A survey on patients medication reconciliation process in an oncological hospital.

OBJECTIVES: The purpose of this study was to assess the impact of medication reconciliation in the clinical practice from a hospital pharmacist point of view. METHODS: A survey of the medication taken by cancer patients was performed on admission and on discharge in an oncological hospital, and then the subjects were followed up until discharge for 8 weeks. The pharmacist entered the data collected into a computer based tool which, by using Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP criteria) and Micromedex™ interactions database, automatically produces a report indicating the possible inconsistencies. The report is to check all potentially inappropriate prescriptions (PIPs) correlated to the drugs assumption by the patient. The appropriateness of the medication was scored using a Medication Appropriateness Index (MAI index) which was used to reconcile the medication list accordingly. RESULTS: Patients reconciled at admission were 98, while patients reconciled at discharge were 90, 8 patients dropped out due to death. After the intervention of the hospital pharmacist, the average value of MAI index showed a significant reduction (3,391 to 2,552 p=0.039) and the median number of drugs prescribed per patient was decreased (7 vs 6; p=0.8058). CONCLUSION: Our study demonstrated that the forms used in the reconciliation process, in particular the record card, is a promising method to increase the quality of the information related to drug use in clinical decisions. We think that medication reconciliation softwares should be widely used by health care professionals involved in the recording of drug history or prescription process.

Defining innovations of therapeutic interventions: a position paper by the Italian Society of Hospital Pharmacists.

Defining innovation in pharmacotherapy is complex because general definitions cannot be easily adapted to the specificity of different therapeutic areas. The Italian Society of Hospital Pharmacists has developed a position paper in which three criteria are used to recognise innovation to a new intervention: (1) clinical relevance of the trial's primary end-point; (2) evidence of superiority; (3) use of an adequate comparator in the controlled trial. Clinically relevant end-points should appear in predetermined lists by therapeutic area managed by our society; likewise, the third criterion must be documented by an authoritative therapeutic guideline recognised to be still valid. A preliminary attempt is presented to retrospectively apply these criteria, particularly the first one, to a series of 21 clinical trials; this initial experience has generated a first list of clinically relevant end-points. This approach of innovation assessment is proposed for application also in the field of medical devices.

Suicide in the national protocol for monitoring sentinel events.

In 2005, the Ministry of Welfare started a protocol for reporting sentinel events, in order to provide monitoring of such events at the national level in a way that makes the data available to others. The main objectives of the monitoring system include the collection of information of sentinel events which occurred in NHS structures. The analysis focused on systems, processes and determining factors contributing to the occurrence of these events, compilation and implementation of recommendations addressed to all the NHS hospitals to minimize the risk of occurrence, and feedback to local health services and Regions. This study describes sentinel events reported to the Ministry of Welfare in the first eighteen months of activity, during which it received 123 reports of sentinel events, suicide being the most reported event. The analysis of the causes and contributing factors has highlighted the lack of application, and sometimes the total absence of appropriate procedures and guidelines which would allow the identification of the possible actions to be taken to counteract the recurrence of these serious events in the interest of public health. In particular, it highlighted the need to disseminate and implement specific recommendations to prevent errors, promote training on clinical risk and improve communication among operators and between operators and patients. Given the importance of suicide in public health policies and the need for preventive activity on this issue, recommendations for the prevention of suicide in hospitals have already been drafted.