| 1. |
- Midlöv, Patrik, et al.
(författare)
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Medication report reduces number of medication errors when elderly patients are discharged from hospital
- 2008
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Ingår i: PHARMACY WORLD & SCIENCE. - : Springer Science and Business Media LLC. - 0928-1231 .- 1573-739X. ; 30:1, s. 92-98
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate whether a Medication Report can reduce the number of medication errors when elderly patients are discharged from hospital. Method We conducted a prospective intervention with retrospective controls on patients at three departments at Lund University Hospital, Sweden that where transferred to primary care. The intervention group, where patients received a Medication Report at discharge, was compared with a control group with patients of the same age, who were not given a Medication Report when discharged from the same ward one year earlier. Main outcome measures The main outcome measure was the number of medication errors when elderly patients were discharged from hospital. Results Among 248 patients in the intervention group 79 (32%) had at least one medication error as compared with 118 (66%) among the 179 patients in the control group. In the intervention group 15% of the patients had errors that were considered to have moderate or high risk of clinical consequences compared with 32% in the control group. The differences were statistically significant (P < 0.001). Conclusion Medication errors are common when elderly patients are discharged from hospital. The Medication Report is a simple tool that reduces the number of medication errors.
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| 2. |
- Hellström, Lina, et al.
(författare)
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Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits.
- 2011
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 67:7, s. 741-752
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Tidskriftsartikel (refereegranskat)abstract
- PurposeTo examine the impact of systematic medication reconciliations when admitted to hospital, and medication review while in hospital, on the number of inappropriate medications and unscheduled drug-related hospital revisits in elderly patients.MethodsA prospective, controlled study in 210 patients, aged 65 years or older, who were admitted to one of three internal medicine wards at a University Hospital in Sweden. Patients received either standard care or care according to the Lund Integrated Medicines Management (LIMM) model. A multi-professional team, including a clinical pharmacist, provided medication reconciliations on admission and medication reviews during the hospital stay for the LIMM group. Blinded reviewers evaluated the appropriateness of the prescribing (using the Medication Appropriateness Index) on admission and discharge, and assessed the probability that a drug-related problem was the reason for any patient readmitted to hospital or visiting the emergency department within three months of discharge (using WHO causality criteria).ResultsThere was a greater decrease in the number of inappropriate drugs in the intervention group than in the control group for both the intention-to-treat population (51% [95% CI 43-58%] versus 39% [95% CI 30-48%], p=0.0446) and the per-protocol population (60% [95% CI 51-67%] versus 44% [95% CI 34-52 %], p=0.0106). There were 6 revisits to hospital in the intervention group which were judged as ‘possibly, probably or certainly drug-related’, compared with 12 in the control group (p=0.0469).ConclusionIn this study, medication reconciliation and reviews provided by a clinical pharmacist in a multi-professional team significantly reduced the number of inappropriate drugs and unscheduled drug-related hospital revisits for elderly patients.
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| 3. |
- Midlöv, Patrik, et al.
(författare)
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Clinical outcomes from the use of Medication Report when elderly patients are discharged from hospital
- 2008
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Ingår i: PHARMACY WORLD & SCIENCE. - : Springer Science and Business Media LLC. - 0928-1231 .- 1573-739X. ; 30:6, s. 840-845
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Tidskriftsartikel (refereegranskat)abstract
- Objective The objective of this study was to investigate whether a Medication Report also can reduce the number of patients with clinical outcomes due to medication errors. Method A prospective intervention study with retrospective controls on patients at three departments at Lund University Hospital, Sweden that where transferred to primary care. The intervention group, where patients received a Medication Report at discharge, was compared with a control group with patients of the same age, who were not given a Medication Report when discharged from the same ward one year earlier. For patients with at least one medication error all contacts with hospital or primary care within 3 months after discharge were identified. For each contact it was evaluated whether this was caused by the medication error. We also compared medication errors that have been evaluated as high or moderate clinical risk with medication errors without clinical risk. Main outcome measures Need for medical care in hospital or primary care within three months after discharge from hospital. Medical care is readmission to hospital as well as visits of study population to primary and out-patient secondary health care. Results The use of Medication Report reduced the need for medical care due to medication errors. Of the patients with Medication Report 11 out of 248 (4.4%) needed medical care because of medication errors compared with 16 out of 179 (8.9%) of patients without Medication Report (p = 0.049). The use of a Medication Report significantly reduced the risk of any consequences due to medication errors, p = 0.0052. These consequences included probable and possible care due to medication error as well as administrative procedures (corrections) made by physicians in hospital or primary care. Conclusions The Medication Report seems to be an effective tool to decrease adverse clinical consequences when elderly patients are discharged from hospital care.
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| 4. |
- Bondesson, Åsa ÅB, et al.
(författare)
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A structured questionnaire to assess patient compliance and beliefs about medicines taking into account the ordered categorical structure of data
- 2009
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 15:4, s. 713-723
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Tidskriftsartikel (refereegranskat)abstract
- RATIONALE, AIMS AND OBJECTIVE: The objectives were to describe and evaluate the structured medication questionnaire and to improve data handling of results from the Morisky four-item scale for patient compliance and Beliefs about Medicines Questionnaire-specific (BMQ-specific). METHODS: A questionnaire was developed with the purpose of being used when identifying medication errors and assessing patient compliance to and beliefs about medicines. RESULTS: A majority of the respondents (62%; CI 45-77%) had at least one medication error. Assuming that all items are equally important in the Morisky four-item scale we presented four alternative ways to create a unidimensional global scale. A two-dimensional global scale was also constructed. The results from the BMQ-specific were presented in different ways, all taking into account that the scale has ordered verbal categories: at the level addressing each specific question, at the sub-scales 'concern' and 'necessity' level and at the global level. CONCLUSIONS: The structured medication questionnaire can be used in daily practice as a tool to identify drug-related problems. The choice of how to use and present data from those scales in research depends on patient characteristics and how discriminating one would like the scales to be.
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| 5. |
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| 6. |
- Bergkvist, Anna, et al.
(författare)
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Improved quality in the hospital discharge summary reduces medication errors-LIMM: Landskrona Integrated Medicines Management.
- 2009
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 65, s. 1037-1046
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We have developed a model for integrated medicines management, including tools and activities for medication reconciliation and medication review. In this study, we focus on improving the quality of the discharge summary including the medication report to reduce medication errors in the transition from hospital to primary and community care. METHODS: This study is a longitudinal study with an intervention group and a control group. The intervention group comprised 52 patients, who were included from 1 March 2006 until 31 December 2006, with a break during summer. Inclusion in the control group was performed in the same wards during the period 1 September 2005 until 20 December 2005, and 63 patients were included in the control group. In order to improve the quality of the medication report, clinical pharmacists reviewed and gave feedback to the physician on the discharge summary before patient discharge, using a structured checklist. Medication errors were then identified by comparing the medication list in the discharge summary with the first medication list used in the community health care after the patient had returned home. RESULTS: By improving the quality of the discharge summary, patients had on average 45% fewer medication errors per patient (P = 0.012). The proportion of patients without medication errors was 63.5% in the control group and 73.1% in the intervention group. However, this increase was not significant (P = 0.319). Patients who used a specific medication dispensing system (ApoDos) had a 5.9-fold higher risk of suffering from medication errors than those without this medication dispensing system (P < 0.001). CONCLUSION: Review and feedback on errors in the discharge summary, including the medication report and a correct medication list, reduced medication errors during the transfer of information from hospital to primary and community care.
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| 7. |
- Midlöv, Patrik, et al.
(författare)
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Medication errors when transferring elderly patients between primary health care and hospital care
- 2005
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Ingår i: PHARMACY WORLD & SCIENCE. - : Springer Science and Business Media LLC. - 0928-1231 .- 1573-739X. ; 27:2, s. 116-120
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aims were to evaluate the frequency and nature of errors in medication when patients are transferred between primary and secondary care. Method: Elderly primary health care patients (> 65 years) living in nursing homes or in their own homes with care provided by the community nursing system, had been admitted to one of two hospitals in southern Sweden, one university hospital and one local hospital. A total of 69 patient-transfers were included. Of these, 34 patients were admitted to hospital whereas 35 were discharged from hospital. Main outcome measure: Percentage medication errors of all medications i.e. any error in the process of prescribing, dispensing, or administering a drug, and whether these had adverse consequences or not. Results: There were 142 medication errors out of 758 transfers of medications. The patients in this study used on an average more than 10 drugs before, during and after hospital stay. On an average, there were two medication errors each time a patient was transferred between primary and secondary care. When patients were discharged from the hospital, the usage of a specific medication dispensing system constituted a significant risk for medication errors. The most common error when patients were transferred to the hospital was inadvertent withdrawal of drugs. When patients left the hospital the most common error was that drugs were erroneously added. Conclusion: Medication errors are common when elderly patients are transferred between primary and secondary care. Improvement in documentation and transferring data about elderly patients' medications could reduce these errors. The specific medication dispensing system that has been used in order to increase safety in medication dispensing does not seem to be a good instrument to reduce the number of errors in transferring data about medication.
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| 8. |
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| 9. |
- Chew, M, et al.
(författare)
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Thalidomide inhibits early atherogenesis in apoE-deficient mice
- 2003
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Ingår i: APMIS : acta pathologica, microbiologica, et immunologica Scandinavica. - 1600-0463. ; 111:Suppl., s. 113-116
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Tidskriftsartikel (refereegranskat)abstract
- Inflammation is present in all stages of atherosclerosis, from fatty streaks to rupture of mature plaques. Tumour necrosis factor (TNF)-alpha is expressed in atherosclerotic lesions but its role in atherogenesis has not been defined. To clarify the role of this cytokine, we administered thalidomide, a compound known to inhibit TNF-alpha production, to homozygous apolipoprotein E-deficient (apoE(-/-)) mice in order to examine the effect of thalidomide on the development of early atherosclerotic lesions. Twelve apoE(-/-) mice were randomized to receive either sustained-release thalidomide or placebo pellets implanted subcutaneously, and the amount of atherosclerosis was quantified six weeks later. Thalidomide was well tolerated and did not result in any changes in body weight. Mice treated with thalidomide had significantly smaller mean (7986+/-5189 vs 19607+/-10353 mum(2), p=0.05) and maximum (15800 [12777-23675] vs 37169 [28000-41351] mum(2), p=0.03) lesion sizes than those treated with placebo. Thus, thalidomide is capable of inhibiting the early development of atherosclerosis, presumably by inhibition of TNF-alpha secretion.
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| 10. |
- Eriksson, Tommy, et al.
(författare)
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Criteria for medicines management in hospitals
- 2011
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Ingår i: EJHP Science. - 1781-7595. ; 17:3, s. 83-88
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Tidskriftsartikel (refereegranskat)abstract
- Study objectives: The aim of this study was to develop quality criteria for further development and use in the Medicines Management(MM) process in European hospitals. Methods: Criteria for MM were developed in three steps using a modified two-stage Delphi-technique. In the first step a literature search was performed and 300 topics were listed. These topics were grouped into three dimensions, eight main and 23 sub areas, rephrased and a questionnaire including 114 criteria that could be perceived as important today and in the near future was prepared. In steps 2 and 3 a panel of experts independently, based on questionnaires, evaluated the importance between the dimensions, areas, and criteria on a four-level Likert-scale. In the second questionnaire the panel had access to the group results from the first questionnaire. Total importance and the three domains of patient safety, environment, and cost-effectiveness were evaluated. Results: Nine of 11 experts completed the two questionnaires. The three dimensions of patient use, healthcare handling, and strategic MM work, were well balanced and the importance ratings between them were 35, 39, and 26%, respectively. No criteria had a full mean importance of 4 but 31 criteria scored between 3.6 and 3.9. The patient safety domain importance scores were generally very high and the environmental domain low. Five criteria were considered to be of very big importance among all experts in the patient safety domain and none in the other two domains. Conclusion: This study provides important information on criteria for the further development of standards and indicators for a quality system in hospital settings, High Performance Medicines Management (HPMM).
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