Biomedical subjects

Steven M Handler

Publications and source records attributed to Steven M Handler.

4 recordsLinked to original sources

PubMed2006

Epidemiology of medication-related adverse events in nursing homes.

BACKGROUND: Nursing home residents are prescribed more medications than patients in any other clinical setting. Although pharmacotherapy for older nursing home residents is usually safe and effective, it can lead to medication-related adverse events such as adverse drug reactions (ADRs), adverse drug withdrawal events (ADWEs), and therapeutic failures (TFs). OBJECTIVE: This article reviews the descriptive (incidence) and analytic (risk factor) epidemiology of medication-related adverse events occurring in nursing home residents as reported in the literature during the last 2 decades. METHODS: A search of MEDLINE and International Pharmaceutical Abstracts was conducted for articles published in English between January 1986 and July 2006 using the following terms: adverse drug events, adverse drug reactions, adverse drug withdrawal events, aged, drug therapy, drug-related problems, medication-related problems, nursing homes, therapeutic failures, and treatment failures. The reference lists of identified articles, recent review articles, book chapters, and the authors' reference library were also searched manually. RESULTS: Seven studies met the inclusion and exclusion criteria and were included in this review. Five studies described ADRs, 1 described ADWEs, and 1 described TFs. The studies of ADRs used different methods of detecting ADRs, resulting in incidence rates ranging from 1.19 to 7.26 per 100 resident-months. The single study of ADWEs reported an incidence of 2.60 per 100 resident-months. An incidence rate for the single study describing TFs could not be calculated. CONCLUSIONS: Medication-related adverse events are common in the nursing home setting. Additional studies are needed to enhance the detection and prevention of medication-related adverse events and to reduce their impact on residents' outcomes and health care costs.

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PubMed2005

Pharmacist detection of peripheral arterial disease through the use of a handheld Doppler.

STUDY OBJECTIVE: To evaluate the effectiveness of a program in which pharmacists screened at-risk patients for peripheral arterial disease using a handheld doppler device. DESIGN: Prospective study. SETTING: Primary care and consultative outpatient clinic. PATIENTS: Forty-one physician-referred patients older than 55 years who had no documented history of peripheral arterial disease. INTERVENTION: The pharmacists administered the San Diego Claudication Questionnaire and performed doppler examinations to calculate ankle-to-brachial indexes (ABIs). Patients with symptoms of claudication or with an ABI of 0.9 or less were considered to have possible peripheral arterial disease. Each diagnosis was confirmed by a physician. These patients were either referred for further evaluation, provided with immediate treatment, or told to continue their current drug regimen, if appropriate. MEASUREMENTS AND MAIN RESULTS: Eight (19.5%) of the 41 patients were diagnosed with peripheral arterial disease. Antiplatelet therapy was started in five patients, and one patient was referred to a vascular specialist. CONCLUSION: This pharmacist-initiated program effectively detected peripheral arterial disease in previously unscreened patients.

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PubMed2004

Medication error reporting in long term care.

BACKGROUND: Medication errors are common causes of medical error in the long-term care (LTC) setting. Despite their frequency and potential clinical impact, most medication errors in LTC facilities remain unreported. Before better reporting systems can be developed to reduce clinically significant medication errors, it is necessary to understand how current medication error reporting systems function. OBJECTIVE: This study describes the medication use and medication error reporting processes, and characterizes the knowledge, attitudes, and beliefs about medication errors of the nursing staff at a single LTC facility. METHODS: Three methods were used to characterize the medication use and medication error reporting processes and the nursing staff's perceptions about such errors. First, key elements and basic processes were defined through observation and semi-structured interviews. Second, medication error reports were reviewed and summarized over a 21-month period. Third, nursing facility staff were surveyed about their knowledge, attitudes, and beliefs concerning medication errors. RESULTS: The medication use process in the LTC setting is similar to that employed in the acute care setting, consisting of 5 steps: prescribing, documenting, dispensing, administering, and monitoring. In the facility studied, an average of 4.7 medication error reports were submitted per month. Staff felt that half of all medication errors were identified and communicated informally through change-of-shift reports rather than through medication error reports. Most staff (85%) believed that disciplinary action was taken against the person who committed an error. CONCLUSIONS: The medication error policies and processes of the LTC facility studied were associated with a low frequency of formal reporting, a narrow perspective on the sources of error, and concerns about disciplinary action. Research is needed to better identify errors, develop interventions that broaden the monitoring perspective to include all health care professionals, reduce the work of reporting, standardize the information collected, and create an institutional atmosphere of participation rather than punishment.

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PubMedDate not supplied

Development and evaluation of a charge capture program for long-term care providers.

OBJECTIVE: Clinicians often have difficulty determining the appropriate Current Procedural Terminology Evaluation and Management code to assign to the type and intensity of patient care they provide. The purpose of this study was to develop, implement, and evaluate a handheld charge capture program for use by providers in the long-term care setting. DESIGN: Using a pre-post study design, we compared the coding accuracy and user satisfaction of an established paper process with a handheld charge capture program created for this study by means of: (1) preimplementation and postimplementation assessment of coding accuracy, and (2) preimplementation and postimplementation clinician survey. SETTING: We studied an academic division of geriatric medicine. PARTICIPANTS: Participants consisted of six clinicians who currently spend at least 50% of their clinical time practicing in the long-term care setting. INTERVENTION: A handheld charge capture program to replace the current paper-based charge capture process was reviewed. RESULTS: Overall coding accuracy improved by approximately 20% when the handheld program was used instead of a paper coding process. The majority of clinicians found that the handheld program was more widely available, efficient, easier to use, and encouraged the participants to document more completely and accurately in the patient's medical record. CONCLUSION: A handheld billing and coding program used by clinicians who provide care for long-term care residents is not only feasible, but leads to an improvement in coding accuracy when compared with a paper process. In addition, clinician satisfaction toward the billing and coding processes improved with the use of the handheld program.

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