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6. Prescription Errors in Older Individuals with an Intellectual Disability: Prevalence and Risk Factors in the Healthy Ageing and Intellectual Disability Study

Author

Zaal, Rianne J., van der Kaaij, Annemieke D. M., and Evenhuis, Heleen M.

Abstract

Prescribing pharmacotherapy for older individuals with an intellectual disability (ID) is a complex process, possibly leading to an increased risk of prescription errors. The objectives of this study were (1) to determine the prevalence of older individuals with an intellectual disability with at least one prescription error and (2) to identify potential risk factors for these prescription errors (age, gender, body mass index (BMI), frailty index, level of intellectual disability and living situation). The study population consisted of 600 older ([greater than or equal to]50 years) individuals with an ID using one or more drugs who were randomly selected from the study cohort of the Healthy Ageing and Intellectual Disability (HA-ID) Study. The medication used at the time of measurement was screened for errors by a hospital pharmacist/clinical pharmacologist and a Master's student pharmacy using consensus methodology. Participants with one or more prescription errors were compared to participants without prescription errors by multivariate logistic regression to identify potential risk factors. The prevalence of individuals with one or more prescription errors was 47.5% (285 of 600 individuals; 95% confidence interval (CI) 43-52%). Relevant errors, defined as errors that actually do require a change of pharmacotherapy, were identified in 26.8% of the individuals (161 of 600 individuals; 95% CI 23-30%). Higher age (adjusted odds ratio (OR[subscript adj]) 1.03; 95% CI 1.01-1.06), less severe intellectual disability (moderate: OR[subscript adj] 0.48; 95% CI 0.31-0.74 and severe: OR[subscript adj] 0.56; 95% CI 0.32-0.98), higher BMI (OR[subscript adj] 1.04; 95% CI 1.01-1.08), higher frailty index (0.39-0.54: OR[subscript adj] 2.4; 95% CI 1.21-4.77 and greater than or equal to 0.55: OR[subscript adj] 3.4; 95% CI 1.03-11.02), polypharmacy (OR[subscript adj] 8.06; 95% CI 5.59-11.62) and use of medicines acting on the central nervous system (OR[subscript adj] 3.34; 95% CI 2.35-4.73) were independently associated with the occurrence of prescription errors. Interventions targeted to high risk patients should be designed and implemented to improve pharmacotherapy in older individuals with an intellectual disability. (Contains 5 tables.)

Published
2013
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16. No Superiority of Tacrolimus Suppositories vs Beclomethasone Suppositories in a Randomized Trial of Patients With Refractory Ulcerative Proctitis

Author

Lie, Mitchell R.K.L., Kreijne, Joany E., Dijkstra, Gerard, Löwenberg, Mark, van Assche, Gert, West, Rachel L., van der Meulen - de Jong, Andrea E., Oldenburg, Bas, Zaal, Rianne J., Hansen, Bettina E., de Vries, Annemarie C., Lie, Mitchell R.K.L., Kreijne, Joany E., Dijkstra, Gerard, Löwenberg, Mark, van Assche, Gert, West, Rachel L., van der Meulen - de Jong, Andrea E., Oldenburg, Bas, Zaal, Rianne J., Hansen, Bettina E., and de Vries, Annemarie C.

Abstract

Background & Aims: Ulcerative proctitis (UP) refractory to 5-aminosalicylic acid (5-ASA) suppositories is a challenge to treat, often requiring step up to immunomodulator or biological therapy. Topical tacrolimus is effective and safe in patients with refractory UP. However, it is not clear how tacrolimus suppositories fit into in the treatment algorithm of UP. Methods: We performed a randomized controlled, double-blind study at 8 hospitals in the Netherlands and Belgium from 2014 through 2017. Eighty-five patients with refractory UP (65% women) were randomly assigned to groups given once daily tacrolimus suppositories (2 mg; n = 43) or beclomethasone (3 mg; n = 42) for 4 weeks. The primary outcome was clinical response (decrease in Mayo score of 3 or more). Secondary outcomes included clinical remission, endoscopic response and remission, adverse events and quality of life. Outcomes were compared using Fisher's exact test and Mann-Whitney U test. Results: Proportions of patients with clinical responses were 63% in the tacrolimus group and 59% in the beclomethasone group (P =.812); proportions of patients in clinical remission were 46% and 38%, respectively (P =.638). Proportions of patients with an endoscopic response were 68% and 60% in the tacrolimus group and in the beclomethasone group (P =.636); proportions in endoscopic remission rates were 30% and 13%, respectively (P =.092) Median increases in the inflammatory bowel disease questionnaire score were 18.0 in the tacrolimus group and 20.5 in the beclomethasone group (P =.395). Adverse event rates did not differ significantly between groups. Conclusions: In a 4-week randomized controlled trial, tacrolimus and beclomethasone suppositories induce comparable clinical and endoscopic responses in patients with UP refractory to 5-ASA. There were no significant differences in adverse events rates. Tacrolimus and beclomethasone supposit

Published
2020

17. Vermijdbare en niet-vermijdbare medicatiegerelateerde schade in het ziekenhuis

Author

Mol, Peter G. M, Van Den Bemt, Patricia M. L. A., Dequito, Aileen B., Van Doormaal, Jasperien E., Zaal, Rianne J., Haaijer-Ruskamp, Floor M., Kosterink, Jos G. W., Methods in Medicines evaluation & Outcomes research, Guided Treatment in Optimal Selected Cancer Patients, Biopharmaceuticals, Discovery, Design and Delivery, and Targeted Gynnaecologic Oncology

Subjects
algorithm, non preventable adverse event, sex difference, adverse drug reaction, nervous system, prevalence, article, rheumatology, gastroenterology, morbidity, medical error, medical record review, computerized provider order entry, hospital admission, hospital patient, female, multicenter study, wellbeing, age, length of stay, male, human, preventable adverse drug event, prospective study
Abstract

OBJECTIVE: To analyse the prevalence of preventable adverse drug events (pADEs) and non-preventable adverse drug reactions (ADRs) as well as the determinants of both pADEs and ADRs. METHODS: Adverse events experienced by patients admitted to two Dutch hospitals with functioning computerized physician order entry (CPOE) systems were prospectively identifed through chart review. For both pADEs and non-preventable ADRs a causal relationship between adverse events and patients' drugs was established using the simplifed Yale algorithm. RESULTS: pADEs and non-preventable ADRs were experienced by 349 (58%) patients, of whom 307 (88%) had non-preventable ADRs. Multi-morbidity (adjusted odds ratio [ORadj] 1.90 and 1.28 respec tively), length of stay (ORadj1.13 and 1.11), admission to the geriatric ward (ORadj7.78 and 3.82) and number of medication orders (ORadj1.25 and 1.13) were signifcantly associated with pADEs and ADRs. Admission to the gastroenterology/rheumatology ward (ORadj0.22 and 0.40) was inversely related to both pADEs and ADRs. Other determinants for ADRs only were female sex (ORadj1.77) and use of drugs affecting the nervous system (ORadj1.83). Age was a signifcant determinant for pADEs only (ORadj1.07). CONCLUSIONS: More than half of the patients admitted to the hospitals are harmed by drugs, of which most are non-serious, non-preventable ADRs. Determinants of both pADEs and ADRs overlap to a large extent. Our results imply the need for signalling early potential adverse events during the normal use of drugs in multimorbid patients or those in geriatric wards. Subsequent therapeutic interventions may improve their well-being more than focusing on errors in the medication process only.

Published
2013

19. Computerized physician order entry (CPOE) system: expectations and experiences of users

Author

van Doormaal, J.E., Mol, P.G.M., Zaal, Rianne J., van den Bemt, P.M.L.A., Kosterink, J.G.W., Vermeulen, K.M., Haaijer-Ruskamp, F.M., and Methods in Medicines evaluation & Outcomes research (M2O)

Subjects
MODEL, MEDICATION SAFETY, CPOE system, IMPACT, health services administration, health care facilities, manpower, and services, education, CLINICAL DECISION-SUPPORT, experiences, ERRORS, implementation, ADVERSE DRUG EVENTS, expectations
Abstract

Objectives To explore physicians' and nurses' expectations before and experiences after the implementation of a computerized physician order entry (CPOE) system in order to give suggestions for future optimization of the system as well as the implementation process. Method On four internal medicine wards of two Dutch hospitals, 18 physicians and 42 nurses were interviewed to measure expectations and experiences with the CPOE system. Using semi-structured questionnaires, expectations and experiences of physicians and nurses with the CPOE system were measured with statements on a 5-point Likert scale (1 = completely disagree, 5 = completely agree). The percentage respondents agreeing (score of 4 or 5) was calculated. Chi-squared tests were used to compare the expectations versus experiences of physicians and nurses and to assess the differences between physicians and nurses. Results In general, both physicians and nurses were positive about CPOE before and after the implementation of this system. Physicians and nurses did not differ in their views towards CPOE except for the overview of patients' medication use that was not clear according to the nurses. Both professions were satisfied with the implementation process. CPOE could be improved especially with respect to technical aspects (including the medication overview) and decision support on drug-drug interactions. Conclusion Overall we conclude that physicians and nurses are positive about CPOE and the process of its implementation and do accept these systems. However, these systems should be further improved to fit into clinical practice.

Published
2010

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