Parent-Reported Errors and Adverse Events in Hospitalized Children

Parents play a large role in monitoring the condition of their children. They are consistently observing and playing an active part in their children’s hospital care. They are able to notice things that health providers might not see. Having different personnel and systems make the efforts to provide the best care to the children complicated. Medical errors unnoticed can lead to preventable adverse side effects. Parents can be a vital resource in identifying errors that can be prevented in the future.

In 2013, a study was conducted to evaluate parent reports of safety incidents their children experienced. These reports that met stated definitions were labeled medical errors or potential adverse events. Parents of randomly selected inpatient children were given surveys to report any safety incidents throughout their stay at the hospital. Reviewers would categorize the safety incidents as either harmful or non-harmful. Finally, they reviewed clinical/demographic data and analyzed medical records obtained from the hospital.

The results showed 37 safety concerns had been reported from 34 of the 383 parents surveyed. 62% of the safety incidents were found to be physician review medical errors. 43% of the medical errors reported by parents did not show up on the medical record review. 30.4% of the medical errors were defined as harmful. They also found that the length of stay was correlated with parental reporting a medical error. This makes sense because the risk increases with greater exposure.

One of the issues that was brought up in this study was excluding non-English speaking families. They should be included in further studies and I think their input will be valuable in further identifying medical errors and potential adverse events. Researchers can utilize language interpreters to translate their surveys to the families.

Khan A, Furtak SL, Melvin P, et al. Parent-Reported Errors and Adverse Events in Hospitalized Children. JAMA Pediatr. doi:10.1001/jamapediatrics.2015.4608 (published 29 February 2016).

 

Antidepressant Use and Risk of Recurrent Stroke: A Population-Based Nested Case-Control Study

Approximately 30% of individuals that have had a stroke are also diagnosed with depression, and although antidepressant therapy is recommended in patients with post-stroke depression, there are no guidelines for choosing therapy options. For this reason, a study was conducted to determine the relationship between the use of various classes of antidepressant medications and the recurrence of stokes. This longitudinal study analyzed health insurance database information of adults over the age of 18 who had a stroke and were readmitted with this condition. Around 10,000 patient cases were included in the study results (6,679 controls; 3,536 cases).  The study found that there was not an increased risk of stroke recurrence in patients taking SSRIs for depression; however, a correlation was found in patients being treated with TCAs (1.41 times increase). The risk for stroke recurrence in patients taking TCAs did not show much differentiation when analyzing dose and treatment duration variations. As a result, the study highly recommends using alternative methods of treatment for depression symptoms in patients who have experienced a stroke.

I believe this article is important to the understanding of pharmaceutical care due to the fact that antidepressants are one of the most commonly prescribed classes of medications. As healthcare professional that prioritize on the safety of treatment methods, we should be aware of medication contraindications so that we can provide the best patient care. Although all healthcare professionals look out for the best interests of the patient, pharmacists specialize on medications and thus will have the best knowledge on the potential dangers associated with treatment methods. This study makes me want to learn more about specific medication contraindications so that I will no how to protect patients health after graduation from pharmacy school.

 

 

Communication needs of patients with altered hearing ability

As discussed in Healthy People 2020, language barriers are a public health issue since they can lead to a decreased access to health care. People who are functionally deaf and hard of hearing (HOH) have difficulty communicating with health care providers as well as have low medication adherence. They have a lower health literacy compared to those who can hear well. The purpose of this research was to identify communication barriers between deaf or HOH patients and pharmacists along with how these barriers affect medication adherence and medication errors. The study consisted of focus group discussions among deaf or HOH patients who used American Sign Language as their primary method of communication.

Several participants expressed how challenging it is to communicate with the pharmacy staff. Some said that the staff would assume that the patient could read lips, even when he or she could not. Many participants tried using written methods to communicate, but found the complexity and amount of information to be overwhelming when written in long paragraphs.

Participants talked about their lack of understanding on the use of their medication, such as when to take it and how it should be taken. Due to this lack of understanding, several participants experienced adverse effects. They stated that to feel comfortable with how to take their medication they had to “learn from experience”. To get more information about their medications, most of the participants look at online resources or ask their friends or spouses – only two ask the pharmacist.

I found this article to be very interesting, especially after having an encounter with a deaf patient at my Community Health site. In the health care system today, disparities exists among patients. As a health care provider, it is important to identify these disparities and address them in an effective way to ensure that all patients are receiving an equal quality of care. In regards to the deaf and HOH, communication can be improved between the patient and pharmacist by perhaps using written methods that involve lists, instead of long paragraphs, so that it is not as overwhelming to read. In addition, the instructions on how to take the medication as well as any warning or adverse effects should be emphasized in a way that the patient can notice them and be cautious. By doing this, pharmacists can show their deaf and HOH patients that they care. Thus, the patients can be comfortable enough with the pharmacist to address any problems or issues that they have, ensuring that they receive the best treatment possible.

Ferguson M, Liu M. Communication needs of patients with altered hearing ability: Informing pharmacists’ patient care services through focus groups. J Am Pharm Assoc. 2015;55:153-60.

http://www.japha.org/article/S1544-3191(15)30036-4/fulltext

Patient perceptions of e-prescribing and its impact on their relationships with providers

In our health care system, prescription information can be electronically transferred from the prescriber to the pharmacist, causing an increase in efficiency and safety along with a decrease in cost. This allows for an improvement in the quality of patient care. This study focused on the perspective of the patients on electronic-prescribing. Its objective was to find the impact of these e-prescribing systems on quality of care, on patient-pharmacist interaction, and on engagement in health care. The study conducted interviews with 12 patients. The results found both positive and negative perceptions on the e-prescribing system.

The positive perceptions were related to an improvement in convenience, safety and quality, and cost. There were less medication errors, such as those caused by the illegibility of a prescriber’s handwriting. The negative perceptions were associated with communication challenges between pharmacists and prescribers, prescriptions being sent to the wrong pharmacy, and the patient feeling as if he or she less control over prescriptions. A common concern expressed by the patients was the lack of opportunity to talk with the community pharmacist during the prescription drop-off step. Patients viewed this step as a chance to learn more about their medication before deciding to have it filled. As well, it provided pharmacists with a chance to discuss nonadherence issues with patients. Another concern was that, oftentimes, a patient would have no knowledge about their prescription, such as drug name or dosage, until reaching the pharmacy.

I found this study very interesting because it looked at the patients’ viewpoints on the use of technology in our health care system. Technology should not only benefit the health care providers, but it should also benefit the patients. Therefore, it is important to understand where patients stand on these issues. This study that was conducted may have allowed researchers to realize that e-prescribing may be decreasing opportunities for a patient-pharmacist relationship to develop. With knowledge about this information, pharmacists may want to put in extra effort to talk with their patients when they are picking up prescriptions to ensure that the patients are fully informed about the medications that they are taking. Being able to develop a relationship with patients is an important aspect of delivering high-quality patient care.

Frail CK, Kline M, Snyder ME. Patient perceptions of e-prescribing and its impact on their relationships with providers: A qualitative analysis. J Am Pharm Assoc. 2014;54:630-33

http://www.japha.org/article/S1544-3191(15)30262-4/fulltext

Novel and Expanded Role for the Pharmacy Technician

A CMS Health Care Innovations Award – funded care transitions program known as SafeMed has the goal of reducing hospital readmissions and overall healthcare cost through the optimization of drug therapy. In particular they focus on adherence to drug therapy in addition to the efficiency of the drug regimens being undertaken by patients who are taking multiple chronic conditions – much like what we would expect in a patient who is eligible for MTM services.

Hospital readmissions are common in these patients who have an abrupt transition from extensive medical oversight to being unmonitored in their homes. Here, SafeMed decided to expand the role of their pharmacy technicians having them follow up with these patients by giving the patients phone calls after they return home from their hospital stays. These technicians were put through a training program with teachings provided by a pharmacist with expertise in MTM and through their basic understanding of MTM services they were appointed to a role of identification of some drug therapy problems. The idea here is not to have a technician assume the role of a pharmacist but rather be a less expensive extra set of eyes which could help draw attention to problems that could then be more promptly resolved by the pharmacist.

More time would be needed to draw conclusions about the clinical outcomes surrounding this program. However, an increase in DTP pharmacist interventions did result from this method which intuitively should result in more effective outpatient treatment and less hospital readmissions resulting in less medical expenses, a parameter which is to be measured in follow up studying of this method. In addition, they aim to improve the education of these technicians which can provide a very useful arm for the pharmacists helping them spot the patients who could use their expertise most.

Reference

Bailey J. SafeMed: using pharmacy technicians in a novel role as community health workers to improve transitions of care.” J Am Pharm Assoc. 2016; 56(1): 73-81.

J Am Pharm Assoc. 2016; 56(1): 73-81

Students as catalysts to increase community pharmacy-led direct patient care service

This study analyzed the effectiveness of an advanced pharmacy practice experience (APPE) elective at 5 colleges of pharmacy in the U.S. that promotes patient care in a community setting. Partner for Promotion (PFP) is an elective that provides student pharmacists with the chance to learn and build patient-centered practice skills that are most often used in community pharmacies.

Over the course of 3 years, 15 different patient care services were implemented, such as MTM, immunizations and prevention services, under PFP by 38 student pharmacists. Faculty at the schools of pharmacy were trained on the PFP program, who recruited local pharmacies to implement it. Each year a survey was completed by the faculty members at the school evaluating the program and its efficacy. The study found that the faculty thought components that were most successful were things such as ease of access to materials for the program and communication among the faculty networks. 100% of the faculty who completed the surveys found PFP to be “very useful” (highest on a scale from 1 to 4).

While the University of Pittsburgh does an incredible job preparing us student pharmacists to be patient care providers, many other schools of pharmacy do not do as much. Programs like this can help prepare more students to be patient-centered practitioners. By training as many student pharmacists as possible in a manner that promotes direct patient care, pharmacists and especially students can greatly help shift our health care from quantity to quality.

Rodin JL, Ulbrich TR, Jennings BT, et al. Students as catalysts to increase community pharmacy-led direct patient care services. J Am Pharm Assoc. 2015;55:642-8.

The adherence impact of a program offering specialty pharmacy services to patients using retail pharmacies

This study looks at a program called Specialty Connect utilized by specialty pharmacies in retail pharmacies. It looked at patient adherence over a 12-month period in 115 CVS Pharmacies in the Philadelphia, PA area.

Patients with “specialty conditions” such as cancer, cystic fibrosis, and pulmonary arterial hypertension were recognized in the Specialty Connect system and pharmacists were prompted to talk with such patients. The patient was given the option of utilizing the service and, if he or she agreed, the choice of having the medication delivered to their home or physician’s office, or available for in-store pick up. The patient was also told the pharmacist was available for counseling 24 hours a day, were counseled on their medications and adherence, and were given the option of refill reminders. The control group followed standard procedures for dispensing and counseling.

Refills of patients who were new to therapy were monitored over the 12-month period as well as those who had previously been receiving specialty medications. Compared to control groups, patients who were new to therapy had an increase of 17.5% in the rate of obtaining a refill on their specialty medications. Patients previously receiving specialty medications had an increase between 6.6% and 10.8% in refill rates.

This study shows how impactful a pharmacist’s interventions truly can be. Especially in the case of specialty mediations, adherence is very important in not only the treatment of the conditions but the costs of the treatments and resolving of issues related to nonadherence. A program like Specialty Connect can help patients with specialty conditions gain better access to and knowledge of their medications.

Moore JM, Matlin OS, Lotvin AM, et al. The adherence impact of a program offering specialty pharmacy serviced to patients using retail pharmacies. J Am Pharm Assoc. 2016;56:47-53.