నైరూప్య
Clinical Pharmacy-2013 : How to develop and assess innovative medication safety clinical programs - Ann Marie Snyder - University of Florida School of Pharmacy
Ann Marie Snyder
Background:
It is well recognized that medication errors occur and can affect success in treating patients. Programs in Germany using the teacher-practitioner model and an HIV/AIDS service in the USA are few of the clinical programs developed and assessed.
Objectives:
In both programs the objective was to 1) determine the incidence medication errors; and 2) describe the nature and cause(s) of errors to guide future programs.
Methods:
In 1 program 10 student-paired groups were used as extenders on an internal medicine ward in 3 consecutive 4- hour long blocks using a paper-based system. In another program a daily antiretroviral utilization report was used to identify adults who were receiving ART, and had been admitted to a tertiary care teaching hospital during 2 consecutive months in 2005. Patients’ charts, medication profiles, and medication administration records were reviewed for medication errors. Once identified, etiology and cause were further investigated through interviews.
Results:
In the first example, 29 actual drug-related problems were identified in 9 patients, median age of 71, range 51-88. There was an average of three drug-related problems per patient, range 1-5. In the later study 69 combined ART- and (OI)-related medication errors were identified in 20 of 26 (77%) evaluated patients, with 2.7 medication errors per patient with 54% of the errors occurred within the first 24 hours of admission. Inadequate medication reconciliation on admission caused 21 of 37 (57%) admission related errors. The most prevalent error types included missing doses (20%), under-dosing (13%), over-dosing (13%), therapy omission (13%), and drug-drug interaction (12%).
Conclusions:
Prospective investigation of potential for medication errors provided in-depth insight into the diverse nature of medication errors, risk factors and potential preventive strategies of the errors. Various approaches can be used based on resources and primary concerns. Maintaining the service and re- evaluation of the changes is possible.
The expression "clinical research" alludes to the whole reference index of a medication/gadget/biologic, in certainty any test article from its origin in the lab to first experience with the shopper advertise and past. When the promising up-and-comer or the particle is distinguished in the lab, it is exposed to pre-clinical investigations or creature examines where various parts of the test article (counting its security harmfulness if relevant and adequacy, if conceivable at this beginning period) are studied. In the United States, when a test article is unapproved or not yet cleared by the Food and Drug Administration (FDA), or when an endorsed or cleared test article is utilized in a manner that may altogether build the dangers (or diminishes the adequacy of the dangers), the information acquired from the pre-clinical examinations or other supporting proof, contextual investigations of off name use, and so on are submitted on the side of an Investigational New Drug (IND) application to the FDA for survey before leading examinations that include even one human and a test article if the outcomes are planned to be submitted to or held for assessment by the FDA whenever later (on account of a previously affirmed test article, whenever expected to submit or hold for review by the FDA on the side of a change in naming or promoting). Where gadgets are concerned the accommodation to the FDA would be for an Investigational Device Exemption (IDE) application if the gadget is a huge hazard gadget or isn't here and there absolved from earlier accommodation to the FDA. Likewise, clinical research may require Institutional Review Board (IRB) or Research Ethics Board (REB) and conceivably other institutional advisory group surveys, Privacy Board, Conflict of Interest Committee, Radiation Safety Committee, Radioactive Drug Research Committee, and so forth endorsement whether the exploration requires earlier accommodation to the FDA. Clinical research audit standards will rely upon which government guidelines the exploration is dependent upon (e.g., (Department of Health and Human Services (DHHS) if governmentally financed, FDA as of now examined) and will rely upon which guidelines the establishments buy in to, notwithstanding any progressively severe measures included by the organization conceivably in light of state or nearby laws/strategies or accreditation substance proposals. This extra layer of audit (IRB/REB specifically) is basic to the security of human subjects particularly when you consider that regularly look into subject to the FDA guideline for earlier accommodation is permitted to continue, by those equivalent FDA guidelines, 30 days after accommodation to the FDA except if explicitly told by the FDA not to start the investigation. Clinical research is frequently led at scholarly clinical focuses and associated look into study locales. These focuses and destinations give the eminence of the scholastic establishment just as access to bigger metropolitan territories, giving a bigger pool of clinical members. These scholarly clinical focuses regularly have their inner Institutional Review Boards that supervise the moral direct of clinical research. The clinical research environment includes an intricate system of locales, pharmaceutical organizations and scholarly research establishments. This has prompted a developing field of innovations utilized for dealing with the information and operational elements of clinical research. Clinical research the board is regularly supported by eClinical frameworks to help mechanize the administration and leading of clinical preliminaries. In the European Union, the European Medicines Agency (EMA) acts along these lines for considers directed in their district. These human examinations are led in four stages in look into subjects that offer agree to take an interest in the clinical preliminaries.