Medication non-adherence, the extent to which a person's behavior does not coincide with medical or health advice, is a serious public health issue. Objectives: 1) Develop a new typology of medication non-adherence, 2) Develop models to predict different types of non-adherence based on Andersen Behavioral Model (ABM) and Leventhal's Common Sense Model (CSM), and 3) Test the models across two different medications used in treating disease conditions with varying symptomatology. Methodology: A new typology of medication non-adherence was developed through literature review of the frequently reported reasons for non-adherence based on the possibility of a cognitive process intervention directed towards patients and the mutability of interventions. The typology was analyzed qualitatively and quantitatively. A new self-reported scale to measure non-adherence was developed from the frequently reported reasons and compared to the Morisky scale. The conceptual models developed using ABM and CSM were tested using regression techniques to identify significant predictors of non-adherence. Results: Qualitative analysis supported the typology from the literature review, yet the quantitative exploratory factor analysis did not support it. Instead, four types of non-adherence each for cholesterol lowering (non-adherence due to managing issues, multiple medication issues, belief issues with medications, forgetfulness due to busy schedule) and asthma maintenance medications (non-adherence due to managing and availability issues, beliefs and convenience issues, cost issues, forgetfulness due to busy schedule) were identified. Predisposing factors such as concern beliefs in medications, enabling factors such as self efficacy, and need factors such as self health and illness perceptions, and severity of disease were significant predictors of medication non-adherence. The Reasons scale had moderate levels of agreement with the Morisky scale based on kappa coefficients. Conclusion: No one typology of medication non-adherence fit cholesterol lowering and asthma maintenance medications, and the typology was driven by type of disease condition and reasons for non-adherence. The Reasons scale measured and categorized non-adherence better than the Morisky scale. Adding CSM to ABM facilitated in identifying predictors of medication non-adherence.

Background: Discrepancies in patient’s medication list can lead to medication errors which is a major cause of both morbidity and mortality today. The aim of the study was to examine the frequency of discrepancies in the Swedish prescription list “My saved prescriptions” regarding noncurrent treatment, incorrect dosages, double prescriptions, and missing prescriptions. Additionally, the purpose was to examine the type of source of information the patients used regarding their drug treatment.   Methods: Collection of data was conducted through interviews at three different pharmacies over a period of four weeks in Stockholm 2020. Patients 18 years or older with at least three prescribed drugs were asked to participate in the study.   Results: Of 157 patients, 74 patients were included. More than 70% of the patients had one or more discrepancies in their prescription list: a noncurrent, a duplicate or an incorrect dosage. 17.6% had at least one missing prescription. About half of the patients had a noncurrent prescription, which was the most common discrepancy among the patients. More than a third, 35.1%, of the patients used the prescription list as a source of information for their drug treatments. Furthermore, 31.1% of the patients used the drug packaging and 17.6% of them only used their memory. 10.8% of the patients used the medication list from healthcare.  Conclusions: The results suggest that discrepancies were quite common in the prescription list, which can increase the risk of medication errors for patients who use the prescription list as a source of information. The implementation of the Swedish National List (NLL) (launching in 2021) will provide the caregivers, pharmacies, and patients with access to the same information about patient’s prescribed drugs. NLL will hopefully reduce the risk of medication errors and it should lead to a reduced necessity of using several different sources for prescribed drugs.

Problem: Asthma affects one out of every ten children in the United States. It is recommended that children with persistent asthma take long-term controller (LTC) medications to achieve control. However, adherence varies, and many children do not take their LTC medication at all. The average cost for hospitalization of a child with asthma is $8,406. Asthma in children also contributes to school absenteeism and a decrease in quality of life. Objective: A literature review was performed to examine factors that affect adherence to LTC medications used to control asthma in children. Method: A literature review was performed using the CINAHL, ERIC, Medline, Psych Info, and Academic Search Premier databases. Keywords included asthma AND child* OR pediatric* AND adherence OR compliance AND corticosteroid* OR “leukotriene modifier*” OR “mast cell stabilizer*” OR “monoclonal antibod*” OR “long-acting beta agonist.*” After applying exclusion criteria 35 articles were included in this review. Results: A variety of factors that affect adherence were identified. Internal factors included age, sex, and race/ethnicity. External factors included socioeconomic status, environment, health perception, lack of motivation, parental education, disease/medication beliefs, family dynamics and planning, responsibility, severity, and exacerbations. Interventional factors included caregiver-family communication, asthma knowledge, specialty care, white coat adherence, number of prescriptions, asthma action plans, medication regimens, and technology. Conclusion: It is recommended that healthcare providers use a four-step process during inpatient and outpatient asthma visits. The steps include assess and educate, collaborate, problem-solve, and follow-up. Collectively, this method can help healthcare providers overcome many of the barriers that were identified.

The purpose was to objectively measure the rate of healing of equine distal limb wounds when a 10% Natural Proprietary Compound (NPC) was compared to a topical antibacterial cream (1% silver sulfadiazine- SSD). Five horses had two wounds measuring 6.25cm2 created on the dorsomedial aspect of each limb. Two contralateral limbs were randomly chosen to be bandaged and the other two limbs were un-bandaged – with one limb of each group being treated with either NPC or SSD. On each limb the most proximal wound was left without topical treatment to act as a control. There was no significant difference between SSD and the compound evaluated in this study when either perimeter or area was assessed. Control wounds were significantly smaller than those treated with an ointment regardless of other variables, giving rise to a proposed location effect. Bandaging by day was significant for the time period approximating 2-5 weeks.

No description available.

RATIONALE AND The double checking of medicines in health care is a contestable procedure. It occupies an obvious position in health care practice and is understood to be an effective defence against medication error but the process is variable and the outcomes have not been exposed to testing. This paper presents an appraisal of the process using data from part of a larger study on the contributory factors in medication errors and their reporting. METHODS: Previous research studies are reviewed; data are analysed from a review of 991 drug error reports and a subsequent series of 40 in-depth interviews with health professionals in an acute hospital in northern England. RESULTS: The incident reports showed that errors occurred despite double checking but that action taken did not appear to investigate the checking process. Most interview participants (34) talked extensively about double checking but believed the process to be inconsistent. Four key categories were apparent: deference to authority, reduction of responsibility, automatic processing and lack of time. Solutions to the problems were also offered, which are discussed with several recommendations. CONCLUSIONS: Double checking medicines should be a selective and systematic procedure informed by key principles and encompassing certain behaviours. Psychological research may be instructive in reducing checking errors but the aviation industry may also have a part to play in increasing error wisdom and reducing risk.

O preparo e a administração de medicamentos são práticas realizadas no cotidiano pela equipe de enfermagem. Para que haja segurança aos pacientes na utilização dos medicamentos, faz-se necessário que os profissionais envolvidos no sistema de medicação tenham o conhecimento e o entendimento do conceito de erro na medicação de maneira clara, para que possam identificar o erro bem como as situações facilitadoras para sua ocorrência. O presente estudo teve como objetivo analisar o conhecimento dos auxiliares de enfermagem de um hospital de ensino sobre o conceito de erro na medicação antes e após a implantação de uma oficina de capacitação. A pesquisa foi realizada em um hospital universitário situado na Região Noroeste do Estado do Paraná. A amostra foi constituída de 47 auxiliares de enfermagem que estavam regularmente matriculados no curso de formação profissionalizante em técnico de enfermagem e que exerciam a atividade assistencial, tendo a medicação como rotina em sua prática. A pesquisa foi aprovada pelo comitê de ética em pesquisa de uma universidade estadual, em conformidade com a Resolução n.º 196/96. Trata-se de um estudo quantitativo com delineamento quase-experimental, tendo como referencial teórico a abordagem sistêmica do erro. A coleta dos dados ocorreu em três etapas: 1. pré-teste, 2. desenvolvimento de uma oficina dinâmica de estudos fundamentada na metodologia da problematização, e 3. pós-teste. Os resultados foram agrupados em sete categorias, as quais seguem: 1. comunicação entre a equipe de saúde; 2. cumprimento do horário da administração de medicamentos; 3. execução do procedimento técnico; 4. dispensação e distribuição dos medicamentos; 5. sistemas de medicação; 6. administração de medicamentos propriamente dita e 7. complicações relacionadas aos medicamentos. Os resultados apontaram que os participantes não perceberam o atraso na administração de medicamentos e a falta de monitoramento pós-administração como erro na medicação, demonstrando uma confiança na regra dos cinco certos e pouco conhecimento dos protocolos de preparo e conservação dos fármacos. Constatou-se a existência de situações facilitadoras para a ocorrência de erro no sistema de medicação, destacando-se que o processo de seleção e prescrição tem maior risco de promover um erro e o processo de dispensação e distribuição possui menor possibilidade em desencadear erro na medicação. / The preparation and administration of medication are daily practices carried out by the nursing team. In order to grant safety to patients in medication use, it becomes necessary for professionals involved in the medication system to possess clear knowledge and understanding about the concept of medication error for them to be able to identify the error, as well as the situations that facilitate its occurrence. This study aimed to analyze the knowledge of nursing auxiliaries at a school hospital with respect to the medication error concept before and after the implantation of a training workshop. The research was carried out at a university hospital located in the northwestern region of Paraná, Brazil. The sample consisted of 47 nursing auxiliaries, who were regularly enrolled in a nursing technician professional formation course and active in nursing care, so that medication was part of their routine practice. The research project was approved by the Research Ethics Committee in accordance with Resolution nº 196/96 - CNS. This is a quantitative and exploratory study with quasi-experimental outlines, adopting the systemic error approach as a reference framework. Data collection involved three phases: 1. pre-test, 2. development of a dynamic study workshop based on problem methodology, and 3. post-test. Results were grouped into seven categories as follows: 1. communication among health team members; 2. accomplishment of medication administration time; 3. technical procedure realization; 4. medication dispensation and distribution; 5. medication systems; 6. medication administration in itself and 7. complications related to medication. We highlighted that, according to the results, the participants did not perceive the delay in medication administration and the lack of post-administration monitoring as a medication error, demonstrating excessive trust in the five rights and little knowledge about the preparation and conservation protocols for pharmaceutical products. We observed the existence of situations that facilitate the occurrence of errors in the medication system, emphasizing that the selection and prescription process contains greater risk of leading to error and that a smaller possibility of medication error is contained in the dispensation and distribution process.

Kan, Ka Lai Carrie. / "May 2008." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 118-125). / Abstracts in English and Chinese, some text in appendix also in Chinese. / Chapter CHAPTER 1: --- INTRODUCTION --- p.1 / Chapter CHAPTER 2: --- LITERATURE REVIEW / Introduction --- p.3 / Medication error --- p.4 / Definition of medication error --- p.4 / Incidents of medication error --- p.6 / The issues of defining medication error --- p.7 / The issue of medication error reporting --- p.8 / Near miss --- p.9 / Factors associated with medication error --- p.10 / System factors --- p.10 / Environmental factors --- p.12 / Human factors --- p.13 / Slips and lapses and medication error --- p.14 / "Distraction, slips and lapses and medication error" --- p.15 / Distraction --- p.15 / Definition of distraction --- p.15 / Consequences of distraction --- p.16 / Factors associated with distraction --- p.16 / Cognitive factors --- p.17 / Personality factors --- p.18 / Environmental factors --- p.18 / Studies on distraction during medication administration --- p.19 / Distraction and medication error --- p.21 / Strategies to reduce distraction --- p.22 / Visual Sign --- p.23 / Definition of visual sign --- p.23 / Nature of visual sign --- p.24 / Studies on visual sign to reduce distraction --- p.25 / Summary of literature review --- p.25 / Chapter CHAPTER 3: --- METHODOLOGY / Introduction --- p.27 / Aims and objectives --- p.27 / Operational definitions --- p.28 / Research design --- p.28 / Setting --- p.31 / Stage one --- p.32 / Setting --- p.32 / Sampling --- p.33 / Instrument --- p.35 / Data collection method --- p.36 / Data analysis --- p.37 / Stage two --- p.38 / Stage three --- p.40 / Pilot study --- p.40 / Validity and reliability of methodology --- p.41 / Interview --- p.41 / Observation --- p.42 / Ethical considerations --- p.43 / Chapter CHAPTER 4: --- FINDINGS / Introduction --- p.44 / Stage one --- p.44 / Baseline interview --- p.44 / Informants' characteristics --- p.44 / Categories and sub-categories --- p.45 / Feelings of medication error --- p.46 / Causes of medication error --- p.47 / Causes of distraction --- p.49 / Perception of distraction --- p.50 / Feelings about distraction --- p.52 / Strategies to reduce distraction --- p.53 / Strategies to reduce medication error --- p.54 / Baseline observation --- p.56 / Findings of stage one --- p.59 / Stage two --- p.60 / One week after implementation observation --- p.60 / Findings of stage two --- p.63 / Stage three / Three months after implementation observation --- p.63 / Follow-up interview --- p.66 / Informants' characteristics --- p.66 / Categories and sub-categories --- p.67 / Conflicting feelings --- p.68 / Different effects on nursing service --- p.69 / Feelings about wearing the red vest --- p.70 / Enhanced a non-distractive culture --- p.72 / Improved cognitive process --- p.73 / Improved performance --- p.75 / Findings of stage three --- p.76 / Comparison of the three stages of quantitative observational data --- p.77 / "Lapse time, items given, and number of patients" --- p.77 / Comparison of lapse time and total distraction --- p.78 / Comparison of the ten items on distraction --- p.78 / Comparison of total distraction --- p.79 / Comparison of near misses --- p.80 / Overall Summary of the findings --- p.80 / Chapter CHAPTER 5: --- DISCUSSION / Introduction --- p.82 / Characteristics of informants and observational data --- p.82 / Nurseśة perception of distraction as a cause of medication administration error --- p.83 / Causes of distraction during medication administration --- p.87 / Evaluation outcome --- p.91 / Evaluation process --- p.98 / Chapter CHAPTER 6: --- "LIMITATIONS, IMPLICATIONS AND RECOMMEDATIONS" / Limitations --- p.111 / Setting --- p.111 / Population and sampling --- p.111 / Observer's influence --- p.112 / Interviewer's influence --- p.112 / Implications for nursing practice --- p.113 / Recommendations for future studies --- p.114 / Conclusion --- p.116 / REFERENCES --- p.118 / APPENDICES / Chapter 1: --- Literature search --- p.126 / Chapter 2: --- Medication Administration Distraction Observation Sheet (MADOS) --- p.127 / Chapter 3: --- Adapted MADOS --- p.128 / Chapter 4: --- Baseline interview guide --- p.129 / Chapter 5: --- Interview consent form --- p.130 / Chapter 6: --- Observation consent form --- p.136 / Chapter 7: --- Informal letter to nursing staff --- p.142 / Chapter 8: --- Follow-up interview guide --- p.144 / Chapter 9: --- Rationale for pilot study --- p.145 / Chapter 10: --- Ethical approval (CUHK) --- p.147 / Chapter 11: --- Ethical approval ( Hospital Administrative Council) --- p.148 / Chapter 12: --- Baseline interview (1) --- p.149 / Chapter 13: --- Baseline observation (MAC 4) --- p.154 / Chapter 14: --- One week after observation (MAC 01) --- p.155 / Chapter 15: --- Three months after observation (MAC 005) --- p.156 / Chapter 16: --- Follow-up interview (08) --- p.157 / TABLES / Chapter 1: --- Different units and the approximate numbers of nurses --- p.30 / Chapter 2: --- Proposed sample size for baseline interview --- p.33 / Chapter 3. --- Medication administration at different scheduled time --- p.35 / Chapter 4. --- Informantśة characteristics at baseline interview --- p.45 / Chapter 5: --- Categories and subcategories: baseline interview --- p.46 / Chapter 6: --- "Elapse time, items given, number of patients, distractions and near misses at baseline observation" --- p.57 / Chapter 7: --- Frequency of the ten items of distraction at baseline observation --- p.57 / Chapter 8: --- Ranking of the ten items on distraction at baseline observation --- p.58

The purpose of this project was to implement an educational program that provided psychiatric nurses with the knowledge and skills to engage patients with a diagnosis of schizophrenia in self-care management regarding medication and treatment adherence. The theory employed in the project was the educational theory. Evidence of effectiveness came from a pre- and postintervention assessment of nurses' knowledge and confidence in teaching about medication, along with a pre- and postassessment of knowledge gained as a result of the educational intervention. Pre- and posteducational rates of patient rehospitalization for medication nonadherence were compared. The results indicated a 15% rate of readmission of schizophrenia patients prior to the educational sessions. The 30-day readmission rate decreased to approximately 5% after the educational sessions. Based on these results, it was concluded that the educational project intervention had a positive impact on improving knowledge and insight of the nurses about nonadherence to medication among patients with schizophrenia. The positive social impact of improving nurses' knowledge of educating schizophrenic patients are increased patient well-being and reduced social costs associated with relapse and readmission. Recommendations from this project include that nurses should educate patients with schizophrenia on how to adhere to medication directives and the importance of doing so.

O preparo e a administração de medicamentos são práticas realizadas no cotidiano pela equipe de enfermagem. Para que haja segurança aos pacientes na utilização dos medicamentos, faz-se necessário que os profissionais envolvidos no sistema de medicação tenham o conhecimento e o entendimento do conceito de erro na medicação de maneira clara, para que possam identificar o erro bem como as situações facilitadoras para sua ocorrência. O presente estudo teve como objetivo analisar o conhecimento dos auxiliares de enfermagem de um hospital de ensino sobre o conceito de erro na medicação antes e após a implantação de uma oficina de capacitação. A pesquisa foi realizada em um hospital universitário situado na Região Noroeste do Estado do Paraná. A amostra foi constituída de 47 auxiliares de enfermagem que estavam regularmente matriculados no curso de formação profissionalizante em técnico de enfermagem e que exerciam a atividade assistencial, tendo a medicação como rotina em sua prática. A pesquisa foi aprovada pelo comitê de ética em pesquisa de uma universidade estadual, em conformidade com a Resolução n.º 196/96. Trata-se de um estudo quantitativo com delineamento quase-experimental, tendo como referencial teórico a abordagem sistêmica do erro. A coleta dos dados ocorreu em três etapas: 1. pré-teste, 2. desenvolvimento de uma oficina dinâmica de estudos fundamentada na metodologia da problematização, e 3. pós-teste. Os resultados foram agrupados em sete categorias, as quais seguem: 1. comunicação entre a equipe de saúde; 2. cumprimento do horário da administração de medicamentos; 3. execução do procedimento técnico; 4. dispensação e distribuição dos medicamentos; 5. sistemas de medicação; 6. administração de medicamentos propriamente dita e 7. complicações relacionadas aos medicamentos. Os resultados apontaram que os participantes não perceberam o atraso na administração de medicamentos e a falta de monitoramento pós-administração como erro na medicação, demonstrando uma confiança na regra dos cinco certos e pouco conhecimento dos protocolos de preparo e conservação dos fármacos. Constatou-se a existência de situações facilitadoras para a ocorrência de erro no sistema de medicação, destacando-se que o processo de seleção e prescrição tem maior risco de promover um erro e o processo de dispensação e distribuição possui menor possibilidade em desencadear erro na medicação. / The preparation and administration of medication are daily practices carried out by the nursing team. In order to grant safety to patients in medication use, it becomes necessary for professionals involved in the medication system to possess clear knowledge and understanding about the concept of medication error for them to be able to identify the error, as well as the situations that facilitate its occurrence. This study aimed to analyze the knowledge of nursing auxiliaries at a school hospital with respect to the medication error concept before and after the implantation of a training workshop. The research was carried out at a university hospital located in the northwestern region of Paraná, Brazil. The sample consisted of 47 nursing auxiliaries, who were regularly enrolled in a nursing technician professional formation course and active in nursing care, so that medication was part of their routine practice. The research project was approved by the Research Ethics Committee in accordance with Resolution nº 196/96 - CNS. This is a quantitative and exploratory study with quasi-experimental outlines, adopting the systemic error approach as a reference framework. Data collection involved three phases: 1. pre-test, 2. development of a dynamic study workshop based on problem methodology, and 3. post-test. Results were grouped into seven categories as follows: 1. communication among health team members; 2. accomplishment of medication administration time; 3. technical procedure realization; 4. medication dispensation and distribution; 5. medication systems; 6. medication administration in itself and 7. complications related to medication. We highlighted that, according to the results, the participants did not perceive the delay in medication administration and the lack of post-administration monitoring as a medication error, demonstrating excessive trust in the five rights and little knowledge about the preparation and conservation protocols for pharmaceutical products. We observed the existence of situations that facilitate the occurrence of errors in the medication system, emphasizing that the selection and prescription process contains greater risk of leading to error and that a smaller possibility of medication error is contained in the dispensation and distribution process.