Assessment of the Medication Safety Practices

It is with pleasure that we, the investigators, thank those who made this study possible. The researchers owe their deepest gratitude for the guidance, continuous support and help of several individuals who, in one way or another, contributed and extended their valuable assistance in the preparation and completion of this study. First and foremost, it is with immense gratitude that the investigators acknowledge the support and help of our dear adviser.

With their enthusiasm, inspiration, and great efforts to explain things clearly and simply, had helped us make it through. Throughout the research, they have provided the investigators encouragement, sound advice, good teaching, good company, and lots of good ideas. We would have been lost without them. The researchers would like to thank all the respondents who answered the research questionnaires and participated in this research study. This study would not have been possible if not for the time, patience, and effort spent by the respondents.

The researchers would also wish to thank our families who continuously support us, motivate us and inspire us to become better people. The researchers would like to thank them for their understanding in all the work that we do. Lastly, the researchers would like to thank the omnipresent God, for giving us the strength to finish this research and for helping us in our darkest days. The Researchers Abstract The study dealt was about the assessment of medication safety practices in the selected Government and Private hospitals in Quezon City.

The study was conducted to placate the researchers’ interest about identification of common medication incidents healthcare facilities usually encountered and determine what and how those medication safety measures and practices are being implemented in two types of hospitals in Quezon City. To gather the needed information, a closed-ended survey type of questionnaire was used. Purposive sampling was used in this study wherein suitable respondents are selected and among the healthcare providers in the field of medicine, physicians, nurses, and pharmacists has most suitable ability to determine medication incidents occurring in the hospital.

Convenience sampling was also employed to suit with the respondents’ availability. The data and the conclusion and recommendations from which those were derived will serve as an ideal about medication errors and incidents and the strategies and methods implemented and used by the healthcare professionals and the hospitals to prevent those; hence, medical practitioners as well as pharmacy students can perform effective patient services so patients be able to receive the services they deserve. TABLE OF CONTENTS CHAPTER 1 Introduction1 Setting of the Study2

Theoretical Framework3 Objectives4 Assumption of the Study4 Significance of the Study5 Definition of Terms6 CHAPTER 2 Local Literature11 Foreign Literature14 Local Studies23 Foreign Studies25 CHAPTER 3 Research Methodology50 Respondents of the Study50 Sampling Technique51 Procedure of Data Gathering51 Statistical Treatment52 CHAPTER 4 Presentation, Analysis, and Interpretations of Data CHAPTER 5 i. Summary of Findings 86 CHAPTER 1 Introduction and Background Introduction Medication therapy is the most common intervention used for most health problems experienced by patients.

These medications are use in the diagnosis, cure, mitigation, treatment or prevention of different disease. Because of the complexity of both medication use and medication management process, these create a significant risk in patients’ safety. With the growing reliance on medication therapy, patients receiving medication interventions are exposed to benefits as well as to potential harm brought about by the medication itself. Benefits include effective management of the illness, slowed progression of the disease and improve patients’ quality of life.

Harm from medication can arise from unintended consequences or medication error. Medication error is defined as a preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professionals, patients and consumers. These events may be related to professional practice, healthcare products, procedures and systems including prescribing, order communication, product labeling, packaging and nomenclature, compounding, dispensing, distribution, administration, education, monitoring and use.

Despite the widespread recognition of the hazards that medication use may potentially affect the patients, there are no widely accepted or standardized methods to measure the safety of medication use. Because of the complexity of medication safety process, it has been a very significant issue in the hospitals throughout the healthcare. And with this, the researcher assessed the presence of medication safety practices in different government and private healthcare institutions in Quezon City for the betterment of patients’ quality of life.

The researchers envisioned to improve medication safety by providing validated data to be used in evaluating and in enhancing the current strategies used by the different healthcare institutions in Quezon City. Setting of the Study The researchers conducted the study in different selected private and government hospitals in Quezon City, which they divided per district. District 1 consists of Sta. Teresita General Hospital, J. P. Sioson General Hospital and Dr. MG- Ramos General Hospital.

District 2 consists of Novaliches General Hospital Commonwealth Hospital and Medical Center, San Lorenzo General Hospital, Fairview General Hospital, New Era General Hospital and FEU- NRMF Medical Center. District 3 consists of Quirino Memorial Medical Center and Villarosa General Hospital. District 4 consists of Delos Santos Medical Center. Theoretical Framework According to Kaizen, Continuous Improvement Theory is an array of powerful techniques that has produced substantial improvements in numerous companies and organizations.

It provides perhaps the most central and universal component of total quality management which itself has helped many companies achieve high quality and productivity. This management approach raises the efficiency of many processes and systems. This theory assumes that further improvements are always possible and that processes should be continuously re-evaluated and improvements are implemented with objectives of increasing quality ad reducing errors. It should be an ongoing effort to improve services, processes and systems.

These efforts can seek incremental improvement over time or breakthrough improvement all at once. Figure 1. Structural Framework of Continuous Improvement Theory General Objectives This study aims to assess the medication safety measures and practices implemented by government and private hospitals in Quezon City. Specific Objectives The specific objectives of the study are the following: 1. To characterize the profile of the government and private hospitals in Quezon City. 2. To identify the medication incidents that their health care facilities commonly encounter 3.

To determine the medication safety measures and practices implemented in government and private hospitals in Quezon City. 4. To identify the healthcare provider included in the hospitals patient safety committee. Assumption of the Study The researchers formulated basic assumptions regarding the problem to determine possible outcomes. They identified some essential assumptions about the study that includes the following: 1. That there would be enough of respondents for the study. 2. That the different hospitals would be able to show cooperatives throughout the study.

3. That the different respondents answer the questionnaires accurately and with honesty. Significance of the Study The result of the study will provide great significance to the following: 1. Patients and Consumers. The patients and the consumers may benefit directly from the study as they will experience a better outcome in their medication therapy. Through this, patients and consumers’ compliance to their medication therapy will be enhanced since they are assured for a better health care system. 2. Health Care Professionals.

As the primary provider of patient care, they will have the opportunity to give the best quality care to their patients. With this study, it would encourage them to practice better patient care that could probably influence patients’ safety. 3. Health Care Institutions. This study would have a great significance to the health care institution since they are considered as the provider of different health care services. Through this study, they will be able to evaluate their current strategies for the medication safety and develop more effective strategies for the betterment of their services.

4. Clinical Students. Since they are still studying, this study would be the bridge in providing them information regarding medication safety. They will get a concrete idea on how different health care institution intervene the occurrences of medication error. 5. Clinical Instructors/ Professors. This may also serve as a basis for the clinical instructors or professors to motivate student to develop interest in pursuing the student in health teachings. They will be able to impart “experimental-based” knowledge to the students of the different strategies used to improve medication safety.

6. Researchers. This research study is composed of different methods through which data were validated. Appropriate validation of data is essential especially for the researchers who are in the field of Allied Health Science in such a way that this study would be a basis for future research. Definition of Terms Administration Error. Any type of medication error, of omission or commission, that occurs in the administration stage when the medication has to be given by a nurse, or the own patient, or a caregiver. (http://www. who. int) Adverse Drug Event.

Any injury occurring during the patient’s drug therapy and resulting either from appropriate care, or from unsuitable or suboptimal care. (http://www. who. int) Adverse Drug Reaction. A response to a medicinal product which is noxious and unintended and which occurs at doses normally used in man for the prophylaxis, diagnosis or therapy of disease or for the restoration, correction or modification of physiological function. (http://www. who. int) Compliance. It refers to the extent to which a patient acts in accordance with the prescribed interval, and dose of a dosing regimen. (http://www.ispor. org) Compounding.

To produce or create by combining two or more ingredients or parts. (Medline Plus) Dispense. To prepare and give out medicines. (Medline Plus) Dispensing Error. A deviation from an interpretable written prescription or medication order, including written modification of the prescription made by a pharmacist following contact with the prescriber or in compliance with the pharmacy policy. (Beso, 2005) Evidence-based Practice. Aconsensus approaches for handling recurring health management problems aimed at reducing practice variability and improving health outcomes.

(http://www. who. int) Health Care. The maintaining and restoration of health by the treatment and prevention of disease especially by trained and licensed professionals. (Medscape) High-alert medications. Drugs that bear a heightened risk of causing significant patient harm when they are used in error. (http://www. who. int) Medication error. Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.

Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use. (NCC MERP, 1998) Medication Safety. It refers to the freedom from accidental injury during the course of medication use; activities to avoid, prevent, or correct adverse drug events which may result from the use of medications. (AHA&HRET&ISMP, 2002) Medication Use System.

A combination of interdependent processes that share the common goal of safe, effective, appropriate, and efficient provision of drug therapy to patients. (Cohen, 1999; AHA&HRET&ISMP, 2002; JCAHO, 2003; Otero 2003). Monitoring Error. The failure to review a prescribed regimen for appropriateness and detection of problems, or failure to use appropriate clinical or laboratory data for adequate assessment of patient response to prescribed therapy. (Leape, 1998) Pharmacodynamics. The relationship between drug concentration at the site of action and the resulting effect, including the time course and intensity of therapeutic and adverse effects.

(http://www. ashp. org/) Pharmacoepidemiology. The study of the use and effects/side-effects of drugs in large numbers of people with the purpose of supporting the rational and cost-effective use of drugs in the population thereby improving health outcomes. (http://apps. who. int) Pharmacokinetics. The study of thetimecourse of drug absorption, distribution, metabolism and excretion. (http://www. ashp. org/) Pharmacology. Science of drugs including their origin, composition, pharmacokinetics, pharmacodynamics, therapeutic use, and toxicology. (IUPAC Recommendations 2012) Pharmacovigilance.

The science and activities relating to the detection, assessment, understanding and prevention of the adverse effects of pharmaceutical products. (WHO, 2002) Prescribing Error. A medication error occurring during the prescription of a medicine that it is about writing the drug order or taking the therapeutic decision, appreciated by any unintentional deviation from standard references such as: the actual scientific knowledge, the appropriate practices usually recognized, the summary of the characteristics of the medicine product, or the mentions according to the regulations. (http://www. who.

int) Prescribing. To order the use of a medicine or other treatment. (Medscape) Route of administration. The path by which a substance is taken into the body (i. e. , by mouth, injection, inhalation, rectum, or by application). (Medline Plus) Side Effects. Anyeffectofadrug,chemical,orothermedicinethatisinadditiontoitsintendedeffect,especiallyaneffectthatisharmfulorunpleasant. (http://dictionary. reference. com) Therapeutic Dilemmas. A situation that requires a choice between options that are or seem equally unfavorable or mutually exclusive. (http://www. apa. org) Therapeutics Committee.

A group of physicians, pharmacists, and other health care providers from different specialties, who advise a managed care plan regarding safe and effective use of medications. The P&T Committee manages the formulary and acts as the organizational line of communication between the medical and pharmacy components of the health plan. (http://www. dakotacare. com) CHAPTER 2 Review of Related Literature and Studies This chapter represents the review on related literature and studies regarding the topic about the Impact of Medication on Patient’s Safety and Its Prevention in Hospitals.

It gives us references about the study, which were made by various medical practitioners. This chapter will allow us to verify the mere significance of medication to a patient’s well-being or the application and management of medications in a hospital setting. Local Literature PPD’s Nursing Drug Guide (NDG) is the only drug guide that considers the needs of Filipino nurses as it lists pharmaceutical products available in the Philippines alongside their equivalent brands in the United States, Canada, United Kingdom, and Australia.

NDG provides concise information on indications, dosages, drug action and interaction, adverse reactions, precautions, pharmacology, and other valuable practice information. PPD’s Nursing Drug Guide was designed and published after conducting a comprehensive study of the needs and wants of Filipino nursing students and professional nurses. Comprehensive listing of pharmaceutical products that are available in the Philippines with their equivalent brands in the US, Canada, UK, and Australia. Advisory board composed of some of the best minds in the nursing academe and profession.

Provides concise information on more than 600 generic drugs and 4,000 brands that are prescribed by doctors and used by patients in the country today. Contains an updated listing of newly-launched drugs from both multinational and local pharmaceutical companies that are used in various clinical settings. Includes drug action and interaction, adverse reaction, precautions, pharmacokinetics and pharmacodynamics, antidotes, use of IV fluids, dosage calculation, and more. Incorporates vital drug information on herbal preparations and multi-component drugs.

Provides Nursing Considerations for every drug entry that are presented in ADPIE (Assessment, Diagnosis, Planning, Implementation, Evaluation) format as endorsed by the Association of Deans of Philippine Colleges of Nursing. Includes SOAPIE charting samples. (http://www. medicommpacific. com/mpinew_ndg. php) Advanced Practice Registered Nurses: The Impact on Patient Safety and Quality: Chapter 43. This chapter will define the role of advanced practice nurses (APNs), review a selected sample of the literature regarding what we know about APNs and patient safety/quality, and describe the research gaps and limitations.

Advanced practice registered nurse is a term used to encompass certified nurse-midwife (CNM), certified registered nurse anesthetist (CRNA), clinical nurse specialist (CNS), and nurse practitioner (NP). Advanced practice nursing is broadly defined as nursing interventions that influence health care outcomes, including the direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy.

In 2004, the number of registered nurses (RNs) prepared to practice in at least one advanced practice role was estimated to be 240,461, or 8. 3 percent of the total RN population. As noted in figure 1 below, the largest group among the APNs was NPs, followed by CNSs. The APN movement has been growing exponentially with APNs employed in every health care sector. According to the Bureau of Labor Statistics, the demand for APNs is expected to continue to increase over the next decade and beyond, as the need and demand for effective health care increases, especially in rural, inner-city, and other underserved areas.

Registered Nurses Prepared for Advanced Practice, March 2004 Source: 2004 National Sample Survey of Registered Nurses, U. S. Department of Health and Human Services, Health Resources and Services Administration. Direct clinical practice is a core competency of any APN role, although the actual skill set varies according to the needs of the patient population. APNs build on the competence of the RN skill set and demonstrate a greater depth and breadth of knowledge, a greater synthesis of data, increased complexity of skills and interventions, and significant role autonomy.

The APN is prepared to assume responsibility and accountability for health promotion and the assessment, diagnosis, and management of patient problems, including the use and prescription of pharmacologic and nonpharmacologic interventions. The American Association of Colleges of Nursing envisions all APN master’s-level programs will evolve to a doctorate of nursing practice (DNP) by 2015.

This evolution to the doctoral level for APN education stems from the three Institute of Medicine (IOM) reports, Too Err is Human, Crossing the Quality Chasm, and Health Professions Education: A Bridge to Quality, which emphasized widespread problems related to patient safety and called for dramatic restructuring of traditional health professions education. These reports recommended all health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidenced-based practice, quality improvement, and informatics.

It was emphasized that the best-prepared senior-level nurses should be in key leadership positions and participating in executive decisions. Complex practice and delivery system demands create a mandate to expand the clinical education and leadership capacity of APNs. Graduates of DNP programs are expected to use advanced communication skills/processes to lead quality improvement and patient safety initiatives in health care systems. (http://www. ncbi. nlm. nih. gov/books/NBK2641/) Foreign Literature.

The Commission has identified medication safety as one of its priorities and as a National Safety and Quality Health Service Standard. The Medication Safety Program aims to improve the safety and quality of medication usage in Australia. Reducing error and harm from medicines through safe and quality use is an important element of our work and is helping us to achieve our objective of leading and coordinating national safety and quality improvements in health care. The Medication Safety Program is advised by a number of standing and advisory committees.

Antimicrobial Stewardship: The National Antimicrobial Stewardship Initiative works to optimize antimicrobial use, improve patient outcomes and reduce the incidence of antimicrobial resistance in Australian hospitals. Electronic Medication Management Systems: The Commission has released the second edition of the Electronic Medication Management Systems: A Guide to Safe Implementation. The Guide provides advice on specifying and implementing safe electronic medication management systems in Australian hospitals.

Medication Charts: A range of standardized medication charts, forms and support materials assists health services improve medication safety. Medication Reconciliation: The Commission is working to improve medication safety and quality through medication reconciliation. High Risk Medicines: Medication safety alerts are issued in response to reported incidents or for medicines with known high risks. Resources include alerts for Vincristine and Intravenous Potassium Chloride. VTE Prevention: Including the National Inpatient Medication Chart VTE Pilot and VTE Prevention Resource Centre. (http://www. safetyandquality.

gov. au/our-work/medication-safety/) Medicines are used to treat infectious diseases, manage symptoms of chronic diseases, and help relieve pain and suffering. Medicines are generally safe when used as prescribed or as their labeling describes. There are, however, risks in taking any medicine. Each year in the United States, adverse drug events—injury resulting from the use of medication—result in over 700,000 visits to hospital emergency departments. Many adverse drug events are preventable. Patients and caregivers can help reduce the risk of harm from medicines by learning about medication safety.

(http://www. cdc. gov/medicationsafety/) Safety monitoring of medicines in common use should be an integral part of clinical practice. The degree to which clinicians are informed about the principles of pharmacovigilance, and practice according to them, has a large impact on health care quality. Education and training of health professionals in drug safety, exchange of information between national centers, the co-ordination of such exchange, and linking clinical experience of drug safety with research and health policy, all serve to enhance effective patient care.

National programmes for pharmacovigilance are perfectly placed for identifying research necessary for better understanding and treatment of drug-induced diseases. Drug safety monitoring is an essential element for the effective use of medicines and for high quality medical care. It has the potential to inspire confidence and trust among patients and health professionals in medicines and contributes to raising standards of medical practice. Pharmacovigilance is a clinical discipline in its own right – one that contributes to an ethos of safety and serves as an indicator of the standards of clinical care practiced within a country.

Healthcare practitioners are in a position to make good use of their patients’ positive and negative experiences of treatment to contribute to medical science and to an improved understanding of disease and of the medicines. There are three approaches that might serve to increase awareness and interest in drug safety among clinicians, and to address research issues. These are described in the following sections. Education, training and access to reliable information: Adverse reactions tend to be viewed, incorrectly, as ‘side effects’ and thus as distractions from patients’ and doctors’ priorities.

Learning about the scope and severity of ADRs should start early in professional training. Good safety monitoring encourages healthcare practitioners to take fuller responsibility for the medicines they use. It improves clinical effectiveness and increases the confidence with which they and their patients use medicines. To achieve something nearer ideal practice more attention needs to be given to training health professionals in diagnosis, management and prevention of ADRs. Not all signals are as specific and dramatic, and readily diagnosed, as were the phocomelia and micromelia caused by thalidomide.

Recognition of less obvious adverse effects requires clinical alertness, accurate diagnosis and an understanding of the principles of causality assessment. Health professionals are more likely to identify and report important ADRs if they have confidence in their ability to diagnose, manage and prevent such reactions. National pharmacovigilance centers and training institutions play a central role in this by encouraging inclusion of the principles and methods of pharmacovigilance and the study of iatrogenic disease at undergraduate and postgraduate levels in schools of medicine, pharmacy and nursing.

Pharmacology curricula should give a higher priority to the study of the safety of medicines. This would lead to an enhanced awareness of the balance between the benefits and harms of medicines. An integrated approach to therapeutic decision-making might be encouraged. Excessive and irrational drug use contributes to adverse reactions. The misuse of medicines is largely caused by the poor quality and inaccessibility of drug information available to practitioners.

These problems are worsened by: • Aggressive and inaccurate marketing and advertising • uninformed patient use and their demands for the latest medicines • lack of accurate drug information Indicators of inappropriate drug use can be obtained from spontaneous reports of ADRs.

Case examples may serve as useful teaching tools for improving the safe use of medicines. In some countries an overwhelming volume of information (as opposed to effective communication of critical information) can serve as a deterrent to rational use. Medication errors and ADRs are well documented in hospitalized and non-hospitalized patients, and they contribute substantially to morbidity and mortality.

They also contribute to the number of hospital admissions and are known to occur in the community setting. Many are predictable and preventable. This suggests considerable opportunity for minimizing the risks of ADRs through rational use, monitoring and follow-up. Early detection is important, particularly in hospitals where systems for detecting ADRs and medication errors will save lives and money. Such systems might be linked to institutional, regional or national pharmacy and therapeutics committees so that information can be used to educate professional staff in safe drug use.

Prospective hospital-based surveillance reduces the risk and severity of ADRs. There is, furthermore, a need to provide health professionals with the skills required to evaluate drug information critically and to decide how the safety profile of a drug (e. g. developed from population data) might be applied to a particular patient. Often, the manufacturer’s product information and promotional materials are the only information available to the practitioner. Evidence-based and comprehensive sources may not be available.

Availability of balanced and reliable drug information is likely to improve standards of use and to reduce the frequency of adverse reactions. Information that includes patients’ subjective experiences of adverse reactions would be most useful to patients and to prescribers of medicines. Product safety information, the way it is currently presented, often consists of lists of adverse reactions, perhaps rated in order of frequency, without real description of how these might affect quality of life.

Moreover, prescribers should be free to practice without being subjected to the vested interest of manufacturers and any conflict in interest. There are also other opportunities for integrating pharmacovigilance into clinical practice through training and education. Participation of National Centre staff in continuing education programmes, conferences, scientific publications and e-mail discussion groups all contribute. The National Centre might serve as a teaching base, and as a training center for medical and pharmacy interns, post-graduate students, pharmacology registrars (residents) and drug information staff.

Research in ADRs and pharmacoepidemiology in departments of internal medicine and pharmacology should be encouraged and promoted. In the training of health professionals it is important to develop competence in evaluating and communicating information about benefit, harm, effectiveness and risk to the patient. Difficulties in communication between patients and healthcare providers represent an important and preventable potential source of harm. The following elements are likely to reduce significantly the risks of adverse effects and their severity: • an adequate drug history of the patient

• rational prescribing and dispensing • proper counseling • the provision of clear and understandable drug information. Communication with health professionals: A further strategy for integrating pharmacovigilance into clinical practice is the creation of open lines of communication and broader collaboration between health professionals and National Centres. For this to happen, National or regional centres need to be situated so that two-way communication between health practitioners and professional staff of the centre is easy.

Drug information and poison centres are ideal locations for this purpose, since many poisoning reports and drug information queries are in fact ADRs. The staff of these centres are in an ideal position to support the work of pharmacovigilance. Pharmacovigilance centres should provide ready access to clinical expertise and sharing of resources, including databases.

Communication materials developed by drug information and poison centers, including newsletters and other publications, can be utilized for disseminating drug alerts and other drug safety information to the professions. Academic departments and university hospitals have proved effective places for national and regional pharmacovigilance centres for a number of reasons.

These include the following: (i) Pharmacovigilance can readily be linked with experimental and clinical pharmacology, and epidemiology in that environment (ii) The location makes peer review of adverse reaction reports easier and more efficient, and it provides ready access to hospital specialists in university departments.

From such a base, an advisory panel for the National Centre with scientific and medical experts can be created (iii) The information obtained from spontaneous reports can be incorporated into undergraduate and postgraduate teaching in the health sciences (iv) Health professionals are likely to feel confident in reporting problems and therapeutic dilemmas to an academic unit with which they are familiar and that they know will consider their reports thoroughly and expertly (v)

Effective medical education strategies such as academic detailing, feedback on individual cases, reminders and soliciting the support of acknowledged experts are most readily achievable under these circumstances. Clinicians making reports expect ready access to the centre and to specialized advice and feedback. They should be encouraged to publish unusual or int.

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