Automated multi-dose dispensing in persons with and without Alzheimer's disease-impacts on pharmacotherapy.

PURPOSE: We investigated the drug use before and after transition to automated multi-dose dispensing (MDD) service among persons with Alzheimer's disease (AD) and compared whether the changes were similar in persons without AD. METHODS: The register-based Finnish nationwide MEDALZ cohort includes 70,718 community-dwelling persons diagnosed with AD during 2005-2011. Each person who initiated MDD was matched in both groups with a comparison person without MDD by age, gender and for persons with AD, also time since AD diagnosis at the start of MDD. The study cohort included 15,604 persons with AD in MDD and 15,604 no-MDD, and 5224 persons without AD in MDD and 5224 no-MDD. Point prevalence of drug use was assessed every 3 months, from 1 year before to 2 years after the start of MDD and compared between persons in MDD to those who did not have MDD. RESULTS: MDD was started on average 2.9 (SD 2.1) years after AD diagnosis. At the start of MDD, the prevalence of drug use increased especially for antipsychotics, antidepressants, opioids, paracetamol and use of ≥ 10 drugs among persons with and without AD. Prevalence of benzodiazepine use (from 12% 12 months before to 17% at start of MDD), memantine (from 29 to 46%) and ≥ 3 psychotropics (from 3.2 to 6.0%) increased among persons with AD. Decreasing trend was observed for benzodiazepine-related drugs, urinary antispasmodics and non-steroidal anti-inflammatory drugs. CONCLUSION: MDD seems to be initiated when use of psychotropics is initiated and the number of drugs increases.

Criterios de Beers para identificar el consumo de medicación potencialmente inapropiada: adaptación para su aplicación en Argentina / Beers criteria to identify the consumption of potentially inappropriate medication: adaptation for its application inArgentina

Introducción. Los Criterios de Beers son los más utilizados para evaluar el uso de medicación potencialmente inapropiada en grandes poblaciones, pero no contemplan algunos medicamentos de uso frecuente fuera de los EE.UU. Objetivo. Realizar una adaptación al contexto de Argentina de los Criterios de Beers publicados en 2019. Métodos. Fue elaborada una lista preliminar de medicación potencialmente inapropiada adaptada a la comercialización local, que luego fue consensuada por un panel de expertos (método Delphi). Resultados. De los 112 medicamentos originales listados en la tabla dos de los Criterios de Beers (en forma individual o como grupo), fueron excluidos 36 por no estar disponibles el país y fueron sumados 23 que no se comercializan en los EE.UU. pero sí en Argentina. Luego de dos rondas y de consensuar la suma a esta lista de dos grupos farmacológicos(antimigrañosos y vasodilatadores periféricos), fue acordado el agregado de picosulfato, bisacodilo, senósidos y cáscara sagrada como medicación potencialmente inapropiada en el grupo de agentes contra el estreñimiento, la fluoxetina entre los inhibidores selectivos de la recaptación de serotonina y el Ginkgo biloba como droga contra la demencia. También hubo consenso en advertir el riesgo de hipotensión ortostática asociado a la tamsulosina, en aconsejar la consideración de la carga anticolinérgica total del esquema terapéutico administrado y en recomendar al paracetamol como primera línea de tratamiento del dolor, asociado o no a opioides. Conclusiones. Contar con una versión de los Criterios de Beers 2019 adaptada al contexto de Argentina contribuirá al desarrollo y monitoreo de intervenciones para prevenir y reducir el consumo de medicación potencialmente inapropiada. (AU)

Introduction.The Beers Criteria is the most widely used criteria to assess the use of potentially inappropriate medication in large populations, but they do not include some medications that are frequently used outside the United States. Objective.To make an adaptation of the Beers Criteria published in 2019 to the context of Argentina. Methods. A preliminary list of potentially inappropriate medication adapted to local market and practice was designed, which was then agreed upon by a panel of experts (Delphi method). Results. Of the 112 original drugs in the table 2 of the Beers Criteria (individually or as a group), 36 were excluded because they were not available in Argentina and 23 locally marketed drugs but not in the US were included. After two rounds and agreeing to add two additional pharmacological groups to this list (antimigraine and peripheral vasodilators), it was decided to add picosulfate, bisacodyl, sennosides and cascara sagrada as potentially inappropriate medication in the group of anti-constipation agents, fluoxetine among. the selective serotonin reup take inhibitors and Ginkgo biloba as an anti-dementia drug. There was also consensus in warning about the risk of orthostatic hypotension associated with tamsulosin,in advising consideration of the total anticholinergic load of the therapeutic regimen administered, and in recommending paracetamol as the first line of pain treatment, associated or not with opioids. Conclusions. Having a version of the Beers Criteria 2019 adapted to the Argentine context will contribute to the development and monitoring of interventions to prevent and reduce the consumption of potentially inappropriate medication. (AU)

Storage of Medications: A Survey of Families in the Pediatric Emergency Department.

OBJECTIVES: To evaluate caregivers' practice of prescription medication storage, particularly of opioid medications, as well as to provide educational materials to families about the opioid crisis. METHODS: Caregivers of patients in a pediatric emergency department were asked to participate in a survey about medication storage practices and beliefs, focusing on opioid medications. Data were collected through a survey documenting demographic data along with knowledge and behaviors of medication storage. Brief education about the US opioid crisis and safe storage was provided. RESULTS: In total, 233 families participated; 3 families declined; 11.5% of caregivers reported storing prescribed medications in a locked or latched place, although most store them "out of reach." Most believed their child or children's friends could not easily access their medications (81.8%). Families who did not keep their medications in locked or latched places had never thought about it (39.7%). In total, 33% of respondents were unaware of the opioid crisis; 87.4% of caregivers said they would use a medication lock box if given one. CONCLUSIONS: Many caregivers are not aware of the opioid crisis and do not keep opioid medications locked up. Half of the caregivers surveyed stated they "never thought about" locking up medications. Most parents would use a lock box if given to them. This opens the door to further study, education, and interventions.

Effect of a Multifaceted Clinical Pharmacist Intervention on Medication Safety After Hospitalization in Persons Prescribed High-risk Medications: A Randomized Clinical Trial.

Importance: The National Action Plan for Adverse Drug Event (ADE) Prevention identified 3 high-priority, high-risk drug classes as targets for reducing the risk of drug-related injuries: anticoagulants, diabetes agents, and opioids. Objective: To determine whether a multifaceted clinical pharmacist intervention improves medication safety for patients who are discharged from the hospital and prescribed medications within 1 or more of these high-risk drug classes. Design, Setting, and Participants: This randomized clinical trial was conducted at a large multidisciplinary group practice in Massachusetts and included patients 50 years or older who were discharged from the hospital and prescribed at least 1 high-risk medication. Participants were enrolled into the trial from June 2016 through September 2018. Interventions: The pharmacist-directed intervention included an in-home assessment by a clinical pharmacist, evidence-based educational resources, communication with the primary care team, and telephone follow-up. Participants in the control group were provided educational materials via mail. Main Outcomes and Measures: The study assessed 2 outcomes over a 45-day posthospital discharge period: (1) adverse drug-related incidents and (2) a subset defined as clinically important medication errors, which included preventable or ameliorable ADEs and potential ADEs (ie, medication-related errors that may not yet have caused injury to a patient, but have the potential to cause future harm if not addressed). Clinically important medication errors were the primary study outcome. Results: There were 361 participants (mean [SD] age, 68.7 [9.3] years; 177 women [49.0%]; 319 White [88.4%] and 8 Black individuals [2.2%]). Of these, 180 (49.9%) were randomly assigned to the intervention group and 181 (50.1%) to the control group. Among all participants, 100 (27.7%) experienced 1 or more adverse drug-related incidents, and 65 (18%) experienced 1 or more clinically important medication errors. There were 81 adverse drug-related incidents identified in the intervention group and 72 in the control group. There were 44 clinically important medication errors in the intervention group and 45 in the control group. The intervention did not significantly alter the per-patient rate of adverse drug-related incidents (unadjusted incidence rate ratio, 1.13; 95% CI, 0.83-1.56) or clinically important medication errors (unadjusted incidence rate ratio, 0.99; 95% CI, 0.65-1.49). Conclusions and Relevance: In this randomized clinical trial, there was not an observed lower rate of adverse drug-related incidents or clinically important medication errors during the posthospitalization period that was associated with a clinical pharmacist intervention. However, there were study recruitment challenges and lower than expected numbers of events among the study population. Trial Registration: ClinicalTrials.gov Identifier: NCT02781662.

Do Errorless Methods Improve Discharge Medication Instruction and Adherence?

PURPOSE AND DESIGN: Postdischarge adverse drug events are a national issue, and effective inpatient instruction may help. Therefore, this intervention study examined whether using errorless teaching/learning methods including pictorial medication cards (ETL + card) improved RN teaching and patient medication adherence among persons with cognitive challenges (PWCCs). METHODS: Convenience samples of RNs and PWCCs from a 24-bed rehabilitation unit provided baseline data. RNs implemented ETL + card, and postintervention data were collected. Adapted and investigator-designed instruments had preliminary reliability/validity. FINDINGS: Postintervention RNs demonstrated more teaching strategies (p = .003), and teaching satisfaction rose from 0% to 50%. Minutes per teaching interaction were unchanged (p > .05). Baseline patients filled a higher number (p = .02) but a lower percentage (67%) of their prescriptions than did postintervention patients (85%). Medication dose adherence scores were unchanged (p > .05). CONCLUSIONS: ETL + card improved RN teaching and possibly patient adherence. Further study is warranted. CLINICAL RELEVANCE: ETL + card may help PWCCs achieve safe medication self-management.

Implementation challenges and opportunities for improved mass treatment uptake for lymphatic filariasis elimination: Perceptions and experiences of community drug distributors of coastal Kenya.

Community drug distributors (CDDs) who are volunteers have the responsibility of awareness creation, household census, drug distribution and record-keeping and are thus key stakeholders in the campaign for Lymphatic Filariasis (LF) elimination. Taking into account their experiences and perceptions is important for a successful elimination campaign. We conducted a qualitative study in 2018 to identify implementation challenges and opportunities for improved mass drug administration (MDA) uptake based on the CDDs perceptions and experiences. Within a larger study that used mixed methods quasi-experimental design, we collected qualitative data from two wards in Kaloleni Sub-County of Kilifi County which was purposively selected owing to its low, 56% and 50.5% treatment coverage in 2015 and 2016 respectively. Focus group discussions (FGDs) (n = 8) and in-depth interviews (IDIs) (n = 8) with CDDs, IDIs (n = 22) with opinion leaders and IDIs (n = 8) with health workers were conducted and the data analyzed by QSR NVIVO version 10 according to thematic areas. The results showed that based on the perceptions and experiences of the CDDs, several challenges: communities' refusal to take the drugs; absenteeism during MDA; non-adherence to CDDs selection criteria; inadequacy in number of CDDs engaged during the campaign and training provided; insufficiency of drugs issued to CDDs; lack of CDDs supervision and low motivation negatively impact on MDA uptake. Opportunities to address the challenges included: awareness creation on MDA, health education on LF and observation of hygiene during drug administration, increased duration of awareness creation and drug administration, adherence to CDDs selection criteria and putting into consideration the vastness of an area and population density while deploying CDDs. Other opportunities include: improved CDDs training and scheduling; issuing of enough drugs to CDDs to meet the communities' demand and improved supervision and motivation of CDDs. Addressing the challenges highlighted is an important step of maximizing MDA uptake. The opportunities presented need to be considered by the NTD program personnel, the county health personnel and the community while planning the implementation of MDA campaigns.

Improving medication safety practice at a community hospital: a focus on bar code medication administration scanning and pain reassessment.

INTRODUCTION: In the USA over 30% of medication errors occur at the point of administration. Among non-surgical patients in US hospitals exposed to opioids, 0.6% experience a severe opioid-related adverse event. In September 2018, Sierra View Medical Center identified two areas of opportunity for quality improvement: bedside bar code medication administration (BCMA) and pain reassessments. At baseline (April 2018 to September 2018) only 81% of medications were scanned prior to administration with pain reassessments completed only 41% of the time 1 hour postopioid administration. OBJECTIVE: To improve BCMA scanning rates (goal ≥95%) and pain reassessments within 1 hour postopioid administration (goal ≥90%). METHODS: Implementation methods included data transparency, weekly dashboards, education and plan-do-study-act (PDSA) cycles informed by feedback from key stakeholders. RESULTS: Following a series of PDSA cycle implementations, barcode medication administration (BCMA) scanning rates improved by 14% (from 81% to 95%) and pain reassessments improved by 50% (from 41% to 91%), sustained 17 months postproject implementation (October 2018 to February 2019). The number of adverse drug events (ADEs) related to administration errors decreased by 17% (estimated annual cost savings of $120 750-239 725 per year) and opioid-related ADEs decreased by 2.6% (estimated annual cost savings of $72 855-80 928 per year). CONCLUSION: Adopting John Kotter's model for change, developing performance dashboards and sustaining engagement among stakeholders on a weekly basis improved bar code medication scanning rates and pain reassessment compliance. The stakeholders created momentum for change in both practice and culture resulting in improved patient safety with a favourable financial impact.

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.

Role of nurses in medication management at the end of life: a qualitative interview study.

BACKGROUND: Patients in the last phase of their lives often use many medications. Physicians tend to lack awareness that reviewing the usefulness of medication at the end of patients' lives is important. The aim of this study is to gain insight into the perspectives of patients, informal caregivers, nurses and physicians on the role of nurses in medication management at the end of life. METHODS: Semi-structured interviews were conducted with patients in the last phase of their lives, in hospitals, hospices and at home; and with their informal caregivers, nurses and physicians. Data were qualitatively analyzed using the constant comparative method. RESULTS: Seventy-six interviews were conducted, with 17 patients, 12 informal caregivers, 15 nurses, 20 (trainee) medical specialists and 12 family physicians. Participants agreed that the role of the nurse in medication management includes: 1) informing, 2) supporting, 3) representing and 4) involving the patient, their informal caregivers and physicians in medication management. Nurses have a particular role in continuity of care and proximity to the patient. They are expected to contribute to a multidimensional assessment and approach, which is important for promoting patients' interest in medication management at the end of life. CONCLUSIONS: We found that nurses can and should play an important role in medication management at the end of life by informing, supporting, representing and involving all relevant parties. Physicians should appreciate nurses' input to optimize medication management in patients at the end of life. Health care professionals should recognize the role the nurses can have in promoting patients' interest in medication management at the end of life. Nurses should be reinforced by education and training to take up this role.

Nursing students' perceptions of clinical learning opportunities and competence in administration of oral medication in the Western Cape.

BACKGROUND: Medication errors may result in patients' harm and even death. The improvement of nursing students' competence in the administration of medication through education and training can contribute to the reduction of medication errors. OBJECTIVES: This study aimed at describing the Bachelor of Nursing students' perceptions about clinical learning opportunities and competence in the administration of oral medication. METHOD: A quantitative descriptive design was employed. An all-inclusive sample of 176 nursing students registered at a university in the Western Cape, South Africa, in 2014 was considered for the study, of whom 125 students consented to participate and completed the questionnaires. Statistical Package for the Social Sciences (SPSS) version 22 was used for data analysis and descriptive statistics were conducted. RESULTS: The findings showed that a minority of students did not have opportunities to rotate in all specific types of wards. The findings indicated that a total of 92% (115) and 86.4% (108) of the 125 respondents were placed in medical and surgical wards, respectively, where they more likely had opportunities to practise the administration of oral medication. However, 59.2% (74) did not practise administration of oral medication on a daily basis. Only 19.2% (24) of respondents perceived themselves as competent in the administration of oral medication. CONCLUSION: The findings indicated that many students perceived their education and training as not providing sufficient learning opportunities to practise the administration of oral medication, whilst the majority of respondents perceived themselves as competent in some of the aspects related to the administration of oral medication, and very few perceived themselves as competent overall in the administration of oral medication.

The Impact of Pharmaceutical Policies on Medicine Procurement Pricing in Indonesia Under the Implementation of Indonesia's Social Health Insurance System.

BACKGROUND: Indonesia's social health insurance (Jaminan Kesehatan Nasional, JKN) has been implemented since 2014. To support medicine provision, the government launched policies reform on medicine pricing, procurement and reimbursement; hence, the system might affect medicine prices in the country. OBJECTIVE: To evaluate the effects of the pharmaceutical policies reforms on medicine procurement prices. METHODS: This was a pre-post observational study. Medicine price data were collected retrospectively from the 2013 Ministry of Health procurement price list, the 2017 e-catalogue procurement system, and the procurement departments at 2 hospitals in Jakarta and Cilegon (both categorized as region I). The 2013 national procurement price was compared with the 2017 e-catalogue price. The hospitals' procurement prices were collected from the data 3 years before and 3 years under Indonesia's social health insurance JKN (2011-2016), and the data were used to assess the medicine procurement prices in real conditions. The outcome measure was the difference in procurement prices before and under the JKN. RESULTS: The results showed that the procurement prices of 429 (79.6%) of 539 medicines listed in the 2017 e-catalogue decreased, of which 210 items (39.0%) showed over a 50% decrease. Nevertheless, the procurement prices of 104 items (19.3%) increased, especially those that were still under patent or those with a few brands registered in Indonesia. The procurement prices in public and private hospitals showed a similar trend, that is, a significant decrease. Interestingly, non-e-catalogue medicine prices also decreased quite steeply, although the prices of the branded generic category in the private hospital remained unchanged. CONCLUSION: The pharmaceutical policies under the JKN implementation had a profound impact on decreasing medicine procurement prices in Indonesia.

[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.

Mobile Apps for Medication Management: Review and Analysis.

BACKGROUND: Pharmacotherapy remains one of the major interventional strategies in medicine. However, patients from all age groups and conditions face challenges when taking medications, such as integrating them into the daily routine, understanding their effects and side effects, and monitoring outcomes. In this context, a reliable medication management tool adaptable to the patient's needs becomes critical. As most people have a mobile phone, mobile apps offer a platform for such a personalized support tool available on the go. OBJECTIVE: This study aimed to provide an overview of available mobile apps, focusing on those that help patients understand and take their medications. We reviewed the existing apps and provided suggestions for future development based on the concept understand and manage, instead of the conventional adhere to medication. This concept aims to engage and empower patients to be in charge of their health, as well as see medication as part of a broader clinical approach, working simultaneously with other types of interventions or lifestyle changes, to achieve optimal outcomes. METHODS: We performed a Web search in the iOS Apple App Store and Android Google Play Store, using 4 search terms: medication management, pill reminder, medication health monitor, and medication helper. We extracted information from the app store descriptions for each eligible app and categorized into the following characteristics: features, author affiliation, specialty, user interface, cost, and user rating. In addition, we conducted Google searches to obtain more information about the author affiliation. RESULTS: A total of 328 apps (175 Android and 153 iOS) were categorized. The majority of the apps were developed by the software industry (73%, 11/15), a minority of them were codeveloped by health care professionals (15%, 3/20) or academia (2.1%; 7/328). The most prevalent specialty was diabetes (23 apps). Only 7 apps focused on mental health, but their content was highly comprehensive in terms of features and had the highest prevalence of the education component. The most prevalent features were reminder, symptom tracker, and ability to share data with a family member or doctor. In addition, we highlighted the features considered innovative and listed practical suggestions for future development and innovations. CONCLUSIONS: We identified detailed characteristics of the existing apps, with the aim of informing future app development. Ultimately, the goal was to provide users with effective mobile health solutions, which can be expected to improve their engagement in the treatment process and long-term well-being. This study also highlighted the need for improved standards for reporting on app stores. Furthermore, it underlined the need for a platform to offer health app users an ongoing evaluation of apps by health professionals in addition to other users and to provide them with tools to easily select an appropriate and trustworthy app.

The development and psychometric testing of Inpatients' Involvement in Medication Safety Scale (IIMSS).

AIM: To develop and test the psychometric characteristics of the Inpatients' Involvement in Medication Safety Scale. BACKGROUND: Medication safety is the third biggest challenge threatening patient safety. Patient involvement in medication safety management is essential, and however, few tools have been developed to assess the related process. METHODS: The scale was formulated through literature review, semi-structured interviews and Delphi expert consultation. A group of 461 inpatients from a tertiary hospital were selected to examine the reliability and validity of the scale. RESULTS: The scale consisted of three dimensions and 23 items. Cronbach's α coefficient was 0.916 for the total scale and was 0.777-0.858 for three subscales; the test-retest reliability was 0.742 for the total scale. The content validity was 0.957, and the item content validity ranged from 0.833 to 1.000. The cumulative variance contribution of three selected factors was 51.19%. CONCLUSIONS: The Inpatients' Involvement in Medication Safety Scale has good reliability and validity and can be used to evaluate inpatients' involvement in medication safety. IMPLICATIONS FOR NURSING MANAGEMENT: The scale provides theoretical reference for clinical nursing safety management, as well as helps nurses to provide targeted medication care for patients and their families.

Interruptions and nursing workload during medication administration process.

OBJECTIVE: To investigate the sources and causes of interruptions during the medication administration process performed by a nursing team and measure its frequency, duration and impact on the team's workload. MÉTODOS: This is an observational study that timed 121 medication rounds (preparation, administration and documentation) performed by 15 nurses and nine nursing technicians in a Neonatal Intensive Care Unit in the countryside of the state of São Paulo. RESULTADOS: 63 (52.1%) interruptions were observed. In each round, the number of interruptions that happened ranged from 1-7, for 127 in total; these occurred mainly during the preparation phase, 97 (76.4%). The main interruption sources were: nursing staff - 48 (37.8%) - and self-interruptions - 29 (22.8%). The main causes were: information exchanges - 54 (42.5%) - and parallel conversations - 28 (22%). The increase in the mean time ranged from 53.7 to 64.3% (preparation) and from 18.3 to 19.2% (administration) - p≤0.05. CONCLUSÃO: Interruptions in the medication process are frequent, interfere in the workload of the nursing team and may reflect on the safety of care.

Interruptions and nursing workload during medication administration process / Interrupciones y carga de trabajo de enfermería durante la administración de medicamentos / Interrupções e carga de trabalho de enfermagem durante a administração de medicamentos

ABSTRACT Objective: To investigate the sources and causes of interruptions during the medication administration process performed by a nursing team and measure its frequency, duration and impact on the team's workload. Métodos: This is an observational study that timed 121 medication rounds (preparation, administration and documentation) performed by 15 nurses and nine nursing technicians in a Neonatal Intensive Care Unit in the countryside of the state of São Paulo. Resultados: 63 (52.1%) interruptions were observed. In each round, the number of interruptions that happened ranged from 1-7, for 127 in total; these occurred mainly during the preparation phase, 97 (76.4%). The main interruption sources were: nursing staff - 48 (37.8%) − and self-interruptions - 29 (22.8%). The main causes were: information exchanges - 54 (42.5%) − and parallel conversations - 28 (22%). The increase in the mean time ranged from 53.7 to 64.3% (preparation) and from 18.3 to 19.2% (administration) - p≤0.05. Conclusão: Interruptions in the medication process are frequent, interfere in the workload of the nursing team and may reflect on the safety of care.

RESUMEN Objetivo: Examinar las fuentes y las causas de interrupciones durante el proceso de administración de medicamentos realizado por el personal de enfermería y también medir su frecuencia, duración e impacto sobre la carga de trabajo de estos. Métodos: Estudio observacional con tiempos cronometrados durante 121 rondas de medicación (preparación, administración y documentación) realizadas por 15 enfermeros y 9 técnicos de enfermería en una Unidad de Cuidado Intensivo Neonatal en el interior de São Paulo. Resultados: Se observaron 63 (52,1%) interrupciones. En cada ronda, ocurrieron de 1-7, totalizando 127, principalmente en la fase de preparación, 97 (76,4%). Las principales fuentes fueron: el personal de enfermería -48 (37,8%)-, y las autointerrupciones -29 (22,8%)-. Ya las principales causas fueron: el intercambio de información -54 (42,5%)- y la conversación paralela -28 (22%)-. El incremento del promedio del tiempo varió del 53,7% al 64,3% (preparación) y del 18,3% al 19,2% (administración) p≤0,05. Conclusión: Las interrupciones en el proceso medicamentoso son frecuentes, interfieren en la carga de trabajo de la enfermería y pueden comprometer la seguridad del cuidado.

RESUMO Objetivo: Investigar fontes e causas das interrupções durante o processo de administração de medicamentos realizado pela equipe de enfermagem e mensurar sua frequência, duração e impacto sobre a carga de trabalho. Métodos: Observacional com tempos cronometrados durante 121 rodadas de medicação (preparo, administração e documentação) realizadas por 15 enfermeiros e nove técnicos de enfermagem em Unidade de Terapia Intensiva Neonatal no interior de São Paulo. Resultados: Foram observadas 63 (52,1%) interrupções. Em cada rodada, ocorreram de 1-7totalizando 127, principalmente na fase de preparo, 97 (76,4%). As principais fontes constituíram-se em: equipe de enfermagem − 48 (37,8%) − e autointerrupções − 29(22,8%). Já as principais causas: troca de informações - 54 (42,5%) − e conversa paralela - 28 (22%). O aumento do tempo médio variou de 53,7 a 64,3% (preparo) e de 18,3 a 19,2% (administração) p≤0,05. Conclusão: Interrupções no processo medicamentoso são frequentes, interferem na carga de trabalho da enfermagem e podem refletir na segurança do cuidado.

Closed-Loop Medication System: Leveraging Technology to Elevate Safety.

BACKGROUND: Healthcare organizations have long been dependent on the vigilance of nurses to identify and intercept medication errors before they can adversely affect patients. New technologies have been implemented in an effort to reduce medication errors; however, few studies have evaluated the long-term effects of technology-based interventions in reducing medication errors. AIM: The aim of this study was to evaluate the effects of barcode medication administration (BCMA) and the closed-loop medication system (CLMS) interventions on medication errors and adverse drug event (ADE) rates. METHODS: An autoregressive integrated moving average model for interrupted time series design was used to evaluate the impact of the BCMA and CLMS interventions on the monthly reported medication error and ADE rates at Humber River Hospital between September 2013 and August 2018. Descriptive statistics were generated to evaluate the types of error and their gravity. RESULTS: A total of 1,712 medication errors and ADEs were reported in the five-year study period. The results of the interrupted time series indicated that the introduction of the BCMA intervention was associated with a statistically significant gradual decrease in reported medication error and ADE rates at 0.002 percentage points per month (p = 0.003). The introduction of the CLMS intervention was associated with an immediate absolute decrease in reported medication error and ADE rates of 0.010% (p = 0.020). CONCLUSIONS: The findings from this study support the adoption of both BCMA and CLMS interventions to prevent medication errors. Staged implementation of CLMS allows time for learning and incorporating barcode scanning. Interprofessional and cross-functional collaboration is necessary to successfully integrate the requirements of each respective discipline and service in the CLMS.

Medication administration safety assessment tool: Construction and validation.

OBJECTIVE: To build and validate the Patient Safety Assessment in Medication Administration (ASPAM - Avaliação da Segurança do Paciente na Administração de Medicamentos) tool. METHOD: Methodological study in which the construction, Content Validation Index (CVI), construct validation (factorial analysis) and reliability were performed in terms of homogeneity (Cronbach's Alpha). RESULTS: The ASPAM reached CVI of 0.77 for simplicity, 0.76 for clarity and 0.93 for relevance. The exploratory factorial analysis was adequate for the tool (Kaiser-Meyer-Olkim of 0.66 and Bartlett's sphericity with p <0.001). The Cronbach's Alpha end of the scale with 28 items was 0.85. CONCLUSION: The ASPAM tool was valid and reliable for the identification of risk-generating conditions for the occurrence of Adverse Drug Events.