ABSTRACT
BACKGROUND: The incidence of preventable adverse drug events (ADE) is approximately one medication error per patient per hospital-day. A quality medication reconciliation (MedRec) process is a crucial intervention used to reduce ADE in the hospital and community setting. Amid the coronavirus disease 2019 (COVID-19) pandemic, preventing medication errors is vital to avoid patient readmission, reduce disease complications, and reduce cost and patient burden on the healthcare system. OBJECTIVES: To develop a standardized MedRec framework that can be implemented in all healthcare settings to reduce patient and staff harm during COVID-19. Also, to create a standardized auditing tool used to assess the quality of the MedRec process and allow for continuous quality improvement. METHODS: A multi-site gap analysis (MGA) was performed to collect observational data that were collected from four different healthcare sites (two hospitals, a long-term care facility, and a community pharmacy). MGA consists of collecting data across several sites which answer a standardized questionnaire. A standardized MedRec framework and auditing tool were developed based on the gaps observed in each site and literature reviews. RESULTS: A standardized MedRec process was not implemented in any of the observed sites. The healthcare sites lacked a designated MedRec team and training related to the MedRec process leading to multiple discrepancies at discharge. Patients were not counselled on changes to home medications, and a discharge report was often not provided upon discharge. Communication mechanisms between community pharmacies and hospital physicians are not available or easily accessible. CONCLUSION: The proposed structured MedRec framework is vital to reduce medication errors and patient harm amid COVID-19. Moreover, the comprehensive auditing tool developed in this study allows for continuous quality improvement resulting in superior quality care, reduction of workflow inefficiencies, cost savings on hospital readmissions, and overall enhanced healthcare system performance.
ABSTRACT
When the first wave of COVID-19 hit in March 2020, health care professionals across Canada were challenged to quickly and efficiently adapt to change their work practices in these unprecedented times. Pharmacy professionals, being some of the very few front-line health care workers who remained accessible in person for patients, had to rapidly adopt critical changes in their pharmacies to respond in the best interest of their patients and their pharmacy staff. As challenging and demanding as such changes were, they provided pharmacists with invaluable lessons that would be imperative as the country enters a potentially more dangerous second wave. This article seeks to identify and summarize opportunities for improvement in pharmacy as learnt from the pandemic's first wave. Such areas include but are not limited to handling of drug shortage and addressing drug hoarding and stockpiling, providing physical and mental support for staff, timing of flu vaccine and COVID-19 screening/testing, collaboration between different health care sites as well as collaboration with patients and with other health care professionals, telemedicine and willingness to adopt innovative ideas, need for more staff training and more precise research to provide accurate information and finally the need for more organizational and workplace support. Learning from what went well and what did not work in the early stages of the pandemic is integral to ensure pharmacy professionals are better prepared to protect themselves and their patients amidst a second and possibly subsequent waves.
ABSTRACT
Most of the current "literature" surrounding the presence of thrombosis in COVID-19 disease and appropriate prophylaxis/treatment modalities is certainly retrospective at best, and anecdotal at worst. But in these times of rapidly changing information and perspective, an assessment of all available data (including expert opinion) is the goal of this review. Bleeding risk factors for COVID-19-associated bleeding may include other systemic diseases, including hypertension, diabetes, cardiovascular disease, and immunosuppression. Individuals with hypertension should not discontinue their medication. Current evidence does not support changes in the management of hypertension. As COVID-19 progresses, coagulation pathways are activated as part of the host inflammatory response to limit the viral infection. Specifically, D-dimers, products of fibrin as it is degraded within clots, are elevated in many cases of hospitalized COVID-19 patients. D-dimers are an indicator of a clot (thrombus) formation and breakdown. More severe COVID-19 disease may lead to overt disseminated intravascular coagulation (DIC), associated with high mortality. DIC is a coagulopathy that may arise from the systemic inflammatory response to the virus and damaged tissue caused by the infection. Bleeding risk factors may include other systemic diseases, including hypertension, diabetes, cardiovascular disease, and immunosuppression. Individuals with hypertension should not discontinue their medication. Current evidence does not support changes in the management of hypertension. As COVID-19 progresses, coagulation pathways are activated as part of the host inflammatory response to limit the viral infection. Specifically, D-dimers, products of fibrin as it is degraded within clots, are elevated in many cases of hospitalized COVID-19 patients. D-dimers are an indicator of a clot (thrombus) formation and breakdown. More severe COVID-19 disease may lead to overt disseminated intravascular coagulation (DIC), associated with high mortality. DIC is a coagulopathy that may arise from the systemic inflammatory response to the virus and damaged tissue caused by the infection. My manuscript presents the risk and evidence around the COVID-19-associated coagulopathies.