No / Objective The objective of this study was to evaluate adherence and causes for non-adherence to antihypertensive therapy in Austrian patients. A special focus was placed on social parameters and behavioural theories. Methods Patients were invited via advertisements in community pharmacies in Austria to complete an online survey. Inclusion criteria were an age of 18 years or older, a diagnosis of arterial hypertension and a current prescription of antihypertensive medication. Adherence was measured by the four-item Morisky scale. Non-adherence was defined by at least one point in the Morisky scale. Several demographic, social and behavioural parameters were analysed as potential co-variables associated with adherence. Results A total of 323 patients completed the online survey, of which 109 (33.7 %) met the criteria for nonadherence. In a multivariable model, self-efficacy and age were associated with adherence, whereas intention and barriers were linked to non-adherence; 56 patients (17.3 %) were classified as intentionally non-adherent. Conclusion This study demonstrates that non-adherence affects an important proportion of patients in the treatment of arterial hypertension. Young age was a particularly important risk factor for non-adherence, and this patient population is, therefore, in need of special attention. Modifiable risk factors were identified that could help improving the treatment of arterial hypertension and potentially other chronic conditions. / European Union’s Seventh Framework Programme FP7/2007–2013 ‘Ascertaining Barriers to Compliance (ABC) project’ under grant agreement number 223477.

Patient Safety: Improving Medication Reconciliation Accuracy for Long-Term Care Residents by Annisa L. Stover MSN, Southern University, 2008 BSN, Our Lady of the Lake College, 2005 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2016 During transition of care, inaccurate medication reconciliation is associated with increased risk of adverse events for patients. Older adults are the population most often affected by medication errors, and long-term care facilities struggle to accurately document medication reconciliation. Errors are more common at hospital discharge, but the critical moment for detecting and resolving them is during hospital or long-term care admission. Guided by Rosswurm and Larrabee's model for change, Rogers' diffusion of innovation, and the Multi-Center Medication Reconciliation Quality Improvement toolkit, a 6-member interdisciplinary team composed of nurses, pharmacists, and institutional stakeholders was mobilized to develop policy and practice guidelines as well as secondary documentation necessary to implement and evaluate a quality improvement initiative to address medication reconciliation. Current evidence was explored and used to develop policy and practice guidelines for medication reconciliation, then submitted to 4 scholars, including 2 practice experts, a nurse administrator, and a specialist in pharmacy, to validate content. Scholarly validation supported the premise that the developed products would be beneficial in the accurate documentation of medication reconciliation. Scholarly feedback was evaluated by comparing to current best practices for medication reconciliation. Implementation, education, and evaluation plans were developed to guide operationalization of policy and practice guidelines. This project may positively affect social change by fostering a new practice policy, practice guidelines, and supporting documents to manage medication reconciliation of long-term care residents transitioning to acute care settings, thereby improving medication safety at transitions of care for vulnerable populations.

Understanding Medication Self-Management Capacity among Older Adults Living in Low-Income Housing Communities ABSTRACT Background: Medication self-management capacity (MMC) is an individual’s cognitive and functional ability to self-administer a medication regimen as prescribed. Poor MMC is an issue in older adults often resulting in negative health outcomes and loss of independence. Therefore, understanding low-income older adults’ capacity to manage their medications may help identify individuals who are at risk for developing medication mismanagement and guide future intervention strategies based on an individual need to promote safe medication use and healthy aging in place in the community. Objectives: 1) To determine the cognitive and physical functional deficiencies in MMC among low-income older adults, 2) To identify variables that predict deficiencies in MMC in this population, 3) To determine the impact of using pharmaceutical aids/services on MMC, and 4) To examine the association between MMC and emergency room (ER) visits. Methods: This was a cross-sectional study of older adult residents living in low-income housing buildings served by the RHWP. At a study interview, information on demographics, medical history, and medication use was collected. MMC was evaluated using the Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) tool. Cognitive and functional status, health literacy and depression symptoms were assessed. ER visits were determined retrospectively over the last six months Descriptive analyses were performed to identify cognitive and physical functional deficiencies in MMC. Linear regression analysis was conducted to identify variables that predict MMC and assess the relationship between MMC and using pharmaceutical aid/service. Logistic regression analysis was used to examine the association between ER visits and MMC. Results: A total of 107 participants were included, and 89% were African-American with an average age of 68.54 years (±7.23). They had an average of 4.92 (±2.85) comorbidities and used approximately 8 (±4.12) medications on a regular basis. The mean total deficiency in medication management was 3 (±2.00) as assessed by MedMaIDE. Lacking medication knowledge was common among the participants: 69.16% could not name and 46% state the indication of all of their medications, and 38.32% did not how and when all of their medications should be taken. When controlling for ADLs and falls, the mean total deficiency score in MedMaIDE increased among those with an educational level equal to high school or less compared with participants who had a higher educational level than high school [β=1.32, 1.24, p= 0.0195, 0.0415, respectively], and participants who reported difficulty reading prescription medication labels or opening medication bottles compared with those who did not report any difficulties [β=1.18, 1.43, p= 0.0036, 0.0047, respectively]. About 20.56% of participants were receiving assistance with medications from someone, and 79.44% used at least one pharmaceutical aid/service. However, receiving assistance with medications and using pharmaceutical aid/service were not significantly associated with MMC [p= 0.5334, 0.0853, respectively]. The participants reported a total of 23 (21.5%) ER visits within six months. The adjusted model for age, educational level, number of comorbidities, and ADLs suggested that for every one-unit increase in the total deficiency score, the odds of ER visits increased by 1.23 (p=0.1809) times. Conclusion: Many older adults who lived in low-income housing had impaired capacity to manage their medications independently. They appeared to have inadequate medication knowledge, which affects their cognitive ability to manage medications. Low educational level and health literacy and reporting trouble reading labels or opening medication bottles were predictors to deficient MMC. Future studies are needed to confirm whether or not MMC predicts those who may not able to remain living independently safely or who may need additional support with medications to remain independent.

Background In 2010, a pilot program was implemented by the Medication Assessment Consultants (MAC) to provide comprehensive medication management (CMM) services to patients in the community of Saskatoon, Saskatchewan. Clinical pharmacists working as consultants, independent of any retail pharmacy or health system organization, delivered the program. The goal of the MAC CMM service was to optimize therapeutic outcomes for individual patients through improved medication use, and to reduce the risk of adverse drug reactions (ADRs). Purpose The purpose of this study was to evaluate the independent consultant pharmacist model for delivering comprehensive medication management (CMM) services employed by the Medication Assessment Consultants (MAC) pilot program. Methods A program evaluation was performed on MAC, consisting of a document review of program materials (e.g., MAC Policy and Procedure Manual, electronic patient records) along with stakeholder interviews. The document review consisted of the collection of existing MAC documents, followed by an analysis of the information contained within each document. Patients, physicians and MAC staff were interviewed using a semi-structured interview approach. Patient and physician interviews were conducted by phone and by an interviewer external to the study. Interviews were continued until saturation was reached. The MAC staff was interviewed in person by the investigator. All interviews were recorded and transcribed verbatim. Thematic analysis was used to identify common themes by having three individuals independently review each group of stakeholder interview transcripts. Results During the 17-month pilot, 53 patients were referred to MAC, mostly from family physicians (79.2%). Patients were elderly (mean 71 years) and mostly female (67.9%). On average, patients were taking 13.3 medications and had 9.2 medical conditions. For the 42 patients for whom an assessment was completed, an average of 5.1 drug therapy problems (DTPs) per patient was identified. The document review revealed that MAC did not achieve all of its internal program objectives (e.g., to generate a consistent flow of patient referrals; to promote the service to physicians and patients; and to improve medication-related short-term outcomes for patients). All three interview groups reported a high level of satisfaction and support for the program. Interviewees described various ways in which they felt that they benefitted from the program, including medication regimen optimization (patients), support in dealing with complex medication regimens (physicians), and a strong sense of personal and professional satisfaction and fulfilment (MAC staff). The evaluation of the MAC program resulted in the identification of several program strengths (e.g., a strong, well-defined patient care process; an accessible service location; MAC pharmacist mentorship and support program), along with opportunities for improvement (e.g., expanded promotional activities; administrative support for the program; implementation of a formal satisfaction survey to obtain regular feedback from key stakeholders). Conclusion The results of this study suggest the independent consultant pharmacist model for the provision of CMM services has potential to be utilized as a new service delivery model (in addition to community pharmacies and primary health care teams) to provide CMM services in the primary health care system (PHCS). The study findings have identified several strengths and opportunities for improvement, which may be useful for future attempts at implementing the CMM service model.

Objective: Medicine administration is the last process of the medication cycle. However, errors can happen during this process. Children are at an increased risk from these errors. This has been extensively investigated but evidence is lacking on effective interventions. Therefore, the aim of this research is to propose safety measures to reduce medication administration errors (MAE) in the Paediatric Intensive Care Unit (PICU). Method: The research was carried out over five studies; 1) systematic literature review, 2) national survey of PICU medication error interventions, 3) retrospective analysis of medication error incidents, 4) prospective observation of the administration practice, and 5) survey of PICU healthcare professionals' opinions on MAE contributory factors and safety measures. Results: Hospital MAE in children found in literature accounted for a mean of 50% of all reported medication error reports (n= 12552). It was also identified in a mean of 29% of doses observed (n= 8894). This study found MAE retrospectively in 43% of all medication incidents (n= 412). Additionally, a total of 269 MAEs were observed (32% per dose observation). The characteristics of the interventions used to reduce MAE are diverse but it illustrated that a single approach is not enough. Also for an intervention to be a success it is fundamental to build a safety culture. This is achieved by developing a culture of collaborative learning from errors without assigning blame. Furthermore, MAE contributing factors were found to include; interruptions, inadequate resources, working conditions and no pre-prepared infusions. The following safety measures were proposed to reduce MAE; 1) dose banding, 2) improved lighting conditions, 3) decision support tool with calculation aid, 4) use of pre-prepared infusions, 5) enhance the double-checking process, 6) medicine administration checklist, and 7) an intolerant culture to interruption. Conclusion: This is one of the first comprehensive study of to explore MAE in PICU from different perspectives. The aim and objectives of the research were fulfilled. Future research includes the need to implement the proposed safety measures and evaluate them in practice.

Medication therapy is the most prevalent and critical intervention of health delivery and the source of most errors in healthcare. Medication errors and associated adverse drug events (ADE) have serious health and economic ramifications, and in elderly patients ADE are the leading cause of morbidity and mortality. Medication reconciliation is the process of evaluating current medication treatment to manage the risk and optimize the outcomes of medication treatment by detecting, solving, and preventing ADEs. This education project answered the question whether education provided to long term care staff would improve knowledge of medication reconciliation and be retained over time. The education program was developed through results of a literature search to identify evidence-based standards for medication reconciliation. The guiding theory for program was Kurt Lewin's theory of planned change. The test was developed on the medication reconciliation content and arrangements made for each of the 30 participants who were RNs, LPNs, and CMAs to take the test before and after the education program and again at 30 and 45 days. Results showed statistically significant improvement (p < 0.05) with knowledge of medication reconciliation retained at 30- and 45-days post intervention. Positive social change is possible as nurses and CMAs in the long-term care facility use the knowledge of medication reconciliation to improve patient medication safety for the long-term care residences in the facility. Through appropriate reconciliation, medication errors and ADEs can be reduced or prevented and patient outcomes improved.

The primary objective of this research was to evaluate the effectiveness of a checklist, compared to a smart pump and bar-code verification system, at detecting different categories of errors in intravenous medication administration. To address this objective, a medication administration safety checklist was first developed in an iterative user-centered design process. The resulting checklist design was then used in a high-fidelity simulation experiment comparing the effectiveness of interventions towards two classifications of error: execution and planning errors. Results showed the checklist provided no additional benefit for error detection over the control condition of current nursing practice. Relative to the checklist group, the smart pump and bar-coding intervention demonstrated increased effectiveness at detecting planning errors. Results of this work will this work will help guide the selection, implementation and design of appropriate interventions for error mitigation in medication administration.

The primary objective of this research was to evaluate the effectiveness of a checklist, compared to a smart pump and bar-code verification system, at detecting different categories of errors in intravenous medication administration. To address this objective, a medication administration safety checklist was first developed in an iterative user-centered design process. The resulting checklist design was then used in a high-fidelity simulation experiment comparing the effectiveness of interventions towards two classifications of error: execution and planning errors. Results showed the checklist provided no additional benefit for error detection over the control condition of current nursing practice. Relative to the checklist group, the smart pump and bar-coding intervention demonstrated increased effectiveness at detecting planning errors. Results of this work will this work will help guide the selection, implementation and design of appropriate interventions for error mitigation in medication administration.

Medication errors are one of the most common causes of patient injuries in healthcare systems. Poor labelling has been identified as a contributing factor of medication errors, particularly for those involving injectable drugs. Colour coding and colour differentiation are two major techniques being used on labels to aid drug identification. However, neither approach has been scientifically proven to minimize the occurrence of or harm from medication errors. This thesis investigates potential effects of different approaches for using colour on standardized labels on the task of identifying a specific drug from a storage area via a controlled experiment involving human users. Three different ways of using colour were compared: labels where only black, white and grey are used; labels where a unique colour scheme adopted from an existing manufacturer’s label is applied to each drug; colour coded labels based on the product’s strength level within the product line. The results show that people might be vulnerable to confusion from drugs that have look-alike labels and also have look-alike, sound-alike drug names. In particular, when each drug label had a fairly unique colour scheme, participants were more prone to misperceive the look-alike, sound-alike drug name as the correct drug name than when no colour was used or when colour was used on the labels with no apparent one-to-one association between the label colour and the drug identity. This result could suggest a perceptual bias to perceive stimuli as the expected stimuli especially when the task involved is familiar and the stimuli look similar to the expected stimuli. Moreover, the results suggest a potential problem that may arise from standardizing existing labels if careful consideration is not given to the effects of reduced visual variations among the labels of different products on how the colours of the labels are perceived and used for drug identification. The thesis concludes with recommendations for improving the existing standard for labelling of injectable drug containers and for avoiding medication errors due to labelling and packaging in general.

Medication errors are one of the most common causes of patient injuries in healthcare systems. Poor labelling has been identified as a contributing factor of medication errors, particularly for those involving injectable drugs. Colour coding and colour differentiation are two major techniques being used on labels to aid drug identification. However, neither approach has been scientifically proven to minimize the occurrence of or harm from medication errors. This thesis investigates potential effects of different approaches for using colour on standardized labels on the task of identifying a specific drug from a storage area via a controlled experiment involving human users. Three different ways of using colour were compared: labels where only black, white and grey are used; labels where a unique colour scheme adopted from an existing manufacturer’s label is applied to each drug; colour coded labels based on the product’s strength level within the product line. The results show that people might be vulnerable to confusion from drugs that have look-alike labels and also have look-alike, sound-alike drug names. In particular, when each drug label had a fairly unique colour scheme, participants were more prone to misperceive the look-alike, sound-alike drug name as the correct drug name than when no colour was used or when colour was used on the labels with no apparent one-to-one association between the label colour and the drug identity. This result could suggest a perceptual bias to perceive stimuli as the expected stimuli especially when the task involved is familiar and the stimuli look similar to the expected stimuli. Moreover, the results suggest a potential problem that may arise from standardizing existing labels if careful consideration is not given to the effects of reduced visual variations among the labels of different products on how the colours of the labels are perceived and used for drug identification. The thesis concludes with recommendations for improving the existing standard for labelling of injectable drug containers and for avoiding medication errors due to labelling and packaging in general.