RESUMO
BACKGROUND: Lack of physical activity is a concern for children across diverse backgrounds, particularly affecting those in rural areas who face distinct challenges compared to their urban counterparts. Community-derived interventions are needed that consider the unique context and additional physical activity barriers in under-resourced rural settings. Therefore, a prospective pre-post pilot/feasibility study of Hoosier Sport was conducted over 8-weeks with 6th and 7th grade children in a low-socioeconomic rural middle school setting. The primary objective of the present study was to assess trial- and intervention-related feasibility indicators; and the secondary objective was to collect preliminary assessment data for physical activity levels, fitness, psychological needs satisfaction, and knowledge of physical activity and nutrition among participating youth. METHODS: This prospective 8-week pilot/feasibility study took place in the rural Midwestern United States where twenty-four middle school students participated in a mixed-methods pre-post intervention during physical education classes. The intervention included elements like sport-based youth development, individualized goal setting, physical activity monitoring, pedometer usage, and health education. Data were collected at baseline (T1) and post-intervention (T3), with intermediate measures during the intervention (T2). Qualitative data were integrated through semi-structured interviews. Analytical methods encompassed descriptive statistics, correlations, repeated measures ANOVA, and thematic analysis. RESULTS: Key findings indicate robust feasibility, with intervention-related scores (FIM, AIM, and IAM) consistently surpassing the "good" threshold and 100% retention and recruitment success. Additionally, participants showed significant physical performance improvement, shifting from the 25th to the 50th percentile in the 6-minute walk test (p < 0.05). Autonomy and competence remained high, reflecting positive perceptions of program practicality. Nutrition knowledge, initially low, significantly improved at post-intervention (p < 0.01), highlighting the efficacy of targeted nutritional education in Hoosier Sport. CONCLUSIONS: This study pioneers a community-engaged model for physical activity intervention in under-resourced rural settings. Positive participant feedback, coupled with improvements in physical fitness and psychosocial factors, highlights the potential of the co-design approach. The findings offer valuable insights and a practical template for future community-based research, signaling the promising impact of such interventions on holistic well-being. This research lays the foundation for subsequent phases of the ORBIT model, emphasizing collaborative, community-driven approaches to address the complex issue of declining physical activity levels among adolescents.
Assuntos
Exercício Físico , Estudos de Viabilidade , População Rural , Humanos , Projetos Piloto , Masculino , Exercício Físico/psicologia , Criança , Feminino , Adolescente , Estudos Prospectivos , Promoção da Saúde/métodos , Meio-Oeste dos Estados Unidos , Avaliação de Programas e Projetos de Saúde , Educação Física e TreinamentoRESUMO
In October 2013, we implemented a hemostatic and antithrombotic (HAT) stewardship program with the primary focus of ensuring appropriate use of intravenous direct thrombin inhibitors (DTI) in patients with heparin-induced thrombocytopenia (HIT). We sought to compare the duration and cost of DTI therapy for the management of HIT before and after implementation of the HAT stewardship program. Following institutional review board approval, we conducted a single center, retrospective chart review of all patients with a suspected diagnosis of HIT as assessed by an anti-heparin-PF4 enzyme-linked immunosorbent assay 6 months pre-HAT and post-HAT implementation. Patients were excluded if they were initiated on a DTI at an outside hospital, had a prior episode of HIT, or received mechanical circulatory support. Clinical characteristics, including demographics, comorbidities, medications, laboratory values, clinical and safety outcomes, length of stay, and mortality, were collected. A total of 592 patients were included; 333 patients were evaluated pre-HAT, while 259 patients were evaluated post-HAT. The mean duration of DTI treatment was significantly decreased in the post-HAT cohort (6.64 vs 5.17 days, p = 0.01), primarily driven by decreased duration of use for patients with suspected HIT (4.07 vs 2.86 days, p = 0.01). The HAT Stewardship program demonstrated a total decrease in annual costs associated with the diagnosis and management of HIT of $248,500. Our results indicate that the implementation of the HAT stewardship program had a significant impact on reducing the duration and costs of DTI therapy and the costs of laboratory evaluations in the management of HIT at our institution.
Assuntos
Fibrinolíticos , Heparina/efeitos adversos , Trombocitopenia , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/economia , Hemostáticos/administração & dosagem , Hemostáticos/economia , Heparina/administração & dosagem , Heparina/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombocitopenia/induzido quimicamente , Trombocitopenia/diagnóstico , Trombocitopenia/tratamento farmacológico , Trombocitopenia/economiaRESUMO
Background: Interruptions in the pharmacy setting by nurses are common. While the source of nurse-generated interruptions may be variable, the appropriateness of these interruptions remains unknown. Objective: To evaluate the impact and appropriateness of nursing interruptions on pharmacist workflow resulting from telephone calls, alphanumeric pagers, and in-person interactions. Methods: An electronic data collection tool was created to record nursing-based interruptions of pharmacists through telephone calls, pages, and in-person interactions. The data were collected during all pharmacist shifts (day, evening, and night) over 14 days in 2 separate, 7-day data collection periods in December 2011 and January 2012. The data collection form comprised 7 questions that addressed the purpose of this study, including the shift; unit location; type, nature, and appropriateness of the interruption; estimated time spent; and whether the interruption was duplicated. Results: A total of 3,531 interruptions were documented during the 14 days of data collection; an average of 252 data points per day were recorded by the pharmacists. About 55% of the interruptions were initiated through alphanumeric pagers, 33% from phone calls, and 12% from face-to-face interactions. Sixty-three percent of the total interruptions were annotated as appropriate interruptions, while 37% of were annotated as inappropriate interruptions. The total time spent addressing the interruptions deemed inappropriate was 75 hours during the study period. Conclusion: Distinct opportunities exist for process improvement changes, as well as educational and behavioral changes, that would greatly benefit nursing and pharmacy staff.
RESUMO
Hemostatic and antithrombotic (HAT) agents are high risk, high cost products. They require close monitoring and dose titration to adequately treat or prevent thrombosis while avoiding bleeding events. Incorporating the principles of inpatient anticoagulation management service into a stewardship program not only improves outcomes and decreases cost, but also improves transitions of care, exposes gaps in therapy management, and leads to the development of institution specific protocols and guidelines. We implemented a HAT Stewardship to provide real time clinical surveillance and management of these agents in an effort to optimize appropriate use, decrease serious adverse events, and minimize costs. The stewardship is staffed daily by an interdisciplinary team comprised of a pharmacist, hematology attending, and medical director. The stewardship focuses on (1) management of heparin-induced thrombocytopenia (HIT), (2) management of patients with Hemophilia A/B with inhibitors and acquired Factor VIII deficiency due to inhibitors, (3) oversight of anticoagulation in patients on extracorporeal membrane oxygenation and (4) assistance with anticoagulation management for patients with mechanical cardiac assist devices. Through implementation of this service, we have been able to demonstrate improved patient care and a positive economic impact exceeding the cost of this program by almost sixfold. Other centers should consider instituting a HAT Stewardship to maximize patient outcomes and minimize adverse events.
Assuntos
Fibrinolíticos/economia , Hemofilia A/economia , Hemofilia B/economia , Hemostáticos/economia , Trombocitopenia/economia , Custos e Análise de Custo , Feminino , Fibrinolíticos/administração & dosagem , Hemofilia A/tratamento farmacológico , Hemofilia B/tratamento farmacológico , Hemostáticos/administração & dosagem , Humanos , Masculino , Trombocitopenia/tratamento farmacológicoRESUMO
BACKGROUND: Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR). METHODS: We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events. RESULTS: We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate)--a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it. CONCLUSIONS: Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373.)
Assuntos
Processamento Eletrônico de Dados , Sistemas de Registro de Ordens Médicas , Erros de Medicação/prevenção & controle , Sistemas de Medicação no Hospital , Preparações Farmacêuticas/administração & dosagem , Centros Médicos Acadêmicos/organização & administração , Esquema de Medicação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Erros de Medicação/estatística & dados numéricos , Estudos de Casos Organizacionais , Inovação Organizacional , Estados UnidosRESUMO
STUDY OBJECTIVE: We assess the impact of emergency department (ED) pharmacists on reducing potentially harmful medication errors. METHODS: We conducted this observational study in 4 academic EDs. Trained pharmacy residents observed a convenience sample of ED pharmacists' activities. The primary outcome was medication errors recovered by pharmacists, including errors intercepted before reaching the patient (near miss or potential adverse drug event), caught after reaching the patient but before causing harm (mitigated adverse drug event), or caught after some harm but before further or worsening harm (ameliorated adverse drug event). Pairs of physician and pharmacist reviewers confirmed recovered medication errors and assessed their potential for harm. Observers were unblinded and clinical outcomes were not evaluated. RESULTS: We conducted 226 observation sessions spanning 787 hours and observed pharmacists reviewing 17,320 medications ordered or administered to 6,471 patients. We identified 504 recovered medication errors, or 7.8 per 100 patients and 2.9 per 100 medications. Most of the recovered medication errors were intercepted potential adverse drug events (90.3%), with fewer mitigated adverse drug events (3.9%) and ameliorated adverse drug events (0.2%). The potential severities of the recovered errors were most often serious (47.8%) or significant (36.2%). The most common medication classes associated with recovered medication errors were antimicrobial agents (32.1%), central nervous system agents (16.2%), and anticoagulant and thrombolytic agents (14.1%). The most common error types were dosing errors, drug omission, and wrong frequency errors. CONCLUSION: ED pharmacists can identify and prevent potentially harmful medication errors. Controlled trials are necessary to determine the net costs and benefits of ED pharmacist staffing on safety, quality, and costs, especially important considerations for smaller EDs and pharmacy departments.
Assuntos
Serviços Médicos de Emergência , Erros de Medicação/prevenção & controle , Farmacêuticos , Adulto , Anti-Infecciosos/administração & dosagem , Anticoagulantes/administração & dosagem , Fármacos do Sistema Nervoso Central/administração & dosagem , Estudos Transversais , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Masculino , Erros de Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Farmacêuticos/normas , Estudos ProspectivosRESUMO
BACKGROUND: Bar coding can reduce hospital pharmacy dispensing errors, but it is unclear if the benefits of this technology justify its costs. The purpose of this study was to assess the costs and benefits and determine the return on investment at the institutional level for implementing a pharmacy bar code system. METHODS: We performed a cost-benefit analysis of a bar code-assisted medication-dispensing system within a large, academic, nonprofit tertiary care hospital pharmacy. We took the implementing hospital's perspective for a 5-year horizon. The primary outcome was the net financial cost and benefit after 5 years. The secondary outcome was the time until total benefits equaled total costs. Single-variable, 2-variable, and multiple-variable Monte Carlo sensitivity analyses were performed to test the stability of the outcomes. RESULTS: In inflation- and time value-adjusted 2005 dollars, total costs during 5 years were $2.24 million ($1.31 million in 1-time costs during the initial 3.5 years and $342 000 per year in recurring costs starting in year 3). The primary benefit was a decrease in adverse drug events from dispensing errors (517 events annually), resulting in an annual savings of $2.20 million. The net benefit after 5 years was $3.49 million. The break-even point for the hospital's investment occurred within 1 year after becoming fully operational. A net benefit was achieved within 10 years under almost all sensitivity scenarios. In the Monte Carlo simulation, the net benefit during 5 years was $3.2 million (95% confidence interval, -$1.2 million to $12.1 million), and the break-even point for return on investment occurred after 51 months (95% confidence interval, 30 to 180 months). CONCLUSION: Implementation of a bar code-assisted medication-dispensing system in hospital pharmacies can result in a positive financial return on investment for the health care organization.
Assuntos
Processamento Eletrônico de Dados/economia , Sistemas de Medicação no Hospital/economia , Serviço de Farmácia Hospitalar/economia , Boston , Análise Custo-Benefício , Método de Monte CarloRESUMO
PURPOSE: The utility of a transitions-of-care (TOC) pharmacist intervention focused on improving the quality and safety of the medication process for high-risk cardiovascular patients was evaluated. METHODS: A quality-improvement initiative was developed for patients with heart failure or acute coronary syndrome followed longitudinally at a hospital's outpatient cardiovascular clinic. The TOC pharmacist intervention occurred either before a patient's outpatient cardiovascular clinic appointment or during a hospitalization. The major outcome analyzed was the number of unplanned hospital readmissions within 30 days. Additional endpoints evaluated included the time to healthcare utilization, number of medication discrepancies identified, percentage of therapeutic recommendations accepted by a provider, number of medication access issues resolved, patient cost savings, patient satisfaction, and mean time spent on an intervention by the pharmacist per patient encounter. RESULTS: A total of 118 patients received the TOC pharmacist intervention. A total of 516 medication discrepancies were identified and corrected, with 55.6% of discrepancies involving cardiovascular medications. A total of 244 recommendations for therapeutic optimization were provided, with an 81% provider acceptance rate and a 100% patient satisfaction rate. Fifty-five patients were provided with medication cost savings, and medication-access issues were resolved for 8 patients. A TOC pharmacist spent means of 98 and 73 minutes on patient education and coordination of care during inpatient and ambulatory encounters, respectively. The 30-day hospital readmission rate for patients with heart failure was reduced by 20%. CONCLUSION: A TOC pharmacist intervention improved the quality and safety of care across both inpatient and ambulatory settings for high-risk cardiovascular patients at our institution.
Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Reconciliação de Medicamentos/normas , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/normas , Papel Profissional , Cuidado Transicional/normas , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Feminino , Humanos , Masculino , Reconciliação de Medicamentos/métodos , Readmissão do Paciente/normas , Serviço de Farmácia Hospitalar/métodos , Projetos Piloto , Fatores de RiscoRESUMO
BACKGROUND: Many dispensing errors made in hospital pharmacies can harm patients. Some hospitals are investing in bar code technology to reduce these errors, but data about its efficacy are limited. OBJECTIVE: To evaluate whether implementation of bar code technology reduced dispensing errors and potential adverse drug events (ADEs). DESIGN: Before-and-after study using direct observations. SETTING: Hospital pharmacy at a 735-bed tertiary care academic medical center. INTERVENTION: A bar code-assisted dispensing system was implemented in 3 configurations. In 2 configurations, all doses were scanned once during the dispensing process. In the third configuration, only 1 dose was scanned if several doses of the same medication were being dispensed. MEASUREMENTS: Target dispensing errors, defined as dispensing errors that bar code technology was designed to address, and target potential ADEs, defined as target dispensing errors that can harm patients. RESULTS: In the pre- and post-bar code implementation periods, the authors observed 115,164 and 253,984 dispensed medication doses, respectively. Overall, the rates of target potential ADEs and all potential ADEs decreased by 74% and 63%, respectively. Of the 3 configurations of bar code technology studied, the 2 configurations that required staff to scan all doses had a 93% to 96% relative reduction in the incidence of target dispensing errors (P < 0.001) and 86% to 97% relative reduction in the incidence of potential ADEs (P < 0.001). However, the configuration that did not require scanning of every dose had only a 60% relative reduction in the incidence of target dispensing errors (P < 0.001) and an increased (by 2.4-fold) incidence of target potential ADEs (P = 0.014). There were several potentially life-threatening ADEs involving intravenous dopamine and intravenous heparin in that configuration. LIMITATIONS: The authors used surrogate outcomes; did not mask assessors to the purpose of study; and excluded the controlled substance fill process (a process with low error rates at baseline) from the study, which may bias the combined decrease in error rates toward a larger magnitude. CONCLUSIONS: The overall rates of dispensing errors and potential ADEs substantially decreased after implementing bar code technology. However, the technology should be configured to scan every dose during the dispensing process.
Assuntos
Rotulagem de Medicamentos/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Processamento Eletrônico de Dados , Erros de Medicação/prevenção & controle , Serviço de Farmácia Hospitalar/métodos , Serviço de Farmácia Hospitalar/normas , Humanos , Gestão da Segurança , Estados UnidosRESUMO
BACKGROUND: Hospital pharmacies dispense large numbers of medication doses for hospitalized patients. A study was conducted at an academic tertiary care hospital to characterize the incidence and severity of medication dispensing errors in a hospital pharmacy. METHODS: Direct observation of dispensing processes was undertaken to determine presence of errors with review by a physician panel to determine severity. RESULTS: A total of 140,755 medication doses filled by pharmacy technicians were observed during a seven-month period, and 3.6% (5075) contalned errors. The hospital pharmacist detected only 79% of these errors during routine verification; thus, 0.75% of doses filled would have left the phannacy with undetected errors. Overall, 23.5% of undetected errors were potential adverse drug events (ADEs), of which 28% were serious and 0.8% were life threatening. The most common potential ADEs were incorrect medications (36%), incorrect strength (35%), and incorrect dosage form (21%). DISCUSSION: Given the volume of medications dispensed, even a low rate of drug distribution process translates into a large number of errors with potential to harm patients. Pharmacy distribution systems require further process redesign to achieve the highest possible level of safety and reliability.
Assuntos
Auditoria Médica , Erros de Medicação/estatística & dados numéricos , Sistemas de Medicação no Hospital/normas , Serviço de Farmácia Hospitalar/normas , Gestão da Segurança , Centros Médicos Acadêmicos , Boston , Humanos , Doença Iatrogênica/epidemiologia , Incidência , Erros de Medicação/classificação , Erros de Medicação/prevenção & controle , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Avaliação de Processos em Cuidados de Saúde , Análise e Desempenho de TarefasRESUMO
OBJECTIVE: Safety advocates have identified barcode verification technology as an important tool to improve health-care practices. METHODS: We evaluated the evidence for the role of barcode technology in improving a wide range of medication safety outcomes across a broad range of settings. Important implementation issues were highlighted to guide standards for the safe adoption of barcode technology. RESULTS: Adverse drug events are common, occurring frequently in both inpatient and outpatient settings. Although approximately half of all preventable adverse drug events in inpatients result from medication errors arising from transcription, dispensing, and administration, these errors are far less likely to be caught than in any of the earlier stages of the medication use process and are therefore most amenable to improvement. When integrated with electronic medication administration records, barcode systems are associated with complete elimination of transcription errors. Furthermore, barcode-assisted dispensing systems are associated with 93% to 96% reductions in dispensing errors, and 85% reductions in potential adverse drug events in dispensing. Most studies have reported large and significant reductions in administration errors by up to 80% after implementation of barcode medication administration systems. Although most studies of barcode technology have been conducted in the adult inpatient setting, the limited data available also support their benefit in pediatric and outpatient settings. CONCLUSIONS: There is growing evidence for the efficacy of barcode solutions in improving overall medication safety. Standards for the implementation of barcode technology are proposed.
Assuntos
Sistemas de Informação em Farmácia Clínica/normas , Processamento Eletrônico de Dados/normas , Erros de Medicação/prevenção & controle , Segurança do Paciente , Adulto , Criança , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Garantia da Qualidade dos Cuidados de SaúdeRESUMO
BACKGROUND: Academic medical centres face the need to care for patients with complex medical conditions, educate physicians-in-training and conduct research, all with increasingly constrained budgets. The adoption of new therapeutic technology presents challenges and opportunities in each of these areas. Severe sepsis remains a major cause of morbidity and mortality, especially in tertiary-care facilities. Recombinant human activated protein C reduces mortality in patients with severe sepsis, but trial data indicate that the benefit of the drug is confined to the more seriously ill patients, while the risk of bleeding complications can be considerable. The cost of the drug is approximately USD 6000-8000 per treated patient. Integration of this product into routine care has produced unique challenges concerning clinical decision making, safety and cost. OBJECTIVES: To describe one hospital's multidisciplinary approach to the adoption of this new medication. METHODS: Before activated protein C was approved for use, Brigham and Women's Hospital (BWH) convened a working group to formulate clinical guidelines proactively. This new agent did not fit into an obvious therapeutic category but cut across multiple clinical disciplines requiring the involvement of several hospital departments in developing policy. As new data on efficacy emerged during the US FDA review of the drug, the working group had to devise a method for using the available information to assist clinical decision making while placing appropriate restrictions on the use of activated protein C. The goal was to make accurate information available to guide ordering physicians' decision making interactively, 24 hours a day. RESULTS: The committee developed a utilisation policy for activated protein C that provided guidance on patient selection, contraindications and risk stratification. Interactive computer-based order entry screens were developed to guide physicians through a complex set of clinical criteria to ensure appropriate evidence-based use. A careful review of contraindications is required as a second step. To risk stratify patients in accordance with the trial subset analyses and the FDA labelling guidelines, ordering physicians are guided in calculating an APACHE II (Acute Physiology and Chronic Health Evaluation) score for the patient. Physicians from several specialties are available for advice and consultation on patients with difficult or controversial conditions. Approximately two-thirds of completed orders passed the clinical algorithm; an additional 35% of patients did not meet the medication criteria but received the drug after the attending physician requested an override of the guidelines. CONCLUSION: The BWH approach to activated protein C used an innovative multidisciplinary approach and computer-assisted order entry to guide clinical use of a new agent with substantial clinical efficacy, risks and costs. This approach provides a model for strategies to deal with other new and complex medical technologies.
Assuntos
Algoritmos , Sistemas de Registro de Ordens Médicas/normas , Guias de Prática Clínica como Assunto , Proteína C/uso terapêutico , Centros Médicos Acadêmicos , Humanos , Comunicação Interdisciplinar , Sistemas de Registro de Ordens Médicas/economia , Sistemas de Registro de Ordens Médicas/tendências , Sistemas de Medicação no Hospital/normas , Sistemas de Medicação no Hospital/estatística & dados numéricos , Sistemas de Medicação no Hospital/tendências , Reprodutibilidade dos TestesRESUMO
PURPOSE: Antineoplastic preparation presents unique safety concerns and consumes significant pharmacy staff time and costs. Robotic antineoplastic and adjuvant medication compounding may provide incremental safety and efficiency advantages compared with standard pharmacy practices. METHODS: We conducted a direct observation trial in an academic medical center pharmacy to compare the effects of usual/manual antineoplastic and adjuvant drug preparation (baseline period) with robotic preparation (intervention period). The primary outcomes were serious medication errors and staff safety events with the potential for harm of patients and staff, respectively. Secondary outcomes included medication accuracy determined by gravimetric techniques, medication preparation time, and the costs of both ancillary materials used during drug preparation and personnel time. RESULTS: Among 1,421 and 972 observed medication preparations, we found nine (0.7%) and seven (0.7%) serious medication errors (P = .8) and 73 (5.1%) and 28 (2.9%) staff safety events (P = .007) in the baseline and intervention periods, respectively. Drugs failed accuracy measurements in 12.5% (23 of 184) and 0.9% (one of 110) of preparations in the baseline and intervention periods, respectively (P < .001). Mean drug preparation time increased by 47% when using the robot (P = .009). Labor costs were similar in both study periods, although the ancillary material costs decreased by 56% in the intervention period (P < .001). CONCLUSION: Although robotically prepared antineoplastic and adjuvant medications did not reduce serious medication errors, both staff safety and accuracy of medication preparation were improved significantly. Future studies are necessary to address the overall cost effectiveness of these robotic implementations.
Assuntos
Antineoplásicos/normas , Erros de Medicação/prevenção & controle , Serviço de Farmácia Hospitalar/organização & administração , Robótica/métodos , Centros Médicos Acadêmicos/economia , Centros Médicos Acadêmicos/organização & administração , Antineoplásicos/economia , Custos e Análise de Custo/estatística & dados numéricos , Composição de Medicamentos/economia , Composição de Medicamentos/métodos , Humanos , Massachusetts , Erros de Medicação/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/normas , Robótica/economia , Gestão da Segurança/métodos , Fluxo de TrabalhoAssuntos
Substâncias Controladas/normas , Atenção à Saúde/normas , Controle de Medicamentos e Entorpecentes , Guias como Assunto/normas , Farmácia/normas , Substâncias Controladas/efeitos adversos , Atenção à Saúde/métodos , Controle de Medicamentos e Entorpecentes/métodos , Pessoal de Saúde/normas , Humanos , Farmácia/métodos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controleRESUMO
Bariatric surgical patients often need changes in formulation and dosages of their medications. The literature contains minimal information regarding pharmaceutical care and consultation services for the bariatric surgery patient. Complex medication regimens and safety concerns initiated a collaborative effort between surgeons and pharmacists to manage more effectively bariatric patients perioperatively. The consultation service included patient identification, pharmacy referral, pharmacist consultation with the patient, communication of recommendations with surgeons, follow-up, and documentation. There were 124 consultations performed from February 2, 2009 to December 1, 2010 with an average of 7.7 medications optimized per patient. Every patient required a minimum of one adjustment to their regimen. The surgeons approved 98% of these recommendations. Of recommendations provided, the majority focused on changing the formulation of the medication in some manner. The collaborative effort between surgeons and pharmacists effected changes in medication transitioning perioperatively and resulted in improved pharmaceutical care for this patient population.
Assuntos
Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Assistência Perioperatória , Assistência Farmacêutica , Encaminhamento e Consulta , Medicina Bariátrica , Comportamento Cooperativo , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/tratamento farmacológico , Estudos RetrospectivosRESUMO
PURPOSE: The results of an evaluation of the impact of pharmacists' medication-related interventions on quality of care in the emergency department (ED) setting are reported. METHODS: Using data from a previously published observational study of medication errors intercepted by ED pharmacists at four academic medical centers, trained reviewers retrospectively analyzed 130 additional pharmacist interventions (those not categorized as medication errors in the primary study) over a specified four-month period to identify "quality interventions" (QIs), defined as those that (1) prevented misuse, underuse, or overuse of medications or (2) improved adherence to quality standards or evidence-based medicine (EBM) standards. The study included an evaluation of the medication classes associated with QIs and the acceptance of pharmacist-recommended QIs. RESULTS: The reviewers identified a total of 91 pharmacist QIs at the four sites during the study period (2.3 QIs per 100 patients or about 1 QI per 100 medication orders). About 45% of the identified QIs improved adherence with EBM or national quality standards; other QIs prevented medication underuse (34%), misuse (14%), or overuse (6%). Pharmacists' QIs most often pertained to antiinfective agents (39%), cardiovascular agents (13%), and anticoagulants and thrombolytics (12%). The overall rate of acceptance of pharmacists' QIs was 93.4%. CONCLUSION: A secondary analysis of data from a previously published study at four medical centers indicated that ED pharmacists often recommend interventions that improve the quality of medication use and adherence to EBM and national quality standards.