Kirsi Kvarnström

Background: The World Health Organization has identified inconsistent medication information and documentation practices among major risk factors jeopardizing medication safety. To tackle this challenge, medication risk management and optimization practices, including documentation, need to be harmonized nationally and regionally. This study aimed at aligning medication reconciliation, prescription review (PR) and medication review (MR) practices and documentation in a regional electronic health record (EHR) system with the national patient information documentation guideline in Finland. Methods: The study was conducted in one of the 21 wellbeing services counties established in connection with a major social and health systems reform in Finland in 2023 (county coverage 210 000 residents). The Delphi consensus method was used with two interprofessional expert panel rounds in 2024. The regional expert panel ( n = 20) consisting of practicing physicians ( n = 5), nurses ( n = 5), and pharmacists ( n = 10) defined the contents of medication reconciliation, PR and MR practices and related patient information that should be documented in the regional EHR system. The preset consensus rate was 80%. The first-round survey was based on the national patient information documentation guideline and an inventory of national and international practices. Results: Consensus was reached on a total of 147 predetermined and expert panelist suggested items. Of them, 39 items related to the contents and documentation of medication reconciliations, 32 items to PRs, and 76 items to MRs. The consensus and response rates (90%) remained high throughout the study. Greater variation was observed when defining the patient groups to whom the medication optimization interventions should be targeted. Conclusions: A strong consensus was reached on the contents and documentation of medication reconciliations, PRs, and MRs within the regional EHR system. The results were consistent with the national documentation guideline, as well as international recommendations and previous research. The Delphi method proved to be a feasible approach for supporting regional implementation of the national documentation guideline and may be useful in similar healthcare system development initiatives. Further research will be needed to evaluate the actual implementation process and impact of the harmonized practices on medication safety and effectiveness.

Introduction: Barcode technology is widely used in hospitals to improve medication safety. Although this technology is considered effective for making system-wide improvements, its implementation faces several challenges. Hospital pharmacists play a key role in supporting this process. Aim: To explore clinical pharmacists’ perceptions of the facilitators and barriers to using barcode technology in a pediatric hospital setting. Method: A qualitative focus group study. Fourteen clinical pharmacists working in the pediatric department of a university hospital were chosen for the focus groups (n = 3) using purposive sampling to identify the individuals who regularly use barcode technology in clinical practice. The focus group discussions, guided by a semi-structured interview guide with six questions, were recorded and transcribed verbatim. Two researchers independently conducted inductive content analysis, which was later thoroughly reviewed by the entire research group. Results: The data revealed four main themes: factors encouraging the adoption of barcode technology, factors complicating barcode workflow, ideas to improve workflow efficiency, and at-risk behaviors. Factors encouraging the adoption of barcode technology were associated with the benefits and usability of barcode technology, increased expertise and teamwork, positive user experience, and supportive functions of the electronic health record (EHR) system. Factors complicating barcode workflow included deficiencies related to barcodes in labels and drug packages, negative attitudes of users, organizational factors, the use of the EHR system, and deficiencies in workstations and equipment. These factors were found to contribute to at-risk behaviors, while ideas to improve workflow efficiency focused on removing factors complicating barcode workflow and reducing at-risk behaviors. Conclusion: Various factors can influence the implementation of barcode technology in clinical practice, underscoring the importance of an organizational process to identify system deficiencies and continuously improve usability. Building on previous studies, our research emphasized the issues related to dispensing and preparation workflows, as well as the need for pediatric-specific EHR system customization as key development areas. Our findings can guide risk management efforts in implementing and maintaining barcode technology in hospitals.

Background Prescribing errors are common in hospital settings and can lead to severe harm to patients. Pharmacist-conducted medication order verification where a pharmacist ensures order appropriateness has been recommended to ensure safe prescribing in hospitals, but systematic scientific evidence of the efficiency is lacking. The objective of this study was to study the effects of pharmacist-conducted medication order verification in hospital settings. Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria and was registered in PROSPERO. The final literature search was conducted in February 2024 covering the period 2000–2023. Only peer-reviewed studies considering the effects of pharmacist-conducted medication order verification in hospital settings were included. Study selection, data extraction and quality assessment were carried out by two individual reviewers. The findings describing the effects of pharmacist-conducted medication order verification were synthesised and categorised according to the Economic, Clinical, and Humanistic Outcomes (ECHO) model. Results A total of 35 studies met the inclusion criteria. All of the studies (n=34) reporting clinical outcomes showed positive results. Pharmacist-conducted medication order verification could detect a wide variability in drug-related problems, with dose-related issues being the most common (n=33 studies). The physician acceptance rate in the pharmacist intervention studies (n=27) varied from 26% up to 100%. Of the verifications, 0.8–45.2% led to a pharmacist intervention. Economic outcomes were reported in seven studies and all showed positive results. None of the included studies reported humanistic outcomes. Conclusions Pharmacist-conducted medication order verification is associated with prevention of drug-related problems and cost savings in hospital settings. Further research is needed on the quality of pharmacist-conducted medication order verification, high-quality studies investigating the economic benefits, the effects on the patient perspective and outpatient medication prescriptions.

Colorectal cancer is a growing global health concern with complex pharmacotherapy, especially as oral anticancer drugs shift responsibility for adherence to patients. This study explores the experiences of colorectal cancer patients in medication counselling in hospitals and community pharmacies. A qualitative study was conducted through semistructured individual interviews with patients with colorectal cancer ( N = 21) from a university hospital. Inductive content analysis was performed using ATLAS.ti software, identifying key categories and subcategories. The following five main themes emerged: sufficiency of counselling; medication reconciliation; management of anticancer medication‐related problems; instructions for contacting healthcare; and instructions for medication use. Patients reported varied experiences. Some felt well‐informed and confident, while others found counselling insufficient and needed more support. Discrepancies in medication reconciliation were raised, particularly regarding nutritional and herbal products. The pharmacy's role in medication risk management was highlighted, with some patients' medications adjusted based on pharmacy consultation. While side effect management was generally addressed, some patients wanted more detailed information. Challenges in accessing counselling were highlighted, especially during weekends. Medication counselling for colorectal cancer patients should be more consistent across healthcare settings. Strengthening the role of pharmacies and enhancing collaboration and information flow between hospitals and pharmacies is crucial for achieving better patient outcomes.

While deprescribing benzodiazepines and related drugs (BZRDs) is crucial for preventing prolonged use and their associated adverse effects, it presents challenges from a healthcare perspective, because of limited resources and time. Recently, a pharmacist‐led deprescribing of BZRDs in the treatment of insomnia was introduced in Helsinki's primary care health centres. To explore pharmacists' and physicians' insights, qualitative semi‐structured interviews were conducted via Microsoft Teams with physicians and pharmacists involved in a pharmacist‐led deprescribing. The interviews were recorded, transcribed verbatim and analysed abductively. A total of four pharmacists and four physicians from four health centres participated in this study. Pharmacist‐led deprescribing was perceived as having positive outcomes and as being efficient, particularly in saving physicians' time and resources. Various patient‐related facilitators and barriers were identified, with patient motivation and willingness being the most cited. Suggestions for improvement included establishing clear criteria for deprescribing, clarifying the roles in the process flow, providing enhanced deprescribing guidance and educational materials and enhancing the patient‐centred approach by actively involving patients in the decision‐making process and considering the patient's overall situation. Overall, the pharmacist‐led model was seen as a promising and resource‐efficient approach to deprescribing BZRDs in primary care health centres.

Objectives: Barcode technologies are commonly used in hospital settings to improve medication safety. However, the implementation of these systems poses several challenges. This narrative review aims to synthesize qualitative studies exploring the facilitators and barriers associated with using barcode technologies in clinical environments. Methods: This review is grounded in the theory of systems-based risk management. A comprehensive literature search was conducted in November 2022 across 3 databases: CINAHL; MEDLINE (Ovid); and Scopus. Two independent reviewers utilized a predetermined SPIDER (Sample; Phenomenon of Interest; Design; Evaluation; Research type) tool for article selection by using Covidence software. The qualitative data from the selected studies were systematically summarized. Results: The search found 197 articles, of which 11 studies from 6 countries met the inclusion criteria. All included studies identified barriers, while 7 studies also highlighted facilitators. Seven common themes emerged as facilitators and barriers: efficacy; implementation; leadership; medication safety; process; technology; and user experience. Three themes—materials; system design; and work environment—were exclusively associated with barriers. Workarounds, such as bypassing barcoding, omitting process steps, and unauthorized process steps, were reported in 8 studies as responses to the barriers. Conclusions: This review underscores the complexity of implementing and maintaining high-leverage, technology-based systemic defenses in clinical practice. The findings provide a foundation for the improvement of the safety and usability of barcode technologies in hospital settings. Future research should focus on developing and testing interventions that address the identified barriers and enhance the facilitators to optimize the use of barcode systems.

Post COVID-19 condition (PCC) can have long-lasting adverse effects, including impacts on work ability. This study explores the facilitators and barriers in the return-to-work (RTW) process. Conducted in spring 2023 at the Outpatient Clinic for Long-Term Effects of COVID-19, this qualitative study involved phone interviews with 32 patients with PCC, of whom 28 were included in the analysis, while four interviews served as pilots. A research doctor conducted semi-structured interviews covering work ability, RTW actions and rehabilitation experiences. The interviews were recorded, transcribed verbatim and analyzed using an inductive approach. Several factors influenced work ability and the RTW process. For individual-related factors, self-guided rehabilitation, stress management, a positive attitude and high motivation supported RTW. Severe symptoms like fatigue and cognitive impairment, along with negative thoughts about them and experience of stress, hindered progress. Work-related factors included supportive employers and flexible work arrangements, while negative attitudes, skepticism about PCC and inflexible workloads were barriers. Health care-related and social factors showed that adequate emotional support and comprehensive healthcare services facilitated rehabilitation, whereas poor support, limited services and insufficient PCC understanding were obstacles. Regarding social insurance, partial sick leave supported RTW, but unmet criteria for benefits posed a barrier. PCC's multifactorial nature, complicated by work ability challenges, requires a holistic approach considering individual, social and work-related factors. Effective support involves understanding patients' experiences and fostering collaboration among healthcare providers, employers and the social security system to facilitate RTW, especially in prolonged cases.

Background: Clear and precise instructions are essential for high-quality medication management. This study focuses on identifying usability and functionality of instructional materials on medicine handling and use produced by hospital pharmacists. The secondary aim is to provide recommendations for hospital pharmacists on writing instructional texts. Methods: Semi-structured interviews were conducted with nurses who read and used medication-related instructions written by hospital pharmacists in a large tertiary hospital in Finland. Data were analyzed using inductive content analysis, incorporating an applied linguistic analysis of the grammatical and structural features of the Finnish-language instructional texts. The analysis focused on the nurses’ instruction-reading practices, identifying both problems and well-functioning dimensions of the texts, and proposing improvements for this type of communication between healthcare professionals. Results: The interviewed nurses (n = 9) consistently found the instructions somewhat challenging, primarily due to their length, complex structure and limited accessibility. While the interviewees stated that the instructions did not present personal difficulties, they expressed concern that other staff in the ward might struggle with the instructions. According to the interviews, readability problems can be mitigated using visual support. Linguistic features such as terminology and the interpretation of impersonal grammatical structures (e.g., passive voice) related to the division of labor were not seen as problematic for the interviewees. The usability of the instructions was enhanced by effective communication with the hospital pharmacists. Conclusion: When producing instructions for staff on the wards, it is important to focus on both internal text features, such as the use of graphics and consistent terminology, as well as external factors, like easy access communication between hospital pharmacists and ward staff.