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"Sutherland, Adam"
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Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: a systematic review
Background
Problems arising from medicines usage are recognised as a key patient safety issue. Children are a particular concern, given that they are more likely than adults to experience medication-related harm. While previous reviews have provided an estimate of prevalence in this population, these predate recent developments in the delivery of paediatric care. Hence, there is a need for an updated, focussed and critical review of the prevalence and nature of drug-related problems in hospitalised children in the UK, in order to support the development and targeting of interventions to improve medication safety.
Methods
Nine electronic databases (Medline, Embase, CINAHL, PsychInfo, IPA, Scopus, HMIC, BNI, The Cochrane library and clinical trial databases) were searched from January 1999 to April 2019. Studies were included if they were based in the UK, reported on the frequency of adverse drug reactions (ADRs), adverse drug events (ADEs) or medication errors (MEs) affecting hospitalised children. Quality appraisal of the studies was also conducted.
Results
In all, 26 studies were included. There were no studies which specifically reported prevalence of adverse drug events. Two adverse drug reaction studies reported a median prevalence of 25.6% of patients (IQR 21.8–29.9); 79.2% of reactions warranted withdrawal of medication. Sixteen studies reported on prescribing errors (median prevalence 6.5%; IQR 4.7–13.3); of which, the median rate of dose prescribing errors was 11.1% (IQR 2.9–13). Ten studies reported on administration errors with a median prevalence of 16.3% (IQR 6.4–23). Administration technique errors represented 53% (IQR 52.7–67.4) of these errors. Errors detected during medicines reconciliation at hospital admission affected 43% of patients, 23% (Range 20.1–46) of prescribed medication; 70.3% (Range 50–78) were classified as potentially harmful. Medication errors detected during reconciliation on discharge from hospital affected 33% of patients and 19.7% of medicines, with 22% considered potentially harmful. No studies examined the prevalence of monitoring or dispensing errors.
Conclusions
Children are commonly affected by drug-related problems throughout their hospital journey. Given the high prevalence and risk of patient harm,, there is a need for a deeper theoretical understanding of paediatric medication systems to enable more effective interventions to be developed to improve patient safety.
Journal Article
Measures and tools assessing medication self-management capability in older people across the hospital-to-home transition: a systematic scoping review
Background
Adverse drug events from medication-related harm (MRH) can lead to hospital readmissions, compromised quality of life, and even death. Post-hospital discharge is a vulnerable period for older adults, who are often unprepared to resume self-care and medication self-management. Assessing medication self-management capability in older people can guide supportive interventions and improve medication-related outcomes. This review aimed to identify measures and tools used to assess medication self-management capability for older patients during the hospital-to-home transition.
Methods
Medline, EMBASE, PsycINFO, CINAHL and Cochrane Library of Systematic Reviews were comprehensively searched for articles from database inception to December 2023. Eligible studies included participants aged 65 or older across the hospital-to-home transition and measures containing at least one medication self-management component. Data extraction was performed using a standardised form, characteristics of measures tabulated, and a narrative approach used to describe measures. Reporting conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews checklist (PRISMA-ScR).
Results
Fourteen studies were included, and 12 unique measures identified. Measures predominantly focused on adherence rather than broader medication self-management components. Timing of measure administration and the individual administering the measure varied greatly. Medication self-management capability was determined through assessment of physical and cognitive skills. Number and type of skills assessed varied between measures. No measures considered all medication self-management components.
Conclusions
Current measures for medication self-management capability assessment primarily focus on cognitive and physical skills, with significant emphasis on adherence. Findings emphasise the importance of comprehensive definitions of medication self-management across the hospital-to-home transition. Recommendations are provided for developing future measures.
Journal Article
‘They Take the Mum Off You When You Come In’: An Ethnographic Study of Parent Experiences of Medicines Safety Systems in English Hospitals
Introduction Medication safety in healthcare settings is a persistent problem, and children may be at greater risk of harm than adults. Most existing research examining medication safety for hospitalised children is from the perspective of healthcare professionals and organisations. This study aimed to ethnographically explore parent and staff perspectives on the role of parents in medication safety in the paediatric hospital setting. Methods 230 h of ethnographic observation and 19 semi‐structured interviews with clinical staff and parents were conducted over paediatric wards in three acute hospitals in Northern England between October 2020 and May 2022. Data was organised and coded using NVivo and analysed thematically. Results Three main themes were identified: (1) Capacity and Capability: Parents were often assumed to be incompetent by organisational policies and managers but at the same time were co‐opted to undertake medication processes to meet operational needs. Parental experience was often ignored or judged negatively. When things went wrong parents were sometimes blamed. (2) Communication: parents were seldom meaningfully involved in decisions about their children's medication or provided with appropriate information unless requested. Parental medication histories were treated with suspicion and validated against inaccurate records. (3) Agency and Autonomy: parents often wanted to participate in their child's care but were expected to be passive observers. Conclusions Medication safety for children is a social phenomenon involving healthcare professionals and parents. However, parents are often relegated to a passive role by healthcare staff. We posit that this represents an example of epistemic injustice in the way parents are assumed to be incompetent outsiders with no understanding of the medical care of their children, despite them offering resilience for medicines safety. We recommend further exploration of how parents contribute to resilience and safety for children in hospital and the barriers to this, and how health services can safely support increased engagement and involvement of parents in the care of their children while in hospital. Patient or Public Contribution Parents contributed to the analysis and interpretation of the data collection and have contributed to the preparation of the manuscript.
Journal Article
The story of Nintendo
This book reveals how Nintendo came into being, the entrepreneurs behind the success of the brand, the key facts about the video game industry, and Nintendo's impact in the global market.
Book
The impact of drug error reduction software on preventing harmful adverse drug events in England: a retrospective database study
IntroductionThe use of intravenous administration systems with dose error reduction software (DERS) is advocated to mitigate avoidable medication harm. No large-scale analysis of UK data has been attempted. This retrospective descriptive study aimed to estimate the prevalence of hard limit events and to estimate the potential severity of DERS events.MethodTwelve months of DERS data was obtained from two NHS trusts in England. Definitions for drug categories and clinical areas were standardised and an algorithm developed to extract hard maximum (HMX) events. Subject matter experts (SMEs) were asked to rate severity of all HMX events on a scale of 0 (no harm) to 10 (death). These were analysed by clinical area and drug category, per 1000 administrations.ResultsA total of 745 170 infusions were administered over 644 052 patient bed days (PBDs). 45% of these (338 263) were administered with DERS enabled. HMX event incidence across the whole dataset was 17.9/1000 administrations (95% CI 17.5 to 18.4); 9.4/1000 PBDs (95% CI 9.2 to 9.7). 6067 HMX events were identified. 4604 were <2-fold deviations and excluded. HMX were identified in all drug categories. The highest incidence was antibacterial drugs (2.21%; 95% CI 2.13 to 2.29). Of the 1415 HMX events reviewed by SMEs, 747 (52.6%) were low/no harm. Drugs with greatest potential harm were antiarrhythmics (21.8/1000 administrations; 95% CI 16.3 to 29.1), parenteral anticoagulants (24.16/1000 administrations; 95% CI 15.3 to 37.9) and antiepileptics (20.86/1000 administrations; 95% CI 16.4 to 26.5). DERS has prevented severe harm or death in 110 patients in these hospitals. Medical and paediatric areas had higher prevalence of potentially harmful HMX events, but these were probably related to profile design.ConclusionCompliance with DERS in this study was 45%. DERS events are common, but potential harm is rare. DERS events are not related to specific clinical areas. There are some issues with definition and design of drug profiles that may cause DERS events, thus future work should focus on implementation and data standardisation for future large-scale analysis.
Journal Article