Lydia Holmdahl

Clinical outcomes from the use of Medication Report when elderly patients are discharged from hospital

Objective The objective of this study was to investigate whether a Medication Report also can reduce the number of patients with clinical outcomes due to medication errors. Method A prospective intervention study with retrospective controls on patients at three departments at Lund University Hospital, Sweden that where transferred to primary care. The intervention group, where patients received a Medication Report at discharge, was compared with a control group with patients of the same age, who were not given a Medication Report when discharged from the same ward one year earlier. For patients with at least one medication error all contacts with hospital or primary care within 3 months after discharge were identified. For each contact it was evaluated whether this was caused by the medication error. We also compared medication errors that have been evaluated as high or moderate clinical risk with medication errors without clinical risk. Main outcome measures Need for medical care in hospital or primary care within three months after discharge from hospital. Medical care is readmission to hospital as well as visits of study population to primary and out-patient secondary health care. Results The use of Medication Report reduced the need for medical care due to medication errors. Of the patients with Medication Report 11 out of 248 (4.4%) needed medical care because of medication errors compared with 16 out of 179 (8.9%) of patients without Medication Report (p = 0.049). The use of a Medication Report significantly reduced the risk of any consequences due to medication errors, p = 0.0052. These consequences included probable and possible care due to medication error as well as administrative procedures (corrections) made by physicians in hospital or primary care. Conclusions The Medication Report seems to be an effective tool to decrease adverse clinical consequences when elderly patients are discharged from hospital care.

In-hospital medication reviews reduce unidentified drug-related problems

PurposeTo examine the impact of a new model of care, in which a clinical pharmacist conducts structured medication reviews and a multi-professional team collates systematic medication care plans, on the number of unidentified DRPs in a hospital setting.MethodsIn a prospective two-period study, patients admitted to an internal medicine ward at the University Hospital of Lund, Sweden, were included if they were ≥ 65 years old, used ≥ 3 medications on a regular basis and had stayed on the ward for ≥ 5 weekdays. Intervention patients were given the new model of care and control patients received conventional care. DRPs were then retrospectively identified after study completion from blinded patient records for both intervention and control patients. Two pairs of evaluators independently evaluated and classified these DRPs as having been identified/unidentified during the hospital stay and according to type and clinical significance. The primary endpoint was the number of unidentified DRPs, and the secondary endpoints were the numbers of unidentified DRPs within each type and clinical significance category.ResultsThe study included a total of 141 (70 intervention and 71 control) patients. The intervention group benefited from a reduction in the total number of unidentified DRPs per patient during the hospital stay: intervention group median 1 (1st–3rd quartile 0–2), control group 9 (6–13.5) (p < 0.001), and also in the number of medications associated with unidentified DRPs per patient: intervention group 1 (0–2), control group 8 (5–10) (p < 0.001). All sub-categories of DRPs that were frequent in the control group were significantly reduced in the intervention group. Similarly, the DRPs were less clinically significant in the intervention group.ConclusionsA multi-professional team, including a clinical pharmacist, conducting structured medication reviews and collating systematic medication care plans proved very effective in reducing the number of unidentified DRPs for elderly in-patients.

Acceptance and importance of clinical pharmacists’ LIMM-based recommendations

Objective The objective of this study was to evaluate the quality of the clinical pharmacy service in a Swedish hospital according to the Lund Integrated Medicine Management (LIMM) model, in terms of the acceptance and clinical significance of the recommendations made by clinical pharmacists. Method The clinical significance of the recommendations made by clinical pharmacists was assessed for a random sample of inpatients receiving the clinical pharmacy service in 2007. Two independent physicians retrospectively ranked the recommendations emerging from errors in the patients’ current medication list and actual drug-related problems according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant). Results The random sample comprised 132 patients (out of 800 receiving the service). The clinical significance of 197 recommendations was assessed. The physicians accepted and implemented 178 (90%) of the clinical pharmacists’ recommendations. Most of these recommendations, 170 (83%), were ranked 3 (somewhat significant) or higher. Conclusion This study provides further evidence of the quality of the LIMM model and confirms that the inclusion of clinical pharmacists in a multi-professional team can improve drug therapy for inpatients. The very high level of acceptance by the physicians of the pharmacists’ recommendations further demonstrates the effectiveness of the process.

The lund integrated medicines management model, health outcomes and processes development.

Background The effects from medication use in clinical trials are hard to achieve in standard care. Instead of health benefits for the patient there is risk of errors and negative consequences such as morbidity, mortality and costs. The risk is highest among older patients admitted and discharged to and from hospital care. Purpose Develop a systematic model for improved medication use when a patient is admitted to hospital. Materials and methods Systematic analysis of problems and limitations in the standard patient medication care process from admission, during stay, at, and after discharge was performed at Lund University hospital. A structured team based model with tools, checklists and responsibilities were developed and tested for each part and for the total model. The clinical pharmacist was introduced as the catalyst for improvement in the team and was responsible for performing medication reconciliation and medication review. Each part of the model was researched stepwise and compared to standard care in studies powered to detect significant differences in processes and outcomes. Three of the outcomes studies were used as input in a probabilistic decision tree model for cost-utility analyses. Results 18 scientific publications and manuscripts have been produced from the development and is the base for four PhD- and more than 30 MSc-theses. The model improves the process of care, that is identifies and solves drug related problem, reduces medication reconciliation errors, and improves medication appropriateness. It also improves healthcare outcomes. Healthcare contacts and hospital readmissions due to medication errors were reduced by 50 percent. For each hour spent by a pharmacist 2-3 h were saved among physicians and nurses. The total model generated savings of €390 and gained utility of 0.005 for each patient. The model is cost saving at a 98% chance. Finally all involved professionals are very satisfied with the process and the pharmacist professional contribution. Conclusions The model has successfully been implemented, researched and also rewarded as best innovation in Swedish healthcare. In Scania (the south of Sweden) there is a political consensus on the benefit and there are concrete plans to employ 40 additional clinical pharmacists

The impact of an integrated clinical pharmacy service on drug-related hospital contacts.

The pharmaceutical industry has a global market size in excess of

Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

600 billion. The industry has in recent times been the centre of much focus as its productivity levels have declined whilst the research and development cost have continued to rise. As the figures for drug development continue to escalate, sustainability of the current development model is being questioned and pharmaceutical companies are re-evaluating their development strategy with focus on implementing a global development programme to enable them to submit simultaneously in a number of regulatory authorities. Regulatory authorities’ role is to safeguard public health and ensure that the drug approval process is carried out in a timely manner. However, pharmaceutical companies can also influence this through the dossier submission strategies used. The aim of this study was to review approvals of new active substances (NASs) by US FDA, EU EMEA, Australian TGA, Canadian TPD, Japanese PMDA and Swissmedic between 1997 and 2008, in order to determine whether the harmonisation of technical guidelines (ICH) has enabled simultaneous submissions and approvals in these markets.Background and objective In 2003, State of North Carolina enacted legislation requiring licensed nursing homes to report medication errors. Since 2004, roughly 400 nursing homes have reported nearly 70,000 medication errors to a web-based error reporting system. Medication errors are a major concern, leading to estimated 800,000 preventable medication related injuries every year in the US. For every dollar spent on drugs in nursing homes,

Medication report reduces number of medication errors when elderly patients are discharged from hospital

1.33 is spent on treatment of drug related morbidity and mortality. This amounts to

The influence of hormonal status and features of the metabolic syndrome on bone density: A population-based study of Swedish women aged 50 to 59 years. The women's health in the Lund area study

7.6 billion for the USA. The aims were firstly to determine proportion of repeat errors occurring per nursing home, to assess contributory factors relating to repeat errors, and association of repeat errors with subsequent patient harm.HRQoL instruments such as the DLQI are useful in assessing how different skin conditions affect patients’ lives, efficacy of patients’ treatment over time and as an additional measure of benefit-risk ratio for certain drugs. If however any decisions are to be made on the basis of a change in HRQoL score over time, then there needs to be a definition of what change in score is meaningful to the patient. The smallest change in score over time that would be meaningful to the patient is called the Minimal Important Difference, or MID. The aim was to determine the MID for the DLQI.Background and objective Accurate dosing of unfractionated heparin (UFH) is difficult to achieve due to inter-patient variability in anticoagulant response, high rate of medication errors with UFH and problems in monitoring heparin via activated partial thromboplastin time (aPTT) levels. Although weight-based nomograms have marked an improvement, they have by no means eliminated limitations associated with UFH therapy. Study aims were to assess whether current dosing nomogram at UNC Hospitals was being used accurately by healthcare staff, and whether doses within the nomogram were achieving therapeutic anticoagulation.