Ensuring Medication Safety for Consumers From Ethnic Minority Backgrounds: The Need to Address Unconscious Bias Within Health Systems

Improving medication safety in varied health systems

Research in Social and Administrative Pharmacy ◽

10.1016/j.sapharm.2019.04.012 ◽

2019 ◽

Vol 15 (7) ◽

pp. 811-812 ◽

Cited By ~ 2

Author(s):

Michelle A. Chui ◽

Marika Pohjanoksa-Mäntylä ◽

Margie E. Snyder

Keyword(s):

Health Systems ◽

Medication Safety

Download Full-text

Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme

BMJ Open Quality ◽

10.1136/bmjoq-2021-001369 ◽

2021 ◽

Vol 10 (4) ◽

pp. e001369

Author(s):

Camille P Vaughan ◽

Ula Hwang ◽

Ann E Vandenberg ◽

Traci Leong ◽

Daniel Wu ◽

...

Keyword(s):

Older Adults ◽

Health System ◽

Medical Record ◽

Electronic Medical Record ◽

Health Systems ◽

Medication Safety ◽

Potentially Inappropriate Medications ◽

Health Administration ◽

Academic Health ◽

The Impact

Enhancing quality of prescribing practices for older adults discharged from the Emergency Department (EQUIPPED) aims to reduce the monthly proportion of potentially inappropriate medications (PIMs) prescribed to older adults discharged from the ED to 5% or less. We describe prescribing outcomes at three academic health systems adapting and sequentially implementing the EQUIPPED medication safety programme.EQUIPPED was adapted from a model developed in the Veterans Health Administration (VA) and sequentially implemented in one academic health system per year over a 3-year period. The monthly proportion of PIMs, as defined by the 2015 American Geriatrics Beers Criteria, of all medications prescribed to adults aged 65 years and older at discharge was assessed for 6 months preimplementation until 12 months postimplementation using a generalised linear time series model with a Poisson distribution.The EQUIPPED programme was translated from the VA health system and its electronic medical record into three health systems each using a version of the Epic electronic medical record. Adaptation occurred through local modification of order sets and in the generation and delivery of provider prescribing reports by local champions. Baseline monthly PIM proportions 6 months prior to implementation at the three sites were 5.6% (95% CI 5.0% to 6.3%), 5.8% (95% CI 5.0% to 6.6%) and 7.3% (95% CI 6.4% to 9.2%), respectively. Evaluation of monthly prescribing including the twelve months post-EQUIPPED implementation demonstrated significant reduction in PIMs at one of the three sites. In exploratory analyses, the proportion of benzodiazepine prescriptions decreased across all sites from approximately 17% of PIMs at baseline to 9.5%–12% postimplementation, although not all reached statistical significance.EQUIPPED is feasible to implement outside the VA system. While the impact of the EQUIPPED model may vary across different health systems, results from this initial translation suggest significant reduction in specific high-risk drug classes may be an appropriate target for improvement at sites with relatively low baseline PIM prescribing rates.

Download Full-text

Ethical Data Stratification and Analysis to Eliminate Unconscious Bias in Learning Health Systems for Palliative Medicine

The Journal of Healthcare Ethics & Administration ◽

10.22461/jhea.1.71628 ◽

2021 ◽

Vol 7 (2) ◽

pp. 1-15

Author(s):

Virginia Miori ◽

Kyle Chalmers ◽

Daniel Miori

Keyword(s):

Decision Making ◽

Palliative Care ◽

Health Systems ◽

Survival Data ◽

Medical Decision ◽

Unconscious Bias ◽

Medical Practitioners ◽

Kaplan Meier ◽

Impact On Survival ◽

To Come

Learning Health Systems (LHS) produce analyses supporting medical decision making. Though algorithms are chosen to eliminate bias, we are left with unconscious bias present in data, due to lack of representation for marginalized populations. This is especially problematic in palliative care. Medical practitioners lack historical foundations for decision making for patients in these underrepresented populations. This paper first reviews the ethical foundations that drive our approach, then describes data stratification and analysis supporting a data-ethical LHS. Kaplan-Meier curves are generated for each of the stratum, demonstrating the value of palliative care and its impact on survival. Data were collected from government and foundation sources, stratified and analyzed to more appropriately weight medical history and characteristics to improve decision making for all populations. “Very well. Sea,” cried Canute, “I command you to come no further! Waves, stop your rolling! Surf, stop your pounding! Do not dare touch my feet!”

Download Full-text

Evaluation of medication safety resources in pediatric hospitals

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa177 ◽

2020 ◽

Vol 77 (Supplement_3) ◽

pp. S78-S86

Author(s):

Kembral L Nelson ◽

Shelly Morvay ◽

Marjorie Neidecker ◽

Sonya Sebastian ◽

Jessica Fischer ◽

...

Keyword(s):

Health Systems ◽

Medication Safety ◽

Assessment Tool ◽

Categorical Variables ◽

Pharmacy Services ◽

Full Time ◽

Pediatric Hospitals ◽

Monitoring Tools ◽

Safety Risks ◽

Barriers And Opportunities

Abstract Purpose As health systems continue to expand pharmacy and clinical services, the ability to evaluate potential medication safety risks and mitigate errors remains a high priority. Workload and productivity monitoring tools for the assessment of operational and clinical pharmacy services exist. However, such tools are not currently available to justify medication safety pharmacy services. The purpose of this study is to determine methods used to assess, allocate, and justify medication safety resources in pediatric hospitals. Methods A 32-question survey was designed and distributed utilizing the Research Electronic Data Capture (REDCap) tool. The survey was disseminated to 46 pediatric hospitals affiliated with the Children’s Hospital Association (CHA). The survey was distributed in October 2018, and the respondents were given 3 weeks to submit responses. Data analysis includes the use of descriptive statistics. Categorical variables were summarized by frequencies and percentages to distinguish the differences between pediatric health systems. Results Of 26 respondents, 15.4% utilized metrics to justify medication safety resources. Metrics utilized were based on medication dispenses, projects, and error coding. Twenty-three percent of respondents were dissatisfied with current pharmacy-based medication safety resources within the organization. There was variability of medication safety resources within pediatric hospitals, including the number of dedicated full-time equivalents, time spent on tasks, and task prioritization. Conclusion Assessing medication safety resources at various pediatric hospitals highlights several potential barriers and opportunities. This information will serve as the foundation for the creation of a standardized workload assessment tool to assist pharmacy leaders with additional resource justification.

Download Full-text