Medication Management Activities Research Articles

Evaluation of Solid Medical Waste Management in Bogor Regional Public Hospitals

Healthcare facilities generate medical waste. If not properly managed, medical waste can damage the environment and spread diseases. Many hospitals in Indonesia do not adhere to medical waste management regulations. This study aimed to evaluate the management of solid medical waste at four public hospitals in Bogor District, Indonesia. A case study design was used to obtain a comprehensive description of the solid medical waste management activities in the hospitals. Data were collected through direct observations, interviews, and document reviews. This study revealed that the medical waste generated in all hospitals was infectious, pathological, pharmaceutical, chemical, and cytotoxic, totaling approximately 4,000-12,000 kg. Hospitals A, B, C, and D fulfilled the Ministry of Environment and Forestry Regulation No. P56 of 2015 criteria, achieving compliance rates of 77%, 83.78%, 83.3%, and 86.48%, respectively. However, several activities of the hospitals did not meet the standards for waste reduction, segregation, on-site transport, temporary storage, and human resource quality. It is important that hospitals establish comprehensive and compliant medical waste management systems.

Environmental Sustainability and Waste Management Practices

Background: The study aims to explore environmental sustainability and medical waste management practices in Ghanaian private hospitals in the Greater Accra Region. It also sought to determine if there is any form of collaboration between private hospitals and district assemblies in managing medical wastes. Methods: A qualitative research approach with a cross-sectional study design was used to collect data from employees of the three private hospitals and the district assemblies. A structured interview guide was employed to gather data from 13 purposively selected participants. Results: The findings of the study indicated that there is a collaboration between private hospitals and district assemblies with regard to medical wastes management activities. Conclusions: It is recommended that policies on medical waste management are enforced to ensure sustainable healthcare waste management. Keywords: Environmental sustainability, collaboration, medical waste, private hospitals, district assemblies.

Impact of on-site pharmacists in residential aged care facilities on the quality of medicines use: a cluster randomised controlled trial (PiRACF study)

Residents of residential aged care facilities (RACFs) have a high prevalence of use of potentially inappropriate medications (PIMs) and resultant medicines-related harm. This study investigated the effect of an on-site pharmacist model on PIMs use and other medication outcomes for residents in RACFs. A multi-facility, non-blind, cluster randomised controlled trial, with randomisation at the facility level, was conducted. Fifteen facilities enrolled and participated in the study, 7 facilities (560 residents) were allocated to the intervention arm and 8 facilities (737 residents) were allocated to the control arm. Each facility in the intervention arm employed an on-site pharmacist for 12 months to perform medication management activities as part of an interdisciplinary care team. The primary outcome was the proportion of residents taking at least one PIM according to the 2019 Beers® Criteria. Using generalised linear mixed-effects models, accounting for confounders and clustering, there was a significant reduction in the proportion of residents prescribed at least one PIM (odds ratio 0.50, 95% confidence interval, 0.335–0.750; p = 0.001) in the intervention arm. There were also significant decreases in the Anticholinergic Cognitive Burden scale and chlorpromazine equivalent daily dose of antipsychotics. The on-site pharmacist intervention significantly improved the appropriateness of medicines use in RACFs.

THE BENEFITS OF SOFTWARE SOLUTIONS IN MEDICAL PATIENT CARE. A DOCVISER ONCOLOGY CASE STUDY

This paper presents a study that looked at the influence of Docviser, an oncology patient management app, on the efficiency and quality of patient care in a hospital context. The research topic was whether doctors could take advantage of Docviser to save time on drug management activities and enhance dosage calculation accuracy. A semi-structured interview with a doctor who had been using Docviser for over a year was conducted. The software considerably reduced the time spent on medication management activities, with treatment administration time cut by at least two hours per patient, according to the data. According to the study, using Docviser provides evident benefits for patient care, such as greater speed and accuracy, as well as improved communication among doctors, pharmacists, and nurses. The findings have significance for medical practitioners, hospital administrators, and governments interested in improving patient care and lowering costs. The study’s shortcomings include a small sample size and a narrow area of inquiry, indicating the need for additional research on the app’s impact on costs as well as patient outcomes.

USER PERSONAS TO GUIDE TECHNOLOGY INTERVENTION DESIGN TO SUPPORT CAREGIVER-ASSISTED MEDICATION MANAGEMENT

Abstract Informal caregivers often help manage medications for people with ADRD. Caregiver-assisted medication management has the potential to optimize outcomes for caregivers and people with ADRD, but is often associated with suboptimal outcomes. We used the user-centered design persona method to represent the needs of ADRD caregivers who manage medications for people with ADRD to guide future design decisions for technology interventions. Data were collected through virtual contextual inquiry in which caregivers (Nf24) sent daily multimedia text messages depicting medication management activities for seven days each, followed by an interview that used the messages as prompts to understand medication management needs. We applied the persona development method to the data to identify distinct caregiver personas, i.e., evidence-derived groups of prospective users of a future intervention. We used team-based affinity diagramming to organize information about participants based on intragroup (dis)similarities, to create meaningful clusters representing intervention-relevant attributes. We then used group consensus discussion to create personas based on attribute clusters. The six identified attributes differentiating personas were: 1. medication acquisition, 2. medication organization, 3. medication administration, 4. monitoring symptoms, 5. care network, 6. technology preferences. Three personas were identified based on differences on those attributes: Regimented Ruth (independent, proactive, tech savvy, controls all medications), Intuitive Ian (collaborative, uses own judgment, some technology, provides some medication autonomy), Passive Pamela (reactive, easy going, technology novice, provides full medication autonomy). These personas can be used to guide technology intervention design by evaluating how well intervention designs support each of them.

Ambulatory care pharmacy practice: Findings from the 2019 National Pharmacist Workforce Survey.

The purpose of this study was to describe the demographics, training, clinical specialties, and practice activities of ambulatory care pharmacists using data from the 2019 National Pharmacist Workforce Study (NPWS). The 2019 NPWS was conducted using a 3-contact electronic survey sent to a random sample of 94,803 pharmacists using the National Association of Boards of Pharmacy Foundation e-Profile system. The 2019 NPWS had a response rate of 67.3% (5,705/8,466), based on the number of prospective respondents who clicked the survey link. A subset of pharmacists' responses (n = 4,557) was used for this analysis, which included those who selected an employment status of "practicing as a pharmacist." Of the 4,557 actively practicing pharmacists responding, 338 (8.0%) reported working in the ambulatory care setting. Ambulatory care pharmacists were predominately White (71.6%), women (67.5%), and/or between the ages of 31 and 40 years (36.9%). A total of 41.3% had completed PGY1 residency training, 14% had completed PGY2 residency training, and 29.3% had completed one or more board certifications. Their most common clinical specialty areas were anticoagulation (21.7%), endocrinology (19.7%), hematology/oncology (16.2%), and primary care (16.2%). A total of 49.6% reported using a collaborative practice agreement. Ambulatory care pharmacists reported more training and certifications than the overall sample of pharmacists. These pharmacists practiced in a variety of clinical specialty areas and engaged in a range of in-person and telecommunication medication management activities. This study provides a baseline assessment of the ambulatory care pharmacist workforce that can be used to assess changes over time.

ANALISIS KETENAGAAN PENGELOLA REKAM MEDIS & INFORMASI KESEHATAN DI PUSKESMAS SRONDOL

Puskesmas in carrying out health services, one of its authorities is to carry out medical record management. Referring to Permenkes no. 55 of 2013 article 2 which states that the administration of medical records must be carried out by medical recorders. Medical Recorder is a person who has passed the Medical Record and Health Information education in accordance with the provisions of the legislation.The purpose of this research is to know the management of medical records, and health information as well as the staff for managing medical records at the Srondol Health Center. This type of research is descriptive qualitative with a case study approach.The results showed that the Srondol Health Center provided health services to BPJS patients and general patients. The patient naming system at the Srondol Health Center is adjusted to ID cards, family cards and other identity cards. Medical record management activities experienced several obstacles because they did not have officers with a medical record education background so that the transfer of medical record media from manual to electronic was constrained. The writing of patient names (Mr, Ny, Son, Br) is not standardized. Diagnostic coding is only known and carried out by doctors and midwives.The conclusion obtained is that the management of medical records and health information at the Srondol Health Center still found some things that were not in accordance with the regulations, so it was advisable to make adjustments to the medical record personnel regulations to improve their services.

Development of a tool to evaluate medication management guidance provided to carers of people living with dementia at hospital discharge: a mixed methods study

ObjectiveMedication management guidance for carers of people with dementia at hospital discharge is important to prevent medication-related harm during transitions of care. This study aimed to develop a tool to...

The impact of life stress, psychological resources, and proactive behaviors on quality of life among people living with HIV

Objectives Quality of life (QoL) is an important consideration for people living with HIV (PWH). We investigated the relationship between stress, psychological resources, and proactive behaviors, on QoL (conceptualized as life satisfaction, successful aging, and depressive symptoms) by testing the hypotheses: (1) greater life stress (stress and functional impairment) is associated with poorer QoL; (2) resources (mastery, resilience, and social support) are associated with better QoL, beyond the influence of stress; and (3) proactive behaviors (medication management and leisure activities) mediate the relationship between resources and QoL. Methods Secondary analyses were performed (N = 128 PWH). Participants’ mean age was 52.3, 83.6% were male, and 53.9 identified as white. Multivariate regressions were performed within the context of path analyses. Results In series 1, greater stress was associated with poorer life satisfaction (p < 0.001), lower self-rated successful aging (p < 0.001), and greater depression (p < 0.001). Functional impairment was associated with lower successful aging (p = 0.017) and greater depression (p = 0.001). In series 2, which accounted for mastery, resilience, social support, as well as demographic covariates, mastery was associated with greater life satisfaction (p = 0.038). In series 3, stress, functional impairment, leisure activities, and ART management were added to the model and social support was associated with engagement in leisure activities (p < 0.001), which was associated with better successful aging (p = 0.006). Fit indices suggested adequate relative fit. In bootstrapped analyses of indirect effects, social support was indirectly associated with successful aging through leisure activities (p = 0.020). Conclusions QoL, as captured by self-rated successful aging, is threatened by stress but positively influenced by social support and engaging in leisure activities. Findings support a model of proactive successful aging for PWH.

Integrating pharmacists into aged care facilities to improve the quality use of medicine (PiRACF Study): protocol for a cluster randomised controlled trial

BackgroundMedication management in residential aged care facilities is an ongoing concern. Numerous studies have reported high rates of inappropriate prescribing and medication use in aged care facilities, which contribute to residents’ adverse health outcomes. There is a need for new models of care that enhance inter-disciplinary collaboration between residential aged care facility staff and healthcare professionals, to improve medication management. Pilot research has demonstrated the feasibility and benefits of integrating a pharmacist into the aged care facility team to improve the quality use of medicines. This protocol describes the design and methods for a cluster randomised controlled trial to evaluate the outcomes and conduct economic evaluation of a service model where on-site pharmacists are integrated into residential aged care facility healthcare teams to improve medication management.MethodsIntervention aged care facilities will employ on-site pharmacists to work as part of their healthcare teams 2 to 2.5 days per week for 12 months. On-site pharmacists, in collaboration with facility nurses, prescribers, community pharmacists, residents and families will conduct medication management activities to improve the quality use of medicines. Aged care facilities in the control group will continue usual care. The target sample size is 1188 residents from a minimum of 13 aged care facilities. The primary outcome is the appropriateness of prescribing, measured by the proportion of residents who are prescribed at least one potentially inappropriate medicine according to the 2019 Beers Criteria. Secondary outcomes include hospital and emergency department presentations, fall rates, prevalence and dose of antipsychotics and benzodiazepines, Anticholinergic Cognitive Burden Score, staff influenza vaccination rate, time spent on medication rounds, appropriateness of dose form modification and completeness of resident’s allergy and adverse drug reaction documentation. A cost-consequence and cost-effectiveness analysis will be embedded in the trial.DiscussionThe results of this study will provide information on clinical and economic outcomes of a model that integrates on-site pharmacists into Australian residential aged care facilities. The results will provide policymakers with recommendations relevant to further implementation of this model.Trial registrationACTRN12620000430932. Registered on 1 April 2020 with ANZCTR

Stimulating the Involvement of Family Members in the Medication Management Activities of Older Adults Through Ambient Displays: Qualitative Study.

Little attention has been paid to how medication management technologies, designed for older adults, modify the participation of family caregivers. We developed a tablet-based ambient display that provides external cues to remind and motivate older adults to take their medications. This study aimed to understand the effect of ambient displays on the involvement of family members in the elderly's medication management. We conducted a 10-week study consisting of interviews administered weekly to nine elderly-caregivers. We identify that new involvement patterns of the family caregivers were provoked through external cues, which made them aware of older adults' medication adherence and encouraged younger relatives to help older adults.

Approaches to a comprehensive solution to the problem of medical waste management

Topical issues of medical waste compliance with Federal Law 89-ФЗ On Production and Consumption Wastes and aspects of conducting medical waste management activities in order to comply with this regulatory legal act are considered. It has been established that when medical waste falls under the federal law FZ-89, additional requirements for conducting waste management activities are not taken into account, the entry of medical waste into the Federal Classification Catalog of Waste (FCCW) as a separate unit and optimization of the certification of medical waste. In our opinion, there are currently gaps in the medical waste management activities in the environmental legislation of the Russian Federation and, as a consequence, in law enforcement practice. An algorithm of scientifically based approaches to solving the main problems of the existing problems that can be applied during the preparation and development of the Information and Technical Guide on the best available technologies (BAT) for medical waste management is proposed.

IMPLEMENTASI MANAJEMEN REKAM MEDIS DI RUMAH SAKIT PKU MUHAMMADIYAH YOGYAKARTA

The medical record service management system and good health information in the hospital will be able to create good order and quality of medical record services, so that patients get fast, equitable and orderly services. Based on the observations that have been made, that the medical record management activities in PKU Muhammadiyah Yogyakarta have been going quite, but there are some obstacles related to the process of recording and managing data, as well as other technical matters relating to the provision of medical record files. Is a type of descriptive research with a qualitative approach. From the results of the study, it was found that the forms used in PKU Muhammadiyah Yogyakarta Hospital used paper forms. The medical record forms used in PKU Muhammadiyah Yogyakarta Hospital for generally include polyclinic sheets, emergency sheets, inpatient sheets, medical resumes, doctor's notes, and notes on drug administration. Assembling or compiling medical record files at PKU Muhamadiyah Hospital has been running well and in accordance with applicable regulations. Coding and indexing in PKU Muhammadiyah Hospital in Yogyakarta is not in accordance with the theory because there is no coding for drugs, devices and radiology.

PNS214 MEDICATION INVENTORY AND MANAGEMENT EFFICIENCIES MODELLED WITHIN A HEALTH-SYSTEM'S AFFILIATED OUTPATIENT CLINICS

Inefficient organization of medication inventory and management in health-system outpatient clinics may be driven by additional costs such as; workflow inefficiencies, on-hand inventory bloat, drug wastage, cancelled patient appointments due to medication availability and others. This model analyzed the potential economic burden base-case with organizational and operational efficiencies from these drivers in health-system level medication management. Data from an ethnographic study of 7 US health-systems with over 50 outpatient clinics were utilized to create an economic model quantifying costs associated with medication management in the outpatient clinic setting, over the course of 1 year from the perspective of the health-system. Two base-case analyses assumed a health-system with 4 acute-care hospitals and 120 outpatient clinics. An “inefficient” analysis assumed a stock out rate of 1 %, waste rate of 10%, one nurse per clinic responsible for all medication management steps, and an order frequency of twice per week. An “efficient” analysis assumed a stock out rate of 1%, waste rate of 3%, one pharmacy technician responsible for all management steps, and an order frequency of once per week. Differences between the two analyses were described descriptively. Subsequent analyses were also performed for different organizational and operational scenarios. The model base-case resulted in a total one-year efficient estimation of $1,590,879. Waste costs were reduced by $770,000 using the efficient scenario. Additional opportunity costs estimated medication management labor efficiencies at $820,879 (Inefficient = $920,488, Efficient = $99,609). The observed reduction in opportunity costs were due to workflow efficiencies and a shift in skilled labor. The “efficient” scenario identified 20,847 hours per year of nursing time available for reallocation from medication management activities. Substantial potential benefit for a health-system may be realized through the use of more efficient medication management policies, procedures, and technologies, as modelled by this analysis.

The patient experience in a community pharmacy mental illness and addictions program.

The Bloom Program was designed to enhance pharmacists' care of people with lived experience of mental illness and addictions in Nova Scotia. The Program's demonstration period was from September 2014 to December 2016 and included a qualitative evaluation of the patient experience. Patients were recruited for individual interviews through Bloom Program pharmacies. Interviews were transcribed verbatim and analyzed following Braun and Clarke's 6-step approach for thematic analysis. Ten patients were interviewed between May and June 2016. Ten themes were determined through data analysis and included medication management, accessing pharmacists in a new way, providing social support, bridging service gaps, providing interim care, reducing financial barriers, navigation and advocacy, holistic approaches, empowerment through knowledge and awareness and collaboration. Pharmacists expectedly provided medication management activities to patients for both physical and mental health concerns in the Bloom Program. Many activities conducted with Bloom Program patients fell outside of dispensing roles and medication management. These activities, such as social support, triage, navigation and increasing access, which were highly valued by patients, are poorly measured and assessed in pharmacy practice research. Participants in the Bloom Program reported the significant contributions of pharmacists and pharmacy teams in their overall health and wellness. Future evaluations of interventions like the Bloom Program should include measurement of constructs valued by patients and also consider impacts on inequalities and inequities. Pharmacy practice researchers can benefit from other research and evaluation being conducted for primary care interventions.

Edge-Based IoT Medical Record System: Requirements, Recommendations and Conceptual Design

This paper presents a conceptual architecture, design, and recommendation for the IoT Edge-based healthcare management system. The suggested architecture aims at distributing the workload of system performance (electronic healthcare services), including monitoring, diagnosis, prediction, as well as managing and archiving medical data of patients across different points of the system (at the edge and on the cloud). The proposed system design consists of two main subsystems (one for monitoring tasks and another one for medical record management activities). Both subsystems interact with multiple kinds of database systems (SQL and NoSQL). Transformational-based system for data migration is presented as a contribution of this paper. Two styles of transformation compositions are considered in the architectural design of transformation agents.

Contextual factors influencing medication management by rural informal caregivers of older adults.

Managing medications is an important part of the rural informal caregiver's role in the community setting, and the context within which care is provided plays an important role in shaping the work they perform. However, little is known about the intra- and interpersonal factors that impact the rural caregiver's involvement in and performance of medication management. To identify contextual factors influencing medication management by rural informal caregivers of older adults. Four separate focus groups with rural caregivers of older adults were conducted with 5-9 caregivers per group. Participants were asked to describe the medication management activities performed and problems they encountered while providing assistance. Focus groups were recorded, transcribed verbatim, and analyzed for themes using an inductive approach. Care recipient independence, or their ability and preference to perform medication-related activities without supervision, was a key factor driving the caregiver's involvement in medication management and how it was performed. Many caregivers used a team-based approach to medication management that supported the care recipient's independence. Care recipient health and function was a driver behind the need for caregiving, and declines in physical and mental health led to changes in how medication management was carried out over time. Caregiver location also impacted the ways in which medication management was performed by caregivers. Interventions and pharmacy services to support medication management by rural informal caregivers should be designed in a way that preserves and promotes the care recipient's independence, and should be tailored to the context within which caregiving is performed.

Design and practice of quality management system on the hospital department level

This paper introduced the design of medical quality management system on department level, and its application and the effect in a large-scale hospital.Our practice demonstrated that this department-level quality management system with the PDCA cycle in the whole process of quality management, can promote the medical quality management activities to be carried out in an organized, regulated, planed, well checked and concluded manner. Key words: Hospital departments; PDCA cycle; Medical quality management; System; Design

ЕКОЛОГО-ПРАВОВІ ТА АДМІНІСТРАТИВНО-ПРАВОВІ АСПЕКТИ УТИЛІЗАЦІЇ МЕДИЧНИХ ВІДХОДІВ

The article analyzes the environmental, legal and administrative aspects of medical waste disposal during the Covid-19 pandemic in Ukraine. The substantiation of priorities of improvement of ecological-legal and administrative-legal maintenance of procedure of utilization of medical waste during the Covid-19 pandemic is presented. It is emphasized that the state takes a number of measures to reduce mortality from this disease, while increasing the negative impact on the environment of medical waste generated as a result of vaccination, disease prevention, diagnosis, inpatient treatment of this disease. Their uncontrolled disposal together with household waste has a negative impact on the environment, polluting land and water resources, is a dangerous source of infection. It is established that the environmental, legal and administrative support of the medical waste disposal procedure during the Covid-19 pandemic is related to the formation of the regulatory framework for medical waste management, including collection, transportation, storage, sorting, processing (processing), disposal, removal, and effective activities of public administration and law enforcement agencies to monitor this process. The facts of successful counteraction of such bodies to illegal activity concerning transportation, storage, utilization of medical waste are emphasized. It was found that many problems in this area are due to insufficient funding of the medical sector. The need to implement effective administrative and legal measures, especially control and supervision of economic entities for the disposal of medical waste, to regulate in detail the procedure for medical waste disposal, to devote an important place to this issue in the National Environmental Action Plan until 2025, approved by the order of the Cabinet of Ministers of April 21, 2021 № 443-r and to strengthen the administrative liability of licensed organizations for the provision of medical services for violations in this area. It is recognized that in such conditions it is extremely important to adapt EU legislation on medical waste disposal to Ukrainian realities.

Management of Common Medical Conditions by Office-Based Psychiatrists.

This study examined the extent of psychiatrists' involvement in general medical management activities for their patients. With data from the 2006-2013 U.S. National Ambulatory Medical Survey-an annual cross-sectional survey of visits in a random week to office-based physicians-general medical management activities in 11,046 visits to psychiatrists, 66,267 to general medical physicians (general and family physicians and internists), and 158,933 to other physicians were compared. General medical management activities included recordings of hypertension, hyperlipidemia, diabetes, or obesity; prescriptions of medications for hypertension, hyperlipidemia, or diabetes; blood pressure or weight measurements; ordering glucose, glycohemoglobin (HbA1c), lipids, or cholesterol laboratory tests; and education or counseling for weight, exercise, diet and nutrition, or tobacco use. Any of the target general medical management activities were provided in 37.0% of visits to psychiatrists, compared with 98.0% of visits to general medical physicians and 78.4% to other physicians. Differences between psychiatrists and all other physician groups were smaller for health education and counseling. For each general medical management activity, many of the psychiatrists did not engage in the activity in any of their sampled visits. The most consistent predictors of general medical management activities in each psychiatrist visit were the extent of these activities in other visits to the same psychiatrist and having recorded other types of general medical management activities in the same visit. Efforts to expand psychiatric practice to general medical management activities require better understanding of barriers to such expansion, better characterization of conditions under which such expansion is feasible, and continuing medication education.