scholarly journals Medication Discrepancy Risk Factors for Pediatric Patients With Epilepsy at Hospital Admission

2021 ◽  
Vol 26 (4) ◽  
pp. 384-394
Author(s):  
Katie Louiselle ◽  
Lory Harte ◽  
Charity Thompson ◽  
Damon Pabst ◽  
Andrea Calvert ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hospital Admission ◽  
Medication Errors ◽  
Pediatric Patients ◽  
Medication History ◽  
Medication Discrepancies ◽  
Improvement Project ◽  
Medication Discrepancy ◽  
Increased Risk ◽  
Patients With Epilepsy

BACKGROUND Children with epilepsy are at increased risk of medication errors due to disease complexity and administration of time-sensitive medication. Errors frequently occur during transitions of care between home and hospital, a time when accuracy of medication history lists is difficult to ascertain. Adverse events likely from medication discrepancies underscore the importance of improving medication reconciliation upon inpatient intake. This quality improvement project was designed to evaluate and optimize the current medication history process in epileptic patients upon hospital admission at a pediatric academic hospital. METHODS A retrospective chart review was conducted on 30 patients with epilepsy admitted in during April, July, and October 2018 to identify unintentional medication discrepancies among 6 sources: documented medication history, inpatient orders from the electronic medical record, outpatient clinic notes, inpatient history and admission document, phone message records, and external insurance claims. RESULTS A total of 63% percent of patients had at least 1 unintentional medication discrepancy. Most discrepancies occurred with daily maintenance anticonvulsants (63%). The most common types were omission of medication history (31%) and inpatient order omissions (27%). The number of medication histories completed with at least 1 discrepancy varied across pharmacists, nurses, and physicians, yet differences were not statistically significant. CONCLUSIONS Our study found a higher incidence of anticonvulsant discrepancies compared with previous studies. This quality improvement initiative identified the absence of a standardized process as the root cause for the high incidence of anticonvulsant discrepancies in pediatric patients with epilepsy at hospital admission.

scholarly journals Identifying Unintentional Medication Discrepancies at Admission among Elderly Inpatients in Vietnam

2021 ◽  
Author(s):  
Phuong Thi Xuan Dong ◽  
Van Thi Thuy Pham ◽  
Linh Thi Nguyen ◽  
Thao Thi Nguyen ◽  
Huong Thi Lien Nguyen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Hospital Admission ◽  
Medication Reconciliation ◽  
Negative Impact ◽  
Medication History ◽  
Medication Discrepancies ◽  
Medication Discrepancy ◽  
Chronic Medication ◽  
Elderly Inpatients

Abstract Background Elderly patients are at high risk of unintentional medication discrepancies during transition care as they are more likely to have multiple comorbidities and chronic diseases that require multiple medications. The main objective of the study was to measure the occurrence and identify risk factors for unintentional medication discrepancies in elderly inpatients during hospital admission.Methods A prospective observational study was conducted from July to December 2018 in a 800-bed geriatric hospital in Hanoi, North Vietnam. Patients over 60 years of age, admitted to one of selected internal medicine wards, taking at least one chronic medication before admission, and staying at least 48 hours were eligible for enrolment. Medication discrepancies of chronic medications before and after admission of each participant were identified by a pharmacist using a step-by-step protocol for the medication reconciliation process. The identified discrepancies were then classified as intentional or unintentional by an assessment group comprised of a pharmacist and a physician. A logistic regression model was used to identify risk factors of medication discrepancies.Results Among 192 enrolled patients, 328 medication discrepancies were identified; of which 87 (26.5%) were unintentional. 32.3% of patients had at least one unintentional medication discrepancy. The most common unintentional medication discrepancy was omission of drugs (75.9% of 87 medication discrepancies). The logistic regression analysis revealed a positive association between the number of discrepancies at admission and the type of treatment wards. Conclusions Medication discrepancies are common at admission among Vietnamese elderly inpatients. This study confirms the importance of obtaining a comprehensive medication history at hospital admission and supports implementing a medication reconciliation program to reduce the negative impact of medication discrepancy, especially for the elderly population.

Obtaining the Best Possible Medication History at Hospital Admission: Description of a Pharmacy Technician-Driven Program to Identify Medication Discrepancies

2021 ◽  
pp. 089719002110212
Author(s):  
Rubiya Kabir ◽  
Samantha Liaw ◽  
Jane Cerise ◽  
Jungen Yi ◽  
Colm Mulvany ◽  
...  
Keyword(s):  
New York ◽  
Hospital Admission ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Medication History ◽  
Cross Sectional ◽  
Medication Discrepancies ◽  
Medication Discrepancy ◽  
Secondary Sources ◽  
Medicine Service

Purpose: Describe the process of obtaining the best possible medication history (BPMH) by Certified Pharmacy Technicians (CPhTs) on hospital admission to identify medication discrepancies. Methods: Cross-sectional, descriptive study conducted between December 2016 and June 2017 at a quaternary center in New York, including all patients 18 years and older admitted to the medicine service through the Emergency Department (ED) and seen by a CPhT. CPhTs obtained the BPMH using a systematic approach involving a standardized interview, checking medications with secondary sources and updating the electronic health record (EHR). Medication discrepancies were identified and categorized by type and risk. Summary statistics were provided as average and standard deviation (SD) for continuous variables, and as frequencies and percentages for categorical variables. Multivariable regression was used to test for associations between patient factors and presence of a medication discrepancy. Results: Of the 3,087 patient visits, the average age was 69 (SD 17.8), 54% were female (n = 1652) and 65% white (n = 2017); comorbidity score breakdown was: 0 (25%, n = 757), 1-2 (33%, n = 1023), 3-4 (23%, n = 699), > 4 (20%, n = 608). The average number of home and discharge medications were 10 (SD 6.1) and 10 (SD 5.4), respectively. The average time spent obtaining the BPMH was 30.6 minutes (SD 12.9). 69% of patients (n = 2130) had at least 1 discrepancy with an average of 4.2 (SD 4.6), of which 43% (n = 920) included high-risk medications. Having a medication discrepancy was associated with a higher number of home medications (p < 0.0001) comorbidities (p < 0.0001), and source of information (p < 0.04). Conclusion: Obtaining the BPMH by CPhTs on hospital admission frequently identifies medication discrepancies. Further studies are needed to evaluate the association between obtaining the BPMH and clinical outcomes.

scholarly journals P032  The burden associated with medicines reconciliation in hospitalised children

2019 ◽  
Vol 104 (7) ◽  
pp. e2.37-e2
Author(s):  
Tathier Qureshi ◽  
Chi Huynh ◽  
Rhian Isaac
Keyword(s):  
Hospital Admission ◽  
Medication Errors ◽  
Pharmacy Student ◽  
National Study ◽  
Medication Discrepancies ◽  
Paediatric Hospital ◽  
Medicines Reconciliation ◽  
Pharmacy Workforce ◽  
West Midlands ◽  
Observation Period

AimMedicines reconciliation in children is an important intervention which prevents unintended medication discrepancies and medication errors from occurring when a child moves from one setting to another, e.g. from home to hospital admission. A national study in England across multiple sites has shown that 1/3 of medication discrepancies are prevented from occurring,1 What has not been evaluated however, is the potential burden that medicines reconciliation would have on the resources, in particular on the pharmacy workforce. The overall aim of this project was to investigate the burden that is associated with admissions medicines reconciliation (AMR) in children.MethodsOver a 10 day period spanning over 4 weeks, rotational pharmacists carrying out hospital admission medicines reconciliation at a paediatric hospital in Birmingham, West Midlands were directly observed by a researcher (pharmacy student). This process was timed, and the student recorded the following observations: -The number of AMRs that were initiated within 24 hours of admissionThe number of AMRs that there completed within 24 hours of admissionThe number of completed and incomplete medicines reconciliationsThe reasons for incompletion of medicines reconciliation during the observation period.

817 A Proactive Feeding Regimen on Meeting Caloric Goals with Continuous Enteral Nutrition Support: A Quality Improvement Project

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S247-S248
Author(s):  
Elizabeth Lu
Keyword(s):  
Quality Improvement ◽  
Enteral Nutrition ◽  
Total Body Surface Area ◽  
Quality Improvement Project ◽  
Nutrition Support ◽  
Burn Patients ◽  
Improvement Project ◽  
Impaired Wound Healing ◽  
Protocol Group ◽  
Increased Risk

Abstract Introduction Severe burn injuries are characterized by elevated metabolic demands. Numerous studies have documented iatrogenic underfeeding of critical care patients, which can lead to malnutrition, impaired wound healing, weakened immune response, and increased risk of infections. Enteral nutrition (EN) support is often utilized to help meet the increased caloric demands of burn patients. However, discrepancies between prescribed and delivered EN can occur due to frequent interruptions, delays initiating EN, gradual advancement of EN rate, and/or physician directed changes. The objective of this quality improvement project is to assess whether a proactive calculation of EN regimens can improve the provision of calories compared to a traditional calculation method. Methods A retrospective review of patients in a pediatric acute burn unit that received continuous EN for greater than three days was performed. The pre-protocol group consisted of patients from January 1st, 2017 to November 30th, 2017 who had continuous EN rates calculated by the dietitian based on 24 hours per day. This group was compared to patients from September 1st, 2018 to July 31st, 2019 who had EN rates calculated by the dietitian based on 23 hours per day (post-protocol group). Periods in which parenteral nutrition was administered or the EN regimen was prescribed in a non-continuous fashion were excluded. The primary outcome measure was the percentage of admissions in which patients met at least 85% of calorie estimations. This project was undertaken as a Quality Improvement initiative and, as such, was not formally supervised by an Institutional Review Board. Results A total of 132 patients (73 pre- and 59 post-protocol) from 134 separate inpatient admissions (73 pre- and 61 post-protocol) were identified. The average total body surface area burn was 40.9% (SD 18.8) vs. 49.4% (SD 19.8) and average age was 8.6 years (SD 5.9) vs. 7.9 years (SD 5.4) in the pre- and post-protocol groups, respectively. Continuous EN ran for an average of 20 hours a day (SD 2.2, median = 21) vs. 21 hours a day (SD 2.7, median = 22) in the pre- and post-protocol groups, respectively. The average number of days on continuous EN was comparable in both groups. The post-protocol group had 75% of admissions meet at least 85% of calorie estimations compared to the pre-protocol group with 52% of admissions having met the goal. Conclusions Due to the heightened metabolic demands of burn patients and the barriers to meeting caloric goals, it is important to minimize calorie deficits with EN support. Although a seemingly small change, calculating continuous EN rates based on 23 hours per day can yield improved caloric provisions compared to rates based on 24 hours per day. Applicability of Research to Practice A proactive approach to calculating continuous EN support should be considered to help decrease caloric deficits.

Quality Improvement Program to Reduce the Prevalence of Pressure Ulcers in an Intensive Care Unit

2008 ◽  
Vol 17 (4) ◽  
pp. 328-334 ◽  
Author(s):  
Rosalind Elliott ◽  
Sharon McKinley ◽  
Vicki Fox
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Pressure Ulcers ◽  
Anatomical Site ◽  
Clinical Expertise ◽  
Improvement Program ◽  
Improvement Project ◽  
Increased Risk ◽  
Quasi Experimental

Background Critically ill patients are at increased risk for pressure ulcers, which increase patients’ morbidity and mortality. Quality improvement projects decrease the frequency of pressure ulcers. Objectives To improve patients’ outcomes by reducing the prevalence of pressure ulcers, identifying areas for improvement in prevention of pressure ulcers, and increasing the adoption of preventive strategies in an intensive care unit. Method Quasi-experimental methods were used for this quality improvement project in which 563 surveys of patients’ skin were performed during 22 audits conducted during a 26-month period. One-on-one clinical instruction was provided to bedside nurses during the surveys, and pressure ulcer data were displayed in the clinical area. Results The frequency of pressure ulcers of all stages showed an overall downward trend, and the prevalence decreased from 50% to 8%. The appropriate allocation of pressure-relieving devices increased from 75% up to 95% to 100%. The likely origin of the ulcer (ie, whether it was hospital or community acquired) and the anatomical site of the pressure ulcers did not change during the study period. Conclusions This program was successful in reducing the prevalence of pressure ulcers among vulnerable intensive care patients and indicates that quality improvement is a highly effective formula for improving patients’ outcomes that is easily implemented by using clinical expertise and existing resources.

Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients

2017 ◽  
Vol 8 (4) ◽  
pp. 453-459 ◽  
Author(s):  
Cathy Woodward ◽  
Richard Taylor ◽  
Minnette Son ◽  
Roozbeh Taeed ◽  
Marshall L. Jacobs ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Quality Improvement ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Wound Infections ◽  
Improvement Project ◽  
Sternal Closure ◽  
Increased Risk ◽  
Delayed Sternal Closure ◽  
Sternal Wound Infections

Background: Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. Methods: Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries. Results: Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007. Conclusion: A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.

scholarly journals Improving access to epilepsy care for homeless patients in the Dublin Inner City: a collaborative quality improvement project joining hospital and community care

2021 ◽  
Vol 10 (2) ◽  
pp. e001367
Author(s):  
Elisabeth Doran ◽  
Enda Barron ◽  
Laura Healy ◽  
Lorraine O'Connor ◽  
Cara Synnott ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Care Pathway ◽  
Primary Care Providers ◽  
Quality Improvement Project ◽  
High Rate ◽  
Care Providers ◽  
Improvement Project ◽  
Pathway Of Care ◽  
Patients With Epilepsy

Homelessness is associated with significant psychosocial and health disparities. The rate of epilepsy among this cohort is eight times greater than that in the settled population, and the associated morbidity is higher due to lack of integrated care, difficulties with treatment adherence, substance abuse and poor social circumstances. There is a high rate of seizure-related death in homeless patients. Seizures are one of the most common neurological cause for emergency department presentation among this population. The aim of this quality improvement project was to use a multistakeholder co-production approach to design a new pathway of care for homeless patients with epilepsy to improve access to specialist epilepsy care and to strengthen the links between hospital and community teams who manage this population. After several years of observation, stakeholder engagement and numerous tests of change, we have created a new care pathway and developed bespoke tools for primary care providers and for physicians working in the emergency department to enable them to assess and manage patients as they present, as well as provide access to remote epilepsy specialist support.

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