Implementing prescribing safety indicators in prisons: A mixed methods study

Abuzour, Aseel; Magola-Makina, Esnath; Dunlop, James; O'Brien, Amber; Khawagi, Wael Y; Ashcroft, Darren M.; Brown, Petra; Keers, Richard N.

doi:10.1111/bcp.15107

Cited by 7 publications

(12 citation statements)

References 24 publications

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“…The 48 included studies which reported at least one opioid-related prescribing indicator (2, 9, 24–69) were published during the period 2010-2019 (n=24)(13, 27, 28, 30–33, 35, 37–39, 41, 43, 45, 46, 49, 50, 54, 55, 57, 60, 63, 65, 66) followed by 2000-2009 (n=13) (9, 24, 29, 34, 42, 44, 48, 56, 58, 59, 62, 67, 68) and 2020-2022 (n=10) (2, 25, 26, 36, 40, 51–53, 61, 69) and only one published in 1990-1999 (47) (Table 2). .…”

Section: Resultsmentioning

confidence: 99%

“…The data of included studies were extracted by two reviewers (NS, WK) using an electronic data collection form and double-checked by two reviewers (NB, LCC). Three major categories of data were extracted from the literature, including (1) literature information: title, leading author, country, and year; (2) methodology: study design, setting, targeted population, indicators sources, and validation methods; and (3) opioid-related prescribe indicators: total number of indicators, opioids name of the medication, duration of medication, disease condition, concomitant medication, risk of the prescribing.…”

Section: Methodsmentioning

confidence: 99%

“…Opioids, one type of potent analgesic, remain the mainstay approach for treating moderate to severe pain used acutely after surgery and for cancer-related pain (1, 2). However, in recent decades, opioid analgesics have been increasingly used in patients with chronic non-cancer pain in Western countries (3).…”

Section: Introductionmentioning

confidence: 99%

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Enhancing Patient Safety in Opioid Prescribing: A Systematic Review of Potential Indicators

Bansal,

Khawagi,

Shang

et al. 2023

Preprint

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BackgroundThis systematic review aimed to identify a comprehensive list of prescribing safety indicators for opioids in any setting from published literature.MethodsLiterature that reported prescribing indicators from 1990-2019 was retrieved from a published systematic review. A subsequent search was conducted from seven electronic databases to identify additional studies from 2019 to 2022. Potential opioid safety prescribing indicators were extracted from studies that reported prescribing indicators of non-injectable opioids and narcotics prescribed to adults with or without specific conditions, concomitant medications, or laboratory monitoring with concerns about the potential safety risk of harm. Retrieved indicators were split by each opioid and merged for the same drugs. Identified indicators were categorised by the type of problem, medication, patient condition/disease, and the risk of the indicators.ResultsOf the 107 indicators retrieved from 48 included articles, 71 were included. Thirty-five (49.3%) opioid prescribing indicators focused on a specific class of opioids, i.e., ‘opioids’ (n=30, 42.3%) and ‘strong opioids’ (n=5, 7.0%); tramadol and fentanyl were the most commonly reported drug (n=6, 8.5%). The indicators account for six types of problems: medication inappropriate to the population (n=16), omission (n=7), inappropriate duration (n=4), inadequate monitoring (n=7), drug-disease interaction (n=16), and drug-drug interaction (n=27). Of all indicators, older age (over 65) is the most common risk factor (n=34, 47.9%). Central nervous system-related adverse effects are the risk of concern for the 27 indicators associated with drug-drug interaction (n=24, 88.9%). Besides, five of the six ‘omission’ indicators are related to ‘without using laxatives’.ConclusionThis review identified a comprehensive list of indicators that can be applied to flag patients with a high risk of opioid-related harm to facilitate complex decision-making in optimising opioids for pain management. Further research is needed to validate and determine the feasibility of identifying hazardous prescribing in various care settings.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Enhancing Patient Safety in Opioid Prescribing: A Systematic Review of Potential Indicators

Bansal,

Khawagi,

Shang

et al. 2023

Preprint

Self Cite

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“…A mixed-methods study from 2021, involving synthesis of prescribing safety indicators, a literature review and nominal group discussion at two English prisons identified similar issues. 28 Notably, prescribing practices that could cause harm were clustered around several high-risk medications, including selective serotonin re-uptake inhibitors and anti-psychotics, which echoes the medication classes described in reports included in our study. Building on this, we shed light on issues involving poor medication access, including delays in receiving these medications.…”

Section: Medicationmentioning

confidence: 99%

Patient safety in prisons: a multi-method analysis of reported incidents in England

et al. 2023

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Objectives Prisoners use healthcare services three times more frequently than the general population with poorer health outcomes. Their distinct healthcare needs often pose challenges to safe healthcare provision. This study aimed to characterise patient safety incidents reported in prisons to guide practice improvement and identify health policy priorities. Design: We carried out an exploratory multi-method analysis of anonymised safety incidents from prisons. Setting Safety incidents had been reported to the National Reporting and Learning System by prisons in England between April 2018 and March 2019. Participants Reports were reviewed to identify any unintended or unexpected incident(s) which could have, or did, lead to harm for prisoners receiving healthcare. Main outcome measures Free-text descriptions were examined to identify the type and nature of safety incidents, their outcomes and harm severity. Analysis was contextualised with subject experts through structured workshops to explain relationships between the most common incidents and contributory factors. Results Of 4112 reports, the most frequently observed incidents were medication-related (n = 1167, 33%), specifically whilst administering medications (n = 626, 54%). Next, were access-related (n = 559,15%), inclusive of delays in patients accessing healthcare professionals (n = 236, 42%) and managing medical appointments (n = 171, 31%). The workshops contextualised incidents involving contributing factors (n = 1529, 28%) into three key themes, namely healthcare access, continuity of care and the balance between prison and healthcare priorities. Conclusions This study highlights the importance of improving medication safety and access to healthcare services for prisoners. We recommend staffing level reviews to ensure healthcare appointments are attended, and to review procedures for handling missed appointments, communication during patient transfers and medication prescribing.

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“…This study therefore aimed to characterise and understand the processes and challenges to prescribing in prisons, explore the causes and impact of these challenges, and identify potential approaches to improve prescribing safety in prisons. Specifically, focus groups were designed to capture harms, as part of wider work to develop indicators of potentially hazardous prescribing (reported here [39]), and interviews (where in depth discussion of risks and benefits) aimed to identify areas of good practice. Prescribing safety indicators describe statements of potentially hazardous prescribing practices that may place patients at risk of harm, and have been utilised previously as part of a pharmacist-led intervention successfully implemented in general (or community) practice and secondary care [40].…”

Section: Introductionmentioning

confidence: 99%

Exploring the challenges to safer prescribing and medication monitoring in prisons: A qualitative study with health care staff

et al. 2022

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Introduction Research suggests that patients who are prisoners experience greater morbidity, increased health inequalities and frequent preventable harm, compared to the general population. Little is known about the process and influencing factors for safe prescribing in the unique prison environment, which may limit the development efforts to improve the quality of care in prisons. This study aimed to understand the process and challenges associated with prescribing in prisons, explore the causes and impact of these challenges, and explore approaches to improve prescribing safety in prisons. Methods Grounded theory informed data collection and analysis of a nominal group discussion by seven participants and semi-structured telephone interviews with twenty prison healthcare staff, including GPs, pharmacists, psychiatrists and nurses. Findings The underlying complexity of prescribing in prison settings increased the level of challenge and influenced the safety of this process. Multiple contributors to the challenges of safe prescribing were identified (comprising governance and policy; the prison structure; staff retention, training and skill mix; IT systems and interface; polypharmacy and co-morbidity; tradability and patient behaviour) with overarching constructs of variations in practice/policy and the influence of prison culture. Participants identified measures to address these challenges through multi-disciplinary collaborative working, increased consistency in processes, and the need for more innovation and education/training. Conclusions Our study highlighted that healthcare provision in prisons is unique and needs to tailor the care provided to patients without enforcing a model focused on primary, secondary or tertiary care. Participants emphasised a necessary shift in workplace culture and behaviour change to support improvements. The COM-B model of behaviour change may be effectively applied to develop interventions in organisations that have in-depth understanding of their own unique challenges.

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Implementing prescribing safety indicators in prisons: A mixed methods study

Cited by 7 publications

References 24 publications

Enhancing Patient Safety in Opioid Prescribing: A Systematic Review of Potential Indicators

Enhancing Patient Safety in Opioid Prescribing: A Systematic Review of Potential Indicators

Patient safety in prisons: a multi-method analysis of reported incidents in England

Exploring the challenges to safer prescribing and medication monitoring in prisons: A qualitative study with health care staff

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