1243 / Medication review in nursing homes

ITALY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Implementation of Patient Safety initiatives / Activities
Assessment of risk and harm There is no specified text here
Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
 
Medication reconciliation and therapy review are defined as the comprehensive evaluation of a patient’s medication regimen any time there is a change in therapy, in an effort to avoid medication errors such as omissions, duplications, dosing errors or drug interactions as well to observe compliance and adherence patterns. The implementation of hospital-based multidisciplinary medication reconciliation or review programs has demonstrated to positively affect the number of medication errors occurring at the bedside, but experiences in outpatient settings are still limited. The aim of this work is to improve therapy appropriateness and patient safety by a multiprofessional team intervention on patient therapies in 19 long term nursing homes for dependent residents of an Italian health district.
Description of the Patient Safety Practice
 
Pilot study was conducted in 2012-2013 in four long term nursing homes. Clinical pharmacists prospectively reviewed all residents’ medication records in order to disclose every potentially inappropriate prescription. At the end of each individual review, a personalized summary report was drawn up. Subsequently, each clinical case was discussed with prescribing physicians in order to update patient pharmacological schedules based on clinical pharmacist’s suggestions. A total of 333 patient records were reviewed during the study pilot period. Patients, 93 male, ranged between 52 and 104 years old. 57% of them were older than 85 years. - 85.9% of patients assumed 5 drugs or more, 25,2 assumed 10 drugs or more. - Overall, therapy review found 871 discrepancies in 2556 prescribed drugs. The most frequently encountered discrepancy was non-adherence to the Drug Formulary (35,5%), followed by inappropriate drug prescription according to Beers and/or START-STOPP criteria (27,4%). - As far as drug interactions is concerned, 243 severe drug interactions were identified. (27,9%). - In 35,5% of cases prescribing physicians accepted pharmacist suggestions based on the revised process and updated patient’s medical schedule accordingly, and autonomously introduced other 96 modification. Specifically, the attention focused on drug-drug interactions, label use of medications (both in terms of indication and posologic regimen), adherence of prescribed drugs to the Drug Formulary consistent with the outpatient therapeutic practice and appropriate prescription for elderly people in accord to Beers and START_STOPP criteria. The 2012 updated Beers criteria for potentially inappropriate medication use in older adults and the STOPP – START criteria were both used in evaluating each patient record. Moreover, the Micromedex database was accessed for drug interaction identification and ranking. The pilot study suggested that clinical pharmacists intervention in medication reconciliation throughout a global review of patient medical records allowed the identification of a significant number of therapeutic discrepancies. Moreover, it is worth noting that prescribing physician well-accepted pharmacists advice on technical basis with a consequent improvement of patient pharmacological therapy but were reluctant to drug substitution or withdrawal in case of potential severe drug interaction warning. The pilot study demonstrated the feasibility of an extensive program of review therapy in all the long term nursing homes of the health district and it identified at least two critical areas: polypharmacy and inadequate risk perception of potential severe interactions in which intervention and training is unavoidable. The extensive program started on 2014. The preliminary results, calculated on 126 subjects in 3 long term nursing homes, confirmed a prevalence rate of discrepancies detected by clinical pharmacists of 35,2% (350/993 therapies) and a 28,3% (99/350) rate of acceptance by clinicians.
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, partly
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Home care
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Yes
Specification of implementation in another health care setting(s)
Not known
Successful implementation's level  of this Patient Safety Practice across settings
Yes, across multiple local/national health systems
Involved health care staff
 
Physicians
Nurses
Pharmacists
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Relative(s)
Point of time in which service user or their reprasentatives' involvement takes place
During the implementation of the Patient Safety Practices
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
No
Short description of the service users' level of involvement
Consultation, such as asking for information
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
http://buonepratiche.agenas.it/questionnaire.aspx?id=5120
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
Yes
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
Not sufficient human resources available
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Chiara Cattaruzzi
Country: ITALY
Organisation: AAS MEDIO FRIULI
E-mail: chiara.cattaruzzi@aas4.sanita.fvg.it
Phone: There is no specified text here
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