Purpose: Drug-drug interactions (DDIs) place a burden on our nation and cause potential harm to patients. Awareness of potential DDIs is essential for safe prescribing. Nurse practitioners (NP) have prescriptive authority throughout the nation, however, little is known about NP prescribing habits. The purpose of this study was to identify NPs' demographic and practice characteristics, DDI knowledge and factors that influence this knowledge.Data Sources: A survey was administered to NP prescribers recruited from a national conference. Data was collected on demographics, practice and technological characteristics, and perceptions and knowledge of DDIs.Conclusions: Data from 305 questionnaires were analyzed. NPs correctly classified 31% of drug pairs. Nitroglycerin and Sildenafil (drug combination to avoid) was classified correctly by the most respondents (90.8%, n = 305); Warfarin and Gemfibrozil (drug combination to usually avoid) the fewest 15.7% (n = 302). A positive correlation was found between NPs in acute care hospital settings and DDI knowledge, indicating higher knowledge scores. Neither hierarchical linear regression model was significant at predicting NPs' DDI knowledge.Implications for Practice: Continuing education needs to be targeted to enhance NPs knowledge of potential clinically significant DDIs. The increased recognition of potential DDIs among NPs will enhance patient safety.

INTRODUCTION: Pain is common in cancer. Pain can present at the time of diagnosis or it can develop during treatment. Cancer-related chronic pain is often treated with long-term (3 or more consecutive refills) opioid prescriptions. Opioids are a controlled substance and are thus regulated at the federal, state, and local levels. OBJECTIVES: The first goal of this study is to examine Boston Children's Hospital's general compliance with federal, state, and local opioid prescribing policies. The second goal of this study is to distinguish cancer patients requiring long-term opioids from non-cancer patients requiring long-term opioids. METHODS: This study was a retrospective chart review using summative qualitative content analysis. This is the process where content is grouped into themes and then is further quantified within each theme. RESULTS: Documents required to ensure compliance with opioid prescribing regulations at the local level are not always well documented. These include the Long-Term Opioid Agreement and the risk evaluation of opioid misuse and abuse using one of several tools annually. At Boston Children's Hospital (BCH), the CRAFFT (car, relax, alone, forget, friends, trouble) questionnaires are used for this purpose. State policies require that, if a patient is not seen at least once every 6 months, physicians must document explicitly why a clinic visit was not possible. These reasons are never clearly listed within the medical record. Additionally, data shows that cancer patients using long-term opioids tend to be younger (mean age 14.4) than non-cancer patients (mean age 26.7). Cancer pain can present either at diagnosis, during treatment, or be present during both. Where n=16 cancer patients, 62.53% experienced pain both at diagnosis and during treatment, 25% experienced pain only during treatment, and 12.5% experience pain only at diagnosis. Finally, data also show that anxiety and comorbidity are common, 34.6% of n=29 patients in both cancer and non-cancer patients using long-term opioids. 34.6% of patients experienced comorbidities of either anxiety or depression. CONCLUSIONS: Despite these discrepancies with documentation, review of patients on long-term opioids revealed those with complex and painful medical conditions generally had valid reasons to require long-term opioids. Therefore, there is no evidence that BCH prescribers are involved in any sort of inappropriate opioid prescribing. Finally, no meaningful conclusions were drawn from data regarding pain score and weight because of inconsistencies in electronic medical record documentation in these areas.

Master of Pharmacy / Medicines are a fundamental healthcare intervention, but the benefits they provide depend entirely on the way in which they are used. This begins with prescribing, a complex task with substantial risks. Systematic evaluation of biomedical factors may be viewed as an essential component of this task, but prescribers also integrate an array of individual, social, cultural, environmental and commercial factors into their prescribing decisions. Furthermore, social and cultural characteristics of the prescriber’s workplace may influence how well prescribing decisions are carried out. Whilst numerous research efforts have helped to construct an in-depth understanding of non-biomedical influences on GP’s prescribing patterns, the characteristics of corresponding sorts of influences in teaching hospitals have not been well determined. In hospitals, supervised medical trainees, registrars and consultants prescribe within the framework of medicines management systems involving nurses, pharmacists and patients. Currently, little is known about whether each of these groups has distinct beliefs, attitudes and values that may affect either prescribing behaviour or how prescribing skills of medical trainees are acquired. The aim of this study was to explore the social and cultural dynamics of prescribing and prescriber training in teaching hospitals. To do this, established qualitative methods were employed. Junior doctors, registrars, consultants, nurses, and pharmacists from two metropolitan teaching hospitals were sampled purposively and invited to participate in semi-structured interviews. A brief questionnaire was used to collect demographic and contextual information. In the interviews, participants were asked about their attitudes towards prescribing, their perceptions of roles and responsibilities, how they communicated prescribing decisions, their perceptions of influences on prescribing, and their perceptions of factors contributing to prescribing errors. Participants were also asked for their opinions on various aspects of new prescriber training. Sampling proceeded until redundancy of themes was established. A pilot study was conducted with one participant from each professional group to optimise the interview schedule, and then using this tool, a further 38 participants were interviewed. In total, eight consultants, eight registrars, nine junior doctors, eleven pharmacists, and seven nurses participated. Using reiterative content analysis of a third of all transcripts, a coding scheme was developed, which was used to label and categorise the remaining transcripts. Categories were further developed and refined. The resultant core themes were cross indexed against the five different health professional types using thematic charts to explore patterns. The main lines of enquiry for this research were mapped, the properties of these categories and interrelationships explored in detail, and a model of the prescribing process was developed. Prescribing at the teaching hospitals was a complex process consisting of multiple steps undertaken by several different health professionals of varying levels of experience from three different health care disciplines. Because of the intricate separation of responsibilities, the operation of the process was highly reliant on the behaviours of each player and their relationships with each other. Key prescribing decisions associated with patient admissions were made, almost exclusively, by medical teams. Prescribing was therefore chiefly characterised by factors influencing the behaviours of the doctors. Their behaviours were influenced by factors relating to their individual characteristics (eg, knowledge, skills, experience); but also by a web of socio-cultural determinants inherent to the environment in which they worked. These factors were related to: the organisational structure of the prescribing process; the knowledge characteristics of the doctors; the communication patterns they used; the underlying assumptions they made about prescribing; and the work environment.

Master of Pharmacy / Medicines are a fundamental healthcare intervention, but the benefits they provide depend entirely on the way in which they are used. This begins with prescribing, a complex task with substantial risks. Systematic evaluation of biomedical factors may be viewed as an essential component of this task, but prescribers also integrate an array of individual, social, cultural, environmental and commercial factors into their prescribing decisions. Furthermore, social and cultural characteristics of the prescriber’s workplace may influence how well prescribing decisions are carried out. Whilst numerous research efforts have helped to construct an in-depth understanding of non-biomedical influences on GP’s prescribing patterns, the characteristics of corresponding sorts of influences in teaching hospitals have not been well determined. In hospitals, supervised medical trainees, registrars and consultants prescribe within the framework of medicines management systems involving nurses, pharmacists and patients. Currently, little is known about whether each of these groups has distinct beliefs, attitudes and values that may affect either prescribing behaviour or how prescribing skills of medical trainees are acquired. The aim of this study was to explore the social and cultural dynamics of prescribing and prescriber training in teaching hospitals. To do this, established qualitative methods were employed. Junior doctors, registrars, consultants, nurses, and pharmacists from two metropolitan teaching hospitals were sampled purposively and invited to participate in semi-structured interviews. A brief questionnaire was used to collect demographic and contextual information. In the interviews, participants were asked about their attitudes towards prescribing, their perceptions of roles and responsibilities, how they communicated prescribing decisions, their perceptions of influences on prescribing, and their perceptions of factors contributing to prescribing errors. Participants were also asked for their opinions on various aspects of new prescriber training. Sampling proceeded until redundancy of themes was established. A pilot study was conducted with one participant from each professional group to optimise the interview schedule, and then using this tool, a further 38 participants were interviewed. In total, eight consultants, eight registrars, nine junior doctors, eleven pharmacists, and seven nurses participated. Using reiterative content analysis of a third of all transcripts, a coding scheme was developed, which was used to label and categorise the remaining transcripts. Categories were further developed and refined. The resultant core themes were cross indexed against the five different health professional types using thematic charts to explore patterns. The main lines of enquiry for this research were mapped, the properties of these categories and interrelationships explored in detail, and a model of the prescribing process was developed. Prescribing at the teaching hospitals was a complex process consisting of multiple steps undertaken by several different health professionals of varying levels of experience from three different health care disciplines. Because of the intricate separation of responsibilities, the operation of the process was highly reliant on the behaviours of each player and their relationships with each other. Key prescribing decisions associated with patient admissions were made, almost exclusively, by medical teams. Prescribing was therefore chiefly characterised by factors influencing the behaviours of the doctors. Their behaviours were influenced by factors relating to their individual characteristics (eg, knowledge, skills, experience); but also by a web of socio-cultural determinants inherent to the environment in which they worked. These factors were related to: the organisational structure of the prescribing process; the knowledge characteristics of the doctors; the communication patterns they used; the underlying assumptions they made about prescribing; and the work environment.

No description available.

Thesis (Ph.D. (Pharmacy)) -- University of Limpopo, 2022 / Antiretroviral (ARV) management in children is considered a challenging process, and patients receiving ARVs remain at risk of medication errors. Recently, there has also been a noticeable increase in Treatment Failure (TF) and the development of drug resistance amongst children on ART. However, ART failure amongst children seems to be an under-recognised issue, and adherence to treatment guidelines is reported to be a challenge among nurses caring for People Living with HIV (PLWHIV). Hence, the aim of this study was to explore the prescribing practices, and to determine the knowledge, understanding, and competence levels of NIMART-trained nurses’ in the management of children on Antiretroviral Therapy (ART) in Public Health Care (PHC) facilities located in a rural district of Limpopo Province. To attain the purpose of the study, the researcher in this study adopted a mixed-method, in an explanatory sequential manner. The quantitative phase adopted a descriptive cross-sectional and retrospective census of medical records to determine whether or not the children on ART were prescribed the correct ARV regimen, dose, strength, dosing frequency and received the correct quantities to last until the next appointment date. Whereas the qualitative phase embraced a total purposive sampling of the NIMART-trained professional nurses to explore their knowledge, understanding and views of ART management in children. The results highlighted that these children under study even though they were prescribed a correct ARV regimen in (n=7045; 96%) of the cases;they were only correctly dosed in (n=7797; 53%); and prescribed the correct strength (n=9539; 77%), with only (n=2748; 36.9%) having received the correct quantity of treatment to last them until the next appointment date. Most nurses even though they rated themselves very knowledgeable and competent in paediatric HIV/AIDS management. This finding was contradicting the results obtained from the medical records, as well as their responses to the given case scenario depicted some level of non-adherence to treatment guidelines as well as a lack of understanding of ARV management. From the findings of this ARV utilisation review and the implementation of the developed ART dosing and dispensing training programme. The study concludes that the nurse's prescribing practice was irrational in this cohort of children, and most prescriptions did not entirely comply with the 2014/15 HIV/AIDs treatment recommendations. Since, this cohort of children was found to be susceptible to medication related errors such as; Drug omissions in ARV regimens; Incorrect dosing & dosing frequencies; as well as incorrectly supplied quantities. From the study findings it is recommended that ARV stewardship programs should be considered in order to develop and establish a core strategy for enhancing quality improvement in the management of HIV-infected children on ART in resource-limited settings, not only to inundate viral suppression and maintain it, but also to help achieve the UNAIDS 95- 95-95 target in children under 15 year / National Research Foundation (NRF)