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BMC Palliative Care Jun 2024Patient safety is crucial for quality of care. Preventable adverse events (AEs) occur in 1 of 20 patients in the hospital, but it is unknown whether this is different...
Adverse events at the end of life of hospital patients with or without a condition relevant for palliative care: a nationwide retrospective record review study in the Netherlands.
BACKGROUND
Patient safety is crucial for quality of care. Preventable adverse events (AEs) occur in 1 of 20 patients in the hospital, but it is unknown whether this is different for patients with a condition relevant for palliative care. The majority of the limited available research on this topic is only focused on patients already receiving palliative care, and do not make comparisons with other patients at the end-of-life. We identified and compared the prevalence, preventability, nature and causes of AEs in patients with and without a condition relevant for palliative care.
METHODS
A nationwide retrospective record review study was performed in 20 Dutch hospitals. A total of 2,998 records of patients who died in hospital in 2019 was included. Records were reviewed for AEs. We identified two subgroups: patients with (n = 2,370) or without (n = 248) a condition relevant for palliative care through the selection method of Etkind (2017). Descriptive analyses were performed to calculate prevalence, nature, causes and prevention strategies. T-tests were performed to calculate differences between subgroups.
RESULTS
We found no significant differences between subgroups regarding AE prevalence, this was 15.3% in patients with a condition relevant for palliative care, versus 12.0% in patients without a condition relevant for palliative care (p = 0.148). Potentially preventable AE prevalence was 4.3% versus 4.4% (p = 0.975). Potentially preventable death prevalence in both groups was 3.2% (p = 0.938). There were differences in the nature of AEs: in patients with a condition relevant for palliative care this was mostly related to medication (33.1%), and in patients without a condition relevant for palliative care to surgery (50.8%). In both subgroups in the majority of AEs a patient related cause was identified. For the potentially preventable AEs in both subgroups the two most important prevention strategies as suggested by the medical reviewers were reflection and evaluation and quality assurance.
DISCUSSION
Patient safety risks appeared to be equally prevalent in both subgroups. The nature of AEs does differ between subgroups: medication- versus surgery-related, indicating that tailored safety measures are needed. Recommendations for practice are to focus on reflecting on AEs, complemented with case evaluations.
Topics: Humans; Netherlands; Retrospective Studies; Palliative Care; Male; Female; Aged; Middle Aged; Aged, 80 and over; Terminal Care; Adult; Medical Errors; Patient Safety
PubMed: 38858703
DOI: 10.1186/s12904-024-01461-z -
Journal of Multidisciplinary Healthcare 2024This study aimed to evaluate racial disparities in medication use and associated factors among pregnant women receiving prenatal care at Brazilian Unified Health System...
PURPOSE
This study aimed to evaluate racial disparities in medication use and associated factors among pregnant women receiving prenatal care at Brazilian Unified Health System primary care health units in the northeast region.
PATIENTS AND METHODS
A total of 1058 pregnant women in the NISAMI Cohort were interviewed between June 2012 and February 2014. Medicines used during pregnancy were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and ANVISA pregnancy risk categories. Prevalence ratios (crude and adjusted) and 95% confidence intervals (CIs) were estimated using Poisson regression with robust error variance. All analyses were stratified by race (Asian, black, brown/mixed, Brazilian indigenous, and white).
RESULTS
Approximately 84% of the pregnant women used at least one medication, with a lower proportion among white women. The most reported medications were antianemic preparations (71.08%; 95% CI 68.27-73.72%), analgesics (21.74%; 95% CI 19.36-24.32%), and drugs for functional gastrointestinal disorders (18.81%; 95% CI 16.57-21.28%). Approximately 29% of women took potentially risky medications during pregnancy, with a higher prevalence among Asian and white women. Factors associated with medication use during pregnancy include a greater number of prenatal consultations, higher education levels, health problems, and smoking. In addition, maternal age above 25 years, smoking status, and two or more previous pregnancies were associated with potentially risky medication use during pregnancy.
CONCLUSION
A high prevalence of medication use during pregnancy was found; however, this prevalence was lower among white women. Nonetheless, black and brown women used antianemic preparations less frequently. This finding suggests that race is a factor of inequity in prenatal care, demanding public policies to mitigate it.
PubMed: 38855020
DOI: 10.2147/JMDH.S455378 -
Nurse Education in Practice Jun 2024To examine final-year undergraduate nursing students' characteristics and their perceived preparedness for medication administration across three universities during...
AIM
To examine final-year undergraduate nursing students' characteristics and their perceived preparedness for medication administration across three universities during COVID-19.
BACKGROUND
Medication administration is a complex process and medication errors can cause harm to the patient. Nurses are at the frontline of medication administration; therefore, nursing students must be well-prepared to administer medicines safely before graduation. Little is known about final-year undergraduate nursing students' perceived medication administration preparedness during COVID-19.
DESIGN
A multi-site study using a cross-sectional survey of student demographics, the 'Preparedness for Medication Administration' (Revised) tool and an open-ended question.
METHODS
The questionnaire was distributed to nursing students in their final semester of the program in 2022 across two universities in Australia and one in New Zealand. Completed surveys n=214. Descriptive statistics were used to analyse the demographic data. Differences in demographic data and preparedness scores between the three universities were analysed using ranked means, correlation coefficient, Chi-Square, Mann- Whitney U and Kruskal- Wallace H. Directed content analysis was used to analyse the data from the open-ended question.
RESULTS
Overall, students reported high preparedness scores for medication. International students reported significantly higher preparedness scores (Md =119, n=29) compared with domestic students (Md=112.00, n=164), U=1759.50, z=-2.231, p=02, r=.16. Mean ranked scores for each item were above average across the three universities. The impact of COVID-19 on curriculum and students' opportunity to practice may be one explanation for the difference in preparedness scores between universities. International participants reported significantly higher scores on the Preparedness for Medication Administration (Revised) tool than domestic participants. Older students were more confident in applying principles of pharmacology to practice. Students' comments generated three major categories and five subcategories indicating preparedness gaps.
CONCLUSION
This study provides insights into students' medication management preparedness during restrictions and before transitioning to the role of Registered Nurse. It highlights the need to provide integrated and comprehensive medication education and assessments throughout the curriculum and the need for additional support for newly graduated nurses in medication management due to the restrictions.
PubMed: 38852272
DOI: 10.1016/j.nepr.2024.104011 -
Age and Ageing Jun 2024Problematic polypharmacy is the prescribing of five or more medications potentially inappropriately. Unintentional prescribing cascades represent an under-researched...
INTRODUCTION
Problematic polypharmacy is the prescribing of five or more medications potentially inappropriately. Unintentional prescribing cascades represent an under-researched aspect of problematic polypharmacy and occur when an adverse drug reaction (ADR) is misinterpreted as a new symptom resulting in the initiation of a new medication. The aim of this study was to elicit key stakeholders' perceptions of and attitudes towards problematic polypharmacy, with a focus on prescribing cascades.
METHODS
qualitative one-to-one semi-structured interviews were conducted with predefined key stakeholder groups. Inductive thematic analysis was employed.
RESULTS
Thirty-one stakeholders were interviewed: six patients, two carers, seven general practitioners, eight pharmacists, four hospital doctors, two professional organisation representatives and two policymakers. Three main themes were identified: (i) ADRs and prescribing cascades-a necessary evil. Healthcare professionals (HCPs) expressed concern that experiencing an ADR would negatively impact patients' confidence in their doctor. However, patients viewed ADRs pragmatically as an unpredictable risk. (ii) Balancing the risk/benefit tipping point. The complexity of prescribing decisions in the context of polypharmacy made balancing this tipping point challenging. Consequently, HCPs avoided medication changes. (iii) The minefield of medication reconciliation. Stakeholders, including patients and carers, viewed medication reconciliation as a perilous activity due to systemic communication deficits.
CONCLUSION
Stakeholders believed that at a certain depth of polypharmacy, the risk that a new symptom is being caused by an existing medication becomes incalculable. Therefore, in the absence of harm, medication changes were avoided. However, medication reconciliation post hospital discharge compelled prescribing decisions and was seen as a high-risk activity by stakeholders.
Topics: Humans; Polypharmacy; Qualitative Research; Male; Attitude of Health Personnel; Female; Aged; Inappropriate Prescribing; Middle Aged; Stakeholder Participation; Drug-Related Side Effects and Adverse Reactions; Practice Patterns, Physicians'; Interviews as Topic; Health Knowledge, Attitudes, Practice; Medication Reconciliation; Aged, 80 and over; Caregivers; Risk Assessment; Perception; Pharmacists
PubMed: 38851215
DOI: 10.1093/ageing/afae116 -
Drugs & Aging Jun 2024Listing tools have been developed to improve medications in older patients, including the Fit fOR The Aged (FORTA) list, a clinically validated, positive-negative list...
BACKGROUND
Listing tools have been developed to improve medications in older patients, including the Fit fOR The Aged (FORTA) list, a clinically validated, positive-negative list of medication appropriateness. Here, we aim to validate MyFORTA, an automated tool for individualized application of the FORTA list.
METHODS
331 participants of a multi-center cohort study (AgeCoDe) for whom the FORTA score (sum of overtreatment and undertreatment errors) had been determined manually (gold standard [GS]) were reassessed using the automated MyFORTA (MF) tool. This tool determines the score from ATC and ICD codes combined with clinical parameters.
RESULTS
The FORTA scores were 9.01 ± 2.91 (mean ± SD, MF) versus 6.02 ± 2.52 (GS) (p < 0.00001). Removing undertreatment errors for calcium/vitamin D (controversial guidelines) and influenza/pneumococcal vaccinations (no robust information in the database), the difference decreased: 7.5 ± 2.7 (MF) versus 5.98 ± 2.55 (GS) (p < 0.00001). The remaining difference was driven by, for example, missing nitro spray in coronary heart disease/acute coronary syndrome as the related information was rarely found in the database, but notoriously detected by MF. Three hundred and forty errors from those 100 patients with the largest score deviation accounted for 68% of excess errors by MF.
CONCLUSION
MF was more sensitive to detect medication errors than GS, all frequent errors only detected by MF were plausible, and almost no adaptations of the MF algorithm seem indicated. This automated tool to check medication appropriateness according to the FORTA list is now validated and represents the first clinically directed algorithm in this context. It should ease the application of FORTA and help to implement the proven beneficial effects of FORTA on clinical endpoints.
Topics: Humans; Aged; Male; Female; Aged, 80 and over; Potentially Inappropriate Medication List; Cohort Studies; Inappropriate Prescribing
PubMed: 38848020
DOI: 10.1007/s40266-024-01120-1 -
Contemporary Clinical Trials... Jun 2024Enteral nutrition (EN) is preferred when oral feeding is not possible. The use of the Nasogastric Tube (NGT) ensures rapid and low-risk nutrient administration. However,...
BACKGROUND
Enteral nutrition (EN) is preferred when oral feeding is not possible. The use of the Nasogastric Tube (NGT) ensures rapid and low-risk nutrient administration. However, confirming the placement through chest radiography, besides delaying the initiation of nutritional therapy, exposes patients to radiation. The pH test of gastric aspirate provides a quicker check for NGT placement, but its reliability is compromised by challenges related to aspirating gastric secretions.
STUDY OBJECTIVE
The main objective of this study is to assess the high-performance placement of NGTs for nutritional purposes, optimizing the evaluation of correct insertion through pH testing using an electronic pH meter. Additionally, the study aims to evaluate patient tolerance to the intervention.
MATERIALS AND METHODS
This single-center RCT will include 150 EN candidate patients divided into three groups. Each group will use distinct NGTs, evaluating placement through pH testing and chest radiography for safety. Tolerance, complications related to NGT placement, and costs will be assessed, with data collected anonymously through a secure electronic database.
ETHICAL CONSIDERATIONS
authorization no. 3624, Territorial Ethical Committee Lombardy 5, October 20, 2023.
IMPLICATIONS AND PERSPECTIVES
This protocol introduces innovative technologies, such as advanced NGTs and an electronic pH meter, aiming to optimize enteral nutrition management. This RCT focuses on replacing X-rays as the primary method for verifying NGT placement, thereby reducing costs, time, and patient exposure to radiation. Data analysis may provide insights into managing patients on pH-altering medication. Implementing innovative technologies has the potential to reduce errors and improve economic efficiency and process sustainability.
PubMed: 38845620
DOI: 10.1016/j.conctc.2024.101312 -
BMC Nursing Jun 2024When any aspect of patient care is overlooked or delayed, it is known as Missed Nursing Care (MNC), leading to adverse events such as medication errors, infections,...
BACKGROUND
When any aspect of patient care is overlooked or delayed, it is known as Missed Nursing Care (MNC), leading to adverse events such as medication errors, infections, increased mortality rates, and poor prognosis. Moral competence is crucial for clinical nurses as it guarantees high-quality patient care in nursing practice. Thus, this study aimed to investigate the correlation between moral competencies and MNC among nurses.
METHODS
This study was conducted with a descriptive-correlational design. The participants in the study were nurses who were currently enrolled at Shahid Beheshti University of Medical Sciences. In order to recruit nurses for the study, a convenience sampling method was implemented. The study tools were completed by a total of two hundred nurses. Research tools included a demographic questionnaire, the Moral Competence of Clinical Nurses Questionnaire, and the Kalisch and Williams Missed Nursing Care (MISSCARE) survey.
ETHICAL CONSIDERATION
This study was approved by the Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences.
RESULTS
The mean scores of moral competencies and MNC were 151.83 ± 12.60 and 42.71 ± 9.38, respectively. In other words, descriptive statistics showed that the moral competence score was more than 75%, and the MNC score was less than 50%. Also, there was a significant negative correlation between the total scores of moral competencies and MNC (r = -0.38, p < 0.001), indicating that more moral competence was correlated with lower levels of MNC.
CONCLUSION
The study revealed a negative correlation between nurses' moral competence and MNC, suggesting that enhancing moral competence could reduce MNC. To reduce MNC occurrences, hospitals, and organizations should prioritize moral competency, according to our research.
PubMed: 38844989
DOI: 10.1186/s12912-024-02058-w -
BMC Public Health Jun 2024To explore the risk factors for maternal near-miss (MNM) using the WHO near-miss approach.
OBJECTIVE
To explore the risk factors for maternal near-miss (MNM) using the WHO near-miss approach.
METHODS
Data were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012-2022. Multivariate logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (aORs) were used to identify risk factors for MNM.
RESULTS
Our study included 780,359 women with 731,185 live births, a total of 2461 (0.32%) MNMs, 777,846 (99.68%) non-MNMs, and 52 (0.006%) maternal deaths were identified. The MNM ratio was 3.37‰ (95%CI: 3.23-3.50). Coagulation/hematological dysfunction was the most common cause of MNM (75.66%). Results of multivariate logistic regression analysis showed risk factors for MNM: maternal age > = 30 years old (aOR > 1, P < 0.05), unmarried women (aOR = 2.21, 95%CI: 1.71-2.85), number of pregnancies > = 2 (aOR > 1, P < 0.05), nulliparity (aOR = 1.51, 95%CI: 1.32-1.72) or parity > = 3 (aOR = 1.95, 95%CI: 1.50-2.55), prenatal examinations < 5 times (aOR = 1.13, 95%CI: 1.01-1.27), and number of cesarean sections was 1 (aOR = 1.83, 95%CI: 1.64-2.04) or > = 2 (aOR = 2.48, 95%CI: 1.99-3.09).
CONCLUSION
The MNM ratio was relatively low in Hunan Province. Advanced maternal age, unmarried status, a high number of pregnancies, nulliparity or high parity, a low number of prenatal examinations, and cesarean sections were risk factors for MNM. Our study is essential for improving the quality of maternal health care and preventing MNM.
Topics: Humans; Female; China; Risk Factors; Pregnancy; Adult; Near Miss, Healthcare; Young Adult; Pregnancy Complications; Logistic Models; Maternal Mortality
PubMed: 38844895
DOI: 10.1186/s12889-024-18970-4 -
PloS One 2024The pharmacist plays an essential role in identifying and managing drug-related problems. The aim of this research was to assess the costs avoided by clinical pharmacist...
BACKGROUND
The pharmacist plays an essential role in identifying and managing drug-related problems. The aim of this research was to assess the costs avoided by clinical pharmacist interventions to resolve drug-related problems.
RESEARCH DESIGN AND METHODS
Clinical pharmacists identified drug-related problems and interventions to address them in consecutive outpatients visiting internal medicine clinics at major teaching and public hospitals in Jordan from September 2012 to December 2013. The costs avoided by each intervention to address drug-related problems were collected from the literature. The collected data were used to calculate the overall cost saved and avoided by the interventions implemented to address the identified drug-related problems, adopting a Jordanian healthcare system perspective.
RESULTS
A total of 2747 patients were enrolled in the study. Diagnostic interventions, such as the need for additional diagnostic testing, were employed in 95.07% of the 13935 intervention to address the drug-related problem "Miscellaneous" which was the most frequent drug-related problems. Other common drug-related problems categories included inappropriate knowledge (n = 6972), inappropriate adherence (4447), efficacy-related drug-related problem (3395) and unnecessary drug therapy (1082). The total cost avoided over the research period was JOD 1418720 per month and total cost saved over the study period was JOD 17250.204. Drug-related problems were associated the number of prescription medications (odds ratio = 1.105; 95% confidence interval = 1.069-1.142), prescribed gastrointestinal drugs (3.485; 2.86-4.247), prescribed antimicrobials (3.326; 1.084-10.205), and prescribed musculoskeletal drugs (1.385; 1.011-1.852).
CONCLUSIONS
The study revealed that pharmacists have provided cognitive input to rationalize and optimize the medication use and prevent errors, that led to the reported projected avoided and saved expenditures via various interventions to address drug-related problems. This highlights the added economic impact to the clinical impact of drug-related problems on patients and the healthcare system. The high prevalence and cost of drug-related problems offer strong rationale for pharmacists to provide more vigilant intervention to improve patient outcomes while maintaining cost effectiveness.
Topics: Humans; Jordan; Pharmacists; Male; Female; Middle Aged; Drug-Related Side Effects and Adverse Reactions; Ambulatory Care Facilities; Aged; Adult; Cost Savings
PubMed: 38843244
DOI: 10.1371/journal.pone.0302287 -
Alternative Therapies in Health and... Jun 2024This meta-analysis aims to investigate the effects of prenatal prophylactic antibiotics on the diversity of intestinal flora in premature infants, with a focus on...
OBJECTIVE
This meta-analysis aims to investigate the effects of prenatal prophylactic antibiotics on the diversity of intestinal flora in premature infants, with a focus on elucidating the rationale behind this investigation and the potential impact of altered intestinal flora on the health of preterm infants, such as increased susceptibility to infections, impaired nutrient absorption, and compromised immune function.
METHODS
Relevant literature consistent with the effects of prenatal prophylactic antibiotics on intestinal flora diversity in preterm infants was systematically searched and screened from both domestic and foreign databases, including Wanfang Medical Center, CNKNET, VIpp, and PubMed. Meta-analysis was performed using RevMan 5.2 software. Inclusion criteria for the study were: (1) comparison of prophylactic antibiotic use versus non-use, (2) no restrictions on subjects' characteristics, (3) follow-up loss < 20%, (4) institutional approval, (5) publication within the time frame from January 2017 to December 2022, (6) minimal missing data or suppliable by author contact, and (7) no major errors in sequencing or detection. Outcome measures included intestinal flora composition, phylum flora content, abundance index, and Shannon index, comparing antibiotic-treated and non-treated groups. RevMan 5.2 software was used for statistical analysis. Counting data was expressed as risk ratio (RR), and weighted mean difference (WMD) or standard mean difference (SMD) was selected as analysis statistics.
RESULTS
The study encompassed five Chinese literature sources, with one deemed low quality and four high quality. No significant publication bias was observed. Among the included studies, a significant reduction in the intestinal flora abundance index ACE was noted in the treated group compared to the non-treated group (RR: -8.10, 95% CI: -8.81 to -7.40, P < .00001). ACE estimates species richness in a microbial community by considering both abundant and rare species. Higher ACE values indicate greater diversity. Similarly, the Shannon diversity index was lower in the medication group compared to the non-medication group (RR: 0.73, 95% CI: 0.64 to 0.82, P < .00001). Shannon Diversity Index measures species diversity and evenness within a community. Higher values indicate higher diversity, considering both the number of species and their relative abundance. Analysis of Firmicutes content revealed a higher level in the treated group (RR: -6.44, 95% CI: -7.26 to -5.63, P < .00001). Additionally, lower Proteus (RR: 10.96, 95% CI: 9.47 to 12.45, P < .00001) and Klebsiella (RR: 15.96, 95% CI: 15.31 to 16.62, P < .00001) content was observed in the treated group. Conversely, Enterococcus content was higher in the treated group (RR: 2.18, 95% CI: 1.84 to 2.52, P < .00001), along with a higher proportion of Enterococcus (RR: 0.45, 95% CI: 0.27 to 0.76, P = .003). These findings collectively suggest that prophylactic antibiotic use in preterm infants significantly alters the composition of intestinal flora.
CONCLUSION
Our findings suggest that prophylactic antibiotic use in preterm infants leads to a notable reduction in intestinal flora diversity, potentially impacting their health outcomes. Decreased microbial diversity has been linked to gastrointestinal issues, infections, and weakened immune function. These results highlight the importance of cautious antibiotic use in this vulnerable population and the need for further research to better understand and mitigate the potential health implications.
PubMed: 38836722
DOI: No ID Found