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2. Psychotropic drug usage characteristics amongst people with severe and profound disability undergoing home medicines review.

Author

Al-Sarawi, Fares, Alderman, Chris, and Auciello, Michael

Subjects
*CLINICAL drug trials, *ANTICONVULSANTS, *DRUG prescribing, *MEDICAL history taking, *PSYCHOLOGY of people with intellectual disabilities, *PSYCHIATRIC drugs, *PHYSICIAN practice patterns, *OFF-label use (Drugs), *DRUG administration, *DRUG dosage
Abstract

Background Over 600 000 Australians currently live with severe physical and intellectual disabilities. Approximately two-thirds of these people are younger than 65 years of age. Home medication reviews are provided for residents of high-level care facilities of the South Australian Department of Disability and Social Inclusion ( DSCI). Aim To describe findings of a detailed analysis of medication use among a convenience sample of institution-dwelling adults with profound intellectual and physical disabilities. Methods Data were collected from a convenience sample of medication reviews conducted over a 12-month period. Descriptive and cross-tabular analysis of medication usage characteristics recorded in medication review reports were analysed with a focus on usage of antipsychotic, antidepressant and mood-stabilising agents. Dosage analysis was based on the Defined Daily Dose ( DDD). A specific focus addressed usage for non-approved purposes not within parameters of the Pharmaceutical Benefits Scheme. Results Initial analysis addressed medication use for 57 clients (mean age 52.96 years). The mean number of medications used was 10.3 (standard deviation 3.31) per client. Antipsychotics were prescribed for 20 clients (35.01%), antidepressants for 21 clients (36.84%) and anticonvulsants for 29 clients (50.88%). Usage for non-approved indications was observed in 41/57 cases. Off-label prescribing was most common with antipsychotics ( n = 16) and anticonvulsant drugs ( n = 14). Usage at doses greater than the DDD was observed in 28 cases, most commonly with antipsychotics. Conclusion This research is thought to be the first detailed analysis of medication use for people with profound disabilities in the Australian context. Data will be used to further explore aspects of treatments provided for these extensively medicated people, and to design strategies to minimise iatrogenic harm. [ABSTRACT FROM AUTHOR]

Published
2016
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3. Prescribing errors and adverse drug reaction documentation before and after implementation of e-prescribing using the Enterprise Patient Administration System

Author

Thomas M. Polasek, Fares Al-Sarawi, Sepehr Shakib, Gillian E. Caughey, Al-Sarawi, Fares, Polasek, Thomas M, Caughey, Gillian E, and Shakib, Sepehr

Subjects
adverse drug reactions, medicine.medical_specialty, e-prescribing, business.industry, Pharmacy, medication safety, medicine.disease, E-Prescribing, Documentation, medicine, Pharmacology (medical), Intensive care medicine, business, Administration (government), prescribing errors, Adverse drug reaction
Abstract

Background: Medication errors are a leading cause of harm to patients in hospital that can be decreased by electronic medication management systems. Aims: This study determined the effects of electronic prescribing using the Enterprise Patient Administration System (EPAS) on prescribing errors and adverse drug reaction (ADR) documentation in South Australian public hospitals. Methods: A prospective structured medication chart audit was conducted before (in 2012) and after the implementation (in Dec 2014) of EPAS, comparing the paper-based National Inpatient Medication Chart (NIMC) with prescribing. All inpatients were eligible for inclusion in the study. Prescribing order errors were determined by the percentage of medication orders that had unclear, illegal or unsafe prescriptions. The quality of ADR documentation was assessed by the percentage of patients with correct documentation. Results: The total number of prescribing errors before and after the implementation of EPAS was 67.7 and 2.8 per 100 orders,respectively. The frequency of prescribing order errors due to unclear, illegal and unsafe prescriptions decreased to almost zero with EPAS. Prescriptions classified as unsafe due to incorrect dose, route of administration or dosing frequency decreased from 5.8% to 0.03% of medication orders before versus after EPAS implementation (p < 0.0001). Completed ADR documentation was similar between the paper-based NIMC and EPAS, but the percentage of patients with ADR alerts who required them was 100% in EPAS compared with 27% on the NIMC (p < 0.0001). Conclusions: E-prescribing using EPAS significantly decreased prescribing errors and increased ADR alerts. Continued implementation of electronic medication management systems is an important approach to improve medication safety. Refereed/Peer-reviewed

Published
2019

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