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1.
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194191

RESUMO

OBJECTIVE: Entrustable Professional Activities (EPAs) are a list of professional tasks (with associated competency ratings) that pharmacy educational organizations support, and accreditation organizations require, for assessment by colleges and schools of pharmacy. This manuscript assesses the perceived frequency of performing EPAs in the population health promoter (PHP) domain among pharmacists practicing in North Dakota. METHODS: This survey assessed the self-reported EPA activities (inclusive of the PHP domain) of registered pharmacists living and practicing in North Dakota. There were 990 pharmacists surveyed, and 457 (46.1%) of pharmacists responded. RESULTS: Within the PHP domain, pharmacists reported performing "Minimize adverse drug events and medication errors" most frequently (mean=3.4, SD=2.0), followed by "Ensure that patients have been immunized against vaccine-preventable diseases" (mean=2.3, SD 2.3), "Maximize the appropriate use of medications in a population" (mean=2.2, SD 2.3), and "Identify patients at risk for prevalent diseases in a population" (mean=1.3, SD=1.9). In these Core EPAs PHP domains, the clinical pharmacists reported the highest level, followed by pharmacy managers and staff pharmacists. CONCLUSION: Pharmacists in North Dakota reported that EPAs in the PHP domain are practiced regularly. Thus, EPAs in the PHP domain have potential as a means to assess outcomes in pharmacy education and practice


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Avaliação Educacional/métodos , Educação em Farmácia , Assistência Farmacêutica/normas , Promoção da Saúde/métodos , Estados Unidos , Educação Baseada em Competências , Internato não Médico/métodos , Erros de Medicação/prevenção & controle
2.
Radiol Clin North Am ; 58(5): 841-850, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32792118

RESUMO

Moderate and severe contrast reactions are rare but can be life threatening. Appropriate contrast reaction management is necessary for the best patient outcome. This review summarizes the types and incidences of adverse events to contrast media, treatment algorithms, and equipment needed to treat common contrast reactions, the current status of contrast reaction management training, and preventative strategies to help mitigate adverse contrast events.


Assuntos
Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Extravasamento de Materiais Terapêuticos e Diagnósticos/prevenção & controle , Gadolínio/efeitos adversos , Iodo/efeitos adversos , Radiologia/educação , Humanos , Erros de Medicação/prevenção & controle , Fatores de Risco
3.
Tex Med ; 116(5): 4-6, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32645190

RESUMO

The last thing a nonsmoking asymptomatic female physician expects during her usual hourly aerobic exercise is a phone call from her internist about a "spiculated lung nodule." There was no need for the rest of the radiologist's sentence: "suspicious for malignancy."


Assuntos
Empatia , Neoplasias Pulmonares/psicologia , Neoplasias Pulmonares/cirurgia , Erros de Medicação/prevenção & controle , Pacientes/psicologia , Médicas/psicologia , Cirurgia Torácica Vídeoassistida , Feminino , Humanos , Cobertura do Seguro , Neoplasias Pulmonares/diagnóstico , Equipe de Assistência ao Paciente , Pneumonectomia , Fumar , Procedimentos Desnecessários
4.
Yakugaku Zasshi ; 140(10): 1285-1294, 2020 Oct 01.
Artigo em Japonês | MEDLINE | ID: mdl-32611936

RESUMO

Care workers at care facilities play an important role in providing medication-administration assistance, and in medication risk management. Nevertheless, research has not made clear the specific concerns that care workers have at work sites, as well as the extent of their burdens. Thus, we conducted a questionnaire survey from October 1 through October 31, 2014 for staff who provide medication-administration assistance at for-pay elderly person homes about the concrete concerns and burdens with regards to the assistance. A total of 1677 respondents were analyzed: 228 nurses and 1449 care workers. Results showed that the care workers had a variety of problems and issues. These included the fact that, since care workers are not medical profession, they were unable to answer questions that the facility residents asked about their medications; they had concerns regarding their own lack of awareness of the efficacies of medications, and as to whether certain drugs were inappropriate for certain patients with swallowing dysfunctions; they wondered whether drugs in tablet forms had to be crushed before administration. They also encountered pharmacological-related issues, including whether administration times and numbers failed to match the lifestyle patterns of facility residents, and so forth. It is presumed that, with active intervention of pharmacists within facilities, these issues could be resolved. Study results, thus, suggested the need for system creation whereby pharmacists can become deeply involved in medication-administration assistance along with the care workers within facilities.


Assuntos
Atitude do Pessoal de Saúde , Erros de Medicação/prevenção & controle , Casas de Saúde , Recursos Humanos de Enfermagem/psicologia , Farmacêuticos , Gestão de Riscos , Adulto , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
5.
Rev Infirm ; 69(260-261): 41-43, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32600597

RESUMO

Nurses are regularly interrupted when performing their tasks. Yet studies have shown that there is a link between the fact of being interrupted when preparing medication and the increased risk of making a mistake. Seeking to reinforce the safety of the medication preparation stage, a team in Normandy studied the benefit, for the nurse, of wearing ear plugs during this specific time.


Assuntos
Atenção , Erros de Medicação/prevenção & controle , Enfermeiras e Enfermeiros/psicologia , Gestão da Segurança/métodos , França , Humanos
6.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194051

RESUMO

BACKGROUND: Self-administered medication (SAM) is encouraged in many hospitals worldwide as it increases patients' knowledge and understanding of their medication, but the effects on other outcomes, e.g. compliance or medication errors, were unclear. OBJECTIVES: To compare medication knowledge, adherence, medication errors, and hospital readmission among inpatients receiving SAM education under the supervision of a multidisciplinary team (study group) with those receiving routine nurse-administered medication (control group). METHODS: This study was a PROBE design. Inpatients with chronic diseases were randomly allocated (1:1) to either the study group or the control group using stratified-block randomization. Knowledge of medications was measured at hospital discharge and at the first two follow-up visits; adherence was measured at the first two follow-up visits, medication errors while in hospital, and hospital readmission within 60 days after discharge. For normally distributed continuous outcomes, mean difference and 95%CI were estimated; otherwise the median and the Mann-Whitney test p-value were reported. The percentage difference and 95%CI were reported for binary outcomes. RESULTS: 70 patients were randomized (35 in each group); all received complete follow-up. Both groups were similar at baseline. Mean (SD) age (years) were 59.2 (11.0) for the study group and 58.3 (12.0) for the control group. Percentages of females in the respective groups were 54.3 and 60.0. Mean time from discharge to the first follow-up visit was two weeks in both groups and time to the second follow-up visit were 68.8 days (study group) and 55.0 days (control group). The study group had significantly higher medication knowledge than the control group at hospital discharge (of the 10-point scale, medians, 8.56 and 6.18, respectively, p < 0.001). The corresponding figures were similar in both groups at the first follow-up visit (medians, 8.25 and 6.26, respectively, p < 0.001). Adherence to medication at the first visit in the study group (percentage mean 92.50% (SD=5.33%)) was significantly higher than that in the control group (79.60% (SD=5.96%)), percentage mean difference 12.90%, [95%CI 10.20%:15.60%], p < 0.001. Medication knowledge and adherence were sustained at the second follow-up visit. During hospitalization, no medication errors were found in the study group, and minimal errors occurred in the control group (1.48%, [95%CI 0.68%:2.28%] of doses administered, p = 0.001). Hospital readmission within 60 days after discharge was significantly lower in the study group (11.4%) than that in the control group (31.4%), percentage difference 20.0% (95%CI 1.4%:38.6%), 1-side Fisher exact p = 0.039. CONCLUSIONS: Among in-patients with chronic diseases, SAM program significantly increased knowledge of and adherence to prescribed medications. Medication errors regarding administration errors were infrequent but significantly higher in the control group. SAM reduced hospital readmission within 60 after discharge


No disponible


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Autoadministração , Comunicação Interdisciplinar , Sistemas de Medicação/organização & administração , Conduta do Tratamento Medicamentoso , Estimativa de Kaplan-Meier , Erros de Medicação/prevenção & controle
7.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194054

RESUMO

OBJECTIVE: To determine the accuracy, variability, and weight uniformity of tablet subdivision techniques utilized to divide the tablets of five drug products that are commonly prescribed for use as half tablets in Jordan. METHODS: Ten random tablets of five commonly subdivided drug products were weighed and subdivided using three subdivision techniques: hand breaking, kitchen knife, and tablet cutter. The five commonly subdivided drug products (warfarin 5 mg, levothyroxine 50 μg, levothyroxine 100 μg, candesartan 16 mg, and carvedilol 25 mg) were weighed. The weights were analyzed for acceptance, accuracy, and variability. Weight variation acceptance criteria were adopted in this work as a tool to indicate the properness of the subdivision techniques used to produce acceptable half tablets. Other relevant physical characteristics of the five products such as tablet shape, dimensions, face curvature, score depth, and crushing strength were measured. RESULTS: All tablets were round in shape, had weights that ranged between 100.63 mg (standard deviation=0.99) and 379.04 mg (standard deviation=3.00), and had crushing strengths that ranged between 23.29 N (standard deviation=3.58)and 103.35 N (standard deviation=14.98). Both candesartan and carvedilol were bi-convex in shape with an extent of face curvature equal to about 33%. In addition, percentage score depth of the tablets had a range between 0% and 24%. The accuracy and variability of subdivision varied according to the subdivision technique used and tablet characteristics. Accuracy range was between 81% and 109.8%. Moreover, the relative standard deviation was between 1.5% and 17.4%. Warfarin 5 mg subdivided tablets failed the weight variation test regardless of the subdivision technique used. Subdivision by hand produced half tablets that were acceptable for levothyroxine 50 μg and levothyroxine 100 μg. Subdivision by knife produced half tablets that were acceptable only for candesartan tablets. However, the tablet cutter produced half tablets that passed the weight variation test for four out of the five drug products tested in this study. CONCLUSIONS: The tablet cutter performed better than the other subdivision techniques used. It produced half tablets that passed the weight uniformity test for four drug products out of the five


No disponible


Assuntos
Humanos , Comprimidos/uso terapêutico , Autoadministração , Prescrições de Medicamentos , Reprodutibilidade dos Testes , Comprimidos/química , Tecnologia Farmacêutica/métodos , Erros de Medicação/prevenção & controle , Jordânia , Comprimidos/farmacocinética , Preparações de Ação Retardada/química , Preparações de Ação Retardada/farmacocinética
8.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194055

RESUMO

BACKGROUND: In dual antiplatelet therapy (DAPT), low-dose acetylsalicylic acid is combined with a P2Y12 inhibitor. However, combining antithrombotic agents increases the risk of bleeding. Guidelines on DAPT recommend using this combination for a limited period of between three weeks and 30 months. This implies the risk of DAPT being erroneously continued after the intended stop date. OBJECTIVE: The primary objective of this study is to assess the proportion of hospitalized patients treated with DAPT whose treatment deviated erroneously and unintentionally from the guidelines. We also assessed risk factors and the effect of a pharmacist intervention. METHODS: All patients admitted to the Spaarne Gasthuis (Haarlem/ Hoofddorp, the Netherlands) who used DAPT between March 25th, 2019, and June 14th, 2019, were, in addition to receiving regular care, reviewed to assess whether their therapy was in line with the guidelines' recommendation and whether deviations were unintended and erroneous. In the event of an unintended deviation, the pharmacist intervened by contacting the prescriber by phone and giving advice to adjust the antithrombotic therapy in line with the guideline. RESULTS: We included 411 patients, of whom 21 patients (5.1%) had a treatment that deviated from the guidelines. For 11 patients (2.7%), the deviation was unintended and erroneous. The major risk factor for erroneous deviation was the use of DAPT before hospital admission (OR 18.7; 95%CI 4.79-72.7). In patients who used DAPT before admission, 18 out of 58 (31.0%) had a deviation from the guidelines of whom 8 (13.8%) were erroneous. For these eight patients, the pharmacist contacted the prescriber, and in these cases the therapy was adjusted in line with the guidelines. CONCLUSIONS: Adherence to the guidelines recommending DAPT was high within the hospital. However, patients who used DAPT before hospital admission had a higher risk of erroneous prescription of DAPT. Intervention by a pharmacist increased adherence to guidelines and may reduce the number of preventable bleeding cases


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/normas , Inibidores da Agregação de Plaquetas/administração & dosagem , Guias de Prática Clínica como Assunto/normas , Farmacêuticos/normas , Doença da Artéria Coronariana/tratamento farmacológico , Estudos Prospectivos , Fibrinolíticos/administração & dosagem , Erros de Medicação/prevenção & controle , Fatores de Risco
9.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194064

RESUMO

BACKGROUND: Although a highly common practice in hospital care, tablet splitting can cause dose variation and reduce drug stability, both of which impair drug therapy. OBJECTIVE: To determine the overall prevalence of tablet splitting in hospital care as evidence supporting the rational prescription of split tablets in hospitals. METHODS: Data collected from inpatients' prescriptions were analyzed using descriptive statistics and used to calculate the overall prevalence of tablet splitting and the percentage of split tablets that had at least one lower-strength tablet available on the market. The associations between the overall prevalence and gender, age, and hospital unit of patients were also assessed. The results of laboratory tests, performed with a commercial splitter, allowed the calculation of the mass loss, mass variation, and friability of the split tablets. RESULTS: The overall prevalence of tablet splitting was 4.5%, and 78.5% of tablets prescribed to be split had at least one lower-strength tablet on the market. The prevalence of tablet splitting was significantly associated with the patient's age and hospital unit. Laboratory tests revealed mean values of mass loss and variation of 8.7% (SD 1.8) and 11.7% (SD 2.3), respectively, both of which were significantly affected by the presence of coating and scoreline. Data from laboratory tests indicated that the quality of 12 of the 14 tablets deviated in at least one parameter examined. CONCLUSIONS: The high percentage of unnecessary tablet splitting suggests that more regular, rational updates of the hospital's list of standard medicines are needed. Also, inappropriate splitting behavior suggests the need to develop tablets with functional scores


No disponible


Assuntos
Humanos , Comprimidos/farmacologia , Prescrições de Medicamentos , Estabilidade de Medicamentos , Uso de Medicamentos/normas , Reprodutibilidade dos Testes , Pacientes Internados , Erros de Medicação/prevenção & controle , Estudos Transversais , Brasil , Comprimidos/análise , Comprimidos/síntese química
10.
Clin Drug Investig ; 40(8): 687-693, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32514939

RESUMO

Patient harm from inadvertent administration of amphotericin B (Fungizone™) instead of liposomal amphotericin (AmBisome®) has been described in the literature and has been the subject of patient safety alerts in the UK. Safe use of intravenous amphotericin depends on the knowledge and awareness of practitioners of the availability and differences between the different presentations of intravenous amphotericin. Knowledge is a weak barrier to error. Recommendations to reduce the risk of error following adverse drug events in the UK, USA and The Netherlands have largely focused on actions to be taken at an organisational level, such as drug supply, storage, dose checking and specifying brand and generic names on prescriptions. None have considered or addressed the contributory factors relating to the products themselves, namely the similarity between the presentations of AmBisome and Fungizone, both of which are manufactured as 50 mg vials despite their different dose recommendations. The need to use multiple vials of Ambisome to prepare infusions for adult patients is contrary to the usual practice of using only one or two vials to prepare doses of injectable medicines for adult patients, increasing the risk of error not only with injectable amphotericin formulations but potentially also with the preparation of other injectable medicines. Whilst the development of robust local risk reduction strategies are important, external factors, such as the design of medicines, should also be identified and highlighted to manufacturers and regulatory authorities as potential contributors to error and harm.


Assuntos
Anfotericina B/efeitos adversos , Antifúngicos/efeitos adversos , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Composição de Medicamentos , Humanos , Erros de Medicação/prevenção & controle
11.
Anesthesiology ; 133(2): 332-341, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32541549

RESUMO

BACKGROUND: While 4 to 10% of medications administered in the operating room may involve an error, few investigations have prospectively modeled how these errors might occur. Systems theoretic process analysis is a prospective risk analysis technique that uses systems theory to identify hazards. The purpose of this study was to demonstrate the use of systems theoretic process analysis in a healthcare organization to prospectively identify causal factors for medication errors in the operating room. METHODS: The authors completed a systems theoretic process analysis for the medication use process in the operating room at their institution. First, the authors defined medication-related accidents (adverse medication events) and hazards and created a hierarchical control structure (a schematic representation of the operating room medication use system). Then the authors analyzed this structure for unsafe control actions and causal scenarios that could lead to medication errors, incorporating input from surgeons, anesthesiologists, and pharmacists. The authors studied the entire medication use process, including requesting medications, dispensing, preparing, administering, documenting, and monitoring patients for the effects. Results were reported using descriptive statistics. RESULTS: The hierarchical control structure involved three tiers of controllers: perioperative leadership; management of patient care by the attending anesthesiologist, surgeon, and pharmacist; and execution of patient care by the anesthesia clinician in the operating room. The authors identified 66 unsafe control actions linked to 342 causal scenarios that could lead to medication errors. Eighty-two (24.0%) scenarios came from perioperative leadership, 103 (30.1%) from management of patient care, and 157 (45.9%) from execution of patient care. CONCLUSIONS: In this study, the authors demonstrated the use of systems theoretic process analysis to describe potential causes of errors in the medication use process in the operating room. Causal scenarios were linked to controllers ranging from the frontline providers up to the highest levels of perioperative management. Systems theoretic process analysis is uniquely able to analyze management and leadership impacts on the system, making it useful for guiding quality improvement initiatives.


Assuntos
Anestesiologia/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Erros de Medicação/prevenção & controle , Salas Cirúrgicas/normas , Melhoria de Qualidade/normas , Teoria de Sistemas , Anestesiologistas/normas , Humanos , Salas Cirúrgicas/métodos , Farmacêuticos/normas , Estudos Prospectivos , Cirurgiões/normas
12.
Farm. hosp ; 44(3): 114-121, mayo-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192344

RESUMO

INTRODUCCIÓN: La tecnología sanitaria se ha convertido en la solución más aceptada para reducir los eventos adversos provocados por los medicamentos, minimizando los posibles errores humanos. La introducción de la tecnología puede mejorar la seguridad y permitir una mayor eficiencia en la clínica. Sin embargo, no elimina todos los tipos de error y puede crear otros nuevos. La administración de medicamentos con código de barras y la utilización de bombas de infusión inteligentes son dos estrategias que pueden emplearse durante la administración de medicamentos para evitar errores antes de que estos lleguen al paciente. OBJETIVO: En este artículo se han revisado diferentes tipos de errores relativos a la administración de medicamentos con código de barras y las bombas de infusión inteligentes, y se ha examinado la forma en la que se producían dichos errores al emplear la tecnología. También se exponen las recomendaciones encaminadas a evitar este tipo de errores. CONCLUSIÓN: Los hospitales deben comprender la tecnología, su funcionamiento y los errores que pretende evitar, así como analizar de qué manera cambiará los procesos clínicos. Es esencial que la dirección del hospital establezca las métricas necesarias y las monitorice regularmente para garantizar el uso óptimo de estas tecnologías. También es importante identificar y evitar desviaciones en los procesos que puedan eliminar o disminuir los beneficios de seguridad para los que fue diseñada. De igual forma, es necesario recopilar periódicamente las opiniones del profesional que la utiliza para detectar los posibles problemas que pudieran surgir. Sin embargo, la dirección debe ser consciente de que incluso con la implementación completa de la tecnología pueden surgir errores a la hora de administrar la medicación


INTRODUCTION: Healthcare-related technology has been widely accepted as a key patient safety solution to reduce adverse drug events by decreasing the risk of human error. The introduction of technology can enhance safety and support workflow; however, it does not eliminate all error types and may create new ones. Barcode medication adminis-tration and smart infusion pumps are two technologies utilized during medication administration to prevent medication errors before they reach the patient. OBJECTIVE: This article reviewed different error types with barcode medi-cation administration and smart infusion pumps and examined how these errors were able to occur while using the technology. Recommendations for preventing these types of errors were also discussed. CONCLUSION: Hospitals must understand the technology, how it is desig-ned to work, which errors it is intended to prevent, as well as understand how it will change staff workflow. It is essential that metrics are set by hospital leadership and regularly monitored to ensure optimal use of these technologies. It is also important to identify and avoid workarounds which eliminate or diminish the safety benefits that the technology was designed to achieve. Front line staff feedback should be gathered on a periodic basis to understand any struggles with utilizing the technology. Leaders must also understand that even with full implementation of technology, medication errors may still occur


Assuntos
Humanos , Erros de Medicação/prevenção & controle , Preparações Farmacêuticas/administração & dosagem , Processamento Eletrônico de Dados/métodos , Bombas de Infusão , Gestão da Segurança/métodos , Acesso a Medicamentos Essenciais e Tecnologias em Saúde , Quimioterapia Assistida por Computador/métodos
13.
Respir Med ; 168: 105949, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32469706

RESUMO

BACKGROUND: Cough is a common yet distressing symptom that results in significant health care costs from outpatient visits and related consultations. OBJECTIVE: The understanding of the pathobiology of cough in recent times has undergone an evolution with Cough hypersensitivity syndrome (CHS) being suggested in most cases of dry cough. However, in the case of productive cough, ancillary mechanisms including impaired Mucociliary clearance, in addition to hypermucosecretory bronchospastic conditions of Smoker's cough, asthma-COPD overlap, bronchiectasis, and allergic bronchopulmonary aspergillosis, need to be critically addressed while optimizing patient care with symptomatic therapy in outpatient settings of India. METHODS: In this review, evidence-based graded recommendations on use of antitussives - & protussives as a Position Paper were developed based on the Level and Quality of Scientific evidence as per Agency for Health Care and Quality (AHRQ) criteria listing and Expert opinions offered by a multidisciplinary EMA panel in India. RESULTS: Management of acute or chronic cough involves addressing common issues of environmental exposures and patient concerns before instituting supportive therapy with antitussives or bronchodilatory cough formulations containing mucoactives, anti-inflammatory, or short-acting beta-2 agonist agents. CONCLUSION: The analyses provides a real world approach to the management of acute or chronic cough in various clinical conditions with pro- or antitussive agents while avoiding their misuse in empirical settings.


Assuntos
Antitussígenos/uso terapêutico , Tosse/tratamento farmacológico , Tosse/etiologia , Aspergilose Broncopulmonar Alérgica/complicações , Asma/complicações , Bronquiectasia/complicações , Broncodilatadores/uso terapêutico , Tosse/diagnóstico , Tosse/economia , Medicina Baseada em Evidências , Expectorantes/uso terapêutico , Diretrizes para o Planejamento em Saúde , Humanos , Índia , Erros de Medicação/prevenção & controle , Depuração Mucociliar , Doença Pulmonar Obstrutiva Crônica/complicações , Fumar/efeitos adversos
14.
J Clin Nurs ; 29(13-14): 2466-2481, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32243030

RESUMO

AIM: To identify the types and frequencies of communication issues (communication pairs, person related, institutional, structural, process and prescription-related issues) detected in medication incident reports and to compare communication issues that caused moderate or serious harm to patients. BACKGROUND: Communication issues have been found to be among the main contributing factors of medication incidents, thus necessitating communication enhancement. DESIGN: A sequential exploratory mixed-method design. METHODS: Medication incident reports from Finland (n = 500) for the year 2015 in which communication was marked as a contributing factor were used as the data source. Indicator phrases were used for searching communication issues from free texts of incident reports. The detected issues were analysed statistically, qualitatively and considering the harm caused to the patient. Citations from free texts were extracted as evidence of issues and were classified following main categories of indicator phrases. The EQUATOR's SRQR checklist was followed in reporting. RESULTS: Twenty-eight communication pairs were identified, with nurse-nurse (68.2%; n = 341), nurse-physician (41.6%; n = 208) and nurse-patient (9.6%; n = 48) pairs being the most frequent. Communication issues existed mostly within unit (76.6%, n = 383). The most commonly identified issues were digital communication (68.2%; n = 341), lack of communication within a team (39.6%; n = 198), false assumptions about work processes (25.6%; n = 128) and being unaware of guidelines (25.0%; n = 125). Collegial feedback and communication from patients and relatives were the preventing issues. Moderate harm cases were often linked with lack of communication within the unit, digital communication and not following guidelines. CONCLUSIONS: The interventions should be prioritised to (a) enhancing communication about work-processes, (b) verbal communication about digital prescriptions between professionals, (c) feedback among professionals and (f) encouraging patients to communicate about medication. RELEVANCE TO CLINICAL PRACTICE: Upon identifying the most harmful and frequent communication issues, interventions to strengthen medication safety can be implemented.


Assuntos
Relações Interprofissionais , Erros de Medicação/prevenção & controle , Gestão de Riscos/métodos , Finlândia , Humanos , Recursos Humanos de Enfermagem no Hospital/organização & administração , Pesquisa Qualitativa
15.
Clin Interv Aging ; 15: 407-417, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32256055

RESUMO

Background: Rational use of medications and monitoring of prescriptions in elderly patients is important to decrease the number and duration of hospitalizations, emergency medical consultations, mortality, as well as medical costs. Purpose: To identify potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs), and determine their prevalence based on the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) v2 criteria and Screening Tool to Alert doctors to Right Treatment (START) v2 criteria for patients aged >65 years. Methods: This cross-sectional study was conducted in two rural counties in Romania based on electronic prescriptions for chronic conditions (EPCCs) issued from 30 days to 90 days by a specialist or general practitioner. Collected EPCCs were evaluated by an interdisciplinary team of specialists based on 26 STOPP v2 criteria and 10 START v2 criteria. Results: PIM prevalence was 25.80% and PPO prevalence was 41.72% for 646 EPCCs. The mean age of patients was 75 years and the mean number of drugs per EPCC was four. The most frequently identified PIMs were treatment duration (6.65%), theophylline administration (5.72%), drug indication (4.64%), cyclo-oxygenase-2 non-steroidal anti-inflammatory drugs (1.39%), and zopiclone prescription (0.77%). Statins (24.76%), beta-blockers (8.04%), and beta-2 agonist/antimuscarinic bronchodilators (5.88%) were the most frequently identified PPOs. Conclusion: PPOs were more prevalent than PIMs for elderly populations living in the two rural counties in Romania we studied. Health practitioners (family physicians, specialists, and pharmacists) should focus on prophylactic and curative considerations when prescribing agents to decrease the morbidity and mortality of elderly rural Romanian patients.


Assuntos
Prescrição Inadequada/estatística & dados numéricos , Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Clínicos Gerais , Humanos , Prescrição Inadequada/prevenção & controle , Masculino , Programas de Rastreamento , Erros de Medicação/prevenção & controle , Prevalência , Romênia
16.
Int J Med Inform ; 137: 104119, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32172184

RESUMO

BACKGROUND: 'Look-alike, sound-alike' (LASA) medicines may be confused by prescribers, pharmacists, nurses and patients, with serious consequences for patient safety. The current research aimed to develop and trial software to proactively identify LASA medicines by computing medicine name similarity scores. METHODS: Literature review identified open-source software from the United States Food and Drug Administration for screening of proposed medicine names. We adapted and refined this software to compute similarity scores (0.0000-1.0000) for all possible pairs of medicines registered in Australia. Two-fold exploratory analysis compared: RESULTS: Screening of the Australian medicines register identified 7,750 medicine pairs with at least moderate (arbitrarily ≥0.6600) name similarity, including many oncology, immunomodulating and neuromuscular-blocking medicines. Computed similarity scores and resulting risk categories demonstrated a modest correlation with the manually-calculated similarity scores (r = 0.324, p < 0.002, 95 % CI 0.119-0.529). However, agreement between the resulting risk categories was not significant (Cohen's kappa = -0.162, standard error = 0.063). CONCLUSIONS: The software (LASA v2) has potential to identify pairs of confusable medicines. It is recommended to supplement incident reports in risk-management programs, and to facilitate pre-screening of medicine names prior to brand/trade name approval and inclusion of medicines in formularies.


Assuntos
Algoritmos , Rotulagem de Medicamentos/estatística & dados numéricos , Erros de Medicação/prevenção & controle , Preparações Farmacêuticas/análise , Farmacêuticos/normas , Software , Austrália , Humanos , Segurança do Paciente
17.
Crit Care Nurs Q ; 43(2): 205-215, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32084063

RESUMO

Patients with Parkinson's disease (PD) face unique challenges when admitted to the hospital. The nature of the disease, complexity of the pharmacotherapeutic home regimens, and the medication-related policies of institutionalized care all contribute to the challenges patients and providers face. In addition, medication errors are common in this population. Incorrectly ordered or omitted home medications or delayed administration can have significant negative consequences including worsening of PD symptoms, dopamine agonist withdrawal syndrome, or malignant or hyperpyrexia syndrome. Also, this patient population may commonly encounter contraindicated medications ordered during their hospitalizations. These medication misadventures negatively affect patient care, which may lead to increased length of stay and significant adverse sequalae. Nurses, pharmacists, and other health care providers can help ease the anxiety of patients and their families by taking detailed medication histories, restarting home medication regimens, customizing medication administration to fit patients' needs, and screening patient profiles for drug-drug and drug-disease interactions. Education of hospital staff regarding the unique needs of this patient population and seeking the advice of specialists in PD can also promote improved patient care.


Assuntos
Unidades de Terapia Intensiva , Anamnese , Erros de Medicação/efeitos adversos , Doença de Parkinson/tratamento farmacológico , Preparações Farmacêuticas/administração & dosagem , Pessoal de Saúde/educação , Hospitalização , Humanos , Erros de Medicação/prevenção & controle , Farmacêuticos
18.
Healthc Q ; 22(SP): 58-71, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049616

RESUMO

This quality improvement initiative to help prevent known medication-related failures during transitions of care was co-led by Patients for Patient Safety Canada, the Institute for Safe Medication Practices Canada, the Canadian Patient Safety Institute, the Canadian Pharmacists Association, and the Canadian Society for Hospital Pharmacists. Initially, the intervention was to develop, test, evaluate and disseminate a medication safety "checklist" for patients and healthcare providers. Through small tests of change, the checklist was redesigned as the "5 Questions to Ask about Your Medications." Collective results demonstrate a shared commitment among more than 200 organizations to empower patients with questions to ask about their medications.


Assuntos
Erros de Medicação/prevenção & controle , Participação do Paciente/métodos , Segurança do Paciente , Canadá , Lista de Checagem , Comunicação , Continuidade da Assistência ao Paciente , Humanos , Educação de Pacientes como Assunto
19.
J Clin Nurs ; 29(13-14): 2239-2250, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32043705

RESUMO

AIMS AND OBJECTIVES: To identify that workarounds (defined as "informal temporary practices for handling exceptions to normal procedures or workflow") by nurses using information technology potentially compromise medication safety. Therefore, we aimed to identify potential risk factors associated with workarounds performed by nurses in Barcode-assisted Medication Administration in hospitals. BACKGROUND: Medication errors occur during the prescribing, distribution and administration of medication. Errors could harm patients and be a tragedy for both nurses and medical doctors involved. Interventions to prevent errors have been developed, including those based on information technology. To cope with shortcomings in information technology-based interventions as Barcode-assisted Medication Administration, nurses perform workarounds. Identification of workarounds in information technology is essential to implement better-designed software and processes which fit the nurse workflow. DESIGN: We used the data from our previous prospective observational study, performed in four general hospitals in the Netherlands using Barcode techniques, to administer medication to inpatients. METHODS: Data were collected from 2014-2016. The disguised observation was used to gather information on potential risk factors and workarounds. The outcome was a medication administration with one or more workarounds. Logistic mixed models were used to determine the association between potential risk factors and workarounds. The STROBE checklist was used for reporting our data. RESULTS: We included 5,793 medication administrations among 1,230 patients given by 272 nurses. In 3,633 (62.7%) of the administrations, one or more workarounds were observed. In the multivariate analysis, factors significantly associated with workarounds were the medication round at 02 p.m.-06 p.m. (adjusted odds ratio [OR]: 1.60, 95% CI: 1.05-2.45) and 06 p.m.-10 p.m. (adjusted OR: 3.60, 95% CI: 2.11-6.14) versus the morning shift 06 a.m.-10 a.m., the workdays Monday (adjusted OR: 2.59, 95% CI: 1.51-4.44), Wednesday (adjusted OR: 1.92, 95% CI: 1.2-3.07) and Saturday (adjusted OR: 2.24, 95% CI: 1.31-3.84) versus Sunday, the route of medication, nonoral (adjusted OR: 1.28, 95% CI: 1.05-1.57) versus the oral route of drug administration, the Anatomic Therapeutic Chemical classification-coded medication "other" (consisting of the irregularly used Anatomic Therapeutic Chemical classes [D, G, H, L, P, V, Y, Z]) (adjusted OR: 1.49, 95% CI: 1.05-2.11) versus Anatomic Therapeutic Chemical class A (alimentary tract and metabolism), and the patient-nurse ratio ≥6-1 (adjusted OR: 5.61, 95% CI: 2.9-10.83) versus ≤5-1. CONCLUSIONS: We identified several potential risk factors associated with workarounds performed by nurses that could be used to target future improvement efforts in Barcode-assisted Medication Administration. RELEVANCE TO CLINICAL PRACTICE: Nurses administering medication in hospitals using Barcode-assisted Medication Administration frequently perform workarounds, which may compromise medication safety. In particular, nurse workload and the patient-nurse ratio could be the focus for improvement measures as these are the most clearly modifiable factors identified in this study.


Assuntos
Processamento Eletrônico de Dados/métodos , Erros de Medicação/prevenção & controle , Sistemas de Medicação no Hospital/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/organização & administração , Fluxo de Trabalho , Adulto , Feminino , Humanos , Masculino , Países Baixos , Estudos Prospectivos
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