Retrospective descriptive assessment of clinical decision support medication-related alerts in two Saudi Arabian hospitals

OBJECTIVES: To determine the frequency of clinical decision support system (CDSS) medication-related alerts generated, accepted, or overridden, to assess appropriateness of alert display and overrides, and to characterise the documentation of clinician justification for these overrides in an academic medical centre in Saudi Arabia. MATERIALS AND METHODS: System-generated CDSS reports for the period June 2015 to December 2017 were retrospectively reviewed and analysed. Alerts were classified into different types, and rates of alert overrides calculated as percentages of all generated alerts. A subset of 307 overridden alerts was assessed for appropriateness of display and override by two clinical pharmacists. Physician documentation of reasons for overriding alerts were categorised. RESULTS: A total of 4,446,730 medication-related alerts were generated from both inpatient and outpatient settings, and 4,231,743 (95.2%) were overridden. The most common alert type was 'duplicate drug', accounting for 3,549,736 (79.8%) of alerts. Of 307 alerts assessed for appropriateness, 246 (80%) were judged to be appropriately displayed and 244 (79%) were overridden appropriately. New drug allergy and drug allergy alerts had the highest percentage of being judged as inappropriately overridden. For 1,594,313 alerts (37.7%), 'no overridden reason selected' was chosen from the drop-down menu. CONCLUSIONS: The alert generation and override rate were higher than reported previously in the literature. The small sample size of 307 alerts assessed for appropriateness of alert display and override is a potential limitation. Revision of the CDSS rules for alerts (focusing on specificity and relevance for the local context) is now recommended. Future research should prospectively assess providers' perspectives, and determine patient harm associated with overridden alerts

Competency-based assessment of practice-based experiential learning in undergraduate pharmacy programmes.

Objective: To obtain feedback from experiential leaning (EL) leads about how competency-based assessments could be undertaken by EL facilitators, and to scope existing EL assessment structures in undergraduate Masters in Pharmacy (MPharm) programmes across the United Kingdom (UK). Methods: A cross-sectional survey was conducted utilizing a nine-item on-line survey, consisting of five open-ended and four closed-ended question. All UK universities with MPharm programmes (n=30) were invited to participate in the survey. Variables of interest were perceptions on activities and competencies that could be assessed by EL facilitators. The survey utilised a 5-point Likert-type response ranging from strongly disagree to strongly agree. Other variables of interest were tools/methods that could be used to assess competency, and perceived advantages and disadvantages of the proposed methods, the latter two captured via open-ended questions. Results: Of the 21 universities that responded (Response rate: 70%), 17 were included in the final analysis. Fourteen of the 17 (82.4%) offered the 4-year programme, while 3 (17.6%) offered both the 4-year and 5-year integrated programme. Assessments were mainly undertaken by university staff (59%), with minimal amounts undertaken during EL (39%). There was unanimous agreement (100%) that facilitators could assess students’ communication skills and professionalism during EL. No consensus, however, was achieved with regard to the tool(s) or method(s) to be used to assess student’s competencies. There were 13 responses to the open-ended comments. An advantage noted was that EL facilitator assessment of students would allow for more accurate evaluation of students in the practice setting, while acknowledging barriers such as the burden of time and the lack of consistency in marking. To address this lack of consistency, the majority highlighted the need for facilitator training. Conclusion: Minimal assessments are currently undertaken during EL, with students predominantly assessed on return to the university. No consensus could be achieved with regard to the tool(s) or method(s) to be used to assess students’ competencies, suggesting that perhaps there is no one-size-fits-all, and that the tools and methods used should be informed by the competencies being assessed

A cross-sectional study examining the nature and extent of interprofessional education in schools of pharmacy in the United Kingdom.

Interprofessional education can prepare the workforce for collaborative practice in complex health and social care systems. The aim of this study was to examine the nature and extent of interprofessional education in schools of pharmacy in the United Kingdom. An online questionnaire was developed using systems theory, published literature and input from an interprofessional expert panel. It included closed and open-ended questions and a demographic section. Following piloting, it was distributed to 31 schools of pharmacy. Descriptive statistics were used for quantitative data, a content analysis approach for qualitative data. Ten schools of pharmacy responded. All reported delivering compulsory interprofessional education. Most (80%) reported an interprofessional steering group overseeing development. Formative and/or summative assessment varied depending on year of study. Mechanism and purpose of evaluation varied, with respondents reporting Kirkpatrick Evaluation Model Levels 1-3 (100%;80%;70%). Two themes were identified: "Variation in Interprofessional Education Approaches and Opportunities" and "Factors Influencing Development and Implementation of Interprofessional Education". Formal teaching was mainly integrated into other modules; various pedagogic approaches and topics were used for campus-based activities. Respondents referred to planned interprofessional education during practice-based placements; some still at pilot stage. Overall, respondents agreed that practice-based placements offered opportunistic interprofessional education, but a more focused approach is needed to maximise student pharmacists' learning potential. Most interprofessional education offered in undergraduate pharmacy curricula in the United Kingdom is campus-based, the nature and extent of which varies between programmes. Very few examples of practice-based activities were reported. Results may inform future interprofessional education curricular developmen

Medication errors and processes to reduce them in care homes in the United Kingdom: a scoping review

Medicines-related incidents are a leading cause of preventable harm across all patient groups, including care home residents. Despite national guidance, there is little information on assessing medication error rates and evaluating changes to reduce them. This review explored the scientific and grey literature on medicines-related incidents, causation and evaluation of changes in care homes in the United Kingdom. The research identified 2951 documents, 32 analysed; some of them covered more than one area. Seven reported rate and causes, eleven causes, eleven made recommendations, and four reported the evaluation of changes to processes and systems. Three areas emerged; 1) medicines-related incident rates ranged between 1% and 38%, 2) incident rates increased where formulations were not tablets or capsules ranging from 12% to 50% depending on the formulation, 3) three evaluations of changes aimed at reducing medicine incidents. Therefore, information on medicines-related incidents in care homes is available, but not systematically described

Healthy living champions network: An opportunity for community pharmacy's sustained participation in tackling local health inequalities

Background Evaluations recognize healthy living champions (HLCs) as key contributors to the Health Living Pharmacy (HLP) project's success; the project has served to reduce pressure on family doctor services and clients who would have otherwise not sought professional advice have accessed HLP services. Objectives To investigate the impact of innovative networking opportunities in supporting HLCs to function within their role and to explore the network's potential in promoting sustained HLP participation. Method Twenty of Portsmouth's (England) HLCs (n = 33) agreed to participate in focus groups. Transcripts were subjected to interpretative phenomenological analysis guided by grounded theory. The transcripts were read repeatedly; recurrent themes were identified and coded manually and consensus was reached by discussion within the research team. Findings Network meetings provide HLCs with professional development, networking opportunities and continued encouragement. Recommendations to develop and sustain the network included the formation of a group committee and establishing of a communication facility accessible between meetings. Conclusion The successful Portsmouth HLP project informed the design of UK HLP projects. The current focus is to build a successful strategy to sustain the positive outcomes, building on the recognized enablers. This study contributes further lessons learned to guide health commissioners and service implementers to best support staff development, involvement and motivation through innovative practice

Systematic review of the safety of medication use in inpatient, outpatient and primary care settings in the Gulf Cooperation Council countries

Background Errors in medication use are a patient safety concern globally, with different regions reporting differing error rates, causes of errors and proposed solutions. The objectives of this review were to identify, summarise, review and evaluate published studies on medication errors, drug related problems and adverse drug events in the Gulf Cooperation Council (GCC) countries. Methods A systematic review was carried out using six databases, searching for literature published between January 1990 and August 2016. Research articles focussing on medication errors, drug related problems or adverse drug events within different healthcare settings in the GCC were included. Results Of 2094 records screened, 54 studies met our inclusion criteria. Kuwait was the only GCC country with no studies included. Prescribing errors were reported to be as high as 91% of a sample of primary care prescriptions analysed in one study. Of drug-related admissions evaluated in the emergency department the most common reason was patient non-compliance. In the inpatient care setting, a study of review of patient charts and medication orders identified prescribing errors in 7% of medication orders, another reported prescribing errors present in 56% of medication orders. The majority of drug related problems identified in inpatient paediatric wards were judged to be preventable. Adverse drug events were reported to occur in 8.5–16.9 per 100 admissions with up to 30% judged preventable, with occurrence being highest in the intensive care unit. Dosing errors were common in inpatient, outpatient and primary care settings. Omission of the administered dose as well as omission of prescribed medication at medication reconciliation were common. Studies of pharmacists’ interventions in clinical practice reported a varying level of acceptance, ranging from 53% to 98% of pharmacists’ recommendations. Conclusions Studies of medication errors, drug related problems and adverse drug events are increasing in the GCC. However, variation in methods, definitions and denominators preclude calculation of an overall error rate. Research with more robust methodologies and longer follow up periods is now required.Peer reviewe

Investigation of industrial pharmacists’ views on pharmaceutical industry careers

To investigate the range of occupations undertaken by pharmacists in the pharmaceutical industry and to explore their views on this area of the profession and its value to the industry. Design Theme analysis of responses to a questionnaire comprising structured and open questions. Subjects and setting Industrial pharmacists on the Industrial Pharmacists Group (IPG) electronic mailing list. Outcome measures Roles and views on industrial pharmacy practice. Results 153 pharmacists from the IPG responded. 107 (70%) worked in research and development, 54 (35%) in regulatory affairs, 49 (32%) in administration and 43 (28%) in quality assurance. Respondents were enthusiastic about their role in the industry, and considered that their pharmacy training was a positive feature in determining the value of the contribution they made to the industry. Key positive themes that emerged included the availability of a wide variety of jobs and ability to perform well due to broad knowledge base. Negative themes included a need for more promotion of this area of practice and better support from the Royal Pharmaceutical Society. Conclusions Many industrial pharmacists think there is a wide range of opportunities for pharmacists to provide a valuable contribution to the industry, particularly in view of their breadth of knowledge, and that this career option should be promoted to potential recruits more effectively