Safe Medication Management Research Articles

Intellectual disability nurses' challenges in medication management in primary health care: A qualitative study.

This study examines how intellectual disability nurses employed in residential living services for persons with intellectual disabilities, in Norway, deal with medication management for these individuals. Using a qualitative study, a total of 18 intellectual disability nurses were interviewed as part of four focus groups. The results demonstrate six main challenges: First, Being alone with the responsibility of medication management - a challenge; Second, The need for further competence development; Third, Teaching and supervising unskilled colleagues in safe medication management; Fourth, Interpreting residents with little or only nonverbal communication; Fifth, The need to act as advocates when residents require hospitalization; Sixth, Deficient systems for medication management on several levels. The findings point to several major flaws in the system of medication management, which necessitates the need for highly qualified intellectual disability nurses. Managers must ensure that there is a secure system to mitigate errors and promote patient safety.

1067-P: The Association between Appointment Modality and Medication Management Discussions in High-Risk Older Adults with Type 2 Diabetes

In older adults with type 2 diabetes (T2D), treatment with sulfonylureas (SUs) or insulin is associated with increased risk for severe hypoglycemia leading to falls, cognitive decline, lower quality of life, and death. Safe medication management in older adults requires effective and ongoing doctor-patient communication about self-management, glucose control, and other factors associated with hypoglycemia. In recent years, health care systems have increasingly relied on virtual appointments for chronic disease management. However, research has suggested that at-risk older populations may be less comfortable navigating these virtual spaces. We tested the hypothesis that older adults with T2D on SUs or insulin would be less likely to have conversations with their doctor about changes to diabetes medications during virtual visits (e.g., by video or telephone). Using data from an ongoing clinical trial (NCT04585191), we examined the association of visit modality with patient-reported medication discussions during the visit. We studied 180 Kaiser Permanente Northern California members (age = 81.1±3.8 years, Hba1c = 7.0±0.6%, 56% women, 73% on SUs). Visit modalities included in-person (n = 110, 61%), video (43, 24%), or telephone (27, 15%) appointments with their primary physician. We found that self-reported diabetes medication discussion did not differ by visit modality (48% vs. 44% vs 41%, p = 0.79). These results were unchanged after adjusting for demographic and clinical variables in a logistic regression model (p = 0.82). Qualitative analysis of open-ended surveys found that most adults (59/85, 69%) who engaged in these conversations considered them to be positive experiences that increased confidence in their treatment plan and satisfaction with their physician. Our results suggest that the ongoing expansion of virtual visit options does not deter older adults from discussing diabetes care with their doctor. Disclosure S.Degrace: None. I.Peterson: None. C.Board: None. R.W.Grant: None. Funding Patient-Centered Outcomes Research Institute (CDR-2019C1-16126)

Healthcare professional’s knowledge and awareness of the medication error reporting systems in the Kuwaiti hospitals

Abstract Objective. A survey was conducted to explore healthcare professional’s (HCPs) knowledge and attitude towards medication errors reporting processes and systems used in their local hospitals. Methods. There were 696 respondents and the observational survey showed the diverse perspectives of HCPs from diverse professions (doctors, pharmacists and nurses) who are at different stages in their career. The survey results highlighted the deficiencies in the medication safety management process, including the follow-up on witnessed or discovered medication errors, the effectiveness of the used reporting systems for medication errors, the standardisation of electronic prescribing software, and the training of HCPs at the six hospitals on medication safety. Key finding. Only 46% of the surveyed stated that their hospital had a mechanism in place for reporting medication errors and 60.7% of the participants agreed that they would submit reports provided the system is not used for performance management and only those need to know will be able to identify their name. Regarding prescription writing, 51% of surveyed HCPs said they utilise electronic prescribing software; however, the overall usage rate of electronic prescribing systems was 49%, with handwritten prescriptions remaining the option used in the majority of the time. In terms of HCP training, 20% of the survey respondents said they did not receive any instruction or direction in the hospitals on pharmacovigilance and patient safety. Conclusions. The Kuwaiti MoH should build a national electronic incident reporting system and establish standardised rules and protocols for incident reporting that is to be anonymous and of compulsory use by all government and private hospitals.

Toxicities associated with sacituzumab govitecan: Data from clinical trials and real-word pharmacovigilance database.

e24093 Background: This study aimed to analyze the adverse effect of sacituzumab govitecan (SG) with multiple source data, to provide reference for clinical medication safety management. Methods: Clinical trials of SG with available safety data were searched and included in the pooled analysis (up to January 5th, 2023). The adverse drug reaction (ADR) signals of SG were collected from the FDA Adverse Event Reporting System (FAERS) database up to January 1st, 2023. The ADR signals were presented and sorted by incidence frequency and reporting odds ratio (ROR) strength, respectively. We also searched and summarized drug interactions with SG in DDInter database. Results: A total of 6 clinical trials enrolled 1737 patients were included in pooled analysis, the most common adverse events of ≥3 grade were neutropenia (51.55%), leukopenia (14.50%), anemia (10.69%), diarrhea (7.30%), fatigue and asthenia (4.23%). In pharmacovigilance study, 1024 AE reports were extracted, the most common toxicities of SG are hematologic and gastrointestinal. AEs not included in the instructions also showed high signals, such as meningitis, colitis and lymphedema. A total of 40 drugs identified can induce drug-drug interaction when concomitant administration with SG. Conclusions: This study provides a comprehensive profile of SG based on clinical trial, FRAES and DDInter database, attention should be paid not only to the common ADRs, but also to the ADRs not reported in the drug instructions and potential drugs that induce drug-drug interactions. [Table: see text]

Self-Management and Its Predictors in adult Patients with Epilepsy: A Cross-Sectional Study.

Appropriate self-management (SM) is crucial in controlling epilepsy and improving self-efficacy, medication adherence and avoidance of seizure triggers in patients with epilepsy (PWE. The aim of this study was to evaluate SM and its predictors among adult PWE in Iran. This cross-sectional study was conducted in 2021. The participants were 335 adult PWEs that were selected from healthcare settings in Hamadan, Iran. Epilepsy Self-Management Scale (ESMS) was used to measure patients' self-management behaviors. Data were analyzed using the independent samples t-test, Pearson's and Spearman's correlation analyses and multiple linear regression analysis. The mean score of SM was 114.37±11, indicating moderate level of SM, and the mean scores of SM in the medication management, seizure management, and safety management subscales were significantly more than the mean scores of the other subscales (P < 0.05). Age, place of residence, marital status, seizure type, seizure frequency, and epilepsy duration significantly predicted 53% of the variance of SM (adjusted R square = 0.532). PWEs have moderate SM and need SM-related education, particularly about lifestyle management and information management. Predictors of SM should be considered to boost SM practice.

Exploring the pharmacological and adverse reaction mechanism of a drug by network pharmacology strategy: Using colchicine to treat Behcet syndrome as an example

Colchicine (COLC) is a natural alkaloid used to treat Behcet syndrome (BS), but its adverse reactions limit its clinical application in treating BS. However, the adverse reaction mechanism of COLC in the treatment of BS remains unclear. Herein, a network pharmacology-based strategy was designed to analyze the pharmacological and adverse reaction mechanism of COLC in treating BS. The biological functions of COLC and BS pathogenesis were analyzed through a series of network construction and analysis. The data above predicted the pharmacological and adverse reaction mechanism of COLC in BS treatment. The pharmacological mechanism of COLC against BS was predicted to control inflammatory responses. Interleukin-8, interleukin-18, integrin alpha-4, integrin beta-2, and tubulin targets are crucial in treating BS. The adverse reactions of COLC in BS treatment were predicted as neurotoxicity and hepatotoxicity. The mechanism of hepatotoxicity may be related to the decrease of cytochrome P450 family 3 subfamily A activity caused by various factors, such as poor hepatic function, the dosage of COLC, and combination with inhibitors. The mechanism of neurotoxicity may be related to the disruption of microtubules in the nervous system by COLC transport across the blood-brain barrier. This study provided basic evidence for the medication safety management of COLC used in treating BS. Moreover, this study demonstrated that it is feasible to analyze the adverse reaction mechanisms of drugs using a network pharmacology strategy, which facilitates systematic drug safety management and evaluation.

Caring for two in the ICU: Pharmacotherapy in the critically ill pregnant patient.

Safe and thoughtful medication management of pregnant patients requiring intensive care unit (ICU) level of care is key to optimizing outcomes for both mother and fetus. Pregnancy induces physiologic alterations that closely mirror the changes expected in a critically ill patient. These changes can be predictable depending on the gestational age and trimester and will directly impact the pharmacokinetic profile of medications commonly used in the ICU; examples include decreased gastric emptying, increased blood and plasma volume, increased glomerular filtration, and increased cardiac output. When pregnant patients require ICU care, the resulting impact on drug absorption, distribution, metabolism, and elimination can be difficult to predict. In addition, there are many nuances of medication metabolism and interface with the placental barrier that should be considered when selecting pharmacotherapy for the pregnant patient. Critical care clinicians need to be aware of medication interactions with the placenta and weigh the risk versus benefit profile of medication use in this patient population. Obstetric critical care admissions have increased over the years, especially during the coronavirus waves. Therefore, understanding the interplay between pregnancy and critical illness to optimize pharmacotherapy selection is crucial to improving health outcomes of mother and fetus. This review highlights pharmacotherapy considerations in the pregnant ICU patient for the following topics: physiologic alterations, categorizing medication risk, supportive care, sepsis, cardiogenic shock, acute respiratory distress syndrome, and venous thromboembolism.

Challenges and responsibilities in the medication management process in 24/7 group housing services for adults with intellectual disability: Interviews with nurses.

Staff in 24/7 group housing services for adults with intellectual disability are responsible for ensuring safe medication management processes and supporting the residents in their health-related issues. Ten interviewed nurses reported several challenges in the medication management process emerging at the staff level, the level of the group home, and the level of the social and healthcare system, and were often related to issues in communication and responsibility. They reported a variety of complex tasks in the medication management process, for which they need a multiple skill set. They also act as healthcare advocates for residents, but healthcare services do not always match residents' needs. Training for social and healthcare professionals, access to healthcare services and the collaboration of social and healthcare services should be improved to provide the people with intellectual disability the best possible pharmacotherapy and healthcare.

Exploring Australian pharmacists' perceptions and practices towards reducing the risk of medicines-related harm in aged care residents.

Background: Older people living in residential aged care facilities frequently experience medicines-related harm. Evidence regarding the perception and practices towards reducing these harms may facilitate the development of customised educational programs for pharmacists providing services in RACFs. Objective: To explore Australian pharmacists' opinions and practices towards reducing the risk of medicines-related harm in aged care residents. Methods: An online survey was developed based on a literature review, expert opinion, and feedback from pharmacists providing services in RACFs. A web link for the survey was shared via professional pharmacy organisations and social media groups with Australian pharmacists providing services in RACFs. Results: A total of 209 pharmacists participated in the survey. Of these, 76% (n = 158) were residential medication management review embedded pharmacists, and 24% (n = 51) were supply pharmacists for RACFs. Most pharmacists believed that medicines-related harm is common in residents (n = 174, 83%), yet few agreed that pharmacists have enough time to participate in medicines-related harm reduction services (n = 60, 28%). There was a high level of agreement regarding the key risk factors (e.g., inappropriate medicines, anticholinergic drug use, and transitions of care) and potential strategies (e.g., embedded pharmacists in RACFs, educating aged care staff, and collaborative pharmacist-led medication reviews) for reducing medicines-related harm in residents. Conclusion: Pharmacists agreed that older residents often experience medicines-related harm, but they did not frequently participate in medicines-related harm reduction services. Initiatives to engage pharmacists in team-based harm reduction services and educate aged care staff regarding safe medication management may improve residents' safety and health outcomes.

Assessing the challenges to medical waste management during the COVID-19 pandemic: Implications for the environmental sustainability in the emerging economies

Emerging economies are struggling with proper and efficient management of waste due to their constrained resources and weak management. In recent days, this crisis has worsened due to the outbreak of the highly contagious COVID-19 pandemic. To avoid building up stockpiles and contaminating communities with potentially contagious medical waste (MW), and to ensure sustainability in the current and post-COVID-19 era, it is a dire need to develop and implement a safe and efficient medical waste management (MWM) system. This research, thereby, aims to identify, assess, and prioritize the key challenges to efficient and sustainable MWM to mitigate the impacts of the disruptions caused by situations like the pandemic in emerging economies. An integrated approach consisting of the Best-Worst Method (BWM), Interpretive Structural Modeling (ISM), and Cross-Impact Matrix Multiplication Applied to Classification (MICMAC) has been proposed to achieve the objectives. Based on the literature review and expert feedback, a total of seventeen challenges were identified and later prioritized by using BWM. The top twelve challenges have been further analyzed using ISM-MICMAC to examine their interrelationships. This study reveals that lack of proper law enforcement and insufficient financial support from investors and the government are two crucial challenges for efficient MWM implementation. The research insights can assist healthcare facility administrators, practitioners, and city managers in identifying the associated challenges and shaping strategic decisions for establishing and managing efficient MWM systems to ensure sustainable development in the post-COVID-19 era.

Polypharmacy: An Overview

Polypharmacy is a growing public health problem which is affecting multitudes worldwide. This emerging public health problem is defined as the routine use of five or more medicines by an individual patient. Many researchers believe that the prevalence of polypharmacy is going to keep increasing since more people are being diagnosed with chronic diseases. Polypharmacy is known to cause many problems such as adverse drug reactions, drug to drug interactions, wastage of resources and increased treatment costs. Countries should raise awareness of polypharmacy and find solutions to this problem. Healthcare professionals should be educated on the dangers of polypharmacy, medication safety and polypharmacy management. Polypharmacy management means a whole systems approach which avoids the use of unnecessary medication for multimorbid patients while maximizing pharmaceutical care. There is ongoing research to investigate polypharmacy because very little is known in the existing literature. This article describes polypharmacy in detail, including the prevalence of polypharmacy, the economic impact of polypharmacy, medication safety and polypharmacy management. This article aims to give a much deeper insight into polypharmacy.

Unapređenje procedura za skladištenje medicinskog otpada

Medical waste is all waste generated by healthcare institutions related to the performance of medical-technical actions in the field of diagnostics, therapy, or research activities. The adequate disposal of medical waste is an issue for virtually all Southeastern European countries primarily because these countries lack the necessary capacities for removing medical waste. The paper aims to review the results and experiences of treating medical waste, as well as the potential risks to patients and medical and non-medical personnel. Implementing a safe medical waste management system could significantly improve the quality of healthcare services and the health of patients, and preserve the environment. The use of steam sterilization has been suggested to reduce the content of biological agents in the waste to an acceptable level by thermal treatment, that is, to achieve biological inactivation.

Research progress on drug-related falls in the elderly

Falls are the leading cause of injury death in the elderly, and medication is one of the important adjustable factors that cause falls in the elderly. Strengthening medication management is of great significance to reduce the incidence of falls in the elderly. This paper systematically reviews the relevant literature from three aspects: the types of fall-related drugs in the elderly, the fall risk assessment scale and the prevention of drug-related falls, in order to provide a theoretical basis for the safe medication management of the elderly, improve the safety of medication in the elderly, and reduce the occurrence of drug-related falls.

Current Status on Medical Radiation Safety Management in Asia: A Questionnaire Survey

Current Status on Medical Radiation Safety Management in Asia: A Questionnaire Survey

Application of an Internet of Medical Things (IoMT) to Communications in a Hospital Environment

IoT technology is used in various industries, including the manufacturing, energy, finance, education, transportation, smart home, and medical fields. In the medical field, IoT applications can provide high-quality medical services through the efficient management of patients and mobile assets in hospitals. In this paper, we introduce an IoT system to the medical field using Sigfox, a low-power communication network for indoor location monitoring used as a hospital network. A proof-of-concept (PoC) was implemented to evaluate the effectiveness of medical device and patient safety management. Specific requirements should be considered when applying the IoMT system in a hospital environment. In this study, the location and temperature of various targets sending signals to the monitoring system using three different networks (Sigfox, Hospital and Non-Hospital) were collected and compared with true data, the average accuracy of which were 69.2%, 72.5%, and 83.3%, respectively. This paper shows the significance in the application of an IoMT using the Sigfox network in a hospital setting in Korea compared with existing hospital networks.

Establishment of a medical device adverse event management system for hospitals

BackgroundThe management of medical device adverse event (MDAE) is one of the most important aspects of improving medical quality and safety management. Nonetheless, hospitals still lack standardized and unified initiatives to improve MDAE management.MethodsThis study, thus, established a MDAE monitoring system on May 1 in 2011 for suspected adverse events and designed a hospital-based dynamic warning system, aiming to standardize the process of MDAE handling and provide real-time monitoring for MDAEs in a hospital. This system was used in the First Affiliated Hospital of Zhejiang University School of Medicine. Numbers and the compound growth rate of MDAE reports from 2010 to 2020 were compared to test the effectiveness of the MDAE monitoring system. Numbers of MDAE reported to the National Adverse Event Monitoring System were also compared over 2013 to 2020, due to the loss of data before 2013 after shutdown of the old system. Efficacy and usability of the hospital-based dynamic warning system was then verified by analyzing risk and warning levels of MDAEs in 2020. Descriptive statistics was used for data analysis in this study.ResultsResults showed that the compound annual growth rates of MDAE reports and those submitted to the National Adverse Event Monitoring System from 2013 to 2020 were 35.0% and 31.5%, respectively. A standardized management of MDAE with full participant, timely response and effective feedback was formed in the hospital by establishment of the MDAE system.ConclusionsThis system effectively improved the monitoring level of MDAEs, helping to improve early detection, early warning, and early intervention of risk of medical device. This study may provide suggestions for medical institutions to establish a MDAE monitoring system, and may promote development of medical quality and safety management for hospitals to some extent.

Communication about medication management during patient–physician consultations in primary care: a participant observation study

ObjectiveTo explore communication about medication management during annual consultations in primary care. Design: passive participant observations of primary care consultations.SettingTwo primary care centres in southern Sweden.ParticipantsConsultations between 18 patients (over...

Ethics of Resident Involvement in Surgical Training

INTRODUCTION: An attending surgeon must maintain a balance between allowing appropriate resident independence while ensuring safe medical management of the patient. This pilot investigation aims to characterize these conflicts within an ethical framework by qualitative analysis of opinions of active teaching physicians and residents in the field. We hypothesize that the ethical principles of patient autonomy, physician beneficence, and justice/equal opportunity can be applied to organizing the themes and opinions that will be provided by study participants. METHODS: After IRB approval, attending physicians and residents from 3 Accreditation Council for Graduate Medical Education–approved institutions were invited to participate in our pilot study. Participation involves completion of an anonymous, peer-revised online survey, structured to characterize the ethical foundations of surgical teaching from the perspective of both teachers and trainees. The survey answers and general demographics are transcribed and coded for quantitative and qualitative analysis. RESULTS: This study is currently ongoing. In preliminary findings, we have identified particular reluctance in providing autonomy to residents when caring for vulnerable populations (ie children, oncology). The importance of disclosure and informed consent has also been a recurring theme. CONCLUSION: Although surgical residents may measure the success of their training on their level of intraoperative independence, we have identified that intraoperative autonomy afforded to the resident does not only depend on their objective skill or experience. There are complex ethical considerations that the attending surgeon must navigate as they decide on appropriate, effective teaching and safe surgical management, which is especially relevant when vulnerable patient populations are involved.

Self-reported unsafe medication behaviour among clinical nurses in China: A nationwide survey.

Unsafe medication behaviour was the direct cause of medication error, while the current status of unsafe medication behaviour among Chinese clinical nurses remains uncertain. To investigate unsafe medication behaviour among Chinese nurses and to analyse its associated factors. A cross-sectional online study was conducted in 31 provinces and municipalities of mainland China. The electronic self-administered questionnaire was used to collect data from July-August 2020, including demographic information (age, gender, initial degree, ultimate education degree, hospital levels, unit nature, professional position, duty, departments, working years and working regions) and an adapted nurse unsafe medication behaviour scale measuring self-reported nurse unsafe medication behaviour (SR-NUMB). A generalized linear mixed model was applied to determine the influencing factors. A total of 10,153 Chinese nurses responded online, and 7,873 responses that met the time control requirements were included finally. It turned out that 80.49% of Chinese nurses had SR-NUMB. Specifically, 72.81% of them had unsafe medication behaviours in the process of medication administration, followed by medication monitoring (53.09%), medication preservation and dispensing (47.42%), and medical order processing (44.53%). A generalized linear mixed model demonstrated that male nurses and nurses who work in secondary hospitals or general hospitals, those who have higher professional positions or duties, those who have been working for 5-10 years, and those who are working in emergency and intensive critical units may have higher level of SR-NUMB compared to other nurses. Suboptimal SR-NUMB among Chinese nurses was identified in our findings. Associated factors, such as gender, hospital levels, unit nature, professional position, duty, working years and departments, should be targeted in future prevention and intervention efforts for safe medication management among Chinese nurses.

Understanding the Use of Pharmacological Knowledge Base Tool Use for Safe Medication Management

Understanding the Use of Pharmacological Knowledge Base Tool Use for Safe Medication Management