Browsing by Subject "lääkitysturvallisuus"

Stakes ja Lääkehoidon kehittämiskeskus määrittelevät lääkitysturvallisuuden lääkkeiden käyttöön liittyväksi turvallisuudeksi, joka voi vaarantua missä tahansa lääkehoidon vaiheessa. Yksi lääkitysturvallisuuteen vaikuttava lääkehoidon osa-alue on lääkeneuvonta. Koska lääkkeitä käytetään ammattilaisilta saatujen ohjeiden perusteella, on lääkeneuvonnan kehittäminen tärkeää. Lääketietouden lisäämisen ohella lääkeneuvonnalla voidaan vaikuttaa lääkkeiden käyttäjien asenteisiin. Lapsen lääkitykseen kohdistuva lääkeneuvonta on haasteellista, sillä huomio täytyy kiinnittää sekä lapseen että vanhempiin. Tutkimuksessa selvitettiin sairaalasta kotiutettavan lapsipotilaan lääkeneuvonnan sisältöä ja kehitystarpeita sekä lääkeneuvonnan toteuttamiseen vaikuttavia asioita. Lisäksi tutkimuksen avulla selvitettiin vanhemmille kotiutuksen jälkeen ongelmallisia lääkehoitoon liittyviä asioita. Tutkimusaineistona käytettiin HUS:n Lastenklinikalla työskentelevien sairaanhoitajien teemahaastatteluja. Toisena aineistona käytettiin vanhempien osastolle soittamia, lasten kotiutuksen jälkeistä lääkehoitoa koskevia puheluita. Aineiston keräys tapahtui hoitajien avulla heidän kirjatessaan tarkoitusta varten muodostettuun lomakkeeseen ylös ne lääkehoitoa koskevat kysymykset, joita vanhemmat soittavat osastoille kotiutuksen jälkeen. Keräykseen osallistuivat HUS:n infektio-osaston, lastentautien osaston ja munuais- ja elinsiirto-osaston hoitajat. Syyskuun 2009 aikana suoritettuihin teemahaastatteluihin osallistui 10 infektio-osaston sairaanhoitajaa. Kuten aiemmissakin tutkimuksissa on todettu, sairaanhoitajilla on suuri vastuu sairaalassa annettavasta lääkeneuvonnasta. Tutkimustulosten mukaan sairaanhoitajat pyrkivät kattavaan lääkeneuvontaan. He painottavat erityisesti perheen pärjäämistä kotona havainnollistamalla antamaansa neuvontaa kirjallisen materiaalin ja antotekniikkaan liittyvän opetuksen avulla, sekä kiinnittämällä huomiota perheen asenteisiin lääkehoitoa kohtaan. Esteinä lääkeneuvonnan toteuttamiselle koettiin sekä vanhempien että hoitajien kiire, joidenkin vanhempien vääränlainen asenne, hoitajien ja vanhempien kielimuurista johtuvat kommunikaatio-ongelmat, neuvontatilan rauhattomuus sekä hoitajille suunnattujen yhteisten ohjeistuksien puute. Lääkeneuvontaan liittyviksi kehityskohteiksi nousivat sekä vanhemmille että hoitajille suunnatut kirjalliset ohjeet, lääkkeisiin liittyvä lisäkoulutus, neuvonnan ajoitus, neuvontatila ja osastofarmaseutin osallistuminen neuvontaan. Kahden kuukauden tutkimusjakson aikana loka-marraskuussa 2009 kirjattiin osastoilla yhteensä 26 kotiutetun potilaan lääkehoitoa koskenutta puhelua. Infektio-osastolle tulleet yhteydenotot (n=7) koskivat pääasiassa lääkkeen annosteluaikoja ja kuurin tarkkaa kestoa. Yksi puhelu koski haittavaikutuksen ilmaantumista ja yksi antotekniikkaa. Lastentautien osastolle tulleista puheluista (n=11) kymmenen koski insuliinien annostusten muuttamista verensokeriarvojen korjaamiseksi. Munuais- ja elinsiirto-osastolle vanhemmat soittivat yleensä kysyäkseen annosteluun liittyviä erityisasioita, kuten annostelua oksennuksen, väärän lääkkeenantoajan ja yliannoksen jälkeen.Munuais- ja elinsiirto-osastolla puheluita kirjattiin yhteensä kahdeksan. Tutkimuksen mukaan hoitajien antama lääkeneuvonta on perusteellista. Lääkehoitoon liittyviä asioita jää kuitenkin vanhemmille epäselväksi, vaikka huomiota kiinnitetään niihin asioihin, joissa vanhemmat tarvitsevat eniten tukea. Osastoille kehitetyn lääkeneuvontamallin tarkoitus on auttaa hoitajia lääkeneuvonnan toteutuksessa, mutta huomionarvoista olisi myös osastofarmaseutin mahdollisuus osallistua neuvontatilanteeseen. Jatkotutkimuksissa olisi hyvä selvittää, millä tavalla neuvontamallia hyödynnetään neuvonnan toteuttamisessa. Erityisesti lapsille suunnattua lääkeneuvontaa on kehitettävä.

There are certain characteristics in children’s medication process, such as weight or body surface area-based drug dosing and off-label use of medications, that expose children to medication errors. Small children especially are prone to physical injuries resulting from medication errors. High-alert medications bear a heightened risk of causing significant, even life-threatening harm to a patient when used in error. The aim of this study was to promote children's medication safety by identifying medication errors and contributing factors to errors associated with the use of high-alert medications in pediatric medication process in a hospital environment. The data of this retrospective register study consisted of voluntary medication error reports (HaiPro) made in the pediatric and adolescent units at Helsinki university hospital (HUS). ISMP's (Institute for Safe Medication Practices) list of high-alert medications in acute care settings was used to limit the data. The data was analyzed by using both quantitative and qualitative methods. The aim of the quantitative analysis was to report the frequencies (n) and proportions (%) of high-alert medications and routes of administration and the aim of the qualitative analysis was to identify the types of medication errors and contributing factors in the data. ISMP’s high-alert medications accounted for approximately one-fifth (19.7%) of all medication error reports made in pediatric and adolescent units in 2018–2020. Twelve medications and intravenous route covered approximately 65.0% of all high-alert medications and routes of administration mentioned in the data. Medication errors were mostly identified in medication administration stage (43.3%) and administration errors were often preceded by prescribing errors. Dosing errors (20.5%) and documenting errors (16.8%) were the most common medication error types in the data. Errors associated with dosing and infusion rate were most often involved in severe medication errors. The most frequently identified contributing factors in the data were associated with the work situation and conditions, documenting and information transfer or medications. More detailed risk analysis considering high-alert medications and the intravenous medication process and targeting preventive barriers to identified risk areas are recommended in pediatric and adolescent units in the future. Barriers should be planned to cover the entire medication process. Among different types of medication errors, multiple dosing errors and errors during the programming of infusion rate require special attention in the future.

Annually thousands of Finnish children are placed in foster care as a measure of child welfare. Institutional foster care is provided by child welfare institutions. Social and health care professionals, such as bachelors in social services, youth workers, practical nurses, and registered nurses working in these institutions are responsible for carrying out the children’s medication treatment. Depending on completed basic and additional training and work experience, the personnel have varying competencies in medication treatment. The aim of this study was to provide research-based information on the challenges and development needs related to the safe and rational medication treatment of children in foster care living in child welfare institutions. This was studied from the point of view of institution personnel and social workers responsible for placement decisions. Furthermore, the study investigated the medication use process of children in institutional foster care and, how the child’s health and medication treatment related needs are considered in the placement process and in selecting the foster care place. The study was conducted as a qualitative study using focus group discussions (FGDs) carried out to child welfare social workers (n=1) and child welfare institution personnel (n=10) during November and December 2022. Semi-structured focus group discussions (n=3) were conducted over the video conferencing software Microsoft Teams®. The participants (n=11) were recruited through child welfare services of Central Uusimaa Wellbeing County. Qualitative content analysis was used to analyze the data. According to the focus groups, medication treatment is common among children living in child welfare institutions. In the daily life of child welfare institutions, there were challenges and development needs related to medication treatment and medication use process. The main challenges and development needs were the lack of up-to-date information regarding the children’s health status and medication, challenges in organizing acute medication treatment, the personnel’s up-to-date drug administration permissions and varying competencies in medication treatment. In addition, fragmented overall responsibility of the medication treatments and poor access to healthcare presented challenges for organizing and carrying out medication treatment for the children. Medication use process during foster care appeared to be fragmented and it was seen to be susceptible to errors. According to this study, the possibilities for taking children’s health status and medical needs into account at the point of placement were scarce. These needs often did not guide placement decisions. Considering the medication use process and medication safety, it is essential that child welfare institutions have access to up-to-date health and medication information of the children. To achieve the best interests of the children, organizing acute medical treatment should be facilitated and the overall responsibility health care and medication therapy clarified. In addition, seamless access to the necessary healthcare must be ensured for children in foster care. Considering medication safety, it is important to ensure that the personnel of child welfare institutions have up-to-date competencies in medication treatment that meet the needs of the children.

Medication safety is a part of patient safety, and means safety related to the use of medicines. Medication safety covers the principles and functions of individuals and organizations working in the healthcare sector to ensure the safety of drug treatment and to protects patient from harm. Medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient or consumer. Medication errors are the leading cause of preventable harm in health care across the world. Therefore, improving medication safety is important from the point of view of the promotion of patient safety. The aim of this study was to gather information about serious medication errors at national level by utilizing data from Valvira to learn from the cases outside the organizations where they occurred. The data of this study consisted of complaints and regulatory statements resolved by Valvira in 2013–2017, in which drug treatment were identified as a main reason and where inappropriateness was found (n=58). Cases were classified with predetermined classification system, and inductive content analysis was used to identify the causes and contributing factors of medication errors. The theoretical framework of the study was the Human Error Theory by James Reason (1990). According its systems-based approach, this study focused on the processes and circumstances of organizations. Of the included 58 cases, medication errors caused patient’s death in 21 cases (36 %) and severe harm in nine cases (16 %). A majority (n=53; 91%) of the errors were estimated to be either definitely or possibly preventable. Most of the patients were older adults (mean age 74 years). The most commonly related drugs in medication errors were enoxaparin (n=7; 6%) and oxycodone (n=7; 6%). The most common therapeutic group causing medication errors was antithrombotic agents (n=17; 13%). Most errors occurred in hospital settings (n=29; 45%) and in elderly care units. Doctors (n=37; 50%) were most often involved in the errors. Most of the medication errors occurred in the prescribing (n=38; 47%), administrating (n=15; 19%) and monitoring stage (n=14; 17%), drug-related problems being most often connected to the drug selection. In severe and fatal cases, there are often several drug related problems identified at different stages of the patient’s drug treatment process. The data of Valvira provide valuable information about medication errors at national level. Qualitative analysis is important especially for learning purposes as it provides better understanding of the causes and contributing factors of medication errors, as well as the complexity of drug treatment processes. Based on this study, it seems that healthcare organizations involved in severe medication error cases have taken into consideration the importance of process development and focused on identifying latent risks in organizational conditions and processes rather than blaming individuals.

Barcode-assisted medication administration can be used to prevent medication errors in pediatric hospital settings, as the medicine and the patient can be safely identified during the drug preparation and administration. The use of barcode-assisted medication administration has been examined in a few qualitative studies. In addition to the benefits, many challenges related to the implementation of this new workflow have been identified. The aim of this study was to identify facilitators and barriers related to the use of barcode-assisted medication administration in a children's hospital. The topic has not been studied in Finland before. A qualitative focus group study was carried out at HUS Helsinki University Hospital in the Department of Children and Adolescents. Ward pharmacists (n=14) were selected for the focus groups (n=3) by purposive sampling to identify persons using barcode-assisted medication administration on their daily work. Two researchers conducted the inductive content analysis independently, after which a consensus was formed first with these researchers and later with the entire research group. COREQ checklist was used to support detailed reporting and to consider the factors that might affect to the reliability of the study in each phase of the study. Four main themes were identified from the data; the barriers, the risk behavior caused by the barriers, the facilitators and the development ideas. The barriers included challenges related to negative attitudes of the end-users, barcodes on drug packages and labels, use of the electronic health record system, workstations and equipment, as well as orientation, competence and management. The barriers caused risk behavior that was related either to the system or to the end-user. On the other hand, the facilitators were associated with the positive experience of the end-user, the increase in expertise and multi-professional cooperation, the functions of the electronic health record system that supported the preparation and administration of the medicines, as well as the benefits of the barcode-assisted medication administration workflow. The development ideas aimed to remove the barriers and the risk behavior related to the use of barcode-assisted medication administration. The users found that the use of barcode-assisted medication administration increased patient and medication safety, although there were still many challenges associated with the new workflow. Barcode-assisted medication administration can be used to reduce medication errors and protect patients from adverse events. The results of this study can be used to develop the usability of barcode technology and their implementation.