51
|
Rouzaud-Laborde C, Damery L, Cestac P, Sallerin B, Calvet P. Mentoring and supervising clinical pharmacist students at patients' bedside: which benefits? J Eval Clin Pract 2016; 22:4-9. [PMID: 26400689 DOI: 10.1111/jep.12444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Hospital clinical pharmacists are involved in teaching students during professional internship. Organization between the unit care and the pharmacy place is complicated. This study evaluated the effectiveness of two pharmaceutical teams: an experienced pharmacist in the pharmacy place, reachable by phone (team 1) or an experienced pharmacist in the ward, near patients and students (team 2). METHODS Pharmaceutical interventions were collected during two successive time periods, each of 6 months in a 15-bed unit (neurology). During the first time period, prescriptions were analyzed by the student (resident) in the ward and experienced pharmacist in the pharmacy place. During the second time period, prescriptions were analyzed by both experienced pharmacist and the resident in the ward. We compared the number, the type, the approval of pharmaceutical interventions and the medication reconciliation activities. Proportions were compared by a chisquared test (or Fisher exact test) as well as the quantitative value was calculated by a Student test. RESULTS 'Mentoring and supervising' students in the ward increased significantly the number of pharmaceutical interventions (PI; 104 interventions for 1408 analyzed prescriptions (7.4%) by the students in the ward and 317 interventions for 1391 (22.8%) by both the experienced pharmacist and the students in the ward (P = 0.002). Furthermore, specific interventions from medication reconciliation were significantly increased by the presence of experienced pharmacist in the ward (0.96% vs. 8.83% P = 0.018). CONCLUSION Effectiveness of clinical pharmacists can be improved by the presence of experienced pharmacist at patients' bedside, near students.
Collapse
Affiliation(s)
- Charlotte Rouzaud-Laborde
- Pharmacy Département, Hôpital Paule de Viguier, University Hospital, Toulouse, Toulouse, France.,Metabolic and Cardiovascular Diseases I2MC, Team 6: Cardiac Remodeling and New Therapies, National Institute of Health and Medical, INSERM, Toulouse, France.,Clinical Pharmacy Department, Pharmaceutical Sciences University of Toulouse, Toulouse III, Toulouse, France
| | - Léa Damery
- Pharmacy Département, Hôpital Paule de Viguier, University Hospital, Toulouse, Toulouse, France
| | - Philippe Cestac
- Pharmacy Département, Hôpital Paule de Viguier, University Hospital, Toulouse, Toulouse, France.,Clinical Pharmacy Department, Pharmaceutical Sciences University of Toulouse, Toulouse III, Toulouse, France.,Team 1: Ageing and Alzheimer Disease: From Observation to Intervention, National Institute of Health and Medical Research, INSERM, Toulouse, France
| | - Brigitte Sallerin
- Pharmacy Département, Hôpital Paule de Viguier, University Hospital, Toulouse, Toulouse, France.,Metabolic and Cardiovascular Diseases I2MC, Team 6: Cardiac Remodeling and New Therapies, National Institute of Health and Medical, INSERM, Toulouse, France.,Clinical Pharmacy Department, Pharmaceutical Sciences University of Toulouse, Toulouse III, Toulouse, France
| | - Pauline Calvet
- Pharmacy Département, Hôpital Paule de Viguier, University Hospital, Toulouse, Toulouse, France
| |
Collapse
|
52
|
Hayashi M, Yamatani A, Funaki H, Miyamoto K. Pharmacoeconomic effect of compliance with pharmacist's intervention based on cancer chemotherapy regimens: a cohort study. J Pharm Health Care Sci 2016; 1:10. [PMID: 26819721 PMCID: PMC4728767 DOI: 10.1186/s40780-014-0007-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 11/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is important for pharmacists to manage cancer chemotherapy regimens in order to achieve safe treatment. We examined whether there was a useful pharmacoeconomic benefit of compliance the exclusion criteria of neutropenia, and the importance of a pharmacist's intervention was considered. METHODS A prospective observational cohort study was conducted at a community-based medical center. Among 374 patients who received chemotherapy between April 2010 and March 2011, 108 patients developed neutropenia and pharmacists recommended suspension of chemotherapy. These patients were divided into a group in whom chemotherapy was suspended (complying group) and a group in whom it was continued (non-complying group). Then the relative dose intensity (RDI) was compared between the two groups, and medical expenses related to the treatment of neutropenia (neutropenia-related costs: NRC) were compared. Analysis was carried out from the perspective of the health insurance provider, so only the direct medical costs were evaluated. RESULTS There was a significant difference of the RDI between a complying group (85.2 ± 10.0%) and a non-complying group (79.3 ± 15.0%) (P = 0.021). The average NRC per patient showed a significant difference between the two groups (complying group: 1,944 ± 412 dollars, non-complying group: 4,394 ± 837 dollars, P = 0.044). The economic effect over one year was 54,205 dollars. CONCLUSION The present findings suggest that ensuring compliance with chemotherapy regimens (including the criteria for neutropenia) is effective from a pharmacoeconomic perspective. Accordingly, pharmacists should intervene as required to improve regimen compliance.
Collapse
Affiliation(s)
- Makoto Hayashi
- Department of Pharmacy, National Hospital Organization Kanazawa Medical Center, 1-1 Shimoishibiki-machi, Kanazawa, Ishikawa 920-8650 Japan.,Department of Medicinal Informatics, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641 Japan
| | - Akimasa Yamatani
- Department of Pharmacy, National Hospital Organization Kanazawa Medical Center, 1-1 Shimoishibiki-machi, Kanazawa, Ishikawa 920-8650 Japan
| | - Hiromu Funaki
- Department of Pharmacy, National Hospital Organization Kanazawa Medical Center, 1-1 Shimoishibiki-machi, Kanazawa, Ishikawa 920-8650 Japan
| | - Kenichi Miyamoto
- Department of Medicinal Informatics, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641 Japan
| |
Collapse
|
53
|
Berdot S, Roudot M, Schramm C, Katsahian S, Durieux P, Sabatier B. Interventions to reduce nurses’ medication administration errors in inpatient settings: A systematic review and meta-analysis. Int J Nurs Stud 2016; 53:342-50. [DOI: 10.1016/j.ijnurstu.2015.08.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/25/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
|
54
|
Guérin A, Hall K, Bussières JF. Pharmacy Practices and Technologies: Evidence for Effectiveness and Adoption into Canadian Hospital Pharmacy Practice. Can J Hosp Pharm 2015; 68:474-7. [PMID: 26715785 PMCID: PMC4690674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Aurélie Guérin
- is a Research Assistant with the Pharmacy Practice Research Unit and the Pharmacy Department, Centre hospitalier universitaire Sainte-Justine, Montréal, Quebec. She is also a DPharm candidate in the Faculté de pharmacie de Paris, Université Paris Descartes, Paris, France
| | - Kevin Hall
- PharmD, was, at the time this study was conducted, a Clinical Associate Professor in Social and Administrative Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta. He is now retired
| | - Jean-François Bussières
- BPharm, MSc, MBA, FCSHP, is Director of the Pharmacy Practice Research Unit and the Pharmacy Department, Centre hospitalier universitaire Sainte-Justine, and Clinical Professor, Faculty of Pharmacy, Université de Montréal, Montréal, Quebec
| |
Collapse
|
55
|
Critchley S. Improving Medication Administration Safety in a Community Hospital Setting Using Lean Methodology. J Nurs Care Qual 2015; 30:345-51. [DOI: 10.1097/ncq.0000000000000112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
56
|
Nguyen HT, Nguyen TD, van den Heuvel ER, Haaijer-Ruskamp FM, Taxis K. Medication Errors in Vietnamese Hospitals: Prevalence, Potential Outcome and Associated Factors. PLoS One 2015; 10:e0138284. [PMID: 26383873 PMCID: PMC4575184 DOI: 10.1371/journal.pone.0138284] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 08/29/2015] [Indexed: 11/21/2022] Open
Abstract
Background Evidence from developed countries showed that medication errors are common and harmful. Little is known about medication errors in resource-restricted settings, including Vietnam. Objectives To determine the prevalence and potential clinical outcome of medication preparation and administration errors, and to identify factors associated with errors. Methods This was a prospective study conducted on six wards in two urban public hospitals in Vietnam. Data of preparation and administration errors of oral and intravenous medications was collected by direct observation, 12 hours per day on 7 consecutive days, on each ward. Multivariable logistic regression was applied to identify factors contributing to errors. Results In total, 2060 out of 5271 doses had at least one error. The error rate was 39.1% (95% confidence interval 37.8%- 40.4%). Experts judged potential clinical outcomes as minor, moderate, and severe in 72 (1.4%), 1806 (34.2%) and 182 (3.5%) doses. Factors associated with errors were drug characteristics (administration route, complexity of preparation, drug class; all p values < 0.001), and administration time (drug round, p = 0.023; day of the week, p = 0.024). Several interactions between these factors were also significant. Nurse experience was not significant. Higher error rates were observed for intravenous medications involving complex preparation procedures and for anti-infective drugs. Slightly lower medication error rates were observed during afternoon rounds compared to other rounds. Conclusions Potentially clinically relevant errors occurred in more than a third of all medications in this large study conducted in a resource-restricted setting. Educational interventions, focusing on intravenous medications with complex preparation procedure, particularly antibiotics, are likely to improve patient safety.
Collapse
Affiliation(s)
- Huong-Thao Nguyen
- Department of Clinical Pharmacy, School of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh city, Ho Chi Minh, Vietnam
- Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, the Netherlands
| | - Tuan-Dung Nguyen
- Department of Clinical Pharmacy, School of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh city, Ho Chi Minh, Vietnam
| | - Edwin R. van den Heuvel
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Flora M. Haaijer-Ruskamp
- Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Katja Taxis
- Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, the Netherlands
- * E-mail:
| |
Collapse
|
57
|
Delage E, Tourel J, Martin B, Guérin A, Moussa A, Lacroix A, Lebel D, Bussières JF. [Not Available]. Can J Hosp Pharm 2015; 68:406-411. [PMID: 26478587 PMCID: PMC4605465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Emmanuelle Delage
- D. Pharm., est assistante de recherche à l'Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Julien Tourel
- D. Pharm., est assistant de recherche à l'Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Brigitte Martin
- B. Pharm., M. Sc., est pharmacienne, Département de pharmacie, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Aurélie Guérin
- est candidate au D. Pharm. et assistante de recherche à l'Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec. Elle est aussi interne en pharmacie, Université Paris Sud XI, Paris, France
| | - Ahmed Moussa
- M. D., FRCPC, FAAP, est néonatalogiste, Département de néonatalogie, Centre hospitalier universitaire Sainte-Justine, et professeur adjoint de clinique, Université de Montréal, Montréal, Québec
| | - Annie Lacroix
- B.Sc. Inf, M. Sc., IPSNN, est chef des processus administratifs en soins infirmiers, Département de néonatalogie, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Denis Lebel
- B. Pharm., M. Sc., FCSHP, est adjoint, Département de pharmacie et Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Jean-François Bussières
- B. Pharm., M. Sc., FCSHP, est chef, Département de pharmacie et Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, et professeur titulaire de clinique, Faculté de pharmacie, Université de Montréal, Montréal, Québec
| |
Collapse
|
58
|
Azevedo Filho FMD, Pinho DLM, Bezerra ALQ, Amaral RT, Silva MED. Prevalência de incidentes relacionados à medicação em unidade de terapia intensiva. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Objetivo Estimar a prevalência de incidentes relacionados à medicação em uma Unidade de Terapia Intensiva. Métodos Estudo transversal que incluiu 116 registros de internações hospitalares no período de 12 meses. O instrumento de pesquisa foi elaborado com base nas variáveis de estudo e validado por dois experts. A prevalência foi calculada considerando o número de internações expostas como numerador e o total de internações investigadas como denominador, calculando intervalo de confiança de 95%. Para a verificação de associação significativa entre as variáveis, utilizou-se o Teste Exato de Fisher, assumindo nível de significância máximo de 5% (p<0,05). Resultados Verificou-se que 113 internações foram expostas a pelo menos um tipo de incidente, totalizando 2.869 ocorrências, sendo 1.437 circunstâncias notificáveis, 1.418 incidentes sem dano, nove potenciais eventos adversos e cinco eventos adversos. Os incidentes aconteceram durante a fase da prescrição (45,4%) e a ausência de conduta dos profissionais de saúde frente aos incidentes foi identificada em 99% dos registros. Conclusão Estimou-se prevalência de 97,4% incidentes relacionados à medicação.
Collapse
|
59
|
Accidents and Incidents Related to Intravenous Drug Administration: A Pre–Post Study Following Implementation of Smart Pumps in a Teaching Hospital. Drug Saf 2015; 38:729-36. [DOI: 10.1007/s40264-015-0308-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
60
|
Wang T, Benedict N, Olsen KM, Luan R, Zhu X, Zhou N, Tang H, Yan Y, Peng Y, Shi L. Effect of critical care pharmacist's intervention on medication errors: A systematic review and meta-analysis of observational studies. J Crit Care 2015; 30:1101-6. [PMID: 26260916 DOI: 10.1016/j.jcrc.2015.06.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 05/30/2015] [Accepted: 06/17/2015] [Indexed: 11/28/2022]
Abstract
Pharmacists are integral members of the multidisciplinary team for critically ill patients. Multiple nonrandomized controlled studies have evaluated the outcomes of pharmacist interventions in the intensive care unit (ICU). This systematic review focuses on controlled clinical trials evaluating the effect of pharmacist intervention on medication errors (MEs) in ICU settings. Two independent reviewers searched Medline, Embase, and Cochrane databases. The inclusion criteria were nonrandomized controlled studies that evaluated the effect of pharmacist services vs no intervention on ME rates in ICU settings. Four studies were included in the meta-analysis. Results suggest that pharmacist intervention has no significant contribution to reducing general MEs, although pharmacist intervention may significantly reduce preventable adverse drug events and prescribing errors. This meta-analysis highlights the need for high-quality studies to examine the effect of the critical care pharmacist.
Collapse
Affiliation(s)
- Tiansheng Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
| | - Neal Benedict
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Keith M Olsen
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Rong Luan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China; Department of Pharmacy, Peking University Third Hospital, Beijing, China.
| | - Xi Zhu
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.
| | - Ningning Zhou
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
| | - Huilin Tang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.
| | - Yingying Yan
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.
| | - Yao Peng
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
| |
Collapse
|
61
|
Shulman R, McKenzie CA, Landa J, Bourne RS, Jones A, Borthwick M, Tomlin M, Jani YH, West D, Bates I. Pharmacist's review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK). J Crit Care 2015; 30:808-13. [PMID: 25971871 DOI: 10.1016/j.jcrc.2015.04.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose was to describe clinical pharmacist interventions across a range of critical care units (CCUs) throughout the United Kingdom, to identify CCU medication error rate and prescription optimization, and to identify the type and impact of each intervention in the prevention of harm and improvement of patient therapy. MATERIALS AND METHODS A prospective observational study was undertaken in 21 UK CCUs from November 5 to 18, 2012. A data collection web portal was designed where the specialist critical care pharmacist reported all interventions at their site. Each intervention was classified as medication error, optimization, or consult. In addition, a clinical impact scale was used to code the interventions. Interventions were scored as low impact, moderate impact, high impact, and life saving. The final coding was moderated by blinded independent multidisciplinary trialists. RESULTS A total of 20517 prescriptions were reviewed with 3294 interventions recorded during the weekdays. This resulted in an overall intervention rate of 16.1%: 6.8% were classified as medication errors, 8.3% optimizations, and 1.0% consults. The interventions were classified as low impact (34.0%), moderate impact (46.7%), and high impact (19.3%); and 1 case was life saving. Almost three quarters of interventions were to optimize the effectiveness of and improve safety of pharmacotherapy. CONCLUSIONS This observational study demonstrated that both medication error resolution and pharmacist-led optimization rates were substantial. Almost 1 in 6 prescriptions required an intervention from the clinical pharmacist. The error rate was slightly lower than an earlier UK prescribing error study (EQUIP). Two thirds of the interventions were of moderate to high impact.
Collapse
Affiliation(s)
- R Shulman
- University College London Hospitals NHS Foundation Trust, Pharmacy, London, NW1 2BU, United Kingdom.
| | - C A McKenzie
- Institute of Pharmaceutical Sciences, Kings College London, London, SE1 9NH, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, Pharmacy and Critical Care, London, SE1 7EH, United Kingdom
| | - J Landa
- Guy's and St Thomas' NHS Foundation Trust, Pharmacy and Critical Care, London, SE1 7EH, United Kingdom
| | - R S Bourne
- Sheffield Teaching Hospitals NHS Foundation Trust, Pharmacy, Sheffield, S5 7AU, United Kingdom
| | - A Jones
- Guy's and St Thomas' NHS Foundation Trust, Pharmacy and Critical Care, London, SE1 7EH, United Kingdom
| | - M Borthwick
- Oxford University Hospitals NHS Trust, Pharmacy, Oxford, OX3 7LE, United Kingdom
| | - M Tomlin
- University Hospitals Southampton NHS Foundation Trust, Pharmacy, Southampton, SO16 6YD, United Kingdom
| | - Y H Jani
- University College London Hospitals NHS Foundation Trust, Pharmacy, London, NW1 2BU, United Kingdom; UCL School of Pharmacy, London WC1N 1AX, United Kingdom
| | - D West
- UCL School of Pharmacy, London WC1N 1AX, United Kingdom
| | - I Bates
- UCL School of Pharmacy, London WC1N 1AX, United Kingdom
| | | |
Collapse
|
62
|
Keers RN, Williams SD, Cooke J, Walsh T, Ashcroft DM. Impact of interventions designed to reduce medication administration errors in hospitals: a systematic review. Drug Saf 2014; 37:317-32. [PMID: 24760475 DOI: 10.1007/s40264-014-0152-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is a need to identify effective interventions to minimize the threat posed by medication administration errors (MAEs). OBJECTIVE Our objective was to review and critically appraise interventions designed to reduce MAEs in the hospital setting. DATA SOURCES Ten electronic databases were searched between 1985 and November 2013. METHODS Randomized controlled trials (RCTs) and controlled trials (CTs) reporting rates of MAEs or related adverse drug events between an intervention group and a comparator group were included. Data from each study were independently extracted and assessed for potential risk of bias by two authors. Risk ratios (RRs, with 95 % confidence intervals [CIs]) were used to examine the effect of an intervention. RESULTS Six RCTs and seven CTs were included. Types of interventions clustered around four main themes: medication use technology (n = 4); nurse education and training (n = 3); changing practice in anesthesia (n = 2); and ward system changes (n = 4). Reductions in MAE rates were reported by five studies; these included automated drug dispensing (RR 0.72, 95 % CI 0.53-1.00), computerized physician order entry (RR 0.51, 95 % 0.40-0.66), barcode-assisted medication administration with electronic administration records (RR 0.71, 95 % CI 0.53-0.95), nursing education/training using simulation (RR 0.17, 95 % CI 0.08-0.38), and clinical pharmacist-led training (RR 0.76, 95 % CI 0.67-0.87). Increased or equivocal outcome rates were found for the remaining studies. Weaknesses in the internal or external validity were apparent for most included studies. LIMITATIONS Theses and conference proceedings were excluded and data produced outside commercial publishing were not searched. CONCLUSIONS There is emerging evidence of the impact of specific interventions to reduce MAEs in hospitals, which warrant further investigation using rigorous and standardized study designs. Theory-driven efforts to understand the underlying causes of MAEs may lead to more effective interventions in the future.
Collapse
Affiliation(s)
- Richard N Keers
- Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, University of Manchester, Manchester, M13 9PT, UK,
| | | | | | | | | |
Collapse
|
63
|
Caractéristiques des revues systématiques présentant les interventions de pharmaciens. ANNALES PHARMACEUTIQUES FRANÇAISES 2014; 72:429-39. [DOI: 10.1016/j.pharma.2014.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/13/2014] [Accepted: 05/16/2014] [Indexed: 11/24/2022]
|
64
|
Faria R, Barbieri M, Light K, Elliott RA, Sculpher M. The economics of medicines optimization: policy developments, remaining challenges and research priorities. Br Med Bull 2014; 111:45-61. [PMID: 25190760 PMCID: PMC4154397 DOI: 10.1093/bmb/ldu021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND This review scopes the evidence on the effectiveness and cost-effectiveness of interventions to improve suboptimal use of medicines in order to determine the evidence gaps and help inform research priorities. SOURCES OF DATA Systematic searches of the National Health Service (NHS) Economic Evaluation Database, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. AREAS OF AGREEMENT The majority of the studies evaluated interventions to improve adherence, inappropriate prescribing and prescribing errors. AREAS OF CONTROVERSY Interventions tend to be specific to a particular stage of the pathway and/or to a particular disease and have mostly been evaluated for their effect on intermediate or process outcomes. GROWING POINTS Medicines optimization offers an opportunity to improve health outcomes and efficiency of healthcare. AREAS TIMELY FOR DEVELOPING RESEARCH The available evidence is insufficient to assess the effectiveness and cost-effectiveness of interventions to address suboptimal medicine use in the UK NHS. Decision modelling, evidence synthesis and elicitation have the potential to address the evidence gaps and help prioritize research.
Collapse
Affiliation(s)
- Rita Faria
- Centre for Health Economics, University of York, York, UK
| | - Marco Barbieri
- Centre for Health Economics, University of York, York, UK
| | - Kate Light
- Centre for Reviews and Disseminations, University of York, York, UK
| | | | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| |
Collapse
|
65
|
Manias E, Kinney S, Cranswick N, Williams A, Borrott N. Interventions to reduce medication errors in pediatric intensive care. Ann Pharmacother 2014; 48:1313-31. [PMID: 25059205 DOI: 10.1177/1060028014543795] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To systematically examine the research literature to identify which interventions reduce medication errors in pediatric intensive care units. DATA SOURCES Databases were searched from inception to April 2014. STUDY SELECTION AND DATA EXTRACTION Studies were included if they involved the conduct of an intervention with the intent of reducing medication errors. DATA SYNTHESIS In all, 34 relevant articles were identified. Apart from 1 study, all involved single-arm, before-and-after designs without a comparative, concurrent control group. A total of 6 types of interventions were utilized: computerized physician order entry (CPOE), intravenous systems (ISs), modes of education (MEs), protocols and guidelines (PGs), pharmacist involvement (PI), and support systems for clinical decision making (SSCDs). Statistically significant reductions in medication errors were achieved in 7/8 studies for CPOE, 2/5 studies for ISs, 9/11 studies for MEs, 1/2 studies for PGs, 2/3 studies for PI, and 3/5 studies for SSCDs. The test for subgroup differences showed that there was no statistically significant difference among the 6 subgroups of interventions, χ(2)(5) = 1.88, P = 0.87. The following risk ratio results for meta-analysis were obtained: CPOE: 0.47 (95% CI = 0.28, 0.79); IS: 0.37 (95% CI = 0.19, 0.73); ME: 0.36 (95% CI = 0.22, 0.58); PG: 0.82 (95% CI = 0.21, 3.25); PI: 0.39 (95% CI = 0.10, 1.51), and SSCD: 0.49 (95% CI = 0.23, 1.03). CONCLUSIONS Available evidence suggests some aspects of CPOE with decision support, ME, and IS may help in reducing medication errors. Good quality, prospective, observational studies are needed for institutions to determine the most effective interventions.
Collapse
Affiliation(s)
- Elizabeth Manias
- Deakin University, Burwood, VIC, Australia The University of Melbourne, Parkville, VIC, Australia
| | - Sharon Kinney
- The University of Melbourne, Parkville, VIC, Australia Royal Children's Hospital, Parkville, VIC, Australia
| | - Noel Cranswick
- The University of Melbourne, Parkville, VIC, Australia Royal Children's Hospital, Parkville, VIC, Australia
| | | | | |
Collapse
|
66
|
Nuckols TK, Smith-Spangler C, Morton SC, Asch SM, Patel VM, Anderson LJ, Deichsel EL, Shekelle PG. The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis. Syst Rev 2014; 3:56. [PMID: 24894078 PMCID: PMC4096499 DOI: 10.1186/2046-4053-3-56] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/29/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Health Information Technology for Economic and Clinical Health (HITECH) Act subsidizes implementation by hospitals of electronic health records with computerized provider order entry (CPOE), which may reduce patient injuries caused by medication errors (preventable adverse drug events, pADEs). Effects on pADEs have not been rigorously quantified, and effects on medication errors have been variable. The objectives of this analysis were to assess the effectiveness of CPOE at reducing pADEs in hospital-related settings, and examine reasons for heterogeneous effects on medication errors. METHODS Articles were identified using MEDLINE, Cochrane Library, Econlit, web-based databases, and bibliographies of previous systematic reviews (September 2013). Eligible studies compared CPOE with paper-order entry in acute care hospitals, and examined diverse pADEs or medication errors. Studies on children or with limited event-detection methods were excluded. Two investigators extracted data on events and factors potentially associated with effectiveness. We used random effects models to pool data. RESULTS Sixteen studies addressing medication errors met pooling criteria; six also addressed pADEs. Thirteen studies used pre-post designs. Compared with paper-order entry, CPOE was associated with half as many pADEs (pooled risk ratio (RR) = 0.47, 95% CI 0.31 to 0.71) and medication errors (RR = 0.46, 95% CI 0.35 to 0.60). Regarding reasons for heterogeneous effects on medication errors, five intervention factors and two contextual factors were sufficiently reported to support subgroup analyses or meta-regression. Differences between commercial versus homegrown systems, presence and sophistication of clinical decision support, hospital-wide versus limited implementation, and US versus non-US studies were not significant, nor was timing of publication. Higher baseline rates of medication errors predicted greater reductions (P < 0.001). Other context and implementation variables were seldom reported. CONCLUSIONS In hospital-related settings, implementing CPOE is associated with a greater than 50% decline in pADEs, although the studies used weak designs. Decreases in medication errors are similar and robust to variations in important aspects of intervention design and context. This suggests that CPOE implementation, as subsidized under the HITECH Act, may benefit public health. More detailed reporting of the context and process of implementation could shed light on factors associated with greater effectiveness.
Collapse
Affiliation(s)
- Teryl K Nuckols
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, 911 Broxton Ave, Los Angeles, CA 90024, USA
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA
| | - Crystal Smith-Spangler
- VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
- Stanford University, Palo Alto, CA 94305, USA
| | - Sally C Morton
- Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA 15261, USA
| | - Steven M Asch
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA
- VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
- Stanford University, Palo Alto, CA 94305, USA
| | - Vaspaan M Patel
- NCQA, 1100 13th street NW, Washington, DC 20005, USA
- UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA 90024, USA
| | - Laura J Anderson
- UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA 90024, USA
| | - Emily L Deichsel
- UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA 90024, USA
| | - Paul G Shekelle
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, 911 Broxton Ave, Los Angeles, CA 90024, USA
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| |
Collapse
|
67
|
Thomas AN, Taylor RJ. An analysis of patient safety incidents associated with medications reported from critical care units in the North West of England between 2009 and 2012. Anaesthesia 2014; 69:735-45. [PMID: 24810765 DOI: 10.1111/anae.12670] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2014] [Indexed: 11/28/2022]
Abstract
Incident reporting is promoted as a key tool for improving patient safety in healthcare. We analysed 2238 patient safety incidents involving medications submitted from up to 29 critical care units each year in the North West of England between 2009 and 2012; 452 (20%) of these incidents led to harm to patients. Although 1461 (65%) incidents were judged to have been preventable, there was no reduction in the rate of incidents per 1000 days between 2009 and 2012 (5.9 in 2009, 6.6 in 2012). Furthermore, in the 2012 data, there were wide variations in the incident rates between units, the median (IQR [range]) rate per 1000 patient days for individual units being 6.8 (3.8-11.0 [1.3-37.1]). The variation in the percentage that could have been avoided was narrower, with a median (IQR [range]) of 70% (61-80% [38-100%]). The most commonly reported drugs were noradrenaline (161 incidents, 92 with harm), heparins (153 incidents, 29 with harm), morphine (131 incidents, 14 with harm) and insulin (111 incidents, 54 with harm). The administration of drugs was the stage in the process where incidents were most commonly reported; it was also the stage most likely to harm patients. We conclude that the wide range in reported rates between units, and the scope for preventing many incidents, suggest that quality improvement initiatives could improve medication safety in the units studied.
Collapse
Affiliation(s)
- A N Thomas
- Salford Royal NHS Foundation Trust, Salford, UK
| | | |
Collapse
|
68
|
Abstract
PURPOSE OF REVIEW The very complex process of intensive care is accompanied by a not unexpected accumulation of risk for error and adverse events. The present review addresses strategies to decrease care errors in several domains of daily intensive care practice. RECENT FINDINGS Strategies to decrease care errors now focus on a systematic approach by identifying latent system failures and change the design of the care process in such a way that inevitable human errors are prevented or their consequences are mitigated. Recent examples refer to the standardization of processes, adaptation to cognitive limitations of human beings, optimization of working conditions, and the increasing use of supporting information technologies. The development of a safety climate constitutes a key element and apparently contributes to reduction of medical errors in ICUs. SUMMARY The present review discusses recent approaches aimed to decrease care errors in ICUs. A growing body of evidence demonstrates that a system based approach with the change of process characteristics and the development of a safety climate is most essential in the effort to increase patient safety.
Collapse
|
69
|
Medication errors in the intensive care unit: literature review using the SEIPS model. AACN Adv Crit Care 2014; 24:389-404. [PMID: 24153217 DOI: 10.1097/nci.0b013e3182a8b516] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medication errors in intensive care units put patients at risk for injury or death every day. Safety requires an organized and systematic approach to improving the tasks, technology, environment, and organizational culture associated with medication systems. The Systems Engineering Initiative for Patient Safety model can help leaders and health care providers understand the complicated and high-risk work associated with critical care. Using this model, the author combines a human factors approach with the well-known structure-process-outcome model of quality improvement to examine research literature. The literature review reveals that human factors, including stress, high workloads, knowledge deficits, and performance deficits, are associated with medication errors. Factors contributing to medication errors are frequent interruptions, communication problems, and poor fit of health information technology to the workflow of providers. Multifaceted medication safety interventions are needed so that human factors and system problems can be addressed simultaneously.
Collapse
|
70
|
Lebel D, Bussières JF. [Not Available]. Can J Hosp Pharm 2014; 67:172-4. [PMID: 24799730 PMCID: PMC4006766 DOI: 10.4212/cjhp.v67i2.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Denis Lebel
- Département de pharmacie et Unité de recherche en pratique pharmaceutique
| | | |
Collapse
|
71
|
Lopez-Martin C, Aquerreta I, Faus V, Idoate A. [Medicines reconciliation in critically ill patients]. Med Intensiva 2014; 38:283-7. [PMID: 24508338 DOI: 10.1016/j.medin.2013.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 04/26/2013] [Accepted: 04/29/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Medicines reconciliation plays a key role in patient safety. However, there is limited data available on how this process affects critically ill patients. In this study, we evaluate a program of reconciliation in critically ill patients conducted by the Intensive Care Unit's (ICU) pharmacist. DESIGN Prospective study about reconciliation medication errors observed in 50 patients. SCOPE ICU PATIENTS All ICU patients, excluding patients without regular treatment. INTERVENTIONS Reconciliation process was carried out in the first 24h after ICU admission. Discrepancies were clarified with the doctor in charge of the patient. MAIN VARIABLE We analyzed the incidence of reconciliation errors, their characteristics and gravity, the interventions made by the pharmacist and their acceptance by physicians. RESULTS A total of 48% of patients showed at least one reconciliation error. Omission of drugs accounted for 74% of the reconciliation errors, mainly involving antihypertensive drugs (33%). An amount of 58% of reconciliation errors detected corresponded to severity category D. Pharmacist made interventions in the 98% of patients with discrepancies. A total of 81% of interventions were accepted. CONCLUSIONS The incidence and characteristics of reconciliation errors in ICU are similar to those published in non-critically ill patients, and they affect drugs with high clinical significance. Our data support the importance of the stablishment of medication reconciliation proceedings in critically ill patients. The ICU's pharmacist could carry out this procedure adequately.
Collapse
Affiliation(s)
- C Lopez-Martin
- Área de Farmacia y Nutrición. AS Hospital Costa del Sol, Marbella, Málaga, España.
| | - I Aquerreta
- Servicio de Farmacia, Clínica Universidad de Navarra, Pamplona, España
| | - V Faus
- Área de Farmacia y Nutrición. AS Hospital Costa del Sol, Marbella, Málaga, España
| | - A Idoate
- Servicio de Farmacia, Clínica Universidad de Navarra, Pamplona, España
| |
Collapse
|
72
|
Chen MJ, Yu S, Chen IJ, Wang KWK, Lan YH, Tang FI. Evaluation of nurses' knowledge and understanding of obstacles encountered when administering resuscitation medications. NURSE EDUCATION TODAY 2014; 34:177-184. [PMID: 23660241 DOI: 10.1016/j.nedt.2013.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 03/08/2013] [Accepted: 04/08/2013] [Indexed: 06/02/2023]
Abstract
AIM The aim of the study was to develop and validate an instrument to evaluate nurses' knowledge and to understand the obstacles that they encounter when administering resuscitation medications. BACKGROUND Insufficient knowledge is a major factor in nurses' drug administration errors. Resuscitation involves situations in which doctors issue oral orders, and is inherently highly stressful. Sufficient knowledge is vital for nurses if they are to respond quickly and accurately when administering resuscitation medications. METHODS A cross-sectional study was conducted. A questionnaire (20 true-false questions) developed from literature and expert input, and validated by subject experts and one pilot study, was used to evaluate nurses' knowledge of resuscitation medications. Stratified sampling and descriptive statistics were applied. RESULTS A total of 188 nurses participated. The overall correct answer rate was 70.5% and the greater the nurse's work experience the higher the score. Only 8% of nurses considered themselves to have sufficient knowledge and 73.9% hoped to gain more training about resuscitation medications. The leading obstacle reported was "interruption of the drug administration procedure on resuscitation" (62.8%). Seventeen out of 20 questions achieved a discriminatory power of over 0.36, indicating good to excellent questions. In the study, a total of 16 resuscitation medication errors were reported by the participants, in which the errors involved atropine (five cases), epinephrine (three cases) and others (eight cases). The errors mainly involved misinterpretation of orders, insufficient knowledge and confusing certain drugs for other look-alike drugs. CONCLUSION Evidence-based results strongly suggest that nurses have insufficient knowledge and could benefit from longer working experience and additional training about resuscitation medications. Further research to validate the instrument is needed and the education of nurses regarding resuscitation medications is recommended.
Collapse
Affiliation(s)
| | - Shu Yu
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - I-Ju Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Wei K Wang
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Hui Lan
- Tri-service General Hospital, Taipei, Taiwan
| | - Fu-In Tang
- School of Nursing, National Yang-Ming University, Taipei, Taiwan.
| |
Collapse
|
73
|
Abstract
AIM This study aims to explore the characteristics of reported medication errors occurring among children in an Australian children's hospital, and to examine the types, causes and contributing factors of medication errors. METHODS A retrospective clinical audit was undertaken of medication errors reported to an online incident facility at an Australian children's hospital over a 4-year period. RESULTS A total of 2753 medication errors were reported over the 4-year period, with an overall medication error rate of 0.31% per combined admission and presentation, or 6.58 medication errors per 1000 bed days. The two most common severity outcomes were: the medication error occurred before it reached the child (n = 749, 27.2%); and the medication error reached the child who required monitoring to confirm that it resulted in no harm (n = 1519, 55.2%). Common types of medication errors included overdose (n = 579, 21.0%) and dose omission (n = 341, 12.4%). The most common cause relating to communication involved misreading or not reading medication orders (n = 804, 29.2%). Key contributing factors involved communication relating to children's transfer across different clinical settings (n = 929, 33.7%) and the lack of following policies and procedures (n = 617, 22.4%). More than half of the reports (72.5%) were made by nurses. CONCLUSION Future research should focus on implementing and evaluating strategies aimed at reducing medication errors relating to analgesics, anti-infectives, cardiovascular agents, fluids and electrolytes and anticlotting agents, as they are consistently represented in the types of medication errors that occur. Greater attention needs to be placed on supporting health professionals in managing these medications.
Collapse
Affiliation(s)
- Elizabeth Manias
- Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | | | | | | |
Collapse
|
74
|
Bagshaw SM, Stelfox HT, McDermid RC, Rolfson DB, Tsuyuki RT, Baig N, Artiuch B, Ibrahim Q, Stollery DE, Rokosh E, Majumdar SR. Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ 2013; 186:E95-102. [PMID: 24277703 DOI: 10.1503/cmaj.130639] [Citation(s) in RCA: 349] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Frailty is a multidimensional syndrome characterized by loss of physiologic and cognitive reserves that confers vulnerability to adverse outcomes. We determined the prevalence, correlates and outcomes associated with frailty among adults admitted to intensive care. METHODS We prospectively enrolled 421 critically ill adults aged 50 or more at 6 hospitals across the province of Alberta. The primary exposure was frailty, defined by a score greater than 4 on the Clinical Frailty Scale. The primary outcome measure was in-hospital mortality. Secondary outcome measures included adverse events, 1-year mortality and quality of life. RESULTS The prevalence of frailty was 32.8% (95% confidence interval [CI] 28.3%-37.5%). Frail patients were older, were more likely to be female, and had more comorbidities and greater functional dependence than those who were not frail. In-hospital mortality was higher among frail patients than among non-frail patients (32% v. 16%; adjusted odds ratio [OR] 1.81, 95% CI 1.09-3.01) and remained higher at 1 year (48% v. 25%; adjusted hazard ratio 1.82, 95% CI 1.28-2.60). Major adverse events were more common among frail patients (39% v. 29%; OR 1.54, 95% CI 1.01-2.37). Compared with nonfrail survivors, frail survivors were more likely to become functionally dependent (71% v. 52%; OR 2.25, 95% CI 1.03-4.89), had significantly lower quality of life and were more often readmitted to hospital (56% v. 39%; OR 1.98, 95% CI 1.22-3.23) in the 12 months following enrolment. INTERPRETATION Frailty was common among critically ill adults aged 50 and older and identified a population at increased risk of adverse events, morbidity and mortality. Diagnosis of frailty could improve prognostication and identify a vulnerable population that might benefit from follow-up and intervention.
Collapse
|
75
|
Nguyen HT, Pham HT, Vo DK, Nguyen TD, van den Heuvel ER, Haaijer-Ruskamp FM, Taxis K. The effect of a clinical pharmacist-led training programme on intravenous medication errors: a controlled before and after study. BMJ Qual Saf 2013; 23:319-24. [PMID: 24195894 DOI: 10.1136/bmjqs-2013-002357] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Little is known about interventions to reduce intravenous medication administration errors in hospitals, especially in low- and middle-income countries. OBJECTIVE To assess the effect of a clinical pharmacist-led training programme on clinically relevant errors during intravenous medication preparation and administration in a Vietnamese hospital. METHODS A controlled before and after study with baseline and follow-up measurements was conducted in an intensive care unit (ICU) and a post-surgical unit (PSU). The intervention comprised lectures, practical ward-based teaching sessions and protocols/guidelines, and was conducted by a clinical pharmacist and a nurse. Data on intravenous medication preparation and administration errors were collected by direct observation 12 h/day for seven consecutive days. Generalised estimating equations (GEE) were used to assess the effect of the intervention on the prevalence of clinically relevant erroneous doses, corrected for confounding factors. RESULTS 1204 intravenous doses were included, 516 during the baseline period (236 on ICU and 280 on PSU) and 688 during the follow-up period (407 on ICU and 281 on PSU). The prevalence of clinically relevant erroneous doses decreased significantly on the intervention ward (ICU) from 64.0% to 48.9% (p<0.001) but was unchanged on the control ward (PSU) (57.9% vs 64.1%; p=0.132). GEE analysis showed that doses on the intervention ward were 2.60 (1.27-5.31) times less likely to have clinically relevant errors (p=0.013). CONCLUSIONS The pharmacist-led training programme was effective, but the error rate remained relatively high. Further quality improvement strategies are needed, including changes to the working environment and promotion of a safety culture.
Collapse
Affiliation(s)
- Huong-Thao Nguyen
- Department of Clinical Pharmacy, School of Pharmacy, University of Medicine and Pharmacy, , Ho Chi Minh City, Vietnam
| | | | | | | | | | | | | |
Collapse
|
76
|
Abstract
Medication errors in intensive care units put patients at risk for injury or death every day. Safety requires an organized and systematic approach to improving the tasks, technology, environment, and organizational culture associated with medication systems. The Systems Engineering Initiative for Patient Safety model can help leaders and health care providers understand the complicated and high-risk work associated with critical care. Using this model, the author combines a human factors approach with the well-known structure-process-outcome model of quality improvement to examine research literature. The literature review reveals that human factors, including stress, high workloads, knowledge deficits, and performance deficits, are associated with medication errors. Factors contributing to medication errors are frequent interruptions, communication problems, and poor fit of health information technology to the workflow of providers. Multifaceted medication safety interventions are needed so that human factors and system problems can be addressed simultaneously.
Collapse
Affiliation(s)
- Karen H. Frith
- Karen H. Frith is Professor, College of Nursing, University of Alabama in Huntsville, 301 Sparkman Dr, Huntsville, AL 35899
| |
Collapse
|
77
|
Coleman JJ, Hodson J, Brooks HL, Rosser D. Missed medication doses in hospitalised patients: a descriptive account of quality improvement measures and time series analysis. Int J Qual Health Care 2013; 25:564-72. [PMID: 23744995 PMCID: PMC3786625 DOI: 10.1093/intqhc/mzt044] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2013] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate the changes in overdue doses rates over a 4-year period in an National Health Service (NHS) teaching hospital, following the implementation of interventions associated with an electronic prescribing system used within the hospital. DESIGN Retrospective time-series analysis of weekly dose administration data. SETTING University teaching hospital using a locally developed electronic prescribing and administration system (Prescribing, Information and Communication System or PICS) with an audit database containing details on every drug prescription and dose administration. PARTICIPANTS Prescription data extracted from the PICS database. INTERVENTION(S) Four interventions were implemented in the Trust: (i) the ability for doctors to pause medication doses; (ii) clinical dashboards; (iii) visual indicators for overdue doses and (iv) overdue doses Root Cause ANALYSIS (RCA) meetings and a National Patient Safety Agency (NPSA) Rapid Response Alert. Main outcome measure(s) The percentage of missed medication doses. RESULTS Rates of both missed antibiotic and non-antibiotic doses decreased significantly upon the introduction of clinical dashboards (reductions of 0.60 and 0.41 percentage points, respectively), as well as following the instigation of executive-led overdue doses RCA meetings (reductions of 0.83 and 0.97 percentage points, respectively) and the publication of an associated NPSA Rapid Response Alert. Implementing a visual indicator for overdue doses was not associated with significant decreases in the rates of missed antibiotic or non-antibiotic doses. CONCLUSIONS Electronic prescribing systems can facilitate data collection relating to missed medication doses. INTERVENTIONS providing hospital staff with information about overdue doses at a ward level can help promote reductions in overdue doses rates.
Collapse
Affiliation(s)
- Jamie J Coleman
- Medical Education Centre, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
| | | | | | | |
Collapse
|
78
|
Carayon P, Wetterneck TB, Cartmill R, Blosky MA, Brown R, Kim R, Kukreja S, Johnson M, Paris B, Wood KE, Walker J. Characterising the complexity of medication safety using a human factors approach: an observational study in two intensive care units. BMJ Qual Saf 2013; 23:56-65. [PMID: 24050986 DOI: 10.1136/bmjqs-2013-001828] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine medication safety in two intensive care units (ICU), and to assess the complexity of medication errors and adverse drug events (ADE) in ICUs across the stages of the medication-management process. METHODS Four trained nurse data collectors gathered data on medication errors and ADEs between October 2006 and March 2007. Patient care documents (eg, medication order sheets, notes) and incident reports were used to identify medication errors and ADEs in a 24-bed adult medical/surgical ICU and an 18-bed cardiac ICU in a tertiary care, community teaching hospital. In this cross-sectional study, a total of 630 consecutive ICU patient admissions were assessed to produce data on the number, rates and types of potential and preventable ADEs across stages of the medication-management process. RESULTS An average of 2.9 preventable or potential ADEs occurred in each admission, that is, 0.4 events per patient-day. Preventable or potential ADEs occurred in 2.6% of the medication orders. The rate of potential ADEs per 1000 patient-days was 276, whereas the rate of preventable ADEs per 1000 patient-days was 9.2. Most medication errors occur at the ordering (32%) and administration stages (39%). In 16-24% of potential and preventable ADEs, clusters of errors occurred either as a sequence of errors (eg, delay in medication dispensing leading to delay in medication administration) or grouped errors (eg, route and frequency errors in the order for a medication). Many of the sequences led to administration errors that were caused by errors earlier in the medication-management process. CONCLUSIONS Understanding the complexity of the vulnerabilities of the medication-management process is important to devise solutions to improve patient safety. Electronic health record technology with computerised physician order entry may be one step necessary to improve medication safety in ICUs. Solutions that target multiple stages of the medication-management process are necessary to address sequential errors.
Collapse
Affiliation(s)
- Pascale Carayon
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, , Madison, Wisconsin, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
79
|
Bourne RS, Choo CL, Dorward BJ. Proactive clinical pharmacist interventions in critical care: effect of unit speciality and other factors. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2013; 22:146-54. [PMID: 23763333 DOI: 10.1111/ijpp.12046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 05/07/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical pharmacists working in critical-care areas have a beneficial effect on a range of medication-related therapies including improving medication safety, patient outcomes and reducing medicines' expenditure. However, there remains a lack of data on specific factors that affect the reason for and type of interventions made by clinical pharmacists, such as unit speciality. OBJECTIVE To compare the type of proactive medicines-related interventions made by clinical pharmacists on different critical-care units within the same institution. METHODS A retrospective evaluation of proactive clinical pharmacist recommendations, made in three separate critical-care areas. Intervention data were analysed over 18 months (general units) and 2 weeks for the cardiac and neurological units. Assessment of potential patient harm related to the medication interventions were made in the neurological and cardiac units. KEY FINDINGS Overall, 5623, 211 and 156 proactive recommendations were made; on average 2.2, 3.8 and 4.6 per patient from the general, neurological and cardiac units respectively. The recommendations acceptance rate by medical staff was approximately 90% for each unit. The median potential severity of patient harm averted by the interventions were 3.6 (3; 4.2) and 4 (3.2; 4.4) for the neurological and cardiac units (P = 0.059). The reasons for, types and drug classification of the medication recommendations demonstrated some significant differences between the units. CONCLUSIONS Clinical pharmacists with critical-care training make important medication recommendations across general and specialist critical-care units. The patient case mix and admitting speciality have some bearing on the types of medication interventions made. Moreover, severity of patient illness, scope of regular/routine specialist pharmacist service and support systems provided also probably affect the reason for these interventions.
Collapse
Affiliation(s)
- Richard S Bourne
- Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals, Northern General Hospital, Sheffield, UK
| | | | | |
Collapse
|