The Impact Of Electronic Medication Administration Records (e-MAR) On Medication Administration Safety And Nurses' Work
Funder
National Health and Medical Research Council
Funding Amount
$735,675.00
Summary
The demands on health systems, both nationally and internationally, are growing, exacerbated by an ageing population and health workforce shortages. The incorporation of information technology into new health care delivery models promises both improvements in the safety and efficiency of care delivery. Medication errors are one of the most significant safety issues for health care systems. Medication management occupies a significant amount of nurses' time, and is also fraught with error potenti ....The demands on health systems, both nationally and internationally, are growing, exacerbated by an ageing population and health workforce shortages. The incorporation of information technology into new health care delivery models promises both improvements in the safety and efficiency of care delivery. Medication errors are one of the most significant safety issues for health care systems. Medication management occupies a significant amount of nurses' time, and is also fraught with error potential. One-third of all medication errors that cause patient harm arise from medication administration errors (MAEs). Electronic medication administration records (e-MARs) provide the potential to make the administration of medications safer for patients by reducing error rates, and also by allowing nurses to more efficiently manage medication tasks. However there is very limited research from Australia or overseas which has examined whether they computerised system work and in fact reduce error rates or save nurses time. In this project we will conduct prospective, controlled observational studies to determine the effectiveness of an electronic medication administration record (e-MAR) to reduce MAEs and the amount of time nurses spend in the medication administration process. The project will apply innovative data collection tools using PDA software purpose-built for these studies which have undergone extensive pilot testing in clinical settings. The results will have important implications for hospitals across Australia and internationally as they consider the implementation of e-MARs. This research will provide the first comprehensive data of medication administration errors in Australia against which future preventative error strategies can be evaluated. The results will provide the evidence needed to develop recommendations about how to reduce MAEs and improve the design of e-MARs.Read moreRead less
Improving Medication Safety In Seniors: A Cross-Jurisdictional Linkage Project
Funder
National Health and Medical Research Council
Funding Amount
$636,717.00
Summary
The project will identify priorities for tackling the current epidemic of hospitalisation of Australians aged 65+ years due to side effects of their medications. Two different groups of medications will be investigated. The first will be the prescribed drugs most often recorded as causes of hospital stay, including those taken to stop blood clotting, for high blood pressure and other cardiovascular problems, for rheumatism or strong pain relief, anti-cancer drugs and steroids. The study will exa ....The project will identify priorities for tackling the current epidemic of hospitalisation of Australians aged 65+ years due to side effects of their medications. Two different groups of medications will be investigated. The first will be the prescribed drugs most often recorded as causes of hospital stay, including those taken to stop blood clotting, for high blood pressure and other cardiovascular problems, for rheumatism or strong pain relief, anti-cancer drugs and steroids. The study will examine which of these drugs taken under what circumstances has the highest risk, so prevention can be better targeted. The study will investigate if adequate laboratory monitoring of the anti- clotting drugs is taking place and whether the guidelines should be updated. The second group will be 68 medications that should be avoided in seniors according to an international expert panel. The research will see how often these 'inappropriate medications' are still prescribed in the Australian setting, and the size of their contributions to unplanned hospital stays. The researchers suspect that this problem is much larger than immediately apparent from routine statistics, because many of the side effects of inappropriate medications are non-specific, such as confusion, drowsiness or difficulty standing up, thus putting seniors at risk of falls and neglect of other aspects of their health. The study will use a unique and new Australian research facility, which has brought together health data on the entire population of WA from both the State and Commonwealth levels, including information on pharmaceuticals, Medicare use, hospital stays and deaths. The facility works in such a way as to preserve patient and GP privacy. A strong feature of this research will be the degree of involvement of a representative and voluntary group of older Australian patients who attend GP clinics, and the GPs themselves, in advising the researchers on what's important to consumers and GPs.Read moreRead less
Ongoing Prospective Audit Using High Quality Data And Database Linkage To Improve The Outcomes Of Macular Disease
Funder
National Health and Medical Research Council
Funding Amount
$843,237.00
Summary
FRB! is a national collaboration of retinal research centres that will collect data during the usual patient consultation. We will track the risks and benefits of the new treatments for macular disease which will inform the development of evidence based clinical management guidelines to assist the clinician to deliver the most appropriate treatment in the safest, most cost effective manner. We aim to support this with information from linked population health databases.
Improving Asthma Control: General Practice Strategies To Optimise Medication Adherence
Funder
National Health and Medical Research Council
Funding Amount
$460,820.00
Summary
Asthma is a major health problem for Australia. Many patients have frequent symptoms and need urgent health care because they do not use a preventer inhaler regularly. This may be intentional e.g. fear of side-effects, and-or unintentional e.g. forgetting. This real-life study will test two simple strategies for GPs to improve their patients' use of preventer medications, to improve asthma control. Innovative technology will allow GPs to tailor the approach to each patient during a normal visit.
Consumer Co-payments For Subsidised Medicines: Impact On Access And Health Outcomes
Funder
National Health and Medical Research Council
Funding Amount
$465,838.00
Summary
Expenditure on pharmaceuticals subsidised under the Pharmaceutical Benefits Scheme (PBS) in Australia was >$6.5b in 2003-04. In efforts to ensure that medicine costs remain affordable, the government instituted cost-effectiveness assessments for listing, brand premium policies and generic substitution and consumer copayments. International research suggests copayments may affect vulnerable populations(1-4) and impact adversely on medicine use(10). In Australia, dispensings of essential and di ....Expenditure on pharmaceuticals subsidised under the Pharmaceutical Benefits Scheme (PBS) in Australia was >$6.5b in 2003-04. In efforts to ensure that medicine costs remain affordable, the government instituted cost-effectiveness assessments for listing, brand premium policies and generic substitution and consumer copayments. International research suggests copayments may affect vulnerable populations(1-4) and impact adversely on medicine use(10). In Australia, dispensings of essential and discretionary medicines fell immediately after the introduction of copayments for concessional card holders in 1991(5). Subsequent analysis found that low income general beneficiaries bore the greatest burden of copayments, with PBS expenditure accounting for 7.4% of their income, compared with 2.4% for those with high incomes(6). Costs appear to be becoming a barrier to medicine use in Australia, with a 2005 survey of 702 Australian adults who required regular medications finding 22% did not fill a prescription because of cost in the last 2 years(7). Similar results were reported in 2002 for 23% of 844 sicker Australian adults(8). A regional survey of 420 households found 20% reported they did not purchase all of their prescription medicines due to costs(9). Apart from the initial analysis of medication changes in 1991 as a result of copayment introduction(5), no Australian study has assessed the impact of these on medication use, nor on the impact of any changes in medication use on health outcomes. While copayments may effectively reduce the cost burden of the PBS to government, they may have an unintended negative effect if costs are generated elsewhere in the health system through increased hospitalisations or emergency department attendances as a result of omission of medicines. This research will explore the association between increasing copayments, medication and health service utilisation, information critical for informing policy on increasing consumer copayments.Read moreRead less
The Effect Of Antiepileptic Medication On Indices Of Bone Health And Risk Factors For Falls And Fractures
Funder
National Health and Medical Research Council
Funding Amount
$469,605.00
Summary
Epilepsy is a common brain disorder and most patients with epilepsy take anti-epileptic drugs (AEDs) for many years. These patients have high rates of bone fractures, but the reasons are uncertain. Earlier studies identifying an association between AED use and bone disease were performed on institutionalised patients, and more recent studies on outpatient populations have been conflicting. A better understanding of this problem is critical for designing potential preventive measures and treatmen ....Epilepsy is a common brain disorder and most patients with epilepsy take anti-epileptic drugs (AEDs) for many years. These patients have high rates of bone fractures, but the reasons are uncertain. Earlier studies identifying an association between AED use and bone disease were performed on institutionalised patients, and more recent studies on outpatient populations have been conflicting. A better understanding of this problem is critical for designing potential preventive measures and treatments. One important additional mechanism by which AEDs may increase fracture risk is impairment of gait and balance, leading to a high risk of falls. We have novel data demonstrating the power of a Twin and Matched Sibling approach to study this important problem. This study showed that chronic AED use was associated with significant deficits in bone mineral density (BMD), a key predictor of the risk of fractures. The proposed project will ask the following questions: 1. Is BMD and estimated bone strength lower in the bones most at risk for fracture in women and men chronically taking AEDs? 2. Is the loss of bone in measurements over time greater in patients continuing to take AEDs? 3. Is the risk of bone loss greater for certain types of AEDs, and is the risk influenced by length of exposure, age and menopausal status? 4. How does AED treatment lead to reductions in BMD and bone strength? 5. Are measures of muscle strength, gait and balance impaired in patients taking AEDs compared with matched people not taking AEDs? The proposed study will utilise twins and pairs of siblings to investigate the effects of the long-term use of AEDs for epilepsy on measures of bone mass and strength, indices of bone turnover, vitamin D status, calcium regulating hormones, mineral levels, sex hormone levels, and measures of muscle strength, gait and balance function. In addition, a group of patients newly commencing AED treatment for epilepsy will be studied over 2 years.Read moreRead less
Attentional Effects On Prepulse Inhibition Of The Acoustic Startle Reflex In Patients With Schizophrenia
Funder
National Health and Medical Research Council
Funding Amount
$278,625.00
Summary
People suffering from schizophrenia exhibit differences from healthy people in the startle reflex, which is a blink of the eyes when a sudden loud sound occurs. Normally, this reflex is reduced in size when a quiet sound occurs a few milliseconds before the startling sound, but this prepulse inhibition of the startle reflex or PPI does not occur to the same degree in people with schizophrenia. The underlying causes of this reduction in PPI in patients with schizophrenia is not known. The most co ....People suffering from schizophrenia exhibit differences from healthy people in the startle reflex, which is a blink of the eyes when a sudden loud sound occurs. Normally, this reflex is reduced in size when a quiet sound occurs a few milliseconds before the startling sound, but this prepulse inhibition of the startle reflex or PPI does not occur to the same degree in people with schizophrenia. The underlying causes of this reduction in PPI in patients with schizophrenia is not known. The most commonly accepted theory is that it reflects a deficit in a basic sensorimotor gating function which could underlie a variety of attentional abnormalities observed in schizophrenia. However, our data indicate that patients exhibit more PPI when they ignore the prepulse stimuli. We wish to test the hypothesis that alterations in PPI in schizophrenic patients are secondary to abnormalities in attention. This is significant because the theory can point to a specific cognitive deficit associated with schizophrenia. We have also found that patients treated with some kinds of antipsychotic medications (the newer atypical antipsychotic medications) do not show reductions in PPI, but patients treated with older types of antipsychotic drug do show reductions in PPI. We intend to investigate the effects of different types of antipsychotics on attentional modulation of PPI. This is significant because it may indicate that patients with a specific kind of cognitive impairment may show improvement with a specific type of medicine. Our data suggests that chronic cannabis use may associated with differences in the startle reflex and in PPI. Understanding how such cannabis use alters PPI may provide insights into why so many people with schizophrenia regularly abuse cannabis.Read moreRead less