Factors influencing prescribing of fall-risk-increasing drugs to the elderly : A qualitative study

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Samhandling mellom allmennleger og apotek ved korreksjon av resepter

Beskriver en kvalitativ studie hvor hensikten var å undersøke hvordan fastleger og apotek-farmasøyter kommuniserer om og håndterer/dokumenterer reseptintervensjoner, og hva begge parter anser som god praksis på området.Bakgrunn. Apotekfarmasøyter intervenerer ved rundt 2% av reseptordinasjoner for å kunne ekspedere dem forsvarlig. Vi ønsket å undersøke hvordan allmennleger og apotekfarmasøyter praktisk håndterer og dokumenterer ulike typer reseptintervensjoner og hva de anser som god praksis på området. Materiale og metode. To fokusgrupper med totalt fem allmennpraktiserende leger, fem apotekfarmasøyter og to legesekretærer ble rekruttert i to ulike geografiske områder. Fokusgruppene tok utgangspunkt i 12 reelle eksempler fra seks ulike kategorier av reseptintervensjoner fra en tidligere studie i apotek. Utsagnene fra fokusgruppene ble sammenfattet og tematisert. Resultater. Legene og apotekfarmasøytene hadde varierende praksis for håndtering av farmasøytenes reseptintervensjoner. Begge parter forventet at den andre dokumenterte reseptintervensjonene og registrerte selv kun i begrenset grad. Legenes elektroniske journalsystemer er ikke tilrettelagt for registrering av reseptintervensjoner. Manglende interne retningslinjer førte til individuell praksis hos både apotekfarmasøytene og legene. Generelt prioriterte farmasøytene legekontakt og tilbakemelding av klinisk relaterte intervensjoner. Legene ønsket tilbakemeldinger oftere enn farmasøytene tilbød. Fortolkning. Det bør utvikles felles retningslinjer for samhandling, prioritering og dokumentasjon av reseptintervensjoner i apotek og på legekontor. Det er behov for en fremtidsrettet kommunikasjonsløsning som ivaretar behovet for rask toveiskommunikasjon og som utnytter mulighetene som ligger i elektroniske løsninger

Barcode medication administration technology use in hospital practice:A mixed-methods observational study of policy deviations

Introduction Barcode medication administration (BCMA) can, if poorly implemented, cause disrupted workflow, increased workload and cause medication errors. Further exploration is needed of the causes of BCMA policy deviations. Objective To gain an insight into nurses’ use of barcode technology during medication dispensing and administration; to record the number and type of BCMA policy deviations, and to investigate their causes. Methods We conducted a prospective, mixed-methods study. Medication administration rounds on two hospital wards were observed using a digital tool and field notes. The SEIPS (Systems Engineering Initiative for Patient Safety) model was used to analyse the data. Results We observed 44 nurses administering 884 medications to 213 patients. We identified BCMA policy deviations for more than half of the observations; these related to the level of tasks, organisation, technology, environment and nurses. Task-related policy deviations occurred with 140 patients (66%) during dispensing and 152 patients (71%) during administration. Organisational deviations included failure to scan 29% of medications and 20% of patient’s wristbands. Policy deviations also arose due to technological factors (eg, low laptop battery, system freezing), as well as environmental factors (eg, medication room location, patient drawer size). Most deviations were caused by policies that interfere with proper and safe BCMA use and suboptimal technology design. Conclusion Our findings indicate that adaptations of the work system are needed, particularly in relation to policies and technology, to optimise the use of BCMA by nurses during medication dispensing and administration. These adaptations should lead to enhanced patient safety, as the absolute goal with BCMA implementation

Is anticholinergic and sedative drug burden associated with postdischarge institutionalization in community-dwelling older patients acutely admitted to hospital? A Norwegian registry-based study

Purpose: Investigate the association between anticholinergic (AC) and sedative (SED)drug burden before hospitalization and postdischarge institutionalization (PDI) incommunity-dwelling older patients acutely admitted to hospital.Methods: A cross-sectional study using data from the Norwegian Patient Registryand the Norwegian Prescription Database. We studied acutely hospitalizedcommunity-dwelling patients≥70 years during 2013 (N=86 509). Patients acutelyadmitted to geriatric wards underwent subgroup analyses (n=1715). We calculateddrug burden by the Drug Burden Index (DBI), use of AC/SED drugs, and the number of AC/SED drugs. Piecewise linearity of DBI versus PDI and a knot point(DBI=2.45) was identified. Statistical analyses included an adjusted multivariable logistic regression model.Results: In the total population, 45.4% were exposed to at least one AC/SED drug,compared to 52.5% in the geriatric subgroup. AC/SED drugs were significantly asso-ciated with PDI. The DBI with odds ratios (ORs) of 1.11 (95% CI 1.07–1.15) forDBI Conclusions: The use of AC/SED drugs was highly prevalent in older patients beforeacute hospital admissions, and significantly associated with PDI. The number, or justusing AC/SED drugs, gave similar associations with PDI compared to applying theDBI. Using AC drugs showed higher sensitivity, indicating that to reduce the risk ofPDI, a clinical approach could be to reduce the number of AC drugs

Legemidler og pasientsikkerhet – fokus på eldre

Fagartikkel som beskriver utfordringer knyttet til legemiddelbruk hos eldre.Hensikt: eldre står for en stor andel av det totale legemiddelbruket og bruker ofte flere ulike legemidler samtidig. Legemiddelbruk hos eldre er dermed et stort og viktig område. Hensikten med denne oversiktsartikkelen er å peke på utfordringer relatert til legemiddelbruk hos eldre og vise hvordan feil legemiddelbruk kan oppstå og mer optimal behandling kan tilstrebes. Materiale og metode: artikkelen favner bredt og dekker ulike fagområder som samfunnsfarmasi, galenisk farmasi, farmakologi og legemiddelanalyse. Den er basert på utvalgte forskningsartikler publisert i internasjonale eller norske vitenskapelige tidsskrifter. Egen forskning er trukket frem særskilt. Resultater: sannsynligheten for feil og uhensiktsmessig bruk av legemidler øker hos pasienter med høy alder. Høy alder medfører også ofte polyfarmasi, noe som øker sannsynligheten for feil ytterligere. Fysiologiske endringer kan føre til endret farmakokinetikk, svelgevansker, og at det blir vanskeligere for pasienten å sette seg godt inn i sin egen medikamentelle behandling for dermed å kunne oppdage eventuelle feil. Ulike utfordringer følger av dette, og kan relateres til forskrivningssituasjonen, utfordringer relatert til skifte mellom ulike omsorgsnivå, legemiddelhåndtering og etterlevelse. Konklusjon: optimal legemiddelbruk hos eldre er en utfordrende problemstilling. Valg av indikasjon og legemiddel, formulering, dosering, behov for informasjon og hvorvidt legemiddellistene er samstemte bør vurderes kritisk. En god balanse mellom effekt og tolerabilitet og total legemiddelbelastning bør tilstrebes

START OG STOPP versjon 2. Screeningverktøy for forskrivning av legemidler til eldre

Screeningverktøy for forskrivning av legemidler til eldre. Validert for norske forhold av Norsk Geriatrisk Forening

Online and Blended Learning Courses for Healthcare Professionals and Policymakers on Patients' Perspectives on Medicine:A Project Report

In order for healthcare professionals to better engage with patients, they need to understand and integrate the perspectives of patients into their daily work. In this project, we developed two courses for healthcare professionals on patients’ perspectives on medicine. One course was an online course that introduced the patients’ perspectives on medicine and explained its importance for healthcare and health policy. The second course was a blended learning course, consisting of online modules and face-to-face webinars, which specified how to explore patients’ perspectives in qualitative interviews, and how to develop implementation plans. Patients participated in the development, execution, and evaluation of both courses. Overall, more than 2000 healthcare professionals enrolled in the first course and, in just over a year, 191 participants completed the online course; 57 healthcare professionals registered in the second blended learning course and six participants completed both components of the course. The relevance of knowledge gained was positively evaluated. Participants especially appreciated the participation of patients. Based on the feedback, the second blended learning course was adapted to run online and both courses continue to be freely available to all interested healthcare professionals on the Coursera platform

Pharmaceutical review of repeat prescribing in general practice medicine and exploration of patients' views on health care and medicine

Repeat prescribing is a common and practical way to prescribe medication for patients with chronic conditions. However, lack of regular review has raised questions about the quality of the prescribing and how this affects patients' compliance and safety. The thesis consists of two main parts. Part One investigated how the effectiveness of repeat prescribing from a general practice surgery could be improved by having a community pharmacist reviewing and intervening on repeat prescriptions, in collaboration with the general practitioner (GP). Patients' experiences with the repeat prescription system, how they managed their medicines and if they perceived any intervention from the pharmacist were explored through domiciliary interviews. The pharmacist reduced the absolute risk (ARR) of drug-related problems (DRPs) by 26%, and the prescription number needed to treat (NNT) was found to be 3.8. Additionally, for every 19 prescriptions reviewed by the pharmacist, a DRP that resulted, or potentially resulted, in clinical improvement in patient care was identified and resolved. Part Two is developed from the experiences of Part One, and includes patients having drug-related consultations with the pharmacist in a general practice surgery. The consultations were followed by qualitative interviews to explore patients' perception of the consultation, their beliefs about medicines and empowerment issues, and how this relates to information provided on medicines. The complexity of how these factors relate were analysed and an empirical model developed and described. The pharmacist significantly reduced the number of repeat prescriptions with DRPs compared to the routine GP surgery procedure and was an effective method of solving DRPs, reducing risks and making significant clinical improvements to patient care. The study further recommends that pharmacists' repeat prescription review must extend beyond prescription-based interventions and move towards a distinct pharmaceutical care programme. This includes pharmacists acting as dependent prescribers responsible for the continuing of patient care with the authority to adjust doses and dosage forms as recommended in the Crown report (1999) but also incorporates the model on patients' beliefs about medicines to successfully implement interventions

Multidosepakkede legemidler i Skandinavia – en systematisk oversikt over muligheter og begrensninger

Artikkelen omhandler en litteraturstudie av vitenskapelige artikler som omhandler multidosepakkede legemidler i Skandinavia fra 2000 til 2011.Bakgrunn og hensikt: å identifisere og oppsummere vitenskapelige artikler som omhandler multidosepakkede legemidler i Skandinavia fra 2000 til 2011. Materiale og metoder: artikler ble identifisert gjennom systematiske søk i PubMed og Embase, samt ved å gjennomgå referanselistene til identifiserte artikler. Det ble også utført et søk i SweMed+. Bare artikler publisert etter 1. januar 2000 ble inkludert. Resultater: gjennom søk ble det totalt identifisert 18 artikler, herav åtte svenske, fire danske og seks norske. Av disse omhandlet åtte studier legemiddelbruk hos hjemmeboende pasienter, tre studier omhandlet sykehuspasienter, to studier omhandlet sykehjemspasienter, og de siste fem omhandlet pasienter eller helsepersonell i ulike settinger. Artiklene konkluderer med både positive og negative følger. Noen studier hevder at innføring av multidose løser problemer relatert til legemiddelbehandling, eksempelvis at de gir en reduksjon i diskrepans mellom legemiddellister, gir færre dispenseringsfeil og legemiddelinteraksjoner, avdekker uhensiktsmessig legemiddelbruk, forenkler transport og administrering av legemidler, og frigjør tid for sykepleiere. Andre artikler konkluderer med at multidose skaper problemer, eksempelvis økt risiko for medisineringsfeil, økt samforskrivning av psykofarmaka, økt forskrivning av andre potensielt uhensiktsmessige legemidler, senker kvaliteten på legemiddelbehandlingen og fører til forskrivning av flere legemidler for den enkelte pasient. Konklusjon: de ønskede positive effektene ved innføring av multidose er bare til en viss grad oppnådd. Dette gjelder økt tid for sykepleiere til å gjøre mer pasientrettet arbeid og redusert interaksjonsproblematikk. Flest utfordringer kan relateres til kommunikasjonsproblemer ved skifte av omsorgsnivå, manglende avklaring av ansvar og manglende samhandling mellom involverte parter. Påstanden om at multidose senker kvaliteten på legemiddelbehandlingen og øker antall legemidler forskrevet bør følges opp med mer forskning

Medication dose calculation errors and other numeracy mishaps in hospitals: Analysis of the nature and enablers of incident reports

Aims: To investigate medication dose calculation errors and other numeracy mishaps in hospitals and examine mechanisms and enablers which lead to such errors. Design: A retrospective study using descriptive statistics and thematic analysis of the nature and enablers of reported incidents. Methods: Medication dose calculation errors and other numeracy mishaps were identified from medication-related incidents reported to the Norwegian Incident Reporting System in 2016 and 2017. The main outcome measures were medications and medication classes involved, severity of harm, outcome, and error enablers. Results: In total, we identified 100 numeracy errors, of which most involved intravenous administration route (n = 70). Analgesics were the most commonly reported drug class and morphine was the most common individual medication. Overall, 78 incidents described patient harm. Frequent mechanisms were 10- or 100-fold errors, mixing up units, and incorrect strength/rate entered into infusion pumps. The most frequent error enablers were: double check omitted or deviated (n = 40), lack of safety barriers to intercept prescribing errors (n = 25), and emergency/stress (n = 21). Conclusion: Numeracy errors due to lack of or improper safeguards occurred during all medication management stages. Dose miscalculation after dilution of intravenous solutions, infusion pump programming, and double-checking were identified as unsafe practices. We discuss measures to prevent future calculation and numeracy errors. Impact: Our analysis of medication dose calculation errors and other numeracy mishaps demonstrates the need for improving safety steps and increase standardization for medication management procedures. We discuss organizational, technological, and educational measures to prevent harm from numeracy errors