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Journal articles on the topic 'Medication'
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Minton, Alyssa, Madeline Nievera, Nathaniel Young, and Joseph Mikels. "Age Differences in Response to Framed Side Effects Information About Hypothetical Medications." Innovation in Aging 4, Supplement_1 (December 1, 2020): 502. http://dx.doi.org/10.1093/geroni/igaa057.1622.
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Abstract Framing equivalent information as a gain (e.g., 90% survival rate) or a loss (e.g., 10% mortality rate) can differentially impact judgments and decision making, such that people make more favorable judgements when information is presented as a positive gain versus a negative loss. The current study investigated how framing and age influences evaluative judgments of hypothetical medications used to treat common health issues when the equivalent probability of experiencing a particular side effect was presented as a gain (e.g., “86% of people who took this medication did not experience rash outbreaks”) or a loss (e.g., “14% of people who took this medication did experience rash outbreaks”). Younger and older adults were presented with health pamphlets for hypothetical medications with three unique side effects for each and indicated the medication’s perceived riskiness, how positively and negatively they felt about the medication, and their likelihood to take the medication. Numeracy, risk-taking behavior, and current affective state were also measured. When information was presented in a loss frame, people reported more negative feelings about the medication, leading to greater perceived riskiness, IE = -.785, SE = .13, p < .001. Age indirectly influenced likelihood via the positive feelings about the medication, IE = .349, SE = .14, p = .013. Younger adults felt more positively about the medications than older adults, leading to an increased willingness to take the medication. These findings provide insight into how framing and age can differentially influence evaluative judgments, perceived risk, and willingness to take medication.
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Turkoski, Beatrice B. "New Medications and Medication Changes." Orthopaedic Nursing 27, no. 5 (September 2008): 318–20. http://dx.doi.org/10.1097/01.nor.0000337284.49832.28.
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&NA;. "New Medications and Medication Changes." Orthopaedic Nursing 27, no. 5 (September 2008): 321–22. http://dx.doi.org/10.1097/01.nor.0000337285.57455.99.
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Ferrario, Catherine G. "Geropharmacology." AACN Advanced Critical Care 19, no. 1 (January 1, 2008): 23–37. http://dx.doi.org/10.4037/15597768-2008-1005.
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Advanced practice nurses’ challenge in managing older adults’ medication regimens from an evidence base is difficult because older adults are vulnerable to medication errors and adverse drug reactions related to a number of factors. Predicting patients’ responses to drugs is compounded during critical illness, adding to the heterogeneity and unpredictability of drug effects that are prevalent premorbidly. In the first part of this 2-part continuing education series, sources of medication errors and older adults’ vulnerability are discussed, including normal changes of aging affecting pharmacokinetics and pharmacodynamics, polypharmacy, self-medicating, patient-family noncompliance, and inappropriately prescribed medications. In the second part, drug classes and drugs posing particular problems for older adults and cautions for acute care and critical care nurses who manage the medications of older adults are highlighted.
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Gunter, Zachariah, Nikolaus Lawson, and Carolyn Bondarenka. "Impact of Dispense Tracking Software on Inpatient Pharmacy Operations." Journal of Pharmacy Technology 38, no. 2 (March 15, 2022): 88–94. http://dx.doi.org/10.1177/87551225211069001.
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Background: When medications dispensed from a hospital inpatient pharmacy aren’t able to be found at their intended destination (ie, a missing dose), this can result in delayed medication administration and rework to redispense the medication. Technology advancements in the medication use process have led to development of dose-tracking software that has the capability to track medication doses throughout the medication use cycle and document a medication’s location to its destination. Objective: The primary objective of this study was to evaluate the impact of dose-tracking software on the number of inpatient pharmacy redispenses and nursing requests for missing medications. Secondary objectives included pharmacy staff satisfaction with dose-tracking software, its impact on workflow and patient safety, and compliance with dose-track scanning. Methods: The study design was a prospective, pre-post implementation to compare the requests for missing doses and associated dispenses of injectable medications during the set evaluation period. Dose-track scanning compliance data was collected and evaluated. A survey was also administered to staff to evaluate employee perception and satisfaction with usability and value of the software. Results: During the preimplementation period, 40 021 injectable doses were dispensed, and 9841 (24.6%) were documented as redispensed doses. After dose-tracking implementation, 42 975 total injectable doses were dispensed with 9839 (22.9%) being redispensed. The count of medication messages was 10 661 in the preperiod and 11 475 in the postperiod. The data were normalized using case mix index (CMI) and patient days to account for variation in severity of illness. Conclusion: Implementation of dose-tracking software showed a decrease in the percentage of redispensed injectable medications.
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Ruppar, Todd M., Vicki S. Conn, and Cynthia L. Russell. "Medication Adherence Interventions for Older Adults: Literature Review." Research and Theory for Nursing Practice 22, no. 2 (June 2008): 114–47. http://dx.doi.org/10.1891/1541-6577.22.2.114.
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This literature review explores the range and nature of medication adherence interventions tested with older adults. The unique needs of older adults require specifically designed and tailored interventions. Low medication adherence rates among some elderly contribute to inadequate pharmacological management of illnesses. Searches were conducted to identify randomized controlled trials of medication adherence; computerized databases, journal hand searches, and ancestry searches yielded 63 studies published between 1977 and 2005 where participants’ mean age was > 60 years. Interventions were categorized by focus (patient, medication, and administration factors). Most were geared toward promoting knowledge and skills for medication-taking and adherence. Gaps were noted in addressing memory aids and self-monitoring strategies; further development of interventions addressing medication and administration factors influencing adherence are also needed. Identified interventions are geared toward self-medicating patients and fail to address caregivers administering medications. Finally, interventions do little to address variations in patterns of adherence among older adults.
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Garza, Pam, Sabrina Q. Mikan, and Linda H. Yoder. "Improving oncology patient medication knowledge through a systematic medication reconciliation process." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 354. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.354.
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354 Background: Patient medication knowledge improves medication adherence. Lack of medication adherence leads to 125,000 deaths per year and $100-$299 billion in cost to the U.S. health care system. An Oncology Advanced Practice Provider (APP) conducted a quality improvement (QI) project to evaluate the effect of an educational review of medications to improve oncology patients’ knowledge regarding medication use. Methods: A QI project consisting of 60 patients seen during their regularly scheduled office visits was conducted. Patients received verbal instructions and written documentation about their medications; prescribed and over-the-counter. Evaluations were conducted and yes/no responses were recorded based on patients’ ability to answer four questions correctly: name of medication, reason for the medication, dosing schedule, and prescriber’s name. This was followed by a second visit using the same process. Results: Participants ranged in age from 42-87 (median = 67); most participants were female (N = 36), Caucasian (N = 37), and retired (N = 31). The total number of medications taken by the participants equaled 174, of which 130 were prescribed and 44 were over the counter medications or supplements. The most common prescribed medications were antiemetics (ondansetron and prochlorperazine) and pain medications (hydrocodone and oxycodone). Other prescribed medications included steroids, antihypertensives, and antiglycemics. The most common over the counter medications were Aspirin, Vitamin D, and multiple vitamins. A total of 612 Medication Reviews were completed. Of these reviews, on Visit I (Initial visit) 274 Educational reviews were required. On Visit II (post educational review) 169 Educational reviews were required. Patients needed 105 fewer educational reviews after the initial educational review. The average time between visits was two weeks. An unexpected finding was the lack of a complete and accurate record of medications taken by the participants as documented in their medical records. Conclusions: An Oncology APP led medication reconciliation process including an educational review showed improved medication knowledge among participants, although more than one review may be needed by some patients. Findings confirm the need for a systematic, comprehensive medication profile in the electronic medical record (EMR) to avoid medication errors in both administration and prescribing. An annual review of medications with patients is critical to their well-being.
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El-Fattah Mohamed Aly, Nagah Abd, Safaa M. El-Shanawany, Maha Ghanem, Maysa Abdalla Elbiaa, Hana Abass Ahmed Mohamed, and Wael M. Lotfy. "Medication safety climate: managing high-alert medication administration and errors among nurses in intensive and critical care units." Egyptian Nursing Journal 20, no. 2 (May 2023): 228–36. http://dx.doi.org/10.4103/enj.enj_16_23.
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Background High-alert medications are drugs that may lead to serious harm when they are wrongly administered to patients. Safe medication administration is the crucial role of nursing staff. Aim This study aims to investigate relationships of medication safety climate and nurses’ knowledge about high-alert medications with managing their administration and errors. Design A cross-sectional correlational study. Sample A convenience sample of 300 nurses. Setting Surgical intensive and critical care units. Tools Self-report questionnaires about medication safety climate, nurses’ knowledge and administration competency of high-alert medications and high-alert medication error experience as well as high-alert medication practice observational tool. Results The nurses’ knowledge, practice, and competencies about administering high-alert medications were below sufficient standards. They described medication safety climate at undesirable levels and reported encountering high-alert medication administration errors of about 25.3%. The medication safety climate and nurses’ knowledge of high-alert medication were associated with and affected nurses’ practice (r =.43; r =.31, respectively) and competencies (r=.32; r=.23, respectively), during administration of high-alert medications. Insufficient levels of medication safety climate and nurses’ knowledge and administration practice of high-medications were the predictive factors of incidence of high-alert medication administration errors among nurses (r =-.18; r =-.32; r = -.21, respectively). Conclusion Sufficient nurses’ knowledge and medication safety climate were deemed to be one of the most important measures to improve managing high-alert medication administration and reduce the occurrence of high-alert medication administration errors. Recommendation The hospital management should implement medication safety in its clinical standards and plan for promoting the safe administration of high-alert medications.
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Hill, Jeoffrey, and Daniel Alford. "Prescription Medication Misuse." Seminars in Neurology 38, no. 06 (December 2018): 654–64. http://dx.doi.org/10.1055/s-0038-1673691.
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AbstractIn the United States, there is a prescription medication misuse crisis including increases in unintentional drug overdose deaths, medications obtained on the illicit market (i.e., diversion), and in the number of individuals seeking treatment for addiction to prescription medications. Neurologists manage patients suffering from conditions (e.g., pain, seizures, spasticity) where the prescriptions of medications with misuse potential are indicated. It is therefore imperative that neurologists understand which medications are liable to misuse and institute strategies to minimize the harm associated with these medications. The authors review the most common medications prescribed by neurologist with misuse potential, and briefly discuss the behaviors that are suggestive of medication misuse and tools for monitoring patients to minimize medication-related harm from misuse.
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Syed, Mahira, and Sarojit Ganguly. "Implementation of STOMP (Stopping Over-Medication of People With Learning Disability, Autism or Both With Psychotropic Medications) PLEDGE: A Quality Improvement Project at Bradford District Care Foundation Trust CAMHS Learning Disability Team." BJPsych Open 8, S1 (June 2022): S114. http://dx.doi.org/10.1192/bjo.2022.343.
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AimsThe project's aim coincides with NHS England STOMP Pledge signed by BDCFT. To maintain up to date records of children and adolescents with learning disabilities eligible for STOMP reviews, implement planned supervised dose reduction, consider alternatives to psychotropics and maintain an up-to-date record of physical health monitoring for patients on antipsychotic medications according to local Trust guidelines.MethodsThe sample consisted of the caseload registered with the CAMHS learning disability Team at BDCFT in December 2021. Each case was reviewed retrospectively through electronic records. Data were collected on a data collection tool designed in Microsoft Excel.Baseline data about Diagnosis and Psychotropic medications prescribed were recorded. The Antipsychotic prescribing practice was audited against local Trust guidelines as part of the project.The project was registered and approved by the Trust Audit Team.ResultsThe study included 106 cases registered in December 2021.42 patients (40%) were prescribed psychotropic medication only10 patients (9%) were prescribed psychotropic medication plus ADHD medication14 patients (13%) were prescribed ADHD medication only40 patients (38%) were not prescribed any medication66 (62%) patients from the sample were prescribed medication.Medications were divided into, Psychotropics and ADHD medication groups. Each group was assessed against a prescription time standard of either less or more than 12 months.Antipsychotics were the most frequently prescribed psychotropic medications; 60% of those prescribed psychotropics were on Antipsychotics. A smaller number (31%) on an Anxiolytic, and an even small number (12%) on an Antidepressant. Anticonvulsants were prescribed to 6 in our sample, but all by another service provider (Paediatrics). 20 patients (38%) were on more than one psychotropic medication.The length of the time was divided into less and more than a year on medication. 20% of patients were on psychotropics for less than 12 months and about 80% for more than 12 months.As there are local BDCFT guidelines for monitoring patients on Antipsychotics, a summary of compliance against standards was included as an audit in the project.All 66 patients on medications were deemed eligible for STOMP reviews, and 64 out of them had behavioural support plan in place.Conclusion66 patients who had eligibility for STOMP: 1.35%: Undergoing reduction plan.2.35%: Reduction was not deemed suitable.3.30%: No review or reduction plan in placeRecommendations are made in the report to achieve full compliance with STOMP objectives and a re-audit in a year to monitor progress.
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Shastay, Ann. "Pet's Medications on Owner's Medication List." Home Healthcare Now 39, no. 1 (January 2021): 50–51. http://dx.doi.org/10.1097/nhh.0000000000000947.
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Kruyer, Lt William Bernard, and Col James R. Hickman. "Medication-Induced Performance Decrements: Cardiovascular Medications." Journal of Occupational and Environmental Medicine 32, no. 4 (April 1990): 342–49. http://dx.doi.org/10.1097/00043764-199004000-00015.
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Lipman, Arthur G. "Compounded Medications Can Compound Medication Problems." Journal of Pharmaceutical Care in Pain & Symptom Control 4, no. 4 (January 1996): 1–3. http://dx.doi.org/10.1300/j088v04n04_01.
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Ryan, Jonathan, Ferdia Bolster, Ian Crosbie, and Eoin Kavanagh. "Antiplatelet medications and evolving antithrombotic medication." Skeletal Radiology 42, no. 6 (January 19, 2013): 753–64. http://dx.doi.org/10.1007/s00256-012-1555-6.
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Ephrem, Ashitha, Sheba Elsa Thomas, and Sreekutty Ravindran. "A Study to Assess the Effect of Media in Promoting Self-Medication Use." International Journal of Research and Review 9, no. 9 (September 27, 2022): 348–54. http://dx.doi.org/10.52403/ijrr.20220938.
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Self-medication is the use of drugs to treat self-diagnosed disorders, symptoms or the intermittent or continued use of prescribed drug for chronic or recurrent disease or symptoms. Todays, self-medication is one of the biggest socio-health and economic problems. This study aimed to find out the importance of media in promotion of self-medication. In this community based survey, a pretested questionnaire was circulated through social media to the general population and the data’s were collected based on the inclusion and exclusion criteria. After analyzing the responses we found that females were practicing self-medications more than males. Self-medication is influenced by many factors such as family, friends, availability of drugs, low perception of risk associated with use of drugs, knowledge of drugs, easy access to internet, and wider media coverage on related health issues. Approximately 190 of the participants admitted to the use of self-medication practice .Most of them were self-medicating for fever, cough and headache. More than half of the respondents had used paracetamol for self-medication. Media plays an important role in the reception of health risks; thus media competence is important in self-medication. Majority of participants use social media to obtain information on self-medication. Keywords: Self- medication, Media, Knowledge
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Atia, Ahmed. "Self-medication's knowledge and practice in adults attending pharmacies in Tripoli, Libya." Journal of medical pharmaceutical and allied sciences 12, no. 2 (April 30, 2023): 5720–23. http://dx.doi.org/10.55522/jmpas.v12i2.4748.
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Self-medication is a widespread practice that may contribute to the antibiotic resistance of human pathogens. This study was aimed to determine the prevalence of self-medication among Libyan patients in Tripoli city. This descriptive, questionnaire- based cross-sectional study was conducted from August to October 2022 among Libyan patients in Tripoli city. The questionnaire was compromising from 13 questions. Three questions were dedicated to the general demographics and the next 10 questions were based on self-medication of drugs for the prevention and treatment of respiratory symptoms. All these questions if answered as a "No" was considered as self-medication. Among 214 participants, 176 (82%) were found to have practiced self-medication; 38.3% of them were aged less than 25 years, the majority being males (60.7%). Lack of time and feeling confidence with self-medication practice were the most common reasons cited behind practicing self-medication. Pain suppressing medications were the most selfmedicated drugs by 55.68%. Pharmacies (67.05%) were the commonest source regarding medicines for self-medication. The higher educated tended to self-medicate more than those with a low level of education. The majority of the respondents to the study reported self-medicating. Therefore, it's essential to enforce the law strictly and raise public awareness of the negative effects of self-medication.
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Coates, Martha, Janeway Granche, and Rose Ann DiMaria-Ghalili. "Source of Purchased Medications and Its Impact on Medication Mistakes and Hospitalizations: The NHATS 2017." Innovation in Aging 4, Supplement_1 (December 1, 2020): 793. http://dx.doi.org/10.1093/geroni/igaa057.2875.
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Abstract Older adults self-administer prescribed medication regimens to treat chronic diseases which can lead to mismanagement, medication related harm and hospitalizations. We examined the extent to which source of purchased medications influenced the occurrence of self-reported medication mistakes and hospitalizations in community-dwelling participants who managed medications independently (N= 3899). The majority (65%) picked-up medications, 18% had medications delivered, and 17% used both (picked-up and delivery). Compared to those picking up their medications, those using delivery only were less likely to have a hospital stay (OR=0.691 [95% CI 0.507-0.943]) and no difference in odds of medication mistakes (OR=1.051 [95% CI 0.764-1.445]), while those using both methods were more likely to report hospital stays (OR=1.429 [95% CI 1.106-1.846]) and medication mistakes (OR = 1.576[95% CI 1.078-2.304]). Older adults who picked-up medications from a local pharmacy and had medications delivered were more likely to report medication mistakes and hospitalizations.
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Monzón-Kenneke, Michele, Paul Chiang, Nengliang (Aaron) Yao, and Mark Greg. "Pharmacist medication review: An integrated team approach to serve home-based primary care patients." PLOS ONE 16, no. 5 (May 25, 2021): e0252151. http://dx.doi.org/10.1371/journal.pone.0252151.
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Background Comprehensive medication review is a patient-centered approach to optimize medication use and improve patient outcomes. This study outlines a pilot model of care in which a remote corporate-based clinical pharmacist implemented comprehensive medication reviews for a cohort of medically complex home-based primary care (HBPC) patients. Method Ninety-six medically complex patients were assessed for medication-related problems. Data collected on these patients were: number of chronic conditions, number of medications, appropriate indication for each medication, dose appropriateness, drug interactions, recommendations for medication optimization and deprescribing. The number of accepted recommendations by the HBPC practice was analyzed. Results On average, the patients were 82 years old and had 13 chronic conditions. They were taking a median of 17 medications. Over a four-month pilot period, 175 medication recommendations were made, and 53 (30.3%) of them were accepted, with most common being medication discontinuation, deprescribing, and dose adjustments. Sixty-four (66.7%) patients were on a medication listed as potentially inappropriate for use in older adults. The most common potentially inappropriate medication was a proton-pump inhibitor (38.5%), followed by aspirin (24%), tramadol (15.6%), a benzodiazepine (13.5%) or an opioid (8.3%). Eighty-one medications were recommended for deprescribing and 27 medications were discontinued (33.3%). There were 24 recommended dose adjustments and 11 medications were dose adjusted (45.8%). Thirty-four medications were suggested as an addition to the current patient regimen, 2 medications were added (5.9%). Conclusion Pharmacist comprehensive medication review is a necessary component of the HBPC healthcare continuum. Additional research is needed to examine whether aligning pharmacists to deliver support to HBPC improves clinical outcomes, reduces healthcare expenditures and improves the patient’s experience.
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Žukauskas, Povilas, Jurgita Daukšienė, Loreta Kubilienė, Rima Jūratė Gerbutavičienė, Vaidas Skyrius, and Raimondas Radžiūnas. "FARMACIJOS FAKULTETO STUDENTŲ ŠEIMŲ NAMŲ VAISTINĖLIŲ TURINIO IR SAVIGYDOS ĮPROČIŲ TYRIMAS." Sveikatos mokslai 23, no. 6 (December 21, 2013): 5–9. http://dx.doi.org/10.5200/sm-hs.2013.124.
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Home medication box - the mirror of whole family medications consumption habits. Family home medication box composition and medications storage order can be a serious indicator that reflects family life, social status, and medication usage. The aim: To evaluate Pharmacy Faculty students families home medication boxes content, storage conditions, value and sources of information which determines home medication box composition. Method: A questionnaire was prepared to perform the research. The research involved 182 first-year and fifth-year students. The study done in 2012. May - October. Results: The families of first-year Pharmacy Faculty students which keeps medications not in original packaging, has medications with passed expiration period in their home medication boxes more often (50.00%) than fifth-year students families (37.50%) (p>0.05). Pharmacy faculty students families containing 4 people usually keep medication of each family member in one place (p<0.001). Conclusions: Pharmacy Faculty students responsibly evaluate home medication box storage conditions and have one special person who is responsible for home medication box composition. Fifth-year Pharmacy Faculty students have a greater influence on home medication box composition than firstyear students.
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Paradissis, Chariclia, Neil Cottrell, Ian Coombes, Ian Scott, William Wang, and Michael Barras. "Patient harm from cardiovascular medications." Therapeutic Advances in Drug Safety 12 (January 2021): 204209862110274. http://dx.doi.org/10.1177/20420986211027451.
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Background Medication harm can lead to hospital admission, prolonged hospital stay and poor patient outcomes. Reducing medication harm is a priority for healthcare organisations worldwide. Recent Australian studies demonstrate cardiovascular (CV) medications are a leading cause of harm. However, they appear to receive less recognition as ‘high risk’ medications compared with those classified by the medication safety acronym, ‘APINCH’ (antimicrobials, potassium, insulin, narcotics, chemotherapeutics, heparin). Our aim was to determine the scale and type of medication harm caused by CV medications in healthcare. Methods A narrative review of adult (>16 years) medication harm literature identified from PubMed and CINAHL databases was undertaken. Studies with the primary outcome of measuring the incidence of medication harm were included. Harm caused by CV medications was described and ranked against other medication classes at four key stages of a patient’s healthcare journey. Where specified, the implicated medications and type of harm were investigated. Results A total of 75 studies were identified, including seven systematic reviews and three meta-analyses, with most focussing on harm causing hospital admission. CV medications were responsible for approximately 20% of medication harm; however, this proportion increased to 50% in older populations. CV medications were consistently ranked in the top five medication categories causing harm and were often listed as the leading cause. Conclusion CV medications are a leading cause of medication harm, particularly in older adults, and should be the focus of harm mitigation strategies. A practical approach to generate awareness among health professionals is to incorporate ‘C’ (for CV medications) into the ‘APINCH’ acronym. Plain language summary Patient harm from cardiovascular medications Background • Harm from medications can cause poor patient outcomes. • Certain medications have been identified as ‘high risk’ and are known to cause high rates of harm. • ‘High risk’ medications are included in medication guidelines used by health professionals. • Cardiovascular medications (e.g. blood pressure and cholesterol medications) are important and have many benefits. • Recent studies have found cardiovascular medications to cause high rates of harm. • Cardiovascular medication harm is often under-recognised in clinical practice. • Some guidelines do not consider cardiovascular medications to be ‘high risk’. Method • This review investigated the extent of harm caused by cardiovascular medications in adults across four healthcare settings: (1) at the time of hospital admission; (2) during hospital admission; (3) after hospital; and (4) readmission to hospital. • Harm caused by cardiovascular medications was ranked against other medication classes. • We investigated the type of cardiovascular medications to cause harm and the type of harm caused. Results • Seventy-five studies were reviewed across 41 countries. • Cardiovascular medications were ranked within the top five medications to cause harm. • Cardiovascular medications were a leading cause of harm in each healthcare setting investigated. • Harm caused by cardiovascular medications was common in older adults (>65 years). • Cardiovascular medications often caused preventable harm. • Medications to treat high blood pressure and abnormal heart rhythms were the most common causes of harm. • We reported kidney injury, electrolyte changes and low blood pressure as common types of harm. Conclusion • Increased focus on cardiovascular medications in clinical practice is needed. • Health professionals need to carefully prescribe and frequently review cardiovascular medications, especially in older adults. • Patient and health professional discussions should be based on both the benefits and harms of cardiovascular medications. • Cardiovascular medications should be included in all ‘high risk’ medication guidelines.
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BARBOSA, Amanda V., Daniele S. SZPAK, and Pedro P. CHRISPIM. "Medication reconciliation in emergency department - the role of clinical pharmacist." Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde 12, no. 1 (March 31, 2021): 596. http://dx.doi.org/10.30968/rbfhss.2021.121.0596.
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Objective: To classify the frequencies and types of pharmaceutical interventions related to medication reconciliation performed in the hospital emergency room. Methods: This is a retrospective sectional study of medication reconciliation carried out in the emergency department of a referral hospital in cardiology from June 11 to August 11, 2019. All patients admitted to the sector at the corresponding period and that have been reconciled were selected for the study. Patients’ home medications were classified according to the Anatomical Therapeutic Chemical Classification and as reconciled, not reconciled or reconciled after pharmaceutical intervention. Types of pharmaceutical interventions considered: suggestions for correcting the omission of patients’ home medications, dose or frequency. Interventions were classified as accepted or not accepted. The patients were divided into two groups: no discrepancies or intentional discrepancies (G1) and unintentional discrepancies (G2). The groups were compared using the Student’s T test (continuous data) and chi-square (x2) or Fisher’s exact test (categorical variables), considering statistical significance values of p <0.05. Results: 182 admissions were analyzed, with an average number of patient’s home medications use of 4.9 ± 3.6 drugs per patient. Of the 900 patients’ home medications, discrepancies were found in 227 medications on medical prescription of admission at the emergency room, being 48.9% intentional discrepancies and 51.1% unintentional discrepancies. Regarding unintentional discrepancies, 81% were due to the medication’s omission correction on the medical prescription; 9.5% were correction of divergent dose of patients’ home medications and frequency of administration respectively and all were adjusted after pharmaceutical intervention. 139 pharmaceutical interventions were performed to correct medication discrepancies, with 83.5% of acceptance by medical staff. Among all the analyzed medications, 51.8% had at least one registration failure by medical and/or nursing staff. Conclusion: The presence of the pharmacist in the emergency room reduced the incidence of unintentional discrepancies related to medication reconciliation, through interventions to correct medication omissions, dose and frequency, being an important element for patient safety.
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Wakai, Eri, Kenji Ikemura, Chika Kato, and Masahiro Okuda. "Effect of number of medications and complexity of regimens on medication adherence and blood pressure management in hospitalized patients with hypertension." PLOS ONE 16, no. 6 (June 10, 2021): e0252944. http://dx.doi.org/10.1371/journal.pone.0252944.
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Introduction Good adherence of antihypertensives is recommended for the accomplishment of hypertension therapy. The number of medications and characteristics contributing to medication regimen complexity, such as dosage forms and dosing frequency, are known to influence medication adherence. However, the effect of medication regimen complexity on the therapeutic efficacy of medicines remains to be clarified. In the present study, we retrospectively investigated the effect of number of medications and medication regimen complexity on medication adherence and therapeutic efficacy in patients with hypertension. Methods According to the inclusion and exclusion criteria, 1,057 patients, who were on medications including antihypertensives on admission at the Mie University Hospital between July 2018 and December 2018, were enrolled in this study. Poor blood pressure management was defined if the systolic or diastolic blood pressure were ≥140 mmHg or ≥ 90 mmHg. Medication regimen complexity was quantified using the medication regimen complexity index (MRCI) score. Results Among 1,057 patients, 164 and 893 patients were categorized into poor and good adherence groups, respectively. The multivariate analyses revealed that age ≥ 71 years and oral MRCI score ≥ 19.5 but not number of oral medications were extracted as risk factors for poor medication adherence. Medication adherence and blood pressure management were poor in the group with oral MRCI score ≥ 19.5, regardless of the age. The rate of readmission was similar. Conclusion Our study is the first to demonstrate that medication regimen complexity rather than number of medications is closely related to medication adherence and blood pressure management. Hence, physicians and/or pharmacists should consider the complexity of medication regimens while modifying them.
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Sawyer, Amanda, Johanna Lake, and Yona Lunsky. "Direct care staff knowledge about medication for individuals with intellectual disabilities." Advances in Mental Health and Intellectual Disabilities 13, no. 3/4 (June 12, 2019): 144–51. http://dx.doi.org/10.1108/amhid-01-2019-0002.
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Purpose The majority of adults with intellectual disabilities (ID) are prescribed at least one, if not multiple medications, with psychotropic medications being the most commonly prescribed. Direct care staff play an important role in psychotropic medication administration and monitoring, yet little is known about their knowledge and comfort with medication. The paper aims to discuss this issue. Design/methodology/approach A 15-item survey, focusing on self-reported knowledge and comfort with psychotropic medication, was completed by 152 direct care staff employed at three agencies providing residential services for individuals with ID across Ontario. Findings In total, 62 per cent of staff respondents reported that psychotropic medications were among the top medications regularly taken by the individuals they support, with behaviour listed as the most commonly reported reason for taking this medication. The majority of staff reported monitoring medication, however, the frequency of monitoring varied considerably. Generally, staff reported feeling comfortable and knowledgeable about medication use, but, most reported a desire for additional medication training. Originality/value This is the first Canadian study to examine staff knowledge and comfort regarding medication use, and the first study to assess PRN (“as needed”) as well as regularly administered medications.
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Jones, Roger. "Medication, Medication." British Journal of General Practice 68, no. 675 (September 27, 2018): 451. http://dx.doi.org/10.3399/bjgp18x698909.
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Johnson, Mary Jayne. "The Medication Adherence Model: A Guide for Assessing Medication Taking." Research and Theory for Nursing Practice 16, no. 3 (July 2002): 179–92. http://dx.doi.org/10.1891/rtnp.16.3.179.53008.
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The Medication Adherence Model (MAM) was developed to describe the process of medication adherence and guide health care providers in assessing medication-taking in individuals with hypertension. The MAM was structured with the idea that two types of nonadherence contribute to inconsistent medication taking, the intentional decision to miss medications, and the unintentional interruptions that cause medications not to be taken. The three core concepts identified in the model are: (a) Purposeful Action, (b) Patterned Behavior, and (c) Feedback. Patients’ initiating and sustaining medication adherence are dependent on the deliberate decision to take medications based on perceived need, effectiveness, and safety (Purposeful Action). Then they establish medication-taking patterns through access, routines, and remembering (Patterned Behavior). Individuals use information, prompts, or events (Feedback) during the appraisal process to evaluate health treatment that, in return, influences individuals’ levels of Purposeful Action and Patterned Behavior (Johnson, 2002; Johnson, Williams, & Marshall, 1999). The MAM depicts the dynamic process of initiating and maintaining medication adherence from the hypertensive patient’s perspective. The model describes the key components of existing cognitive and self-regulatory models, and identifies an additional behavioral component. The succinct organization of the MAM may facilitate health care providers’ ability to evaluate and individualize interventions for promoting medication taking.
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Kauser, Rehana, Mahmoud Saeed, Edward Marson, Saman Asad, Amoune Mohamed, and Georgina Knowles. "Looking at Current Practices Regarding Implementation of Covert Administration of Medication Policy." BJPsych Open 8, S1 (June 2022): S159—S160. http://dx.doi.org/10.1192/bjo.2022.451.
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AimsThe aims of the audit was to find out current practices regarding implementation of covert administration policy guidance. The Covert Medication Administration policy was introduced during the past two years, but due to ongoing pandemic, awareness of it was low. Guidelines for when making a decision to administer medication covertly were clear in the policy. Covert medication administration is a very restrictive practice, albeit clearly in a patient's best interests. Instances were found when medication for physical health was administered covertly and there isn't authority to do so under the Mental Health Act as noted in Care Quality Commissioning inspections.MethodsThe sample selection was obtained by Incident Reporting forms for covert medication prescription from which 10 patients were identified from a four month retrospective sample of geriatric psychiatric inpatient admissions at the Juniper Centre at Moseley Hall Hospital, Birmingham from April to August 2021.ResultsCovert medications administered were used to treat physical and mental health conditions. The physical health medication given was not for side-effects of mental health medication. Of the 22 medications and 10 patients there were no instances where the covert medication checklist had been completed. 9 of 22 medications (41%) (across 7 patients (70%)) had neither a best interest meeting nor a separate discussion held with the patient's family, friend, carer or advocate documented on the electronic record. Of the 22 medications, 7 medications (32%) belonging to 3 different patients had documentation of pharmacist involvement in the decision of covert medication administration whereas 15 medications belonging to 8 different patients did not.ConclusionOur findings conclude inadequate following of the standards protocol of the covert medication administration policy. Despite 77% of medications being prescribed with a completed multi-disciplinary covert care plan and 95% of medications having had completed Incident Reporting forms, the rest of the standards were notably missed.
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Zaki, Izzati Abdul Halim, Rizah Mazzuin Razali, Mahmathi Karuppannan, Shubashini Gnanasan, and Rosmaliah Alias. "147 Prevalence and Drug Classes of Medication Discrepancies among Elderly Patients Discharged from a Tertiary Hospital." Age and Ageing 48, Supplement_4 (December 2019): iv34—iv39. http://dx.doi.org/10.1093/ageing/afz164.147.
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Abstract Introduction Medication-related hospital admission may lead to the development of harmful and unwanted side effects that increase the risk of mortality and morbidity. Multiple steps are being executed to overcome the medication errors and one of the strategies is through conducting the medication reconciliation process. This process involves creating an accurate list of patient’s medications which to be compared with the current medications list upon transfer from different point of care or discharge. Any differences detected are categorized as medication discrepancies either being intentional or unintentional. This study aims to determine the prevalence and drug classification of medications discrepancies among patient discharged from a geriatric ward. Method This study was conducted retrospectively for three months in a geriatric ward. Comparisons were made between medications list on admission from the Medication History Assessment Form with the in-patient medication chart and medications upon discharge by a pharmacist to detect any discrepancies. Descriptive analysis was used to identify prevalence and the drug classification of medication discrepancies among elderly patients discharged from tertiary hospital. Results 1056 medications for 74 patients were screened for discrepancies. 689 (65.3%) discrepancies were detected with a mean of 9.31 ± SD 4.02. The highest number of intentional and unintentional medication discrepancies were detected in cardiovascular drugs (29.1%, n = 155) and (36.5%, n = 57). The drugs on admission and upon discharged that involved in discrepancies were diuretics, antihypertensives and antilipemic agents. Conclusion The number of medication discrepancies was found to be common among elderly patients discharged from the geriatric wards. Findings from this study have highlighted the importance of comprehensive medication reconciliation process prior to discharge in preventing medication discrepancies.
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Majdi Tolah, Khaled, Abdulmajeed Ghallab Alamri, Yasser Salman Almohammedi, Azhar Abdulrahman Kurban, Meeral Majdi Tolah, Khadega Ahmed Salem, Ahmed Majdi Tolah, and Sami Abdo Radman Al-Dubai. "PERCEPTION OF SELF-MEDICATION AMONG TAIBA UNIVERSITY STUDENTS, SAUDI ARABIA." International Journal of Advanced Research 11, no. 05 (May 31, 2023): 969–76. http://dx.doi.org/10.21474/ijar01/16953.
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Self-medication refers to the practice of treating oneself with medication without consulting a healthcare professional. This practice can be dangerous to health. This study aimed to assess the practice of self-medications and associated factors among students in Taiba University, Saudi Arabia. Across sectional study was employed to investigate the practice of self-medications among 210 students in Taiba University by using a self-administered questionnaire.Among all respondents, 87.1% practiced self-medication at least one medication in the last year. The most common self-medication was pain killers (80%) and the most common indication of use was headache (75%). Reasons of self-medication practices were previous experience (52.9%) and no serious health symptoms (51.0%). The most common source of information was personal knowledge (51.0%). The prevalence of elf-medication practice was 87.1%. The most common self-medication was pain killers while, the most common indication of self-medication was headache. The most common reason for self-medication practices was previous experience, and the most common source of information was personal knowledge. Males practiced self-medications more than females.
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Fossum, Mariann, Lee Hughes, Elizabeth Manias, Paul Bennett, Trisha Dunning, Alison Hutchinson, Julie Considine, Mari Botti, Maxine M. Duke, and Tracey Bucknall. "Comparison of medication policies to guide nursing practice across seven Victorian health services." Australian Health Review 40, no. 5 (2016): 526. http://dx.doi.org/10.1071/ah15202.
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Objectives The objective of this paper is to review and compare the content of medication management policies across seven Australian health services located in the state of Victoria. Methods The medication management policies for health professionals involved in administering medications were obtained from seven health services under one jurisdiction. Analysis focused on policy content, including the health service requirements and regulations governing practice. Results and Conclusions The policies of the seven health services contained standard information about staff authorisation, controlled medications and poisons, labelling injections and infusions, patient self-administration, documentation and managing medication errors. However, policy related to individual health professional responsibilities, single- and double-checking medications, telephone orders and expected staff competencies varied across the seven health services. Some inconsistencies in health professionals’ responsibilities among medication management policies were identified. What is known about the topic? Medication errors are recognised as the single most preventable cause of patient harm in hospitals and occur most frequently during administration. Medication management is a complex process involving several management and treatment decisions. Policies are developed to assist health professionals to safely manage medications and standardise practice; however, co-occurring activities and interruptions increase the risk of medication errors. What does this paper add? In the present policy analysis, we identified some variation in the content of medication management policies across seven Victorian health services. Policies varied in relation to medications that require single- and double-checking, as well as by whom, nurse-initiated medications, administration rights, telephone orders and competencies required to check medications. What are the implications for practitioners? Variation in medication management policies across organisations is highlighted and raises concerns regarding consistency in governance and practice related to medication management. Lack of practice standardisation has previously been implicated in medication errors. Lack of intrajurisdictional concordance should be addressed to increase consistency. Inconsistency in expectations between healthcare services may lead to confusion about expectations among health professionals moving from one healthcare service to another, and possibly lead to increased risk of medication errors.
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Deardorff, W. James, Bocheng Jing, Matthew Growdon, Kristine Yaffe, Kenneth Boockvar, and Michael Steinman. "UNNECESSARY AND HARMFUL MEDICATION USE IN COMMUNITY DWELLING PERSONS WITH DEMENTIA." Innovation in Aging 6, Supplement_1 (November 1, 2022): 414. http://dx.doi.org/10.1093/geroni/igac059.1626.
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Abstract Persons with dementia (PWD) often have multiple comorbidities which results in extensive medication use despite potentially limited benefit and increased risk of adverse events. Compared to the nursing home, little is known about medication overuse and misuse among the ~70% of PWD in the community. Therefore, we examined medication use from Medicare Part D prescriptions among 1,289 community-dwelling PWD aged ≥66 from the Health and Retirement Study. We classified medication overuse as over-aggressive treatment of chronic conditions (e.g., insulin/sulfonylurea use with hemoglobin A1c<7.5%) and medications inappropriate near the end of life. We classified medication misuse as medications that negatively affect cognition (strongly anticholinergics/sedative-hypnotics) and problematic medications (using Beers and STOPP criteria). We describe the prevalence and patterns of different types of medication overuse/misuse. Frequently problematic medications included antipsychotics (9%), benzodiazepines (12%), and gabapentinoids (13%). Our findings highlight the burden of unnecessary/harmful medications among PWD and inform future deprescribing interventions.
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Bazoni, Patrícia Silva, Ronaldo José Faria, Francisca Janiclecia Rezende Cordeiro, Élida da Silva Timóteo, Alciellen Mendes da Silva, Ana Luisa Horsth, Eduardo Frizzera Meira, Jéssica Barreto Ribeiro dos Santos, and Michael Ruberson Ribeiro da Silva. "Self-Medication during the COVID-19 Pandemic in Brazil: Findings and Implications to Promote the Rational Use of Medicines." International Journal of Environmental Research and Public Health 20, no. 12 (June 16, 2023): 6143. http://dx.doi.org/10.3390/ijerph20126143.
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Self-medication is identified by the consumption of medications without a prescription or guidance from a qualified prescribing professional. This study estimated the prevalence, profile, and associated factors with self-medication during the COVID-19 pandemic in Brazil. A cross-sectional study was conducted through a household survey in the Alegre city, from November to December 2021. Descriptive analysis was performed for the sociodemographic and clinical characteristics of the interviewees. Poisson regression with robust variance was used to identify the association of sociodemographic and clinical variables with self-medication. A total of 654 people were interviewed, of whom 69.4% were self-medicating. The younger age group (PR = 1.13; 95% CI = 1.01–1.26), female gender (PR = 1.19; 95% CI = 1.04–1.37), consumption of alcoholic beverages (PR = 1.13; 95% CI = 1.01–1.25), and problems with adherence to pharmacological treatment (PR = 1.15; 95% CI = 1.04–1.28) were associated with self-medication, while the occurrence of polypharmacy (PR = 0.80; 95% CI = 0.68–0.95) was a protective factor for self-medication. Self-medication was directly related to over-the-counter drugs, with analgesics dipyrone and paracetamol being the most commonly used. Self-medication consumption of prescription drugs, including those under special control, was identified to a lesser extent.
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Niriayo, Yirga Legesse, Abraham Mamo, Kidu Gidey, and Gebre Teklemariam Demoz. "Medication Belief and Adherence among Patients with Epilepsy." Behavioural Neurology 2019 (April 23, 2019): 1–7. http://dx.doi.org/10.1155/2019/2806341.
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Background. Medication adherence and belief are crucial to achieving the desired goal of therapy in epileptic patients. However, there is a lack of study regarding medication adherence and belief in our setting. Therefore, the purpose of this study was to investigate medication adherence and belief and associated factors among ambulatory patients with epilepsy. Method. A cross-sectional study was conducted on randomly selected epileptic patients at the neurologic clinic of Ayder Comprehensive Specialized Hospital, Ethiopia. Medication adherence and belief were assessed using self-reported questionnaires which were developed based on the review of different literatures. Data were analyzed using binary logistic regression analysis. Result. We included a total of 292 patients. Almost two-thirds (65.4%) of the patients were nonadherent to their medications. The most common cause of nonadherence was forgetfulness (48.7%) followed by inability to get medicine (28.8) and safety concern (23.5%). The majority (78.4%) of the patients had high medication necessity belief while 44.1% had high concern belief about the potential adverse effect of their medications. Overall, 39.4% of the patients had a negative belief toward their medications. Comorbidity (AOR: 3.51, 95% CI: 1.20-10.31), seizure encounter within the last 3 months (AOR: 5.45, 95% CI: 2.48-12.00), low medication necessity belief (AOR: 3.38, 95% CI: 1.14-10.00), high medication concern belief (AOR: 4.23, 95% CI: 2.07-8.63), and negative medication belief (AOR: 4.17, 95% CI: 1.74-10.02) were predictors of medication nonadherence. Conclusion. Majority of the epileptic patients were nonadherent to their medications, and more than one-third of the patients had a negative medication belief. Low medication necessity belief, high medication concern belief, negative medication belief, comorbidity, and seizure encounter were predictors of medication nonadherence. Therefore, healthcare providers should design educational programs to enhance the patients’ believe about their medication in order to improve medication adherence and overall treatment outcome.
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Idris, Muhammad Usamah Bin Mohamed, Nursa'adah Binte Jamil, Xu Yi, Lim Su-Fee, Ang Shin Yuh, Fazila Aloweni, and Rachel Marie Towle. "Keeping patients safe through medication review and management in the community." British Journal of Community Nursing 29, no. 6 (June 2, 2024): 288–93. http://dx.doi.org/10.12968/bjcn.2024.29.6.288.
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Background: There are numerous publications on inpatient medication errors. However, little focus is given to medication errors that occur at home. Aims: To describe and analyse the types of medication errors among community-dwelling patients following their discharge from an acute care hospital in Singapore. Method: This is a retrospective review of a ‘good catch’ reporting system from December 2018 to March 2022. Medication-related errors were extracted and analysed. Findings: A total of 73 reported medication-related error incidents were reviewed. The mean age of the patients was 78 years old (SD=9). Most patients managed their medications independently at home (45.2%, n=33). The majority of medications involved were cardiovascular medications (51.5%, n=50). Incorrect dosing (41.1%, n=39) was the most common medication error reported. Poor understanding of medication usage (35.6%, n=26) and lack of awareness of medication changes after discharge (24.7%, n=18) were the primary causes of the errors. Conclusion: This study's findings provide valuable insights into reducing medication errors at home. More attention must be given to post-discharge care, especially to preventable medication errors. Medication administration and management education can be emphasised using teach-back methods.
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Lauffenburger, Julie C., Nancy Haff, Marie E. McDonnell, Daniel H. Solomon, Elliott M. Antman, Robert J. Glynn, and Niteesh K. Choudhry. "Exploring patient experiences coping with using multiple medications: a qualitative interview study." BMJ Open 11, no. 11 (November 2021): e046860. http://dx.doi.org/10.1136/bmjopen-2020-046860.
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ObjectiveLong-term adherence to evidence-based medications in cardiometabolic diseases remains poor, despite extensive efforts to develop and test interventions and deploy clinician performance incentives. The limited success of interventions may be due to ignored factors such as patients’ experience of medication-taking. Despite being potentially addressable by clinicians, these factors have not been sufficiently explored, which is particularly important as patients use increasing numbers of medications. The aim is to explore patient perspectives on medication-taking, medication properties that are barriers to adherence, and coping strategies for their medication regimen.DesignIndividual, in-person, semistructured qualitative interviews.SettingUrban healthcare system.ParticipantsTwenty-six adults taking ≥2 oral medications for diabetes, hypertension or hyperlipidaemia with non-adherence. Interviews were digitally recorded and transcribed. Data were analysed using developed codes to generate themes. Representative quotations were selected to illustrate themes.ResultsParticipants’ mean age was 55 years, 46% were female and 39% were non-white. Six key themes were identified: (1) medication-taking viewed as a highly inconvenient action (that patients struggle to remember to do); (2) negative implications because of inconvenience or illness perceptions; (3) actual medication regimens can deviate substantially from prescribed regimens; (4) certain medication properties (especially size and similar appearance with others) may contribute to adherence deviations; (5) development of numerous coping strategies to overcome barriers and (6) suggestions to make medication-taking easier (including reducing drug costs, simplifying regimen or dosing frequency and creating more palatable medications).ConclusionPatients with poor adherence often find taking prescription medications to be undesirable and take them differently than prescribed in part due to properties of the medications themselves and coping strategies they have developed to overcome medication-taking challenges. Interventions that reduce the inconvenience of medication use and tailor medications to individual needs may be a welcome development.
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Loput, Charity M., Connie L. Saltsman, Risa C. Rahm, Wm Dan Roberts, Sanya Sharma, Cindy Borum, and Jennifer A. Casey. "Evaluation of medication administration timing variance using information from a large health system’s clinical data warehouse." American Journal of Health-System Pharmacy 79, Supplement_1 (October 15, 2021): S1—S7. http://dx.doi.org/10.1093/ajhp/zxab378.
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Abstract Purpose An analysis to determine the frequency of medication administration timing variances for specific therapeutic classes of high-risk medications using data extracted from a health-system clinical data warehouse (CDW) is presented. Methods This multicenter retrospective, observational analysis of medication administration data from 14 hospitals over 1 year was conducted using a large enterprise health-system CDW. The primary objective was to assess medication administration timing variance for focused therapeutic classes using medication orders and electronic medication administration records data extracted from the electronic health record (EHR). Administration timing variance patterns between standard hospital staffing shifts, within therapeutic drug classes, and for as-needed (PRN) medications were also studied. To assess medication administration timing variance, calculated variables were created for time intervals of 30-59, 60-120, and greater than 120 minutes. Scheduled medications were assessed for delayed administration and PRN medications for early administration. Results A total of 5,690,770 medication administrations (3,418,275 scheduled and 2,272,495 PRN) were included in the normalized data set. Scheduled medications were frequently subject to delays of ≥60 minutes (15% of administrations, n = 275,257) when scheduled for administration between 9-10 AM and between 9-10 PM. By therapeutic drug class, scheduled administrations of insulins, heparin products, and platelet aggregation inhibitors were the most commonly delayed. For PRN medications, medications in the anticoagulant and antiplatelet agent class (most commonly heparin flushes and line-management preparations) were most likely to be administered early, defined as more than 60 minutes from the scheduled time of first administration. Conclusion The findings of this study assist in understanding patterns of delayed medication administration. Medication class, time of day of scheduled administration, and frequency were factors that influenced medication administration timing variance.
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Antimisiaris, Demetra, Brittany McHolan, Daniela Moga, and Cortney Mospan. "Medication Related Problems." Senior Care Pharmacist 36, no. 2 (February 1, 2021): 68–82. http://dx.doi.org/10.4140/tcp.n.2021.68.
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When selecting and managing psychoactive medications in older people, it is equally important to focus on avoidance of toxicity as it is to focus on efficacy. Higher psychoactive medication load is associated with increased rate and risk of all cause hospitalization. The medication classes used to treat depression and related comorbidities include antidepressants, antipsychotics, stimulants, mood stabilizers, lithium, anxiolytics and sedative hypnotics. This discussion will examine considerations to help avoid medication related problems relevant to medications used to treat depression in the antidepressant pharmacological class.
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Antimisiaris, Demetra, Brittany McHolan, Daniela Moga, and Cortney Mospan. "Medication Related Problems." Senior Care Pharmacist 36, no. 2 (February 1, 2021): 68–82. http://dx.doi.org/10.4140/tcp.n.2021.68.
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When selecting and managing psychoactive medications in older people, it is equally important to focus on avoidance of toxicity as it is to focus on efficacy. Higher psychoactive medication load is associated with increased rate and risk of all cause hospitalization. The medication classes used to treat depression and related comorbidities include antidepressants, antipsychotics, stimulants, mood stabilizers, lithium, anxiolytics and sedative hypnotics. This discussion will examine considerations to help avoid medication related problems relevant to medications used to treat depression in the antidepressant pharmacological class.
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Grinalds, McKenzie S., Natalie C. Washburn, Joel W. Daniel, and Todd A. Walroth. "Interrater reliability and ease of use of the High-Alert Medication Stratification Tool‒Revised Prospective (HAMST-R PRO): A prospective, multisite study." American Journal of Health-System Pharmacy 79, no. 4 (November 1, 2021): 218–29. http://dx.doi.org/10.1093/ajhp/zxab407.
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Abstract Objective The High-Alert Medication Stratification Tool‒Revised (HAMST-R) was originally designed to standardize the identification of high-alert medications (HAMs) according to safety risk. The primary objective of this multisite study was to assess interrater reliability of the HAMST-R PRO, a version of the tool designed to prospectively evaluate safety risk of medications during evaluation for formulary addition. Methods HAMST-R was designed as an objective tool to evaluate HAMs at a single site during the HAMST-R phase I study. Phase II of the study demonstrated the validity of the tool in a multisite, national study. In this third study, 11 medication safety experts from 8 health systems across the United States and 1 in Canada facilitated evaluation of medications prospectively with the HAMST-R PRO during the formulary review process for 27 medications. At each site, at least 5 individuals were asked to review each medication. Interrater reliability was evaluated using Kendall’s coefficient of concordance. Ease of use was determined by participant interviews. Results Overall interrater reliability for HAMST-R PRO was found to be 0.76 (P < 0.001) across all sites, indicating substantial agreement between users. Interrater reliability among individual sites ranged from 0.52 to 0.82 (P < 0.05 for all sites). Conclusion Interrater reliability of HAMST-R PRO is substantial, indicating consistency and agreement among pharmacists utilizing this tool to evaluate safety risk of medications before their addition to a health-system formulary. This information can be used to identify potential interventions for each step of the medication-use process that institutions may implement to decrease a medication’s potential safety risk.
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Goulas, Clara, Laura Lohan, Marion Laureau, Damien Perier, Véronique Pinzani, Marie Faucanie, Valérie Macioce, et al. "Involvement of Pharmacists in the Emergency Department to Correct Errors in the Medication History and the Impact on Adverse Drug Event Detection." Journal of Clinical Medicine 12, no. 1 (January 3, 2023): 376. http://dx.doi.org/10.3390/jcm12010376.
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(1) Incomplete or wrong medication histories can lead to missed diagnoses of Adverse Drug Effects (ADEs). We aimed to evaluate pharmacist-identified ED errors in the medication histories obtained by physicians, and their consequences for ADE detection. (2) This prospective monocentric study was carried out in an ED of a university hospital. We included adult patients presenting with an ADE detected in the ED. The best possible medication histories collected by pharmacists were used to identify errors in the medication histories obtained by physicians. We described these errors, and identified those related to medications involved in ADEs. We also identified the ADEs that could not have been detected without the pharmacists’ interventions. (3) Of 735 patients presenting with an ADE, 93.1% had at least one error on the medication list obtained by physicians. Of the 1047 medications involved in ADEs, 51.3% were associated with an error in the medication history. In total, 23.1% of the medications involved in ADEs were missing in the physicians’ medication histories and were corrected by the pharmacists. (4) Medication histories obtained by ED physicians were often incomplete, and half the medications involved in ADEs were not identified, or were incorrectly characterized in the physicians’ medication histories.
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Scher, Ann I., Paul B. Rizzoli, and Elizabeth W. Loder. "Medication overuse headache." Neurology 89, no. 12 (August 18, 2017): 1296–304. http://dx.doi.org/10.1212/wnl.0000000000004371.
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It is a widely accepted idea that medications taken to relieve acute headache pain can paradoxically worsen headache if used too often. This type of secondary headache is referred to as medication overuse headache (MOH); previously used terms include rebound headache and drug-induced headache. In the absence of consensus about the duration of use, amount, and type of medication needed to cause MOH, the default position is conservative. A common recommendation is to limit treatment to no more than 10 or 15 days per month (depending on medication type) to prevent headache frequency progression. Medication withdrawal is often recommended as a first step in treatment of patients with very frequent headaches. Existing evidence, however, does not provide a strong basis for such causal claims about the relationship between medication use and frequent headache. Observational studies linking treatment patterns with headache frequency are by their nature confounded by indication. Medication withdrawal studies have mostly been uncontrolled and often have high dropout rates. Evaluation of this evidence suggests that only a minority of patients required to limit the use of symptomatic medication may benefit from treatment limitation. Similarly, only a minority of patients deemed to be overusing medications may benefit from withdrawal. These findings raise serious questions about the value of withholding or withdrawing symptom-relieving medications from people with frequent headaches solely to prevent or treat MOH. The benefits of doing so are smaller, and the harms larger, than currently recognized. The concept of MOH should be viewed with more skepticism. Until the evidence is better, we should avoid dogmatism about the use of symptomatic medication. Frequent use of symptom-relieving headache medications should be viewed more neutrally, as an indicator of poorly controlled headaches, and not invariably a cause.
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Sleath, Betsy, Susan J. Blalock, David Covert, Asheley Cockrell Skinner, Kelly W. Muir, and Alan L. Robin. "Patient Race, Reported Problems in Using Glaucoma Medications, and Adherence." ISRN Ophthalmology 2012 (November 21, 2012): 1–7. http://dx.doi.org/10.5402/2012/902819.
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Objective. The objectives of the study were to (a) describe various factors potentially related to objectively measured adherence to glaucoma medications and self-reported glaucoma medication adherence self-efficacy and (b) examine the relationship between patient race, the number of patient reported-problems, and adherence in taking their glaucoma medication. This was a cross-sectional study conducted at two glaucoma subspecialist referral ophthalmology practices. Methods. We measured subjects' reported problems in using glaucoma medications, adherence to glaucoma medications utilizing the Medication Events Monitoring System (MEMS) devices, and general glaucoma medication adherence self-efficacy using a previously validated 10-item scale. Multivariable logistic and linear regression was used to analyze the data. Results. Seventy-one percent of patients self-reported at least one problem in using their glaucoma medications. White patients were more than 3 times more likely to be 80% adherent in using their glaucoma medications than non-White patients. Patients who had glaucoma longer reported significantly higher glaucoma medication adherence self-efficacy. Patients who reported more problems in using their medications had significantly lower glaucoma medication adherence self-efficacy. Conclusions. Eye care providers should assess patient reported problems and glaucoma medication adherence self-efficacy and work with patients to find ways to reduce the number of problems that patients experience to increase their self-efficacy in using glaucoma medications.
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Tran, Tim, Simone E. Taylor, Andrew Hardidge, Elise Mitri, Parnaz Aminian, Johnson George, and Rohan A. Elliott. "The Prevalence and Nature of Medication Errors and Adverse Events Related to Preadmission Medications When Patients Are Admitted to an Orthopedic Inpatient Unit: An Observational Study." Annals of Pharmacotherapy 53, no. 3 (September 20, 2018): 252–60. http://dx.doi.org/10.1177/1060028018802472.
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Background: Medication errors commonly occur when patients move from the community into hospital. Whereas medication reconciliation by pharmacists can detect errors, delays in undertaking this can increase the risk that patients receive incorrect admission medication regimens. Orthopedic patients are an at-risk group because they are often elderly and use multiple medications. Objective: To evaluate the prevalence and nature of medication errors when patients are admitted to an orthopedic unit where pharmacists routinely undertake postprescribing medication reconciliation. Methods: A 10-week retrospective observational study was conducted at a major metropolitan hospital in Australia. Medication records of orthopedic inpatients were evaluated to determine the number of prescribing and administration errors associated with patients’ preadmission medications and the number of related adverse events that occurred within 72 hours of admission. Results: Preadmission, 198 patients were taking at least 1 regular medication, of whom 176 (88.9%) experienced at least 1 medication error. The median number of errors per patient was 6 (interquartile range 3-10). Unintended omission of a preadmission medication was the most common prescribing error (87.4%). There were 17 adverse events involving 24 medications in 16 (8.1%) patients that were potentially related to medication errors; 6 events were deemed moderate consequence (moderate injury or harm, increased length of stay, or cancelled/delayed treatment), and the remainder were minor. Conclusion and Relevance: Medication errors were common when orthopedic patients were admitted to hospital, despite postprescribing pharmacist medication reconciliation. Some of these errors led to patient harm. Interventions that ensure that medications are prescribed correctly at admission are required.
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Jallow, Fatoumata, Elisa Stehling, Zara Sajwani-Merchant, Kathryn M. Daniel, Kimberly G. Fulda, Anna M. Espinoza, Ayse P. Gurses, Alicia I. Arbaje, and Yan Xiao. "A Multisite Qualitative Analysis of Perceived Roles in Medication Safety: Older Adults’ Perspectives." Journal of Patient Experience 10 (January 2023): 237437352311588. http://dx.doi.org/10.1177/23743735231158887.
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Older adults and caregivers play an essential role in medication safety; however, self-perception of their and health professionals’ roles in medication safety is not well-understood. The objective of our study was to identify the roles of patients, providers, and pharmacists in medication safety from the perspective of older adults. Semi-structured qualitative interviews were held with 28 community-dwelling older adults over 65 years who took five or more prescription medications daily. Results suggest that older adults’ self-perceptions of their role in medication safety varied widely. Older adults perceived that self-learning about their medications and securing them are critical to avoiding medication-related harm. Primary care providers were perceived as coordinators between older adults and specialists. Older adults expected pharmacists to inform them of any changes in the characteristics of medications to ensure medications were taken correctly. Our findings provide an in-depth analysis of older adults’ perceptions and expectations of their providers’ specific roles in medication safety. Educating providers and pharmacists about the role expectations of this population with complex needs can ultimately improve medication safety.
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Alotaibi, Majed H. "Medication Safety." Journal of Medical Science And clinical Research 11, no. 06 (June 30, 2023): 111–13. http://dx.doi.org/10.18535/jmscr/v11i6.21.
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Drug therapy is the most common healing mediation in medicine to recover patient well-being. In spite of the concentrating to help patients, there are numerous examples of inappropriate medication procedures and practices that compromise drug efficacy and lead to preventable medication errors, thereby jeopardizing patient health. Insecure medication practices leading to medication errors are one of the leading reasons of healthcare-related illness and mortality that globally published drug safety fact files. Understanding these characteristic risks will allow healthcare suppliers to better manage drawbacks and efforts to guarantee drug security in healthcare delivery. When safety policies and risk organization skills are integrated into health methods and medication rehearses, safer hospitals and main care can be achieved. Safety and danger management are integrated into healthcare arrangements and processes
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Apsay, Khandy Lorraine Guerrero, Gianille Geselle Alvarado, Marlon Charles Paguntalan, and Sittie Hannah Tumog. "CONTRIBUTING FACTORS TO MEDICATION ERRORS AS PERCEIVED BY NURSING STUDENTS IN ILIGAN CITY, PHILIPPINES." Belitung Nursing Journal 4, no. 6 (November 7, 2018): 537–44. http://dx.doi.org/10.33546/bnj.566.
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Background: Nursing students are allowed to give medication with clinical supervision to give medications with clinical supervision to enhance skills in medication administration. However, studies suggest that some students commit medication errors due to knowledge, personal, administrative and environmental factors.Objective: This study will identify factors that cause student nurses to commit medication errors and correlate it to the number of perceived medication errors committed.Methods: A correlational design was used to correlate the factors contributing to medication administration and the number of medication errors committed by the students. 388 randomly selected nursing students were asked to answer a Modified Medication Error Questionnaire which measures the knowledge, administrative, personal and environmental factors which may contribute to medication administration errors. Medication administration errors are measured according to the number of times a student commits as perceived by them.Results: Lack of knowledge of the drug and equipment to be used for administration, decrease in confidence, poor clinical assessment of patients; conditions, and poor follow ups from clinical instructor are identified concerns under knowledge factor. Poor positive feedback, inadequate supervision and belittling ways of clinical instructors are identified under the administrative factor. Fear of administering an injection or giving medications is a common problem under personal factor. Inappropriate labelling of medications, unfavorable room temperature, lack of space, inadequate lighting, disorganized medication administration schedule and noise are problems found under environmental factor. A minority of 17.3% claimed that they have encountered a medication error in any of their clinical duties.Conclusion: Knowledge, administrative, personal and environmental factors have no effect towards medication errors. However, the relationship between age and the number of perceived medications errors is established. More in-depth investigation is recommended to determine the type of medication errors committed and its detrimental effects towards patient safety.
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Branham, Ashley, Joseph Moose, and Stefanie Ferreri. "Retrospective Analysis of Medication Adherence and Cost Following Medication Therapy Management." INNOVATIONS in pharmacy 1, no. 1 (June 1, 2010): 12. http://dx.doi.org/10.24926/iip.v1i1.195.
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Objective: To determine if pharmacist-provided medication therapy management (MTM) improves medication adherence in Medicare patients. A secondary objective is to compare the total monthly cost of a patient's prescription medication regimen 6 months before and 6 months following a comprehensive medication review (CMR).
Design: Retrospective analysis of medication adherence, pre-post comparison.
Setting: Three independent pharmacies in North Carolina.
Patients: 97 Medicare Part D beneficiaries with one or more chronic disease states who participated in a comprehensive medication review (CMR).
Intervention: MTM services provided by community pharmacists.
Main outcome measure: Change in adherence as measured by the proportion of days covered (PDC) and change in medication costs for patients and third party payers.
Results: Patients were adherent to chronic disease-state medications before and after MTM (PDC≥ 0.8). Overall, change in mean adherence before and after MTM did not change significantly (0.87 and 0.88, respectively; p = 0.43). However, patients taking medications for cholesterol management, GERD, thyroid and BPH demonstrated improved adherence following a CMR. No change in adherence was noted for patients using antihypertensives and antidiabetic agents. Average total chronic disease-state medication costs for participants were reduced from $210.74 to $193.63 (p=0.08) following the comprehensive medication review. Total costs for patient and third party payers decreased from patients prescribed antilipemics, antihypertensives, GERD and thyroid disorders following a CMR.
Conclusions: Pharmacist-provided MTM services were effective at improving medication adherence for some patients managed with chronic medications. Pharmacist-provided MTM services also were effective in decreasing total medication costs.
Type: Original Research
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Tarciuc, Petruța, Ana Maria Alexandra Stanescu, Camelia Cristina Diaconu, Luminita Paduraru, Alina Duduciuc, and Smaranda Diaconescu. "Patterns and Factors Associated with Self-Medication among the Pediatric Population in Romania." Medicina 56, no. 6 (June 25, 2020): 312. http://dx.doi.org/10.3390/medicina56060312.
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Background and objectives: Self-medication is a global phenomenon in both developed and emerging countries. At present, data regarding the practice, patterns, and factors associated with self-medication in Romanian patient groups of various ages and health are relatively scarce. A pilot study that uses a questionnaire was conducted to observe the attitudes as well as the behaviors of a group of Romanian parents related to self-medication, specifically their beliefs and perceived risks of the administration of medicine to their children without medical advice, frequency of self-medications, symptoms, and types of medications most commonly used without medical advice. Materials and Methods: The questionnaire was sent via e-mail or WhatsApp link on a mobile phone using the existing data at the general practitioner’s office together with the protection of data form and the informed consent form; some participants completed the questionnaire when they came for a regular visit at the general practitioner’s office. Of 246 applied questionnaires, we had a rate of responses of 98%. Results: We found a high percentage (70%) of parents who self-medicate their children. The data reveals a significant relation between parents’ beliefs on self-medication and their tendency to administrate drugs to their children without medical advice. A significant relation was also found between the likelihood of parental self-medication for their children and the number of illnesses experienced by their children over the six-month period prior to the survey. Even when parents have a correct understanding of self-medication risks, these are not aligned with actual behavior; therefore, parents continue to administer drugs to their children without medical advice. Conclusions: Our study helps to describe the patterns of parents’ decisions about self-medicating their children and to identify parents who are more predisposed to administering self-medication to their children.
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Steele, Abigail J., Josef D. Berletic, and Michael R. Gionfriddo. "Pharmacist-Driven Geriatric Medication Assessment at an Acute Care Teaching Hospital." Senior Care Pharmacist 38, no. 5 (May 1, 2023): 179–84. http://dx.doi.org/10.4140/tcp.n.2023.179.
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Older patients are often prescribed many medications and are at higher risk for medication-related problems. Pharmacists can help to identify potentially inappropriate medication use that may precipitate adverse drug events resulting in mental status changes, falls, and hospitalization. A Pharmacist-Driven Geriatric Medication Assessment program was established by clinical pharmacists to evaluate medication use in older patients admitted to a pilot unit of an acute care hospital as part of an Age-Friendly Care initiative. This article describes the implementation of this program and the types of medication interventions pursued by the pharmacists. Pharmacist recommendation acceptance rate by the health care team was greater than 90% overall for medication reconciliation, potentially inappropriate medications, and other medication interventions.
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Levenson, Steven. "Addressing Medications Definitively By Avoiding “Medication Management”." Caring for the Ages 22, no. 7 (October 2021): 4–7. http://dx.doi.org/10.1016/j.carage.2021.09.007.
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Bhalla, Devender, Elham Lotfalinezhad, Fatemeh Amini, Ahmad Delbari, Reza Fadaye-Vatan, Vida Saii, and Kurosh Gharagozli. "Medication Beliefs and Adherence to Antiseizure Medications." Neurology Research International 2020 (October 23, 2020): 1–9. http://dx.doi.org/10.1155/2020/6718915.
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Introduction. The primary objective of our study was to determine the nature of medication beliefs and their association with adherence to antiseizure medications (ASMs) among elderly epilepsy patients. Our secondary objective was to enhance the psychometric properties and factor structure parameters of the Beliefs about Medications Questionnaire (BMQ) adapted to epilepsy and affected aged subjects. Methods. A population-based survey was performed in which older adults (≥60 years of age) were invited for a free face-to-face consultation with the specialists as well as for the collection of necessary data. The eligible subjects were those who are affected with epilepsy and having epileptic seizures of any type. In addition, the participants were required to be of any sex, currently under treatment with ASMs, resident of Tehran, and able and interested to participate independently. All were carefully examined with a reasonably detailed case-history examination. Two Persian questionnaires used were Medication Adherence Rating Scale (MARS) and BMQ. Those with a MARS score of ≥6 were considered as adherent to ASMs. All data were described in descriptive terms. We did a group comparison of means and proportions for all possible independent variables between adherents and nonadherents. Then, we did a hierarchical multiple linear regression. For this, independent variables were categorized into three different blocks: (a) sociodemographic block (Block-1), (b) treatment side-effect block (Block-2), and (c) BMQ block that included ten items of the BMQ scale (Block-3). We also did a forward step-wise linear regression by beginning with an empty model. We also estimated the psychometric properties and factor structure parameters of BMQ and its two subdomains. Results. Of all (N = 123, mean age: 63.3 years, 74.0% males), 78.0% were adherent (mean score: 7.0, 95% CI 6.2–7.8) to ASMs. The MARS scores were not different between males and females. The mean BMQ score was 23.4 (95% CI 19.8–27.0) with the mean need score of 20.0 (95% CI 18.0–22.0) and mean concern score of 16.5 (95% CI 14.3–18.7). A positive need-concern differential was 20.4%. Upon hierarchical regression, the adjusted R2 for Block-1 was 33.8%, and it was 53.8% for Block-2 and 92.2% for Block-3. Upon forward step-wise linear regression, we found that “ASMs disrupt my life” (ß −1.9, ES = −1.1, p = 0.008 ) as the only belief associated with adherence. The alpha coefficient of BMQ was 0.81. Conclusions. Ours is one of the very few studies that evaluated medication beliefs and their association with adherence to ASMs among elderly epilepsy patients in a non-western context. In our context, medication beliefs are likely to have an independent role in effecting adherence to ASMs, particularly the concern that “ASMs disrupt life.” Treating physicians should cultivate good conscience about ASMs and evaluate the patient’s medication beliefs early-on to identify those who might be at the risk of becoming nonadherent.