Critique of Policies and Procedures †Free Samples to Students

Qestion: Discuss about the Critique of Policies and Procedures. Answer: Introduction An adverse drug event is any response to a particular drug that is unintended and noxious that occurs in man, at doses normally used for diagnosis, prophylaxis, therapy of a disease or for modifying physiological functions (Fokoue-Nkoutche et al. 2015). Such adverse events predict hazards that can arise due to future administration of the drug and create a warrant for prevention of that specific treatment. The two policies namely, the National Action Plan for adverse drug event prevention (U.S Department of Health and Human Services) and the Preventing adverse drug events Policy Guideline (Government of South Australia) will be compared in this report, to evaluate their effectiveness on managing adverse drug events. Preventing patient harm from adverse drug events (ADEs) or medications is regarded as a major patient safety priority across all hospitals and patient care centres. Strong evidences suggest that ADEs are preventable. Both the aforementioned policies work towards preventing adverse events that result from drug discrepancies (Carayon et al. 2014). The 2 policies emphasize on surveillance as the essential component of managing and preventing adverse drug reactions. The policies work by coordinating the existing federal surveillance data and resources to assess the rates of health burden and incidence of adverse drug events (Gladden et al. 2014). According to the policies, the public health agencies will work together in coordinating ADE surveillance efforts to progress assessment in preventing ADEs related to diabetes agent, anticoagulants and opioids in the target population. The policies state that health agencies will provide a range of opportunities to the patients that will help them assess their progress in prevention of such adverse drug events within health care delivery networks. The two polices focus on documenting the nature and type of any previously known allergies or ADEs in relevant cases. They also illustrate the appropriate documentation of medication history (Hellstrm et al. 2012). Lack of education, poor comm unication, incomplete information transfer, inadequate access to healthcare services, all contribute to ADEs.The policies focus on the role of efficient communication skills and the transfer of information during handover. Evidence from several studies suggest that good interpersonal communication skills in healthcare settings emphasize on the fact that a provision for information is sufficient as well as necessary to improve individual behavior (Sheldon and Hilaire 2015). Subsequently, all health practitioners andresearchers have moved beyond traditional information sharing practices (that were based on one-way monologue), towards more appropriate and useful ways of informationexchange(that are based on two-way dialogue). The abovementioned aspects are associated with the occurrence of adverse drug events. Moreover, another similarity lies in the sharing of healthcare information between the carer and the patients. Thus, it can be stated that the two policies are similar in various aspects. There are some differences between the two policies. While the policy formulated by the South Australia government elaborates more on communication, access to information on allergic history, reporting ADEs to Therapeutic Goods Administration (TGA) and efficient clinical handover or transfer of information (includes discharge summaries, allergy details and medical history), it does not illustrate the different management techniques or procedures that should be followed if an incident of adverse drug reaction occurs. On the other hand, the National Action Plan focuses on evidence based prevention techniques to address adverse drug events (US Department of Health and Human Services 2014). This policy formulates guidelines that provide patient-centered care, which is central to the decision-making process. The two key objectives of this policy is to identify preventable, common and measurable adverse drug events (ADEs), which result in significant cases of patient harm, and align the ef forts of federal health agencies in reducing such patient harms from specific ADEs. The policy targets three regions for preventing adverse drug reactions. These target regions are: Diabetes agents (Hypoglycemia) Anticoagulants (Bleeding) Opioids (Oversedation or Respiratory depression) While the first policy does not address evidence-based research to counter the action of adverse drug reactions, the second elaborates sharing of existing evidence-based prevention procedures across federal and non-federal health agencies or several healthcare providers and the concerned patients. The National Plan states that supporting dissemination and development of evidence-based prevention procedures prove effective in preventing ADEs. Collaboration with healthcare agencies involved in providing patient care, will help in disseminating the procedures or tools for treating patient populations at higher risk. The SA Health Guideline states that all allergy and ADE details should be documented in the medical records of patients. This also includes the use of electronic records or CPOE. Computerized provider order entry (CPOE) systems are designed in a way to replace paper based ordering system of a hospital. The users are allowed to input the entire range of orders electronically and maintain online medication administration records. The changes made to an order are reviewed by concerned health personnel. The primary steps that are focused are using basic information related to technology and addressing support capability of clinical decisions for safety. The 8-step physician workflow used by CPOE include access to the system, patient selection, data review, data entry, order confirmation, order processing, result receiving and measuring outcomes or accountability (Spaulding and Raghu 2013). Moreover, the SA health policy emphasizes on the use of several electronic systems such as HASS ED, EPAS and iPharmacy (pharmacy management system) to support the documentation of preventing ADE. It also states that these electronic systems will enhance transfer of information and decision support. Hence, it can be deduced from the above stated facts that there are significant differences in the two policies, although both of them work towards managing adverse drug event s. Evidence-based suggestion The National Action Plan is organized into seven sections. The first 4 sections of the plan outline the development and scope of the plan; they identify the surveillance resources that will help to monitor and measure the burden of ADEs, followed by description of the prevention approaches by identification of the key determinants, review of incentives and opportunities that can prevent ADEs. The following 3 sections of the action plan address the high-priority targets such as diabetes agents, anticoagulants and opioids (Voepel-Lewis et al. 2015). The most pertinent actions are highlighted in each area of evidence-based procedures, surveillance areas, incentives and research. The plan suggests that inadequate studies have been conducted in the field of ADE economic impact. Results from older data used in the plan indicate that, adverse drug reactions impose a huge financial burden on healthcare expenditures (Sultana et al. 2013). The plan utilizes evidence from several analyses and s hows that Medicare beneficiaries are more likely to acquire ADEs during hospital stays with Medicare reimbursing. Hospital readmissions due to avoidable ADEs contribute to the huge burden on the healthcare system (Zon and Ganz 2017). The National Action Plan lays stress on conservative estimates that indicated an incidence of 380,000-450,000 ADEs among hospitalized patients every year. Studies suggested that a majority of these events were attributed to opioid and anticoagulant administration, and most of these events were preventable (Chen et al. 2014). Furthermore, the action plan is considered to be more rigorous because it collected evidences from studies that were conducted in outpatient settings, which indicated that 2/3rd of hospital admissions occurred due to 4 medication classes, 3 out of which were preventable targets for ADE: insulin, oral diabetes agents like sulfonylurea and anticoagulants like warfarin. The ADE National Action Plan therefore intended to address patient harms that occurred due to prescribed medication use. It wanted to collate, identify and communicate the gaps and opportunities within the federal system and among external stakeholders. The ultimate goal of the plan was to support and strengthen healthcare providers and systems in their efforts of ensuring safe patient care with regards to ADE prevention. In addition, the plan provided insights on evidence-based practices, to maintain greater consistency in application of the practices. Public health surveillance is generally referred to as the systematic collection, evaluation and interpretation of healthcare data that is essential for the planning, implementation and assessment of public health practice. Surveillance is closely associated with the dissemination of the analyzed data to prevent and control unwanted medical discrepancies. ADE surveillance encompasses identification of the injury (loss of consciousness, hemorrhage, hypoglycemia or other abnormalities) and its attribution to excess or wrong drug exposure. There are several limitations of administrative data in review of clinical documentation. Clinical documentation based ADE surveillance utilizes different algorithmic detection methods and sampling techniques for determining drug related injuries. The National Action Plan is a better policy since it focused on the proximate factors that contributed to ADEs. Results from several studies indicated that altered pharmacokinetics, multiple medications, chronic conditions and medication mismanagement due to physical frailty and cognitive decline are important contributors of ADEs. The fact that the plan elaborated on the effect of anticoagulants in ADEs was supported by research evidences. Anticoagulants are regarded as the mainstay therapy for acute and long-term prevention of thromboembolic disorders. The primary ADE associated with anticoagulants is bleeding. Thus, a plethora of factors such as co-morbidities, age, concomitant medications like warfarin influence thrombotic and hemorrhagic risks. One important health issue identified with respect to administration of diabetic agents is hypoglycemia (Raschi et al. 2013). Hypoglycemia has been defined as abnormal low levels of blood glucose concentration that exposes a person to potential harm (American Diabetes Association 2016). The plan promoted efforts for accurate data collection and timely measurement of trends and burden related to hypoglycemic events. Furthermore, this plan also focused on the adverse reactions that occur due to prolonged opioid exposure. Evidence suggests that opioids cause a number of ADEs that are detrimental to the quality and health of patients (Minkowitz et al. 2014). These adverse reactions include over sedation, gastrointestinal disturbances such as vomiting, nausea and constipation, respiratory depression, pruritus and hormonal dysfunction. The SA Health Guideline on the other hand did not identify any key determinants of such adverse reactions. It primarily laid stress on the importance of documentation and reporting of previous or new adverse drug reactions or allergies. The policy outlined the procedures and responsibilities that are needed to be followed by health professionals to report already known or new adverse drug allergies and reactions. The main focus of this policy was on access to information regarding allergic reactions and their corresponding communication. Therefore, it can be stated that the National Action Plan is more rigorous. Focussing on differences Considering the ways by which health information technology could be used to support the goals of the Action Plan, it illustrated the role of CPOE and medical reconciliation in managing ADEs. These were identified as core measures that addressed documentation of the patient medication list. The primary benefit of CPOE over any other procedure is its proven role in reducing medication errors that usually occur due to illegible handwriting or medical order transcription that makes it difficult to interpret the orders. CPOE systems are designed in a way to mimic thepaper chart workflow (Safdari, Shahmoradi and Ilati 2012). On the other hand, medical reconciliation tries to identify what medications were being given to a patient before hospital admission and focuses on confirmation of appropriate medication orders during and post-hospitalisation (Reiner 2012). The action plan is considered more rigorous based on the prevention strategies or tools it elaborated. The plan utilised techniques of increasing accessibility of evidence based knowledge, effective coordination and communication of real-time care facilities, science-driven multidisciplinary treatment approaches and promotion of best standards within the community. Moreover, the main drawback of the SA guideline lies in the fact that it did not discuss any strategies that have proved effective in reducing ADE apart from communication and medical documentation. Conclusion Thus, it can be concluded that an adverse drug event is a form of an injury that results from wrong medical interventions related to a particular drug. Medication errors are the most common reasons for such events. Prevention of such errors is crucial to improve the quality of healthcare among patients. Administration of drugs at rates higher than acceptable doses and lack of access to medical paper records lead to such condition. 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