Healthcare professionals' perceptions on medication communication challenges and solutions - text mining and manual content analysis-cross-sectional study

Background Communication challenges contribute to medication incidents in hospitals, but it is unclear how communication can be improved. The aims of this study were threefold: firstly, to describe the most common communication challenges related to medication incidents as perceived by healthcare professionals across specialized hospitals for adult patients; secondly, to consider suggestions from healthcare professionals with regard to improving medication communication; and thirdly, to explore how text mining compares to manual analysis when analyzing the free-text content of survey data. Methods This was a cross-sectional, descriptive study. A digital survey was sent to professionals in two university hospital districts in Finland from November 1, 2019, to January 31, 2020. In total, 223 professionals answered the open-ended questions; respondents were primarily registered nurses (77.7 %), physicians (8.6 %), and pharmacists (7.3 %). Text mining and manual inductive content analysis were employed for qualitative data analysis. Results The communication challenges were: (1) inconsistent documentation of prescribed and administered medication; (2) failure to document orally given prescriptions; (3) nurses' unawareness of prescriptions (given outside of ward rounds) due to a lack of oral communication from the prescribers; (4) breaks in communication during care transitions to non-communicable software; (5) incomplete home medication reconciliation at admission and discharge; (6) medication lists not being updated during the inpatient period due to a lack of clarity regarding the responsible professional; and (7) work/environmental factors during medication dispensation and the receipt of verbal prescriptions. Suggestions for communication enhancements included: (1) structured digital prescriptions; (2) guidelines and training on how to use documentation systems; (3) timely documentation of verbal prescriptions and digital documentation of administered medication; (4) communicable software within and between organizations; (5) standardized responsibilities for updating inpatients' medication lists; (6) nomination of a responsible person for home medication reconciliation at admission and discharge; and (7) distraction-free work environment for medication communication. Text mining and manual analysis extracted similar primary results. Conclusions Non-communicable software, non-standardized medication communication processes, lack of training on standardized documentation, and unclear responsibilities compromise medication safety in hospitals. Clarification is needed regarding interdisciplinary medication communication processes, techniques, and responsibilities. Text mining shows promise for free-text analysis.Peer reviewe

Onko lääkkeiden antaminen potilaille vaarallista? Analyysi Suomessa vuosina 2007-2017 raportoiduista vaaratapahtumista

Tämän tutkimuksen tarkoituksena oli kuvata lääkkeiden antamiseen liittyvät vuosina 2007-2017 vapaaehtoisesti raportoidut terveydenhuollon organisaatioiden vaaratapahtumat (HaiPro), niiden aiheuttamat seuraukset potilaille ja terveydenhuollon yksiköille sekä niistä aiheutuneet toimenpiteet. Aineisto sisälsi yhteensä (n=167 634) HaiPro raporttia 48:stä eri organisaatiosta Suomesta. Aineisto kuvattiin frekvenssi- ja prosenttijakaumilla. Lääkkeen antamiseen liittyvien vaaratapahtumien määrä lisääntyi vuosittain. Raportoijista valtaosa oli hoitohenkilökuntaa. Yleisimmät virhetyypit olivat antamatta jäänyt lääke, neste tai verituote tai väärä ajankohta. Vaaratapahtumista aiheutui potilaille eriasteista haittaa. Terveydenhuollon yksiköille vaaratapahtumista aiheutui yleisimmin lisätyötä tai vähäisiä hoitotoimia, ei haittaa tai imagohaittaa. Yleisimmin raportoitiin vaaratapahtumasta seuranneeksi toimenpiteeksi ”poikkeaman/ virheen korjaava toimenpide” tai ”potilaan / asiakkaan tarkkailu / informointi asiassa”. Tulosten perusteella lääkkeen antamiseen liittyvistä vaaratapahtumista aiheutuu potilaille eriasteisia haittoja sekä terveydenhuollon organisaatioille ylimääräistä työtä, kustannuksia ja imagohaittoja. Lääkehoidon turvallisuus tulisi olla terveydenhuollon organisaatioiden ja henkilöstön prioriteettina, jolloin haittoja ja niistä aiheutunutta ylimääräistä työtä voidaan vähentää.  &nbsp

Circulating cell-free DNA in health and disease - the relationship to health behaviours, ageing phenotypes and metabolomics

Circulating cell-free DNA (cf-DNA) has emerged as a promising biomarker of ageing, tissue damage and cellular stress. However, less is known about health behaviours, ageing phenotypes and metabolic processes that lead to elevated cf-DNA levels. We sought to analyse the relationship of circulating cf-DNA level to age, sex, smoking, physical activity, vegetable consumption, ageing phenotypes (physical functioning, the number of diseases, frailty) and an extensive panel of biomarkers including blood and urine metabolites and inflammatory markers in three human cohorts (N = 5385; 17–82 years). The relationships were assessed using correlation statistics, and linear and penalised regressions (the Lasso), also stratified by sex.cf-DNA levels were significantly higher in men than in women, and especially in middle-aged men and women who smoke, and in older more frail individuals. Correlation statistics of biomarker data showed that cf-DNA level was higher with elevated inflammation (C-reactive protein, interleukin-6), and higher levels of homocysteine, and proportion of red blood cells and lower levels of ascorbic acid. Inflammation (C-reactive protein, glycoprotein acetylation), amino acids (isoleucine, leucine, tyrosine), and ketogenesis (3-hydroxybutyrate) were included in the cf-DNA level-related biomarker profiles in at least two of the cohorts.In conclusion, circulating cf-DNA level is different by sex, and related to health behaviour, health decline and metabolic processes common in health and disease. These results can inform future studies where epidemiological and biological pathways of cf-DNA are to be analysed in details, and for studies evaluating cf-DNA as a potential clinical marker.</p