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Antidepressants and the risk of hyponatremia: a Danish register-based population study.

https://arctichealth.org/en/permalink/ahliterature287562
Source
BMJ Open. 2016 May 18;6(5):e011200
Publication Type
Article
Date
May-18-2016
Author
Katja Biering Leth-Møller
Annette Højmann Hansen
Maia Torstensson
Stig Ejdrup Andersen
Lars Ødum
Gunnar Gislasson
Christian Torp-Pedersen
Ellen Astrid Holm
Source
BMJ Open. 2016 May 18;6(5):e011200
Date
May-18-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antidepressive Agents, Tricyclic - therapeutic use
Citalopram - therapeutic use
Clomipramine - therapeutic use
Denmark - epidemiology
Duloxetine Hydrochloride - therapeutic use
Female
Humans
Hyponatremia - blood - epidemiology
Incidence
Male
Mianserin - analogs & derivatives - therapeutic use
Middle Aged
Registries
Retrospective Studies
Risk factors
Serotonin Uptake Inhibitors - therapeutic use
Serotonin and Noradrenaline Reuptake Inhibitors - therapeutic use
Sodium - blood
Venlafaxine Hydrochloride - therapeutic use
Abstract
To examine the association between classes of antidepressants and hyponatremia, and between specific antidepressants and hyponatremia.
Retrospective register-based cohort study using nationwide registers from 1998 to 2012.
The North Denmark Region.
In total, 638 352 individuals were included.
Plasma sodium was obtained from the LABKA database. The primary outcome was hyponatremia defined as plasma sodium (p-sodium) below 135 mmol/L and secondary outcome was severe hyponatremia defined as p-sodium below 130 mmol/L. The association between use of specific antidepressants and hyponatremia was analysed using multivariable Poisson regression models.
An event of hyponatremia occurred in 72 509 individuals and 11.36% (n=6476) of these events happened during treatment with antidepressants. Incidence rate ratios and CIs for the association with hyponatremia in the first p-sodium measured after initiation of treatment were for citalopram 7.8 (CI 7.42 to 8.20); clomipramine 4.93 (CI 2.72 to 8.94); duloxetine 2.05 (CI 1.44 to 292); venlafaxine 2.90 (CI 2.43 to 3.46); mirtazapine 2.95 (CI 2.71 to 3.21); and mianserin 0.90 (CI 0.71 to 1.14).
All antidepressants except mianserin are associated with hyponatremia. The association is strongest with citalopram and lowest with duloxetine, venlafaxine and mirtazapine.
Notes
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PubMed ID
27194321 View in PubMed
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Assessment of drug treatment quality in two Danish health-care centres.

https://arctichealth.org/en/permalink/ahliterature138140
Source
Dan Med Bull. 2011 Jan;58(1):A4218
Publication Type
Article
Date
Jan-2011
Author
Kajsa Edfors
Stig Ejdrup Andersen
Author Affiliation
Department of Surgical Gastroenterology, Herlev Hospital.
Source
Dan Med Bull. 2011 Jan;58(1):A4218
Date
Jan-2011
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Aspirin - therapeutic use
Denmark
Diuretics - therapeutic use
Female
Heart Failure - drug therapy
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Middle Aged
Myocardial Ischemia - drug therapy
Qualitative Research
Quality of Health Care - standards - statistics & numerical data
Spironolactone - therapeutic use
Abstract
Bridging the primary and secondary sector, health-care centres aim to reduce morbidity and prevent further hospitalization in patients with chronic heart diseases. The aim of this study was to describe the quality of drug treatment in patients with chronic heart diseases in two Copenhagen health-care centres.
Over a period of three months, 28 patients with heart failure (HF) or ischaemic heart disease (IHD) were included. The participants were interviewed and clinically examined.
The patients received an average of nine drugs, and only about one third were clinically well-treated. Among IHD patients, 74% received beta blockers and 64% angiotensin converting enzyme-inhibitors (ACE-I) as indicated. All received statins and 92% acetylsalicylic acid. Among HF patients, 67% received ACE-I, 87% beta blockers and 77% diuretics as indicated. Overall, 10%, 31% and 40% of the HF patients received smaller than recommended doses of ACE-I, beta blockers, and diuretics, respectively. In 68% of the patients, 35 potential drug interactions were identified, none of which were deemed potentially harmful.
This small descriptive study indicates that patients in health-care centres might be undertreated and receive drug therapy only partly in accordance with the guidelines. However, since we had no access to medical charts, any reasons for not treating patients with a certain drug or selecting a lower than recommended dose could not be evaluated. Nevertheless, patients may benefit from closer involvement of clinicians or GPs in the multidisciplinary teams of the health-care centres.
PubMed ID
21205564 View in PubMed
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[Benzodiazepines and cyclopyrrolones prior to, during and after hospital admission].

https://arctichealth.org/en/permalink/ahliterature143086
Source
Ugeskr Laeger. 2010 May 24;172(21):1602-6
Publication Type
Article
Date
May-24-2010
Author
Frederik Trier Møller
Stig Ejdrup Andersen
Author Affiliation
Klinisk Farmakologisk Afdeling, Bispebjerg Hospital, 2400 København NV, Denmark.
Source
Ugeskr Laeger. 2010 May 24;172(21):1602-6
Date
May-24-2010
Language
Danish
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anti-Anxiety Agents - administration & dosage
Benzodiazepines - administration & dosage
Denmark
Drug Prescriptions - statistics & numerical data
Drug Utilization - statistics & numerical data
Female
Hospitalization
Humans
Hypnotics and Sedatives - administration & dosage
Internal Medicine
Male
Middle Aged
Patient Admission
Patient Discharge
Retrospective Studies
Surgery Department, Hospital
Abstract
The aim was to describe the prescription patterns of benzodiazepines (BZD) and cyclopyrrolones (Z-drugs) in a population of medical and surgical patients prior to, during and after hospital admission.
Data were collected from medical records, the physicians' order entry system and the national electronic pharmacy registry.
Overall, 38% of the 135 included patients did not receive BZD/Z-drugs at any time. A total of 30% were pre-admission users. While in hospital, 50% were users and 17% were users at discharge and 30% during the six months follow-up period (p or= 3 prescriptions for BZD/Z-drugs (chronic users) compared with 21 (16%) before admission.
Medical and surgical hospitalized patients are frequently treated with Z-drugs and BZDs prior to, during and after hospital admission. The usage pattern changes significantly during hospital admission, with more prescriptions for Z-drugs being issued.
PubMed ID
20525473 View in PubMed
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Clinical pharmacist service in the acute ward.

https://arctichealth.org/en/permalink/ahliterature107766
Source
Int J Clin Pharm. 2013 Dec;35(6):1137-51
Publication Type
Article
Date
Dec-2013
Author
Trine Rune Høgh Nielsen
Stig Ejdrup Andersen
Mette Rasmussen
Per Hartvig Honoré
Author Affiliation
Region Zealand Hospital Pharmacy, Næstved Hospital, Ringstedgade 65, 4700, Næstved, Denmark, trn@regionsjaelland.dk.
Source
Int J Clin Pharm. 2013 Dec;35(6):1137-51
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Denmark
Drug-Related Side Effects and Adverse Reactions - prevention & control
Emergency Service, Hospital - organization & administration
Female
Humans
Male
Medication Errors - prevention & control
Middle Aged
Observer Variation
Pharmacists - organization & administration
Pharmacy Service, Hospital - organization & administration
Physicians - statistics & numerical data
Professional Role
Workflow
Abstract
The majority of hospitalised patients have drug-related problems. Clinical pharmacist services including medication history, medication reconciliation and medication review may reduce the number of drug-related problems. Acute and emergency hospital services have changed considerably during the past decade in Denmark, and the new fast-paced workflows pose new challenges for the provision of clinical pharmacist service.
To describe and evaluate a method for a clinical pharmacist service that is relevant and fit the workflow of the medical care in the acute ward.
Acute wards at three Danish hospitals.
The clinical pharmacist intervention comprised medication history, medication reconciliation, medication review, medical record entries and entry of prescription templates into the electronic medication module. Drug-related problems were categorised using The PCNE Classification V6.2. Inter-rater agreement analysis was used to validate the tool. Acceptance rates were measured as the physicians' approval of prescription templates and according to outcome in the PCNE classification.
Acceptance rate of the clinical pharmacists' interventions through the described method and inter-rater agreement using the PCNE classification for drug-related problems.
During 17 months, 188 patients were included in this study (average age 72 years and 55 % women). The clinical pharmacists found drug-related problems in 85 % of the patients. In the 1,724 prescriptions, 538 drug-related problems were identified. The overall acceptance rate by the physicians for the proposed interventions was 76 % (95 % CI 74-78 %). There was a substantial inter-rater agreement when using the PCNE classification system.
The methods for a clinical pharmacist service in the acute ward in this study have been demonstrated to be relevant and timely. The method received a high acceptance rate, regardless of no need for oral communication, and a substantial inter-rater agreement when classifying the drug-related problems.
PubMed ID
23979824 View in PubMed
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Clinical Pharmacology in Denmark in 2016 - 40 Years with the Danish Society of Clinical Pharmacology and 20 Years as a Medical Speciality.

https://arctichealth.org/en/permalink/ahliterature279948
Source
Basic Clin Pharmacol Toxicol. 2016 Dec;119(6):523-532
Publication Type
Article
Date
Dec-2016
Author
Kim Brøsen
Stig Ejdrup Andersen
Jeanett Borregaard
Hanne Rolighed Christensen
Palle Mark Christensen
Kim Peder Dalhoff
Per Damkier
Jesper Hallas
Jens Heisterberg
Niels Jessen
Gesche Jürgens
Jens Peter Konnerup Kampmann
Britt Elmedal Laursen
Torben Laursen
Lars Peter Nielsen
Birgitte Klindt Poulsen
Henrik Enghusen Poulsen
Ljubica Vukelic Andersen
Thomas Senderovitz
Jesper Sonne
Source
Basic Clin Pharmacol Toxicol. 2016 Dec;119(6):523-532
Date
Dec-2016
Language
English
Publication Type
Article
Keywords
Career Mobility
Denmark
Drug Industry - manpower
Drug Monitoring
Drug and Narcotic Control - manpower
Drug-Related Side Effects and Adverse Reactions - prevention & control - therapy
Forensic Toxicology - education - history - manpower - trends
History, 20th Century
History, 21st Century
Humans
Information Services - manpower
International Agencies
Internationality
Pharmacology, Clinical - education - history - manpower - trends
Societies, Scientific - history - trends
Specialization - history - trends
Abstract
The Danish Society of Clinical Pharmacology was founded in 1976, and mainly thanks to the persistent efforts of the society, clinical pharmacology became an independent medical speciality in Denmark in 1996. Since then, clinical pharmacology has gone from strength to strength. In the Danish healthcare system, clinical pharmacology has established itself as an indispensible part of the efforts to promote the rational, safe and economic use of drugs. Clinical pharmacologists are active in drug committees both in hospitals and in the primary sector. All clinical pharmacology centres offer a local medicines information service. Some centres have established an adverse drug effect manager function. Only one centre offers a therapeutic drug monitoring service. Clinical pharmacologists are responsible for the toxicological advice at the Danish Poison Information Centre at Bispebjerg University Hospital in the Capital Region. The Department of Clinical Pharmacology at Aarhus University Hospital works closely together with forensic toxicologists and pathologists, covering issues regarding illicit substances, forensic pharmacology, post-mortem toxicology, expert testimony and research. Therapeutic geriatric and psychiatric teach-inns for specialist and junior doctors are among the newest initiatives organized by clinical pharmacologists. Clinical pharmacologists work also in the Danish Medicines Agency and in the Danish pharmaceutical industry, and the latter has in particular a great growth potential for creating new jobs and career opportunities for clinical pharmacologists. As of July 2016, the Danish Society of Clinical Pharmacology has 175 members, and 70 of these are specialists in clinical pharmacology corresponding to approximately 2.5 specialists per 1000 doctors (Denmark has in total 28,000 doctors) or approximately 12 specialists per one million inhabitants.
PubMed ID
27685872 View in PubMed
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Comments to the letter to the editors by Naunton.

https://arctichealth.org/en/permalink/ahliterature165289
Source
Eur J Clin Pharmacol. 2007 Apr;63(4):417
Publication Type
Article
Date
Apr-2007

Danish physicians' preferences for prescribing escitalopram over citalopram and sertraline to treatment-naïve patients: a national, register-based study.

https://arctichealth.org/en/permalink/ahliterature119185
Source
Eur J Clin Pharmacol. 2013 May;69(5):1167-71
Publication Type
Article
Date
May-2013
Author
Karen Killerup Poulsen
Dorte Glintborg
Søren Ilsøe Moreno
Steffen Thirstrup
Lise Aagaard
Stig Ejdrup Andersen
Author Affiliation
Faculty of Health and Medicines Sciences, University of Copenhagen, Copenhagen, Denmark.
Source
Eur J Clin Pharmacol. 2013 May;69(5):1167-71
Date
May-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Citalopram - therapeutic use
Denmark
Drug Utilization
General practitioners
Humans
Physician's Practice Patterns
Physicians
Psychiatry
Registries
Serotonin Uptake Inhibitors - therapeutic use
Sertraline - therapeutic use
Abstract
To investigate whether general practitioners, hospital physicians and specialized practitioners in psychiatry have similar preferences for initiating treatment with expensive serotonin-specific reuptake inhibitors (SSRIs).
All first-time prescriptions for the SSRIs escitalopram, citalopram and sertraline reported to the Danish National Register of Medicinal Product Statistics from April 1, 2009 until March 31, 2010 were analysed with regard to treatment naivety and type of prescriber. A prescription was considered as first time if the patient had not received a prescription for the same drug within the last 2 years. Patients who had not received a prescription for an antidepressant within 6 months prior to the date of redemption were classified as treatment-naïve.
We included 82,702 first-time prescriptions, 65,313 (79 %) of which were for treatment-naïve patients. Of the treatment-naïve patients, 19 % were initially prescribed escitalopram. Hospital physicians prescribed escitalopram to 34 % of their treatment-naïve patients, while practitioners specialized in psychiatry prescribed it to 25 %, and general practitioners prescribed it to 17 %. General practitioners, however, were responsible for initiating 87 % of all treatment-naïve patients.
The most expensive SSRI, escitalopram, is prescribed as first choice to one in five patients receiving their first antidepressant of escitalopram, citalopram or sertraline. General practitioners made the bulk of all first-time SSRI prescriptions to treatment-naïve patients.
PubMed ID
23128965 View in PubMed
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Disregarded use of herbal medical products and dietary supplements among surgical and medical patients as estimated by home inspection and interview.

https://arctichealth.org/en/permalink/ahliterature61510
Source
Pharmacoepidemiol Drug Saf. 2005 Sep;14(9):639-45
Publication Type
Article
Date
Sep-2005
Author
Bente Glintborg
Stig Ejdrup Andersen
Eva Spang-Hanssen
Kim Dalhoff
Author Affiliation
Clinic of Internal Medicine I, H:S Bispebjerg Hospital, Copenhagen, Denmark.
Source
Pharmacoepidemiol Drug Saf. 2005 Sep;14(9):639-45
Date
Sep-2005
Language
English
Publication Type
Article
Keywords
Aged
Cross-Sectional Studies
Denmark - epidemiology
Diet
Dietary Supplements
Drug Interactions
Drug Utilization
Female
Home Care Services
Hospital records
Humans
Interviews
Male
Patients
Plant Preparations
Research Support, Non-U.S. Gov't
Surgical Procedures, Operative
Abstract
PURPOSE: More and more patients use herbal medical products (HMP) and dietary supplements (DS). Due to the possibility of drug interactions and side effects, it is important that physicians are aware of the use. The aim of the present cross sectional survey was to analyse the consumption of HMP and DS among patients recently discharged from two hospital departments. METHODS: Patients were visited within 1 week after discharge and interviewed about their use of HMP and DS. Stored products were inspected and registered. Hospital files and discharge letters were examined to establish the frequency of registration. RESULTS: Totally, 83 surgical and 117 medical patients were included (n = 200), 139 patients (70%) were women. 53 patients (27%) stored no HMP or DS, whereas the home inventories of 147 patients (74%) comprised 343 products. 116 patients (58%) used HMP or DS daily and 25 patients (13%) used the products on demand. The most frequently used product was multivitamins (82 patients = 41%). Totally, 61% of the products were used on the patients' own initiative. In 3% of the used products, patients were aware of possible side effects. No patients were aware of possible drug interactions. Only 21% of the 211 HMP and DS used daily prior to admission were recorded in the hospital files. CONCLUSIONS: The use of HMP and DS was frequent among surgical and medical patients. The use was often not recorded in the hospital files and patients' knowledge of possible side effects and drug-interactions was minimal.
PubMed ID
15546157 View in PubMed
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[Drug costs in departments of internal medicine. An analysis of costs for patients and departments].

https://arctichealth.org/en/permalink/ahliterature185674
Source
Ugeskr Laeger. 2003 Apr 7;165(15):1565-8
Publication Type
Article
Date
Apr-7-2003
Author
Rasmus Rabøl
Anne Kolbye
Stig Ejdrup Andersen
Author Affiliation
Klinisk Farmakologisk Enhed, H:S Bispebjerg Hospital, DK-2400 København NV.
Source
Ugeskr Laeger. 2003 Apr 7;165(15):1565-8
Date
Apr-7-2003
Language
Danish
Publication Type
Article
Keywords
Adult
Aged
Cost Savings
Denmark
Drug Costs
Drug Utilization - economics
Female
Hospital Costs
Hospital Departments - economics
Humans
Internal Medicine - economics
Male
Middle Aged
Organizational Policy
Patient Admission
Patient Discharge
Pharmacy Service, Hospital - economics
Physician's Practice Patterns - economics
Questionnaires
Abstract
The aim of the study was to compute the daily cost of drugs for patients admitted to internal medicine wards and to determine the impact of hospitalization on these costs. Secondly, the aim was to estimate the potential savings on ward drug expenses if the drug prescription was done in accordance with hospital recommendations.
A total of 113 patients from two general internal medicine wards were included consecutively. Drug information was obtained from the case records and through post-discharge telephone interviews.
The patients' daily drug costs increased from admission to discharge by DKK 11.95 (95% CI: DKK 5.41-18.49), p = 0.0004. When prescriptions with explicitly determined end dates were excluded, no increment was observed. Post discharge interviews (n = 51) revealed that patients' daily drug costs were similar to the level at admission. The average ward drug expenses per admission were DKK 302.72 (95% CI: DKK 209.07-396.37). A total of 31% and 28% of the prescriptions could have been replaced by drugs in accordance with the hospital drug policy. The average potential amount which could be saved by using a consistent generic prescription was DDK 8.66 (95% CI: DKK 4.61-12.72) per admission.
The patients' daily drug costs increased significantly from admission to discharge, but the cost increment did not exist one month after discharge. Although roughly one third of the prescriptions could have been substituted, the potential percentage saved only amounted to 2.9.
PubMed ID
12715661 View in PubMed
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Source
Ugeskr Laeger. 2006 Nov 27;168(48):4185-8
Publication Type
Article
Date
Nov-27-2006
Author
Stig Ejdrup Andersen
Author Affiliation
H:S Bispebjerg Hospital, Klinisk Farmakologisk Enhed, København NV. sea01@bbh.hosp.dk
Source
Ugeskr Laeger. 2006 Nov 27;168(48):4185-8
Date
Nov-27-2006
Language
Danish
Publication Type
Article
Keywords
Cross-Sectional Studies
Denmark
Drug Administration Schedule
Drug Prescriptions - standards
Humans
Medication Errors - nursing - prevention & control - statistics & numerical data
Medication Systems, Hospital - standards
Polypharmacy
Quality Assurance, Health Care
Risk factors
Safety Management
Abstract
Most Danish hospitals have ward-based medication supply systems: frequently used drugs are stored in ward drug cupboards and dispensed by nursing staff. The objective of this study was to describe the frequency of dispensing errors and to identify risk factors.
Cross-sectional study conducted on five hospital wards. Random samples of dispensed drugs were compared to the written drug orders.
In total, 619 (94.4%) of the 656 samples were dispensed correctly (95% CI 92.3 to 95.9%). Among 2360 opportunities for error (2336 dispensed plus 24 prescribed but not dispensed doses), 42 errors were detected, error rate 1.8% (95% CI 1.3 to 2.4%). 55% of all errors were omissions. Logistic regression analysis revealed that dispensing errors were associated with the scheduled administration time, the ward and the number of dispensed doses. Having one rather than two nurses dispensing and administering drugs did not affect the error rate.
For each scheduled time, approximately 19 of 20 patients' drugs are correctly dispensed. Although the clinical significance of errors was not rated, the advantage of having one rather than two nurses dispensing and administering is dubious. Reducing poly-pharmacy, however, might reduce the error rate and this strategy should be tested in a prospective study. As a direct consequence of this study, emphasis will be placed on analysing and learning procedures from wards with low error rates.
PubMed ID
17147941 View in PubMed
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18 records – page 1 of 2.