Medication Safety in Psychiatry: Experiences from Medication Reviews and a Nurse-led Intervention.

Publikation: Bog/antologi/rapport/kliniske retningslinjerBogForskningpeer review


Medication errors are the most frequent adverse incidents in healthcare systems across the world causing increased mortality, morbidity, and increased costs for both society and patients. Potentially inappropriate prescriptions (PIPs) also lead to increased mortality, morbidity, and increased health care costs. However, PIPs are primarily studied in the elderly. The exclusion of psychiatric patients is common to these studies of medication errors and PIPs. Hence, the aim of this PhD thesis was to investigate the prevalence and potentially clinical consequences of medication errors and PIPs, as well as nurses’ ability to identify PIPs for psychiatric patients validated by comparing with the findings of senior clinical pharmacology physicians’ (SCPP) medication reviews. Finally, the aim was also to discover nurses’ perceptions of nurse-physician collaboration (NPC) on medication optimisation.
The four studies were comprised of two cross-sectional studies, one controlled before-and-after study including psychiactric patients admitted to bed units in the North Denmark Region, and one qualitative thematic study. In Study I, three methods were applied to collect data (observation, unannounced visits, and chart audit), for the purpose of identifying errors in the medication process. The results of Study I showed errors in 17% of all opportunities for error and 8% of errors in the medication were assessed to be potentially harmful and were thus being medication errors. In the next cross-sectional study, Study II, systematic medication reviews were applied by SCPPs to identify PIPs and to assess potential clinical consequences. The study included all psychiatric patients admitted to a bed unit in the North Denmark Region over a three-month period. The results in Study II demonstrated 349 PIPs in 1291 prescriptions with 33% of patients affected by at least one potentially serious prescription and 12% of patients affected by at least one potentially fatal prescription. Study III, was a controlled before-and-after study, with a two-month baseline and a six-month follow-up period, where all patients received a medication review by SCPPs and these medication reviews were considered gold standard. The intervention consisted of a pharmacology training course for nurses in the intervention bed units and afterwards the nurses reviewed medication lists to identify PIPs. The study was carried out in two intervention bed units and two control bed units. Primary outcomes were the SCPPs identification of PIPs, before and during the intervention, but adjusted for the nurses’ identifications of PIPs during the intervention. Results indicated potential improvement in the mean number of PIPs per patient and the number of patients with at least one PIP. Secondary outcomes counted the prevalence and types of PIPs altered by physicians as a consequence of nurses observations. Study IV, the final study, was a qualitative thematic analysis of the nurses’ perceptions of NPC on medication optimisation for psychiatric patients. The nurses described challenges with NPC relating to both individual as well as organisational factors.
Conclusively, this PhD thesis demonstrates that errors, medication errors and PIPs are frequent in psychiatric patients. Nurses reviewing patients’ medications could only produce non-significant potential improvements. These results should be viewed in the light of the fact that the nurses described a perceived everyday work environment, in which beneficial NPC regarding medication optimisation was not given due consideration. Future studies should, on a larger scale, focus on how and by which methods nurses may contribute to better observation, identification, and reporting of errors and the inappropriate use of medication in psychiatry.

ForlagAalborg Universitetsforlag
Antal sider217
ISBN (Elektronisk)978-87-7210-033-3
StatusUdgivet - 2017
NavnPh.d.-serien for Det Sundhedsvidenskabelige Fakultet, Aalborg Universitet


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