Epidemiology of medication-related adverse events in nursing homes

Handler, Steven M.; Wright, Rollin M.; Ruby, Christine M.; Hanlon, Joseph T.

doi:10.1016/j.amjopharm.2006.09.011

Cited by 142 publications

(93 citation statements)

References 57 publications

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“…Research is also needed to further explore the barriers to reporting of other medication-related problems, including adverse drug reactions, adverse drug withdrawal events, and therapeutic failures. 43 Research can also help develop alternative detection strategies that do not rely primarily on self-report. Current examples of these alternative strategies include: pharmacy and laboratory computerized clinical event monitors, natural language processing of clinical notes, and identification of certain ICD-9 E codes associated with adverse effects of drugs.…”

Section: Implications and Further Researchmentioning

confidence: 99%

Identifying Modifiable Barriers to Medication Error Reporting in the Nursing Home Setting

Handler

Perera

Olshansky

et al. 2007

Journal of the American Medical Directors Association

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Objectives-To have healthcare professionals in nursing homes identify organizational-level and individual-level modifiable barriers to medication error reporting.Design-Nominal group technique sessions to identify potential barriers, followed by development and administration of a 20-item cross-sectional mailed survey.Participants and Setting-Representatives of 4 professions (physicians, pharmacists, advanced practitioners, and nurses) from 4 independently owned, nonprofit nursing homes that had an average bed size of 150, were affiliated with an academic medical center, and were located in urban and suburban areas.Measurements-Barriers identified in the nominal group technique sessions were used to design a 20-item survey. Survey respondents used 5-point Likert scales to score factors in terms of their likelihood of posing a barrier ("very unlikely" to "very likely") and their modifiability ("not modifiable" to "very modifiable"). Immediate action factors were identified as factors with mean scores of <3.0 on the likelihood and modifiability scales, and represent barriers that should be addressed to increase medication error reporting frequency.Results-In 4 nominal group technique sessions, 28 professionals identified factors to include in the survey. The survey was mailed to all 154 professionals in the 4 nursing homes, and 104 (67.5%) responded. Response rates by facility ranged from 55.8% to 92.9%, and rates by profession ranged from 52.0% for physicians to 100% for pharmacists. Most respondents (75.0%) were women.Corresponding Author: S. M. Handler, MD, MS, Division of Geriatric Medicine, University of Pittsburgh, 3471 Fifth Ave, Suite 500, Pittsburgh, PA 15213, USA, 412-692-2360 (office phone), 412-291-2141 (fax), handlersm@upmc.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Respondents had worked for a mean of 9.8 years in nursing homes and 5.4 years in their current facility. Of 20 survey items, 14 (70%) had scores that categorized them as immediate action factors, 9 (64%) of which were organizational barriers. Of these factors, the 3 considered most modifiable were (1) lack of a readily available medication error reporting system or forms, (2) lack of information on how to report a medication error, and (3) lack of feedback to the reporter or rest of the facility on medication errors that have been reported. NIH Public AccessAuthor Manuscript J Am Med Dir Assoc. Author manuscript; available in PMC 2008 November 1. Conclusions-The study results provide a broad-based perspective of the barriers to medication error reporting in the nursing home setting...

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Section: Implications and Further Researchmentioning

confidence: 99%

Identifying Modifiable Barriers to Medication Error Reporting in the Nursing Home Setting

Handler

Perera

Olshansky

et al. 2007

Journal of the American Medical Directors Association

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“…El gasto/envase mostró un incremento de 7,9 % (p=0,001). Se incrementó el uso de especialidades farmacéuticas genéricas (7,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27),2 % [p=0,001]) y se redujo el de absorbentes súper noche para la incontinencia urinaria (58,3-32,9 % [p=0,001]). En antihipertensivos y sistema nervioso central no se alcanzaron resultados concluyentes.…”

Section: Introductionunclassified

“…[2][3][4] En España, las personas mayores de 65 años representan el 17 % de la población total, mientras que el gasto generado en su atención representa el 50 % del total y alrededor del 70 % de la factura farmacéutica (Fuente: Instituto Nacional de Estadística).Diversos artículos consultados, sobre el uso de medicamentos dedicados a la atención de las personas mayores, estudian el abordaje de fármacos específicos en determinadas enfermedades crónicas o en su consumo inapropiado, pero la mayoría, son coincidentes en demostrar perfiles de sobre-utilización, que ocasionan un mayor riesgo en desarrollar efectos adversos, interacciones medicamentosas y errores en la medicación. [5][6][7][8][9] Por tanto, a todos los actores sanitarios se les plantea la necesidad de reducir el consumo injustificado de fármacos, optimizar su eficiencia y promover estrategias orientadas a facilitar el uso racional del medicamento, con criterios de seguridad y eficacia. [10][11][12][13][14][15][16] Desde el Servicio Catalán de la Salud (CatSalut), análogo a otras comunidades autonómicas, se están realizando diversas estrategias que intentan abordar este problema de actuación, tanto en los centros residenciales geriátricos como en sus entidades proveedoras de referencia.…”

Section: Introductionunclassified

Efectividad de una intervención en la mejora del uso de medicamentos en centros residenciales geriátricos

Mainar¹,

Loño²,

Rosales³

et al. 2009

Rev. cub. salud pública

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RESUMENObjetivos Medir la efectividad de un programa de mejora de la prescripción de medicamentos y sus efectos y accesorios en un conjunto de residencias geriátricas a los cinco años de su inicio. Métodos Estudio multicéntrico, antes-después, que incluyó las prescripciones registradas durante el período de estudio (referencia: año 2001, 107 centros; comparación: año 2006, 152 centros). Las intervenciones realizadas fueron: a) carta de presentación y entrevista inicial, b) información de cuadro de mandos, y c) realización de varias entrevistas de seguimiento. Las principales mediciones se evaluaron mediante una serie de indicadores cuantitativos, entre ellos, gasto/envase, gasto/residente y envases/residente, y cualitativos generales como son: valor intrínseco farmacológico elevado, especialidades genéricas y absorbentes súper noche para la incontinencia urinaria, y de selección o uso relativo (proporciones de principios activos recomendados) por año. Se efectuó un análisis multivariante para la corrección del modelo. Resultados El número de pacientes estudiados fue de 4 795 y 6 350, respectivamente. El gasto/residente fue de 1 575,61±358,88 euros (referencia) y 1 929,03±421,31 euros (comparación), con un incremento de 22,4 % (p<0,001). El gasto/envase mostró un incremento de 7,9 % (p=0,001). Se incrementó el uso de especialidades farmacéuticas genéricas (7,8-27,2 % [p=0,001]) y se redujo el de absorbentes súper noche para la incontinencia urinaria (58,3-32,9 % [p=0,001]). En antihipertensivos y sistema nervioso central no se alcanzaron resultados

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“…[41] The authors recruited a multidisciplinary expert panel to reach consensus on certain triggers for potential ADEs. Out of a list of 80 potential signals, the experts reached consensus on 40 ADE signals.…”

Section: Medication Therapy Monitoring and Quality Improvementmentioning

confidence: 99%

“…The expert panel in the Handler study also suggested that quinidine, procainamide, disopyramide be frequently monitored as well, as excessively high or low serum levels of these medications also serve as a trigger for a potential adverse effect. [41] When developing or revising medication monitoring policies it is important to keep the following key principles in mind. [40] First, medication monitoring is a multidisciplinary process that requires the skills and talents of the healthcare team and also involves subjective and objective assessments.…”

Section: Medication Therapy Monitoring and Quality Improvementmentioning

confidence: 99%

Common issues in the medication use processes in nursing homes: a review of medication use quality improvement strategies

Hughes

Freeman

Slaton

2016

JNEP

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Background: A continuous evaluation of safety practices in nursing homes and long-term care (LTC) facilities is needed. Numerous studies have highlighted the deficiencies in safety processes of nursing homes compared with institutional practice despite the fact that many residents in the nursing home setting also suffer from complex medical conditions and are receiving multiple medications to treat the comorbidities. As part of larger grant initiative, an extensive search was conducted to identify common problems in nursing facilities and potential strategies for improvement. This review highlights common problems in the medication use process in nursing facilities and strategies to improve processes and general resident safety based upon pertinent findings from the literature. Findings: There are proven medication safety strategies utilized in institutions that should be a foundational practice in nursing and LTC facilities. These strategies include, but are not limited to, reduction of polypharmacy and increased sensitivity to and prioritization of medication therapy monitoring processes, which will assist in the creation of a culture of safety. Specific goals of this process includes frequent education and encouraged use of best practices surrounding handling of high-alert medications, proper drug administration (e.g., crushing medications), drug interactions and reporting of adverse medication events. Conclusion: Medication use process failures are common in nursing and LTC facilities. However, an integrated approach can be used to mitigate some of the common problems. Pharmacists and nurses should work more closely to implement proven medication safety strategies. Implementing these strategies in concert with improved communication between team members can benefit residents by preventing avoidable events and hospitalizations.

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Epidemiology of medication-related adverse events in nursing homes

Cited by 142 publications

References 57 publications

Identifying Modifiable Barriers to Medication Error Reporting in the Nursing Home Setting

Identifying Modifiable Barriers to Medication Error Reporting in the Nursing Home Setting

Efectividad de una intervención en la mejora del uso de medicamentos en centros residenciales geriátricos

Common issues in the medication use processes in nursing homes: a review of medication use quality improvement strategies

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