Abstract:Background Medication-related hospital admissions in Australia have previously been estimated to account for approximately 3% of all hospital admissions, with hospital entry points being a point of vulnerability. The timely medication review and reconciliation by a pharmacist at the early stage of an admission for patients admitted to the Acute Medical Unit (AMU) would be beneficial. Setting The Emergency Department (ED) and AMU in a 300 bed tertiary teaching hospital, in South Australia. Objective To investig… Show more
“…Medication errors can be reduced by the presence of an additional medical admission pharmacist seven days a week, as this can improve the number of full medication histories taken on admission. 21 Many of the medication errors occurring in the acute medical unit could be reduced with wider implementation of electronic prescribing systems. However, in 2013 only 13% of acute NHS hospitals surveyed had a hospital-wide electronic prescribing system.…”
Section: Discussionmentioning
confidence: 99%
“…Figure 3.Driver diagram showing the key areas causing iatrogenic harm to patients in the acute medical unit and potential interventions to target these areas. 12,15,16,21–23 These exemplar interventions were identified in scoping searches of pre-existing literature.…”
Objective Six per cent of hospital patients experience a patient safety incident, of which 12% result in severe/fatal outcomes. Acutely sick patients are at heightened risk. Our aim was to identify the most frequently reported incidents in acute medical units and their characteristics. Design Retrospective mixed methods methodology: (1) an a priori coding process, applying a multi-axial coding framework to incident reports; and, (2) a thematic interpretative analysis of reports. Setting Patient safety incident reports (10 years, 2005–2015) collected from the National Reporting and Learning System, which receives reports from hospitals and other care settings across England and Wales. Participants Reports describing severe harm/death in acute medical unit were identified. Main outcome measures Incident type, contributory factors, outcomes and level of harm were identified in the included reports. During thematic analysis, themes and metathemes were synthesised to inform priorities for quality improvement. Results A total of 377 reports of severe harm or death were confirmed. The most common incident types were diagnostic errors ( n = 79), medication-related errors ( n = 61), and failures monitoring patients ( n = 57). Incidents commonly stemmed from lack of active decision-making during patient admissions and communication failures between teams. Patients were at heightened risk of unsafe care during handovers and transfers of care. Metathemes included the necessity of patient self-advocacy and a lack of care coordination. Conclusion This 10-year national analysis of incident reports provides recommendations to improve patient safety including: introduction of electronic prescribing and monitoring systems; forcing checklists to reduce diagnostic errors; and increased senior presence overnight and at weekends.
“…Medication errors can be reduced by the presence of an additional medical admission pharmacist seven days a week, as this can improve the number of full medication histories taken on admission. 21 Many of the medication errors occurring in the acute medical unit could be reduced with wider implementation of electronic prescribing systems. However, in 2013 only 13% of acute NHS hospitals surveyed had a hospital-wide electronic prescribing system.…”
Section: Discussionmentioning
confidence: 99%
“…Figure 3.Driver diagram showing the key areas causing iatrogenic harm to patients in the acute medical unit and potential interventions to target these areas. 12,15,16,21–23 These exemplar interventions were identified in scoping searches of pre-existing literature.…”
Objective Six per cent of hospital patients experience a patient safety incident, of which 12% result in severe/fatal outcomes. Acutely sick patients are at heightened risk. Our aim was to identify the most frequently reported incidents in acute medical units and their characteristics. Design Retrospective mixed methods methodology: (1) an a priori coding process, applying a multi-axial coding framework to incident reports; and, (2) a thematic interpretative analysis of reports. Setting Patient safety incident reports (10 years, 2005–2015) collected from the National Reporting and Learning System, which receives reports from hospitals and other care settings across England and Wales. Participants Reports describing severe harm/death in acute medical unit were identified. Main outcome measures Incident type, contributory factors, outcomes and level of harm were identified in the included reports. During thematic analysis, themes and metathemes were synthesised to inform priorities for quality improvement. Results A total of 377 reports of severe harm or death were confirmed. The most common incident types were diagnostic errors ( n = 79), medication-related errors ( n = 61), and failures monitoring patients ( n = 57). Incidents commonly stemmed from lack of active decision-making during patient admissions and communication failures between teams. Patients were at heightened risk of unsafe care during handovers and transfers of care. Metathemes included the necessity of patient self-advocacy and a lack of care coordination. Conclusion This 10-year national analysis of incident reports provides recommendations to improve patient safety including: introduction of electronic prescribing and monitoring systems; forcing checklists to reduce diagnostic errors; and increased senior presence overnight and at weekends.
“…This omission may impair patient care, considering that the integration of pharmacists into core healthcare teams seemed to facilitate better health outcomes, better team decision making regarding medication use, improved continuity of care and patient safety. 2,29,[40][41][42][43]31,32,[34][35][36][37][38][39] Most nurses' and pharmacists' notes did not present information on the medication use at admission and hospital discharge, especially the absence of treatment duration. Omission of relevant information on the use of medications may increase days of hospitalization, lead to treatment interruptions and compromise patient safety.…”
Background. Effective communication regarding the use of medications in
a hospital environment is a process that contributes to the promotion of
patient safety. Despite its importance, especially for medication
reconciliation, written communication about the use of medications in
medical records remains insufficiently investigated. Aim. To describe
the documentation in medical records regarding the medication use
process by pharmacists, physicians and nurses on admission, during the
hospital stay, and on hospital discharge.Method. A retrospective
cross-sectional chart review study was carried out in medical records of
patients admitted to a teaching hospital in Northeast Brazil. The study
considered all patients admitted between December 2016 and February
2017, aged 18 or older and hospitalized for at least 48 hours. The
clinical notes made by pharmacists, physicians and nurses were examined
at three transition points of care. Data were collected using a
developed questionnaire and aimed at gathering the use of medications
prior to hospital admission, changes in the prescribed medications in
hospital stay and discharge, as well as prescription non-conformities.
Non-conformities were considered as any irregularities reported by the
healthcare team involving the medication use process. Communication
failures between the three healthcare professionals were also analyzed
and classified. Results. This study included 202 patients with a mean
age of 51.48 (SD 6.42, range: 19-97) years. There was no record of a
patient or relative interview on allergies and adverse drug reactions in
54 (26.8%) physician notes, 44 (21.9%) nursing notes, and 8 (22.9%)
of pharmacist notes. Moreover, 1,588 changes in prescriptions were
identified during data collection, but only 390 (24.5%) of these
changes were justified. Conclusion. Medication-related information in
medical records was incomplete and inconsistent in the clinical notes of
the three studied professions, especially in the pharmacists’
documentation. Future studies should focus on investigating the
consequences of interprofessional communication in patient care.
“…In light of this view, it becomes unclear what pharmacists’ roles are in a multiprofessional patient care environment, since the gaps of documentation prevent proper analysis of their interventions. This omission may impair patient care, considering that the integration of pharmacists into core healthcare teams facilitates better health outcomes, better team decision making regarding medication use, improved continuity of care and patient safety 2,29,31,32,34‐43 . Most nurses’ and pharmacists’ notes did not present information on the medication use at admission and hospital discharge, especially the absence of treatment duration.…”
Section: Discussionmentioning
confidence: 99%
“…This omission may impair patient care, considering that the integration of pharmacists into core healthcare teams facilitates better health outcomes, better team decision making regarding medication use, improved continuity of care and patient safety. 2,29,31,32,[34][35][36][37][38][39][40][41][42][43] Most nurses' and pharmacists' notes did not present information on the medication use at admission and hospital discharge, especially the absence of treatment duration. Omission of relevant information on the use of medications may increase days of hospitalisation, lead to treatment interruptions and compromise patient safety.…”
Background
Effective communication regarding the use of medications in hospital environments is a process that contributes to patient safety. Despite its importance, written communication about the medication use process in medical records remains insufficiently investigated.
Aim
To describe the documentation in medical records regarding the medication use process by pharmacists, physicians and nurses on admission, during the hospital stay, and at hospital discharge.
Method
A retrospective cross‐sectional chart review study was carried out in medical records of patients admitted to a teaching hospital in Northeast Brazil. The study considered all patients admitted between December 2016 and February 2017, aged 18 or older and hospitalised for at least 48 hours. Clinical notes made by pharmacists, physicians and nurses were examined at three transition points of care. Data were collected using a questionnaire relating to the use of medications prior to hospital admission, changes in the prescribed medications during the hospital stay and discharge, as well as prescription non‐conformities. Communication failures between the three healthcare professional groups were analysed and classified. The study was authorised by the Hospital's Board of Directors and approved by the Research Ethics Committee of the Federal University of Sergipe.
Results
This study included 202 medical records of patients with a mean age of 51.48 (SD 6.42, range: 19‐97) years. There was no record of a patient or relative interview on allergies and adverse drug reactions in 54 (26.8%) physician notes, 44 (21.9%) nursing notes, and 9 (25.0%) pharmacist notes. Moreover, 1,588 changes in prescriptions were identified during data collection, and 1,198 (75.4%) of these were unjustified.
Conclusion
Medication‐related information in medical records was incomplete and inconsistent in the clinical notes of the three studied professions, especially in pharmacists' documentation. Future studies should focus on investigating the consequences of interprofessional communication in patient care.
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