The main goal of the project consists in evaluating the safety of nurse medication administration and in identifying the risk areas of the medication process at selected wards of CZ hospitals. The prospective, multicentric, observation-intervention study will be used to determine the number of medication errors at nurse medic. administration and to propose and implement preventive and corrective interventions in practice. At the same time, the long-term sustainability and effectiveness of the interventions will be observed. About 21000 medic. administrations will be monitored during three observations. The sociological research will approach a representative sample of CZ nurses (about 1200). Its goal will consist in evaluating the most frequent causes of errors in the area of nurse medication administration. The reasons of success or failure of the implemented interventions at the cooperating wards of the selected hospitals will be monitored in form of a questionnaire survey made before and after the implementation of the interventions among 100 nurses, 300 patients.

Hlavním cílem projektu je vyhodnotit bezpečnost podávání léčiv sestrou, identifikovat rizikové oblasti medikačního procesu na vybraných lůžkových odděleních českých nemocnic. V rámci prospektivní, multicentrické observačně intervenční studie bude stanoven počet lékových pochybení při podávání léků sestrou, navrženy a do praxe implementovány preventivně nápravné intervence. Zároveň bude sledována dlouhodobá udržitelnost a efektivita těchto intervencí. Během tři observací bude sledováno přibližně 21 000 podání léků. V rámci sociologického šetření bude osloven reprezentativní vzorek sester České republiky (cca 1200). Jeho cílem bude vyhodnotit nejčastější příčiny pochybení v oblasti podávání léčiv sestrami. Důvody úspěšnosti či selhání zavedených intervencí na spolupracujících pracovištích vybraných nemocnic budou sledovány formou dotazníkového šetření provedeného před a po realizaci intervencí u 100 sester a 300 pacientů.

• Keywords
• intervence, clinical pharmacy, interventions, podání léku, Sestra, Nurse, klinická farmacie, lékový problém, medication administration, drug-related problem,

• NML Publication type
• závěrečné zprávy o řešení grantu AZV MZ ČR

• Publication type
• Meeting Abstract MeSH

• Publication type
• Meeting Abstract MeSH

• Publication type
• Meeting Abstract MeSH

Úvod: Podání léčiv hospitalizovanému pacientovi představuje kritické místo při poskytování zdravotních služeb a je spojené s výskytem různých kategorií pochybení s reálným dopadem na zdraví pacienta a náklady zdravotní péči. Cíl: Cílem práce bylo analyzovat vliv intervencí a jejich udržitelnost na prevalenci pochybení spojených s podáním léčiv sestrou hospitalizovaným pacientům. Metodika: Data pochází z observačně intervenční studie probíhající v letech 2020 až 2023 a analyzující podání léčiv sestrou v jedné z českých nemocnic. Sběr dat proběhl formou přímého pasivního pozorování týmem tvořeným sestrou a farmaceutem na interním a chirurgickém oddělení a oddělení následné péče, a to vždy tři po sobě jdoucí dny v době ranních, poledních a večerních podání léčiv. Zaznamenána byla všechna léčiva podaná v době pozorování, údaje o pacientovi, sestře podávající léčiva, vlastním podání léčiva a správném způsobu podání a zacházení s jednotlivými lékovými formami. Všechna data včetně údajů o sestrách byla anonymizovaná a standardním způsobem ochráněna. Po prvním sběru dat byly na základě získaných dat vytvořeny a implementovány komplexní intervence. Pochybení byla rozdělena na léková a procesní a pomocí statistických metod byl zhodnocen dopad a udržitelnost navržených intervencí. Výsledky: Celkem bylo pozorováno podání 3 826 léčiv podávaných 55 sestrami 222 pacientům průměrně starším 75 let. Ve více než 80 % se jednalo o pevné perorální lékové formy. Nejvyšší prevalence pochybení byla zaznamenána u těchto kategorií: nesprávný časový odstup od potravy, chybějící identifikace pacienta, absence dezinfekce rukou sestry před podáním léčiva, neprovedené kontroly užití léčiva pacientem a nepoužití čistých pomůcek pro přípravu léčiva. Ve všech těchto případech se ukázaly navržené intervence jako účinné a bylo zaznamenáno statisticky významné zlepšení v průběhu studie. Závěr: Pozitivní dopad intervencí na snížení výskytu lékových pochybení při podání léčiv sestrou ukazuje, že udržení a další posílení kultury bezpečí při poskytování zdravotní péče v nemocnici vyžaduje opakovanou edukaci zdravotnických pracovníků.

Introduction: The medication administration to hospitalized patients is critical in the delivery of healthcare services and is associated with the occurrence of various categories of errors with real impact on patient health and healthcare costs. Aim: The aim of this study was to analyse the impact of interventions and their sustainability on the prevalence of errors asso­ciated with medication administration by nurses to hospitalized patients. Methods: Data were obtained from an observational intervention study conducted from 2020 to 2023 and analysing medication administration by nurses in one of the Czech hospitals. Data collection was done by direct passive observation by a team including a nurse and a pharmacist in the internal medicine, surgery, and long-term wards on three consecutive days during morning, midday, and evening administrations. All drugs administered at the time of observation, details of the patient, the nurse administering the medicine, the actual administration of the medicine, and the correct method of administration and handling of each dosage form were recorded. All data, including nurse data, were anonymised, and protected. After initial data collection, complex interventions were developed and implemented based on the data collected. Errors were divided into medication and process errors and the impact and sustainability of the proposed interventions were assessed using statistical methods. Results: A total of 3 826 drugs administered by 55 nurses to 222 patients with a mean age over 75 years were observed. More than 80 % were solid oral dosage forms. The highest prevalence of errors was incorrect timing in relation to food, lack of patient identification, lack of nurse hand disinfection prior to medication administration, failure to check if patient used administered drug, failure to use clean equipment for medication administration. In all these cases, the proposed interventions proved to be effective, and a statistically significant improvement was observed over the course of the study. Conclusion: The positive impact of the interventions on reducing the occurrence of medication errors in the administration of medicines by nurses shows that maintaining and further strengthening a safety culture in the delivery of healthcare in the hospital requires repeated education of healthcare workers.

• MeSH
• Patient Safety MeSH
• Hospitalization MeSH
• Humans MeSH
• Medication Errors * prevention & control   MeSH
• Harm Reduction MeSH
• Nurse Clinicians education   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Observational Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH

BACKGROUND: The study aimed to evaluate the agreement of prescribed drug dosages with renal dosing recommendations and describe adverse drug events (ADEs) contributing to hospital admissions of patients with chronic kidney disease (CKD). METHODS: This cross-sectional study focused on CKD patients admitted to University Hospital Hradec Králové, with an estimated glomerular filtration rate below 60 ml/min. The necessity for renal dosage adjustments was determined using the Summary of Product Characteristics (SmPC). For medications requiring renal dosage adjustment according to SmPC, agreement between the prescribed and recommended renal dosage was assessed. ADEs were adjudicated using the OPERAM drug-related hospital admissions adjudication guide. RESULTS: Of 375 CKD patients, 112 (30%, 95% CI 25-34) were prescribed drug dosages in disagreement with SmPC renal dosage recommendations. Perindopril, metformin, and ramipril were most frequently dosed in disagreement with SmPC. ADE-related hospital admissions occurred in 20% (95% CI 16-24) of CKD patients. CONCLUSION: CKD patients are often prescribed medication dosages in disagreement with SmPC renal dosing recommendations. Besides explicit factors, treatment goals, feasibility of monitoring and alternative treatment must be weighed when assessing drug and dosage appropriateness. Gastrointestinal bleeding was the most frequent ADE that contributed to hospital admissions of CKD patients.

• MeSH
• Renal Insufficiency, Chronic * complications   MeSH
• Glomerular Filtration Rate MeSH
• Kidney MeSH
• Humans MeSH
• Hospitals MeSH
• Drug-Related Side Effects and Adverse Reactions * epidemiology   etiology   MeSH
• Cross-Sectional Studies MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

• Publication type
• Meeting Abstract MeSH

• MeSH
• Pulmonary Disease, Chronic Obstructive diagnosis   physiopathology   therapy   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH

Introduction: Administering medication is one of the riskiest operations in healthcare. This research aims to map the reasons and context for disrupting nurses while administering medicines in selected inpatient wards of 4 hospitals in South Bohemia. Methods: We used the method of directly observing general and practical nurses while administering drugs – in selected internal and surgical wards and long-term care and rehabilitation wards. The data was collected in 2021, 2022, and 2023. Results: 18,370 inpatient medicine administrations were observed during the morning, midday, and evening administrations. 58 nurses from 4 hospitals, with an average age of 37.4, participated in the research. We recorded 791 interruptions. The most common reasons were patient questions and work communication, but we also recorded interruptions unrelated to nursing care. Conclusion: Due to the lack of strategies, we recommend introducing preventive measures and educational interventions in the monitored hospitals to reduce disruption while nurses are administering medicinal products, and thus improve the quality and safety of the nursing care provided.

Clinical pharmacy as an area of practice, education and research started developing around the 1960s when pharmacists across the globe gradually identified the need to focus more on ensuring the appropriate use of medicines to improve patient outcomes rather than being engaged in manufacturing and supply. Since that time numerous studies have shown the positive impact of clinical pharmacy services (CPS). The need for wider adoption of CPS worldwide becomes urgent, as the global population ages, and the prevalence of polypharmacy as well as shortage of healthcare professionals is rising. At the same time, there is great pressure to provide both high-quality and cost-effective health services. All these challenges urgently require the adoption of a new paradigm of healthcare system architecture. One of the most appropriate answers to these challenges is to increase the utilization of the potential of highly educated and skilled professionals widely available in these countries, i.e., pharmacists, who are well positioned to prevent and manage drug-related problems together with ensuring safe and effective use of medications with further care relating to medication adherence. Unfortunately, CPS are still underdeveloped and underutilized in some parts of Europe, namely, in most of the Central and Eastern European (CEE) countries. This paper reviews current situation of CPS development in CEE countries and the prospects for the future of CPS in that region.

• Publication type
• Journal Article MeSH