Joo Hanne Poulsen

Background/objectives: Chronic kidney disease (CKD) affects approximately 800 million individuals worldwide and poses a growing health challenge. To support safer prescribing practices, our research group developed a renal risk medication quick guide (RRMQG), which provides recommendations for the 50 most prevalent renal risk medications (RRMs). This study explored the usefulness of implementing the RRMQG in Danish hospital settings. Methods: In this multicenter pilot study conducted across six Danish hospitals, 28 clinical pharmacists applied the RRMQG during medication reviews of frail, geriatric patients with renal impairment from May to October 2023. Useability was explored through structured surveys completed by the pharmacists. Results: Among 182 patients, 378 RRMs were detected, and 14% of these were associated with potential drug-related problems (DRPs). The RRMs were distributed across 35 of the 50 from the RRMQG, and patients received an average of two RRMs each. Most pharmacists found the RRMQG manageable for implementation in practice. Conclusions: The RRMQG was useful and manageable for implementation in practice in Danish hospitals, particularly due to its medication-specific recommendations. However, adjustments to the RRMQG may be beneficial by, for example, adding opioids or context-relevant medications to meet individual needs.

INTRODUCTION. Automated multi-dose drug dispensing (MDD) enhances patient safety and adherence and releases staff resources, but it also causes frustration among healthcare professionals during transitions between general practice and hospital admission. This study explored healthcare professionals' perspectives on the use of MDD during the transition from hospital to general practice. METHODS. In April 2024, a focus group interview was conducted with four hospital-based physicians (HBPs), three general practitioners (GPs) and two clinical pharmacists at the University Hospital of Southern Denmark in Aabenraa, Denmark. RESULTS. The GPs’ attitudes towards MDD were generally more positive than those of HBPs, who found management of medication changes to MDD complex due to insufficient knowledge and lack of support for MDD in evenings and during weekends. Consequently, MDD was discontinued, which increased the workload of GPs after discharge. Proposed solutions included increased involvement of hospital pharmacy staff, the establishment of collaboration with community pharmacies, and regulatory amendments to transfer responsibility for MDD to community pharmacies. CONCLUSIONS. The proposed initiatives to optimise the management of MDDs in hospitals involved pharmacy personnel. Enhanced collaboration and coordination among pharmacies and healthcare providers concerning MDD were essential to strengthening the primary healthcare sector. FUNDING. None. TRIAL REGISTRATION. NCT06451692.

Background: Multi-morbidity is associated with multiple medication use, which potentially increases the risk of adverse drug events. Pharmacist-led medication reviews have been introduced to meet these challenges. Aim: To evaluate the implementation of pharmacist-led medication reviews for older patients admitted to an orthopedic ward in terms of quality and safety from the perspectives of patients, hospital-based physicians, nurses, and healthcare assistants. Method: Patients (n=11) were interviewed, with the interviews having a reflexive thematic analysis using the hermeneutic approach, while healthcare-professionals’ (HCPs) (n=26) perspectives on pharmacist-led medication reviews were assessed using questionnaires. Results: The qualitative patient interviews revealed four themes: (1) Positive perception of pharmacists’ medication communication, (2) Mixed perceptions of a medication review, (3) Satisfaction with the general outcome of the medication review, and (4) Safety perception with medication treatment. Twenty-six HCPs completed the questionnaire (response rate 48%) with a distribution of 10 hospital-based physicians (38%), eight nurses (31%), and eight healthcare assistants (31%). Almost 85% of the HCPs (n = 22) were familiar with the pharmacist conducting medication reviews. More than 70% of the HCPs reported that pharmacist-led medication reviews contributed to increased quality of admitted patients’ medication use. Conclusion: High levels of satisfaction with the outcomes of the medication reviews—particularly regarding quality, patient safety, and their overall positive impact on the ward—indicate that both patients and HCPs perceived the service as highly valuable in supporting patient care throughout the medication process.

Resumé Introduktion Præparatskift forårsaget af forsyningsvanskeligheder udfordrer patientsikkerheden og kan føre til medicineringsfejl og hospitalsindlæggelser. Præparatskift skaber forvirring og usikkerhed blandt sundhedsprofessionelle og patienter, som ofte udtrykker bekymring ved præparatskift, især ved tilbagevendende symptomer og bivirkninger. Praktiske udfordringer som fx synkeproblemer eller ændringer i injektionsmedicin kan påvirke compliance. Sundhedsprofessionelle spiller en vigtig rolle i at sikre patientsikkerheden gennem patientuddannelse og kontinuitet i pleje. Formål Studiet formål er at undersøge patienters erfaringer med præparatskift og behovet for information og støttende initiativer ved skifte i injektionsbehandlinger, som selvadministreres i eget hjem. Metode Fire fokusgruppeinterviews blev gennemført online og fysisk med ni patienter, som har erfaring med præparatskift af subkutane injektioner. Data blev analyseret ved hjælp af en tematisk netværksanalyse. Resultater Fire hovedtemaer blev identificeret: 1) Behov for forberedelse ved skift af injektionsmedicin. 2) Tryghed ved ny injektionsmedicin 3) Informationskilde ved skift i injektionsmedicin. 4) Økonomisk perspektiv. Konklusion Patienter ønsker mundtlig information om præparatskift ved sygeplejekonsultationer, og sygehusapotekerne kan støtte ambulatorierne ved at sikre rettidig information om præparatskift. Demonstrationsenheder er vigtige for patientsikkerheden, da de giver patienterne mulighed for at øve sig i håndteringen og administrationen af et nyt præparat i patientsikre omgivelser. Medicinalleverandører opfordres til at levere disse ved licitationsprocessen. Keywords: Præparatskift i injektionsmedicin, patientperspektiv, sygeplejekonsultationer, patienttryghed, demonstrationsdevice, selvadministration, patientsikkerhed, licitationsskift.

Background and aim: Hospitalization often leads to changes in patients’ medicine which challenges a safe medication use after discharge. Medicine information helplines (MIHs) can be valuable for patients in overcoming these challenges. This study evaluates patient satisfaction with a newly established Danish hospital-based MIH for discharged patients. The MIH is operated by experienced pharmacists and a pharmacy technician, and the study explores how the service affects the patient’s concerns and perception of safety in relation to their medication, followed by an assessment of the clinical impact of MIH on patient safety. Method: A randomized controlled study design was used in the present study. The study was registered at clinicaltrials.gov with the identification number NCT03829995. Participants were randomized 1:4 (50:200) into a control- and intervention group. Participants in the control group were offered standard care and those in the intervention group were offered access to the MIH. A telephone interview performed 2–4 weeks after discharge assessed patient satisfaction with the helpline and patient’s feeling of safety in relation to medicine use (primary outcome). Data were analyzed using a Mann-Whitney U test. After case handling of each enquiry to the MIH, the cases were assessed with regard to medication-related problems (MRPs) and clinical impact of the MIH service was assessed (primary outcome). Results: A total of 250 participants were included in the study and 152 participated in the telephone interviews (33 control and 119 intervention). Thirty-seven questions were enquired by 26 participants to the MIH. Of these, 8 were requested before the telephone interviews and these patients all expressed a high satisfaction with the MIH (score 4.57 +/- 0.73 on a 5-point scale). Most patients offered access to the MIH expressed that it increased the sense of safety in relation to their medicines (79%). However, comparing the control- and intervention group with regard to patient concerns and feeling of safety in relation to medicine use no differences were found. Evaluation of the enquiries revealed at least one MRP per enquiry, and in most cases the advice given were assessed to have a high- or moderate clinical significance. Conclusion: The MIH was appreciated by the participants, indicating that the MIH could be a valuable service for discharged patients in improving the sense of safety in relation to medication and alleviating MRPs. Providing easy access for patients to medicine information may contribute to patient safe medicine use after discharge.

Medicines used at Danish public hospitals are purchased through tendering. Together with drug shortage, tendering result in drug changes, known to compromise patient safety, increase medicine errors and to be resource demanding for healthcare personnel. Details on actual resources required in the clinic setting to manage drug changes are unknown. The aim of the study is to explore time spend by hospital personnel in a drug change situation when dispensing medicine to in- and outpatients in a hospital setting in the Capital Region of Denmark. A time and motion study, using direct observation combined with time-registration tools, such as eye-tracking, video recording and manual time tracking. Data were obtained from observing nurses and social and health care assistants with dispensing authority while dispensing or extraditing medicine before and after the implementation of drug changes in two clinical setting; a cardiology ward and a rheumatology outpatient clinic. Hospital personnel at the cardiology inpatient ward spent 20.5 seconds on dispensing a drug, which was increased up to 28.4 seconds by drug changes. At the rheumatology outpatient clinic, time to extradite medicine increased from 8 minutes and 6 seconds to 15 minutes and 36 seconds by drug changes due to tender. Similarly, drug changes due to drug shortage prolonged the extradition time to 16 minutes and 54 seconds. Statistical analysis reveal that drug changes impose a significant increase in time to dispense a drug for both in- and outpatients. Clinical hospital personnel spent significantly longer time on drug change situations in the dispensing of medicine to in- and outpatients in a hospitals. This study emphasizes that implementing drug changes do require extra time, thus, the hospital management should encounter this and ensure that additional time is available for the hospital personnel to ensure a safe drug dispensing process.

Background: Drug change (DC) is a common challenge in Danish hospitals. It affects the work of hospital personnel and has potentially serious patient safety consequences. Focus on medication safety is becoming increasingly important in the prevention of adverse events. The aim of this study is to identify and describe patient safety challenges related to DCs, and to explore potential facilitators to improve patient safety in the medication process in Danish hospital setting. Method: Two qualitative methods were combined. Data were obtained from the Danish Patient Safety Database (DPSD) containing incidents reports of adverse events related to DCs. Additionally, five semi-structured focus group interviews with hospital personnel (doctors, nurses, pharmacists and pharmacy technicians) from the five regions of Denmark were held. Results: The DPSD search identified 88 incidents related to DCs due to tender or drug shortage. The incidents were linked to prescribing errors, incorrect dose being dispensed/administered, and delayed/omitted treatment. Four themes from the interviews emerged: (1) challenges related to the drug itself; (2) situational challenges; (3) challenges related to the organization/IT systems/personnel; (4) facilitators/measures to ensure patient safety. Conclusion: DC is as a complex challenge, especially related to drug shortage. The results allow for a deeper understanding of the challenges and possible facilitators of DCs on the individual and organizational level. Pharmacy personnel were identified to play a key role in ensuring patient safety of DCs in hospitals. Indeed, this emphasizes that pharmacy personnel should be engaged in developing patient safety strategies and support hospital personnel around drug changes.