Background: Adverse drug reactions (ADRs) pose a significant burden on patients and the health system. ADR reporting contributes to data that guide patient safety strategies. Despite numerous strategies aimed to improve ADR reporting rates, ADRs continue to be under-reported. Aim: To compare the effectiveness and efficiency of identifying institutional ADRs using the International Classification of Diseases 10th Revision Australian Modification (ICD-10-AM) clinical coding surveillance and spontaneous reporting. Method: Medical records of multi-day (staying overnight or longer) inpatient separations (single patient encounter resulting in discharge) assigned an ADR-related ICD-10-AM code were retrospectively reviewed to verify if an ADR had occurred and whether the codes assigned were appropriate. ADR reports received via the spontaneous reporting system were also reviewed. ADRs were assessed for causality, seriousness and type of reaction. The drugs, type of adverse reactions involved and the resource implications of this reporting method were also investigated. Results: ICD-10-AM coding surveillance and spontaneous reporting resulted in an ADR reporting rate of 3.3% and 0.4% of inpatient separations, respectively. ICD-10-AM coding surveillance was more likely to identify type A ADRs than spontaneous reports although there were no significant differences in seriousness or causality. The ICD-10-AM codes assigned were appropriate in 94% of cases, with the omission of drugs being the most common discrepancy. Conclusion:The ICD-10-AM coding surveillance is an effective and efficient method of improving ADR reporting by utilising data collected for administrative purposes.
The majority of patients and clinicians reported a positive impact of e-prescribing on safety and efficiency. Both groups valued safe and effective use of medicines, although differences existed in the importance placed on key system features. A greater focus on patient engagement and communication is needed to optimise the delivery of patient-centred care.
The argument for integrating interprofessional education (IPE) activities into the workplace has been made concurrently with the call for collaborative clinical practice. An exploratory case study investigation of existing activities in a large metropolitan health care network was undertaken to inform the development of future IPE initiatives. Purposive sampling invited clinicians involved in the design or delivery of workplace IPE activities to participate in a semi-structured interview to discuss their existing programs and the opportunities and challenges facing future work. Interviews were audiotaped, transcribed and thematically analysed. In total, 15 clinicians were interviewed representing medicine, nursing, occupational therapy, pharmacy, physiotherapy, psychology, social work and speech pathology. The IPE programs identified included one medical and midwifery student workshop, several dedicated new graduate or intern programs combining the professions and multiple continuing professional development programs. Three dominant themes were identified to inform the development of future work: clinician factors, organisational factors and IPE considerations. In addition to the cultural, physical and logistical challenges associated with education that integrates professions in the workplace, the time required for the design and delivery of integrated team training should be accounted for when establishing such programs. Considerations for sustainability include ongoing investment in education skills for clinicians, establishment of dedicated education roles and expansion of existing education activities.
Background: Studies evaluating the impact of surgical preadmission clinic (PAC) pharmacists have reported significant improvements in medication management. However, despite the increased uptake of pharmacy services in this area, randomised controlled studies are limited. Aim: To investigate the impact of a surgical PAC pharmacist on the quality of medication management from preadmission to discharge. Method: A prospective, randomised, controlled design was used to assign patients to either the intervention or control groups. The intervention group received standard PAC care plus assessment by a PAC pharmacist. The control group received standard PAC care only. Both groups also received standard inpatient care, and were followed from PAC to discharge, and data collected on pharmacist interventions, medication reconciliation and medication history documentation. Results: 171 patients were randomised to the intervention group and 184 to the control group. The intervention group had significantly more regular and as required prescription medicines, and complementary and alternative medicines documented per patient than the control group; and significantly more pharmacist interventions (31%) than the control group. The PAC pharmacist made 27% of interventions in the intervention group. Medication reconciliation at admission was 81% for the intervention group and 75% for the control group. Medication reconciliation for both groups was 90% at discharge. Conclusion: A surgical PAC pharmacist had a positive impact on medication management through improved quality of medication histories and documentation, interventions and medication reconciliation.
Background Medication errors are a significant problem in Australian hospitals. This is the first study of the impact of an integrated electronic medication prescribing (e‐prescribing) and dispensing system on medication errors. Aim To evaluate the impact of an integrated e‐prescribing and dispensing system implemented in outpatient clinics and the emergency department on prescribing and dispensing errors. Method Prescribing and dispensing errors were identified over 2 weeks before and after implementation of the integrated system. Errors were identified through original prescription, e‐prescribing and dispensing systems review. Error rates, types, severity and patient waiting times for prescription dispensing were compared. Results The study included 379 patients prescribed 654 medicines in the before group and 375 patients prescribed 635 medicines in the after group. Prescribing and dispensing error rates per patient were reduced by 93% (from 2.98 to 0.2; p < 0.0001) and 98% (from 1.27 to 0.03; p < 0.0001), respectively. The proportions of patients with at least one procedural or clinical prescribing error showed significant reductions of 81% (95% CI 77–85%) and 3.4% (95% CI 0.1–6.7%). The proportions of patients with at least one procedural or clinical dispensing error showed signicant reductions of 61% (94% CI 56–66%) and 2% (95% CI 0.7–3.6%). Fifty system‐related prescribing errors were identified. Mean error severity score was minor in both groups. Median patient waiting time for prescription dispensing was reduced by 52% (from 27 to 13 min; p < 0.0001). Conclusion Implementation of the integrated system significantly reduced prescribing and dispensing errors and patient waiting times for prescription dispensing. Clinicians need to manage new system‐related errors to reduce associated risks.
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