| 1. |
- 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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| 2. |
- 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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| 3. |
- 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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| 4. |
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| 5. |
- 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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| 6. |
- 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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| 7. |
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| 8. |
- Lidfeldt, Jonas, et al.
(författare)
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The influence of hormonal status and features of the metabolic syndrome on bone density: A population-based study of Swedish women aged 50 to 59 years. The women's health in the Lund area study
- 2002
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Ingår i: Metabolism, Clinical and Experimental. - : Elsevier BV. - 1532-8600. ; 51:2, s. 267-270
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated whether there is an association between bone density and features of the metabolic syndrome in relation to hormonal status. All women aged 50 to 59 years living in a defined geographic area in Sweden were offered a health assessment program including blood glucose, lipid profile, blood pressure, and bone densitometry. Women were divided into 3 groups according to their hormonal status: premenopausal (PM), postmenopausal with hormone replacement therapy (PMT), and postmenopausal without hormone replacement therapy (PMO). Of the 6,886 women investigated, 7% were PM, 41% PMT, and 52% PMO. The overall prevalence of osteopenia and osteoporosis, according to the World Health Organization (WHO) definition, was 42.6% and 6.6%, respectively. T-score in the PM group was higher than in the PMT (P <.05) and PMO groups (P <.001) and higher in the PMT group compared with the PMO group (P <.001). Also, in the total cohort, the bone density was positively associated with body weight, body mass index (BMI), waist-to-hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum triglycerides, and blood glucose (P <.001 for all) and negatively associated with serum levels of cholesterol (P <.05) and high-density lipoprotein (HDL) (P <.001). This was most evident among the PMO women, suggesting that the influence of metabolic factors on bone density increases when the levels of hormones decrease. This indicates that hormone replacement therapy maintains treated women in a premenopausal status concerning the metabolic factors.
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| 9. |
- 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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| 10. |
- 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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