Use of a generic protocol in documentation of prescription errors in Estonia, Norway and Sweden

Beskriver en studie hvor hensikten var å evaluere egnethet av et generisk instrument for å dokumentere forskrivningsproblemer som krever kontakt med lege før utlevering.Pharmacists have an important role in detecting, preventing, and solving prescription problems, which if left unresolved, may pose a risk of harming the patient. Objective: the objectives of this study were to evaluate the feasibility of a generic study instrument for documentation of prescription problems requiring contact with prescriber before dispensing. The study was organized: 1) by countries: Estonia, Norway and Sweden; 2) by type of prescriptions: handwritten prescriptions, printouts of prescriptions in the electronic medical record and electronically transmitted prescriptions to pharmacies; and 3) by recording method - self-completion by pharmacists and independent observers. Methods: observational study with independent observers at community pharmacies in Estonia (n=4) and Sweden (n=7) and self-completed protocols in Norway (n=9). Results: pharmacists' in Estonia contacted the prescriber for 1.47% of the prescriptions, about 3 times as often as in Norway (0.45%) and Sweden (0.38%). Handwritten prescriptions dominated among the problem prescriptions in Estonia (73.2%), printouts of prescriptions in the electronic medical record (89.1%) in Norway and electronically transmitted prescriptions to pharmacies (55.9%) in Sweden. More administrative errors were identified on handwritten prescriptions and printouts of prescriptions in the electronic medical record in Estonia and in Norway compared with electronically transmitted prescriptions to pharmacies in Sweden (p<0.05 for prescription types and p<0.01 for countries). However, clinically important errors and delivery problems appeared equally often on the different types of prescriptions. In all three countries, only few cases of drug interactions and adverse drug reactions were identified. Conclusion: despite the different patterns of prescription problems in three countries, the instrument was feasible and can be regarded appropriate to document and classify prescription problems necessitating contact with prescriber before dispensing, irrespective of the type of prescription or recording method

Probleemsed retseptid, mille alusel ravimi väljastamine apteegist nõuab konsultatsiooni ravimi ordineerijaga Eesti, Norra ja Rootsi võrdlusuuringu põhjal

Uuringu eesmärgiks oli võrrelda probleemsete retseptide esinemissagedust ja sisu Eestis, Norras ning Rootsis. Retsept on probleemne, kui proviisor peab enne ravimi väljastamist apteegist pöörduma ravimi ordineerija poole, samas saab apteeker paljud formaalsed probleemid lahendada iseseisvalt või koostöös patsiendiga. Vaatlusuuring toimus 2006.–2007. a ja selles osales 4 apteeki Eestist, 9 apteeki Norrast ja 6 apteeki Rootsist. Probleemseid retsepte esines enim Eestis, järgnesid Norra ja Rootsi. Formaalsed probleemid olid enim levinud Eestis, ravimi annuse, tugevuse ja ravimivormiga eksiti enam Eestis ja Rootsis. Rootsis oli 28,6%-l ja Norras 25,1%-l juhtudest probleemiks puudulik info ravimi annustamise ning manustamise kohta. Probleemsete retseptide suurem esinemine Eestis oli peamiselt seotud käsitsi kirjutatud retseptide suure osakaaluga. Elektrooniliste retseptide kasutuselevõtu korral võivad ilmneda aga uut tüüpi sisulised vead. Eesti Arst 2010; 89(1):5−1

Profession Driven Improvement of the Quality of Pharmacy Practice Implementation of Community Pharmacy Services Quality Guidelines in Estonia

Constant improvement of the quality of community pharmacy services is important in the development of contemporary patient care. A national and voluntary Community Pharmacy Services Quality Guidelines (CPSQG) was developed to formulate the principles of contemporary pharmacy services, including quality criteria for service provision. The purpose of this study was to identify the implementation of the CPSQG as a profession-driven initiative towards improving and harmonizing community pharmacy services in Estonia. Three cross-sectional electronic surveys were conducted among community pharmacies in Estonia in 2014 (N = 478 pharmacies), 2016 (N = 493), and 2019 (N = 494), and the CPSQG indicators were used for evaluation of the service quality. In this study, the aggregated data, collected in three study years were used to identify the implementation of guidelines into practice. For data analysis, the One-Way ANOVA test and Post-hoc multiple comparisons were used. The results demonstrated slow implementation of the CPSQG, but guidelines-based evaluation enabled a detailed overview of the community pharmacy activities and provided services. In order to develop community pharmacy services more efficiently, the use of implementation science principles, continuous introduction of the CPSQG to the pharmacists, and more active involvement of the state could be considered in the future.info:eu-repo/semantics/publishedVersio

Systematic studies on the Holothuroidea of the New Zealand region

A systematic account of the holothurians of the New Zealand region is given, together with diagnoses of orders, families, sub-families, genera and species. The report is based on a total of 970 specimens, which comprise 18 genera, including Mensamariella n.g., and 25 species, including Protankyra rigida, Chiridota alleni, Chiridota mortenseni, Neothyonidium armatum, and Trachythyone squamata, spp.nov. Genera and species known in the fauna, but not encountered during the course of the present study, are diagnosed, and their systematic positions and distribution patterns are briefly considered. The distribution of known holothurians within the New Zealand region is discussed, as also are the external relationships and ultimate derivation of the group. The taxonomic state of the Class as a whole is indicated, and comments are made on the reliability of systematic characters within each group, together with some suggestions for modification and possible improvement of the present-day situation

Maksaensüümide aktiivsuse jälgimine agomelatiini kasutamisel: praktika muutumist võrdlev uuring ja haigusjuhu kirjeldus

Taust ja eesmärk. Agomelatiinist põhjustatud maksakahjustus on harva esinev, ent raske kõrvaltoime. 2016. aastal korraldatud uuring näitas, et enamikul agomelatiinravi alustanud patsientidel riskivähendamise meetmetes ettenähtud maksaensüümide aktiivsust ei määratud. Käesoleva uuringu eesmärk oli hinnata, kas agomelatiini kasutamisel on maksaensüümide aktiivsuse jälgimine võrreldes varasema perioodiga muutunud.Metoodika. Eesti Haigekassa retseptikeskusele ja ravikindlustuse andmekogusse tehti päring perioodil 01.06.2016–31.07.2019 agomelatiinravi alustanud patsientidele välja kirjutatud retseptide ning perioodil 01.05.2016–31.07.2019 tehtud järgmiste laboriuuringute kohta: ALP, ASAT, ALAT, LDH, CK, GGT, CK-Mba ja alfa-amülaas. Ravi alustanute puhul hinnati, kas 15 päeva jooksul enne ravimi esmakordset väljaostmist ja ravi ajal tehti vajalikud analüüsid. Maksafunktsiooni jälgimise skeemi täielikku järgimist hinnati ravi alustanutel, kes kasutasid agomelatiini vähemalt 6 kuud.Tulemused ja järeldused. Ravi eel tehti maksaensüümide aktiivsust hindav analüüs 29%-le kasutajatest ning vähemalt üks analüüs ravi alustamisel või kogu ravi vältel 57%-le kasutajatest. Ravi alustanutest, kes said ravi agomelatiiniga vähemalt 6 kuud, järgiti maksafunktsiooni jälgimise skeemi 5%-l. Võrreldes eelmise uuringuga on maksaensüümide aktiivsuse määramine veidi suurenenud, kuid jätkuvalt ebapiisav

Older adults using multi-dose dispensing exposed to risks of potentially inappropriate medications

Background: Multi-dose dispensing (MDD) of medications is a health technology designed to promote medication adherence and patient safety. MDD has been used as an alternative to ordinary prescription dispensing for patients, mostly elderly with high medication use. Objective: To evaluate the initiation phase of the MDD service to older adults >= 65 years and assess wheter the medication use of the new MDD patients is appropriate in terms of drug related problems. Methods: The European Union EU(7)-PIM list and the Inxbase databases were used for identifying potentially inappropriate medications (PIMs) and drug-drug interactions (DDIs). The study sample consisted of a total of 208 patients aged 65-108 years who were involved in the MDD service (PharmaService Ltd.) in Finland in 2015-2016. Clinically significant differences of PIM and DDI occurrences were identified using a Pearson's chi-square test throughout the demographic groups under study. Results: Results demonstrate that for 81% of the study participants, at least one medication from the EU (7)-PIM list was prescribed, and up to 64% of PIMs were clinically significant. According to the Inxbase database, five patients (2.4%) were prescribed category D clinically significant DDIs. Additionally, 61% of the patients saw an increase in the number of medications prescribed within six months after the initial MDD order. Conclusions: The results suggest that the MDD service should be accompanied by a regular medication review tailored to specific patient groups (i.e., older patients) to avoid potential DRPs.Peer reviewe

Intelligent Structured Intermittent Auscultation (ISIA): A Mixed Methods Evaluation of an Informed Decision-Making Framework for Fetal Heart Rate Monitoring

Intermittent Auscultation (IA) of the fetal heart (FH) is a screening tool for the assessment of fetal well-being during labour; the detection of changes in the FH rate and rhythm may signal fetal compromise. While the evidence reveals that IA is as effective as continuous cardiotocography (CTG) for FH monitoring for low-risk women, current practitioners favour the use of continuous CTG despite the risk of significantly increased maternal and fetal morbidity. Translating the knowledge of the effectiveness of IA into practice became the primary aim of this study. While auscultation and palpation are essential midwifery skills, the teaching of IA does not go beyond simply outlining the protocol for frequency, duration, and timing and less is understood about the underlying physiology associated with what is heard and the reassurance of fetal wellbeing that this provides. A knowledge translation intervention, in the form of an evidence-based informed decision-making framework for Intelligent Structured Intermittent Auscultation (ISIA) and a comprehensive educational intervention were developed to enhance midwives‘ knowledge and awareness of IA and to influence decision-making and practice for FH monitoring for low-risk women. A mixed methods non-experimental pre- and post - intervention study design was used to evaluate the knowledge intervention. Pre measures included a retrospective review of 511 medical records to assess existing FH monitoring practices, and focus groups with 14 midwives explored barriers and facilitators to the use of IA. The intervention was then delivered to a mix of 33 midwives and doctors three months later, followed by a second review of 422 medical records and focus groups with seven midwives to determine any changes in practice and to evaluate outcomes. The findings revealed a statistically significant increase in the use of ISIA with improved documentation, and a relative decrease of 14% in the use an admission CTG for low risk women. The ISIA framework has wide applicability in all maternity settings. This research has illuminated the effects of culture, organisation and the socio-political context on the ability for midwives to utilise their fundamental midwifery skills to promote, facilitate and protect normal physiological birth in the institutional maternity care setting. Engagement with a Knowledge Translation project and the introduction of the ISIA framework for FHR monitoring for low risk women has given midwives voice to generate change

Farmaatsiaterminite lühendid

Eesti Arst 2017; 96(6):357–36

Farmaatsiaterminoloogia ja Euroopa farmakopöa

Artiklis on toodud ingliskeelse Euroopa farmakopöa eestikeelne terminoloogia. Eestikeelsed terminid (4 tabelit) ravimivormide, manustamisviiside ja pakendite kohta avaldatakse vastavalt Euroopas kehtivale tavale rahvusvahelises väljaandes Standard Terms. Eesti Arst 2004; 83(6): 414-43

Evaluation of medication safety assessment tools for pharmacist-led medication reviews: the Eastern European pilot project

Background: Pharmacist-led medication reviews (MR) are one of the key methods to support medication safety in polypharmacy patients. The aims of this study were to pilot MRs in Eastern European community pharmacies, describe medication use in polypharmacy patients, and evaluate the usability of medication safety assessment tools