Alternative mechanisms for delivery of medication in South Africa: A scoping review.

BACKGROUND: The number of people in South Africa with chronic conditions is a challenge to the health system. In response to the coronavirus infection, health services in Cape Town introduced home delivery of medication by community health workers. In planning for the future, they requested a scoping review of alternative mechanisms for delivery of medication to patients in primary health care in South Africa. METHODS: Databases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Data was analysed both quantitatively and qualitatively. RESULTS: A total of 4253 publications were identified and 26 included. Most publications were from the last 5 years (n = 21), research (n = 24), Western Cape (n = 15) and focused on adherence clubs (n = 17), alternative pick-up-points (n = 14), home delivery (n = 5) and HIV (n = 17). The majority of alternative mechanisms were supported by a centralised dispensing and packaging system. New technology such as smart lockers and automated pharmacy dispensing units have been piloted. Patients benefited from these alternatives and had improved adherence. Available evidence suggests alternative mechanisms were cheaper and more beneficial than attending the facility to collect medication. CONCLUSION: A mix of options tailored to the local context and patient choice that can be adequately managed by the system would be ideal. More economic evaluations are required of the alternatives, particularly before going to scale and for newer technology.

Survey on the situation of telepharmacy as applied to the outpatient care in hospital pharmacy departments in Spain during the COVID-19 pandemic.

OBJECTIVE: To analyze the status of the implementation and development of  telepharmacy as applied to the pharmaceutical care of outpatients treated at  hospital pharmacy services in Spain during the COVID-19 pandemic. METHOD: Six weeks after the beginning of the confinement period, an online 10- question survey was sent to all members of the Spanish Society of Hospital  Pharmacists. A single response per hospital was requested. The survey included  questions on the provision of remote pharmaceutical care prior to the onset of  the health crisis, patient selection criteria, procedures for home delivery of  medications and the means used to deliver them, the number of patients who  benefited from telepharmacy, and the number of referrals made. Finally,  respondents were asked whether a teleconsultation was carried out before  sending patients their medication and whether these deliveries were recorded. RESULTS: A total of 39.3% (n = 185) of all the hospitals in the National Health  System (covering all of Spain's autonomous regions) responded to the survey.  Before the beginning of the crisis, 83.2% (n = 154) of hospital pharmacy  services did not carry out remote pharmaceutical care activities that included  telepharmacy with remote delivery of medication. During the study period,  119,972 patients were treated, with 134,142 deliveries of medication being  completed. Most hospitals did not use patient selection criteria. A total of 30.2%  of hospitals selected patients based on their personal circumstances. Home  delivery and informed delivery (87%; 116,129 deliveries) was the option used in most cases. The means used to deliver the medication mainly included the use  of external courier services (47.0%; 87 hospitals) or the hospital's own transport services (38.4%; 71 hospitals). As many as 87.6% of hospitals carried out  teleconsultations prior to sending out medications and 59.6% recorded their  telepharmacy activities in the hospital pharmacy appointments record. CONCLUSIONS: The rate of implementation of telepharmacy in outpatient care in  Spain during the study period in the pandemic was high. This made it possible to guarantee the continuity of care for a large number of patients.

Objetivo: Analizar la situación de la implantación y desarrollo de la telefarmacia aplicada a la atención farmacéutica a pacientes externos de los servicios de  farmacia hospitalaria en España durante la pandemia por la COVID-19.Método: Se envió una encuesta online de 10 preguntas a todos los socios de la  Sociedad Española de Farmacia Hospitalaria a las seis semanas del inicio del  periodo de confinamiento por la pandemia. Se solicitó una única respuesta por  hospital. Se incluyeron preguntas sobre la realización de atención farmacéutica  no presencial con dispensación a distancia previa al inicio de la crisis sanitaria,  los criterios de selección de pacientes, los procedimientos de envío de  medicación y los medios utilizados, el número de pacientes que se han  beneficiado de la telefarmacia y el número de envíos realizados. Por último, se  identificó la realización o no de teleconsulta previa al envío de medicación y si la  actividad quedó registrada.Resultados: Un 39,3% (n = 185) del total de hospitales públicos del Sistema  Nacional de Salud pertenecientes a todas las comunidades autónomas  respondieron a la encuesta. El 83,2% (n = 154) de los servicios de farmacia  hospitalarios no realizaban actividades de atención farmacéutica no presencial  con telefarmacia que incluyeran envío de medicación antes del inicio de la crisis  sanitaria. En el periodo de estudio se atendieron 119.972 pacientes y se  realizaron 134.142 envíos de medicación. La mayoría de los hospitales no  utilizaron criterios de selección de pacientes. El 30,2% de los centros  seleccionaron en función de las circunstancias personales del paciente. La  dispensación domiciliaria y entrega informada (87%; 116.129 envíos) fue la  opción utilizada de forma mayoritaria para el envío. Los medios para hacer llegar la medicación fueron, principalmente, la mensajería externa (47%; 87 centros) o medios propios del hospital (38,4%; 71 centros). Un 87,6% de los hospitales realizaron teleconsulta previa al envío de medicación y el 59,6% registró la actividad de telefarmacia en la agenda de citación. Conclusiones: La implantación de la telefarmacia aplicada a la atención a  pacientes externos en España durante la pandemia ha sido elevada. Así se ha  podido garantizar la continuidad de los tratamientos de un elevado número de  pacientes.

Are medications safely used by residents in elderly care homes? - A multi-centre observational study from Sri Lanka.

BACKGROUND: Most residents in elderly care homes in Sri Lanka do not receive formal, on-site, patient care services. OBJECTIVE: To evaluate the appropriateness of prescribing, dispensing, administration, and storage practices of medication used by residents in selected elderly care homes in Colombo District, Sri Lanka. METHODOLOGY: This was a prospective, cross-sectional, multi-center study of 100 residents with chronic, non-communicable diseases, who resided in nine selected elderly care homes in Sri Lanka. Medication histories were obtained from each resident/caregiver and the appropriateness of medications in their current prescription was reviewed using standard treatment guidelines. Prescriptions were cross-checked against respective dispensing labels to identify dispensing errors. Medication administration was directly observed on two separate occasions per resident for accuracy of administration, and matched against the relevant prescription instructions. Medication storage was also observed in terms of exposure to temperature and sunlight, the suitability of container, and adequacy of separation if using multiple medications. RESULTS: The mean age of residents was 70±10.5 years and the majority were women (72%). A total of 168 errors out of 446 prescriptions were identified. The mean number of prescribing errors per resident was 1.68±1.23 [median, 2.00 (1.00-3.00)]. Inappropriate dosing frequencies were the highest (37.5%;63/168), followed by missing or inappropriate medications (31.5%;53/168). The mean number of dispensing errors per resident was 15.9±13.1 [median, 14.0 (6.00-22.75)] with 3.6 dispensing errors per every medication dispensed. Mean administration errors per resident was 0.95±1.5 [median, 0.00 (0.00-1.00)], with medication omissions being the predominant error (50.5%;48/95). Another lapse was incorrect storage of medications (143 storage errors), and included 83 medications not properly separated from each other (58.0%). CONCLUSION: Multiple errors related to prescribing, dispensing, administration, and storage were identified amongst those using medication in elderly care homes. Services of a dedicated consultant pharmacist could improve the quality of medication use in elderly care homes in Sri Lanka.

The social implications of participant choice on adherence to Isonaizid Preventive Therapy (IPT): A follow-up study to high completion rates in Eswatini.

BACKGROUND: Eswatini (formerly Swaziland) has one of the highest rates of TB and HIV co-disease in the world. Despite national efforts to improve service delivery and prevent TB and HIV transmission, rates remain high. A recent prospective, observational study of integrated, patient-selected IPT delivery showed extraordinary improvements in IPT adherence, running counter to previous assumptions. This prompted the need to understand contextual and unseen study factors that contributed to high rates of adherence. OBJECTIVE: To investigate high rates of IPT adherence rates among people living with HIV who participated in an observational study comparing modes of IPT delivery. METHODS: Community-based participatory research guided the development of in-person administration of semi-structured questionnaires. Observational and field note data were analyzed. Qualitative data were analyzed using content analysis. RESULTS: We interviewed 150 participants and analyzed responses from the 136 who remembered being given a choice of their IPT delivery method. Fifty-seven percent were female and the median age was 42. Nearly 67% of participants chose to receive facility-based IPT. High rates of self-reported IPT treatment adherence were linked to four key concepts: 1) adherence was positively impacted by community education; 2) disclosure of status served to empower participant completion; 3) mode of delivery perceptions positively impacted adherence; and 4) choice of treatment delivery seen as helpful but not essential for treatment completion. DISCUSSION: Achieving higher rates of IPT adherence in Eswatini and similar rural areas requires community-engaged education and outreach in coordination with care delivery systems.

[Prospective risk analysis in a retrocession unit: Focus on drug dispensation process]. / Analyse des risques a priori en unité de rétrocession hospitalière : focus sur le processus de dispensation.

OBJECTIVES: Failure mode effect analysis (FMEA) improves safety in the drug life cycle. As the drug dispensation by hospital's pharmacy can be at risk, the FMEA tool has been used to evaluate and enhance the process. METHODS: After detailing the process, a first FMEA has been run in 2015. Corrective actions were implemented every time criticality indexes (CI) were above 15. One year later, we have evaluated potential impacts of these actions by running a new FMEA. RESULTS: In 2015, 11 failure modes were prioritized (CI>15) and the total CI for the overall process was 397. Corrective actions were implemented and one year later this amount has decreased by 14% (340) with 6 failure modes still prioritized. Thus, thanks to the FMEA, risks could be identified in year "y", they were taken into account and corrected and then effectively reassessed in year "y+1". CONCLUSION: This study showed us the interest of performing FMEA analysis in the drug dispensation process by hospital. The renewal of this risk analysis after a year helped us to monitor corrective actions, to evaluate their effectiveness and to improve safety. Finally, FMEA seems to be an effective way to steer the drug dispensation process.

Improving drug safety in hospitals: a retrospective study on the potential of adverse drug events coded in routine data.

BACKGROUND: Adverse drug events (ADEs) that occur during hospitalization are an ongoing medical concern. Systematic strategies for ADE identification are lacking. The aim of this study was to evaluate the potential to identify adverse drug events caused by medication errors (preventable ADEs, pADEs), and previously unknown adverse drug reactions (ADRs or non-preventable ADEs, npADEs) in inpatients by combining diagnosis codes in routine data with a chart review. METHODS: Diagnoses of inpatients are routinely coded using the International Classification of Diseases, 10th Revision (ICD-10). A total of 2326 cases were sampled from routine data of four hospitals using a set of ICD-10 German Modification ADE codes. Following a chart review, cases were evaluated in a standardized process with regard to drug relation and preventability of events. RESULTS: By chart review, 1302 cases were classified as hospital-acquired and included in the evaluation. This yielded 1285 cases indicating an ADE. 96.8% of ADEs (1244 ADEs) were classified as known npADEs, only three cases as suspected previously unknown npADEs, one case as event after drug abuse. A total of 37 ADEs were classified as preventable (2.9% of all ADEs) by identifying a medication error as probable cause. The prevalence of pADEs varied considerably between included ADE codes, with hemorrhagic diathesis due to coumarins and localized skin eruptions showing the highest rates (8.7 and 9.1%, respectively). Most frequent medication errors were non-compliance to a known allergy, and improper dose. CONCLUSIONS: When focusing on specific ADE codes, routine data can be used as markers for npADEs and medication errors, thus providing a meaningful complement to existing drug surveillance systems. However, the prevalence of medication errors is lower than in former studies on the frequency of pADEs.

Actions for safety in the prescription, use and administration of medications in emergency care units. / Ações para segurança na prescrição, uso e administração de medicamentos em unidades de pronto atendimento.

OBJECTIVE: To identify what risks and incidents related to the drug therapy process are presented in an Emergency Care Unit (UPA) and to present proposals for management actions and safe practices, in the perception of the nursing team. METHOD: Qualitative research, in the research-action modality, developed in the scenario of UPA, located in the interior of São Paulo. Data collection was done through interviews and focus groups with 33 professionals, between June 2015 and April 2016. For the data treatment, the Content Analysis Technique was used. RESULTS AND DISCUSSION: From the participants' reports, thematic categories were organized, with the risks and incidents related to the drug therapy process being one of the listed categories, as well as proposals for actions. CONCLUSION: The study allowed the implementation of patient safety actions related to the administration of drugs in a PAU, offering a higher quality of care.

Lanreotide vs octreotide LAR for patients with advanced gastroenteropancreatic neuroendocrine tumors: An observational time and motion analysis.

BACKGROUND: Lanreotide and octreotide acetate suspension for injectable (LAR) are both recommended for clinical use in patients with locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors. However, each agent possesses unique attributes in terms of their drug-delivery characteristics. The study objective was to compare overall drug-delivery efficiency between lanreotide and octreotide LAR in gastroenteropancreatic neuroendocrine tumor patients. METHODS: This study employed an observational time and motion design among patients treated with lanreotide or octreotide LAR across five US cancer centers. Baseline patient data collection included age, disease grade and duration, prior therapies and performance status. Drug-delivery time (drug preparation and administration), total patient time and resource use data were collected for gastroenteropancreatic neuroendocrine tumors receiving lanreotide (n = 22) or octreotide LAR (n = 22). Following each administration, qualitative data on the drug-delivery experience was collected from patients and nurses. RESULTS: Lanreotide was associated with a significant reduction in mean delivery time (2.5 min; 95% CI:2.0 to 3.1) compared to octreotide LAR (6.2 min; 95%CI: 4.4 to 7.9; p = 0.004). The mean total patient time for lanreotide and octreotide LAR was comparable between groups (32.1 vs. 36.6 minutes; p = 0.97). Nurses reported increased concerns with octreotide LAR related to needle clogging (p = 0.034) and device failures (p = 0.057). Overall, lanreotide had a median satisfaction score of 5.0 compared to a score of 4.0 with octreotide LAR (p = 0.03). CONCLUSIONS: Lanreotide was associated with significant reductions in drug-delivery time compared to octreotide LAR, which contributed to an improvement in overall healthcare efficiency. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03017690.

What is new in paediatric medication safety?

Medication-related errors are among the most common medical errors, and studies have shown that the paediatric population is particularly vulnerable. Errors can occur during any step in the medication process. This review article seeks to highlight new advancements in the field of paediatric medication safety at each stage of the medication process, from ordering and transcribing to medication dispensing and administration. We will focus on interventions that are increasingly widely used, such as computerised provider order entry with clinical decision support, barcoding technologies and safe medication administration through technologies pumps (SMART pumps), as well as innovative mobile application devices and workflow management systems that are being piloted at single institutions. By highlighting what is new in paediatric medication safety, as well as the gaps that remain, we hope to continue to foster focus on this critically important area in order to create the safest possible environment for children.

O processo de trabalho de um time de medicação na perspectiva de uma pesquisa-ação / The work process of a medication team from an action research perspective

Objetivou-se descrever e analisar o processo de trabalho do time de medicação na unidade de terapia intensiva neonatal. Pesquisa-ação realizada com 21 enfermeiros de uma unidade neonatal de um hospital universitário. Foram realizadas entrevistas, pesquisa documental, observação sistemática e seminários para a coleta e análise temática dos dados. O estudo apontou três categorias: dificuldades encontradas no processo de trabalho do time de medicação; caracterização dos recursos materiais e ambiente de trabalho; padronização do processo de trabalho do time de medicação. As principais barreiras apontadas foram a falta de padronização do processo de trabalho e a ausência e/ou atualização de instrumentos que subsidiam sua prática. Desta forma, a partir das ações do grupo foram elaborados os seguintes produtos: fluxograma do processo de trabalho; construção e padronização de impressos; atualização de Protocolos Operacionais Padrão e atribuições da equipe de enfermagem; padronização de material de almoxarifado, farmácia e apoio.

This study aimed to describe and analyze the work process of the medication team in a neonatal intensive care unit. This action research was carried out with the participation of 21 nurses at a university hospital neonatal unit. Interviews were conducted, along with documental research, systematic observation and workshops for data collection and thematic analysis. The study indicated three categories: difficulties encountered in the work process of the medication team; description of material resources and working environment; and standardization of the work process of the medication team. The principal barriers indicated were lack of standardization of the work process and the absence and/or updating of instruments supporting work practices. As such, the following products were elaborated from the group actions: work process flowchart; development and standardization of printouts; updating of Standard Operational Protocols and duties of the nursing team; and standardization of storeroom, pharmacy and support material.

Ações para segurança na prescrição, uso e administração de medicamentos em unidades de pronto atendimento / Acciones para la seguridad en la prescripción, consumo y administración de medicamentos en una unidad de pronta atención / Actions for safety in the prescription, use and administration of medications in emergency care units

Resumo OBJETIVO Identificar os riscos e incidentes relacionados ao processo de terapia medicamentosa no cenário de uma Unidade de Pronto Atendimento (UPA) e propor ações de gerenciamento e práticas seguras, na percepção da equipe de enfermagem. MÉTODO Pesquisa qualitativa, na modalidade pesquisa-ação, desenvolvida no cenário de uma UPA, localizada no interior de São Paulo. A coleta dos dados foi realizada por meio de entrevistas e grupos focais com 33 profissionais, entre junho de 2015 a abril de 2016. Para o tratamento dos dados utilizou-se a Técnica de Análise de Conteúdo. RESULTADOS E DISCUSSÃO A partir dos relatos dos participantes foram organizadas categorias temáticas, sendo os riscos e incidentes relacionados ao processo de terapia medicamentosa uma das categorias elencadas, assim como propostas de ações. CONCLUSÃO O estudo possibilitou a implementação de ações de segurança ao paciente relacionadas à administração de medicamentos em uma UPA, oferecendo maior qualidade do cuidado.

Resumen OBJETIVO Identificar cuáles son los riesgos e incidentes relacionados con el proceso de terapia medicamentosa en una Unidad de Pronta Atención (UPA) y presentar propuestas de acciones de gestión y prácticas seguras en la percepción del equipo de enfermería. MÉTODO Investigación cualitativa, en la modalidad investigación-acción, desarrollada en el escenario de una UPA, ubicada en el interior de San Pablo. Se recolectaron los datos a través de entrevistas y grupos focales con 33 profesionales, entre junio de 2015 y abril de 2016. Para procesar los datos, se utilizó la Técnica de Análisis de Contenido. RESULTADOS Y DISCUSIÓN A partir de los relatos de los participantes, se organizaron categorías temáticas, siendo los riesgos e incidentes relacionados al proceso de terapia medicamentosa una de las categorías enumeradas, así como las propuestas de acciones. CONCLUSIÓN El estudio permitió implementar acciones de seguridad del paciente relacionadas con la administración de medicamentos en una UPA, ofreciendo mayor calidad del cuidado.

ABSTRACT Objective: To identify what risks and incidents related to the drug therapy process are presented in an Emergency Care Unit (UPA) and to present proposals for management actions and safe practices, in the perception of the nursing team. Method: Qualitative research, in the research-action modality, developed in the scenario of UPA, located in the interior of São Paulo. Data collection was done through interviews and focus groups with 33 professionals, between June 2015 and April 2016. For the data treatment, the Content Analysis Technique was used. Results and discussion: From the participants' reports, thematic categories were organized, with the risks and incidents related to the drug therapy process being one of the listed categories, as well as proposals for actions. Conclusion: The study allowed the implementation of patient safety actions related to the administration of drugs in a PAU, offering a higher quality of care.

[From vaccine manufacturing to its availability in pharmacy]. / De la fabrication d'un vaccin à sa mise à disposition en pharmacie.

After a brief overview of vaccine industry and the regulatory requirements for biologics, the biological and pharmaceutical manufacturing of vaccine is presented. Vaccine production specificities are discussed. They show that, despite recent efforts and progress, continuously adapting vaccine supply to demand "at any time and in any place" remains a challenge, for reasons inherent in biological production, which is a production in tight flow, structurally delicate (control of the biological hazard), and weakly reactive.

Development and evaluation of an algorithm-based tool for Medication Management in nursing homes: the AMBER study protocol.

BACKGROUND: Residents of nursing homes are susceptible to risks from medication. Medication Reviews (MR) can increase clinical outcomes and the quality of medication therapy. Limited resources and barriers between healthcare practitioners are potential obstructions to performing MR in nursing homes. Focusing on frequent and relevant problems can support pharmacists in the provision of pharmaceutical care services. This study aims to develop and evaluate an algorithm-based tool that facilitates the provision of Medication Management in clinical practice. METHODS AND ANALYSIS: This study is subdivided into three phases. In phase I, semistructured interviews with healthcare practitioners and patients will be performed, and a mixed methods approach will be chosen. Qualitative content analysis and the rating of the aspects concerning the frequency and relevance of problems in the medication process in nursing homes will be performed. In phase II, a systematic review of the current literature on problems and interventions will be conducted. The findings will be narratively presented. The results of both phases will be combined to develop an algorithm for MRs. For further refinement of the aspects detected, a Delphi survey will be conducted. In conclusion, a tool for clinical practice will be created. In phase III, the tool will be tested on MRs in nursing homes. In addition, effectiveness, acceptance, feasibility and reproducibility will be assessed. The primary outcome of phase III will be the reduction of drug-related problems (DRPs), which will be detected using the tool. The secondary outcomes will be the proportion of DRPs, the acceptance of pharmaceutical recommendations and the expenditure of time using the tool and inter-rater reliability. ETHICS AND DISSEMINATION: This study intervention is approved by the local Ethics Committee. The findings of the study will be presented at national and international scientific conferences and will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: DRKS00010995.

The efficacy and stability of an information and communication technology-based centralized monitoring system of adherence to immunosuppressive medication in kidney transplant recipients: study protocol for a randomized controlled trial.

BACKGROUND: Immunosuppression non-adherence in kidney transplant recipients (KTRs) not only increases the risk of medical intervention due to acute rejection and graft loss but burdens the socioeconomic system in the form of increased healthcare costs. An aggressive preemptive effort by healthcare professionals, geared to ensure adherence to immunosuppressants in KTRs, is significant and imperative. METHODS/DESIGN: This study was designed as a prospective, open-label, multicenter, randomized controlled study aimed at evaluating the efficacy and stability of an information and communication technology (ICT)-based centralized monitoring system in boosting medication adherence in KTRs. One hundred fourteen KTRs registered throughout the year 2017 to 2018 are randomized into either the ICT-based centralized home monitoring system or to ambulatory follow-up. The planned follow-up duration is 6 months. The ICT-based centralized home monitoring system described consists of a smart pill box equipped with personal identification system, a home monitoring system, an electronic Case Report Form (eCRF) system, and a comprehensive clinical trial management system (CTMS). It alerts both patients and medical staff with texts and pill box alarms if there is a dosage/dosing time error or a missed dose. Medication adherence and transplant outcomes for the follow-up period are compared between the two groups, while patient satisfaction as well as the stability and cost-effectiveness of the ICT-based monitoring system are to be evaluated. DISCUSSION: This on-going study is expected to determine if consistent use of the ICT-based centralized monitoring system described could maximize mediation adherence and subsequently enhance transplant outcomes in KTRs. Further, it would lay the foundation for successful implementation of this ICT-based monitoring system for effective management of medication adherence in KTRs. TRIALS REGISTRATION: ClinicalTrials.gov, Identifier: NCT03136588 . Registered on 20 April 2017.

Availability and Accuracy of EMS Information about Chronic Health and Medications in Cardiac Arrest.

INTRODUCTION: Field information available to emergency medical services (EMS) about a patient's chronic health conditions or medication therapies could help direct patient care or be used to investigate outcome disparities. However, little is known about the field availability or accuracy of information of chronic health conditions or chronic medication treatments in emergent circumstances, especially when the patient cannot serve as an information resource. We evaluated the prehospital availability and accuracy of specific chronic health conditions and medication treatments among out-of-hospital cardiac arrest (OHCA) patients. METHODS: The investigation was a retrospective cohort study of adult persons suffering ventricular fibrillation OHCA treated by EMS in a large metropolitan county from January 1, 2007, to December 31, 2013. The study was designed to determine the availability and accuracy of EMS ascertainment of selected chronic health conditions and medication treatments. We evaluated chronic health conditions of "any heart disease," congestive heart failure (CHF), and diabetes and medication treatments of beta blockers and loop diuretics using two distinct sources: 1) EMS report, and 2) hospital record specific to the OHCA event. Because hospital information was considered the gold standard, we restricted the primary analysis to those who were admitted to hospital. RESULTS: Of the 1,496 initially eligible patients, 387 could not be resuscitated and were pronounced dead in the field, one patient was left alive at scene due to Physician's Orders for Life-sustaining Treatment (POLST) orders, 125 expired in the emergency department (n=125), and 983 were admitted to hospital. A total of 832 of 1,496 (55.6%) had both sources of data for comparison and comprised the primary analytic group. Using the hospital record as the gold standard, EMS ascertainment had a sensitivity of 0.79 (304/384) and a specificity of 0.88 (218/248) for any prior heart disease; sensitivity 0.45 (47/105) and specificity 0.87 (477/516) for CHF; sensitivity 0.71 (143/201) and specificity 0.98 (416/424) for diabetes; sensitivity 0.70 (118/169) and specificity 0.94 (273/290) for beta blockers; sensitivity 0.70 (62/89) and specificity 0.97 (358/370) for loop diuretics. CONCLUSION: In this cohort of OHCA, information about selected chronic health conditions and medication treatments based on EMS ascertainment was available for many patients, generally revealing moderate sensitivity and greater specificity.

The use of a contextual, modal and psychological classification of medication errors in the emergency department: a retrospective descriptive study.

AIMS AND OBJECTIVES: To describe the contextual, modal and psychological classification of medication errors in the emergency department to know the factors associated with the reported medication errors. BACKGROUND: The causes of medication errors are unique in every clinical setting; hence, error minimisation strategies are not always effective. For this reason, it is fundamental to understand the causes specific to the emergency department so that targeted strategies can be implemented. DESIGN: Retrospective analysis of reported medication errors in the emergency department. METHODS: All voluntarily staff-reported medication-related incidents from 2010-2015 from the hospital's electronic incident management system were retrieved for analysis. Contextual classification involved the time, place and the type of medications involved. Modal classification pertained to the stage and issue (e.g. wrong medication, wrong patient). Psychological classification categorised the errors in planning (knowledge-based and rule-based errors) and skill (slips and lapses). RESULTS: There were 405 errors reported. Most errors occurred in the acute care area, short-stay unit and resuscitation area, during the busiest shifts (0800-1559, 1600-2259). Half of the errors involved high-alert medications. Many of the errors occurred during administration (62·7%), prescribing (28·6%) and commonly during both stages (18·5%). Wrong dose, wrong medication and omission were the issues that dominated. Knowledge-based errors characterised the errors that occurred in prescribing and administration. The highest proportion of slips (79·5%) and lapses (76·1%) occurred during medication administration. It is likely that some of the errors occurred due to the lack of adherence to safety protocols. CONCLUSION: Technology such as computerised prescribing, barcode medication administration and reminder systems could potentially decrease the medication errors in the emergency department. There was a possibility that some of the errors could be prevented if safety protocols were adhered to, which highlights the need to also address clinicians' attitudes towards safety. RELEVANCE TO CLINICAL PRACTICE: Technology can be implemented to help minimise errors in the ED, but this must be coupled with efforts to enhance the culture of safety.

Views of patients and professionals about electronic multicompartment medication devices: a qualitative study.

OBJECTIVES: To explore the perceived acceptability, advantages and disadvantages of electronic multicompartment medication devices. DESIGN: Qualitative study using 8 focus groups and 10 individual semistructured interviews. Recordings were transcribed and analysed thematically. Strategies were employed to ensure the findings were credible and trustworthy. PARTICIPANTS AND SETTING: Community pharmacists (n=11), general practitioners (n=9), community nurses (n=12) and social care managers (n=8) were recruited from the National Health Service (NHS) and local authority services. Patients (n=15) who were current conventional or electronic multicompartment medication device users or had medication adherence problems were recruited from community pharmacies. 3 informal carers participated. RESULTS: Electronic multicompartment medication devices which prompt the patient to take medication may be beneficial for selected individuals, particularly those with cognitive impairment, but who are not seriously impaired, provided they have a good level of dexterity. They may also assist individuals where it is important that medication is taken at fixed time intervals. These are likely to be people who are being supported to live alone. No single device suited everybody; smaller/lighter devices were preferred but their usefulness was limited by the small number/size of storage compartments. Removing medications was often challenging. Transportability was an important factor for patients and carers. A carer's alert if medication is not taken was problematic with multiple barriers to implementation and no consensus as to who should receive the alert. There was a lack of enthusiasm among professionals, particularly among pharmacists, due to concerns about responsibility and funding for devices as well as ensuring devices met regulatory standards for storage and labelling. CONCLUSIONS: This study provides indicators of which patients might benefit from an electronic multicompartment medication device as well as the kinds of features to consider when matching a patient with a device. It also highlights other considerations for successful implementation including issues of responsibility, regulation and funding.

A Smartwatch-Driven Medication Management System Compliant to the German Medication Plan.

Medication adherence is an important factor for the outcome of medical therapies. To support high adherence levels, smartwatches can be used to assist the patient. However, a successful integration of such devices into clinicians' or general practitioners' information systems requires the use of standards. In this paper, a medication management system supplied with smartwatch generated feedback events is presented. It allows physicians to manage their patients' medications and track their adherence in real time. Moreover, it fosters interoperability via a ISO/IEC 16022 data matrix which encodes related medication data in compliance with the German Medication Plan specification.