Antidote application: an educational system for treatment of common toxin overdose

Poisonings account for almost 1% of emergency room visits each year. Time is a critical factor in dealing with a toxicologic emergency. Delay in dispensing the first antidote dose can lead to life-threatening sequelae. Current toxicological resources that support treatment decisions are broad in scope, time-consuming to read, or at times unavailable. Our review of current toxicological resources revealed a gap in their ability to provide expedient calculations and recommendations about appropriate course of treatment. To bridge the gap, we developed the Antidote Application (AA), a computational system that automatically provides patient-specific antidote treatment recommendations and individualized dose calculations. We implemented 27 algorithms that describe FDA (the US Food and Drug Administration) approved use and evidence-based practices found in primary literature for the treatment of common toxin exposure. The AA covers 29 antidotes recommended by Poison Control and toxicology experts, 19 poison classes and 31 poisons, which represent over 200 toxic entities. To the best of our knowledge, the AA is the first educational decision support system in toxicology that provides patient-specific treatment recommendations and drug dose calculations. The AA is publicly available at http://projects.met- hilab.org/antidote/

Development of Drug Therapy Management System by the participation of Pharmacist in Multidisciplinary Team: A Participatory Action Research in the Non-communicable Disease Clinic at Damnoensaduak Hospital

วัตถุประสงค์: เพื่อพัฒนาระบบการดูแลด้านยาโดยเภสัชกรในคลินิกโรคไม่ติดต่อเรื้อรังที่มีความเหมาะสมกับบริบทของโรงพยาบาลดำเนินสะดวก วิธีการศึกษา: การวิจัยเชิงปฏิบัติการแบบมีส่วนร่วมและกระบวนการพัฒนาแบบต่อเนื่อง เก็บข้อมูลระหว่างพฤศจิกายน 2559 ถึงกันยายน 2560 จากบุคลากรทางการแพทย์ 14 คน ร่วมกันวิเคราะห์ปัญหา ออกแบบและทดสอบระบบ แล้วนำระบบที่พัฒนาขึ้นไปดูแลผู้ป่วยโรคไม่ติดต่อเรื้อรัง ตามแนวคิดองค์ประกอบ CCM และการพัฒนาแบบวงล้อ PDCA ผลการศึกษา: ระบบการดูแลด้านยาโดยเภสัชกรที่พัฒนาขึ้นประกอบด้วยการทำงานของเภสัชกร 3 ขั้นตอน คือ 1. การคัดกรองปัญหาด้านยาโดยใช้ระบบเทคโนโลยีสารสนเทศและจากการซักประวัติของเภสัชกร 2. การจัดการด้านยา และ 3. การส่งต่อข้อมูลแก่บุคลากรทางการแพทย์และผู้ป่วย ในการพัฒนาระบบอาศัยทุกองค์ประกอบของรูปแบบการดูแลโรคเรื้อรัง โดยมีเป้าหมายและทิศทางเป็นองค์ประกอบเริ่มต้นในการพัฒนา ซึ่งระหว่างการดำเนินงานต้องใช้ทั้งระบบสารสนเทศ การปรับระบบและกระบวนการบริการ ระบบการสนับสนุนการจัดการตนเอง และระบบการสนับสนุนการตัดสินใจ พบว่าระบบสารสนเทศมีความสำคัญต่อการพัฒนาระบบการดูแลด้านยามากที่สุด ระบบที่พัฒนาขึ้นสามารถคัดกรองปัญหาที่คาดว่าเกี่ยวข้องกับยาก่อนวันนัดได้ร้อยละ 17.8 และในวันนัดคัดกรองได้ร้อยละ 42.7 ปัญหาส่วนใหญ่ที่พบ คือ ผู้ป่วยบริหารยาผิด (ร้อยละ 67.6) พบว่าแพทย์ให้การรักษาที่สอดคล้องกับข้อมูลที่ส่งต่อให้ร้อยละ 63.6 สรุป: บทบาทเภสัชกรในทีมสหสาขาวิชาชีพโดยการทำงานเชิงรุกอาศัยระบบเทคโนโลยีสารสนเทศและการซักประวัติโดยเภสัชกรร่วมกันสามารถสนับสนุนให้การจัดการด้านยาในผู้ป่วยโรคติดต่อเรื้อรังได้เหมาะสมยิ่งขึ้นคำสำคัญ : ระบบการดูแลด้านยา, วิจัยแบบมีส่วนร่วม, เภสัชกร, ทีมสหสาขาวิชาชีพ, โรคไม่ติดต่อเรื้อรัง, วงจรพีดีซีเอ, โมเดลการดูแลโรคเรื้อรังObjective: To develop a drug therapy management system with pharmacist participating in multidisciplinary team suitable for the non-communicable disease (NCD) clinic of Damnoensaduak Hospital. Method: This participatory action research (PAR) was performed from November 2016 to September 2017. Fourteen healthcare providers were selected to be in the PAR team to coordinate analysis, design based on the components of Chronic Care Model (CCM) concept, and implementation of the developed system using the Plan-Do-Check-Act (PDCA) cycle. Results: The developed drug therapy management system consisted of three roles of pharmacists, namely (1) screening drug related problems (DRP) using information technology and history taking, (2) drug therapy management, and (3) communication of the patient’s information to the team and patient. All components of CCM could be implemented. Resource and policy were the initial components for development. During the ongoing process, other components namely clinical information systems, delivery system design, self-care support and decision-making support were applied with the information system component as the most important one. The developed system could screen 17.8% and 42.7% DRPs before and on the appointment day, respectively. Most DRPs were errors in patient’s self-administration (67.6%). The physician responded to the DRP in agreement with the information communicated by pharmacist by 63.6%. Conclusion: The proactive role of pharmacist using the information technology and history taking in the multidisciplinary team could offer an effective drug therapy in NCD patients. Keywords: drug therapy management system,participatory action research,pharmacist, multidisciplinary team, non-communicable disease, PDCA cycle, chronic care mode

Step towards multiplatform framework for supporting pediatric and neonatology care unit decision process

Children are an especially vulnerable population, particularly in respect to drug administration. It is estimated that neonatal and pediatric patients are at least three times more vulnerable to damage due to adverse events and medication errors than adults are. With the development of this framework, it is intended the provision of a Clinical Decision Support System based on a prototype already tested in a real environment. The framework will include features such as preparation of Total Parenteral Nutrition prescriptions, table pediatric and neonatal emergency drugs, medical scales of morbidity and mortality, anthropometry percentiles (weight, length/height, head circumference and BMI), utilities for supporting medical decision on the treatment of neonatal jaundice and anemia and support for technical procedures and other calculators and widespread use tools. The solution in development means an extension of INTCare project. The main goal is to provide an approach to get the functionality at all times of clinical practice and outside the hospital environment for dissemination, education and simulation of hypothetical situations. The aim is also to develop an area for the study and analysis of information and extraction of knowledge from the data collected by the use of the system. This paper presents the architecture, their requirements and functionalities and a SWOT analysis of the solution proposed.CT - Fundação para a Ciência e Tecnologia within the Project Scope UID/CEC/00319/2013 and PTDC/EEI - SII/1302/2012 (INTCare II

Fusing drug enforcement: a study of the El Paso Intelligence Center

This article examines the evolution of the El Paso Intelligence Center (EPIC), a key intelligence component of the Drug Enforcement Administration, to shed light on fusion efforts in drug enforcement. Since 1974, EPIC has strived to fuse the resources and capabilities of multiple government agencies to counter drug trafficking and related threats along the Southwest US border. While undergoing a steady growth, the Center has confronted a host of challenges that illuminate the uses and limits of multi-agency endeavors in drug enforcement. An evaluative study of the Center shows that it is well aligned with the federal government priorities in the realm of drug enforcement; however the extent to which the Center’s activities support the government’s efforts in this domain is not so clear. The Center needs to improve the way it reviews its own performance to better adapt and serve its customers

Evaluation Research and Institutional Pressures: Challenges in Public-Nonprofit Contracting

This article examines the connection between program evaluation research and decision-making by public managers. Drawing on neo-institutional theory, a framework is presented for diagnosing the pressures and conditions that lead alternatively toward or away the rational use of evaluation research. Three cases of public-nonprofit contracting for the delivery of major programs are presented to clarify the way coercive, mimetic, and normative pressures interfere with a sound connection being made between research and implementation. The article concludes by considering how public managers can respond to the isomorphic pressures in their environment that make it hard to act on data relating to program performance.This publication is Hauser Center Working Paper No. 23. The Hauser Center Working Paper Series was launched during the summer of 2000. The Series enables the Hauser Center to share with a broad audience important works-in-progress written by Hauser Center scholars and researchers

Medication administration errors for older people in long-term residential care

Background Older people in long-term residential care are at increased risk of medication errors. The purpose of this study was to evaluate a computerised barcode medication management system designed to improve drug administrations in residential and nursing homes, including comparison of error rates and staff awareness in both settings. Methods All medication administrations were recorded prospectively for 345 older residents in thirteen care homes during a 3-month period using the computerised system. Staff were surveyed to identify their awareness of administration errors prior to system introduction. Overall, 188,249 attempts to administer medication were analysed to determine the prevalence of potential medication administration errors (MAEs). Error classifications included attempts to administer medication at the wrong time, to the wrong person or discontinued medication. Analysis compared data at residential and nursing home level and care and nursing staff groups. Results Typically each resident was exposed to 206 medication administration episodes every month and received nine different drugs. Administration episodes were more numerous (p < 0.01) in nursing homes (226.7 per resident) than in residential homes (198.7). Prior to technology introduction, only 12% of staff administering drugs reported they were aware of administration errors being averted in their care home. Following technology introduction, 2,289 potential MAEs were recorded over three months. The most common MAE was attempting to give medication at the wrong time. On average each resident was exposed to 6.6 potential errors. In total, 90% of residents were exposed to at least one MAE with over half (52%) exposed to serious errors such as attempts to give medication to the wrong resident. MAEs rates were significantly lower (p < 0.01) in residential homes than nursing homes. The level of non-compliance with system alerts was low in both settings (0.075% of administrations) demonstrating virtually complete error avoidance. Conclusion Potentially inappropriate administration of medication is a serious problem in long-term residential care. A computerised barcode system can accurately and automatically detect inappropriate attempts to administer drugs to residents. This tool can reliably be used by care staff as well as nurses to improve quality of care and patient safety