Class of 2007 Abstract / Objectives: To describe the after-hours medication needs in rural hospital pharmacies which are closed during the night. Methods: Entries in a night medication log from a 60 bed rural Arizona hospital that closed for 12 hours at night were collected. Complete entries were assigned a night of the week, a month of the year, and a two hour time period. Data was collected from April 1, 2005 to March 30, 2006. Entries were sorted into groups, counted, and ranked. Groups were compared using student’s t-test. The top 200 drug products ranked by quantity was recorded for a trial of fit into a night formulary. Results: The night medication log contained 4986 complete entries accounting for 669 individual drug products. Non-pharmacy staff entered the pharmacy after-hours 2070 times and removed 10449 drug dosage units. No significant difference in night medication need was found between summer and winter month or weeknight and weekend night. Early night need was significantly different than late night need (p = 0.01). The top 200 drug products covered 83.3% of the medication quantity need of the hospital. Conclusions: The study found that a large percentage (83.3%) of the night medication need could be accessible from a 200 item night formulary. Seasonal and weekend differences were non-significant with only time of night differences being significant. These results could justify the extending of current hours or establishment of a night formulary to decrease entrances into the pharmacy when a pharmacist is not on duty.

Stroke is a significant contributor to the global burden of disease in adults. With the risk of recurrent stroke high, preventative medicines aimed at risk factor reduction are the method of choice for addressing the challenge of increased morbidity and mortality and improving patient outcomes. Research in stroke has shown that adherence to medication is problematic and survivors face considerable practical and physical barriers to taking prescribed medicines. Understanding these challenges can inform the development of strategies to improve medication taking behaviour through delivery of interventions in the primary care setting. This thesis aims to identify potential strategies to inform interventions to improve medication taking in stroke. The research: identified key barriers and facilitators of medication adherence for the secondary prevention of stroke - firstly from within the primary care setting and then from the perspective of an online stroke forum; explored the appropriateness of the online forum as a method of data collection for conducting qualitative research compared with a traditional qualitative interview approach; investigated medication taking among community stroke survivors to characterise patients who receive help with medicines and estimate the proportion who have unmet needs and miss medicines; and examined attitudes from across the stroke spectrum towards a novel approach to medication taking for secondary prevention (i.e. fixed-dose combination polypill). Findings showed that survivors face considerable barriers to medicine taking, but that facilitators, particularly the caregiver role, can encourage good medication taking practice. The online forum has potential as a source of data to understand stroke survivors' behaviour, and a novel strategy to taking stroke medicines has promise. These findings enhance current thinking around medicine taking behaviour in stroke and can inform the development of effective interventions to improve medication taking practices and address nonadherence among stroke survivors. Implications for clinical practice are discussed, and recommendations are provided for future research.

Medication errors during drug administration are an issue in the nursing profession. The errors that occur due to intravenous vein infusions pose threats to patients due to the mode of administration and the risk of occurrence. Strategies such as guardrails have been implemented to reduce the rate of such errors. Despite these guardrails, facilities record mixed results on the effectiveness of infusion pumps in reducing medication errors. The project was designed as a quantitative study to evaluate the effectiveness of guardrails in reducing medication errors at the facility. Data analysis included error reports from the facility before and after the implementation of the guardrails, as well as reports from the software used to monitor the effectiveness of the infusion pumps. Descriptive statistics was used to determine the frequency distribution, percentages, and mean, while t-tests were conducted on the two paired samples. Results showed errors reduced to 7% after the intervention, with a steady decline over the years. The p-value of 0.001 showed that there was a significant difference (α -?¤ 0.05) after the use of guardrails and prior to their usage, indicating that the intervention was effective in reducing the occurrence of medication errors. These findings can be used to promote positive social change at the facility to reduce the occurrence of medication errors during drug administration. The data will be useful to hospital administrators, nursing managers, and nursing staff to encourage compliance in the use of guardrails to help reduce medication errors.

The cost of healthcare in the United States has increased due to growing numbers of patients who live with chronic health problems, such as heart disease. The cost of healthcare is compounded by the cost in terms of complications of cardiovascular disease secondary to medication non-adherence. Education about medication use and adherence, safety, and side effects was needed for patients in a cardiovascular unit to improve adherence to medications as prescribed. Results of a health care provider (HCP) and nursing staff needs assessment provided by the site showed the need for improved cardiovascular medication education. The project focused question asked if cardiovascular patient medication education provided to HCPs and nursing staff would be incorporated into practice by the HCPs and nursing staff. The purpose of the project was to improve the education provided to patients by the HCPs and nursing staff. A literature review provided content for the educational program. Strategies to promote adherence and medication safety and a patient education worksheet were presented with guidance on implementation. Post education qualitative results from HCPs and nursing staff showed that the sheet was implemented and helpful with educating cardiovascular patients. This project promotes positive social change by the implementation of a patient education program that may improve patient education and adherence to cardiovascular medications. As a result, improved adherence to medications may reduce patient and healthcare related costs long term.

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<p>The aim of the study was to investigate nurses’ perception about patients’ participation in medicine treatment and how to make the patient participate. A qualitative method was used and six nurses were interviewed. The nurses’ perceptions of patients’ participation in medicine treatment were characterized especially by patients having good knowledge about their medicines. Therefore, the nurses considered it important to be well-informed about the effect of the medicines. Furthermore, everyone believed that giving information on the basis of the patient’s knowledge-level and answering questions from the patient were important nursing care. The result was considered a less anxiety and more satisfied patient who is compliant to medicine prescription, so that unnecessary hospital admissions could be avoided. However, information is occasionally followed-up. Other measures were to explain and give motivation for treatment. The nurse is available to the patient and notices effects of the treatment that can be drawn to the doctor’s attention. The way to communicate and cooperate with the patient is considered important but dialogue is not common and sometimes the patient’s opinion is not requested. Moreover, it happens that the nurses prove to have a paternalistic attitude. Obstacles that were mentioned were lackof time, dementia, certain diseases and urgent situations. The nurses meant that respect should be shown if patients do not want to participate. Conclusion: The patient participation and influence ought to be strengthening by the nurses’ attitude of the advantage that the patient participates in his own care. Wrong approach by the nurses need to be changed in favour of patients influence. Besides, all leaders at all levels in the healthcare sector, need to be organized in order to facilitate patient participation of the best quality.</p>

The aim of the study was to investigate nurses’ perception about patients’ participation in medicine treatment and how to make the patient participate. A qualitative method was used and six nurses were interviewed. The nurses’ perceptions of patients’ participation in medicine treatment were characterized especially by patients having good knowledge about their medicines. Therefore, the nurses considered it important to be well-informed about the effect of the medicines. Furthermore, everyone believed that giving information on the basis of the patient’s knowledge-level and answering questions from the patient were important nursing care. The result was considered a less anxiety and more satisfied patient who is compliant to medicine prescription, so that unnecessary hospital admissions could be avoided. However, information is occasionally followed-up. Other measures were to explain and give motivation for treatment. The nurse is available to the patient and notices effects of the treatment that can be drawn to the doctor’s attention. The way to communicate and cooperate with the patient is considered important but dialogue is not common and sometimes the patient’s opinion is not requested. Moreover, it happens that the nurses prove to have a paternalistic attitude. Obstacles that were mentioned were lackof time, dementia, certain diseases and urgent situations. The nurses meant that respect should be shown if patients do not want to participate. Conclusion: The patient participation and influence ought to be strengthening by the nurses’ attitude of the advantage that the patient participates in his own care. Wrong approach by the nurses need to be changed in favour of patients influence. Besides, all leaders at all levels in the healthcare sector, need to be organized in order to facilitate patient participation of the best quality.

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Musculoskeletal pain is one of the most common illnesses among the people in NE Thailand which is commonly treated by self-medication. Ya-chud (several medicines together in a small plastic bag) for the treatment of musculoskeletal pain is an illegal treatment but has been used by lay people for more than 20 years. A better understanding of the people's perception of and behaviour in taking Ya-chud for treatment of musculoskeletal pain should help in designing an effective implementation programme to reduce the taking ofYa-chud. The study group was 15 years old and over and lived in 2 rural (N = 619) and 2 urban (N = 494) areas of NE Thailand. The study method used individual interviewing. The study aimed to investigate self-treatment of musculoskeletal pain with and without Ya-chud in the urban and rural areas. The attitudes of Ya-chud users in the urban (N = 136) and the rural (N = 128) were measured using a 6 point Likert Scale with a Conbach's alpha coefficient of 0.7509. Comparative analyses of variables between these two areas and between the users and non-users were conducted. Indepth interviews and laboratory analysis of Ya-chud samples were carried out to obtain more detailed information. The study found that Ya-chud for musculoskeletal pain was often used as the alternative treatment to treat pain which occurred at many locations of the body at the same time when the previous outcome had been unsatisfactory. The discriminant stepwise analysis showed that 85.9 percent of Ya-chud users in both rural and urban areas were 25 years old and over and had an education level of primary/secondary school. The overall prevalence of Ya-chud users in the rural areas was higher than in the urban areas but the prevalence of those who had taken Ya-chud within one year was greater in the urban areas. Ya-chud use varied with the season. It peaked during periods of heavy work such as harvesting. The main source of Ya-chud was groceries (82.3 percent in the urban and 79.6 percent in the rural). People had the perception that Ya-chud was a potent drug, cheap and had beneficial effects. They also perceived that the specific name of Ya-chud was easy to remember and described their symptoms. Attitudes towards Ya-chud were positive in the rural areas but negative in the urban areas (p < 0.01). Most of the respondents did not know the harmful effects of Ya-chud. The study showed that the locations of pain for nonusers were not different from the users and also that the treatment outcome after taking Ya-chud was predominantly 'no change' (46.2 percent in the rural and 44.6 . percent in the urban) (p < 0.01). The results from the Ya-chud users in-depth interviews indicated that in the urban areas there was more use of massage, rest and health services for the treatment of musculoskeletal pain but in the rural areas medicines from the drug stores were more often used (p < 0.01). Only 10.9 percent of the respondents could be cured by the above treatments in the urban areas and 4.4 percent in the rural areas (p > 0.05). After taking Ya-chud the result of treatment was a 'cure' for 45.5 percent of users in the urban and for 35.3 percent of users in the rural areas (p > 0.05). Identification of the medicines contained in a packet showed that steroids, NSAIDs and tranquillisers were most often combined in a package. It can be concluded that Ya-chud for musculoskeletal pain is not only unnecessary but also a dangerous use of these hazardous medicines which mask the symptoms rather than cure the illness. Intensive and continuous education campaigns together with legal enforcement should be beneficial for a short term programme to reduce Ya-chud use. Long term programmes should focus on providing licensed dispensers in every drug store so that the lay people can gain more helpful knowledge about medicines and so that legal enforcement can be better implemented since pressure could then be brought to ensure such licensed dispensers complied with legislation.