Safety of People with Intellectual Disabilities in Hospital. What Can the Hospital Pharmacist Do to Improve Quality of Care?

How can pharmacists can contribute to safety by improving health outcomes and reducing health inequalities for people with intellectual disabilities?

Source: Pharmacy | Free Full-Text

Author: Bernadette Flood

Abstract 

People with intellectual disabilities are vulnerable in healthcare environments. They experience health and healthcare inequalities, and when admitted to general hospitals are at a greater risk of patient safety incidents. This is well known in specialist services, but less recognized within primary or secondary healthcare. The most significant barriers to safer and better healthcare appear to include ‘invisibility’ of people with intellectual disabilities within health-care systems, widespread lack of staff understanding of intellectual disability, the vulnerabilities of people with intellectual disabilities, and the reasonable adjustment they may need in order to access health-care services. They may be ‘invisible’ to pharmacists in general hospitals. This article aims to raise awareness among those pharmacists and others providing care and support to people with intellectual disabilities in hospital in relation to how pharmacists can contribute to safety. Medication is the main therapeutic intervention in this population. Research is needed to determine the role of pharmacists in improving health outcomes and reducing health inequalities in this vulnerable population group when they are admitted to general hospitals. Full article
(This article belongs to the Special Issue Health Services Research in the Use of Medicines)

Pain and pain assessment in people with intellectual disability: Issues and challenges in practice

Source: 2017 – British Journal of Learning Disabilities – Wiley Online Library

Authors: Owen Doody, Maria E. Bailey

Abstract

Accessible summary

Pain is difficult to identify when people cannot communicate. If pain is not identified, it cannot be managed and causes stress. Pain assessment is essential in order to identify pain. Pain assessment requires a combination of knowledge, health assessments and observations.

Abstract

Background Individuals with intellectual disability experience the same chronic diseases and conditions as the general population, but are more likely to have physical and psychological co-morbidities, resulting in a higher risk of experiencing pain and having more frequent or severe pain.

Method This position paper aims to highlight the importance of pain assessment for people with intellectual disability. Results As people with intellectual disability live within the community and/or remain in the family home, they are accessing a wide range of healthcare services. This necessitates that nurses across all care settings are knowledgeable regarding appropriate/alternative pain assessment methods for people with intellectual disability. While many pain assessment tools are available for use with the intellectual disability population, they are often not well established or infrequently used to establish their validity.

Conclusion Although self-report is the gold standard in pain assessment, pain assessment for people with intellectual disability is often challenging as they may be unable to self-report their pain due to their levels of communication or cognitive ability. Assessment requires a combination of approaches amalgamating: pain assessment, health assessment and observation of behaviours.

“Tell me what they do to my body”: A survey to find out what information people with learning disabilities want with their medications

Fifty-eight people completed the questionnaire. Many of them said they did not get enough information about their medicine. Most people wanted easy-read leaflets and pictures.

Authors: Rebecca Fish, Chris Hatton, Umesh Chauhan

Source: British Journal of Learning Disabilities – 2017 – Wiley Online Library

Abstract

Accessible summary

We gave a questionnaire to self-advocates who were attending a conference. The questionnaire asked them how they felt about the information they get with their medicine. Fifty-eight people completed the questionnaire. Many of them said they did not get enough information about their medicine. Most people wanted easy-read leaflets and pictures. There are many different places to find easy-read information on the internet. We think they should be collected and checked. We also think that doctors and chemists need to spend more time with people to explain about medicines.

Abstract

Background Previous research has found that people with learning disabilities are not given prescription information that is tailored to their needs. We wanted to find out people’s information requirements.

Materials and Methods A questionnaire was co-produced by the authors and consultants with learning disabilities. It asked what information people received from their GP and pharmacist about medications. The questionnaire was circulated at a self-advocacy conference in the North of England. Fifty-eight self-advocates completed the questionnaire.

Results Information from GPs and pharmacists was mainly instructional, referring to when and how to take the medicine and dosage. Most respondents struggled to read the leaflets and remember verbal information. Many wanted the information in easy-read format, and some wanted pictures or diagrams as well. A key theme was that health professionals often talked only to carers or support workers rather than involving the patient directly, and some respondents disclosed that they were not informed about side effects or alternative medications.

Conclusions Health professionals should take time to discuss health issues and medication with the individual rather than only with carers. This could be facilitated by providing information in an accessible format.

Opioid Prescribing: Where you live matters

Source: Opioid Prescribing: Where you live matters

Download Opioid Factsheet

The amount of opioids prescribed in the US peaked in 2010 and then decreased each year through 2015. However, prescribing remains high and vary widely from county to county. Healthcare providers began using opioids in the late 1990s to treat chronic pain (not related to cancer), such as arthritis and back pain. As this continued, more opioid prescriptions were written, for more days per prescription, in higher doses. Taking opioids for longer periods of time or in higher doses increases the risk of addiction, overdose, and death. In 2015, six times more opioids per resident were dispensed in the highest-prescribing counties than in the lowest-prescribing counties. County-level characteristics, such as rural versus urban, income level, and demographics, only explained about a third of the differences. This suggests that people receive different care depending on where they live.  Healthcare providers have an important role in offering safer and more effective pain treatment.

Healthcare providers can:

  • Follow the CDC Guideline for Prescribing Opioids for Chronic Pain, which includes recommendations such as:
    • Use opioids only when benefits are likely to outweigh risks.
    • Start with the lowest effective dose of immediate-release opioids.  For acute pain, prescribe only the number of days that the pain is expected to be severe enough to require opioids.
    • Reassess benefits and risks if considering dose increases.
  • Use state-based prescription drug monitoring programs (PDMPs) which help identify patients at risk of addiction or overdose.

Knowledge and expectations of direct support professionals towards effects of psychotropic drug use in people with ID

To achieve sufficient collaboration of intellectual disability support professionals in reducing inappropriate psychotropic drug use of clients, vocational educational training is needed.

Source: Knowledge and expectations of direct support professionals towards effects of psychotropic drug use in people with intellectual disabilities – Kuijper – 2017 – Journal of Applied Research in Intellectual Disabilities – Wiley Online Library

Abstract

Background/Introduction

In this study, we investigated intellectual disability support professionals’ knowledge and expectations towards effects of psychotropic drug use on behaviour and drug use in their clients, because shortcomings may lead to misinterpretations of behavioural symptoms and inappropriate drug use.

Methods

Two self-designed questionnaires were used to measure the knowledge and expectations of 194 support professionals in 14 residential facilities regarding psychotropic drug use and effects of antipsychotics on behavioural, cognitive and mental functioning of people with intellectual disability. The psychometric properties of both questionnaires were adequate.

Results

A majority of the professionals had unrealistic expectations regarding the positive effects of antipsychotics on cognitive and behavioural functioning, and 94% scored below the cut-off scores regarding knowledge; 60% indicated they needed education and training.

Conclusions

To achieve sufficient collaboration of intellectual disability support professionals in reducing inappropriate psychotropic drug use of clients, vocational educational training is needed.

Study finds $200 billion in avoidable health care costs | American Pharmacists Association

Source: Study finds $200 billion in avoidable health care costs | American Pharmacists Association

Medication misuse, non-adherence, errors contribute to wasteful spending

Health care costs caused by improper and unnecessary use of medications exceeded $200 billion in 2012, amounting to an estimated 10 million hospital admissions, 78 million outpatient treatments, 246 million prescriptions, and 4 million emergency department visits annually, according to a new report from the IMS Institute for Healthcare Informatics.

This amount, representing 8% of the nation’s health care spending that year, “could pay for the health care of more than 24 million currently uninsured U.S. citizens,” said Murray Aitken, IMS Executive Director, in a news release announcing the report, Avoidable Costs in U.S. Healthcare: The $200 Billion Opportunity from Using Medicines More Responsibly.

These avoidable costs arose when patients failed to receive the right medications at the right time or in the right way, or received them but failed to take them, according to the report. Improvement is necessary in six areas: medication nonadherence, lag in adoption of evidence-based treatment practice, misuse of antibiotics, medication errors, suboptimal use of generics, and mismanaged polypharmacy in older adults.

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