Medication Management Process Research Articles

Factors influencing pharmacists' intentions to use Pharmacy Information Systems

The Pharmacy Information System (PIS) is a sub-system of the hospital information system, which is designed to assist pharmacists in safely managing the medication process. To maximize the benefits of PIS, it is important to assess its impact on pharmacists' workflow and medication management processes. The PIS was implemented at King Abdulaziz Medical City-Riyadh (KAMC-Riyadh) 15 years ago. However, its impact on the work of pharmacists has not been satisfactorily explored. Our study was conducted at the Pharmaceutical Care Department of KAMC-Riyadh, and the data were collected from the inpatient pharmacist staff through a survey-based questionnaire. The majority of PIS users reported having a favorable experience with the technology, and to most of the items related to functionality. The present study identified potential key factors; those that are likely to influence pharmacists' personal intentions for using PIS. However, extended use of PIS would require reducing the rate of demotivated users.

A Statewide Medication Management System: Health Information Exchange to Support Drug Therapy Optimization by Pharmacists across the Continuum of Care.

Background While evidence generally supports the use of medication management technology, systems are typically implemented and evaluated piecemeal rather than as part of a comprehensive model for medication management. Systems to support drug therapy optimization, increasingly a key role of pharmacists in our healthcare system, have not yet been reported. Objective Our objective is to describe the design, implementation, and use of health information technology to support the hospital and community pharmacists' management of medications for high-risk patients statewide in the “Pharm2Pharm” model of care. Our aims were to make it easier for the pharmacists to access information needed to identify and resolve drug therapy problems using best practices for medication management and communicate with other members of the care team. Methods The pharmacist's roles and the medication management processes guided the design of the supporting technology, which was implemented after the Pharm2Pharm model was launched and the pharmacists' technology needs were assessed. Priorities for technology included sending care transition documents from hospital to community pharmacist securely and efficiently, access to medical records, including medications and laboratory results, documentation, and patient tracking. Implementation and use of the technology were documented. Results Communications, medication management, and population management solutions were implemented to support the Pharm2Pharm model. The pharmacists delivering services through this model adopted and meaningfully used this technology to support their work. Conclusion Implementing technology with value outside of the Pharm2Pharm model was a strategic approach to investment. This work emphasizes the importance of shifting the focus of technology from supporting a specific piece of the medication management process to supporting the goal of optimizing medication regimens. Health information exchange systems can provide important technology needed to integrate pharmacists into care teams as they are deployed to improve patient outcomes.

Medication Management in Municipality-Based Healthcare: A Time and Motion Study of Nurses.

The objective of this observational time and motion study was to increase our understanding of how nurses in home healthcare currently distribute their work time with a focus on the medication management process. The research was conducted in four municipalities in the southern part of Sweden. Participants were nurses working in home healthcare. The study measured proportion of time, comparison of proportions of time, proportion of time spent multitasking, and rate of interruptions per hour. Of total observed time, 20.4% was spent on medication management and of these tasks the highest proportion of time was spent on communications and dispensing medications. Nurses in nursing homes spent more time (23.0% vs. 17.4%, p = 0.001) on medication management than nurses in private homes. Nurses spent 47.9% of their time completing tasks with someone else, including patients, but had minimal interaction with prescribers. We observed a rate of 1.2 (95% CI 1.1-1.4) interruptions per hour on average and 30% of all interruptions occurred during medication management tasks. Nurses spent 3.7% of their time multitasking. Interruptions while performing medication-related tasks were common, as well as multitasking. Causes and consequences of the results need to be addressed in order to improve the safety of medication management for patients receiving municipality-based home care.

Deprescribing medications in older people: a narrative review.

In the aging population, the process of medication prescribing and management is likely to be complex and challenging. Polypharmacy and inappropriate medication use are more prevalent among older people and are associated with geriatric syndromes, reduced cognitive and functional outcomes, and increased mortality. Deprescribing is the process of planned and supervised tapering or safe withdrawal of potentially inappropriate medication that can cause harm, or is no longer indicated or beneficial to the current therapy. The purpose of deprescribing is to reduce inappropriate polypharmacy, medication burden and harm, and to improve patient health-related outcomes. Deprescribing is best performed by reducing medicines one at a time, and the whole process requires careful assessment, effort, commitment and time. Deprescribing should be considered after careful assessment of the patient's overall health, therapeutic goals, medication adherence to current treatment regimen and willingness to deprescribe the medicine. Many medications can be safely removed; to successfully achieve this, the process of deprescribing should follow an evidence-based, patient-centered and team-based approach involving both the healthcare professionals and the patient/caregivers to effectively reduce inappropriate medication use.

User Goals Extraction for a mhealth-based Medication Management System for Individuals with Visual Impairment

Background: Prevalence of visual impairment is increasing all around the world and this impairment makes the medication management process more complicated. According to literature, Technology, particularly mobile technology has a significant impact on both medication adherence and improving quality of life for people with visual impairment. Due to aforementioned facts, the researchers decided to identify the user’s goals for a mHealth-based medication management system for visually impaired individuals to help the developers to design and develop a medication management system for visually impaired individuals considering to improve their medication adherence and also preserve their independence. Methods: A goal directed approach, introduced by Cooper, has been used in order to extract the goals of visually impaired users who would employ a medication management system. One the most important concepts of this method are designing personas. The needed data for designing personas were extracted from two literature reviews and interviews with 14 visually impaired individuals and three experts of this area. Therefore the personas’ different goals were defined. Results: As the results of this study, three personas were designed according to the extracted data and three categories of user goals including experience goals, end goals and life goals were determined for this system. Conclusion: This study could help the researchers and developers to design and develop an appropriate digital product for people with visual impairment, in order to increase their medication adherence. In addition, the findings of this study could help the policy makers of different areas to increase the quality of life for the people with visual impairment by eliminating the barriers of independent and effective medication adherence.

Self-management of medication during hospitalisation: Healthcare providers' and patients' perspectives.

To explore healthcare providers' and patients' perspectives on self-management of medication during the patients' hospital stay. Self-administration of medications relates to the process in which hospitalised patients-instead of healthcare professionals-prepare and consume medications by themselves. Literature suggests possible advantages of medication self-management such as increased patient satisfaction, adherence to pharmacotherapy and self-care competence. A qualitative descriptive study design was adopted, using semistructured interviews and qualitative content analysis to examine data. Six physicians, 11 nurses, six hospital pharmacists and seven patientswere recruited from one regional hospital and two university hospitals, situated in Belgium. Interviews were conducted between October 2014-January 2015. Strengths of medication self-management were described by participants, relating to benefits of self-management for patients, time-saving benefits for nurses and benefits for better collaboration between patients and healthcare providers. Weaknesses were also apparent for patients as well as for nurses and physicians. Opportunities for self-management of medication were described, relating to the organisation, the patient and the process for implementing self-management. Threats for self-management of medication included obstacles related to implementation of self-managed medications and the actual process of providing medication self-management. A structured overview of conditions that should be fulfilled before allowing self-management of medication concerned patient-related conditions, the self-managed medication and the organisation of self-management of medication. This study provides new insights on the strengths, weaknesses, opportunities and threats from the perspectives of key stakeholders. Interpretation of these findings resulted in an overview of adaptations in the medication management process to facilitate implementation of self-management of medication. A medication management process for self-management of medication was proposed. Further interventional studies are needed to test and refine this process before implementing it in daily practice.

Medication management strategies used by older adults with heart failure: A systems-based analysis.

Older adults with heart failure use strategies to cope with the constraining barriers impeding medication management. Strategies are behavioral adaptations that allow goal achievement despite these constraining conditions. When strategies do not exist, are ineffective or maladaptive, medication performance and health outcomes are at risk. While constraints to medication adherence are described in literature, strategies used by patients to manage medications are less well-described or understood. Guided by cognitive engineering concepts, the aim of this study was to describe and analyze the strategies used by older adults with heart failure to achieve their medication management goals. This mixed methods study employed an empirical strategies analysis method to elicit medication management strategies used by older adults with heart failure. Observation and interview data collected from 61 older adults with heart failure and 31 caregivers were analyzed using qualitative content analysis to derive categories, patterns and themes within and across cases. Data derived thematic sub-categories described planned and ad hoc methods of strategic adaptations. Stable strategies proactively adjusted the medication management process, environment, or the patients themselves. Patients applied situational strategies (planned or ad hoc) to irregular or unexpected situations. Medication non-adherence was a strategy employed when life goals conflicted with medication adherence. The health system was a source of constraints without providing commensurate strategies. Patients strived to control their medication system and achieve goals using adaptive strategies. Future patient self-mangement research can benefit from methods and theories used to study professional work, such as strategies analysis.

Safe medication management in specialized home healthcare - an observational study

BackgroundMedication management is a complex, error-prone process. The aim of this study was to explore what constitutes the complexity of the medication management process (MMP) in specialized home healthcare and how healthcare professionals handle this complexity. The study is theoretically based in resilience engineering.MethodData were collected during the MMP at three specialized home healthcare units in Sweden using two strategies: observation of workplaces and shadowing RNs in everyday work, including interviews. Transcribed material was analysed using grounded theory.ResultsThe MMP in home healthcare was dynamic and complex with unclear boundaries of responsibilities, inadequate information systems and fluctuating work conditions. Healthcare professionals adapted their everyday clinical work by sharing responsibility and simultaneously being authoritative and preserving patients’ active participation, autonomy and integrity. To promote a safe MMP, healthcare professionals constantly re-prioritized goals, handled gaps in communication and information transmission at a distance by creating new bridging solutions. Trade-offs and workarounds were necessary elements, but also posed a threat to patient safety, as these interim solutions were not systematically evaluated or devised learning strategies.ConclusionsTo manage a safe medication process in home healthcare, healthcare professionals need to adapt to fluctuating conditions and create bridging strategies through multiple parallel activities distributed over time, space and actors. The healthcare professionals’ strategies could be integrated in continuous learning, while preserving boundaries of safety, instead of being more or less interim solutions. Patients’ and family caregivers’ as active partners in the MMP may be an underestimated resource for a resilient home healthcare.

Medication adherence: staying within the boundaries of safety

An important domain of patient safety is the management of medications in home and community settings by patients and their caregiving network. This study applied human factors/ergonomics theories and methods to data about medication adherence collected from 61 patients with heart failure accompanied by 31 informal caregivers living in the US. Seventy non-adherence events were identified, described, and analysed for performance shaping factors. Half were classified as errors and half as violations. Performance shaping factors included elements of the person or team (e.g. patient limitations), task (e.g. complexity), tools and technologies (e.g. tool quality) and organisational, physical, and social context (e.g. resources, support, social influence). Study findings resulted in a dynamic systems model of medication safety applicable to patient medication adherence and the medication management process. Findings and the resulting model offer implications for future research on medication adherence, medication safety interventions, and resilience in home and community settings.Practitioner Summary: We describe situational and habitual errors and violations in medication use among older patients and their family members. Multiple factors pushed performance towards risk and harm. These factors can be the target for redesign or various forms of support, such as education, changes to the plan of care, and technology design.

Use of failure mode effect analysis (FMEA) to improve medication management process

PurposeMedication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety.Design/methodology/approachThe study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored.FindingsThe percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes.Research limitations/implicationsFMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing FMEA but also for implementing the corrective actions.Practical implicationsFMEA is an effective proactive risk-assessment tool and is a continuous process which can be continued in phases. The corrective actions taken resulted in reduction in RPN, subjected to further evaluation and usage by others depending on the facility type.Originality/valueThe application of the tool helped the hospital in identifying failures in medication management process, thereby prioritising and correcting them leading to improvement.

COMPREHENSIVE MEDICATION MANAGEMENT SERVICES IN A BRAZILIAN SPECIALITY PHARMACY: A QUALITATIVE ASSESSMENT

Objective: To understand and describe the implementation process of a comprehensive medication management (CMM) service in a public speciality pharmacy in Brazil.Methods: Ethnographic study conducted over 17 mo (September 2014 to February 2016) in a public speciality pharmacy. Semi-structured interviews were conducted with twelve participants. Notes on field journals, resulting from participant observation conducted by the two pharmacists directly responsible for the service implementation, were also used as a source of data.Results: Ten important conditions to improve the success of CMM service implementation were identified: manager support; evaluation of physical and material resources; evaluation of human resources practitioners’ characteristics and knowledge about the theoretical framework of CMM services; time dedicated to CMM services; redefining the work process; defining patient eligibility criteria to CMM service; defining patient flow to CMM service; communication with healthcare team; integration with the staff; and marketing the service internally.Conclusion: The results unveiled by this article can be used by pharmacists and managers as a tool to optimize the implementation of CMM services in different healthcare settings. These conditions do not consist the only aspects necessary to ensure the success of the service; however, they can contribute to optimize the implementation process of the practice

Issues in the Medication Management Process in People Who Have Intellectual and Developmental Disabilities: A Qualitative Study of the Caregivers' Perspective.

People who have intellectual and developmental disabilities (IDD) often rely on caregivers to assist in the medication management process. The aim of this study was to learn from caregivers, who are either family or support staff, what major issues arise throughout the process of managing medication and how these might be addressed. Problems identified by caregivers include (a) prescribers understanding of insurance and agency policies regarding medication utilization; (b) lack of continuity of care and accuracy of the medication record as well as clinical records;

Medication management in the operating suite

AbstractBackgroundThe Logan Hospital Pharmacy Department undertook a review of medication management within the operating suite (OS).AimThis review sought to identify the medication management pathways within the OS and how the department could contribute to the safe, effective and efficient use of medications within this highly specialised environment.MethodA clinical pharmacist project officer (CPPO) visited the suite and observed, documented and reviewed the current medication management processes. Staff interviews were also conducted.ResultsA number of key issues were identified. These included the process of medication storage for general and cold‐chain pharmaceuticals, the dilution and wastage of pre‐drawn medications and open access to restricted antimicrobials. There were also issues with inter‐ and intra‐departmental communication. Following the project, a multi‐disciplinary working group was established to address the issues raised.ConclusionThere is an active role for the pharmacist to play in the medication management cycle within the OS.

Promoting Patient Safety with Human Factors Methods

Medication management is a complex and mentally demanding endeavor performed by multiple individuals in diverse settings and at variable points in time. Achieving the goal of safe care delivery with optimized patient outcomes requires ongoing communication, coordination, and interaction between an array of technologies and roles across the health care continuum. Human factors principles and methods have the potential to substantially improve patient safety throughout this high-risk cycle. The purpose of this interactive discussion panel is to explore the medication management process from a sociotechnical perspective to identify specific challenges and vulnerabilities, and recommend strategies that leverage human factors processes and design principles to efficiently and effectively address safety critical issues.

The medication reconciliation process and classification of discrepancies: a systematic review.

Medication reconciliation is a part of the medication management process and facilitates improved patient safety during care transitions. The aims of the study were to evaluate how medication reconciliation has been conducted and how medication discrepancies have been classified. We searched MEDLINE, EMBASE, CINAHL, PubMed, International Pharmaceutical Abstracts (IPA), and Web of Science (WOS), in accordance with the PRISMA statement up to April 2016. Studies were eligible for inclusion if they evaluated the types of medication discrepancy found through the medication reconciliation process and contained a classification system for discrepancies. Data were extracted by one author based on a predefined table, and 10% of included studies were verified by two authors. Ninety-five studies met the inclusion criteria. Approximately one-third of included studies (n=35, 36.8%) utilized a 'gold' standard medication list. The majority of studies (n=57, 60%) used an empirical classification system and the number of classification terms ranged from 2 to 50 terms. Whilst we identified three taxonomies, only eight studies utilized these tools to categorize discrepancies, and 11.6% of included studies used different patient safety related terms rather than discrepancy to describe the disagreement between the medication lists. We suggest that clear and consistent information on prevalence, types, causes and contributory factors of medication discrepancy are required to develop suitable strategies to reduce the risk of adverse consequences on patient safety. Therefore, to obtain that information, we need a well-designed taxonomy to be able to accurately measure, report and classify medication discrepancies in clinical practice.

Improving Medication Safety Based on Reports in Computerized Patient Safety Systems.

In recent years, patient safety has been a serious concern internationally. Medication in particular is a significant area in improving patient safety because medication errors are a crucial clinical problem. This study aimed to explore suggestions to improve medication safety reported via computerized patient safety systems in hospitals. The research data were retrospectively collected from the computerized patient safety incident reporting systems in one university hospital and two regional hospitals in Finland. Open-ended records concerning prescribing medicines (n = 136), dispensing medicines (n = 362), administering medicines to patients (n = 538), and documenting medication (n = 434) were included in the analysis. The data were analyzed by using inductive content analysis. Based on the study findings, there is a need to develop and standardize procedures related to all four parts of medication management process. Moreover, working environment, multiprofessional collaboration, and knowledge and skills of the professionals should be developed. Promoting medication safety in hospitals is an urgent challenge. The study results indicated that computerized patient safety incident reporting systems can provide important qualitative information to improve medication process to be safer.

Medication Errors in Voluntary Reported Incidents at a Jordanian Hospital = الأخطاء الدوائية في الحوادث الطوعية في مستشفى أردني

Medication incident reports may help organizations to prevent medication errors and to improve patient outcomes. Aims: To assess the prevalence, origin, type, and severity of reported medication incidents at Jordan University Hospital, utilizing a voluntary non-punitive reporting system. Materials and Methods: The present study is of a retrospective design. All voluntary non-punitive incident reports that occurred between January 2014 to March 2015 at Jordan University Hospital were retrieved from the quality department of the hospital. Detailed content analysis was conducted to obtain all relevant information. Data were coded anonymously and analyzed using SPSS version 20. Results: There was an increase in reporting of medication errors overtime and almost all of the reporters were nurses. A total of 58 medication error reports including 86 medications were related to errors in medication management process starting from prescribing, dispensing to administration of medications. Two-thirds of those reports originated from the internal medicine department and the neonatal intensive care unit. The most common drug classes associated with those reports were anti-infectives, antivirals, antifungals, cardiovascular medications and chemotherapy agents. The majority of errors occurred during the administration phase where missed doses and wrong time accounted for more than 52% of the reported incidents. Around 98.8% of reported incidents did not cause major harm to patients. Conclusion: Results of this study showed low percent of a broad variety of medication errors in multiple hospital departments. Additional research is required to identify possible improvements to optimize reporting and to enhance the response to each report.

Medication Error Propagation In Intensive Care Units

We examined propagation of medication errors at various stages of the medication management process (ordering, transcription, preparation, dispensing, administration and monitoring) in two ICUs of a medical center. We performed a secondary analysis of 1,732 medication events identified in a group of 630 ICU patients. A Markov Chain model showed that errors propagate throughout the medication management process, in particular between the stages of preparation, dispensing and administration.

Usability Flaws in Medication Alerting Systems: Impact on Usage and Work System.

Previous research has shown that medication alerting systems face usability issues. There has been no previous attempt to systematically explore the consequences of usability flaws in such systems on users (i.e. usage problems) and work systems (i.e. negative outcomes). This paper aims at exploring and synthesizing the consequences of usability flaws in terms of usage problems and negative outcomes on the work system. A secondary analysis of 26 papers included in a prior systematic review of the usability flaws in medication alerting was performed. Usage problems and negative outcomes were extracted and sorted. Links between usability flaws, usage problems, and negative outcomes were also analyzed. Poor usability generates a large variety of consequences. It impacts the user from a cognitive, behavioral, emotional, and attitudinal perspective. Ultimately, usability flaws have negative consequences on the workflow, the effectiveness of the technology, the medication management process, and, more importantly, patient safety. Only few complete pathways leading from usability flaws to negative outcomes were identified. Usability flaws in medication alerting systems impede users, and ultimately their work system, and negatively impact patient safety. Therefore, the usability dimension may act as a hidden explanatory variable that could explain, at least partly, the (absence of) intended outcomes of new technology.

Smilow expands the universe of cancer care with telepharmacy

T Smilow Cancer Hospital at Yale–New Haven Hospital has gone where no cancer care may have gone before. The cancer hospital acquired several private physician practices across Connecticut and set them up as outposts for cancer care, where patients receive the same level of excellent care but at a clinic close to home. The key to the endeavor’s success was the pharmacy leadership’s vision to implement a telepharmacy model to meet all regulatory requirements and provide safe, high-quality, and ef cient patient care.