Potential hazards in the medication use process at the hospital community interface and a strategy to reduce them.

Aims of the study The aim of this thesis was to improve medication safety at the hospital community interface by generating a framework to identify the potential hazards in the current medication use process and devising a strategy to reduce them. Methods Mixed methods research was used. Healthcare record review was used to survey the potential hazards in the medication use process; interviews were used to obtain a broad perspective of the pharmacy workforce and services delivered at points around transfer of care and to explore the error vulnerabilities in the system and the attributes of the safety culture. The findings from all studies were integrated and triangulated to develop a framework to improve medication safety at points around transfer of care. Results Medication non-reconciliation on discharge from acute and public hospital care was common (50% of inpatient episodes, 16% of medications) and had the potential to cause moderate to severe harm (65%) and medium to high potential to result in unplanned readmission to hospital (38%). Primary care practitioners perceived that the deficits in communication and reconciliation limited their ability to ensure the appropriate use of medication. Delivery of evidence based clinical pharmacy services on admission and discharge was identified in the survey of chief hospital pharmacists as rare ( Conclusions Medication non-reconciliation is common and has the potential to cause patient harm. Strategies to improve patient safety should focus on advancing the medication safety culture, implementing system and process change. Future work should concentrate on development, implementation and evaluation of this strategy

Promoting Peer Debate in Pursuit of Moral Reasoning Competencies Development: Spotlight on Educational Intervention Design

Research indicates that appropriately designed educational interventions may impact positively on moral reasoning competencies development (MRCD) as measured by a psychometric measure known as the Defining Issues Test (DIT). However, findings include that educational interventions intended to impact on MRCD do not consistently promote measurable pre-post development. This paper reviews the theoretical background to the use of educational interventions to impact on MRCD, and spotlights how underpinning Neo-Kohlbergian theory might inform the design of an intervention in order to optimise impact on MRCD. Findings indicate that peer debate - regarding ethical concepts in profession-specific dilemma scenarios, what action(s) might be taken and how ‘less than ideal’ action options might be justified - is essential. Five examples of an adapted format of ‘Neo-Kohlbergian’ profession-specific ‘intermediate concept measures’ (ICMs) are included and were integrated into a 16 week blended learning educational intervention in a manner that promoted repeated exposure to peer debate regarding dilemmas, and the educational intervention design was trialled in a study with 27 volunteer community pharmacists in Ireland. An overview of the design, development and delivery of the intervention is provided. The paper concludes with recommendations for further development of the ‘idea’. Conflict of Interest: None   Type: Idea Pape

Medication-related outcomes and health equity : evidence for pharmaceutical care

Marginalised people experience diminished access to pharmaceutical care and worse medication-related outcomes than the general population. Health equity is a global priority. This article explores the key evidence of health inequity and medication use, structures the causes and contributory factors and suggests opportunities that can be taken to advance the pharmaceutical care agenda so as to achieve health equity. The causes of, and contributors to, this inequity are multi-fold, with patient- and person-related factors being the most commonly reported. Limited evidence is available to identify risk factors related to other aspects of a personal medication use system, such as technology, tasks, tools and the internal and the external environments. Multiple opportunities exist to enhance equity in medication-related outcomes through pharmaceutical care research and practice. To optimise the effects and the sustainable implementation of these opportunities, it is important to (1) ensure the meaningful inclusion and engagement of members of marginalised groups, (2) use a person-centred approach and (3) apply a systems-based approach to address all of the necessary components of a system that interact and form a network as work processes that produce system outcomes.peer-reviewe

Attitudes to Interprofessional Education Among Health Science Students Engaging in a Multidisciplinary Workshop Series

Introduction: Interprofessional education (IPE) provides an opportunity for students from single-professions to interact with other disciplines. Student attitude to IPE can impact engagement and change in attitude may provide an indicator of the impact of IPE. This study examines pre-workshop attitudes to IPE and change in attitude following a series of three IPE workshops. Methods: Preworkshop attitudes were examined using the Readiness for Interprofessional Learning Scale (RIPLS) and the Interprofessional Education Perception Scale (IEPS). The IEPS was repeated at the start of Workshop 1 and at the end of Workshop 3. Data were analyzed using linear regression analysis and linear mixed methods for repeated measures. Results: 405 students participated (pre-workshop n=122; workshop 1 n=244; workshop 3 n=236). Pre-workshop attitudinal scores were high. While male gender and studying medicine negatively predicted attitude across some domains, previous experience of a joint patient treatment session on clinical placement positively predicted attitude in the domain of Perception of Actual Cooperation (standardised Beta 0.283, p=0.005). Attitude to IPE improved across all domains of the IEPS from online preparation to the end of workshop 3 (pCompetency and Autonomy, and in the domain of Perceived Need for Cooperation improved only following online preparation, while the domain of Perception of Actual Cooperation improved following both online preparation and participation in the workshops. Discussion: The results presented reflect positively on student readiness for IPE. Attitudes were further improved following engagement in a structured series of IPE workshops

Barriers and facilitators of medicines reconciliation at transitions of care in Ireland - a qualitative study

Background: Medication error at transitions of care is common. The implementation of medicines reconciliation processes to improve this issue has been recommended by many regulatory and safety organisations. The aim of this study was to gain insight from healthcare professionals on the barriers and facilitators to the medicines reconciliation implementation process. Methods: Semi-structured interviews were conducted in Ireland with a wide range of healthcare professionals (HCPs) involved with medicines reconciliation at transitions of care. Thematic analysis was undertaken using an adaptation of a combined theoretical framework of Grol, Cabana and Sluisveld to classify the barriers and facilitators to implementation of medicines reconciliation. Results: Thirty-five participants were interviewed, including eleven community pharmacists (CPs), eight hospital pharmacists (HPs), nine hospital consultants (HCs), five general practitioners (GPs), and two non-consultant hospital doctors (NCHDs). Themes were categorized into barriers and facilitators. Barriers included resistance from existing professional cultures, staff interest and training, poor communication and minimal information and communications technology (ICT) support. Solutions (facilitators) suggested included supporting effective multidisciplinary teams, greater involvement of pharmacists in medicines reconciliation, ICT solutions (linked prescribing databases, decision support systems) and increased funding to provide additional (e.g. admission and discharge reconciliation) and more advanced services (e.g. community pharmacist delivered medicines use review). Conclusions: Medicines reconciliation is advocated as a solution to the known problem of medication error at transitions of care. This study identifies the key challenges and potential solutions that policy makers, managers and HCPs should consider when reviewing the practices and processes of medicines reconciliation in their own organisations

Unintended discontinuation of medication following hospitalisation: a retrospective cohort study

Objectives: Whether unintended discontinuation of common, evidence-based, long-term medication occurs after hospitalisation; what factors are associated with unintended discontinuation; and whether the presence of documentation of medication at hospital discharge is associated with continuity of medication in general practice. Design: Retrospective cohort study between 2012 and 2015. Setting: Electronic records and hospital supplied discharge notifications in 44 Irish general practices. Participants: 20?488 patients aged 65 years or more prescribed long-term medication for chronic conditions. Primary and secondary outcomes: Discontinuity of four evidence-based medication drug classes: antithrombotic, lipid-lowering, thyroid replacement drugs and respiratory inhalers in hospitalised versus non-hospitalised patients; patient and health system factors associated with discontinuity; impact of the presence of medication in the hospital discharge summary on continuity of medication in a patient?s general practitioner (GP) prescribing record at 6?months follow-up. Results: In patients admitted to hospital, medication discontinuity ranged from 6%?11% in the 6?months posthospitalisation. Discontinuity of medication is significantly lower for hospitalised patients taking respiratory inhalers (adjusted OR (AOR) 0.63, 95% CI (0.49 to 0.80), p<0.001) and thyroid medications (AOR 0.62, 95%?CI (0.40 to 0.96), p=0.03). There is no association between discontinuity of medication and hospitalisation for antithrombotics (AOR 0.95, 95%?CI (0.81 to 1.11), p=0.49) or lipid lowering medications (AOR 0.92, 95%?CI (0.78 to 1.08), p=0.29). Older patients and those who paid to see their GP were more likely to experience increased odds of discontinuity in all four medicine groups. Less than half (39% to 47.4%) of patients had medication listed on their hospital discharge summary. Presence of medication on hospital discharge summary is significantly associated with continuity of medication in the GP prescribing record for lipid lowering medications (AOR 1.64, 95%?CI (1.15 to 2.36), p=0.01) and respiratory inhalers (AOR 2.97, 95%?CI (1.68 to 5.25), p<0.01). Conclusion: Discontinuity of evidence-based long-term medication is common. Increasing age and private medical care are independently associated with a higher risk of medication discontinuity. Hospitalisation is not associated with discontinuity but less than half of hospitalised patients have medication recorded on their hospital discharge summary