Quality Indicators for In-Hospital Pharmaceutical Care of Dutch Elderly Patients

Wierenga, Peter C.; Klopotowska, Joanna E.; Smorenburg, Susanne M.; Kan, Hendrikus J. van; Bijleveld, Yuma A.; Dijkgraaf, Marcel G. W.; Rooij, Sophia E. de

doi:10.2165/11587700-000000000-00000

Cited by 11 publications

(19 citation statements)

References 39 publications

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“…Similar reliability rates were found by Wierenga et al [27] when they applied their 87-item QI set on 10 test patients. Good inter-rater reliability results show that the QIs were explicitly defined.…”

Section: Discussionsupporting

confidence: 85%

“…[23]–[25], [27] After selecting the QIs, these were adapted to the surgical population incorporating national and local surgical care guidelines. Expert opinion of the consultant surgeon and hospital pharmacist was used during this consensus based selection and composition process of QIs.…”

Section: Methodsmentioning

confidence: 99%

“…relevance and appropriateness for the surgical population, and on content validity and face validity, such as phrasing and comprehensibility. [20], [27], [29], [30] They scored these aspects on a 9-point Likert scale. If a score of five or below was assessed by the expert panel, we indicated this test as fail and excluded the quality indicator.…”

Section: Methodsmentioning

confidence: 99%

“…In the last step, the inter-rater agreement was assessed to obtain information about the reliability of the composed QI set. [20], [27], [31] Inter-rater reliability was assessed by two independent reviewers on 50 test patients. The agreement between reviewers on eligibility and on pass rates of the quality indicators on the eligible patients, was calculated by use of Cohen's kappa (κ) statistic [32] in SPSS version 18.0 (SPSS Inc., Chicago, IL).…”

Section: Methodsmentioning

confidence: 99%

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Quality of Pharmaceutical Care in Surgical Patients

et al. 2014

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BackgroundSurgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements.ObjectiveTo assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements.MethodsFor this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients.ResultsThirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and ‘sensitivity to change’. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%).ConclusionsThis quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced.

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Section: Discussionsupporting

confidence: 85%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Quality of Pharmaceutical Care in Surgical Patients

et al. 2014

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“…However, because the degree of ADEs recognition may differ between medical specialties or countries [11, 23], more studies are needed to confirm our findings. Strategies such as the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP), Screening Tool to Alert doctors to the Right Treatment (STOP) [57], and quality indicators for in-hospital pharmaceutical care of elderly patients [58] have the potential to improve the recognition of ADEs by detecting inappropriate prescribing. Considering ADEs as a differential diagnosis in older patients should be a standard approach on admission and during the hospital stay.…”

Section: Discussionmentioning

confidence: 99%

Recognition of adverse drug events in older hospitalized medical patients

Klopotowska

Wierenga

Smorenburg

et al. 2012

Eur J Clin Pharmacol

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ObjectiveTo assess medical teams’ ability to recognize adverse drug events (ADEs) in older inpatients.MethodsThe study cohort comprised 250 patients aged 65 years or older consecutively admitted to Internal Medicine wards of three hospitals in the Netherlands between April and November 2007. An independent expert team identified ADEs present upon admission or occurring during hospitalization by a structured retrospective patient chart review. For all ADEs identified, the expert team assessed causality, severity, preventability, and recognition by medical teams.ResultsThe medical teams did not recognize 19.9 % of all ADEs present upon admission {60.4 ADEs [95 % confidence interval (CI) 51.5–70.8] per 100 hospitalizations} and 20.3 % of all ADEs occurring during the hospital stay [47.2 ADEs (95 % CI 39.4–56.5) per 100 hospitalizations]. Unrecognized ADEs were significantly more often ADEs with possible causality (p=0.014, df=1), ADEs caused by medication errors (p<0.001, df=1), and ADEs not manifesting as new symptoms (p<0.001, df=1). The medical teams did not recognize 23.2 % of mild to moderately severe ADEs and 16.5 % of severe, life-threatening, or fatal ADEs. The recognition of ADEs varied with event type.ConclusionsThe recognition of ADEs by medical teams was substantial for those ADEs with evident causality and with clinically apparent and severe consequences. ADEs mimicking underlying pathologies with a lower severity went unrecognized much more often, as did those resulting only in abnormal laboratory values. Tools to improve the recognition of ADEs by medical teams should, therefore, focus on those ADEs that are more challenging to detect.

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Identifying Inappropriate Prescribing for Older People

Elliott

Stehlik

2013

Pharmacy Practice and Res

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Older people are at risk of polypharmacy, inappropriate prescribing and adverse drug reactions. Reasons include comorbidities, altered pharmacodynamics and pharmacokinetics, and limited evidence to guide drug therapy decisions, especially for people aged > 75 years. Tools to assist with identifying inappropriate prescribing for older people have been developed. The most well known is the Beers criteria, a list of medications that an expert panel agreed should usually be avoided. Criticism of the Beers criteria and limited applicability outside of North America, led to the development of other tools and a major revision of the Beers criteria in 2012. Since 2008, the Screening Tool of Older Persons' Prescriptions and the Screening Tool to Alert doctors to Right Treatment have gained popularity. Australian indicators and electronic decision support systems have also been developed. This article provides an overview of the tools for identifying (and avoiding) inappropriate prescribing and their application in clinical practice and research.

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Quality Indicators for In-Hospital Pharmaceutical Care of Dutch Elderly Patients

Abstract: We developed a valid and reliable set of QIs to efficiently assess the quality of the in-hospital pharmaceutical care provided to elderly Dutch patients.

Cited by 11 publications

References 39 publications

Quality of Pharmaceutical Care in Surgical Patients

Quality of Pharmaceutical Care in Surgical Patients

Recognition of adverse drug events in older hospitalized medical patients

Identifying Inappropriate Prescribing for Older People

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