Medication-related Activities Research Articles

Effective implementations to reduce medication administration errors in a tertiary care teaching hospital

Background: Medication Administration Errors (MAEs) can lead to unmet therapeutic objectives as these errors can directly harm the patient and affect the outcome of therapy. Materials and Methods: This was an implementation research planned to evaluate the effect of interventions on the prevalence and severity of MAEs over three years, from 2020 to 2022, at a tertiary care hospital where clinical pharmacists were allotted to look into medication-related activities. Amedication error reporting form, developed by the pharmacologist, was used to collect MAE data. Analysis of this information aided in the planning of interventions to curtail the occurrence of such errors in the future. Interventions included drug and disease education leaflets, bedside training, vial/ampoule reading training, understanding different dose strengths, maintaining patient bedside boxes, antibiotic reconstitution leaflets for reference, and charts to guide safe drug administration. Results: The effect of these interventions was analyzed at the end of each year on the prevalence and nature of MAEs, where a decline of 38.97% was found in 2021 and a further 34.88% in 2022, considering the number of opportunities. The most prevalent was the wrong dose (~57%) errors commonly found with oral solid dosage forms and the cardiovascular group of drugs (42.5%). These MAEs were mainly of no harm category C (64%), while only 1.5% of them had caused harm (category E) to the patient, but none of these was sentinel. Conclusion: Interventions by clinical pharmacists successfully helped reduce MAEs and prevented patient harm in the further study period.

Advanced-scope pharmacist roles in medical outpatient clinics: a cost-consequence analysis.

There is a growing body of evidence that supports the clinical effectiveness of pharmacist roles in outpatient settings. However, limited studies have investigated the economic efficiency of advanced-scope outpatient pharmacist roles, particularly in the Australian setting. Assessing the overall costs and benefits of these outpatient pharmacist roles is needed to ensure service sustainability. To use a cost-consequence approach to evaluate the advanced-scope outpatient pharmacist roles across multiple clinic disciplines from the hospital perspective. A cost-consequence analysis was undertaken using data from a previous clinical-effectiveness study. All outpatient pharmacist consults conducted from 1 June 2019 to 31 May 2020 across 18 clinic disciplines were evaluated. Consequences from the pharmacist services included number of consults conducted, number of medication-related activities and number of resolved recommendations. The overall cost to the hospital for the outpatient pharmacist service across all clinics was AU$1 991 122, with a potential remuneration of AU$3 895 247. There were 10 059 pharmacist consults undertaken for the 12-month period. Medication-related activities performed by pharmacists primarily included 6438 counselling and education activities and 4307 medication list activities. When the specialist pharmacist roles were added to the outpatient clinics, several health service benefits were also realised. The addition of pharmacist roles to outpatient clinics can increase the cost of services; however, they also can increase medication optimisation activities. Future research should examine a societal perspective that includes broader cost and effectiveness outcomes. This study could justify the implementation of advanced-scope outpatient pharmacist roles in other Australian hospitals.

Patient perceptions and experiences with medication-related activities in the emergency department: a qualitative study

BackgroundEmergency department (ED) pharmacists reduce medication errors and improve quality of medication use. Patient perceptions and experiences with ED pharmacists have not been studied. The aim of this study was...

The Medication-Related, Information-Seeking Experiences and Barriers for Family Caregivers of Older People

Objective To characterize family caregivers of older people' experiences related to medication information-seeking, including the ability to find medication information and barriers faced in the medication information-seeking process. Design A prospective cross-sectional survey of family caregivers of older people. Setting An online panel of self-identified family caregivers. Participants Family caregivers of older people 60 years of age or older. Results A total 555 family caregivers of older people responded to the survey. Caregiver respondents' mean age was 43.6 (± 14.0) years; they were primarily female (82.5%) and White (74.4%). About three-quarters of respondents assisted with managing medications for care-recipients. Caregivers whose care-recipients were taking medications (n = 537) performed a variety of medication-related activities with 67.8% looking up information online in the last month. While 70.6% of caregivers have asked pharmacists about medication information, only 21.0% considered pharmacists their primary source of such information. Barriers to looking for medication-related information included lack of time to speak to medical providers (51.0%) and pharmacists (45.3%), being unsure about the best source for information (45.9%), and time needed to care for others (43.0%). Conclusion Family caregivers of older people are involved in managing medications, including looking up medication-related information. Several barriers impact caregivers' ability to find medication-related information. Pharmacists can be more proactive in assessing and supporting caregivers' medication-related information needs.

A longitudinal time and motion study quantifying how implementation of an electronic medical record influences hospital nurses’ care delivery

Aim backgroundMany health care services are implementing or planning to undergo digital transformation to keep pace with increasing Electronic Medical Record (EMR) functionality. The aim of this study was to objectively measure nursing care delivery before and following introduction of an EMR. Design and methodsAn extensive program of work to expand an EMR across our health service using a ‘big bang’ methodology was undertaken. The program incorporated digital care delivery workflows including physiological observations, clinical notes and closed loop medication management. The validated Work Observation Method by Activity Timing (WOMBAT) method was applied to undertake a direct observational time and motion study of nurses’ work in a major Australian hospital immediately prior to and six months following the introduction of a full clinical EMR. ResultsTime and motion results were from observing approximately one week of nursing time pre (paper) to six months post (EMR) implementation. A non-significant 6.4% increase in the proportion of time spent on direct care was observed when using the EMR with a statistically significant increase in mean time per direct care task (2.5 min vs 3.9 min, p = 0.001). The proportion of time spent on medication-related activities did not significantly change although the average time per task rose from 2.0 to 2.9 min (p = 0.008). A significant reduction in proportion of time spent in transit and indirect care tasks when using the electronic workflows was reported. No statistically significant changes to the proportions of time spent on professional communication, direct care or documentation were observed. ConclusionsSuccessful EMR implementation is possible without adversely affecting allocation of nursing time. Our findings from deploying a large scale EMR across all healthcare craft groups and workflows have described for nurses that an EMR enables them to spend longer with patients per direct care episode and use their time on other activities more effectively.

Scenario-based preference modeling to examine the robustness of airport mega projects initiatives

Airports are a high complex type of projects that are exposed to many disruptiveness. Proper management between airport expansion projects and airport operations is needed to ensure safety and efficiency of the project and the aviation. Scenario-based preference modeling is one of the robustness analysis techniques that describes the influence of disruptive scenarios on the project initiatives across different criteria. A scenario-based preference model was applied in this work to investigate the influence of different scenarios on Kuwait International Airport expansion. Scenario-based preference is a multi-criteria assessment, which allows the involvement of multiple stakeholders. The key target of the model was to illustrate the most and least robust initiatives, and the highest and least ranked initiatives over the scenarios. The analysis also ranked the scenarios based on their level of disruptiveness. The outcomes of this method can be used to mitigate the system and improve the project robustness by understanding each kind of risk impact. The results showed that the most and least disruptive scenarios were S3, economic crisis, and S5, compelling circumstance, and the most robust initiative was x1, completion of the main terminal building (T2). It is important to discuss the contribution and insights extracted from these analyses. For example, showing the most and least disruptive scenarios is not enough. It is important to mention what insights the readers can gain by knowing the importance of these scenarios. It is very important to highlight the significance of the results. The results showed that the most disruptive scenario was economic crisis. This indicates the fact that current Covid 19 pandemic had significantly affected the local economy, reduced country income that is based mainly on oil and consumed considerable budget on medical related activities. This had resulted in a lower expenditure on mega infrastructure projects as the airport, which caused considerable delay and interruption to major activities. Furthermore, the results showed that the most robust initiative was completion of the main terminal building (T2). This is mainly true due to the fact that the government is very keen to complete this major terminal in the airport as it will release the pressure on the old portion of the airport and increase the airport capacity. Based on these facts, it is clear that priorities in airport infrastructure activities and construction initiatives were affected considerably by the global and local circumstances and come first the global pandemic.

Patterns of interaction with information sources: A case study of a home healthcare admission nurse completing medication-related activities

A method is presented for understanding how people interact with information sources in complex work environments. The method is based on 1) the importance of focusing on information transformations in cognitive work systems articulated in the information trails model and 2) the concept of mediated actions from activity theory as a framework for systematically describing the activities of a human actor. The method was applied to data from a single observation of a home healthcare nurse completing medication-related activities during an admission visit. During the visit, the nurse provided or obtained information using 21 different action patterns to interact with information sources. Using these action patterns, the complexity of different care activities was inspected. The presented method provides a tool for identifying work system redesign opportunities for improving information flow.

Experiences of psychotropic medication use and decision-making for adults with intellectual disability: a multistakeholder qualitative study in the UK

ObjectivesUnderstanding patient and carer perspectives is essential to improving the quality of medication prescribing. This study aimed to explore experiences of psychotropic medication use among people with intellectual disability (ID)...

Outcomes of a hospital-based recreation program

The experience of hospitalization is stressful and traumatic for children and their families. A common way to address these threats to positive development is by introducing play programs in hospitals. Studies of therapeutic activities have had a decided focus on medical-related outcomes. Few studies have explored potential outcomes for children who participate in recreational play activities. This study explored potential short-term changes in children after participating in a recreational play experience, from the perspectives of parents/caregivers and of hospital staff. One-hundred and ten parents/caregivers and 114 hospital staff completed questionnaires after interacting with the “Hospital Outreach Program” (HOP), reflecting a total of 126 patients. Questionnaires included questions about patients' anxiety, comfort in the hospital, openness to hospital staff, positive affect, sadness, physical pain, physical activity level, and socializing with other patients, and other potential changes. Results showed several reports of improvements in patients' positive affect and sadness. Few respondents reported any changes in patients' socializing with other patients and physical pain. Parents/caregivers and hospital staff perceived other short-term outcomes involving more activity, communication, and willingness to participate in medical-related activities. The findings from this study contribute to the research base on effects of adult-led, recreation-focused, in-hospital activities for pediatric patients.

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.

Primary care workflow process mapping of medication-related activities performed by non-provider staff: A pilot project's approach.

A workflow process mapping approach was previously developed to understand the impact of primary care medication use processes on medication safety. The workflow process mapping approach was applied to a pilot project in one primary care practice. The objective of this article is to: (1) exemplify how workflow process mapping was implemented in one primary care practice to characterize medication safety issues (i.e., critical workflow gaps/deviations), (2) discuss the identified critical medication safety workflow gaps and deviations, and (3) summarize the pragmatic, practice-level recommendations developed to enhance practice-level medication safety. Four medication-related activities were directly observed, including: (1) medication reconciliation, (2) warfarin medication management, (3) vaccination administration, and (4) medication renewal requests. Observations occurred with registered nurses, medical assistants, and telephone operators. An ideal-state and observed workflow process map was created for each medication-related activity and was compared to identify critical medication safety workflow gaps and deviations. Practice-level recommendations were developed to enhance workflow and medication safety across all medication-related activities. 111 medication-related observations were recorded over 6-weeks across all 4 workflows (100 observation hours). A total of 17 critical workflow safety gaps, 9 critical workflow step deviations, and 9 workflow sequence deviations were identified. Seventy-six percent of total workflow gaps resulted from inappropriate medication verification. Most workflow step deviations (33%) were due to inappropriate documentation, whereas most sequence deviations (44%) stemmed from inadequate medication verification. Practice-level recommendations to enhance warfarin medication safety were prioritized and implemented prior to the completion of the pilot project. The results of this workflow mapping pilot project exemplify the need to enhance primary care medication safety for workflows conducted by non-provider staff members in primary care practices. Additionally, this approach can be used to identify opportunities for primary care pharmacist integration, particularly for practices with little or no prior pharmacist involvement.

Workflow process mapping to characterize office-based primary care medication use and safety: A conceptual approach.

We developed the PCMedSafety conceptual framework to illustrate primary care medication safety transformation opportunities. PCMedSafety demonstrates the interrelationship between the practice-level primary care delivery system, medication workflow processes for common medication-related activities, and medication use and safety outcomes. This framework was used to conceptualize a workflow process mapping approach to characterize and evaluate the safety of medication-related activities performed in primary care practices. In this article, we conceptually describe how workflow process mapping of primary care medication-related activities can be used to: (1) understand and characterize common office-based primary care medication-related workflows, and (2) identify medication-related workflow process gaps and deviations and their impact on medication use and safety within office-based primary care. Workflow process mapping of primary care medication-related activities consists of 9 major steps, including: (1) identification of a primary care practice, (2) establishment of a workflow mapping team, (3) selection of medication-related activities, (4) development of ideal-state workflow process map(s), (5) selection of data elements and development of data collection form(s), (6) development of a workflow observation schedule, (7) completion of direct workflow observations, (8) development of observed workflow process map(s), and (9) data analysis to identify medication safety workflow gaps and deviations. The medication workflow process mapping approach illustrated in this article can be used by primary care executive leadership, clinician leaders, primary care providers, and clinical pharmacists to identify, resolve, and prevent medication safety concerns within a primary care practices. Workflow gaps and deviations identified through workflow process mapping can be used to inform practice-specific opportunities for: (1) team-based primary care redesign to integrate clinical pharmacists into the expanded primary care team; (2) workforce development, including staff/provider training and role delegation for common primary care medication-related activities; and (3) improvements in workflow efficiency and consistency to reduce preventable medication errors.

Medication administration and interruptions in nursing homes: A qualitative observational study.

To contribute in-depth knowledge of the characteristics of medication administration and interruptions in nursing homes. The following research questions guided the study: How can the medication administration process in nursing homes be described? How can interruptions during the medication administration process in nursing homes be characterized? Medication administration is a vital process across healthcare settings, and earlier research in nursing homes is sparse. The medication administration process is prone to interruptions that may lead to adverse drug events. On the other hand, interruptions may also have positive effects on patient safety. A qualitative observational study design was applied. Data were collected using partial participant observations. An inductive content analysis was performed. Factors that contributed to the observed complexity of medication administration in nursing homes were the high number of single tasks, varying degree of linearity, the variability of technological solutions, demands regarding documentation and staff's apparent freedom as to how and where to perform medication-related activities. Interruptions during medication administration are prevalent and can be characterised as passive (e.g., alarm and background noises), active (e.g., discussions) or technological interruptions (e.g., use of mobile applications). Most interruptions have negative outcomes, while some have positive outcomes. A process of normalisation has taken place whereby staff put up with second-rate technological solutions, noise and interruptions when they are performing medication-related tasks. Before seeking to minimise interruptions during the medication administration process, it is important to understand the interconnectivity of the elements using a systems approach. Staff and management need to be aware of the normalisation of interruptions. Knowledge of the complexity of medication administration may raise awareness and highlight the importance of maintaining and enhancing staff competence.

Implications and implementation of Biomedical Waste Management Rules 2016 in hospitals and a common biomedical waste treatment facility in Andhra Pradesh, India

Biomedical waste (BMW) originated from various medical-related activities are potentially hazardous to human and animal health and poses significant threat to environment. BMW however can be rendered safe and unobjectionable, both aesthetically and environmentally if healthcare facility managers implement the appropriate requirements and recommendations of the several codes of practice and technical advice. This paper gives a brief description of the BMW Rules 2016 and the amendments thereof, the current BMW management practices in the selected health facilities in Vijayawada and a common BMW treatment facility. The case study was carried out by general survey of the facilities. It was observed that the hospitals were largely abiding to the prescribed regulations in case of collection, storage and handling the BMW. The disposal and treatment is being carried out by a proprietary firm and is in compliance with the regulatory standards.

Automated drug dispensing systems in the intensive care unit: a financial analysis.

IntroductionTo evaluate the economic impact of automated-drug dispensing systems (ADS) in surgical intensive care units (ICUs). A financial analysis was conducted in three adult ICUs of one university hospital, where ADS were implemented, one in each unit, to replace the traditional floor stock system.MethodCosts were estimated before and after implementation of the ADS on the basis of floor stock inventories, expired drugs, and time spent by nurses and pharmacy technicians on medication-related work activities. A financial analysis was conducted that included operating cash flows, investment cash flows, global cash flow and net present value.ResultsAfter ADS implementation, nurses spent less time on medication-related activities with an average of 14.7 hours saved per day/33 beds. Pharmacy technicians spent more time on floor-stock activities with an average of 3.5 additional hours per day across the three ICUs. The cost of drug storage was reduced by €44,298 and the cost of expired drugs was reduced by €14,772 per year across the three ICUs. Five years after the initial investment, the global cash flow was €148,229 and the net present value of the project was positive by €510,404.ConclusionThe financial modeling of the ADS implementation in three ICUs showed a high return on investment for the hospital. Medication-related costs and nursing time dedicated to medications are reduced with ADS.

Medication Calculation

Medication dose calculation is one of several medication-related activities that are conducted by nurses daily. However, medication calculation skills appear to be an area of global concern, possibly because of low numeracy skills, test anxiety, low self-confidence, and low self-efficacy among student nurses. Various didactic strategies have been developed for student nurses who still lack basic mathematical competence. However, we suggest that the critical nature of these skills demands the investigation of alternative and/or supplementary didactic approaches to improve medication calculation skills and to reduce failure rates. Digital game-based learning is a possible solution because of the following reasons. First, mathematical drills may improve medication calculation skills. Second, games are known to be useful during nursing education. Finally, mathematical drill games appear to improve the attitudes of students toward mathematics. The aim of this article was to discuss common challenges of medication calculation skills in nurse education, and we highlight the potential role of digital game-based learning in this area.

Landscape of Medication Management in the Minnesota Patient-Centered Medical Home (PCMH)

Purpose: To describe the landscape of medication management within the patient-centered medical homes (PCMH) in the state of Minnesota.
 Methods: An electronic survey of care coordinators within PCMHs certified with the Department of Health in state of Minnesota was conducted. The survey and follow up were distributed by the Minnesota Department of Health. At the time the survey was distributed, there were 161 certified PCMHs in the state.
 Results: The final analysis included 21 respondents. Size, setting, and time as a certified PCMH varied between practices. PCMHs reported a higher percentage of patients enrolled at lower complexity tiers (35.0 percent at tier I and 40.4 percent enrolled at tier II), with PCMHs with clinical pharmacist services reporting slightly increased frequency of higher complexity patients. The composition of the care team varied from clinic to clinic, but all clinics were multidisciplinary with a mean of 5.8 different provider types listed for each clinic. Physicians were the most common providers of medication management across all settings, and one respondent reported that medication management services are not formally provided in his/her clinic. The presence or absence of a clinical pharmacist did not significantly influence care coordination time dedicated to medication-related activities. Respondents residing in a clinic with clinical pharmacist services reported a high level of satisfaction with pharmacist-provided services.
 Conclusion: The implementation of the PCMH model in many of the participating clinics was relatively recent and there remains much to be learned regarding the landscape of comprehensive medication management in the PCMH. The reported distribution of patients in complexity tiers suggests that clinics may use different strategies to determine resource allocation. Although the presence of a clinical pharmacist did not influence care coordination time dedicated, care coordinators valued services provided by clinical pharmacists.
 
 Type: Original Research

Carving Out the Pharmacist's Role in the Elusive ACO

Accountable care organizations (ACOs) were established as part of the Affordable Care Act, the health care reform act signed by President Obama in 2010. An ACO, comprising a network of physicians and facilities that managed the health care needs of Medicare beneficiaries, is an innovative model for delivering health care services. While pharmacist involvement in ACOs is not federally mandated, their skills and experience suggest that they can play a viable role in these organizations. The medication-related activities that the ACO will need to provide are consistent with those currently being performed by consultant pharmacists in long-term care, so there could well be opportunities for these practitioners as ACOs are established and evolve.

Stories from the trenches: Experiences of Alberta pharmacists in obtaining additional prescribing authority.

Pharmacists in Alberta can apply to the Alberta College of Pharmacists in order to obtain the designation of additional prescriber. This designation uniquely allows them to initiate therapy, in addition to other medication-related activities. Our objective was to examine specific experiences of pharmacists regarding the decision to apply and the application itself, and use this information to help inform other pharmacists who are considering additional prescribing. All pharmacists involved in a randomized, controlled trial being conducted in rural Alberta who had received their additional prescribing authorization (APA) were invited to participate. Pharmacists were contacted via e-mail and asked to respond to questions regarding their experiences in applying for APA. Responses were analyzed using content analysis and the identites of all respondents were kept anonymous. Fourteen pharmacists were invited to participate. Review and examination of the responses revealed 3 main themes: motivation, hurdles and outcomes. Motivation can be understood as the reasons why they applied for their APA. Hurdles include any problems encountered of a personal, environmental or professional nature. Outcomes refer to how this designation has changed their practice. Pharmacists had to address many factors that were unexpected during the application process; however, the eventual outcome of obtaining APA was deemed beneficial, both professionally and with regard to patient care. The information shared from these pharmacists will help other pharmacists, regardless of jurisdiction, overcome some of the challenges associated with obtaining advanced prescribing privileges.

Impact of Bar-code Medication Administration on Nursing Activity Patterns and Usage Experience in Taiwan

As medication safety is a foremost goal of patient safety, the adoption of bar-code medication administration can help nurses ensure safe medication administration. The aims of the study were to explore the impact on nursing activity patterns of using this device and to understand the nurses' usage of this technology. The data collection was conducted in a medical center in northern Taiwan using work sampling observation and qualitative interviews. A total of 4940 observations were conducted on two groups of nurses who did or did not use the device, and six nurses were interviewed using a semistructured interview guide. The results showed that the nurses who used this device spent less time on medication-related activities and more on indirect care and unit-related activities, especially on the day and night shifts. Three themes were identified from the follow-up interviews: facilitating nursing workflow, improving medication safety, and encountering operational difficulties. Although the technology use could divert the nurses' practice patterns from medication-related activities to indirect care and unit-related activities, their direct care was not compromised. In addition, although the bar-code medication administration use could improve workflow and patient safety, hardware sufficiency and system functionality deserve more attention in the technology adoption process.