Teaching adults SAFE medication management

One in nine visits to the emergency department is the result of a drug-related adverse event and is possibly preventable (Zed et al., 2008). The rehabilitation nurse has the opportunity to teach adults a comprehensive medication management plan that will help reduce medication errors. Most patients have minimal medication experience or instruction; this article documents the effectiveness of using a S = systematic, A = accurate, F = functional, and E = effective instructional methodology to help patients learn about their medications. The methodology helps rehabilitation nurses teach the average patient about handling, absorbing, and implementing the information. This article presents detailed instruction about the salient points of the SAFE instructional program. Several figures, a checklist, and pictures demonstrate the techniques utilized. Prevention of medication errors is emphasized throughout.     

Medication Discrepancies Identified at Time of Hospital Discharge in a Geriatric Population

Background

It has been reported that 14.1% of geriatric patients experience ≥1 medication discrepancies after hospitalization.

Objective

The goal of this study was to identify and characterize discharge medication list discrepancies among geriatric patients and to describe characteristics associated with discrepancies.

Methods

An institutional review board–approved retrospective review was conducted of patients aged ≥65 years discharged from hospitalist and internal medicine services at a large tertiary care hospital from August 2008 to December 2009. A random cohort of 200 patients was selected and categorized by age, gender, attending medical service, and the absence or presence of a pharmacist on the service. Medication lists were obtained from physician discharge summaries, discharge orders, and nursing discharge lists.

Results

A total of 1923 medication discrepancies were identified, consisting of 402 related to the absence or presence of a medication, 298 related to the dosage administered at one time, 223 related to the number of daily doses, and 1000 related to the route of administration. Physician discharge summaries contained the most medication discrepancies. There was no relationship between patient age and the number of medication discrepancies (r² = 0.006; P = 0.279), whereas there was a linear relationship between the number of medications and the number of discrepancies (r² = 0.249; P < 0.001). The internal medicine team with a pharmacist had a lower average number of discrepancies per patient compared with other medicine services that did not have a pharmacist present.

Conclusions

Medication discrepancies at the time of hospital discharge are a common occurrence for geriatric patients. Physician summaries might be the least reliable source of discharge medication lists. The number of discrepancies appears to not be associated with patient age, but rather with the number of medications at discharge. Discrepancies among medication lists are common, and the presence of a pharmacist may reduce the number that occur.     

Emergency department medication lists are not accurate

Background: Medication errors are a common source of adverse events. Errors in the home medication list may impact care in the Emergency Department (ED), the hospital, and the home. Medication reconciliation, a Joint Commission requirement, begins with an accurate home medication list. Objective: To evaluate the accuracy of the ED home medication list. Methods: Prospective, observational study of patients aged > 64 years admitted to the hospital. After obtaining informed consent, a home medication list was compiled by research staff after consultation with the patient, their family and, when appropriate, their pharmacy and primary care doctor. This home medication list was not available to ED staff and was not placed in the ED chart. ED records were then reviewed by a physician, blinded to the research-generated home medication list, using a standardized data sheet to record the ED list of medications. The research-generated home medication list was compared to the standard medication list and the number of omissions, duplications, and dosing errors was determined. Results: There were 98 patients enrolled in the study; 56% (55/98, 95% confidence interval [CI] 46–66%) of the medication lists for these patients had an omission and 80% (78/98, 95% CI 70–87%) had a dosing or frequency error; 87% of ED medication lists had at least one error (85/98, 95% CI 78–93%). Conclusion: Our findings now add the ED to the list of other areas within health care with inaccurate medication lists. Strategies are needed that support ED providers in obtaining and communicating accurate and complete medication histories.     

老年冠心病患者用药知识、信念及行为的调查与分析

目的通过对干部门诊老年冠心病(coronary heart disease,CHD)患者用药知识、信念、行为及其影响因素的调查与分析,为患者进一步实施用药知识教育提供帮助。方法随机整群抽取4个干休所的124名老年冠心病患者,采用自行设计调查问卷对用药知识、信念与行为进行调查、评估与分析。结果74.2%的老年冠心病患者用药知识欠缺,既往因冠心病住院的次数、现患慢性病种类数、离(退)休前的工作性质是影响患者掌握用药知识的因素;50%以上的老年冠心病患者用药行为关键方面依从性差,既往1年内药物不良反应发生种类数可能影响患者的用药行为;老年冠心病患者用药知识、信念及行为未完全达到统一。结论门诊老年冠心病患者在疾病控制过程中,需要更多系统、持续、不断更新的用药知识,以促进其树立正确的用药观念,建立良好的用药行为。     

Nurse delivered medication safety screening program for home care visits

Home care clients have safety barriers related to medication storage, disposal, and safe use of opioids. Limited research is available regarding medication safety initiatives in the home care setting. This study evaluates a medication safety initiative, linked with opioid misuse and overdose prevention screening, for home care clients with different levels of service. Training and screening tools designed for community pharmacies by the Opioid & Naloxone Education (ONE) Program were modified for use by home health nurses. All new admits to the home health services were screened for medication storage, medication disposal, and use of pain medications. Patients taking opioids were screened for opioid-specific risks. Interventions based on screening results included education, provision of medication lock boxes, drug disposal packets, and/or naloxone. Most home care clients (85%) are properly storing their medication and 38% were not properly disposing unused medications. Higher levels of care had greater pain medication needs, including the provision of naloxone. This study demonstrates the opportunity to incorporate medication safety screening into nursing home health visits.     

Oral medication management in inpatient psychiatric care in Turkey

The aim of this study was to describe current status of oral medication management and related situations by nurses who work on psychiatric wards in Turkey. The study was performed in 34 psychiatric wards in Turkey, and 471 nurses agreed to participate in the study. Data were collected by a questionnaire. In our study, it was determined that one quarter of the nurses do not collect data about past medication history of the patient before giving medications, and 59.7% of the nurses checked all the patients' mouths after each pill was given. The orders are checked by 80.5% of the nurses every day. The leading patient reaction nurses face during medication administration was refusal to take the medication. The nurses stated that they first informed the physician without making any intervention on patients who did not take their pills. The nurses primarily observed the patient to evaluate the effect of a medication (84.3%) and, with a similar percent (82.8%), the side effects of a medication. In conclusion, continuing education, certification and post-graduated courses is provided for nurses about their other roles and responsibilities as well as increasing the quality of oral medication administration which is a difficult area.     

Implementing AORN Recommended Practices for Medication Safety

Medication errors in the perioperative setting can result in patient morbidity and mortality. The AORN “Recommended practices for medication safety” provide guidance to perioperative nurses in developing, implementing, and evaluating safe medication use practices. These practices include recognizing risk points in the medication use process, collaborating with pharmacy staff members, conducting preoperative assessments and postoperative evaluations (eg, medication reconciliation), and handling hazardous medications and pharmaceutical waste. Strategies for successful implementation of the recommended practices include promoting a basic understanding of the nurse's role in the medication use process and developing a medication management plan as well as policies and procedures that support medication safety and activities to measure compliance with safe practices.     

Perioperative pharmacology: a framework for perioperative medication safety

Learning pharmacology is a critical element of any health care practitioner's education to ensure quality and safety in perioperative care. The medication-use process and safe medication use are two important principles that contribute to the safe use of pharmacological agents in perioperative clinical practice. The medication-use process consists of procuring, prescribing, transcribing, dispensing, administering, and monitoring; however, variations in the medication-use process result from demands unique to the perioperative environment, and these variations can sometimes bypass the safety nets within the system. Understanding these variances will help perioperative practitioners recognize threats to patient safety and help ensure the patient's well-being. Responsibilities of a safe medication-use system include assuring the public that practitioners use medications efficiently, safely, and effectively, and fully document all medications administered.     

Medication management by graduate nurses: before, during and following medication administration

The purpose of the present study was to explore graduate nurses' perceptions of their medication management activities in the acute care context. A qualitative research design with a semistructured interview schedule was used to elicit information from participants. The sampling population consisted of graduate nurses involved in direct patient care in medical and surgical wards of a Melbourne metropolitan teaching hospital, completing a graduate nurse program. Twelve graduate nurses participated in the interviews. Two major themes emerged: (i). monitoring medications and (ii). interventions for patient care. The findings indicate that graduate nurses are required to address several facets of the medication management role in their daily practice. It is pertinent to examine ward dynamics to ensure that graduate nurses have ready access to experienced health care professionals. Through collegial support, graduate nurses should also be encouraged to critically examine the different possibilities when making clinical judgments about monitoring patient medications.     

单纯或联合药物治疗复发性外阴阴道念珠菌病48例疗效分析

目的 :探讨两种方法治疗复发性外阴阴道念珠菌病的效果。方法 :将 4 8例复发性外阴念珠菌阴道炎的患者随机分为两组 ,分别给予两种治疗方法。Ⅰ组 (2 5例 ) :每晚米可定泡腾片 1片塞入阴道 ,连续用药 7～ 10d。首次用药后 1周复查 ,临床及白带真菌学培养阴性进入维持期治疗 ,即每周 1次米可定泡腾片 1片阴道塞 ,连续 5个月。Ⅱ组 (2 3例 ) :单次口服氟康唑15 0mg外加每晚米可定泡腾片 1片阴道塞 ,连续用药 7～ 10d。首次用药后 1周复查 ,临床及白带真菌学培养阴性进入维持期治疗 ,即每月月经第 1天口服氟康唑 15 0mg外加每周 1次米可定泡腾片 1片阴道塞、连续 5个月。结果 :首次治疗后 1周及第1个月、12个月两组的治愈率、无效率及假阳性率统计学结果无差异 (P >0 .0 5 ) ,而维持治疗第 1、3和 6个月Ⅱ组的治愈率显著高于Ⅰ组、无效率显著低于Ⅰ组 (P <0 .0 5 )。结论 :氟康唑口服与米可定泡腾片阴道联合用药半年能有效减少治疗期间复发率 ,但停药后并不能降低复发率。     

Infusion volume control and calculation using metronome and drop counter based intravenous infusion therapy helper

This study assessed the method of fluid infusion control using an IntraVenous Infusion Controller (IVIC). Four methods of infusion control (dial flow controller, IV set without correction, IV set with correction and IVIC correction) were used to measure the volume of each technique at two infusion rates. The infused fluid volume with a dial flow controller was significantly larger than other methods. The infused fluid volume was significantly smaller with an IV set without correction over time. Regarding the concordance correlation coefficient (CCC) of infused fluid volume in relation to a target volume, IVIC correction was shown to have the highest level of agreement. The flow rate measured in check mode showed a good agreement with the volume of collected fluid after passing through the IV system. Thus, an IVIC could assist in providing an accurate infusion control.