An assessment of pharmaceutical inspection reports from nursing and residential homes for the elderly in Northern Ireland

Objectives To highlight issues currently being inspected in nursing, residential and dual‐registered homes (care homes) for the elderly in Northern Ireland as part of a pharmaceutical inspection. Methods A cross‐sectional survey and analysis of reports from pharmaceutical inspections in Northern Ireland care homes between January 1999 and December 2000 was undertaken, using reports provided by the four Registration and Inspection Units (R & I Units 1–4) within the region. Reports were reviewed and all recommendations made by inspectors were classified into 11 main categories. Binary logistic regression was used to examine possible relationships between the type of home (nursing, residential or dual‐registered) or the R & I unit and the recommendations made by the inspectors, with corresponding odds ratios and 95% confidence intervals. Key findings Reports from 415 homes (one report per home) formed the final sample for analysis. Each R & I unit used different documentation to conduct a pharmaceutical inspection. Homes received the majority of recommendations from inspectors in the categories ‘Records’ (66.7% of all homes), ‘Policies and protocols’ (39.3%) and ‘Medication’ (31.8%). More recommendations in a number of categories emanated from R & I unit 4 compared with R & I unit 1 (referent). Dual‐registered homes (those registered as a nursing and residential facility) were more likely to receive a recommendation in the categories ‘Storage of medicine’, ‘Order and receipt of medication’ and ‘Equipment’ than nursing or residential homes. Conclusion Inspections of care homes should be standardised in terms of documentation used and facilities should be given guidance on issues that are likely to result in recommendations from inspectors. In the longer‐term, pharmaceutical inspections should move from a focus on structure/process measures to those that emphasise quality in prescribing.     

Working alongside nursing staff to review medication in nursing homes

□ Pharmacists performed medication reviews in nursing homes using the nursing staff as a source of information □ Lack of access to medical records did hamper the review but was not the main reason for non‐implementation □ The recommendations were more likely to be implemented if further clinical information was supplied to the general practitioner □ All of the pharmacists, all of the nursing staff responding and a majority of the GPs who responded wished to see the project continue □ Future training of community pharmacists should focus on “how to review”.     

浅析药监执法住宅检查权的正确运用

目的对药监执法过程中住宅检查权的正确运用提出建议。方法介绍了住宅检查权的定义、性质及法律依据,分析了住宅检查权与非法侵宅、非法搜查的区别,探讨了在药监执法过程中住宅检查权的正确运用问题。结果与结论在特殊原因、特定条件下,药监部门可行使住宅检查权,依法定程序、运用法定手段、检查法定区域,及时发现、处理涉药违法行为,维护良好的市场秩序。     

A pharmaceutical advisory service in a private nursing home: provision and outcome

A survey of pharmaceutical care in two private nursing homes in Norfolk identified concerns relating to the extent and nature of patient therapy as well as its administration and documentation (see p83). With the support of medical and nursing staff, relevant policy documents were reviewed by the investigating pharmacist and then implemented. A laxative policy was also introduced. During the next five months, monthly medication reviews were made for the 60 patients (eight male, 52 female; mean age 84 [±9] years) who remained from the original survey. Recommendations concerning individual drug therapy were subsequently evaluated. Of the 44 recommendations for changes in prescribing and administration of drugs that were accepted by the medical/nursing staff, 37 produced positive outcomes for the patient. Compared with the baseline data, there were significant increases in the number of patients who were free of possible drug induced problems (P<0.05) or no longer constipated (P<0.005) and a significant increase in the proportion of medicines administered in accordance with the prescriber's wishes (P<0.05). The accuracy and completeness of drug administration records had improved and guidelines for nurse prescribing had been rationalised. The mean daily number of items taken by patients had fallen by 1.5. Based on these data, provision of pharmaceutical care to private nursing homes should produce significant cost savings and improve patient care.     

Clinical medication review by a pharmacist of patients on repeat prescriptions in general practice

□ The government proposes an extension to pharmacists' role to medicine management, including services such as medication review □ We found that pharmacist‐conducted clinical medication review identified medication related problems in nearly half of the patients seen and a quarter of medicines reviewed □ Pharmacist‐conducted clinical medication review is effective in identifying clinical issues related to patients' repeat medication and recommendations are accepted by general practitioners □ There are education and training issues for pharmacy if this model is to be accepted more widely. The pharmacist will need to be part of the primary health care team with access to medical records     

Nursing and residential care for the elderly in Northern Ireland: the contribution of the pharmacist

Aim of the study: To gain more detailed information on the current pharmaceutical service provision in nursing and residential homes in Northern Ireland and to assess the views of care staff on future pharmacy services. Method: A structured questionnaire was developed and mailed to all nursing and residential homes (n=586) in Northern Ireland on two occasions. Results: A response rate of 68% (n=396) was obtained. The most frequent services currently provided by community pharmacists were the supply of medication and the collection of unwanted, discontinued or outofdate medicines. The majority of respondents also reported receiving advice on safekeeping, correct administration of medicines, advice on more appropriate formulations and advice on patient medication records from the community pharmacist. Over a third of all the respondents received advice on compliance devices. A similar proportion stated that their care staff were trained by the pharmacist on broad medication management issues.Over 90% of all homes strongly supported staff training by pharmacists on the recognition of medicationrelated problems as a future service. Over 70% of all respondents thought additional guidelines and advice for missed dosages and the use of home remedies would be beneficial. A review of patient medication records to assess drugdrug interactions and possible adverse drug reactions by pharmacists was supported by over 65% of all respondents. Conclusions: This work has demonstrated that those responsible for care in nursing and residential facilities strongly support further involvement by the pharmacist in these care facilities; pharmacy policy makers must ensure that such services are developed to meet the needs of these vulnerable elderly residents.     

Development of a process-oriented quality improvement strategy for the medicines pathway in nursing homes using the SEIPS model

Background and objectiveMedication errors in nursing homes are highly prevalent and occur in different stages of the medicines pathway. The application of the SEIPS (System Engineering Initiative for Patient Safety) model facilitates the identification of work system factors that contribute to errors. Therefore, the aim of our research was to investigate in-depth the medicines pathway in nursing homes by using the SEIPS model and to develop a set of key activities and aggregated key interventions to be used as a basis for quality-improvement strategies.MethodsA variety of qualitative methods, including observations, semi-structured interviews, the development of a flowchart, an expert meeting and a working symposium, were used to identify processes and work system components. Key interventions and activities were developed in three rounds (one development and two validation rounds) across the different research methods to fine-tune the defined key interventions and activities.ResultsOur analysis revealed a large variety of tasks as well as persons elements, aspects related to technology and tools, organisational factors and environmental elements that all interact and influence the medicines pathway. The large number of tasks could be linked to eight overarching processes: prescribing, purchase and ordering, delivery, storage, preparation, administration, monitoring and (re-)admission. After three rounds (one development and two validation rounds), a final set of 137 key activities and 27 aggregated key interventions, concretising the eight processes, was obtained.ConclusionThe in-depth analysis of processes within the medicines pathway in nursing homes resulted in a set of key activities and aggregated key interventions which may serve as a basis for the nursing home sector and policy makers to enhance a safe and efficient medicines pathway.     

A search for socio‐economic influences in behaviour and attitudes to medicines available for self‐medication and NHS prescription

□ Variations in medicines purchased for pain relief and dyspepsia in areas with contrasting socio‐economic characteristics mirror morbidity and mortality data for the localities □ A higher overall use of medicines, both purchased and prescribed, was found in the more socially “deprived” area □ Purchasers of medicines in the “deprived” area were more frequent users of these medicines □ Purchasers of medicines in the “deprived” area were more likely to be taking concurrent prescribed medication.     

Multidisciplinary medication review: evaluation of a pharmaceutical care model for nursing homes

Objective The objective of this study was to assess implementation of a pharmaceutical care model for the multidisciplinary care of elderly patients in nursing homes. Setting Prospective study, medication review, from January 2007 to December 2009 in ten nursing homes affiliated to the Pharmacie interjurassienne (PIJ), Switzerland. Method Medication use data were collected and reviewed by a pharmacist, focusing on drug indication, dosing, side effects, renal/hepatic elimination and interactions. Drug-related problems (DRPs) were discussed face-to-face with the responsible physician and a nurse. The pharmaceutical care issues were formulated and medication interventions proposed during this meeting. DRPs and interventions were documented using the Pharmaceutical Care Network Europe scheme version 5.00 (PCNE V5.00). The economic impact of the service was estimated through a retrospective evaluation of annual drug costs. A satisfaction evaluation was conducted among practitioners and nurses. Main outcome measures DRPs, interventions, treatment changes implemented. Results Drug therapy of 329 patients was reviewed. The number of medicines per patient ranged from 2 to 27 (mean 12.8). A total of 1,225 DRPs were detected and discussed with the physician and the nurse. Medication review led to 343 medical evaluations secondary to drug-drug interactions and 803 treatment adaptations: 373 drugs were stopped, 197 dosages changed, 95 instructions for use amended, 86 drug choices were altered, 35 drug formulations changed and 17 new drugs started. According to the Anatomical Classification System, the main classes involved in interventions were related to Alimentary tract and metabolism (n = 285), Nervous system (n = 189) and Cardiovascular system (n = 115). Since the outset of the PIJ, the annual drug costs decreased in nursing homes with medication review including a pharmacist, whereas it was stable in the other nursing homes. The satisfaction evaluation showed a very positive appreciation by practitioners and nurses. Conclusion The study showed an efficient pharmaceutical care model, well accepted by physicians and nurses. It also indicated that for elderly patients, continuous drug review contributed to improved drug therapy, reduced unnecessary polypharmacy and reduced pharmaceutical costs.     

A randomised,controlled study to quantify the benefits of community pharmacist interventions on the prescribing of cardiovascular drugs in general practice

□ The impact of a one‐off medication review by a specially trained community pharmacist, with recommendations to the patient's general practitioner was studied □ No differences were observed in any of the physiological or biochemical monitoring indicators □ There was greater improvement post‐intervention in some key quality prescribing indicators (eg, prescribing of antiplatelet and beta blocker or ACE inhibitor post‐MI); others showed equal improvement in both groups (diabetic patients on ACE inhibitor) □ A single review of medication records by a practice‐based pharmacist, with a dependence on the general practitioner to implement change may have limited benefit.     

Use of Medicines that Influence Falls or Fractures in a Residential Home Setting

Objective: To study the pattern of use of medicines that may contribute to, or protect against, falls and fractures in the setting of a UK residential home population, and to compare the results with a similar study conducted in 2001.Setting and method: A cross-sectional survey was conducted in 2003 in 18 residential homes. A trained community pharmacist visited the homes to retrieve information about use of medicines whilst demographic details were provided by the residential home staff.Main outcome measure: The proportion of patients who were prescribed medicines with a potential positive benefit in preventing fractures, and medicines that may cause elderly people to fall.Results: The study population consisted of 581 residents. Compared to the 2001 study, the use of both calcium and vitamin D had increased significantly (8.3% versus 2.1%). Although, the overall prescribing of psychotropics in 2003 was relatively low, there was a trend for increased prescribing of these medicines which have been identified as risk factors for falling.Conclusion: In a residential home setting in the UK, the use of psychotropic drugs is not uncommon, whereas there is limited use of drugs that have the potential for preventing morbidity associated with falls.     

Integrating the community pharmacist into the diabetes team: evaluation of a new care model for patients with Type 2 diabetes mellitus

□ Diabetes is a major public health issue affecting 3 per cent of the population □ Integration of the pharmacist into the multidisciplinary care of patients with chronic conditions is supported by the profession and the government □ Community pharmacists engaging with their established customers and access to relevant data can, through use of a systematic process, identify the pharmaceutical needs of this patient group □ The model of care proposed is feasible in a primary care setting, resulting in acceptance of pharmaceutical care issues general practitioners and an improvement in patient care     

中国药包材微生物检查方法及标准的合理性探讨

《国家药包材标准》2015年版收载了130个药包材标准,在保障药包材及药品质量安全方面发挥了重要作用。然而,随着中国药典2020年版的修订和对药包材微生物限度检查认识的不断提高,当前药包材标准中的5类29种微生物和无菌检查方法及限度标准的合理性存在一定问题。本文从药包材微生物标准的项目设置、检查方法等方面分析存在的问题,提出优化项目等7个方面的修订建议,探讨建立基于风险的药包材微生物检查方法及标准的可行性,以期为中国药包材微生物检查方法及标准体系的完善提供参考。     

Preliminary investigation of the problems associated with supply of palliative care medicines in primary care

□ Fax‐back was a cost effective method for administration of a self‐completion questionnaire which produced a high (76 per cent) response rate □ Problems with supply of palliative care medicines were reported by 58.5 per cent of health authorities responding to the survey □ Supply of medicines out of hours was the most common problem reported (93 per cent), with stock levels held in pharmacies and problems with specialist medicines also causing problems in over 50 per cent of respondents □ Some health authorities reported that protocols for supply of palliative medicines, or the existence of designated community pharmacies for their provision, reduced the problems reported □ Further research into effectiveness of protocols and designated palliative care pharmacies is indicated, and our study has identified those health authorities where such research could be targeted     

把握现场检查重点环节 有效提高认证质量

目的探讨GSP现场检查重点问题,为有效提高药品GSP认证质量提供参考。方法对新修订药品GSP实施以来的检查情况进行梳理,讨论现场认证检查过程中应把握的重点环节,分析检查报告中易出现的问题。结果与结论应进一步统一检查标准,检查报告的撰写应更加规范,以更好地对药品经营企业实施监管,建立良好的药品市场秩序。