Erratum to: Patient Safety: A Deep Concern to Caregivers

The original article https://pubs.lib.umn.edu/index.php/innovations/article/view/1639 was published on 2019-02-08 .This article has been retracted by the Editor and Publisher due to the inappropriate use of previously published work. This article has been retracted: please see INNOVATIONS in pharmacy retraction policy (https://pubs.lib.umn.edu/index.php/innovations/policies).

Erratum to: Framework for Patient Safety

The original article https://pubs.lib.umn.edu/index.php/innovations/article/view/1637 was published on 2019-02-08 .This article has been retracted by the Editor and Publisher due to the inappropriate use of previously published work. This article has been retracted: please see INNOVATIONS in pharmacy retraction policy (https://pubs.lib.umn.edu/index.php/innovations/policies).

Erratum to: Extemporaneous Compounding: Selective Pharmacists with Separate Skill

The original article https://pubs.lib.umn.edu/index.php/innovations/article/view/1660 was published on 2019-02-08 .This article has been retracted by the Editor and Publisher due to the inappropriate use of previously published work. This article has been retracted: please see INNOVATIONS in pharmacy retraction policy (https://pubs.lib.umn.edu/index.php/innovations/policies).

The Excellence of Pharmacy Practice

Over the past 50 years, the role of pharmacists has evolved along with the health care needs of our population. In addition to dispensing medications and ensuring patient safety, today’s pharmacists are taking a larger role as medical counselors, educators and advocates. They are integral part of the health care team, and are among the most trusted and accessible health care professionals. This accessibility allows them to perform more patient care activities, including counseling, medication management, and preventive care screenings. Beyond the care provided to individual patients, pharmacists have expanded their reach to influence the public health of communities. A pharmacist is uniquely positioned to provide disease state management through appropriate medication therapy management that has been demonstrated to improve patient outcomes and decrease overall health care costs. This role is more important than ever as the environment is demanding new practice and payment models that are required to further optimize care and outcomes while addressing the unsustainable increases in health care costs.

Extemporaneous Compounding: Selective Pharmacists with Separate Skill

Extemporaneous compounding takes place in community and hospital pharmacies. There are usually specialist compounding pharmacies in major towns and cities, but any pharmacy may undertake compounding as long as they have appropriate facilities according to state-based legislation (e.g. allocated clean bench, specific compounding equipment). Although development is a continuous process, companies are customizing features to meet the majority of patient needs, but the very nature of the process cannot meet all patient needs. The risk-benefit ratio of using traditionally compounded medicines is favorable for patients who require specialized medications that are not commercially available, as they would otherwise not have access to suitable treatment. However, if an FDA-approved drug is commercially available, the use of an unapproved compounded drug confers additional risk with no commensurate benefit. Published reports of independent testing by the FDA, state agencies, and others consistently show that compounded drugs fail to meet specifications at a considerably higher rate than FDA-approved drugs. Compounded sterile preparations pose the additional risk of microbial contamination to patients. In the last 11 years, three separate meningitis outbreaks have been traced to purportedly 'sterile' steroid injections contaminated with fungus or bacteria, which were made by compounding pharmacies. The 2012 outbreak has resulted in intense scrutiny of pharmacy compounding practices and increased recognition of the need to ensure that compounding is limited to appropriate circumstances.

Framework for Patient Safety

A commitment on quality objectives is a crucial element of quality policy in HROs, such as hospitals and other healthcare institutions. The quality of care includes objectives related to effectiveness, efficiency, and a patient's experience. Healthcare organizations are also aware of the importance of promoting safety practices and the resiliency analysis of the clinical practice in order to improve quality. Patient Safety Culture has been defined as the product of individual and group values, attitudes, competencies, and patterns of behavior that determines their commitment, style, and proficiency with the organization's health and safety programs. The safety culture of a health center offers an indirect means for its involvement in quality. Poor involvement of professionals in safety has negative consequences for patients. Envisioning the future of patient safety is more than an academic exercise. Appealing visions can help channel human energies, set new directions, and open the doors to alternative approaches. An outside observer is struck by three characteristics that are very different from the culture of the early 21st century: a deep sense of individual and institutional accountability for safety, an emphasis on fairness and transparency, and pervasive collaboration and teamwork based on mutual respect. Speaking up is important for patient safety, but healthcare professionals often hesitate to voice their concerns. Direct supervisors have an important role in influencing speaking up. However, good insight into the relationship between managers' behavior and employees' perceptions about whether speaking up is safe and worthwhile is still lacking. The evaluation should cover the following areas in both instruments: strategy (inquiry on their commitment to the quality and safety strategy, indicators' feedback, and risks maps), support systems for clinical decisions (digital record algorithms to make decisions and for accessibility to patient clinical information), equipment (adequacy), follow-up (availability of tests when needed), person-centered care (respect of patients' values and preferences), evidence-based practice (practices in accordance with guidelines), delays (on scheduled tests, surgery, and outpatient care), and cost-effective treatments (adequacy).

Patient Compliance: Fact or Fiction?

The word ‘compliance' comes from the Latin word complire, meaning to fill up and hence to complete an action, transaction, or process and to fulfil a promise. In the Oxford English Dictionary, the relevant definition is ‘The acting in accordance with, or the yielding to a desire, request, condition, direction, etc.; a consenting to act in conformity with; an acceding to; practical assent”. Compliance with therapy is simply patients understanding of medication, motivation toward having this medication is a prescribed manner with the belief that the prescriber and prescribed medicine will be beneficial for his well-being. Although this is often the case, in a number of situations, the physician and pharmacist have not provided the patient with adequate instructions or have not presented the instructions in such a manner that the patient understands them. Nothing should be taken for granted regarding the patient's understanding of how to use medication, and appropriate steps must be taken to provide patients with the information and counseling necessary to use their medications as effectively and as safely as possible. 20% to 30% of new prescriptions are never filled at the pharmacy. Medication is not taken as prescribed 50% of the time. For patients prescribed medications for chronic diseases, after six months, the majority take less medication than prescribed or stop the medication altogether. There are both federal and state laws that make using or sharing prescription drugs illegal. If someone take a pill that was prescribed to someone else or give that pill to another person, not only is it against the law, it's extremely dangerous.

The New Era of Pharmacists in Ambulatory Patient Care

Pharmacy is evolving from a product-oriented to a patient-oriented profession. This role modification is extremely healthy for the patient, the pharmacist, and other members of the health-care team. However, the evolution will present pharmacists with a number of new challenges. Now, more than in the past, pharmacists must make the acquisition of contemporary practice knowledge and skills a high priority, to render the level of service embodied in the concept of pharmaceutical care. Pharmacy educators' organizations and regulatory bodies must all work together to support pharmacists as they assume expanded health-care roles. Pharmacy and the healthcare industry must work to ensure that the pharmacist is compensated justly for all services. But before this can happen it will be necessary for pharmacy to demonstrate value-added to the cost of the prescription. Marketing of the purpose of pharmacy in the health-care morass and of the services provided by the pharmacist is needed to generate an appropriate perceived value among purchasers and users of health-care services. Pharmacists should view themselves as dispensers of therapy and drug effect interpretations as well as of drugs themselves. Service components of pharmacy should be identified clearly to third party payers and be visible to consumers, so that they know what is available at what cost and how it may be accessed. In the future, pharmacy services must be evaluated on patient outcome (i.e., pharmaceutical care) rather than the number of prescriptions dispensed, and pharmacy must evolve toward interpretation and patient consultation, related to the use of medication technologies.

Pharmacists in Critical Care

The beginnings of caring for critically ill patients date back to Florence Nightingale's work during the Crimean War in 1854, but the subspecialty of critical care medicine is relatively young. The first US multidisciplinary intensive care unit (ICU) was established in 1958, and the American Board of Medical Subspecialties first recognized the subspecialty of critical care medicine in 1986. Critical care pharmacy services began around the 1970s, growing in the intervening 40 years to become one of the largest practice areas for clinical pharmacists, with its own section in the SCCM, the largest international professional organization in the field. During the next decade, pharmacy services expanded to various ICU settings (both adult and pediatric), the operating room, and the emergency department. In these settings, pharmacists established clinical practices consisting of therapeutic drug monitoring, nutrition support, and participation in patient care rounds. Pharmacists also developed efficient and safe drug delivery systems with the evolution of critical care pharmacy satellites and other innovative programs. In the 1980s, critical care pharmacists designed specialized training programs and increased participation in critical care organizations. The number of critical care residencies and fellowships doubled between the early 1980s and the late 1990s. Standards for critical care residency were developed, and directories of residencies and fellowships were published. In 1989, the Clinical Pharmacy and Pharmacology Section was formed within the Society of Critical Care Medicine, the largest international, multidisciplinary, multispecialty critical care organization. This recognition acknowledged that pharmacists are necessary and valuable members of the physician-led multidisciplinary team. The Society of Critical Care Medicine Guidelines for Critical Care Services and Personnel deem that pharmacists are essential for the delivery of quality care to critically ill patients. These guidelines recommend that a pharmacist monitor drug regimen for dosing, adverse reactions, drug-drug interactions, and cost optimization for all hospitals providing critical care services. The guidelines also advocate that a specialized, decentralized pharmacist provide expertise in nutrition support, cardiorespiratory resuscitation, and clinical research in academic medical centers providing comprehensive critical care.

Alternative Treatments for Minor GI Ailments

About 80% of the population worldwide use a variety of traditional medicine, including herbal medicines, for the diagnosis, prevention and treatment of illnesses, and for the improvement of general well-being. Total consumer spending on herbal dietary supplements in the United States reached an estimated $8.085 billion in 2017. In addition, the 8.5% increase in total sales from 2016 is the strongest growth for these products in more than 15 years. The main reason to use herbal products in these countries is the assumption of a better tolerability compared to synthetic drugs. Whereas in developing countries herbal medicines are mostly the only available and affordable treatment option. Surveys from industrialized countries reveal as main health areas in which herbal products are used for upper airway diseases including cough and common cold; other leading causes are gastrointestinal, nervous and urinary complaints up to painful conditions such as rheumatic diseases, joint pain and stiffness. Gastrointestinal disorders are the most widespread problems in health care. Many factors may upset the GI tract and its motility (or ability to keep moving), including: eating a diet low in fiber; lack of motion or sedentary lifestyle; frequent traveling or changes in daily routine; having excessive dairy products; anxiety and depression; resisting the urge to have a bowel movement habitually or due to pain of hemorrhoids; misuse of laxatives (stool softeners) that, over time, weaken the bowel muscles; calcium or aluminum antacids, antidepressants, iron pills, narcotics; pregnancy. About 30% to 40% of adults claim to have frequent indigestion, and over 50 million visits are made annually to ambulatory care facilities for symptoms related to the digestive system. Over ten million endoscopies and surgical procedures involving the GI tract are performed each year. Community-based studies from around the world demonstrate that 10% to 46% of all children meet the criteria for RAP. Gastrointestinal disorders such as chronic or acute diarrhea, malabsorption, abdominal pain, and inflammatory bowel diseases can indicate immune deficiency, present in 5% to 50% of patients with primary immunodeficiencies. The gastrointestinal tract is the largest lymphoid organ in the body, so it is not surprising that intestinal diseases are common among immunodeficient patients. Gastroenterologists therefore must be able to diagnose and treat patients with primary immunodeficiency. Further, pathogens do influence the gut function. On the other hand, dietary habits and specific food types can play a significant role in the onset, treatment, and prevention of many GI disorders. Many of these can be prevented or minimized by maintaining a healthy lifestyle, and practicing good bowel habits.

A Comprehensive Review of Acne Vulgaris

Acne, also known as acne vulgaris (AV), is a long-term skin disease that occurs when hair follicles are clogged with dead skin cells and oil from the skin. It is characterized by blackheads or whiteheads, pimples, oily skin, and possible scarring. An intact stratum corneum and barrier, normal natural moisturizing factor and hyaluronic acid levels, normal Aquaporin-3 (AQP3) expression (localized at the basal lateral membranes of collecting duct cells in the kidney), and balanced sebum secretion are qualities of the skin that fall in the middle of the oily–dry spectrum. Patients rarely, if ever, complain about reduced sebum production, but elevated sebum production, yielding oily skin that can be a precursor to acne, is a common complaint. Several factors are known to influence sebum production. AV is mostly triggered by Propionibacterium acnes in adolescence, under the influence of normal circulating dehydroepiandrosterone (DHEA). It is a very common skin disorder which can present with inflammatory and noninflammatory lesions chiefly on the face but can also occur on the upper arms, trunk, and back. Age, in particular, has a significant and well-known impact, as sebum levels are usually low in childhood, rise in the middle-to-late teen years, and remain stable into the seventh and eighth decades until endogenous androgen synthesis dwindles. Sebum, the oily secretion of the sebaceous glands containing wax esters, sterol esters, cholesterol, di- and triglycerides, and squalene, imparts an oily quality to the skin and is well known to play an important role in acne development. Acne can’t be prevented or cured, but it can be treated effectively. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up. Depending on its severity, acne can cause emotional distress and scar the skin. Acne may cause scarring of the skin, but generally causes no long-term health problems. In self-body image, some parts of the body including face play an important role. Existence of even a minor lesion in this part may be unpleasant for the patient and seems large. This image can cause mental disorders including depression and anxiety, low self-esteem, and decrease in social relationships. However, high levels of anxiety and depression in patients with facial acne are not related to oxidative stress, according to a study published online in the Journal of Cosmetic Dermatology

Medication Risk Management

Historically, the FDA has interpreted the requirement that a drug must be “safe” to mean that the benefits of a drug outweigh its risks. The determination was made on a “categorical” basis, where the totality of risks was weighted against the totality of benefits when considered for the purposes outlined in the drug product’s labeling. If a drug did not meet this criterion, it was not approved or its label was rewritten to narrow the conditions for use. This logic was endemic in the FDA for most of the 20th century. On average, two to four drugs over each 5-year period were withdrawn from the marketplace after post-marketing surveillance data uncovered new risks. Similarly, on occasion, the FDA would require some special “tool” or intervention to improve a product’s safety profile. Harm associated with medication remains the second most common type of incident in hospitals, as reported by the Clinical Excellence Commission. Health services actively review medication safety. The vast majority of medication errors result in no injury.  A minor injury may result, for example, in a patient needing an increased level of monitoring.  Even if incidents result in minor injury, managers and staff still take any errors very seriously, reviewing the actions around the incident and making improvements as a result. FDA’s new concepts for risk management amount to a “cultural shift” in the logic of drug approval and the FDA’s role. The key events that led to this change can be traced to a series of reports that highlighted the need for improved medical safety. In 1999, the IOM released a report entitled, “To Err is Human.” This report reviewed the nature and cause of medication errors, estimating that up to 98,000 people died each year due to these errors. In their assessment, the IOM included both adverse drug reactions and human errors in drug administration. The report captured the attention of news reporters and the government. Headlines proclaimed alarm at the larger number of fatalities caused by medical errors. Consequently, there was a government-wide initiative started to develop methods and institute procedures to reduce medical errors. Statements made by FDA officials regarding some of these withdrawals suggested that the FDA no longer believed that passive oversight and re-labeling drugs with new warnings was sufficient. Furthermore, the FDA no longer believed that it was sufficient to identify safe conditions of use in the label and that healthcare professionals and patients had to comply with advocated directions of use for the drug to remain on the market.   Article Type: Commentary

Patient Safety: A Deep Concern to Caregivers

Patient safety is a global concern and is the most important domains of health-care quality. Medical error is a major patient safety concern, causing increase in health-care cost due to mortality, morbidity, or prolonged hospital stay. A definition for patient safety has emerged from the health care quality movement that is equally abstract, with various approaches to the more concrete essential components. Patient safety was defined by the IOM as “the prevention of harm to patients.” Emphasis is placed on the system of care delivery that prevents errors; learns from the errors that do occur; and is built on a culture of safety that involves health care professionals, organizations, and patients. Patient safety culture is a complex phenomenon. Patient safety culture assessments, required by international accreditation organizations, allow healthcare organizations to obtain a clear view of the patient safety aspects requiring urgent attention, identify the strengths and weaknesses of their safety culture, help care giving units identify their existing patient safety problems, and benchmark their scores with other hospitals.   Article Type: Commentary