Integration of Medication Safety Training and Development of a Culture of Safety in Pharmacy Education

Medication safety events with the potential for patient harm do occur in health care settings. Pharmacists are regularly tasked with utilizing their medication knowledge to optimize the medication use process and reduce the likelihood of error. To prepare for these responsibilities in professional practice, it is important to introduce patient safety principles during educational experiences. The Accreditation Council for Pharmacy Education (ACPE) and the American Society of Health-System Pharmacists (ASHP) have set forth accreditation standards focused on the management of medication use processes to ensure these competencies during pharmacy didactic learning and postgraduate training. The experience described here provides perspective on educational and experiential opportunities across the continuum of pharmacy education, with a focus on a relationship between a college of pharmacy and healthcare system. Various activities, including discussions, medication event reviews, audits, and continuous quality improvement efforts, have provided the experiences to achieve standards for these pharmacy learners. These activities support a culture of safety from early training.

Effect of Replacing Vendor QTc Alerts with a Custom QTc Risk Alert in Inpatients

Objective The aim of the study is to implement a customized QTc interval clinical decision support (CDS) alert strategy in our electronic health record for hospitalized patients and aimed at providers with the following objectives: minimize QTc prolongation, minimize exposure to QTc prolonging medications, and decrease overall QTc-related alerts. A strategy that was based on the validated QTc risk scoring tool and replacing medication knowledge vendor alerts with custom QTc prolongation alerts was implemented. Methods This is a retrospective quasi-experimental study with a pre-intervention period (August 2019 to October 2019) and post-intervention period (December 2019 to February 2020). The custom alert was implemented in November 2019. Results In the pre-implementation group, 361 (19.3%) patients developed QTc prolongation, and in the post-implementation group, 357 (19.6%) patients developed QTc prolongation (OR: 1.02, 95% CI: 0.87–1.20, p = 0.81). The odds ratio of an action taken post-implementation compared with pre-implementation was 18.90 (95% CI: 14.03–25.47, p <0. 001). There was also a decrease in total orders for QTc prolonging medications from 7,921 (5.5%) to 7,566 (5.3%) with an odds ratio of 0.96 (95% CI: 0.93–0.99, p = 0.01). Conclusion We were able to decrease patient exposure to QTc prolonging medications while not increasing the rate of QTc prolongation as well as improving alert action rate. Additionally, there was a decrease in QTc prolonging medication orders which illustrates the benefit of using a validated risk score with a customized CDS approach compared with a traditional vendor-based strategy. Further research is needed to confirm if an approach implemented at our organization can reduce QTc prolongation rates.

Factors Influencing Self-Reported Medication Use in the Survey of Health Aging and Retirement in Europe (SHARE) Dataset

The validity of self-reported medication use in epidemiological studies is an important issue in healthcare research. Here we investigated factors influencing self-reported medication use for multiple diagnoses in the seventh wave of the Survey of Health Aging and Retirement in Europe (SHARE) dataset in n = 77,261 participants (ages: mean = 68.47, standard deviation = 10.03 years). The influence of mental, physical, and sociodemographic parameters on medication self-report was analyzed with logistic regressions and mediation models. Depression, memory function, and polypharmacy influenced the self-report of medication use in distinct disorders to varying degrees. In addition, sociodemographic factors, knowledge about diagnosis, the presence of several chronic illnesses, and restrictions of daily instrumental activities explained the largest proportion of variance. In the mediation model, polypharmacy had an indirect effect via depression and memory on self-reported medication use. Factors influencing medication self-report vary between different diagnoses, highlighting the complexity of medication knowledge. Therefore, it is essential to assess the individual parameters and their effect on medication behavior. Relying solely on medication self-reports is insufficient, as there is no way to gage their reliability. Thus, self-reported medication intake should be used with caution to indicate the actual medication knowledge and use.

The Effectiveness of Pharmacist-Led Medication Review in Petaling District Health Office

Medication review is an important service in optimising medicine use and improves clinical outcomes. This study aims to assess the effectiveness of pharmacist-led medication review on patients’ knowledge and adherence. For this prospective study, 480 patients were randomly recruited in six primary healthcare clinics in Petaling District Health Office. Patients were interviewed with a questionnaire and validated medication adherence scale during recruitment and at follow-up visit to assess their medication knowledge and adherence. The data was analysed using Chi-square tests and paired t-tests to determine the correlation between medication knowledge and adherence with patient demographics. Among 408 patients that had completed the follow-up, 16.9% of patients showed medication knowledge deficits on recruitment. However, there is a significant improvement in the medication knowledge indices during the follow-up session (p < 0.001). Elderly patients were found to benefit from medication review with better medication knowledge and adherence postmedication review. The study found that the number of good adherers increased by 29.3% after the medication review. A further study demonstrating the effectiveness of medication review in cultivating knowledge retention and sustained adherence in the longer-term is warranted. Future work shall also focus on measuring the cost-effectiveness of pharmacistled medication review implementation in primary healthcare settings. Pharmacist-led medication review is an essential and effective service in primary health care facilities for patients to enhance their knowledge on their medications, and adherence especially in elderly patients on chronic medications.

The impact of poor medication knowledge on health-related quality of life in people with Parkinson’s disease: a mediation analysis

Purpose This study aimed to determine how limited medication knowledge as one aspect of health literacy contributes to poorer health-related quality of life (HRQoL) in people with Parkinson’s disease (PD). Methods Demographical data, PD-specific data (MDS-Unified Parkinson’s Disease-Rating Scale, Nonmotor symptom scale), and data about depressive symptoms (Beck’s depression inventory), cognition (Montreal cognitive assessment), HRQoL (Short-Form Health Questionnaire-36, SF-36), and medication knowledge (names, time of taking, indication, dosage) were assessed in 193 patients with PD. Multivariate analysis of variance (MANOVA), multivariate analysis of covariance, and mediation analyses were used to study the relationship between medication knowledge and HRQoL in combination with different mediators and covariates. Results Overall, 43.5% patients showed deficits in at least one of the 4 knowledge items, which was associated with higher age, number of medications per day and depression level, and poorer cognitive function, motor function, and lower education level. Using one-way MANOVA, we identified that medication knowledge significantly impacts physical functioning, social functioning, role limitations due to physical problems, and role limitations due to emotional problems. Mediation models using age, education level, and gender as covariates showed that the relationship between knowledge and SF-36 domains was fully mediated by Beck’s Depression Inventory but not by Montreal Cognitive Assessment. Conclusions Patients who expressed unawareness of their medication did not necessarily have cognitive deficits; however, depressive symptoms may instead be present. This concomitant depressive symptomatology is crucial in explaining the contribution of nonadherence and decreased medication knowledge to poor quality of life.

Integrating the Public Health Services Model into Age-Friendly Pharmacies: A Case Study on the Pharmacies in Taiwan

Taiwan is expected to become a superaged society by 2026. Community pharmacies have recently joined Taiwan’s primary care system; they have great potential to provide professional healthcare services. This study examined whether the services provided by community pharmacists enhance medication adherence, enable the identification and solution of drug therapy problems, and are accepted by community residents. The Department of Public Health, Taoyuan City, collaborated with the Taoyuan Pharmacist Association over 11 months in 2018 in enabling pharmacists to dispense prescriptions and provide medication adherence consultations, cognitive services, and home and institutional medical care services. This study designed four satisfaction questionnaires to assess the feasibility and performance of these services. Regarding the services related to medication knowledge and adherence, 92.10% of the patients reported overall satisfaction, and all understanding and ability scores were improved in more than 95% of patients. The number of patients highly cooperative regarding their medication had risen from 14 to 234 after the intervention, and the number with low medication adherence had dropped from 533 to 33. More than 90% of respondents indicated that the institutional medical care services had significantly improved their medication knowledge and behaviors. The feasibility of the incorporation of integrated the public health services model into age-friendly pharmacies was confirmed by this study.

The role of forest in the knowledge production of traditional medication in Tejang Village Sebesi Island, South Lampung

Forest has a crucial role in elevating public welfare. It provides various products such as food, beverages, clothes, residence, musical instruments, and medicines. The medicines originated from the forest could act as the supplier for livelihood particularly for a traditional healer. The traditional healer is one of the health treatments sources for the people of Sebesi Island. For traditional healers, the forest is also beneficial in the knowledge production of traditional medication. This study purposes to examine the role of the forest in knowledge production carried out by traditional healers and identify the patterns of knowledge production. Data collection was done through interviewing, involving four traditional healers in Tejang Village, Sebesi Island, South Lampung. Another method was literature study related to the roles of forests in traditional medication and knowledge production. The knowledge production process can occur through giving agents, both human and non-human ones, namely teachers, family members, books, and dreams. The interaction between those healers with the forest also resulted in the medication knowledge. The role of the forest in the knowledge production of traditional medication is that it transforms into a place for semedi or meditation when doing ngelmu, knowledge sources about medication, and the place for the existence of medicinal plants.

SOSIOEKONOMI, PENGETAHUAN PENYAKIT DIARE DAN PENGETAHUAN SWAMEDIKASI DIARE PADA IBU BALITA DI YOGYAKARTA

In Indonesia, the prevalence of diarrhea is highest among children under five. Economic factors and maternal knowledge are, in this case, significantly related to diarrhea incidence, and the latter substantially defines self-medication measures taken for acute diarrhea treatment. The research was intended to determine the extent to which socioeconomic conditions and diarrheal knowledge formed comprehension of such treatment. For this purpose, it employed a cross-sectional study with 504 research subjects, namely, mothers of children under five in the Special Region of Yogyakarta, Indonesia. Data were collected using a validated questionnaire consisting of items on socioeconomic details (education, employment, income), diarrheal knowledge, and relevant self-medication knowledge. Afterward, education and post-test were conducted using the same list of questions. Analytical techniques were carried out to identify how significant socioeconomic characteristics determined knowledge of diarrheal disease and self-medication.Results showed that, socioeconomically, a large proportion of research subjects attained secondary to tertiary education (76%), were unemployed (71%), and earned low income (62%). Educational attainment was found to be significantly related to levels of knowledge of diarrheal disease and self-medication (p < 0.005), but employment status and income were not (p > 0.005). Analysis results also indicate a significant relationship (p = 0.000) between the level of knowledge of diarrheal disease and that of diarrheal self-medication. Overall, socioeconomic status (i.e., level of education) and diarrheal knowledge is significantly related to diarrheal self-medication knowledge.

Knowledge and Power Relations in Older Patients’ Communication About Medications Across Transitions of Care

Communicating about medications across transitions of care is a challenging process for older patients. In this article, we examined communication processes between older patients, family members, and health professionals about managing medications across transitions of care, focusing on older patients’ experiences. A focused ethnographic design was employed across two metropolitan hospitals. Data collection methods included interviews, observations, and focus groups. Following thematic analysis, data were analyzed using Fairclough’s Critical Discourse Analysis and Medication Communication Model. Older patients’ medication knowledge and family members’ advocacy challenged unequal power relations between clinicians and patients and families. Doctors’ use of authoritative discourse impeded older patients’ participation in the medication communication. Older patients perceived that nurses’ involvement in medication communication was limited due to their task-related routines. To reduce the unequal power relations, health professionals should be more proactive in sharing information about medications with older patients across transitions of care.

Evaluation of a patient self-medication program in allogeneic hematopoietic stem cell transplantation

Introduction Patients admitted for allogeneic hematopoietic stem cell transplantation (allo-HSCT) are discharged with multiple new medications. At our institution, a new patient Self Medication Program (SMP) was implemented on the allo-HSCT units. An SMP allows patients to practice self-administration of medications in a controlled environment before discharge. We assessed the impact of the SMP on patient medication knowledge, self-efficacy, adherence, and safety. Patient and staff satisfaction with the SMP was also explored. Methods Participants in the SMP group received medication counseling by a pharmacist and self-managed their medications with nursing supervision until discharge. Participants in the pre-SMP group received medication counseling by a pharmacist at discharge. All participants completed a Medication Knowledge and Self-Efficacy Questionnaire before discharge and at follow-up. Safety endpoints were assessed for SMP participants. Results Twenty-six patients in the pre-SMP group and 25 patients in the SMP group completed both questionnaires. Median knowledge scores in the pre-SMP group versus the SMP group were 8.5/10 versus 10/10 at discharge ( p = 0.0023) and 9/10 versus 10/10 at follow-up ( p = 0.047). Median self-efficacy scores were 38/39 in the pre-SMP group versus 39/39 in the SMP group at both discharge and follow-up ( pdischarge = 0.11, pfollow-up = 0.10). The SMP was associated with at least 1 medication event in 7 participants, but no medication incidents. Patient and staff surveys showed a positive perceived value of the SMP. Conclusion Our results demonstrate that the SMP is associated with durable, improved medication knowledge, a trend towards improved self-efficacy, and largely positive perceptions among both staff and patient participants.