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PAZOUR, JENNIFER A., SARAH E. ROOT, RUSSELL D. MELLER, LISA M. THOMAS, and SCOTT J. MASON. "SELECTING AND ALLOCATING REPACKAGING TECHNOLOGY FOR UNIT-DOSE MEDICATIONS IN HOSPITAL PHARMACIES." International Journal of Innovation and Technology Management 10, no. 03 (June 2013): 1340011. http://dx.doi.org/10.1142/s0219877013400117.
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To increase patient safety and support bedside-point-of-care medication administration, millions of unit-dose medications are dispensed in hospitals and health systems daily. Because not all medications are available in unit-dose form directly from the manufacturer, hospitals must repackage medications in unit-dose form themselves. We develop a mathematical model that simultaneously determines which level of technology is warranted and how each medication that is not delivered to the pharmacy in unit-dose form should be repackaged subject to multiple constraints. This model has been integrated into a free Excel-based tool available to pharmacy directors. We test our model with data based on small, medium, and large hospitals and conduct sensitivity analyses to gain further insight. We illustrate how the results from our model can aid in incorporating qualitative aspects into technology selection. Our results show that a semi-automated repackaging system is the most economical technology alternative for most hospital pharmacy in-house repackaging operations. This result, however, is sensitive to the number of unit-dose medications to repackage and the available labor.
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Zhang, Yichen, Haishaerjiang Wushouer, Sheng Han, Mengyuan Fu, Xiaodong Guan, Luwen Shi, and Anita Wagner. "The impacts of government reimbursement negotiation on targeted anticancer medication price, volume and spending in China." BMJ Global Health 6, no. 7 (July 2021): e006196. http://dx.doi.org/10.1136/bmjgh-2021-006196.
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IntroductionNew targeted therapies have changed cancer treatment in the past decades. However, high prices of targeted anticancer medications have increased economic burden for both patients and health insurance systems. In July 2017, China implemented combined medication price negotiation and mandatory reimbursement policies for 15 targeted anticancer medications. This study assesses effects of the policy on hospital procurement prices, volumes and spending.MethodsUsing a quasi-experimental interrupted time series design, we analysed procurement data from the Chinese Medical Economic Information of 789 public hospitals in 30 provinces between January 2016 and September 2018. The intervention group consisted of 15 targeted anticancer medications with negotiated prices in 2017. The comparison group consisted of six targeted anticancer medications without negotiated prices by 2018. The effective date of the policy was September 2017.ResultsAfter the implementation of the 2017 medication price negotiation and reimbursement policy, cost per defined daily dose (DDD) of the 15 targeted anticancer medications dropped US$71.21 on average from an average US$169.24/DDD before (p=0.000). Compared with what would have happened without the intervention, cost/DDD of price-negotiated medications decreased by 48.9% (p=0.000), procurement volumes increased by 143.0% (p=0.000) and hospital medication spending decreased by 6.9% (p=0.146).ConclusionsThe 2017 medication price negotiation and reimbursement policy decreased targeted medication procurement costs per DDD, increased volumes procured and at least temporarily contained spending. These changes should result in better access to and affordability of targeted anticancer medications in China.
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Pedersen, Craig A., Philip J. Schneider, Michael C. Ganio, and Douglas J. Scheckelhoff. "ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration—2020." American Journal of Health-System Pharmacy 78, no. 12 (March 23, 2021): 1074–93. http://dx.doi.org/10.1093/ajhp/zxab120.
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Abstract Purpose Results of the 2020 ASHP national survey of pharmacy practice in hospital settings are presented. Methods Pharmacy directors at 1,437 general and children’s medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. IQVIA supplied data on hospital characteristics; the survey sample was drawn from the IQVIA hospital database. Results The response rate was 18.7%. Almost all hospitals (92.5%) have a method for pharmacists to review medication orders on demand. Most hospitals (74.5%) use automated dispensing cabinets (ADCs) as their primary method for drug distribution. A third of hospitals use barcodes to verify doses during dispensing in the pharmacy and to verify ingredients when intravenous medications are compounded. More than 80% scan barcodes when restocking ADCs. Sterile workflow management technology is used in 21.3% of hospitals. Almost three-quarters of hospitals outsource some sterile preparations. Pharmacists can independently prescribe in 21.1% of hospitals. Pharmacist practice in ambulatory clinics in 46.2% of health systems and provide telepharmacy services in 28.4% of health systems. Conclusion Pharmacists continue their responsibility in their traditional role in preparation and dispensing of medications. They have successfully employed technology to improve safety and efficiency in performance of these duties and have employed emerging technologies to improve the safety, timeliness, and efficiency of the administration of drugs to patients. As pharmacists continue to expand their role to all aspects of medication use, new opportunities highlighted in ASHP’s Practice Advancement Initiative 2030 have been identified.
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Badawoud, EM, E. Seoane-Vazquez, HS Alhamdan, and S. Jacobson. "Automation Of Hospital Medication Distribution Systems In The Us." Value in Health 19, no. 7 (November 2016): A485. http://dx.doi.org/10.1016/j.jval.2016.09.802.
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Cohen, Michael R., Susan M. Proulx, and Stephanie Y. Crawford. "Survey of hospital systems and common serious medication errors." Journal of Healthcare Risk Management 18, no. 1 (September 1998): 16–27. http://dx.doi.org/10.1002/jhrm.5600180104.
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Coppola, Sarah M., Patience Osei, Ayse P. Gurses, Myrtede Alfred, David M. Neyans, Ken R. Catchpole, Anjali Joseph, et al. "Process Risks in Perioperative Medication Delivery." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 64, no. 1 (December 2020): 1100. http://dx.doi.org/10.1177/1071181320641265.
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One anesthesia provider is often responsible for prescribing, formulating, dispensing, administering, and documenting medications in the operating room. Unlike other hospital units, there are few safety interventions. Systems engineering approaches can provide important insights into improving patient safety during medication delivery processes (Kaplan et al., 2013; Reid et al., 2005). This study observed anesthesia medication delivery during 20 anesthetic cases in the OR and interviewed 10 anesthesia providers in a large midatlantic academic hospital using a Systems Engineering Initiative for Patient Safety (SEIPS) framework to identify process risk in perioperative medication delivery (Holden et al., 2013). Anesthesia attendings, fellows, residents, and certified resident nurse anesthetists (CRNAs) were sampled based on who was in the OR during observations and who volunteered for interviews. Interviews were transcribed and coded through a consensus procedure. The medication delivery process was described using a SEIPS-based process map. Tasks were separated based on the anesthesia phase, though the tasks and phases are not linear; e.g: a provider may prepare for the next case during the maintenance phase.
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Aseeri, Mohammed, Ghadeer Banasser, Omar Baduhduh, Sabirin Baksh, and Nasser Ghalibi. "Evaluation of Medication Error Incident Reports at a Tertiary Care Hospital." Pharmacy 8, no. 2 (April 19, 2020): 69. http://dx.doi.org/10.3390/pharmacy8020069.
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Background: Medications errors (MEs) have been a major concern of healthcare systems worldwide. Voluntary-based incident reporting is the mainstay system to detect such events in many institutions. However, the number of reports can be highly variable across institutions depending on their adoption of the safety culture. This study aimed to evaluate and analyze medication error incidents that were submitted through the hospital safety reporting system in 2015 at a tertiary care center in the western region of Saudi Arabia, and to explore the most common types of harmful MEs in addition to the risk factors that led to such harmful incidents. Methods: This is a descriptive study that was conducted utilizing 624 medication error reports extracted from the hospital safety reporting system. Reports were analyzed based on the medication name, event type, event description, nodes of the medication use process, harm score (adapted from the National Coordinating Council for Medication Error Reporting and Prevention harm index), patients’ age/gender, incident setting, and time of occurrence as documented in the Safety Reporting System (SRS). Furthermore, all errors that resulted in injury or harm to patients had a deeper review by two senior pharmacists to find contributing factors that led to these harmful incidents and recommend system-based preventive strategies. Results: This study showed that most reported incidents were near misses (69.3%). The pediatric population was involved in 28.4% of the incident reports. Most of the reported incidents were categorized as occurring in the inpatient setting (57.4%). Medication error incidents were more likely to be reported in the morning shift versus evening and night shift (77.4% vs. 22.6%). Most reported incidents involved the dispensing stage (36.7%). High-alert medications were reported in 281 out of 624 events (45%). Conclusions: The hospital medication safety reporting program is a great tool to identify system-based issues in the medication management system. This study identified many opportunities for improvement in the medication use system, especially in management of chemotherapy and anticoagulant agents.
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Linkens, A. E. M. J. H., V. Milosevic, P. H. M. van der Kuy, V. H. Damen-Hendriks, C. Mestres Gonzalvo, and K. P. G. M. Hurkens. "Medication-related hospital admissions and readmissions in older patients: an overview of literature." International Journal of Clinical Pharmacy 42, no. 5 (May 30, 2020): 1243–51. http://dx.doi.org/10.1007/s11096-020-01040-1.
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Abstract Background The number of medication related hospital admissions and readmissions are increasing over the years due to the ageing population. Medication related hospital admissions and readmissions lead to decreased quality of life and high healthcare costs. Aim of the review To assess what is currently known about medication related hospital admissions, medication related hospital readmissions, their risk factors, and possible interventions which reduce medication related hospital readmissions. Method We searched PubMed for articles about the topic medication related hospital admissions and readmissions. Overall 54 studies were selected for the overview of literature. Results Between the different selected studies there was much heterogeneity in definitions for medication related admission and readmissions, in study population and the way studies were performed. Multiple risk factors are found in the studies for example: polypharmacy, comorbidities, therapy non adherence, cognitive impairment, depending living situation, high risk medications and higher age. Different interventions are studied to reduce the number of medication related readmission, some of these interventions may reduce the readmissions like the participation of a pharmacist, education programmes and transition-of-care interventions and the use of digital assistance in the form of Clinical Decision Support Systems. However the methods and the results of these interventions show heterogeneity in the different researches. Conclusion There is much heterogeneity in incidence and definitions for both medication related hospital admissions and readmissions. Some risk factors are known for medication related admissions and readmissions such as polypharmacy, older age and additional diseases. Known interventions that could possibly lead to a decrease in medication related hospital readmissions are spare being the involvement of a pharmacist, education programs and transition-care interventions the most mentioned ones although controversial results have been reported. More research is needed to gather more information on this topic.
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&NA;. "US vs UK hospital drug distribution systems - medication errors compared." Inpharma Weekly &NA;, no. 1017 (December 1995): 21. http://dx.doi.org/10.2165/00128413-199510170-00046.
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&NA;. "US vs UK hospital drug distribution systems ??? medication errors compared." Reactions Weekly &NA;, no. 581 (December 1995): 2. http://dx.doi.org/10.2165/00128415-199505810-00003.
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Kerns, Margaret P., and Sandra McBournie. "Medication Safety: Implementing a Systems Approach in a Rural Hospital." Journal For Healthcare Quality 24, no. 4 (July 2002): 30–34. http://dx.doi.org/10.1111/j.1945-1474.2002.tb00443.x.
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Lo, Connie, Rosemary Burke, and Johanna I. Westbrook. "Electronic Medication Management Systems' Influence on Hospital Pharmacists' Work Patterns." Journal of Pharmacy Practice and Research 40, no. 2 (June 2010): 106–10. http://dx.doi.org/10.1002/j.2055-2335.2010.tb00516.x.
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Pellegrin, Karen, Francis Chan, Natalie Pagoria, Sheena Jolson-Oakes, Reece Uyeno, and Andrew Levin. "A Statewide Medication Management System: Health Information Exchange to Support Drug Therapy Optimization by Pharmacists across the Continuum of Care." Applied Clinical Informatics 09, no. 01 (January 2018): 001–10. http://dx.doi.org/10.1055/s-0037-1620262.
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Background While evidence generally supports the use of medication management technology, systems are typically implemented and evaluated piecemeal rather than as part of a comprehensive model for medication management. Systems to support drug therapy optimization, increasingly a key role of pharmacists in our healthcare system, have not yet been reported. Objective Our objective is to describe the design, implementation, and use of health information technology to support the hospital and community pharmacists' management of medications for high-risk patients statewide in the “Pharm2Pharm” model of care. Our aims were to make it easier for the pharmacists to access information needed to identify and resolve drug therapy problems using best practices for medication management and communicate with other members of the care team. Methods The pharmacist's roles and the medication management processes guided the design of the supporting technology, which was implemented after the Pharm2Pharm model was launched and the pharmacists' technology needs were assessed. Priorities for technology included sending care transition documents from hospital to community pharmacist securely and efficiently, access to medical records, including medications and laboratory results, documentation, and patient tracking. Implementation and use of the technology were documented. Results Communications, medication management, and population management solutions were implemented to support the Pharm2Pharm model. The pharmacists delivering services through this model adopted and meaningfully used this technology to support their work. Conclusion Implementing technology with value outside of the Pharm2Pharm model was a strategic approach to investment. This work emphasizes the importance of shifting the focus of technology from supporting a specific piece of the medication management process to supporting the goal of optimizing medication regimens. Health information exchange systems can provide important technology needed to integrate pharmacists into care teams as they are deployed to improve patient outcomes.
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Jorgenson, James A., Tess K. Leiker, and Craig C. Herzog. "Combined Medication-and-Supply Automated Delivery System in an Ambulatory Setting." Hospital Pharmacy 37, no. 8 (August 2002): 828–32. http://dx.doi.org/10.1177/001857870203700813.
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This article describes the implementation and analysis of an automated system for the distribution of medications and supplies in an ambulatory clinic setting. Distribution, charging, and control of medications and supplies provided to ambulatory clinics is an issue that presents numerous problems for hospital pharmacy departments. A combined automated unit to handle both supplies and medications was studied as an alternative to traditional manual systems. Problems with our manual system were identified. A comparative analysis of revenue, medication and supply cost before and after automation is presented. Increases in revenue, decreases in supply cost, and improved medication expense documentation were noted with the automated system.
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Gallimore, Jennie J., and Peter K. Wong. "Implementation of Electronic Systems for Prescribing and Delivering Medication in Hospitals: Issues in Real Practice." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 51, no. 11 (October 2007): 740–44. http://dx.doi.org/10.1177/154193120705101129.
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Electronic systems are being purchased by hospitals to improve procuring, prescribing, dispensing, administering medications and patient monitoring processes. The purpose of this paper is to describe issues related to implementation of computer technologies to support the pharmaceutical process in a real hospital setting. Examining the issues can help to improve processes and systems and provides an indication where hospital resources may need to be directed to solve problems of immediate concern. Future research needs for improving electronic systems are presented.
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Miller, Daryl E., Teresa E. Roane, and Karen D. McLin. "Reduction of 30-Day Hospital Readmissions after Patient-centric Telephonic Medication Therapy Management Services." Hospital Pharmacy 51, no. 11 (November 1, 2016): 907–14. http://dx.doi.org/10.1310/hpj5111-907.
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Background Transitional care programs are a growing topic in health care systems across the country, with a focus on achieving a reduction in hospital readmissions and improving patient and medication safety. Numerous strategies have been employed and studied to determine successful approaches to patient transition from the hospital setting to the home setting. Pharmacist-mediated postdischarge telephonic outreach has demonstrated decreased hospital readmission rates in multiple hospital systems. Objective To evaluate the effectiveness of pharmacist-facilitated telephonic medication therapy management (MTM) services on reducing hospital readmissions. Methods A retrospective chart analysis ( n = 314) was performed for patients who received MTM services following hospital discharge between February 23, 2014 and July 4, 2014. The primary outcome was 30-day all-cause readmission. The secondary outcomes were identification of pharmacist interventions for and recommendations about medication-related problems and discrepancies found between the patients' reported medication list and the hospital discharge medication list. Results The data revealed no statistically significant difference in hospital readmission rates between the intervention and control groups (odds ratio, 1.04; 95% CI, 0.68–1.60). Pharmacists intervened on 189 medication-related problems via facsimile to the prescriber (35.7% of charts), contacted prescribers by phone for 23 medication-related or health-related issues, and identified 823 medication list discrepancies (78.34% of charts). Conclusion Although the provision of telephonic MTM services by pharmacists did not result in an improvement in the readmission rate during this study period, pharmacists were able to intervene on numerous medication-related problems and medication list discrepancies.
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Tan, Yixin, Rohan A. Elliott, Belinda Richardson, Francine E. Tanner, and Michael I. Dorevitch. "An audit of the accuracy of medication information in electronic medical discharge summaries linked to an electronic prescribing system." Health Information Management Journal 47, no. 3 (March 27, 2018): 125–31. http://dx.doi.org/10.1177/1833358318765192.
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Background: Poor communication of medication information to general practitioners when patients are discharged from hospital is a widely recognised problem. There has been little research exploring the accuracy of medication information in electronic discharge summaries (EDS) linked to hospital e-prescribing systems. Objective: To evaluate the accuracy of medication lists and medication change information in EDS produced using an integrated e-prescribing and EDS system (where EDS discharge medication lists were imported from discharge e-prescription records, medication change information was manually entered, and medications were dispensed from paper copies of the patients' e-prescriptions). Method: Retrospective audit of EDSs for a random sample, representative of adult patients ( n = 87) discharged from a major teaching hospital. EDS medication lists were compared to pharmacist-verified paper discharge prescriptions (considered to be the most accurate discharge medication list) to identify discrepancies. EDS medication change information was compared to medication changes identified by comparing pharmacist-verified “Medication History on Admission” forms with pharmacist-verified paper discharge prescriptions. Results: There were 85/87 (98%) EDSs that included a discharge medication list. Of these, 50/85 (59%) contained one or more medication list discrepancies (median 1, range 0–15). The most common discrepancy was omission of medication (58%); 84/131 (64%) discrepancies were considered clinically significant (risk of adverse outcome); 162/351 (46%) clinically significant medication changes were stated in the EDS; and 153/351 (44%) changes were both stated and included a reason. Conclusion: EDS discrepancies were common despite integration with e-prescribing. Eliminating paper prescriptions, enhancing e-prescribing/EDS functionality and involving pharmacists in EDS preparation may reduce discrepancies.
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Chamoun, Nibal, Ulfat Usta, Lamis R. Karaoui, Pascale Salameh, Souheil Hallit, Patricia Shuhaiber, Anna-Maria Henaine, Youssef Akiki, Rony M. Zeenny, and Katia Iskandar. "Current Trends in Hospital Pharmacy Practice in Lebanon." Hospital Pharmacy 55, no. 2 (January 19, 2019): 112–18. http://dx.doi.org/10.1177/0018578718823733.
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Objectives: For decades, the role of hospital pharmacists has been instrumental in elevating pharmacy practice worldwide. Recently, the Hospital Pharmacy Section of the International Pharmaceutical Federation (FIP), the European Association of Hospital Pharmacists (EAHP), and the American Society of Health-System Pharmacists (ASHP) updated their statements about the future role and responsibilities of the pharmacy executive in hospitals and health systems. A series of surveys were conducted around the globe to better understand the current state of hospital pharmacy practice. The purpose of these surveys was to identify challenges in hospital pharmacy practice and to develop improvement strategies. The objective of this national survey is to evaluate hospital pharmacy practice in Lebanon. Methods: A cross-sectional observational study was performed among pharmacists working in hospital settings in Lebanon, from January through June 2016. Based on a literature review, a questionnaire to elicit Lebanese hospital pharmacists’ practice was developed. Results: The results showed a nonsignificant difference between university teaching and nonuniversity teaching hospitals in the processes of drug procurement, preparation, dispensing, and drug administration. However, statistically significant differences were observed between university teaching and nonuniversity teaching hospitals with respect to having clinical pharmacists ( P < .001) and highly qualified personnel ( P < .005). Pharmacy services in teaching hospitals seemed to be more advanced cooperating with affiliated medical schools. Furthermore, teaching hospitals were more likely to have pharmacists providing information about the safety of the medications used ( P = .029). Although not statistically significant, there was a higher trend toward having a designated champion for medication safety ( P = .052). Conclusion: The results of our survey showed that teaching hospitals were more compliant with the International Statements of Hospital Pharmacy Practice compared with nonteaching hospitals. There is room for improvement especially if the application of the accreditation standards for safe hospital pharmacy practice becomes mandatory for all hospitals, which is expected to standardize pharmacy practice and secure both medication and patient safety.
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Hess, Elizabeth, Shannon E. Palmer, Andrew Stivers, and Lindsey B. Amerine. "Impact of an electronic health record transition on chemotherapy error reporting." Journal of Oncology Pharmacy Practice 26, no. 4 (September 4, 2019): 787–93. http://dx.doi.org/10.1177/1078155219870590.
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Background Incident reporting systems allow for frontline employees to report errors and are a critical component of healthcare patient safety programs. Although incident reporting systems cannot quantify total errors, organizations can utilize incident reporting systems to help identify risks and trends to act upon. The objective of this article is to utilize incident reporting systems to evaluate trends in medication error reporting before and after implementation of a new electronic health record system. Methods A five-month pre- and post-analysis was completed in a cancer hospital following electronic health record conversion by reviewing medication errors reported via the institution’s voluntary incident reporting systems. Error reports included medication error category, date error was reported/occurred, patient location at time of error, harm severity score, medication(s) involved, medication use system node error originated/discovered in, medication source, narrative summary, and contributing factors. Data were analyzed using descriptive statistics within Office Excel. Results Oncology medication error reports submitted pre- and post-electronic health record were 68 vs. 57, respectively. During the pre- and post-electronic health record conversion, a majority of errors had a harm severity index of 0 or 1; 12 (18%) in pre-electronic health record and 3 (5%) in post-electronic health record were level 2, and one (1%) in pre-electronic health record vs. 0 in post-electronic health record were level 3. Reported medication errors originated most commonly during the prescribing, administration, and preparation/dispensing phase and were primarily identified in the administration phase of the medication use process. The most frequently reported error category was ‘wrong dose’ followed by ‘other’ and ‘overdose’ in the pre-electronic health record phase and ‘missing dose/delayed delivery’ and ‘order incorrect’ in the post-electronic health record phase. The most frequently reported medications included methotrexate, chemotherapy (unspecified), and cisplatin. Conclusion Analyzing data from incident reporting system reports allowed our institution to understand different trends of reporting in the cancer hospital following electronic health record adoption. Utilization of incident reporting systems must be combined with proactive risk identification approaches to enable systems-focused improvements to improve patient safety.
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Indriani, Siti. "Penggunaan Electronic Medication Management (EMM) dalam Menurunkan Kejadian Medication Error di Keperawatan." Jurnal Surya 11, no. 03 (January 2, 2020): 33–39. http://dx.doi.org/10.38040/js.v11i03.53.
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Errors in drug administration are adverse events for patients. Reducing the incidence of medication errors will significantly improve patient safety and quality of medication use. The traditional system makes staff spend time searching through notes on a compilation paper of what drugs patients must pay throughout the treatment process that is given. This process is not only lengthy, but also can easily increase opportunities for differences and mistakes. Many hospitals and health services are turning to digital systems as a solution. The EMM system supports the improvement of quality, safety, and support for drug management in hospitals. This includes providing support for doctors, nurses and pharmacists to prescribe, order, accept, reconcile, issue and install digital drug administration. EMM covers the entire treatment cycle in the hospital including prescribing by doctors, approved and issued drug orders by pharmacists, and administration of drugs by nurses. The use of EMM can provide benefits that are improving the quality of patient-oriented nursing care, the quality of clinical services and the use of information technology. Nurses as health workers with the largest
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Kuo, Yu-Chun, and Shou-Hsia Cheng. "Adoption of medication alert systems in hospital outpatient departments in Taiwan." International Journal of Medical Informatics 102 (June 2017): 111–17. http://dx.doi.org/10.1016/j.ijmedinf.2017.03.012.
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Pedersen, Craig A., Philip J. Schneider, Michael C. Ganio, and Douglas J. Scheckelhoff. "ASHP national survey of pharmacy practice in hospital settings: Prescribing and transcribing—2019." American Journal of Health-System Pharmacy 77, no. 13 (June 23, 2020): 1026–50. http://dx.doi.org/10.1093/ajhp/zxaa104.
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Abstract Purpose Results of the 2019 ASHP national survey of pharmacy practice in hospital settings are presented. Methods Pharmacy directors at 4,863 general and children’s medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online, using an online survey application. IQVIA supplied data on hospital characteristics; the survey sample was drawn from the IMS Health hospital database. Results The response rate was 10.8%. Pharmacists are increasingly managing medication use in the areas of vancomycin therapy, antibiotic selection and dosing, and anticoagulation. Electronic health record (EHR) decision support is guiding prescribing, and nearly 50% of hospitals are customizing drug warnings. Adoption of compounding technology continues, with 43.6% of hospitals using technology in their sterile compounding processes. Nearly half of hospitals have active opioid stewardship programs, and pharmacists are leading these efforts. Specialty pharmacy operations are growing in health systems. Human resource commitments to support new services are increasing; however, vacancy rates for technicians are challenging. Staff credentialing continues to expand for pharmacist and technicians. Conclusion Pharmacists continue to assume greater responsibility for writing medication orders, dosing, ordering laboratory tests, and monitoring outcomes. Health-system pharmacists are taking a leading role in addressing the opioid crisis, advancing safety in compounded sterile preparations through adoption of intravenous workflow technologies, and optimizing EHR applications to leverage clinical decision support tools to improve the safe prescribing and use of medications.
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Haims, Maria, Denise Rousseau, Donna Keyser, Ed Harrison, and Carl Sirio. "A Framework and Methodology for Achieving Region-Wide Patient Safety Improvements." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 46, no. 15 (September 2002): 1394–98. http://dx.doi.org/10.1177/154193120204601518.
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Adverse patient events, including nosocomial (hospital-acquired) infection rates and medication errors, are among the nation's most pervasive patient safety problems. The Pittsburgh Regional Healthcare Initiative (PRHI), a regional coalition for healthcare quality improvement, has identified the elimination of medication errors and nosocomial infections as a primary goal. PRHI has facilitated the implementation and use of two different reporting systems in all 30 of its member hospitals designed to facilitate work toward this goal: 1) the Centers for Disease Control (CDC) National Nosocomial Infection Surveillance System (NNIS); and 2) the US Pharmacopeia (USP) MedMARx®, a medication error reporting system. The aims of this study are to understand 1) how well the reporting systems and their standards of use succeed in generating usable information; 2) how well feedback review systems, related to the reporting, function; and 3) the problem-solving systems through which knowledge is translated into organizational and inter-organizational learning. The methodological approach reflects a systems view, includes several levels of analysis, and utilizes triangulation of both qualitative and quantitative data. Data collection components include hospital profiles, site visit interviews, structured diaries, surveys, intervention case studies and report design feedback forms, along with data collected from the reporting systems themselves.
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Toh, Ming Ren, and Lita Chew. "Turning waste medicines to cost savings: A pilot study on the feasibility of medication recycling as a solution to drug wastage." Palliative Medicine 31, no. 1 (July 18, 2016): 35–41. http://dx.doi.org/10.1177/0269216316639798.
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Background: Unused medicines represent a major source of wastage in healthcare systems around the world. Previous studies have suggested the potential cost savings from recycling the waste medicines. However, issues of product safety and integrity often deter healthcare institutions from recycling donated medications. Aim: To evaluate the feasibility of medication recycling and to assess the actual cost savings from recycling waste medicines and whether reusability of waste medicines differed among various drug classes and donor sources. Design and setting: Donated medications from hospitals, private medical clinics and patients were collected and assessed using a medication recycling protocol in a hospice care setting from November 2013 through January 2014. Costs were calculated using a reference pricing list from a public hospital. Results: A total of 244 donations, amounting to 20,759 dosage units, were collected during the study period. Most donations (90.8%) were reusable, providing a total of S$5266 in cost savings. Less than 2 h daily was spent by a single pharmacy technician on the sorting and distributing processes. Medications donated by health facilities were thrice more likely to be reusable than those by patients (odds ratio = 3.614, 95% confidence interval = 3.127, 4.176). Medications belonging to Anatomical Therapeutic Chemical class G (0.0%), H (8.2%) and L (30.0%) were the least reusable. Conclusion: Most donated medications were reusable. The current protocol can be further streamlined to focus on the more reusable donor sources and drug classes and validated in other settings. Overall, we opine that it is feasible to practise medication recycling on a larger scale to reduce medication wastage.
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Zheng, Wu Yi, Bethany Van Dort, Romaric Marcilly, Richard Day, Rosemary Burke, Sepehr Shakib, Young Ku, Hannah Reid-Anderson, and Melissa Baysari. "A Tool for Evaluating Medication Alerting Systems: Development and Initial Assessment." JMIR Medical Informatics 9, no. 7 (July 16, 2021): e24022. http://dx.doi.org/10.2196/24022.
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Background It is well known that recommendations from electronic medication alerts are seldom accepted or acted on by users. Key factors affecting the effectiveness of medication alerts include system usability and alert design. Thus, human factors principles that apply knowledge of human capabilities and limitations are increasingly used in the design of health technology to improve the usability of systems. Objective This study aims to evaluate a newly developed evidence-based self-assessment tool that allows the valid and reliable evaluation of computerized medication alerting systems. This tool was developed to be used by hospital staff with detailed knowledge of their hospital’s computerized provider order entry system and alerts to identify and address potential system deficiencies. In this initial assessment, we aim to determine whether the items in the tool can measure compliance of medication alerting systems with human factors principles of design, the tool can be consistently used by multiple users to assess the same system, and the items are easy to understand and perceived to be useful for assessing medication alerting systems. Methods The Tool for Evaluating Medication Alerting Systems (TEMAS) was developed based on human factors design principles and consisted of 66 items. In total, 18 staff members recruited across 6 hospitals used the TEMAS to assess their medication alerting systems. Data collected from participant assessments were used to evaluate the validity, reliability, and usability of the TEMAS. Validity was assessed by comparing the results of the TEMAS with those of prior in-house evaluations. Reliability was measured using Krippendorff α to determine agreement among assessors. A 7-item survey was used to determine usability. Results The participants reported mostly negative (n=8) and neutral (n=7) perceptions of alerts in their medication alerting system. However, the validity of the TEMAS could not be directly tested, as participants were unaware of any results from prior in-house evaluations. The reliability of the TEMAS, as measured by Krippendorff α, was low to moderate (range 0.26-0.46); however, participant feedback suggests that individuals’ knowledge of the system varied according to their professional background. In terms of usability, 61% (11/18) of participants reported that the TEMAS items were generally easy to understand; however, participants suggested the revision of 22 items to improve clarity. Conclusions This initial assessment of the TEMAS allowed the identification of its components that required modification to improve usability and usefulness. It also revealed that for the TEMAS to be effective in facilitating a comprehensive assessment of a medication alerting system, it should be completed by a multidisciplinary team of hospital staff from both clinical and technical backgrounds to maximize their knowledge of systems.
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Climent, C., I. Font Noguera, J. L. Poveda Andrés, E. López Briz, and S. Peiró. "Medication Errors in a Tertiary Hospital With Three Different Drug Delivery Systems." Farmacia Hospitalaria (English Edition) 32, no. 1 (January 2008): 18–24. http://dx.doi.org/10.1016/s2173-5085(08)70025-x.
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Kummer, Tyge-F., Kerstin Schäfer, and Neda Todorova. "Acceptance of hospital nurses toward sensor-based medication systems: A questionnaire survey." International Journal of Nursing Studies 50, no. 4 (April 2013): 508–17. http://dx.doi.org/10.1016/j.ijnurstu.2012.11.010.
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Farre, Albert, Gemma Heath, Karen Shaw, Teresa Jordan, and Carole Cummins. "The role of paediatric nurses in medication safety prior to the implementation of electronic prescribing: a qualitative case study." Journal of Health Services Research & Policy 22, no. 2 (January 13, 2017): 99–106. http://dx.doi.org/10.1177/1355819616686995.
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Objectives To explore paediatric nurses’ experiences and perspectives of their role in the medication process and how this role is enacted in everyday practice. Methods A qualitative case study on a general surgical ward of a paediatric hospital in England, one year prior to the planned implementation of ePrescribing. Three focus groups and six individual semi-structured interviews were conducted, involving 24 nurses. Focus groups and interviews were audio-recorded, transcribed, anonymized and subjected to thematic analysis. Results Two overarching analytical themes were identified: the centrality of risk management in nurses’ role in the medication process and the distributed nature of nurses’ medication risk management practices. Nurses’ contribution to medication safety was seen as an intrinsic feature of a role that extended beyond just preparing and administering medications as prescribed and placed nurses at the heart of a dynamic set of interactions, practices and situations through which medication risks were managed. These findings also illustrate the collective nature of patient safety. Conclusions Both the recognized and the unrecognized contributions of nurses to the management of medications needs to be considered in the design and implementation of ePrescribing systems.
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Carroll, Noel, and Ita Richardson. "Enablers and barriers for hospital pharmacy information systems." Health Informatics Journal 26, no. 1 (March 7, 2019): 406–19. http://dx.doi.org/10.1177/1460458219832056.
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Pharmacy plays a pivotal role in supporting acute clinical care pathways. However, across hospital environments, pharmacies are often stretched by growing service demands and conflicted by increased medication and service costs. Ultimately, such factors contribute towards process inefficiencies that impact on the provision of healthcare services. Following a literature review, we examined clinical pharmacy services by undertaking three acute hospital pharmacy case studies. We adopted an ethnographic approach, observing and interviewing pharmacists, pharmacy staff and nurses. With a view to improving healthcare information systems (ISs), we identified the enablers and barriers in service efficiency, thus identifying opportunities for pharmacy IS implementation across acute hospital environments. The findings also reveal some of the key enablers and barriers towards the introduction of hospital IS innovation. We present recommendations to overcome such barriers.
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Nelson, Kembral L., Shelly Morvay, Marjorie Neidecker, Sonya Sebastian, Jessica Fischer, Junan Li, Vinita Pai, and Jenna Merandi. "Evaluation of medication safety resources in pediatric hospitals." American Journal of Health-System Pharmacy 77, Supplement_3 (August 20, 2020): S78—S86. http://dx.doi.org/10.1093/ajhp/zxaa177.
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Abstract Purpose As health systems continue to expand pharmacy and clinical services, the ability to evaluate potential medication safety risks and mitigate errors remains a high priority. Workload and productivity monitoring tools for the assessment of operational and clinical pharmacy services exist. However, such tools are not currently available to justify medication safety pharmacy services. The purpose of this study is to determine methods used to assess, allocate, and justify medication safety resources in pediatric hospitals. Methods A 32-question survey was designed and distributed utilizing the Research Electronic Data Capture (REDCap) tool. The survey was disseminated to 46 pediatric hospitals affiliated with the Children’s Hospital Association (CHA). The survey was distributed in October 2018, and the respondents were given 3 weeks to submit responses. Data analysis includes the use of descriptive statistics. Categorical variables were summarized by frequencies and percentages to distinguish the differences between pediatric health systems. Results Of 26 respondents, 15.4% utilized metrics to justify medication safety resources. Metrics utilized were based on medication dispenses, projects, and error coding. Twenty-three percent of respondents were dissatisfied with current pharmacy-based medication safety resources within the organization. There was variability of medication safety resources within pediatric hospitals, including the number of dedicated full-time equivalents, time spent on tasks, and task prioritization. Conclusion Assessing medication safety resources at various pediatric hospitals highlights several potential barriers and opportunities. This information will serve as the foundation for the creation of a standardized workload assessment tool to assist pharmacy leaders with additional resource justification.
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Abebe, Ephrem, and Michelle A. Chui. "Exploring Barriers to Medication Safety in an Ethiopian Hospital Emergency Department: A Human Factors Engineering Approach." INNOVATIONS in pharmacy 9, no. 1 (February 7, 2018): 7. http://dx.doi.org/10.24926/iip.v9i1.950.
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Objective: To describe challenges associated with the medication use process and potential medication safety hazards in an Ethiopian hospital emergency department using a human factors approach.
Methods: We conducted a qualitative study employing observations and semi-structured interviews guided by the Systems Engineering Initiative for Patient Safety model of work system as an analytical framework. The study was conducted in the emergency department of a teaching hospital in Ethiopia. Study participants included resident doctors, nurses, and pharmacists. We performed content analysis of the qualitative data using accepted procedures.
Results: Organizational barriers included communication failures, limited supervision and support for junior staff contributing to role ambiguity and conflict. Compliance with documentation policy was minimal. Task related barriers included frequent interruptions and work-related stress resulting from job requirements to continuously prioritize the needs of large numbers of patients and family members. Person related barriers included limited training and work experience. Work-related fatigue due to long working hours interfered with staff’s ability to document and review medication orders. Equipment breakdowns were common as were non-calibrated or poorly maintained medical devices contributing to erroneous readings. Key environment related barriers included overcrowding and frequent interruption of staff’s work. Cluttering of the work space compounded the problem by impeding efforts to locate medications, medical supplies or medical charts.
Conclusions: Applying a systems based approach allows a context specific understanding of medication safety hazards in EDs from low-income countries. When developing interventions to improve medication and overall patient safety, health leaders should consider the interactions of the different factors.
Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties".
Treatment of Human Subjects: IRB review/approval required and obtained
Type: Original Research
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Eskew, James A., Judith Jacobi, William F. Buss, Heather M. Warhurst, and Cynthia L. Debord. "Using Innovative Technologies to Set New Safety Standards for the Infusion of Intravenous Medications." Hospital Pharmacy 37, no. 11 (November 2002): 1179–89. http://dx.doi.org/10.1177/001857870203701112.
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Intravenous (IV) administration errors present a particularly challenging problem to hospital pharmacists. Current control systems intercept only 2% of drug administration errors causing preventable adverse drug events (PADEs).4 Estimated costs per preventable ADE are $4685 (1993 dollars). Of the most serious, life-threatening errors, 60% are associated with IV therapy. Conventional, general-purpose infusion devices cannot limit doses or easily be customized for specific patient populations. Clarian Health Partners, a 1400-bed health care system, consolidated infusion devices at three hospitals by implementing the MEDLEY Medication Safety System with Guardrails Safety Software. This new technology offers an innovative IV medication safety platform that functions at the point of care. Clarian became the first U.S. health care system to use this system on a hospital-wide basis. Development of a customized data set based on Clarian's best-practice guidelines was completed in 60 days, and installation at the 775-bed Methodist Hospital was completed in 3 hours. A potentially serious error was averted on the first day of system use. Initial data indicate that use of the IV medication safety system at Clarian's three hospitals will result in 4,000 events of reprogramming annually due to Guardrails alerts.
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Bazzell, Brian, Deb Wagner, Karin M. Durant, and Brian Callahan. "Insights on developing a field hospital formulary and medication distribution process in preparation for a second surge of COVID-19 cases." American Journal of Health-System Pharmacy 77, no. 21 (July 24, 2020): 1763–70. http://dx.doi.org/10.1093/ajhp/zxaa232.
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Abstract Purpose The coronavirus disease 2019 (COVID-19) pandemic has caused health systems across the country to plan for field hospitals to care for patients outside of traditional healthcare settings in the event of a second surge. Here we describe key considerations for the implementation of pharmacy operations and a field hospital formulary at an offsite location within a 2-week time frame. Summary Development of an offsite field hospital formulary is first dependent on the location and patient population defined for the field hospital. Creation of a limited formulary for a planned field hospital in Michigan involved reviewing physical space limitations and drug distribution workflows, assessing current prescribing trends, creating drug categories, and creating formulary guidelines to limit formulary options in each therapeutic category. Ultimately, our institution developed a 140-medication field hospital formulary, a process to enable appropriate use of nonformulary drugs, and a mixed operations model including automated dispensing cabinets and a manual cart-fill process. Although the institution did not have to open the field hospital, the process used for developing the formulary and determining distribution models will allow for an immediate implementation if a second surge occurs. Conclusion A methodical approach to developing limited formularies and pharmacy operations in a field hospital setting will allow health systems to establish efficient and effective medication distribution services in the event of a second surge of COVID-19 cases.
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Aquino, Jéssica A., Isabella R. Silva, Daiana C. Elias, Juliana A. Godinho, André Oliveira Baldoni, Cristina Sanches, and Mariana L. Pereira. "Scenery of Brazilian studies on medication errors: an integrative review." Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde 10, no. 2 (May 5, 2020): 477. http://dx.doi.org/10.30968/rbfhss.2019.102.0477.
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The objective of this integrative review was to identify studies conducted in Brazil that address the occurrence of medication errors in a hospital environment. A integrative review was conducted with national observational studies which analyzed the occurrence of errors related to medication in the hospital environment. 1028 articles were found, of which only 23 (20.4%) studies met the eligibility criteria and were included in the review. Among the professional classes most investigated in medication errors are nurses (44.8%), followed by physicians (24.1%), nursing technicians (17.2%) and pharmacists (13.9%). The most prevalent medication errors are those related to dose (18.0%), omission (15.7%), time of administration (11.2%) and prescription (11.2%). The strategies of investigation of errors used in the Brazilian hospital systems do not always cover all professionals involved in the medication process. It is necessary that professionals work in an interdisciplinary way, aiming at the safety and well-being of the patient.
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Anderson, David J., and Craig S. Webster. "A systems approach to the reduction of medication error on the hospital ward." Journal of Advanced Nursing 35, no. 1 (July 2001): 34–41. http://dx.doi.org/10.1046/j.1365-2648.2001.01820.x.
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Tamblyn, Robyn, Nancy Winslade, Todd C. Lee, Aude Motulsky, Ari Meguerditchian, Melissa Bustillo, Sarah Elsayed, et al. "Improving patient safety and efficiency of medication reconciliation through the development and adoption of a computer-assisted tool with automated electronic integration of population-based community drug data: the RightRx project." Journal of the American Medical Informatics Association 25, no. 5 (October 11, 2017): 482–95. http://dx.doi.org/10.1093/jamia/ocx107.
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Abstract Background and Objective Many countries require hospitals to implement medication reconciliation for accreditation, but the process is resource-intensive, thus adherence is poor. We report on the impact of prepopulating and aligning community and hospital drug lists with data from population-based and hospital-based drug information systems to reduce workload and enhance adoption and use of an e-medication reconciliation application, RightRx. Methods The prototype e-medical reconciliation web-based software was developed for a cluster-randomized trial at the McGill University Health Centre. User-centered design and agile development processes were used to develop features intended to enhance adoption, safety, and efficiency. RightRx was implemented in medical and surgical wards, with support and training provided by unit champions and field staff. The time spent per professional using RightRx was measured, as well as the medication reconciliation completion rates in the intervention and control units during the first 20 months of the trial. Results Users identified required modifications to the application, including the need for dose-based prescribing, the role of the discharge physician in prescribing community-based medication, and access to the rationale for medication decisions made during hospitalization. In the intervention units, both physicians and pharmacists were involved in discharge reconciliation, for 96.1% and 71.9% of patients, respectively. Medication reconciliation was completed for 80.7% (surgery) to 96.0% (medicine) of patients in the intervention units, and 0.7% (surgery) to 82.7% of patients in the control units. The odds of completing medication reconciliation were 9 times greater in the intervention compared to control units (odds ratio: 9.0, 95% confidence interval, 7.4-10.9, P < .0001) after adjusting for differences in patient characteristics. Conclusion High rates of medication reconciliation completion were achieved with automated prepopulation and alignment of community and hospital medication lists.
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Bochkarev, B. G., I. V. Kalinin, and T. I. Kabakova. "A COMPARATIVE ANALYSIS OF THE ASSORTMENT OF DIFFERENT MEDICATION GROUPS USED IN THE CENTRAL REGIONAL HOSPITAL OF THE MUNICIPAL REGION AND THE REGIONAL HOSPITAL OF THE FEDERAL STATE-OPERATED HEALTHCARE AGENCY “MEDICAL AND SANITARY CENTER-23” (FKUZ MSCH-23) OF THE FEDERAL PENITENTIARY SERVICE (FSIN) OF RUSSIA." Pharmacy & Pharmacology 6, no. 3 (July 16, 2018): 269–87. http://dx.doi.org/10.19163/2307-9266-2018-6-3-269-287.
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Providing quality pharmaceutical care is a key task of healthcare; any medical organization must respond efficiently to a change in both external and internal factors that affect the medical support of patients. The aim of this study was to analyze the structure of medication consumption in comparable hospitals in the penitentiary and civilian healthcare systems. Materials and methods. The study was conducted on the basis of content analysis, documentary observation, ABC analysis, and comparison of performance indicators of medical organizations. Results and discussion. This study analyzed the assortment of commodity stocks of medications in the regional clinical hospital that is a part of the structure of FSIN and a typical central regional hospital (CRH). Using ABC analysis it was established that the Group A (the most costly) medications in the penitentiary medical organization consisted exclusively of anti-viraldrugs used for treating HIV-infected patients, which is 54.91% of the stock that are represented by 18 international non-proprietary medication names. In turn, Group A of the medication assortment of the State Budgetary Healthcare Organization of the Republic of Adygea (GBUZ RA) “Krasnogvardeiskaia CRH” consists of three pharmacological groups – plasma substitutes, cardiovascular medications, and antibiotics. On the basis of the obtained data, the study identified different groups of medications and studied their assortment based on international non-proprietary namesand medication forms that received preference either in the branch of Clinical Hospital-2 (KB-2) FKUZ MSCh-23 FSIN of Russia or GBUZ RA “Krasnogvardeiskaia CRH” (38 ATC groups in all). The first group consists of medications from the following 12 ATC groups (31.6%), the assortment of which can be found exclusively in the branch of “KB-2” FKUZ MSCh-23 of the Federal Penitentiary Service of Russia: antiretroviral, muscle relaxants, anticonvulsants, adaptogens, antidepressants) or significantly exceeds similar stocks in GBUZ RA “Krasnogvardeiskaia CRH”: anti-asthmatic agents (3 times), anti-fungal drugs (3 times), hormones except for insulin (2.2 times), respiratory regulators (2 times), non-steroidal anti-inflammatory drugs (1.7 times), medications regulating the gastrointestinal function (1.5 times), and antibacterial agents (1.4 times). The second group consists of medications of the following 9 ATC groups (23.7%) that are stocked only by GBUZ RA “Krasnogvardeiskaia CRH”: antifermental drugs, radiocontrast agents, chondroprotective and antiparasitic medications, and -- within a wider diapason of non-proprietary drugs and forms of manufacture – diuretics (5 times), antitubercular (3 times), antiviral with the exception of anti-HIV (2 times), spasmolytics (2 times), and hypertension drugs (1.5 times). It was determined that the main medical activity of medical organizations subordinate to FSIN of Russia, is aimed at treatment and prevention of complications of the most socially dangerous diseases – HIV/AIDS and tuberculosis – as well as therapy of the associated diseases. It was shown that pharmacists do not use methods of pharmacological-economic analysis in their work, and the medication needs of medical organizations are only 20% satisfied. Conclusion. The identified shortcomings attest to the need to develop and implement a more effective system for the formation of stockpiles in the pharmacies of the penitentiarymedical organization.
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K. H., Supriya, Shashikumar N. S., Prakash G. M., and Rajeshwari N. "Analysis of medication errors in medicine ward of medical college teaching hospital, Mandya." International Journal of Basic & Clinical Pharmacology 8, no. 12 (November 25, 2019): 2741. http://dx.doi.org/10.18203/2319-2003.ijbcp20195289.
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Background: Medication errors are one of the most common types of medical error that is seen in hospitalised patients. Since medication error is one of the growing concerns of healthcare issue and have implications on patient safety, the purpose of this study was to identify medication error and in turn would help to create awareness among healthcare professionals and provide safety to the patients.Methods: Study was initiated after obtaining approval from the Institutional Ethics Committee. The study was done for a period of 1 year between June 2016 and May 2017. Clinical data and data regarding the medication that was prescribed, transcribed, dispensed, administered was collected and was analysed for various types of medication errors during the different stages of medication use process.Results: A total of 351 subjects were recruited in the study for assessing medication error. About 2,283 drugs were prescribed among 351 patients. Maximum number of drugs was administered through parenteral route (50.3%). Medication error was most common during the prescribing stage (51.4%) followed by transcribing stage (39.1%), administration stage (6.9%), and dispensing stage (2.6%). On an average 6 drugs were prescribed per patient. Total of about 5411 errors have occurred out of which 98.8% of errors were preventable, 1.2% of errors were non-preventable. Cardiovascular system (21.9%) and endocrine and renal system (21.9%) was commonly affected due to the medication errors.Conclusions: Medication errors are one of the commonest problems of the healthcare system should be identified and documented and their causes should be studied in order to develop systems that minimize the recurrence.
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Smith, Joshua, Qingxia Chen, Joshua Denny, Dan Roden, Kevin Johnson, and Randolph Miller. "Evaluation of a Novel System to Enhance Clinicians' Recognition of Preadmission Adverse Drug Reactions." Applied Clinical Informatics 09, no. 02 (April 2018): 313–25. http://dx.doi.org/10.1055/s-0038-1646963.
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Background Often unrecognized by providers, adverse drug reactions (ADRs) diminish patients' quality of life, cause preventable admissions and emergency department visits, and increase health care costs. Objective This article evaluates whether an automated system, the Adverse Drug Effect Recognizer (ADER), could assist clinicians in detecting and addressing inpatients' ongoing preadmission ADRs. Methods ADER uses natural language processing to extract patients' medications, findings, and past diagnoses from admission notes. It compares excerpted information to a database of known medication adverse effects and promptly warns clinicians about potential ongoing ADRs and potential confounders via alerts placed in patients' electronic health records (EHRs). A 3-month intervention trial evaluated ADER's impact on antihypertensive medication ordering behaviors. At the time of patient admission, ADER warned providers on the Internal Medicine wards of Vanderbilt University Hospital about potential ongoing preadmission antihypertensive medication ADRs. A retrospective control group, comprised similar physicians from a period prior to the intervention, received no alerts. The evaluation compared ordering behaviors for each group to determine if preadmission medications changed during hospitalization or at discharge. The study also analyzed intervention group participants' survey responses and user comments. Results ADER identified potential preadmission ADRs for 30% of both groups. Compared with controls, intervention providers more often withheld or discontinued suspected ADR-causing medications during the inpatient stay (p < 0.001). Intervention providers who responded to alert-related surveys held or discontinued suspected ADR-causing medications more often at discharge (p < 0.001). Conclusion Results indicate that ADER helped physicians recognize ADRs and reduced ordering of suspected ADR-causing medications. In hospitals using EHRs, ADER-like systems could improve clinicians' recognition and elimination of ongoing ADRs.
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Bitan, Yuval, Yisrael Parmet, Geva Greenfield, Shelly Teng, Richard I. Cook, and Mark E. Nunnally. "Making Sense of the Cognitive Task of Medication Reconciliation Using a Card Sorting Task." Human Factors: The Journal of the Human Factors and Ergonomics Society 61, no. 8 (March 26, 2019): 1315–25. http://dx.doi.org/10.1177/0018720819837037.
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Objective: To explore cognitive strategies clinicians apply while performing a medication reconciliation task, handling incomplete and conflicting information. Background: Medication reconciliation is a method clinicians apply to find and resolve inconsistencies in patients’ medications and medical conditions lists. The cognitive strategies clinicians use during reconciliation are unclear. Controlled lab experiments can explore how clinicians make sense of uncertain, missing, or conflicting information and therefore support the development of a human performance model. We hypothesize that clinicians apply varied cognitive strategies to handle this task and that profession and experience affect these strategies. Method: 130 clinicians participated in a tablet-based experiment conducted in a large American teaching hospital. They were asked to simulate medication reconciliation using a card sorting task (CaST) to organize medication and medical condition lists of a specific clinical case. Later on, they were presented with new information and were asked to add it to their arrangements. We quantitatively and qualitatively analyzed the ways clinicians arranged patient information. Results: Four distinct cognitive strategies were identified (“Conditions first”: n = 76 clinicians, “Medications first”: n = 7, “Crossover”: n = 17, and “Alternating”: n = 10). The strategy clinicians applied was affected by their experience ( p = .02) but not by their profession. At the appearance of new information, clinicians moved medication cards more frequently (75.2 movements vs. 49.6 movements, p < .001), suggesting that they match medications to medical conditions. Conclusion: Clinicians apply various cognitive strategies while reconciling medications and medical conditions. Application: Clinical information systems should support multiple cognitive strategies, allowing flexibility in organizing information.
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Gunja, Naren, Ian Dunlop, Milan Vaghasiya, Kevin Kuan, and Simon Poon. "Patient-centric implementation of an electronic medication management system at a tertiary hospital in Western Sydney." BMJ Health & Care Informatics 25, no. 3 (July 2018): 169–75. http://dx.doi.org/10.14236/jhi.v25i3.1005.
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BackgroundTraditional implementations of electronic medication management (EMM) systems have involved two common formats – a ‘big bang’ approach on the day of go-live, or a phased ward-by-ward approach over months.ObjectiveTo describe the patient-centric roll-out, a novel implementation model in converting from paper to EMM.MethodThis model iteratively converted a large tertiary teaching hospital to electronic from paper medication charts, commencing the roll-out in the emergency department (ED). The tenet of ‘one patient, one chart’ was maintained with new patients commenced on EMM, while existing inpatients were maintained on paper charts until their discharge. In the second week, all other intake points commenced patients on EMM, and in the third week, all remaining patients were manually converted to EMM. The implementation was assessed with training completion rates, staff satisfaction surveys, focus group interviews and incident logs.ResultsAt go-live, 79% of doctors, 68% of nurses and 90% of pharmacists were trained in the EMM system. The ED converted to electronic prescribing within 24 hours; by day 20, all patients were on EMM. Two hundred and thirty issues were logged, none critical, of which 22 were escalated. Of the 51,063 medications administered, there were 13 EMM-related clinical incidents including three double dosing errors, none of which led to an adverse event or death. Overall, 77% of staff surveyed were satisfied with the EMM implementation.ConclusionsThe patient-centric roll-out model represents an innovative and safe approach with a single medication chart reducing transcription and improved medication safety for the patient and the organisation.
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Khan, Gulam Muhammad. "Drug Error beyond the Hospital and Role of Pharmacists in drug Safety Process." Janapriya Journal of Interdisciplinary Studies 8 (December 31, 2019): 169–76. http://dx.doi.org/10.3126/jjis.v8i0.27316.
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Medication related error is one of the most common error prevailing in this time. Medication error can be defined as a ‘failure in the treatment process that leads to or has potential to lead to harm to the patient. Medication error can occur from the process of ordering to the administration to the patient. Among the healthcare professionals; a pharmacist can be responsible in identification of contributing factors and reducing its occurrence. Great efforts are needed in this area, due to diversity in the types of errors, the relationship between the provider and the patient, information transfer, optimization of e-prescribing systems, the lack of adequate training in analyzing the collected data and poor practical strategies for maintaining accurate drug lists in electronic medical records. Recently healthcare professionals have started becoming aware about the risks of patients’ medication exposure. After all, still the area of medication safety beyond the hospital setting needs community pharmacy intervention to avoid malpractice claims and misled decisions in solving medication safety-related problems in the outpatient setting. Approaches like medication reviews and reconciliation, monitoring drug therapy, reporting error will help in identify and prompt the detection of errors, open productive discussions, quality control checks, and effective system-based decisions like performing risk assessment subsequently reduces the harm and risks before patient is exposed to any form of drug error.
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Al Mustafa, Safa Azaat, Mehmood Khan, and Matloub Hussain. "Implementing Barcode Medication Administration Systems in Public Sector Medical Units." International Journal of Decision Support System Technology 10, no. 2 (April 2018): 23–39. http://dx.doi.org/10.4018/ijdsst.2018040102.
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Medication errors in healthcare have a high cost since it is one of the main causes of harming a patient; it leads to inefficient utilization of healthcare organization resources. The barcode medication administration system helps in improving the patients' safety. The purpose of this article is to determine preparatory needs for introducing a Barcoding Medication Administration System (BCMA) in the medical units in one of the largest tertiary hospital in Abu Dhabi City, United Arab Emirates. Analytical Hierarchical Process (AHP) has been employed to describe systematic decision-making by prioritizing different factors that affect the implementation of BCMA and how technology plays a role in helping to reduce or prevent human errors by promoting safety in the health care sectors. Five major domains are identified: leadership, technology, process, education, quality and safety. Leadership was found to be the most important factor oppositely of technology was the least important.
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Wimpenny, Peter, and Pamela Kirkpatrick. "Roles and systems for routine medication administration to prevent medication errors in hospital-based, acute care settings: a systematic review." JBI Database of Systematic Reviews and Implementation Reports 8, no. 10 (2010): 405–46. http://dx.doi.org/10.11124/01938924-201008100-00001.
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Wimpenny, Peter, and Pamela Kirkpatrick. "Roles and systems for routine medication administration to prevent medication errors in hospital-based, acute care settings: a systematic review." JBI Library of Systematic Reviews 8, no. 10 (2010): 405–46. http://dx.doi.org/10.11124/jbisrir-2010-123.
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Sulkers, Heather, Tania Tajirian, Jane Paterson, Daniela Mucuceanu, Tracey MacArthur, John Strauss, Kamini Kalia, Gillian Strudwick, and Damian Jankowicz. "Improving inpatient mental health medication safety through the process of obtaining HIMSS Stage 7: a case report." JAMIA Open 2, no. 1 (September 19, 2018): 35–39. http://dx.doi.org/10.1093/jamiaopen/ooy044.
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Abstract Although electronic health record systems have been implemented in many health settings globally, how organizations can best implement these systems to improve medication safety in mental health contexts is not well documented in the literature. The purpose of this case report is to describe how a mental health hospital in Toronto, Canada, leveraged the process of obtaining Healthcare Information Management Systems Society (HIMSS) Stage 7 on the Electronic Medical Record Adoption Model to improve clinical care specific to medication safety in its inpatient settings. Examples of how the organization met several of these HIMSS criteria are described as they relate to utilizing data from the system to support clinician practice and/or decision-making for medication safety.
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Kwong, Kiu Yan, and Ben Y. F. Fong. "Quality Management of Inpatient Medication Administration in Hong Kong Public Hospitals." Asia Pacific Journal of Health Management 15, no. 2 (May 21, 2020): S91–98. http://dx.doi.org/10.24083/apjhm.v15i2.395.
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Medicine maladministration can result in various side effects to patients, including serious complications, extended medical care, incapacity and death. In Hong Kong public hospitals, the pattern of medication error consists of prescribing error usually made by physicians, dispensing error resulted from pharmacists and dispensers, drug administration error caused by nurses and patient-care workers and technology-related error associated with technology used in the drug administration process. Medication Administration Record (MAR) and ward stock are the usual inpatient medication system within Hospital Authority public hospitals before the development of the electronic system, while the Inpatient Medication Order Entry (IPMOE) functions to provide real-time accessibility in patients’ medication profiles by different professions and health units. However, several factors are related with medication errors. For instance, the ambiguous handwriting orders in the MAR prescribed by physicians affect the transcription by pharmacists and the administration procedures in ward by nurses. Administering medicines in ward stock before pharmacists vetting increase the chance of making errors. Poor interface issues between users and system, and the computer over-reliance are also contributed in resultant technology-related errors. In order to reduce the occurrence of medication incidents, implementation of Automated Pharmacy Distribution Systems helps moving towards a closed loop medication management system. Modifying technologies in barcode assisted medication administration and enhancing the IPMOE with a pop-up message could help intercepting drug administration errors to patients.. The elimination of the potential risks arising from the prescribing, dispensing and drug administration processes brings the achievement of medication safety in Hong Kong public hospitals.
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&NA;. "Hospira and InnerWireless Partner to Enhance Connectivity Between Hospital Systems and Medication Management Devices." Journal of Hospice & Palliative Nursing 8, no. 4 (July 2006): 195–96. http://dx.doi.org/10.1097/00129191-200607000-00007.
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Mehlman, Kaylee A., Victoria Cho, and Timothy W. Meyers. "The Importance of Electronic Health Record Access For Accurately Completing Drug Regimen Reviews." Senior Care Pharmacist 36, no. 7 (July 1, 2021): 350–56. http://dx.doi.org/10.4140/tcp.n.2021.350.
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Objective: To challenge the standard of practice by evaluating the identification of medication discrepancies found depending on type of access to an electronic health record (EHR). In other words, is there a difference in the number of discrepancies between a pharmacist with only access to the postacute long-term care (PALTC) EHR (ie, single-access pharmacist [SAP]) compared with a pharmacist with access to both the PALTC and hospital EHRs (ie, dual-access pharmacist DAP) In October 2018, the Improving Medicare Post-Acute Care Transformation (IMPACT) Act mandated admission drug review (DRR) upon admission to a post-acute, long-term care (PALTC) facility. Summary: This was a prospective study investigating the occurrence of medication therapy problems (MTP) identified by two different DRR processes; SAP versus DAP. Data were collected in a community hospital and a stand-alone PALTC facility. It was found that the DAP identified more safety-related medication needs and medication omissions than an SAP. There was a significant association between the type of access and whether a MTP (ie, yes or no) was discovered, the type of medication-related need, and MTP category. Conclusion: These results strongly suggest that current standard of practice should change to require access to both hospital and PALTC EHR systems for a pharmacist completing the medication reconciliation. Until the gap in EHR interoperability is closed, the potential breakdown in communication associated with SAP places patients transitioning from hospital to PALTC facilities at increased risk for medication problems and accompanying adverse medication events.
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Mehlman, Kaylee A., Victoria Cho, and Timothy W. Meyers. "The Importance of Electronic Health Record Access For Accurately Completing Drug Regimen Reviews." Senior Care Pharmacist 36, no. 7 (July 1, 2021): 350–56. http://dx.doi.org/10.4140/tcp.n.2021.350.
Full textAbstract:
OBJECTIVE: To challenge the standard of practice by evaluating the identification of medication discrepancies found depending on type of access to an electronic health record (EHR). In other words, is there a difference in the number of discrepancies between a pharmacist with only access to the postacute long-term care (PALTC) EHR (ie, single-access pharmacist [SAP]) compared with a pharmacist with access to both the PALTC and hospital EHRs (ie, dual-access pharmacist DAP) In October 2018, the Improving Medicare PostAcute Care Transformation (IMPACT) Act mandated admission drug review (DRR) upon admission to a postacute, long-term care (PALTC) facility.<br/> SUMMARY:This was a prospective study investigating the occurrence of medication therapy problems (MTP) identified by two different DRR processes; SAP versus DAP. Data were collected in a community hospital and a stand-alone PALTC facility. It was found that the DAP identified more safety-related medication needs and medication omissions than an SAP. There was a significant association between the type of access and whether a MTP (ie, yes or no) was discovered, the type of medication-related need, and MTP category.<br/> CONCLUSION: These results strongly suggest that current standard of practice should change to require access to both hospital and PALTC EHR systems for a pharmacist completing the medication reconciliation. Until the gap in EHR interoperability is closed, the potential breakdown in communication associated with SAP places patients transitioning from hospital to PALTC facilities at increased risk for medication problems and accompanying adverse medication events.