Educational interventions to reduce nurse medication interruptions: A scoping review.

BACKGROUND: Preventable harm from medicines is a global problem creating huge economic and social burden. Interruptions occur frequently in clinical environments causing medication episodes to take longer and having a cognitive cost on the nurse. AIM: The aim of this scoping review is to identify and evaluate educational interventions that have been employed to reduce medication interruptions and improve medication safety. METHODS: Six databases were searched for the scoping review (PubMed, Embase, Cochrane Library, CINAHL, Pishin and Medline) along with reference lists and grey literature searches. Articles were included if they were written in English, published between 2010 and 2020 and employed an education intervention (including bundled interventions). Databases were searched using keywords and Boolean operators. RESULTS: Eight studies met the inclusion criteria. Seven of these studies were conducted in hospital (adults n = 6, paediatric n = 1) and one study in a university with undergraduate nurses. Four studies used a combined intervention and four exclusively employed an education intervention. Five studies found a significant decrease in the number of interruptions post intervention, but one of the studies that exclusively employed an education intervention found no significant difference. Changes in the nurses' behaviour post intervention were also cited in two studies. IMPLICATIONS FOR FUTURE RESEARCH: There was a lack of exclusive education interventions, making it difficult to determine the effectiveness of education at reducing medication interruptions. This review highlights the necessity of some interruptions when performing tasks, for example, to make a nurse aware of a deteriorating patient. However, as the majority of studies used the number of interruptions to determine the effectiveness of the intervention, there is uncertainty as to whether this is the right outcome measure to use. In the future, a focus on outcome measures reflecting change in nurse behaviour may be more effective in determining the strength of an educational intervention.

Impact of a medicines helpline for patients.

OBJECTIVES: The objectives of this study were to establish what happened to patients after they contacted a hospital-based medicines helpline, to describe the nature of the calls received and to measure patient satisfaction. The study also set out to investigate whether access to patients' hospital records or local expertise was necessary to answer the calls received. METHODS: To assess what happened to patients after contact with the helpline and their satisfaction with the service, consenting callers were sent a questionnaire. To capture the nature of calls received, and investigate how often access to local knowledge was required, a retrospective analysis of calls was performed. RESULTS: Patients and their carers followed the advice given in 95.9% (n=93) of cases. Patients rated their problem as having been resolved as the most frequent outcome (52.2% n=35), followed by feeling reassured about their medicine or illness (44.8% n=30). On a 6-point rating scale (where 1 was poor and 6 was excellent) 80.2% (n=77) of respondents rated the helpline service as 6, and a further 15.6% (n=15) as 5. Patients mainly called with concerns about safety or how to take medicines and some related to discharge errors. Access to local knowledge was required in 74.5% (n=149) of cases. CONCLUSIONS: The helpline helps to reassure patients when they return home from hospital. They trust and follow the advice given, and have their medication-related problems resolved. Prompt access to patients' records or local expertise is an advantage for the successful running of the helpline.

The Impact of Lowering Haemoglobin Targets on Patterns of Erythropoiesis-Stimulating Agent Use in Patients on Haemodialysis.

BACKGROUND/AIMS: Haemoglobin (Hb) targets have been reduced in patients receiving haemodialysis (HD). We have investigated the impact of new guidance on current practices and costs. METHODS: Anaemia management in all patients undergoing thrice-weekly HD was retrospectively reviewed. Hb targets were compared against Kidney Disease: Improving Global Outcomes 2012 recommendations. The impact of new guidance was assessed by comparing anaemia parameters pre- and post-guideline publication. RESULTS: Two hundred and ninety two patients, with a mean age of 64 years were included. The Hb target range was achieved in 44% patients and was above target in 51%. In a sub-group of 230 patients, the mean Hb did not differ during Q4-2011 and Q4-2012. A reduction in erythropoiesis-stimulating agent (ESA) use was observed. ESA efficiency (Hb/ESA) increased in the later period (6.08 vs. 6.41 g/l/µg) and was associated with a 3% cost reduction. CONCLUSION: Introduction of guidelines lowering Hb targets in HD patients led to more efficient ESA usage and cost-savings. Anaemia treatment, however, remains unnecessarily aggressive in some patients. Further reductions in Hb and ESA dose are achievable.

Cardiac auscultation via simulation: a survey of the approach of UK medical schools.

BACKGROUND: A decline in clinical skills of medical students and junior doctors is well documented. We aim to determine how the 32 UK medical schools utilise simulated heart sounds to develop medical students' cardiac auscultation skills. METHODS: Representatives of all 32 UK medical schools were contacted with a survey questionnaire. Data analysis was carried out using SPSS. Continuous variables e.g. teaching group size were described using median and interquartile range (IQR). RESULTS: 27 Medical schools use a form of simulated heart sounds as a teaching method (2 representatives were unsure, 3 did not respond). This teaching is mandatory in 17 schools. Simulation-based teaching tends to be offered during 3rd year of medical training [median = 3rd year, interquartile range (IQR) 2-3]. Seven medical schools offered simulation teaching more than once. The median number of students in each session was 7.5 [IQR = 5.5-9.5]. One medical school reported that they were unsure how best to implement the heart sound simulation into the medical undergraduate curriculum. CONCLUSION: The results of our survey of all the UK medical schools suggest that heart sound simulation are used mainly as an introduction to heart murmurs rather than a tool for repetitive practice, complementing clinical experience. Most medical schools do not measure the impact of such teaching on clinical examination.