Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 5 de 5
Filtrar
1.
Int J Health Care Qual Assur ; 31(6): 531-544, 2018 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-29954263

RESUMO

Purpose The purpose of this paper is to explore the implications of registered nurses' (RNs) use of a computerized decision support system (CDSS) in medication reviews. Design/methodology/approach The paper employs a quasi-experimental, one-group pre-test/post-test design with three- and six-month follow-ups subsequent to the introduction of a CDSS. In total, 11 RNs initiated and prepared a total of 54 medication reviews. The outcome measures were the number of drug-related problems (DRPs) as reported by the CDSS and the RNs, respectively, the RNs' views on the CDSS, and changes in the quality of drug treatment. Findings The CDSS significantly indicated more DRPs than the RNs did, such as potential adverse drug reactions (ADRs). The RNs detected additional problems, outside the scope of the CDSS, such as lack of adherence. They considered the CDSS beneficial and wanted to continue using it. Only minor changes were found in the quality of drug treatments, with no significant changes in the drug-specific quality indicators (e.g. inappropriate drugs). However, the use of renally excreted drugs in reduced renal function decreased. Practical implications The RNs' use of a CDSS in medication reviews is of value in detecting potential ADRs and interactions. Yet, in order to have an impact on outcomes in the quality of drug treatment, further measures are needed. These may involve development of inter-professional collaboration, such as established procedures for the implementation of medication reviews, including the use of CDSS. Originality/value This is, to the best of the authors' knowledge, the first study to explore the implications of medication reviews, initiated and prepared by RNs who use a CDSS. The paper adds further insight into the RNs' role in relation to quality of drug treatments.


Assuntos
Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Recursos Humanos de Enfermagem/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Interações Medicamentosas , Feminino , Humanos , Prescrição Inadequada/estatística & dados numéricos , Masculino , Adesão à Medicação/estatística & dados numéricos , Erros de Medicação/prevenção & controle , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem/psicologia , Polimedicação , Suécia
2.
Pharmacoepidemiol Drug Saf ; 26(3): 335-343, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28071845

RESUMO

PURPOSE: To investigate how reporting of adverse drug reactions (ADRs) among adults in Sweden is associated to age and sex, in addition to seriousness of the reaction and drug utilisation. METHODS: Individual case safety reports (ICSRs) reported by healthcare professionals to the national pharmacovigilance database 2008-2011 were related to defined daily dose (DDD) in the Swedish Prescribed Drug Register (SPDR) for individual's ≥20 years. Data were stratified into five age groups. Crude and adjusted (by age standardisation of prescribed drugs) reporting rate (RR) and reporting rate ratio was evaluated as well as impact of sex-dependent drugs. RESULTS: Based on 9898 included ICSRs, the crude results show that overall RR was almost similar for both serious and non-serious reports and indicates highest RR in the youngest age group. Women had higher rates than men, with predominance for non-serious reports, contrary to men who had a higher RR of serious ones. Standardisation led partly to the same result, but age-related distribution was adjusted, with highest overall RR in the oldest age groups. Sex-dependent drugs had marginal impact on the results. CONCLUSION: Age and sex have impact on spontaneous reporting of ADRs. After adjusting for dispensed drugs and by standardisation of age-related differences in prescribed drugs, results indicate that healthcare professionals more frequently reported ADRs for the oldest individuals and for women. Serious reports were more frequently reported for men. Copyright © 2017 John Wiley & Sons, Ltd.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Farmacovigilância , Medicamentos sob Prescrição/efeitos adversos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medicamentos sob Prescrição/administração & dosagem , Fatores Sexuais , Suécia/epidemiologia , Adulto Jovem
3.
J Nurs Manag ; 25(1): 56-64, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27620980

RESUMO

AIM: To describe variations in nurses' perceptions of using a computerised decision support system (CDSS) in drug monitoring. BACKGROUND: There is an increasing focus on incorporating informatics into registered nurses' (RNs) clinical practice. Insight into RNs' perceptions of using a CDSS in drug monitoring can provide a basis for further development of safer practices in drug management. METHOD: A qualitative interview study of 16 RNs. Data were analysed using a phenomenographic approach. RESULTS: The RNs perceived a variety of aspects of using a CDSS in drug monitoring. Aspects of 'time' were evident, as was giving a 'standardisation' to the clinical work. There were perceptions of effects of obtained knowledge and 'evidence' and the division of 'responsibilities' between RNs and physicians of using the CDSS. CONCLUSION: The RNs perceived a CDSS as supportive in drug monitoring, in terms of promoting standardised routines, team-collaboration and providing possibilities for evidence-based clinical practice. IMPLICATIONS: Implementing a CDSS seems to be one feasible strategy to improve RNs' preconditions for safe drug management. Nurse managers' engagement and support in this process are vital for a successful result.


Assuntos
Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Monitoramento de Medicamentos/métodos , Enfermeiras e Enfermeiros/psicologia , Casas de Saúde/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Informática em Enfermagem/instrumentação , Informática em Enfermagem/métodos , Pesquisa Qualitativa
4.
Scand J Prim Health Care ; 34(1): 37-45, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26846298

RESUMO

OBJECTIVE: To explore registered nurses' experience of medication management in municipal care of the elderly in Sweden, with a focus on their pharmacovigilant activities. DESIGN: A qualitative approach using focus-group discussions was chosen in order to provide in-depth information. Data were analysed by qualitative content analysis. SETTING: Five focus groups in five different long-term care settings in two regions in Sweden. SUBJECT: A total of 21 registered nurses (RNs), four men and 17 women, aged 27-65 years, with 4-34 years of nursing experience. RESULTS: The findings reveal that RNs in municipal long-term care settings can be regarded as "vigilant intermediaries" in the patients' drug treatments. They continuously control the work of staff and physicians and mediate between them, and also compensate for existing shortcomings, both organizational and in the work of health care professionals. RNs depend on other health care professionals to be able to monitor drug treatments and ensure medication safety. They assume expanded responsibilities, sometimes exceeding their formal competence, and try to cover for deficiencies in competence, experience, accessibility, and responsibility-taking. CONCLUSION: The RNs play a central but also complex role as "vigilant intermediaries" in the medication monitoring process, including the issue of responsibility. Improving RNs' possibility to monitor their patients' drug treatments would enable them to prevent adverse drug events in their daily practice. New strategies are justified to facilitate RNs' pharmacovigilant activities. KEY POINTS: This study contributes to the understanding of registered nurses' (RNs') role in medication management in municipal care of the elderly (i.e. detecting, assessing, and preventing adverse drug events or any drug-related problems). RNs can be considered to be "vigilant intermediaries" in elderly patients' drug treatments, working at a distance from staff, physicians, and patients. RNs occasionally take on responsibilities that exceed their formal competence, with the patients' best interests in mind. In order to prevent adverse drug events in municipal care of the elderly, new strategies are justified to facilitate RNs' pharmacovigilant activities.


Assuntos
Monitoramento de Medicamentos , Enfermagem Geriátrica , Serviços de Saúde para Idosos , Assistência de Longa Duração , Enfermeiras e Enfermeiros , Papel Profissional , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Farmacovigilância , Pesquisa Qualitativa
5.
J Eval Clin Pract ; 21(1): 145-52, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25327625

RESUMO

RATIONALE, AIMS AND OBJECTIVES: Adverse drug reactions (ADRs) represent a major health problem and previous studies show that nurses can have an active role in promoting medication safety. The aim of this study was to describe and evaluate nurses' self-reported competence and pharmacovigilant activities in clinical practice and also to explore the impact of age, education, workplace and nursing experience on these matters. METHODS: This cross-sectional study was based on a questionnaire covering areas related to nurses' medication competence, including knowledge, assessment and information retrieval, and pharmacovigilant activities within these areas, for example, the detection and assessment of ADRs. A 45-item questionnaire was 2013 sent out to 296 nurses in different settings and counties in Sweden. They were selected on the basis of having applied to a university course including pharmacovigilance during 2008-2011. One hundred twenty-four had participated in the courses (exposed) and 172 had applied to the courses but not participated (unexposed). RESULTS: Completed questionnaires were obtained from 75 exposed (60%) and 93 unexposed (54%) nurses. Overall nurses rated themselves high in medication competence but low in pharmacovigilant activities. Significant (P ≤ 0.001) differences between groups were observed regarding medication competence. The exposure of completed dedicated courses in pharmacovigilance was the strongest factor for self-reported medication competence when adjusted for age, other education, workplace and experience. No significant differences between the groups were found regarding the number of pharmacovigilant activities during the 6 months prior to answering the questionnaire. CONCLUSION: Dedicated university courses improved nurses' self-reported competence in pharmacovigilance but did not increase the number of related activities. Education per se seems to be not sufficient to generate pharmacovigilant activities among nurses.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/organização & administração , Competência Clínica , Erros de Medicação/prevenção & controle , Enfermeiras e Enfermeiros/estatística & dados numéricos , Autorrelato , Adulto , Idoso , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Autoeficácia , Suécia , Local de Trabalho
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA