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18. Nurses' responses to patients' medication self‐management problems in hospital and the use of recommendations.

Author

Mortelmans, Laura, Goossens, Eva, De Cock, Anne‐Marie, van den Bemt, Patricia, and Dilles, Tinne

Subjects
MEDICATION therapy management, MEDICAL personnel, HOSPITAL utilization, PATIENTS' attitudes, HOSPITAL patients
Abstract

This study aimed to describe the use of recommendations as a guide for healthcare providers to support patients experiencing medication self‐management problems and to evaluate their feasibility, user‐friendliness and usefulness. Between March and August 2023, 58 hospitalized patients completed a self‐assessment on medication self‐management problems. The problems addressed in this self‐assessment were based on a list of frequently encountered medication self‐management problems from previous research. Consequently, 18 nurses responded to the reported problems using the recommendations. Nurses evaluated the feasibility, user‐friendliness and usefulness of these recommendations through a survey. A total of 217 medication self‐management problems were reported by 58 patients. Nurses intervened in 52% of the problems using the recommendations. According to nurses, the recommendations were user‐friendly and feasible but required a substantial time investment. Considering these pilot‐based results, the recommendations have the potential to be a valuable resource for nurses in practice, though this potential requires further exploration. [ABSTRACT FROM AUTHOR]

Published
2024
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25. Adoption of antithrombotic stewardship and utilization of clinical decision support systems —A questionnaire-based survey in Dutch hospitals

Author

Graafsma, Jetske, Klopotowska, Joanna E., Derijks, Hieronymus J., van de Garde, Ewoudt M.W., Hoge, Rien H.L., Kruip, Marieke J.H.A., Meijer, Karina, Karapinar-Carkit, Fatma, van den Bemt, Patricia M.L.A., Graafsma, Jetske, Klopotowska, Joanna E., Derijks, Hieronymus J., van de Garde, Ewoudt M.W., Hoge, Rien H.L., Kruip, Marieke J.H.A., Meijer, Karina, Karapinar-Carkit, Fatma, and van den Bemt, Patricia M.L.A.

Abstract

Antithrombotics require careful monitoring to prevent adverse events. Safe use can be promoted through so-called antithrombotic stewardship. Clinical decision support systems (CDSSs) can be used to monitor safe use of antithrombotics, supporting antithrombotic stewardship efforts. Yet, previous research shows that despite these interventions, antithrombotics continue to cause harm. Insufficient adoption of antithrombotic stewardship and suboptimal use of CDSSs may provide and explanation. However, it is currently unknown to what extent hospitals adopted antithrombotic stewardship and utilize CDSSs to support safe use of antithrombotics. A semi-structured questionnaire-based survey was disseminated to 12 hospital pharmacists from different hospital types and regions in the Netherlands. The primary outcome was the degree of antithrombotic stewardship adoption, expressed as the number of tasks adopted per hospital and the degree of adoption per task. Secondary outcomes included characteristics of CDSS alerts used to monitor safe use of antithrombotics. All 12 hospital pharmacists completed the survey and report to have adopted antithrombotic stewardship in their hospital to a certain degree. The median adoption of tasks was two of five tasks (range 1–3). The tasks with the highest uptake were: drafting and maintenance of protocols (100%) and professional’s education (58%), while care transition optimization (25%), medication reviews (8%) and patient counseling (8%) had the lowest uptake. All hospitals used a CDSS to monitor safe use of antithrombotics, mainly via basic alerts and less frequently via advanced alerts. The most frequently employed alerts were: identification of patients using a direct oral anticoagulant (DOAC) or a vitamin K antagonist (VKA) with one or more other antithrombotics (n = 6) and patients using a VKA to evaluate correct use (n = 6), both reflecting basic CDSS. All participating hospitals adopted antithrombotic stewardship, but the adopted t

Published
2024

26. Medication reviews by emergency department pharmacists in patients hospitalised for an adverse drug event:a cost study

Author

Rahman, Rehana N., Polinder, Suzanne, Nikolik, Bojan, Hoek, Amber E., Janssen, Marjo J.A., Schuit, Stephanie C.E., van den Bemt, Patricia M.L.A., Karapinar-Çarkit, Fatma, Rahman, Rehana N., Polinder, Suzanne, Nikolik, Bojan, Hoek, Amber E., Janssen, Marjo J.A., Schuit, Stephanie C.E., van den Bemt, Patricia M.L.A., and Karapinar-Çarkit, Fatma

Abstract

Objective: To perform a cost study of pharmacist-led medication reviews in patients with an acute hospitalization for adverse drug events. Method: Emergency department pharmacists performed medication reviews in patients hospitalized after visiting the emergency department for an adverse drug event (ADE). Control patients were hospitalized after an emergency department visit not related to an ADE and received usual care. The costs of the intervention were labour costs of the junior emergency department pharmacist and the cost savings consisted of costs of medication that was stopped or reduced during six months after the intervention. Sensitivity analyses were performed to evaluate different scenarios. Results: In the intervention group (n = 104) 113 medication changes led to stopping or reducing medication, accounting for averted costs of €22,850. In the control group (n = 112) 39 medication changes led to stopping or reducing medication, accounting for averted costs of €299. The mean labour costs of the intervention were €138 per patient, resulting in saved costs of €61 per patient per six months. Sensitivity analyses showed that if the intervention would be performed by a senior clinical pharmacist, there are no cost savings (€-21), if parts of the intervention would be executed by pharmacy technicians (e.g. administrative tasks), cost savings would be augmented to €87, if outliers in costs associated with medication reduction would be excluded, there are no cost savings (€-35) and if the costs of reduced medication were extrapolated to one year, cost savings would be €260. Conclusion: In this study, medication reviews by junior emergency department pharmacists in patients hospitalized after an emergency department visit for an ADE lead to a cost reduction over a six month period. Trial registration: The main study is registered on the ISRCTN registry with trial I

Published
2024

28. Medication adherence to CFTR modulators in patients with cystic fibrosis: a systematic review.

Author

Hansen, Carina M. E., Breukelman, Anna J., van den Bemt, Patricia M. L. A., Zwitserloot, Annelies M., van Dijk, Liset, and van Boven, Job F. M.

Subjects
PATIENT compliance, CYSTIC fibrosis transmembrane conductance regulator, CYSTIC fibrosis, PATIENT monitoring, ELECTRONIC surveillance
Abstract

Background In the last decade, a fundamental shift in the treatment of cystic fibrosis (CF) took place due to the introduction of CF transmembrane conductance regulator (CFTR) modulators. Adequate medication adherence is a prerequisite for their effectiveness, but little is known about adherence to CFTR modulators. We aimed to assess the extent of medication adherence to CFTR modulators in patients with CF and assess which characteristics are associated with adherence. Methods A systematic review following PRISMA guidelines was performed. Studies needed to report adherence to CFTR modulators. Main outcomes were: 1) level of medication adherence and 2) associations of demographic and/or clinical characteristics with adherence. Results In total, 4082 articles were screened and 21 full-text papers were assessed for eligibility. Ultimately, seven studies were included. Most studies were retrospective and focused on adherence to ivacaftor or lumacaftor–ivacaftor with only one focusing on elexacaftor–tezacaftor–ivacaftor. The majority used pharmacy refill data with adherence determined with the proportion of days covered (PDC) or the medication possession ratio (MPR). One study additionally used electronic monitoring and patient self-reported adherence. Adherence was 0.62–0.99 based on pharmacy data (PDC or MPR), 61% via electronic monitoring and 100% via self-report. Age <18 years appeared to be associated with good adherence, as was a higher lung function. Conclusions Despite the wide variety of adherence methods used, adherence to CFTR modulators is suboptimal, based on objective measures such as pharmacy refill data or electronic monitoring. CFTR modulator adherence measurement and definitions requires more standardisation with a preference for objective and granular methods. [ABSTRACT FROM AUTHOR]

Published
2024
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42. Prevalence and determinants of medication administration errors in clinical wards:A two-centre prospective observational study

Author

Jessurun, Janique Gabriëlle, Hunfeld, Nicole Geertruida Maria, de Roo, Michelle, van Onzenoort, Hein Antonius Walterus, van Rosmalen, Joost, van Dijk, Monique, van den Bemt, Patricia Maria Lucia Adriana, Jessurun, Janique Gabriëlle, Hunfeld, Nicole Geertruida Maria, de Roo, Michelle, van Onzenoort, Hein Antonius Walterus, van Rosmalen, Joost, van Dijk, Monique, and van den Bemt, Patricia Maria Lucia Adriana

Abstract

Aims and objectives: To identify the prevalence and determinants of medication administration errors (MAEs). Background: Insight into determinants of MAEs is necessary to identify interventions to prevent MAEs. Design: A prospective observational study in two Dutch hospitals, a university and teaching hospital. Methods: Data were collected by observation. The primary outcome was the proportion of administrations with one or more MAEs. Secondary outcomes were the type, severity and determinants of MAEs. Multivariable mixed-effects logistic regression analyses were used for determinant analysis. Reporting adheres to the STROBE guideline. Results: MAEs occurred in 352 of 2576 medication administrations (13.7%). Of all MAEs (n = 380), the most prevalent types were omission (n = 87) and wrong medication handling (n = 75). Forty-five MAEs (11.8%) were potentially harmful. The pharmaceutical forms oral liquid (odds ratio [OR] 3.22, 95% confidence interval [CI] 1.43–7.25), infusion (OR 1.73, CI 1.02–2.94), injection (OR 3.52, CI 2.00–6.21), ointment (OR 10.78, CI 2.10–55.26), suppository/enema (OR 6.39, CI 1.13–36.03) and miscellaneous (OR 6.17, CI 1.90–20.04) were more prone to MAEs compared to oral solid. MAEs were more likely to occur when medication was administered between 10 a.m.–2 p.m. (OR 1.91, CI 1.06–3.46) and 6 p.m.–7 a.m. (OR 1.88, CI 1.00–3.52) compared to 7 a.m.–10 a.m. and when administered by staff with higher professional education compared to staff with secondary vocational education (OR 1.68, CI 1.03–2.74). MAEs were less likely to occur in the teaching hospital (OR 0.17, CI 0.08–0.33). Day of the week, patient-to-nurse ratio, interruptions and other nurse characteristics (degree, experience, employment type) were not associated with MAEs. Conclusions: This study identified a high MAE prevalence. Identified determinants suggest that focusing interventions on complex pharmaceutical forms and error-prone administration times may contribute to MAE reducti

Published
2023

45. Risk factors for QTc interval prolongation

Author

Heemskerk, Charlotte P. M., Pereboom, Marieke, van Stralen, Karlijn, Berger, Florine A., van den Bemt, Patricia M. L. A., Kuijper, Aaf F. M., van der Hoeven, Ruud T. M., Mantel-Teeuwisse, Aukje K., and Becker, Matthijs L.

Published
2017
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48. Environmentally sustainable prescribing: recommendations for EU pharmaceutical legislation

Author

Piët, Joost D, Booth, Amy, Donker, Erik M, de Ponti, Fabrizio, Lunghi, Carlotta, Poluzzi, Elisabetta, Janssen, Ben J A, Tun, SanYuMay, Bekker, Charlotte, Dima, Lorena, Costa, João, Jalving, Mathilde, Oude Munnink, Thijs H, van den Bemt, Patricia M L A, Labriffe, Marc, van Emden, Tomás, van Waardenburg, Vera, Likic, Robert, Richir, Milan, van Agtmael, Michiel A, Moermond, Caroline T A, and Tichelaar, Jelle

Published
2024
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