Jiri Vlcek

Background: The patterns of oral anticoagulant (OAC) prescription have significantly changed in recent years, with direct oral anticoagulants (DOACs) gradually replacing warfarin. While this transition occurred earlier in some countries, limited data are available about its timeline in the Czech Republic. Objectives: This study aimed to analyse trends in OAC prescriptions in the Czech Republic from 2019 to 2024, focusing on the shift from warfarin to DOACs and the patterns of utilisation of individual DOACs. Methods: A retrospective analysis was conducted using national electronic prescription data from the State Institute for Drug Control (SÚKL). Annual drug consumption is presented as defined daily doses per thousand inhabitants per day (DDD/TID). Results: Total OAC utilisation increased from 18.83 to 26.70 DDD/TID between 2019 and 2024 (p < 0.01), with an average of 22.99 ± 3.05 DDD/TID. DOACs surpassed warfarin in total prescriptions in 2021. Rivaroxaban (6.84 ± 3.00 DDD/TID) and apixaban (5.24 ± 2.43 DDD/TID) exhibited the highest growth, while dabigatran utilisation (3.00 ± 0.66 DDD/TID) showed a halt in increase after 2022. Conclusion: DOACs have progressively replaced warfarin in the Czech Republic, but this transition occurred later than in other developed countries. This shift was likely influenced by local changes in prescribing restrictions. Further research is warranted to evaluate prescription patterns based on specific indications.

Missed and unfinished nursing care in hospitals depends on the quality of human resources. This paper aims to analyze the influence of selected work characteristics on missing and incomplete nursing care in inpatient wards of Czech hospitals. The relationship between the rate of missed and unfinished nursing care and selected work characteristics was studied using the Czech version of the standardized questionnaire, the MISSCARE Survey. The study was conducted from September 26, 2021, to October 15, 2021. Controlled interviews with 1,205 nurses working in ward blocks in Czech hospitals were used. The research results showed statistically significant connections between selected work characteristics and missed and unfinished nursing care. Nurses with the highest level of education (Master, Ph.D.), nurses with specialized education, nurses with the lowest number of working hours (less than 30 hours per week), and nurses with the highest number of years of work experience (21 years and over) show a significantly lower rate of missed nursing care. Nurses from surgical departments, specialist nurses, and nurses with the highest education (Master, Ph.D.) report statistically significantly lower unfinished care levels. In contrast, nurses from regional/district hospitals, practical nurses/nursing assistants, and nurses with the lowest education (secondary school of nursing) report significantly higher unfinished nursing care levels. The information obtained can be used to improve nursing processes in the identified weak parts, strategic planning of nursing care, and sufficient personnel. AcknowledgmentsI would like to express my gratitude to co-authors and other members of the research team – Hana Hajduchová, Chloubová Ivana, Hana Kubešová, Josef Malý, Martin Doseděl, Ondřej Tesař, and Kateřina Malá-Ládová, without whose support the article could not have been published.Supported by the Ministry of Health of the Czech Republic, grant no. NU20-09-00257. All rights reserved.

Aim. The study aimed to identify the occurrence of medication administration errors in clinical practice. Material and methods. This was a direct observational study. The study included observing the medication administration process over three years in four hospitals in the Czech Republic. STROBE was used as a checklist. Results. A total of 18,370 medication administrations to hospitalized patients were observed and recorded, including morning, noon, and evening administrations. The most common MAE was substituting a prescribed medication without the doctor’s consent, especially among nurses aged 35-44 (p < 0.001). These MAEs involved giving a medication of diff erent strength than prescribed (p < 0.001), giving the wrong medication (p < 0.001), and giving a diff erent dose (p < 0.001). Substitutions of MAEs occurred most often during morning medication administration (p < 0.001). Conclusions. A critical fi nding of this study was the substitution of medications without a doctor’s consent. It has been found that MAEs were not uncommon in clinical practice, and factors such as the nurse’s age, overall length of clinical practice, education, and workplace interruptions played a role.

BackgroundThe 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).MethodsThis cross-sectional study focused on CKD patients admitted to University Hospital Hradec Kralove, 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.ResultsOf 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.ConclusionCKD 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.

Background: Medication administration errors (MAE) are a worldwide issue affecting the safety of hospitalized patients. Through the early identification of potential causes, it is possible to increase the safety of medication administration (MA) in clinical nursing. The study aimed to identify...

Background: An international consensus list of potentially clinically significant drug-drug interactions (DDIs) in older people has been recently validated. Our objective was to describe the prevalence and characteristics of drug combinations potentially causing clinically significant DDIs identified in the medication history of older patients admitted to the hospital and the prevalence and characteristics of manifest DDIs–DDIs involved in adverse drug events present at hospital admission, DDIs that contributed to ADE-related hospital admissions, and DDIs involved in drug-related laboratory deviations.Methods: The data were obtained from our previous study that examined the drug-relatedness of hospital admissions to University Hospital Hradec Králové via the department of emergency medicine in the Czech Republic. Patients ≥ 65 years old were included. Drug combinations potentially causing clinically significant DDIs were identified using the international consensus list of potentially clinically significant DDIs in older people.Results: Of the 812 older patients admitted to the hospital, 46% were exposed to drug combinations potentially causing clinically significant DDIs. A combination of medications that affect potassium concentrations accounted for 47% of all drug combinations potentially causing clinically significant DDIs. In 27 cases, potentially clinically significant DDIs were associated with drug-related hospital admissions. In 4 cases, potentially clinically significant DDIs were associated with ADEs that were present at admissions. In 4 cases, the potentially clinically significant DDIs were associated with laboratory deviations. Manifest DDIs that contributed to drug-related hospital admissions most frequently involved antithrombotic agents and central nervous system depressants.Conclusion: The results confirm the findings from the European OPERAM trial, which found that drug combinations potentially causing clinically significant DDIs are very common in older patients. Manifest DDIs were present in 4.3% of older patients admitted to the hospital. In 3.3%, manifest DDIs contributed to drug-related hospital admissions. The difference in the rates of potential and manifest DDIs suggests that if a computerized decision support system is used for alerting potentially clinically significant DDIs in older patients, it needs to be contextualized (e.g., take concomitant medications, doses of medications, laboratory values, and patients’ comorbidities into account).

Background: Drug-related hospital admissions (DRAs) represent a significant problem affecting all countries worldwide. This study aimed to determine the prevalence and preventability of DRAs, identify the most common medications involved in DRAs, the most common clinical manifestations of DRAs and describe the preventability aspects of DRAs.Methods: This cross-sectional study examined unplanned hospital admissions to the University Hospital Hradec Králové via the department of emergency medicine in August–November 2018. Data were obtained from electronic medical records. The methodology of DRA identification was adapted from the OPERAM DRA adjudication guide.Results: Out of 1252 hospital admissions, 195 DRAs have been identified (145 related to treatment safety, 50 related to treatment effectiveness). The prevalence of DRAs was 15.6% (95% CI 13.6–17.6). The most common medication classes involved in DRAs related to treatment safety were Antithrombotic agents, Antineoplastic agents, Diuretics, Corticosteroids for systemic use, and Beta blocking agents. The most common medication classes involved in DRAs related to treatment effectiveness included Diuretics, Antithrombotic agents, Drugs used in diabetes, Agents acting on the renin-angiotensin system, and Lipid modifying agents. Gastrointestinal disorders were the leading causes of DRAs related to treatment safety, while Cardiac disorders were the leading causes of DRAs related to treatment effectiveness. The potential preventability of DRAs was 51%. The highest share of potential preventability in medication classes repeatedly involved in DRAs related to treatment safety was observed for Anti-inflammatory and antirheumatic products, Psycholeptics, and Drugs used in diabetes. Potentially preventable DRAs related to treatment safety were most commonly associated with inappropriate drug selection, inappropriate monitoring, inappropriate dose selection, and inappropriate lifestyle measures. On the contrary, DRAs related to treatment effectiveness were more commonly associated with medication nonadherence.Conclusion: It should be emphasized that in most DRAs, medications were only a contributory reason of hospital admissions and that benefits and risks have to be carefully balanced. It is highlighted by the finding that the same medication classes (Antithrombotic agents and Diuretics) were among the most common medication classes involved in DRAs related to treatment safety and simultaneously in DRAs related to treatment effectiveness. The study highlighted that apart from problems related to prescribing, problems related to monitoring and patient-related problems represent significant preventability aspects.

Background Geriatric patients represent a vulnerable population in terms of adverse drug events (ADEs). Objective The aims of this study were to determine the prevalence and preventability of hospital admissions to a geriatric ward related to ADEs, to identify medications involved in these ADEs and to describe potential preventability aspects of ADE-related admissions. Setting University Hospital Hradec Králové, Czech Republic. Methods This cross-sectional study evaluated acute hospital admissions to the geriatric ward of University Hospital Hradec Králové over a period of nine months (April–December 2017). Medication reviews were performed in order to identify ADE-related hospital admissions. Causality was assessed using the World Health Organization-Uppsala Monitoring Centre criteria. Modified Schumock-Thornton algorithm was used to assess the preventability of ADEs. Main outcome measure 9-month-prevalence of ADE-related hospital admissions. Results A total of 366 hospital admissions were included. The 9-month-prevalence of ADE-related hospital admissions was 11.75% [95% confidence interval 8.45–15.05]. Antithrombotic agents and diuretics represented the most common medication classes associated with ADEs (30.2% each). Electrolyte disturbances and gastrointestinal haemorrhages and ulcerations were the most frequently observed ADEs associated with hospital admission. Out of 43 ADE-related hospitalisations, 23 (53.5%) were considered potentially preventable. Conclusion The contribution of ADEs to hospital admission to the geriatric ward was not negligible. Our results also suggest that 53.5% of identified ADE-related admissions could be potentially prevented. This finding demonstrates just how important the research on the preventability of medication-related hospitalisations is. Further studies and implementations are still needed aiming to minimize the risk of medication-related harm.