Drug safety

OBJECTIVES: There is widespread use of unlicensed medicines within primary and secondary care but little information is available around how these medicines are used. This analysis examines and evaluates the content and quality of relevant guidance documentation currently in use within the UK. METHODS: Guidance documents were identified through a literature search as well as email requests to pharmacy organisations throughout the UK. Unlicensed medicine documentation suitable for inclusion in the analysis underwent thematic analysis and quality assessment using the AGREE II tool...

No abstract text is available yet for this article.

Parenteral nutrition (PN) is a complex, high-alert medication, and errors associated with the use of this therapy may lead to significant harm to patients. This document reviews error reports from the Institute for Safe Medication Practices' Medication Errors Reporting Program that are associated with the PN use process over the past 10 years. Actual PN-related errors are outlined, with most occurring in the PN-compounding/dispensing and PN administration steps. Clinicians involved in any phase of the PN use process should review their institutional or homecare company's processes for reporting of PN errors and collaborate with their medical safety officer and/or committees involved with medication error reporting...

Description: The American Diabetes Association (ADA) annually updates the Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes. Methods: For the 2017 Standards, the ADA Professional Practice Committee updated previous MEDLINE searches performed from 1 January 2016 to November 2016 to add, clarify, or revise recommendations based on new evidence...

BACKGROUND: The dangers of co-administration of opioid pain relievers (OPRs) and benzodiazepines (BZDs) are well documented. The combination of OPRs and BZDs make up the majority of medications involved in prescription drug-related overdose and are often used concomitantly. This pattern is consistent among the veteran population where mental health illness and substance abuse are prominent. The Veterans Health Administration implemented the Opioid Safety Initiative (OSI) aimed at improving patient safety surrounding OPRs...

A 69-year-old male underwent elective percutaneous coronary intervention requiring placement of a drug-eluting stent to the first obtuse marginal artery. Four hours following the administration of a ticagrelor loading dose, he developed dyspnea and sinus pauses. Aminophylline was administered and resulted in immediate and sustained symptom resolution. Ticagrelor has been associated with dyspnea and bradyarrhythmias, both attributed to increased adenosine exposure. Ticagrelor inhibits reuptake of intracellular adenosine...

No abstract text is available yet for this article.

Developing and implementing a policy for safe pro re nata medications practices became a priority when 1 nurse questioned a regularly occurring double-range narcotic order. This article describes how double-range medications can compromise patient safety and how a small rural hospital with minimal resources was able to develop an interdisciplinary practice standard to ensure safe medication practices.

Ready-to-use solutions are the most preferable and most common dosage forms for injectable and topical ophthalmic products. Drugs formulated as solution almost always have chemical and physical stability challenges as well as solubility limitations and the need to prevent inadvertent microbial contamination issues. The first in this series of articles took us through a discussion of optimizing the physical stability of solutions. This article concludes this series of articles with a discussion on foreign particles, protein aggregation, and immunogenicity; optimizing microbiological activity; and osmolality (tonicity) agents, and discusses how these challenges and issues are addressed...

PURPOSE: A standardized medication plan for patients has been developed and recently enacted into German law depicting all medicines taken. It can only increase medication safety if patients use and understand it. We evaluated patients' comprehensibility of the medication plan and analyzed potential variables influencing patients' understanding. METHODS: The medication plan template v2.0 was first tested in N = 40 patients, and the "Evaluation Tool to test the handling of the Medication Plan" (ET-MP) was developed, rating patients' understanding from 0 to 100 %...

Parenteral nutrition (PN) is a high-alert medication with a complex drug use process. Key steps in the process include the review of each PN prescription followed by the preparation of the formulation. The preparation step includes compounding the PN or activating a standardized commercially available PN product. The verification and review, as well as preparation of this complex therapy, require competency that may be determined by using a standardized process for pharmacists and for pharmacy technicians involved with PN...

AIM: The aim of this overview was to examine the effectiveness of interventions designed to improve patient safety by reducing medication administration errors using data from systematic reviews. BACKGROUND: Medication administration errors remain unacceptably high despite the introduction of a range of interventions aimed at enhancing patient safety. Systematic reviews of strategies designed to improve medication safety report contradictory findings. A critical appraisal and synthesis of these findings are, therefore, warranted...

Ready-to-use solutions are the most preferable and most common dosage forms for injectable and topical ophthalmic products. Drugs formulated as solution almost always have chemical and physical stability challenges as well as solubility limitations and the need to prevent inadvertent microbial contamination issues. This article, which takes us through a discussion of optimizing the physical stability of solutions, represents the first of a series of articles discussing how these challenges and issues are addressed...

The past decade has seen a significant growth in diagnostic CT imaging as a direct result of the clinical value provided by CT imaging. At the same time, many new techniques and resources are now available to make CT imaging safe. This article presents the basics of CT dosimetry and their usage in clinical practices, methods to implement CT dose reduction, followed by a summary of legislation, and guidelines related to patient safety in diagnostic CT imaging. Also, CT radiation dose diagnostic reference levels from published regional and national surveys are reviewed and applied in a CT dose tracking and monitoring program...

BACKGROUND: The US Institute for Safe Medication Practices' (ISMP) Medication Safety Self-Assessment (MSSA) tool for hospitals is a comprehensive tool for assessing safe medication practices in hospitals. AIMS: To adapt and remodel the ISMP MSSA tool for hospitals so that it can be used in individual wards in order to support long-term medication safety initiatives in Finland. METHODS: The MSSA tool was first adapted for Finnish hospital settings by a four-round (applicability, desirability and feasibility were evaluated) Delphi consensus method (14 panellists), and then remodelled by organizing the items into a new order which is consistent with the order of the ward-based pharmacotherapy plan recommended by the Ministry of Social Affairs and Health...

WHAT IS KNOWN AND OBJECTIVE: There is conclusive evidence demonstrating that formulary restrictions are associated with reduced utilization and pharmacy spending of the restricted drugs. However, prior efforts to implement restrictive formularies have been associated with inconsistent rates of therapy discontinuation and mixed impacts on adherence to therapy. Also, the impact of transferring patients from an already restrictive formulary to a more aggressive model has not been previously examined...

No abstract text is available yet for this article.

PURPOSE: Over the last decade, the use of oral chemotherapy (OC) for the treatment of cancer has dramatically increased. Despite their route of administration, OCs pose many of the same risks as intravenous agents. In this quality improvement project, we sought to examine our current process for the prescription of OC at the Abramson Cancer Center of the University of Pennsylvania and to improve on its safety. METHODS: A multidisciplinary team that included oncologists, advanced-practice providers, and pharmacists was formed to analyze the current state of our OC practice...

INTRODUCTION: Osteoporosis is a disease that has spread worldwide and has become a relevant public health problem. Over the last 2 decades, a number of drugs have been licensed for its treatment owing to their efficacy in preventing fragility fractures. The safety profiles of these drugs are well defined with data from extensive programs of pharmacovigilance to support it. AREAS COVERED: In this article we reviewed the long-term safety of Bisphosphonates, Calcium, Vitamin D, Selective Estrogen Receptor Modulators, Teriparatide and Denosumab...

In total parenteral nutrition (TPN), especially in the case of preterm infants, simultaneous administration of vitamins and trace elements is still a problematic issue: guidelines put in evidence the lack of specific documentation. In this work NMR spectroscopy was applied to the study of vitamins (pyridoxine hydrochloride, thiamine nitrate, riboflavin-5'-phosphate and nicotinamide) stability in presence of salts and trace elements. Vitamins in D2O were first analyzed by (1)H NMR spectroscopy in absence of salts and trace elements; changes in chemical shifts or in diffusion coefficients, measured by NMR DOSY technique, were analyzed...