Fører bruk av en ny prosedyre for legemiddelsamstemming i sykehus til mer nøyaktige legemiddellister? En kvantitativ studie ved fire sykehus i Helse Nord RHF

Bakgrunn og formål: Prosedyre for legemiddelsamstemming (LMS) skal innføres ved alle sykehus i Helse Nord RHF og kliniske farmasøyter fra Sykehusapotek Nord HF skal gjøre kontrollmålinger for å undersøke om prosedyren fører til mer korrekte legemiddellister. Formålet med oppgaven er å 1) karakterisere uoverensstemmelser (UO) identifisert ved kontrollmålinger på fire sykehus i Helse Nord, 2) undersøke hvilke faktorer som påvirker om en legemiddelliste inneholder UO, og 3) undersøke sammenhengen mellom samstemming av legemiddellister og UOr identifisert ved kontrollmåling. Metode: Kontrollmålinger ble utført i perioden juli 2014 til januar 2015. Resultat: De 249 legemiddellistene som ble samstemt tilhørte en pasientpopulasjon med 53% menn og en gjennomsnittsalder på 61 år. Det ble identifisert minst én UO i 59% av legemiddellistene, og gjennomsnittlig antall UOr per liste med UO var 2,4. Hyppigst identifisert UO var ”Bruker annet legemiddel i tillegg til det som er oppgitt på kurven” (56% av totalt antall UOr). Regresjonsanalysen viste at kvinner hadde økt odds for at en UO ble identifisert i legemiddellisten. I tillegg økte oddsen med økt antall legemidler i bruk. Det ble observert en trend for færre identifiserte UOr i legemiddellistene som var dokumentert samstemte sammenlignet med de som ikke var dokumentert samstemte, men forskjellen var ikke statistisk signifikant. Samstemming av legemiddellister etter prosedyre innført ved de aktuelle sykehusene ser dermed ikke ut til å påvirke antall identifiserte UOr ved kontrollmålinger. Konklusjon: Selv om vi observerte en trend der dokumentert samstemte legemiddellister fra avdeling inneholdt færre uoverensstemmelser enn listene som ikke var dokumentert samstemte, var dette ikke statistisk signifikant. Muligvis kan trenden bli signifikant med et større datamateriale. For å øke riktighet av legemiddellister i sykehus i Helse Nord må antakelig prosedyre for LMS enten implementeres bedre eller endres

Emergency department physicians’ experiences and perceptions with medication-related work tasks and the potential role of clinical pharmacists

Purpose Medication-related problems are frequent among emergency department patients. Clinical pharmacists play an important role in identifying, solving, and preventing these problems, but are not present in emergency departments worldwide. We aimed to explore how Norwegian physicians experience medication-related work tasks in emergency departments without pharmacists present, and how they perceive future introduction of a clinical pharmacist in the interprofessional team. Methods We interviewed 27 physicians in three emergency departments in Norway. Interviews were audio-recorded, transcribed, and analysed using qualitative content analysis. Results Our informants’ experience with medication-related work tasks mainly concerned medication reconciliation, and few other tasks were systematically performed to ensure medication safety. The informants were welcoming of clinical pharmacists and expressed a need and wish for assistance with compiling patient’s medication lists. Simultaneously they expressed concerns regarding e.g., responsibility sharing, priorities in the emergency department and logistics. These concerns need to be addressed before implementing the clinical pharmacist in the interprofessional team in the emergency department. Conclusions Physicians in Norwegian emergency departments welcome assistance from clinical pharmacists, but the identified professional, structural, and legislative barriers for this collaboration need to be addressed before implementation

Patient perceptions and experiences with medication-related activities in the emergency department: a qualitative study

Background Emergency department (ED) pharmacists reduce medication errors and improve quality of medication use. Patient perceptions and experiences with ED pharmacists have not been studied. The aim of this study was to explore patients’ perceptions of and experiences with medication-related activities in the ED, with and without an ED pharmacist present.Methods We conducted 24 semistructured individual interviews with patients admitted to one ED in Norway, 12 before and 12 during an intervention, where pharmacists performed medication-related tasks close to patients and in collaboration with ED staff. Interviews were transcribed and analysed applying thematic analysis.Results From our five developed themes, we identified that: (1) Our informants had low awareness and few expectations of the ED pharmacist, both with and without the pharmacist present. However, they were positive to the ED pharmacist. (2) Our informants expressed a variation of trust in the healthcare system, healthcare professionals and electronic systems, though the majority expressed a high level of trust. They believed that their medication list was automatically updated and assumed to get the correct medication. (3) Some informants felt responsible to have an overview of their medication use, while others expressed low interest in taking responsibility regarding their medication. (4) Some informants did not want involvement from healthcare professionals in medication administration, while others expressed no problems with giving up control. (5) Medication information was important for all informants to feel confident in medication use, but the need for information differed.Conclusion Despite being positive to pharmacists, it did not seem important to our informants who performed the medication-related tasks, as long as they received the help they needed. The degree of trust, responsibility, control and information varied among ED patients. These dimensions can be applied by healthcare professionals to tailor medication-related activities to patients’ individual needs

Integrating the clinical pharmacist into the emergency department interdisciplinary team: a study protocol for a multicentre trial applying a non-randomised stepped-wedge study design

Introduction - The ‘emergency department (ED) pharmacist’ is an integrated part of the ED interdisciplinary team in many countries, which have shown to improve medication safety and reduce costs related to hospitalisations. In Norway, few EDs are equipped with ED pharmacists, and research describing effects on patients has not been conducted. The aim of this study is to investigate the impact of introducing clinical pharmacists to the interdisciplinary ED team. In this multicentre study, the intervention will be pragmatically implemented in the regular operation of three EDs in Northern Norway; Tromsø, Bodø and Harstad. Clinical pharmacists will work as an integrated part of the ED team, providing pharmaceutical care services such as medication reconciliation, review and/or counselling. The primary endpoint is ‘time in hospital during 30 days after admission to the ED’, combining (1) time in ED, (2) time in hospital (if hospitalised) and (3) time in ED and/or hospital if re-hospitalised during 30 days after admission. Secondary endpoints include time to rehospitalisation, length of stay in ED and hospital and rehospitalisation and mortality rates. Methods and analysis - We will apply a non-randomised stepped-wedge study design, where we in a staggered way implement the ED pharmacists in all three EDs after a 3, 6 and 9 months control period, respectively. We will include all patients going through the three EDs during the 12-month study period. Patient data will be collected retrospectively from national data registries, the hospital system and from patient records. Ethics and dissemination - The Regional Committee for Medical and Health Research Ethics and Local Patient Protection Officers in all hospitals have approved the study. Patients will be informed about the ongoing study on a general basis with ads on posters and flyers