The willingness and attitude of patients towards self-administration of medication in hospital

Background: Literature suggests a positive impact of self-administration of medication during hospitalization on medication adherence and safety, and on patient satisfaction. However, self-administration is not a common practice in Belgian hospitals. The aim of this study was to describe patients’ willingness towards self-administration of medication while in hospital. Methods: A cross-sectional observational study was conducted in three Belgian hospitals in November and December 2015. All patients of 14 randomly selected wards were asked to participate. The structured questionnaire comprised patient characteristics, their willingness and attitude towards self-administration of medication, perceived ability to self-administer during hospitalization, and prerequisites and perceived consequences. Results: In total, 124 patients participated (36% of all eligible patients). The main reasons not to participate were the patients’ physical and mental condition (30%) and the absence of patients during the time of data collection (23%). The majority of the 124 participating patients had a positive attitude towards the implementation of self-administration; 83.9% were willing to self-administer their medication while in hospital. Most important prerequisites were self-administration at home before and after hospitalization, patients’ motivation, and a regular evaluation of the patients’ competences. Patients acknowledged benefits such as an increase in autonomy, independence and medication knowledge. Patients did not expect self-administration would cause important safety issues. Conclusion: The majority of patients, capable of participating in the study, would want to self-administer medication during hospitalization. They had a positive attitude towards self-administration of medication. Nevertheless, patients stated important conditions which need to be considered in order to implement self-administration

Did we do everything we could have? Nurses’ contributions to medicines optimisation: a mixed method study

Aim To explore UK professionals’ interpretations of medicines optimization and expansion of nurses’ roles. Design This mixed‐methods study sought professionals’ views on nurses’ involvement, competency and engagement in monitoring patients for adverse effects of medicines, monitoring adherence, prescribing and patient education. Method An online survey and interviews were undertaken with nurses, doctors and pharmacists in Wales and England, May 2018 to July 2019. Results In all, 220 nurses, 17 doctors and 62 pharmacists responded to the online survey, and 24 professionals were interviewed. Nurses were divided over extending their roles, with 123/220 (55.9%) wishing to extend roles in monitoring patients for possible adverse drug reactions (ADRs), 111/220 (50.5%) in adherence monitoring, 121/220 (55.0%) in prescribing and 122/220 (55.4%) in patient education. The best‐qualified nurses were the most willing to increase involvement in monitoring patients for ADRs (aOR 13.00, 1.56–108.01). Interviews revealed that both nurses and doctors assumed the other profession was undertaking this monitoring. Respondents agreed that increasing nurses’ involvement in medicines optimization would improve patient care, but expressed reservations about nurses’ competencies. Collaboration between nurses and doctors was suboptimal (rated 7/10 at best) and between nurses and pharmacists even more so (6/10 at best). Conclusion Juxtaposition of datasets identified problems with medicines optimization: although most respondents agreed that increasing nurses’ involvement would positively impact practice, their educational preparation was a barrier. Only ~50% of nurses were willing to expand their roles to fill the hiatus in care identified and ensure that at least one profession was taking responsibility for ADR monitoring. Impact To improve multiprofessional team working and promote patient safety, nurse leaders should ensure patients are monitored for possible ADRs by at least one profession. Initiatives expanding nurses’ roles in medicines optimization and prescribing might be best targeted towards the more educated nurses, who have multidisciplinary support

EUPRON: nurses’ practice in interprofessional pharmaceutical care in Europe. A cross-sectional survey in 17 countries

Abstract Objectives Safe pharmaceutical care (PC) requires an interprofessional team approach, involving physicians, nurses and pharmacists. Nurses’ roles however, are not always explicit and clear, complicating interprofessional collaboration. The aim of this study is to describe nurses’ practice and interprofessional collaboration in PC, from the viewpoint of nurses, physicians and pharmacists. Design A cross-sectional survey. Setting The study was conducted in 17 European countries, each with their own health systems. Participants Pharmacists, physicians and nurses with an active role in PC were surveyed. Main outcome measures Nurses’ involvement in PC, experiences of interprofessional collaboration and communication and views on nurses’ competences. Results A total of 4888 nurses, 974 physicians and 857 pharmacists from 17 European countries responded. Providing patient education and information (PEI), monitoring medicines adherence (MMA), monitoring adverse/therapeutic effects (ME) and prescribing medicines were considered integral to nursing practice by 78%, 73%, 69% and 15% of nurses, respectively. Most respondents were convinced that quality of PC would be improved by increasing nurses’ involvement in ME (95%), MMA (95%), PEI (91%) and prescribing (53%). Mean scores for the reported quality of collaboration between nurses and physicians, collaboration between nurses and pharmacists and interprofessional communication were respectively <7/10, ≤4/10, <6/10 for all four aspects of PC. Conclusions ME, MMA, PEI and prescribing are part of nurses’ activities, and most healthcare professionals felt their involvement should be extended. Collaboration between nurses and physicians on PC is limited and between nurses and pharmacists even more

The NUPHAC-EU Framework for Nurses' Role in Interprofessional Pharmaceutical Care: Cross-Sectional Evaluation in Europe.

Clear role descriptions promote the quality of interprofessional collaboration. Currently, it is unclear to what extent healthcare professionals consider pharmaceutical care (PC) activities to be nurses' responsibility in order to obtain best care quality. This study aimed to create and evaluate a framework describing potential nursing tasks in PC and to investigate nurses' level of responsibility. A framework of PC tasks and contextual factors was developed based on literature review and previous DeMoPhaC project results. Tasks and context were cross-sectionally evaluated using an online survey in 14 European countries. A total of 923 nurses, 240 physicians and 199 pharmacists responded. The majority would consider nurses responsible for tasks within: medication self-management (86-97%), patient education (85-96%), medication safety (83-95%), monitoring adherence (82-97%), care coordination (82-95%), and drug monitoring (78-96%). The most prevalent level of responsibility was 'with shared responsibility'. Prescription management tasks were considered to be nurses' responsibility by 48-81% of the professionals. All contextual factors were indicated as being relevant for nurses' role in PC by at least 74% of the participants. No task nor contextual factor was removed from the framework after evaluation. This framework can be used to enable healthcare professionals to openly discuss allocation of specific (shared) responsibilities and tasks

Medication calculation skills of graduating nursing students within European context.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadAim: The aim of this study is to evaluate the medication calculation skills of graduating nursing students in six European countries and analyse the associated factors. Background: Medication calculation skills are fundamental to medication safety, which is a substantial part of patient safety. Previous studies have raised concerns about the medication calculation skills of nurses and nursing students. Design: As part of a broader research project, this study applies a multinational cross-sectional survey design with three populations: graduating nursing students, nurse managers and patients. Methods: The students performed two calculations (tablet and fluid) testing medication calculation skills requiring different levels of conceptual understanding and arithmetic. The managers and patients answered one question about the students' medication kills. In total, 1,796 students, 538 managers and 1,327 patients participated the study. The data were analysed statistically. The STROBE guideline for cross-sectional studies was applied. Results: Almost all (99%) of the students performed the tablet calculation correctly, and the majority (71%) answered the fluid calculation correctly. Older age, a previous degree in health care and satisfaction with their current degree programme was positively associated with correct fluid calculations. The patients evaluated the students' medication skills higher than the nurse managers did and the evaluations were not systematically aligned with the calculation skills tested. Conclusions: Nursing students have the skills to perform simple medication calculations, but a significant number of students have difficulties with calculations involving multiple operations and a higher level of conceptual understanding. Due to the variation in students' medication calculation skills and the unalignment between the managers' and patients' evaluations and the calculation tests, further research is needed. Relevance to clinical practice: Graduating nursing students enter clinical field as qualified professionals, but there is still room for improvement in their medication calculation skills. This calls for attention in the fields of clinical nursing, education and research. Keywords: drug dosage calculations; graduating nursing students; medication calculation skills; nurse managers; patients.Academy of Finland European Commissio

Delirium, introduction to a confused mind

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Oxygen and Hydrogen Isotope Characteristics of Hydrothermal Alteration at the Ann-Mason Porphyry Copper Deposit, Yerington, Nevada

Late Cenozoic normal faulting has tilted a 3- by 5-km block containing the mid-Jurassic Ann-Mason porphyry copper deposit ≈ 90º W and exposed the hydrothermal alteration pattern in cross section from 1- to 6-km palcodepth. Oxygen and hydrogen isotopes have been used to deduce sources of hydrothermal fluids. Fresh samples of the host Yerington batholith pluton have typical calc-alkaline magmatic isotopic compositions (δ^(18)O_(whole rock) = 6.7-7.0‰; δD_(biotite) = -85 to -88‰). The various types of hydrothermally altered rocks have similar δD and δ^(18)O values, only slightly isotopically shifted from original magmatic values, except along an axial zone within and above the orebody. In this zone, altered rocks are enriched in ^(18)O by 1 to 3.5 per mil, and δ^(18)O values increase with decreasing palcodepth. The δ^(18)O values of the whole rock and/or feldspar and the δD values of biotite, chlorite, and/or actinolite in the various alteration zones are as follows: propylitic alteration is widespread and is isotopically similar to fresh rock: δ(18)O = 6.2 to 7.2 per mil, δD = -82 to -92 per mil. Potassic alteration, characterized by 100 percent alteration of hornblende to biotite and Cu mineralization, occurs at ≈ 3.5-km palcodepth along the axis of the mineralizing granite porphyry dike swarm: δ^(18)O = 6.5 to 8.4 per mil, δD = -68 to -96 per mil. Sodic-calcic alteration, characterized by hydrothermal oligoclase-actinolite-sphene, occurs laterally alongside and below the ore zone at 3- to 6-km palcodepth: δ(18)O = 5.7 to 8.4 per mil, δD = -67 to -90 per mil. Late-stage sodic (albite-chlorite) alteration occurs at 1- to 4-km palcodepth in the vicinity of the axial zone: δ(18)O = 6.7 to 9.6 per mil, δD = -79 to -85 per mil. The youngest, late-stage sericitic alteration occurs at the shallowest levels, primarily at <1- to 2-km palcodepth, and displays a distinct ^(18)O and D enrichment: δ^(18)O = 9.8 to 10.4 per mil, δD = -61 per mil. Integration of stable isotope data, geologic field relations, and phase equilibria constraints indicates that the high-salinity fluids responsible for potassic alteration and Cu mineralization were of internal (magmatic) origin, but that synchronous, deep, convecting, saline, sodic-calcic fluids were largely derived from external (nonmagmatic) sources. A third type of fluid, also external but lower in temperature and much more dilute, was prevalent at shallow levels and caused latestage sericitic alteration. This was either an isotopically heavy, coastal meteoric water or a seawater