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.
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).
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.
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.
Review the evidence regarding methods to prevent wrong site operations and present a framework that healthcare organizations can use to evaluate whether they have reduced the probability of wrong site, wrong procedure, and wrong patient operations.
Operations involving the wrong site, patient, and procedure continue despite national efforts by regulators and professional organizations. Little is known about effective policies to reduce these "never events," and healthcare professional's knowledge or appropriate use of these policies to mitigate events.
A literature review of the evidence was performed using PubMed and Google; key words used were wrong site surgery, wrong side surgery, wrong patient surgery, and wrong procedure surgery. The framework to evaluate safety includes assessing if a behaviorally specific policy or procedure exists, whether staff knows about the policy, and whether the policy is being used appropriately.
Higher-level policies or programs have been implemented by the American Academy of Orthopaedic Surgery, Joint Commission on Accreditation of Healthcare Organizations, Veteran's Health Administration, Canadian Orthopaedic, and the North American Spine Society Associations to reduce wrong site surgery. No scientific evidence is available to guide hospitals in evaluating whether they have an effective policy, and whether staff know of the policy and appropriately use the policy to prevent "never events."
There is limited evidence of behavioral interventions to reduce wrong site, patient, and surgical procedures. We have outlined a framework of measures that healthcare organizations can use to start evaluating whether they have reduced adverse events in operations.
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.
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.
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. The adapted and remodelled tool was pilot tested in eight central hospital wards.
The original MSSA tool (231 items under ten key elements) was modified preliminarily before the Delphi rounds and 117 items were discarded, leaving 114 items for Delphi evaluation. The panel suggested 36 new items of which 23 were accepted. A total of 114 items (including 91 original and 23 new items) were accepted and remodelled under six new components that were pilot tested. The pilot test found the tool time-consuming but useful.
It was possible to adapt the ISMP's MSSA tool for another hospital setting. The modified tool can be used for a hospital pharmacy coordinated audit which supports long-term medication safety initiatives, particularly the establishment of ward-based pharmacotherapy plans as guided by the Ministry of Social Affairs and Health.
To adapt a US Institute for Safe Medication Practices' Medication Safety Self Assessment (MSSA) tool to, and test its usefulness in, Finnish community pharmacies.
A three-round Delphi survey was used to adapt self-assessment characteristics of the US MSSA tool to Finnish requirements, and to obtain a consensus on the feasibility and significance of these characteristics in assessing the safety of medication practices in community pharmacies. The Delphi modified self-assessment tool was piloted in 18 community pharmacies in order to refine the tool, using a questionnaire containing structured and open-ended questions.
A total of 211 self-assessment characteristics were accepted to the self-assessment tool for pilot use by expert panellists in the Delphi rounds. Most pilot users considered the tool as useful in: identifying medication safety targets for development; medication safety assessment; and identifying the strengths of medication safety. The substance of the self-assessment tool was considered as comprehensive and essential for medication safety. Most criticism was regarding: the multiplicity of self-assessment characteristics; interpretation of some characteristics; and that all the characteristics were not yet available. After the modification, according to the pilot users' comments, the final Finnish tool consisted of 230 medication safety characteristics.
The study indicated the feasibility of adapting a US medication safety self-assessment tool for use in community pharmacy practice in Finland. More efforts should be made to familiarise Finnish community pharmacists with the self-assessment tool and its benefits, and get them to use the tool as part of their long-term quality improvement.
To examine the psychometric and unit of analysis/strength of culture issues in patient safety culture (PSC) measurement.
Two cross-sectional surveys of health care staff in 10 Canadian health care organizations totaling 11,586 respondents.
A cross-validation study of a measure of PSC using survey data gathered using the Modified Stanford PSC survey (MSI-2005 and MSI-2006); a within-group agreement analysis of MSI-2006 data. Extraction Methods. Exploratory factor analyses (EFA) of the MSI-05 survey data and confirmatory factor analysis (CFA) of the MSI-06 survey data; Rwg coefficients of homogeneity were calculated for 37 units and six organizations in the MSI-06 data set to examine within-group agreement.
The CFA did not yield acceptable levels of fit. EFA and reliability analysis of MSI-06 data suggest two reliable dimensions of PSC: Organization leadership for safety (alpha=0.88) and Unit leadership for safety (alpha=0.81). Within-group agreement analysis shows stronger within-unit agreement than within-organization agreement on assessed PSC dimensions.
The field of PSC measurement has not been able to meet strict requirements for sound measurement using conventional approaches of CFA. Additional work is needed to identify and soundly measure key dimensions of PSC. The field would also benefit from further attention to strength of culture/unit of analysis issues.