Quality of Medication Use

There are multiple facets to the quality assessment of medication use. Among them are monitoring of 

Step 4 Evaluation stage (study the results of the changes implemented during this cycle) 

Step 3 Observation stage (collect information on the effect of the planned changes which have been implemented) 

Step 1 Planning stage (identify objectives, define data which may be available, define new data needs, plan change or test) 

Step 2 Implementation or pilot stage (complete the planned changes or test) 

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Gurwitz ]H, Rochon R Improving the quality of medication use in elderly patients a not-so-simple prescription. Arch. Intern. Med. 2002 162 1670-1672. Isetts BJ, McKone BJ. Practice changes facilitated by pharmaceutical care. In Knowlton CH and Perma RP, Eds., Pharmaceutical Care, 2nd ed. Bethesda, MD American Society of Health-System Pharmacy, 2003, chap. 12, pp. 213-231. 

A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while medication is in the control of a healthcare professional/ patient/ or consumer (6). Not all medication errors reach the patient. These are often referred to as "near misses." They are not usually considered to be ADEs only because no harm was done. Preventable ADEs are a subset of medication errors that cause harm to a patient (7). Figure 26.1 depicts the relationship between ADES/ medication errorS/ and adverse drug reactions (8). Because adverse drug reactions are generally unexpected/ they are not presently considered to be a reflection of medication use quality in a classic sense. However/ as genetic variances become a more prominent consideration in drug selection and monitoring/ it may be possible to predict and avoid some of the reactions that have been previously unexpected. This offers an opportunity to improve the quality of medication use. 

Several approaches have been described for improving medication use through the use of dosing service teams. Demonstrated enhancements in the quality of medication use have been reported for anticoagulants antimicrobials anticonvulsants and other drugs. The common method of these programs is... 

Adoption of standardized medication order forms has been demonstrated to increase the quality of medication use and the effectiveness of medications that are prone to error (72, 73). Chemotherapy, patient-controlled analgesia, and antimicrobial drug therapy are likely candidates for order standardization. Yet another approach to improved medication use is implementation of alert systems for sudden, unexpected actions, such as medication stop orders, or use of antidote-type drugs, such as diphenhydramine. 

The medication use process is a complex system intended to optimize patient outcomes within organizational constraints. Quality medication use involves selection of the optimal drug, avoidance of adverse medication events, and completion of the therapeutic objective. Safe medication practices focus on the avoidance of medication errors. Medication use review and ongoing medication monitoring activities focus on optimizing medication selection and use. These two approaches are important means of assessing and optimizing the quality of medication use. 

McKee M, Black N. Does the current use of junior doctors in the United Kingdom affect the quality of medical care Soc Sci Med 1992 34(5) 549-558. 

However, no specific method of reducing heart failure is addressed, and heart failure itself has many potential outcomes. On the other hand, if the problem is addressed more narrowly, a more narrowly defined objective could be studied. For example, one may look to reduce the number of heart failure exacerbations related to noncompliance with medications. Additionally, other specific objectives may be included, such as increasing the quality of life of patients with heart failure, reducing the number of medications used by patients with heart failure, or making patients more aware of behavioral and dietary modifications related to heart failure. 

The pharmacist, in concert with the medical and nursing staffs, must develop policies and procedures for ensuring the quality of medication therapy. This must include processes designed to ensure the safe and effective use of medications and to increase the probability of desired patient outcomes. 

Pharmacopoeial monographs on medicinal substances describe basic requirements that need to be met to assure appropriate quality of the product. Most of the monographs indicate purity at the 98-99 % level, which means that a content of 1-2 % impurities is allowed. In cases of medications used in high doses, such as vitamins or antibiotics, which have daily doses from few hundred milligrams up to a few grams, a 1-2 % level of impurities can have serious consequences for patients. 

The medication use system in an institutional setting offers even more complexity, with more chances for error. The five subsystems of the medication system in a hospital are selection and procurement of drugs, drug prescribing, preparation and dispensing, drug administration, and monitoring for medication or related effects (11). Evaluation and improvement of medication use quality require consideration of all of these subsystems. 

Figure 26.2 is a flowchart of appropriate, safe, effective, and efficient use of medications in the hospital setting (12). It incorporates the role of the prescriber, nurse, pharmacist, and patient in a typical inpatient environment. It also depicts the role of the organization s pharmacy and therapeutics committee and quality improvement functions, which will be discussed later in this chapter. The decision to treat a patient in a hospital or extended-care facility typically adds a nurse or other healthcare provider (respiratory therapist, etc.) to the trio described in the ambulatory care setting. Every time that individual has to read, interpret, decide, or act is yet another opportunity for a mistake to occur. Each of the steps in the medication use process provides an opportunity for correct or incorrect interpretation and implementation of the tactics that support the therapeutic plan. With this many opportunities for medication misadventures to occur, it is easy to understand why tracking and improving quality are important aspects of medication use. 

Focused or targeted medication use evaluation follows a reasonably well-established cycle identification of a potential problem in the use of a specific drug or therapy, collection and comparison of data, determination of compliance with a pre-established guideline/expectation, and action as needed to improve discrepancies between expected and measured results. This type of medication use evaluation provides an excellent opportunity to apply the Shewhart cycle for continuous quality improvement (Figure 26.3). Focused medication use projects are typically selected for a specific reason. Table 26.4 lists reasons to consider drugs for focused evaluation projects. 

Patient education and medication counseling are an integral part of the healthcare process. The two-way flow of information in these processes is important to improve the quality of care and patient outcomes, and to build patient-practitioner relationships. This article discusses how, through the processes of patient education and medication counseling, pharmacists can ensure that patients take their medications correctly and achieve the most beneficial outcomes of medication use. A variety of methods of communication and counseling skills are presented. 

The types of outcomes that result from medical care interventions can be described in a number of ways. One classic fist, called the five D s, although quite negatively worded, captures a wide range of outcomes used in assessing the quality of medical care. The five D s are death, disease, disability, discomfort, and dissatisfaction. 

Even thongh most medications are likely to be safe during pregnancy, clinicians will struggle to make decisions about choosing therapy. Information abont medication safety in pregnancy comes from a variety of sources. One of the most important questions for the clinician is how to evaluate the quality of the evidence related to the safety of medications used in pregnancy. 

The classical computer tomography (CT), including the medical one, has already been demonstrated its efficiency in many practical applications. At the same time, the request of the all-round survey of the object, which is usually unattainable, makes it important to find alternative approaches with less rigid restrictions to the number of projections and accessible views for observation. In the last time, it was understood that one effective way to withstand the extreme lack of data is to introduce a priori knowledge based upon classical inverse theory (including Maximum Entropy Method (MEM)) of the solution of ill-posed problems [1-6]. As shown in [6] for objects with binary structure, the necessary number of projections to get the quality of image restoration compared to that of CT using multistep reconstruction (MSR) method did not exceed seven and eould be reduced even further. 

These designed methods will allow hereinafter development of the high-performance remedies, using biologically active substances from Arctium lappa L. root. Identification of stmcture and quality contents allows to obtain correct prediction of phamiacological properties of this groups of compounds. Express method allows to make supply of medical herb raw material more rational. 

The quality control of PVC, plasticizers, and additives must be done according to certain standards. In the case of making the blending material for medical uses, medical grade PVC, which contains <3 ppm vinylchloride monomers, should be used. 

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