scholarly journals A Survey of Nursing Home Physicians to Determine Laboratory Monitoring Adverse Drug Event Alert Preferences

2014 ◽  
Vol 05 (04) ◽  
pp. 895-906 ◽  
Author(s):  
S. Perera ◽  
D.A. Nace ◽  
C.M. Culley ◽  
S.M. Handler ◽  
R.D. Boyce
Keyword(s):  
Nursing Home ◽  
Adverse Drug Event ◽  
Adverse Drug Events ◽  
Clinical Event ◽  
Drug Event ◽  
Specific Information ◽  
Laboratory Monitoring ◽  
Term Care ◽  
Home Setting ◽  
Communication Modalities

SummaryObjective: We conducted a survey of nursing home physicians to learn about (1) the laboratory value thresholds that clinical event monitors should use to generate alerts about potential adverse drug events (ADEs); (2) the specific information to be included in the alerts; and (3) the communication modality that should be used for communicating them.Methods: Nursing home physician attendees of the 2010 Conference of AMDA: The Society for Post-Acute and Long-Term Care Medicine.Results: A total of 800 surveys were distributed; 565 completed surveys were returned and seven surveys were excluded due to inability to verify that the respondents were physicians (a 70% net valid response rate). Alerting threshold preferences were identified for eight laboratory tests. For example, the majority of respondents selected thresholds of ≥ 5.5 mEq/L for hyperkalemia (63%) and ≤ 3.5 without symptoms for hypokalemia (54%). The majority of surveyed physicians thought alerts should include the complete active medication list, current vital signs, previous value of the triggering lab, medication change in the past 30 days, and medication allergies. Most surveyed physicians felt the best way to communicate an ADE alert was by direct phone/voice communication (64%), followed by email to a mobile device (59%).Conclusions: This survey of nursing home physicians suggests that the majority prefer alerting thresholds that would generally lead to fewer alerts than if widely accepted standardized laboratory ranges were used. It also suggests a subset of information items to include in alerts, and the physicians’ preferred communication modalities. This information might improve the acceptance of clinical event monitoring systems to detect ADEs in the nursing home setting.Citation: Boyce RD, Perera S, Nace DA, Culley CM, Handler SM. A survey of nursing home physicians to determine laboratory monitoring adverse drug event alert preferences. Appl Clin Inf 2014; 5: 895–906http://dx.doi.org/10.4338/ACI-2014-06-RA-0053

scholarly journals Using ActionADE to create information continuity to reduce re-exposures to harmful medications: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jeffrey P. Hau ◽  
Penelope M. A. Brasher ◽  
Amber Cragg ◽  
Serena Small ◽  
Maeve Wickham ◽  
...  
Keyword(s):  
Health Information ◽  
Adverse Drug Event ◽  
Primary Outcome ◽  
Adverse Drug Events ◽  
Primary Objective ◽  
Drug Event ◽  
Controlled Trials ◽  
Drug Reactions ◽  
Main Trial ◽  
Randomized Controlled

Abstract Background Repeat exposures to culprit medications are a common cause of preventable adverse drug events. Health information technologies have the potential to reduce repeat adverse drug events by improving information continuity. However, they rarely interoperate to ensure providers can view adverse drug events documented in other systems. We designed ActionADE to enable rapid documentation of adverse drug events and communication of standardized information across health sectors by integrating with legacy systems. We will leverage ActionADE’s implementation to conduct two parallel, randomized trials: patients with adverse drug reactions in the main trial and those diagnosed with non-adherence in a secondary trial. Primary objective of the main trial is to evaluate the effects of providing information continuity about adverse drug reactions on culprit medication re-dispensations over 12 months. Primary objective of the secondary trial is to evaluate the effect of providing information continuity on adherence over 12 months. Methods We will conduct two parallel group, triple-blind randomized controlled trials in participating hospitals in British Columbia, Canada. We will enroll adults presenting to hospital with an adverse drug event to prescribed outpatient medication. Clinicians will document the adverse drug event in ActionADE. The software will use an algorithm to determine patient eligibility and allocate eligible patients to experimental or control. In the experimental arm, ActionADE will transmit information to PharmaNet, where adverse drug event information will be displayed in community pharmacies when re-dispensations are attempted. In the control arm, ActionADE will retain information in the local record. We will enroll 3600 adults with an adverse drug reaction into the main trial. The main trial’s primary outcome is re-dispensation of a culprit or same-class medication within 12 months; the secondary trial’s primary outcome will be adherence to culprit medication. Secondary outcomes include health services utilization and mortality. Discussion These studies have the potential to guide policy decisions and investments needed to drive health information technology integrations to prevent repeat adverse drug events. We present an example of how a health information technology implementation can be leveraged to conduct pragmatic randomized controlled trials. Trial registration ClinicalTrials.gov NCT04568668, NCT04574648. Registered on 1 October 2020.

Utility of Different Data Standards to Document Adverse Drug Event Symptoms and Diagnoses: A Mixed Methods Study (Preprint)

2021 ◽  
Author(s):  
Erina Chan ◽  
Serena S Small ◽  
Maeve E Wickham ◽  
Vicki Cheng ◽  
Ellen Balka ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Adverse Drug Event ◽  
Adverse Drug Events ◽  
Retrospective Chart Review ◽  
Drug Event ◽  
Free Text ◽  
Snomed Ct ◽  
Data Standards ◽  
Data Standard ◽  
Research Assistants

BACKGROUND Existing systems to document adverse drug events often use free text data entry, producing non-standardized, unstructured data prone to misinterpretation. Standardized terminology may improve data quality, but it is unclear which data standard is most appropriate to document adverse drug event symptoms and diagnoses. OBJECTIVE Our objective was to compare the utility, strengths, and weaknesses of different data standards for documenting adverse drug event symptoms and diagnoses. METHODS We performed a mixed-methods sub-study of a multicenter retrospective chart review. We reviewed research records of prospectively diagnosed adverse drug events at 5 Canadian hospitals. Two pharmacy research assistants independently entered symptoms and/or diagnoses for adverse drug events using 4 standards: MedDRA, SNOMED CT, SNOMED Adverse Reaction, and ICD-11. Disagreements between research assistants regarding case-specific utility of data standards were discussed until reaching consensus. We used consensus ratings to determine proportion of adverse drug events covered by a data standard, and coded and analyzed field notes from consensus sessions. RESULTS We reviewed 573 adverse drug events and found MedDRA and ICD-11 had excellent coverage of adverse drug event symptoms and/or diagnoses. While MedDRA had the highest number of matches between the research assistants, ICD-11 had the fewest. SNOMED ADR had the lowest proportion of adverse drug event coverage. Research assistants were most likely to encounter terminological challenges with SNOMED ADR and usability challenges with ICD-11, and least likely with MedDRA. CONCLUSIONS Usability, comprehensiveness, and accuracy are important features of data standards for documenting ADE symptoms and diagnoses. Based on our results, we would recommend the use of MedDRA.

Drug-related problems with targeted/immunotherapies at an oncology outpatient clinic

2019 ◽  
Vol 26 (3) ◽  
pp. 595-602
Author(s):  
Esra Kucuk ◽  
Aygin Bayraktar-Ekincioglu ◽  
Mustafa Erman ◽  
Saadettin Kilickap
Keyword(s):  
Adverse Drug Event ◽  
Clinical Pharmacist ◽  
Adverse Drug Events ◽  
Drug Event ◽  
Targeted Chemotherapy ◽  
Drug Related Problems ◽  
Patients With Cancer ◽  
Common Drug ◽  
Oncology Care ◽  
The Impact

Background Some studies in the literature describe drug-related problems in patients with cancer, although few studies focused on patients receiving targeted chemotherapy and/or immunotherapy. To identify the incidence of drug-related problems in patients receiving targeted chemotherapy and/or immunotherapy, and demonstrate the impact of a clinical pharmacist in an outpatient oncology care setting. Methods Prospective study was conducted in a hospital outpatient oncology clinic between October 2015 and March 2016. Patients greater than 18 years old receiving cetuximab, nivolumab, ipilimumab, or pembrolizumab were included in the study and monitored over a three-month period by a clinical pharmacist. Drug-related problems were analyzed using the Pharmaceutical Care Network Europe classification system. The main outcome measures were the frequency and causes of drug-related problems and the degree of resolution achieved through the involvement of a clinical pharmacist. Results A total of 54 patients (mean age: 57 ± 12 years) were included. There were 105 drug-related problems and 159 associated causes. Among the planned interventions (n = 149), 92 interventions were at the patient-level with 88 (96%) being accepted by the doctors. This resulted in 68 (65%) drug-related problems being completely resolved and 9 (8.6%) being partially resolved. The most common drug-related problem identified was “adverse drug event” (n = 38, 36%). Of the 105 drug-related problems, 63 (60%) related to targeted chemotherapy and/or immunotherapy with 34 (54%) classified as an “adverse drug event.” Conclusion Adverse drug events were the most common drug-related problems in patients with cancer. The involvement of a clinical pharmacist improved the identification of drug-related problems and helped optimize treatment outcomes in patients receiving targeted chemotherapy/immunotherapy.

Psychoactive Drug Misuse in Long-Term Care: Some Contributing Factors

1988 ◽  
Vol 1 (3) ◽  
pp. 189-194 ◽  
Author(s):  
David S. Sherman
Keyword(s):  
Nursing Home ◽  
Adverse Effects ◽  
Nursing Home Residents ◽  
Psychoactive Drug ◽  
Prescribing Patterns ◽  
Drug Misuse ◽  
Psychoactive Drugs ◽  
Contributing Factors ◽  
Term Care ◽  
Home Setting

Surveys have identified inappropriate psychoactive drug prescribing patterns as a major problem in the care of nursing home residents. Residents without a documented history of mental illness often receive drugs intended to treat psychiatric problems. One of the greatest areas of misuse of these drugs is in the treatment of agitation in elderly demented residents. For example, although this purpose is likely the most common reason antipsychotic drugs are used in the nursing home setting, no well designed study has yet demonstrated that these agents are effective for this problem. Elderly individuals are particularly sensitive to the adverse effects of psychoactive drugs. Due to the gradual or insidious onset of some adverse effects, psychoactive drug toxicity may often be underestimated. The most serious example of a clinically underrecognized adverse effect of psychoactive drugs is tardive dyskinesia. Misinterpretation of certain nursing home residents' behaviors may lead to medication with tranquilizing drugs when other approaches may be safer and more effective. Excessive use of psychoactive drugs is not only physically harmful, but also encourages an apathetic attitude toward implementation of more humane ways of dealing with behaviorally disturbed nursing home residents.

Long-term care

2017 ◽  
pp. 273-280
Author(s):  
Jos M. G. A. Schols ◽  
Adam Gordon
Keyword(s):  
Nursing Home ◽  
Long Term Care ◽  
Institutional Care ◽  
Nursing Home Residents ◽  
Term Care ◽  
Home Setting ◽  
Nursing Home Setting ◽  
Care For Older People

In this chapter, institutional long-term care for older people is addressed from a European perspective. A short historical overview is followed by some thoughts on how long-term institutional care may develop in the future, including a consideration of the role of informal care as a competing and complementary sector. It then describes the clinical profile of nursing home residents including reason(s) for admission, access issues, and length of stay. Thereafter, the types of care offered to nursing home residents will be described, with particular attention given to staffing and financing issues. Special consideration is given to the medical care of nursing home residents. Finally, we consider quality assurance in long-term care and how this is approached in different legislations before closing with a description of relevant themes and issues for research in the nursing home setting.

scholarly journals Does context matter? Voluntary work in long-term care

2021 ◽  
Vol 12 (1) ◽  
pp. 155-180
Author(s):  
Laila Tingvold ◽  
Oddvar Førland
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
Long Term Care ◽  
Home Care Services ◽  
Voluntary Work ◽  
Term Care ◽  
Home Setting ◽  
Care Services

Introduction: Increased voluntary work in long-term care (LTC) is encouraged in white papers in Norway as well as in many other western states. This is due to the growth in the number of service recipients and a subsequent economic burden for the state. Voluntary work in nursing homes and home care services take place in different spatial contexts, but little attention has been paid to how the different contexts may potentially influence the possibilities for voluntary work. The aim of this study is to obtain new knowledge of the significance of context in recruitment of volunteers in LTC. Method: A cross-sectional study was conducted among leaders in nursing homes and home services in 50 municipalities across all regions of Norway. Descriptive analysis was used. Results: According to the leaders, home care services had less voluntary work than nursing homes. Respondents from home care scored “poor flow of information” and “low interest in the municipality” as major hinderances, more so than respondents from nursing homes did. Discussion: Nursing homes typically have many residents under one roof following a similar schedule. Thus, volunteer-run activities are held more easily at set times and incorporated into the daily life of the institutions. On the other hand, home dwellers in home care stay in a more individualised setting with more autonomy and can opt out of activities that nursing home residents would normally join. Skill acquisition, networking and socializing are common motivations for volunteering, and a nursing home setting may be an easier context to obtain this. The governmental endeavour for increased voluntary work in LTC can be seen as an effort to meet expected rises in public expenditure. However, the realism can be debated due to substantial challenges on the future potential of volunteerism in LTC, especially in the home care context.

scholarly journals LESSONS LEARNED FROM NURSING HOME CIVIL MONETARY PENALTY PROJECTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S770-S770
Author(s):  
Diana L Sturdevant ◽  
Kathleen C Buckwalter
Keyword(s):  
Nursing Home ◽  
Quality Of Care ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Lessons Learned ◽  
Federal State ◽  
Future Research ◽  
Term Care ◽  
Home Setting

Abstract Nursing homes must comply with numerous federal/state regulations to receive Medicare and Medicaid funding. Failure to comply with these regulations can result in deficiency citations, and depending on the severity of the deficiency, a resulting Civil Monetary Penalty (CMP). Through the Centers for Medicare and Medicaid Services (CMS) Civil Monetary Penalty Reinvestment Program, CMP funds are reinvested to support activities that benefit nursing home residents and that protect or improve their quality of life or quality of care. This symposium presents some of the unique challenges, successes, failures, and surprise findings from CMP-funded nursing home quality improvement projects in two, predominantly rural Midwestern states: Oklahoma and Kansas. Dr. Williams presents findings of a pilot-study testing an adaptation of a successful family caregiver telehealth support intervention in the nursing home setting and implications for future research. Dr. Sturdevant shares successes, challenges, and unanticipated results from the “It’s Not OK to Fall” project, a comprehensive, 3 year fall prevention project implemented in Oklahoma nursing homes. Lastly, Ms. Round’s paper describes the implementation and findings of a Long-term Care Leadership Academy aimed at improving leadership and team building skills of three levels of nursing home staff, including Administrators/Directors’ of Nursing, RN/LPN charge nurses and certified nursing assistants. Discussant, Dr. Kathleen Buckwalter Ph.D., FAAN, RN, will discuss how principles of nursing home culture change provides a common framework for these projects and conclude by offering suggestions on how promotion of these principles might improve the quality of care provided by nursing homes.

PP88 Intravenous Medication Delivery System Cost-Effectiveness Analysis

2018 ◽  
Vol 34 (S1) ◽  
pp. 99-99
Author(s):  
Antonio Peregrino ◽  
Roberto Silva ◽  
Alexander Itria ◽  
Carlos Silva ◽  
Ana Tolentino ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Adverse Drug Event ◽  
Adverse Drug Events ◽  
Cost Effective ◽  
Drug Event ◽  
Base Case ◽  
Infusion Pumps ◽  
System Perspective ◽  
Medication Delivery ◽  
Intravenous Medication

Introduction:Medication delivery is one of the most common interventions in clinical practice. It requires the direct involvement of nurses and high precision infusion pumps in order to increase the infusion accuracy. Any mistake in the medication delivery process can lead to a medication error, resulting in adverse events with considerable increases in hospital length of stay and cost. Research studies should analyze this area more in emerging countries, as their realities differ from the realities of developed countries, where most of the literature of this area has been developed. This research study analyses this area in Brazil, a leading emerging country. The incorporation of these technologies in health services have caused two major problems: uncertainty around its effectiveness in reducing adverse drug event rates related to infusion dose errors, and the high cost of their inputs. The objective of this study was to analyze the cost-effectiveness of intelligent drug library infusion pumps to reduce adverse drug events during intravenous medication delivery in pediatric and neonatal patients.Methods:Cost-effectiveness was evaluated using a decision-tree framework, considering two scenarios as the base case: the reference one, which uses conventional infusion pumps for intravenous medication delivery with a volume greater than 60 mL, and an alternative one, which uses the drug library infusion pumps. The analysis is with the Unified Health System (Brazil's publicly funded health care system) perspective. The Monte Carlo simulations addressed the uncertainties of the framework. The effectiveness measure was avoidance of adverse drug events.Results:The probabilistic analysis showed the drug library infusion pumps to be more cost-effective than conventional pumps. This ratified what had already been revealed by acceptance curve, which demonstrated that the drug library infusion pumps are more likely to be cost-effective compared to the conventional infusion pumps (with a minimum of the incremental cost-effectiveness of USD 1,501.28).Conclusions:The study demonstrated that the use of the drug library infusion pumps in the pediatric and the neonatal intensive care unit can improve the results of the adverse drug event reduction strategy.

Epidemiology of Adverse Drug Events in the Nursing Home Setting

Drugs & Aging ◽  
1995 ◽  
Vol 7 (3) ◽  
pp. 203-211 ◽  
Author(s):  
Johanne Monette ◽  
Jerry H. Gurwitz ◽  
Jerry Avorn
Keyword(s):  
Nursing Home ◽  
Adverse Drug Events ◽  
Home Setting ◽  
Nursing Home Setting

scholarly journals DO WARMED BLANKETS CHANGE PAIN, AGITATION, MOOD, OR ANALGESIC USE AMONG NURSING HOME RESIDENTS?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S623-S623
Author(s):  
Christine Kovach
Keyword(s):  
Nursing Home ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Comparison Group ◽  
Nursing Home Residents ◽  
Acute Injury ◽  
Term Care ◽  
Home Setting ◽  
Analgesic Use

Abstract Warmed blankets have not been empirically tested for use in long-term care. The purpose of this study was to describe the use of warmed blankets in a nursing home setting and to determine if use was associated with changes in pain, agitation, mood, or analgesic use. Short-term measures were compared from baseline to post warmed blanket use and longer term differences were compared between those receiving warmed blankets and a randomly selected comparison group. Excluded from eligibility were those using a transdermal drug, with an acute injury, acute inflammatory process, multiple sclerosis, open skin wound, or other condition that could be worsened by superficial heat. Measures included the Revised Faces Pain Scale, PAIN-AD scale, the Brief Agitation Rating Scale, and from the electronic medical record one month measures pain complaints, pain severity, and analgesic use. Long-term measures were taken from the electronic medical record. Of the 141 eligible residents, 24.1% (n = 34) received a warmed blanket over the one month study period. There were statistically significant decreases in both pain level and agitation between baseline, 20 minutes after application, and the subsequent shift assessments (p < .001). There were also long-term changes in the number of pain complaints (p = .040), severity of pain complaints (p = .009), and prn analgesic use (p = .011). There were no statistically significant differences between the treated group and comparison group on any long-term measures. Warmed blankets are a low-cost intervention with a high potential for bringing comfort to nursing home residents.

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