Patient Safety Practices Research Articles

Incorporating patient safety into early undergraduate medical education: teaching medical students to perform surgical time outs during anatomy

ObjectivesTo introduce surgical safety checklists and time outs to future physicians through early incorporation of time outs in the first year gross anatomy course.SettingThe Wayne State University School of Medicine...

The influence of patient-centeredness on patient safety perception among inpatients.

PurposeThis study investigated the influence of patient-centeredness on patient safety perception among inpatients, with particular focus on the relationships between subfactors of patient-centeredness and patient safety perception.MethodsData were collected from 122 inpatients in a university hospital from September 24 to October 8, 2019. Patient-centeredness was evaluated using the Patient-Centeredness Assessment Scale; patient safety perception was evaluated using the Korean version of the Patient Safety Perception Scale. Multiple linear regression analysis was conducted using SPSS for Windows 24.0.ResultsAverage patient-centeredness score among inpatients was 77.14 ± 12.64 (range 0–100), and average patient safety perception score was 99.24 ± 15.90 (range 24–120). Patient-centeredness influenced patient safety perception (R2 = 70%, F = 27.75, p < .001). With respect to subfactors of patient safety perception, the medical team’s activities to ensure safety was affected by the general treatment process and overall evaluation of patient-centeredness (R2 = 54%, F = 13.14, p < .001); patient safety practice was influenced only by the general treatment process (R2 = 39%, F = 7.02, p < .001); and trust in the medical system was affected by nurses’ service, the general treatment process, and the hospital environment (R2 = 44%, F = 8.49, p < .001).ConclusionsTo enhance patient safety perception, strategies should seek to strengthen patient-centeredness and its related subfactors, particularly the general treatment process, the hospital environment, and nurses’ service.

Road towards promoting patient safety practices among hospital pharmacists: Hospital-based baseline patient safety culture assessment cross-sectional survey.

Patient safety is a fundamental aspect of a healthcare system. The aim of this study was to assess the perception and determinants of the patient safety culture of pharmacists in hospitals, in Riyadh, Saudi Arabia.A survey was conducted with pharmacists in the pharmacies of governmental, /military and private hospitals in Riyadh, Saudi Arabia. The pharmacy survey on patient safety culture questionnaire developed by Agency for Healthcare Research and Qualtity, a hard copy was distriuted to the pharmacists. The positive response rate (RR) was calculated and compared across hospitals using a chi-square test. The predictors of patient safety grades were identified using the generalized estimating equation. The data was analyzed using SAS.A total of 538 questionnaires were distributed, of which 411 responded (RR 76.4%). Of the participants, 229 (56%) were females. The majority 255 (62%) were in the 18 to 34 years age range, and 361 (88%) had a bachelor's degree. The majority of the sample 376 (92%) was a pharmacist. The Positive RR (PRR) ranged between (25.6%–74%). The highest PRR was observed in teamwork (74.4%), followed by ‘staff, training and skills’ (68%), and ‘organizational learning continuous improvement’ (66%). The lowest PRR was observed in ‘staffing, work pressure, and pace’ (25.5%). Comparing the PPR of the various healthcare sectors, the governmental hospitals scored the highest in all patient safety domains. Generalized Estimating Equation analysis showed that with increase in scores of all patient safety culture domains increased the likelihood of reporting a better patient safety grade, whereas respondents’ demographic characteristics had no effect except the working experience years 6 years and above had odds of poor reporting of the patient safety grade (odds ratio = 2.54, 95% confience interval (1.543, 4.194), (P = .0003).The grades achieved in the various domains of patient safety culture by pharmacists in Riyadh are below the expected standard. The highest scores were achieved in teamwork, with the lowest scores in staffing, work pressure and pace. Overall, pharmacists in government hospital settings have a better perception of patient safety than their peers in other settings. These results provide the baseline evidence for developing future interventional studies aiming at improving patient safety culture in hospital pharmacy settings.

Medical record keeping practices in a tertiary level hospital

Medical record is the most important document in the medical field. This cross sectional study was conducted at Chittagong Medical College hospital from January to December, 2017 with the aim to assess the existing medical record keeping practices. Around 214 patients’ record files were selected by systematic sampling method and 30 record keeping personnel were also interviewed. Data were collected by review of records by observational checklist and semi-structured questionnaire were administered to medical record keeping personnel. This study showed that, out of 44 items of patient record file among them 33 items were recorded in 100%. Majority of the medical records (89.7%) were satisfactorily completed. All of the respondents mentioned that they had no training regarding medical record keeping practices. All the respondents stated that some problem faced during keeping the medical record and (90.0%) respondents stated that computerized medical record system could solve the problem they faced. This study showed that, the medical recording status is good in majority areas but keeping practice was not organized at all. There were important defects in keeping the medical records. It seems that there are multiple factors contributing to the problem, such as lack of manpower, insufficient record room and they had no training about medical record keeping practice. It is necessary for the government to develop policies and strategies to improve medical record keeping practice for patient safety, to reduce error, repetition of investigations, protect the medico legal issues and future health care advancement.&#x0D; Asian J. Med. Biol. Res. December 2020, 6(4): 723-730

The impact of multidisciplinary team care on decreasing intensive care unit mortality

Patients with critical illness and high mortality risk are frequently admitted to intensive care units (ICUs). Therefore, improving the quality of healthcare for these patients is essential. Improving overall health and following best practices for patient safety are important goals in the health-care sector; especially in critically ill patients. To achieve these goals, many researches have been conducted to develop procedures, protocols and improve ICU structure and design. To discuss the effectiveness of multidisciplinary team (MDT) implementation in ICUs in the Saudi Arabian hospitals and how would this approach significantly reduce ICU mortality rates and improves the quality of healthcare. This review search of electronic search engines was conducted, including ProQuest, Medline, and Google Scholar. The search was narrowed to a total of 21 articles between 2010 and 2020 articles were included, which were found to match the inclusion criteria. Findings indicated a positive effect of the MDT care on decreasing the ICU's mortality rates. The studies reviewed have documented the necessity of successful MDT care implementation for improved survival rates. A collaborative approach by the various health-care providers-nurses, physicians, intensivists, respiratory therapists, and pharmacists–enhances patient care, improves clinical outcomes, and reduces the mortality rate.

Clinical Characteristics and Influence Factor Analysis of ABO Typing Discrepancy Among Patients in a Tertiary Hospital.

An accurate interpretation of the ABO blood group of an individual is of utmost importance to ensure patient safety and good transfusion practices. The aim of the study was to determine the incidence and causes of ABO typing discrepancies among patients and analysis of the clinical characteristics as well. A retrospective observational study was carried out in the Department of Laboratory Medicine in the General Hospital of Chinese PLA from March 2018 to December 2020. Records of patients were collected and analyzed for frequency, clinical characteristics, and influencing factors of ABO typing discrepancies. There were 132 ABO typing discrepancies patients (57 females, 75 males), aged from 3 to 84 (50.3 ± 19.3) years, with history of operation 89 cases (67.42%) and blood transfusion 23 cases (17.42%). In the control group, there were 142 cases (63 females and 79 males), aged 10 - 78 years (50.5 ± 15.55), with operation history 68 cases (47.88%) and blood transfusion history 2 cases (1.40%). Among the inconsistent blood types group, there were 59 cases (44.7%) type B, 38 cases (28.8%) type A, 28 cases (21.2%) type AB, and 7 cases (5.3%) type O. There were 21 cases (15.9%) in the department of hematology, 15 cases (11.36%) in the department of orthopedics, 14 cases (10.6%) in the department of hepatobiliary surgery, 11 cases (8.33%) in the department of general surgery, 11 cases (8.33%) in the department of vascular surgery, and less than 5% in other departments. The common cause of ABO typing discrepancies was due to low/weak affinity antibody (3.79%), low/weak affinity antibody B (18.18%), weak A antigen (3.03%), weak B antigen (12.12%), hematopoietic stem cell transplantation (10.60%), irregular antibody (46.70%), subtype (3.79%), and cold agglutination (1.51%). The diseases in the ABO discrepancy group mainly included hematological disorders, malignant tumors, osteoarthritis and so on. Binary logistic regression showed that hematological disorders, malignant tumors, history of operation (p = 0.01), and history of blood transfusion (p = 0.017) were the influencing factors of ABO typing discrepancies. It is possible that the antibody of ABO blood group system could not be detected. The independent influence factors were hematological disorders, malignant tumor, blood transfusion history and operation history for ABO typing discrepancies. It was necessary to analyze the causes correctly and judge the correct blood group by serological methods.

Patient Safety in Selected Healthcare Facilities in Caraga Region: An Aiken Model Approach

This study aimed to determine the nursing organizational factors and patient safety in selected healthcare facilities in the Philippines. It utilized quantitative approach of research specifically descriptive correlational research design. The inclusion criteria of the entire population were composed mainly of 455 nurses employed among the five selected healthcare facilities in Caraga Region, Philippines within a period of 1 year and above offering inpatient and outpatient healthcare services. Results revealed that there was a positive response on organizational factors such as nursing foundations for quality care, nurse participation in hospital affairs, nurse manager leadership, ability and support and collegial nurse-physician relationships. Patient Safety with regards to supervisor/manager, wok area/unit, frequency of events reported, and communications, patient safety grade, hospital and number of events reported were positively performed and practiced. The patient safety practices were directly affected by the organizational factors being tested.

Blood group systems

Blood group systems

National self-assessment process of patient safety practices in service, from 2016 to 2019: an analysis from the perspective of health surveillance

Introdução: O preenchimento do Formulário da Autoavaliação das Práticas de Segurança do Paciente elaborado pela Anvisa é realizado de forma voluntária e anual serviços de saúde com leitos de UTI e envolve a avaliação de indicadores de estrutura e processo, baseada na Resolução da Diretoria Colegiada da Anvisa nº 36, de 25 de julho de 2013. Objetivo: Analisar o processo de autoavaliação nacional realizado pela Anvisa sob a óptica da vigilância, no período de 2016 a 2019. Método: Realizou-se um estudo retrospectivo, de análise documental no qual foram analisadas e comparadas as informações que eram comuns em quatro Relatórios da Autoavaliação das Práticas de Segurança do Paciente em Serviços de Saúde. Resultados: Observou-se que houve aumento da participação dos hospitais da autoavaliação ao longo dos anos; que a meta prevista no Plano Integrado não foi alcançada; e que os indicadores de processo apresentaram menor conformidade que os de estrutura. Conclusões: Urge a necessidade de implementação de estratégias do Sistema Nacional de Vigilância Sanitária tanto para sensibilizar os gestores sobre a importância da autoavaliação das práticas de segurança do paciente, quanto para a implementação de melhorias nos serviços, bem como de políticas públicas consistentes que visem garantir assistência à saúde de qualidade para a população brasileira.

Exploring Strength Areas of Patient Safety Culture Improvement in KAMC, Makkah, Saudi Arabia

Background: Patient safety culture is an extremely important aspect and a crucial issue in health services. Assessing patient safety culture is a fundamental in obtaining first-hand information on healthcare settings that will help to identify positive areas and shortcomings in patient safety practices that require future improvement. Objective: This study aims to investigate the strengths area of patient safety culture improvement. Also, this study evaluates employees’ perceptions concerning patient safety culture. Subjects and Methods: A mixed methodology and cross-sectional design was used to achieve the aim of the study. Hospital Survey on Patient Safety Culture questionnaire was used to collect data from 350 front line health care providers at specialized hospital, Makkah, Saudi Arabia. Results: The highest rated Patient safety culture dimensions from health care staff perspective was teamwork within units and across the unit, supervisor/ manager expectations and actions promoting patient safety and over all perception of patient safety. The lowest rated dimension was non punitive response to errors, Communication openness, and frequency of events reported. The most of the participants given excellent or very good score in overall patient safety grade, and the majority of the respondents never reported any events during last 12 months. The study statistically proved the relationship between patient safety culture and area of work and number of events reported. In this study result showed that there is significantly difference exist between 12 dimensions of composite items with patient’s safety culture. Conclusion and Recommendations: This study found the strengths and areas of improvements of patient safety culture in the hospital. The good leadership support, effective communication, sufficient staffing, team work, open communication about errors and adequate working hours can improve patient safety culture. This study recommends the health care leaders to create an institutional strategic plan to improve patient safety programs in hospital settings.

Using Evidence: A Nursing Assessment Protocol for Acute Geropsychiatric Patients.

The Centers for Disease Control and Prevention estimates that approximately 20% of the United States population lives with at least one mental health issue. The most common mental illnesses affecting older Americans include anxiety, cognitive, and mood disorders. These patients may exhibit behaviors indicating agitation or anxiety during necessary hospital stays that warrant de-escalation techniques and appropriate medications to help manage emergent symptoms. This quality improvement intervention was intended to demonstrate enhancement of the nursing assessment and reassessment of patients demonstrating symptoms of agitation and anxiety requiring intervention. Assessment of the established nursing practice demonstrated compromised patient safety and led to planning and implementation of a new practice standard that incorporated an evidence-based tool. Nurses utilized a protocol that employed the Pittsburgh Agitation Scale to augment documentation of the nursing assessment for patients exhibiting symptoms of marked anxiety and agitation. Following a 3-month trial, chart audits were completed to assess results of the protocol's implementation. Significant improvement was noted in the nursing assessment process as evidenced in required documentation of nursing assessment and reassessment including use of the protocol. Implementing standards to guide nursing care can support both patient safety and professional practice.

Perfil do biomédico esteta e a segurança do paciente em procedimentos estéticos: uma revisão integrativa

Objetivo: Descrever por meio de uma revisão integrativa o perfil do Biomédico Esteta e a segurança do paciente em procedimentos estéticos. Métodos: Trata-se de um estudo de revisão integrativa sobre o papel do Biomédico Esteta e a segurança do paciente em procedimentos estéticos. O estudo foi realizado a partir da busca por artigos disponibilizados pelas plataformas: Pubmed, SCIELO e Portal Capes, a pesquisa priorizou textos em português e inglês e documentos das resoluções do Conselho Regional e Federal de Biomedicina. Após a seleção dos critérios de inclusão e exclusão, 7 artigos foram selecionados para análise íntegra. Resultados: Foi possível observar que relação entre os procedimentos aderidos às boas práticas de segurança do paciente e o conhecimento das técnicas pelos biomédicos, proporcionam um resultado seguro nos tratamentos estéticos e, embora ainda não existam protocolos específicos segundo a OMS para os procedimentos estéticos, nota-se que o risco de complicações e intercorrências durante ou após os procedimentos são baixos desde que haja o acompanhamento correto. Considerações finais: Diante disso, foi possível estabelecer anotável a necessidade pela contribuição com a segurança do paciente e os cuidados paliativos acercados procedimentos estéticos de modo a possibilitar uma boa resposta terapêutica.

Impact of the COVID-19 pandemic on clinical radiography practice in low resource settings: The Ghanaian radiographers’ perspective

IntroductionThe COVID-19 pandemic has altered the professional practice of all healthcare workers, including radiographers. In the pandemic, clinical practice of radiographers was centred mostly on chest imaging of COVID-19 patients and radiotherapy treatment care delivery to those with cancer. This study aimed to assess the radiographers’ perspective on the impact of the pandemic on their wellbeing and imaging service delivery in Ghana. MethodsA cross-sectional survey of practising radiographers in Ghana was conducted online from March 26th to May 6th, 2020. A previously validated questionnaire that sought information regarding demographics, general perspectives on personal and professional impact of the pandemic was used as the research instrument. Data obtained was analysed using Microsoft Excel® 2016. ResultsA response rate of 57.3% (134/234) was obtained. Of the respondents, 75.4% (n = 101) reported to have started experiencing high levels of workplace-related stress after the outbreak. Three-quarters (n = 98, 73.1%) of respondents reported limited access to any form of psychosocial support systems at work during the study period. Half (n = 67, 50%) of the respondents reported a decline in general workload during the study period while only a minority (n = 18, 13.4%) reported an increase in workload due to COVID-19 cases. ConclusionThis national survey indicated that majority of the workforce started experiencing coronavirus-specific workplace-related stress after the outbreak. Albeit speculative, low patient confidence and fear of contracting the COVID-19 infection on hospital attendance contributed to the decline in general workload during the study period. Implications for practiceIn order to mitigate the burden of workplace-related stress on frontline workers, including radiographers, and in keeping to standard practices for staff mental wellbeing and patient safety, institutional support structures are necessary in similar future pandemics.

Avoiding Inferior Alveolar Nerve Injury during Osseous Genioplasty: A Guide for the Safe Zone by Three-Dimensional Virtual Imaging.

No consensus exists about the safest position for performing the osseous genioplasty, with 5 to 6 mm below the mental foramen being the most frequently recommended position. This study intends to generate a safe distance guide to minimize the risk of inferior alveolar nerve injury during osteotomy. Pretreatment cone-beam computed tomography-derived three-dimensional models from adult patients with skeletal class I to III patterns and cleft lip/palate deformity who underwent orthodontic-surgical interventions (n = 317) were analyzed. A three-dimensional vertical distance between the inferior margin of the mental foramen and the lowest point of the inferior alveolar nerve canal was measured in each three-dimensional hemimandible (n = 634). Statistical analysis was performed to generate the safe distance guide in a stepwise fashion at 95, 99, and 99.99 percent confidence levels. Class III (4.35 ± 1.42 mm) and cleft lip/palate (4.42 ± 1.53 mm) groups presented significantly (p < 0.001) larger three-dimensional distances than class I (3.44 ± 1.54 mm) and class II (3.66 ± 1.51 mm) groups. By considering the 5- to 6-mm safe distance parameter, 6.4, 5.0, 10.6, 16, and 9.9 percent of hemimandibles were at risk of osteotomy-induced nerve injury in the class I, class II, class III, cleft lip/palate, and overall cohorts, respectively. Overall, the safe distance zone to perform the osteotomy was set at 7.06, 8.01, and 9.12 mm below the mental foramen, with risk probabilities of 2.5, 0.5, and 0.0005 percent, respectively. This study contributes to patient safety and surgeon practice by proving a safe distance guide for genioplasty.

Safety practices and opportunities for improvement in brachytherapy: A patient safety practices survey of the American Brachytherapy Society membership

PurposeSafe delivery of brachytherapy and establishing a safety culture are critical in high-quality brachytherapy. The American Brachytherapy Society (ABS) Quality and Safety Committee surveyed members regarding brachytherapy services offered, safety practices during treatment, quality assurance procedures, and needs to develop safety and training materials. Methods and MaterialsA 22-item survey was sent to ABS membership in early 2019 to physicians, physicists, therapists, nurses, and administrators. Participation was voluntary. Responses were summarized with descriptive statistics and relative frequency distributions. ResultsThere were 103 unique responses. Approximately one in three was attending physicians and one in three attending physicists. Most were in practice >10 years. A total of 94% and 50% performed gynecologic and prostate brachytherapy, respectively. Ninety-one percent performed two-identification patient verification before treatment. Eighty-six percent performed a time-out. Ninety-five percent had an incident reporting or learning system, but only 71% regularly reviewed incidents. Half reviewed safety practices within the last year. Twenty percent reported they were somewhat or not satisfied with department safety culture, but 92% of respondents were interested in improving safety culture. Most reported time, communication, and staffing as barriers to improving safety. Most respondents desired safety-oriented webinars, self-assessment modules, learning modules, or checklists endorsed by the ABS to improve safety practice. ConclusionsMost but not all practices use standards and quality assurance procedures in line with society recommendations. There is a need to heighten safety culture at many departments and to shift resources (e.g., time or staffing) to improve safety practice. There is a desire for society guidance to improve brachytherapy safety practices. This is the first survey to assess safety practice patterns among a national sample of radiation oncologists with expertise in brachytherapy.

Exploring Safety Aspects in Dental School Clinics Including Droplet Infection Prevention

BACKGROUND: Health-care safety focuses on improving patient’s and worker’s safety in a safe working clinics’ environment and prevent infection transmission including droplet infections as seasonal influenza and novel coronavirus (COVID-19). Dental health-care personnel (DHCP) are the target of safety measures and are themselves responsible for elimination of preventable harm. Dental schools are expected to demonstrate the model for quality safe care.&#x0D; AIM: This study aims to achieve high-quality safe dental care at dental clinics, Faculty of Dentistry, Cairo University.&#x0D; METHODS: A cross-sectional survey study was conducted at two Dental Outpatient Clinics, Cairo University. Disk review of policies, observation checklists for practices and awareness questionnaires of DHCP were used.&#x0D; RESULTS: DHCP showed good awareness for most of infection control (IC) and X-ray safety items. However, there are no policies or procedures to control droplet infections in the clinics. The clinics were closed in the current COVID-19 pandemic. There were poor patient safety practices, hand hygiene compliance, and personal protective equipment (PPE) use except for protecting clothes and disposable gloves. Students showed better compliance for patient safety guidelines. Other safety policies were poorly communicated.&#x0D; CONCLUSION: There should be preparedness plan to deal with any droplet infection outbreak, epidemic or pandemic as COVID-19 in all dental settings. There is a need to initiate dental safety unit in dental schools to implement, communicate, train, and supervise all dental safety practices including infection control.

Bleeding management after implementation of the Hemorrhage Code (Code H) at the Hospital Israelita Albert Einstein, São Paulo, Brazil.

ABSTRACTObjective To describe the implementation of a care protocol based on rapid response teams, for management and resolution of bleeding.Methods A hospital protocol called Hemorrhage Code (Code H) was devised and developed. In a flow line, a multidisciplinary team provides comprehensive, fast and effective care to the patient with a severe hemorrhagic condition. In another flow line, professionals based at the hospital pharmacy focus on identifying patients at risk of bleeding, to avoid this event. Several hospital professionals and sectors were trained, each with specific roles, ensuring full support to the medical and nursing staffs.Results After implementing this protocol, we were able to significantly reduce the number of catastrophic events related to failure in bleeding management.Conclusion Code H is an example of a value-based medicine and precision medicine project by delivering comprehensive and multidisciplinary care, in addition to point-of-care testing introduced in clinical practice, optimizing patient safety and care practices at the hospital. Furthermore, it will be possible to minimize the risk of lawsuits for the hospital and physicians, as well as rationalizing resources with benefits for administrators and payers.

System-Level Patient Safety Practices That Aim to Reduce Medication Errors Associated With Infusion Pumps: An Evidence Review.

ObjectivesIn this literature review, we discuss 2 system-level, nurse-targeted patient safety practices (PSPs) that aim to reduce medication errors associated with infusion pumps, including smart pumps. One practice focuses on implementing structured process changes and redesigning workflows to improve efficiencies with pump use. The other focuses on investing in initial and ongoing staff training on the correct use, maintenance, and monitoring of infusion pumps.MethodsTwo databases were searched for “infusion pumps” and related synonyms, along with relevant terms for each PSP. Articles were excluded if outcomes were not directly relevant to the PSP addressed in this review, the article was out of scope, or study design was insufficiently described.ResultsLimited research was found on best practices for reducing errors and improving infusion pump use through workflow and process changes, as well as education and training. Four studies reported medication administration errors, procedural errors, or deviations from hospital policy as clinical outcomes of workflow or process changes. Mixed results were found examining process outcomes related to pump handling. Education on the correct use of smart pumps was found to decrease medication errors and adverse drug events, and 2 studies found an increase in nurses’ adherence to using the medication safety software library as a result of education.ConclusionsStandardization of process and integration of technology and workflows were found as facilitators. Type and content of education provided were identified as facilitators, whereas time and energy constraints on nurse educators can be barriers to implementing large hospital-wide education programs.

The Effect of Opioid Stewardship Interventions on Key Outcomes: A Systematic Review.

We sought to identify potential patient safety practices to reduce high-risk opioid prescribing. We conducted a systematic review of the literature to identify opioid stewardship (OS) strategies implemented in primary care and other settings. Included studies evaluated an OS strategy or a multicomponent OS initiative to address potential harms of opioids and used experimental or quasi-experimental designs. We identified 14 studies and 1 systematic review that met inclusion criteria. Most studies examined multicomponent OS interventions, which often consisted of guideline-recommended clinical interventions or care processes (e.g., use urine drug screening, check Prescription Drug Monitoring Program), as well as implementation strategies (e.g., dashboards, audit and feedback). Most studies examined the effect of OS interventions on reducing the potential risks of opioids with judicious prescribing and guideline-concordant care (e.g., reduce inappropriate high opioid dosages, avoid co-prescribing opioids and benzodiazepines, use urine drug screening, treatment agreements). The strength of the evidence is low to moderate that OS efforts decrease numbers of opioid prescriptions, proportion of patients on long-term opioids, or days' supply. The strength of the evidence for OS initiatives producing significant reductions in opioid dosages was moderate. Future research is needed on the effectiveness of OS interventions, particularly studies with experimental designs and in diverse settings within the health care system.

Using Deprescribing Practices and the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions Criteria to Reduce Harm and Preventable Adverse Drug Events in Older Adults.

Approximately 98% of older Americans are simultaneously taking 5-or more-medications to manage at least 2 chronic conditions. Polypharmacy and the use of potentially inappropriate medications (PIMs) are a concern for older adults because they pose a risk for adverse drug events (ADEs), which are associated with emergency department visits and hospitalizations and are an important patient safety priority. We sought to review the evidence of patient safety practices aimed at reducing preventable ADEs in older adults, specifically (i) deprescribing interventions to reduce polypharmacy and (ii) use of the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) to reduce PIMs. We conducted a systematic review of literature published between 2008 and 2018 that studied examined the effect of these interventions to reduce preventable ADEs in older adults. Twenty-six studies and 1 systematic review were included (14 for deprescribing and 12 for STOPP and the systematic review). The deprescribing interventions involved decision support tools, educational interventions, and medication reviews by pharmacists and/or providers. Deprescribing studies primarily examined the effect of interventions on process outcomes and observed reductions in polypharmacy, often significantly. A few studies also examined clinical and economic outcomes. Studies of the use of the STOPP screening criteria most commonly reported changes in PIMs, as well as some economic outcomes. Deprescribing interventions and interventions using the STOPP criteria seem effective in reducing polypharmacy and PIMs in older adults, respectively. Future research on the effectiveness of these approaches on clinical outcomes, the comparative effectiveness of different multicomponent interventions using these approaches, and how to most effectively implement them to improve uptake and evidence-based care is needed.