Medication Safety Principles and Practice in CKD.

Ensuring patient safety is a priority of medical care because iatrogenic injury has been a primary concern. Medications are an important source of medical errors, and kidney disease is a thoroughfare of factors threatening safe administration of medicines. Principal among these is reduced kidney function because almost half of all medications used are eliminated via the kidney. Additionally, kidney patients often suffer from multimorbidity, including diabetes, hypertension, and heart failure, with a range of prescribers who often do not coordinate treatments. Patients with kidney disease are also susceptible to further kidney injury and metabolic derangements from medications, which can worsen the disease. In this review, we will present the key issues and threats to safe medication use in kidney disease, with a focus on predialysis CKD, as the scope of medication safety in ESKD and transplantation are unique and deserve their own consideration. We discuss drugs that need to be avoided or dose modified, and review the complications of a range of medications routinely administered in CKD, as these also call for cautious use.

Best practices for safe use of insulin pen devices in hospitals: Recommendations from an expert panel Delphi consensus process.

PURPOSE: A Delphi consensus development process was used to identify best practices for the safe use of insulin pen devices in hospitals. METHODS: A panel of healthcare professionals with experience in patient safety activities and development of insulin-use guidelines was selected. In round 1 of a 4-round Delphi process, panelists were asked to identify key concepts and practices relating to safe use of insulin pen devices in hospitals. In round 2, panelists indicated their level of agreement with draft practice statements reflecting input received in round 1; statements with strong support were refined based on panelist suggestions. In round 3, the modified draft statements were rated for potential impact on patient safety. In round 4, panelists selected a final list of statements to recommend as best practices. RESULTS: A 12-member interprofessional panel consisting of nurses, pharmacists, and physicians participated in the Delphi process. In round 1, panelists submitted more than 450 statements describing safe practices for insulin pen use. Based on that input, 125 draft practice statements were developed; among 98 statements receiving panelist support in round 2, 76 were judged in round 3 to be critical to patient safety or likely to have a positive impact on patient safety. In round 4, panelists unanimously affirmed a final list of 35 best-practice statements for the safe use of insulin pens in hospitals. CONCLUSION: A Delphi consensus development process yielded a list of recommended best practices to help ensure the safe use of insulin pen devices in hospitals and health systems.

Beliefs and behaviors of professionally engaged pharmacists.

OBJECTIVES: To define professional engagement and establish a list of beliefs and behaviors characteristic of professionally engaged pharmacists. DESIGN: A 4-round online Delphi consensus technique. Round 1: Panelists were asked to identify the beliefs and behaviors characteristic of professionally engaged pharmacists. Investigators then crafted representative statements. Round 2: Panelists agreed with statements as written, agreed with changes, or disagreed. Round 3: Panelists distributed 100 points among the modified belief and behavior statements, reflecting the relative weight and importance of each. Round 4: Panelists rated overall agreement with statements and the definition of professional engagement with the use of a 4-point Likert scale. SETTING: Not applicable. PARTICIPANTS: Fifteen pharmacists with a deep interest in and knowledge of professional engagement. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Consensus statements regarding the beliefs and behaviors characteristic of a professionally engaged pharmacist and a consensus definition of professional engagement. RESULTS: From 128 submissions regarding beliefs provided by panelists in round 1, 18 statements were crafted and 12 statements achieved consensus. From 72 submissions regarding behaviors provided by panelists in round 1, 15 statements were crafted and 9 statements achieved consensus. Panelists' agreement with each of the final statements achieved a mean score greater than 3.9 on a 4-point Likert scale. Consensus was achieved regarding the definition of professional engagement. The professionally engaged pharmacist "thinks and behaves in ways that positively affect patients' health and advance the profession's values and societal mission." CONCLUSION: Professional engagement in pharmacists is composed of cognitive, behavioral, and affective components. This work provides a framework to describe professional engagement and lays the foundation for future scholarly work. The ability to measure professional engagement will allow us to correlate professional engagement with outcomes and design interventions to catalyze increased engagement in the profession.