| 1. |
- 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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| 2. |
- Bergkvist, Anna, et al.
(författare)
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The process of identifying, solving and preventing drug related problems in the LIMM-study
- 2011
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Ingår i: International Journal of Clinical Pharmacy. - : Springer Science and Business Media LLC. - 2210-7703 .- 2210-7711. ; 33:6, s. 1010-1018
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Tidskriftsartikel (refereegranskat)abstract
- Objective To avoid negative effects of drug treatment and need for additional medical care, drug treatment must be individualised. Our research group has developed a model for clinical pharmacy which improves several aspects of the patient's drug treatment. This study describes the process behind these improvements, i.e. drug related problems identified by pharmacists within a clinical pharmacy service. Setting Three wards at a department of internal medicine. Method Pharmacists performed systematic interventions during the patient's hospital stay, aiming to identify, solve and prevent drug related problems in the elderly. Identified drug related problems were put forward to the health care team and discussed. Information on identified problems, and their outcomes was collected and analysed. A questionnaire was used to evaluate the health care personnel's attitudes towards the process. Main outcome measure The number of drug related problems identified by the clinical pharmacists, the proportion of problems discussed with the physicians, the proportion of problems adjusted by the physicians and whether pharmacists and physicians prioritised any subgroup of drug related problems when choosing which problems to address. Finally, we wanted to evaluate the health care personnel's attitudes towards the model. Results In total, 1,227 problem were identified in 190 patients. The pharmacists discussed 685 (55.8%) of the identified problems with the physicians who accepted 438 (63.9%) of the suggestions. There was no significant difference in which subgroup to put forward and which to adjust. There was a high response rate (84%) to the questionnaire, and the health care personnel estimated the benefits to be very high, both for the patients and for themselves. Conclusion The process for identifying, solving and preventing drug related problems was good and the different types of problems were considered equally important. The addition of a clinical pharmacy service was considered very useful. This suggests that the addition of our clinical pharmacy service to the hospital setting add skills of great importance.
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| 3. |
- 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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| 4. |
- Bondesson, Åsa ÅB, et al.
(författare)
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Acceptance and importance of clinical pharmacists' LIMM-based recommendations.
- 2012
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Ingår i: International Journal of Clinical Pharmacy. - : Springer Science and Business Media LLC. - 2210-7703 .- 2210-7711. ; 34:2, s. 272-276
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Tidskriftsartikel (refereegranskat)abstract
- Objective The objective of this study was to evaluate the quality of the clinical pharmacy service in a Swedish hospital according to the Lund Integrated Medicine Management (LIMM) model, in terms of the acceptance and clinical significance of the recommendations made by clinical pharmacists. Method The clinical significance of the recommendations made by clinical pharmacists was assessed for a random sample of inpatients receiving the clinical pharmacy service in 2007. Two independent physicians retrospectively ranked the recommendations emerging from errors in the patients' current medication list and actual drug-related problems according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant). Results The random sample comprised 132 patients (out of 800 receiving the service). The clinical significance of 197 recommendations was assessed. The physicians accepted and implemented 178 (90%) of the clinical pharmacists' recommendations. Most of these recommendations, 170 (83%), were ranked 3 (somewhat significant) or higher. Conclusion This study provides further evidence of the quality of the LIMM model and confirms that the inclusion of clinical pharmacists in a multi-professional team can improve drug therapy for inpatients. The very high level of acceptance by the physicians of the pharmacists' recommendations further demonstrates the effectiveness of the process.
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| 5. |
- Bondesson, Åsa ÅB
(författare)
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Aspects on optimisation of drug therapy in the elderly
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Elderly patients often use many drugs, increasing the risk for drug-related problems. Aim: To optimise drug therapy in the elderly by identifying, resolving and preventing drug-related problems. Methods: (Paper I) Medication reviews were conducted on nursing home patients’ with epilepsy or Parkinson’s disease by a multi-speciality team, whom identified drug-related problems and when appropriate suggested therapy changes to the intervention patients’ responsible physician. The effect of this intervention was evaluated on health-related quality of life. (Paper II) GPs’ and nurses’ opinions towards the previous pharmacotherapeutic intervention, in Paper I, were evaluated using a questionnaire. (Paper III) Medication errors during the transfer between primary care and hospital were investigated for patient providing care by the community, by collecting and reviewing all medication notes used for the information transfer. (Paper IV) Clinical pharmacists interviewed patients admitted to the hospital using the developed Structured Medication Questionnaire, to identify medication errors and assess patients’ compliance to and beliefs about medicines. (Paper V) Systematic medication reviews and medication care plans were conducted on intervention inpatients, by a multidisciplinary team, to reduce the number of unidentified drug-related problems during the hospital stay, which were identified and evaluated retrospectively. The physicians’ and nurses’ opinions towards this working model were evaluated using a questionnaire. Result: (Paper I) Many drug-related problems were identified among the nursing home patients, but no improvement in health-related quality of life. (Paper II) Both GPs and nurses were positive towards further cooperation regarding pharmacotherapeutic interventions. (Paper III) On average two medication errors occurred each time a patient was transferred between primary and secondary care. (Paper IV) A majority of the patients (62%, CI 45-77%) had at least one medication error. Using this questionnaire, poor compliance and negative beliefs were also identified. (Paper V) Inpatients in the intervention group benefited from a reduction of unidentified drug-related problems. In general physicians and nurses were very positive towards this working model. Conclusion: The research comprising this thesis has demonstrated a need for attention towards drug treatment and drug-related problems in the elderly. The Structured Medication Questionnaire and structured medication reviews may be used as tools to identify drug-related problems. Once identified the drug-related problems have the potential to be prevented or resolved, thereby optimising drug therapy.
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| 6. |
- Bondesson, Åsa ÅB, et al.
(författare)
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In-hospital medication reviews reduce unidentified drug-related problems
- 2013
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 69:3, s. 647-655
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To examine the impact of a new model of care, in which a clinical pharmacist conducts structured medication reviews and a multi-professional team collates systematic medication care plans, on the number of unidentified DRPs in a hospital setting. Methods In a prospective two-period study, patients admitted to an internal medicine ward at the University Hospital of Lund, Sweden, were included if they were >= 65 years old, used >= 3 medications on a regular basis and had stayed on the ward for >= 5 weekdays. Intervention patients were given the new model of care and control patients received conventional care. DRPs were then retrospectively identified after study completion from blinded patient records for both intervention and control patients. Two pairs of evaluators independently evaluated and classified these DRPs as having been identified/unidentified during the hospital stay and according to type and clinical significance. The primary endpoint was the number of unidentified DRPs, and the secondary endpoints were the numbers of unidentified DRPs within each type and clinical significance category. Results The study included a total of 141 (70 intervention and 71 control) patients. The intervention group benefited from a reduction in the total number of unidentified DRPs per patient during the hospital stay: intervention group median 1 (1st-3rd quartile 0-2), control group 9 (6-13.5) (p < 0.001), and also in the number of medications associated with unidentified DRPs per patient: intervention group 1 (0-2), control group 8 (5-10) (p < 0.001). All sub-categories of DRPs that were frequent in the control group were significantly reduced in the intervention group. Similarly, the DRPs were less clinically significant in the intervention group. Conclusions A multi-professional team, including a clinical pharmacist, conducting structured medication reviews and collating systematic medication care plans proved very effective in reducing the number of unidentified DRPs for elderly in-patients.
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| 7. |
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| 8. |
- Eriksson, Tommy, et al.
(författare)
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Experiences from the implementation of structured patient discharge information for safe medication reconciliation at a Swedish university hospital
- 2011
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Ingår i: EJHP Science. - 1781-7595. ; 17:2, s. 42-49
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Tidskriftsartikel (refereegranskat)abstract
- Study objectives: A method for medication reconciliation that reduces medication errors and healthcare contacts when a patient is discharged from hospital, LIMM-DI (Lund integrated medicines management-discharge information) had been previously developed by the authors. LIMM-DI is structured information written for the patient and sent to the next caregiver. In this study, the use (implementation ratio) and errors when used were measured. Methods: During two three-week periods in 2008 and 2009 information on the use of LIMM-DI for every discharged patient at Skåne University Hospital in Lund, Sweden was collected. Medication errors and quality by chart reviews based on a previously developed checklist were also measured. The focus was placed on the medication report—which medications have been changed and why—and the medication list, two vital parts of LIMM-DI. Results: One hundred and thirty eight (27%) and 163 (31%) of the patients received LIMM-DI in periods 1 and 2, respectively. The mean number of errors per patient decreased from period 1 to 2 in the medication list (6.5 [standard deviation, SD, 6.0] versus 3.9 (SD, 4.2), p = 0.00098) but not in the medication report (5.3 [SD, 6.3] versus 5.3 [SD, 5.9], p = 0.99). Conclusion: Contrary to expectations, the implementation of LIMM-DI was slow and there was no great reduction in the number of medication errors. There is a need to improve the current strategy and to consider alternative strategies for improving patient safety in the discharge medication reconciliation process.
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| 9. |
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| 10. |
- Eriksson, Tommy, et al.
(författare)
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The hospital LIMM-based clinical pharmacy service improves the quality of the patient medication process and saves time
- 2012
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Ingår i: European Journal of Hospital Pharmacy: Science and Practice. - : BMJ. - 2047-9964 .- 2047-9956. ; 19:4, s. 375-377
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The Lund Integrated Medicines Management (LIMM) model improves the patient medication process and reduces primary care contact and rehospitalisation. The objective was to evaluate the quality of medication management activities and the time spent on these activities using the LIMM model in hospital and primary care. Methods: Questionnaires were distributed to physicians and nurses in hospitals, with and without the LIMM model, and in primary care. A time study of the activities of clinical pharmacists was also performed. Results: Responses were received from 67 physicians and nurses working in hospitals and 210 in primary care. The respondents thought that the quality of medication management would be much improved using the LIMM model. The model was associated with total median time savings by nurses and physicians of at least 1 h per patient, while the clinical pharmacist spent only 1 h with each patient. Conclusion: The LIMM model reduced the total time required for each patient by at least 1 h and improved the quality of the process.
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