Objective: To investigate the feasibility of switching overweight schizophrenic patients to arip... more Objective: To investigate the feasibility of switching overweight schizophrenic patients to aripiprazole and to assess the impact of 12 months of aripiprazole treatment on weight in routine practice.Method: This was a non-controlled cohort study in overweight schizophrenic patients. Data were collected before treatment with aripiprazole was started and at 12-month follow-up.Results: A total of 53 patients were included; of these 55% continued using aripiprazole for 12 months. Aripiprazole treatment for 12 months (P = 0.027) and stopping clozapine or olanzapine treatment (P = 0.038) predicted weight loss (≥3 kg). Patients receiving aripiprazole monotherapy (n = 16, mean −3.0 kg) had similar weight loss than patients receiving aripiprazole in addition to another antipsychotic drug (n = 13, mean −4.4 kg).Conclusion: In routine practice once aripiprazole treatment was started, more than half of the patients remained on aripiprazole and most of them lost weight. Adding aripiprazole to clozapine gave similar weight loss as monotherapy with aripiprazole.
The effectiveness of pharmacotherapy partly depends on patients' compliance. However nonc... more The effectiveness of pharmacotherapy partly depends on patients' compliance. However noncompliance with pharmacotherapy occurs frequently. It is particularly a problem in diseases requiring long-term treatment. On average chronically ill patients only take about half of their medication as prescribed. Especially patients with chronic psychiatric diseases, such as schizophrenia, are known to have low compliance rates. Atypical antipsychotics or depot medication are believed to improve compliance. In our systematic literature review we identified ten studies analysing the differences in compliance rates between atypical and typical antipsychotics. However our analyses did not show a difference in compliance rates except for clozapine. The higher compliance rates for clozapine might be explained by the regular monitoring and thus frequent patient contact. A positive effect of depot antipsychotics on compliance could be explained by the easy detection of noncompliant patients.
Objective To determine the incidence of errors in preparing and administering intravenous (i.v.) ... more Objective To determine the incidence of errors in preparing and administering intravenous (i.v.) drugs, identify the stages in the process at which errors occurred and evaluate their clinical importance. Methods A prospective ethnographic study using disguised observation was carried out on two wards in one German non-university hospital. Results We observed 22 nurses administering 122 i.v. drug preparations and administrations. One or more errors occurred in the preparation and administration of 58 of 122 i.v. drug doses (error rate 48%, 95% confidence interval 39–57%). In total, 65 errors were identified. Of doses, 4 had potentially severe errors (3%), 38 (31%) potentially moderate errors and 16 (13%) potentially minor errors. Common errors included multiple step preparations and the co-administration of potentially incompatible drugs as intermittent infusions. Conclusion A high incidence of i.v. drug errors was found in the study hospital. Effective strategies to reduce potentially harmful errors are urgently needed. Measures could include a reduction in the number of ward-based i.v. drug preparations, improvement of staff training and the introduction of ward-based clinical pharmacy services.
Objectives: To investigate the incidence and the severity of intravenous (i.v.) drug preparation ... more Objectives: To investigate the incidence and the severity of intravenous (i.v.) drug preparation and administration errors in two countries and three pharmacy services. Method: A disguised observational method was used to record details of the preparation and administration of prescribed i.v. drugs on two wards in each of three teaching hospitals: one with a traditional British ward pharmacy service (TBP) and two hospitals in Germany, one with a traditional ward stock supply (TGP) and one with a satellite pharmacy service (GSP) with unit dose system. Main outcome measures: Errors in i.v. drug preparation and administration and their potential significance. Results: The number of observed preparations/administrations were: TBP 77/63, TGP 126/109 and GSP 134/106. The preparation error rates were: TBP 22% (95% confidence interval: 13‐31%), TGP 23% (16‐30%) and GSP 31% (23‐39%). The administration error rates were TBP 27% (16‐38%), TGP 49% (39‐58%) and GSP 22% (14‐30%). The percentage of administration errors on the wards with TGP was statistically significantly higher than in the other two services. Common errors at the study sites with TBP and GSP were omissions. Wrong rate of administration occurred most frequently on the wards with TGP. The majority of errors were likely to be of 'moderate' to 'severe' outcome. Careful drug chart reading could possibly reduce omission errors on the wards with TBP. A change of the German nursing law ('Krankenpflegegesetz') to legally entitle nurses to administer i.v. drugs could probably result in better training, national guidelines and standards. Conclusion: This study found a high rate of i.v. medication errors of moderate to severe significance. Changes in practice should be considered to make i.v. therapy safer for patients.
Safety improvements are sometimes based on the premise that introducing measures to combat minor ... more Safety improvements are sometimes based on the premise that introducing measures to combat minor or no-harm incidents proportionately reduces the incidence of major incidents involving harm. This is in line with the principle of the Heinrich ratio, which asserts that there is a relatively fixed ratio between the incidence of no-harm incidents, minor incidents and major incidents. This principle has been advocated as a means of targeting and evaluating new safety initiatives. Both thought experimentation and analysis of empirical data were used to examine the plausibility of this principle. A descriptive statistical analysis was carried out using triangle plots to display the relative frequencies of the occurrence of safety incidents classified as minor, moderate or severe. Thought experiments indicated that the principle of a fixed Heinrich ratio has a dubious logical foundation. Analysis of emergency department attendance and studies of medication errors demonstrated marked variation in the relative ratios of different outcomes. Triangle plots of UK road traffic accident data revealed a hitherto unrecognized systematic pattern of change that contradicts the principle of the Heinrich ratio. This study of the principle of a fixed Heinrich ratio invalidates it: introducing measures to reduce the incidence of minor incidents will not inevitably reduce the incidence of major incidents pro rata. Any safety policies based on the assumption that the Heinrich ratio is true need to be rethought.
Safety improvements are sometimes based on the premise that introducing measures to combat minor ... more Safety improvements are sometimes based on the premise that introducing measures to combat minor or no-harm incidents proportionately reduces the incidence of major incidents involving harm. This is in line with the principle of the Heinrich ratio, which asserts that there is a relatively fixed ratio between the incidence of no-harm incidents, minor incidents and major incidents. This principle has been advocated as a means of targeting and evaluating new safety initiatives. Both thought experimentation and analysis of empirical data were used to examine the plausibility of this principle. A descriptive statistical analysis was carried out using triangle plots to display the relative frequencies of the occurrence of safety incidents classified as minor, moderate or severe. Thought experiments indicated that the principle of a fixed Heinrich ratio has a dubious logical foundation. Analysis of emergency department attendance and studies of medication errors demonstrated marked variation in the relative ratios of different outcomes. Triangle plots of UK road traffic accident data revealed a hitherto unrecognized systematic pattern of change that contradicts the principle of the Heinrich ratio. This study of the principle of a fixed Heinrich ratio invalidates it: introducing measures to reduce the incidence of minor incidents will not inevitably reduce the incidence of major incidents pro rata. Any safety policies based on the assumption that the Heinrich ratio is true need to be rethought.
Objective: To investigate the feasibility of switching overweight schizophrenic patients to arip... more Objective: To investigate the feasibility of switching overweight schizophrenic patients to aripiprazole and to assess the impact of 12 months of aripiprazole treatment on weight in routine practice.Method: This was a non-controlled cohort study in overweight schizophrenic patients. Data were collected before treatment with aripiprazole was started and at 12-month follow-up.Results: A total of 53 patients were included; of these 55% continued using aripiprazole for 12 months. Aripiprazole treatment for 12 months (P = 0.027) and stopping clozapine or olanzapine treatment (P = 0.038) predicted weight loss (≥3 kg). Patients receiving aripiprazole monotherapy (n = 16, mean −3.0 kg) had similar weight loss than patients receiving aripiprazole in addition to another antipsychotic drug (n = 13, mean −4.4 kg).Conclusion: In routine practice once aripiprazole treatment was started, more than half of the patients remained on aripiprazole and most of them lost weight. Adding aripiprazole to clozapine gave similar weight loss as monotherapy with aripiprazole.
The effectiveness of pharmacotherapy partly depends on patients' compliance. However nonc... more The effectiveness of pharmacotherapy partly depends on patients' compliance. However noncompliance with pharmacotherapy occurs frequently. It is particularly a problem in diseases requiring long-term treatment. On average chronically ill patients only take about half of their medication as prescribed. Especially patients with chronic psychiatric diseases, such as schizophrenia, are known to have low compliance rates. Atypical antipsychotics or depot medication are believed to improve compliance. In our systematic literature review we identified ten studies analysing the differences in compliance rates between atypical and typical antipsychotics. However our analyses did not show a difference in compliance rates except for clozapine. The higher compliance rates for clozapine might be explained by the regular monitoring and thus frequent patient contact. A positive effect of depot antipsychotics on compliance could be explained by the easy detection of noncompliant patients.
Objective To determine the incidence of errors in preparing and administering intravenous (i.v.) ... more Objective To determine the incidence of errors in preparing and administering intravenous (i.v.) drugs, identify the stages in the process at which errors occurred and evaluate their clinical importance. Methods A prospective ethnographic study using disguised observation was carried out on two wards in one German non-university hospital. Results We observed 22 nurses administering 122 i.v. drug preparations and administrations. One or more errors occurred in the preparation and administration of 58 of 122 i.v. drug doses (error rate 48%, 95% confidence interval 39–57%). In total, 65 errors were identified. Of doses, 4 had potentially severe errors (3%), 38 (31%) potentially moderate errors and 16 (13%) potentially minor errors. Common errors included multiple step preparations and the co-administration of potentially incompatible drugs as intermittent infusions. Conclusion A high incidence of i.v. drug errors was found in the study hospital. Effective strategies to reduce potentially harmful errors are urgently needed. Measures could include a reduction in the number of ward-based i.v. drug preparations, improvement of staff training and the introduction of ward-based clinical pharmacy services.
Objectives: To investigate the incidence and the severity of intravenous (i.v.) drug preparation ... more Objectives: To investigate the incidence and the severity of intravenous (i.v.) drug preparation and administration errors in two countries and three pharmacy services. Method: A disguised observational method was used to record details of the preparation and administration of prescribed i.v. drugs on two wards in each of three teaching hospitals: one with a traditional British ward pharmacy service (TBP) and two hospitals in Germany, one with a traditional ward stock supply (TGP) and one with a satellite pharmacy service (GSP) with unit dose system. Main outcome measures: Errors in i.v. drug preparation and administration and their potential significance. Results: The number of observed preparations/administrations were: TBP 77/63, TGP 126/109 and GSP 134/106. The preparation error rates were: TBP 22% (95% confidence interval: 13‐31%), TGP 23% (16‐30%) and GSP 31% (23‐39%). The administration error rates were TBP 27% (16‐38%), TGP 49% (39‐58%) and GSP 22% (14‐30%). The percentage of administration errors on the wards with TGP was statistically significantly higher than in the other two services. Common errors at the study sites with TBP and GSP were omissions. Wrong rate of administration occurred most frequently on the wards with TGP. The majority of errors were likely to be of 'moderate' to 'severe' outcome. Careful drug chart reading could possibly reduce omission errors on the wards with TBP. A change of the German nursing law ('Krankenpflegegesetz') to legally entitle nurses to administer i.v. drugs could probably result in better training, national guidelines and standards. Conclusion: This study found a high rate of i.v. medication errors of moderate to severe significance. Changes in practice should be considered to make i.v. therapy safer for patients.
Safety improvements are sometimes based on the premise that introducing measures to combat minor ... more Safety improvements are sometimes based on the premise that introducing measures to combat minor or no-harm incidents proportionately reduces the incidence of major incidents involving harm. This is in line with the principle of the Heinrich ratio, which asserts that there is a relatively fixed ratio between the incidence of no-harm incidents, minor incidents and major incidents. This principle has been advocated as a means of targeting and evaluating new safety initiatives. Both thought experimentation and analysis of empirical data were used to examine the plausibility of this principle. A descriptive statistical analysis was carried out using triangle plots to display the relative frequencies of the occurrence of safety incidents classified as minor, moderate or severe. Thought experiments indicated that the principle of a fixed Heinrich ratio has a dubious logical foundation. Analysis of emergency department attendance and studies of medication errors demonstrated marked variation in the relative ratios of different outcomes. Triangle plots of UK road traffic accident data revealed a hitherto unrecognized systematic pattern of change that contradicts the principle of the Heinrich ratio. This study of the principle of a fixed Heinrich ratio invalidates it: introducing measures to reduce the incidence of minor incidents will not inevitably reduce the incidence of major incidents pro rata. Any safety policies based on the assumption that the Heinrich ratio is true need to be rethought.
Safety improvements are sometimes based on the premise that introducing measures to combat minor ... more Safety improvements are sometimes based on the premise that introducing measures to combat minor or no-harm incidents proportionately reduces the incidence of major incidents involving harm. This is in line with the principle of the Heinrich ratio, which asserts that there is a relatively fixed ratio between the incidence of no-harm incidents, minor incidents and major incidents. This principle has been advocated as a means of targeting and evaluating new safety initiatives. Both thought experimentation and analysis of empirical data were used to examine the plausibility of this principle. A descriptive statistical analysis was carried out using triangle plots to display the relative frequencies of the occurrence of safety incidents classified as minor, moderate or severe. Thought experiments indicated that the principle of a fixed Heinrich ratio has a dubious logical foundation. Analysis of emergency department attendance and studies of medication errors demonstrated marked variation in the relative ratios of different outcomes. Triangle plots of UK road traffic accident data revealed a hitherto unrecognized systematic pattern of change that contradicts the principle of the Heinrich ratio. This study of the principle of a fixed Heinrich ratio invalidates it: introducing measures to reduce the incidence of minor incidents will not inevitably reduce the incidence of major incidents pro rata. Any safety policies based on the assumption that the Heinrich ratio is true need to be rethought.
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