Combining research and design: A mixed methods approach aimed at understanding and optimising inpatient medication storage systems

Background Almost every patient admitted to hospital will receive medication during their stay. Medication errors are an important cause of patient morbidity and mortality, as well as an economic burden for healthcare institutions. Research suggests that current methods of storing medication on hospital wards are not fit for purpose, contributing to inefficiency and error. Aim To improve medication storage in inpatient areas, by exploring variation and challenges related to medication storage and designing a prototype solution. Methods Set in four hospitals in an English teaching hospital trust, the study used a mixed methods approach comprising a quantitative descriptive survey of storage facilities and practices followed by mixed methods observations of medication rounds and interviews with patients, nurses and pharmacy staff. Quantitative data were presented descriptively and qualitative data analysed thematically and using a human-centered design approach. Results We identified wide variation in medication storage facilities and practices across 77 wards. Observations and staff interviews in six wards revealed five problem areas: poor management of multiple storage facilities; lack of visibility and organisation of medication within trolleys; inadequate size of storage; lack of ownership and knowledge of standard practice; and use of key locks. Patients were largely satisfied with receiving their medication. Systematic and consistent physical organisation of medication in medication trolleys, and integrating and implementing principles of best practice, were identified as areas for intervention. Discussion and conclusion Variation in medication storage facilities and practices existed both across the organization and on individual wards. Multiple challenges were identified in how medication was stored, which if addressed may improve the efficiency and safety of medication administration and in turn, staff and patient experience. The use of design principles alongside a research approach resulted in a rapid, iterative process for developing and refining potential solutions to improve inpatient medication storage.

Home medication management problems and associated factors among psychiatric patients under home care pharmacy services at government hospitals in west Malaysia

Background Proper home medication management plays a role in improving medication adherence, preserving drug efficacy and ensuring safe medication practices, which is crucial to establish positive treatment outcomes. However, no published studies are available on home medication management among psychiatric patients. The study aimed to identify home medication management problems among psychiatric patients in Malaysia and to examine the association between inappropriate medication storage and lack of medication administration schedule with socio-demographic factors, disease insight, number of medication and type of Home Care Pharmacy Services (HCPS). Methods This multicentre cross-sectional study was conducted among psychiatric patients under HCPS in six government hospitals in west Malaysia. Data was extracted from the HCPS form used for each visit as per protocol published by the Pharmaceutical Services Division, Ministry of Health Malaysia. A minimum sample size of 169 was needed. Proportional random sampling was applied. Associations between inappropriate medication storage and lack of medication administration schedule with study parameters were analysed using multiple logistic regressions. Results A total of 205 home visits were conducted with 229 home medication management problems identified; inappropriate medication storage and lack of medication administration schedule topped the list. Inappropriate medication storage was significantly associated with low income [AOR=4.34 (95%CI 1.17:15.98), p=0.027], alcohol consumption [AOR=14.26 (95%CI 1.82:111.38), p=0.011], poor insight [AOR=2.34 (95%CI 1.08:5.06), p=0.030] and part-time HCPS [AOR=2.60 (95%CI 1.20:5.67), p=0.016]. Lack of administration schedule was significantly associated with low income [AOR=6.90 (95%CI 1.46:32.48), p=0.014], smoking [AOR=2.43 (95%CI 1.20:4.92), p=0.013], poor insight [AOR=5.32 (95%CI 2.45:11.56), p<0.05] and part-time HCPS [AOR=2.96 (95%CI 1.42:6.15), p=0.004]. Conclusions Inappropriate medication storage and lack of medication administration schedule is common among psychiatric patients. The study also highlighted the potential of HCPS to improve disease insight and home medication management among psychiatric patients, provided if the service is utilised fully.

Medication Management at Home and Medication Adherence in Older Patients with Polypharmacy: In-Depth Interviews with Home Visits

Objectives: This study qualitatively explores the patients with polypharmacy medication management at home. Design: Qualitative study with in-depth interviews and home visits Setting: A semiurban area in the Pathum-Thani province, Thailand. Participants: We interviews 19 elderly patients aged ≥60 years with polypharmacy at their houses and took photos of medication storage locations. Results: Of the 19 patients (mean age=69 years), nine reported good medication adherence. Two themes emerged: medication management at home and factors affecting medication adherence. Medication management at home comprised three subthemes: a medication storage system, a medication sorting system, and remaining medications. Some patients with medication nonadherence removed medications from blister packages. Other factors affecting medication adherence included knowledge, attitude, and lifestyles. All the patients had a positive attitude towards medication adherence; however, misunderstanding about medication administration prevented them from adhering to medications. Conclusion: The elderly patients managed medications at home differently. Medication nonadherence was common in those who removed medications from blister packages. Doctors and pharmacists should encourage the patients to use pillboxes or discourage patients from removing medications from blister packages.

Medication Handling and Storage among Pilgrims during the Hajj Mass Gathering

We aimed to investigate the knowledge and practices of Hajj pilgrims regarding medication storage and handling during the Hajj mass gathering. In this cross-sectional study, adult pilgrims from 30 countries were interviewed using a structured questionnaire during the 2019 Hajj. The study enrolled 1221 participants with a mean age of 50.8 years (SD = 12.5, range = 18–98) and male:female ratio of 1.7:1. Most pilgrims were literate, 50.4% had a university or higher education, and 38% reported at least one underlying health condition. Most pilgrims reported receiving education regarding the proper way to store their medication during Hajj, mainly from physicians (73.7%) and pharmacists (39.4%). Although 68.2% of pilgrims had good knowledge regarding medication storage and the potential effect of inappropriate storage conditions on medications and health, inadequate knowledge and poor practice were identified among some. Level of education, having an underlying health condition and receiving health education on mediation storage were independently associated with good knowledge. Most pilgrims took their medications with them during Hajj, although storage and handling of their medication also varied depending on the stages of their Hajj pilgrimage journey. Improving Hajj pilgrims’ awareness and knowledge about appropriate storage and handling of their medications are beneficial in reducing the risk of associated adverse health outcomes, both during Hajj and beyond the mass gathering.

The Role of National Food Security in a Massive Pandemic: The Case of Covid-19

This paper proposes the national pandemics contingency plan for any country based on the application of the minimum food, water & medication storage for a massive pandemic quota (ψ-Quota). Consequently, the main objective of the ψ-Quota is to calculate the approximate amount of food, water, and medicines storage amount annually in case of a possible massive pandemic crisis. Finally, this paper is divided into three sections: (i) the minimum food, water, and medicine quota storage calculation in case of a massive pandemic; (ii) the food, water, and medicine storage quota for a massive pandemic; (iii) the geographical distribution and mapping of the emergency aid supplier’s modules in case of a massive pandemic for any country. Finally, the ψ-Quota was applied on the case of Malaysia.

SAFER brief community intervention: a primary suicide prevention strategy to improve firearm and medication storage behaviour

ObjectiveTo determine if a brief intervention, called Signpost, Assess, Facts, Emotion, Recommend (SAFER), designed to motivate changes in behaviour to secure firearms and medications to prevent future suicide is feasible to implement in community-based settings such as gun shows, acceptable to participants at higher risk for suicide including veterans and men in the middles years (35–64) and improves firearm and medication locking behaviours.Methods1175 people received SAFER over a 12-month period at 18 gun shows and community events in 2019 and completed a preassessment measuring firearms ownership, storage practices, knowledge about suicide as the leading type of firearm fatality and attitudes about suicide prevention. 372 responded to a brief postassessment using comparable measures.Results85% of participants reported keeping firearms at home. 43.7% reported current or prior military service. 53.2% were males between the ages of 35 and 64. Among those who responded to the postassessment, 61% of participants reported SAFER to be highly valuable. Safe firearms storage improved among participants who completed the preassessment and postassessment (51.2% pre, 66.0% post; p<0.01) as did safe medication storage (14.8% pre, 21.6% post; p=0.01). Knowledge that most firearm fatalities are suicides (33.4% pre, 45.8% post; p<0.01) also improved.ConclusionsIt is feasible, acceptable and effective to reach groups at elevated risk for suicide using a brief intervention strategy in unconventional settings. Community-based interventions to improve safe storage motivated by suicide prevention messaging should be prioritised because men in the middle years are less likely to use mental health services.

Perbandingan Motion Graphic dan Leaflet terhadap Peningkatan Pengetahuan Ibu Rumah Tangga dalam Menyimpan Obat

Inadequate storage of medicines at home is a common health problem in the community. Therefore, it is important to promote this issue through interesting media to increase knowledge related to medication storage. This study aims to compare conventional media (leaflet) with motion graphics in increasing knowledge of drug storage at home. Quasi-experimental research with a pretest-posttest design was applied to 45 housewives with similar education levels. In the initial stage, the leaflet group (23 people) and the motion graphic group (22 people) were given a pretest about medication storage, then were intervened with the media for 5 minutes, we're given a post-test afterward. The results showed there were significant differences in medication storage knowledge between groups that were exposed to motion graphics and leaflets (p-value=0,029). The median score of the knowledge in the motion graphic group was significantly higher (85,71) than the leaflet group (71,43). Motion graphics might be beneficial as an educational media to deliver message related to effective drug management for the community, especially housewives.