No / Many studies have highlighted the problems associated with different aspects of medicines reconciliation (MR). These have been followed by numerous recommendations of good practice shown in published studies to decrease error; however, there is little to suggest that practice has significantly changed. The study reported here was conducted to review local medicines reconciliation practice and compare it to data within previously published evidence. To determine current medicines reconciliation practice in four acute hospitals (A–D) in one region of the United Kingdom and compare it to published best practices. Quantitative data on key indicators were collected prospectively from medical wards in the four hospitals using a proforma compiled from existing literature and previous, validated audits. Data were collected on: i) time between admission and MR being undertaken; ii) time to conduct MR; iii) number and type of sources used to ascertain current medication; and iv) number, type and potential severity of unintended discrepancies. The potential severity of the discrepancies was retrospectively dually rated in 10% of the sample using a professional panel. Of the 250 charts reviewed (54 Hospital A, 61 Hospital B, 69 Hospital C, 66 Hospital D), 37.6% (92/245) of patients experienced at least one discrepancy on their drug chart, with the majority of these being omissions (237/413, 57.1%). A total of 413 discrepancies were discovered, an overall mean of 1.69 (413/245) discrepancies per patient. The number of sources used to reconcile medicines varied with 36.8% (91/247) only using one source of information and the patient being used as a source in less than half of all medicines reconciliations (45.7%, 113/247). In three out of the four hospitals the discrepancies were most frequently categorized as potentially requiring increased monitoring or intervention. This study shows higher rates of unintended discrepancies per patient than those in previous studies, with omission being the most frequently occurring type of discrepancy. None of the four centers adhered to current UK guidance on medicines reconciliation. All four centers demonstrated a strong reliance on General Practitioner (GP)-based sources. A minority of discrepancies had the potential to cause injury to patients and to increase utilization of health care resources. There is a need to review current practice and procedures at transitions in care to improve the accuracy of medication history-taking at admission by doctors and to encourage pharmacy staff to use an increased number of sources to validate the medication history. Although early research indicates that safety can be improved through patient involvement, this study found that patients were not involved in the majority of reconciliation encounters.

Medication safety and improving communication at care transitions are an international priority. There is vast evidence on the scale of error associated with medicines reconciliation and some evidence of successful interventions to improve reconciliation. However, there is insufficient evidence on the factors that contribute towards medication error at transitions, or the roles of those involved. This thesis examined current UK medicines reconciliation practice within primary and secondary care, and the role of HCPs and patients. Using a mixed-method, multi-centre design, the type and severity of discrepancies at admission to hospital were established and staff undertaking medicines reconciliation across secondary and primary care were observed, using evidence-informed framework, based on a narrative literature review. The overall processes used to reconcile medicines were similar; however, there was considerable inter and intra-organisational variation within primary and secondary care practice. Patients were not routinely involved in discussions about their medication, despite their capacity to do so. Various human factors in reconciliation-related errors were apparent; predominantly inadequate communication, individual factors e.g. variation in approach by HCP, and patient factors e.g. lack of capacity. Areas of good practice which could reduce medicines reconciliation-related errors/discrepancies were identified. There is a need for increased consistency and standardisation of medicines reconciliationrelated policy, procedures and documentation, alongside communication optimisation. This could be achieved through a standardised definition and taxonomy of error, the development of a medicines reconciliation quality assessment framework, increased undergraduate and post-graduate education, improved patient engagement, better utilisation of information technology and improved safety culture.

Abstract Over 90% of addicts start substance use during adolescence. There are few studies focusing on the comorbidity and temporality of substance dependence among adolescents. The aim of this study was to investigate the comorbidity and temporality of substance use disorders, to identify the factors leading to intravenous drug dependence and to evaluate the psychotropic medication history among adolescents. The study population comprised a sample of 508 (300 girls) 12- to 17-year-old hospitalized inpatients during a defined 5-year period. Substance use and other psychiatric disorders were identified according to DSM-IV criteria and adolescents’ socio-demographic and substance use background was examined. The main findings of the present study include the following: The most common comorbidities of alcohol and drug dependence are behavioral, depressive and phobic disorders; Phobic and behavioral disorders develop generally prior to the onset of alcohol and drug dependence; Drug dependent boys are more likely to have depression than girls (IV); In adolescence, phobic disorders may influence the development of secondary substance dependence within a few years from the onset of phobia (I); Behavioral disorders are associated with earlier initiation of daily smoking, and earlier age of onset of daily smoking is associated with an increased risk for alcohol and drug dependence (III); Adolescents with intravenous drug dependence start experiment with drugs at young age, often before the age of 10 years, and present more commonly with parental absence and troubled school background (II); Prescribed benzodiazepine medication is associated with an increased risk of sedative dependence (V). These findings imply that psychiatric comorbidity plays a pivotal role in the development of substance use disorders in adolescence. Those adolescents who experiment with substances at a young age are at greatest risk of substance dependence and intravenous drug use before the age of 18. Family dynamics seem to play an important role in this development. The psychotropic medication history of substance-using adolescents often differs greatly from current evidence-based guidelines and is dominated by those medications that are frequently abused. / Tiivistelmä Yli 90 % päihdeongelmaisista aloittaa päihteidenkäytön nuoruusiällä. Silti päihdehäiriöiden ja niihin liittyvän psykiatrisen sairastavuuden – komorbiditeetin ja tämän ajallisen ilmenemisen – temporaliteetin - tutkimus nuorisoväestössä on suppeaa. Väitöskirjatutkimuksen tarkoituksena oli kartoittaa nuoruusiän päihdehäiriöiden komorbiditeetin ja temporaliteetin ominaispiirteitä, selventää taustalla olevia sosiodemografisia tekijöitä, sekä arvioida päihdehäiriöisten nuorten reseptilääkehistoriaa päihdehäiriöiden synnyn ymmärtämiseksi. Tutkimusaineisto koostui 508 (300 tyttöä) 12-17-vuotiaasta akuuttia psykiatrista sairaalahoitoa tarvitsevasta potilaista. Nuorten psykiatrinen- ja päihdesairastavuus selvitettiin DSM-IV diagnoosijärjestelmän mukaisesti, sekä sosiodemografinen tausta kartoitettiin kattavasti. Alkoholi- ja huumeriippuvaisilla nuorilla yleisimpiä komorbideja häiriöitä olivat käytös-, masennus- ja pelkohäiriöt. Pelko- ja käytöshäiriöt ilmenivät yleensä ajallisesti ennen alkoholi- ja huumeriippuvuutta. Huumeriippuvaisilla pojilla oli tyttöjä useammin masennusta (IV). Pelkohäiriöt vaikuttivat sekundaarisen päihderiippuvuuden kehittymiseen mahdollisesti jo muutamien vuosien kuluessa pelkohäiriöiden ilmenemisestä (I). Käytöshäiriöt liittyivät aikaisempaan päivittäisen tupakoinnin aloittamiseen joka liittyy edelleen sekä alkoholi- että huumeriippuvuuteen (III). Suonensisäisen huumeidenkäytön aloittaminen nuorella iällä liittyi selkeästi vanhemmattomaan kotiin, sekä jo ala-asteella alkaneisiin koulunkäyntiongelmiin. Vaikeimmin päihderiippuvaisten nuorten päihteidenkäyttökokeilut alkoivat merkittävän nuorena, jo onnen 10 ikävuotta ala-asteella (II). Bentsodiatsepiinien reseptilääkkekäyttö sairaalahoitoa aiemmin liittyi merkittävästi sedatiiviriippuvuuteen (V). Löydösten perusteella psykiatrisella sairastavuudella on merkittävää rooli päihdehäiriön kehittymisessä jo nuoruusiällä. Nuoret, joiden päihdekokeilut alkavat varhain, ovat suurimmassa riskissä riippuvuuteen ja ajautumiseen suonensisäiseen käyttöön. Päihderiippuvaisilla nuorilla on lisäksi taipumus sekä reseptilääkkeiden väärinkäyttöön, että kykyä näiden hankkimiseen - myös lääkärin määräämänä.

Medication safety and improving communication at care transitions are an international priority. There is vast evidence on the scale of error associated with medicines reconciliation and some evidence of successful interventions to improve reconciliation. However, there is insufficient evidence on the factors that contribute towards medication error at transitions, or the roles of those involved. This thesis examined current UK medicines reconciliation practice within primary and secondary care, and the role of HCPs and patients. Using a mixed-method, multi-centre design, the type and severity of discrepancies at admission to hospital were established and staff undertaking medicines reconciliation across secondary and primary care were observed, using evidence-informed framework, based on a narrative literature review. The overall processes used to reconcile medicines were similar; however, there was considerable inter and intra-organisational variation within primary and secondary care practice. Patients were not routinely involved in discussions about their medication, despite their capacity to do so. Various human factors in reconciliation-related errors were apparent; predominantly inadequate communication, individual factors e.g. variation in approach by HCP, and patient factors e.g. lack of capacity. Areas of good practice which could reduce medicines reconciliation-related errors/discrepancies were identified. There is a need for increased consistency and standardisation of medicines reconciliationrelated policy, procedures and documentation, alongside communication optimisation. This could be achieved through a standardised definition and taxonomy of error, the development of a medicines reconciliation quality assessment framework, increased undergraduate and post-graduate education, improved patient engagement, better utilisation of information technology and improved safety culture.

No description available.