scholarly journals Detection and Management of Common Medication Errors inInternal Medicine Wards: Impact on Medication Costs and Patient Care

2019 ◽  
Vol 9 (1) ◽  
pp. 174-179 ◽  
Author(s):  
Kamal Boostani ◽  
Hamid Noshad ◽  
Farahnoosh Farnood ◽  
Haleh Rezaee ◽  
Soheil Teimouri ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Pharmaceutical Care ◽  
Medication Errors ◽  
Clinical Pharmacist ◽  
Health Care Team ◽  
Inappropriate Drug ◽  
Cross Sectional ◽  
Medication Therapy ◽  
Medication Costs ◽  
Internal Medicine Wards

Introduction: Medication errors (MEs) are a leading cause of morbidity and mortality, yet they have remained as confusing and underappreciated concept. The complex pharmacotherapy in hospitalized patients and sometimes serious clinical consequences of MEs necessitate continued report and surveillance of MEs as well as persistent pharmaceutical care for patients at medical wards. This study evaluated the frequency, types, clinical significance, and costs of MEs in internal medicine wards. Method: In this 8-month prospective and cross-sectional study, an attending clinical pharmacist, as an integral member of a health care team, visited the patients during each physician's ward round at the morning. All MEs including prescription, transcription, and administration errors were detected, recorded, and subsequently appropriate corrective interventions were proposed during these rounds. The changes in the medications' cost after implementing clinical pharmacist's interventions were compared to the calculated medications' cost, assuming that the MEs would not have been detected by clinical pharmacist and continued up to discharge time of the patients. Results: 89% of the patients experienced at least one ME during their hospitalization. A mean of 2.6 errors per patient or 0.2 errors per ordered medication occurred in this study. More than 70% of MEs happened at the prescription stage by treating physicians. The most prevalent prescription errors were inappropriate drug selection, unauthorized drugs and untreated indication. The highest MEs occurred on cardiovascular agents followed by antibiotics, and vitamins, minerals, and electrolytes. Total number of MEs showed a marked correlation with the total number of ordered medications and patients’ length of hospitalization. The net effect of clinical pharmacist’s contributions in medication therapy management was to decline medications’ costs by 33.9%. None of the MEs caused the patients harm. Conclusion: The role of clinical pharmacy services in detection, prevention and reducing the cost of MEs is of paramount importance to internal medicine wards. Key words: clinical pharmacist; medication errors; pharmaceutical care; internal medicine.

scholarly journals Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards

2013 ◽  
Vol 88 (5) ◽  
pp. 739-747
Author(s):  
Luiz Mauricio Costa Almeida ◽  
Michelle dos Santos Diniz ◽  
Lorena dos Santos Diniz ◽  
Jackson Machado-Pinto ◽  
Francisco Chagas Lima Silva
Keyword(s):  
Internal Medicine ◽  
Comparative Study ◽  
Medical Records ◽  
Skin Barrier ◽  
Epidemiological Studies ◽  
Internal Medicine Ward ◽  
Cross Sectional ◽  
Systemic Corticosteroids ◽  
Internal Medicine Wards ◽  
Belo Horizonte

BACKGROUND: Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES: To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS: It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS: We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION: It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively.

scholarly journals Role of the Novel Integrated Clinical Pharmacist Menu Software in Improving Medication Therapy Management

2021 ◽  
pp. 103-114
Author(s):  
Muhammad Tahir Aziz ◽  
Toofeeq Ur Rehman ◽  
Sadia Qureshi ◽  
Kashif Sajjad
Keyword(s):  
Decision Support ◽  
Medication Errors ◽  
Clinical Decision Support ◽  
Clinical Pharmacist ◽  
Clinical Decision ◽  
Medication Therapy Management ◽  
Decision Support Tools ◽  
Medication Therapy ◽  
Therapeutic Outcomes ◽  
Support Tools

Background: Medication therapy management (MTM) continues to offer pharmacists the opportunity to use their knowledge, assist patients and caregiver in improving therapeutic outcomes, however the change is slow. Health information technology has been noted as an important driver in the success of MTM and has a potential role in improving therapeutic outcomes and reducing medication errors. Objective: This research aimed to design an integrated clinical pharmacist menu (CPM) software along with clinical decision support tools, optimizing MTM services and reducing medication errors. Methods: The integrated CPM software was designed abridged with decision support tools. A comparative study was conducted in a setting of integrated CPM software versus paper-based clinical pharmacy services (P-CPS) for the evaluation of MTM services. Clinical decision support systems (CDSS) and automated significant laboratory and medication alerts were analyzed for the improvement of MTM and impact on the identification and resolution of medication errors. Results: MTM improved after the application of the CPM software with a difference of 100% in “medication history generation” and “patient care plan,” with a reduction in medication errors by 39.8%. The identification of medication errors and verification of medication order significantly improved from 49% to 82% (p = 0.00) and from 4.5% to 7.0% (p = 0.00), respectively, in the CPM setting. The CDSS tool in the CPM software generated 730, 1802, and 198 auto alerts for “drug–drug interaction,” “inappropriate dose,” and “dose adjustment in an abnormal clinical laboratory test,” respectively, which improved the resolution and identification of medication errors. Conclusion: The CPM is user-friendly, which improved the MTM services. Medication error identification and resolution were significantly improved by the CPM software.

scholarly journals Root Cause Analysis of Medication Administration Error by Nursing Staff at a Number of Medical Institutes in Riyadh

2021 ◽  
pp. 152-161
Author(s):  
Tahani Alrahbeni ◽  
Muteeb Eid Alenezi
Keyword(s):  
Medication Errors ◽  
Clinical Pharmacist ◽  
Medication Administration ◽  
Cross Sectional Study ◽  
Ministry Of Health ◽  
Target Number ◽  
Cross Sectional ◽  
Medication Administration Error ◽  
Administration Error ◽  
The Times

Background: Medication errors genuinely influence patient safety, staying cost in hospital and integrity of nursing job, because the nurses play a specific part in managing the medication for the patients. The present study was done with the aim to investigate factors associated with nurses’ medication errors in a number of medical institutes (Ministry of Health) and the role of clinical pharmacist in these errors. Methodology: The present study was a cross-sectional study based on standardized questionnaire which was designed and distributed to the target nurses in a number of medical institutes (Ministry of Health). The target number was (171) which was achieved depending on the calculation of sample size after the questionnaires was gathered; data was subjected to descriptive and inferential statistics. Results: The highest mean score of error was obtained in the factor related to medication packaging reason, which includes that different medications look alike, and the names of at least 60 medications were similar by 82.7%.  The second group of reasons was system associated, which included: abbreviations were used instead of writing the orders out completely, overall 60.5% of the times nurses were pulled between teams. Third reason, overall 45.3% of the times the errors were associated with pharmacy when they did not prepare\label the medication correctly, and clinical pharmacist did not give education workshops to the nurses. Documentation issues were the fourth reason, 39.5% of the times nurses were interrupted while administering medication to perform other duties and nurses on the same unit did not adhere to the approved medication administration procedure. Conclusion: The data of the current study suggested the ranking of five reasons or root causes of why medication errors happened. These are medication package, system related, pharmacy related, documentation-transcription reason and physician-nurse related respectively. Furthermore, clinical pharmacists must thrive to improve the nurses' knowledge of how these factors will lead to critical errors and help them discover strategies to prevent these errors from happening.

scholarly journals The Impact of Clinical Pharmacist Interventions on Medication Errors Management in the Postoperative Cardiac Intensive Care Unit

2020 ◽  
Vol 27 (3) ◽  
pp. 433-438
Author(s):  
Naser Safaie ◽  
Hanieh Azizi ◽  
Sajad Khiali ◽  
Taher Entezari-Maleki
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medication Errors ◽  
Clinical Pharmacist ◽  
Therapeutic Process ◽  
Laboratory Data ◽  
Cross Sectional ◽  
Clinical Pharmacists ◽  
Heart Center ◽  
The Impact

Background: Medication errors (MEs) frequently occur in intensive care unit (ICU) admittedpatients. The present study aimed to evaluate the frequency and types of MEs in an open heartsurgery heart ICU and clinical pharmacists’ role in the management of them. Methods: This cross-sectional, observational study was performed from October 2016 toMarch 2017 in the Shahid Madani Heart Center. A clinical pharmacist reviewed patients’ files,laboratory data, and physician orders during morning hours. All of the MEs and the clinicalpharmacies’ recommendations for the management of them were analyzed. Results: A total of 311 MEs were observed in the medical files of 152 patients. The rate of MEswas 2.04 errors per patient and 0.19 errors per ordered medication. The acceptance rate of MEswas 72.6%. The most type of MEs was ‘forgot to order’ (75 cases, 24.1%) followed by "wrongfrequency" and "adding a drug" in 56 (18%) and 49 (15.8) patients, respectively. Most MEs wereinsignificant. Conclusion: MEs occur at different stages of the therapeutic process in the postoperative cardiacintensive care unit, and clinical pharmacists play an essential role in detecting and managingMEs.

scholarly journals Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study

2021 ◽  
Vol 34 (6) ◽  
pp. 420
Author(s):  
Ricardo Marinho ◽  
Ana Pessoa ◽  
Marta Lopes ◽  
João Rosinhas ◽  
João Pinho ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Nutritional Risk ◽  
Charlson Comorbidity Index Score ◽  
Cross Sectional ◽  
Risk Screening ◽  
Internal Medicine Wards ◽  
Nutritional Risk Screening 2002 ◽  
Nutritional Risk Screening

Introduction: Disease-related undernutrition is highly prevalent and requires timely intervention. However, identifying undernutrition often relies on physician judgment. As Internal Medicine wards are the backbone of the hospital setting, insight into the prevalence of nutritional risk in this population is essential. We aimed to determine the prevalence of nutritional risk in Internal Medicine wards, to identify its correlates, and to assess the agreement between the physicians’ impression of nutritional risk and evaluation by Nutritional Risk Screening 2002.Material and Methods: A cross-sectional multicentre study was performed in Internal Medicine wards of 24 Portuguese hospitals during 2017. Data on demographics, previous hospital admissions, primary diagnosis, and Charlson comorbidity index score were collected. Nutritional risk at admission was assessed using Nutritional Risk Screening 2002. Agreement between physicians’ impression of nutritional risk and Nutritional Risk Screening 2002 was tested by Cohen’s kappa.Results: The study included 729 participants (mean age 74 ± 14.6 years, 51% male). The main reason for admission was respiratory disease. Mean Charlson comorbidity index score was 5.8 ± 2.8. Prevalence of nutritional risk was 51%. Nutritional risk was associated with admission during the previous year (odds ratio = 1.65, 95% confidence interval: 1.22 - 2.24), solid tumour with metastasis (odds ratio = 4.73, 95% confidence interval: 2.06 - 10.87), any tumour without metastasis (odds ratio = 2.04, 95% confidence interval:1.24 - 3.34), kidney disease (odds ratio = 1.83, 95% confidence interval: 1.21 - 2.75), peptic ulcer (odds ratio = 2.17, 95% confidence interval: 1.10 - 4.25), heart failure (odds ratio = 1.51, 95% confidence interval: 1.11 - 2.04), dementia (odds ratio = 3.02, 95% confidence interval: 1.96 - 4.64), and cerebrovascular disease (odds ratio = 1.62, 95% confidence interval: 1.12 - 2.35). Agreement between physicians’ evaluation of nutritional status and Nutritional Risk Screening 2002 was weak (Cohen’s kappa = 0.415, p < 0.001).Discussion: Prevalence of nutritional risk in the Internal Medicine population is very high. Admission during the previous year and multiple comorbidities increase the odds of being at-risk. Subjective physician evaluation is not appropriate for nutritional screening.Conclusion: The high prevalence of at-risk patients and poor subjective physician evaluation suggest the need to implement mandatory nutritional screening.

scholarly journals Comparison of Beers criteria and EU(7) potentially inappropriate medications list for the potentially inappropriate medications in Indian elderly inpatients

2019 ◽  
Vol 8 (5) ◽  
pp. 1106
Author(s):  
Manoj H. Thummar ◽  
Tejas K. Patel ◽  
Varsha Y. Godbole ◽  
Manoj Kumar Saurabh
Keyword(s):  
Internal Medicine ◽  
Elderly Patients ◽  
Inappropriate Medication ◽  
Cross Sectional Study ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Cross Sectional ◽  
Elderly Inpatients ◽  
Internal Medicine Wards ◽  
Inappropriate Medications

Background: Use of inappropriate medication is an important problem in present geriatric clinical practice. No specific potentially inappropriate medications (PIM) tools are available considering the availability of drugs in India. Aim and objective were to assess prevalence and pattern of potentially inappropriate medication (PIM) use in elderly inpatients by updated Beers criteria 2015 and EU(7) PIM list 2015.Methods: This cross-sectional study was carried out on medical records of elderly patients (≥65 yrs) admitted in the internal medicine wards and intensive care units (ICU) over a period of 6 weeks. The medications were evaluated for the PIM use as per Beers criteria and EU(7) PIM list.Results: A total of 225 patients (mean age- 71.48 yrs) were admitted in internal medicine wards and ICU during study period. Total 184 PIM belonged to 33 different medications were used during study period. The prevalence of PIM in internal medicine wards and ICUs were 51.96% and 57.14%, respectively. The prevalence of PIM was significantly higher with the EU(7) PIM list than Beers criteria (49.77% vs. 21.77%) [p<0.0001]. The commonly prescribed PIM were dextromethorphan (13.33%), ranitidine (11.11%) and glipizide (10.22%).Conclusions: Elderly patients frequently receive PIM. EU(7) PIM list identifies more PIM among elderly inpatients than Beers criteria.

scholarly journals Southern Yemeni Pharmacy Dispensers ' Understanding, Attitudes and Perceived Barriers Related to Pharmaceutical Care

2020 ◽  
Vol 10 (4-s) ◽  
pp. 6-12
Author(s):  
Shuhd Alawi ◽  
Nazeh Al-Abd ◽  
Ali Rageh ◽  
Wafa F.S. Badulla ◽  
Mohammed Alshakka
Keyword(s):  
Community Pharmacy ◽  
Pharmaceutical Care ◽  
Physical Space ◽  
Community Pharmacists ◽  
Cross Sectional Study ◽  
Bachelor's Degree ◽  
Community Pharmacies ◽  
Cross Sectional ◽  
Medication Therapy ◽  
Positive Attitudes

Background: Pharmaceutical care (PC) is the value of a practice that includes recognizing and solving medication therapy issues to improve patient outcomes. Studies regarding this issue in Yemen are very limited. Objectives: The study aims to assess the perception of community pharmacists to the concept of Pharmaceutical care and the obstacles that limit the provision of pharmaceutical care. Method: A descriptive cross-sectional study of community pharmacy dispensers (CPDs) was conducted among pharmacists and pharmacy technicians working in community pharmacies in different areas of South Yemen from September 2019 until December 2019. The structured self-administered questionnaires consist of four sections dealing with the demographics of participants and their understanding of the concept of pharmaceutical care and their attitudes and obstacles to the implementation of pharmaceutical care in Yemen. The collected data was analyzed using Statistical Package for Social Sciences (SPSS) version 25.0 Results: A total of Two-hundred pharmacists were included in this study. The result revealed that there were a reasonable number of experts (over 5 years' experience) and educated pharmacists( Diploma and bachelor’s degree) available for counseling patients about specific issues in the community pharmacies. Interestingly, all the respondents had good knowledge of pharmaceutical care and the majority of the pharmacists (87.5%) had a favorable attitude toward pharmaceutical care and their role in the health care system. The overall results relating to the perceived frequency of community pharmacy services provision was lower than (50%) in most statements. The result indicated a gap in the community pharmacists' communication with the patients. There are several barriers impedes the active and effective involvement of community pharmacists such as; insufficient communication with physicians, lack of physical space for pharmaceutical care, the slow introduction of pharmacists’ law, and others. Conclusion: The results revealed that pharmacists' understanding of the pharmaceutical care concept is good despite that there was no real implementation of pharmaceutical care. Even though they had positive attitudes towards the concept but there were many barriers to the effective application. Keywords: Pharmaceutical Care Concept; Community Pharmacists; South Yemen

scholarly journals Evaluation of the Appropriate Use of Ceftriaxone in Internal Medicine Wards of Wad Medani Teaching Hospital in Sudan

2020 ◽  
Vol 7 (03) ◽  
pp. 4757-4765
Author(s):  
Mohammed I. Malik ◽  
Mohmmed Albadawy M. Alagab ◽  
Maha Mirghani Maatoug ◽  
Fawkia E. Zahran ◽  
Abelhameed H. Elmubarak ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Teaching Hospital ◽  
Bacterial Resistance ◽  
Treatment Guidelines ◽  
Sensitivity Test ◽  
Appropriate Use ◽  
Dose Frequency ◽  
Cross Sectional ◽  
Internal Medicine Wards ◽  
Culture And Sensitivity

Background: Antibiotics are one of the commonly prescribed drugs over the world. Overprescribing of antibiotics may result in serious bacterial resistance. The main cause of inappropriate prescription of antibiotics is the absence of guidelines and protocols for its use. The aim of this study was to evaluate the appropriate use of ceftriaxone (broad-spectrum third generation cephalosporin antibiotic) in internal medicine wards of Wad Medani teaching hospital in Sudan, as well as comparing its use with reference to the standard of Sudan treatment guidelines and reliable references like British National Formula (BNF) and Sanford guide. Methods: Prospective cross –sectional study conducted in the internal medicine department at Wad Medani Teaching hospital by reviewing the files of all in-patients admitted to medical wards, who received ceftriaxone between November and December, 2018 and the appropriateness use of ceftriaxone was evaluated depending on six criteria: indication, dose, frequency, duration of treatment, culture and sensitivity test and drug –drug interaction Results: A total of 280 admitted patient’s treatment chart containing ceftriaxone injection were analyzed. Ceftriaxone was indicated empirically in 91.1% mostly for respiratory tract infection (35%). Ceftriaxone appropriate dose was given in 59% of patients, inappropriate frequency in 68.9% and incorrect duration in 51.1%. Co-administered drugs with major interaction in 3.6% of patients. Conclusions: This study revealed high inappropriate use of ceftriaxone where it was given without implementing culture and sensitivity test in the majority of patients. This may result in treatment failure so educational programs is recommended to address the irrational use of antibiotic.

Perceptions of slow codes by nurses working on internal medicine wards

2018 ◽  
Vol 26 (6) ◽  
pp. 1734-1743 ◽  
Author(s):  
Freda DeKeyser Ganz ◽  
Rotem Sharfi ◽  
Nehama Kaufman ◽  
Sharon Einav
Keyword(s):  
Internal Medicine ◽  
Standard Deviation ◽  
Personal Characteristics ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Ethical Implications ◽  
Cardio Pulmonary Resuscitation ◽  
Ethical Approval ◽  
Internal Medicine Wards ◽  
Patient Prognosis

Background: Cardio-pulmonary resuscitation is the default procedure during cardio-pulmonary arrest. If a patient does not want cardio-pulmonary resuscitation, then a do not attempt resuscitation order must be documented. Often, this order is not given; even if thought to be appropriate. This situation can lead to a slow code, defined as an ineffective resuscitation, where all resuscitation procedures are not performed or done slowly. Research objectives: To describe the perceptions of nurses working on internal medicine wards of slow codes, including the factors associated with its implementation. Research design: This was a cross-sectional, descriptive study. Participants completed a personal characteristics questionnaire and the Perceptions and Factors of Slow Codes questionnaire designed for this study. Participants and research context: The sample was a convenience sample of nurses working on internal medicine wards in two Israeli hospitals. Ethical considerations: The study received ethical approval from both institutions, where data were collected and stored according to institutional policy. Findings: Most reported that resuscitations were conducted according to protocol (n = 90, 76.2%). Some took their time calling the code (n = 22, 18.3%), or waited by the bedside and did not perform cardio-pulmonary resuscitation (n = 45, 37.5%). Factors most associated with slow codes were poor patient prognosis (mean = 3.52/5, standard deviation = 1.27) and a low chance of patient survival (mean = 3.37/5, standard deviation = 1.21). Two-thirds (n = 76, 66.8%) reported that slow codes were done on their unit and the majority (n = 80, 69%) perceived slow codes as ethical. Discussion: This study confirms that slow codes are part of medical care on internal medicine wards, where most nurses perceive them as an ethical alternative. These perceptions are in contrast to most legal and ethical opinions expressed in the literature. Conclusion: Nurses should be educated about the legal and ethical implications of slow codes, and qualitative and quantitative studies should be conducted that further investigate its implementation.

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