Unplanned rehospitalisation due to medication harm following an Acute Myocardial Infarction.

Introduction The contribution of medication harm to rehospitalisation and adverse patient outcomes after an acute myocardial infarction (AMI) needs exploration. Rehospitalisation is costly to both patients and the healthcare facility. Following an AMI, patients are at risk of medication harm as they are often older, have multiple comorbidities and polypharmacy. This study aimed to quantify and evaluate medication harm causing unplanned rehospitalisation after an AMI. Methods This was a retrospective cohort study of patients discharged from a quaternary hospital post-AMI. All rehospitalisations within 18 months were identified using medical record review and coding data. The primary outcome measure was medication harm rehospitalisation. Preventability, causality and severity assessments of medication harm were conducted. Results A total of 1564 patients experienced an AMI and 415 (26.5%) were rehospitalised. Eighty-nine patients (5.7% of total population; 6.0% of those discharged) experienced a total of 101 medication harm events. Those with medication harm were older (p=0.007) and had higher rates of heart failure (p=0.005), chronic kidney disease (CKD) (p=0.046), chronic obstructive pulmonary disease (COPD) (p=0.037) and a prior history of ischaemic heart disease (p=0.005). Gastrointestinal (GI) bleeding, acute kidney injury (AKI) and hypotension were the most common medication harm events. Forty percent of events were avoidable and 84% were classed as 'serious'. Furosemide, antiplatelets and angiotensin-converting enzyme inhibitors (ACEi) were the most commonly implicated medications. The median time to medication harm rehospitalisation was 79 days (interquartile range [IQR]: 16-200 days). Conclusion Medication harm causes unplanned rehospitalisation in 5.7% of all AMI patients (1 in 17 patients; 6.0% of those discharged). The majority of harm was serious and occurred within the first 200 days of discharge. This study highlights that measures to attenuate the risk of medication harm rehospitalisation are essential, including post-discharge medication management.

Behavioural outcomes of interprofessional education within clinical settings for health professional students: A systematic literature review.

Interprofessional education facilitates collaborative practice, which promotes high-quality patient care and patient safety. Interprofessional education (IPE) experiences within clinical settings provide an opportunity for the development of interprofessional collaborative practice competence. The aim of this systematic review was to review the literature evaluating interprofessional education for health professional students within clinical settings and summarize the behavioral outcomes. Databases searched were PubMed, Embase, Scopus, Web of Science, Taylor & Francis Online, ERIC and PsycINFO. Full-text articles were independently screened by two reviewers and included if agreed. Outcomes were analyzed using Kirkpatrick's model modified for IPE. Studies with behavioral change outcomes were analyzed and synthesized using narrative methods. Included studies provided evidence that IPE experiences in clinical settings can enable students to develop and integrate interprofessional collaborative practice competencies, across diverse types of settings. Key tasks enabling students to achieve these learning outcomes included synchronous patient consultations, collaborative development of integrative health-care plans outside of patient consultations, and participation in socialization with health-care teams. There were limitations in the methodological design of the included studies, with limited use of comparator groups and validated tools, high usage of self-report data and serious risk of bias identified across all quantitative included studies. In conclusion, high-quality research designed to measure the construct of behavioral change is lacking. Such research could further investigate the key tasks in IPE experiences in clinical settings that are necessary for students to develop the range of required collaborative practice competencies and integrate these. This could provide clarification regarding if and how this could be achieved across different types of clinical placements.

The impact of hospital-based post-discharge pharmacist medication review on patient clinical outcomes: A systematic review.

Background: Clinical pharmacists have been shown to identify and resolve medication related problems post-discharge, however the impact on patient clinical outcomes is unclear. Aims: To undertake a systematic review to identify, critically appraise and present the evidence on post-discharge hospital clinics that provide clinical pharmacist medication review; report the patient clinical outcomes measured; and describe the activities of the clinical pharmacist. Methods: Published studies evaluating a patient clinical outcome following a post-discharge hospital clinic pharmacy service were included. All studies needed a comparative design (intervention vs control or comparator). Pubmed, Embase, CINAHL, PsycnINFO, Web of Science, IPA and APAIS-Health databases were searched to identify studies. The type of clinic and the clinical pharmacist activities were linked to patient clinical outcomes. Results: Fifty-seven studies were included in the final analysis, 14 randomised controlled trials and 43 non-randomised studies. Three key clinic types were identified: post-discharge pharmacist review alone, inpatient care plus post-discharge review and post-discharge collaborative clinics. The three main outcome metrics identified were hospital readmission and/or representation, adverse events and improved disease state metrics. There was often a mix of these outcomes reported as primary and secondary outcomes. High heterogeneity of interventions and clinical pharmacist activities reported meant it was difficult to link clinical pharmacist activities with the outcomes reported. Conclusions: A post-discharge clinic pharmacist may improve patient clinical outcomes such as hospital readmission and representation rates. Future research needs to provide a clearer description of the clinical pharmacist activities provided in both arms of comparative studies.

A collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: Patient and general practitioner perceptions.

A collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: patient and general practitioner perceptions. Background: Pharmacists working in general practice settings are slowly emerging in Australia, with comprehensive medication reviews forming a large part of their role in optimising pharmaceutical care. In Australia, pharmacists are entirely reliant on general practitioners (GPs) accepting and implementing their recommendations to manage drug related problems (DRPs). The next step is a model where the pharmacist takes on responsibility for implementing some of their recommendations. Aim: To investigate patient and general practitioner perceptions of a collaborative model of care where the pharmacist has increased responsibility in assisting the general practitioner manage patients with chronic conditions. Method: Semi-structured, phone and face-to-face interviews were conducted with a purposive sample of patients and GPs respectively. Data were transcribed by a professional transcription service, collated using NVivo 12 Plus and analysed using Braun and Clarke's thematic analysis. Provisional codes were generated and clustered into categories, from which themes were identified. Results: Eighteen interviews were conducted (12 patients, 6 GPs). Four themes were identified from the patient interview data: pharmacist attributes; acknowledgement of the impact of the pharmacist, understanding of the GP-pharmacist collaborative model; relationships with and attitudes towards medicines and health care providers. Four themes were identified from the general practitioner interview data: pharmacist attributes; relationships with pharmacists; impressions on collaboration; impressions of the pharmacist's recommendations. Patients' and GPs' perceptions of the collaborative model of care overall were positive, acknowledging the advantages of a patient-centred, interdisciplinary approach and the potential benefits to patients. Conclusion: The GP-pharmacist collaborative model was viewed favourably by patients and GPs, with some GPs articulating the value in the pharmacist's increased responsibility as they implemented some recommendations to manage DRPs.

Feasibility of a collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: a preliminary study.

BACKGROUND: Pharmacists working in general practices provide medication reviews with recommendations to general practitioners (GPs) to optimise medications. We describe a model where the pharmacist is empowered with increased responsibility to implement agreed recommendations through collaborative prescribing. AIM: To assess a collaborative pharmacist prescribing model incorporating increased pharmacist responsibility, for patients with chronic diseases in general practice. METHOD: This was a pre-test-post-test quasi experimental pilot study using a pharmacist embedded in three Australian general practices. A pharmaceutical care plan was developed with patients and their GP to identify drug related problems (DRPs). The pharmacist discussed recommendations to manage DRPs with the GP and implemented recommendations agreed by the GP and patient over the six-month study period. Outcome measures included acceptance and implementation rate of recommendations made by the pharmacist. RESULTS: The pharmacist made 135 recommendations to optimise medicine use of which 126 (93.3%) were accepted by the GP. There were 105 (83.3%) implemented by the end of the study of which the pharmacist implemented 62 (49.3%). CONCLUSION: Compared to other Australian studies using a general practice pharmacist model, this study suggested increased pharmacist responsibility through collaborative prescribing led to high acceptance and implementation rates of recommendations to manage DRPs.

Interprofessional identity in clinicians: A scoping review.

Interprofessional collaborative practice (IPCP) has been recognized as invaluable in delivering safe, high-quality patient care with finite resources. However, despite a decade of advances in interprofessional (IP) research, policy, and competency frameworks, IPCP does not always occur in practice. One reason may be the influence of a clinician's identity in an IP context. The purpose of this scoping review was to understand the nature of IP identity in healthcare clinicians. The PRISMA framework was used to support a comprehensive search strategy and screening of 1746 articles. Inclusion criteria included original research, theses, and reviews, a primary focus on IP identity or professional identity (PI) in an IP team, and a focus on health professionals, including students transitioning to practice. Ninety-five papers met the eligibility criteria, though once charted, just four of the 95 papers focused on IP identity in clinicians. Three further papers examined shared team identity, 25 papers referred to, but did not focus on IP identity, and the remaining 63 papers explored PI in an IP team. While limited studies on clinician IP identity restrict conclusive findings, patterns were identified to direct further research on the nature of IP identity in clinicians. These include values and beliefs, individual and personal factors, profession and professional experience, education, socialization, context, leadership, and the process of IP identity development. While identity is undeniably central to being a clinician, the values, beliefs, attributes, and experiences that contribute to clinician IP identity, how clinician IP identity develops, and factors that influence IP identity remain unclear. The results of this review highlight the value of further investigation of the nature of IP identity, the interplay between PI and IP identity, and identity in an IP context.

Retrospective study of the prevalence and characteristics of adverse drug events in adults who present to an Australian emergency department.

OBJECTIVE: To determine the burden, on the ED, of harm from unintentional adverse drug events (ADEs) in the community. METHODS: A retrospective, observational study of 936 randomly selected presentations to a level 6 ED at a principal referral hospital in Brisbane, Australia, in November 2017. Clinical records were screened by a pharmacist, who identified suspected ADEs. All suspected ADEs and a random selection of presentations without ADEs were reviewed by an expert panel, which classified, by consensus: occurrence and type of ADE, contribution of ADE to presentation, severity of harm and preventability of presentation. Medication-related ED presentations (ADE-Ps) and potential ADEs were, respectively, defined as presentations directly attributable to an ADE, and medication events that occurred but did not cause the ED presentation. Descriptive data analysis was performed. RESULTS: The median (interquartile range) age of patients was 40 (27-58) years, with 49.7% (95% confidence interval [CI] 46.5-52.9) being male. The prevalences of ADE-Ps and potential ADEs were 9.2% (95% CI 7.5-11.3) and 5.0% (95% CI 3.8-6.6), respectively. The severity of harm was classified as 'death or likely permanent harm' in 4.7% (95% CI 0.2-9.1) of ADE-Ps, 'temporary harm' (89.5%, 95% CI 83.1-96.0) and 'minimal or no harm' (5.8%, 95% CI 0.9-10.8). Most (79.1%, 95% CI 70.5-87.7) ADE-Ps were preventable. CONCLUSIONS: There is a high burden on emergency care because of unintended medication harm in the community. Interventions to reduce such harm are likely to require a co-ordinated primary, acute and public healthcare response. The high proportion of presentations with potential ADEs indicates opportunity for harm mitigation in the ED.

Evaluation of two European risk models for predicting medication harm in an Australian patient cohort.

PURPOSE: To externally evaluate the performance of two European risk prediction models, for identifying patients at high-risk of medication harm, in an Australian hospital setting. METHODS: This was a secondary analysis of a pre-existing cohort study described in a recently published study by Falconer et al. (Br J Clin Pharmacol 87(3):1512-1524, 2021) describing the development of a predictive risk model for inpatient medication harm. We retrospectively extracted relevant variables using the electronic health records of general medical and geriatric patients admitted to a quaternary hospital, in Brisbane, over 6 months from July to December 2017. This dataset was used to externally evaluate the two European models, The Brighton Adverse Drug Reaction Risk (BADRI) model by Tangiisuran et al. and a risk model developed by Trivalle et al. The variables were entered into both models and the patients' risk of medication harm was calculated, and compared with actual patient outcomes. Predictive performance was evaluated by measuring area under the receiver operative characteristic (AuROC) curves. RESULTS: The Australian patient cohort included 1982 patients (median age 74 years), of which 136 (7%) patients experienced ≥ 1 medication harm event(s). External evaluation of the two European models identified that both the BADRI and the Trivalle models had reduced predictive performance in an Australian patient cohort, compared with their original studies (AuROC of 0.63 [95% CI: 0.58-0.68] and 0.60 [95% CI: 0.55-0.65], respectively). CONCLUSION: Neither model demonstrated sufficient discrimination to warrant further evaluation in our local setting. This is likely a result of variations between the development and the validation cohorts, and the change in healthcare systems over time, and highlights the need for an up-to-date and context-specific risk prediction model.

Platelet Function Assays for the Diagnosis of Aspirin Resistance.

Aspirin, an antiplatelet drug, is commonly used at low doses for numerous indications, including prophylaxis of cardiovascular, neurovascular, and venous thromboembolic events. Due to review articles suggesting that aspirin resistance may result in poorer outcomes, interest in assessing platelet function is increasing. Despite this, platelet function tests are rarely used as part of routine clinical practice and therefore, a basic understanding of these tests may be lacking. Although aspirin resistance can be categorized as clinical or laboratory resistance, determining laboratory resistance is the only way to determine resistance before treatment failure occurs. Therefore, knowledge of platelet assays to determine aspirin resistance is of importance. The following review aims to provide a framework for clinicians to understand the main principles of platelet function tests. This includes comparison of the most frequently used platelet assays to diagnose aspirin resistance, including the basic mechanism, methodology, reference ranges, inter-assay comparison, and their respective clinical considerations when using.

Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety.

Discrepancies between the medicines consumed by patients and those documented in the medical record can affect medication safety. We aimed to characterize medication discrepancies and medication regimen complexity over time in a cohort of outpatients with decompensated cirrhosis, and evaluate the impact of pharmacist-led intervention on discrepancies and patient outcomes. In a randomized-controlled trial (n = 57 intervention and n = 57 usual care participants), medication reconciliation and patient-oriented education delivered over a six-month period was associated with a 45% reduction in the incidence rate of 'high' risk discrepancies (IRR = 0.55, 95%CI = 0.31-0.96) compared to usual care. For each additional 'high' risk discrepancy at baseline, the odds of having ≥ 1 unplanned medication-related admission during a 12-month follow-up period increased by 25% (adj-OR = 1.25, 95%CI = 0.97-1.63) independently of the Child-Pugh score and a history of variceal bleeding. Among participants with complete follow-up, intervention patients were 3-fold less likely to have an unplanned medication-related admission (adj-OR = 0.27, 95%CI = 0.07-0.97) compared to usual care. There was no association between medication discrepancies and mortality. Medication regimen complexity, frequent changes to the regimen and hepatic encephalopathy were associated with discrepancies. Medication reconciliation may improve medication safety by facilitating communication between patients and clinicians about 'current' therapies and identifying potentially inappropriate medicines that may lead to harm.

Patient harm from cardiovascular medications.

BACKGROUND: Medication harm can lead to hospital admission, prolonged hospital stay and poor patient outcomes. Reducing medication harm is a priority for healthcare organisations worldwide. Recent Australian studies demonstrate cardiovascular (CV) medications are a leading cause of harm. However, they appear to receive less recognition as 'high risk' medications compared with those classified by the medication safety acronym, 'APINCH' (antimicrobials, potassium, insulin, narcotics, chemotherapeutics, heparin). Our aim was to determine the scale and type of medication harm caused by CV medications in healthcare. METHODS: A narrative review of adult (>16 years) medication harm literature identified from PubMed and CINAHL databases was undertaken. Studies with the primary outcome of measuring the incidence of medication harm were included. Harm caused by CV medications was described and ranked against other medication classes at four key stages of a patient's healthcare journey. Where specified, the implicated medications and type of harm were investigated. RESULTS: A total of 75 studies were identified, including seven systematic reviews and three meta-analyses, with most focussing on harm causing hospital admission. CV medications were responsible for approximately 20% of medication harm; however, this proportion increased to 50% in older populations. CV medications were consistently ranked in the top five medication categories causing harm and were often listed as the leading cause. CONCLUSION: CV medications are a leading cause of medication harm, particularly in older adults, and should be the focus of harm mitigation strategies. A practical approach to generate awareness among health professionals is to incorporate 'C' (for CV medications) into the 'APINCH' acronym. PLAIN LANGUAGE SUMMARY: Patient harm from cardiovascular medications: Background: • Harm from medications can cause poor patient outcomes.• Certain medications have been identified as 'high risk' and are known to cause high rates of harm.• 'High risk' medications are included in medication guidelines used by health professionals.• Cardiovascular medications (e.g. blood pressure and cholesterol medications) are important and have many benefits.• Recent studies have found cardiovascular medications to cause high rates of harm.• Cardiovascular medication harm is often under-recognised in clinical practice.• Some guidelines do not consider cardiovascular medications to be 'high risk'.Method: • This review investigated the extent of harm caused by cardiovascular medications in adults across four healthcare settings:(1) at the time of hospital admission;(2) during hospital admission;(3) after hospital; and(4) readmission to hospital.• Harm caused by cardiovascular medications was ranked against other medication classes.• We investigated the type of cardiovascular medications to cause harm and the type of harm caused.Results: • Seventy-five studies were reviewed across 41 countries.• Cardiovascular medications were ranked within the top five medications to cause harm.• Cardiovascular medications were a leading cause of harm in each healthcare setting investigated.• Harm caused by cardiovascular medications was common in older adults (>65 years).• Cardiovascular medications often caused preventable harm.• Medications to treat high blood pressure and abnormal heart rhythms were the most common causes of harm.• We reported kidney injury, electrolyte changes and low blood pressure as common types of harm.Conclusion: • Increased focus on cardiovascular medications in clinical practice is needed.• Health professionals need to carefully prescribe and frequently review cardiovascular medications, especially in older adults.• Patient and health professional discussions should be based on both the benefits and harms of cardiovascular medications.• Cardiovascular medications should be included in all 'high risk' medication guidelines.

Reducing Medical Admissions and Presentations Into Hospital through Optimising Medicines (REMAIN HOME): a stepped wedge, cluster randomised controlled trial.

OBJECTIVE: To investigate whether integrating pharmacists into general practices reduces the number of unplanned re-admissions of patients recently discharged from hospital. DESIGN, SETTING: Stepped wedge, cluster randomised trial in 14 general practices in southeast Queensland. PARTICIPANTS: Adults discharged from one of seven study hospitals during the seven days preceding recruitment (22 May 2017 - 14 March 2018) and prescribed five or more long term medicines, or having a primary discharge diagnosis of congestive heart failure or exacerbation of chronic obstructive pulmonary disease. INTERVENTION: Comprehensive face-to-face medicine management consultation with an integrated practice pharmacist within seven days of discharge, followed by a consultation with their general practitioner and further pharmacist consultations as needed. MAJOR OUTCOMES: Rates of unplanned, all-cause hospital re-admissions and emergency department (ED) presentations 12 months after hospital discharge; incremental net difference in overall costs. RESULTS: By 12 months, there had been 282 re-admissions among 177 control patients (incidence rate [IR], 1.65 per person-year) and 136 among 129 intervention patients (IR, 1.09 per person-year; fully adjusted IR ratio [IRR], 0.79; 95% CI, 0.52-1.18). ED presentation incidence (fully adjusted IRR, 0.46; 95% CI, 0.22-0.94) and combined re-admission and ED presentation incidence (fully adjusted IRR, 0.69; 95% CI, 0.48-0.99) were significantly lower for intervention patients. The estimated incremental net cost benefit of the intervention was $5072 per patient, with a benefit-cost ratio of 31:1. CONCLUSION: A collaborative pharmacist-GP model of post-hospital discharge medicines management can reduce the incidence of hospital re-admissions and ED presentations, achieving substantial cost savings to the health system. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12616001627448 (prospective).

Development and validation of the Adverse Inpatient Medication Event model (AIME).

AIMS: Medication harm has negative clinical and economic consequences, contributing to hospitalisation, morbidity and mortality. The incidence ranges from 4 to 14%, of which up to 50% of events may be preventable. A predictive model for identifying high-risk inpatients can guide a timely and systematic approach to prioritisation. The aim of this study is to develop and internally validate a risk prediction model for prioritisation of hospitalised patients at risk of medication harm. METHODS: A retrospective cohort study was conducted in general medical and geriatric specialties at an Australian hospital over six months. Medication harm was identified using International Classification of Disease (ICD-10) codes and the hospital's incident database. Sixty-eight variables, including medications and laboratory results, were extracted from the hospital's databases. Multivariable logistic regression was used to develop the final risk model. Performance was evaluated using area under the receiver operative characteristic curve (AuROC) and clinical utility was determined using decision curve analysis. RESULTS: The study cohort included 1982 patients with median age 74 years, of which 136 (7%) experienced at least one adverse medication event(s). The model included: length of stay, hospital re-admission within 12 months, venous or arterial thrombosis and/or embolism, ≥ 8 medications, serum sodium < 126 mmol/L, INR > 3, anti-psychotic, antiarrhythmic and immunosuppressant medications, and history of medication allergy. Validation gave an AuROC of 0.70 (95% CI: 0.65-0.74). Decision curve analysis identified that the AIME may be clinically useful to help guide decision making in practice. CONCLUSION: We have developed a predictive model with reasonable performance. Future steps include external validation and impact evaluation.

A Narrative Review of Aspirin Resistance in VTE Prophylaxis for Orthopaedic Surgery.

Total hip arthroplasties (THA) and total knee arthroplasties (TKA) confer one of the highest risks for developing venous thromboembolism (VTE) and pharmacological prophylaxis is imperative to help mitigate the risks. Aspirin is the most cost-effective medication for VTE prophylaxis, and its use post-THA/TKA has grown in popularity. Aspirin resistance is categorised as clinical or laboratory resistance with obesity, advancing age, diabetes mellitus, dyslipidaemia and inflammatory diseases identified as risk factors for aspirin resistance. Treatment failure due to aspirin resistance has been reported in cardiovascular and cerebrovascular disease leading to increased rates of mortality and re-embolisation. However, aspirin resistance in patients undergoing a THA/TKA has not been described, nor has there been investigation into the incidence rates or clinical outcomes. The aim of this narrative review is to appraise the concept of aspirin resistance in the context of aspirin use for VTE prophylaxis after THA/TKA surgeries. This is important to investigate as the risk factors for aspirin resistance, including obesity, advancing age, diabetes mellitus, dyslipidaemia and inflammatory diseases, are also risk factors for THA/TKA and risk factors for VTE. The presence of aspirin resistance in patients undergoing orthopaedic surgery may place patients at greater risk of thrombotic events if aspirin is prescribed for VTE prophylaxis. This could further increase the risk of complications associated with VTE and potential long-term consequences such as post-thrombotic syndrome. Future research is required to explore and quantify the rates of aspirin resistance and the clinical outcomes in orthopaedic patients; especially in those patients with these overlapping risk factors for THA/TKA, VTE and aspirin resistance.

Using a structured, patient-centred, educational exchange to facilitate a shared conversation about stroke prevention medications.

OBJECTIVE: The aim of this study was to investigate the feasibility of a structured patient-centred educational exchange to facilitate a shared conversation about stroke prevention medications. METHODS: Participants (18 years or older) with a principal diagnosis of stroke or transient ischaemic attack were purposively sampled from the stroke unit of a 780-bed teaching hospital in Australia and consented to participate in the study. A patient-centred educational exchange was conducted face to face at the bedside before discharge and by telephone post discharge. The structure of these sessions was adapted from academic detailing, an educational strategy, which includes identifying experience, listening to the needs of the audience, and tailoring messages to influence behaviour. To facilitate sharing of needs, three questionnaires, validated as research tools, were used to identify participants' experience, perceptions, and beliefs. The identified perceptions were used to personalize educational messages. The outcomes of the study were to provide descriptions of patients' perceptions necessities and concerns about their condition and medications, provide examples of personalized responses to these, evaluate acceptability by patients, and determine the time taken to share the information. RESULTS: Sixteen participants completed both the bedside session (average duration 27 minutes) and the telephone follow-up (average duration 23 minutes). The strongest patient concern identified was having another stroke. Personalized responses included emphasizing long-term treatment in response to the perception that stroke will last for a short time, reinforcement of necessity for medications, and further exploration of concerns. CONCLUSION: The questionnaires engaged the participants, allowing them to share perceptions and beliefs, facilitating a patient-centred educational exchange in a timely manner.

Better understanding the influence and complexity of beliefs on medication adherence in asthma.

OBJECTIVE: The aim was to better understand how beliefs influence medication adherence in asthma. METHODS: All participants were prescribed an inhaled corticosteroid for a diagnosis of asthma. Each participant completed a survey consisting of: Beliefs about Medicines Questionnaire (BMQ), Brief-Illness Perception Questionnaire (B-IPQ) and Multi-dimensional Health Locus of Control Scale (MHLCS). Adherence to inhaled corticosteroids was elicited using the Medication Adherence Report Scale (MARS). Multiple linear regression with interaction effects was used to identify significant predictors of medication adherence and interactions between beliefs. RESULTS: A total of 198 participants completed the survey. The mean(±SD) MARS score was 19.2(±4.5). A multivariable model (adjusted R2 = 0.39) predicted adherence using: age, asthma hospitalisation, timeline (B-IPQ) subscale, necessity and concern (BMQ) subscales, doctor (MHLCS) subscale and the two interaction effects (concerns [BMQ] moderated by chance [MHLCS] and treatment control [B-IPQ] moderated by understanding [B-IPQ]). CONCLUSION: The findings of this study contribute to a better understanding of the role of beliefs in medication adherence in asthma. Certain beliefs meaningfully interrelate and change the relationship they have with medication adherence. PRACTICE IMPLICATIONS: If these beliefs are causally related to medication adherence and can be intervened upon, the findings are useful for providing targets to personalise adherence support.

How hospital pharmacists prioritise patients at high-risk for medication harm.

BACKGROUND: Medication harm is experienced by up to 30% of hospitalised patients, of which 7% experience severe harm. Pharmacist review can mitigate this harm. However, in increasingly busy hospitals, with high patient throughput, and scarce resources, there is a need to prioritise patients. Current methods are cumbersome, include many risk factors and are not evaluated in the clinical setting. OBJECTIVES: To determine key criteria used by hospital pharmacists and investigate perspectives related to patient prioritisation for potential medication harm in the hospital setting. METHODS: This study used two methods; focus groups and a cross-sectional survey of Australian hospital pharmacists. Focus groups were used to identify criteria and perspectives related to prioritisation and were analysed thematically. Criteria from focus groups, and a systematic review, were used to design the survey. The survey was distributed via the Society of Hospital Pharmacists of Australia. The top 10 prioritisation criteria, and associated sub-criteria selected by over 50% of respondents were ranked. Combination of criteria used most frequently on a day-to-day basis were identified. RESULTS: Twenty clinical pharmacists participated in four, one-hour, audio recorded focus groups. Using inductive thematic analysis of transcripts three themes were identified; 1) prioritisation criteria, 2) barriers to, and 3) facilitators of patient prioritisation, with five sub-themes and 26 codes. Pharmacists identified a number of barriers such as a lack of relevant handover information. Organisational demands, such as patient discharge and medications supply also influenced priority and could act as barriers to a pharmacist enacting their prioritisation plan. A total of 231 pharmacists completed the survey. High priority criteria included, renal impairment, use of high-risk medications and therapeutic drug monitoring. CONCLUSION: Pharmacists described prioritisation as a multifactorial process with a focus on high-risk medications and renal impairment. These findings will inform the development of a predictive risk score for patient prioritisation.

Defining and classifying terminology for medication harm: a call for consensus.

PURPOSE: The multiplicity in terms and definitions of medication-related harm has been a long-standing challenge for health researchers, clinicians, and regulatory bodies. The purpose of this narrative review was to report the diversity of terms; compare definitions, classifications, and models describing medication harm; and suggest which may be useful in both clinical practice and the research setting. METHODS: A narrative review of key studies defining and/or classifying medication harm terminology was undertaken. RESULTS: This review found that numerous terms are used to describe medication harm, and that there is a lack of consistency in current definitions, classifications, and applications. This lack of consistency applied across clinical jurisdictions and regulatory terminologies. A number of limitations in current definitions and classifications were identified. These included the exclusion of key types of medication harm events, ambiguous wording, and a lack of clarity and consensus on subclassifications. In general, there was some overlap in key models from the literature and these were presented to describe similarities and differences. CONCLUSION: Without uniformity quantifying, comparing, combining, or extrapolating medication harm data, such as a rate of harm in a specific population, is a challenge for those involved in medication safety and pharmacovigilance. There is a pressing need for further discussion and international consensus on this topic. Adoption of standard descriptors by practitioner groups, regulatory and policy organisations would foster quality improvement and patient safety.