Medication Administration Time Research Articles

Exposición laboral a citostáticos en el equipo de enfermería de atención primaria

IntroductionCytostatic drugs are classified as potentially dangerous to health when handled. Methotrexate is a cytostatic and immunosuppressive drug increasingly used in primary care for the treatment of various rheumatological and dermatological problems. Therefore, those workers, such as nurses, who may be exposed to these risks, as a consequence of their professional work must be observed. ObjectivesDescribe the management and exposure of methotrexate in the primary care nursing team of Orihuela Health Department, Spain. MethodologyIt corresponds to a descriptive observational study, carried out in the period from April 1 to 25, 2023. An observation guide was applied during a direct visit with nursing and following the recommendations of the current protocols for the management and exposure to cytostatics. Sampling was non-probabilistic for convenience. The sample size was calculated based on the nursing staff by estimating a proportion considering 7 health care areas and 31 auxiliary offices. As an inclusion criterion, a minimum of one year's experience in the administration of medication in the units under study was taken into account. ResultsOf a total of 124 nurses who provide services in primary care at the Orihuela Health Department, a total of 66 nurses participated. The mean age was 37.34 (SD 12.66). Two groups of nurses were created according to basic health zones with inhabitants of more than 25,000 or less than 25,000. It was considered that the Health Planning of the Territory in the autonomous communities of the Information System defined by Royal Decree 137/1984 of 22, on basic health structures for the improvement of Primary Care. In the observation guide, the lowest values were obtained in the evaluation/information of the patient regarding the management and exposure of methotrexate in the nurses. All nurses in both groups successfully applied the 5 rights of medication administration (route, dose, time, patient, and medication) for the safe management of methotrexate. ConclusionThe results obtained in our research highlight the need to describe the management and exposure of methotrexate in the nursing team and the relevance of seeking methods to improve knowledge and skills. In this sense, this study could, through the observation guide used, improve the management and exposure to methotrexate in the primary care nursing team and avoid unnecessary risks that can have serious consequences for nurses and patients.

Improving Medication Management for Inpatients with a Secondary Diagnosis of Parkinson Disease.

Patients who have Parkinson disease require individualized medication regimens to optimize care. A review of the medication management of patients admitted to a tertiary care hospital with a secondary diagnosis of Parkinson disease found significant departures from the patients' home regimen. Medication regimens are often altered by health care teams unfamiliar with Parkinson disease-specific care in order to conform to standard hospital medication orders and administration times, potentially resulting in increased patient falls, delirium, and mortality.A nurse-led multidisciplinary team consisting of pharmacy, nursing, informatics, neurology, and quality personnel implemented a quality improvement (QI) project between July 2020 and July 2022 to identify patients with Parkinson disease, including those with a secondary diagnosis and those undergoing deep brain stimulation, and customize medication management in order to reduce length of stay, mortality, falls, falls with harm, and 30-day readmissions. The QI project team also evaluated patient satisfaction with medication management.Among patients with a secondary diagnosis of Parkinson disease, the proportion who had medication histories conducted by a pharmacy staff member increased from a baseline of 53% to more than 75% per month. For all patients with Parkinson disease, those whose medication history was taken by a pharmacy staff member had orders matching their home regimen 89% of the time, whereas those who did not had orders matching the home regimen only 40% of the time. Among patients with a secondary diagnosis of Parkinson disease, the length-of-stay index decreased from a baseline of 1 to 0.94 and observed-to-expected mortality decreased from 1.03 to 0.78. The proportion of patients experiencing a fall decreased from an average of 5% to 4.08% per quarter, while the proportion of patients experiencing a fall with harm decreased from an average of 1% to 0.75% per quarter. The rate of 30-day readmissions decreased from 10.81% to 4.53% per quarter. Patient satisfaction scores were 1.95 points higher for patients who had medication histories taken by pharmacy than for those who did not (5 versus 3.05).

Medication incidents associated with the provision of medication assistance by non-medical care staff in residential care facilities.

The shift towards community-based care in Japan has led to increased medication assistance for older people by non-medical care staff. These staff members help take pre-packaged medications, apply patches, and administer eye drops. This study assessed the risks associated with such assistance by reviewing medication-related incidents across 106 residential care facilities between April 1, 2015, and March 31, 2016. An analysis of incident reports showed that all incidents were minor, with no serious outcomes. The incidents were categorized into four types: dropped drugs, misdelivery/misuse of medicines, forgetting to take medicines, and loss of medicines, with dropped drugs being the most frequent. Most incidents occurred in the morning and primarily involved residents with intermediate nursing care needs. These findings indicate a low risk of serious incidents because of medication assistance from non-medical staff. However, the frequency and nature of the incidents were influenced by the timing of medication administration and the care needs of the residents. These insights highlight the need for customized approaches to medication assistance, considering the residents' care levels and potentially optimizing medication administration times to improve safety in residential care settings.

Decreasing Nonemergent Nurse Interruptions During Peak Medication Administration Time Utilizing "The Golden Hour".

Decreasing Nonemergent Nurse Interruptions During Peak Medication Administration Time Utilizing "The Golden Hour".

Evaluation of a Pharmacist-Led Implementation of Standardized Medication Administration Times for Inpatients Receiving Hemodialysis.

Missed medication doses are a common and often preventable medication-related error that have been associated with an increased length of stay and mortality. Hemodialysis is a common, relatively predictable reason that patients are unavailable, resulting in missed doses. To evaluate the implications of a pharmacist-led intervention to standardize the medication administration times for patients requiring hemodialysis who were prescribed antihypertensives, antiepileptics, apixaban, and/or antimicrobials. A retrospective preanalysis and postanalysis of a pharmacist-led intervention were performed at a single-center, safety net hospital. Patients receiving dialysis and prescribed one of the targeted medications were included. The primary endpoint was the composite of missed and delayed doses. A total of 25 patients receiving 126 dialysis sessions in the preintervention group and 29 patients receiving 80 dialysis sessions in the postintervention group were included for analysis. For the primary endpoint, 118 (18%) versus 57 (9.3%) doses were missed or delayed in the preintervention versus postintervention group, respectively (P < 0.001). The primary endpoint was driven by fewer delayed doses in the postgroup. The number of antimicrobials given on a correct schedule increased in the postintervention group (98.3% vs 99.1%, P = 0.044). A pharmacist-led intervention for standard medication administration times in patients requiring hemodialysis increased the number of prescribed medication doses given and given on time. The intervention also led to more antimicrobials administered at appropriate times relative to dialysis sessions.

Timing of diuretic administration effects on urine volume in hospitalized patients.

Importance: Some medications have effects that depend on the time of day they are given. Current knowledge of the time-of-day effects of specific medications in hospitalized patients with cardiovascular disease is very limited. In hospitalized patients, increased medication efficiency might reduce dose (and associated side effects) and/or the length of time in the Intensive Care Unit (ICU) or hospital-potentially improving patient outcomes and patient and family quality of life and reducing financial costs. We studied whether the time of day or night patients in Cardiac or Intensive Care Units receive a diuretic affects urine volume. Methods: In this observational study, data were collected from 7,685 patients (63% male, 18 to 98 years old) admitted to one hospital's Acute Care Cardiac units, Cardiac ICUs, Cardiac Surgery ICUs, and/or Non-cardiac ICUs who received intravenous furosemide (a diuretic), had measurements of urine volume, were hospitalized for ≥3days between January 2016 to July 2021 and were older than 18years. The outcomes of interest were urine volume normalized by the most recent (not older than 24h) weight or body mass index (BMI), (i) in the hour after the time of diuretic administration, and (ii) when no diuretics were administered for the previous 3h. Results: We identified diuretic medication administration time 23:00-04:59 as a predictor of higher urine volume response. For patients without recent diuretic medication, higher urine volume was predicted 11:00-16:59 and 17:00-22:59. Other factors that affected urine volume response to the diuretic were sex, age, medication dose, creatinine concentration, diagnoses, and hospital unit. Discussion: Time-of-day of medication administration may be a factor associated with increased medication efficiency. Randomized controlled trials should be conducted to quantify the relative effect of modifiable factors, such as time of medication administration, that may affect short- and longer-term outcomes.

Parkinson’s disease medications in hospital: A retrospective audit of prescribing and administration errors

Background: Managing Parkinson’s disease (PD) medications in the acute hospital setting is complex. Mismanagement of PD medications such as inaccurate medication administration time and prescribing errors is common which can lead to the worsening of PD symptoms. Aim and Objectives: The aim of the study was to identify the extent of PD medication prescribing and administration errors in adult inpatients and pharmacists’ impact across a Victorian metropolitan hospital. Materials and Methods: A retrospective review analyzed a sample of 30 patients admitted between January and April 2022. PD medication orders (PDMO) and medication administration records (MAR) were reviewed; charting errors were identified based on reconciliation of PDMO with the pharmacist-led best-possible medication history (p-BPMH). Administration errors were identified through a review of MAR and PDMO charted time or p-BPMH documented administration time for each PD medication. Results: A total of 60 PDMO and 469 administration instances were reviewed. About 83.3% (50) of PDMOs had at least one instance of delay or omission in administration. 45.0% (27) of PDMO charting errors led to delays or omissions in administration. The timing of administration was the most common charting error accounting for 18.3% (11) of PDMOs. Documentation of p-BPMH within 24 h of admission led to a reduction of charting errors (52.9% vs. 76.9%, respectively). PD medications that were administered on time compared to p-BPMH documented time and PDMO charted time were 48.6% (228/469) and 53.7% (252/469), respectively. Conclusion: This study identified a high degree of PDMO charting and administration errors for patients with PD. Strategies to improve PD medication management are warranted.

Barriers to access to psychiatric medications in Missouri county jails.

Objectives of this study were to characterize barriers to receiving psychiatric medications for people who are incarcerated, to compare barriers before competency restoration to those after competency restoration, and to characterize psychiatric medication formularies. A survey of county jails in Missouri was completed between October 2021 and February 2022. Survey questions were answered by medical department personnel, nurses, or a person responsible for medication oversight. Formularies were requested. Of 97 jails contacted, 51 completed the survey (53%). Most jails allowed patients to supply their own medications and reported they were "often" or "always" able to continue home medications. Inability to provide home medications was frequently attributed to cost. Notably, only 57% of jails were able to provide long-acting injectable antipsychotics (LAIA), 22% charged a fee for administration of medications, and 31% would not adjust medication times based on food requirements. No major differences existed precompetency and postcompetency for any question. Jail policies varied; thus, medication access for patients should be approached at the individual level. Potential areas to target to improve access are medication administration times, LAIA access, and removal of medication administration fees.

Cardiologist-Directed Sedation Management in Patients Undergoing Transvenous Lead Extraction: A Single-Centre Retrospective Analysis.

The demand for transvenous lead extraction (TLE) has increased. In line with this, the safety of such procedures has also increased. Traditionally, TLE is performed under resource-intensive general anaesthesia. This study aims to evaluate the safety and outcomes of Cardiologist-lead deep sedation for TLE. We retrospectively analysed 328 TLE procedures performed under deep sedation from 2016 to 2019. TLE procedures were performed by experienced electrophysiologists. Sedation was administered by a specifically trained cardiologist (bolus midazolam/fentanyl and propofol infusion). Procedural sedation data including blood pressure, medication administration and sedation time were collected. Complications related to sedation and the operative component of the procedure were analysed retrospectively. The sedation-associated complication rate during TLE was 22.0%. The most common complication (75% of complications) was hypotension requiring noradrenaline, followed by bradycardia requiring atropine (13% of complications). Additionally, the unplanned presence of an anaesthesiologist was needed in one case (0.3%). Deep sedation was achieved with midazolam (mean dose 42.9 ± 26.5 µg/kg), fentanyl (mean dose 0.4 ± 0.6 µg/kg) and propofol (mean dose 3.5 ± 1.2 mg/kg/h). There was no difference in medication dosage between those with a sedation-associated complication and those without. Sedation-associated complications appeared significantly more in patients with reduced LVEF (p = 0.01), renal impairment (p = 0.01) and a higher American Society of Anaesthesiologists (ASA) class (p = 0.01). Deep sedation for TLE can be safely performed by a specifically trained cardiologist, with a transition to general anaesthesia required in only 0.3% of cases. We continue to recommend the on-call availability of an anaesthesiologist and cardiac surgeon in case of major complications.

Implementing a Pediatric Resident Physician/Bedside Nurse Shadow Program to Improve Interprofessional Collaboration and Understanding, and to Transform Practice

INTRODUCTION Resident physician/nurse collaboration is essential for patient safety and optimal clinical outcomes. Interprofessional shadowing experiences can facilitate understanding of team roles; however, enhanced understanding may not transform individual practices leading to workplace improvement. This educational innovation utilized a resident/nurse shadow program to raise awareness of interprofessional roles and as a needs assessment to identify and educate about specific system-wide standards that can lead residents to transform their practices to improve nurse workflow. METHODS From 2018-2020, 44 first-year pediatric residents at a free-standing children’s hospital shadowed nine nurse preceptors. Each nurse received an orientation and checklist of topics to cover. Residents observed nursing responsibilities including admissions, line placement and medication administration. All participants completed pre-post surveys. RESULTS Post-surveys demonstrated a statistically significant improvement (p&lt;.00001) in Likert scores of residents’ self-rated understanding of nursing cares and workflow. The experience uncovered three system-wide scheduling standards where resident modification of ordering practices could optimize nursing workflow: timing of morning lab draws, new medication administration, and delivery of dietary formula. The shadow program was modified to include education in these three areas and participants had statistically significant (p&lt;.01) increased knowledge of timing of morning labs and new medication administration (35% and 39% improvement, respectively). Nurse understanding of resident workflow was not measured due to limited data.DISCUSSION A resident/nurse shadow program successfully improved resident awareness of nursing roles and was an innovative way to identify specific areas of workflow improvement. Program modifications are required to create a true, bidirectional, resident/nurse interprofessional shadow experience.

Tenecteplase: A Review of Its Pharmacology and Uses.

Tenecteplase: A Review of Its Pharmacology and Uses.

724 How Nursing Turnover Rates Effected a Series of Pediatric Mock Codes

Abstract Introduction Pediatric mock codes (PMC) were first introduced to the Burn Trauma ICU (BTICU) in Fall 2020. The goal of the PMCs were to increase efficiency in a code situation and to increase nursing confidence. However, due to the unique timing of initiation, this hospital also chose to look at how turnover rates affected the outcomes of the PMCs. The time period chosen was during the COVID crisis and the unit had an increasing number of nurses leaving for contract positions. Methods The PMCs created were specifically designed to replicate the pediatric population the team cares for. A different PMC scenario was presented every six months for a total of four mock codes. The nurses completed the PMCs with a team approach, with each team consisting of two to six nurses. During the mock code, the nurse educator kept track of time, monitored role assignments and completion of major tasks, and ensured pre and post surveys were completed. The pre and post surveys evaluated the nurse’s self-confidence, biggest concern regarding a pediatric code, and if they had previously participated in a PMC. Results Over the period of two years, 82 participants were captured. However, these were not unique individuals, as some nurses participated in all four mock codes. It was expected that each time the mock code was completed, the number of nurses who had participated in PMC would increase. However, as time progressed, the rate of previous participation actually decreased. Instead of improving on time to compressions or medication administration time, the times stayed the same over the two-year time frame. When evaluating the comments on the survey, the staff concerns also did not change over time. Medication administration remained the number one concern across all four mock codes. Even though the PMC did not improve skills, 100% of those who participated expressed an increase in confidence level. Conclusions Nursing units depend on novice nurses gaining knowledge and skills and progressing into the expert nurses on the unit. However, the loss of permanent staff and the hiring of new nurses has had an impact on this cycle. The unit lost many of its expert nurses before the new nurses had time to advance. This can be directly seen in the turnover rate and the previous participation in the PMC. Essentially this halted the unit as a whole from growing their skill set in the pediatric population. However, as the nursing market stabilizes, there are future plans to continue to evaluate the PMC skills and outcomes. Applicability of Research to Practice As nursing turnover rates increase, patient complications and outcomes should also be evaluated to see if a correlation is present.

Nighttime medication administration and patient perception of sleep in the intensive care unit

AbstractIntroductionEnvironmental, patient, disease, and care‐related factors can lead to sleep disruption in the intensive care unit (ICU). Medication administration is a potentially modifiable factor in this setting that has not been well described as a target for sleep improvement.ObjectivesTo determine characteristics of nighttime medication administration practices in the ICU, evaluate the effect on patient perceived sleep, and assess the opportunity for pharmacist‐led nighttime medication administration stewardship.MethodsThis was a multicenter, retrospective, observational cohort study. Patients included for chart review had perceived sleep measured using the Richards‐Campbell Sleep Questionnaire (RCSQ). Data were collected on patient characteristics, ICU exposures, and nighttime medications administered. Four RCSQ groups defined for comparison were RCSQ 0–25 indicating “very poor” sleep, 26–50 “poor” sleep, 51–75 “good” sleep, and 76–100 “very good” sleep.ResultsOverall, 115 patients with RCSQ assessments and 435 nighttime medication administrations were included. Nighttime medications were most commonly cardiovascular (28.9%) and central nervous system (21.4%) agents, administered via intravenous (54.5%) and oral (22.7%) routes. Patient characteristics were comparable between the four groups except for history of head trauma. Patients reporting very poor sleep had a significantly higher median number of nighttime medications administered as compared to patients reporting very good sleep (4.0 [interquartile range (IQR) (2, 6)] vs. 2.5 [IQR 1, 4], adjusted p = 0.048). Approximately three‐quarters of nighttime medications occurred between the hours of 22:00–0:59 and 5:00–5:59. Nearly 40% of nighttime medications could have been retimed for daytime administration.ConclusionsUnnecessary nighttime medication administration is common and associated with poor patient perceived sleep in the ICU. Pharmacists are well‐positioned to evaluate timing of medication administration and cluster medication‐related care for daytime hours, when appropriate. Nighttime medication stewardship optimization by pharmacists is an opportunity to improve patient perceived sleep in the ICU.

ANTIRETROVIRAL MEDICATION ADHERENCE AMONG PATIENTS WITH HIV/AIDS AT A COMMUNITY MEDICAL CENTER IN VIETNAM

Introduction: Non-adherence to antiretroviral (ARV) medications is a common issue worldwide and in Vietnam. Purpose: To assess patients’ adherence to ARV medications and to determine factors associated with adherence among patients with HIV/AIDS in Ho Chi Minh City (HCMC). Methods: A cross-sectional study was conducted on 360 outpatients being on ARV therapy at a community medical center in HCMC from 15th March to 20th June in 2020. We invited patients aged 18 or above who have been on ARV treatment for at least 6 months to participate in the study. Data was collected through patient interviews and medical records. Medication adherence was assessed regarding timing of medication administration and dosing adherence using Morisky Medication Adherence Scale-8-item Questionnaire (MMAS-8). Factors associated with optimal adherence were identified by multivariable logistic regression model. Results: The median age of 360 patients was 38 (33 - 43), 72.5% were male. The proportion of optimally adherent patients was 56.4%. Factors associated with better adherence were increased age, stronger belief in medications, and adherence aids use. Factors associated with poorer adherence were alcohol consumption in the previous 30 days, concerns about side effects, twice-daily ARV therapy, and undesirable effects in the previous 3 months. Conclusion: Optimal adherence to ARV medications among HIV/AIDS patients was relatively limited. To improve medication adherence, health workers may need to simplify ARV regimens and counsel patients more intensively (especially for the younger) about the effectiveness of ARV medications, alcohol intake reduction and the use of adherence aids.

No Increased Risk of Nonunion with Bisphosphonate Use in a Medicare Claims Cohort Following Operatively Treated Long-Bone Fractures.

The diagnosis of a fragility fracture represents an important intervention event for the initiation of medical osteoporosis treatments. However, it is unclear if osteoporosis medications increase the risk of nonunion if administered in the setting of acute fracture. The purpose of the present study was to investigate whether bisphosphonates or selective estrogen receptor modulators/hormone replacement therapy (SERM/HRT) are associated with nonunion following fracture in a Medicare population. A retrospective analysis of Medicare claims from 2016 to 2019 was performed to identify patients ≥65 years of age who had a surgically treated long-bone fracture as identified with Current Procedural Terminology (CPT) codes and International Classification of Diseases, 10th Revision (ICD-10) codes. Successive claims were linked for each beneficiary through 1 year following the fracture to determine fracture union status. Multivariable logistic regression models were specified to identify the association between medications and fracture union status while controlling for age, sex, race, Charlson Comorbidity Index (CCI), and fracture type. Of the 111,343 included fractures, 10,452 (9.4%) were associated with a diagnosis of nonunion within 1 year. The nonunion group was younger (79.8 ± 8.3 versus 80.6 ± 8.4 years; p < 0.001), more likely to be White (92.4% versus 90.9%; p < 0.001), and more likely to have a CCI of ≥2 (50.9% versus 49.4%; p < 0.001). Bisphosphonate use was more common in the nonunion group (12.2% versus 11.4%; p = 0.017). When controlling for race, age, sex, and CCI, neither bisphosphonates (OR, 1.06 [95% CI, 0.99 to 1.12]; p = 0.101) nor SERM/HRT (OR, 1.13 [0.93 to 1.36]; p = 0.218) were associated with nonunion. Bisphosphonate use within 90 days post-fracture was not significantly associated with nonunion (OR, 0.94 [95% CI, 0.86 to 1.03]; p = 0.175), and the timing of medication administration did not influence fracture union status. The rate of nonunion after operatively treated long-bone fractures was 9.4%. In this cohort, use of a bisphosphonate or SERM/HRT was not associated with fracture union status at 1 year. Orthopaedic surgeons should not withhold or delay initiating medical therapies for osteoporosis in the setting of acute fracture out of concern for nonunion. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Blind Spots: Biases in Prehospital Race and Ethnicity Recording

Objective Inequities have been described in areas of prehospital care ranging from pain medication administration and scene time, to stroke and cardiac arrest management. Though a critical element in understanding inequity, race and ethnicity information are often missing from the prehospital patient care report. This study aimed to characterize and understand demographic trends among records with missing race and ethnicity information. Methods This before-and-after retrospective review compared patient care reports prior to and after an intervention that mandated the recording of patient race and ethnicity. Records with incomplete race and ethnicity information in the before group were evaluated to understand demographic patterns associated with this incomplete documentation. Results Among 98,725 patient care reports, race/ethnicity in the before period as compared to the after period was less likely to be documented in nonwhite patients (p < 0.001), younger patients (p < 0.001), male patients (p < 0.001), and non-emergent transports (p < 0.001). Conclusions When compared to data after the implementation of mandated race and ethnicity fields, missing race and ethnicity data were found to be more common in patients of color, younger patients, males, and those transported non-emergently. Inconsistent completion of race and ethnicity documentation may lead to a poor understanding of equity issues within a system, suggesting a need for mandatory race and ethnicity fields.

Improper administration

Proper timing of medication administration can maximize effectiveness, minimize adverse effects, optimize adherence, and prevent unnecessary polypharmacy. This is because drug-food interactions and medication temporal patterns can have substantial effects on patient outcomes. This article examines

Medication safety climate from the perspectives of healthcare providers: A cross-sectional study.

Medication safety as an indicator of care quality is the measures taken by healthcare team members to prevent or adjust adverse drug events at the time of medication administration. This study was conducted to investigate the medication safety climate from healthcare providers' perspectives. This cross-sectional descriptive study was conducted in a selected educational hospital affiliated with the Isfahan University of Medical Sciences, Isfahan, Iran, in 2021. Participants were healthcare providers who are involved in the medication process. The sampling was done using the quota method. The study instruments were a demographic questionnaire and the Medication Safety Climate (MSC). The total mean of positive responses to MSC items was 64.11%, denoting a moderate-level MSC. Collected data were managed using the SPSS software (v. 16.0) and were summarized using the measures of descriptive statistics, namely mean, standard deviation, frequency, and percentage. The lowest and the highest dimensional mean scores were related to the management support for medication safety dimension (mean: 48.42%) and the Teamwork dimension (mean: 80.43%), respectively. Managers' inattention and insufficient understanding of safety provide the basis for medication errors and threaten patient safety. Healthcare team members are highly motivated to provide quality and safe care by observing the managers' positive performance regarding patient safety. To improve the medication safety climate, healthcare team members are required to work in a safe workplace and have sufficient job satisfaction. Health center managers need to employ a proactive approach to prevent errors.

Analýza podání léčiv ve vztahu k potravě a použitým nápojům u hospitalizovaných pacientů

Proper medication administration in relation to beverage or food is one of the essential tools to achieve the pharmacotherapy goals. It is not known whether this is also considered in the care of inpatients. The aim of this study was to describe and analyse the current practice of medication administration in relation to food and beverages to patients hospitalized in four hospitals in the Czech Republic. This study was conducted based on the results of the first phase of a prospective observation study focused on the safety of medication administration performed by nurses. All data, including the timing of medication administration in relation to food and the data on beverages used, were obtained by the method of direct observation. The team of observersaccompanied the nurse during medication administration. The appropriateness of the medication administration in relationto food/beverages was assessed according to the summary of product characteristics and the published literature. In total, the administration of 5718 oral medications and 198 insulins were analysed. Unproper food timing wasobserved in 15.7% of oral medication administrations and 26.8% of insulin administrations. The highest number ofunproper food timing occurred in the proton pump inhibitors, antihypertensives, and prokinetics. Tea (63.4%) was the most used beverage. Errors with clinically serious impact have been observed in some groups of drugs. The necessity of a systemic approach in management of medication administration is required including interdisciplinary cooperation.

Helicobacter Pylori: A Review of Current Treatment Options in Clinical Practice.

When prescribing antibiotics, infection eradication rates, local resistance rates, and cost should be among the most essential considerations. Helicobacter pylori is among the most common infections worldwide, and it can lead to burdensome sequela for the patient and the healthcare system, without appropriate treatment. Due to constantly fluctuating resistance rates, regimens must be constantly assessed to ensure effectiveness. This was a narrative review. The sources for this review are as follows: searching on PubMed, Google Scholar, Medline, and ScienceDirect; using keywords: Helicobacter pylori, Treatment Options, Clinical Practice. Multiple antibiotics are prescribed as part of the regimen to thwart high resistance rates. This can lead to unwanted adverse reactions and adherence issues, due to the amount and timing of medication administration, which also may contribute to resistance. Single-capsule combination capsules have reached the market to ease this concern, but brand-only may be problematic for patient affordability. Due to the previously mentioned factors, effectiveness and affordability must be equally considered. This review will utilize guidelines to discuss current treatment options and give cost considerations to elicit the most effective regimen for the patient.