Knowledge Of Medication Safety Research Articles

Medication safety knowledge, attitudes and practices among community pharmacists in Lebanon

Background: The effectiveness of a national post-marketing surveillance program depends directly on the active participation of all health professionals. There is no current comprehensive and active pharmacovigilance program available in Lebanon.Objectives: To assess the knowledge, attitudes, and practices (KAP) among community pharmacists in Lebanon with respect to potential pharmacovigilance and adverse-drug-reaction reporting in Lebanon.Methods: A cross-sectional descriptive study, using a self-administered KAP questionnaire and conducted between March and July 2016, included 1857 pharmacists practicing in community settings. Statistical analysis included χ2 test for dichotomous or multinomial qualitative variables, and Wilcoxon test for quantitative variables with non-homogeneous variances or non-normal distribution.Results: The majority of responders had good knowledge concerning the concept and purpose of pharmacovigilance as well as adverse drug reactions (how to report these/the importance of reporting adverse events/the definition of an adverse event and pharmacovigilance). Concerning community pharmacists’ attitudes and practice towards pharmacovigilance, the majority described having a positive attitude towards their role in adverse drug reaction reporting and this activity was even seen as one of their core duties. The questionnaire revealed a lack of practice and training regarding pharmacovigilance. Nonetheless, the pharmacists agreed on the Order of Pharmacists in Lebanon and the Ministry of Health’s role in promoting this practice and helping them be more involved in reporting adverse drug reactions (ADRs). The pharmacists thought that they are well positioned regarding patient-safety practice in their pharmacies and the results were not statistically different between pharmacy employers and employees.Conclusion: Lebanese pharmacists have the required knowledge and positive attitude to start reporting ADRs, were aware of ADRs occurring with various medicines post-marketing, yet were currently not able to disseminate this information widely or to record it centrally, emphasizing the importance of establishing a national ADR reporting system.

Evaluation of Patient and Family Engagement Strategies to Improve Medication Safety.

Patient and family engagement (PFE) is critical for patient safety. We systematically reviewed types of PFE strategies implemented and their impact on medication safety. We searched MEDLINE, EMBASE, reference lists and websites to August 2016. Two investigators independently reviewed all abstracts and articles, and articles were additionally reviewed by two senior investigators for selection. One investigator abstracted data and two investigators reviewed the data for accuracy. Study quality was determined by consensus. Investigators developed a framework for defining the level of patient engagement: informing patients about medications (Level 1), informing about engagement with health care providers (Level 2), empowering patients with communication tools and skills (Level 3), partnering with patients in their care (Level 4), and integrating patients as full care team members (Level 5). We included 19studies that mostly targeted older adults taking multiple medications. The median level of engagement was 2, ranging from 2-4. We identified no level 5 studies. Key themes for patient engagement strategies impacting medication safety were patient education and medication reconciliation, with a subtheme of patient portals. Most studies (84%) reported implementation outcomes. The most commonly reported medication safety outcomes were medication errors, including near misses and discrepancies (47%), and medication safety knowledge (37%). Most studies (63%) were of medium to low quality, and risk of bias was generally moderate. Among the 11 studies with control groups, 55% (n=6) reported statistically significant improvement on at least one medication safety outcome. Further synthesis of medication safety measures was limited due to intervention and outcome heterogeneity. Key strategies for engaging patients in medication safety are education and medication reconciliation. Patient engagement levels were generally low, as defined by anovel framework for determining levels of patient engagement. As more patient engagement studies are conducted, this framework should be evaluated for associations with patient outcomes.

Medication Safety Simulation to Assess Student Knowledge and Competence

BackgroundMedication administration is an important part of the nurse's role. Students and new nursing graduates often lack knowledge and competency to safely administer medications. Simulation can facilitate student learning about medication safety. PurposeThis simulation intervention study tested the differences in knowledge, competency, and perceptions of medication safety between students who did and did not participate in safety enhanced medication administration simulations. MethodThis was a two-group pretest-posttest design. Participants completed the Medication Safety Knowledge Assessment (MSKA) and the Healthcare Professionals Patient Safety Assessment (HPPSA) pretests at the start of the semester. The control group participated in the usual simulations/debriefings; the intervention group participated in one additional medication administration simulation, as well as medication safety enhanced simulations. During the final simulation of the semester, participants’ competency in medication administration safety was rated using the Medication Safety Critical Element Checklist (MSCEC). All participants completed the MSKA and HPPSA posttests. ResultsData for the MSKA were analyzed using a Knowledge Pass/Fail cut score of 21 correct answers or more to pass. The HPPSA scores were analyzed using t tests and MSCEC between groups scores were compared. There were statistically significant differences in student knowledge (MSKA) and competency (MSCEC) for students who participated in the medication safety enhanced simulations. Conclusions/ImplicationsMedication safety is essential to ensuring patient safety; it is important to ensure that nursing graduates are well-prepared to provide safe care. Outcomes of this study support the evidence that simulation is an effective strategy to improve student learning.

Pharmacy Educators’ Knowledge of Medication Safety and Their Perception Toward Its Integration into the Doctor of Pharmacy Curriculum in Saudi Arabia

Objective. To assess pharmacy educators' knowledge of medication safety and their perception toward its integration into the PharmD curriculum in Saudi Arabia. Methods. A survey was administered to pharmacy educators at a college of pharmacy and its affiliate hospital. Knowledge, training, and perception toward integrating medication safety into the PharmD curriculum were evaluated. Results. More than 50% of respondents indicated that medication safety should be covered within selected courses, and 65% indicated that such courses should be mandatory. Pharmacy practice educators had significantly higher levels of knowledge about medication safety than their nonpractice counterparts. Perceptions toward medication safety integration into the curriculum varied significantly by general discipline, academic degree, years of experience, and gender. Conclusion. Pharmacy educators in Saudi Arabia understand the importance of medication safety and its integration into the curriculum. Further studies are needed to guide curricular change to achieve this integration.

Doing the right things and doing things right: inpatient drug surveillance assisted by clinical decision support

Increased budget constraints and a continuous focus on improved quality require an efficient inpatient drug surveillance process. We describe a hospital-wide drug surveillance strategy consisting of a multidisciplinary evaluation of...

Immigrant Mothers’ Knowledge of Medication Safety and Administration for Young Children

The goals of this paper are to compare immigrant (Southeast Asian and Chinese) and non-immigrant (Taiwanese) mothers’ knowledge of medication safety and administration for children, and to reveal how the accessibility of medical resources could affect immigrant mothers’ medication administration. The medication knowledge and communication ability of immigrants are suggested to be insufficient, which could be the main reason for medication errors. When medical resources can be accessed easily, immigrant mothers’ medication errors may be reduced. A survey with stratified sampling was used. Data were gathered from 643 participants with young children in Taiwan. A researcher-designed questionnaire was used to solicit participants’ responses concerning medication preservation and medication administration. Southeast Asian mothers need the help of doctors or family members; they frequently administer suppositories to febrile children, store children’s medication in the fridge, and pay less attention to the expiry date. Chinese immigrant mothers tend to let children take Chinese medicine, give previously prescribed drugs to sick children, give other children’s medication to sick children, and buy medicines at a pharmacy without a doctor’s prescription. When the participants spend more than 31 minutes travelling to the nearest clinic, they are more likely to misuse medication, such as giving previously prescribed drugs to a sick child, and combining medication with Chinese medicine. The findings of this study suggest that the medication knowledge and administration habits of immigrant and non-immigrant mothers differ. The parents of young children take sick children to seek proper medical treatment when they are able to easily access medical resources.

Baseline Knowledge and Education on Patient Safety in the Ambulatory Care Setting for 4th Year Pharmacy Students

Objectives: To assess the baseline knowledge of fourth year student pharmacists on their ability to properly identify and categorize medication related problems (MRP) during their Advanced Pharmacy Practice Experience (APPE) in the ambulatory care setting, and to assess the efficacy of a written resource designed to educate and train users on identification and documentation of MRP's and used for this purpose with participating students on their ambulatory care APPE.
 Methods: A pretest consisting of ten multiple-choice questions was administered electronically to fourth year student pharmacists (N=18) at the start of their ambulatory care APPE. The test was designed to assess both the students' baseline knowledge regarding MRP's, and their ability to identify a wide variety of medication-related problems. Students then received a written copy of The Medication Therapy Intervention & Safety Documentation Program training manual and were asked to read it in its entirety in the first week of their APPE. Finally, students were given a posttest survey (identical to the pretest) to complete to assess if their knowledge had increased from baseline.
 Results: The average score for the 18 students taking the baseline knowledge pre-test was 63.33%, indicating limited baseline knowledge regarding the identification and classification of MRP's. In assessing the effectiveness of the written training document, the overall posttest results compared to pretest results did not indicate improvement in students' knowledge or ability to properly identify and classify medication related problems (MRP) after reviewing the training manual. The average scores declined from 63.33% on the pretest to 62.78% on the posttest, although this was not found to be statistically significant (p = 0.884). However, a statistically significant decline in students' knowledge occurred on one specific question, which tested their ability to classify MRP's (p = 0.029).
 Conclusions: Based on the results of the pre-test, students at our institution enter their APPE year with limited baseline knowledge of medication safety within the ambulatory care setting. Results from the posttest indicate potential ineffectiveness of a written document in providing effective education on MRP's to students in the experiential setting. Education may be made more effective with a hands-on, active learning approach that overcomes the limitations of other passive forms of learning.
 
 Type: Student Project

A Brief Educational Intervention Improves Medication Safety Knowledge in Grandparents of Young Children.

Background and ObjectivesIncreasing grandparent-grandchild interactions have not been targeted as a potential contributing factor to the recent surge in pediatric poisonings. We hypothesized that in grandparents with a young grandchild, a single educational intervention based on the PROTECT “Up & Away” campaign will improve safe medication knowledge and storage at follow-up from baseline.MethodsThis prospective cohort study validated the educational intervention and survey via cognitive debriefing followed by evaluation of the educational intervention in increasing safe medication storage. Participants had to read and speak English and have annual contact with one grandchild ≤ 5-years-old. Participants were recruited from a convenience sample of employees in a regional healthcare system. They completed a pre-intervention survey querying baseline demographics, poisoning prevention knowledge, and medication storage, followed by the educational intervention and post-intervention survey. Participants completed a delayed post-intervention survey 50–90 days later assessing medication storage and poisoning prevention knowledge. Storage sites were classified as safe or unsafe a priori; a panel classified handwritten responses.Results120 participants were enrolled; 95 (79%) completed the delayed post-intervention survey. Participants were predominantly female (93%) and white (76%); 50% had a clinical degree. Participants averaged 1.9 grandchildren. Initially, 23% of participants reported safe medication storage; this improved to 48% after the intervention (OR 6.4; 95% CI = 2.5–21.0). 78% of participants made at least one improvement in their medication storage after the intervention even if they did not meet all criteria for safe storage. Participants also demonstrated retention of poisoning prevention knowledge.ConclusionsThis brief educational intervention improved safe medication storage and poisoning prevention knowledge in grandparents of young children; further evaluation of this intervention is warranted.

Connective tissue disease in pregnancy

Connective tissue diseases (CTD) include a variety of chronic multisystem disorders with a high percentage of autoimmune conditions. Many of these conditions affect women of childbearing age and, therefore, pregnancy poses an important challenge for doctors looking after such women. Knowledge of medication safety, the effect of pregnancy on such diseases and vice versa, together with preconception counselling and multidisciplinary team care, are the basic pillars needed to provide the best obstetric and medical care to these women. In this review, we discuss the management of the most common autoimmune CTD before, during and after pregnancy, along with the most relevant issues regarding appropriate medication.

The learning experiences of student nurses in pediatric medication management: A qualitative study

Traditionally, the 'five rights' (right patient, right route, right drug, right time, and right dose) principle is taught to be practiced during every medication administration process. Nursing educators use this principle to evaluate student performance. However, health care unit factors and education system characteristics that can contribute to student errors should not be underestimated. Students often felt stressed when medicating children during clinical practicum. The voices of these students are rarely represented. To understand students' experiences and perceptions of medication administration during their pediatric clinical practicum. A descriptive qualitative study design was adopted. A university in Northern Taiwan. A total of 34 undergraduate students who had completed a pediatric clinical practicum participated in a one-on-one interview. Each student was interviewed according to a semi-structured interview guide and was encouraged to disclose individual feelings and thoughts toward their experiences in pediatric medication administration. Eight themes emerged. The findings suggest that to decrease students' anxiety and increase their competence, pediatric instructors should improve their teaching strategies to better prepare students for clinical training. Providing self-directed learning activities and resources to improve students' familiarity with medication and medication safety knowledge is necessary. Instructors should provide students with a secure environment to discuss their medication errors. The 'nine rights' should be taught in fundamental nursing courses to enhance students' awareness during the medication administration process, and students should continue to practice the 'nine rights' in later pediatric clinical courses. Equal importance should be given to system failures that impact patient safety.

Effect of Barcode-assisted Medication Administration on Emergency Department Medication Errors

Barcode-assisted medication administration (BCMA) is technology with demonstrated benefit in reducing medication administration errors in hospitalized patients; however, it is not routinely used in emergency departments (EDs). EDs may benefit from BCMA, because ED medication administration is complex and error-prone. A naïve observational study was conducted at an academic medical center implementing BCMA in the ED. The rate of medication administration errors was measured before and after implementing an integrated electronic medical record (EMR) with BCMA capacity. Errors were classified as wrong drug, wrong dose, wrong route of administration, or a medication administration with no physician order. The error type, severity of error, and medications associated with errors were also quantified. A total of 1,978 medication administrations were observed (996 pre-BCMA and 982 post-BCMA). The baseline medication administration error rate was 6.3%, with wrong dose errors representing 66.7% of observed errors. BCMA was associated with a reduction in the medication administration error rate to 1.2%, a relative rate reduction of 80.7% (p < 0.0001). Wrong dose errors decreased by 90.4% (p < 0.0001), and medication administrations with no physician order decreased by 72.4% (p = 0.057). Most errors discovered were of minor severity. Antihistamine medications were associated with the highest error rate. Implementing BCMA in the ED was associated with significant reductions in the medication administration error rate and specifically wrong dose errors. The results of this study suggest a benefit of BCMA on reducing medication administration errors in the ED.

Pharmacists as an Underutilized Resource for Improving Community-Level Support of Breastfeeding

With their highly visible roles in the community, frequent interactions with soon-to-be and new parents, and knowledge of medication safety, pharmacists can be a key component in breastfeeding promotion and support. A review of the literature showed that pharmacists have poor knowledge but positive attitudes toward breastfeeding and that pharmacy practices are variable and mostly guided by personal experience. A review of 58 health professional organizations' English-language infant feeding/breastfeeding policy statements showed that no US pharmacists' association has a position statement, as exists for professional pharmacist organizations in Canada and Australia. We explored pharmacists' interactions with mothers before and after birth and possible opportunities to expand pharmacists' roles in the promotion and support of breastfeeding. Barriers to meeting unmet needs of breastfeeding mothers were identified in order to plan strategies for implementing programs to address these barriers. Through input obtained from pharmacy and breastfeeding experts and from information available in the published literature, good matches between unmet needs and capabilities were identified in (a) provision of health promotion resources and public awareness campaigns, (b) assistance with purchase of breastfeeding products and pumps, and (c) provision of information, support, and referral related to commonly encountered difficulties as well as medication use during lactation. Absence of adequate breastfeeding knowledge was identified as a crucial barrier. Leveraging pharmacists to address unmet preventive health needs is especially important as we strive to align resources to support healthy behaviors in our current health care delivery environment.

The Impacts of using community health volunteers to coach medication safety behaviors among rural elders with chronic illnesses

It is a challenge for rural health professionals to promote medication safety among older adults taking multiple medications. A volunteer coaching program to promote medication safety among rural elders with chronic illnesses was designed and evaluated. A community-based interventional study randomly assigned 62 rural elders with at least two chronic illnesses to routine care plus volunteer coaching or routine care alone. The volunteer coaching group received a medication safety program, including a coach and reminders by well-trained volunteers, as well as three home visits and five telephone calls over a two-month period. All the subjects received routine medication safety instructions for their chronic illnesses. The program was evaluated using pre- and post-tests of knowledge, attitude and behaviors with regard to medication safety. Results show the volunteer coaching group improved their knowledge of medication safety, but there was no change in attitude after the two-month study period. Moreover, the group demonstrated three improved medication safety behaviors compared to the routine care group. The volunteer coaching program and instructions with pictorial aids can provide a reference for community health professionals who wish to improve the medication safety of chronically ill elders.

Expanding pharmacists' roles in breastfeeding support: A pilot study of an online breastfeeding tutorial for student pharmacists

ObjectivesA 2011 report to the US Surgeon General by the US Public Health Service Chief Pharmacist provides rationale and a compelling discussion to support health reform through pharmacists delivering expanded patient care services. With their highly visible role in the community, frequent interactions with soon-to-be and new parents, and knowledge of medication safety, pharmacists can be a key component in the promotion and support of breastfeeding, an important, and underutilized health behavior. This expanded role in breastfeeding support would be consistent with the pharmaceutical care concept. Exposing student pharmacists to breastfeeding information beyond traditional medication and lactation information can facilitate the early shaping of their attitudes and understanding. MethodsWe created and pilot-tested an online tutorial that complements existing medication–lactation education at three schools of pharmacy. A survey was conducted to understand pharmacy students' attitudes regarding their roles in infant feeding. ResultsAfter the online tutorial, student pharmacists most commonly expressed moderate confidence in answering questions that parents have on breastfeeding (47% moderately confident, 39% extremely or very confident, and 14% not very or not at all confident) and on introducing solid foods (41% moderately confident, 35% extremely or very confident, and 24% not very or not at all confident). Almost all student pharmacists felt they had an important role in providing breastfeeding information and support. ConclusionsLeveraging pharmacists to address unmet preventive health needs is especially important in our current health care delivery environment. A short online tutorial is a feasible mechanism for expanding student pharmacist awareness about breastfeeding.

Establishing the Medication Safety Research Network of Indiana (Rx-SafeNet): Perspectives of Community Pharmacy Employees.

The objective of this cross-sectional survey was to determine community pharmacy employee research project priorities and assess interest levels, barriers, and facilitators to joining a new community pharmacy practice-based research network (PBRN) and use this information in subsequent PBRN development. One hundred forty pharmacists and 40 support staff responded. The majority (72%) of respondents were somewhat interested or needed more information to determine their level of interest in joining a PBRN; 15% were very interested. While all research topics were regarded as important, dispensing errors were rated as the most important. Time constraints were considered the greatest barrier to participation. Greater knowledge of medication safety, enrichment of patient care, and improved patient and provider relationships were considered important reasons for joining a PBRN. Responses indicated favorable interest levels and project support from potential network members, though education and awareness campaigns are needed to enhance community pharmacy employee understanding of and involvement in research and PBRNs, specifically the Medication Safety Research Network of Indiana (Rx-SafeNet), a new network administered by the Purdue University College of Pharmacy. While the generalizability of survey results is limited, they were useful in determining policies and procedures of the new network. Surveying all employees involved in the future PBRN during the network development process is a unique approach to developing these types of networks in the U.S. Understanding support staff perspectives is important considering the critical role they play in project implementation and operations. Emerging PBRNs from any discipline may benefit from considering adding this step to their development.

Creative Strategies to Improve Patient Safety

Approximately 770,000 Americans are hospitalized and suffer adverse drug events (ADEs) costing billions of dollars each year. An ADE occurs when a patient is injured by an adverse drug reaction. Improved medication administration could prevent about 2.5 million ADEs (Institute of Medicine, 2004). This project provided an education for patients and nurses and a medication fact sheet. Outcomes included updating allergy records, improving medication safety knowledge, and improving nurses' adverse drug reactions and allergy reports.

Perceptions of medication safety among patients with inflammatory bowel disease

Objective. The aim of this study was to assess attitudes towards and knowledge of medication safety in inflammatory bowel disease (IBD). IBD patients frequently require long-term treatment with potentially toxic medications. Techniques are employed to improve patient awareness of medication safety, but there are sparse data on their effectiveness. Material and methods. Questionnaires relating to the safety and efficacy of commonly used IBD treatments (aminosalicylates, corticosteroids, immunomodulators, biologics) were completed by IBD patients attending the gastroenterology clinics at a teaching hospital. Results. One hundred patients (51 male) with a median (interquartile range) age of 37 (29–49) years were included: 56 Crohn's disease, 44 ulcerative colitis. Aminosalicylates (median 0.8 (IQR 0.1–1.9)) were ranked as the safest medication; corticosteroids (4.6 (1.1–8.2)), immunomodulators (4.2 (1.1–8.4) and biologics (4.4 (1.1–6.8)) were ranked equally. 36%, 53% and 79% reported no knowledge regarding safety of corticosteroids, immunomodulators and biologics, respectively. Most patients wish to be informed of all medication side-effects, no matter how rare, and ranked their gastroenterologist as their primary information source. Conclusions. IBD patients want to be informed of all potential adverse events and identify their gastroenterologist as their principal information source. The majority have no knowledge regarding or underestimate the toxicity of common IBD medications. This places a responsibility on gastroenterologists to manage and meet patients' expectations in the area of medication safety.