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Summary adherence estimates do not portray the true incongruity between drug intake, nurse documentation and physicians' orders.

Cohen-Glickman I, Haviv YS, Cohen MJ - BMC Nephrol (2014)

Bottom Line: Drug practices were abstracted from their records and compared to electronic pharmacy data.We found a high rate of physician order turbulence for active vitamin D and calcium.Summary estimates do not divulge the extent of these disparities.

View Article: PubMed Central - PubMed

Affiliation: Dialysis unit, Nephrology and Hypertension services, Hadassah-Hebrew University Medical Center, POB 12000, En Kerem campus, Jerusalem 91120, Israel. yhaviv@hadassah.org.il.

ABSTRACT

Background: Hemodialysis patients (HD) need to adhere to a complex medication regimen. Because their daily pill burden is one of the highest reported, poor compliance is a major cause of therapeutic failure. The primary aim of this study was to define patterns of medication prescription, intake and documentation among HD patients.

Methods: HD patients treated between 2007 and 2009 and assigned to the largest health service provider in Israel were randomly selected. Drug practices were abstracted from their records and compared to electronic pharmacy data. The discrepancy between drug intake reports and the actual purchase was measured to estimate adherence. Drug purchase, intake report and physician order were plotted in complementing diagrams to appreciate consistency and discrepancy patterns.

Results: The study included full analysis of 75 patients. The mean overall drug adherence was 56.7% (95% CI 53.6-59.9%), varying among drug families and over time. Often, there was a systematic disengagement between the nurses' documentation and the actual patient purchase. Specifically, we observed either different quantities of medication use, improper documentation of a non-purchased drug, drug purchase without nurse documentation and futile physician attempts to modify prescriptions of unpurchased medication. We found a high rate of physician order turbulence for active vitamin D and calcium.

Conclusions: Drug prescription, documentation and adherence are incongruent and their mismatches are diverse. Summary estimates do not divulge the extent of these disparities. These system-wide communication failures compromise patient care. Strategies to promote system reconciliation and reasonable medication prescription are in need.

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Related in: MedlinePlus

Medication purchase, reporting and adherence patterns of ACE inhibitors and ARB’s, in the form of color medication plates. The plates reflect patient purchase patterns (A), nurse reported intake (B), patient adherence calculations (C) and purchase and dose consistencies (D). Each row represents a patient and each column represents a month, rows are numbered from 1 to 75 and each represents a patient in our study. E depicts color coding of the medication plates.
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Fig1: Medication purchase, reporting and adherence patterns of ACE inhibitors and ARB’s, in the form of color medication plates. The plates reflect patient purchase patterns (A), nurse reported intake (B), patient adherence calculations (C) and purchase and dose consistencies (D). Each row represents a patient and each column represents a month, rows are numbered from 1 to 75 and each represents a patient in our study. E depicts color coding of the medication plates.

Mentions: In addition to calculating the adherence rate, we found during data collection that the patterns of medication purchase and reported intake were inconsistent to the extent that merely presenting descriptive statistics would have underscored the patchiness of the phenomenon. We therefore sought to present the raw data itself to allow a better appreciation of what we perceived as therapeutic pandemonium (Figure 1 and Additional file 1: Figures S2-S12). In these diagrams, drug intake behavior of individual patients is depicted in each row and each column represents a calendar month. These comprehensive plates reflect patient purchase patterns (designated A), nurse reported intake (designated B), patient adherences (designated C) and purchase and dose consistencies/discrepancies (designated D) in the form of color medication plates. Each plate depicts one drug or a family of drugs. The rows are numbered from 1 to 75 and each represents a patient in our study. Each patient is consistently represented by the same number. In all plates, white bars reflect patient death.Figure 1


Summary adherence estimates do not portray the true incongruity between drug intake, nurse documentation and physicians' orders.

Cohen-Glickman I, Haviv YS, Cohen MJ - BMC Nephrol (2014)

Medication purchase, reporting and adherence patterns of ACE inhibitors and ARB’s, in the form of color medication plates. The plates reflect patient purchase patterns (A), nurse reported intake (B), patient adherence calculations (C) and purchase and dose consistencies (D). Each row represents a patient and each column represents a month, rows are numbered from 1 to 75 and each represents a patient in our study. E depicts color coding of the medication plates.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230519&req=5

Fig1: Medication purchase, reporting and adherence patterns of ACE inhibitors and ARB’s, in the form of color medication plates. The plates reflect patient purchase patterns (A), nurse reported intake (B), patient adherence calculations (C) and purchase and dose consistencies (D). Each row represents a patient and each column represents a month, rows are numbered from 1 to 75 and each represents a patient in our study. E depicts color coding of the medication plates.
Mentions: In addition to calculating the adherence rate, we found during data collection that the patterns of medication purchase and reported intake were inconsistent to the extent that merely presenting descriptive statistics would have underscored the patchiness of the phenomenon. We therefore sought to present the raw data itself to allow a better appreciation of what we perceived as therapeutic pandemonium (Figure 1 and Additional file 1: Figures S2-S12). In these diagrams, drug intake behavior of individual patients is depicted in each row and each column represents a calendar month. These comprehensive plates reflect patient purchase patterns (designated A), nurse reported intake (designated B), patient adherences (designated C) and purchase and dose consistencies/discrepancies (designated D) in the form of color medication plates. Each plate depicts one drug or a family of drugs. The rows are numbered from 1 to 75 and each represents a patient in our study. Each patient is consistently represented by the same number. In all plates, white bars reflect patient death.Figure 1

Bottom Line: Drug practices were abstracted from their records and compared to electronic pharmacy data.We found a high rate of physician order turbulence for active vitamin D and calcium.Summary estimates do not divulge the extent of these disparities.

View Article: PubMed Central - PubMed

Affiliation: Dialysis unit, Nephrology and Hypertension services, Hadassah-Hebrew University Medical Center, POB 12000, En Kerem campus, Jerusalem 91120, Israel. yhaviv@hadassah.org.il.

ABSTRACT

Background: Hemodialysis patients (HD) need to adhere to a complex medication regimen. Because their daily pill burden is one of the highest reported, poor compliance is a major cause of therapeutic failure. The primary aim of this study was to define patterns of medication prescription, intake and documentation among HD patients.

Methods: HD patients treated between 2007 and 2009 and assigned to the largest health service provider in Israel were randomly selected. Drug practices were abstracted from their records and compared to electronic pharmacy data. The discrepancy between drug intake reports and the actual purchase was measured to estimate adherence. Drug purchase, intake report and physician order were plotted in complementing diagrams to appreciate consistency and discrepancy patterns.

Results: The study included full analysis of 75 patients. The mean overall drug adherence was 56.7% (95% CI 53.6-59.9%), varying among drug families and over time. Often, there was a systematic disengagement between the nurses' documentation and the actual patient purchase. Specifically, we observed either different quantities of medication use, improper documentation of a non-purchased drug, drug purchase without nurse documentation and futile physician attempts to modify prescriptions of unpurchased medication. We found a high rate of physician order turbulence for active vitamin D and calcium.

Conclusions: Drug prescription, documentation and adherence are incongruent and their mismatches are diverse. Summary estimates do not divulge the extent of these disparities. These system-wide communication failures compromise patient care. Strategies to promote system reconciliation and reasonable medication prescription are in need.

Show MeSH
Related in: MedlinePlus