22 research outputs found
Master of Science
thesisThere is a high risk for communication failures at the hospital discharge. Discharge summaries (DCS) can mitigate these risks by describing not only the hospital course but also follow-up plans. Improvement in the DCS may play a crucial role to improve communication at this transition of care. This research identifies gaps between the local standard of practice and best practices reported in the literature. It also identifies specific components of the DCS that could be improved through enhanced use of health information technology. A manual chart review of 188 DCS was performed. The medication reconciliations were analyzed for completeness and for medical reasoning. The pending results reported in the DCS were compared to those identified in the enterprise data warehouse (EDW). Documentation of follow-up arrangements was analyzed. Report of patient preferences, patient goals, lessons learned, and the overall handover tone were also noted. Patients were discharged on an average of 9.8 medications. Only 3% of the medication reconciliations were complete regarding which medications were continued, changed, new, and discontinued; 94% were incomplete and medical reasoning was frequently absent. There were 358 pending results in 188 hospital discharges. 14% of those results were in the DCS while 86% were only found in the EDW. Less than 50% iv of patients had clear documentation of scheduled follow-up. Patient preferences, patient goals, and lessons learned were rarely (6%, 1%, and 3% respectively) included. There was a handover tone in only 17% of the DCS. The quality gaps in the DCS are consistent with the literature. Medication reconciliations were frequently incomplete, pending results were rarely available, and documentation of follow-up care occurred less than half of the time. Evaluating the DCS primarily as a clinical handover is novel. Information necessary for safe handovers and to promote continuity of care is frequently missing. Future improvements should reshape the DCS to improve continuity of care
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Medicines Reconciliation: Roles and Process. An examination of the medicines reconciliation process and the involvement of patients and healthcare professionals across a regional healthcare economy, within the United Kingdom.
Medication safety and improving communication at care transitions are an
international priority. There is vast evidence on the scale of error associated
with medicines reconciliation and some evidence of successful interventions to
improve reconciliation. However, there is insufficient evidence on the factors
that contribute towards medication error at transitions, or the roles of those
involved. This thesis examined current UK medicines reconciliation practice
within primary and secondary care, and the role of HCPs and patients. Using a
mixed-method, multi-centre design, the type and severity of discrepancies at
admission to hospital were established and staff undertaking medicines
reconciliation across secondary and primary care were observed, using
evidence-informed framework, based on a narrative literature review.
The overall processes used to reconcile medicines were similar; however, there
was considerable inter and intra-organisational variation within primary and
secondary care practice. Patients were not routinely involved in discussions
about their medication, despite their capacity to do so. Various human factors
in reconciliation-related errors were apparent; predominantly inadequate
communication, individual factors e.g. variation in approach by HCP, and
patient factors e.g. lack of capacity. Areas of good practice which could reduce
medicines reconciliation-related errors/discrepancies were identified. There is a
need for increased consistency and standardisation of medicines reconciliationrelated
policy, procedures and documentation, alongside communication
optimisation. This could be achieved through a standardised definition and
taxonomy of error, the development of a medicines reconciliation quality
assessment framework, increased undergraduate and post-graduate education,
improved patient engagement, better utilisation of information technology and
improved safety culture
A practitioner behaviour change intervention for deprescribing in the hospital setting
Background
Half of older people in hospital have a pre-admission medicine prescribed that is potentially inappropriate. Deprescribing research has historically focused on the primary care setting. The aim of this thesis was to develop a practitioner behaviour change intervention for enhancing deprescribing in the hospital setting.
Methods
Underpinned by behavioural science, the research programme comprised four empirical studies: evaluation of existing hospital deprescribing activity; survey of patientsâ and carersâ attitudes towards deprescribing; focus groups with geriatricians and pharmacists to identify key barriers and enablers to address in an intervention; expert panel consensus study to select Behaviour Change techniques (BCTs) for the intervention.
Results
Deprescribing in hospital occurred for 0.6% of pre-admission medicines, of which 84.1% was reactive in response to harm and 15.9% proactive to prevent harm.
Deprescribing in hospital was acceptable to patients and carers: 97.4% and 76.3% respectively were willing to accept a doctorâs deprescribing proposition.
Geriatricians and pharmacists described several existing deprescribing enablers in hospital including alignment with their generalist role/knowledge and routine patient monitoring.
Key barriers to deprescribing were a misconception of patientsâ and carersâ resistance to deprescribing, pharmacistsâ perception that deprescribing is riskier than continuing to prescribe, pharmacistsâ working patterns limiting capacity to support deprescribing and it being a low hospital priority. Introduction of incentives to deprescribe was an enabler.
Six BCTs were selected and characterised to address the key barriers and enabler: social comparison (two distinct characterisations); salience of consequences; pros and cons; restructure the physical environment; action planning.
Conclusion
There is significant scope to increase deprescribing in hospital and this is acceptable to patients and carers. The behavioural intervention to enhance geriatrician and pharmacist led deprescribing requires modelling to determine the optimal configuration of BCTs. Subsequent testing of the intervention is necessary to determine efficacy at enhancing deprescribing and impact on patient outcomes
Textbook of Patient Safety and Clinical Risk Management
Implementing safety practices in healthcare saves lives and improves the quality of care: it is therefore vital to apply good clinical practices, such as the WHO surgical checklist, to adopt the most appropriate measures for the prevention of assistance-related risks, and to identify the potential ones using tools such as reporting & learning systems. The culture of safety in the care environment and of human factors influencing it should be developed from the beginning of medical studies and in the first years of professional practice, in order to have the maximum impact on clinicians' and nurses' behavior. Medical errors tend to vary with the level of proficiency and experience, and this must be taken into account in adverse events prevention. Human factors assume a decisive importance in resilient organizations, and an understanding of risk control and containment is fundamental for all medical and surgical specialties. This open access book offers recommendations and examples of how to improve patient safety by changing practices, introducing organizational and technological innovations, and creating effective, patient-centered, timely, efficient, and equitable care systems, in order to spread the quality and patient safety culture among the new generation of healthcare professionals, and is intended for residents and young professionals in different clinical specialties
Building the evidence for the impact of pharmacists in general practice: a multi-method, realistic study
Background: There has recently been a drive to integrate pharmacists into UK
general practices to tackle workload pressures and enhance patient access to
healthcare. Although not a new role, it is the first time that pharmacist presence in
general practice is being formally funded and tested. Therefore, little is known about
how pharmacists in general practices impact the wider healthcare system.
Aim: To build evidence on the impact of pharmacists in general practice, via in-depth
elicitation of stakeholder experiences.
Methods: A multi-method, ârealisticâ approach was followed, including qualitative
focus groups with general practice-based staff to identify impact measurement
problems for pharmacists in general practice; an e-Delphi study to reach consensus,
amongst experts, on what pharmacist activities are important to record as part of
impact identification; and qualitative interviews with community pharmacy teams and
patients to explore their experiences of general practice-based pharmacists. Focus
groups and interviews were audio-recorded and transcribed verbatim. Qualitative
data was analysed thematically and quantitative data via descriptive statistics.
Results: Pharmacists carry out various valuable services in general practice,
however, the majority of existing national measures are not fit for purpose in
targeting pharmacist work and capturing the whole spectrum and quality of services.
There was agreement on recording primarily funding-related activities, which
included medication reviews, high-risk drug monitoring and medicines
reconciliations. Pharmacy colleagues in general practices and community
pharmacies are willing to develop mutual relationships, which could result in stronger
links between the two settings and streamlined workloads. Patients are satisfied with
easy access to a pharmacist in general practice who is able to interact with them at a
high standard. Lack of awareness, however, limits uptake of pharmacist-led services.
Conclusions: General practice-based pharmacists could better link different
healthcare teams and enhance accessibility to, and quality of, primary care services.
Ways to effectively capture pharmacist impact are still needed. Findings will inform
policy attempting to frame pharmacist services in general practice as per needs and
expectations of stakeholders
Pay for performance in health care
This book provides a balanced assessment of pay for performance (P4P), addressing both its promise and its shortcomings. P4P programs have become widespread in health care in just the past decade and have generated a great deal of enthusiasm in health policy circles and among legislators, despite limited evidence of their effectiveness. On a positive note, this movement has developed and tested many new types of health care payment systems and has stimulated much new thinking about how to improve quality of care and reduce the costs of health care. The current interest in P4P echoes earlier enthusiasms in health policyâsuch as those for capitation and managed care in the 1990sâthat failed to live up to their early promise. The fate of P4P is not yet certain, but we can learn a number of lessons from experiences with P4P to date, and ways to improve the designs of P4P programs are becoming apparent. We anticipate that a âsecond generationâ of P4P programs can now be developed that can have greater impact and be better integrated with other interventions to improve the quality of care and reduce costs.Publishe
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What is the Role of a Pharmacist in a Parkinsonâs Disease Interdisciplinary Team?
The care of people with Parkinsonâs disease (PD) involves input from different
healthcare professionals (HCPs). A literature search identified that the HCPs
involved in PD multidisciplinary (MDT) clinics, including interdisciplinary team
(IDT), varied both in the number and type of HCPs. None of the studies
identified involved pharmacists. Pharmacists have shown benefits when
working in MDTs for other long-term conditions (LTCs); however, their role in
PD MDTs was identified as a gap in the literature.
The aim of the study was to determine the role of pharmacists in a PD IDT.
Patients attended a PD IDT clinic comprising PD nurse, physiotherapist,
occupational therapist and pharmacist. A mixed methods convergent design
was used to collect both qualitative and quantitative data. Qualitative focus
group and interview data were analysed using The Framework Method.
Quantitative data analysis involved counts of HCP interventions.
Pharmacists can support PD IDTs as they have in other LTC MDTs by
conducting holistic medication reviews. Three new roles were identified for
pharmacists in PD IDTs as: 1) independent prescribing, 2) supporting HCPS in
their roles by supporting staff knowledge, and 3) leading the PD IDT clinics.
Quantitative data showed the pharmacist made a medication review
intervention for all patients.
HCPs and patients identified the roles and value of involving pharmacists in PD
IDTs. The PD IDT clinics offer a holistic approach to patient care and a greater
opportunity for patients to be involved. The findings identified a âreview-shared care templateâ
for PD IDTs and recommends development of a âpharmacistâs PD competency frameworkâ