In-hospital medication reviews reduce unidentified drug-related problems

Purpose To examine the impact of a new model of care, in which a clinical pharmacist conducts structured medication reviews and a multi-professional team collates systematic medication care plans, on the number of unidentified DRPs in a hospital setting. Methods In a prospective two-period study, patients admitted to an internal medicine ward at the University Hospital of Lund, Sweden, were included if they were >= 65 years old, used >= 3 medications on a regular basis and had stayed on the ward for >= 5 weekdays. Intervention patients were given the new model of care and control patients received conventional care. DRPs were then retrospectively identified after study completion from blinded patient records for both intervention and control patients. Two pairs of evaluators independently evaluated and classified these DRPs as having been identified/unidentified during the hospital stay and according to type and clinical significance. The primary endpoint was the number of unidentified DRPs, and the secondary endpoints were the numbers of unidentified DRPs within each type and clinical significance category. Results The study included a total of 141 (70 intervention and 71 control) patients. The intervention group benefited from a reduction in the total number of unidentified DRPs per patient during the hospital stay: intervention group median 1 (1st-3rd quartile 0-2), control group 9 (6-13.5) (p < 0.001), and also in the number of medications associated with unidentified DRPs per patient: intervention group 1 (0-2), control group 8 (5-10) (p < 0.001). All sub-categories of DRPs that were frequent in the control group were significantly reduced in the intervention group. Similarly, the DRPs were less clinically significant in the intervention group. Conclusions A multi-professional team, including a clinical pharmacist, conducting structured medication reviews and collating systematic medication care plans proved very effective in reducing the number of unidentified DRPs for elderly in-patients

Medication reviews in primary care in Sweden: importance of clinical pharmacists' recommendations on drug-related problems.

Background One way of preventing and solving drug-related problems in frail elderly is to perform team-based medication reviews. Objective To evaluate the quality of the clinical pharmacy service to primary care using structured medication reviews, focusing on the clinical significance of the recommendations made by clinical pharmacists. Setting A random sample of 150 patients (out of 1541) who received structured team based medication reviews. The patients lived at a geriatric nursing home or were ≥65 years and lived in ordinary housing with medication-related community help. Method Based on information on symptoms, kidney function, blood pressure, diagnoses and the medication list, a pharmacist identified possible drug-related problems and supplied recommendations for the general practitioner to act on. Two independent physicians retrospectively ranked the clinical significance of the recommendations according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant). Main outcome measure The clinical significance of the recommendations. Results In total 349 drug-related problems were identified, leading to recommendations. The vast majority of the recommendations (96 %) were judged to have significance 3 or higher and more than the half were judged to have significance 4 or higher. Conclusion The high proportion of clinically significant recommendations provided by pharmacists when performing team-based medication reviews suggest that these clinical pharmacy services have potential to increase prescribing quality. As such, the medication reviews have the potential for contributing to a better and safer drug therapy for elderly patients

Experiences from the implementation of structured patient discharge information for safe medication reconciliation at a Swedish university hospital

Study objectives: A method for medication reconciliation that reduces medication errors and healthcare contacts when a patient is discharged from hospital, LIMM-DI (Lund integrated medicines management-discharge information) had been previously developed by the authors. LIMM-DI is structured information written for the patient and sent to the next caregiver. In this study, the use (implementation ratio) and errors when used were measured. Methods: During two three-week periods in 2008 and 2009 information on the use of LIMM-DI for every discharged patient at Skåne University Hospital in Lund, Sweden was collected. Medication errors and quality by chart reviews based on a previously developed checklist were also measured. The focus was placed on the medication report—which medications have been changed and why—and the medication list, two vital parts of LIMM-DI. Results: One hundred and thirty eight (27%) and 163 (31%) of the patients received LIMM-DI in periods 1 and 2, respectively. The mean number of errors per patient decreased from period 1 to 2 in the medication list (6.5 [standard deviation, SD, 6.0] versus 3.9 (SD, 4.2), p = 0.00098) but not in the medication report (5.3 [SD, 6.3] versus 5.3 [SD, 5.9], p = 0.99). Conclusion: Contrary to expectations, the implementation of LIMM-DI was slow and there was no great reduction in the number of medication errors. There is a need to improve the current strategy and to consider alternative strategies for improving patient safety in the discharge medication reconciliation process

Clinical outcomes from the use of Medication Report when elderly patients are discharged from hospital

Objective The objective of this study was to investigate whether a Medication Report also can reduce the number of patients with clinical outcomes due to medication errors. Method A prospective intervention study with retrospective controls on patients at three departments at Lund University Hospital, Sweden that where transferred to primary care. The intervention group, where patients received a Medication Report at discharge, was compared with a control group with patients of the same age, who were not given a Medication Report when discharged from the same ward one year earlier. For patients with at least one medication error all contacts with hospital or primary care within 3 months after discharge were identified. For each contact it was evaluated whether this was caused by the medication error. We also compared medication errors that have been evaluated as high or moderate clinical risk with medication errors without clinical risk. Main outcome measures Need for medical care in hospital or primary care within three months after discharge from hospital. Medical care is readmission to hospital as well as visits of study population to primary and out-patient secondary health care. Results The use of Medication Report reduced the need for medical care due to medication errors. Of the patients with Medication Report 11 out of 248 (4.4%) needed medical care because of medication errors compared with 16 out of 179 (8.9%) of patients without Medication Report (p = 0.049). The use of a Medication Report significantly reduced the risk of any consequences due to medication errors, p = 0.0052. These consequences included probable and possible care due to medication error as well as administrative procedures (corrections) made by physicians in hospital or primary care. Conclusions The Medication Report seems to be an effective tool to decrease adverse clinical consequences when elderly patients are discharged from hospital care

The hospital LIMM-based clinical pharmacy service improves the quality of the patient medication process and saves time

Objective: The Lund Integrated Medicines Management (LIMM) model improves the patient medication process and reduces primary care contact and rehospitalisation. The objective was to evaluate the quality of medication management activities and the time spent on these activities using the LIMM model in hospital and primary care. Methods: Questionnaires were distributed to physicians and nurses in hospitals, with and without the LIMM model, and in primary care. A time study of the activities of clinical pharmacists was also performed. Results: Responses were received from 67 physicians and nurses working in hospitals and 210 in primary care. The respondents thought that the quality of medication management would be much improved using the LIMM model. The model was associated with total median time savings by nurses and physicians of at least 1 h per patient, while the clinical pharmacist spent only 1 h with each patient. Conclusion: The LIMM model reduced the total time required for each patient by at least 1 h and improved the quality of the process

Acceptance and importance of clinical pharmacists' LIMM-based recommendations.

Objective The objective of this study was to evaluate the quality of the clinical pharmacy service in a Swedish hospital according to the Lund Integrated Medicine Management (LIMM) model, in terms of the acceptance and clinical significance of the recommendations made by clinical pharmacists. Method The clinical significance of the recommendations made by clinical pharmacists was assessed for a random sample of inpatients receiving the clinical pharmacy service in 2007. Two independent physicians retrospectively ranked the recommendations emerging from errors in the patients' current medication list and actual drug-related problems according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant). Results The random sample comprised 132 patients (out of 800 receiving the service). The clinical significance of 197 recommendations was assessed. The physicians accepted and implemented 178 (90%) of the clinical pharmacists' recommendations. Most of these recommendations, 170 (83%), were ranked 3 (somewhat significant) or higher. Conclusion This study provides further evidence of the quality of the LIMM model and confirms that the inclusion of clinical pharmacists in a multi-professional team can improve drug therapy for inpatients. The very high level of acceptance by the physicians of the pharmacists' recommendations further demonstrates the effectiveness of the process

Assessment of Riga city environment in the recent rural newcomers point of view

Mana pētījuma nosaukums ir „Rīgas pilsētvides vērtējums neseno laucinieku skatījumā” Mana pētījuma mērķis bija noskaidrot, kādas problēmas rodas nesenajiem lauciniekiem, pārceļoties uz dzīvi Rīgas sociālajā pilsētas vidē. Darba autore pētījumā analizēja nesenā laucinieka, kurš pilsētā dzīvo tikai no trīs līdz pieciem gadiem, Rīgas sociālās pilsētvides vērtējumu. Darba autore definēja sekojošas analīzes vienības, proti, drošība jeb cilvēku savstarpējās palīdzības sniegšana pilsētā; privātā telpa jeb nesenā laucinieka spēja norobežoties no apkārtējiem pilsētā, sociālie sakari, kā arī identitāte jeb nesenā laucinieka piederības izjūta pilsētai. Darba autore veica kvalitatīvu pētījumu, kura ietvaros tika intervēti tie nesenie laucinieki, kuri Rīgā dzīvo tikai no trīs līdz pieciem gadiem. Mana pētījuma pētnieciskais jautājums bija, kā tiek veidotas un uzturētas savstarpējās attiecības starp lauciniekiem un pilsētniekiem Rīgā? Kvalitatīvā pētījuma ietvaros tika veiktas sešas padziļinātās intervijas, lai noskaidrotu, kādi faktori nosaka neseno laucinieku pilnvērtīgu iekļaušanos Rīgas pilsētā, urbānajā kopienā, īpaši akcentējot, neseno laucinieku iekļaušanos pilsētas sociālajā vidē. Darba autore pētījumā izmantoja pilsētas ekoloģijas teorijas. Nesenā laucinieka, kurš pilsētā dzīvo tikai no trīs līdz pieciem gadiem, savstarpējās attiecības ar pilsētniekiem raksturo atsvešinātība, bezpersoniskums, virspusējība, mainība, epizodiskums, kā arī aprēķins jeb izdevīguma princips. Rīgas pilsētvide ietekmē nesenā laucinieka, kurš pilsētā dzīvo tikai no trīs līdz pieciem gadiem, mijiedarbību ar pilsētniekiem, kā arī nosaka cilvēku uzvedību pilsētā. Rezultātā nesenais laucinieks tiecas norobežoties no cieša kontakta ar cilvēkiem pilsētā. Atslēgas vārdi: Adaptācija; Kopiena; PilsētvideThe title of my study is ,,Assessment of Riga city environment in the recent rural newcomers point of view” The aim of my study was to clarify issues, which usually arise when rural newcomers move to the urban, social environment. Author of the bachelor work analyzes those rural newcomers, who have migrated to the city of Riga just three to five years ago, re-assessing social environment change of the capital. Author defines the following points of the analysis: namely, security (mutual assistance rendering practices in the city of Riga); private space (recent rural newcomer ability to shut themselves off from the surrounding social environment); the social relations as well as the identity (recent rural newcomer sense of belonging to the social and economic structure). Authorused a qualitative methodology and managed to interview those recent rural newcomers living in the capital for abovementioned period of time. The research subject of this particular study was to demonstrate, how the social relations are managed between the target research group. Within the framework of this qualitative study the author of the bachelor work managed to do six in-depth interviews in order to find out which factors determine the recent rural newcomer inclusion in the city of Riga, as well as inclusion into the urban community, with particular emphasis on the inclusion of those into the urban social environment.. Author used urban ecology theories. The mutual relations between the city dwellers and the recent rural newcomers, can be characterized as alienated, impersonalized, superficial, episodic, as well as prudent in the bad, social way. The environment of the city directly affects interaction between the newcomers, and townsmen, as well as mutual behavior of these groups, therefore. newcomers tend to shut himself off from close contact with people constantly living in the urban area. Key words: Adaptation; Community; City environment