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Background Medication safety management during the hospital-to-home transition for older adults with chronic disease is a key focus in public health. This study aims to develop and evaluate the feasibility and preliminary efficacy of a personalized Patient for Medication Safety (PFMS) intervention programme for older adults with chronic disease during this transition. Methods A parallel, two-arm, randomized controlled trial was conducted. The PFMS intervention included medication reconciliation before discharge, two bedside education sessions, a portable pillbox, and six remote motivational interviews over six weeks following discharge. Both the intervention and the control groups received usual care. Feasibility was assessed using recruitment rates, retention rates, intervention adherence, data collection completion rates, satisfaction surveys, and post-intervention interviews. Outcome measures (patient participation in medication safety, health literacy, healthcare worker support, and self-efficacy) were evaluated at baseline and post-intervention. The incidence and frequency of medication discrepancies were evaluated at one and six week post-discharge. Generalized estimating equations were used to examine within-group, between-group, and time-related changes in outcomes. Thematic analysis was used to analyse the qualitative data. Results A total of 30 patients were enrolled in the feasibility study, with 27 completing the study. The recruitment rate was 83.3%, retention rate 90%, and intervention adherence rate 81.3%. No adverse events occurred during the intervention period. Most participants reported high satisfaction. At the end of the intervention, significant differences were observed between the two groups in patient participation in medication safety (time effect), health literacy (between-group effect), medication discrepancies (time and interaction effects), and perceived healthcare provider support (between-group, time, and interaction effects) (all P  < 0.05). No significant difference was found in self-efficacy ( P >0.05). Patient feedback identified: (1) facilitators for accepting the PFMS intervention: care from healthcare workers and could benefit; (2) barriers: lack of comprehension and knowledge, lack of time, concern about bothering healthcare workers, negative attitudes associated with aging, sense of self-fulfillment, and intervention fatigue; (3) suggestions for improving the PFMS programme: increased identity credibility and provision of personalized support. Conclusions The PFMS intervention is feasible and shows preliminary efficacy in certain aspects during the hospital-to-home transition for older adults with chronic disease. Future research should refine the intervention to better enhance patient participation in medication safety behaviours and self-efficacy. Trial registration This trial was retrospectively registered on 18 April 2024 in the China Clinical Trial Registry (ChiCTR2400083215).

Despite restrictive opioid management guidelines, opioid use disorder (OUD) remains a major public health concern. Machine learning (ML) offers a promising avenue for identifying and alerting clinicians about OUD, thus supporting better clinical decision-making regarding treatment. This study aimed to assess the clinical validity of an ML application designed to identify and alert clinicians of different levels of OUD risk by comparing it to a structured review of medical records by clinicians. The ML application generated OUD risk alerts on outpatient data for 649,504 patients from 2 medical centers between 2010 and 2013. A random sample of 60 patients was selected from 3 OUD risk level categories (n=180). An OUD risk classification scheme and standardized data extraction tool were developed to evaluate the validity of the alerts. Clinicians independently conducted a systematic and structured review of medical records and reached a consensus on a patient's OUD risk level, which was then compared to the ML application's risk assignments. A total of 78,587 patients without cancer with at least 1 opioid prescription were identified as follows: not high risk (n=50,405, 64.1%), high risk (n=16,636, 21.2%), and suspected OUD or OUD (n=11,546, 14.7%). The sample of 180 patients was representative of the total population in terms of age, sex, and race. The interrater reliability between the ML application and clinicians had a weighted kappa coefficient of 0.62 (95% CI 0.53-0.71), indicating good agreement. Combining the high risk and suspected OUD or OUD categories and using the review of medical records as a gold standard, the ML application had a corrected sensitivity of 56.6% (95% CI 48.7%-64.5%) and a corrected specificity of 94.2% (95% CI 90.3%-98.1%). The positive and negative predictive values were 93.3% (95% CI 88.2%-96.3%) and 60.0% (95% CI 50.4%-68.9%), respectively. Key themes for disagreements between the ML application and clinician reviews were identified. A systematic comparison was conducted between an ML application and clinicians for identifying OUD risk. The ML application generated clinically valid and useful alerts about patients' different OUD risk levels. ML applications hold promise for identifying patients at differing levels of OUD risk and will likely complement traditional rule-based approaches to generating alerts about opioid safety issues.

BackgroundPrimary healthcare has a significant role in promoting the rational use of medicines. Finland’s health and social services reform aims to strengthen primary healthcare services and prevent diseases with multi-professional teamwork. Pharmacists should be involved in the development of the medication management process in primary care.PurposeThe aim was to identify risk factors in the medication management process in primary care to target a clinical pharmacist’s work tasks which could improve medication safety.Material and MethodsThis study was conducted in public health centers in Espoo, Southern Finland. First, a medication safety audit tool for primary healthcare was developed based on the audit tool for hospitals. Second, medication safety audits were conducted at four public health centers. In the audits, the pharmacotherapy plan and the medication management process were observed, and the renewal process of electronic prescriptions was evaluated. Based on the audit results, a proposal was made on the key development areas of the medication management process and the role description of the clinical pharmacist.ResultsThe key development areas identified with the medication safety audits were 1) updating and implementing the unit-based pharmacotherapy plans, 2) standardizing the medication reconciliation protocol, 3) documenting and utilizing the patient‘s pharmacotherapy plan, 4) standardizing the protocol for reviewing and documenting drug allergies, and 5) a need for medication safety protections in emergency care services. Furthermore, the lack of up-to-date medicines information when renewing electronic prescriptions was identified, as most of the prescriptions are renewed outside physicians’ appointments without direct contact with a patient. The suggested core task areas of the primary care clinical pharmacist at public health centers to improve medication safety were: 1) pharmacotherapy plan and quality control; 2) medication risk management; 3) development of the medication management process; and 4) other work tasks related to clinical pharmacy.ConclusionsWith medication safety audits, it was possible to identify the medication safety risks in the medication management process and prioritize a clinical pharmacist’s work tasks that improve medication safety. The identified development areas and medication safety work would suit the primary care clinical pharmacist’s role.Conflict of InterestNo conflict of interest

Background: Medication wastage is causing a cost burden to the healthcare system that is worth millions of dollars. An economic and ecological friendly intervention such as using a patient’s own medications (POM) has proven to reduce wastage and save the cost spent by the hospital. The potential benefits of using POM in inpatient settings have yet to be explored in a country with universal health coverage. This study aimed to pilot test the POM intervention in an adult ward setting and to perform the economic analysis of using POM and ward stock during hospitalization. Methods: A prospective cross-sectional observational study was conducted among the patients admitted to the medical and surgical wards in a public hospital located in Brunei Darussalam between February 2022 and April 2022. Hospitalized adults above 18 years old with regular medications with a minimum length of stay of 48 h and a maximum length of stay of 21 days were included in the study. These eligible patients were divided into a POM group and a non-POM group. The economic analysis of using POM was performed by calculating the direct cost per unit of medication used during admission (from unit-use, ward stock and POM) and comparing the cost spent for both groups. Expired ward stock deemed as medication wastage was determined. Medical research ethics were approved, and all participating patients had given their written informed consent before enrolling in this study. Results: A total of 112 patients aged 63.2 ± 15.8 years participated in this study. The average cost of medication supplied by the inpatient pharmacy for the non-POM group was USD 21.60 ± 34.20 per patient, whereas, for the POM group, it was approximately USD 13.00 ± 18.30 per patient, with a mean difference of USD 8.60 ± 5.17 per patient (95% CI: −3.95, 27.47, p ≥ 0.05). The use of POM minimized 54.03% (USD 625.04) of the total cost spent by the hospital for the POM group within the period of the study. Conclusion: The pilot study showed that the supplied medication cost per patient was not significantly different between the POM and non-POM groups. Nevertheless, the utilization of POM during hospitalization is capable of reducing at least 50% of the total cost spent on inpatient medications by the hospital. The use of POM during hospitalization also helped in reducing the total time spent on the medication process per patient.

The opioid crisis has significantly impacted adolescents and their families. This is attributed in part to increased opioid prescriptions in pediatric emergency departments (EDs) due to acute pain conditions and injuries. Although EDs frequently prescribe opioids, no effective preventative interventions have been implemented to educate adolescents and their families on safe opioid use. This study evaluates the MedSMA℞T Families intervention, which consists of an engaging serious game, Adventures in PharmaCity, and a personalized Family Medication Safety Plan (FMSP) with the aim of reducing opioid misuse and promoting opioid medication safety. The MedSMA℞T Families intervention was developed to educate adolescents and adults prescribed opioids on safe practices such as opioid storage and disposal. This study aimed to explore and characterize adolescents' and parents' experiences and perspectives on implementing the MedSMA℞T Families intervention in the ED to improve opioid education and safety among adolescents. A total of 93 participants, including 16 children and 77 parents, were recruited from the pediatric ED at a tertiary academic hospital to play the MedSMA℞T game in the ED. A total of 16 participants, including 8 children and 8 parents, were followed up with interviews to gather qualitative feedback. Participants engaged with the MedSMA℞T game-Adventures in PharmaCity-and the FMSP. Data were collected through gameplay observation and 75-minute semistructured interviews via Zoom. Quantitative in-game data were analyzed using descriptive analysis and qualitative data were analyzed using thematic analysis with NVivo (version 14; Lumivero). Parents spent an average of 22.16 (SD 4.97) minutes playing the game, while children spent an average of 21.99 (SD 8.06) minutes. Families appreciated the game's design and noted usability challenges and suggested enhancements for clearer gameplay instructions. Participants reported increased knowledge of opioid safety, highlighted the importance of communication with health care providers, and a desire for a mobile app to assist with medication management. The FMSP was perceived as valuable for promoting awareness of safe practices and connected well to the knowledge gained from the game. The MedSMA℞T Families intervention was well received as a beneficial educational tool to educate adolescents and their families on safe opioid use. Additionally, it highlights a clear need for more accessible digital tools to increase opioid education. This feedback indicates a strong interest in improving educational resources to ensure safe opioid management within families.

Background Community pharmacists play a crucial role in promoting medication safety within the community healthcare team. Effective communication by community pharmacists with other health professionals is essential to facilitate the sharing of patient healthcare information. In the context of information sharing between physicians and community pharmacists, assertive self-expression (defined as ‘a style of openly expressing one's needs and feelings while respecting others’) is beneficial. The aim of this study is to identify factors associated with assertive self-expression among community pharmacists. Methods A cross-sectional study was conducted by surveying 3,446 Japanese community pharmacists working at pharmacies across 10 prefectures. Participants were invited to complete a survey form by email and assessed for assertive self-expression using the Interprofessional Assertiveness Scale. Characteristics of participants and pharmacies were compared using univariate analysis. A generalized linear model was used to explore the factors associated with assertive self-expression. Results A total of 961 responses by community pharmacists were included in the analysis. Univariate analysis identified significant differences in assertive self-expression scores based on age, employment status, education, years of working experience as a pharmacist, pharmacist home visit service, and participation in joint regional workshops or conferences. After adjustment, participation in joint regional workshops or conferences was significantly associated with assertive self-expression (odds ratio, 1.037; 95% confidence interval, 1.005–1.070; p  = 0.023). Conclusions This study showed that assertive self-expression among community pharmacists was associated with participation in joint regional workshops and conferences. Further research is needed to examine whether enhancing assertive self-expression facilitates pharmacists' interprofessional communication skills and improves medication safety.

Acute generalized exanthematous pustulosis (AGEP) is a rare severe cutaneous adverse reaction in neonates and is most commonly drug-induced. Vaccine-associated cases are uncommon in this age group. We report a term male neonate who developed clusters of non-follicular pustules on erythematous plaques approximately 6 hours after receiving a birth dose of hepatitis B vaccine. The infant remained clinically stable, without fever or systemic involvement, and had no exposure to concomitant medications. The rapid onset following a single exposure, characteristic morphology, and prompt resolution were highly suggestive of AGEP. Laboratory investigations and skin biopsy were not performed due to rapid clinical improvement. Infectious etiologies and transient neonatal pustular dermatoses were considered less likely based on the clinical course. Patch testing with the same vaccine lot was positive, supporting a type IV hypersensitivity mechanism. The eruption resolved almost completely within 48 hours with topical hydrocortisone, without complications or recurrence.

AimTo evaluate the effectiveness of a ‘Do not interrupt’ bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.MethodsA parallel eight cluster randomised controlled study was conducted in a major teaching hospital in Adelaide, Australia. Four wards were randomised to the intervention which comprised wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders. Control wards were blinded to the intervention. Structured direct observations of medication administration processes were conducted. The primary outcome was non-medication-related interruptions during individual medication dose administrations. The secondary outcomes were total interruption and multitasking rates. A survey of nurses' experiences was administered.ResultsOver 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications. At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed. Intervention wards experienced a significant reduction in non-medication-related interruptions from 50/100 administrations (95% CI 45 to 55) to 34/100 (95% CI 30 to 38). Controlling for clustering, ward type and medication route showed a significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards. A total of 88 nurses (38.8%) completed the poststudy survey. Intervention ward nurses reported that vests were time consuming, cumbersome and hot. Only 48% indicated that they would support the intervention becoming hospital policy.DiscussionNurses experienced a high rate of interruptions. Few were related to the medication task, demonstrating considerable scope to reduce unnecessary interruptions. While the intervention was associated with a statistically significant decline in non-medication-related interruptions, the magnitude of this reduction and its likely impact on error rates should be considered, relative to the effectiveness of alternate interventions, associated costs, likely acceptability and long-term sustainability of such interventions.

ObjectivesTo provide national estimates of the number and clinical and economic burden of medication errors in the National Health Service (NHS) in England.MethodsWe used UK-based prevalence of medication errors (in prescribing, dispensing, administration and monitoring) in primary care, secondary care and care home settings, and associated healthcare resource use, to estimate annual number and burden of errors to the NHS. Burden (healthcare resource use and deaths) was estimated from harm associated with avoidable adverse drug events (ADEs).ResultsWe estimated that 237 million medication errors occur at some point in the medication process in England annually, 38.4% occurring in primary care; 72% have little/no potential for harm and 66 million are potentially clinically significant. Prescribing in primary care accounts for 34% of all potentially clinically significant errors. Definitely avoidable ADEs are estimated to cost the NHS £98 462 582 per year, consuming 181 626 bed-days, and causing/contributing to 1708 deaths. This comprises primary care ADEs leading to hospital admission (£83.7 million; causing 627 deaths), and secondary care ADEs leading to longer hospital stay (£14.8 million; causing or contributing to 1081 deaths).ConclusionsUbiquitous medicines use in health care leads unsurprisingly to high numbers of medication errors, although most are not clinically important. There is significant uncertainty around estimates due to the assumption that avoidable ADEs correspond to medication errors, data quality, and lack of data around longer-term impacts of errors. Data linkage between errors and patient outcomes is essential to progress understanding in this area.

Patient medication safety in the acute care setting is a foundational action provided by nurses and healthcare providers for safe patient care. Hospitalization of patients with Parkinson's disease (PD) can be dangerous due to the unique and variable medication regimen required. Patients with PD often have their medication administered inappropriately in the acute care setting (e.g., holding a PD medication in preparation for surgery, not administering the medication on the patient's home schedule, and delaying administration). The research question posed in this study was the following: does a PD medication educational intervention in the clinical setting enhance knowledge, comfort, and competence of practicing nurses in the care of patients with PD regarding their medication safety? A mixed methods study design was used for this 5-month, two-part study with a sample of practicing RNs at three different hospitals. Part one of the study assessed nurses' initial knowledge of PD and PD medication safety and included an educational intervention. Part two of the study occurred 3 months later and evaluated if knowledge from the educational intervention was retained. The study was conducted in two parts and included a pre-test, educational intervention, post-test, and follow-up test 3 months later. The educational intervention consisted of a 15-minute video of two PD advanced practice nurses being interviewed regarding the general care of a patient with PD. The pre-test, post-test, and follow-up test were identical and consisted of six questions regarding knowledge, comfort, and self-perceived competency. Participants were additionally asked three open-ended questions at follow-up to gain insight on the effectiveness of the educational intervention. A total sample of 252 RNs participated in this study. Statistically significant improvements in knowledge, comfort, and self-perceived competency were observed in the post-test scores compared to pre-test scores. These statistically significant improvements were retained after 3 months, despite a 42.9% decrease in the number of responders (n = 252 vs. n = 144). Additionally, compared to the post-test, there were no statistically significant declines in knowledge, comfort, or competency in the follow-up test. Qualitative findings indicated that the training regarding PD medications was retained and found to be valuable, even if it was seldom applied in practice. A review of the literature and this study both support the need for increased education for practicing nurses as it relates to PD and PD medication safety. Healthcare systems, organizations, and associations that support continuing education for nurses create a stronger workforce. Education has been found to keep nurses up to date on the latest advances in care and treatment while also providing exposure to other areas of nursing beyond their clinical settings. Promoting better patient outcomes through safe medication administration is a hallmark of nursing care excellence. This study found that supporting the use of an educational intervention of PD medication safety for nurses improved RN levels of knowledge, comfort, and competency up to 3 months later. As the population of those with PD increases, healthcare systems, and nurses must now, more than ever, be poised to care for these individuals. This is a critical point in PD patient care since persons with PD are hospitalized 1.5 times more than their peers without PD.