M.A.A.); (M.A.B.)
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia
| | - Anjum Naeem
- Pharmaceutical Care Department, Ministry of National Guard—Health Affairs, Jeddah 22384, Saudi Arabia; (A.F.A.); (A.N.); (M.A.A.); (M.A.B.)
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia
| | - Meaad A. Almazmomi
- Pharmaceutical Care Department, Ministry of National Guard—Health Affairs, Jeddah 22384, Saudi Arabia; (A.F.A.); (A.N.); (M.A.A.); (M.A.B.)
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia
| | - Meshail A. Baswaid
- Pharmaceutical Care Department, Ministry of National Guard—Health Affairs, Jeddah 22384, Saudi Arabia; (A.F.A.); (A.N.); (M.A.A.); (M.A.B.)
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia
| | - Yahya A. Alzahrani
- Pharmaceutical Care Department, Ministry of National Guard—Health Affairs, Jeddah 22384, Saudi Arabia; (A.F.A.); (A.N.); (M.A.A.); (M.A.B.)
- Department of Pharmacy, East Jeddah Hospital, Ministry of Health, Jeddah 22253, Saudi Arabia
- Correspondence: (Y.A.A.); (A.M.A.)
| | - Abdullah M. Alzahrani
- Pharmaceutical Care Department, Ministry of National Guard—Health Affairs, Jeddah 22384, Saudi Arabia; (A.F.A.); (A.N.); (M.A.A.); (M.A.B.)
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia
- Correspondence: (Y.A.A.); (A.M.A.)
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Van Der Linden L, Hias J, Walgraeve K, Loyens S, Flamaing J, Spriet I, Tournoy J. Factors associated with the number of clinical pharmacy recommendations: findings from an observational study in geriatric inpatients. Acta Clin Belg 2021; 76:119-126. [PMID: 31642397 DOI: 10.1080/17843286.2019.1683128] [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] [Indexed: 12/28/2022]
Abstract
Objectives: Drug-related problems are prevalent in older inpatients and can be reduced by providing clinical pharmacy (CP) services. Details concerning implementation in clinical practice are frequently lacking. The aim was to describe the output of one such CP program and to identify factors associated with CP recommendations.Methods: A CP program was installed at three acute geriatric wards in a teaching hospital. A convenience sample was collected, consisting of inpatients who received a CP consultation at discharge. Medical conditions, patient demographics, and drug use were evaluated retrospectively. Number and type of the CP recommendations were determined. A Poisson regression analysis was performed to determine factors associated with the number of CP recommendations.Results: A cohort of 524 patients, aged 85 (interquartile range (IQR): 82-89) years was included. On admission, 10.31 (standard deviation: 4.49) drugs were taken. Three (IQR: 2-4) CP recommendations were provided per patient, of which 70.2% targeted drug discontinuation. A model was derived, containing the following factors: number of drugs on admission (incidence rate ratio (IRR): 1.063; 95% confidence interval (CI): 1.052-1.074), number of previous contacts with the geriatric department (IRR: 0.869; 95%CI: 0.816-0.926), presence of left-ventricular dysfunction (IRR: 1.179, 95% CI: 1.023-1.360), the number of new drugs (IRR: 1.046; 95% CI: 1.021-1.071) and use of colecalciferol (IRR: 1.22; 95% CI: 1.088-1.367).Conclusions: Five factors were associated with the number of CP recommendations at discharge. This could allow for further patient stratification to increase the efficiency of the CP program.
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Affiliation(s)
- Lorenz Van Der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Julie Hias
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | | | - Silke Loyens
- Faculty Of Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
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van der Steen CNW, Brokx S, van den Hanenberg F, van der Stelt R, van Onzenoort-Bokken L, Keijsers CJPW. A pharmacotherapy self-assessment improves prescribing by prompting junior doctors to study further. Br J Clin Pharmacol 2021; 87:3268-3278. [PMID: 33527489 DOI: 10.1111/bcp.14747] [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: 10/07/2020] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS Junior doctors frequently prescribe incorrectly and this can cause serious harm to patients. Pharmacotherapy education in most medical schools falls short in preparing their students to prescribe safely in clinical practice. According to the theory of assessment-driven learning, a pharmacotherapy self-assessment for junior doctors may reduce potential harmful prescriptions in clinical practice, by revealing deficits in prescribing knowledge and skills. METHODS In this single centre, prospective cohort study, the potential harmful prescriptions of junior doctors in clinical practice were compared before and after a pharmacotherapy self-assessment with and without additional pharmacotherapy education. RESULTS Potential harmful prescriptions best known to cause harm to patients were studied in all the prescriptions written out by 199 junior doctors in the first 2 months of their employment in our hospital. The pharmacotherapy self-assessment reduced the total number of potential harmful prescriptions made by junior doctors relative to those made by junior doctors in the control group (1.3 vs. 3.2%, respectively; P < .001). Additional education did not reduce potential harmful prescriptions beyond the effect of the self-assessment alone (1.3 vs. 1.0%, P > .05). CONCLUSIONS Pharmacotherapy self-assessment leads to fewer potential harmful prescriptions made by junior doctors in clinical practice, thereby improving patient safety. More research is needed to investigate whether additional pharmacotherapy education strategies reduce potential harmful prescriptions further.
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Affiliation(s)
- Carlijn N W van der Steen
- Department of Geriatric Medicine, Department of Clinical Pharmacology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Steffi Brokx
- Maastricht University, Maastricht, the Netherlands
| | | | | | - Lonneke van Onzenoort-Bokken
- Department of Pediatrics, Department of Clinical Pharmacology, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Carolina J P W Keijsers
- Department of Geriatric Medicine, Department of Clinical Pharmacology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
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Omer U, Veysey M, Crampton P, Finn G. What makes a model prescriber? A documentary analysis. MEDICAL TEACHER 2021; 43:198-207. [PMID: 33161821 DOI: 10.1080/0142159x.2020.1839031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION In recent years, the authority to prescribe medications in healthcare has expanded to include pharmacists, nurses and Allied Healthcare Professionals. Subsequently, the quantity of guidelines describing appropriate prescribing practice has increased. Despite this, the literature notes a lack of consensus regarding the overall qualities of a good prescriber. The aim of this study was to attempt to define what makes a model prescriber in practice, regardless of professional background. METHODS A documentary analysis of UK-based and international prescribing practice guidelines was performed. Data analysis was conducted through a constructivist grounded theory approach to enable concepts to be identified from the data itself without the use of pre-defined categories. RESULTS A total of 13 guideline documents were analysed. Overall, four core categories of a model prescriber in practice were identified: Knowledgeable: including that of disease and drug properties; Safe: relating to appropriate drug quantities and treatment-monitoring; Good Communicators: with both patients and colleagues; Contemporary: through enhancing knowledge and skills. CONCLUSIONS These four categories can serve as a definition of a high-level prescriber and as an additional tool for prescribing educators to evaluate the extent their curriculum develops and assesses the core qualities needed by their students to be high-level prescribers in practice.
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Affiliation(s)
- Usmaan Omer
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Martin Veysey
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Paul Crampton
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Gabrielle Finn
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
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Lloyd M, Watmough SD, O'Brien SV, Hardy K, Furlong N. Evaluating the impact of a pharmacist-led prescribing feedback intervention on prescribing errors in a hospital setting. Res Social Adm Pharm 2020; 17:1579-1587. [PMID: 33341404 DOI: 10.1016/j.sapharm.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/19/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prescribing errors are prevalent in hospital settings with provision of feedback recommended to support prescribing of doctors. Feedback on prescribing has been described as feasible and valued but limited by doctors, with pharmacists described as credible facilitators of prescribing feedback. Evidence supporting prescribing feedback has been limited to date. A formalised programme of pharmacist-led prescribing error feedback was designed and implemented to support prescribers. OBJECTIVE To evaluate the impact of a prescribing feedback intervention on prescribing error rates and frequency of prescribing error severity and type. METHOD Prospective prescribing audits were undertaken across sixteen hospital wards in a UK teaching hospital over a five day period with 36 prescribers in the intervention group and 41 in the control group. The intervention group received pharmacist-led, individualised constructive feedback on their prescribing, whilst the control group continued with existing practice. Prescribing was re-audited after three months. Prescribing errors were classified by type and severity and data were analysed using relevant statistical tests. RESULTS A total of 5191 prescribed medications were audited at baseline and 5122 post-intervention. There was a mean prescribing error rate of 25.0% (SD 16.8, 95% CI 19.3 to 30.7) at baseline and 6.7% (SD 9.0, 95% CI 3.7 to 9.8) post-intervention for the intervention group, and 19.7% (SD 14.5, 95% CI 15.2 to 24.3) at baseline and 25.1% (SD 17.0, 95% CI 19.8 to 30.6) post-intervention for the control group with a significant overall change in prescribing error rates between groups of 23.7% (SD 3.5, 95% CI, -30.6 to -16.8), t(75) = -6.9, p < 0.05. The frequency of each error type and severity rating was reduced in the intervention group, whilst the error frequency of some error types and severity increased in the control group. CONCLUSION Pharmacist-led prescribing feedback has the potential to reduce prescribing errors and improve prescribing outcomes and patient safety.
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Affiliation(s)
- M Lloyd
- Clinical Education Department, St. Helens and Knowsley Hospitals NHS Trust, Whiston, Merseyside, L35 5DR, UK.
| | - S D Watmough
- School of Medicine, Faculty of Health and Social Care, Edge Hill University, Ormskirk, L39 4QP, UK
| | - S V O'Brien
- St. Helens CCG, St. Helens Chambers, St. Helens, Merseyside, WA10 1YF, UK
| | - K Hardy
- St. Helens and Knowsley Hospitals NHS Trust, Whiston, Merseyside, L35 5DR, UK
| | - N Furlong
- St. Helens and Knowsley Hospitals NHS Trust, Whiston, Merseyside, L35 5DR, UK
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Kalsi IA, Sheikh Y. Response to: Twelve tips for facilitating medical students prescribing learning on clinical placement. MEDICAL TEACHER 2020; 42:1431-1432. [PMID: 32285722 DOI: 10.1080/0142159x.2020.1752365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Yusuf Sheikh
- GKT School of Medical Education, King's College London, London, UK
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Alshahrani F, Marriott JF, Cox AR. A qualitative study of prescribing errors among multi-professional prescribers within an e-prescribing system. Int J Clin Pharm 2020; 43:884-892. [PMID: 33165835 PMCID: PMC8352824 DOI: 10.1007/s11096-020-01192-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/29/2020] [Indexed: 11/16/2022]
Abstract
Background Computerised Physician Order Entry (CPOE) is considered to enhance the safety of prescribing. However, it can have unintended consequences and new forms of prescribing error have been reported. Objective The aim of this study was to explore the causes and contributing factors associated with prescribing errors reported by multidisciplinary prescribers working within a CPOE system. Main Outcome Measure Multidisciplinary prescribers experience of prescribing errors in an CPOE system. Method This qualitative study was conducted in a hospital with a well-established CPOE system. Semi-structured qualitative interviews were conducted with prescribers from the professions of pharmacy, nursing, and medicine. Interviews analysed using a mixed inductive and deductive approach to develop a framework for the causes of error. Results Twenty-three prescribers were interviewed. Six main themes influencing prescribing were found: the system, the prescriber, the patient, the team, the task of prescribing and the work environment. Prominent issues related to CPOE included, incorrect drug name picking, default auto-population of dosages, alert fatigue and remote prescribing. These interacted within a complex prescribing environment. No substantial differences in the experience of CPOE were found between the professions. Conclusion Medical and non-medical prescribers have similar experiences of prescribing errors when using CPOE, aligned with existing published literature about medical prescribing. Causes of electronic prescribing errors are multifactorial in nature and prescribers describe how factors interact to create the conditions errors. While interventions should focus on direct CPOE issues, such as training and design, socio-technical, and environmental aspects of practice remain important.
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Affiliation(s)
- Fahad Alshahrani
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Security Forces Hospital, Riyadh, Saudi Arabia
| | - John F Marriott
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anthony R Cox
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Hias J, Walgraeve K, Tournoy J, Flamaing J, Spriet I, Van der Linden L. Physician's feedback on a clinical pharmacy program on geriatric wards. Acta Clin Belg 2020; 75:321-328. [PMID: 31179904 DOI: 10.1080/17843286.2019.1629054] [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] [Indexed: 12/30/2022]
Abstract
OBJECTIVES As clinical pharmacy (CP) services can improve drug use and clinical outcome in older inpatients, a dedicated CP program was installed at the geriatric wards of an academic hospital. The aim of this study was to evaluate and potentially improve the CP program, by obtaining physician's feedback. METHODS An anonymous e-questionnaire was sent to all physicians who were active between October 2014 and March 2018 on the acute geriatric wards (80 beds) of the University Hospitals Leuven, Belgium. Thematic content analysis was applied. Six themes were defined: satisfaction with the service, time allocation of the clinical pharmacists, content and clinical relevance of pharmaceutical interventions, communication, time savings for the treating physician and future perspectives. RESULTS A total of 45 physicians (59%) completed the e-questionnaire. All respondents were satisfied with the content of the provided pharmaceutical recommendations. A minority (44%) found that a 0.8 full-time equivalent clinical pharmacist presence was sufficient in terms of the expected workload. The provided CP interventions improved quality of care according to 38 (84%) physicians. Oral and written communication were considered necessary by 89% and 82% of physicians, respectively. On average, an estimated 30 minutes physician time (IQR: 15-60) per patient was saved as a result of the program. The majority (87%) preferred clinical pharmacist presence for discharge support in all geriatric patients. CONCLUSION Physician's satisfaction with the CP service was very high. CP services in geriatric inpatients were perceived to be clinically relevant as well as time-saving by the involved physicians.
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Affiliation(s)
- Julie Hias
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | | | - Jos Tournoy
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Linton KD, Murdoch-Eaton D. Twelve tips for facilitating medical students prescribing learning on clinical placement. MEDICAL TEACHER 2020; 42:1134-1139. [PMID: 32065546 DOI: 10.1080/0142159x.2020.1726309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Prescribing is a complex clinical skill requiring mastery by the end of basic medical training. Prescribing errors are common in newly qualified doctors, aligned with expressed anxiety about prescribing, particularly with high-risk medications. Learning about prescribing needs to start early in medical training, underpinned by regular opportunities for reflective practice. Authentic learning within the clinical work environment is more effective than lecture based learning and allows potential immediate feedback. Educational strategies should support prescribing learning underpinned by appropriate formative and summative assessments. Students should routinely be expected to use resources including an online formulary, sustained through tracking individual progress through use of their own personal formulary or 'p' drugs. Regular prescribing practice with embedded feedback during undergraduate training will help to ensure newly qualified doctors are more confident and competent prescribers.
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Affiliation(s)
- Kate D Linton
- Academic Unit of Medical Education, The Medical School, University of Sheffield, Sheffield, UK
| | - Deborah Murdoch-Eaton
- Academic Unit of Medical Education, The Medical School, University of Sheffield, Sheffield, UK
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Helou RI, Foudraine DE, Catho G, Peyravi Latif A, Verkaik NJ, Verbon A. Use of stewardship smartphone applications by physicians and prescribing of antimicrobials in hospitals: A systematic review. PLoS One 2020; 15:e0239751. [PMID: 32991591 PMCID: PMC7523951 DOI: 10.1371/journal.pone.0239751] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Antimicrobial stewardship (AMS) programs promote appropriate use of antimicrobials and reduce antimicrobial resistance. Technological developments have resulted in smartphone applications (apps) facilitating AMS. Yet, their impact is unclear. OBJECTIVES Systematically review AMS apps and their impact on prescribing by physicians treating in-hospital patients. DATA SOURCES EMBASE, MEDLINE (Ovid), Cochrane Central, Web of Science and Google Scholar. STUDY ELIGIBILITY CRITERIA Studies focusing on smartphone or tablet apps and antimicrobial therapy published from January 2008 until February 28th 2019 were included. PARTICIPANTS Physicians treating in-hospital patients. INTERVENTIONS AMS apps. METHODS Systematic review. RESULTS Thirteen studies met the eligibility criteria. None was a randomized controlled trial. Methodological study quality was considered low to moderate in all but three qualitative studies. The primary outcomes were process indicators, adherence to guidelines and user experience. Guidelines were more frequently accessed by app (53.0% - 89.6%) than by desktop in three studies. Adherence to guidelines increased (6.5% - 74.0%) significantly for several indications after app implementation in four studies. Most users considered app use easy (77.4%->90.0%) and useful (71.0%->90%) in three studies and preferred it over guideline access by web viewer or booklet in two studies. However, some physicians regarded app use adjacent to colleagues or patients unprofessional in three qualitative studies. Susceptibility to several antimicrobials changed significantly post-intervention (from 5% decrease to 10% - 14% increase) in one study. CONCLUSIONS Use of AMS apps seems to promote access to and knowledge of antimicrobial prescribing policy, and increase adherence to guidelines in hospitals. However, this has been assessed in a limited number of studies and for specific indications. Good quality studies are necessary to properly assess the impact of AMS apps on antimicrobial prescribing. To improve adherence to antimicrobial guidelines, use of AMS apps could be considered.
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Affiliation(s)
- R I Helou
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D E Foudraine
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - G Catho
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - A Peyravi Latif
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - N J Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
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Boyd-Carson H, Doleman B, Lockwood S, Williams JP, Tierney GM, Lund JN. Trainee-led emergency laparotomy operating. Br J Surg 2020; 107:1289-1298. [DOI: 10.1002/bjs.11611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/21/2020] [Accepted: 03/09/2020] [Indexed: 01/16/2023]
Abstract
Abstract
Background
To achieve completion of training in general surgery, trainees are required to demonstrate competency in common procedures performed at emergency laparotomy. The aim of this study was to describe the patterns of trainee-led emergency laparotomy operating and the association between postoperative outcomes.
Methods
Data on all patients who had an emergency laparotomy between December 2013 and November 2017 were extracted from the National Emergency Laparotomy Audit database. Patients were grouped by grade of operating surgeon: trainee (specialty registrar) or consultant (including post-Certificate of Completion of Training fellows). Trends in trainee operating by deanery, hospital size and time of day of surgery were investigated. Univariable and adjusted regression analyses were performed for the outcomes 90-day mortality and return to theatre, with analysis of patients in operative subgroups segmental colectomy, Hartmann's procedure, adhesiolysis and repair of perforated peptic ulcer disease.
Results
The study cohort included 87 367 patients. The 90-day mortality rate was 15·1 per cent in the consultant group compared with 11·0 per cent in the trainee group. There were no increased odds of death by 90 days or of return to theatre across any of the operative groups when the operation was performed with a trainee listed as the most senior surgeon in theatre. Trainees were more likely to operate independently in high-volume centres (highest- versus lowest-volume centres: odds ratio (OR) 2·11, 95 per cent c.i. 1·91 to 2·33) and at night (00.00 to 07.59 versus 08.00 to 11.59 hours; OR 3·20, 2·95 to 3·48).
Conclusion
There is significant variation in trainee-led operating in emergency laparotomy by geographical area, hospital size and by time of day. However, this does not appear to influence mortality or return to theatre.
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Affiliation(s)
- H Boyd-Carson
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK
- National Emergency Laparotomy Audit Project Team, Royal College of Anaesthetists, London, UK
- Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - B Doleman
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK
- Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - S Lockwood
- National Emergency Laparotomy Audit Project Team, Royal College of Anaesthetists, London, UK
| | - J P Williams
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK
- Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - G M Tierney
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK
- National Emergency Laparotomy Audit Project Team, Royal College of Anaesthetists, London, UK
- Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - J N Lund
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK
- Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
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Tong EY, Mitra B, Yip G, Galbraith K, Dooley MJ. Multi-site evaluation of partnered pharmacist medication charting and in-hospital length of stay. Br J Clin Pharmacol 2020; 86:285-290. [PMID: 31631393 DOI: 10.1111/bcp.14128] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/25/2019] [Accepted: 09/02/2019] [Indexed: 01/03/2023] Open
Abstract
AIMS To undertake a multicentre evaluation of translation of a partnered pharmacist medication charting (PPMC) model in patients admitted to general medical units in public hospitals in the state of Victoria, Australia. METHODS Unblinded, prospective cohort study comparing patients before and after the intervention. Conducted in seven public hospitals in Victoria, Australia from 20 June 2016 to 30 June 2017. Patients admitted to general medical units were included in the study. Medication charting by pharmacists using a partnered pharmacist model was compared to traditional medication charting. The primary outcome variable was the length of inpatient hospital stay. Secondary outcome measures were medication errors detected within 24 h of the patients' admission, identified by an independent pharmacist assessor. RESULTS A total of 8648 patients were included in the study. Patients who had PPMC had reduced median length of inpatient hospital stay from 4.7 (interquartile range 2.8-8.2) days to 4.2 (interquartile range 2.3-7.5) days (P < 0.001). PPMC was associated with a reduction in the proportion of patients with at least 1 medication error from 66% to 3.6% with a number needed to treat to prevent 1 error of 1.6 (95% confidence interval: 1.57-1.64). CONCLUSION Expansion of the partnered pharmacist charting model across multiple organisations was effective and feasible and is recommended for adoption by health services.
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Affiliation(s)
| | | | - Gary Yip
- Alfred Health, Prahran, Victoria, Australia
| | - Kirstie Galbraith
- Monash University (Parkville Campus), Parkville, Victoria, Australia
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The Patient-Held Active Record of Medication Status (PHARMS) study: a mixed-methods feasibility analysis. Br J Gen Pract 2020; 69:e345-e355. [PMID: 31015221 DOI: 10.3399/bjgp19x702413] [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: 10/08/2018] [Accepted: 11/21/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Medication errors frequently occur as patients transition between hospital and the community, and may result in patient harm. Novel methods are required to address this issue. AIM To assess the feasibility of introducing an electronic patient-held active record of medication status device (PHARMS) at the primary-secondary care interface at the time of hospital discharge. DESIGN AND SETTING A mixed-methods study (non-randomised controlled intervention, and a process evaluation of qualitative interviews and non-participant observation) among patients >60 years in an urban hospital and general practices in Cork, Ireland. METHOD The number and clinical significance of errors were compared between discharge prescriptions of the intervention (issued with a PHARMS device) and control (usual care, handwritten discharge prescription) groups. Semi-structured interviews were conducted with patients, junior doctors, GPs, and IT professionals, in addition to direct observation of the implementation process. RESULTS In all, 102 patients were included in the final analysis (intervention n = 41, control n = 61). Total error number was lower in the intervention group (median 1, interquartile range [IQR] 0-3) than in the control group (median 8, IQR (4-13.5, P<0.001), with the clinical significance score in the intervention group also being lower than the control group (median 2, IQR 0-4 versus median 11, IQR 5-20, P<0.001). The PHARMS device was found to be technically implementable using existing information technology infrastructure, and acceptable to all key stakeholders. CONCLUSION The results suggest that using PHARMS devices within existing systems in general practice and hospitals is feasible and acceptable to both patients and doctors, and may reduce medication error.
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Zirpe KG, Seta B, Gholap S, Aurangabadi K, Gurav SK, Deshmukh AM, Wankhede P, Suryawanshi P, Vasanth S, Kurian M, Philip E, Jagtap N, Pandit E. Incidence of Medication Error in Critical Care Unit of a Tertiary Care Hospital: Where Do We Stand? Indian J Crit Care Med 2020; 24:799-803. [PMID: 33132563 PMCID: PMC7584841 DOI: 10.5005/jp-journals-10071-23556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Medication error in developed countries is of primary concern when there is a question of adversity to a patient's health, but in developing countries like India, it is just a term and its significance is undervalued. The incidence of medication error is essential to estimate the proper medical care provided in the healthcare system. Objective The main objective of the study is to determine the incidences of medication error in critical care unit and to evaluate its risk outcomes. Materials and methods This is a prospective observational study conducted over a period of 6 months in a critical care unit of a tertiary care hospital. Medication chart review method was opted for data collection. The medication errors were mainly classified as prescription, transcription, indenting, dispensing, and administration error. A total of 6,705 charts were reviewed. The NCCMERP risk index was used to evaluate the outcome of errors. Results Of the total 6,705 charts, 410 medication errors were found, i.e., 6.11%. The most common error is transcription error that constitutes 44.1% of the total errors, followed by prescription error 40%, and administration error 14%. The frequency of indenting and dispensing errors is negligible with 1.5% and 0.5%, respectively. The main causes of medication errors are due to incomplete prescription 50.2% and wrong doses 22.9%. In drug class, antibiotics and antihypertensive agents are most prone to medication error. About 87.1% errors belonged to the Category B of National Coordinating Council for Medication Error Reporting and Prevention risk index. Conclusion Majority of the errors are transcription errors followed by prescription and administration errors. Consultant doctors have to be more vigilant during prescribing and verifying the medication charts. Clinical pharmacists should act as a checkpoint at each step of medication process to identify and prevent medication errors. How to cite this article Zirpe KG, Seta B, Gholap S, Aurangabadi K, Gurav SK, Deshmukh AM, et al. Incidence of Medication Error in Critical Care Unit of a Tertiary Care Hospital: Where Do We Stand? Indian J Crit Care Med 2020;24(9):799–803.
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Affiliation(s)
- Kapil G Zirpe
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Bhavika Seta
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Sharvari Gholap
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Sushma K Gurav
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Abhijeet M Deshmukh
- Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Prajkta Wankhede
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Swapna Vasanth
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Mariamma Kurian
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Elizabeth Philip
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Nirmala Jagtap
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Esther Pandit
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
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Yang JH, Liao YF, Lin WB, Wu W. Prescribing errors in electronic prescriptions for outpatients intercepted by pharmacists and the impact of prescribing workload on error rate in a Chinese tertiary-care women and children's hospital. BMC Health Serv Res 2019; 19:1013. [PMID: 31888758 PMCID: PMC6936080 DOI: 10.1186/s12913-019-4843-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 12/17/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Prescribing errors may, influenced by some risk factors, cause adverse drug events. Most studies in this field focus on errors in prescriptions for hospital inpatients, with only a few on those for outpatients. Our study aimed to explore the incidence of prescribing errors in electronic prescriptions and illustrate the trend of prescribing workload and error rate over time. METHODS The cross-section study was performed between September, 2015 and November, 2015. Prescribing errors were intercepted by pharmacists using a prescription reviewing system under which prescriptions with errors were transferred to a specific computer and recorded by another pharmacist and the incidence of total prescribing errors and severe errors was then calculated. A subgroup analysis was conducted in accordance to the number of drug orders, the age group of patients, the seniority of physicians, the specialty of physicians, the working day when prescriptions were issued, and the prescribing workload of physicians. A time-series analysis was employed to analyze the trend of prescribing workload and error rate, and the correlation between them. RESULTS Totally, 65,407 patients were included in this study and 150,611 prescriptions with 294,564 drug orders (including 584 different drugs) were reviewed for identification of errors. A total of 534 prescribing errors (an error rate of 0.34%) were identified. Severe errors accounted for 13.62% of total errors. The subgroup analysis showed prescriptions of multiple drug orders, for pediatric patients aged 29 days to 12 years, from physicians specializing in ophthalmology and otorhinolaryngology, or prescribing on weekdays were more susceptible to errors. A time-series analysis demonstrated no correlation between prescribing workload and error rate which increased at the end of each working shift while prescribing workload decreased. CONCLUSION Less than 1% of the studied prescriptions came with errors among which one in seven were severe ones. But prescribing errors were in no relation to workloads. What's more, further studies are needed to investigate pharmacist-led intervention to reduce prescribing errors.
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Affiliation(s)
- Jian-Hui Yang
- Department of Pharmacy, Women and Children's Hospital, School of Medicine, Xiamen University, No. 10 Zhenhai Road, Xiamen, 361001, China.
| | - Yu-Fang Liao
- Department of Pharmacy, Women and Children's Hospital, School of Medicine, Xiamen University, No. 10 Zhenhai Road, Xiamen, 361001, China
| | - Wu-Bin Lin
- Department of Pharmacy, Women and Children's Hospital, School of Medicine, Xiamen University, No. 10 Zhenhai Road, Xiamen, 361001, China
| | - Wen Wu
- Department of Pharmacy, Women and Children's Hospital, School of Medicine, Xiamen University, No. 10 Zhenhai Road, Xiamen, 361001, China
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Tran T, Johnson DF, Balassone J, Tanner F, Chan V, Garrett K. Effect of an integrated clinical pharmacy service with the general medical units on patient flow and medical staff satisfaction: a pre‐ and postintervention study. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Tim Tran
- Pharmacy Department Austin Health Melbourne Australia
- Centre for Medicine Use and Safety Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Douglas Forsyth Johnson
- Department of General Medicine Austin Health Melbourne Australia
- Department of Medicine Austin Health The University of Melbourne Melbourne Australia
| | | | | | - Vincent Chan
- Pharmacy Department Austin Health Melbourne Australia
- Discipline of Pharmacy School of Health and Biomedical Sciences RMIT University Bundoora, Melbourne Australia
| | - Kent Garrett
- Pharmacy Department Austin Health Melbourne Australia
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