The nuts and bolts of pills and potions: the functions of a drug safety working group

2011 ◽  
Vol 35 (4) ◽  
pp. 395
Author(s):  
Noleen S. Nath ◽  
Ellen H. Jones ◽  
Peter Stride ◽  
Manuja Premaratne ◽  
Darshit Thaker ◽  
...  
Keyword(s):  
Adverse Events ◽  
Drug Safety ◽  
Working Group ◽  
Adverse Drug Events ◽  
Improve Patient Safety ◽  
Peer Group ◽  
Medication Management ◽  
Medication Administration ◽  
Similar Data ◽  
Hospitalised Patients

Hospitalised patients commonly experience adverse drug events (ADEs) and medication errors. Runciman reported that ADEs in hospitals account for 20% of reported adverse events and contribute to 27% of deaths where death followed an adverse event. Hughes recommends multidisciplinary hospital drug committees to assess performance and raise standards. The new Code of Conduct of the Medical Board of Australia recommends participation in systems for surveillance and monitoring of adverse events, and to improve patient safety. We describe the functions and role of a Drug Safety Working Group (DSWG) in a suburban hospital, which aims to audit and promote a culture of prescribing and medication administration that is prudent and cautious to minimise the risk of harm to patients. We believe that regular prescription monitoring and feedback to Resident Medical Officers (RMOs) improves medication management in our hospital. What is known about the topic? Adverse drug events are common, leading to increased patient dissatisfaction, increased hospital morbidity and mortality, and increased costs. There is extensive medical literature on the problems of individual drugs, and global information of ADEs in healthcare, but little information for local solutions. What does this paper add? This paper details our experience and methods of running a drug safety working group (DSWG) in a suburban hospital. We strongly believe in a multidisciplinary committee, with feedback to RMOs given by their peer group. This ‘how we do it’ approach is largely absent from medical journals. What are the implications for practitioners? We strive for safer prescribing in our environment and hope to develop for inter-hospital benchmarking with other hospital DSWGs of clearly similar data, with an aim to raise state or nationwide standards.

scholarly journals ADVERSE EVENTS RELATED TO DRUG ADMINISTRATION BY THE NURSING TEAM: AN INTEGRATIVE REVIEW

2021 ◽  
Author(s):  
Aline Rodrigues Vaz ◽  
Daniely Sousa De Oliveira ◽  
Raquel Vilanova Araújoara ◽  
Polyana Norberta Mendes ◽  
Carlos Átila Pereira de Araújo ◽  
...  
Keyword(s):  
Adverse Events ◽  
Adverse Drug Events ◽  
Research Question ◽  
Length Of Hospital Stay ◽  
Medication Administration ◽  
Integrative Review ◽  
Inherent Risk ◽  
Secondary Damage ◽  
Nursing Team ◽  
Key Resources

Medications are key resources used to alleviate patient suffering, but they carry the inherent risk of causing adverse events. Method: this is an integrative review using the terms: nursing, medication, adverse drug events, medication administration and patients. Data were categorized in Excel and categorized according to the research question. Results: Among the types of adverse events found, nausea and vomiting prevailed (n= 5; 24%); hypotension (n=4; 17%); Tachycardia and drowsiness (n=3; 14%); allergic reaction (n=2; 10%), headache and hypoglycemia (n=1; 5%).Conclusion: ADE had a direct impact on the increase in the length of hospital stay, deaths and secondary damage to the patient's health, and indirectly on the increase costs of hospitalizations.

scholarly journals An electronic trigger based on care escalation to identify preventable adverse events in hospitalised patients

2017 ◽  
Vol 27 (3) ◽  
pp. 241-246 ◽  
Author(s):  
Viraj Bhise ◽  
Dean F Sittig ◽  
Viralkumar Vaghani ◽  
Li Wei ◽  
Jessica Baldwin ◽  
...  
Keyword(s):  
Adverse Events ◽  
Care Management ◽  
Adverse Drug Events ◽  
Diagnostic Errors ◽  
Rapid Response Team ◽  
Data Repository ◽  
Patient Falls ◽  
Hospitalised Patients ◽  
Response Team ◽  
Preventable Harm

BackgroundMethods to identify preventable adverse events typically have low yield and efficiency. We refined the methods of Institute of Healthcare Improvement’s Global Trigger Tool (GTT) application and leveraged electronic health record (EHR) data to improve detection of preventable adverse events, including diagnostic errors.MethodsWe queried the EHR data repository of a large health system to identify an ‘index hospitalization’ associated with care escalation (defined as transfer to the intensive care unit (ICU) or initiation of rapid response team (RRT) within 15 days of admission) between March 2010 and August 2015. To enrich the record review sample with unexpected events, we used EHR clinical data to modify the GTT algorithm and limited eligible patients to those at lower risk for care escalation based on younger age and presence of minimal comorbid conditions. We modified the GTT review methodology; two physicians independently reviewed eligible ‘e-trigger’ positive records to identify preventable diagnostic and care management events.ResultsOf 88 428 hospitalisations, 887 were associated with care escalation (712 ICU transfers and 175 RRTs), of which 92 were flagged as trigger-positive and reviewed. Preventable adverse events were detected in 41 cases, yielding a trigger positive predictive value of 44.6% (reviewer agreement 79.35%; Cohen’s kappa 0.573). We identified 7 (7.6%) diagnostic errors and 34 (37.0%) care management-related events: 24 (26.1%) adverse drug events, 4 (4.3%) patient falls, 4 (4.3%) procedure-related complications and 2 (2.2%) hospital-associated infections. In most events (73.1%), there was potential for temporary harm.ConclusionWe developed an approach using an EHR data-based trigger and modified review process to efficiently identify hospitalised patients with preventable adverse events, including diagnostic errors. Such e-triggers can help overcome limitations of currently available methods to detect preventable harm in hospitalised patients.

scholarly journals Registered Nurses’ Experiences with the Medication Administration Process

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Hanna Pirinen ◽  
Lotta Kauhanen ◽  
Riitta Danielsson-Ojala ◽  
Johan Lilius ◽  
Ilona Tuominen ◽  
...  
Keyword(s):  
Information Technology ◽  
Registered Nurses ◽  
Adverse Drug Events ◽  
Medication Management ◽  
Medication Administration ◽  
Hospital Environment ◽  
Descriptive Research ◽  
Paper Form ◽  
Qualitative Descriptive ◽  
Purposive Sample

Background. Registered nurses (RNs) have a role in the medication administration process (MAP) multiple times per day in a hectic hospital environment. This requires a great deal from the RNs in order to accomplish the demanding task of avoiding adverse drug events. However, the process has not been widely studied from the nurses’ perspective. Aim. The aim of this study was to describe the different stages of MAP from the RNs’ perspective. Methods. A qualitative descriptive research design, with a purposive sample involving thematic interviews of 20 RNs and questions to them in a paper form, was conducted in two medical units. Data was analyzed by using deductive content analysis. Results. The results revealed that RNs confront numerous problems such as equivocal prescriptions, problems with information technology (IT), unavailability or incompatibility of the medicines, a substantial amount of generic substitutions, and changing medicine brands. Disruptions and distraction run through each stage of the MAP, excluding prescribing. The RNs desire support in all stages of the MAP. Conclusion. There are areas to improve in each stage of the MAP from the RNs perspective. Real-time and ubiquitous documentation, along with software including the data and knowledge required in medication management, is needed.

Medication reconciliation process: Assessing value, adoption, and the potential of information technology from pharmacists’ perspective

2021 ◽  
Vol 27 (1) ◽  
pp. 146045822098727
Author(s):  
Abdullah Al Anazi
Keyword(s):  
Information Technology ◽  
Medication Reconciliation ◽  
Improve Patient Safety ◽  
Medication Management ◽  
Medication Administration ◽  
User Preferences ◽  
Legal Responsibility ◽  
External Data ◽  
Indispensable Tool

The Medication Reconciliation (MedRec) process aims to improve patient safety through safe prescription and medication administration. A validated survey was carried out to address aspects related to MedRec process, its obstacles, the role of information technology, and the required functionalities for optimizing the MedRec process. A total of 81% of the survey’s respondents acknowledged the roles of EHR (62% of respondents), PHR (41%), and electronic medication registration list (33%) as necessary technology tools for MedRec. Most respondents emphasized the need to compile multiple medications’ entries of information technology systems into one application (96.4%), allowing the entries from community pharmacies (90.6%). Further, incorporating information technology into the MedRec process presents a challenge in terms of legal responsibility (92 %) and the ability to integrate medications with other hospitals and community medications (78.6%). Findings affirm the need for a well-designed MedRec process aided with information technology solutions. The external data and user preferences should be considered when redesigning the MedRec process. The study also suggests initiating a policy that mandates sharing data necessary for creating a compiled medication list for each patient. MedRec is an indispensable tool for building a fruitful medication management system in a healthcare organization.

scholarly journals The potential of artificial intelligence to improve patient safety: a scoping review

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
David W. Bates ◽  
David Levine ◽  
Ania Syrowatka ◽  
Masha Kuznetsova ◽  
Kelly Jean Thomas Craig ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Patient Safety ◽  
Adverse Events ◽  
Scoping Review ◽  
Adverse Drug Events ◽  
Improve Patient Safety ◽  
Relevant Literature ◽  
Pressure Sensors ◽  
Diagnostic Errors ◽  
Improve Patient

AbstractArtificial intelligence (AI) represents a valuable tool that could be used to improve the safety of care. Major adverse events in healthcare include: healthcare-associated infections, adverse drug events, venous thromboembolism, surgical complications, pressure ulcers, falls, decompensation, and diagnostic errors. The objective of this scoping review was to summarize the relevant literature and evaluate the potential of AI to improve patient safety in these eight harm domains. A structured search was used to query MEDLINE for relevant articles. The scoping review identified studies that described the application of AI for prediction, prevention, or early detection of adverse events in each of the harm domains. The AI literature was narratively synthesized for each domain, and findings were considered in the context of incidence, cost, and preventability to make projections about the likelihood of AI improving safety. Three-hundred and ninety-two studies were included in the scoping review. The literature provided numerous examples of how AI has been applied within each of the eight harm domains using various techniques. The most common novel data were collected using different types of sensing technologies: vital sign monitoring, wearables, pressure sensors, and computer vision. There are significant opportunities to leverage AI and novel data sources to reduce the frequency of harm across all domains. We expect AI to have the greatest impact in areas where current strategies are not effective, and integration and complex analysis of novel, unstructured data are necessary to make accurate predictions; this applies specifically to adverse drug events, decompensation, and diagnostic errors.

scholarly journals Overview of important methods used for causality assessment of adverse drug events in pharmacovigilance

2020 ◽  
Vol 1 (2) ◽  
pp. 6-12
Author(s):  
Pushpraj Prafulla Gawai 
Keyword(s):  
Adverse Events ◽  
Causal Relationship ◽  
Drug Safety ◽  
Adverse Drug Events ◽  
Causality Assessment ◽  
Medical Conditions ◽  
Related Factors ◽  
The World ◽  
Single Method

Introduction: The method of assessing causality between adverse events and suspect drugs is the most challenging task in pharmacovigilance. It requires attentive consideration of both the adverse events and suspect drugs, patient-related factors, and co-suspect drugs and other medical conditions of the patient. Objectives: This review aimed to look for different methods available or reported for causality assessment and give a brief comparison between the methods. Methods: Many pieces of literature were reviewed to present a summary of commonly used important methods for causality assessment. Results: Though different methods were developed to assess causality, no single method has been proved to produce an accurate or authentic ascertainable evaluation of the causal relationship. Conclusions: Hence, causality assessment has become an important step in evaluating drug safety. Due to a lack of uniformity, reliability, and rationality, no single method can be accepted as a standard one across the world.

scholarly journals Supporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support tool

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Melissa T. Baysari ◽  
Mai H. Duong ◽  
Patrick Hooper ◽  
Michaela Stockey-Bridge ◽  
Selvana Awad ◽  
...  
Keyword(s):  
Decision Support ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Adverse Drug Events ◽  
Digital Health ◽  
Usability Testing ◽  
Routine Care ◽  
Assessment Tools ◽  
Support Tool ◽  
Hospitalised Patients

Abstract Background Despite growing evidence that deprescribing can improve clinical outcomes, quality of life and reduce the likelihood of adverse drug events, the practice is not widespread, particularly in hospital settings. Clinical risk assessment tools, like the Drug Burden Index (DBI), can help prioritise patients for medication review and prioritise medications to deprescribe, but are not integrated within routine care. The aim of this study was to conduct formative usability testing of a computerised decision support (CDS) tool, based on DBI, to identify modifications required to the tool prior to trialling in practice. Methods Our CDS tool comprised a DBI MPage in the electronic medical record (clinical workspace) that facilitated review of a patient’s DBI and medication list, access to deprescribing resources, and the ability to deprescribe. Two rounds of scenario-based formative usability testing with think-aloud protocol were used. Seventeen end-users participated in the testing, including junior and senior doctors, and pharmacists. Results Participants expressed positive views about the DBI CDS tool but testing revealed a number of clear areas for improvement. These primarily related to terminology used (i.e. what is a DBI and how is it calculated?), and consistency of functionality and display. A key finding was that users wanted the CDS tool to look and function in a similar way to other decision support tools in the electronic medical record. Modifications were made to the CDS tool in response to user feedback. Conclusion Usability testing proved extremely useful for identifying components of our CDS tool that were confusing, difficult to locate or to understand. We recommend usability testing be adopted prior to implementation of any digital health intervention. We hope our revised CDS tool equips clinicians with the knowledge and confidence to consider discontinuation of inappropriate medications in routine care of hospitalised patients. In the next phase of our project, we plan to pilot test the tool in practice to evaluate its uptake and effectiveness in supporting deprescribing in routine hospital care.

Medication Administration Practices in United States’ Schools: A Systematic Review and Meta-synthesis

2021 ◽  
pp. 105984052110263
Author(s):  
Ashley A. Lowe ◽  
Joe K. Gerald ◽  
Conrad Clemens ◽  
Cherie Gaither ◽  
Lynn B. Gerald
Keyword(s):  
United States ◽  
Systematic Review ◽  
Public Schools ◽  
Medication Management ◽  
The United States ◽  
Medication Administration ◽  
Full Time ◽  
Level Of Training ◽  
K 12 ◽  
Keyword Searches

Schools often provide medication management to children at school, yet, most U.S. schools lack a full-time, licensed nurse. Schools rely heavily on unlicensed assistive personnel (UAP) to perform such tasks. This systematic review examined medication management among K-12 school nurses. Keyword searches in three databases were performed. We included studies that examined: (a) K-12 charter, private/parochial, or public schools, (b) UAPs and licensed nurses, (c) policies and practices for medication management, or (d) nurse delegation laws. Three concepts were synthesized: (a) level of training, (b) nurse delegation, and (c) emergency medications. One-hundred twelve articles were screened. Of these, 37.5% (42/112) were comprehensively reviewed. Eighty-one percent discussed level of training, 69% nurse delegation, and 57% emergency medications. Succinct and consistent policies within and across the United States aimed at increasing access to emergency medications in schools remain necessary.

scholarly journals Adverse medication events in a psychiatric practice: a naturalistic study

2013 ◽  
Vol 37 (12) ◽  
pp. 395-397
Author(s):  
Eugene G. Breen
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Adverse Drug Events ◽  
Psychiatric Training ◽  
Clinical Implications ◽  
Naturalistic Study ◽  
Near Misses ◽  
Significant Events ◽  
Core Module ◽  
Sector Service

Aims and methodTo document the number and type of adverse medication events in a psychiatric sector service. Significant new adverse events were collated by the author and team over 30 months. Intervention to prevent any adverse event was enacted as soon as any were noticed or anticipated.ResultsThirty-six significant events occurred including three deaths and nine near misses. Corrective action was taken immediately any adverse event occurred. Inadequate communication between various hospital clinics, general practitioner practices, psychiatric clinics and pharmacies was the biggest avoidable cause of adverse events.Clinical implicationsAwareness of adverse drug events is essential in psychiatry. Clear, transparent pathways of prescribing are a key requirement to reduce avoidable adverse medication events. Psychopharmacology is a core module for psychiatric training.

Polypharmazie – Lösungswege für eine verbesserte Arzneimitteltherapiesicherheit

2017 ◽  
Vol 142 (14) ◽  
pp. 1046-1053
Author(s):  
Olaf Krause ◽  
Gesine Picksak ◽  
Ulrike Junius-Walker
Keyword(s):  
Older People ◽  
General Practitioners ◽  
Nursing Care ◽  
Drug Safety ◽  
Medication Management ◽  
Team Work ◽  
Communication Tool ◽  
Old People ◽  
Medication Plan ◽  
Drug Problems

AbstractPolypharmacy (≥ 5 drugs) is common among older people and may lead to falls, ADEs and delirium. Adherence is an important part in the medication management. Simple questions (i. e. for OTC, handling and omission of drugs) are effective. As most old people are treated by general practitioners (GP), they play a key role for drug safety and reducing polypharmacy. The involvement of pharmacists in analyzing one patient‘s drugs can enhance solutions for drug problems (“two-man rule”). An IT-based medication plan acts as an important communication tool for an enhanced team work between doctors, pharmacists and nursing care.

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