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. 2023 Feb 15;40(1):Doc3.
doi: 10.3205/zma001585. eCollection 2023.

Development of a project for interprofessional collaboration between medical and pharmacy students to improve medication safety in polypharmacy (PILLE)

Affiliations
Free PMC article

Development of a project for interprofessional collaboration between medical and pharmacy students to improve medication safety in polypharmacy (PILLE)

Sabine Gehrke-Beck et al. GMS J Med Educ. .
Free PMC article

Abstract

Aim: Interprofessional collaboration is particularly relevant to patient safety in outpatient care with polypharmacy. The educational project "PILLE" is meant to give medical and pharmacy students an understanding of the roles and competencies needed for cooperation in the provision of healthcare and to enable interprofessional learning.

Method: The curriculum is aimed at pharmacy and medical students and was developed in six steps according to the Kern cycle. It is comprised of an interprofessional seminar, a joint practical training in a simulated pharmacy, and a tandem job shadowing at a primary care practice. The project was implemented in three stages due to the pandemic: The interprofessional online seminar based on the ICAP model and the digital inverted classroom was held in the 2020 winter semester; the interprofessional practical training was added in the 2021 summer semester; and the interprofessional tandem job shadowing at a primary care practice in the 2021 winter semester. Attitudes toward interprofessional learning, among other things, was measured in the evaluation using the SPICE-2D questionnaire (Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education).

Results: In the first three semesters, a total of 105 students (46 pharmacy, 59 medicine) participated in the project, of which 78 participated in the evaluation (74% response rate). The students stated, in particular, that they had learned about the competencies and roles of the other profession and desired additional and more specific preparatory materials for the course sessions. The SPICE-2D questionnaire showed high values for both groups of students already in the pre-survey and these increased further as a result of the project.

Conclusion: Joint case-based learning could be implemented under the conditions imposed by the pandemic. Online teaching is a low-threshold means to enable interprofessional exchange.

Zielsetzung: In der ambulanten Versorgung von Patient*innen mit Polypharmazie ist interprofessionelle Zusammenarbeit für die Patientensicherheit besonders relevant. Das Lernprojekt PILLE soll Rollenverständnis und Kompetenzen für eine kooperative Versorgung an Pharmazie- und Medizinstudierende vermitteln und interprofessionelles Lernen ermöglichen.

Methodik: Das Curriculum wurde nach dem Kern-Zyklus in sechs Schritten entwickelt und umfasst ein interprofessionelles Seminar, eine gemeinsame Fallbearbeitung in einer Simulationsapotheke und eine Hospitation in einer Hausarztpraxis für Pharmazie- und Medizinstudierende. Pandemiebedingt wurde das Lernprojekt in drei Stufen implementiert: im Wintersemester 2020 das Online-Seminar basierend auf dem ICAP-Modell und dem Konzept des digitalen inverted classroom, im Sommersemester 2021 ergänzend das interprofessionelle Praktikum und im Wintersemester 2021 die Hospitation in einer Hausarztpraxis. In der Evaluation wurde u.a. die Einstellung zu interprofessionellem Lernen mit dem SPICE-2D Fragebogen (Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education) erhoben.

Ergebnisse: In den ersten drei Semestern nahmen insgesamt 105 Studierende (46 Pharmazie, 59 Medizin) am Lernprojekt teil, davon beteiligten sich 78 an der Evaluation (74% Rücklauf). Die Studierenden geben an, besonders zu Kompetenzen und Rolle der anderen Berufsgruppe gelernt zu haben und wünschen sich weitere gezielte Vorbereitungsmaterialien für den Unterricht. Der SPICE-2D Fragebogen zeigt bereits vorab hohe Werte bei beiden Studierendengruppen, die sich durch das Lernprojekt weiter erhöhten.

Schlussfolgerung: Gemeinsames fallbasiertes Lernen war unter Pandemiebedingungen umsetzbar. Online-Lehre bietet eine niedrigschwellige Möglichkeit, interprofessionellen Austausch zu ermöglichen.

Keywords: distance education; interprofessional education; patient safety; polypharmacy; teaching.

Conflict of interest statement

The authors declare that they have no competing interests.

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. 2023 Mar 11.
doi: 10.1007/s00228-023-03469-5. Online ahead of print.

Evaluation of Global trigger tool as a medication safety tool for adverse drug event detection-a cross-sectional study in a tertiary hospital

Affiliations

Evaluation of Global trigger tool as a medication safety tool for adverse drug event detection-a cross-sectional study in a tertiary hospital

Ville Valkonen et al. Eur J Clin Pharmacol. .

Abstract

The objective of this study is to describe and analyze adverse drug events (ADE) identified using the Global trigger tool (GTT) in a Finnish tertiary hospital during a 5-year period and also to evaluate whether the medication module of the GTT is a useful tool for ADE detection and management or if modification of the medication module is needed. A cross-sectional study of retrospective record review in a 450-bed tertiary hospital in Finland. Ten randomly selected patients from electronic medical records were reviewed bimonthly from 2017 to 2021. The GTT team reviewed a total of 834 records with modified GTT method, which includes the evaluation of possible polypharmacy, National Early Warning Score (NEWS), highest nursing intensity raw score (NI), and pain triggers. The data set contained 366 records with triggers in medication module and 601 records with the polypharmacy trigger that were analyzed in this study. With the GTT, a total of 53 ADEs were detected in the 834 medical records, which corresponds to 13 ADEs/1000 patient-days and 6% of the patients. Altogether, 44% of the patients had at least one trigger found with the GTT medication module. As the number of medication module triggers increased per patient, it was more likely that the patient had also experienced an ADE. The number of triggers found with the GTT medication module in patients' records seems to correlate with the risk of ADEs. Modification of the GTT could provide even more reliable data for ADE prevention.

Keywords: Adverse drug events; Global trigger tool; Medication safety; Polypharmacy.

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. 2023 Feb 28.
doi: 10.1002/jhm.13068. Online ahead of print.

Advancing pediatric medication safety using real-world data: Current problems and potential solutions

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Advancing pediatric medication safety using real-world data: Current problems and potential solutions

James W Antoon et al. J Hosp Med. .
No abstract available

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. 2023 Feb 20;20(4):3725.
doi: 10.3390/ijerph20043725.

Severity and Management of Adverse Drug Reactions Reported by Patients and Healthcare Professionals: A Cross-Sectional Survey

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Free PMC article

Severity and Management of Adverse Drug Reactions Reported by Patients and Healthcare Professionals: A Cross-Sectional Survey

Warisara Srisuriyachanchai et al. Int J Environ Res Public Health. .
Free PMC article

Abstract

Adverse drug reaction (ADR) severity levels are mainly rated by healthcare professionals (HCPs), but patient ratings are limited. This study aimed to compare patient-rated and pharmacist-rated ADR severity levels and determined methods employed for ADR management and prevention by patients and HCPs. A cross-sectional survey was conducted in outpatients visiting two hospitals. Patients were asked about ADR experiences using a self-administered questionnaire, and additional information was retrieved from the medical records. In total, 617 out of 5594 patients had experienced ADRs (11.0%), but 419 patients were valid (68.0%). Patients commonly reported that their ADR severity level was moderate (39.4%), whereas pharmacists rated the ADRs as mild (52.5%). There was little agreement between patient-rated and pharmacist-rated ADR severity levels (κ = 0.144; p < 0.001). The major method of ADR management by physicians was drug withdrawal (84.7%), while for patients, it was physician consultation (67.5%). The main methods for ADR prevention by patients and HCPs were carrying an allergy card (37.2%) and recording drug allergy history (51.1%), respectively. A higher level of ADR bothersomeness was associated with higher ADR severity levels (p < 0.001). Patients and HCPs rated ADR severity and used ADR management and prevention methods differently. However, patient rating of ADR severity is a potential signal for severe ADR detection of HCPs.

Keywords: adverse drug reactions; management; patient self-reporting; prevention; severity.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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. 2023 Mar;117(3):P7-P9.
doi: 10.1002/aorn.13889.

Guideline for Medication Safety

Guideline for Medication Safety

Lisa Croke. AORN J. 2023 Mar.
No abstract available

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. 2023 Feb 15;archdischild-2022-324772.
doi: 10.1136/archdischild-2022-324772. Online ahead of print.

For children admitted to hospital, what interventions improve medication safety on ward rounds? A systematic review

Affiliations

For children admitted to hospital, what interventions improve medication safety on ward rounds? A systematic review

Charlotte King et al. Arch Dis Child. .

Abstract

Objective: Every year, medication errors harm children in hospitals. Ward rounds are a unique opportunity to bring information together and plan management. There is a need to understand what strategies can improve medication safety on ward rounds. We systematically reviewed published interventions to improve prescribing and safety of medicines on ward rounds.

Design: Systematic review of randomised controlled trials and observational studies.

Setting: Studies examining inpatient ward rounds.

Patients: Children and young people aged between 0 and 18 years old.

Interventions: Any intervention or combination of interventions implemented that alters how paediatric ward rounds review inpatient medications.

Main outcome measure: Primary outcome was improvement in medication safety on paediatric ward rounds. This included reduction in prescribing error rates, healthcare professionals' opinions on prescribing and improvement in documentation on ward rounds.

Results: Three studies were eligible for review. One examined the use of an acrostic, one the use of a checklist, and the other a use of a specific prescribing ward round involving a clinical pharmacist and doctor. None of the papers considered weight-based errors or demonstrated reductions in clinical harm. Reductions in prescribing errors were noted by the different interventions.

Conclusions: There are limited data on interventions to improve medication safety in paediatric ward rounds, with all published data being small scale, either quality improvement or audits, and locally derived/delivered. Good-quality interventional or robust quality improvement studies are required to improve medication safety on ward rounds.

Prospero registration number: CRD42022340201.

Keywords: Paediatrics; Pharmacology.

Conflict of interest statement

Competing interests: None declared.

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Observational Study
. 2023 Feb;30(1):e100622.
doi: 10.1136/bmjhci-2022-100622.

Improving medication safety in a paediatric hospital: a mixed-methods evaluation of a newly implemented computerised provider order entry system

Affiliations
Free PMC article
Observational Study

Improving medication safety in a paediatric hospital: a mixed-methods evaluation of a newly implemented computerised provider order entry system

Man Qing Liang et al. BMJ Health Care Inform. 2023 Feb.
Free PMC article

Abstract

Objectives: Computerised provider order entry (CPOE) systems have been implemented around the world as a solution to reduce ordering and transcription errors. However, previous literature documented many challenges to attain this goal, especially in paediatric settings. The objectives of this study were to (1) analyse the impact of a paediatric CPOE system on medication safety and (2) suggest potential error prevention strategies.

Methods: A pre-post observational study was conducted at the pilot ward (n=60 beds) of a paediatric academic health centre through mixed methods. The implementation project and medication management workflows were described through active participation to the project management team, observation, discussions and analysis of related documents. Furthermore, using incident reports, the nature of each error and error rate was compared between the preperiod and postperiod.

Results: The global error rate was lower, but non-statistically significant, in the post implementation phase, which was mostly driven by a significant reduction in errors during order acknowledgement, transmission and transcription. Few errors occurred at the prescription step, and most errors occurred during medication administration. Furthermore, some errors could have been prevented using a CPOE in the pre-implementation period, and the CPOE led to few technology-related errors.

Discussion and conclusion: This study identified both intended and unintended effects of CPOE adoption through the entire medication management workflow. This study revealed the importance of simplifying the acknowledgement, transmission and transcribing steps through the implementation of a CPOE to reduce medication errors. Improving the usability of the electronic medication administration record could help further improve medication safety.

Keywords: clinical pharmacy information systems; health information systems; information technology; pharmacy research; safety management.

Conflict of interest statement

Competing interests: None declared.

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Medication Rounds: A Tool to Promote Medication Safety for Children with Medical Complexity

Christina R Rojas et al. Jt Comm J Qual Patient Saf. .

Abstract

Children with medical complexity (CMC) often have lengthy medication lists and are at risk of experiencing suboptimal medication management. This tool tutorial describes a novel and pragmatic strategy for the development and implementation of medication rounds, a model that promotes medication safety for hospitalized CMC. An interprofessional group designed and implemented a pharmacy-led medication rounding care model, in which clinicians and pharmacists partner weekly to conduct reviews of all patient medications on a general pediatrics CMC team using a comprehensive checklist. This approach fosters medication safety for hospitalized CMC and could be adapted to other complex inpatient populations.

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. 2023 Jan 28;20(3):2327.
doi: 10.3390/ijerph20032327.

Detecting Medication Risks among People in Need of Care: Performance of Six Instruments

Affiliations
Free PMC article

Detecting Medication Risks among People in Need of Care: Performance of Six Instruments

Tobias Dreischulte et al. Int J Environ Res Public Health. .
Free PMC article

Abstract

Introduction: Numerous tools exist to detect potentially inappropriate medication (PIM) and potential prescribing omissions (PPO) in older people, but it remains unclear which tools may be most relevant in which setting.

Objectives: This cross sectional study compares six validated tools in terms of PIM and PPO detection.

Methods: We examined the PIM/PPO prevalence for all tools combined and the sensitivity of each tool. The pairwise agreement between tools was determined using Cohen's Kappa.

Results: We included 226 patients in need of care (median (IQR age 84 (80-89)). The overall PIM prevalence was 91.6 (95% CI, 87.2-94.9)% and the overall PPO prevalence was 63.7 (57.1-69.9%)%. The detected PIM prevalence ranged from 76.5%, for FORTA-C/D, to 6.6% for anticholinergic drugs (German-ACB). The PPO prevalences for START (63.7%) and FORTA-A (62.8%) were similar. The pairwise agreement between tools was poor to moderate. The sensitivity of PIM detection was highest for FORTA-C/D (55.1%), and increased to 79.2% when distinct items from STOPP were added.

Conclusion: Using a single screening tool may not have sufficient sensitivity to detect PIMs and PPOs. Further research is required to optimize the composition of PIM and PPO tools in different settings.

Keywords: adverse drug reaction; inappropriate medication; nursing home residents; polypharmacy; prescribing omission.

Conflict of interest statement

The authors declare no conflict of interest.

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. 2023 Jan 19;20(3):1879.
doi: 10.3390/ijerph20031879.

The Impact of an Electronic Medication Management System on Medication Deviations on Admission and Discharge from Hospital

Affiliations
Free PMC article

The Impact of an Electronic Medication Management System on Medication Deviations on Admission and Discharge from Hospital

Milan R Vaghasiya et al. Int J Environ Res Public Health. .
Free PMC article

Abstract

Medication errors at transition of care remain a concerning issue. In recent times, the use of integrated electronic medication management systems (EMMS) has caused a reduction in medication errors, but its effectiveness in reducing medication deviations at transition of care has not been studied in hospital-wide settings in Australia. The aim of this study is to assess medication deviations, such as omissions and mismatches, pre-EMMS and post-EMMS implementation at transition of care across a hospital. In this study, patient records were reviewed retrospectively to identify medication deviations (medication omissions and medication mismatches) at admission and discharge from hospital. A total of 400 patient records were reviewed (200 patients in the pre-EMMS and 200 patients in the post-EMMS group). Out of 400 patients, 112 in the pre-EMMS group and 134 patients in post-EMMS group met the inclusion criteria and were included in the analysis. A total of 105 out of 246 patients (42.7%) had any medication deviations on their medications. In the pre-EMMS group, 59 out of 112 (52.7%) patients had any deviations on their medications compared to 46 out of 134 patients (34.3%) from the post-EMMS group (p = 0.004). The proportion of patients with medication omitted from inpatient orders was 36.6% in the pre-EMMS cohort vs. 22.4% in the post-EMMS cohort (p = 0.014). Additionally, the proportion of patients with mismatches in medications on the inpatient charts compared to their medication history was 4.5% in the pre-EMMS group compared to 0% in the post-EMMS group (p = 0.019). Similarly, the proportion of patients with medications omitted from their discharge summary was 23.2% in the pre-EMMS group vs. 12.7% in the post-EMMS group (p = 0.03). Our study demonstrates a reduction in medication deviations after the implementation of the EMMS in hospital settings.

Keywords: digital health; electronic medication management system; medication reconciliation; medication safety.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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. 2023 Feb;7(1):e001765.
doi: 10.1136/bmjpo-2022-001765.

Development and validation of a risk prediction model for medication administration errors among neonates in the neonatal intensive care unit: a study protocol

Affiliations
Free PMC article

Development and validation of a risk prediction model for medication administration errors among neonates in the neonatal intensive care unit: a study protocol

Josephine Henry Basil et al. BMJ Paediatr Open. 2023 Feb.
Free PMC article

Abstract

Introduction: Medication administration errors (MAEs) are the most common type of medication error. Furthermore, they are more common among neonates as compared with adults. MAEs can result in severe patient harm, subsequently causing a significant economic burden to the healthcare system. Targeting and prioritising neonates at high risk of MAEs is crucial in reducing MAEs. To the best of our knowledge, there is no predictive risk score available for the identification of neonates at risk of MAEs. Therefore, this study aims to develop and validate a risk prediction model to identify neonates at risk of MAEs.

Methods and analysis: This is a prospective direct observational study that will be conducted in five neonatal intensive care units. A minimum sample size of 820 drug preparations and administrations will be observed. Data including patient characteristics, drug preparation-related and administration-related information and other procedures will be recorded. After each round of observation, the observers will compare his/her observations with the prescriber's medication order, hospital policies and manufacturer's recommendations to determine whether MAE has occurred. To ensure reliability, the error identification will be independently performed by two clinical pharmacists after the completion of data collection for all study sites. Any disagreements will be discussed with the research team for consensus. To reduce overfitting and improve the quality of risk predictions, we have prespecified a priori the analytical plan, that is, prespecifying the candidate predictor variables, handling missing data and validation of the developed model. The model's performance will also be assessed. Finally, various modes of presentation formats such as a simplified scoring tool or web-based electronic risk calculators will be considered.

Keywords: Neonatology.

Conflict of interest statement

Competing interests: N/A.

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Randomized Controlled Trial
. 2023 Feb 4;401(10374):347-356.
doi: 10.1016/S0140-6736(22)01841-4.

A 12-gene pharmacogenetic panel to prevent adverse drug reactions: an open-label, multicentre, controlled, cluster-randomised crossover implementation study

Collaborators, Affiliations
Randomized Controlled Trial

A 12-gene pharmacogenetic panel to prevent adverse drug reactions: an open-label, multicentre, controlled, cluster-randomised crossover implementation study

Jesse J Swen et al. Lancet. .

Abstract

Background: The benefit of pharmacogenetic testing before starting drug therapy has been well documented for several single gene-drug combinations. However, the clinical utility of a pre-emptive genotyping strategy using a pharmacogenetic panel has not been rigorously assessed.

Methods: We conducted an open-label, multicentre, controlled, cluster-randomised, crossover implementation study of a 12-gene pharmacogenetic panel in 18 hospitals, nine community health centres, and 28 community pharmacies in seven European countries (Austria, Greece, Italy, the Netherlands, Slovenia, Spain, and the UK). Patients aged 18 years or older receiving a first prescription for a drug clinically recommended in the guidelines of the Dutch Pharmacogenetics Working Group (ie, the index drug) as part of routine care were eligible for inclusion. Exclusion criteria included previous genetic testing for a gene relevant to the index drug, a planned duration of treatment of less than 7 consecutive days, and severe renal or liver insufficiency. All patients gave written informed consent before taking part in the study. Participants were genotyped for 50 germline variants in 12 genes, and those with an actionable variant (ie, a drug-gene interaction test result for which the Dutch Pharmacogenetics Working Group [DPWG] recommended a change to standard-of-care drug treatment) were treated according to DPWG recommendations. Patients in the control group received standard treatment. To prepare clinicians for pre-emptive pharmacogenetic testing, local teams were educated during a site-initiation visit and online educational material was made available. The primary outcome was the occurrence of clinically relevant adverse drug reactions within the 12-week follow-up period. Analyses were irrespective of patient adherence to the DPWG guidelines. The primary analysis was done using a gatekeeping analysis, in which outcomes in people with an actionable drug-gene interaction in the study group versus the control group were compared, and only if the difference was statistically significant was an analysis done that included all of the patients in the study. Outcomes were compared between the study and control groups, both for patients with an actionable drug-gene interaction test result (ie, a result for which the DPWG recommended a change to standard-of-care drug treatment) and for all patients who received at least one dose of index drug. The safety analysis included all participants who received at least one dose of a study drug. This study is registered with ClinicalTrials.gov, NCT03093818 and is closed to new participants.

Findings: Between March 7, 2017, and June 30, 2020, 41 696 patients were assessed for eligibility and 6944 (51·4 % female, 48·6% male; 97·7% self-reported European, Mediterranean, or Middle Eastern ethnicity) were enrolled and assigned to receive genotype-guided drug treatment (n=3342) or standard care (n=3602). 99 patients (52 [1·6%] of the study group and 47 [1·3%] of the control group) withdrew consent after group assignment. 652 participants (367 [11·0%] in the study group and 285 [7·9%] in the control group) were lost to follow-up. In patients with an actionable test result for the index drug (n=1558), a clinically relevant adverse drug reaction occurred in 152 (21·0%) of 725 patients in the study group and 231 (27·7%) of 833 patients in the control group (odds ratio [OR] 0·70 [95% CI 0·54-0·91]; p=0·0075), whereas for all patients, the incidence was 628 (21·5%) of 2923 patients in the study group and 934 (28·6%) of 3270 patients in the control group (OR 0·70 [95% CI 0·61-0·79]; p <0·0001).

Interpretation: Genotype-guided treatment using a 12-gene pharmacogenetic panel significantly reduced the incidence of clinically relevant adverse drug reactions and was feasible across diverse European health-care system organisations and settings. Large-scale implementation could help to make drug therapy increasingly safe.

Funding: European Union Horizon 2020.

Conflict of interest statement

Declaration of interests MP received partnership funding from the UK Medical Research Council (MRC) Clinical Pharmacology Training Scheme (cofunded by MRC, Roche, Union Chimique Belge [UCB] Pharma, Eli Lilly, and Novartis); a PhD studentship jointly funded by the UK Engineering and Physical Sciences Research Council and AstraZeneca; unrestricted educational grant support for the UK Pharmacogenetics and Stratified Medicine Network from Bristol Myers Squibb; and human leucocyte antigen genotyping panel with MC Diagnostics but does not benefit financially from this, outside of the submitted work. JCS received speaker honoraria from Novartis for lectures on CYP2C9 pharmacogenetics and siponimod metabolism, outside of the submitted work. MS was partly supported by the Robert Bosch Stiftung and German Research Foundation (DFG) under Germany's Excellence Strategy (EXC 2180—390900677); and outside of the submitted work received support from Green Cross WellBeing, Gilead Sciences, Robert Bosch, CORAT Therapeutics, and Agena Bioscience. ES was partly supported by the Robert Bosch Stiftung and the German Research Foundation (DFG) under Germany's Excellence Strategy (EXC 2180—390900677). RT was partly supported by the Robert Bosch Stiftung. MK received research funding from Bayer and Roche, educational grants from Novartis and Servier, and consultancy fees from Pharmetheus, outside of the submitted work. SJ received consultancy fees from Pharmetheus, outside of the submitted work. All other authors declare no competing interests.

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Editorial
. 2023 Apr 1;129(7):989-991.
doi: 10.1002/cncr.34650. Epub 2023 Jan 27.

Building new standards to prevent harm from medication errors in children with cancer

Affiliations
Editorial

Building new standards to prevent harm from medication errors in children with cancer

Sara E Helmig et al. Cancer. .

Abstract

Children with cancer receive many medications outside the hospital administered by their caregivers. The study by Walsh et al. shows the number and types of medication errors in these patients. The study includes data from three different centers. Importantly, the study shows the types of errors that cause harm. The authors describe how the harmful errors can be prevented. We suggest ways these results can be used to identify which patients and families will benefit from additional attention. Providing more help at clinic and in the home may help prevent harmful medication errors in children with cancer.

Keywords: leukemia; lymphoma; medication errors; outpatient; pediatric.

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Review
. 2023 Mar 1;17(1):3-7.
doi: 10.1097/SPC.0000000000000634. Epub 2023 Jan 20.

The role of oncology pharmacists and comprehensive medication reconciliation in informing treatment plans for older adults with cancer and downstream outcomes

Affiliations
Review

The role of oncology pharmacists and comprehensive medication reconciliation in informing treatment plans for older adults with cancer and downstream outcomes

Andrew Whitman et al. Curr Opin Support Palliat Care. .

Abstract

Purpose of review: Proper medication management is an essential part of older adult cancer care. An aging population, an increase in anticancer treatment options, and high rates of comorbid conditions make navigating general medication reconciliation complicated. This review will highlight the recent literature describing the roles of the oncology pharmacist in caring for older adults with cancer.

Recent findings: The body of literature highlighting oncology pharmacist roles in this population is mainly focused on polypharmacy and potentially inappropriate medication assessments, deprescribing nonessential therapies, drug-drug interaction reviews, and immunization optimization. Outcomes associated with oncology pharmacist interventions are still lacking as well as the development of benchmarks for appropriate pharmacy-based care in the older adult oncology population.

Summary: Oncology pharmacist interventions in older adults with cancer have the potential to improve patient care. Future randomized studies in this area of practice are warranted in order to clearly define the optimal impact of oncology pharmacists.

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Meta-Analysis
. 2022 Dec 29;2022:8367444.
doi: 10.1155/2022/8367444. eCollection 2022.

Beta-Blockers for Primary Prevention of Anthracycline-Induced Cardiac Toxicity: An Updated Meta-Analysis of Randomized Clinical Trials

Affiliations
Free PMC article
Meta-Analysis

Beta-Blockers for Primary Prevention of Anthracycline-Induced Cardiac Toxicity: An Updated Meta-Analysis of Randomized Clinical Trials

Armin Attar et al. Cardiovasc Ther. .
Free PMC article

Abstract

Aim: Cardiotoxicity is a well-recognized complication of chemotherapy with Anthracyclines. However, results from trials evaluating beta-blockers for prevention are controversial. Therefore, we performed a meta-analysis to find whether prophylactic administration of beta-blockers can help prevent Anthracyclines-induced cardiotoxicity.

Methods: We assessed randomized trials and observational studies where a prophylactic intervention was compared with a control arm in patients with a normal left ventricular ejection fraction (LVEF) receiving Anthracyclines. The primary outcome was EF reduction. The secondary outcome was the development of Cancer Therapeutics-Related Cardiac Dysfunction (CTRCD), defined as a decrease in the LVEF of >10% to a value of <53%.

Results: We included 17 trials comprising 1291 patients (671 patients in the intervention arm and 620 in the control arm). Carvedilol was administered in eight studies, and others used bisoprolol, metoprolol, or nebivolol. Compared with baseline, LVEF reduced in both intervention and control groups after chemotherapy (MD = -1.93%, 95% CI: -2.94, -0.92, p = 0.001, I2 = 72.1% vs. MD = -4.78%, 95% CI: -6.51, -3.04, p = 0.001, I 2 = 91.6%, respectively). LVEF was less reduced among the beta-blocker receivers (MD = 3.44%, 95% CI: 1.41-5.46, p = 0.001, I2 = 94.0%). Among the eight studies reporting the incidence of CTRCD, 45 out of 370 participants in the intervention arm and 54 out of 341 in the control arm were reported to experience this complication (RR = 0.76; 95% CI: 0.53,1.09; I 2 = 24.4%; p = 0.235).

Conclusion: Treatment with beta-blockers prevents dilatation of the left ventricle, development of diastolic dysfunction, and reduction of LVEF. However, these hemodynamic effects do not translate into a significant reduction in CTRCD incidence and prevention of hospitalization for heart failure or cardiac death.

Conflict of interest statement

All authors declare that they do not have any conflict of interest.

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. 2023 Jan 16;20(2):1635.
doi: 10.3390/ijerph20021635.

Assessment of Knowledge, Attitude and Practices of the Hospital and Community Pharmacists in Saudi Arabia (Jeddah) towards Inappropriate Medication Use in Older Adults

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Free PMC article

Assessment of Knowledge, Attitude and Practices of the Hospital and Community Pharmacists in Saudi Arabia (Jeddah) towards Inappropriate Medication Use in Older Adults

Adel A Alfahmi et al. Int J Environ Res Public Health. .
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Abstract

In Saudi Arabia, the older adult population is growing and is projected to increase three-fold by 2030. Potentially inappropriate medications (PIMs) are harmful to older adults' and have a direct impact on clinical, health and economic outcomes. Pharmacists have a vital role in medication tailoring for older adults as multidisciplinary team members. However, there is also a paucity of research regarding pharmacists' participation in detecting and avoiding PIMs use among older adults in Saudi Arabia. A cross-sectional, self-administered survey was conducted to assess the knowledge, practices, and attitude of pharmacists from seven hospitals and ten community pharmacies in Jeddah, Saudi Arabia. The survey comprised three sections; (i) identifying participants' general characteristics, (ii) assessing their knowledge of PIMs use in older adults and (iii) examining the pharmacist's attitude towards the procedures followed in dispensing for older adults. Inferential and descriptive statistics were used to analyse the survey data. A total of 157 community and hospital pharmacists participated in this study. Most of them dispensed medication weekly to older adults (85.4%), and 43.3% had relevant work experience of six to ten years. Though 44.6% of the participants were aware of PIMs that older adults should avoid, only 10.8% claimed adequate knowledge about PIMs. From the given three clinical case scenarios, a minority of pharmacists (21.7%) chose the correct answers, with a mean score of 2.38 ± 2.91 (95% CI 2.35-3.15). Participants who claimed to have knowledge of PIMs had a significantly higher mean score than those who did not, 4.59 ± 2.81 25 (95% CI 2.35-2.61). A minority of the pharmacists (14.7%) used screening tools such as STOPP, Beers criteria, or Medication Appropriateness Index (MAI) to detect PIMs in older adults. No statistically significant differences were detected when comparing the levels of knowledge of pharmacists with 1 to 5 years of practice to pharmacists with 6 to 15 and more years of experience (p = 0.431). Pharmacists' knowledge, attitude and practices toward PIMs use in older adults in Saudi Arabia should be improved. The application of PIMs detection tools such as STOPP/START or Beers criteria currently has no place in day-to-day pharmacists' roles in Saudi Arabia. Therefore, concerned stakeholders should develop educational programs to improve pharmacists' knowledge of PIMs and promote the effective use of PIM screening tools such as Beers and STOPP criteria in their practice.

Keywords: Beers criteria; PIMs; STOPP/START; adverse drug reactions; older adults; pharmacists; potentially inappropriate medication.

Conflict of interest statement

The authors declare no conflict of interest.

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