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1.
Sr Care Pharm ; 35(1): 3-12, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31883540

RESUMO

The term "elder orphan" is an emerging description of an individual older than 65 years of age who lacks dependents or close family members on whom to rely for assistance, particularly in dealing with health problems. As the number of elder orphans continues to grow, this population is increasingly at risk. Some social determinants of health affect the elder-orphan population disproportionately, including financial security, housing, and transportation. Medication nonadherence may be a sign of increasing isolation and unaddressed problems. Elder orphans may have difficulty managing their health care, and pharmacists can help by identifying patients without support systems may be able to act as valuable assets to these patients. Brown-bag medication reviews, medication therapy management, and thorough medication reconciliation are excellent interventions to prevent medication misadventure. Identifying other medical professionals and services that can support the elder orphan is also prudent.


Assuntos
Reconciliação de Medicamentos , Farmacêuticos , Idoso , Humanos , Adesão à Medicação , Conduta do Tratamento Medicamentoso
3.
J Drugs Dermatol ; 18(10): 1049-1052, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31603634

RESUMO

Drug re-exposure resulting in Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) is a rare phenomenon and has scarcely been reported. With an aging population, polypharmacy, and a lack of a unified electronic medical record, standard recommendations to prevent or minimize the risk of re-exposure are necessary. We identified five patients, with diagnosis confirmed SJS/TEN, and determined the clinical characteristics and contributing risk factors leading to re-exposure. Polypharmacy, multiple prescribers, advanced age, medical illiteracy, retention of discontinued medications and self-prescribing all contributed to re-exposure in this cohort of patients. This case series demonstrates the potentially deadly effect of drug re-exposure, and the need for both streamlined and integrated medication allergy documentation systems. J Drugs Dermatol. 2019;18(10):1049-1052.


Assuntos
Anamnese , Reconciliação de Medicamentos , Síndrome de Stevens-Johnson/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retratamento/efeitos adversos , Fatores de Risco , Índice de Gravidade de Doença , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/etiologia , Adulto Jovem
4.
Ned Tijdschr Geneeskd ; 1632019 10 01.
Artigo em Holandês | MEDLINE | ID: mdl-31580036

RESUMO

Transitions of care pose a risk to medication safety. To reduce patient harm, medication reconciliation is advised. However, implementation of medication reconciliation is difficult due to time constraints. We present two female patients aged 82 and 84 years. In both women, unintentional discrepancies arose, went undetected and led to patient harm. Accurate information transfer is essential for continuity of patient care. Medication reconciliation comprises four steps, i.e. verification (identify discrepancies), clarification (check the collected list), reconciliation (document the reason for medication changes) and transfer (communicate the updated list). This article discusses the steps of medication reconciliation and those medication errors that arise during a patient's transfer from the home setting to hospitalization or a clinic visit. We show that medication reconciliation is not merely an administrative task. As the patient is the only constant factor in health care, patient participation is essential.


Assuntos
Erros de Medicação/prevenção & controle , Reconciliação de Medicamentos/métodos , Transferência de Pacientes/métodos , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Erros de Medicação/efeitos adversos , Participação do Paciente
6.
BMC Health Serv Res ; 19(1): 659, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511070

RESUMO

BACKGROUND: The first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1. METHODS: MARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site's local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient. DISCUSSION: A mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform. We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation.


Assuntos
Reconciliação de Medicamentos , Melhoria de Qualidade/organização & administração , Cuidado Transicional/organização & administração , Registros Eletrônicos de Saúde , Medicina Baseada em Evidências , Pesquisas sobre Serviços de Saúde , Humanos , Reconciliação de Medicamentos/métodos , Segurança do Paciente
7.
Stud Health Technol Inform ; 264: 1278-1282, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438131

RESUMO

With the adoption of Personal Health Records (PHRs) integrated with Electronic Health Records (EHRs) and the increase of accessibility to data, institutions have the possibility of exchanging medical information with their patients. Involving the patient reported data has the potential to improve the quality of care and safety and create a feedback loop between patients and health professionals. The objective of this study is to describe a user-centered design of a module for medication list with reconciliation functionalities managed by the patients themselves, and connected to their EHR for supervision and medical validation. We conducted 42 interviews (31 patients and 11 general practitioners). From the interviews, we performed qualitative analysis and extracted the main findings from comments in both groups. Correctitude rate was 57 to 100%, and satisfaction of use (SUS) maximum was 96% and 92%. These findings may be relevant to patients, health care providers, and policymakers.


Assuntos
Registros de Saúde Pessoal , Reconciliação de Medicamentos , Registros Eletrônicos de Saúde , Pessoal de Saúde , Humanos
8.
Med Care ; 57(10): 836-842, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31464843

RESUMO

BACKGROUND: Pharmacy dispensing data are frequently used to identify prevalent medication use as a predictor or covariate in observational research studies. Although several methods have been proposed for using pharmacy dispensing data to identify prevalent medication use, little is known about their comparative performance. OBJECTIVES: The authors sought to compare the performance of different methods for identifying prevalent outpatient medication use. RESEARCH DESIGN: Outpatient pharmacy fill data were compared with medication reconciliation notes denoting prevalent outpatient medication use at the time of hospital admission for a random sample of 207 patients drawn from a national cohort of patients admitted to Veterans Affairs hospitals. Using reconciliation notes as the criterion standard, we determined the test characteristics of 12 pharmacy database algorithms for determining prevalent use of 11 classes of cardiovascular and diabetes medications. RESULTS: The best-performing algorithms included a 180-day fixed look-back period approach (sensitivity, 93%; specificity, 97%; and positive predictive value, 89%) and a medication-on-hand approach with a grace period of 60 days (sensitivity, 91%; specificity, 97%; and positive predictive value, 91%). Algorithms that have been commonly used in previous studies, such as defining prevalent medications to include any medications filled in the prior year or only medications filled in the prior 30 days, performed less well. Algorithm performance was less accurate among patients recently receiving hospital or nursing facility care. CONCLUSION: Pharmacy database algorithms that balance recentness of medication fills with grace periods performed better than more simplistic approaches and should be considered for future studies which examine prevalent chronic medication use.


Assuntos
Bases de Dados Factuais/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Reconciliação de Medicamentos/métodos , Pacientes Ambulatoriais/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Adulto , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estados Unidos
9.
BMC Health Serv Res ; 19(1): 493, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311537

RESUMO

BACKGROUND: The Institute for Healthcare Improvement identifies medication reconciliation as the shared responsibility of nurses, pharmacists, and physicians, where each has a defined role. The study aims to assess the clinical impact of pharmacy-led medication reconciliation performed on day one of hospital admission to the internal medicine service. METHODS: This is a pilot prospective study conducted at two tertiary care teaching hospitals in Lebanon. Student pharmacists who were properly trained and closely supervised, collected the medication history, and pharmacists at the corresponding sites performed the reconciliation process. Interventions related to the unintended discrepancies were relayed to the medical team. The main outcome was the number of unintended discrepancies identified. The time needed for medication history, and the information sources used to complete the Best Possible Medication History were also assessed. The unintended discrepancies were classified by medication class and route of medication administration, by potential severity, and by proximal cause leading to the discrepancy. For the bivariate and multivariable analysis, the dependent variable was the incidence of unintended discrepancies. The "total number of unintended discrepancies" was dichotomized into yes (≥ 1 unintended discrepancy) or no (0 unintended discrepancies). Independent variables tested for their association with the dependent variable consisted of the following: gender, age, creatinine clearance, number of home medications, allergies, previous adverse drug reactions, and number of information sources used to obtain the BPMH. Results were assumed to be significant when p was < 0.05. RESULTS: During the study period, 204 patients were included, and 195 unintended discrepancies were identified. The most common discrepancies consisted of medication omission (71.8%), and the most common agents involved were dietary supplements (27.7%). Around 36% of the unintended discrepancies were judged as clinically significant, and only 1% were judged as serious. The most common interventions included the addition of a medication (71.8%) and the adjustment of a dose (12.8%). The number of home medications was significantly associated with the occurrence of unintended discrepancies (ORa = 1.11 (1.03-1.19) p = 0.007). CONCLUSIONS: Pharmacy-led medication reconciliation upon admission, along with student pharmacist involvement and physician communication can reduce unintended discrepancies and improve medication safety and patient outcomes.


Assuntos
Medicina Interna/estatística & dados numéricos , Reconciliação de Medicamentos/organização & administração , Admissão do Paciente/estatística & dados numéricos , Serviço de Farmácia Hospitalar/organização & administração , Idoso , Idoso de 80 Anos ou mais , Feminino , Pesquisa sobre Serviços de Saúde , Hospitais de Ensino , Humanos , Líbano , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Atenção Terciária à Saúde
10.
J Trauma Acute Care Surg ; 87(1): 147-152, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31259873

RESUMO

BACKGROUND: It has been well established that many classes of medications on the Beers list of Potentially Inappropriate Medications (PIMs) are associated with falls and injuries in the geriatric population, but little work has been performed to understand if similar relationships exist among the nongeriatric adult population. METHODS: A retrospective chart review of 32 months of trauma encounters at our Level I trauma center was performed in nongeriatric adults aged 18 years to 64 years. Encounters were reviewed by mechanism of injury and intake medication reconciliation. The data were then evaluated for associations between PIMs and falls. RESULTS: Of the 7,897 trauma encounters in the study period, 6,493 had completed medication reconciliation, and 4,154 were between the ages of 18 years and 64 years. There was a statistically significant disproportionate number of those who sustained a fall on psychoactive medications and proton pump inhibitors, and the odds of a trauma patient presenting as a fall were also significantly higher on these select classes of PIMs. CONCLUSION: The PIMs associated with falls in the geriatric population are also associated with falls in the nongeriatric population. This study supports the judicious prescribing of these medications, as they may have risks beyond what was originally thought. LEVEL OF EVIDENCE: Prognostic, level IV.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Lista de Medicamentos Potencialmente Inapropriados , Medicamentos sob Prescrição/efeitos adversos , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Prescrição Inadequada/efeitos adversos , Prescrição Inadequada/estatística & dados numéricos , Masculino , Reconciliação de Medicamentos , Pessoa de Meia-Idade , Estudos Retrospectivos , Ferimentos e Lesões/etiologia , Adulto Jovem
11.
Expert Rev Clin Pharmacol ; 12(7): 643-659, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155978

RESUMO

Introduction: Combined antiretroviral therapy has transformed HIV infection into a chronic disease thus people living with HIV (PLWH) live longer. As a result, the management of HIV infection is becoming more challenging as elderly experience age-related comorbidities leading to complex polypharmacy and a higher risk for drug-drug or drug-disease interactions. Furthermore, age-related physiological changes affect pharmacokinetics and pharmacodynamics thereby predisposing elderly PLWH to incorrect dosing or inappropriate prescribing and consequently to adverse drug reactions and the subsequent risk of starting a prescribing cascade. Areas covered: This review discusses the demographics of the aging HIV population, physiological changes and their impact on drug response as well as comorbidities. Particular emphasis is placed on common prescribing issues in elderly PLWH including drug-drug interactions with antiretroviral drugs. A PubMed search was used to compile relevant publications until February 2019. Expert opinion: Prescribing issues are highly prevalent in elderly PLWH thus highlighting the need for education on geriatric prescribing principles. Adverse health outcomes potentially associated with polypharmacy and inappropriate prescribing should promote interventions to prevent harm including medication reconciliation, medication review, and medication prioritization according to the risks/benefits for a given patient. A multidisciplinary team approach is recommended for the care of elderly PLWH.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Padrões de Prática Médica/normas , Fatores Etários , Idoso , Envelhecimento , Fármacos Anti-HIV/efeitos adversos , Interações de Medicamentos , Humanos , Prescrição Inadequada/prevenção & controle , Reconciliação de Medicamentos/métodos , Equipe de Assistência ao Paciente/organização & administração , Polimedicação
12.
Lakartidningen ; 1162019 May 07.
Artigo em Sueco | MEDLINE | ID: mdl-31192436

RESUMO

A prerequisite for rational use of medicines is adequate prescribing skills; drug treatment is a complex task requiring diagnostic competence combined with pharmacologic knowledge and patient communication skills. Acquiring professional confidence in the art of prescribing is essential during medical training. The results of this questionnaire study, conducted in four medical schools in Sweden after the course in internal medicine (252 respondents; response rate: 74%; median age: 24 years, 61% female), show that 45% and 62% were confident in performing medication reviews and writing medication summary reports, respectively, i.e. the basics of prescribing. The confidence increased by the number of reviews and reports performed, i.e. the extent of practice (correlation coefficients: 0.41 and 0.38, respectively, both p<0.0001), as did the extent of the students' reflection on important aspects of drug treatment such as adherence, adverse reactions, renal function, dosing, and drug interactions. In multivariate regression analyses, major predictors for confidence in performing medication reviews were extent of practice and extent of clinical supervision. The results suggest that these factors are keys to acquiring professional confidence in the art of prescribing.


Assuntos
Prescrições de Medicamentos/normas , Educação de Graduação em Medicina , Reconciliação de Medicamentos/normas , Estudantes de Medicina/psicologia , Adulto , Competência Clínica , Feminino , Humanos , Medicina Interna/educação , Masculino , Farmacologia/educação , Farmacologia Clínica/educação , Autoimagem , Inquéritos e Questionários , Suécia , Adulto Jovem
13.
Sr Care Pharm ; 34(6): 384-392, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31164185

RESUMO

OBJECTIVE: The purpose of this study was to evaluate differences in medication discrepancy identification between pharmacists and nurses for patients 50 years of age and older receiving home health services following discharge from an inpatient hospital. It also evaluates the potential cost savings to the health care system as a result of avoiding adverse drug events (ADEs). Medication discrepancies were documented within seven days following hospital discharge.
DESIGN: The study was a secondary analysis of existing data from a completed randomized clinical trial.
SETTING: Home health care following transition from inpatient hospital care.
PARTICIPANTS: Hospitalized patients (N = 101) 50 years of age or older referred for home care services following discharge.
INTERVENTION: Existing data on medication discrepancy identification by pharmacists and nurses and potential costs of ADEs that could result were evaluated. Anticipated costs of ADEs unrecognized by nurses were estimated using Centers for Medicare & Medicaid Services claims data.
MAIN OUTCOME MEASURES: Number and severity of medication discrepancies identified by pharmacists and nurses, potential consequences for patient health and health care utilization, and anticipated costs to the health care system.
RESULTS: Pharmacists identified 677 medication discrepancies, of which 271 (40%) were considered likely to result in an ADE. Nurses identified 202 (30%) of the 677 medication discrepancies identified by pharmacists. It was estimated that approximately $9,670 in additional health care expenses could have been prevented within the cohort by pharmacist intervention.
CONCLUSION: Pharmacists identified more medication discrepancies during transition from hospital to home when compared with nurses, with the potential benefit of preventing more ADEs and saving associated health care costs during such care transitions.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Reconciliação de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/economia , Humanos , Erros de Medicação , Pessoa de Meia-Idade , Alta do Paciente , Farmacêuticos , Estados Unidos
14.
Sr Care Pharm ; 34(3): 169-186, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31155024

RESUMO

OBJECTIVE: To provide a review of the available evidence regarding pharmacotherapy and areas of pharmacist intervention in transitions of care (TOC) for the geriatric population with heart failure (HF).
DATA SOURCES: A PubMed search of articles published from 1995 through July 2018 was performed using a combination of the following words: heart failure, geriatric, elderly, (TOC), multidisciplinary, pharmacist.
STUDY SELECTION/DATA EXTRACTION: Relevant original research, review articles, and guidelines were assessed for the management of elderly patients with HF. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, and complete results.
DATA SYNTHESIS: HF is a common cause of morbidity, mortality, and hospitalizations in the elderly population. While it is important that patients adhere to evidencebased medications for HF, there are additional precautions and monitoring recommendations for this population because of a higher risk of adverse effects. Elderly patients with HF also require additional care during the transition of care process because they are at high risk for readmission during this time because of a variety of factors, including medication changes, barriers to medication use, and lack of communication between health care providers. As part of a multidisciplinary team, pharmacists can help to identify and address issues.
CONCLUSION: Pharmacists can improve patient care outcomes in patients with HF by providing updated recommendations on pharmacotherapy and being involved in the TOC process.
.


Assuntos
Insuficiência Cardíaca , Reconciliação de Medicamentos , Cuidado Transicional , Idoso , Hospitalização , Humanos , Farmacêuticos
15.
Int J Clin Pharm ; 41(4): 1110-1117, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31073974

RESUMO

Background The post-discharge Medicines-Use-Review (dMUR) is a commissioned service in England and Wales whereby community pharmacists facilitate patients' understanding of their medicines and resolve any medicine-related problems. This service is poorly utilised. Objective To explore the impact of raising hospital patients' awareness of dMURs on their uptake. Setting Hospital in South East England. Method Patients on medical wards with at least one change (medicine, or dose regimen) to their admission medicines were provided with standardized written and verbal information about the service. Participants were responsible for their own medicines and anticipated that they would be discharged home. Structured telephone interviews conducted 4 weeks after discharge explored any medicine-related issues experienced, and reasons for engaging, or not, with the dMUR service. Responses to closed questions were analysed using descriptive statistics. Responses to open questions were analysed thematically. Ethics approval was obtained. Main outcome measure Proportion of patients who received a dMUR and their motivations or barriers to accessing the service. Results Hundred patients were recruited and 84 interviewed. Their mean (SD) age was 73 (11) years. They were taking a median (range) of 9 (2-19) medicines. 67% (56/84) remembered receiving information about dMURs. Nine (11%) had attempted to make an appointment although four had not received the service because the pharmacist was unavailable. Most (88%) were not planning to access the service. The most common reason given was poor morbidity or mobility (13/31, 42%). Conclusion The use of written and verbal information to encourage patients to use the dMUR service had minimal impact.


Assuntos
Serviços Comunitários de Farmácia/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Reconciliação de Medicamentos , Alta do Paciente , Participação do Paciente/psicologia , Idoso , Estudos Transversais , Inglaterra , Feminino , Humanos , Masculino , Educação de Pacientes como Assunto , Telefone , País de Gales
16.
Australas Emerg Care ; 22(2): 103-106, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31042529

RESUMO

BACKGROUND: A self-administered patient medication history form may improve efficiency of workflow in the emergency department. The objective of this study was to evaluate the patient perspective of completing a self-administered medication history form in the emergency department. METHODS: This was a cross-sectional survey of patients who presented to an urban emergency department in Australia. Face and content validity of the survey was established via an iterative process that included pharmacists and patients. After completing a self-administered medication history form, patients were surveyed regard their perspective of this approach. The results of each survey question were evaluated descriptively. RESULTS: A total of 113 completed the survey. The mean age was 59±19 years, and 52% were male. Most patients (87%, n=98) did not think there were any problems completing a self-administered list while waiting to be seen by a physician or pharmacist in the emergency department. Some patients preferred other modalities for clinicians to obtain the list due to their lack of recollection or confusion (4%, n=4), preferred that clinicians utilised existing lists or evaluated medications brought with them (2%, n=2), preferred the convenience of answering questions rather than writing (1%, n=1), or did not list a reason (1%, n=1). CONCLUSION: Most patients who present to the emergency department view a self-administered medication history form positively.


Assuntos
Documentação/normas , Pacientes/estatística & dados numéricos , Autoadministração/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais/estatística & dados numéricos , Documentação/métodos , Documentação/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Reconciliação de Medicamentos/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Autoadministração/métodos , População Urbana/estatística & dados numéricos
17.
PLoS One ; 14(4): e0215459, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31039162

RESUMO

INTRODUCTION: Discharge from the intensive care unit (ICU) is a high-risk process, leading to numerous potentially harmful medication transfer errors (PH-MTE). PH-MTE could be prevented by medication reconciliation by ICU pharmacists, but resources are scarce, which renders the need for predicting which patients are at risk for PH-MTE. The aim of this study was to develop a prognostic multivariable model in patients discharged from the ICU to predict who is at increased risk for PH-MTE after ICU discharge, using predictors of PH-MTE that are readily available at the time of ICU discharge. MATERIAL AND METHODS: Data for this study were derived from the Transfer ICU Medication reconciliation study, which included ICU patients and scored MTE at discharge of the ICU. The potential harm of every MTE was estimated with a validated score, where after MTE with potential for harm were indicated as PH-MTE. Predictors for PH-MTE at ICU discharge were identified using LASSO regression. The c statisticprovided a measure of the overall discriminative ability of the prediction model and the prediction model was internally validated by bootstrap resampling. Based on sensitivity and specificity, the cut-off point of the prediction model was determined. RESULTS: The cohort contained 258 patients and six variables were identified as predictors for PH-MTE: length of ICU admission, number of home medications and patient taking one of the following medication groups at home: vitamin/mineral supplements, cardiovascular medication, psycholeptic/analeptic medication and medication for obstructive airway disease. The c of the final prediction model was 0.73 (95%CI 0.67-0.79) and decreased to 0.62 according to bootstrap resampling. At a cut-off score of two the prediction model yielded a sensitivity of 70% and a specificity of 61%. CONCLUSIONS: A multivariable prediction model was developed to identify patients at risk for PH-MTE after ICU discharge. The model contains predictors that are available on the day of ICU discharge. Once external validation and evaluation of this model in daily practice has been performed, its incorporation into clinical practice could potentially allow institutions to identify patients at risk for PH-MTE after ICU discharge, on the day of ICU discharge, thus allowing for efficient, patient-specific allocation of clinical pharmacy services. TRIAL REGISTRATION: Dutch trial register: NTR4159, 5 September 2013, retrospectively registered.


Assuntos
Unidades de Terapia Intensiva , Erros de Medicação/prevenção & controle , Erros de Medicação/estatística & dados numéricos , Alta do Paciente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Reconciliação de Medicamentos/métodos , Pessoa de Meia-Idade , Modelos Estatísticos , Análise Multivariada , Near Miss/estatística & dados numéricos , Países Baixos , Prognóstico , Estudos Prospectivos , Fatores de Risco
18.
Int J Clin Pharm ; 41(4): 880-887, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31054061

RESUMO

Background Little information is available regarding pharmacist's intervention to solve drug-related problems (DRPs) in a stroke unit. Objective To investigate the nature and frequency of DRPs along with the role of pharmacists in a stroke unit. Setting The study was conducted at the stroke unit of Siriraj hospital, a university affiliated tertiary care hospital in Thailand. Method A retrospective descriptive study of DRPs and pharmacists' interventions for stroke patients was performed during July 2015 to December 2016. Data were collected from patient's medical records and pharmacist's intervention record forms. DRPs were categorized using the Hepler-Strand classification. The stroke pharmacist team, consisting of a board-certified pharmacotherapy specialist, neurology pharmacy residents and stroke unit pharmacists, participated in the multidisciplinary ward round in the stroke unit 5 days a week. All patients were visited by a member of the stroke pharmacist team within the first two days of their admission to conduct a thorough review of drug therapy for every patient and provided appropriate recommendation to the multidisciplinary team either verbally during the ward round or with written information in the patients' medical charts, as appropriate. Main Outcome Measure (a) incidence and characteristics of DRPs (b) types and the acceptance of pharmacists' interventions. Results A total of 859 patients were admitted, of those, 768 patients had ≥ 1 DRPs and a total of 796 DRPs were identified. Clinical pharmacists provided 659 interventions to the multidisciplinary team. The most common DRPs identified were "untreated indications" (22.6%) and "non-compliance" (21.0%). Of all DRPs, 74.6% were stroke related issues. The most implicated drugs were antihypertensive drugs, followed by antithrombotic therapies. The multidisciplinary team accepted 84.7% of pharmacists' interventions. Conclusion DRP in a stroke unit is common. Clinical pharmacists in a stroke unit can effectively reduce and prevent DRPs with the focus on performing medication reconciliation, providing recommendation on dosage adjustment and proper drug selection for stroke patients.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Erros de Medicação/prevenção & controle , Farmacêuticos , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Papel Profissional , Acidente Vascular Cerebral , Idoso , Feminino , Humanos , Masculino , Reconciliação de Medicamentos/estatística & dados numéricos , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/estatística & dados numéricos , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Tailândia/epidemiologia
19.
Sr Care Pharm ; 34(5): 317-324, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31054590

RESUMO

Discrepancies between electronic prescribing systems and patients' actual use of medicines can result in adverse events and medication errors and have serious consequences for the patients. The discrepancies can be identified when performing a thorough medication reconciliation. Computerized health care systems throughout the Danish health care sector are integrated with the Shared Medication Record (SMR). In the SMR, current medication and medication prescriptions are registered. The aim of this study was to evaluate the number and types of discrepancies between medications listed in the SMR and an updated medication list, obtained through a thorough medication reconciliation, for patients admitted in Danish hospitals. Pharmacists listed the number and type of discrepancies for 412 patients. A total of 1,004 discrepancies were registered, with a mean number of 2.4 medication discrepancies per patient. For 25% (n = 101) of the patients, no discrepancies were found, 20% (n = 86) had one discrepancy, and 16% (n = 66) had five or more discrepancies. More than 50% of the patients had one or more medications in the SMR that the patient did not administer, and 12.6% used medications that were not listed in the SMR. This shows that the SMR should not be used as the only source of information when recording medication history.


Assuntos
Prescrição Eletrônica , Reconciliação de Medicamentos , Prescrições de Medicamentos , Humanos , Erros de Medicação , Farmacêuticos
20.
Int J Clin Pharm ; 41(4): 853-858, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31093941

RESUMO

Background Clinical pharmacist interventions have been shown to improve drug use in older adults. Study findings are seldom externally validated however. Objective First, to validate a minimized iteration of a previously tested intervention of clinical pharmacists in a non-academic setting with limited staffing resources. Second, to compare the potentially inappropriate medication (PIM) reduction to two previous controlled interventional studies. Methods A controlled study was performed at geriatric wards. The control group received usual care. The intervention group was exposed to a clinical pharmacist led medication review, based on the use of the RASP list, (the Rationalization of Home Medication by an Adjusted STOPP list in Older Patients). Drug use on admission and at discharge were evaluated, including the number of RASP-identified potentially inappropriate medications (PIMs). The PIM reduction was compared to two previous controlled study findings using a linear mixed model. Results Drug use declined during hospital stay, without differences between control (n = 29) and intervention group (n = 32). Antidepressants and hypnotic drugs were discontinued more frequently in IG patients. More PIMs were reduced in the intervention patients (control vs. intervention: 1.0 vs. 3.0, p < 0.001). Across three controlled studies, a robust reduction of 1.56 PIMs (95% confidence interval 1.10-2.02, p < 0.001) was observed in favor of the CP interventions. Conclusion The minimal CP intervention resulted in fewer RASP PIMs. No net reduction of drug use was observed, yet fewer antidepressants and hypnotic drugs were used. The RASP PIM reduction was comparable to previous investigations.


Assuntos
Reconciliação de Medicamentos/métodos , Serviço de Farmácia Hospitalar , Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
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