Interrater reliability of the Observer Rating of Medication Taking scale in an inpatient mental health facility

Non‐adherence to medication remains a major barrier to recovery from mental illnesses. Identification of those patients likely to experience adherence difficulties is best undertaken during inpatient treatment, prior to discharge into the community. More objective assessments of adherence behaviours might assist staff to more effectively target support to those patients most in need. This study investigated the interrater reliability of an inpatient behavioural observation scale of patient engagement with medication: the Observer Rating of Medication Taking (ORMT) scale. Eight mental health nurses working in a psychiatric hospital inpatient setting were trained in the use of the ORMT using video‐based vignettes. Working in pairs, staff then independently rated adherence behaviours of 13 inpatients in a rehabilitation unit (total of 160 ratings) over a 1‐week period. Concurrently, two expert raters also undertook independent ratings of patient medication‐taking behaviour using the ORMT. Interrater reliability was assessed across both staff and expert raters. The results indicated that the ORMT has satisfactory interrater reliability, and can be appropriately used in an inpatient setting. The observational location of raters on the ward influenced the range of medication‐taking behaviours observed, and thus the extent of concordance between raters. Further research to determine if the ORMT predicts adherence in the community is warranted.     

Implementing AORN Recommended Practices for Medication Safety

Medication errors in the perioperative setting can result in patient morbidity and mortality. The AORN “Recommended practices for medication safety” provide guidance to perioperative nurses in developing, implementing, and evaluating safe medication use practices. These practices include recognizing risk points in the medication use process, collaborating with pharmacy staff members, conducting preoperative assessments and postoperative evaluations (eg, medication reconciliation), and handling hazardous medications and pharmaceutical waste. Strategies for successful implementation of the recommended practices include promoting a basic understanding of the nurse's role in the medication use process and developing a medication management plan as well as policies and procedures that support medication safety and activities to measure compliance with safe practices.     

Preliminary reliability of an observer rating scale for assessing medication adherence on psychiatric wards

Objectives  Medication non-adherence is a major contributor to poor outcomes following discharge from psychiatric hospitals. It is therefore imperative that staff are able to accurately assess the extent to which patients have engaged with treatment. This study presents data on a new observer rating instrument of patient medication adherence.
Methods  Staff participating in a medication adherence training programme ('Medication Alliance') were given a brief overview of the Observer Rating of Medication Taking (ORMT) scale. Participants then watched six video vignettes of patient adherence behaviour and provided a rating on their scale for each vignette. Participant ratings were then compared with 'expert' ratings.
Results  Percentage agreement between 'experts' and participants ranged from a low of 68% through to 98% agreement. Only one vignette was rated significantly differently [ Mdiff  = 0.33, t (49) = 2.08, P  = 0.007], with 32% of people falling outside the expert rating range (all of those ratings being higher). This difference was attributed to between group differences, [ F (2,47) = 3.49, P  < 0.05] and post hoc assessment suggested that the differences between expert and trainee ratings for the vignette may be explained by trainee characteristics, as distinct from inherent characteristics of the rating scale.
Conclusion  The ORMT can help mental health professionals identify particular non-adherent behaviours thus facilitating identification and treatment of likely non-adherence before discharge. The scale appears to be accessible to a variety of professions with a range of experience and requires minimum training in order to be used reliably.     

Role of depressive symptoms and self‐efficacy of medication adherence in Korean patients after successful percutaneous coronary intervention

This cross‐sectional study sought to identify the prevalence of medication adherence and to explore the role of depression and self‐efficacy on medication adherence among patients with coronary artery diseases. Participants were recruited among outpatients who successfully underwent primary percutaneous coronary intervention (PCI) with drug‐eluting stent at academic medical centres in Cheonan, South Korea. Medication adherence was evaluated by the eight‐item Morisky Medication Adherence Scale using a validated Korean version. Prevalence of non‐adherent to medication was 60.3%. With non‐depressed and high self‐efficacy as reference and after adjusting for age and gender, the models showed that those with depression and low self‐efficacy are more likely to be non‐adherent to medication. Therefore, future studies should focus on the development of interventions designed to reduce depression and increase self‐efficacy for improving patient adherence to cardiovascular medications following PCI.     

The effect of adherence therapy on medication adherence,health beliefs,self-efficacy,and depressive symptoms among patients diagnosed with major depressive disorder

Medication adherence is a crucial health issue in major depressive disorder (MDD) that requires regular monitoring and attention. Hence, there are multiple reasons for medication non-adherence among them. This study aimed to examine the effect of adherence therapy (AT) on medication adherence, health beliefs, self-efficacy, and depressive symptoms among patients diagnosed with MDD. One group pretest-posttest, repeated measures time-series design was conducted. A sample of 32 patients was recruited conveniently; they received eight weekly sessions of AT. A self-reported questionnaire was used to measure variables. The analysis showed that the mean scores of the baseline indicated non-adherence, moderate general benefits beliefs about the medication, high beliefs that medication is harmful, high beliefs that doctors overuse medication, high beliefs about potential adverse effects from medication, low perception of MDD severity, and high threatening perception regarding MDD, a moderate degree of confidence in the ability to taking medications, and patients had moderately severe depressive symptoms (M = 16, 3.2, 3.1, 4.1, 3.8, 50, 3, 16 respectively). Over four measurement points, adherence therapy enhanced positive beliefs towards taking medication and illness, increased medication adherence self-efficacy, improved medication adherence, and decreased depressive symptoms (F = 68.57–379.2, P < 0.001). These improvements were clinically significant in all variables immediately post-AT but declined minimally over time. The study indicated that integrating AT as part of the pre-discharge protocol is one core component to sustaining positive healthcare outcomes. Continuous efforts should be paid in terms of the long-term sustainability of an intervention to enhance adherence and clinical outcomes.     

Depression and medication adherence among older Korean patients with hypertension: Mediating role of self‐efficacy

Many studies have reported the negative effects of depression on adherence to antihypertensive medication. However, little is known about the mechanism underlying this relationship in elderly patients with hypertension. The aim of this cross‐sectional study is to examine the mediating role of self‐efficacy in the relationship between depression and medication adherence among older patients with hypertension. The data were collected from October to December 2014. A total of 255 older patients with hypertension were assessed using the Geriatric Depression Scale, the Self‐efficacy for Appropriate Medication Use Scale, and the Morisky Medication Adherence Scale. Hierarchical linear regression analysis and the Sobel test were used to examine the mediating role of self‐efficacy in the relationship between depression and medication adherence. Depression and self‐efficacy were statistically significant predictors of medication adherence in older patients with hypertension. Self‐efficacy partially mediated the relationship between depression and medication adherence. Interventions targeting self‐efficacy could increase the confidence of patients in their ability to actively take their medicines. Moreover, health care providers should be aware of the importance of early detection of depression in older patients with hypertension. Future studies with longitudinal data are warranted to clarify the multidirectional relationships between depression, self‐efficacy, and medication adherence.     

Medication adherence and significant others' support of consumers with schizophrenia in Australia

Medication adherence is problematic in people with chronic illness. The purpose of this exploratory study was to examine the effects of the perceived support from significant others on the oral antipsychotic medication taking of consumers with schizophrenia. A convenience sample of 81 consumers took part in the study. The consumers were recruited by case managers from the community in the western region of Melbourne and in regional and rural Victoria, Australia. No difference was found in self-reported medication adherence between the consumers with significant others' support and those without significant others' support. The perceived effect of having a supportive relationship with significant others was not associated with increased medication adherence. The findings indicated that the significant others' support did not influence the self-reported medication adherence of the consumers with schizophrenia. The results highlighted the importance of considering medication adherence as a multidimensional concept.     

Emergency department medication lists are not accurate

Background: Medication errors are a common source of adverse events. Errors in the home medication list may impact care in the Emergency Department (ED), the hospital, and the home. Medication reconciliation, a Joint Commission requirement, begins with an accurate home medication list. Objective: To evaluate the accuracy of the ED home medication list. Methods: Prospective, observational study of patients aged > 64 years admitted to the hospital. After obtaining informed consent, a home medication list was compiled by research staff after consultation with the patient, their family and, when appropriate, their pharmacy and primary care doctor. This home medication list was not available to ED staff and was not placed in the ED chart. ED records were then reviewed by a physician, blinded to the research-generated home medication list, using a standardized data sheet to record the ED list of medications. The research-generated home medication list was compared to the standard medication list and the number of omissions, duplications, and dosing errors was determined. Results: There were 98 patients enrolled in the study; 56% (55/98, 95% confidence interval [CI] 46–66%) of the medication lists for these patients had an omission and 80% (78/98, 95% CI 70–87%) had a dosing or frequency error; 87% of ED medication lists had at least one error (85/98, 95% CI 78–93%). Conclusion: Our findings now add the ED to the list of other areas within health care with inaccurate medication lists. Strategies are needed that support ED providers in obtaining and communicating accurate and complete medication histories.     

智能药物管理系统在老年慢性病患者住院-居家过渡期的应用

目的 研发智能药物管理系统,并探讨该系统在老年慢性病患者住院-居家过渡期中的应用效果。方法 基于协同设计理论,结合前期需求调研,于2021年6-9月,选取某公立医院的老年慢性病住院患者作为研究对象,采用随机数字法进行分组,干预组49例,对照组45例。对照组采用口服药的常规管理模式,干预组采用智能药物管理系统进行用药管理。干预前后调查2组的用药依从性、用药知识和合理用药自我效能得分,干预后收集干预组对系统的评价量表。结果 干预组患者的用药依从性、合理用药自我效能得分及均高于对照组（P<0.05）;是否使用微信小程序对用药知识得分及差值比较差异无统计学意义（P>0.05）;92%的患者对智能药物管理系统具有较高的满意度。结论 智能药物管理系统能有效提高老年慢性病患者的用药依从性及合理用药自我效能,且具有较好的适老性和可行性,拓展了用药安全管理的服务范畴,值得进一步推广。     

Improving Advanced Practice Provider Knowledge and Assessment of Medication Adherence in Patients with Cardiovascular Disease

Medication nonadherence is a widespread problem among cardiovascular patients. Advanced practice providers (APPs) play a critical role in assessing for medication adherence upon hospital admission. A pre–post intervention design was used to determine the effect of an education module on APP knowledge and assessment of medication adherence in cardiovascular patients over a 12-week period in the Division of Cardiology. We found a statistically significant increase in cardiology APP knowledge and assessment of medication adherence upon hospital admission using an education module and providing a valid and reliable assessment tool in the electronic health record.     

肾移植受者免疫抑制药物依从性现况分析

目的:调查肾移植受者免疫抑制药物依从性的现况并分析其影响因素。方法:采用一般情况调查表和免疫抑制药物依从性Basel评估量表对肾移植受者进行多中心横断面调查。结果:共纳入819例肾移植受者,免疫抑制药物依从性差的发生率为43.8%,其中不按时服药最常发生,其次是漏服药。免疫抑制药物依从性的独立影响因素包括移植时间、器官来源、术后是否存在并发症和透析时间。结论:目前肾移植受者的免疫抑制药物依从率较低,尤其是移植时间长、活体供肾、有并发症以及透析时间短的受者,医务人员在随访过程中应重视该人群依从性的筛查,帮助肾移植受者进行疾病和药物的管理。     

Evaluation of contextual influences on the medication administration practice of paediatric nurses

Title. Evaluation of contextual influences on the medication administration practice of paediatric nurses. Aim. This paper is a report of a study conducted to explore the impact of preidentified contextual themes (related to work environment and socialization) on nursing medication practice. Background. Medication administration is a complex aspect of paediatric nursing and an important component of day‐to‐day nursing practice. Many attempts are being made to improve patient safety, but many errors remain. Identifying and understanding factors that influence medication administration errors are of utmost importance. Method. A cross‐sectional survey was conducted with a sample of 278 paediatric nurses from the emergency department, intensive care unit and medical and surgical wards of an Australian tertiary paediatric hospital in 2004. The response rate was 67%. Result. Contextual influences were important in determining how closely medication policy was followed. Completed questionnaires were returned by 185 nurses (67%). Younger nurses aged <34 years thought that their medication administration practice could be influenced by the person with whom they checked the drugs (P = 0·001), and that there were daily circumstances when it was acceptable not to adhere strictly to medication policy (P < 0·001), including choosing between following policy and acting in the best interests of the child (P = 0·002). Senior nurses agreed that senior staff dictate acceptable levels of medication policy adherence through role modelling (P = 0·01). Less experienced nurses reported greater confidence with computer literacy (P < 0·001). Conclusions. Organizations need to employ multidisciplinary education programmes to promote universal understanding of, and adherence to, medication policies. Skill mix should be closely monitored to ensure adequate support for new and junior staff.     

National study on the frequency, types, causes, and consequences of voluntarily reported emergency department medication errors

Background: Medication errors contribute to significant morbidity, mortality, and costs to the health system. Little is known about the characteristics of Emergency Department (ED) medication errors. Study Objective: To examine the frequency, types, causes, and consequences of voluntarily reported ED medication errors in the United States. Methods: A cross-sectional study of all ED errors reported to the MEDMARX system between 2000 and 2004. MEDMARX is an anonymous, confidential, de-identified, Internet-accessible medication error-reporting program designed to allow hospitals to report, track, and share error data in a standardized format. Results: There were 13,932 medication errors from 496 EDs analyzed. The error rate was 78 reports per 100,000 visits. Physicians were responsible for 24% of errors, nurses for 54%. Errors most commonly occurred in the administration phase (36%). The most common type of error was improper dose/quantity (18%). Leading causes were not following procedure/protocol (17%), and poor communication (11%), whereas contributing factors were distractions (7.5%), emergency situations (4.1%), and workload increase (3.4%). Computerized provider order entry caused 2.5% of errors. Harm resulted in 3% of errors. Actions taken as a result of the error included informing the staff member who committed the error (26%), enhancing communication (26%), and providing additional training (12%). Patients or family members were notified about medication errors 2.7% of the time. Conclusion: ED medication errors may be a result of the acute, crowded, and fast-paced nature of care. Further research is needed to identify interventions to reduce these risks and evaluate the effectiveness of these interventions.     

高血压患者家庭功能及社会支持对药物依从性的影响

目的了解高血压患者家庭功能、社会支持、药物依从性现状,并分析家庭功能和社会支持对药物依从性的影响。方法选取高血压患者496例,对其进行药物依从性、家庭功能、社会支持的问卷调查。结果药物依从性好155例,占31.25%;依从性差223例,占44.96%;依从性极差118例,占23.79%;药物依从性总分为(6.50±0.34)分。家庭功能良好373例,占75.20%;中度障碍98例,占19.76%;严重障碍25例,占5.04%。社会支持总分为(33.67±6.45)分。多元线性回归分析显示,药物依从性的主要影响因素有家庭人均月收入、病程、慢性病情况、情感度、亲密度、合作度、主观支持。结论临床护理人员应提高患者的家庭功能和社会支持水平,以提高患者的药物依从性,进而提高其生活质量。     

Medication Adherence App for Food Pantry Clients With Diabetes: A Feasibility Study

Low-income food pantry clients are unable to adhere to the diet and physical activity recommendations of the American Diabetes Association. The aim of the study is to test the feasibility of using a mobile phone app to improve diabetes medication adherence. Clients with uncontrolled type 2 diabetes were enrolled in a mobile phone app featuring 70 days of text message reminders and incentives. The app and the 4-item Morisky Medication Adherence Scale evaluated medication adherence. Clinically significant medication adherence of 93% was achieved with use of the app. Phone app use is feasible among urban low-income clients to improve medication adherence.     

Doctor-Related Medication Safety Incidents on a Specialist Palliative Medicine Inpatient Unit: A Retrospective Analysis of Three Years of Voluntary Reporting

Patients receiving palliative care and those at the end of life are known to be susceptible to medical errors. Errors related to medications are the most avoidable cause of patient harm. This retrospective study examined reported anonymized medication safety incidents, related to physician errors, assessed by the risk committee in a specialist palliative care unit over a 3-year time period. The aim of the study was to describe medication errors, with specific attention paid to what type of errors occurred and when these errors happened. Of the 218 reported medication safety incidents 28% (n = 62) were related to doctor prescribing. The data showed that there was a wide variation per year in the numbers of reported medication safety incidents. Medication prescribing errors were the most common error, followed by medication omissions. Medication safety incidents are at least in part dependent on staff reporting. Fostering a culture of openness that is blame free is crucial to medication error reporting. Formal reporting may help to increase patient safety and forms an essential element in the clinical governance and risk management of an institution.     

Risk profiles for non-adherence to antipsychotic medications

Poor adherence to medications is common in individuals with schizophrenia, and can lead to relapse and re-hospitalization. This paper presents the findings of an Australian study of the factors affecting antipsychotic medication taking in individuals with schizophrenia. The Factors Influencing Neuroleptic Medication Taking Scale was used with a non-probability sample of mental health service users. Ethics approval was obtained from a university and a hospital ethics committee. Data were analysed using spss version 15. Most participants had insight into their illness and were aware of the stigma of mental illness. Around 70% experienced annoying side effects, while nearly half admitted alcohol consumption. About one-fifth admitted they had missed taking medications during the previous week. Significant others played a variable role in medication taking. Over 80% were satisfied with their relationships with health professionals, but were less satisfied with access to these professionals, especially psychiatrists. Logistic regression analysis showed that age, impact of medication side effects, and access to psychiatrists were independent predictors of medication omission. It is argued that medication taking is a complex issue, which needs to be taken into consideration in health professional training and measures to promote adherence.     

不同类型养老机构老年人服药依从性调查

目的:调查并分析不同类型养老机构老年人服药依从性现状。方法:采用分层抽样法,通过问卷调查对重庆市12所养老机构的203例老年人进行横断面调查。结果:不同类型养老机构老年人的服药种类、服药方式、医疗保健费用承受度及药物不良反应发生率不同,不同机构工作人员对老年人服药情况关注度也不同;护养院老年人服药信念显著高于养老院和老年公寓;护养院老年人服药依从性显著高于养老院老年人;老年人的服药信念、服药频率及工作人员关注程度是其服药依从性的影响因素。结论:不同类型养老机构老年人的服药依从性存在较大差异,护养院老年人的口服用药相对较安全,应积极推进养老机构向"互联网+医养结合"方向转型发展。