Patients with repeated acute admissions to somatic departments: sociodemographic characteristics, disease burden, and contact with primary healthcare sector - a retrospective register-based case-control study.

BACKGROUND: Healthcare systems face escalating capacity challenges and patients with repeated acute admissions strain hospital resources disproportionately. However, studies investigating the characteristics of such patients across all public healthcare providers in a universal healthcare system are lacking. OBJECTIVE: To investigate characteristics of patients with repeated acute admissions (three or more acute admissions within a calendar year) in regard to sociodemographic characteristics, disease burden, and contact with the primary healthcare sector. METHODS: This matched register-based case-control study investigated repeated acute admissions from 1 January 2014 to 31 December 2018, among individuals, who resided in four Danish municipalities. The study included 6169 individuals with repeated acute admissions, matched 1:4 to individuals with no acute admissions and one to two acute admissions, respectively. Group comparisons were conducted using conditional logistic regression. RESULTS: Receiving social benefits increased the odds of repeated acute admissions 9.5-fold compared with no acute admissions (odds ratio (OR) 9.5; 95% confidence interval (CI) 8.5; 10.6) and 3.4-fold compared with one to two acute admissions (OR 3.4; 95% CI 3.1; 3.7). The odds of repeated acute admissions increased with the number of used medications and chronic diseases. Having a mental illness increased the odds of repeated acute admissions 5.8-fold when compared with no acute admissions (OR 5.7; 95% CI 5.2; 6.4) and 2.3-fold compared with one to two acute admissions (OR 2.3; 95% CI 2.1; 2.5). Also, high use of primary sector services (e.g. nursing care) increased the odds of repeated acute admissions when compared with no acute admissions and one to two acute admissions. CONCLUSIONS: This study pinpointed key factors encompassing social status, disease burden, and healthcare utilisation as pivotal markers of risk for repeated acute admissions, thus identifying high-risk patients and facilitating targeted intervention.

Opportunistic screening for COPD among socially marginalized patients.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common disease associated with premature death. Tobacco exposure is the main risk factor, but lower socioeconomic status, early life insults, and occupational exposures are also important risk factors. Socially marginalized people, facing homelessness, substance use disorder, and mental illness, are likely to have a higher risk of developing COPD, and, furthermore, experience barriers to healthcare access and consequently poorer outcomes. OBJECTIVE: This study aims to assess COPD prevalence and the impact of opportunistic screening among hospitalized patients who are in contact with hospital social nurses. These patients constitute a group of patients with a high prevalence of psychiatric and somatic diseases, substance use, low life expectancy, and are socially marginalized. METHODS: The present prospective longitudinal study includes a clinical examination at baseline. Participants will have spirometry done and be interviewed regarding risk factors, socioeconomic conditions, and respiratory symptoms. The 5-year follow-up assessment incorporates data from baseline and register data over the 5 years, including information on morbidity, use of COPD medication, hospital contacts, mortality, and socioeconomic factors. ANTICIPATED RESULTS: Referral for further diagnostic work-up and management after the screening, including COPD treatment and smoking cessation support, is expected to improve survival rates. The study is still enrolling patients. TRIAL REGISTRATION: The study is registered at ClinicalTrials.gov , NCT04754308 with study status: "enrolling".

A Danish version of the MISSCARE survey: Translation and validation.

BACKGROUND: Measuring missed nursing care in clinical settings may serve as an important indicator for improving patient safety and nursing staff retention. Internationally, several tools exist, with the MISSCARE Survey being the most frequently used and validated; however, no tools are available in the Danish language. AIM: This study aimed at translating the MISSCARE Survey from US English to Danish and evaluate its psychometric properties. METHODS: The translation followed the recommended method, that is forward-and-backward translation, involving clinical experts and a professional, native English-speaking translator. The final version was approved by the survey's original developer. Face validity was tested among 10 nurses and 1 practical nurse. Nursing staff from 34 selected departments at Aarhus University Hospital's (n = 1241) were invited to participate in a pilot test in November 2020. The survey consisted of a demographic section, a section of 'nursing elements' (Part A) and section of 'reasons' (Part B). Acceptability was assessed on Part A and B. Reliability was tested by Cronbach's alpha, and psychometric properties were investigated using Confirmatory Factor Analysis (Part B). RESULTS: The face-validity test resulted in minor contextual changes and the addition of a 'not applicable' response option in Part A. The pilot test had a 42.6% response rate (n = 529). Acceptability was good, with 1-10 missing responses per item in Part A and 0-20 missing responses in Part B. The numbers of 'not applicable' responses ranged from 0 to 81. The overall Cronbach's alpha was 0.81. Factor-loading ranges were 0.62-0.48 for 'communication', 0.79-0.39 for 'materials and resources', and 0.50-0.35 for 'labour', suggesting an acceptable fit with the theoretical model. CONCLUSION: The MISSCARE Survey was successfully translated into Danish. The psychometric properties confirmed the questionnaire as a valid and reliable tool for measuring missed nursing care in Danish hospital settings.

Consensus on predictors of clinical deterioration in emergency departments: A Delphi process study.

AIM: The study aim was to determine relevance and applicability of generic predictors of clinical deterioration in emergency departments based on consensus among clinicians. METHODS: Thirty-three predictors of clinical deterioration identified from literature were assessed in a modified two-stage Delphi-process. Sixty-eight clinicians (physicians and nurses) participated in the first round and 48 in the second round; all treating hospitalized patients in Danish emergency departments, some with pre-hospital experience. The panel rated the predictors for relevance (relevant marker of clinical deterioration) and applicability (change in clinical presentation over time, generic in nature and possible to detect bedside). They rated their level of agreement on a 9-point Likert scale and were also invited to propose additional generic predictors between the rounds. New predictors suggested by more than one clinician were included in the second round along with non-consensus predictors from the first round. Final decisions of non-consensus predictors after second round were made by a research group and an impartial physician. RESULTS: The Delphi-process resulted in 19 clinically relevant and applicable predictors based on vital signs and parameters (respiratory rate, saturation, dyspnoea, systolic blood pressure, pulse rate, abnormal electrocardiogram, altered mental state and temperature), biochemical tests (serum c-reactive protein, serum bicarbonate, serum lactate, serum pH, serum potassium, glucose, leucocyte counts and serum haemoglobin), objective clinical observations (skin conditions) and subjective clinical observations (pain reported as new or escalating, and relatives' concerns). CONCLUSION: The Delphi-process led to consensus of 19 potential predictors of clinical deterioration widely accepted as relevant and applicable in emergency departments.

A new situation awareness model decreases clinical deterioration in the emergency departments-A controlled intervention study.

BACKGROUND: Studies have suggested that adding subjective parameters to early warning score (EWS) systems might prompt more proactive treatment and positively affect clinical outcomes. Hence, the study aimed to investigate effect of a situation awareness model consisting of objective and subjective parameters on clinical deterioration in adult emergency department (ED) patients. METHODS: This controlled pre-and-post interventional study was carried out in July-December 2016 and November 2017-April 2018. In ED patients ≥ 18 years, we examined if a situation awareness model compared with a conventional EWS system could reduce clinical deterioration. The new model consisted of a regional EWS, combined with skin observation, clinical concern and patients' and relatives' concerns, pain, dyspnea, and team risk assessment. Clinical deterioration was defined as change in vital signs requiring increased observation or physician assessment, that is, increase in early warning score from either 0 or 1 to score ≥2 or an increase from score ≥2 and above. Secondary outcomes were mortality, intensive care unit (ICU) admissions, and readmissions. RESULTS: We included 34 556 patients. Patients with two or more registered EWS were included in the primary analysis (N = 21 839). Using difference-in-difference regression, we found a reduced odds of clinical deterioration of 21% (OR 0.79 95% CI [0.69; 0.90]) in the intervention groups compared with controls. No impact on mortality, ICU, or readmissions was found. CONCLUSION: The situation awareness model reduces odds of clinical deterioration, defined as a clinically relevant increase in EWS, in an unselected adult population of ED patients. However, there was no effect on secondary outcomes.

Functional decline in emergency department patients with dyspnea: a register-based cohort.

BACKGROUND: Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably, patients acutely admitted to hospital with dyspnea have a high risk of functional decline. OBJECTIVE: The aim of this study was to describe patient characteristics, hospital trajectory and use of physiotherapy services by dyspneic patients in an emergency department. The study also wanted to compare readmission and death among patients with and without a functional decline and to identify predictors of functional decline. METHODS: Data originated from a historic cohort of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients who were treated at the emergency department (ED) for dyspnea in 2015. The main outcome measures were readmission, death and functional decline. RESULTS: In total, 2048 dyspneic emergency treatments were registered. Within 30 days after discharge, 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, P < 0.001) and mortality (9.3% vs. 3.6%, P = 0.009) as well as mortality within 1 year (36.1% vs. 13.4%, P < 0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. CONCLUSION: Patients suffering from acute dyspnea are seen at the ED at all hours. In total, one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seem to be particularly vulnerable.

An evaluation of the Danish version of the Pediatric Anesthesia Emergence Delirium scale.

BACKGROUND: Emergence Delirium (ED) is a common complication from anesthesia. Although ED has a short duration, detection is important due to the risk that ED poses for post-operative complications in the child. The Pediatric Anesthesia Emergence Delirium (PAED) scale has been translated into Danish, but it has not yet been validated. The aim of this study was to investigate the inter-rater reliability, criterion validity, and responsiveness of the Danish version of the PAED scale as well as to determine the prevalence of ED. METHOD: A sample of 100 post-operative children were enrolled and assessed with the PAED scale at pre-specified time intervals. Inter-rater reliability was assessed independently by 2 raters. For criterion validity, a clinical expert was chosen as the gold standard. Sensitivity and specificity were based on a comparison between the scoring of the raters and the gold standard. Responsiveness was assessed by comparing changes in scores. Prevalence was based on the PAED scale's cut-off level of ≥10 points. RESULTS: A high level of agreement was found, with an intraclass correlation coefficient of 0.85-0.94. Few outliers appeared in the Bland-Altman plot. Sensitivity ranged from 70% to 86%, and the specificity of both raters against the gold standard was 100%. Changes in scores were indicative of responsiveness. Prevalence was 13.2%. CONCLUSION: The Danish version of the PAED scale was found reliable and demonstrated high levels of sensitivity and specificity. In addition, it was possible to identify changes in scores over time. Prevalence was in line with existing literature.

Do the carers care? A phenomenological study of providing care for patients suffering from alcohol use disorders.

Excessive alcohol consumption can have adverse effects on health, and patients who suffer from alcohol use disorders are subject to much stigmatization. Nurses are often the first point of contact when patients enter the acute medical unit, and it is pivotal that this contact establishes the basis for future collaboration. The aim of this study is to elucidate nurses' lived experience of providing care to patients suffering from alcohol use disorders. This present study has a qualitative research design, anchored in phenomenological and hermeneutical methodology as described in reflective lifeworld research. Ten in-depth, open-ended interviews with nurses working in an acute medical unit were conducted. The analysis showed that providing care to patients suffering from alcohol use disorders was a highly complex task to accomplish. This required the nurse to engage with the patient in a sensitive cooperation in order to be dealing with the intricacy of the patient's life situation and balancing care between standardized procedures and the complexity of the patients. Further, a two-sided feeling of responsibility emerged: a professional responsibility and a personal responsibility causing the provision of care as being caught between feelings of despondency and resignation. Nurses lack opportunities for being creative in determining how to provide care; instead, patients' perspectives of well-being should be taken into account and should guide the provision of a meaningful care. Nurses must call for opportunities to deviate from the firmly established procedures restraining the care of this population.

The Cornell Assessment of Pediatric Delirium: Translation and inter-rater reliability in a Danish pediatric intensive care unit.

BACKGROUND: Delirium is a serious medical problem and recognized as a common syndrome in critically ill children. Without routine screening, delirium diagnosis is often missed by the medical providers. Internationally, there are tools to assess pediatric delirium (PD), but none currently available in Danish. The aim of this project was to translate the Cornell Assessment of Pediatric Delirium (CAPD) into Danish and determine its feasibility and reliability in a Danish clinical setting. METHODS: Translation was done in accordance with WHO guidelines. Linguistic and cultural differences were reconciled with the original developers of the instrument. The Danish CAPD was then tested in a prospective cohort of children admitted to a single pediatric intensive care unit at a university hospital in Denmark. Inter-rater reliability was determined using weighted Kappa statistics. RESULTS: Thirty children were enrolled, and 92 delirium assessments were completed. Inter-rater reliability (n = 84) revealed that inter-observer agreement among the nurses was high (κ 0.85). The Danish version of the CAPD was successfully administered in all children. CONCLUSIONS: Standardized assessment tools are a pre-requisite to identify PD. A Danish version of the CAPD now exists, and preliminary testing has demonstrated it as feasible and reliable for use in a Danish clinical setting. A multi-institutional study is needed to determine the prevalence of PD in Denmark.

Scheduled care-As a way of caring: A phenomenological study of being cared for when suffering from alcohol use disorders.

AIMS AND OBJECTIVES: To elucidate the lived experience of how patients with alcohol use disorders experience being cared for when admitted to acute medical units. BACKGROUND: Alcohol use is health damaging and is identified as one of the major avoidable risk factors, and alcohol use disorder is classified among the most harmful, debilitating disease categories. Patients suffering from alcohol use disorders are characterised by complex problems and health pictures spawned by chaotic lifestyles. However, the experience of the hospitalisation from patients' perspective is poorly documented. DESIGN: The present study has a qualitative research design and is anchored in phenomenological and hermeneutical methodology, as described in reflective lifeworld research. METHODS: The data set consists of 15 in-depth interviews with patients suffering from alcohol use disorders admitted to an acute medical unit. A purposive sampling strategy was used, and the interviews were conducted as open dialogues. The study was reported in accordance with the consolidated criteria for reporting qualitative research. RESULTS: Being cared for when hospitalised was experienced as a two-stage process that changed throughout the hospitalisation from an experience of scheduled care experienced as caring to an experience of scheduled care experienced as non-caring. Four constituents further described the variable experiences: being in a safe haven, sharing a tacit but mutual goal, being in a chaotic space and being on your own. CONCLUSIONS: The study showed that being met in an authentic presence by nurses was a powerful tool that helped ease the hospitalisation. Patients suffering from alcohol use disorders call for an intentional and distinctive attentiveness and authentic presence from the nurses throughout their hospitalisation. RELEVANCE TO CLINICAL PRACTICE: Our findings highlight that patients suffering from alcohol use disorders call for an intentional and distinct attentiveness from nurses throughout the hospitalisation, where a possible transfer of attention is noticed and responded to in the care provided.

Physicians' and Nurses' Attitudes and Actions Regarding Perioperative Medication Management.

PURPOSE: To investigate physicians' and nurses' attitudes and actions related to the prescription and administration of perioperative antibiotics and opioids during a 2-week period. DESIGN: A quantitative descriptive and analytical research design performed at a Danish University Hospital. METHODS: An email survey using an 18-item questionnaire was sent to 163 nurses and physicians involved in the perioperative period. FINDINGS: Of 163 participants, 114 (69.9%) returned the questionnaire. Between 12% and 29% of the respondents reported that they did not correctly manage the medication, although they thought it to be important. Between 41% and 68% of the respondents experienced incorrect medication management with significant differences among professions and specialties. CONCLUSIONS: The study confirms a knowing-doing gap in medication management in perioperative settings, highlighting the need to address this issue, to ensure that physicians and nurses act in accordance with their beliefs and consider the importance of medication safety in interdisciplinary work across specialties.

Complex automated medication systems reduce medication administration errors in a Danish acute medical unit.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of two automated medication systems in reducing medication administration errors. DESIGN: The study was a controlled before-and-after study and included three observation periods with collection of data during a 3-week period as initial baseline and two subsequent follow-up periods at 10 and 20 months. SETTING: The study was conducted in two Danish acute medical units. INTERVENTIONS: Two automated medication systems were implemented: (i) a complex automated medication system (cAMS) consisting of an automated dispensing cabinet, automated unit-dose dispensing and barcode medication administration (BCMA) and (ii) a non-patient-specific automated medication system (npsAMS) consisting of automated unit-dose dispensing and BCMA. MAIN OUTCOME MEASURE: The occurrence of administration errors and sub-types; procedural and clinical errors were observed. The proportion of errors was calculated by dividing the number of doses with one or more errors with the number of opportunities for errors. Difference-in-difference analysis using logistic regression was used to assess changes in proportion of errors. RESULTS: Compared with control, the cAMS reduced the overall risk of administration errors in the intervention unit, (odds ratio (OR) 0.53; 95% confidence interval (CI) 0.27-0.90) and procedural errors were significantly reduced as well (OR 0.44; 95% CI 0.126-0.94). The npsAMS effectively reduced the clinical errors in the intervention ward (OR 0.38; 95% CI 0.15-0.96). CONCLUSIONS: In line with previous research, this study found that technological interventions in the medication administration process could reduce the occurrence of medication errors.

Dyspnoea and self-management strategies in patients admitted to the emergency department: A study of patients' experiences.

AIMS AND OBJECTIVE: To explore patients' experiences of acute dyspnoea, physical functioning and perspectives on course of illness prior to admission to the emergency department. BACKGROUND: Many emergency admissions are considered unnecessary and avoidable. In this perspective, it seems relevant to gain insight into the patients' perspective on acute dyspnoea and the need for emergency admission. However, only few studies have investigated reasons for emergency admission from a patient perspective. DESIGN: A qualitative study was conducted with semi-structured interviews among six patients previously admitted to the emergency department due to dyspnoea. Data collection and analysis were carried out according to Kvale & Brinkmann using meaning condensation. FINDINGS: Dyspnoea was experienced as an unpleasant breathlessness in the form of pain or suffocation, which limited usual physical activities, negatively impacting on quality of life. Self-management strategies such as medication, breathing exercises, distraction from breathing, and mental and physical relaxation in general were used to avoid hospital admission. The chronically ill patients saw the following ways to alternate course of disease to avoid admissions to the emergency department: easier access to specialised emergency medical care, medical supplies in the patient's home and making existing physical exercise programmes more accessible and interesting. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: It would be relevant to further investigate whether prehospital interventions may remedy acute dyspnoea among chronically ill patients, and whether such interventions are cost-effective.

Cost-Effectiveness Analysis of an Automated Medication System Implemented in a Danish Hospital Setting.

OBJECTIVES: To evaluate the cost-effectiveness of an automated medication system (AMS) implemented in a Danish hospital setting. METHODS: An economic evaluation was performed alongside a controlled before-and-after effectiveness study with one control ward and one intervention ward. The primary outcome measure was the number of errors in the medication administration process observed prospectively before and after implementation. To determine the difference in proportion of errors after implementation of the AMS, logistic regression was applied with the presence of error(s) as the dependent variable. Time, group, and interaction between time and group were the independent variables. The cost analysis used the hospital perspective with a short-term incremental costing approach. The total 6-month costs with and without the AMS were calculated as well as the incremental costs. The number of avoided administration errors was related to the incremental costs to obtain the cost-effectiveness ratio expressed as the cost per avoided administration error. RESULTS: The AMS resulted in a statistically significant reduction in the proportion of errors in the intervention ward compared with the control ward. The cost analysis showed that the AMS increased the ward's 6-month cost by €16,843. The cost-effectiveness ratio was estimated at €2.01 per avoided administration error, €2.91 per avoided procedural error, and €19.38 per avoided clinical error. CONCLUSIONS: The AMS was effective in reducing errors in the medication administration process at a higher overall cost. The cost-effectiveness analysis showed that the AMS was associated with affordable cost-effectiveness rates.

Potentially inappropriate prescriptions in patients admitted to a psychiatric hospital.

Background Very little is known about the general appropriateness of prescribing for psychiatric patients. Aims To identify prevalence and types of potentially inappropriate prescribing (PIP) of psychotropic and somatic medications, to assess the severity of potential clinical consequences and to identify possible predictive factors of PIP in a sample of adult psychiatric in-patients. Methods A descriptive, cross-sectional design using medication reviews by clinical pharmacologists to identify PIP during a 3-month period. The setting was in-patient units in a psychiatric department of a Danish university hospital during a 3-month period (September 2013-November 2013). Patients medication lists (n = 207) were reviewed at the time of admission and all identified PIPs were assessed for potential consequences by clinical pharmacologists. Results There were 349 PIP identified in 1291 prescriptions. The proportion of patients found to have at least one PIP was 123/207 (59%) and the proportions of patients with at least one PIP assessed to be potentially serious or fatal was 69/207 (33%) and 24/207 (12%), respectively. Interactions between drugs 125/207 (36%) and too high doses of drugs 56/207 (16%) were the most frequent PIP. Predictive factors for PIP were polypharmacy (>5 prescriptions) and having one or more somatic diagnoses. Conclusion PIP is common in psychiatric patients and potentially fatal. Particularly polypharmacy (>5 prescriptions) and concomitant somatic illness were associated with the probability of PIP. Improving the quality of prescribing might benefit from an interprofessional approach and thus better training of physicians and nurses is needed in order to minimize PIP.

Nurses' Perspectives on Patient Satisfaction and Expectations: An International Cross-Sectional Multicenter Study With Implications for Evidence-Based Practice.

BACKGROUND: Addressing patient expectations is necessary to achieve high satisfaction. However, few data are available on nurses' perceptions and performance with respect to patient expectations and satisfaction. OBJECTIVES: This international multicenter study aimed to: (a) evaluate nurses' attitudes and performance with respect to patient satisfaction and expectations, and (b) identify predictors of nurses' inquiry of patients' satisfaction at the point of discharge. METHODS: A questionnaire examining attitudes and performance toward patient satisfaction and expectations was developed and validated. Nurses at four academic hospitals in the United States, the United Kingdom, Israel, and Denmark were surveyed. RESULTS: A total of 536 nurses participated in the study (response rate 85.3%). Nurses expressed positive attitudes toward activities related to patient satisfaction and expectations, endorsing the importance of talking with patients about their satisfaction status (91.6%) and their expectations (93.2%). More than half of the responders (51.8%) claimed to have responded to the status of patient satisfaction or dissatisfaction (Israel: 25%; United States: 54.9%; United Kingdom: 61.7%; Denmark: 69.9%; p < .001). However, only 12.1% stated that they routinely ask patients about their level of satisfaction, with nurses in the United States (18.3%) and Denmark (17.5%) more likely to ask compared to nurses in the United Kingdom (7.4%) and Israel (6.3%; p = .001). Adjusted logistic regression identified four significant predictors (p < .05) of nurses' inquiry about patients' satisfaction: "Responding to patient's satisfaction status" (OR: 3.1; 95% CI: 1.7-5.8); "Documenting patient's satisfaction status" (OR: 2.8; 95% CI: 1.6-5.1); "Asking routinely about expectations" (OR: 5.4; 95% CI: 3-9.7); and "Responded to expectations during the past month" (OR: 4.3; 95% CI: 1.9-9.4). LINKING EVIDENCE TO ACTION: These findings warrant further investigation, potentially into the nurses' work environments or educational programs, to better understand why nurses' positive attitudes toward patient satisfaction and expectations do not result in actively asking patients about their satisfaction level and what should be done to improve nurses' performance. Healthcare organizations and policy makers should develop and support structured programs to address patient expectations and improve patient satisfaction during hospitalization.

Number of drugs most frequently found to be independent risk factors for serious adverse reactions: a systematic literature review.

In order to reduce the numbers of medication errors (MEs) that cause adverse reactions (ARs) many authors have tried to identify patient-related risk factors. However, the evidence remains controversial. The aim was to review systematically the evidence on the relationship between patient-related risk factors and the risk of serious ARs. A systematic search in Pubmed, Embase, Cochrane Systematic Reviews, Psychinfo and SweMed+ was performed. Included full text articles were hand searched for further references. Peer reviewed papers including adults from primary and secondary healthcare were included if they clearly defined seriousness of the ARs and described correlations to risk factors by statistical analysis. A total of 28 studies were identified including 85,212 patients with 3385 serious ARs, resulting in an overall frequency of serious ARs in 4% of patients. Age, gender and number of drugs were by far the most frequently investigated risk factors. The total number of drugs was the most consistent correlated risk factor found in both univariate and multivariate analyses. The number of drugs is the most frequently documented independent patient-related risk factor for serious ARs in both the general adult population as well as in the elderly. The existing evidence is however conflicting due to heterogeneity of populations and study methods. The knowledge of patient-related risk factors for experiencing ARs could be used for electronic risk stratification of patients and thereby allocation of healthcare resources to high risk patients.

Identifying high-risk medication: a systematic literature review.

PURPOSE: A medication error (ME) is an error that causes damage or poses a threat of harm to a patient. Several studies have shown that only a minority of MEs actually causes harm, and this might explain why medication reviews at hospital admission reduce the number of MEs without showing an effect on length of hospital stay, readmissions, or death. The purpose of this study was to define drugs that actually cause serious MEs. We conducted a literature search of medication reviews and other preventive efforts. METHODS: A systematic search in PubMed, Embase, Cochrane Reviews, Psycinfo, and SweMed+ was performed. Danish databases containing published patient complaints, patient compensation, and reported medication errors were also searched. Articles and case reports were included if they contained information of an ME causing a serious adverse reaction (AR) in a patient. Information concerning AR seriousness, causality, and preventability was required for inclusion. RESULTS: This systematic literature review revealed that 47 % of all serious MEs were caused by seven drugs or drug classes: methotrexate, warfarin, nonsteroidal anti-inflammatory drugs (NSAIDS), digoxin, opioids, acetylic salicylic acid, and beta-blockers; 30 drugs or drug classes caused 82 % of all serious MEs. The top ten drugs involved in fatal events accounted for 73 % of all drugs identified. CONCLUSION: Increasing focus on seven drugs/drug classes can potentially reduce hospitalizations, extended hospitalizations, disability, life-threatening conditions, and death by almost 50 %.

Physician awareness of fluid volume administered with intravenous antibiotics - a structured interview-based study.

Objective: Fluids administered as drug diluents with intravenous (IV) medicine constitute a substantial fraction of fluids in inpatients. Are physicians aware of fluid volumes administered with IV antibiotics for patients with suspected infections? Does addressing this lead to adjustments in 24-hour fluid administration/antibiotics? Methods: This cross-sectional interview-based study was conducted in three emergency departments. Physicians were interviewed after prescribing around-the-clock IV antibiotics for ³24 hours to patients with suspected infection. A structured interview guide assessed the physicians' awareness, considerations, and practices when prescribing IV antibiotics. The 24-hour antibiotic fluid volume was calculated. Results: We interviewed 100 physicians. The 24-hour fluid volume administered with IV antibiotics was 400mL (interquartile range: 300-400). Totally, 53% of physicians (n=53) were unaware of the fluid volume administered with IV antibiotics. 76% (n=76) did not account for the antibiotic fluid volume in the 24-hour fluid administration. 96% (n=96) indicated that they would not adjust prescribed fluids after receiving information about 24-hour antibiotic fluid volume administered for their specific patient; no comorbidities associated with fluid intolerance was primary reason for not adjusting prescribed fluids/antibiotics. 79% (n=79) opted for visibility of fluid volumes administered with IV antibiotics in the medical record. Conclusion: The majority of physicians were unaware of fluid volumes administered as a drug diluent with IV antibiotics. The majority chose not to make post-prescribing adjustments to their planned fluid administration; they regarded their patient as fluid tolerable. The physicians opted for visibility of fluid volumes administered as diluents during the prescribing process.

How does a nursing crisis management intervention impact relatives' experiences in two trauma centres? A time-series study.

Background: Being a relative to a trauma patient may be a dramatic experience. Often, trauma centre nurses do not feel they have the competences needed to meet relatives experiencing a crisis. Therefore, a need exists to enhance their crisis management competencies. Objective: To investigate relatives' experiences of a nursing crisis management intervention on information, inclusion and support, including the importance of these needs in two Danish trauma centres. Design: A prospective intervention study based on interrupted time series. The intervention, conducted in 2020-2021, consisted of a crisis management training programme. Settings: The Trauma Centre of the Aarhus University Hospital and Aalborg University Hospital in Denmark. Participants: Relatives (18+ years) of critically ill or injured patients (n = 293). Methods: Data were collected using a 32-item questionnaire. The primary outcome was relatives' overall experience of the quality of the information, inclusion and support measured on a visual analogue scale (VAS) (0-10). Secondary outcomes were changes in risk ratios and scores between the periods for each of the three main variables. The outcome was measured as weighted and non-weighted scores, taking into account the importance of each variable. Besides use of interrupted time series, predictive and weight-adjusted analyses were performed. Time series comprised a before-period (6 months), an implementation period (3 months) and an after-period (6 months). Due to ceiling effect, the predictive analysis was dichotomized using the median scores for information, inclusion and support. Results: Overall, no differences were observed between the participants' characteristics in each of the three periods. Comparing the implementation period with the after-period revealed a statistically significant positive difference between the relatives' assessment of crisis management [p = 0.009]. Additionally, the probability of scoring >8 from before to after the intervention increased statistically significantly [Risk ratio 1.21, 95 % confidence interval 1.16-1.27]. The secondary outcomes showed that the greatest change over time was inclusion of relatives [Risk ratio, 1.25 95 % confidence interval 1.15-1.35]. Information had the greatest effect on relatives' experience of nurses' provision of crisis management and was also the needs area that relatives considered most important. However, information was also the needs area that evolved least during the study. Conclusions: Based on the selected cut-off levels, the intervention appeared to have a positive effect on relatives' experiences - especially inclusion of relatives. In the weighted analyses, information was considered most important and also had the greatest effect on relatives' overall experience. Nurses' crisis management competencies should be prioritized in trauma centres.