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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.

Show MeSH
Flow chart showing patients and data inclusion in the study. *CHS-Clalit health services.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
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Fig2: Flow chart showing patients and data inclusion in the study. *CHS-Clalit health services.

Mentions: *Since the different Dialysis units affiliated with our institute do not document patient information in an identical manner, not all information presented was availed for all patients. See text and FigureĀ 2 for exclusion criteria.


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)

Flow chart showing patients and data inclusion in the study. *CHS-Clalit health services.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Flow chart showing patients and data inclusion in the study. *CHS-Clalit health services.
Mentions: *Since the different Dialysis units affiliated with our institute do not document patient information in an identical manner, not all information presented was availed for all patients. See text and FigureĀ 2 for exclusion criteria.

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