Effects of Occupational Therapy on Hospitalized Chronic Schizophrenia Patients with Severe Negative Symptoms

The aim of this study was to determine whether occupational therapy (OT) can improve the interpersonal relationships and negative symptoms of hospitalized chronic schizophrenia patients with severe negative symptoms. Subjects were 38 patients with chronic schizophrenia. They were randomly divided into an OT group and a control group. Patients in the OT group participated in cooking activities once a week for 15 weeks, while patients in the control group did not. During this period, both groups had the usual treatment except for the cooking activities. In interviews, the patient was asked to place a chair toward the interviewer (a therapist). The angle and distance from the interviewer were taken as indicators of an ability to have interpersonal relationships. Negative symptoms were evaluated with the Scale for the Assessment of Negative Symptoms (SANS). Patients who received OT were able to sit at the smaller angle and shorter distance from the interviewer than before OT (p=0.015 and p=0.013, respectively). The total SANS score was lower after OT than before OT (p=0.033). In the control group, the distance from the interviewer also decreased during the experimental period (p=0.040) but the seating angle and the SANS scores did not change. The results suggest that OT can help to improve a relationship allowing the patient to face the therapist and that it might improve negative symptoms of schizophrenia

Medication incidents related to automated dose dispensing in community pharmacies and hospitals - a reporting system study

Contains fulltext : 135965.pdf (publisher's version ) (Open Access)INTRODUCTION: Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals. METHODS: The medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR) reporting system were selected and characterized independently by two researchers. MAIN OUTCOME MEASURES: Person discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident. RESULTS: From January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4%) incidents from community pharmacies and 11,428 (75.6%) incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8%) were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2%) were related to ADD than in hospitals (41/11,428 = 0.4%). The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag. CONCLUSION: A proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an incident

Contribution of renal impairment to potentially preventable medication-related hospital admissions.

Item does not contain fulltextBACKGROUND: Medication errors and renal impairment contribute to severe adverse drug events, which may lead to hospital admission. OBJECTIVE: To determine whether medication errors and renal impairment contribute to hospital admission and examine these errors for strategies to prevent admissions. METHODS: The 714 medication-related hospital admissions reported in the prospective multicenter study HARM (Hospital Admissions Related to Medication) were analyzed. The patients were divided into 3 groups based on the availability of creatinine levels: group A, the home-monitored group (n = 227); group B, the hospital-monitored group (n = 420); and group C, the unmonitored group (n = 67). RESULTS: After assessment, 70 admissions (10%) were considered to be related to a medication error and renal impairment (A, 29; B, 41; C, none). In these 70 patients, 85 errors occurred in group A, 66 errors in group B, and none in group C. Dosing errors were identified in 46 patients (A, 14; B, 32), a drug-drug interaction in 22 patients (A, 13; B, 9), and a drug-disease interaction in 17 patients (A, 10; B, 7). CONCLUSIONS: Renal impairment and medication errors may lead to medication-related hospital admissions. Monitoring renal function and adjusting pharmacotherapy according to renal function might help to prevent hospital admissions. This can be a strategy for research on how to decrease the number of medication-related hospital admissions.1 mei 201

Self-reported uptake of recommendations after dissemination of medication incident alerts

Item does not contain fulltextINTRODUCTION: In the Netherlands, a Central Medication Incidents Registration (CMR) system is operational. To prevent recurrence of reported medication incidents the CMR sends medication incident alerts with recommendations. It is up to the healthcare workers whether or not to implement the recommendations in clinical practice, which may lead to variations in degrees of uptake of the recommendations. OBJECTIVE: The aim of this study was to explore the degree of self-reported uptake of the recommendations and to identify potential determinants associated with successful uptake. DESIGN: This is a cross-sectional study conducted within a convenience sample of 33 Dutch hospital pharmacies. The study was carried out from April 2009 to September 2010. MEASUREMENTS: Three alerts were selected for the study: administration of methotrexate in a dosage of once a day instead of once a week, administration of undiluted potassium-sodium-phosphate concentrate, and administration of glucose 50% instead of 5%. The primary outcome was the degree of self-reported uptake of the specific recommendations and the associations of the degree of uptake with several potential determinants. RESULTS: Twenty-one hospitals (63.6%) had adopted all recommendations about methotrexate. A quarter of the hospitals (24.2%) had adopted all recommendations related to potassium-sodium-phosphate concentrate. For the alert about glucose 50%, none of the hospitals had implemented all the recommendations. No statistically significant associations between potential determinants and the degree of uptake were found. CONCLUSIONS: This study is the first to investigate the degree of uptake of the recommendations of three different CMR alerts. The alerts varied in the degrees of self-reported uptake of the recommendations, with the methotrexate alert having the highest degree of uptake. No significant associations with potential determinants were found

A nationwide medication incidents reporting system in The Netherlands

Contains fulltext : 95576.pdf (publisher's version ) (Closed access)Objective Many Dutch hospitals have established internal systems for reporting incidents. However, such internal systems do not allow learning from incidents that occur in other hospitals. Therefore a multicenter, information technology (IT) supported reporting system named central medication incidents registration (CMR) was developed. This article describes the architecture, implementation and current status of the CMR in The Netherlands and compare it with similar systems in other countries. System Description Adequate IT is required to sufficiently support a multicenter reporting system. The CMR system consists of a website, a database, a web-based reporting form, an application to import reports generated in other reporting systems, an application to generate an overview of reported medication incidents, and a national warning system for healthcare providers. Current Status From the start of CMR 90 of all 93 (96.8%) hospitals and 872 of 1948 (44.8%) community pharmacies participated. Between March 2006 and March 2010 the CMR comprised 15 694 reports of incidents. In the period from March 2010 to March 2011, 1642 reports were submitted by community pharmacies in CMR and the hospitals submitted 2517 reports. CMR is similar to various systems in other countries, but it seems to use more IT applications. Discussion The CMR is developing into a nationwide reporting system of medication incidents in The Netherlands, in which hospitals, community pharmacies, mental healthcare organizations and general practitioners participate. Conclusion The architecture of the system met the requirements of a nationwide reporting system across different healthcare providers

Targeting outpatient drug safety: recommendations of the Dutch HARM-Wrestling Task Force.

Item does not contain fulltextBACKGROUND: Two Dutch observational studies (HARM [Hospital Admissions Related to Medication] and IPCI [Integrated Primary Care Information]) have shown that approximately 5% of all unplanned hospital admissions are associated with adverse drug events (ADEs), of which 40-46% are potentially preventable. These studies prompted the initiation of a Dutch multidisciplinary task force, which was assigned to reduce the number of prescriber-related hospital admissions related to medications (HARMs) in a quick-win way. OBJECTIVE: The aim of the study was to identify the most relevant ADEs and to develop a limited number of recommendations for concrete interventions, which should be feasible and relatively easy to convert into computerized drug safety alerts. METHOD: To identify the major ADEs, crude data of HARM and IPCI were reanalysed and compared with different international studies, followed by structured literature searches for further characterization of the identified ADEs, their risk factors and potential risk-reduction strategies. Based on this information, the Task Force drew up general and drug-specific recommendations. As the recommendations of the Task Force are a mixture of evidence- and expert-based risk-reducing strategies, they have been graded in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. RESULTS: Seven pharmacologically predictable ADEs associated with ten drug classes were responsible for more than half of all potentially preventable hospital admissions in the IPCI and HARM studies, which was comparable to the results of international studies. Gastrointestinal and other bleedings were the most frequent ADE, followed by disturbances of diabetes mellitus control, electrolyte disturbances, fractures, renal insufficiency and heart failure. Nine general and 34 drug-specific recommendations were developed. CONCLUSIONS: As HARMs constitute a significant public health problem, the Task Force underlines the need to implement its recommendations as soon as possible. They do not replace existing guidelines, but reinforce, complement and fine-tune existing Dutch and international guidelines. Further research is still required to assess the cost consequences and cost effectiveness of some recommendations, and to monitor the implementation of the recommendations and their effect on the incidence of potentially preventable HARMs

Relevance of foreign alerts and newsletters for the medication errors reporting programme in the Netherlands: an explorative retrospective study

INTRODUCTION: National reporting programmes usually collect and analyse medication error reports from healthcare providers in their own country and only disseminate guidance to healthcare providers within the borders of their country. It is unclear how much different national programmes could learn from each other. The aim of this study was therefore to explore to what extent alerts and newsletters about medication errors issued in other countries could also be relevant for the Netherlands. METHODS: Ninety disseminated information items that had been issued by three national programmes (Canada, the US and the UK) in the period from June 2009 until June 2012 were collected. These items were compared with the national reporting programme Central Medication Incidents Registration (CMR-NL) in The Netherlands. Each selected item was subsequently assessed independently with six assessment criteria: is the medicine available in the Netherlands? If so, could a similar error occur in the Netherlands? Did the CMR-NL reporting programme receive any reports about a comparable (or even identical) error? If so, did these reports include any errors with serious temporary or permanent harm? Did the CMR-NL disseminate output about it?; If so, what was the dissemination date of CMR-NL? Results : From the 90 items, 87.8 % (n = 79) were relevant for Dutch healthcare. For 43 of the 90 items (47.8 %), the CMR-NL had received comparable (or even identical) errors but had not disseminated any alert or newsletter about these errors. The CMR-NL had disseminated an alert or newsletter for 14 of the 90 items (15.6 %). CONCLUSION: This study showed for a broad range of errors that the Dutch national reporting programme could learn from the three reporting programmes in Canada, the US and the UK. National reporting programmes can benefit from sharing alerts and newsletters that enhance the learning between countries

Identification of drug-related problems by a clinical pharmacist in addition to computerized alerts

Background Both clinical pharmacists and computerized physician order entry systems with clinical decision support (CPOE/CDSS) can reduce drug-related problems (DRPs). However, the contribution of a clinical pharmacist in addition to CPOE/CDSS has not been established in a prospective study. Objective To determine which DRPs can be identified by a clinical pharmacist in a setting with routine use of CPOE/CDSS. Setting Two surgical and two neurological wards in St. Elisabeth hospital, a 600-bed teaching hospital in the Netherlands. Methods In this observational prospective follow-up study a clinical pharmacist reviewed the pharmacotherapy of patients admitted to surgical and neurological wards to identify DRPs (i.e. medication errors and adverse drug events) and discussed the relevance of identified problems and interventions to resolve these with the responsible physician. Acceptance of the proposed interventions and the presence of alerts in CPOE/CDSS were assessed. Primary outcome was the proportion of DRPs identified by the clinical pharmacist that also triggered a CPOE/CDSS alert. Differences between the DRPs that generated an alert and those that did not were expressed as relative risks or analyzed with Chi square statistics or Mann–Whitney U tests. Main outcome measure The proportion of drug-related problems identified by the clinical pharmacist that also generated an alert in the CPOE/CDSS. Results During 1206 medication reviews, 442 potential DRPs were identified; 286 (65 %) DRPs were considered relevant and 247 (56 %) of the proposed interventions were accepted. A CPOE/CDSS alert was generated for 35 (8 %) of the DRPs the clinical pharmacist identified. The only difference between problems that triggered an alert and those that did not was the class of the DRP (indication 23 vs. 36 %, effectiveness 23 vs. 13 %, safety 23 vs. 10 % and pharmaceutical care issues 31 vs. 42 %, p = 0.02). CPOE/CDSS triggered 623 additional alerts that were handled during routine pharmacy service. Conclusions As most DRPs identified by a clinical pharmacist were not detected in daily clinical practice by CPOE/CDSS, a clinical pharmacist contributes to reducing DRPs. The sensitivity of CPOE/CDSS to detect certain classes of problems should be optimized. Keywords: Adverse drug events, Clinical decision support system, Clinical pharmacis

Erroneous exchange of asparaginase forms in the treatment of acute lymphoblastic leukemia

Item does not contain fulltextFor the treatment of children with acute lymphoblastic leukemia (ALL), Dutch pediatric oncologists use the Dutch Childhood Oncology Group ALL 10 protocol. This protocol is complex, as it comprises many different drug regimens. One of the drugs is asparaginase which is available in different forms with different pharmacokinetics: Escherichia coli asparaginase, Erwinia asparaginase, and pegylated E. coli asparaginase [polyethylene glycol (PEG) asparaginase]. Here, we report the case of a 3-year-old patient treated with ALL who was 8 times erroneously treated with E. coli asparaginase instead of PEG asparaginase. As E. coli asparaginase was administered to the patient in the lower dosage regimen of PEG asparaginase, she was undertreated, but at the end of the treatment the patient was in complete remission. This case report describes the actual course of treatment, the reasons why it went wrong, and possible preventive measures