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A systematic review of patient medication error on self-administering medication at home
Expert Opinion on Drug Safety
Abstract
Introduction:
Medication errors have been analyzed as a health professionals' responsibility (due to mistakes in prescription, preparation or dispensing). However, sometimes, patients themselves (or their caregivers) make mistakes in the administration of the medication. The epidemiology of patient medication errors (PEs) has been scarcely reviewed in spite of its impact on people, on therapeutic effectiveness and on incremental cost for the health systems.
Areas covered:
This study reviews and describes the methodological approaches and results of published studies on the frequency, causes and consequences of medication errors committed by patients at home. A review of research articles published between 1990 and 2014 was carried out using MEDLINE, Web-of-Knowledge, Scopus, Tripdatabase and Index Medicus.
Expert opinion:
The frequency of PE was situated between 19 and 59%. The elderly and the preschooler population constituted a higher number of mistakes than others. The most common were: incorrect dosage, forgetting, mixing up medications, failing to recall indications and taking out-of-date or inappropriately stored drugs. The majority of these mistakes have no negative consequences. Health literacy, information and communication and complexity of use of dispensing devices were identified as causes of PEs. Apps and other new technologies offer several opportunities for improving drug safety.
... A medication self-administration error (MSE) can happen when a patient takes a prescribed medication at an incorrect time or dosage, is mixed up with other medications, or is improperly stored. Medication errors pose a significant challenge for healthcare systems as they diminish the efficacy of treatments and increase costs [3]. Patient safety is jeopardized by MSE, which can lead to more severe outcomes like hospitalization or even death [4]. ...
... While research on medication errors and their associated factors has predominantly centered on incidents within hospital settings, the majority of errors, especially in older adult patients with polypharmacy, actually occur in community settings. Despite this, a limited number of studies have investigated issues related to medication errors following the self-administration of medicines in 'patients' homes [3,5,25,26]. The latest systematic review by Aldila et al. [5] identified types of MSEs and their influencing factors, specifically among the older adult population. ...
... The extensively examined intrinsic causal factors are associated with patient profiles and their level of health literacy. Extrinsic factors contributing to patient medication errors are connected to the quality of information provided, communication with caregivers, and the complexity of dispensing devices [3]. Acknowledging the diverse definitions of health literacy, we incorporated this concept into a main category named 'Deficiency in Effective Communication and Education. ...
Background
Polypharmacy and low literacy increase medication self-administration errors (MSEs) among older adults, adversely affecting both patients and healthcare systems through increased costs and reduced treatment efficacy.
Objectives
This study explored the reasons for MSEs among illiterate and low-literate older adults with polypharmacy from the perspective of older adults, informal family caregivers, physicians, and pharmacists.
Method
The qualitative study used a conventional content analysis approach from September 2022 to April 2023. Purposeful sampling was used to recruit participants for interviews.
Results
The study included fifteen older adults, five caregivers, four physicians, and seven pharmacists. Seven main categories were extracted: 1) Age-related physical and cognitive changes, 2) Medication Mismanagement, 3) Inhibitor beliefs of proper medication use, 4) Caregiving challenges, 5) Deficiency in effective communication and education, 6) Health systems inefficiencies, 7) The challenges of producing, dispensing and obtaining medications.
Conclusion
The origins of MSEs encompass a broad spectrum of factors, ranging from individual to systemic levels. Successful interventions for reducing errors will be those that take into account all aspects of error occurrence and strive to minimize them through a holistic approach. The findings highlight the importance of improving organizational health literacy strategies for older adults with limited literacy. Tailoring health information to the specific needs of older patients is crucial for addressing MSEs.
... 7 [3][4][5][6][7][8] The recommendations are user-friendly. 7 [ 3 -8] Implementing the recommendations in practice is timeconsuming. ...
... 8 [4][5][6][7][8][9][10] The recommendations are useful in supporting patients who experience problems with their medications. ...
... 8 [5][6][7][8][9][10] The recommendations can help me as a healthcare provider to support and advise patients if they experience problems with their medications. ...
This study aimed to describe the use of recommendations as a guide for healthcare providers to support patients experiencing medication self‐management problems and to evaluate their feasibility, user‐friendliness and usefulness. Between March and August 2023, 58 hospitalized patients completed a self‐assessment on medication self‐management problems. The problems addressed in this self‐assessment were based on a list of frequently encountered medication self‐management problems from previous research. Consequently, 18 nurses responded to the reported problems using the recommendations. Nurses evaluated the feasibility, user‐friendliness and usefulness of these recommendations through a survey. A total of 217 medication self‐management problems were reported by 58 patients. Nurses intervened in 52% of the problems using the recommendations. According to nurses, the recommendations were user‐friendly and feasible but required a substantial time investment. Considering these pilot‐based results, the recommendations have the potential to be a valuable resource for nurses in practice, though this potential requires further exploration.
... However, in many cases, patients themselves commit medication errors during self-administration [6]. A medication selfadministration error (MSE) at home occurs when a medication is prescribed by the physician but taken at the wrong time or dose, confused with other medications, or wrongly stored [7]. ...
... More information is needed to clarify and confirm the results among independent community-dwelling older adults with polypharmacy at their homes without limiting them to a particular disease. Moreover, studies on medication use in older adults have mainly focused on the predictors of medication adherence, and few studies examine the predictors of MSEs [7]. ...
... Recognizing factors relating to MSEs can orient healthcare professionals in clinical practice and help them to provide the necessary supportive care and to design effective interventions [2]. So, based on previous studies [7,12], we hypothesized that the older adults' profile, medical and medication history, and beliefs about medication and receiving support can affect MSEs. Therefore, this study aimed to identify the extent of MSEs and their contributing factors (including sociodemographic, medical history, medication-related factors, medication belief, and monitoring of medications by a caregiver) among illiterate and low-literate community-dwelling older adults who take at least 5 medications in their homes via hierarchical regression. ...
Background
Older adults with polypharmacy are more prone to medication errors. People with low educational attainment have more difficulties in taking their medications.
Objectives
This study aimed to identify the extent of medication self-administration errors (MSEs) and the contributing factors among illiterate and low-literate community-dwelling older adults with polypharmacy.
Method
The present cross-sectional study was conducted among people aged 60 and above. The data were collected using the sociodemographic, clinical, and Belief about Medicines Questionnaires (BMQ). To determine the extent of MSE, a medication error checklist was used. The negative binomial hierarchical regression model in the five blocks was performed.
Results
The final sample size was 276 people. The frequency of MSEs in the last 6 months was 69.2%. Sixteen percent of participants had made four or more mistakes. The most common MSEs were forgetting, improper taking of medications with food, improper timing, incorrect dosage (lower dose), and forgetting the doctor’s instructions. Near 18% of participants reported adverse events following their mistakes. The significant predictors of MSEs were being completely illiterate (p = 0.021), the higher number of doctor visits per year (p = 0.014), irregularly seeing doctors (p < .001), the higher number of medications (p < .001), and having poor medication beliefs (p < .001).
Conclusion
Despite the high prevalence of MSEs among older patients, practical strategies to deal with them at their homes have not been established among health systems. MSE as a multifactorial event can be caused by a collection of internal and external factors. Further studies to identify the role of patients, clinicians, procedures, and systems in developing MSEs as interconnected components are needed.
... Descriptions of the studied contexts are reported in Table 2 and further described in this section. Of the 27 reviews, 16 focused on specific populations/settings including community-dwelling adults [18,[29][30][31], home care setting [32,33], neonatal intensive care setting [26,34], inpatient setting [27,35], pediatrics [36], elderly [37], hematopoietic stem cell transplantation patients [38], mental health patients [39], perioperative setting [40], and acute care setting [28]. Six reviews focused on the geographical location of the Middle East [41,42], Iran [43,44], Africa [45], or Southeast Asia RCTs since these could not be used to reliably assess the incidence and/or prevalence and reviews. ...
... All but six [26,27,30,34,43,48] of the reviews reported quality assessments of the included articles. The two most common quality assessment tools were the Allan and Barker instrument (with or without modifications) and the Critical Appraisal Skills Program checklist. ...
... Other methods reported were metaregression [28] and inductive analysis [33] but with little detail provided. The review of Assiri et al. (2018) had three prespecified categories [18], while four reviews classified factors according to emerging themes [30,32,40,45]. ...
Introduction
Medication errors are common events that compromise patient safety and are prevalent in all health-care settings. This umbrella review aims to systematically evaluate the evidence on contributory factors to medication errors in health-care settings in terms of the nature of these factors, methodologies and theories used to identify and classify them, and the terminologies and definitions used to describe them.
Areas covered
Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, and Google Scholar were searched from inception to March 2022. The data extraction form was derived from the Joanna Briggs Institute (JBI) Reviewers’ Manual, and critical appraisal was conducted using the JBI quality assessment tool. A narrative approach to data synthesis was adopted.
Expert opinion
Twenty-seven systematic reviews were included, most of which focused on a specific health-care setting or clinical area. Decision-making mistakes such as non-consideration of patient risk factors most commonly led to error, followed by organizational and environmental factors (e.g. understaffing and distractions). Only 10 studies had a pre-specified methodology to classify contributory factors, among which the use of theory, specifically Reason’s theory was commonly used. None of the reviews evaluated the effectiveness of interventions in preventing errors. The collated contributory factors identified in this umbrella review can inform holistic theory-based intervention development.
... These include details about the medication purpose, dosing instructions, potential side effects, warnings, as well as benefits and risks. Poor PMI increases risk for negative outcomes such as ineffective treatment, medication errors, adverse drug events, and increasing morbidity [1]. Alternatively, effective PMI is a critical factor in supporting consumer medication knowledge and adherence [2,3]. ...
... The most recent summary evidence, published by Mullen et al., characterized studies comparing one or more types of PMI and consolidated the evidence associated with positive outcomes. The primary conclusions were as follows: (1) preference and knowledge were the most commonly assessed outcomes, (2) some types of PMI (SI and technology-supported tools) were less studied, and (3) clear evidence supported the use of plain language principles, typographic cues, quantitative descriptors and standardized formats for WMI and PGCL. In the review, a quarter of studies examined behavioral outcomes and only 4% of studies examined clinical outcomes. ...
Well-designed prescription medication information (PMI), defined as materials which communicate the essential information needed for a patient to safely and accurately self-administer a medication at or near the time of prescribing, is important for patient education. A previous review identifying best practices in the design of PMI was last completed using studies published through 2015.
The aim of this review was to present an updated description of studies comparing one or more types of PMI, including details of if or how patients were involved in PMI design, and to consolidate design elements associated with positive outcomes.
Four databases (Ovid, Embase, CINAHL, and Cochrane) were searched for studies comparing one or more types of PMI using a specified literature search with follow-up citation searching of included articles. Eligible studies were (1) conducted in English-speaking countries, (2) randomized controlled trials, and (3) published in 2016 or later. Consistent findings from at least two well-conducted studies were deemed ‘strong’ evidence and inconsistency in study findings or quality were deemed ‘moderate’ evidence.
Thirty-two articles were included and most had some risk (n = 24) or high risk of bias (n = 4). Two-thirds of articles (n = 21) reported on the details of PMI development, and over half (n = 14) conducted formal pilot testing or obtained feedback from patients. Findings suggested benefits when patients were involved in PMI development. Twelve studies examined written medication information (e.g., leaflets), ten examined pharmacy-generated contained labelling (e.g., instructions printed on pill bottles), two examined supplemental information (e.g., medication regimen charts), and fourteen examined PMI delivered using technology-supported tools (e.g., text message instructions). The most prevalent assessed outcomes were knowledge (n = 19), behaviors (n = 17), attitudes/beliefs (n = 11), and clinical outcomes, such as blood pressure (n = 3). Several studies demonstrated positive outcomes when PMI was designed according to health literacy principles of plain language, typographic cues, actionable instructions, large font, and white space. Multiple trials of pictograms and illustrations alongside paired text and text messages to deliver PMI also had positive outcomes. Although there were several studies that examined interactive websites, audio, and video delivery of PMI, mixed findings resulted in moderate evidence. Novel methods of PMI delivery were identified: a plain language label for as-needed medications, strategic memory training, inclusion of patient photos and quotes, Quick Response codes, and electronic health record strategies.
Overall, a high proportion of studies included patients in the development of PMI and focused on behavioral outcomes. However, clinical outcomes appear to be understudied. In addition to health literacy principles, there is strong evidence for pictograms with paired text when used in written medication information and pharmacy-generated labels. There is moderate evidence for using text messages to deliver PMI. Novel methods require additional study to determine best practices in design.
... After hospital discharge, non-adherence to medication is observed in 24% to40% of patients [16,17]. The prevalence of medication errors by community-dwelling patients is estimated between 19 and 59% which is a threat to safe medication use [18]. For older people with complex therapeutic regimens, this prevalence increases to 75% [18]. ...
... The prevalence of medication errors by community-dwelling patients is estimated between 19 and 59% which is a threat to safe medication use [18]. For older people with complex therapeutic regimens, this prevalence increases to 75% [18]. ...
Purpose
The study aimed to develop and evaluate a medication diary for patients to report problems with medication use to enable shared-decision making and improve medication adherence.
Methods
Based on a search for existing diaries, a review of the content, and a list of medication self-management problems compiled from previous research, a paper and pencil version of a medication diary was developed. The diary was reviewed for clarity and overall presentation by five healthcare providers and nine patients. Afterwards, user-friendliness was evaluated by 69 patients with polypharmacy discharged from hospital during a quantitative prospective study.
Results
The medication diary consists of several parts: (1) a medication schedule allowing patients to list their medicines, (2) information sheets allowing patients to write down specific medication-related information, (3) a monthly overview to indicate daily whether medication-related problems were experienced, (4) problem sheets elaborating on the problems encountered, (5) space for specific medication-related questions for healthcare providers to facilitate shared-decision making. The review phase resulted in minor textual adjustments and one extra problem in the problem sheet. Most participants, who tested the medication diary for two months, found the diary user-friendly (80%) and easy to fill in (89%). About 40% of participants reported problems with medication use. Half of the patients indicated that the diary can facilitate discussing problems with healthcare providers.
Conclusion
The medication diary offers patients the opportunity to report problems regarding their medication use in a proven user-friendly manner and to discuss these problems with healthcare providers. Reporting and discussing problems with medication use can serve as a first step towards making shared decisions on how to address the problems encountered.
... There was positive correlation between the admission rates and the prescription rates of their associated therapeutic classification for the following medications: T36 systematic antibiotics (BNF 5-Infections), T40 23 Also, this increase in hospital admission could be due to inappropriate medication, inappropriate number of doses or non-compliance with the medication, which might have resulted in undertreatment or overdosing. 24 Overdosing is common among several classes of drugs, such as injectable drugs, where it was found that many errors occurred during the administration of injectable drugs, especially in intensive care units. 25 Overdosing is also associated with drugs having narrow therapeutic windows, where the difference between the toxic dose and the therapeutic dose is small, and any small increase in the dose or interaction with another treatment may lead to harm. ...
... 27 Intentional or unintentional non-compliance with the prescribed medications results in a decrease in therapeutic efficacy, which causes complications in the patient's health in addition to the additional costs resulting from these complications Open access and treatment. 24 Howard et al reported that nitrates, loop diuretics, antiepileptics, corticosteroids and insulin are most closely associated with with-compliance errors because these drugs have to be taken regularly and their non-compliance may result in dangerous complications. 28 In this study, the most common three groups of medications that cause hospital admissions related to MEs were T39 (non-opioid analgesics, antipyretics and antirheumatics), T43 (psychotropic drugs, not elsewhere classified) and T42 (antiepileptic, sedative-hypnotic and antiparkinsonism drugs). ...
Objective
To explore the correlation between prescribing rate of medications and hospital admissions related to medications administration errors in England and Wales during the time from 1999 to 2020.
Design
An ecological study.
Setting
A population-based study using hospital admission data that are publicly available in the UK. Data in this study were extracted from the Hospital Episode Statistics database in England and the Patient Episode Database in Wales from Wales. The Prescription Cost Analysis database was used to extract the prescription data.
Participants
Patients who were hospitalised all National Health Service (NHS) trusts and any independent sector funded by NHS trusts.
Primary outcome measure
Hospitalisation rates related to medication administration errors and its associated prescriptions.
Results
The annual rate of hospital admissions related to medication administration errors increased by 32.0% (from 184.21 (95% CI 183.0 to 185.4) in 1999 to 243.18 (95% CI 241.9 to 244.4) in 2020 per 100 000 persons. The most common three indications of hospital admissions were T39 (non-opioid analgesics, antipyretics and antirheumatics), T43 (psychotropic drugs), T42 (antiepileptic, sedative-hypnotic and antiparkinsonism drugs). The age group 15–59 years had the highest number of hospital admissions (83.4%). Women contributed to 59.1% of the total number of hospital admissions. Admission rate among men increased by 16.7%. Among women, the admission rate increased by 44.6%.
Conclusion
Admission rates due to medication administration errors increased markedly in the past decade. This increase was correlated with an increase in the prescription rate of several therapeutic classes. Patients taking non-opioid analgesics, antipyretics and antirheumatics, psychiatric medications, antiepileptic, sedative-hypnotic and antiparkinsonism drugs should have their recommended (and administered) doses closely monitored. They should be followed up on a regular basis to ensure that they are taking their medications as prescribed.
... In addition, problems have been reported in organizing correct and timely intake of medication [14], opening medication packages [15][16][17][18][19][20] or storage of medicines [14,21,22]. The medication intake itself also proves problematic: taking an incorrect dose, taking the wrong medicine, forgetfulness or deliberately not taking medicines are common problems reported [6,23]. Patients' knowledge of side effects and interactions seems insufficient [8,12]. ...
... In the first phase of this study, we composed a list of twenty medication self-management problems. Previous research has shown that problems with medication self-management are various and not solely limited to medication intake [6,7,9,10,[12][13][14][15][17][18][19][21][22][23]25,42]. Therefore, within the project group, we made a conscious decision not to prioritize just a few problems, but to focus as broadly as possible on the entire process of medication selfmanagement. ...
Medication self-management problems such as the inability to correctly obtain, understand, organize, administer or monitor medication can result in negative patient outcomes. However, supportive tools for healthcare providers to assist patients with medication self-management problems are lacking. This study aimed to develop recommendations for healthcare providers to support patients with polypharmacy who experience medication self-management problems. A three-phase study was conducted starting with (1) the mapping of medication self-management problems, followed by (2) a scoping review providing a list of relevant interventions and actions for each respective problem and (3) a three-round modified e-Delphi study with experts to reach consensus on the relevance and
clarity of the recommended interventions and actions. The cut-off for consensus on the relevance and clarity of the recommendations was set at 80% expert agreement. Experts could propose additional recommendations based on their professional experience and expertise. The experts (n = 23) involved were healthcare professionals (i.e., nurses, pharmacists, and physicians) with specific expertise in medication management of patients with polypharmacy. Simultaneous with the second e-Delphi round, a panel of patients with polypharmacy (n = 8) evaluated the usefulness of recommendations. Results obtained from the patient panel were fed back to the panel of healthcare providers in the third e-Delphi round. Descriptive statistics were used for data analysis. Twenty medication selfmanagement problems were identified. Based on the scoping review, a list of 66 recommendations for healthcare providers to support patients with the identified medication self-management problems was composed. At the end of the three-round e-Delphi study, the expert panel reached consensus on the relevance and clarity of 67 recommendations, clustered according to the six phases of the medication self-management model by Bailey et al. In conclusion, this study resulted in a guidance document including recommendations that can serve as a resource for healthcare providers to support patients with polypharmacy in case of medication self-management problems. Future research should focus on the evaluation of the feasibility and user-friendliness of the guide with recommendations in clinical practice.
... 17,26,34,35 Possible strategies for improving ME in pediatric outpatients with chronic diseases at home involve eHealth technologies or digital interventions designed to improve accessibility, quality, and effectiveness of health care, also during the current COVID-19 lockdown. [36][37][38][39][40][41][42] Knowing whether a tailored eHealth supporting all medication management phases would allow parents of children and adolescents with chronic diseases to record ME at home might help health care professionals monitor and limit out-ofhospital ME incidence rates. ...
... Although our cohort shows a high percentage of enteral drugs prescribed (93.3%) compared with literature, ME in antihypertensive and diuretic drugs are astonishingly three times higher than published levels. 11,40,52 Compared with the current researchers' interests on other drugs involved in MEs at home (antibiotics, inhaled steroids, topical antifungal medications, antihistamines, and inhaled bronchodilators), 2,15 our novel important finding on MEs in antihypertensives and diuretics emphasizes how crucial it is to monitor these drug doses and dilutions in children with chronic diseases and high severity ranking. 44 Our app findings could show parents how to adapt drug dilution to the continuously changing weights and body surfaces in growing children. ...
Introduction: Whereas ample information describes medication errors (MEs) in children or in mixed pediatric and adult populations discharged with acute or chronic diseases from hospital to community settings, little is known about MEs in children and adolescents with chronic diseases discharged home, a major concern. To promote home medication safety, we trained parents of children discharged with chronic diseases to record ME with a tailored cell-phone eHealth app. Methods: In a 1-year prospective study, we used the app to monitor ME in patients with chronic diseases discharged home from a tertiary hospital in Rome, Italy. Univariate and multivariate analyses detected the ME incidence rate ratio (IRR). Results: Of the 310 parents enrolled, 194 used the app. The 41 MEs involved all drug management phases. The ME IRR was 0.46 errors per child. Children <1 year had the highest ME risk (1.69 vs. 0.35, p = 0.002). Children discharged from the cardiology unit had a statistically higher ME IRR than others (3.66, 95% confidence interval: 1.01-13.23%). Conclusions: The highest ME risk at home involves children with chronic diseases <1 year old. A significant ME IRR at home concerns children with heart diseases of any age. Parents find a tailored eHealth app for monitoring and reporting ME at home easy to use. At discharge, clinical teams need to identify age-related and disease-residual risks to target additional actions for monitoring ME, thus increasing medication safety at home.
... Patient-initiated errors while taking prescription medications is an important safety concern since they might lead to several adverse drug events and almost half of the patients in primary care had one or more dosing errors [1]. Advanced age, limited health literacy, and low education were the main factors related to misunderstanding of medication instructions and labels [2][3][4]. For patients having low health literacy, even instructions that are brief and relatively simple might be challenging and lead to several misunderstandings [4]. ...
Background
The Medication Literacy Scale for Adults (MELSA) version I was previously developed among adults with high educational levels. However, the validity of the tool for the general populations was not established.
Objective
The aim of the study was to develop and evaluate the psychometric properties of the MELSA version II among community-dwelling Turkish adults with both low and high education levels.
Methods
After the item development and content and face validity testing, test-retest reliability, explanatory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency, item response theory approach (Rasch analysis), and hypothesis testing were carried out.
Results
The interclass correlation coefficient (agreement) was 0.753 between the test and the two weeks retest. Kuder Richardson-20 was 0.89 with a unidimensional structure, according to EFA, CFA, and Rasch analysis. Rasch analysis indicated the person reliability of the 9-item MELSA version II as 0.74. Participants with a high education level and a high level of self-reported reading ability for health-related information had a higher score on MELSA version II (p < 0.05).
Conclusion
The 9-item MELSA version II is a web-based scale that is brief, valid, and easy to administer in person using an mobile device. It could be used in different countries and populations after conducting appropriate translation and cultural adaptation.
... Data indicate that patients, especially the elderly, often do not pay attention to the storage conditions of medications and store them contrary to the manufacturer's recommendations [7,8]. Thus, medicines can be temporarily stored in some places of the house where elevated temperatures or long-term exposure to solar radiation are possible. ...
Type 2 diabetes is a serious health problem worldwide. Metformin as the first-line drug in diabetes treatment mainly inhibits glucose production in the liver. Diabetes is often accompanied by other diseases, so patients may take many medications at the same time and have trouble controlling the therapy. This, in turn, may result in medications being stored in different, sometimes random places in the patient’s home where elevated temperatures or long-term exposure to solar radiation are possible. In this study, we aimed to analyze whether the total hemispherical reflectance and emittance values of metformin extended-release tablets would distinguish tablets stored correctly from those stored inconsistently with the manufacturer’s recommendations. Unexpired and expired extended-release tablets containing 750 mg metformin were tested. Unexpired tablets were analyzed in two ways i.e., 15 randomly selected tablets were stored as recommended (day 0), and the 15 next tablets in the blister were stored on a windowsill, where they were exposed to daylight for several hours during the day in mid-spring 2024 for 20 days (day 20). Total hemispherical reflectance (THR) was measured within seven spectral ranges from 335 nm to 2500 nm with a 410-Solar Reflectometer while emittance was analyzed within six spectral infrared ranges from 1500 nm to 21 microns with an ET 100 emissometer. The day 0 tablets showed the highest THR values in five spectral ranges from 400 to 1700 nm compared to expired and day 20 tablets. In the further infrared ranges, from 1.5 to 21 microns, unexpired tablets on day 0 had the lowest reflectance compared to day 20 tablets and expired tablets. This means that a greater amount of IR beam was absorbed by this type of tablet. Therefore, higher emittance was demonstrated by day 0 tablets than by other analyzed tablets. In addition, the emittance values for day 0 tablets decreased with increasing temperature. In conclusion, the storage of metformin extended-release tablets under unfavorable conditions may affect the physical structure of this drug form, which is manifested by changes in the reflectance and directional and hemispherical thermal emittance.
... Individual measures (e.g. improving patient health literacy [13,14]) as well as structural interventions (e.g. medication reviews (MR) in inpatient [15,16] or outpatient [17,18] settings) to improve this situation have been identified [19]. ...
Background
Number of drugs are increasing with older age and present a risk factor for various adverse health outcomes. A comprehensive medication therapy management (MTM) before admission for elective surgery may help reduce unnecessary and potentially inadequate medications (PIM) and thus improve patient health. Our goal was to evaluate the implementation of PHAROS, a perioperative MTM intervention study, from the perspective of health care providers. The PHAROS intervention aimed to improve medication appropriateness in older inpatients at the outpatient / inpatient interface.
Methods
We performed a qualitative interview study within a pilot intervention study comparing a comprehensive MTM with standard care in older inpatients (≥ 65 years) in Germany. Semi-structured interviews with health care professionals were performed from March to July 2021. The Consolidated Framework for Implementation Research (CFIR) was used to guide development of interview guide, data coding, analysis, and reporting of findings.
Results
Ten health care professionals involved in the implementation of PHAROS were interviewed. Based on CFIR-constructs, facilitators included need for and meaningfulness of the intervention as well as positive and supportive cooperation within the project team. Implementation of MTM at the interface of inpatient to outpatient care before elective surgery was hampered by personal and organizational barriers as well as barriers resulting from broader health care structures in Germany. In particular, lack of documentation standards, missing compatibility with clinical workflow, difficulties in stakeholder engagement, as well as communication barriers between outpatient and inpatient care interfaces hindered implementation of the intervention.
Conclusions
Further studies should consider focusing on facilitators to pharmaceutical implementations such as transparent and clear communication structures between stakeholders, standardization of medication documentation, and intervention structures that are adapted to hospital workflows.
Trial registration
https://drks.de Identifier: DRKS00014621, this study was part of the PHAROS study.
... Medication errors may occur in both inpatient and outpatient settings [13] and in different patient population [14]. Various individuals, including any healthcare personnel, may be responsible for medication errors, including doctors, pharmacists, the patients themselves, their caregivers, or their families [15][16][17]. The prevalence of medication errors among various personnel varies between studies [18][19][20][21], and while healthcare providers and patients are encouraged to report all medication errors encountered to the Food and Drug Administration (FDA) [22], medication errors remain underreported [23,24]. ...
Background
Medication errors are preventable incidents resulting from improper use of drugs that may cause harm to patients. They thus endanger patient safety and offer a challenge to the efficiency and efficacy of the healthcare system. Both healthcare professionals and patients may commit medication errors.
Methods and objectives
A cross-sectional, observational study was designed using a self-developed, self-administered online questionnaire. A sample was collected using convenience sampling followed by snowball sampling. Adult participants from the general population were recruited regardless of age, gender, area of residence, medical history, or educational background in order to explore their practice, experience, knowledge, and fear of medication error, and their understanding of this drug-related problem.
Results
Of the 764 participants who agreed to complete the questionnaire, 511 (66.9%) were females and 295 (38.6%) had a medical background. One-fifth of participants had experienced medication errors, with 37.7% of this segment reporting these medication errors. More than half of all medication errors (84, 57.5%) were minor and thus did not require any intervention. The average anxiety score for all attributes was 21.2 (The highest possible mean was 36, and the lowest possible was 0). The highest level of anxiety was seen regarding the risk of experiencing drug-drug interactions and the lowest levels were around drug costs and shortages. Being female, having no medical background, and having experience with medication errors were the main predictors of high anxiety scores. Most participants (between 67% and 92%) were able to recognise medication errors committed by doctors or pharmacists. However, only 21.2 to 27.5% of participants could recognise medication errors committed by patients. Having a medical background was the strongest predictor of knowledge in this study (P < 0.001).
Conclusion
The study revealed that the prevalence of self-reported medication errors was significantly high in Jordan, some of which resulted in serious outcomes such as lasting impairment, though most were minor. Raising awareness about medication errors and implementing preventive measures is thus critical, and further collaboration between healthcare providers and policymakers is essential to educate patients and establish effective safety protocols.
... In the recent national census of 2020, individuals aged 65 and above accounted for 13.5% of the total population, surpassing the UN's aging society benchmark of 7% [2]. This demographic shift places unprecedented pressure on the healthcare system, particularly concerning the safety of medication use among older adults [3,4]. As they age, older adults experience a decline in physical function and an increase in chronic diseases, necessitating the management of multiple medications [5][6][7]. ...
Background
The safety of medication use among older adults is a growing concern, given the aging population. Despite widespread attention, the exploration of medication literacy in older adults, particularly from the perspective of information literacy, is in its nascent stages.
Methods
This study utilized the existing literature to define medication information literacy (MIL) as a theoretical framework. A two‐round Delphi survey was conducted to identify the essential components of a MIL indicator system for older adults. The analytic hierarchy process (AHP) was then used to assign weights to each indicator.
Results
The study observed relatively high response rates in both rounds of the questionnaire, which, along with expert authority coefficients (Cr) of 0.86 and 0.89, underscores the credibility and expertise of the panellists. Additionally, Kendall's coefficient of concordance (Kendall's W) ranging from 0.157 to 0.33 (p < 0.05) indicates a consensus among experts on the identified indicators. Utilizing the Delphi process, a MIL indicator system for older adults was developed, comprising five primary and 23 secondary indicators. These indicators were weighted, with medication information cognition and acquisition emerging as pivotal factors in enhancing medication literacy among older adults.
Conclusions
This study developed a MIL indicator system tailored for older adults using the Delphi approach. The findings can inform healthcare professionals in providing customized medication guidance and assist policymakers in crafting policies to enhance medication safety among older adults.
Patient or Public Contribution
Patient and public engagement played a pivotal role in the development of our medication information literacy indicator system for older adults. Their involvement contributed to shaping research questions, facilitating study participation, and enriching evidence interpretation. Collaborations with experts in geriatric nursing, medicine, and public health, along with discussions with caregivers and individuals with lived experience, provided invaluable insights into medication management among older adults. Their input guided our research direction and ensured the relevance and comprehensiveness of our findings.
... Medication errors can happen in various settings involving doctors, paramedical staff, patients, and their relatives. While clinicians are usually held responsible for these errors, many are beyond their control [1] . Changing a culture of not reporting errors remains difficult, yet it is essential to report them to ensure patient safety and advance medical knowledge. ...
Ayurveda offers various formulations for different ailments, including Jatyadi oil, a topical medicine commonly used for wounds and ulcers. While it’s local application is well-documented for conditions like sinuses, papules, dermatitis, wounds, ulcers, burns, and abrasions, its oral ingestion is not standard practice due to potential adverse effects. Objective: This report aims to highlight the consequences of inadvertent oral ingestion of Jatyadi oil by a patient. Methods: The case report is based on a real-life incident involving a patient who mistakenly ingested Jatyadi oil. The effects were studied by discussing the matter with the patient and reviewing relevant literature. Conclusion: While medications are meant to heal, incorrect usage can lead to harm. Although accidental oral intake of Jatyadi oil may not be overly concerning, it is crucial to avoid such occurrences. Patients should be properly instructed regarding the correct dose, route, and method of medication intake to prevent such incidents.
... However, there are several hurdles and limitations that may delay the progress in combating AMR at state level. Some of these include; the misuse of antibiotics as the patients are prescribed with wrong doses and incorrect route of administration (Mira et al., 2015). There aren't enough AMR awareness campaigns that specifically target the animal production industry, especially in low-and middle-income nations (Dankar et al., 2022). ...
... Subgroup analysis indicated a significant variance in medication errors prevalence between direct observation and chart review methods. Our figure is comparable to that reported by Thomas [27,53]. These results suggest a consistently high prevalence of medication errors in emergency departments across different regions and populations. ...
Medication errors significantly compromise patient safety in emergency departments. Although previous studies have investigated the prevalence of these errors in this setting, results have varied widely.
The aim was to report pooled data on the prevalence and severity of medication errors in emergency departments, as well as the proportion of patients affected by these errors.
Systematic searches were conducted in Embase, PubMed, and the Cochrane Library from database inception until June 2023. Studies provided numerical data on medication errors within emergency departments were eligible for inclusion. Random-effects meta-analysis was employed to pool the prevalence of medication errors, the proportion of patients experiencing these errors, and the error severity levels. Heterogeneity among studies was assessed using the I2 statistic and Cochran’s Q test.
Twenty-four studies met the inclusion criteria. The meta-analysis gave a pooled prevalence of medication errors in emergency departments of 22.6% (95% Confidence Interval [CI] 19.2–25.9%, I2 = 99.9%, p < 0.001). The estimated proportion of patients experiencing medication errors was 36.3% (95% CI 28.3–44.3%, I2 = 99.8%, p < 0.001). Of these errors, 42.6% (95% CI 5.0–80.1%) were potentially harmful but not life-threatening, while no-harm errors accounted for 57.3% (95% CI 14.1–100.0%).
The prevalence of medication errors, particularly those potentially harmful, underscores potential safety issues in emergency departments. It is imperative to develop and implement effective interventions aimed at reducing medication errors and enhancing patient safety in this setting.
... Every manufactured medicine, dietary supplement, or other preparation bought from a pharmacy is characterized by storage conditions specified by the manufacturer. However, data demonstrated that few patients read the leaflets accompanying the products or check the storage information carefully [4]. ...
This study aimed to assess the changes occurring during the storage of tablets of three effervescent preparations available in Polish pharmacies containing calcium and quercetin from various manufacturers under stressful conditions (45 °C, UV radiation) using a hyperspectral Specim IQ camera (Finland), X-ray microtomography (Germany), and selected pharmacopoeial parameters. All measurements were made three times at the beginning of the experiment (day 0) and then on days 3 and 10. In general, for all analyzed preparations, the values of reflectance (within a range from visible light to near-infrared) were significantly higher on day 0 than after 10 days of heat and UV (p < 0.001 each). The hardness of the tablets of all analysed preparations was higher on days 3 and 10 compared to day 0. Significant differences were found in the density of the internal structure of the tested preparations (p < 0.001), but in Preparations 1 and 2 on day 10, the density was higher compared to the initial density. In contrast, the porosity was lower on day 10 than on day 0 for Preparations 1 and 2, while in Preparation 3, it remained the same. In conclusion, lower reflectance values indicate that more light passes through/into the tablet, and the increase in density and decrease in porosity may indicate changes in the microstructure of the tablets.
... This property describes the length of time a drug product will retain its ability to exert its intended therapeutic effect and also ensures the safety of the drug's use during Sensors 2024, 24, 630 2 of 10 this period. Many patients store medications before use contrary to the manufacturers' recommendations [7]. In consequence, environmental conditions such as elevated temperature or UV radiation [8,9] may lead to the loss of original properties. ...
Environmental conditions can lead to changes in the physical and chemical structures of drug products. In this study, the stability of cefuroxime tablets stored under adverse conditions was evaluated based on total directional–hemispherical reflectance (THR). The THR value was measured before and after the tablets’ exposure to stress factors (temperature of 45 °C and UV radiation). Each measurement was performed three times within seven spectral bands at the beginning of the experiment (day 0), and then on days 1, 2, 3, 5, and 7. In addition, hyperspectral profiles (400–1030 nm) were analyzed on days 0 and 7. A significant decrease in THR values in all wavelength ranges was observed when day 7 vs. day 0 were compared, especially for spectral bands of 335–380 nm and 1700–2500 nm (Δ = 0.220, p < 0.001 and Δ = 0.171, p < 0.001, respectively). The hyperspectral analysis confirmed a decrease in the reflectance after the end of stress conditions in the visible light range (400–700 nm) compared to tablets before the experiment. This may indicate that more radiation entered the tablets. In conclusion, the THR of cefuroxime tablets decreases during the exposure to heat and UV radiation, which may result from some physicochemical changes that have occurred during storage.
... In addition, interventions to support self-management of medicines have overlooked the frail older population. 18,19 A minority of studies has examined occurrences of medicines safety issues in people's homes, 20 with some identifying polypharmacy and complexity of treatment as contributing factors in older adults. 21 Previous studies, informed by a resilient healthcare (Safety II) approach, 22 which highlights how variability plays an important contributory role in safety in complex systems, 23 offered insight into the medicines management experiences of patients at discharge from hospital. ...
Introduction
Many older people live with both multiple long‐term conditions and frailty; thus, they manage complex medicines regimens and are at heightened risk of the consequences of medicines errors. Research to enhance how people manage medicines has focused on adherence to regimens rather than on the wider skills necessary to safely manage medicines, and the older population living with frailty and managing multiple medicines at home has been under‐explored. This study, therefore, examines in depth how older people with mild to moderate frailty manage their polypharmacy regimens at home.
Methods
Between June 2021 and February 2022, 32 patients aged 65 years or older with mild or moderate frailty and taking five or more medicines were recruited from 10 medical practices in the North of England, United Kingdom, and the CARE 75+ research cohort. Semi‐structured interviews were conducted face to face, by telephone or online. The interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis.
Findings
Five themes were developed: (1) Managing many medicines is a skilled job I didn't apply for; (2) Medicines keep me going, but what happened to my life?; (3) Managing medicines in an unclear system; (4) Support with medicines that makes my work easier; and (5) My medicines are familiar to me—there is nothing else I need (or want) to know.
While navigating fragmented care, patients were expected to fit new medicines routines into their lives and keep on top of their medicines supply. Sometimes, they felt let down by a system that created new obstacles instead of supporting their complex daily work.
Conclusion
Frail older patients, who are at heightened risk of the impact of medicines errors, are expected to perform complex work to safely self‐manage multiple medicines at home. Such a workload needs to be acknowledged, and more needs to be done to prepare people in order to avoid harm from medicines.
Patient and Public Involvement
An older person managing multiple medicines at home was a core member of the research team. An advisory group of older patients and family members advised the study and was involved in the first stages of data analysis. This influenced how data were coded and themes shaped.
... Os pacientes que praticam a automedicação com erros são mais propensos a errarem novamente várias vezes, com grande parte das reações adversas sendo atribuídas a erros do próprio paciente, como utilização de doses incorretas, continuação ou descontinuação de uma medicação sem orientação médica e também desconhecimento de indicações e efeitos adversos de cada fármaco (Mira et al., 2015). Dentre os idosos, a maioria considera como seguros e eficazes os medicamentos isentos de prescrição, que também são os principais responsáveis por hospitalizações devido a intoxicação por automedicação. ...
O objetivo foi compreender a efetividade da atuação do farmacêutico na prevenção e redução do número de casos de intoxicação medicamentosa em idosos atribuída à automedicação. Seguindo as recomendações adaptadas da diretriz PRISMA, foi feita a busca nas bases de dados PubMed e MEDLINE, considerando como critérios de elegibilidade a disponibilidade do texto completo, idioma e ano de publicação, sendo incluídos apenas estudos publicados em português ou inglês, entre janeiro de 2013 e setembro de 2023. Evidenciamos que o farmacêutico é fundamental para reduzir o uso de medicamentos potencialmente inapropriados prescritos aos idosos, alertar sobre possíveis efeitos adversos, identificar idosos de risco para automedicação e manejar a polifarmácia da melhor forma possível. A facilidade do acesso a tais profissionais os torna fundamentais para o processo de educação em saúde, orientações sobre autocuidado, controle da automedicação, instruções de uso correto de medicações prescritas e identificação precoce de efeitos adversos para evitar o mascaramento de doenças graves. Apesar de bem estabelecido, o papel do farmacêutico na redução do número de casos de intoxicação por automedicação em idosos ainda não é exercido com a frequência esperada. Novas pesquisas devem identificar as principais barreiras para a atuação do farmacêutico na prevenção da automedicação irresponsável em idosos, determinar estratégias para identificação de idosos com maior risco e protocolos de intervenção. Somente assim, a intervenção farmacêutica será padronizada e poderá ser colocada em prática para reduzir os casos de intoxicação por automedicação em idosos.
... A cross-sectional study 10 focusing on elderly patients on polypharmacy (n = 265) revealed these patients' lack of understanding about necessary precautions and appropriate methods to store their medications. Furthermore, a review presented in 11 stated that the incidence of medication errors varied between 19% and 59%. Common errors included incorrect dosage, forgetting or mixing up medications, inability to recall indications, or usage of out-of-date or improperly stored drugs. ...
Background
Mobile applications have the potential to assist patients and caregivers in managing chronic diseases, but current offerings are typically limited to a single disease or only focused on patients. A multifaceted app could expand the user base and provide more comprehensive support for patients who usually suffer from diverse chronic conditions at the same time and their caregivers.
Objectives
This study aimed to design, develop, and evaluate a mobile application that could aid chronic patients and their caregivers in managing the range of chronic conditions.
Methods
Focus group meetings were conducted with patients and caregivers to identify their needs, which were translated into app functionalities. The final version of the app was evaluated through a survey and analysis of the most used features.
Results
Five focus group (FG) meetings were held, involving 39 patients and 22 caregivers. The app included medication aids, self-monitoring aids, activation reminders, messages for caregiver shifts, remote monitoring, medicine management, and informative videos. Testing by 65 patients revealed that medication reminders (96.8% positive responses), medicine information (96.8%), messages for caregiver shifts (90.3%), and ease of use (80.6%) were the most valued aspects. The most frequently used feature was the health data record check.
Conclusions
A multifaceted mobile application can address the needs of a variety of chronic patients and their caregivers, while still being easy to use. The app's most used functionalities were aligned with the needs expressed in the FG, which reflects the success of this study and suggests that future research could benefit from incorporating similar user-centered design methodologies.
... Our findings represent the epidemiology, clinical effects, and consequences of MEs in all regions of Thailand. MEs are reported in both hospital settings [5,7,9,12] and domestic settings, as well as in outpatient healthcare facilities [10,11,36]. In this study, we focused on MEs occurring among adult patients only in healthcare facilities and that were caused by medical personnel. ...
Medication errors (MEs) are a global health problem. We conducted this study to clarify the clinical characteristics, outcomes, and factors associated with MEs that caused harm to adult patients (>15 years of age) who were managed in hospitals or healthcare facilities. We performed a 10-year retrospective study (2011–2020) by analyzing data from the Ramathibodi Poison Center (RPC) database (RPC Toxic Exposure Surveillance System). There were a total of 112 patients included in this study. Most were women (59.8%) and had underlying diseases (53.6%). The mean patient age was 50.5 years. Most MEs occurred during the afternoon shift (51.8%) and in the outpatient department (65.2%). The most common type of ME was a dose error (40.2%). Local anesthetic was the most common class of ME-related drug. Five patients died due to MEs. We analyzed the factors associated with MEs that caused patient harm, including death (categories E–I). The presence of underlying diseases was the single factor that was statistically significantly different between groups. Clinical characteristics showed no significant difference between patients aged 15–65 years and those aged >65 years. In conclusion, our findings emphasized that MEs can cause harm and even death in some adult patients. Local anesthetics were the most commonly involved in MEs. Having an underlying disease might contribute to severe consequences from MEs. Preventive measures and safety systems must be highlighted and applied to prevent or minimize the occurrence of MEs.
... The patients and relatives do not report significant problems in remembering to take their medication except when routines are interrupted or they are preoccupied, which is similar to other studies that reported that age itself is not a predictor of non-adherence [47]. However, forgetting to take medication is common [48]. Some of the participating patients reported using an alarm on the phone to remember to take their medications if preoccupied or interrupted. ...
Background
On average, older patients use five or more medications daily. A consequence is an increased risk of adverse drug reactions, interactions, or medication errors. Therefore, it is important to understand the challenges experienced by the patients, relatives, and healthcare professionals pertinent to the concomitant use of many drugs.
Methods
We conducted a qualitative study using focus group interviews to collect information from patients, relatives, and healthcare professionals regarding older patients’ management of prescribed medicine. We interviewed seven patients using five or more medications daily, three relatives, three general practitioners, nine nurses from different healthcare sectors, one home care assistant, two hospital physicians, and four pharmacists.
Results
The following themes were identified: (1) Unintentional non-adherence, (2) Intentional non-adherence, (3) Generic substitution, (4) Medication lists, (5) Timing and medication schedule, (6) Medication reviews and (7) Dose dispensing/pill organizers.
Conclusion
Medication is the subject of concern among patients and relatives. They become confused and insecure about information from different actors and the package leaflets. Therefore, patients often request a thorough medication review to provide an overview, knowledge of possible side effects and interactions, and a clarification of the medication’s timing. In addition, patients, relatives and nurses all request an indication of when medicine should be taken, including allowable deviations from this timing. Therefore, prescribing physicians should prioritize communicating information regarding these matters when prescribing.
... This approach is justified because inappropriately planned, implemented, and self-managed medications may negatively impact their health and functional ability. 12,13 Despite this situation, factors contributing to medication-related risks are not routinely included in the comprehensive health screenings even though age-specific medication risk assessment tools exist that can be self-administered by older adults. 14 This cross-sectional study aimed to identify the preventive medication-related risk factors in home-dwelling older adults aged 75 years using a new Delfoi-validated self-assessment screening tool 15,16 (LOTTA Checklist) as part of a comprehensive health screening. ...
Background
Poor medication management may negatively impact the health and functional capacity of older adults. This cross‐sectional study aimed to identify medication‐related risk factors in home‐dwelling residents using a validated self‐assessment as part of comprehensive health screening.
Methods
The data were derived from comprehensive health screening (PORI75) for older adults of 75 years living in Western Finland in 2020 and 2021. One of 30 validated measures in health screening focused on identifying medication‐related risk factors (LOTTA Checklist). The Checklist items were divided into (1) systemic risk factors (10 items) and (2) potentially drug‐induced symptoms (10 items). Polypharmacy was categorized according to the number of used drugs: (1) no polypharmacy (<5 drugs), (2) polypharmacy (≥5 and <10), and (3) excessive polypharmacy (≥10). The linearity across these three polypharmacy groups was evaluated using the Cochran–Armitage test.
Results
Altogether, 1024 out of 1094 residents who participated in the health screening consented to this study (n = 569 in 2020 and n = 459 in 2021). The mean number of all drugs in use was 7.0 (range 0−26; SD 4.1), with 71% of the residents using >5 drugs, that is, having polypharmacy. Of the systemic risk factors most common was that the resident had more than one physician responsible for the treatment (48% of the residents), followed by missing drug list (43%), missing regular monitoring (35%), and unclear durations of the medication (35%). The most experienced potentially drug‐induced symptoms were self‐reported constipation (21%), urinating problems (20%), and unusual tiredness (17%). An increasing number of drugs in use, particularly excessive polypharmacy, was associated with various medication‐related risk factors.
Conclusion
As a part of comprehensive health screening the LOTTA Checklist provides useful information to prevent medication‐related risk factors in home‐dwelling older adults. The Checklist could be used to guide planning and implementing health services in the future.
... The most common were: incorrect dosage, forgetting, mixing up medications, failing to recall indications, and taking out-of-date or inappropriately stored drugs. 31 Therefore, it is necessary to explain self-medication, including the correct use of drugs, possible side effects of these drugs, the allowed duration use of drugs, and the importance of referring to health workers if there is no improvement. Moreover, pharmaceutical care has become the central concept of pharmaceutical services in the community, in which the pharmacists are directly responsible to patients to improve the quality of services or patient-oriented services. ...
Background:
It has been reported that children are already practicing self-medication. Indeed, at the children's age, they are not allowed to self-medicate due to limited knowledge regarding self-medication, leading to inappropriate drug therapy or self-toxicity becoming problems in public health.
Objective:
This study aimed to determine how school-age adolescents carry out self-medication behavior.
Methods:
The study was designed as a cross-sectional in which data were collected using questionnaire methods. There were 195 students recruited in this study, consisting of SDN Keputih-245 Elementary School students, SMPN 19 Surabaya Junior High School, and SMAN 11 Surabaya Senior High School.
Results:
The results showed that most of the students had purchased medicine independently without a doctor's prescription. The primary source of information regarding self-medication by school students is family. Although most of the respondents stated they always inform their parents or doctors, it has been found that the practice of self-medication by school-age teenagers without informing their parents or doctors exists. Moreover, less than 50% of student respondents believe that self-medication is safe.
Conclusion:
The role of pharmacists is urgently needed to provide proper education related to drug information and self-medication to increase school-age students' knowledge.
... Self-medication, on the one hand, is seen as a large component of self-care, which relies heavily on the consumer's expertise when it comes to medication use; on the other hand, though, if not practiced rationally, it can lead to multiple problems, including drug abuse and resistance 13 . A recent systematic review reported the frequency of patient medication errors to be between 19% and 59%, with the most common ones being incorrect dosage, forgetting, mixing up medications, failing to recall indications, and taking outof-date or inappropriately stored drugs 14 . Arguments have been presented, though, in favor of rational self-medication practices. ...
Objectives: To assess the frequency of self-medication and its associated factors among outpatients. Methods: A cross-sectional study was conducted at the outpatient department of Fatima Hospital, Baqai Medical University, from May 2019 to September 2019. After checking eligibility, a total of 360 outpatients were included in the study using the convenience sampling technique. Being aged 18 years or above and belonging to either gender were the study's inclusion criteria, whereas refusal to give verbal informed consent was the exclusion criterion of the study. The data was collected by interviewing the study participants using a structured questionnaire. Statistical package for social sciences version 21 was used for data analysis, while inferential analysis was performed using univariate and multivariable binary logistic regression. Results: The study results showed that 118 (32.8%) of the participants were suffering from a chronic illness, 240 (66.7%) of them kept medicines at their houses, 235 (65.3%) of them self-medicated, whereas the mean duration of their self-medication was found to be 9.90 ± 8.51 years. Moreover, age, educational status, employment status, and keeping medicines at the house were significantly associated with self-medication of the participants were those who were aged 50 years or above (AOR,7.83; 95% CI,2.27-27.04; p=0.001), able to read and write (AOR, 4.36; 95% CI, 1.58-11.98; p=0.004) and kept medicines at the house (AOR, 46.35; 95% CI, 20.07-107.06; p<0.001) had significantly higher odds of self-medication than those who were aged up to 30 years, were illiterate or did not keep medicines at house respectively whereas those who were employed/self-employed (AOR, 0.30; 95% CI, 0.10-0.88; p=0.028) had significantly lower odds of self- medication than those who were unemployed. Conclusion: Almost two-thirds of the participants were found to be self-medicating. Moreover, age, educational status, employment status, and keeping medicines at the house were significantly associated with the self-medication of the respondents.
... Likewise, perceptual knowledge can shape decision-making patterns about drugs and illnesses suffered by patients. 58,59 There were 3 factors that can influence the formation of a person's perception, including: targets and perceptions, the individual concerned, and the situation. The target of perception can be a person, object or event. ...
Pedicab drivers who are exposed to pollution and have a smoking habit are at high risk of developing COPD (chronic obstructive pulmonary disease). The initial disturbance that occurs is a decrease in lung function which often causes complaints of cough symptoms. A person's knowledge and perception can influence how the pattern of self-medicating cough treatment so far. The purpose of this study was to determine the knowledge and perception of Self-medication of cough medicine. The research design was cross-sectional. The material of this research was in the form of information from subjects using direct questions and answers (interviews) with knowledge and perceptions of self-medicating cough medicine questionnaire. This research was conducted from September to December 2018 and used descriptive data analysis. The respondents involved were 163 peoples. Most respondents had a low level of knowledge of self-medication of cough medicine (97 of 163). The results of perception of self-medication of cough medicine indicated that most respondents had negative level (78 of 163). There was a relationship between knowledge and perception about self-medication of cough medicine (p=0.006). The proper health education strategy by increasing knowledge can also improve perceptions of self-medicine of cough medicine.
... Furthermore, a study by Qiao et al showed that social support is positively associated with ML in patients. 18 In other words, family caregivers are unable to provide comprehensive medication information and emotional support, which will lead to medication errors or adverse emotions in patients 31 and may increase the risk of cardiovascular adverse events, such as rehospitalization and death, thus increasing the burden on family caregivers. 32 Therefore, this study proposes that ML may play a mediating role between family caregiver burden and medication adherence in patients after MVR. ...
Background
Oral anticoagulant is a necessary long-term treatment after mechanical valve replacement (MVR), and medication adherence has a great impact on patients with MVR. Although family caregiver burden is negatively correlated with medication adherence, little is known about the underlying mechanism.
Purpose
To test whether family caregiver burden influences medication adherence through post-traumatic growth or medication literacy in patients with MVR.
Patients and Methods
A total of 206 patients after MVR were included in this cross-sectional study from July 2021 to December 2021. Data regarding medication adherence, family caregiver burden, post-traumatic growth, and medication literacy were collected by questionnaires. Data were analyzed through SPSS, and pathway analysis was conducted by using AMOS, based on the bootstrapping method.
Results
Post-traumatic growth was positively associated with medication adherence (r = 0.284, P < 0.05). Post-traumatic growth independently mediated the association of family caregiver burden on medication adherence [β = 0.32, 95% confidence intervals: (−0.016, −0.008)]. The mediated effect value for post-traumatic growth was 0.07, accounting for 24.14% of the total effect. The model’s fit indices were adequate.
Conclusion
The mediating effect of post-traumatic growth between family caregiver burden and medication adherence existed in patients with MVR. Interventions considering post-traumatic growth may be useful to increase medication adherence and improve patient rehabilitation.
... In addition to these, DRPs have been shown to negatively influence quality of life (QoL). A worse QoL was significantly associated with the occurrence of errors (mainly in the dose), where Patient's medication errors occurs between 19% and 59%, noting that elderly patients makes more errors than others, especially with the dosage [14,15]. ...
Objective: Diabetic patients usually have co-morbidities requiring the use of multiple medications, making them more vulnerable in experiencing drug related problems (DRPs) that may affect their quality of life (QOL). The objective of this study was to asses DRP in type 2 diabetes (T2D) patients and factors associated with its occurrence and the DRPs that affect QoL. Methods: A cross-sectional study was conducted among T2D patients who were attending a tertiary care teaching hospital, Lebanon. The identification and assessment of DRPs were based on the Pharmaceutical Care Network Europe tool version 8.03. The QoL was assessed using Health Related Quality of Life Brief Clinical Inventory. Results: The total number of DRP was 313 with a mean of 2.05 ± 1.03 per patient. The most common DRPs encountered were adverse drug event (31.3%), untreated symptoms or indication ( 10.54%), effect of drug treatment not optimal (7.34%) and high drug dose (7.34%). Logistic regression showed that polypharmacy and several comorbidities such as stroke, dyslipidemia, heart failure, coronary artery disease, renal and liver impairment were common factors significantly associated with different types of DRPs (p<0.005). The risk of having problems” No effect of drug treatment”,” Effect of drug treatment not optimal” and “Adverse drug event (possibly) occurring” was significantly increased in patients with abnormal HbA1c. The use of sulfonylurea increases the risk of ” Inappropriate duplication of therapeutic group” (p= 0.047). Following a low sugar diet showed to decrease the probability of having problem” Patient uses/takes more drug than prescribed” by 99.99%. On the other hand, insulin administration showed to increase 7.63 times this probability (p=0.006). The average HRQoL was 40 ± 9.900. Linear regression showed that problems “Untreated indication and “Patient uses unnecessary drug” were associated with poor QoL score. Having a medical insurance was found to be associated with better HRQoL scores. Conclusion: Early identification of DRPs and factors associated with them are essential to pre- vent and resolve them in diabetic patients by engaging clinical pharmacist, which may ultimately improve patient’s QoL
... A cohort study has shown that the prevalence of potentially harmful medication errors in children was 3 times higher than that in adults (Kaushal et al., 2008). A systematic review has also shown that the prevalence of medication errors was higher in children (53-67%) than in adults (12-59%) (Mira et al., 2015). Studies from Lebanon, Israel, and Australia have shown that pediatric hospital admissions due to DRPs represented 7.9-17.7% ...
Introduction: Drug-related problems (DRPs) refer to events or circumstances involving drug therapy that actually or potentially interfere with desired health outcomes. DRPs might be severe for children with chronic diseases managed at primary health care institutions, but the relevant research is scarce.
Objective: In this cross-sectional study, we aimed to explore the prevalence, types, causes, and influencing factors of DRPs in children with chronic diseases in a Chinese primary health care institution.
Methods: We recruited children with chronic diseases who visited the pediatric outpatient department in a primary health care institution from July 1 to 12 October 2021. Clinical pharmacists identified DRPs through medication therapy reviews, classified the types and causes of DRPs, and distinguished the manifested DRPs that affected the outcome and potential DRPs that were going to affect the outcome.
Results: A total of 188 children with chronic diseases was included, and 584 DRPs were identified in 89.89% of participants. The most common type of DRPs was “treatment effectiveness” (a manifested problem or potential problem with the effect of the pharmacotherapy; 83.56%), of which 67.29% were potential DRPs. The second common type was “treatment safety” (patient suffers or could suffer from an adverse drug event; 14.21%), of which 89.16% were potential DRPs. The most common cause of DRPs was related to the process of use (42.24%), such as “patient uses/takes less drug than prescribed or does not take the drug at all,” “patient stores drug inappropriately,” and “patient administers/uses the drug in a wrong way.” The second common cause was related to the process of dispensing (29.83%), such as “necessary information not provided or incorrect advice provided” and “prescribed drug is not available.” The third common cause was related to the process of prescribing (26.21%), such as “drug dose is too low” and “no or incomplete drug treatment despite an existing indication.” The number of combined medications was an influencing factor for the frequency of DRPs (p < 0.05).
Conclusion: This cross-sectional study showed that the current situation regarding DRPs among children with chronic diseases managed in the primary health care institution was serious. The types of DRPs were mainly related to treatment effectiveness, and improper usage of medications was one of the main causes of DRPs. The number of combined drugs was the influencing factor for the frequency of DRPs. In the future, pharmacists should consider formulating pharmaceutical intervention strategies for this specific group according to the characteristics of DRPs.
... However, arbitrary use of medicaments can have several risks and side effects, including poisoning, misdiagnosis, medication error (ME) (15), adverse drug reactions (16), endorse drug . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. ...
Background
Human health is largely affected by self-medication in both ways, adversely and favorably, as evidenced by the COVID-19 pandemic. The fear of spreading COVID-19 among health workers and hospital environments has led many Bangladeshi people to practice self-medicate for as a preventive strategy against this disease. Consequently, this practice entails an improper and injudicious use of medicine to cure self-recognized symptoms. To date, the COVID-19 has no effective treatment. The lack of a cure for COVID-19 and the continual progression of the diseases in educational settings induce a substantial population to practice self-medication. Therefore a study of self-medication practices is necessary for the framework of the pandemic. This study aimed to estimate the prevalence and factors associated with self-medication to prevent or manage future COVID-19 infections among recovered COVID-19 patients.
Methods
This cross-sectional study was conducted from September 2020 to February 2021 using an e-survey along with 360 participants. Data were collected using a pre-tested self-reported questionnaire. Descriptive statistics and correlations analysis were performed in the study.
Results
Among 360 participants, males were 69.7%, and females 30.3%. The prevalence of self-medication is 11%, and monthly family income, residence, education, occupation, and previous history of SM are the associated factors. Among the participants, 29.7% use antibiotics, and 30% use herbal products or drugs as medication.
Conclusion
The present study found SMP is moderately prevalent among COVID-19 recovered patients. To minimize the rate of SMP, adequate health care access systems and public education should be introduced, and media & community should be engaged in rational use of medication.
Background
Age, polypharmacy and comorbidity are examples of known factors that increase the risk of adverse drug reactions in patients. The use of high‐risk medication also entails a heightened risk of harm. There is currently no information available on the home care patients' experiences and medication burden experienced due to their high‐risk medication use and how they manage their medication. Further investigation with regard to this combination is necessary. The patient's experiences and medication burden related to high‐risk medication use can be taken into account when drawing up guidelines and standards of care for healthcare professionals.
Objectives
To describe home care patients' experiences and medication burden related to high‐risk medication use, more specifically how patients manage their high‐risk medication use, which professional support they receive and which potential adverse drug reactions they experience.
Design
A cross‐sectional study of home care patients in Belgium, aged 65 years and older who took at least one high‐risk medication.
Results
In our population of 106 home care patients, a median use of 8 medications per patient is reported, of which 2 can be considered high‐risk medication. Metformin, insulin and lormetazepam are the most frequently used high‐risk medications. Home care patients believe their medication is important to them, are able to manage the intake and seem to have a high level of therapy adherence. Most patients do not believe their medication intake implies a certain risk. Most patients are supported by a home care nurse for the preparation of their medication. A mean number of 5 symptoms/potential adverse drug reactions is reported out of the 21 potential adverse drug reactions questioned. The potential adverse drug reaction most frequently attributed to medication use was bleeding.
Conclusions
Practice guidelines with detailed medicine‐specific protocols are needed to enhance (high‐risk) medication‐related care in an overall high‐risk medication policy. Understanding the patient's risk experiences and communicating with the patient is important to ensure safe medication care but also to identify patients at risk for nonadherence and adverse reactions. The patient's experiences with their medication intake provide rich information for healthcare providers and should therefore be included in patient observations. Home care nurses should closely follow up on the home care patient's medication therapy with respect for the patient's autonomy.
This study aimed to examine the relationship between medication literacy and the degree to which patients are considered capable of medication self-management, the factors influencing the strength of this relationship and the factors influencing a patient’s capability for medication self-management. Between January and April 2022, a cross-sectional survey was conducted on hospitalised patients (65+) with polypharmacy. Medication literacy was evaluated using the MEDication Literacy Assessment of Geriatric patients and informal caregivers (MED-fLAG). The SelfMED assessment determined a patient’s capability for medication self-management. The relationship between MED-fLAG and SelfMED was explored with Pearson’s r. Moderation analysis was used to explore the factors influencing the strength of the relationship between both. Linear regression explored the factors influencing SelfMED scores. In total, 169 patients participated in the study. Patients considered themselves more capable of in-hospital medication self-management (8/10 rating) compared to nurses’ and physicians’ opinions (6/10 rating). Interactive medication literacy scored higher (mean = 3.0) than functional (mean = 2.9) and critical medication literacy (mean = 2.8). The more medication literacy skills, the more patients were considered able for medication self-management by healthcare providers (r = 0.630, p<0.001). Moderation analysis could not reveal any factors that significantly affected the strength of the relationship between both. Age, managing medication independently at home, the number of chronic conditions and medication literacy were significant predictors of a patient’s capability for in-hospital medication self-management. This study demonstrated a rather strong correlation between the results of the MED-fLAG and the SelfMED assessment. Hence, SelfMED can be used as a stand-alone first screening instrument to determine a patient’s capability for in-hospital medication self-management, without first assessing medication literacy. MED-fLAG can provide valuable insights into the medication literacy of patients considered less capable of managing their medication, allowing medication information and interventions to be tailored to the patient.
Objectives
To investigate the factors influencing medication errors made by informal caregivers while providing care at home.
Methods
A cross-sectional study based on an online survey, which included both structured and open-ended questions, was conducted in Spain. The survey comprised 49 questions to collect self-reported avoidable medication errors made by caregivers at home.
Results
A total of 685 caregivers participated in the survey, with 346 considered qualified (having received >20 h of training). On average, 13.5 (SD 38.2, 95% CI 10.5–16.5) errors per caregiver per year were self-reported. Errors were more prevalent among non-qualified caregivers, males, direct relatives of the care recipient, those with external occupations, or those who used external aids.
Conclusion
Errors made by informal caregivers occur more frequently than expected, and recognizing these errors remains a challenge. Training is essential for creating safer care environments by increasing awareness of error sources and the risks associated with medication. Recipients’ direct relatives should receive appropriate training, considering differences between male and female caregivers. Associations and companies within the care economy sector should prioritize the creation of safer home care environments as a key objective.
Introduction: An aging population presents significant challenges in pharmacotherapy oversight, with elderly individuals often lacking comprehensive information about their medical conditions. Case Report: This paper addresses medication errors in the elderly, highlighting a case study of a 68-year-old male who ingested Warfarin® instead of Famodin®, leading to a severe overdose. Conclusion: The incident underscores the risks of phonetic confusion in drug names and the necessity for robust safety protocols. Collaborative efforts among healthcare stakeholders are crucial to ensuring safe medication administration and reducing errors.
Background:
Medication errors are known to cause adverse drug reactions, hospital admissions and mortality. In most resource-poor settings, medication errors occur but are undocumented.
Objective:
This study sought to investigate medication errors in a diabetic clinic at Komfo Anokye Teaching Hospital (KATH), Ghana.
Methods:
The research combined both qualitative and quantitative data collection methods. The quantitative aspect involved retrospectively reviewing patient folders over two years (1st January 2019 to 31st December 2021). Patients' folders were reviewed to identify possible medication errors. The qualitative arm explored underlying factors and experiences related to medication errors through interviews with healthcare workers. Ten healthcare professionals at KATH were interviewed using an interview guide.
Results:
A total of 264 patients' folders were retrieved. The majority (23.11%) of the patients were between 18 and 25 y.o., and there were more females (52.27%) than males. About 60% of the patients had diabetes and hypertension comorbidity. The overall prevalence of medication errors was 18.18%. The most prevalent type of medication error identified was wrong drug formulation (n = 19, 39.58%). About 47.92% of the medication errors resulted in adverse events and this was predominantly caused by antidiabetic drugs (47.83%) and anti-hypertensive drugs (34.78%). Patients in the age category of 26-35 y.o. [aOR: 0.31, CI: 0.11-0.90] had reduced odds of medication errors whilst patients with comorbidity of diabetes and hypertension [aOR: 5.95, CI: 2.43-14.60] had an increased odds of medication errors. Large patient population, low staff numbers and inadequate knowledge of drugs by healthcare workers were factors that contributed to medication errors.
Conclusion:
Medication errors was moderately high in this diabetic clinic, and the errors led to a number of adverse events. Age, diabetes and hypertension comorbidity, large patient population, low staff numbers, and inadequate knowledge about drugs were identified as factors that influenced medication errors.
Background
Preventable harms from medications are significant threats to patient safety in community settings, especially among ambulatory older adults on multiple prescription medications. Patients may partner with primary care professionals by taking on active roles in decisions, learning the basics of medication self-management, and working with community resources.
Objective
This study aims to assess the impact of a set of patient partnership tools that redesign primary care encounters to encourage and empower patients to make more effective use of those encounters to improve medication safety.
Methods
The study is a nonrandomized, cross-sectional stepped wedge cluster-controlled trial with 1 private family medicine clinic and 2 public safety-net primary care clinics each composing their own cluster. There are 2 intervention sequences with 1 cluster per sequence and 1 control sequence with 1 cluster. Cross-sectional surveys will be taken immediately at the conclusion of visits to the clinics during 6 time periods of 6 weeks each, with a transition period of no data collection during intervention implementation. The number of visits to be surveyed will vary by period and cluster. We plan to recruit patients and professionals for surveys during 405 visits. In the experimental periods, visits will be conducted with two partnership tools and associated clinic process changes: (1) a 1-page visit preparation guide given to relevant patients by clinic staff before seeing the provider, with the intention to improve communication and shared decision-making, and (2) a library of short educational videos that clinic staff encourage patients to watch on medication safety. In the control periods, visits will be conducted with usual care. The primary outcome will be patients’ self-efficacy in medication use. The secondary outcomes are medication-related issues such as duplicate therapies identified by primary care providers and assessment of collaborative work during visits.
Results
The study was funded in September 2019. Data collection started in April 2023 and ended in December 2023. Data was collected for 405 primary care encounters during that period. As of February 15, 2024, initial descriptive statistics were calculated. Full data analysis is expected to be completed and published in the summer of 2024.
Conclusions
This study will assess the impact of patient partnership tools and associated process changes in primary care on medication use self-efficacy and medication-related issues. The study is powered to identify types of patients who may benefit most from patient engagement tools in primary care visits.
Trial Registration
ClinicalTrials.gov NCT05880368; https://clinicaltrials.gov/study/NCT05880368
International Registered Report Identifier (IRRID)
DERR1-10.2196/57878
Purpose
To test the use of Ring-IT, a novel 3D tactile bottle neck adaptor in topical eye drop adherence in visually impaired patients.
Methods
Bottle neck ring adaptors with either one, two or three protrusions with cube or sphere endings were designed. In phase 1, low vision was simulated in healthy subjects (n=20) with a 20/200 vision simulator; while in phase 2, visually impaired patients (n=26; 20/70 or worse) were recruited. Subjects were randomised to six combinations of varying protrusions and shapes on medication bottles and asked to identify these traits at different presentations. Responses and time to identify were recorded.
Results
Phase 1: 98.3% of subjects correctly identified the number of protrusions. Mean time to identify was 4.5±6.1 s. Identification success for cube and sphere end pieces were 91.7% and 73.3%, with average time for identification of 9.9±7.6 and 10.9±9.0 s. In phase 2, 92.3% of subjects correctly identified the number of protrusions. Mean time to identify was 6.0±3.0 s. Identification success for cube and sphere end pieces were 78.2% and 74.4%; with average time for identification of 7.5±4.8 and 8.5±5.6 s, respectively.
Conclusions
Ring-IT was identified with accuracy and speed by both low vision simulated subjects, and by patients with true limited visual capabilities. These tactile bottle neck ring adaptors can be used as an assistive low vision aid device and may increase eye drop regimen adherence in visually impaired patients.
For adequate pulmonary drug therapy, choosing the appropriate type of inhaler is just as important as selecting the right type of drug. This chapter on pulmonary drug delivery devices provides the background knowledge that is required for making a suitable inhaler choice and giving a proper instruction for its adequate use. Different types of inhalers may be available for the same type of drug and the prescriber has to ascertain that the requirements for correct operation match the cognitive, inspiratory and mechanical skills of the patient. To make a good choice and give the correct instructions for use, the instructor therefore has to know the working principle of various pulmonary drug delivery devices, understand the mechanisms that govern aerosol deposition in the respiratory tract, be able to interpret different aerosol characterisation definitions correctly and know how to operate selected devices best for an optimal therapy. This chapter aims to familiarize instructors with this complex matter.KeywordsPulmonary drug deliveryInhaler systemAerosolDrug depositionHuman respiratory tractAerodynamic diameterFine particle doseInhalation manoeuvre
Background:
Knowing the frequency and characteristics of adverse events is key to implementing actions that can prevent their occurrence. However, reporting systems are insufficient for this purpose and epidemiological studies are also required. Currently, the reviewing of clinical records is the gold standard method for knowing the frequency and characteristics of adverse events.Research on adverse events in primary care setting have been limited and primarily focuses on specific types of events (medication errors…) or patients. Large studies that search for any kind of adverse event in all patients are scarce.This study aimed to estimate the prevalence of adverse events in the primary care setting and their characteristics.
Methods:
Setting: all 262 primary healthcare centres in the Madrid region (Spain) during the last quarter of 2018.Design: cross-sectional descriptive study.Eligible population: subjects over 18 years of age who attended medical consultation over the last year (N=2,743,719). Randomised sample stratified by age.Main outcomes: age, sex, occurrence of an adverse event, number of consultations in the study period, avoidability, severity, place of occurrence, type of event, and contributory factors. The clinical records were reviewed by three teams, each composed of one doctor and one nurse trained and with expertise in patient safety.The SPSS software package (version 26) was used for the statistical analyses.
Results:
The evaluators reviewed 1,797 clinical records. The prevalence ofadverse events over the study period was 5.0%[confidence interval (CI) 95%:4.0%‒6.0%], with higher values in women (5.7%;CI95%:4.6%‒6.8%;P=0.10) and patients over 75 years of age (10.3%;CI95%:8.9%‒11.7%;P<0.001). The overall occurrence per hundred consultations was estimated to be 1.58% (CI95%:1.28%‒1.94%).Of the detected adverse events, 71.3%(CI95%:62.1%‒80.5%) were avoidable. Additionally, 60.6%(CI95%:50.7%‒70.5%) were categorised as mild, 31.9%(CI95%:22.4%‒41.4%) as moderate, and 7.4%(CI95%:2.1%‒12.7%) as severe. Primary care was the occurrence setting in 76.6%(CI95%:68.0%‒85.2%) of cases. The overall incidence of adverse events related to medication was 53.2%(CI95%:50.9%‒55.5%). The most frequent types of AE were prescription errors (28.7%;CI95%:19.5%‒37.9%), followed by drug administration errors by patients (17.0%;CI95%:9.4%‒24.6%), and clinical assessment errors (11.7%;CI95%:5.2%‒18.2%). The most common contributory factors were those related to the patient (80.6%;CI95%:71.1%‒90.1%) and tasks (59.7%;CI95%:48.0%‒71.4%).
Conclusion:
A high prevalence of adverse events (1 in 66 consultations) was observed, which was slightly higher than those reported in similar studies. About three out of four such events were considered to be avoidable and one out of 13 were severe. Prescription errors, drug administration errors by patients, and clinical assessment errors were the most frequent types of adverse events.
Background
Older people often experience medication management problems due to multimorbidity, polypharmacy and medication complexity. There is often a large gap between patients’ self-reported and actual abilities to handle the self-administration of their medication. Here we report on the development and evaluation of a new tool to assess the ability of non-demented hospitalized patients to self-administer medication in different dosage forms. To this end, we video-recorded the patients’ medication management performance and implemented a novel assessment scheme, which was applied by several independent raters.
Methods
Sixty-seven in-patients ≥70 years of age and regularly taking ≥5 different drugs autonomously of the ABLYMED study agreed to the video recording of their medication management performance with five different dosage forms. All raters underwent a training and applied a standardized assessment form and written guide with rating rules for evaluation. In a pilot phase, video recordings of three patients were rated by 19 raters (15 medical students, two expert raters to determine a reference standard, and two main raters who later rated the total sample). In the rating phase, based on the ratings obtained from the two main raters, we determined interrater (assessed every section of 20 patients as agreement between the raters at one point of time) and intrarater (assessed as consistency within each rater across three points of time) agreement by intraclass correlation analysis.
Results
In the pilot phase we obtained an overall sufficient agreement pattern, with an adjustment of the rating rules for patches. In the rating phase we achieved satisfactory agreement between the two raters (interrater reliability) and across different points of time (intrarater reliability). For two dosage forms (eye-drops and pen), rater training needed to be repeated to reach satisfactory levels.
Discussion
Our novel rating procedure was found to be objective, valid and reproducible, given appropriate training of the raters. Our findings are an important part of a larger research project to implement a novel assessment for the ability to self-administer medication in different dosage forms. Further, they can support the development of patient trainings to improve medication management and secure independent living.
Objectives
This study aimed to identify the knowledge structure of medication safety nursing education literature by developing schematic diagrams of the relationship between keywords from a macro perspective. This study also identifies the research topics and trends over time.
Design
This quantitative content study used text network analysis to explore keywords and research topics using topic modeling within the medication safety nursing education literature.
Data sources
PubMed, EMBASE, and Cochrane databases were used to search for the medication safety nursing education literature published until December 2021.
Methods
Keywords from 2085 articles were examined using text network analysis and topic modeling with NetMiner 4.4.3.
Results
The keywords with the most frequency and the highest networking degree in centrality were “patient,” “medication,” “program,” “nurse,” and “care.” The emerging keywords assessed by time periods were identified; the first phase (“heart failure,” “insulin,” “chemotherapy,” and “infusion”), the second phase (“medication errors,” “staff,” and “information”), the third phase (“program,” “management,” and “data”). The results of topic modeling were as follows: safe medication administration, safe medication reconciliation process, medication education for patients, medication errors in nursing practice, and multidisciplinary teamwork for medication safety.
Conclusion
These findings will help nursing researchers and educators to understand the trends and insights for medication safety education and educate future nurses to provide safer nursing care.
Les erreurs médicamenteuses représentent un défi mondial de santé publique lancé par l’Organisation Mondiale de la Santé en 2017. Ces erreurs peuvent survenir tout au long du processus médicamenteux mais le plus souvent au stade de l’administration, tant en milieu hospitalier que communautaire. Les erreurs médicamenteuses impliquent différents acteurs tels que les patients et les professionnels de santé, notamment le personnel infirmier. L’impact de ces erreurs est plus important pour les populations fragiles comme les enfants et les personnes âgées. En réponse à ce défi, il est important de quantifier les erreurs médicamenteuses et d’investiguer les sources d’hétérogénéité dans leurs taux, ainsi que d’identifier les déterminants de ces erreurs dans les populations à risque. En réalisant une revue systématique de la littérature et une méta-analyse, nous avons estimé la prévalence des erreurs d’administration chez les adultes hospitalisés, tout en explorant et maitrisant l’hétérogénéité. La prévalence moyenne d’au moins une erreur d’administration atteignait 26% avec maitrise d’hétérogénéité. La principale source d’hétérogénéité des taux poolés de cette méta-analyse était liée aux méthodes de calcul, spécifiquement le dénominateur. La standardisation de ces méthodes est donc une nécessité. La deuxième et la troisième études rétrospectives se basaient sur une analyse des déclarations des erreurs médicamenteuses au Guichet Français entre 2013 et 2017. Tout âge et dans milieux de soins confondus, les erreurs les plus fréquemment déclarées concernaient le stade d’administration. Au travers des analyses multivariées, nous avons identifié les déterminants des erreurs dans les populations pédiatrique et gériatrique par comparaison aux adultes. Dans les deux milieux hospitalier et communautaire, les antibactériens à usage systémique (Odds Ratio ajusté, ORa=2.54; Intervalle de Confiance 95%, IC95% : 1.57-4.11 et ORa=2.08 ; IC95% : 1.46-2.96, respectivement), et le type d’erreur de dose (ORa=2.51 ; IC95% : 1.71-3.68 et ORa=1.33 ; IC95% : 1.04-1.70, respectivement) étaient plus susceptibles d’être associés aux erreurs déclarées chez la population pédiatrique par comparaison aux adultes. D’autre part, dans ces deux milieux, les agents antithrombotiques (ORa=2.63 ; IC95% : 1.66-4.16 et ORa=4.46 ; IC95% : 2.70-7.37, respectivement) étaient plus susceptibles d’être associés aux erreurs médicamenteuses, ainsi qu’aux erreurs avec effet indésirable grave chez la population gériatrique par comparaison aux adultes. Les erreurs médicamenteuses représentent un risque majeur pour les patients et particulièrement les populations pédiatrique et gériatrique. Des stratégies de prévention ciblée sont nécessaires.
Abstract
BACKGROUND:Medication literacy encompasses the cognitive and social skills necessary for individuals to obtain, comprehend, communicate, calculate, and process medication-related information necessary to make informed decisions. Personal and contextual factors are widely recognized to influence the way that individuals acquire and maintain medication literacy skills. Despite a growing number of studies on medication literacy, current definitions remain general, lacking consideration for the specificities of older adults and hospitalization.
OBJECTIVE:The project was conducted to identify, compare, and summarize the attributes, antecedents, and consequences of medication literacy in hospitalized older adults and to propose a refined definition.
METHODS:A three-phase hybrid model of concept development was performed that included a literature review and focus groups with hospital nurses. In the final analytic phase, findings from the literature and focus groups were compared, and a refined definition of the concept was elaborated.
KEY RESULTS:From the synthesis of 24 publications and the narrative data of 14 hospital nurses, 19 themes were described: 4 related to attributes, 8 to antecedents, and 7 to consequences. Medication literacy of hospitalized older adults has been further defined as the degree to which older adults and/or their natural caregivers can develop and maintain multidimensional skills, namely functional, interactive, and critical medication literacy skills. Adjustment of these skills is characterized by a dynamic and potentially complex process. In practice, optimal medication literacy might be achieved through control of and involvement in the medication regimen and the decisions related to it, and/or by using practical means to facilitate medication self-management (e.g., using lists, notes, reminders).
CONCLUSIONS:The proposed refined definition might enhance professionals' common understanding of the concept and its application in practice, policy, and research. Managing a medication regimen is a complex activity that requires a high level of integration and coordination of cognitive and social skills
These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs.
Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site (www.ismp.org), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.
Objectives To synthesise contributing factors leading to medicine-related problems (MRPs) in adult patients with cardiovascular diseases and/or diabetes mellitus from their perspectives.
Design A systematic literature review of qualitative studies regarding the contributory factors leading to MRPs, medication errors and non-adherence, followed by a thematic synthesis of the studies.
Data sources We screened Pubmed, EMBASE, ISI Web of Knowledge, PsycInfo, International Pharmaceutical Abstract and PsycExtra for qualitative studies (interviews, focus groups and questionnaires of a qualitative nature).
Review methods Thematic synthesis was achieved by coding and developing themes from the findings of qualitative studies.
Results The synthesis yielded 21 studies that satisfied the inclusion and exclusion criteria. Three themes emerged that involved contributing factors to MRPs: patient-related factors including socioeconomic factors (beliefs, feeling victimised, history of the condition, lack of finance, lack of motivation and low self-esteem) and lifestyle factors (diet, lack of exercise/time to see the doctor, obesity, smoking and stress), medicine-related factors (belief in natural remedies, fear of medicine, lack of belief in medicines, lack of knowledge, non-adherence and polypharmacy) and condition-related factors (lack of knowledge/understanding, fear of condition and its complications, and lack of control).
Conclusions MRPs represent a major health threat, especially among adult patients with cardiovascular diseases and/or diabetes mellitus. The patients’ perspectives uncovered hidden factors that could cause and/or contribute to MRPs in these groups of patients.
Medication errors affect the pediatric age group in all settings:
outpatient, inpatient, emergency department, and at home. Children may be at special risk due to size and physiologic variability, limited communication ability, and treatment by nonpediatric health care providers. Those with chronic illnesses and on multiple medications may be at higher risk of experiencing adverse drug events. Some strategies that have been employed to reduce harm from pediatric medication errors include e-prescribing and computerized provider order entry with decision support, medication reconciliation, barcode systems, clinical pharmacists in medical settings, medical staff training, package changes to reduce look-alike/sound-alike confusion, standardization of labeling and measurement devices for home administration, and quality improvement interventions to promote nonpunitive reporting of medication errors coupled with changes in systems and cultures. Future research is needed to measure the effectiveness of these preventive strategies.
Nonadherence and medication errors are common among patients with complex drug regimens. Apps for smartphones and tablets are effective for improving adherence, but they have not been tested in elderly patients with complex chronic conditions and who typically have less experience with this type of technology.
The objective of this study was to design, implement, and evaluate a medication self-management app (called ALICE) for elderly patients taking multiple medications with the intention of improving adherence and safe medication use.
A single-blind randomized controlled trial was conducted with a control and an experimental group (N=99) in Spain in 2013. The characteristics of ALICE were specified based on the suggestions of 3 nominal groups with a total of 23 patients and a focus group with 7 professionals. ALICE was designed for Android and iOS to allow for the personalization of prescriptions and medical advice, showing images of each of the medications (the packaging and the medication itself) together with alerts and multiple reminders for each alert. The randomly assigned patients in the control group received oral and written information on the safe use of their medications and the patients in the experimental group used ALICE for 3 months. Pre and post measures included rate of missed doses and medication errors reported by patients, scores from the 4-item Morisky Medication Adherence Scale (MMAS-4), level of independence, self-perceived health status, and biochemical test results. In the experimental group, data were collected on their previous experience with information and communication technologies, their rating of ALICE, and their perception of the level of independence they had achieved. The intergroup intervention effects were calculated by univariate linear models and ANOVA, with the pre to post intervention differences as the dependent variables.
Data were obtained from 99 patients (48 and 51 in the control and experimental groups, respectively). Patients in the experimental group obtained better MMAS-4 scores (P<.001) and reported fewer missed doses of medication (P=.02). ALICE only helped to significantly reduce medication errors in patients with an initially higher rate of errors (P<.001). Patients with no experience with information and communication technologies reported better adherence (P<.001), fewer missed doses (P<.001), and fewer medication errors (P=.02). The mean satisfaction score for ALICE was 8.5 out of 10. In all, 45 of 51 patients (88%) felt that ALICE improved their independence in managing their medications.
The ALICE app improves adherence, helps reduce rates of forgetting and of medication errors, and increases perceived independence in managing medication. Elderly patients with no previous experience with information and communication technologies are capable of effectively using an app designed to help them take their medicine more safely.
Clinicaltrials.gov NCT02071498; http://clinicaltrials.gov/ct2/show/NCT02071498 (Archived by WebCite at http://www.webcitation.org/6OJjdHVhD).
This was a systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Evidence mapping was used to reveal the effect of drug reminder packaging on medication adherence, to identify research gaps and to make suggestions for future research.
PubMed, Embase, CINAHL and PsycINFO were searched with an end date of September 2013 using the Medical Subject Headings (MeSH) term 'medication adherence' and 20 different search terms for 'drug reminder packaging', limited to the English and German languages. Additional references were identified through cross-referencing. All prospective controlled trials with an intervention using drug reminder packaging for patients taking at least one medication without the assistance of a health-care professional were included in the evidence mapping of the effect of drug reminder packaging on adherence and outcomes according to the Economic, Clinical and Humanistic Outcomes (ECHO) model.
A total of 30 studies met the inclusion criteria: 10 randomized controlled trials, 19 controlled clinical trials and 1 cohort study. Drug reminder packaging had a significant effect on at least one adherence parameter in 17 studies (57%). The methodological quality was strong in five studies. Two studies provided complete information. Clear research gaps emerged.
Overall, the studies showed a positive effect of drug reminder packaging on adherence and clinical outcomes. However, poor reporting and important gaps like missing humanistic and economic outcomes and neglected safety issues limit the drawing of firm conclusions. Suggestions are made for future research.
Drug is an important part of disease treatment, but medication errors happen frequently and have significant clinical and financial consequences. The prevalence of prescription medication use among the ambulatory adult population increases with advancing age. Because of the global aging society, outpatients need to improve medication safety more than inpatients.
The elderly with multiple chronic conditions face the complex task of medication management. To reduce the medication errors for the elder outpatients with chronic diseases, a cloud medication safety supporting system is designed, demonstrated and evaluated.
The proposed system is composed of a three-tier architecture: the front-end tier, the mobile tier and the cloud tier. The mobile tier will host the personalized medication safety supporting application on Android platforms that provides some primary functions including reminders for medication, assistance with pill-dispensing, recording of medications, position of medications and notices of forgotten medications for elderly outpatients. Finally, the hybrid technology acceptance model is employed to understand the intention and satisfaction level of the potential users to use this mobile medication safety support application system.
The result of the system acceptance testing indicates that this developed system, implementing patient-centered services, is highly accepted by the elderly.
This proposed M-health system could assist elderly outpatients' homecare in preventing medication errors and improving their medication safety.
Objective:
To analyse information about the errors made by diabetic and renal patients based on information provided by professionals (general practitioners, specialists, and nurses) and the patients themselves.
Subjects and methods:
A descriptive study was carried out by interviewing 199 patients and 60 professionals from the Spanish provinces of Alicante and Madrid. The interview explored the frequencies and types of oversights, confusions, and misinterpretations and the factors that contributed to them.
Results:
Among the 199 patients, 59 (29.5%) and 42 (70%) of the 60 professionals considered that patients frequently made errors that affected the success of their treatment. There were no differences in the frequency of the reported errors based on gender (p = 0.7), educational level (p = 0.9), or marital status (p = 0.5). The most commonly reported errors were taking the wrong medication (n = 70; 35%) and mixing up medicines (n = 15; 7.5%). Diabetics who had not been adequately informed, compared to renal patients, reported a higher number of errors (p = 0.02).
Conclusions:
Patient errors were frequent because of communication failures and confusions. Diabetic patients had a higher chance of committing an error than renal patients. Patient education must include clear and personalized instructions for improving self-care and reducing risks when using medicines.
ABSTRACT
The inhaled route of medicines delivery has been heralded as a major development in respiratory therapeutics. Drug delivery via inhalation offers significant advantages such as greater efficacy and reduced side effects, as compared to the oral route of drug administration. Consequently, several innovative drug delivery devices have been developed for manufacturers of drugs used in respiratory conditions. Asthma therapy is now largely available in the inhaled form, with devices ranging from conventional nebulisers to the more contemporary dry powder inhalers. Dry powder inhaler devices include devices with discrete multi dose units (eg the Accuhaler), or a reservoir with a mechanism for metering dose amounts (eg the Turbuhaler), with the patients inspiratory flow generating targeted drug delivery. Whilst quite evolutionary in design and concept, a major limitation to the effective use of inhaled medication is the inability of patients to use these devices correctly as high rates of incorrect device technique (28-68%), with pressurised metered dose inhalers and dry powder inhalers, have been reported. In turn, incorrect device usage defeats the purpose of therapy, and has been shown to lead to poor control and outcomes in those using inhaled corticosteroids for prevention of asthma symptoms.
Pharmacists are in an excellent position to educate patients about appropriate inhaler technique, as they are the last health care professionals seen by patients before an inhaled medication is used. International asthma guidelines recommend that pharmacists should form part of a team approach to patient education about use of inhalers. In addition, current evidence suggests that pharmacists' interventions can lead to a positive impact on the management of many chronic diseases including asthma. However, pharmacists are not currently fulfilling their responsibilities regarding educating patients on correct inhaler technique. Studies have revealed an alarming lack of knowledge regarding the correct use of inhaler devices among community pharmacists.
With these issues in focus, this project aimed to determine the effect of a specialised counselling service delivered by specially trained community pharmacists to asthma patients on dry powder inhaler technique, and to assess patients’ resultant clinical and humanistic health outcomes. In addition, a subsequent aim was to develop a module for asthma educators to use in training pharmacists on correct inhaler technique, so they could in turn deliver appropriate inhaler technique education to their asthma patients. This module could then be used to sustain the inhaler technique education service in community practice.
To meet these aims, the study was undertaken in stages. The first stage was to conduct an interactive device-training workshop that followed the "train the trainer" approach, based on adult learning principles, including physical demonstration, hands-on training with inhalers, peer assessment and instant feedback. In this workshop, pharmacists were randomly assigned to Active and Control groups. Pharmacists in the Active group were trained on device technique and lung function assessment (Peak Flow Meter (PFM) use) in order to be able to deliver an intervention targeting inhaler technique, while pharmacists in the Control group were trained in lung function assessment (PFM use) only, in order to deliver standard care. The training workshops lasted 3 and 2 hours for Active and Control groups respectively.
The project then moved into the second stage, where a blinded cluster randomised study was conducted to investigate the effect of a simple pharmacist delivered educational intervention, targeting inhaler technique, on patients' clinical and humanistic outcomes.
The pharmacists approached every second asthmatic patient who presented a prescription for an inhaled corticosteroid contained in a TH or ACC device at their pharmacy. Following a 2 week run-in period, where PFM readings were recorded, patients in the Active group presented at the pharmacy for 5 visits (time = 0,1,2,3,6 months), at which times the intervention was delivered. The intervention included a specialised "Show-and-Tell" Inhaler Technique counselling service, with augmented verbal counselling and physical demonstration using a placebo inhaler, addressing all steps in the inhaler technique checklist. Active pharmacists highlighted any incorrect steps initially performed by the patients on a custom-designed "Inhaler Technique Label" which was pre-printed with the items from the technique checklists. At the completion of counselling, the pharmacist attached the highlighted Inhaler Technique Label to the patient's own inhaler. At each subsequent visit, inhaler technique assessment and education were repeated. Patients in the Control group visited the pharmacy for assessment at the same intervals and received standard care. Both groups also performed 2 weeks of peak flow monitoring before visits at 3 and 6 months. Asthma severity was assessed at every visit, while reliever use was assessed at baseline, 3 and 6 months from baseline. Data for humanistic outcomes (Asthma-related Quality of Life (AQOL) and Perceived Control (PC)) were collected at baseline, 3 and 6 months from baseline.
With regards to the pharmacists' own inhaler technique following the workshop, inhaler technique of Active pharmacists was later re-assessed at 3 and 6 months. Both pharmacist groups were reassessed 12 months after study completion i.e. 2 years post-initial training at the workshop. After the final assessment, Control group pharmacists were delivered the Active group inhaler technique education.
One hundred and sixteen patients were screened by the 31 pharmacists recruited and commenced two weeks of Peak Expiratory Flow (PEF) monitoring, with 97 (84%) returning to complete enrolment at visit 2. Inhaler technique education took an average of 2.5 minutes/patient/visit. With completion of data record forms, the total visit time per patient (including 6 visits) was approximately one hour.
At baseline, patients in all groups demonstrated poor inhaler technique, with Correct Technique observed in 9% Active and 5% Control TH users, and in 10% Active and 17% Control ACC users. At 3 months, Correct Technique was demonstrated by 85% Active TH and 96% Active ACC users (Control group was not assessed). At 6 months, Correct Technique was significantly better in Active than Control patients (TH: 10/20 (50%) vs. 2/14 (14%), p=0.032; ACC: 23/29 (79%) vs. 3/21 (14%), p<0.001). In the TH Active group, there was a significantly greater proportion of patients demonstrating Correct Technique at each visit compared with baseline, with a slight trend to decrease between 3 months and 6 months (p=0.531). Results were similar for the ACC group.
Improvements in TH and ACC technique were reflected in improved clinical outcomes. Min%Max (index of PEF variability) at 3 months and 6 months, adjusted for baseline, was significantly higher (indicating less variability) for the Active compared with the Control patients (3 months: 83.8±8.3% (mean±SD) vs. 77.6±9.2%, p<0.001; 6 months: 78.9 ± 9.7% vs. 74.4±8.9%, p=0.002, One-way ANCOVA). When TH and ACC data were analyzed separately, both device groups showed a significant improvement in Min%Max (reduced variability) between the Active and Control groups at 3 months (TH: 86.2±7.0% vs. 76.8±9.8, p=0.005; ACC: 82.1±8.8% vs. 78.5±8.9%, p<0.001), with a significant difference at 6 months only for ACC (78.3±7.9% vs. 75.2±8.8, p=0.005).
With both inhaler types combined, the Active group showed a trend towards lower reliever use over time, which was not significantly different to the Control group when adjusted for baseline.
At 2, 3 and 6 months, there were significant differences in the distribution of asthma severity between Active and Control groups. For TH users, significant differences were seen in the distribution of asthma severity between Active and Control groups at 2 and 3 months, and for ACC users, at 3 months only.
For both inhaler groups combined, there were statistically significant and clinically-important differences in AQOL and PC between Active and Control groups at 3 months (AQOL: 0.8±0.5 vs. 1.35±0.6; PC: 44.0±5.7 vs. 39.5±4.4) and 6 months (AQOL: 0.8±0.6 vs. 1.3±0.6; PC: 43.8±4.9 vs. 39.8±4.0, p<0.001 for each, One-way ANCOVA). Similar results were seen in the TH and ACC groups separately.
Twenty seven pharmacists completed the study. Correct Technique for both inhalers was maintained by all Active pharmacists at 3 and 6 months, except for one pharmacist at 6 months. One year after study completion (2 years after the training workshop), Correct Technique was demonstrated on TH by 10/12 (83%) Active and 1/9 (11%) Control pharmacists, and on ACC by 9/12 (75%) Active and 1/9 (11%) Control pharmacists.
Following the success of the intervention, an Inhaler Technique Educational Module was designed based on the findings of the preceding clinical study, to offer an evidence based educational tool, capable of optimising community pharmacists' inhaler technique and providing them with the required skills to review and educate asthma patients on correct inhaler technique. This module has been presented to the Pharmaceutical Society of Australia, a major national body, with a proposal to implement the project nationally.
In summary, this study demonstrated that a simple educational intervention taking only 2.5 minutes, targeting inhaler technique, was feasible for delivery by community pharmacists, and resulted in improved clinical and humanistic outcomes for patients with asthma. This study also highlights the critical role of face-to-face pharmacist-patient interactions about inhaled medications. The study processes and results have led to the development of an Inhaler Technique Educational Module, whose feasibility and effectiveness have been demonstrated. This module offers a solution to the ongoing problem of inhaler technique training and provides a sustainable training model that can be offered to the profession.
Understanding and organizing medication regimens can be challenging, and many patients struggle to properly dose prescribed medicine, potentially leading to less effective treatment or even harm. Generic prescriptions are increasingly common and may change in appearance, adding further complexity. The authors aimed to investigate familiarity with the drug regimen among a cohort of patients with diagnosed hypertension. Specifically, they determined the prevalence of patients' knowledge of their prescribed drug names and dosages compared to those who relied only on physical characteristics (size, shape, color) of their medications. The relationship between patients' identification strategies, self-reported adherence, and health outcomes (blood pressure control, hospitalization) were investigated. Patients who were dependent on the visual identification of their prescription medicine reported worse adherence. In addition, they had significantly lower rates of blood pressure control and greater risk of hospitalization. The ability to identify prescribed medicines by name may be helpful for screening and responding to patients at greater risk of making medication errors or being less engaged with their regimen for adherence purposes.
Introduction:
Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing concern for older adults. MEDLINE and EMBASE databases were searched from January 1, 1986 to June 30, 2013) to identify relevant articles in people aged > 65 years.
Areas covered:
We present information about: i) prevalence of polypharmacy and unnecessary medication use; ii) negative consequences of polypharmacy; and iii) interventions to improve polypharmacy.
Expert opinion:
International research shows that polypharmacy is common in older adults with the highest number of drugs taken by those residing in nursing homes. Nearly 50% of older adults take one or more medications that are not medically necessary. Research has clearly established a strong relationship between polypharmacy and negative clinical consequences. Moreover, well-designed interprofessional (often including clinical pharmacist) intervention studies that focus on enrolling high-risk older patients with polypharmacy have shown that they can be effective in reducing aspects of unnecessary prescribing with mixed results on distal health outcomes.
Objective
To detect and describe medication errors and adherence to therapy in polymedicated (> 5 drugs) elderly patients (> 65 years).
Method
A descriptive, observational study using a phone survey to polymedicated elderly outpatients. Sociodemographic, clinical, and pharmacotherapeutic data were collected, as well as information on their functional and mental capability. The number, type and severity of medication errors were measured, as was non-adherence.
Results
Errors were detected in 42.5% of 73 responders, with a total of 55 errors, and a mean 1.77 errors per patient. Most commonly found errors included inappropriate administration frequency and therapeutic duplicity. Regarding adherence, 43.8% were non-compliants, being sporadic in 68.8% and sequential in 31.2% of the cases. A positive relationship between error number and drug number or adherence was found.
Conclusions
Actions are required from a multidisciplinary standpoint to reduce this high percentage of errors.
Background:
Asthma remains a serious global health challenge. Poor control of asthma symptoms is due in part to incorrect use of oral inhaler devices that deliver asthma medications, such as poor inhalation technique or use of a metered dose inhaler (MDI) after the recommended number of doses is expelled.
Objective:
To review published research on the potential for patients to overestimate or underestimate the amount of asthma rescue medication in MDIs without integrated dose-counting mechanisms.
Methods:
We searched PubMed and EMBASE using search terms "dose counter and asthma" and "dose counter and metered dose inhaler" for English language publications up to July, 2012, with a manual search of references from relevant articles.
Results:
Up to 40% of patients believe they are taking their asthma medication when they actually are activating an empty or nearly empty MDI. Device design makes it impossible for an MDI to cease delivering drug doses at an exact point, and the number of actuations in an MDI may be twice the nominal number of recommended medication doses. Once the recommended number of medication doses is expelled, remaining actuations deliver decreasing concentrations of active medication and increasing concentrations of propellants and excipients. This phenomenon, called "tail-off," is particularly problematic when medications are formulated as suspensions, as are rescue medications to control acute bronchospasm. Reliable inhalation of rescue medication could reduce asthma-related morbidity.
Conclusion:
By helping to ensure that patients receive accurate metered doses of asthma rescue medication to relieve bronchoconstriction, dose counters may help to improve asthma management.
Healthcare practices involve risks for patients, but there has been little research to date on the occurrence of adverse events (AE) in primary care (PC). The frequency of AE in PC in Spain, the factors that contribute to their occurrence, their severity and their preventability, were analysed.
Observational cross-sectional study was carried out in 48 PC centres in 16 regions of Spain. PC professionals were asked to assess whether the AE was caused by the healthcare or if it was an expectable consequence of the patient's underlying condition. A total of 452 healthcare professionals who attended 96 047 consultations were involved.
A total of 773 AE were identified, so that the point prevalence of AE was 0.8% [95% confidence interval (CI) 0.76-0.85]. A majority of AE (64.3%) were considered preventable and only 5.9% were severe, usually related to medication [odds ratio (OR) = 4.6; 95% CI 2.1-10.3]. The most frequent causal factor of the AE was associated with medication (adverse drug reactions and medication errors), but problems in communication and management were at the root of many of the AE. Nurses reported more preventable AE (OR = 1.9; 95% CI 1.2-2.8).
In spite of an AE being less damaging in PC, large numbers of patients and professionals suffer their consequences each year. An awareness of the magnitude and impact of AE is the first step on the road to the cultural change necessary for achieving safer healthcare.
Objective:
To analyse the frequency of mistakes in communication between the physician and the patient and their incidence in errors in self-administered drugs.
Methods:
We undertook a descriptive, cross-sectional study based on interviews with a random sample of patients older than 65 years who were polymedicated (five or more drugs) and had multiple comorbidities. Data were analysed about the patients' reports of what the physician said, medication mistakes by the patients and their consequences.
Results:
Responses were provided by 382 patients. A medication error in the last year was reported by 287 patients (75%), and 16 patients (4%) reported four or more errors. Most cases concerned the dosage, a similar appearance of the medication or a lack of understanding of the physician's instructions. Very severe consequences occurred in 19 cases (5%). Multiple comorbidities (P = 0.006) and a greater number of treatments (P = 0.002) were associated with making mistakes. Frequent changes in prescription (P = 0.02), not considering the prescriptions of other physicians (P = 0.01), inconsistency in the messages (P = 0.01), being treated by various different physicians at the same time (P = 0.03), a feeling of not being listened to (P < 0.001) or loss of trust in the physician (P < 0.001) were associated with making medication mistakes.
Conclusions:
Mistakes by polymedicated patients with multiple comorbidities represent a real risk that should be addressed by the professionals. A review should be made of the routine control questions that the physician asks the patient to identify what other drugs the patient may be taking that have been indicated by another physician.
Analyze the frequency of medication errors committed and reported by patients.
Descriptive study based on a telephone survey of a random sample of adult patients from the primary care level of the Spanish public health care system. A total of 1 247 patients responded (75% response rate); 63% were women and 29% were older than 70 years.
While 37 patients (3%, 95% CI: 2-4) experienced complications associated with medication in the course of treatment, 241 (19.4%, 95% CI: 17-21) reported having made some mistake with their medication. A shorter consultation time (P < 0.01) and a worse assessment of the information provided by the physician (P < 0.01) were associated with the fact that during pharmacy dispensing the patient was told that the prescribed treatment was not appropriate.
In addition to the known risks of an adverse event due to a health intervention resulting from a system or practitioner error, there are risks associated with patient errors in the self-administration of medication. Patients who were unsatisfied with the information provided by the physician reported a greater number of errors.
This study aimed to examine drug packaging and labeling, identifying similarities among them that may lead to medication errors, which may occur by unintentional substitution, in different sectors of the pharmacy of a university hospital in northeastern Brazil.
Cross-sectional observational study, which included 300 pharmaceutical presentations (150 pairs) that were photographed from May to December 2010. Concordance analysis of data related to the pictures of possibly similar packaging and labels was validated using the Kappa index.
Of all drugs evaluated (n = 150), about 43% of "possibly similar drugs" were in the central pharmacy (n = 65) and were related to small-volume parenteral solutions. The strength of interobserver agreement in the category "very similar to each other" was considered "satisfactory" (Kappa = 0584) in 90.66% of the drugs evaluated (n = 136). The overall Kappa analysis of the study was 0.488. Variables with statistical significance were: "same color label or packaging", with the respective percentages for both primary and secondary packaging (52%-44%), p = 0.028; the variable "same color of drug presentation" obtained similar values and statistical significance to the previous variable; for the variable "same arrangement of words", the values found for both packages were close to 50%, p = 0.001; and for the variable "same color of the words", the percentages were: (50.7% - 44%) (p = 0.008).
Our results indicate similarities related to the labeling of drugs with potential for errors, especially in dispensing, storage, and administration if preventive measures are not adopted.
Medical errors account for ∼98,000 deaths per year in the United States. They increase disability and costs and decrease confidence in the health care system. We review several important types of medical errors and adverse events. We discuss medication errors, healthcare-acquired infections, falls, handoff errors, diagnostic errors, and surgical errors. We describe the impact of these errors, review causes and contributing factors, and provide an overview of strategies to reduce these events. We also discuss teamwork/safety culture, an important aspect in reducing medical errors.
1) describe and determine the feasibility of using cell-phone-based ecological momentary assessment (EMA) to measure blood glucose monitoring and insulin administration in adolescent Type 1 diabetes, 2) relate EMA to traditional self-report and glycemic control, and 3) identify patterns of adherence by time of day and over time using EMA.
Adolescents with Type 1 diabetes (n = 96) completed baseline measures of cell phone use and adherence. Glycemic control (measured by levels of HbA1c) was obtained from medical records. A subgroup of adolescents (n = 50) completed 10 days of EMA to assess blood glucose monitoring frequency, timing of glucose monitoring, insulin administration, and insulin dosing. One third of adolescents were not allowed to use their cell phones for diabetes at school. Parental restrictions on cell phone use at home were not prevalent.
The EMA response rate (59%) remained stable over the 10-day calling period. Morning time was associated with worse monitoring and insulin administration, accounting for 59-74% of missed self-care tasks. EMA-reported missed glucose checks and missed insulin doses were correlated to traditional self-report data, but not to HbA1c levels. Trajectory analyses identified two subgroups: one with consistently adequate adherence, and one with more variable, and worse, adherence. The latter adherence style showed worse glycemic control.
Mobile phones provide a feasible method to measure glucose monitoring and insulin administration in adolescents, given a limited assessment duration. The method provided novel insights regarding patterns of adherence and should be explored in clinical settings for targeting or tailoring interventions.
Children with chronic conditions often have complex medication regimens, usually administered at home by their parents.
To describe the types of medication errors in the homes of children with chronic conditions. METHODS Our home visit methods include direct observation of administration, medication review and prescription dose checking. Parents of children with sickle cell disease and seizure disorders taking daily medications were recruited from paediatric subspecialty clinics from November 2007 to April 2009. Potential errors were reviewed by two physicians who made judgments about whether an error had occurred or not, and its severity.
On 52 home visits, the authors reviewed 280 medications and found 61 medication errors (95% CI 46 to 123), including 31 with a potential to injure the child and 9 which did injure the child. Injuries often occurred when parents failed to fill prescriptions or to change doses due to communication problems, leading to further testing or continued pain, inflammation, seizures, vitamin deficiencies or other injuries. Errors not previously reported in the literature included communication failures between two parents at home leading to administration errors and difficulty preparing the medication for administration. 95% of parents not using support tools (eg, alarms, reminders) for medication use at home had an error compared to 44% of those using supports (χ(2)=13.9, p=0.0002).
Home visits detected previously undescribed types of outpatient errors which were common among children with sickle cell disease and seizure disorders. These should be targeted in future intervention development.
Objective
To present a case of nafcillin-induced interstitial nephritis.
Methodology
Case report and literature review.
Setting
Hospital.
Results
Three days following initiation of nafcillin therapy for staphylococcal pneumonia, an 80-year-old woman developed allergic manifestations and progressive renal impairment suggestive of acute allergic interstitial nephritis. These manifestations were completely reversed within 96 hours of cessation of nafcillin therapy.
Conclusions
In the clinical setting of acute renal failure in a patient on nafcillin therapy, acute interstitial nephritis should be considered. Prompt cessation of nafcillin therapy has generally been associated with reversal of symptoms and an improvement in renal function.
There are some indications that a more active patient participation in the relationship with professionals helps to identify risks to patient safety. Patients report are having a similar number of EA that identified by screening medical records. There are some indications that they are reliability in these reports. When the patient who has suffered an EA is honestly informed the likelihood that be followed by a litigious is minimized, while increasing the likelihood that a satisfactory evaluation of care. The role of patients as a second control to reduce EA may be explored. Patients make also mistakes in the course of treatment. This fact cannot be rejected. The identification of all these sources of patients' error contributes to patient safety.
Objective:
To evaluate caregiver (parent or guardian) use of over-the-counter medications (OTCs) as related to the accuracy and correctness of dosing for children seen at a pediatric emergency department with nonemergent concerns.Design:
Prospective patient series.Setting:
A tertiary care pediatric emergency center.Participants:
A representative sample of children with nonemergent chief complaints.Interventions:
A questionnaire about general demographic characteristics, recent OTC use, and medical history of the patients was given to each caregiver. A mock scenario was then presented that required the caregivers to determine and measure a correct dose of acetaminophen for their child. A dose of 9 to 16.5 mg/kg was considered correct. Accuracy of measuring was considered within ±20% of the caregivers' stated intended dose for their child.Results:
One hundred caregivers were enrolled in the study. Mean caregivers' age was 29 years, with 82% having at least a high school education. Seventy-seven percent of their children used OTCs within the previous 2 months, and Tylenol (acetaminophen) was the most commonly used. While 66% of the caregivers reported Tylenol use, only 8% reported the use of acetaminophen. During the dosing scenario, only 40 % of the caregivers stated an appropriate dose for their child and only 67% accurately measured the amount of acetaminophen they intended. Forty-three percent measured out a correct amount of acetaminophen for their child. However, almost one third of these occurred strictly by accident because they inaccurately measured an improper intended dose. Combining these results, only 30% of the caregivers were able to demonstrate both an accurately measured and correct dose for their child.Conclusions:
Although a large number of caregivers administer OTCs, knowledge of these medications, and accuracy and correctness of dosing remain a marked concern. Improved caregiver education on the accuracy and correctness of dosing OTCs is necessary.Arch Pediatr Adolesc Med. 1997;151:654-656
Objective - To determine the prevalence of an incorrect inhalation technique and to examine its determinants among primary care patients with asthma or chronic obstructive pulmonary disease (COPD). Design - Cross-sectional study. Setting - 28 general practitioners in The Netherlands. Subjects - 558 asthma and COPD patients, aged 16-75 years. Main outcome measures - Inhalation technique was assessed using a standardised inhaler-specific checklist. Pulmonary function assessment and questionnaires were used to collect data about inhaler, patient and disease characteristics. Results - Overall, 24.2% of the patients made at least one essential mistake in their inhalation technique. The type of inhaler appeared to be the strongest independent determinant of an incorrect inhalation technique. Compared to patients using the Diskhaler, patients using the Rotahaler/Spinhaler, Turbuhaler, Metered Dose Inhaler (MDI) or Cyclohaler/Inhaler-Ingelheim were at significantly higher risk of making inhalation mistakes (odds ...
Objective.
—To estimate the prevalence of recent over-the-counter (OTC) medication use in a national sample of preschool-age children.Design.
—Follow-up survey of a nationally representative sample of 3-year-old children in the US population by telephone or personal interview.Participants.
—A total of 8145 children whose mothers were interviewed for the 1991 Longitudinal Follow-up to the National Maternal and Infant Health Survey.Main Outcome Measures.
—Report of any OTC medications given in the past 30 days and the type of medications that the child received.Results.
—During the past 30 days, 53.7% of all 3-year-old children in the United States were given some OTC medications. Among OTC medication users, the most common medications reported were Tylenol (66.7%) and cough or cold medicine (66.7%). Most respondents reported that recent child illness episodes (70%) were treated with OTC medications. After adjustment for recent child illness, women who were white (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.13 to 1.55), were more educated (OR, 1.58; 95% CI, 1.24 to 2.00), and had higher incomes (OR, 1.75; 95% CI, 1.33 to 2.30) were more likely to have given their child OTC medications. Women without health insurance were also more likely to have given OTC medications (OR, 1.27; 95% CI, 1.04 to 1.55). Provider visits, but not telephone calls, were associated with a reduction in OTC medication usage.Conclusions.
—Over-the-counter medications are an important component of health care for treating illness in US preschool-age children. The high prevalence of use has occurred despite the dearth of scientific proof for the effectiveness of certain classes of OTC medications and the risks associated with improper use.(JAMA. 1994;272:1025-1030)
Context Adverse drug events, especially those that may be preventable, are among
the most serious concerns about medication use in older persons cared for
in the ambulatory clinical setting.Objective To assess the incidence and preventability of adverse drug events among
older persons in the ambulatory clinical setting.Design, Setting, and Patients Cohort study of all Medicare enrollees (30 397 person-years of
observation) cared for by a multispecialty group practice during a 12-month
study period (July 1, 1999, through June 30, 2000), in which possible drug-related
incidents occurring in the ambulatory clinical setting were detected using
multiple methods, including reports from health care providers; review of
hospital discharge summaries; review of emergency department notes; computer-generated
signals; automated free-text review of electronic clinic notes; and review
of administrative incident reports concerning medication errors.Main Outcome Measures Number of adverse drug events, severity of the events (classified as
significant, serious, life-threatening, or fatal), and whether the events
were preventable.Results There were 1523 identified adverse drug events, of which 27.6% (421)
were considered preventable. The overall rate of adverse drug events was 50.1
per 1000 person-years, with a rate of 13.8 preventable adverse drug events
per 1000 person-years. Of the adverse drug events, 578 (38.0%) were categorized
as serious, life-threatening, or fatal; 244 (42.2%) of these more severe events
were deemed preventable compared with 177 (18.7%) of the 945 significant adverse
drug events. Errors associated with preventable adverse drug events occurred
most often at the stages of prescribing (n = 246, 58.4%) and monitoring (n
= 256, 60.8%), and errors involving patient adherence (n = 89, 21.1%) also
were common. Cardiovascular medications (24.5%), followed by diuretics (22.1%),
nonopioid analgesics (15.4%), hypoglycemics (10.9%), and anticoagulants (10.2%)
were the most common medication categories associated with preventable adverse
drug events. Electrolyte/renal (26.6%), gastrointestinal tract (21.1%), hemorrhagic
(15.9%), metabolic/endocrine (13.8%), and neuropsychiatric (8.6%) events were
the most common types of preventable adverse drug events.Conclusions Adverse drug events are common and often preventable among older persons
in the ambulatory clinical setting. More serious adverse drug events are more
likely to be preventable. Prevention strategies should target the prescribing
and monitoring stages of pharmaceutical care. Interventions focused on improving
patient adherence with prescribed regimens and monitoring of prescribed medications
also may be beneficial.
Older persons following a prolonged complex drug regimen often make mistakes when taking their medication. Currently, the widespread use of tablets and smartphones has encouraged the development of applications to support self-management of medication.
The aim of this study was to design, develop and assess an app that transforms medication-associated ean-13 (barcodes) and Quick Response codes (QR) into verbal instructions, to enable safer use of medication by the elderly patients taking multiple medications.
Meetings were held in which participated a total of 61 patients.
The results showed that patients appreciated the application and found it useful for safer use of medicines.
The study results support the use of such technology to increase patient safety taking multiple medications safety.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Objective:
To determine whether elderly patients with complex drug regimens have enough information to ensure safe drug use.
Methods:
A cross-sectional study was conducted in Spain based on interviews of a random sample of 265 patients aged over 65 and taking at least five drugs for multiple comorbidities. General practitioners reported on diagnoses, drugs, dosage and biochemical laboratory results. Patients were asked about the medications they were taking (with higher scores indicating greater knowledge).
Results:
The patients took an average of 7.9 medications (SD 3.0). The mean scores were low for precautions (mean 0.3, SD 0.7) and how to properly store medications (mean 2.0, SD 3.0). Scores were significantly higher when physicians regularly provided patients with information (F-test 3.3, p = 0.039) and were not related to gender, years of treatment or health status. Frequent changes in medication adversely affected the scores (p = 0.03). Higher scores were related to a smaller number of medication errors (t-test 2.2, p = 0.032, CI 95% of the difference 0.6 - 1.2).
Conclusions:
Older complex chronic patients are unaware of the precautions they must adopt to use their medications safely. Patient knowledge does contribute to reducing medication errors. When physicians change prescriptions, modify doses or introduce new medications, more information needs to be provided for safe use of the drugs.
To evaluate the effectiveness of an intervention based on motivational interviewing to reduce medication errors in chronic patients over 65 with polypharmacy.
Cluster randomized trial that included doctors and nurses of 16 Primary Care centers and chronic patients with polypharmacy over 65 years. The professionals were assigned to the experimental or the control group using stratified randomization. Interventions consisted of training of professionals and revision of patient treatments, application of motivational interviewing in the experimental group and also the usual approach in the control group. The primary endpoint (medication error) was analyzed at individual level, and was estimated with the absolute risk reduction (ARR), relative risk reduction (RRR), number of subjects to treat (NNT) and by multiple logistic regression analysis.
Thirty-two professionals were randomized (19 doctors and 13 nurses), 27 of them recruited 154 patients consecutively (13 professionals in the experimental group recruited 70 patients and 14 professionals recruited 84 patients in the control group) and completed 6 months of follow-up. The mean age of patients was 76 years (68.8% women). A decrease in the average of medication errors was observed along the period. The reduction was greater in the experimental than in the control group (F=5.109, P=.035). RRA 29% (95% confidence interval [95% CI] 15.0-43.0%), RRR 0.59 (95% CI:0.31-0.76), and NNT 3.5 (95% CI 2.3-6.8).
Motivational interviewing is more efficient than the usual approach to reduce medication errors in patients over 65 with polypharmacy.
To examine the degree to which recommended provider counseling strategies, including advanced communication techniques and dosing instrument provision, are associated with reductions in parent liquid medication dosing errors.
Cross-sectional analysis of baseline data on provider communication and dosing instrument provision from a study of a health literacy intervention to reduce medication errors. Parents whose children (<9 years) were seen in 2 urban public hospital pediatric emergency departments (EDs) and were prescribed daily dose liquid medications self-reported whether they received counseling about their child's medication, including advanced strategies (teachback, drawings/pictures, demonstration, showback) and receipt of a dosing instrument. The primary dependent variable was observed dosing error (>20% deviation from prescribed). Multivariate logistic regression analyses were performed, controlling for parent age, language, country, ethnicity, socioeconomic status, education, health literacy (Short Test of Functional Health Literacy in Adults); child age, chronic disease status; and site.
Of 287 parents, 41.1% made dosing errors. Advanced counseling and instrument provision in the ED were reported by 33.1% and 19.2%, respectively; 15.0% reported both. Advanced counseling and instrument provision in the ED were associated with decreased errors (30.5 vs 46.4%, P = .01; 21.8 vs 45.7%, P = .001). In adjusted analyses, ED advanced counseling in combination with instrument provision was associated with a decreased odds of error compared to receiving neither (adjusted odds ratio 0.3; 95% confidence interval 0.1-0.7); advanced counseling alone and instrument alone were not significantly associated with odds of error.
Provider use of advanced counseling strategies and dosing instrument provision may be especially effective in reducing errors when used together.
Dentists recommend over-the-counter medications for postoperative pain in children, and parents often make dosing errors when administering these medications. The authors compared the dosing accuracy when parents used various measuring devices and aimed to identify risk factors associated with dosing errors.
The authors recruited parent-child pairs visiting the Pediatric Clinic at the College of Dentistry at The University of Tennessee Health Science Center, Memphis, and three private dental offices. The parents completed a survey and a liquid measuring exercise. The authors instructed parents to measure 5 milliliters of liquid by using a medicine cup with clear markings, a medicine cup with printed markings, a cylindrical measuring spoon and an oral syringe. For the medicine cup with printed markings, the authors placed the parents randomly into one of two groups: those receiving text-only instructions or those receiving text-pictogram instructions. The authors weighed each device before and after the measuring exercise and compared the difference in weight with a reference weight of 5 mL.
A total of 120 parent-child pairs participated. The results of a McNemar test revealed a significant difference in parents' ability to measure accurate doses with the various devices. The results of a Pearson χ(2) test showed no statistically significant difference between the control and study groups for dosing accuracy. The χ(2) analysis results showed no significant differences in risk factors that could be associated with dosing errors.
Medicine cups were the devices parents reported using most frequently. Medicine cups had a higher occurrence of dosing errors when compared with the other devices. No sociodemographic factors were associated with dosing errors. Practical Implications. Dentists can improve pain management in pediatric patients by educating parents about accurate measuring devices, weight-based dosing and correct interpretation of medication dosing charts.
Medication errors (ME) are a major concern to healthcare systems. Most studies evaluated ME occurring in healthcare facilities; only few focused on ME outside them. The objective was to characterise ME occurring outside healthcare facilities. A prospective observational follow-up study evaluating all ME occurring outside healthcare facilities reported to a national poison information centre during a 5-month period. For each ME case, a detailed questionnaire was filled and a follow-up call was made within 7 days. The collected data included demographics, circumstances, type of error and outcome. Of 1381 consecutive ME cases were included; 97.8% involved a single incident and 88.3% one drug. The main characteristics of the ME were as follows: children younger than 6 years old (58.9%), parents responsible for 55.6% of cases, wrong dose 34.5% and different medication 30.1%. Analgesics (27.4%) and antimicrobials (12.2%) were the most common pharmaceuticals. The main reasons for the ME were look-alike packaging (31.4%) and misunderstood instructions (28%). Most followed up patients (97.1%) were asymptomatic or mildly affected; there was one severe case and no mortality. Most ME occurring outside healthcare facilities are single incidents, involving young children who were administered a wrong dose or medication due to look-alike packaging or misunderstood instructions with asymptomatic or mild outcome. Improved packaging, labelling and patient education are suggested to reduce ME.
Objective
To report the precautions taken by diabetic patients to avoid treatment errors and to provide advice to increase their safety.MethodsA descriptive study of patients’ behaviors to minimize errors and tips by professionals to improve safety. Ninety-nine insulin-treated patients were randomly recruited from 3 primary healthcare centers and 2 hospitals. An opportunity sample of 33 doctors and nurses was also surveyed.ResultsInformation of all prescriptions (p = 0.005), review of doubts before the visit (p = 0,009), and diet adherence (p = 0.02) were the only precautions reported by patients that related to a lower number of patient errors. Female patients better follow at home instructions for blood glucose monitoring (odds ratio 0.07; 95% confidence interval (CI) 0.1-0.6) and use pillboxes to avoid errors (odds ratio 0.23; 95% CI 0.1-0.6) more frequently than male patients. Male patients more commonly carry with them a card with information about allergies (odds ratio 5.03; 95% CI 1.4-17.5). Patients with a longer course of disease tend to withhold information about other treatments from their doctors (β -15.8; 95% CI -23.2-8.4). For healthcare professionals, safety may increase if patients: play a more active role in their treatment (91%), and inform their doctors about their different treatments (88%).Conclusions
Promotion of patient autonomy, improved communication to patients, and systematic information about the most common medication errors may contribute to patient safety.
Objective
To describe the adverse drug events (ADEs) reported by doctors of a primary health care centre in the patient's medical record.
Design
A retrospective, descriptive study.
Setting
Burriana Health Centre (Castellón), Spain.
Participants
All patients over 75 with a clinical history held on paper at the health centre, i.e. non-institutionalized patients seen on an out-patient basis, were checked.
Measurements
A total of 2044 paper-based medical records were analysed, in which 832 histories describing 1893 ADEs (90.4% unforeseen and 9.6% preventable) were found. This means that 41% of the patients experienced one or more adverse events, with an average of 2.28 ADEs per patient.
Results
Most ADEs (85.3%) were light, but 6% were classified as serious, with high digestive haemorrhage caused by NSAIDs standing out as the most common serious problem (37.3%). The pharmacotherapeutic groups most involved in ADEs were cardiovascular therapy (29.4%), antiinfectious drugs (21.2%) and nervous system drugs (20.1%). Seventeen cases of intoxication were detected (0.9% total ADEs), with digoxin responsible for 67% of the serious intoxications. It was observed that ADEs occur with statistical significance most frequently in women (OR=1.73; CI 95%, 1.42-2.10). After an age-stratified analysis, it was concluded that the only sub-group where the increase in risk was not significant was the group of people over 85 years old.
Conclusions
ADEs create a serious public health problem, with negative effects on patients. Although most ADEs are unforeseen (90.4%), it is still worrying that 9.6% of the ADEs identified are preventable.
Correspondencia: Leales, 29. La Arboleja. 30009 Murcia. España
Most patients cannot remember their entire medication regimen and occasionally forget to take their medication.
The objective of the study was to design, develop, and demonstrate the feasibility of a new type of medication self-management system using smartphones with real-time medication monitoring.
We designed and developed a smartphone-based medication self-management system (SMSS) based on interviews of 116 patients. The system offered patients two main functions by means of smartphones: (1) storage and provision of an accurate, portable medication history and medication-taking records of patients; and (2) provision of a reminder to take medication only when the patient has forgotten to take his/her medication. These functions were realized by two data input methods: (a) reading of prescription data represented in two-dimensional barcodes using the smartphone camera and getting the photographic images of the pills; and (b) real-time medication monitoring by novel user-friendly wireless pillboxes.
Interviews suggested that a pocket-sized pillbox was demanded to support patient's medication-taking outside the home and pillboxes for home use should be adaptable to the different means of pillbox storage. In accordance with the result, we designed and developed SMSS. Ten patients participated in the feasibility study. In 17 out of 47 cases (36.2%), patients took their medication upon being presented with reminders by the system. Correct medication-taking occurrence was improved using this system.
The SMSS is acceptable to patients and has the advantage of supporting ubiquitous medication self-management using a smartphone. We believe that the proposed system is feasible and provides an innovative solution to encourage medication self-management.
Objective:
As home medication use increases, medications previously managed by nurses are now managed by patients and their families. Our objective was to describe the types of errors occurring in the home medication management of children with cancer.
Methods:
In a prospective observational study at 3 pediatric oncology clinics in the northeastern and southeastern United States, patients undergoing chemotherapy and their parents were recruited from November 2007 through April 2011. We reviewed medical records and checked prescription doses. A trained nurse visited the home, reviewed medication bottles, and observed administration. Two physicians independently made judgments regarding whether an error occurred and its severity. Overall rates of errors were weighted to account for clustering within sites.
Results:
We reviewed 963 medications and observed 242 medication administrations in the homes of 92 patients. We found 72 medication errors. Four errors led to significant patient injury. An additional 40 errors had potential for injury: 2 were life-threatening, 13 were serious, and 25 were significant. Error rates varied between study sites (40-121 errors per 100 patients); the weighted overall rate was 70.2 errors per 100 patients (95% confidence interval [CI]: 58.9-81.6). The weighted rate of errors with injury was 3.6 (95% CI: 1.7-5.5) per 100 patients and with potential to injure the patient was 36.3 (95% CI: 29.3-43.3) per 100 patients. Nonchemotherapy medications were more often involved in an error than chemotherapy.
Conclusions:
Medication errors were common in this multisite study of outpatient pediatric cancer care. Rates of preventable medication-related injuries in this outpatient population were comparable or higher than those found in studies of hospitalized patients.
Objective:
To analyze the extent to which Spanish leaflets and drug information on the Net met quality criteria.
Research design and methods:
A descriptive study was conducted comparing readability (REA) and comprehensibility (COM) criteria of a random sample of 77 marketed products of the 12 active ingredients most frequently sold in 2010 in Spain. Leaflets were approved by the Spanish Agency for Medication (AEMPS). Flesch index, DISCERN, ELF, MIDAS and CIRF scales were used to evaluate quality criteria.
Results:
COM assessment yielded between 63 and 77% of the maximum possible scores on the scales. None of the websites or leaflets met all the quality criteria of the DISCERN, CIRF or MIDAS scales. Four (3%) leaflets met all the 22 quality criteria of ELF. The leaflets showed shortcomings regarding: medication benefits (17 required substantial improvements, 31.5%), correct forms of storage (13, 24.1%), contraindications (12, 22.2%), side effects (11, 20.4%) and precautions to be taken (9, 16.7%).
Conclusions:
The quality of the information approved by the AEMPS is superior to that which can be found by surfing the Net. More specific information on precautions, complications and how to avoid common patient errors would allow patients the best chance to contribute to their own clinical safety.
Self-management is critical to achieving diabetes treatment goals. Mobile phones and Bluetooth® can support self-management and lifestyle changes for chronic diseases such as diabetes. A mobile health (mHealth) research platform—the Few Touch Application (FTA)—is a tool designed to support the self-management of diabetes. The FTA consists of a mobile phone-based diabetes diary, which can be updated both manually from user input and automatically by wireless data transfer, and which provides personalized decision support for the achievement of personal health goals. Studies and applications (apps) based on FTAs have included: (1) automatic transfer of blood glucose (BG) data; (2) short message service (SMS)-based education for type 1 diabetes (T1DM); (3) a diabetes diary for type 2 diabetes (T2DM); (4) integrating a patient diabetes diary with health care (HC) providers; (5) a diabetes diary for T1DM; (6) a food picture diary for T1DM; (7) physical activity monitoring for T2DM; (8) nutrition information for T2DM; (9) context sensitivity in mobile self-help tools; and (10) modeling of BG using mobile phones.
The correct use of inhalation devices is an inclusion criterion for all studies comparing inhaled treatments. In real life, however, patients may make many errors with their usual inhalation device, which may negate the benefits observed in clinical trials. Our study was undertaken to compare inhalation device handling in real life. A total of 3811 patients treated for at least 1 month with an inhalation device (Aerolizer, Autohaler, Diskus, pressurized metered dose inhaler (pMDI), or Turbuhaler) were included in this observational study performed in primary care in France between February 1st and July 14th, 2002. General practitioners had to assess patient handling of their usual inhaler device with the help of a checklist established for each inhaler model, from the package leaflet. Seventy-six percent of patients made at least one error with pMDI compared to 49-55% with breath-actuated inhalers. Errors compromising treatment efficacy were made by 11-12% of patients treated with Aerolizer, Autohaler, or Diskus compared to 28% and 32% of patients treated with pMDI and Turbuhaler, respectively. Overestimation of good inhalation by general practitioners was maximal for Turbuhaler (24%), and lowest for Autohaler and pMDI (6%). Ninety percent of general practitioners felt that participation in the study would improve error detection. These results suggest that there are differences in the handling of inhaler devices in real life in primary care that are not taken into account in controlled studies. There is a need for continued education of prescribers and users in the proper use of these devices to improve treatment efficacy.
Patients use several types of devices to measure liquid medication. Using a criterion ranging from a 10% to 40% variation from a target 5 mL for a teaspoon dose, previous studies have found that a considerable proportion of patients or caregivers make errors when dosing liquid medication with measuring devices.
To determine the rate and magnitude of liquid medication dose errors that occur with patient/caregiver use of various measuring devices in a community pharmacy.
Liquid medication measurements by patients or caregivers were observed in a convenience sample of community pharmacy patrons in Korea during a 2-week period in March 2011. Participants included all patients or caregivers (N = 300) who came to the pharmacy to buy over-the-counter liquid medication or to have a liquid medication prescription filled during the study period. The participants were instructed by an investigator who was also a pharmacist to select their preferred measuring devices from 6 alternatives (etched-calibration dosing cup, printed-calibration dosing cup, dosing spoon, syringe, dispensing bottle, or spoon with a bottle adapter) and measure a 5 mL dose of Coben (chlorpheniramine maleate/phenylephrine HCl, Daewoo Pharm. Co., Ltd) syrup using the device of their choice. The investigator used an ISOLAB graduated cylinder (Germany, blue grad, 10 mL) to measure the amount of syrup dispensed by the study participants. Participant characteristics were recorded including gender, age, education level, and relationship to the person for whom the medication was intended.
Of the 300 participants, 257 (85.7%) were female; 286 (95.3%) had at least a high school education; and 282 (94.0%) were caregivers (parent or grandparent) for the patient. The mean (SD) measured dose was 4.949 (0.378) mL for the 300 participants. In analysis of variance of the 6 measuring devices, the greatest difference from the 5 mL target was a mean 5.552 mL for 17 subjects who used the regular (etched) dosing cup and 4.660 mL for the dosing spoon (n = 10; P < 0.001). Doses were within 10% of the 5 mL target volume for 88.7% (n = 266) of the participant samples. Only 34 cases (11.3%) had dose errors greater than 10%, and only 6 cases (2.0%) had a variance of more than 20% from the 5 mL target volume. Dose errors greater than 10% of the target volume were more common for the etched dosing cup (47.1%, n = 8), the dosing spoon (50.0%, n = 5), and the printed dosing cup (30.8%, n = 4), but these 3 devices were used by only 13.3% of the study participants.
Approximately 1 in 10 participants measured doses of liquid medication with a volume error greater than 10%, and these dose errors were more common with the etched dosing cup, the dosing spoon, and the printed dosing cup. Pharmacists have an opportunity to counsel patients or caregivers regarding the appropriate use of measuring devices for liquid medication.
To report the precautions taken by diabetic patients to avoid treatment errors and to provide advice to increase their safety.
A descriptive study of patients' behaviors to minimize errors and tips by professionals to improve safety. Ninety-nine insulin-treated patients were randomly recruited from 3 primary healthcare centers and 2 hospitals. An opportunity sample of 33 doctors and nurses was also surveyed.
Information of all prescriptions (p = 0.005), review of doubts before the visit (p = 0,009), and diet adherence (p = 0.02) were the only precautions reported by patients that related to a lower number of patient errors. Female patients better follow at home instructions for blood glucose monitoring (odds ratio 0.07; 95% confidence interval (CI) 0.1-0.6) and use pillboxes to avoid errors (odds ratio 0.23; 95% CI 0.1-0.6) more frequently than male patients. Male patients more commonly carry with them a card with information about allergies (odds ratio 5.03; 95% CI 1.4-17.5). Patients with a longer course of disease tend to withhold information about other treatments from their doctors (β -15.8; 95% CI -23.2-8.4). For healthcare professionals, safety may increase if patients: play a more active role in their treatment (91%), and inform their doctors about their different treatments (88%).
Promotion of patient autonomy, improved communication to patients, and systematic information about the most common medication errors may contribute to patient safety.
OBJECTIVE: To determine the frequency of possible medication errors in a population of older home healthcare patients according to expert panel objective criteria.
DESIGN: A cross-sectional survey.
SETTING: Two of the largest urban home healthcare agencies in the United States.
PARTICIPANTS: Home healthcare patients age 65 and older admitted to selected offices of these agencies between October 1996 and September 1998.
MEASUREMENTS: We used two sets of consensus-based expert panel criteria to define possible medication errors. The Home Health Criteria identify patients with patterns of medication use and signs and symptoms that indicate sufficient likelihood of a medication-related problem to warrant reevaluating the patient. The Beers criteria identify medications that experts have deemed generally inappropriate for older patients.
RESULTS: The 6,718 study subjects took a median of five drugs; 19% were taking nine or more medications. A possible medication error was identified for 19% of patients according to Home Health Criteria, 17% according to the Beers criteria, and 30% according to either. Possible errors increased linearly with number of medications taken. When patients taking one to three medications were compared with those taking nine or more drugs, the percentages with possible errors were, respectively, 10% and 32% for the Home Health Criteria, 8% and 32% for the Beers criteria, and 16% and 50% for both.
CONCLUSION: Nearly one-third of the home healthcare patients surveyed had evidence of a potential medication problem or were taking a drug considered inappropriate for older people. More-effective methods are needed to improve medication use in this vulnerable population. J Am Geriatr Soc 49:719–724, 2001.
Objectives: To compare the ability of parents to calculate and demonstrate the correct paracetamol (acetaminophen) dose, interval, and frequency for their child when using either product information leaflets or the Parental Analgesia Slide.
Background: Prescribing information provided with over-the-counter medication may be a source of confusion for parents delivering analgesics to children at home. Accurate administration is essential to ensure safe and effective treatment of children’s pain or fever. The Parental Analgesia Slide is a new device developed with the objective of improving parental dosing accuracy.
Methods: In this prospective, randomized study, 160 parents accompanying children aged between one and 13 years old were randomly allocated to complete a paracetamol dose calculation and administration questionnaire using one of two sources of prescribing information. Absolute percentage dose error and the number of correct dosage intervals, frequencies, and demonstrated drug volumes were compared.
Results: Use of the Parental Analgesia Slide resulted in a reduction in the absolute percentage dose error from a median of 33.3 to 0% (P < 0.001) and an increase in the number of correct dosage intervals and frequencies (59/80 to 70/80, P = 0.046). There was no difference in the number of correctly demonstrated drug volumes (P = 0.082) despite a greater number of parents opting to use an oral syringe rather than a dosing spoon when using the Slide (24/80 to 44/80, P = 0.002).
Conclusions: The Parental Analgesia Slide resulted in improved parental ability to calculate paracetamol dose, interval, and frequency while preserving their ability to demonstrate an accurate drug volume.
Medication errors are widely reported for hospitalised patients, but limited data are available for medication errors that occur in community-based and clinical settings. Epidemiological data from poisons information centres enable characterisation of trends in medication errors occurring across the healthcare spectrum.
The objective of this study was to characterise the epidemiology and type of medication errors reported to the National Poisons Information Centre (NPIC) of Ireland.
A 3-year prospective study on medication errors reported to the NPIC was conducted from 1 January 2007 to 31 December 2009 inclusive. Data on patient demographics, enquiry source, location, pharmaceutical agent(s), type of medication error, and treatment advice were collated from standardised call report forms. Medication errors were categorised as (i) prescribing error (i.e. physician error), (ii) dispensing error (i.e. pharmacy error), and (iii) administration error involving the wrong medication, the wrong dose, wrong route, or the wrong time.
Medication errors were reported for 2348 individuals, representing 9.56% of total enquiries to the NPIC over 3 years. In total, 1220 children and adolescents under 18 years of age and 1128 adults (≥ 18 years old) experienced a medication error. The majority of enquiries were received from healthcare professionals, but members of the public accounted for 31.3% (n = 736) of enquiries. Most medication errors occurred in a domestic setting (n = 2135), but a small number occurred in healthcare facilities: nursing homes (n = 110, 4.68%), hospitals (n = 53, 2.26%), and general practitioner surgeries (n = 32, 1.36%). In children, medication errors with non-prescription pharmaceuticals predominated (n = 722) and anti-pyretics and non-opioid analgesics, anti-bacterials, and cough and cold preparations were the main pharmaceutical classes involved. Medication errors with prescription medication predominated for adults (n = 866) and the major medication classes included anti-pyretics and non-opioid analgesics, psychoanaleptics, and psychleptic agents. Approximately 97% (n = 2279) of medication errors were as a result of drug administration errors (comprising a double dose [n = 1040], wrong dose [n = 395], wrong medication [n = 597], wrong route [n = 133], and wrong time [n = 110]). Prescribing and dispensing errors accounted for 0.68% (n = 16) and 2.26% (n = 53) of errors, respectively.
Empirical data from poisons information centres facilitate the characterisation of medication errors occurring in the community and across the healthcare spectrum. Poison centre data facilitate the detection of subtle trends in medication errors and can contribute to pharmacovigilance. Collaboration between pharmaceutical manufacturers, consumers, medical, and regulatory communities is needed to advance patient safety and reduce medication errors.
In this article, we review the legal basis of trade dress as it has applied to pharmaceutical products and consider the public health implications of variations in pill appearance. We then discuss how a system of more uniform drug appearance could be designed to reduce medical error and promote patient adherence to treatment regimens that involve generic drugs.
generic drugs not look like the brand-name medicine, they don’t even look like each other. As a result, patients can receive a drug that looks different when they refill a prescription leading to confusion, failure to take medications as prescribed, and the waste of valuable time of physicians and pharmacists in counseling patients to reduce their anxiety. The problem is particularly troublesome for elderly patients who often take several medications concurrently and are more susceptible to confusion. The U.S. Food and Drug Administration (FDA) has recently decided that the current system of providing medical information to consumers about drugs is inadequate and is developing more patient friendly information to accompany
This study aimed to examine the utility of using color and shape to differentiate drug strength information on over-the-counter medicine packages. Medication errors are an important threat to patient safety, and confusions between drug strengths are a significant source of medication error.
A visual search paradigm required laypeople to search for medicine packages of a particular strength from among distracter packages of different strengths, and measures of reaction time and error were recorded.
Using color to differentiate drug strength information conferred an advantage on search times and accuracy. Shape differentiation did not improve search times and had only a weak effect on search accuracy.
Using color to differentiate drug strength information improves drug strength identification performance. Color differentiation of drug strength information may be a useful way of reducing medication errors and improving patient safety.
The objective of this study was to characterize how successfully patients with diabetes are able to distinguish between pens of the same pen type containing long- and short-acting insulins.
Structured one-on-one interviews were conducted with 400 patients with diabetes in the United States, using either a differentiated (n = 100) or undifferentiated (n = 100) SoloSTAR® (insulin glargine vs insulin glulisine) or (n = 200) FlexPen® (insulin detemir vs insulin aspart). A pair of each pen type was presented simultaneously, and participants were asked to identify the pen that they would use to (1) inject at lunch, (2) inject once daily, and (3) inject at breakfast and how they differentiated between pens. The short-acting insulin pen was then presented, and the interviewer asked whether this was the correct pen to administer insulin once or thrice daily.
More patients successfully identified the correct SoloSTAR pen across the tests vs FlexPen, and the error rate (incorrect selection/inability to select) was significantly lower, respectively [2.7% (n = 8) vs 16.3% (n = 98)]. The most common reason cited for correct responses among all patients was color (of the label/pen, according to pen type).
This study suggests that the full pen body color used on SoloSTAR pens enhances the patient's ability to differentiate between the pens for long- and short-acting insulin and is a notable improvement compared with the standard approach of differing label color.