The diploma thesis deals with the issues quality of health care in the hospitals of Vysočina Region. The quality of health care is being studied in hospitals in Jihlava, Havlíčkův Brod, Třebíč, Pelhřimov and Nové Město na Moravě. The aim of the diploma thesis, on the basis of the results, is to propose recommendations for hospitals in the Vysočina Region and on which areas of health care quality management should focus the hospitals. The benefit of the thesis is evaluation of the process for obtaining accreditations, monitoring of adverse events and proposals for quality management of health care.All hospitals have a health care quality management system. The basis for making recommendations is qualitative research, especially a deep interview. Conclusion of diploma thesis is fact, that the quality of health care is important for hospitals in the region.

5 ABSTRACT Candidate: Lenka Polláková1 Supervisor: prof. RNDr. Jiří Vlček, CSc.1 Consultant: doc. MUDr. Tomáš Soukup, Ph.D.2 1 Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University 2 2nd Department of Internal Gastroenterology, University Hospital in Hradec Králové Title of the master thesis: Analysis of non-cardiac adverse event of glucocorticoid pulse therapy Intravenous glucocorticoid pulse therapy (PT GC) is effective in life threatening flares of rheumatic diseases. However, due to GC's pleiotropic effect, higher doses and additive nongenomic mechanism in pulse regimen, it is not free of complications (1). The aim of theoretical part was to describe from literature research the relevance of PT GC, its non- cardiac adverse events (AE) in rheumatic patients and their influencing factors. The aim of experimental part of the study was to analyze the occurrence of non-cardiac AE in real-life setting, analyze risk factors of potential adverse drug reactions (ADR) and its complications and analyze the risk minimalization management in real-life setting. Patients were administered 1000 mg methylprednisolone in 3 to 5 doses on alternating days. Analysis includes 277 rheumatic patients with 325 pulse therapy courses. Data were collected retrospectively from their...

Jakub Žalud PhDr. Alena Javůrková Ph.D. adverse effects of antiepileptics, their classification and expression from the patient's subjective assumption was that the patient's experience of the adverse effects of antiepileptic drugs will significant overall (p˂0.05; R2 = 0.20). ts was not statistically significant (p˃0.05; R2 = 0.21). (p˃0.05; R2 = 0.16).

Analysis of the Effect of Pharmacotherapy on the Risk of a Fall I. Author: Klára Šturcová1 Tutor: Josef Malý1 1 Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Pague Introduction: Falls of hospitalized patients are one of the most common problems in health institutions. In terms of prevention of falls it is necessary to analyze all the factors that might have contributed to the emergence of a fall and subsequently minimize these risk factors. Objectives: The aim of the thesis was to analyze the possible drugs and other causes of falls of patients hospitalized in a certain rehabilitation institution. Methods: The data were collected from 21 March to 31 July 2014 in an institution providing rehabilitation care. The evaluated group consisted of patients who fell during the hospitalization in this period. The data about the fall, personal and drug anamnesis were transferred to an electronic form and subsequently evaluated by means of the frequency analysis, converted into graphs and tables and discussed. Results: 67 patients experienced 79 falls. Women experienced 53 % of falls; men experienced 47 % of falls. 87 % of the patients fell once, 9 % of the patients fell twice, 4 % of the patients fell three times. 58 % of all falls were experienced by...

Current status: Medication errors within the context of safe and high quality health care are one of the most frequently discussed topics of recent years. They are part of the medical process, occur in different forms, affect patients of all ages and decrease the quality of provided health care. Prescriptions of medication in medical documentation have to be clearly legible and include all the required information. Nurses' role within the medicaiton process could be described as an ultimate "safeguard" that can prevent medication errors. Goals: The objectives of this research are to assess nurses' awareness of medication errors, ssess their ability to detect medication errors and find out the level of their knowledge regarding the correct procedures and measures following medication error detection.Methodology: The research was conducted using a qualitative research method. The in-depth interviews with nurses were carried out at a surgical critical care unit at the hospital in Jindrichuv Hradec. Following the collection of a sufficient amount of data the interviews were coded using the "pen and pencil" technique and then divided into categories.Research file: In order to achieve the highest level of objectivity the research was carried out with a group of nurses who work at the same unit of a hospital department. The research file included nurses who had varied levels of education and numbers of years of experience. Results: Surgical critical care unit nurses are not aware of the exact definition of medication errors. Only one nurse was able to discuss adverse events with related consequences. The remaining nurses' awareness of medication errors corresponded to the classification described in the relevant foreign and Czech academic literature. None of the interviewed nurses detected all the errors included in the simulated scenarios. Only one nurse, who is currently completing her qualification in this specialty, detected a wrongly prescribed antidote. The simulated scenarios also included a group of high-risk medications that is commonly used at the unit. The first medication included in this group was a 7.45% solution of potassium (KCl). A majority of the participants detected the high concentration of this high-risk medication. Another high-risk medication was a 10% concentrate of NaCl in an infusion; this error was also detected by the majority of the nurses. The third high-risk medication was a wrongly prescribed insulin (it lacked the detailed description of units, time and route). This prescription error was not detected by the majority of participating nurses. Another type of medication error included in the simulated scenarios was a group of medications used specifically in critical care. Only half of the participating nurses successfully detected the errors related to the prescription of this group of medications. The last type or medication errors focused on incomplete prescription by doctors. The most frequently detected error was a prescription of an opiate that lacked the route and the least frequently detected error was a wrong prescription of an infusion administration. It is evident that the nurses always inform the doctor when they detect a medication error. They are more willing to inform the ward sister in cases of incidents caused by somebody else. Only a small group of nurses are willing to inform the senior consultant, the head nurse or the hospital management. Only one nurse associated medication error reporting with an audit. However the majority of nurses agrees that it is important to report any medication errors.Conclusion: The analysed data suggested that the nurses were aware of medication errors. The analysis of the results of the simulated scenarios suggested that nurses' ability to detect medication errors in prescriptions was related to the number of years of experience and the level of education.

The quality issue of provided health care is the topic which is constantly getting more attention. In this area there is always even probably will be always - something to improve. The patients´ safety in healthcare facilities is affected by the so-called culture of safety.The research was conducted in six medical institutions of the South Bohemian Region, though seven were originally planned. However, I was not given the data here, probably due to the long term incapacity of the respondent. The research was focused precisely on the area of care quality and patient safety. A mixed method research (qualitative and quantitative) was deliberately used in this task. The aim was to map the most common causes of adverse events and then, based on the causes, to propose possible arrangements to prevent the occurrence of the causes. For this purpose five research questions were established.The outcomes obtained were processed into tables, plus the graphical representation of some was accompanied. Then, in the "discussion" chapter, the results were compared and analyzed in more detail.

Healthcare risk management consists of continuous consideration of potential adverse situations and their prevention. In this sense, healthcare facilities consider any source of uncertainty to be a risk which must be eliminated or, at least, reduced. International studies show that up to 70% of adverse events could be prevented. Reasons for observing various types of adverse events may differ in individual healthcare facilities. However, most adverse events are observed in an effort to prevent their consequences upon patients' health.

Dual Antidepressant Consumption in the Czech Republic Author: Kristýna Čiháková Supervisor: PharmDr. Pavel Horký, Ph.D. Consultant: PharmDr. Kateřina Malá, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction: Antidepressants are widely used in many indications. Dual antidepressants are prescribed in treatment of depressive disorder, anxiety disorder, in pain therapy and insomnia. Besides that, there are trials to prove the efficacy of dual antidepressants in different indications. Generally, antidepressant consumption in the Czech Republic is increasing. The question is, what the real proportion of dual antidepressant consumption is. Objective: As the objective, dual antidepressant consumption was analysed. Methods: The consumption of antidepressants venlafaxine, duloxetine, mirtazapine and mianserin was performed in the period from 1 January 2008 to 31 December 2018. The State Institute for Drug Control (SÚKL) database was used. The data were described by descriptive statistics. The drug consumption in Defined Daily Doses (DDD) was converted into Defined Daily Dose/1,000 inhabitants/day (DID). In addition, comparison of use of particular dual antidepressant doses was made. Results: Overall, the relative consumption of dual...

SSRI antidepressant consumption in Czech republic Author: Júlia Behrová Supervisor: PharmDr. Pavel Horký, PhD. Consultant: PharmDr. Eva Zimčíková, Ph.D Introduction: Selective serotonin reuptake inhibitors increase the available amount of neurotransmitter serotonin in synapses, resulting in their antidepressant and anxiolytic effect. Objective: The objective of this diploma thesis was to evaluate the consumption of SSRI antidepressants in the Czech Republic in the period from 01. 01. 2008 - 31. 12. 2018, based on the data on consumption from the State Institute of Drug Control (SIDC). Methods: The research consisted of a retrospective analysis of the SIDC database. The study included all approved SSRI in the Czech Republic. Drug Utilization Review was used in the thesis as a methodology. Drug consumption is calculated as the number of defined daily doses per thousand inhabitants per day (DID). The data on the number of residents was acquired from the Czech Statistical Office. Descriptive statistics and ATC/DDD methodology were applied. Results: The consumption of sertraline and escitalopram increased significantly during the period under review. For sertraline, the DID increased from an initial 8.623 to 15.513, increasing consumption by 1.8 fold. The greatest increase in consumption was observed...

Analysis of the effect of pharmacotherapy on the risk of falls in inpatents III Author: Tereza Honsová Tutor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction: Falls are frequent and unwanted events happening in healthcare facilities. The falls have a multifactorial character. The prevention is the best way how to improve a quality of healthcare and a quality of the patient's life. All of the doctors, clinical pharmacists and nurses can help to realize it by cooperating with each other, working with professional information and by individual attitude to each patient. Objective: The aim of this study was to analyze the effect of the fall risk-increasing drugs to falls in hospitalized patients and to recommend the right interventions to prevent the fall. Methodology: For the analysation, classification and quantification of the fall risk-increasing drugs, drug related problems and interventions a special online database was created. All of the doctors, clinical pharmacists and nurses were collecting details about the pacients and about how the fall happened. Fall risk-increasing drugs and drug-related problems were then analyzed by clinical pharmacists. Potential interventions were suggested. Also other...