Finding Consensus About the Level of Medication Safety in a Hospital Setting: Development and an Example of Application of a Modified Delphi Method.

A version of the Institute for Safe Medication Practices (ISMP) questionnaire adapted to the Austrian inpatient setting was used to sample the estimates of a group of experts regarding the level of medication safety in a level II hospital. To synthesize expert opinions on a group level reproducibly, classical Delphi method elements were combined with an item weight and performance weight decision-maker. This newly developed information synthesis method was applied to the sample dataset to examine method applicability. Method descriptions and flow diagrams were generated. Applicability was then tested by creating a synthesis of individual questionnaires. An estimate of the level of medication safety in an Austrian level II hospital was, thus, generated. Over the past two decades, initiatives regarding patient safety, in general, and medication safety, in particular, have been gaining momentum. Questionnaires are state of the art for assessing medication practice in healthcare facilities. Acquiring consistent data about medication in the complex setting of a hospital, however, has not been standardized. There are no publicly available benchmark datasets and, in particular, there is no published method to reliably synthesize expertise regarding medication safety on an expert group level. The group-level information synthesis method developed in this study has the potential to synthesize information about the level of medication safety in a hospital setting more reliably than unstructured approaches. A medication safety level estimate for a representative Austrian level II hospital was generated. Further studies are needed to establish convergence characteristics and benchmarks for medication safety on a larger scale.

DEL-FINE: a new tool for assessing the delirogenic properties of drugs of relevance for European pharmacotherapy.

This article presents a list of potentially delirogenic properties of drugs that are currently of relevance to drug therapy in Europe, which was created through a Delphi process including experts from professions relevant to diagnosis and treatment of delirium. The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) defines delirium as a disturbance in attention, awareness and cognition that develops over a short period of time and fluctuates. Possible causes of delirium are manifold: usually delirium is considered to develop in a multifactorial way, caused by inalterable parameters, such as advanced age and pre-existing cognitive impairment and precipitated by modifiable parameters, such as the use of certain drugs or substance withdrawal. Delirium is a serious condition with a pronounced impact on morbidity, mortality and costs to the healthcare system. Circumstances and drugs that might precipitate or worsen delirium should therefore be avoided whenever possible. A list of drugs that might have a detrimental influence on the emergence and duration of delirium has been created using the terms "delirogenity" and "delirogenic" to describe the potential of a drug or withdrawal to cause or worsen delirium. The results are novel and noteworthy, as their focus is on substances relevant to European pharmacotherapy. Furthermore, they represent a methodical consensus from a group of experts of a wide variety of professions relevant to the prevention, diagnosis and treatment of delirium, such as nursing, pharmacy, pharmacology, surgical and internal medicine, neurology, psychiatry, intensive care and medicine, with working, teaching and scientific experience in several European countries practicing both in primary and secondary care.

[Pain as adverse drug reaction]. / Die unerwünschte Arzneimittelwirkung Schmerz.

We present a multidisciplinary (anaesthesiology--clinical pharmacy--bioinformatics) analysis of pain as possible adverse drug reaction taking different manifestations of pain, indication groups, relevance to the Austrian drug market and possible mechanistic influence of drugs on development and apprehension of pain into consideration.We designed an overview that shows how transmitters that play a part in nociception and antinociception can be influenced by drugs. This allows conclusions to the dolorigene potential of therapeutics.