A Systematic Review of the Legal Considerations Surrounding Medicines Management

publishedVersio

Nurses’ Adherence to Patient Safety Principles: A Systematic Review

Background: Quality-of-care improvement and prevention of practice errors is dependent on nurses’ adherence to the principles of patient safety. Aims: This paper aims to provide a systematic review of the international literature, to synthesise knowledge and explore factors that influence nurses’ adherence to patient-safety principles. Methods: Electronic databases in English, Norwegian, and Finnish languages were searched, using appropriate keywords to retrieve empirical articles published from 2010–2019. Using the theoretical domains of the Vincent’s framework for analysing risk and safety in clinical practice, we synthesized our findings according to ‘patient’, ‘healthcare provider’, ‘task’, ‘work environment’, and ‘organisation and management’. Findings: Six articles were found that focused on adherence to patient-safety principles during clinical nursing interventions. They focused on the management of peripheral venous catheters, surgical hand rubbing instructions, double-checking policies of medicines management, nursing handover between wards, cardiac monitoring and surveillance, and care-associated infection precautions. Patients’ participation, healthcare providers’ knowledge and attitudes, collaboration by nurses, appropriate equipment and electronic systems, education and regular feedback, and standardization of the care process influenced nurses’ adherence to patient-safety principles. Conclusions: The revelation of individual and systemic factors has implications for nursing care practice, as both influence adherence to patient-safety principles. More studies using qualitative and quantitative methods are required to enhance our knowledge of measures needed to improve nurse’ adherence to patient-safety principles and their effects on patient-safety outcomes

A qualitative study of older patients’ and family caregivers’ perspectives of transitional care from hospital to home

Author's accepted version (postprint).This is an Accepted Manuscript of an article published by Springer in Research and Theory for Nursing Practice on 05/03/2021.Available online: https://connect.springerpub.com/content/sgrrtnp/early/2021/03/05/rtnp-d-20-00067acceptedVersio

Testing a model for identifying nursing and paramedic students’ risk in level 1 human bioscience

BACKGROUND Factors such as the number of hours of paid work, class attendance and university admission scores have been shown to impact on student success. Conflicting results have been demonstrated for factors such as age, healthcare work experience and previous study of biology. Self-efficacy has been linked to academic achievement and performance in science courses has been directly linked to overall academic achievement. At our regional university the student demographic profile of students enrolled in Human Bioscience 1 indicates that up to 50% of students complete the final year of high school and consequently at least half enter through alternative pathways. AIMS 1. Gather detailed information regarding the student demographic profile 2. Develop a model for student risk independent of university admission scores. 3. Prospectively test the model METHOD Students enrolled in Human Bioscience 1 (n=1328) in 2011-12 were invited to undertake an online survey and short science test. The response rate was 70.4%. Data was matched to student final results. A linear model using restricted maximum likelihood was used to analyse the data. Validation of the model was undertaken using 10% of the data randomly selected with the remaining 90% of the data being used to estimate the model. Predicted TotalMark was then compared with the observed TotalMark. Prospective testing of the model was undertaken with data collected during session 1 of 2014. RESULTS Socioeconomic status and the short science test score were not significant to the model. The average correlation between the predicted TotalMark from the model and the actual observed TotalMark for 2011-12 cohort was 0.319 (Range 0.086 – 0.538). A comparison of the demographic characteristics between the two groups, 2011-12 and 2014, indicated similar profiles. Both groups contain students enrolled to study by distance mode and on a campus. The model was used to predict the potential mark to be achieved by the 2014 students. The predicted marks were classified as pass or fail based on a mark >49.5%. McNemars test was then used to determine if this prediction was significantly different from the observed pass/fail result. Only 8 of 300 students were misclassified. The test showed there was no significant difference between observed and predicted values. DISCUSSION Students enrolled in the nursing course are less likely to succeed than their paramedic counterparts with similar backgrounds. The risk is further increased for students aged less than 25 years and students who are the first in their family to attend university. The predictive model highlighted the tension between previous health care work experience and study success. If the student had work experience but was studying on campus the work experience had a negative impact. This may be related to age as those studying on campus are younger overall and work experience is unlikely to have been at a high level of responsibility. This contrasted with those studying by distance, most of who were older and had a higher level of responsibility due to prior technical college qualifications. Limitations to the model include factors such as carer responsibility and measures of the students’ self-efficacy, engagement and anxiety all of which have been shown to impact on student success. Socioeconomic status was determined by geographic location which may not accurately reflect the status for an individual student. IMPLICATIONS With the increasing diversity of undergraduate student populations, the ability to identify students at risk of attrition is more important than ever. The regression model provides a mechanism to identify students who may be assisted by targeted strategies, such as pre-study resources and inclusion of mechanisms for building study resilience

Adverse Drug Reactions in Norway: A Systematic Review

Prescription medicines aim to relieve patients’ suffering but they can be associated with adverse side effects or adverse drug reactions (ADRs). ADRs are an important cause of hospital admissions and a financial burden on healthcare systems across the globe. There is little integrative and collective knowledge on ADR reporting and monitoring in the Norwegian healthcare system. Accordingly, this systematic review aims to investigate the current trends in ADR reporting, monitoring, and handling in the Norwegian healthcare system and describe related interventions. Appropriate keywords, with regard to ADRs in both English and Norwegian languages, were used to retrieve articles published from 2010 to 2019. Six articles met the inclusion criteria. The findings offer a comprehensive picture of ADR reporting and monitoring in the Norwegian healthcare system. Psychotropic medicines were most commonly implicated by patients, while professionals most commonly reported ADRs associated with anticoagulants. The current ADR systems were compiled with the involvement of both patients and healthcare providers to record all types of drugs and ADRs of various severities, and aimed at improving ADR tracking. However, there is a need to improve current initiatives in terms of feedback and quality, and more studies are needed to explore how ADR profiles, and the associated vigilance, can improve the safety of medicines management in Norway

Looking for the “Little Things”: A Multi-Disciplinary Approach to Medicines Monitoring for Older People Using the ADRe Resource

As prescribing has become the dominant modality of medical treatment, the “pharmaceuticalization” of practice has often resulted in treatment “at a distance”, with doctors having limited contact with patients. Older and poorer people, who are socially distanced from medical prescribers, suffer more adverse drug reactions (ADRs) than the general population. This paper advocates a team approach to checking patients in care homes systematically for ADRs, using information from manufacturers’ guidelines. It explains the benefits of medicines monitoring to protect older patients from iatrogenic harm, such as over-sedation and falls. The ADRe profile is a sophisticated paper-based check-list, which helps nurses and carers play an active role in monitoring signs symptoms that indicate problems. Better monitoring allows doctors and pharmacists to adjust prescribing and respond to identified ADRs. We argue that Implementation of tools like ADRe can be accelerated by changes to the regulatory regime and better inter-professional cooperation

Learning from Patient Safety Incidents in the Emergency Department: A Systematic Review

Background: Patient safety incidents are commonly observed in critical and high demanding care settings , including the emergency department. There is a need to understand what causes patient safety incidents in emergency departments and determine the implications for excellence in practice. Objective: Our aim was to systematically review the international literature on patient safety incidents in emergency departments and determine what can be learned from reported incidents to inform and improve practice. Discussion: Patient safety incidents in emergency departments have a number of recognized contributing factors. These can be used as groundwork for the development of effective tools to systematically identify incident risk. Participation in efforts to diminish risk and improve patient safety through appropriate incident reporting is critical for removing barriers to safe care. Conclusions: This review enhances our awareness of contributing factors to patient safety incidents within emergency departments and encourages researchers from different disciplines to investigate the causes of practice errors and formulate safety improvement strategies. Ó 2019 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/)

Impacts of Climate and Insect Herbivory on Productivity and Physiology of Trembling Aspen (Populus tremuloides) in Alaskan Boreal Forests

Climate change is impacting forested ecosystems worldwide, particularly in the Northern Hemisphere where warming has increased at a faster rate than the rest of the globe. As climate warms, trembling aspen (Populus tremuloides) is expected to become more successful in northern boreal forests because of its current presence in drier areas of North America. However, large-scale productivity decline of aspen has recently been documented throughout the United States and Canada as a result of drought and insect outbreaks. We used tree ring measurements (basal area increment (BAI) and stable carbon isotopes (δ 13C)) and remote sensing indices of vegetation productivity (NDVI) to study the impact of climate and damage by the aspen epidermal leaf miner (Phyllocnistis populiella) on aspen productivity and physiology in interior Alaska. We found that productivity decreased with greater leaf mining and was not sensitive to growing season (GS) moisture availability. Although productivity decreased during high leaf mining years, it recovered to pre-outbreak levels during years of low insect damage, suggesting a degree of resilience to P. populiella mining. Climate and leaf mining interacted to influence tree ring δ 13C, with greater leaf mining resulting in decreased δ 13C when GS moisture availability was low. We also found that NDVI was negatively associated with leaf mining, and positively correlated with BAI and the δ 13C decrease corresponding to mining. This suggests that NDVI is capturing not only variations in productivity, but also changes in physiology associated with P. populiella. Overall, these findings indicate that the indirect effects of P. populiella mining have a larger impact on aspen productivity and physiology than climate under current conditions, and is essential to consider when assessing growth, physiology and NDVI trends in interior Alaska

Nurses’ Adherence to Patient Safety Principles: A Systematic Review

Background: Quality-of-care improvement and prevention of practice errors is dependent on nurses’ adherence to the principles of patient safety. Aims: This paper aims to provide a systematic review of the international literature, to synthesise knowledge and explore factors that influence nurses’ adherence to patient-safety principles. Methods: Electronic databases in English, Norwegian, and Finnish languages were searched, using appropriate keywords to retrieve empirical articles published from 2010–2019. Using the theoretical domains of the Vincent’s framework for analysing risk and safety in clinical practice, we synthesized our findings according to ‘patient’, ‘healthcare provider’, ‘task’, ‘work environment’, and ‘organisation and management’. Findings: Six articles were found that focused on adherence to patient-safety principles during clinical nursing interventions. They focused on the management of peripheral venous catheters, surgical hand rubbing instructions, double-checking policies of medicines management, nursing handover between wards, cardiac monitoring and surveillance, and care-associated infection precautions.Patients’ participation, healthcare providers’ knowledge and attitudes, collaboration by nurses, appropriate equipment and electronic systems, education and regular feedback, and standardization of the care process influenced nurses’ adherence to patient-safety principles. Conclusions: The revelation of individual and systemic factors has implications for nursing care practice, as both influence adherence to patient-safety principles. More studies using qualitative and quantitative methods are required to enhance our knowledge of measures needed to improve nurse’ adherence to patient-safety principles and their effects on patient-safety outcomes.</p

Effectiveness of earlier antenatal screening for sickle cell disease and thalassaemia in primary care: cluster randomised trial

Objective To evaluate the effectiveness of offering antenatal screening for sickle cell disease and thalassaemia in primary care as a way of facilitating earlier uptake of screening