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Clinical Pharmacists (clinical + pharmacist)
Selected AbstractsStrategies to reduce medication errors with reference to older adultsINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2006Brent Hodgkinson BSc (Hons) MSc GradCertPH GradCertEcon(Health) Abstract Background, In Australia, around 59% of the general population uses prescription medication with this number increasing to about 86% in those aged 65 and over and 83% of the population over 85 using two or more medications simultaneously. A recent report suggests that between 2% and 3% of all hospital admissions in Australia may be medication related with older Australians at higher risk because of higher levels of medicine intake and increased likelihood of being admitted to hospital. The most common medication errors encountered in hospitals in Australia are prescription/medication ordering errors, dispensing, administration and medication recording errors. Contributing factors to these errors have largely not been reported in the hospital environment. In the community, inappropriate drugs, prescribing errors, administration errors, and inappropriate dose errors are most common. Objectives, To present the best available evidence for strategies to prevent or reduce the incidence of medication errors associated with the prescribing, dispensing and administration of medicines in the older persons in the acute, subacute and residential care settings, with specific attention to persons aged 65 years and over. Search strategy, Bibliographic databases PubMed, Embase, Current contents, The Cochrane Library and others were searched from 1986 to present along with existing health technology websites. The reference lists of included studies and reviews were searched for any additional literature. Selection criteria, Systematic reviews, randomised controlled trials and other research methods such as non-randomised controlled trials, longitudinal studies, cohort or case,control studies, or descriptive studies that evaluate strategies to identify and manage medication incidents. Those people who are involved in the prescribing, dispensing or administering of medication to the older persons (aged 65 years and older) in the acute, subacute or residential care settings were included. Where these studies were limited, evidence available on the general patient population was used. Data collection and analysis, Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calculated from individual comparative studies containing count data where possible. All other data were presented in a narrative summary. Results, Strategies that have some evidence for reducing medication incidents are: ,,computerised physician ordering entry systems combined with clinical decision support systems; ,,individual medication supply systems when compared with other dispensing systems such as ward stock approaches; ,,use of clinical pharmacists in the inpatient setting; ,,checking of medication orders by two nurses before dispensing medication; ,,a Medication Administration Review and Safety committee; and ,,providing bedside glucose monitors and educating nurses on importance of timely insulin administration. In general, the evidence for the effectiveness of intervention strategies to reduce the incidence of medication errors is weak and high-quality controlled trials are needed in all areas of medication prescription and delivery. [source] Prescribing errors on medical wards and the impact of clinical pharmacistsINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 1 2003Ms Alison Dale clinical services pharmacist Objectives To assess the incidence of prescribing errors, predict patient outcome from clinical pharmacists' recommendations made in response to identified prescribing errors, and evaluate the influence of clinical pharmacists on recommendation implementation. Method Clinical pharmacy activities were conducted on two wards, one of which had an existing clinical pharmacy service (intervention ward) while the other did not (control ward). For the control ward, prescribing errors were documented but not followed up unless a potentially life-threatening problem was identified. Prescribing errors were identified and recommendations made by pharmacists. A consultant physician and pharmacist conducted an independent, blinded assessment of these recommendations to predict the impact on patient outcome if implemented. Recommendations were communicated to medical staff or implemented by the pharmacist on the intervention ward only. The proportion of recommendations implemented for intervention and control group patients were recorded. Setting Two medical wards in a UK district general hospital. The study was carried out over 12 weeks. Key findings There were 740 errors recorded for 235 patients. Fourteen recommendations could not be assessed. For all recommendations, the consultant and pharmacist predicted patient outcomes with life-saving (one consultant vs three pharmacist), major (186 vs 318), minor (328 vs 324), neutral (211 vs 85) or harmful (five vs five) impact respectively. For the intervention group, 79% of recommendations were implemented, including 81 of 92 (88%) predicted by the consultant to have major impact on patient outcomes. In the control group, only 18% of recommendations were spontaneously implemented, including only 10 of 94 (11%) recommendations predicted by the consultant to have major impact. Conclusion Ward-based clinical pharmacists identified large numbers of prescribing errors and made clinically significant recommendations. Implementation of recommendations was predicted to improve the outcome of patient care. Further research, specifically assessing the outcome of pharmacists' recommendations on patient care, is warranted. [source] Risk of drug-related problems for various antibiotics in hospital: assessment by use of a novel method,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2008Hege Salvesen Blix MSc Abstract Purpose To investigate the use of antibiotics in hospitals, to explore drug-related problems (DRPs) linked to antibiotics and to introduce a novel way of expressing the risks accompanying use of various antibiotics. Methods Patients from internal medicine departments in four Norwegian hospitals were prospectively included in 2002. Demographics, drugs used, medical history, laboratory data and clinical/pharmacological risk factors were recorded. DRPs were identified by clinical pharmacists and assessed in multidisciplinary hospital teams. A new term, the drug risk ratio, was established and defined as the number of times the antibiotic was associated with DRPs in relation to the number of times it was used. Results Out of the 668 patients included, 283 patients (42%) used antibiotics (AB users). AB users were older (76.2 vs. 73.9), used more drugs on admission (5.1 vs. 4.4) and had more DRPs (3.0 vs. 2.2) than non-users. The DRP categories no further need for drug, non-optimal drug and non-optimal dose were most frequently observed. The drug risk ratio, calculated for 12 antibiotic groups, was highest for aminoglycosides (0.77), , -lactamase-resistant penicillins (0.56), macrolides (0.54) and quinolones (0.48) and lowest for first- and third-generation cephalosporins, 0.17 and 0.13, respectively. Conclusions Nearly half of the hospitalised patients were prescribed antibiotics and antibiotic associated DRPs occurred frequently. The drug risk ratio for the different antibiotic groups varied with a factor of six from the lowest to the highest. A high drug risk ratio would alert of antibiotics which require heightened awareness when going to be used in clinical practice. Copyright © 2008 John Wiley & Sons, Ltd. [source] | ||||||||||