Combining research and design: A mixed methods approach aimed at understanding and optimising inpatient medication storage systems

BACKGROUND: Almost every patient admitted to hospital will receive medication during their stay. Medication errors are an important cause of patient morbidity and mortality, as well as an economic burden for healthcare institutions. Research suggests that current methods of storing medication on hospital wards are not fit for purpose, contributing to inefficiency and error. AIM: To improve medication storage in inpatient areas, by exploring variation and challenges related to medication storage and designing a prototype solution. METHODS: Set in four hospitals in an English teaching hospital trust, the study used a mixed methods approach comprising a quantitative descriptive survey of storage facilities and practices followed by mixed methods observations of medication rounds and interviews with patients, nurses and pharmacy staff. Quantitative data were presented descriptively and qualitative data analysed thematically and using a human-centered design approach. RESULTS: We identified wide variation in medication storage facilities and practices across 77 wards. Observations and staff interviews in six wards revealed five problem areas: poor management of multiple storage facilities; lack of visibility and organisation of medication within trolleys; inadequate size of storage; lack of ownership and knowledge of standard practice; and use of key locks. Patients were largely satisfied with receiving their medication. Systematic and consistent physical organisation of medication in medication trolleys, and integrating and implementing principles of best practice, were identified as areas for intervention. DISCUSSION AND CONCLUSION: Variation in medication storage facilities and practices existed both across the organization and on individual wards. Multiple challenges were identified in how medication was stored, which if addressed may improve the efficiency and safety of medication administration and in turn, staff and patient experience. The use of design principles alongside a research approach resulted in a rapid, iterative process for developing and refining potential solutions to improve inpatient medication storage

Disease impact of rheumatoid arthritis in patients not treated with advanced therapies; survey findings from the National Rheumatoid Arthritis Society

Objective The aim was to reveal the everyday impact of living with RA in people not treated with advanced therapies (i.e. biologic or targeted synthetic DMARDs). Methods People with RA, with disease duration >2 years, not currently treated with advanced therapies, completed an online survey promoted by the National Rheumatoid Arthritis Society. Items covered demographics, current treatment, RA flare frequency, the Rheumatoid Arthritis Impact of Disease (RAID) tool and questions reflecting work status and ability. Descriptive and multivariable regression analyses were performed. Results There were 612 responses from patients having a mean age of 59 years, 88% female, 37.7% with disease duration 2–5 years and 27.9% with disease duration 5–10 years. In the last year, 90% reported an RA flare, with more than six flares in 23%. A RAID patient acceptable state was recorded in 12.4%. Each of the seven domains was scored in the high range by >50% respondents; 74.3% scored sleep problems and 72% fatigue in the high range. A need to change working hours was reported by 70%. Multivariable analyses revealed that increasing difficulties with daily physical activities, reduced emotional and physical well-being in the past week were all significantly associated with pain, number of flares and ability to cope (P < 0.005). The RAID score was significantly predictive of the number of flares. Conclusion Patients not currently treated with advanced therapies experience profound difficulties in everyday living with RA, across a broad range of measures. We advocate that patient-reported measures be used to facilitate holistic care, addressing inflammation and other consequences of RA on everyday life

Patient satisfaction with community pharmacy COVID-19 vaccination in Northern Ireland

Introduction Northern Ireland’s community pharmacies have contributed substantially to the COVID-19 response, with over 436,000 COVID-19 vaccines administered since March 2021. Community pharmacy has an established role across the UK in delivering influenza vaccination programmes. Research has found that community pharmacy vaccination can increase vaccine availability and uptake and is highly valued by patients1, and although European studies have demonstrated high satisfaction with community pharmacy COVID-19 vaccination services2, further studies are required that are applicable to a UK context. Aim This evaluation aimed to measure user satisfaction with the HSC community pharmacy COVID-19 vaccination service, reasons why users chose community pharmacy for vaccination, and user attitudes towards service quality in three key quality domains of patient-centredness, professionalism, and privacy. The findings aimed to inform recommendations for service improvement for future vaccination campaigns. Methods Following ethical approval from Keele University School of Pharmacy &amp; Bioengineering Research Ethics Committee, a cross-sectoral survey of individuals accessing COVID-19 vaccination from 61 participating community pharmacies was carried out between 20th September 2022 and 3rd December 2022. Voluntary participation was offered to all individuals accessing COVID-19 vaccination from pharmacies purposively chosen as representative of the community pharmacy network. Respondent views on service quality and overall satisfaction were collected anonymously via a Microsoft Forms questionnaire. The results were analysed for overall satisfaction and across three quality domains of patient-centredness, professionalism and privacy identified from the literature as mattering most to users of pharmacy services3. The results were reported using descriptive statistics including frequencies, percentages, skewness and measurements of central tendency. The findings informed the development of five key recommendations for future service improvement. Results 135 patients completed the online questionnaire. Overall patient satisfaction was extremely high, with 100% of respondents indicating they would recommend the service to friends and family and that they would return to a community pharmacy for COVID-19 vaccination. 96% of participants cited convenience, trust, ease of access and time spent at the pharmacy as reasons they chose community pharmacy for vaccination. Respondents were very satisfied with the quality of the service provided across the domains of patient-centredness, professionalism and privacy. Over 95% of participants were very satisfied with the quality of the service, professionalism of the vaccinator and caring of the pharmacy team, however only 73.2% of respondents were very satisfied with the standard of the consultation room. Discussion/Conclusion Overall satisfaction with community pharmacy COVID-19 vaccination in Northern Ireland is very high. Participants largely chose to access vaccination from community pharmacies for reasons of convenience, trust, ease of appointment and time spent at the pharmacy. Users are very satisfied with service quality in terms of patient-centredness, professionalism and privacy. Although generalisation is limited due to relatively small sample size, underrepresentation of some geographical areas and the potential for selection bias arising from voluntary participation and use of online questionnaires, this evaluation still provides a framework for continued quality improvement and a detailed perspective on user attitudes towards community pharmacy COVID-19 vaccination that has informed the development of recommendations for service improvement. References 1. Maidment, I; Young, E; MacPhee, M; Booth, A; Zaman, H; Breen, J; Hilton, A; Kelly, T; Wong, G. Rapid realist review of the role of community pharmacy in the public health response to COVID-19. BMJ Open [Internet] 2021 [cited 2023 Apr 17];11:e050043. Available at: https://doi.org/10.1136/bmjopen-2021-050043 2. Piraux, A; Cavillon, M; Ramond-Roquin, A; Faure, S. Assessment of Satisfaction with Pharmacist-Administered COVID-19 Vaccinations in France: PharmaCoVax. Vaccines [Internet] 2022 [cited 2023 Apr 17];10, 440. Available at: https://doi.org/10.3390/vaccines10030440 3. Watson, M; Silver, K; Watkins, R. How does the public conceptualise the quality of care and its measurement in community pharmacies in the UK: a qualitative interview study. BMJ Open [Internet] 2019 [cited 2023 Apr 17];9:e027198. Available at https://doi.org/10.1136/bmjopen-2018-02719

Representativeness of a digitally engaged population and a patient organisation population with rheumatoid arthritis and their willingness to participate in research: a cross-sectional study.

Objectives: To describe (1) the representativeness of (a) users of an online health community (HealthUnlocked.com (HU)) with rheumatoid arthritis (RA) and (b) paid members of an RA patient organisation, the National Rheumatoid Arthritis Society (NRAS), compared with the general RA population; and (2) the willingness of HU users with RA to participate in types of research (surveys, use of an app or activity tracker, and trials). Methods: A pop-up survey was embedded on HU to determine the characteristics of users and their willingness to participate in research. An anonymous data set of NRAS member characteristics was provided by the NRAS (N=2044). To represent the general RA population, characteristics of people with RA were identified from the Clinical Practice Research Datalink (CPRD) (N=20 594). Cross-sectional comparisons were made across the three groups. Results: Compared with CPRD, HU respondents (n=615) were significantly younger (49% aged below 55 years compared with 23% of CPRD patients), significantly more deprived (21% in the most deprived Townsend quintile compared with 12% of CPRD patients) and had more recent disease, with 62% diagnosed between 2010 and 2016 compared with 37% of CPRD patients. NRAS members were more similar to the CPRD, but significantly under-represented those aged 75 years or over and over-represented those aged 55-75 years compared with the CPRD. High proportions of HU users were willing to participate in future research of all types. Conclusions: NRAS members were broadly representative of the general RA population. HU users were younger, more deprived and more recently diagnosed. HU users were willing to participate in most types of research

KMT-2016-BLG-2052L: Microlensing Binary Composed of M Dwarfs Revealed from a Very Long Time-scale Event

We present the analysis of a binary microlensing event KMT-2016-BLG-2052, for which the lensing-induced brightening of the source star lasted for 2 seasons. We determine the lens mass from the combined measurements of the microlens parallax \pie and angular Einstein radius \thetae. The measured mass indicates that the lens is a binary composed of M dwarfs with masses of $M_1\sim 0.34~M_\odot$ and $M_2\sim 0.17~M_\odot$. The measured relative lens-source proper motion of $\mu\sim 3.9~{\rm mas}~{\rm yr}^{-1}$ is smaller than $\sim 5~{\rm mas}~{\rm yr}^{-1}$ of typical Galactic lensing events, while the estimated angular Einstein radius of \thetae\sim 1.2~{\rm mas} is substantially greater than the typical value of $\sim 0.5~{\rm mas}$. Therefore, it turns out that the long time scale of the event is caused by the combination of the slow $\mu$ and large \thetae rather than the heavy mass of the lens. From the simulation of Galactic lensing events with very long time scales ($t_{\rm E}\gtrsim 100$ days), we find that the probabilities that long time-scale events are produced by lenses with masses $\geq 1.0~M_\odot$ and $\geq 3.0~M_\odot$ are $\sim 19\%$ and 2.6\%, respectively, indicating that events produced by heavy lenses comprise a minor fraction of long time-scale events. The results indicate that it is essential to determine lens masses by measuring both \pie and \thetae in order to firmly identify heavy stellar remnants such as neutron stars and black holes.Comment: 9 pages, 11 figure

The potential use of plant species within a Renosterveld landscape for the phytoremediation of glyphosate and fertiliser

CITATION: Jacklin, D. M., Brink, I. C. & De Waal, J. 2020. The potential use of plant species within a Renosterveld landscape for the phytoremediation of glyphosate and fertiliser. Water SA, 46(1):94-103, doi:10.17159/wsa/2020.v46.i1.7889.The original publication is available at: http://www.scielo.org.zaENGLISH ABSTRACT: In South Africa, fertiliser and herbicide pollutants resulting from agricultural practices indirectly lead to the degradation of surface freshwater and groundwater quality. Nitrogen and phosphorus, and glyphosate, derived from agricultural fertiliser and herbicide applications, respectively, contribute to watercourse toxicity. Adjacent to many of the surface freshwater systems are some of South Africa's most productive agricultural lands, where natural ecosystems are converted to croplands, resulting in the degradation of natural vegetation and deterioration of freshwater quality. The critically endangered status of some Renosterveld vegetation types is the product of agricultural expansion, nutrient loading through fertilisation and the spraying of herbicides. A buffer of Renosterveld vegetation along river corridors may contribute to the remediation of agricultural pollutants prior to entering watercourses. The utilisation of wetland plants occurring within Renosterveld for agricultural pollutant extraction can increase river corridor biodiversity, creating indigenous refuges and facilitating habitat connectivity. A laboratory phytoremediation system was designed and constructed to investigate the pollutant-removal potential of indigenous species occurring in Renosterveld vegetation (amongst other areas), compared with commonly used invasive alien plants (IAP) in floating wetland designs. Five pollutant parameters - ammonia, nitrate, orthophosphate and two glyphosate concentrations - reflect environmental stresses on 14 wetland species naturally occurring within Renosterveld vegetation. Effluent analyses indicated significant removal efficiencies for the indigenous vegetation across both fertiliser and herbicide pollutants, with the two most effective species identified as Phragmites australis and Cyperus textilis, with 95.87% and 96.42% removal, respectively. All wetland species displayed greater pollutant removal than the unvegetated soil control and when compared to an IAP and palmiet assemblage, indicated similar pollutant-removal efficiencies, justifying their use as an acceptable alternative.Publisher's versio

A realist review of medication optimisation of community dwelling service users with serious mental illness

Background: Severe mental illness (SMI) incorporates schizophrenia, bipolar disorder, non-organic psychosis, personality disorder or any other severe and enduring mental health illness. Medication, particularly antipsychotics and mood stabilisers are the main treatment options. Medication optimisation is a hallmark of medication safety, characterised by the use of collaborative, person-centred approaches. There is very little published research describing medication optimisation with people living with SMI. Objective: Published literature and two stakeholder groups were employed to answer: What works for whom and in what circumstances to optimise medication use with people living with SMI in the community? Methods: A five-stage realist review was co-conducted with a lived experience group of individuals living with SMI and a practitioner group caring for individuals with SMI. An initial programme theory was developed. A formal literature search was conducted across eight bibliographic databases, and literature were screened for relevance to programme theory refinement. In total 60 papers contributed to the review. 42 papers were from the original database search with 18 papers identified from additional database searches and citation searches conducted based on stakeholder recommendations. Results: Our programme theory represents a continuum from a service user’s initial diagnosis of SMI to therapeutic alliance development with practitioners, followed by mutual exchange of information, shared decision-making and medication optimisation. Accompanying the programme theory are 11 context-mechanism-outcome configurations that propose evidence-informed contextual factors and mechanisms that either facilitate or impede medication optimisation. Two mid-range theories highlighted in this review are supported decision-making and trust formation. Conclusions: Supported decision-making and trust are foundational to overcoming stigma and establishing ‘safety’ and comfort between service users and practitioners. Avenues for future research include the influence of stigma and equity across cultural and ethnic groups with individuals with SMI; and use of trained supports, such as peer support workers. PROSPERO registration number: CRD42021280980

OGLE-2016-BLG-0613LABb: A Microlensing Planet in a Binary System

We present the analysis of OGLE-2016-BLG-0613, for which the lensing light curve appears to be that of a typical binary-lens event with two caustic spikes but with a discontinuous feature on the trough between the spikes. We find that the discontinuous feature was produced by a planetary companion to the binary lens. We find 4 degenerate triple-lens solution classes, each composed of a pair of solutions according to the well-known wide/close planetary degeneracy. One of these solution classes is excluded due to its relatively poor fit. For the remaining three pairs of solutions, the most-likely primary mass is about $M_1\sim 0.7\,M_\odot$ while the planet is a super-Jupiter. In all cases the system lies in the Galactic disk, about half-way toward the Galactic bulge. However, in one of these three solution classes, the secondary of the binary system is a low-mass brown dwarf, with relative mass ratios (1 : 0.03 : 0.003), while in the two others the masses of the binary components are comparable. These two possibilities can be distinguished in about 2024 when the measured lens-source relative proper motion will permit separate resolution of the lens and source.Comment: 14 pages, 9 figure

Is health care getting safer?

Patient safety has been high on the national and international agenda in health care for almost a decade. In the United Kingdom, reviews of case records have shown that over 10% of patients experience an adverse event while in hospital,1 2 a figure reflected in similar studies around the world.3 Considerable efforts have been made to improve safety, and it is natural to ask whether these efforts have been well directed. Are patients any safer? The answer to this simple question is curiously elusive. Although some aspects of safety are difficult to measure for technical reasons (defining preventability for instance), the main problem is that measurement and evaluation have not been high on the agenda. We believe that the lack of reliable information on safety and quality of care is hindering improvement in safety across the world. The principal approach to patient safety in the UK, United States, and many other countries has been to establish local and national reporting systems; these systems invite voluntary reporting of unspecified safety incidents with the aim of learning lessons and feeding back the findings into the system. However, these reporting systems do not effectively detect adverse events. In the most recent comparison, reporting systems detected only about 6% of adverse events found by systematic review of records.2 Reporting systems are a valuable component of a safety system, but they are essentially systems for warning and communication inside an organisation and, if large scale, of detecting rare events not easily detectable by other means. They cannot and never will act as a measurement system for safety. Here, we use the example of the UK National Health Service to determine whether it is possible to assess change in several core areas that reflect the safety of health care and, if so, what changes are apparent. We focus on measures of outcome, in the sense of definable events that happen to patients (infections, morbidity, mortality) and on key measures of process (such as drug errors). We have not considered concepts such as culture or resilience that are held to reflect safety but are not proved indices of clinical process or outcome. Defining safety is itself a challenge, and we do not pretend that the indicators can provide more than a crude measure of overall levels of safety. The indicators we have chosen are, however, all important to patients

Does splinting the upper limb improve the quality of life and functional independence of stroke survivors?

Introduction and Background: Up to 80% of stroke survivors have impairments of the upper limb, which considerably affects participation in everyday activities and quality of life (Langhorne et al., 2009). Improving upper limb function to maximise functional potential is an integral part of a stroke survivor’s rehabilitation programme (Lum et al., 2009). The use of splinting to improve functional outcomes has been a source of debate in the literature as its application in practice is diverse and warrants further research to guide practice (Basaran et al., 2012). Methods: An in-depth case study approach was used to evaluate eight stroke survivors’ sensorimotor and functional outcomes following a splinting regime using either dorsal or volar splints. The ICF framework was used to develop and structure the study. Data collection occurred biweekly for 2 months and then at 6 months to evaluate the impact of splinting. Descriptive and nonparametric data analysis of sensorimotor, functional and quality of life measures was done using SPSS. Results and conclusion: All participants showed some degree of improvement in majority of the study measures following an 8-week splinting programme. For younger participants, improvements of sensorimotor components were significantly associated with an improvement in functional ability and quality of life. Impact: The findings highlight areas of splinting practice that are potentially effective for the rehabilitation of the upper limb of stroke survivors but require research on a larger population using randomised controlled trials to confirm the findings. Implications for practice: A 6 month splinting programme has the potential to effect sensorimotor, functional and quality of life outcomes for individuals in the chronic phase of Stoke rehabilitation. There are many variables that need to be considered and the structure of the ICF model is well suited in guiding OTs when using splints for the rehabilitation of the upper limb for stroke survivors. References Basaran, A., E e, U., Karadavut, K.I., Balbaloglu, O., Bulmus, N. (2012) Hand splinting for poststroke spasticity: a randomized controlled trial. Topics In Stroke Rehabilitation. 19(4), 329#8211337. Langhorne, P., Coupar, F., Pollock, A. (2009) Motor recovery after stroke: a systematic review. The Lancet Neurology. 8(8), 741#8211754. Lum, P.S., Mulroy, S., Amdur, R.L., Requejo, P., Prilutsky, B.I., Dromerick, A.W. (2009) Gains in upper extremity function after stroke via recovery or compensation: Potential differential effects on amount of real-world limb use. Topics In Stroke Rehabilitation. 16(4), 237#8211253. Keywords Neurological practice, Research, Practice – present and future, Voluntary/third sector services Contact E-mail Addresses [email protected]