The effect of a transitional pharmaceutical care program on the occurrence of ADEs after discharge from hospital in patients with polypharmacy

Introduction: Transitional care programs (i.e. interventions delivered both in hospital and in primary care), could increase continuity and consequently quality of care. However, limited studies on the effect of these programs on Adverse Drug Events (ADEs) post-discharge are available. Therefore, the aim of this study was to investigate the effect of a transitional pharmaceutical care program on the occurrence of ADEs 4 weeks post-discharge. Methods: A multicentre prospective before-after study was performed in a general teaching hospital, a university hospital and 49 community pharmacies. The transitional pharmaceutical care program consisted of: teach-back to the patient at discharge, a pharmaceutical discharge letter, a home visit by a community pharmacist and a clinical medication review by both the community and the clinical pharmacist, on top of usual care. Usual care consisted of medication reconciliation at admission and discharge by pharmacy teams. The primary outcome was the proportion of patients who reported at least 1 ADE 4 weeks post-discharge. Multivariable logistic regression was used to adjust for potential confounders. Results: In total, 369 patients were included (control: n = 195, intervention: n = 174). The proportion of patients with at least 1 ADE did not statistically significant differ between the intervention and control group (general teaching hospital: 59% vs. 67%, ORadj 0.70 [95% CI 0.38–1.31], university hospital: 63% vs 50%, OR adj 1.76 [95% CI 0.75–4.13]). Conclusion: The transitional pharmaceutical care program did not decrease the proportion of patients with ADEs after discharge. ADEs after discharge were common and more than 50% of patients reported at least 1 ADE. A process evaluation is needed to gain insight into how a transitional pharmaceutical care program could diminish those ADEs

Application of intervention mapping to develop and evaluate a pharmaceutical discharge letter to improve information transfer between hospital and community pharmacists

Background: Insufficient information transfer is a major barrier in the transition from hospital to home. This study describes the systematic development and evaluation of an intervention to improve medication information transfer between hospital and community pharmacists. Objective: To develop and evaluate an intervention to improve the medication information transfer between hospital and community pharmacists based on patients', community and hospital pharmacists’ needs. Methods: The intervention development and evaluation was guided by the six-step Intervention Mapping (IM) approach: (1) needs assessment to identify determinants of the problem, with a scoping review and focus groups with patients and healthcare providers, (2) formulation of intervention objectives with an expert group, (3) inventory of communication models to design the intervention, (4) using literature review and qualitative research with pharmacists and patients to develop the intervention (5) pilot-testing of the intervention in two hospitals, and (6) a qualitative evaluation of the intervention as part of a multicenter before-after study with hospital and community pharmacists. Results: Barriers in the information transfer are mainly time and content related. The intervention was designed to target a complete, accurate and timely medication information transfer between hospital and community pharmacists. A pharmaceutical discharge letter was developed to improve medication information transfer. Hospital and community pharmacists were positive about the usability, content, and comprehensiveness of the pharmaceutical discharge letter, which gave community pharmacists sufficient knowledge about in-hospital medication changes. However, hospital pharmacists reported that it was time-consuming to draft the discharge letter and not always feasible to send it on time. The intervention showed that pharmacists are positive about the usability, content and comprehensiveness. Conclusion: This study developed an intervention systematically to improve medication information transfer, consisting of a discharge letter to be used by hospital and community pharmacists supporting continuity of care

Medication-Related Hospital Readmissions Within 30 Days of Discharge:Prevalence, Preventability, Type of Medication Errors and Risk Factors

Contains fulltext : 233572.pdf (Publisher’s version ) (Open Access

Implementation of a pharmacist-led transitional pharmaceutical care programme:Process evaluation of Medication Actions to Reduce hospital admissions through a collaboration between Community and Hospital pharmacists (MARCH)

What is known and objective: The recently conducted Medication Actions to Reduce hospital admissions through a collaboration between Community and Hospital pharmacists (MARCH) transitional care programme, which aimed to test the effectiveness of a transitional care programme on the occurrence of ADEs post-discharge, did not show a significant effect. To clarify whether this non-significant effect was due to poor implementation or due to ineffectiveness of the intervention as such, a process evaluation was conducted. The aim of the study was to gain more insight into the implementation fidelity of MARCH. Methods: A mixed methods design and the modified Conceptual Framework for Implementation Fidelity was used. For evaluation, the implementation fidelity and moderating factors of four key MARCH intervention components (teach-back, the pharmaceutical discharge letter, the post-discharge home-visit and the transitional medication review) were assessed. Quantitative data were collected during and after the intervention. Qualitative data were collected using semi-structured interviews with MARCH healthcare professionals (community pharmacists, clinical pharmacists, pharmacy assistants and pharmaceutical consultants) and analysed using thematic analysis. Results and Discussion: Not all key intervention components were implemented as intended. Teach-back was not always performed. Moreover, 63% of the pharmaceutical discharge letters, 35% of the post-discharge home-visits and 44% of the transitional medication reviews were not conducted within their planned time frames. Training sessions, structured manuals and protocols with detailed descriptions facilitated implementation. Intervention complexity, time constraints and the multidisciplinary coordination were identified as barriers for the implementation. What is new and Conclusion: Overall, the implementation fidelity was considered to be moderate. Not all key intervention components were carried out as planned. Therefore, the non-significant results of the MARCH programme on ADEs may at least partly be explained by poor implementation of the programme. To successfully implement transitional care programmes, healthcare professionals require full integration of these programmes in the standard work-flow including IT improvements as well as compensation for the time investment

Therapeutically dosed low molecular weight heparins in renal impairment:a nationwide survey

Purpose International guidelines vary in their recommendations whether or not to reduce the therapeutic dose of low molecular weight heparins (LMWHs) in renal impairment. The use of anti-Xa monitoring as a basis of dose adjustments is also a matter of debate. As this may lead to variations in treatment policies, we aimed to study the treatment policies of therapeutically dosed LMWHs in renal impairment in Dutch hospitals. Methods An 11-item survey was distributed between June 2020 and March 2021 to hospital pharmacists, representing Dutch hospital organisations. Primary outcomes were the dosing regimens of therapeutically dosed LMWHs in renally impaired patients. Secondary outcomes were the proportion of hospitals that used anti-Xa monitoring and the anti-Xa target range used. Results There was a response from 56 of 69 (81%) Dutch hospital organisations where in each case a hospital pharmacist completed the survey. In these hospitals, 77 LMWH regimens were in use. In 76 of 77 (99%) regimens, a regular dose reduction was used at the start of treatment. Fifty-five of these hospitals used a dose reduction if estimated glomerular filtration rate (eGFR) < 50 ml/min and 17 used a dose reduction if eGFR < 30 ml/min. Anti-Xa levels were not routinely monitored in 40% of regimens, while 22% monitored anti-Xa if eGFR < 50 ml/min, 27% if eGFR < 30 ml/min and 10% in other eGFR cutoff values. Target ranges of 1.0-2.0 IU/ml (once daily) and 0.5/0.6-1.0 IU/ml (twice daily) were used in 69% of regimens that included monitoring of anti-Xa. Conclusion Treatment policies show substantial diversity in therapeutically dosed LMWHs in renally impaired patients. The most commonly used treatment regimen was a regular dose reduction if eGFR is < 50 ml/min, without anti-Xa monitoring

Patients’ and providers’ perspectives on medication relatedness and potential preventability of hospital readmissions within 30 days of discharge

Background: Hospital readmissions are increasingly used as an indicator of quality in health care. One potential risk factor of readmissions is polypharmacy. No studies have explored the patients’ perspectives on the medication relatedness and potential preventability of their readmissions. Objective: To compare the patients’ perspectives on the medication relatedness and potential preventability of their readmissions with the providers’ perspectives. Methods: Patients unplanned readmitted within 30 days after discharge at one of the participating departments of OLVG Hospital in Amsterdam were interviewed during their readmission. Patients’ perspectives regarding medication relatedness of their readmissions, the potential prevent

Agitation as adverse drug reaction of doxapram in preterm neonates:Prevalence and potential risk factors

Agitation as adverse drug reaction of doxapram in preterm neonates: prevalence and potential risk factors Background Apnea of prematurity (AOP) is a common complication in premature neonates. AOP can be treated with methylxanthines (e.g. caffeine) and maximal non-invasive ventilation. If this treatment does not suffice, doxapram can be added. Doxapram is used off-label in preterm neonates and evidence on efficacy and safety of its use is limited. Objective This research aimed to investigate the prevalence of agitation as possible adverse drug reaction (ADR) of doxapram treatment in preterm neonates. The secondary aim was to identify risk-factors for occurrence of this ADR. Design All patients born &lt; 32 weeks of gestation that were treated with doxapram between December 2013 and May 2017 on the neonatal intensive care unit (NICU) of the Erasmus University Medical Center in Rotterdam were eligible for inclusion. All relevant demographic data and the numeric rating scale (NRS) agitation of the included patients were collected retrospectively. An event of agitation was defined as an NRS agitation of ≥ 4. Causality was formally assessed by a pharmacist and clinician using an adjusted version of Kramer's algorithm. Prevalence was calculated by dividing all patients with a causally related event of agitation by the total number of patients. Associations of potential risk factors with agitation as an ADR of doxapram were investigated by performing univariable and multivariable logistic regression. Results 119 patients were included. Prevalence of agitation as ADR of doxapram was 17.6%. The male sex was significantly associated with agitation as ADR of doxapram (odds ratio [OR] = 4.5; 95% confidence interval [CI] = 1.2-16.3). None of the other potential risk factors was associated with agitation as an ADR of doxapram. Conclusion The prevalence of agitation as ADR of doxapram in premature neonates was 17.6% and the male sex was significantly associated with the occurrence of agitation. Extra attention towards agitation as possible ADR of doxapram treatment in preterm neonates is needed.</p

Agitation as adverse drug reaction of doxapram in preterm neonates:Prevalence and potential risk factors

Agitation as adverse drug reaction of doxapram in preterm neonates: prevalence and potential risk factors Background Apnea of prematurity (AOP) is a common complication in premature neonates. AOP can be treated with methylxanthines (e.g. caffeine) and maximal non-invasive ventilation. If this treatment does not suffice, doxapram can be added. Doxapram is used off-label in preterm neonates and evidence on efficacy and safety of its use is limited. Objective This research aimed to investigate the prevalence of agitation as possible adverse drug reaction (ADR) of doxapram treatment in preterm neonates. The secondary aim was to identify risk-factors for occurrence of this ADR. Design All patients born &lt; 32 weeks of gestation that were treated with doxapram between December 2013 and May 2017 on the neonatal intensive care unit (NICU) of the Erasmus University Medical Center in Rotterdam were eligible for inclusion. All relevant demographic data and the numeric rating scale (NRS) agitation of the included patients were collected retrospectively. An event of agitation was defined as an NRS agitation of ≥ 4. Causality was formally assessed by a pharmacist and clinician using an adjusted version of Kramer's algorithm. Prevalence was calculated by dividing all patients with a causally related event of agitation by the total number of patients. Associations of potential risk factors with agitation as an ADR of doxapram were investigated by performing univariable and multivariable logistic regression. Results 119 patients were included. Prevalence of agitation as ADR of doxapram was 17.6%. The male sex was significantly associated with agitation as ADR of doxapram (odds ratio [OR] = 4.5; 95% confidence interval [CI] = 1.2-16.3). None of the other potential risk factors was associated with agitation as an ADR of doxapram. Conclusion The prevalence of agitation as ADR of doxapram in premature neonates was 17.6% and the male sex was significantly associated with the occurrence of agitation. Extra attention towards agitation as possible ADR of doxapram treatment in preterm neonates is needed.</p