Evidence tabel: Voorkomen van schade door medicatie tijdens opna


Codering relevantie 1=relevant 2=twijfel 3=niet relevant	Artikel-nr	Referentie 1	Populatie 2	Studie design 3	Korte beschrijving interventie	Uitkomstmaten (Primair en secundair)	Uitkomst/ resultaat	Relevant voor andere vraag? 4
3	332	Sandilands et al, 2010 Br J Clin Pharmacol	The study group comprised final year medical students at the University of Edinburgh. I-groep: 50 students C-groep: 28 students	RCT?	During the 8 week module, students in the intervention group received focused doctor- and pharmacist-led prac- tical prescribing teaching, in addition to the standard teaching programme already provided.	P: prescribing errors S: prescribing assessment, and confindence	Prescribing assessment score higher in teaching group versus control group [70% (67, 73) versus 62% (56, 68), P = 0.007]. Allergy documentation: teaching group versus control group: 98% (96, 100) versus 74% (59, 90); P = 0.0001 Post-teaching confidence: teaching group versus control group: 3.8 (3.7, 3.9) versus 3.2 (2.9, 3.5), P = 0.0002 No effect on the number of prescribing errors.	2
3	333	Saxena K, et al. AMIA Annu Symp Proc 2011	Niet beschreven enkel vermelding: all patients who received inpatient medical/surgical care in 5 multi specialty community hospitals	prospective time series analysis/study, observationeel	Clinical decision alters which prompted the providers/end users on the computer screen on which they were working (only 9 were analyzed)	Responses of prescribers in terms of the number of alerts addressed and how the providers responded to these alerts.	Monitoring of CDSS in place changed the provider ordering behavior by 41.75% of the time alerts were raised.	2
3	337	Weitman LR, et al. The Joint Comission Journal on Quality and Patient safety 2011	Niet bechreven enkel vermlding: 28.929 adult inpatient admssion and obervation encounters during the 183-day study period	Prospective analysis during 6 months study period, observationeel	Implementaion of surveillance dashboard for clincial pharmacist to monitor the following high-risk drugs: aminoglycoside, heparin/enoxaparin, warfarin.	Dashboard Coverage Dashboard Utilization Pharmacists interventions	Coveregae of aminoglycoside and warfarin was 100 % (used during all days of study period), of heparin/enoxaparin 71%. Dahsboard utilization: 100% of aminoglycoside cases were viewed in detail, 32% of warfarin cases and only 4% of heparin/enoxaparin cases Pharmacist interventions: not further sepcified, only the numbers of comments created by pharmacists were shown	2
3	340	Wiplfi et al. Stud Health Technol Inform. 2011	The intervention was targeted on physicians and on patients	Observantional	Study designed to observe how physicians act upon alters when prescribing. For this purpose questionaries, interviews and observantions during work rounds were conducted.	Kwalitatieve resultaten	The main finding was that physiscians appreciate alerts as insurance for situations they are not familiar with. Also, non-modal alerts (not interrputing diring the work process) are not overcharging the physicians, however attention should be paid on how to best visualize the ever growing number of alerts.	2
2	349	Cozart et al. Q Manage Health Care 2010	This article desribes development of an ADE survilliance tool; geen specifieke populatie beschreven	Kwalitatieve analyse	Article describes a development of an ADE trigger tool to identify patients which suffered from an ADE.	Alleen kwalitatieve data; In Phase 3, surveillance was integrated into daily work flows and organizational balanced scorecards where it was accepted as a quantitative measure of medication safety performance	Het implementeren van ADE data in dahsboards waarmee afdelingshoofden inzicht hebben in hoeveel ADE’s op hun afdeling plaats vinden kan een manier zijn om meer alert te zijn en te verbeteren op de werkvloer. Helaas is het effect op het ADE’s in dit artikel niet beschreven.	2
2	354	Duff et al. Contemporary nurse: a journal for the Australian nursing profession 2009	No data, only the following info: the case mix is 70% surgical, 30% medical and 45% of the patient population is over 65 years of age. The project was conucted over a 12-moth period in a 250 bed acute care private hospital in Australia.	Observational with a baseline measurement and ongoing collection of data by monthly retrospective chart review	Multifaceted intervention: - loading dose nomogram places on the warfarin chart - clinical pathway incorporated in EHR for nurses - reintroduction of warfarin booklet - warfarin patient education checklist - self-paced online information package - audit and feedback to clinicians about the process and outcome data - opinion leaders were recruited to the project team.	Process indicators: 1) % patients within INR above 4 whose dose has been adjusted or reviewed prior to the next warfarin dose2) % of patients with AF who are discharged on warfarin dose3) % of patients discharged on warfarin who received writen info regarding warfarin prior to discharge4) % of patients prescribed warfrin loading dose according to hospital protocolOutcomes:5) % of warfarin patients with abnormal bleeding6) % of warfarin patients with cerebral bleeding7) % warfarin patients with INR >58) % warfarin patients who die as a result of an AE	1: was already 100% at baseline 2: was already 94% at baseline 3: increased by 54% (31-85%) 4: increase by 12% (42-54%) 5: decrease by 1.2% (1.2-0%) 7: decrease by 2.6% (3.7- 1.1%) There were no cerebral bleeds, deaths.	2
3	358	Faye et al. Jt Comm J Qual Patient Saf. 2010	Aimed at nurses who were recruited from an ICU ward: 7 volunteerd	Proactive risk assessement	geen	NA	A total of 54 failure modes were identified across the seven steps of the medication management process. For the 4 most critical failure modes, nurses listed 21 contributing factors and 21 recovery processes	2
2	383	Roberts et al. J Am Med Inform Assoc 2010	A 300-bed teaching hospital specializing in care for the elderly. Number of patients not specified.	Before (6 months)-after study (5 months) 2004	CDSS focusing on the dosing of renally cleared drugs (GFR+)  combined with academic detailing Drugs monitored: allopurinol, ACEI, digoxin, furosemide, lithium, metformin, and spironolactone	Dosing conformity (DC) Appropriate TDM (aTDM) Tot nader order stop van risico geneesmiddelen tijdens een periode van acute nierinsufficientie (tno stop ANI)	DC for enoxaparin improved from 68 to 86% (p = 0.03), for gentamicin from 63 to 87% (p = 0.01), and for vancomycin from 47 to 77% (p = 0.07). aTDM for gentamicin improved from 70 to 90% (p = 0.02) and for vancomycine from 61 to 84% (p = 0.17). Tno stop during ANI: 38 verus 62% of times (p = 0.01)The use of academic detailing dramatically increased the uptake of GFR+, and should be strongly considered as a valuable adjunct for the introduction of computerized CDSS outside any primary workflows.	2
2	384	Roberts et al Am J Health Syst Pharm. 2010	NA	Pre- post intervention time series analysis, with intervention and control hospitals	Additional technology including computerized provider order entry (CPOE), an advanced CDSS, and evidence-based order sets was implemented in nine hospitals. A 17 item trigger tool was incorporated wich fired alerts to physicians.	Number of potential ADE’s captured Number of true postives per 1000 admissions	Significant increase during post-intervention (p <0.0001) in intervention hospitals Significant increase druing post-intverntion (p <0.01) in intervention hospitals	2
2	388	Seidling et al. Qual Saf Health Care 2010	In phase 1, 5030 patients (53.4% female) were included in the analysis, with a mean (SD) age of 55.9 years (16). In phase 2, 4948 patients were included (mean (SD) age of 55.9 years (15.9), 52.6% female).	Prospective, open, monocentric study with two sequential phases	For 170 compounds, detailed information on upper dose limits was compiled. The CDSS was integrated into the local prescribing platform for outpatients and patients at discharge, providing immediate dosage feedback.	Frequency of excessive doses before and after intervention considering potential induction of new medication errors. Predictors for alert adherence were analysed	The final prescription rate of excessive doses was significantly reduced by 20% compared with phase 1 (p<0.001). In 54 of the 425 cases, where physicians stuck to the original dosage regimen, they specified a reason for the appropriateness of the prescribed dosage (12%), most often claiming that the dosage was considered clinically appropriate (n = 47).	2
3	391	Serrano-Fabia et al. J Oncol Pharm Pract. 2010	1311 adult patients administered antineoplastic treatment, median patient age 64	A longitudinal, monocentre, prospective 2-year (January 2003 -to December 2004) cohort study was made in	No intervention implemented	Number of medication errors (ME’s)	During the study period, a total of 276MEs were identified in 225 patients, accounting for 237 opportunities for pharmacotherapeutic improve- ment, i.e., the detection rate was 20.9 MEs per 1000 patient-days (95%CI: 18.5–23.5). Eighty percent of the MEs did not reach the patient (16.8 MEs per 1000 patient-days). Primarly because of pharmacists intervention (68%).	2
3	393	Snyder et al. International Journal for Quality in Health Care 2010	NA	NA	NA	NA	Non-voluntary detection methods were much more effective at detecting events than traditional self-report methods.	2
3	395	Stockwell et al. Crit Care Med 2010	NA	NA	Artikel gaat over ADE detectie methodes, hun voor en nadelen en zoemt in specifiek op ICU setting. Goed overzichtsartikel maar dus geen interventie studie.	NA	NA	2
1	399	Trivalle et al. The Journal of Nutrition, Health & Aging 2010	576 patients (mean age: 83.6 ± 7.9 years) were consecutively included	Randomised prospective study (baseline 2 wks and intervention phase of 2 weeks). Controle (I-) en interventie afdelingen (I+)	For one week, I+ rehabilitation care teams received specific information about prescribing in the elderly, ADE’s, how to prevent them and how to identify them.	The main outcome of this trial was the change in the proportion of ADE’s in elderly patients in the intervention- units, compared to the control group.	There were fewer ADE’s in the intervention group (n = 38, 22%) than in the control group (n = 63, 36%; p = 0.004) Het is onduidelijk of het hier gaat op vermijdbare ADE’s of totaal aantal ADE’s. Zeer onduidelijke resulataten sectie	2
3	402	Vessels et al, Pharm World Sci (2010)	76 patients with mean age of 48 years. Performed in a 15-bed nephrology ward of 1 university hospital in Iran; study period Dec 2008 – March 2009	Cross-sectional study	Patient files, laboratory data, and physician orders were reviewed by a clinical pharmacist that attended the ward three times a week during morning hours. Any prescription error identified by the clinical pharmacist, and whether it was accepted by the physician and resulted in an intervention was documented. Besides reviewing physician’s orders, the clinical pharmacist attended the teaching rounds once a week	Rate of prescription errors Acceptance of pharmacist’s advices	10.5 per 100 medication orders. The attending physician agreed to 96.5% of the prescription errors and interventions were made.	2
2	409	Berqvist et al. Eur J Clin Pharmacol (2009)	60 patients enrolled in the study—250 in the intervention group and 210 in the control group. The mean age of the patients was 80.3 years.	Before- after study	Nurses were given a 1-day training in clinical pharmacology to identify drug-related problems (DRP’s). All patients admitted to the ward aged 65 or more were studied. Patients at the same ward before the intervention were considered as control group.	Outcome variables were re-hospitalized 3 months from discharge, drug-related re- admissions, the proportion of inappropriate drug use (IDU), and DRP’s found by the nurses.	The nurses found 86 clinically significant DRP’s not detected by the usual care. A substantial part of the DRP’s detected by the nurses were revealed with assistance of Symptoms Assessment Form (SYM). There were no statistical difference in the number of drug-related re-admissions between the groups, IDU or 3 months re-hospitalization.	2
2	422	Coombes et al. Qual Saf Health Care 2009	730 pre-implementation and 751 post-implementation patients;age not specified	Prospective before-and-after observational audit	A mediction chart specific for warfarin dosing	Prescribing error rate Documentation of ADRs Prescribing errors related to prescribing a drug for which patient had a reported ADR INR >5	Prescribing error decrease from 20% to 15.8% (p = 0.03) Previous ADRs were not documented in 19.5% before and 11.2 after intervention (p = 0.032) Prescribing errors involving selection of a drug to which a patient had a previous ADR decreased from 11.3% of patients before to 4.6% after (p 0.021) INR >5 decreased from 1.9% before to 1.45% after (0.004)	2
3	426	Flood et al. Am J Geriatr Pharmacother. 2009	47 patients were included in the study. The mean (SD) age was 73.5 (7.5) years	Prospective, observational study of older cancer patients admitted to 1 unit	Oncology–Acute Care for Elders (OACE) unit that uses an interdisciplinary team to en- hance recognition and management of geriatric syndromes in hospitalized older adult cancer patients	processes and outcomes of interdisciplinary communication regarding medications	The OACE team made 51 medication recommendations, and 42 of those recommendations (82%) were implemented. Twenty-five patients (53%) had an alteration in their medication regimen; 13 (28%) had a potentially inappropriate medication discontinued. A medication error was corrected in ~1 of every 8 patients (6/47 [13%]).	2
3	433	Kadmon et al. Pediatrics 2009	Pediatric ICU, In total 5000 orders were reviewed >>1250 orders from each of 4 periods	Observational before-and-after study	CPOE implementation (period 2) followed by CDSS implementation (period 3) followed by a change in prescription authorization (drugs could be prescribed only by a physician and as previously by nurses, period 4)	Medication prescription errors Potential adverse drug events (ADE’s)	Rate of potential ADE’s decreased significantly in periods 3 and 4 (to 0.8% and 0.7%, respectively; P <.005) in versus period 1 and 2. The rate of MPEs decreased significantly in period 3 (to 3.8%; P <.05) and a dramatically significant decrease in period 4 (to 0.7%; P <.0005) versus periode 1 and 2.	2
3	435	Kazandjian et al. Qual Saf Health Care 2009	NA	NA	NA	Beschijrving van implementatie graad van ziekenhuisbreden medicatieveiligheid plan	No relevant outcomes reported	2
3	437	Kliger et al. The Joint Commission Journal on Quality and Patient Safety	A total of 1841 medication doses were observed on 7 units	Before-and-after study, 3 periodes	Intergrated Nurse Leadership Program to improve safety of medication administration	Accurace of medication administration	Improvement from 85% in the baseline to 92% six moths after the intervention and 96% 18 months after the intervention.	2
3	439	Lathela et al. Connecting Health and Humans 2009	NA	NA	Is een poster over RFID technologie (vergelijkbaar aan barcode technologie) voor identificatie van patient en zijn/haar geneesmiddelen.	Geen resultaten	NA	2
1	444	Agrawal et al. Br J Clin Pharmacol 2009	NA	NA	Betreft een verslag van een Europese conferentie over medicatieveiligheid. Het artikel is een samenvatting van aanbevelingen om medicatieveiligheid te verhogen in de zorg.	Aanbevelingen genoemd: - Student education - Taking an accurate medication history - Assessment of prescribing skills - Identifying hazardous drugs, patients, professionals and settings - Involving clinical pharmacists - Using uniform prescription forms - Bar-coded medication administration - Development of better monitoring systems for detecting medication errors - Improve interprofessional (digital) communication - Patient communication and engagement		2
2	446	Porat et al. Qual Saf Health Care 2009	61 nurses with a minimum of 2,5 years of ICU experience	Intervention-control audit	Colour-coded labels for intravenous high-risk medication on ICU. Laboratory stimualtion, imitaing ICU, was designed to measure the effect of the intervention.	Safety of medication treatment Overall duration of nurses’ orientation with drugs and lines at the patient’s bedside.	Identification of IV bgas improved (p <0.0001)Time required for description of overall drugs and lines was reduced (p = 0.04) Imporved error identifcation (p = 0.03) Reduced average performance time for overall tasks (p <0.0001)	2
3	451	Seidling et al. Eur J Clin Pharmacol (2009)	We retrospectively assessed consecutive electronic prescrip- tions in a tertiary care teaching hospital during a 1-year study period (1 November 2006 to 31 October 2007) A total of 2457 statin-containing medication regimens, matched the inclusion criteria.	Retrospecive observational study	DDI alert-system that considers prescribed dosage	Frequency of statin–drug interaction alerts.	More than half of the DDI alerts that presented in a clinical decision support system can be reduced if DDI-specific upper dose limits is considered.	2
3	455	Sunol et al. Qual Saf Health Care 2009	NA	NA	Betreft een observational study in acute care hospitals in eight European countries (Belgium, Czech Republic, France, Ireland, Netherlands, Poland, Spain and United Kingdom) to investigate quality improvement strategies in healthcare systems.	Data were collected on patient safety structures and mechanisms in 389 acute care hospitals in eight EU countries using a web-based questionnaire. Subsequently, an on-site audit was carried out by independent surveyors in 89 of these hospitals to assess patient safety outputs.		2
2	460	Bemt vd p et al. Ann Pharmacother 2009	In the preintervention period, 204 patients were evaluated; 93 were included in the postintervention analysis. Mean age 60 years Setting: Preop polikliniek	Before-after observational study	The intervention consisted of the addition of a pharmacy technician to the preoperative screening clinic to perform the same tasks as anesthesiologists as related to medication reconciliation. If necessary, the patient was advised on stopping the antithrombotic. On the day that the patient was supposed to stop the antithrombotic, that person's community pharmacist contacted the patient to determine whether this had been done.	The main outcome measures were the proportions of patients with one or more medication discrepancy, one or more allergy discrepancy, and one or more antithrombotic error.	The proportion of patients with one or more medication discrepancy (RR 0.29; 95% Cl 0.12 to 0.71) was statistically significantly reduced in the postintervention group. The proportions of patients with one or more allergy discrepancy (RR 0.76; 95% Cl 0.35 to 1.64) and one or more antithrombotic errors (RR 0.18; 95% Cl 0.02 to 1.33) were reduced, but not significantly.	Op de polikliniek
1	461	Doormaal van et al. J Am Med Inform Assoc. 2009	592 patients during the baseline period and 603 patients during the post-intervention period were included. The mean age of the patients included in both periods was rather high (