Prevalence of medication-related problems among patients with renal compromise in an Indian hospital

What is known and Objective: Patients suffering from renal dysfunction often have multiple medical conditions either as a cause or as a consequence of their renal disease. These patients receive an average of 10–12 medications daily leading to complex dosing schedules and are more likely to develop medication‐related problems (MRPs). The objectives of this study were to determine the nature and extent of MRPs in renally compromised patients and to explore the potential clinical significance of the MRPs. The potential for a clinical pharmacist to contribute towards resolving or preventing some of these MRPs was also explored. Methods: A prospective study was conducted for a period of 9 months in the renal unit of Jagadguru Shri Shivaratheeshwara (JSS) Medical College Hospital, Mysore, India. Patients undergoing dialysis on outpatient basis and patients who were admitted under the care of or referred to the nephrologists for renal dysfunction from other specialties were reviewed. Patterns of the MRPs were identified using an adapted Hepler and Strand criteria. The potential clinical significance of the MRPs and the contribution of the clinical pharmacist in resolving or minimizing some of the MRPs were also explored. Results and Discussion: Three hundred and twenty‐seven MRPs were identified with 308 patients reviewed. The incidence of MRPs was found to be 1·06 ± 0·85 per patient reviewed. The most common MRP identified in our study was overdose (19·3%) followed by adverse drug reactions (19·0%). Cardiovascular agents (33·6%) followed by anti‐infective agents (26·3%) were the most common therapeutic classes of medication implicated in causing MRPs. Twenty‐six per cent of the MRPs identified were explored to be potentially moderate or major in clinical significance. The clinical pharmacists’ recommendations were accepted in 97% of the cases, which resulted in a change in therapy in 83% of the cases. What is new and Conclusion: Medication‐related problems are frequent in renally compromised patients in our patient population. The high level of acceptance of clinical pharmacist’s recommendations by the nephrologists demonstrates that clinical pharmacists may help improve overall patient care in this setting.     

A new reliable tool (PVC assess) for assessment of peripheral venous catheters

Rationale and aims To evaluate the extensive use of peripheral venous catheters (PVCs), including catheter‐related complications, a reliable tool for PVC assessment is needed. The aim of this study was to develop such a tool to evaluate PVCs in relation to management, documentation and signs and symptoms of thrombophlebitis (TH), as well as to determine its inter‐rater and test‐retest reliability. Method The tool development included confirmation of content and face validity. Two groups of registered nurses used the new tool (PVC assess ) to assess PVC management and signs of TH independently. Group A (n = 3) assessed 26 items in 67 PVCs bedside (inter‐rater reliability). Group B (n = 3) assessed photographs (67 PVCs, 21 items) of the same PVCs as those in Group A with a 4‐week interval (test‐retest reliability). Proportion of agreement P(A) and Cohen's kappa were calculated to evaluate inter‐rater and test‐retest reliability. Results Among nurses assessing PVCs at bedside, the P(A) was good to excellent (0.80–1) in 96% of the items in PVC assess . In 80% of the items kappa was substantial to almost perfect (0.61–1). TH sign erythema fell into the fair range (kappa = 0.40). In test‐retest reliability analysis the P(A) was within the good and excellent range (0.80–1.0) and kappa varied from moderate to almost perfect (0.41–1.0) in 95% of the items. One item ‘outer dressing is clean’ was in fair range (0.21–0.40). Conclusions The PVC assess instrument shows satisfactory inter‐rater and test‐retest reliability. Reliability tests on reviewing documentation remain to be performed.     

Development,intra- and inter-rater reliability of the New Zealand Secretion Scale (NZSS)

Abstract

Purpose: The New Zealand Secretion Scale (NZSS) has been developed for comprehensive assessment of accumulated secretions during endoscopy. The scale rates secretion severity under the subcategories location, amount and response. This study describes the scale’s development and reliability when used by experts and untrained raters.

Method: One expert scored 254 endoscopy videos using the NZSS and performed repeat measures on 100 randomly selected videos one month later. These 100 videos were scored by a second expert in a randomised order. In a second arm of the study, 28 raters scored 10 endoscopy videos, without training on the NZSS. Seventeen had experience in endoscopy (mean 1.8 years, SD?=?1.0). Reliability was calculated across the entire cohort and as a function of experience interpreting endoscopy.

Result: Strong internal consistency (Cronbach’s α?=?0.88), and high inter-item (>0.60) and corrected item-total correlations (>0.70) were established. Inter-rater (ICC?=?0.99) and intra-rater reliability (ICC?=?0.95) of the experts was excellent. Inter-rater reliability of the untrained raters ranged from ICC?=?0.65–0.79, with no significant influence of experience on reliability.

Conclusion: The NZSS is a reliable assessment of secretion severity during endoscopy and can be used without training. This comprehensive scale will support research evaluating the predictive value of accumulated secretions.     

Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system

Purpose: Cerebral palsy (CP) is the most common disability in childhood. The gross motor function classification system (GMFCS) has become an important tool to assess motor function in CP patient. In 2007, the expanded and revised (E&R) version of GMFCS which includes age band for youth 12–18 years of age was developed. The aim of this study was to evaluate reliability of Turkish version of expanded and revised GMCS. Methods: We assessed interobserver reliability between two physical medicine and rehabilitation specialists in 136 children with CP and test-retest reliability within a subgroup of 48 patients. Percent agreement, intraclass correlation coefficient (ICC) and μ statistics were used to evaluate reliability. Result: The ICC between two physicians was 0.97 and the total agreement was 89%. This result indicates excellent agreement. The overall weighted μ was 0.86. High test-retest reliability was found (ICC: 0.94 95% confidence interval) and the total agreement was 75% for test-retest reliability. Conclusion: The Turkish version of the E&R GMFCS is shown to be reliable and valid for assessment of Turkish CP children.

Implications for Rehabilitation

• Cerebral palsy (CP) is the major developmental disability affecting function in children.

• Assessment of functional status of children with CP is important for planning treatment.

• The gross motor function classification system (GMFCS) can be considered to be a diagnostic tool for predicting motor development in children with CP based on self-initiated movement, emphasising on sitting, transfers and mobility. The expanded GMFCS includes an age band for youth 12–18 years of age.