Jordan M, Young-Whitford M, Mullan J, et al. Aust J Gen Pract. 2022;51:521-528.
Interventions such as deprescribing, pharmacist involvement, and medication reconciliation are used to reduce polypharmacy and use of high-risk medications such as opioids. In this study, a pharmacist was embedded in general practice to support medication management of high-risk patients. This study presents perspectives of the pharmacists, general practitioners, practice personnel, patients, and carers who participated in the program.
Gleeson LL, Ludlow A, Wallace E, et al. Explor Res Clin Soc Pharm. 2022;6:100143.
Primary care rapidly shifted to telehealth and virtual visits at the start of the COVID-19 pandemic. This study asked general practitioners (GPs) and pharmacists in Ireland about the impact of technology (i.e., virtual visits, electronic prescribing) on medication safety since the pandemic began. Both groups identified electronic prescribing as the most significant workflow change. GPs did not perceive a change in medication safety incidents due to electronic prescribing; pharmacists reported a slight increase in incidents.
Polypharmacy in older adults is an ongoing safety concern due to the risk of being prescribed a potentially inappropriate medication or co-prescription of medications with dangerous interactions. In this study of adults aged 65 and older with chronic pain, 54% were taking at least one potentially inappropriate medication and 43% were at moderate or high risk of adverse drug events. Measures such as involvement of a pharmacist in medication review could reduce risk of adverse drug events in older adult outpatients.
Dionisi S, Di Simone E, Liquori G, et al. Public Health Nurs. 2022;39:876-897.
Causes of medication errors occurring in home care may differ from those in the hospital setting. This systematic review identified three main risk factors for medication errors in the home: transition documentation, medication reconciliation, and communication among the multidisciplinary team. Most studies recommend involvement of a pharmacist as a member of the care team.
Procaccini D, Kim JM, Lobner K, et al. Jt Comm J Qual Patient Saf. 2022;48:154-164.
Weight-based medication dosing is a common source of medication errors in children. This systematic review identified limited evidence that overweight and obese children maybe be at increased risk of weight-based medication dosing errors, but the authors note that the clinical significance is unknown.
Wallis KA, Elley CR, Moyes SA, et al. BJGP Open. 2022;6:BJGPO.2021.0129.
Common high-risk medications such as antiplatelets and non-steroidal anti-inflammatory drugs (NSAIDs) have the potential to cause serious patient harm. This randomized trial examined the usefulness of an existing intervention to support safer prescribing in general practice to improve safe high-risk prescribing.
van der Zanden M, de Kok L, Nelen WLDM, et al. Diagnosis (Berl). 2021;8:333-339.
Endometriosis is a common clinical condition that is often subject to missed or delayed diagnosis. This qualitative study explored patients’ perspectives on the diagnostic process of endometriosis. Findings suggest that the diagnosis of endometriosis is hindered by delayed consultation, inadequate understanding and appraisal of symptoms by general practitioners, and inadequate communication between patients and providers.
Aldila F, Walpola RL. Res Social Adm Pharm. 2021;17:1877-1886.
Older adults are at increased risk of medicine self-administration errors (MSEs) due to polypharmacy, cognitive decline, and decline in physical abilities. In this review, incorrect dosing was the most common MSE; the most common factor influencing the errors is complex medication regimens due to the need for multiple medications. Additional research is needed into how community pharmacists can assist older adults at risk of MSE.
Clinical pharmacist involvement has improved medication safety in several clinical areas. Using the therapeutic outcome monitoring (TOM) method, pharmacists in this study identified 43 negative outcomes associated with oral chemotherapy medication and performed 81 pharmaceutical interventions. The TOM method increased patient safety by improving the use of medications.
Patients taking oral anti-cancer drugs may experience severe side effects and medication errors. In this randomized controlled study, patients taking oral chemotherapy drugs were randomized to receive usual care (control) or additional intensive pharmacological/pharmaceutical care (intervention). Patients in the intervention group reported considerably fewer medication errors and side effects and increased treatment satisfaction.
Carvalho IV, Sousa VM de, Visacri MB, et al. Pediatr Emerg Care. 2021;37:e152-e158.
This study sought to determine the rate of pediatric emergency department (ED) visits due to adverse drug events (ADE). Of 1,708 pediatric patients, 12.3% were admitted to the ED due to ADEs, with the highest rates of admission due to neurological, dermatological, and respiratory medications. The authors recommend the involvement of clinical pharmacists to prevent and identify ADEs in the pediatric population, particularly through education of children’s caregivers and health professionals.
The American Society of Clinical Oncology/Oncology Nursing Society and the Institute for Safe Medication Practices (ISMP) recommend independent double checks for certain medications In this retrospective study, pharmacists performed independent double checks on 1,645 anti-cancer parenteral orders. Pharmacists identified 30 errors during the first verification, and 10 errors on the second, resulting in a 33.3% increase in corrected errors.
Emonds EE, Pietruszka BL, Hawley CE, et al. J Am Pharm Assoc (2003). 2021;61:e143-e151.
The “Hospital at Home" program provides inpatient medical treatment (such as intravenous medications, daily laboratory monitoring, and basic imaging) to patients in their home under close clinician supervision. The authors found that integration of a pharmacist into the program enabled detection and resolution of medication discrepancies, which contributed to cost savings from medication dispensing and avoided early hospital discharge.
Gurwitz JH, Kapoor A, Garber L, et al. JAMA Intern Med. 2021;181:610-618.
High-risk medications have the potential to cause serious patient harm if not administered correctly. In this randomized trial, a pharmacist-directed intervention (including in-home assessment by a clinical pharmacist, communication with the primary care team, and telephone follow-up) did not result in a lower rate of adverse drug events or medication errors involving high-risk drug classes during the posthospitalization period.
Fudge N, Swinglehurst D. BMJ Open. 2021;11:e042504.
Polypharmacy – particularly in older adults – can increase the risk of adverse drug events. Based on an ethnographic case study of community pharmacies in England, the authors found that polypharmacy was a pervasive problem but rarely discussed as a safety concern and not actively challenged by pharmacy staff.
Luetsch K, Rowett D, Twigg MJ. BMJ Qual Saf. 2021;30:418-430.
Pharmacist-led medication reconciliation after hospital discharge has been found to reduce medication discrepancies, but its effect on subsequent healthcare utilization is not clear.In this evidence synthesis, the authors explored the reasons why pharmacist-led medication reconciliation after hospital discharge succeeds or fails. The authors found that medication reconciliation resulting in beneficial outcomes was performed in accordance with patient preferences, promoted coordination and collaboration between healthcare professionals, and established trust between patients and providers.
Herges JR, Garrison GM, Mara KC, et al. J Am Pharm Assoc (2003). 2020;61:68-73.
The goal of medication reconciliation is to prevent adverse events by identifying unintended medication discrepancies during transitions of care. This retrospective cohort evaluated the impact of attending a pharmacist-clinician collaborative (PCC) visit after hospital discharge with their medication containers on risk of 30-day readmission. Among adult patients on at least 10 total medications, findings indicate no significant difference in 30-day hospital readmission risk between patients presenting to a PCC visit with their medication containers compared with patients who did not. However, when patients did present to their PCC visit with medication containers, pharmacists identified more medication discrepancies and resolved more medication-related issues.
Zhou J, Calip GS, Rowan S, et al. Pharmacotherapy. 2020;40:992-1001.
This study analyzed the association between potentially inappropriate prescribing involving opioids prescribed by dentists and emergency department visits and hospitalizations among older patients. Results indicated that a significant proportion of older patients prescribed opioids by their dentist have contraindications (such as psychotropic medication use) which places them at increased risk for 30-day hospitalizations.
Lerner JE, Martin JI, Gorsky GS. Sex Res Social Pol. 2020;18:409-426.
This study used national survey data to examine avoidance of healthcare services among transgender, gender nonconforming, and non-binary people. Researchers found that nearly one quarter of respondents reported not seeking healthcare when necessary because they anticipated being disrespected or mistreated by healthcare professionals. Previous experience with certain discriminatory behavior such as invasive questions, refusal of care, verbal harassment, as well as cost and needing to educate providers, were strong predictors of healthcare avoidance.
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