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Su WTK, Lehto MR, Degnan DD, Yih Y, Duffy VG, DeLaurentis P. Healthcare Professionals Risk Assessments for Alert Overrides in High-Risk IV Infusions Using Simulated Scenarios. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2020; 40:1342-1354. [PMID: 32339316 DOI: 10.1111/risa.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 03/02/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
This study aimed to use healthcare professionals' assessments to calculate expected risk of intravenous (IV) infusion harm for simulated high-risk medications that exceed soft limits and to investigate the impact of relevant risk factors. We designed 30 infusion scenarios for four high-risk medications, propofol, morphine, insulin, and heparin, infused in adult intensive care unit (AICU) and adult medical and surgical care unit (AMSU). A total of 20 pharmacists and 5 nurses provided their assessed expected risk of harm in each scenario. Descriptive statistics, analysis of variance with least square mean, and post hoc test were conducted to test the effects of field limit type, soft (SoftMax), and hard maximum drug limit types (HardMax), and care area-medication combination on risk of harm. The results showed that overdosing scenarios with continuous and bolus dose limit types were assessed with significantly higher risks than those of bolus dose rate type. An overdose infusion in AICU over a large SoftMax was assessed to be of higher risk than over a small one, but not in AMSU. For overdose infusions with three levels of drug amount, greater drug amount in AICU and AMSU was assessed to have higher risk, except insignificant risk difference between the infusions with higher and moderate drug amount in AMSU. This study obtained expected risk for simulated high-risk IV infusions and found that different field limit and SoftMax types can affect expected risk based on healthcare professionals' perspectives. The findings will be regarded as benchmarks for validating risk quantification models in future research.
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Affiliation(s)
- Wan-Ting K Su
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI, USA
| | - Mark R Lehto
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Dan D Degnan
- Professional Programs Laboratory, Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, Gerald D. and Edna E. Mann Hall, West Lafayette, IN, USA
| | - Yuehwern Yih
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, Gerald D. and Edna E. Mann Hall, West Lafayette, IN, USA
| | - Vincent G Duffy
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Poching DeLaurentis
- Regenstrief Center for Healthcare Engineering, Purdue University, Gerald D. and Edna E. Mann Hall, West Lafayette, IN, USA
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Gates PJ, Baysari MT, Gazarian M, Raban MZ, Meyerson S, Westbrook JI. Prevalence of Medication Errors Among Paediatric Inpatients: Systematic Review and Meta-Analysis. Drug Saf 2020; 42:1329-1342. [PMID: 31290127 DOI: 10.1007/s40264-019-00850-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The risk of medication errors is high in paediatric inpatient settings. However, estimates of the prevalence of medication errors have not accounted for heterogeneity across studies in error identification methods and definitions, nor contextual differences across wards and the use of electronic or paper medication charts. OBJECTIVE Our aim was to conduct a systematic review and meta-analysis to provide separate estimates of the prevalence of medication errors among paediatric inpatients, depending on hospital ward and the use of electronic or paper medication charts, that address differences in error identification methods and definitions. METHODS We systematically searched five databases to identify studies published between January 2000 and December 2018 that assessed medication error rates by medication chart audit, direct observation or a combination of methods. RESULTS We identified 71 studies, 19 involved paediatric wards using electronic charts. Most studies assessed prescribing errors with few studies assessing administration errors. Estimates varied by ward type. Studies of paediatric wards using electronic charts generally reported a reduced error prevalence compared to those using paper, although there were some inconsistencies. Error detection methods impacted the rate of administration errors in studies of multiple wards, however, no other difference was found. Definition of medication error did not have a consistent impact on reported error rates. CONCLUSIONS Medication errors are a frequent occurrence in paediatric inpatient settings, particularly in intensive care wards and emergency departments. Hospitals using electronic charts tended to have a lower rate of medication errors compared to those using paper charts. Future research employing controlled designs is needed to determine the true impact of electronic charts and other interventions on medication errors and associated harm among hospitalized children.
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Affiliation(s)
- Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia.
| | - Melissa T Baysari
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Madlen Gazarian
- School of Medical Sciences, Faculty of Medicine, University of NSW Sydney, Sydney, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Sophie Meyerson
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
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Madorran E, Stožer A, Bevc S, Maver U. In vitro toxicity model: Upgrades to bridge the gap between preclinical and clinical research. Bosn J Basic Med Sci 2020; 20:157-168. [PMID: 31621554 PMCID: PMC7202182 DOI: 10.17305/bjbms.2019.4378] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/29/2019] [Indexed: 11/30/2022] Open
Abstract
The Centers for Disease Control and Prevention (CDC) provides extensive data that indicate our need for drugs to maintain human population health. Despite the substantial availability of drugs on the market, many patients lack specific drugs. New drugs are required to tackle this issue. Moreover, we need more reliable models for testing drug toxicity, as too many drug approval failures occur with the current models. This article briefly describes various approaches of the currently used models for toxicity screening, to justify the selection of in vitro cell-based models. Cell-based toxicity models have the best potential to reliably predict drug toxicity in humans, as they are developed using the cells of the target organism. However, currently, a large gap exists between in vitro cell-based approach to toxicity testing and the clinical approach, which may be contributing to drug approval failures. We propose improvements to in vitro cell-based toxicity models, which is often an insight approach, to better match this approach with the clinical homeostatic approach. This should enable a more accurate comparison of data between the preclinical as well as clinical models and provide a more comprehensive understanding of human physiology and biological effects of drugs.
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Affiliation(s)
- Eneko Madorran
- Institute of Anatomy, Histology and Embryology, Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Department of Pharmacology, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Andraž Stožer
- Institute of Physiology, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Sebastjan Bevc
- Department of Pharmacology, Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Department of Nephrology, Clinic for Internal Medicine, University Medical Center Maribor, Maribor, Slovenia
| | - Uroš Maver
- Department of Pharmacology, Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Institute of Biomedical Sciences, Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Kuo SY, Wu JC, Chen HW, Chen CJ, Hu SH. Comparison of the effects of simulation training and problem-based scenarios on the improvement of graduating nursing students to speak up about medication errors: A quasi-experimental study. NURSE EDUCATION TODAY 2020; 87:104359. [PMID: 32058883 DOI: 10.1016/j.nedt.2020.104359] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/06/2019] [Accepted: 01/27/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Medication administration errors are common among new nurses. Nursing students might be less willing to speak up about errors because of a lack of knowledge and experience. OBJECTIVES To examine the effects of simulation training and problem-based scenarios on speaking up about medication errors among graduating nursing students. DESIGN Prospective, controlled experimental study design. SETTING A university four-year nursing program in Taiwan. PARTICIPANTS In total, 93 graduating nursing students in their last semester were recruited. Sixty-six students who received both a problem-based scenario and medication administration simulation training comprised the experimental group, while 27 students who received problem-based scenarios alone comprised the control group. METHODS Experimental group students underwent 2 h of simulation training. This training class was designed based on Kolb's experiential learning theory for knowledge development and speaking up about errors. Students in both groups administered medications in problem-based scenarios with eight embedded errors. Students' performance in speaking up about medication errors was directly observed and graded using an objective structured checklist. The McNeamer Chi-squared test, paired t-test, Z test, t-test, and Hedges' g effect size were conducted. RESULTS The number of times participants spoke up about medication errors significantly improved in both the experimental group (pre-test: 2.05 ± 1.12 and post-test 6.14 ± 1.25, t = 22.85, p<0.001) and control group (pretest: 2.04 ± 1.16 and post-test: 4.26 ± 1.63, t = 6.33, p<0.001). However, after the intervention, the mean number of times participants spoke up about medication errors in the experimental group was significantly higher than that in the control group (t = 5.99, p<0.001) in the post-test. CONCLUSIONS Simulation training exhibited more-significant improvements than problem-based scenarios. Nursing schools and hospitals should incorporate simulation training or at least problem-based scenarios to improve medication safety.
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Affiliation(s)
- Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan.
| | - Jen-Chieh Wu
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan; Department of Emergency, Taipei Medical University Hospital, 252 Wuxing Street, Taipei 11031, Taiwan
| | - Hui-Wen Chen
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan; School of Nursing, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei 112, Taiwan
| | - Chia-Jung Chen
- Department of Nursing, Taipei Medical University Hospital, 252 Wuxing Street, Taipei 11031, Taiwan
| | - Sophia H Hu
- School of Nursing, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei 112, Taiwan.
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ÖZDEMİR N, ÇELİKER A, KUŞKONMAZ BB, OKUR FV, UÇKAN ÇETİNKAYA D. Evaluation of Drug-Related Problems in a Pediatric Bone Marrow Transplantation Unit Identified by a Clinical Pharmacist in-Training in a 7 Month Period. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2020. [DOI: 10.33808/clinexphealthsci.590213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Luokkamäki S, Härkänen M, Saano S, Vehviläinen-Julkunen K. Registered Nurses' medication administration skills: a systematic review. Scand J Caring Sci 2020; 35:37-54. [PMID: 32168398 DOI: 10.1111/scs.12835] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/09/2020] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this review was to identify methods for measuring Registered Nurses' medication administration skills and to describe these skills. DESIGN A systematic literature review. DATA SOURCES The CINAHL, PubMed, Scopus, Cochrane, PsycInfo and Medic databases were searched for articles from the period 2007-2018. REVIEW METHODS Two researchers independently selected the articles and evaluated their quality using the National Heart, Lung and Blood Institute study quality assessment tools. The data were analysed using content analysis. RESULTS A total of 727 studies were identified of which 22 studies were included in this review. A total of six different measurement methods were identified: questionnaire or survey, observation, knowledge test or exam, focus group interviews, chart reviews and voluntarily reported errors. Different methods provided different information on medication administration skills. Medication administration skills were classified under nine areas: (1) safe ordering, handling, storing and discarding of medications, (2) preparing of medications, (3) the administration of medications to patients, (4) documentation, (5) evaluation and assessment of medication-related issues, (6) drug calculation skills, (7) cooperation with other professionals and (8) with the patients and (9) reporting of medication information. The results demonstrated that there are many areas that need to be improved to increase medication safety. CONCLUSIONS Medication administration includes many different phases, as a result of which nurses need to have many various skills to cope with medication administration as required by their profession. This review shows that nurses' medication administration skills need to be developed, and special attention should be paid to the preparation and administration phases. It is important to regularly utilise different teaching strategies and verify nurses' medication competence. As each research method has different limitations, it is vital that further studies combine different methods to form a comprehensive picture of nurses' medication administration skills.
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Affiliation(s)
- Sanna Luokkamäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | | | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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Borradale H, Andersen P, Wallis M, Oprescu F. Misreading Injectable Medications-Causes and Solutions: An Integrative Literature Review. Jt Comm J Qual Patient Saf 2020; 46:291-298. [PMID: 32151563 DOI: 10.1016/j.jcjq.2020.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND This integrative review examines research identifying the misreading of injectable medications as a cause of medication error in hospitals, factors affecting injectable medication visibility leading to medication errors, and interventions to increase the readability of injectable medications. Signal detection theory (SDT) is applied to explain why visual enhancement of injectable medications may improve accuracy of administration. METHODS Academic health databases were searched for articles published between 2000 and 2019. An integrative review methodology permitted exploration and critique of both theoretical and empirical literature. RESULTS Fifteen studies reported that misreading injectable medications contributed to medication errors. Five studies investigated interventions to improve visualization of injectable medications. SDT suggested three factors may contribute to misreading injectable medications: (1) environmental light levels, (2) medication labels, and (3) clinician factors. CONCLUSION Although the literature on this topic was limited and not definitive, results of this review indicated possible ways to improve practice and targets for future research to reduce medication errors due to misreading injectable medication labels.
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Alrabadi N, Haddad R, Haddad R, Shawagfeh S, Mukatash T, Al-rabadi D, Abuhammad S. Medication errors among registered nurses in Jordan. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Objectives
Medication error (ME) is like a venom dispersing in clinical practice, particularly the process of drugs’ administration. Nurses, as the direct drug administrators, are in critical defense lines to prevent its occurrence. Therefore, our aims were to explore nurses’ understanding, perception, attitude and prevalence of MEs and thereafter defining the main factors associated with its occurrence and needed for designing proper policies for its sufficient prevention.
Methods
Self-reported questionnaires were obtained from 156 nurses distributed almost equally between the 3 major teaching hospitals in Jordan. The questionnaires aimed at measuring their understanding, attitudes, and the prevalence of MEs.
Key findings
The majority of respondents were males (51.3%), young (25–34, 75%), hold a BSc degree (84.6%). Most of their experiences were less than 5 years (67.3%). The level of understanding of the definition, associated factors, and the consequences of ME was acceptable between registered nurses in Jordanian teaching hospitals. Nurses who had the lowest experience (0–5 years) were the highest in committing MEs (P-value = 0.006). Otherwise, gender, age, and education were not significantly associated with MEs. The participants reported that the most common causes of medication error were setting the infusion devices incorrectly, distraction, labeling and packaging problems. Participants declared that the incidents of MEs are underreported (Reporting rate (28.3%)) and they believed that it was most likely due to the fear of losing their job, misjudgment on the seriousness of the incidence that warrant reporting, and fear from coworkers' actions.
Conclusions
MEs are common and may be underreported among registered nurses in Jordan. National policymakers should take critical steps to encourage the nurses to report any error in medication administration and therefore reducing its occurrence.
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Affiliation(s)
- Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rabia Haddad
- King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Razan Haddad
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Shaima Shawagfeh
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Tareq Mukatash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Daher Al-rabadi
- King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Sawsan Abuhammad
- Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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Gates PJ, Baysari MT, Mumford V, Raban MZ, Westbrook JI. Standardising the Classification of Harm Associated with Medication Errors: The Harm Associated with Medication Error Classification (HAMEC). Drug Saf 2020; 42:931-939. [PMID: 31016678 PMCID: PMC6647434 DOI: 10.1007/s40264-019-00823-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Classifying harm associated with a medication error can be time consuming and labour intensive and limited studies undertake this step. There is no standardised process, and few studies that report harm assessment provide adequate methods to allow for study replication. Studies typically mention that a clinical review panel classified patient harm and provide a reference to a classification tool. Moreover, in many studies it is unclear whether potential or actual harm was classified as studies refer only to ‘error severity’. The tools used to categorise the severity of patient harm vary widely across studies and few have been assessed for inter-rater reliability and criterion validity. In this paper, we describe the systematic process we undertook to synthesise the defining elements and strengths, while mitigating the limitations, of existing harm classification tools to derive the Harm Associated with Medication Error Classification (HAMEC). This new tool provides a harm classification for use across clinical and research settings. The provision of an explicit process for its application and guiding category descriptors are designed to reduce the risk of misclassification and produce results that are comparable across studies. As the World Health Organisation embarks on its international safety challenge of reducing medication-related harm by 50%, accompanying methodological advances are required to measure progress.
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Affiliation(s)
- Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
| | - Melissa T Baysari
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Virginia Mumford
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Bifftu BB, Mekonnen BY. The Magnitude of Medication Administration Errors among Nurses in Ethiopia: a Systematic Review and Meta-analysis. J Caring Sci 2020; 9:1-8. [PMID: 32296652 PMCID: PMC7146728 DOI: 10.34172/jcs.2020.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/28/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction: Nurses are the final safety check in the process of medication administration process to prevent errors that adversely affect life; yet death of comprehensive evidences in Ethiopia. The present study aimed to assess the pooled magnitude of MAEs (Medication Administration Errors) in Ethiopia. Methods: Systematic literature search in the databases of Pub-Med, Cochrane, and Google Scholar for gray literature were performed until December 3, 2018. The quality of study was assessed using criteria adopted from similar studies. Heterogeneity test and evidence of publication bias were assessed. Moreover, sensitivity analysis was also performed. Pooled prevalence of MAE was calculated using the random effects model. Results: A total of 2142 medication administrations were from observational and 681from self-reported studies were included in this systematic review and meta-analysis. The most prevalent and frequently reported type of MAEs was documentation error (52% to 87.5%) and time error (25.5% to 58.5%) respectively. Overall, the pooled magnitude of MAE was found to be 39.3% (95% CI, 29.1%-49.5%).It has no evidence of significant heterogeneity (I2 = 0%, P = 0.57) and publication bias Egger's test (P = 0.40). Conclusion: Overall, more than one in four observed/perceived medication administrations had errors. Documentation error is the most prevalent type of error. Nurses are suggested to strengthen their focus on the rights of medication administration guide particularly, documentation of their activities need special attention.
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Affiliation(s)
- Berhanu Boru Bifftu
- Department of Community Health Nursing, School of Nursing, University of Gondar College of Medicine and Health Science, Gondar, Ethiopia
| | - Bezenaw Yimer Mekonnen
- Department of Community Health Nursing, School of Nursing, University of Gondar College of Medicine and Health Science, Gondar, Ethiopia
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Millichamp T, Johnston AN. Interventions to support safe medication administration by emergency department nurses: An integrative review. Int Emerg Nurs 2020; 49:100811. [DOI: 10.1016/j.ienj.2019.100811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/07/2019] [Accepted: 10/24/2019] [Indexed: 11/26/2022]
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Oduyale MS, Patel N, Borthwick M, Claus S. Co-administration of multiple intravenous medicines: Intensive care nurses' views and perspectives. Nurs Crit Care 2020; 25:156-164. [PMID: 31950570 DOI: 10.1111/nicc.12497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/25/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Co-administration of multiple intravenous (IV) medicines down the same lumen of an IV catheter is often necessary in the intensive care unit (ICU) while ensuring medicine compatibility. AIMS AND OBJECTIVES This study explores ICU nurses' views on the everyday practice surrounding co-administration of multiple IV medicines down the same lumen. DESIGN Qualitative study using focus group interviews. METHODS Three focus groups were conducted with 20 ICU nurses across two hospitals in the Thames Valley Critical Care Network, England. Participants' experience of co-administration down the same lumen and means of assessing compatibility were explored. All focus groups were recorded, transcribed verbatim, and analysed using thematic analysis. Functional Resonance Analysis Method was used to provide a visual representation of the co-administration process. RESULTS Two key themes were identified as essential during the process of co-administration, namely, venous access and resources. Most nurses described insufficient venous access and lack of compatibility data for commonly used medicines (eg, analgesics and antibiotics) as particular challenges. Strategies such as obtaining additional venous access, prioritizing infusions, and swapping line of infusion were used to manage IV administration problems where medicines were incompatible, or of unknown or variable compatibility. CONCLUSIONS Nurses use several workarounds to manage commonly encountered medication compatibility problems that may lead to delays in therapy. Organizations should review and tailor compatibility resources towards commonly administered medicines using an interdisciplinary approach. Developing a clinical decision-making pathway to minimise variability while promoting safe co-administration practice should be prioritised. RELEVANCE TO CLINICAL PRACTICE This study highlights several ways ICU nurses are able to manage challenges associated with co-administration and the need for the development of a more robust and comprehensive compatibility resource that is relevant to everyday practice through collaboration between nurses and pharmacists.
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Affiliation(s)
| | - Nilesh Patel
- Reading School of Pharmacy, University of Reading, Reading, UK
| | - Mark Borthwick
- Pharmacy Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Text Mining Method for Studying Medication Administration Incidents and Nurse-Staffing Contributing Factors: A Pilot Study. Comput Inform Nurs 2019; 37:357-365. [PMID: 30870188 DOI: 10.1097/cin.0000000000000518] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Incident reporting systems are being implemented globally, thus increasing the profile and prevalence of incidents, but the analysis of free-text descriptions remains largely hidden. The aims of the study were to explore the extent to which incident reports recorded staffing issues as contributors to medication administration incidents. Incident reports related to medication administration (N = 1012) were collected from two hospitals in Finland between January 1, 2013, and December 31, 2014. The SAS Enterprise Miner 13.2 and its Text Miner tool were used to excavate terms and descriptors and to uncover themes and concepts in the free-text descriptions of incidents with (n = 194) and without (n = 818) nurse staffing-related contributing factors. Text mining included (1) text parsing, (2) text filtering, and (3) modeling text clusters and text topics. The term "rush/hurry" was the sixth most common term used in incidents where nurse-staffing was identified as a contributing factor. Nurse-staffing factors, however, were not pronounced in clusters or in text topics of either data set. Text mining offers the opportunity to analyze large free-text mass and holds promise for providing insight into the antecedents of medication administration incidents.
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Tam SYJ, Coller JK, Wignall A, Gibson RJ, Khatri A, Barbé C, Bowen JM. Intestinal accumulation of silica particles in a rat model of dextran sulfate sodium-induced colitis. Ann Gastroenterol 2019; 32:584-592. [PMID: 31700235 PMCID: PMC6826066 DOI: 10.20524/aog.2019.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/18/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Ulcerative colitis (UC) is a lifelong inflammatory bowel disease characterized by periods of intense colonic inflammation leading to debilitating symptoms. Delivery methods of current UC treatments are suboptimal and associated with side effects. Silica particles are a potential alternative delivery method for UC therapeutics, given their promising drug-loading and safety profiles. However, it is unknown whether silica particles preferably accumulate at sites of colonic inflammation. This study aimed to correlate silica particle accumulation with colonic inflammation in a rat UC model. Methods: Albino Wistar rats received 4.5% dextran sulfate sodium (DSS) in drinking water (n=6) for 7 days to induce UC. Control rats (n=6) received drinking water only. UC activity was assessed daily using disease activity index. All rats were orally gavaged with silica particles labeled with Alexa-633 tags on day 9, followed by imaging at 3, 6, and 24 h. Silica particle distribution and accumulation were examined using biophotonic imaging, confocal microscopy and fluorescent spectrophotometry. Rats were killed on day 10, with jejunum, ileum and colon collected for histopathological scoring and quantification of fluorescence. Results: Rats treated with DSS had significantly higher UC disease activity (P=0.033) and colonic histopathological scores (P=0.0087) compared to controls. No statistically significant between-group differences in silica particle accumulation were seen on live imaging or tissue analysis. Conclusions: No correlation was seen between silica particle accumulation and colonic inflammation. However to draw clear conclusions, further research is required to establish the potential of silica particles as a UC-targeted delivery method.
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Affiliation(s)
- Shu Yie Janine Tam
- Discipline of Physiology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia (Shu Yie Janine Tam, Anthony Wignall, Joanne M. Bowen)
| | - Janet K Coller
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia (Janet K. Coller)
| | - Anthony Wignall
- Discipline of Physiology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia (Shu Yie Janine Tam, Anthony Wignall, Joanne M. Bowen).,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia (Anthony Wignall)
| | - Rachel J Gibson
- Discipline of Anatomy, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia (Rachel J. Gibson).,Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia (Rachel J. Gibson)
| | - Aparajita Khatri
- Ceramisphere Pty Ltd, College Street Gladesville, New South Wales (Aparajita Khatri, Chris Barbé), Australia This work was a collaborative endeavor between the University of Adelaide and Ceramisphere Pty Ltd
| | - Chris Barbé
- Ceramisphere Pty Ltd, College Street Gladesville, New South Wales (Aparajita Khatri, Chris Barbé), Australia This work was a collaborative endeavor between the University of Adelaide and Ceramisphere Pty Ltd
| | - Joanne M Bowen
- Discipline of Physiology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia (Shu Yie Janine Tam, Anthony Wignall, Joanne M. Bowen)
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Härkänen M, Paananen J, Murrells T, Rafferty AM, Franklin BD. Identifying risks areas related to medication administrations - text mining analysis using free-text descriptions of incident reports. BMC Health Serv Res 2019; 19:791. [PMID: 31684924 PMCID: PMC6829803 DOI: 10.1186/s12913-019-4597-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some medications carry increased risk of patient harm when they are given in error. In incident reports, names of the medications that are involved in errors could be found written both in a specific medication field and/or within the free text description of the incident. Analysing only the names of the medications implicated in a specific unstructured medication field does not give information of the associated factors and risk areas, but when analysing unstructured free text descriptions, the information about the medication involved and associated risk factors may be buried within other non-relevant text. Thus, the aim of this study was to extract medication names most commonly used in free text descriptions of medication administration incident reports to identify terms most frequently associated with risk for each of these medications using text mining. METHOD Free text descriptions of medication administration incidents (n = 72,390) reported in 2016 to the National Reporting and Learning System for England and Wales were analysed using SAS® Text miner. Analysis included text parsing and filtering free text to identify most commonly mentioned medications, followed by concept linking, and clustering to identify terms associated with commonly mentioned medications and the associated risk areas. RESULTS The following risk areas related to medications were identified: 1. Allergic reactions to antibacterial drugs, 2. Intravenous administration of antibacterial drugs, 3. Fentanyl patches, 4. Checking and documenting of analgesic doses, 5. Checking doses of anticoagulants, 6. Insulin doses and blood glucose, 7. Administration of intravenous infusions. CONCLUSIONS Interventions to increase medication administration safety should focus on checking patient allergies and medication doses, especially for intravenous and transdermal medications. High-risk medications include insulin, analgesics, antibacterial drugs, anticoagulants, and potassium chloride. Text mining may be useful for analysing large free text datasets and should be developed further.
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Affiliation(s)
- Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Yliopistoranta 1c, Kuopio, Finland
| | - Jussi Paananen
- Institute of Biomedicine, University of Eastern Finland, Yliopistoranta 1c, Kuopio, Finland
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, / UCL School of Pharmacy, London, UK
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Arthur J, Reddy A, Smith U, Hui D, Park M, Liu D, Vaughan-Adams N, Haider A, Williams J, Bruera E. Practices and perceptions regarding intravenous opioid infusion and cancer pain management. Cancer 2019; 125:3882-3889. [PMID: 31291011 PMCID: PMC11186036 DOI: 10.1002/cncr.32380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/01/2019] [Accepted: 06/06/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND In view of the recent opioid crisis, ways to promote safe and effective opioid-related practices are needed. Faster intravenous (iv) opioid infusion rates can result in increased adverse effects and risk for nonmedical opioid use. Data on best practices regarding safe iv opioid administration for cancer pain are limited. This study examined iv opioid bolus infusion practices and perceptions about opioids in cancer pain among 4 groups of inpatient oncology nurses. METHODS An anonymous cross-sectional survey was conducted among oncology nurses working in medical, surgical, intensive care unit (ICU), and emergency department (ED) settings. An iv opioid bolus infusion speed less than 120 seconds was considered too fast. RESULTS The participant response rate was 59% (731 of 1234). Approximately 58%, 54%, and 58% of all nurses administered morphine, hydromorphone, and fentanyl, respectively, in less than 120 seconds. The median morphine infusion speeds were 55, 60, 60, and 85 seconds for ICU, surgical, ED, and medical unit nurses, respectively (P = .0002). The odds ratios for infusing too fast were 2.04 and 2.52 for ED (P = .039) and ICU nurses (P = .003), respectively, in comparison with medical unit nurses, and they were 0.27 and 0.18 with frequent (P = .003) and very frequent use of a timing device (P = .0001), respectively, in comparison with no use. CONCLUSIONS More than half the nurses working in the inpatient setting reported administering iv opioids too fast. ICU nurses administered opioids the fastest. Nurses who frequently used a timing device were less likely to infuse too fast. Further research is needed to standardize and improve the safe intermittent administration of iv opioids to patients with cancer.
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Affiliation(s)
- Joseph Arthur
- Dept of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Akhila Reddy
- Dept of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Uniqua Smith
- Dept. of Nursing, The University of Texas MD Anderson Cancer, Houston, Texas
| | - David Hui
- Dept of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Minjeong Park
- Dept. of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Diane Liu
- Dept. of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas
| | | | - Ali Haider
- Dept of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Janet Williams
- Dept of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Eduardo Bruera
- Dept of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
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A Comparison of Error Rates Between Intravenous Push Methods: A Prospective, Multisite, Observational Study. J Patient Saf 2019; 14:60-65. [PMID: 28902007 DOI: 10.1097/pts.0000000000000419] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Current literature estimates the error rate associated with the preparation and administration of all intravenous (IV) medications to be 9.4% to 97.7% worldwide. This study aims to compare the number of observed medication preparation and administration errors between the only commercially available ready-to-administer product (Simplist) and IV push traditional practice, including a cartridge-based syringe system (Carpuject) and vials and syringes. METHODS A prospective, multisite, observational study was conducted in 3 health systems in various states within the United States between December 2015 and March 2016 to observe IV push medication preparation and administration. Researchers observed a ready-to-administer product and IV push traditional practice using a validated observational method and a modified data collection sheet. All observations were reconciled to the original medication order to determine if any errors occurred. RESULTS Researchers collected 329 observations (ready to administer = 102; traditional practice = 227) and observed 260 errors (ready to administer = 25; traditional practice = 235). The overall observed error rate for ready-to-administer products was 2.5%, and the observed error rate for IV push traditional practice was 10.4%. CONCLUSIONS The ready-to-administer group demonstrated a statistically significant lower observed error rate, suggesting that use of this product is associated with fewer observed preparation and administration errors in the clinical setting. Future studies should be completed to determine the potential for patient harm associated with these errors and improve clinical practice because it relates to the safe administration of IV push medications.
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DeLaurentis P, Walroth TA, Fritschle AC, Yu D, Hong JE, Yih Y, Fuller J. Stakeholder perceptions of smart infusion pumps and drug library updates: A multisite, interdisciplinary study. Am J Health Syst Pharm 2019; 76:1281-1287. [PMID: 31325354 PMCID: PMC6695576 DOI: 10.1093/ajhp/zxz135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Results of a questionnaire-based study to evaluate smart infusion pump end users' perceptions and understanding of the drug library update process are reported. METHODS The Indianapolis Coalition for Patient Safety, Inc., in partnership with the Regenstrief Center for Healthcare Engineering, conducted a 33-item electronic, cross-sectional survey across 5 Indiana health systems from May through November 2017. Interdisciplinary participants identified for survey distribution included nurses, pharmacists, biomedical engineers, administrators, and medication safety officers. The survey assessed the following domains: patient safety, the drug library update process, knowledge of drug libraries and the update process, and end-user perceptions. RESULTS A total of 778 submitted surveys were included in the data analysis, with a large majority of responses (90.2%) provided by nurses. The use of drug libraries for ensuring patient safety was deemed extremely important or important by 88% of respondents, but 36% indicated that they were unsure of whether drug libraries are updated on a routine basis in their health system. Approximately two-thirds agreed that the current update process improves quality of care (65.0%) and patient safety (68.1%). Moreover, 53.3% agreed that the current drug library update process was effective. However, less than 10% responded correctly when asked about the steps required to update the drug library. Furthermore, only 18% correctly indicated that when a pump is on it may not necessarily contain the most up-to-date version of the drug library. CONCLUSION A survey of 5 health systems in Indianapolis identified several end-user knowledge gaps related to smart pump drug library updates. The results suggest that these gaps were most likely due to a combination of the 2-step update process and the fact that the current drug library version is not easy to find and/or user-friendly and it is unclear when an update is pending.
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Affiliation(s)
- Poching DeLaurentis
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN
| | | | | | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN
| | - Jee Eun Hong
- School of Industrial Engineering, Purdue University, West Lafayette, IN
| | - Yuehwern Yih
- School of Industrial Engineering and Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN
| | - James Fuller
- Indianapolis Coalition for Patient Safety, Inc., Indianapolis, IN
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Reed L, Tarini BA, Andreae MC. Vaccine administration error rates at a large academic medical center and its affiliated clinics - Familiarity matters. Vaccine 2019; 37:5390-5396. [PMID: 31350155 DOI: 10.1016/j.vaccine.2019.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 06/29/2019] [Accepted: 07/05/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to track and describe the absolute number of vaccine administration errors and corresponding error rates over time and by patient age and vaccine type. METHODS Total vaccines administered to patients aged 0 through 19 years 364 days from 1/1/2006 through 12/31/2017 at a large academic health system in the Midwest United States with primary, specialty and school-based clinics, and a pediatric hospital were obtained from an electronic medical record. Vaccine administration errors over the same time period for the same patient criteria were analyzed from the health system's incident reporting system and further compared to the frequency of all incidents reported. Vaccine administration error rates were calculated. Data were analyzed by patient age, vaccine type and year administered. RESULTS Of the 1,431,206 vaccine doses given, 552 vaccine administration errors were identified (0.04%). The highest error rates occurred in children aged 2, 3, and 19 years. Vaccine types with the highest error rate were Td, rabies and pneumococcal polysaccharide vaccines. Overall vaccine doses given and errors reported increased over the study period. However, the increase was disproportionate, resulting in an increase in the error rate initially followed by a stabilization at the end of the study period. CONCLUSIONS Vaccine administration errors are uncommon. The error rate appears to be stabilizing. Errors are more likely at ages when vaccines are not commonly given, with vaccines that have age-specific dosing and with vaccines that are given less often. This suggests more safety checks are needed for vaccines that are rarely used or given off-schedule, and manufacturers should avoid vaccines with age-specific dosing.
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Affiliation(s)
- Lauren Reed
- Division of General Pediatrics, University of Michigan Medical School, Michigan Medicine, Ann Arbor, MI 48105, United States.
| | - Beth A Tarini
- Center for Translational Research, Children's National Health System, Washington, DC 20010, United States
| | - Margie C Andreae
- Division of General Pediatrics, University of Michigan Medical School, Michigan Medicine, Ann Arbor, MI 48105, United States
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Baker DW, Campbell R. Standardized Orders for Titrating Vasopressors: Do Efforts to Improve Safety Slow Delivery of Care? Jt Comm J Qual Patient Saf 2019; 45:589-590. [PMID: 31366441 DOI: 10.1016/j.jcjq.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Basil JH, Wong JN, Zaihan AF, Zaharuddin Z, Mohan DSR. Intravenous medication errors in Selangor, Malaysia: prevalence, contributing factors and potential clinical outcomes. DRUGS & THERAPY PERSPECTIVES 2019. [DOI: 10.1007/s40267-019-00633-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Márquez-Hernández VV, Fuentes-Colmenero AL, Cañadas-Núñez F, Di Muzio M, Giannetta N, Gutiérrez-Puertas L. Factors related to medication errors in the preparation and administration of intravenous medication in the hospital environment. PLoS One 2019; 14:e0220001. [PMID: 31339914 PMCID: PMC6655641 DOI: 10.1371/journal.pone.0220001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/06/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Medication errors have long been associated with low-quality medical care services and significant additional medical costs. OBJECTIVE The aim of this study was to culturally adapt and validate the questionnaire on knowledge, attitudes and behaviors in the administration of intravenous medication, as well as to explore these factors in a hospital setting. METHODS The study was divided into two phases: 1) validation and cross-cultural adaptation, and 2) cross-sectional study. A total of 276 hospital-based nursing professionals participated in the study. RESULTS A Cronbach's alpha value of 0.849 was found, indicating good internal consistency. In the multivariate analysis, statistically significant differences were found between knowledge and attitudes, demonstrating that having greater suitable knowledge correlates with having a more positive attitude. It was also discovered that having a positive attitude as well as the necessary knowledge increases the possibility of engaging in adequate behaviors. CONCLUSIONS The knowledge, attitudes and behavior questionnaire has a satisfactory internal consistency in order to be applied to the Spanish context. Implications for nursing management: Knowledge acquisition and positive attitude are both factors which promote adequate behavior, which in turn seems to have an impact on medication errors prevention. Health institutions must encourage continuous education for their employees.
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Affiliation(s)
- Verónica V. Márquez-Hernández
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
- Research Group for Health Sciences, University of Almería, Almería Spain
| | | | | | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Noemi Giannetta
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Lorena Gutiérrez-Puertas
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
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Chen A, Vogan E, Foglio J, Davis R, Reddy AJ, Lam SW. Effect of Detailed Titration Instructions on Time to Hemodynamic Stability in ICU Patients Requiring Norepinephrine. Jt Comm J Qual Patient Saf 2019; 45:606-612. [PMID: 31320260 DOI: 10.1016/j.jcjq.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study was conducted to assess the effect of titration instructions on patients receiving norepinephrine. METHODS In a single-center, retrospective cohort of patients who received at least 24 hours of norepinephrine as their first vasopressor (n = 1,303), patients were classified by whether they received norepinephrine before (n = 616) or after (n = 687) titration instructions were added. RESULTS Patients in the two groups had significant differences at baseline. On univariate analysis, time to hemodynamic stability was significantly longer in the post group (32 minutes [interquartile range (IQR): 12-65] vs. 10 minutes [IQR: 0-26]; p < 0.01). On multivariate analysis, addition of titration instructions was associated with an increase of 24 minutes in time to hemodynamic stability after accounting for differences in baseline systolic blood pressure, fluid boluses before norepinephrine, baseline arrhythmia, and number of other vasopressors or titratable infusions (p = 0.02). CONCLUSION In this evaluation, time to hemodynamic stability was significantly longer after addition of norepinephrine titration instructions even when accounting for differences in baseline characteristics.
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Abstract
Infusion-associated medication errors have the potential to cause the greatest patient harm. A 21-year review of errors and near-miss reports from a national medication error-reporting program found that infusion-associated medication errors resulted in the identification of numerous best practices that support patient safety. A content analysis revealed that most errors involved improper dosage, mistaken drug choice, knowledge-based mistakes, skill-based slips, and memory lapses. The multifaceted nature of administering medications via infusions was highlighted. Opportunities for improvements include best practices such as developing learning cultures and reinforcing the independent double-check process on medications. Staff will likely benefit from education on specific medications, prescription details, and smart pump technology.
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75
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Moisoglou I, Galanis P, Meimeti E, Dreliozi A, Kolovos P, Prezerakos P. Nursing staff and patients' length of stay. Int J Health Care Qual Assur 2019; 32:1004-1012. [PMID: 31282261 DOI: 10.1108/ijhcqa-09-2018-0215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to investigate the effect of nurse staffing, nurse education and work experience on patients' length of stay (LOS) in the Greek public hospitals. DESIGN/METHODOLOGY/APPROACH A cross-sectional study, with retrospective administrative data, was implemented. From all seven Regional Health Authorities of Greece, 25 general surgical units in 17 public hospitals participated in the study. FINDINGS All over the hospitals were studied, 32,287 patients ⩾17 years old and 203 nursing staff, who were working in the study units, were included in the analysis. According to the multivariate linear regression model, increased years of experience as a nurse (b= -0.04, 95% CI= -0.06 to -0.02, p=0.001) and increased percentage of registered nurse to the total nursing staff (b= -1.18, CI= -1.88 to -0.47, p=0.03) were associated with decreased patient LOS. ORIGINALITY/VALUE This was the first extended study in Greece, which explored the relationship between nurse staffing, nurse education, work experience and the LOS. The role that nurse staffing play together with its characteristics in the provision toward the quality healthcare services has already been recognized worldwide. The findings revealed the great shortage of nursing staff and the significant correlation between the work experience and educational level to patients' LOS.
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Affiliation(s)
- Ioannis Moisoglou
- Department of Quality Assurance and Continuing Education, General Hospital of Lamia, Lamia, Greece
| | - Petros Galanis
- Department of Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens , Athens, Greece
| | - Evangelia Meimeti
- Department of Administration Office, 1st Regional Healthcare Authority of Attica, Athens, Greece
| | - Angeliki Dreliozi
- Department of Administration Office, 2nd Regional Health Authority, Piraeus, Greece
| | - Petros Kolovos
- Department of Nursing, University of Peloponnese , Tripoli, Greece
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Athanasakis E. A meta‐synthesis of how registered nurses make sense of their lived experiences of medication errors. J Clin Nurs 2019; 28:3077-3095. [DOI: 10.1111/jocn.14917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/30/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
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Rashed AN, Tomlin S, Forbes B, Whittlesea C. Current practice of preparing morphine infusions for nurse/patient-controlled analgesia in a UK paediatric hospital: healthcare professionals' views and experiences. Eur J Hosp Pharm 2019; 25:327-330. [PMID: 31157051 DOI: 10.1136/ejhpharm-2015-000866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/26/2016] [Accepted: 03/01/2016] [Indexed: 11/03/2022] Open
Abstract
Objective To explore the views and experiences of healthcare professionals (HCPs) regarding the preparation of morphine infusions for nurse/patient-controlled analgesia (N/PCA). Methods Three focus groups were conducted with HCPs (anaesthetists, nurses in theatres and wards) at one UK children's hospital. Focus groups were transcribed verbatim and content analysis was used to identify themes. Results A variety of approaches are used to prepare morphine infusions. A lack of appreciation of the excess volume present in morphine ampoules that nominally contain 1 or 2 mL was identified. Other sources of error were miscalculation, complexity of the multistep procedure, distractions and time pressure. Participants suggested that 'ready-to-use' prefilled syringes and preprogrammed syringe pumps would improve practice and minimise the risk of error. Conclusions Risks associated with the preparation of infusions for paediatric N/PCA, in particular non-appreciation of the overage (excess volume) in morphine ampoules, raise concerns about the accuracy of current practices.
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Affiliation(s)
- Asia N Rashed
- Institute of Pharmaceutical Science, King's College London, King's Health Partners, London, UK.,Pharmacy Department, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Stephen Tomlin
- Institute of Pharmaceutical Science, King's College London, King's Health Partners, London, UK.,Pharmacy Department, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Ben Forbes
- Institute of Pharmaceutical Science, King's College London, King's Health Partners, London, UK
| | - Cate Whittlesea
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
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Carrez L, Bouchoud L, Fleury S, Combescure C, Falaschi L, Sadeghipour F, Bonnabry P. Work overload is related to increased risk of error during chemotherapy preparation. J Oncol Pharm Pract 2019; 25:1456-1466. [PMID: 31084249 DOI: 10.1177/1078155219845432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Chemotherapy preparation units face peaks in activity leading to high workloads and increased stress. The present study evaluated the impact of work overloads on the safety and accuracy of manual preparations. METHOD Simulating overwork, operators were asked to produce increasing numbers of syringes (8, 16, and 24), with markers (phenylephrine or lidocaine), within 1 h, in an isolator, under aseptic conditions. Results were analyzed using qualitative and quantitative criteria. Concentration deviations of < 5%, 5%-10%, 10%-30%, and >30% from the expected concentration were considered as accurate, weakly accurate, inaccurate, and wrong concentrations, respectively. RESULTS Twenty-one pharmacy technicians and pharmacists carried out 63 preparation sessions (n = 1007 syringes). A statistically significant decrease in the manufacturing time for one syringe was observed when workload increased (p < 0.0001). Thirty-nine preparation errors were recorded: 30 wrong concentrations (deviation > 30%), 6 mislabeling, 2 wrong diluents, and 1 wrong drug. There was no statistically significant difference in the mean concentration accuracy of final preparations across the three workloads. The overall error rate increased with the number of preparations made in 1 h: 1.8% for 8 preparations, 2.7% for 16 preparations, and 5.4% for 24 preparations (p < 0.05). CONCLUSION Although pharmacy technicians and pharmacists were able to increase production speeds with no effect on mean concentration accuracy under stressful conditions, there were greater probability errors being made. These results should encourage actions to spread workloads out over the day to avoid peaks in activity.
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Affiliation(s)
- Laurent Carrez
- 1 Pharmacy, Geneva University Hospitals, Geneva, Switzerland
| | - Lucie Bouchoud
- 1 Pharmacy, Geneva University Hospitals, Geneva, Switzerland
| | - Sandrine Fleury
- 1 Pharmacy, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Farshid Sadeghipour
- 2 School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Pascal Bonnabry
- 2 School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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Hermanspann T, van der Linden E, Schoberer M, Fitzner C, Orlikowsky T, Marx G, Eisert A. Evaluation to improve the quality of medication preparation and administration in pediatric and adult intensive care units. DRUG HEALTHCARE AND PATIENT SAFETY 2019; 11:11-18. [PMID: 30936751 PMCID: PMC6429998 DOI: 10.2147/dhps.s184479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose To determine the type, frequency, and factors associated with medication preparation and administration errors in adult intensive care units (ICUs) and neonatal ICUs (NICUs)/pediatric ICUs (PICUs). Patients and methods We conducted a prospective direct observation study in an adult ICU and NICU/PICU in a tertiary university hospital. Between June 2012 and June 2013, a clinical pharmacist and medical student observed the nursing care staff on weekdays during the preparation and administration of intravenous drugs. We analyzed the frequency and type of preparation and administration errors and factors associated with errors. Results Six hundred and three preparations in the adult ICU and 281 in the NICU/PICU were observed. Three hundred and eighty-five errors occurred in the adult ICU and 38 in the NICU/PICU. There were 5,040 and 2,514 error opportunities, with overall error rates of 7.6% and 1.5%, respectively. The total opportunities for error meant each single step of preparation and administration that was relevant for the drug. Most errors applied to the category “uniform mixing” (adult ICU: n=227, 59%; NICU/PICU: n=14, 37%). The multivariate logistic regression results showed a significantly different influence of the “preparation type” for the adult ICU compared with the NICU/PICU with regard to the occurrence of an error. Preparations for adult patients of the LCD type (liquid concentrate with diluent into syringe or infusion bag) were more often associated with errors than the P (powder in a glass vial that must be reconstituted and diluted if necessary), P=0.012, and LC (liquid concentrate into syringe), P=0.002 type. Conclusion “Uniform mixing” was the most erroneous preparation step in intravenous drug preparations in two ICUs. Improvement of nurse training and the preparation of prefilled syringes in the pharmacy might reduce errors and improve the quality and safety of drug therapy.
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Affiliation(s)
- Theresa Hermanspann
- Hospital Pharmacy, RWTH Aachen University Hospital, Aachen, Germany, .,Department of Pediatric and Adolescent Medicine, Section of Neonatology, RWTH Aachen University Hospital, Aachen, Germany,
| | - Eva van der Linden
- Department of Pediatric and Adolescent Medicine, Section of Neonatology, RWTH Aachen University Hospital, Aachen, Germany,
| | - Mark Schoberer
- Department of Pediatric and Adolescent Medicine, Section of Neonatology, RWTH Aachen University Hospital, Aachen, Germany,
| | - Christina Fitzner
- Department of Medical Statistics, Medical Faculty RWTH Aachen University, Aachen, Germany.,Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Thorsten Orlikowsky
- Department of Pediatric and Adolescent Medicine, Section of Neonatology, RWTH Aachen University Hospital, Aachen, Germany,
| | - Gernot Marx
- Department of Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Albrecht Eisert
- Hospital Pharmacy, RWTH Aachen University Hospital, Aachen, Germany, .,Institute of Pharmacology and Toxicology, Medical Faculty RWTH Aachen University, Aachen, Germany
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Schepel L, Aronpuro K, Kvarnström K, Holmström AR, Lehtonen L, Lapatto-Reiniluoto O, Laaksonen R, Carlsson K, Airaksinen M. Strategies for improving medication safety in hospitals: Evolution of clinical pharmacy services. Res Social Adm Pharm 2019; 15:873-882. [PMID: 30928317 DOI: 10.1016/j.sapharm.2019.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Medication safety risks are the most important preventable factors jeopardizing patient safety. To manage these risks, extending pharmacists' involvement in patient care and patient safety work has been systematically addressed in patient safety initiatives since the early 2000s. OBJECTIVE To explore the extent and range of clinical pharmacy services in Finnish hospitals to promote medication safety: 1) in 2011, when the first National Patient Safety Strategy, the new Health Care Act and the Medicines Policy 2020 had been recently enacted; and 2) five years later in 2016. METHODS The study was conducted in 2011 and 2016 as a national online survey targeted to hospital pharmacies (n = 24) and medical dispensaries (n = 131 in 2011; n = 28 in 2016). The questions were analyzed using descriptive statistics and qualitative content analysis. RESULTS Overall response rate was 60% in 2011 and 52% in 2016. Clinical pharmacy services were provided by 51% of the responding units in 2011, whereas by 85% in 2016. The reported number of clinical pharmacists had increased during the five years. The most notable increase in reported tasks occurred in conducting medication reconciliations (+63% increase in the number of providing units). By 2016 pharmacists had extended their tasks particularly towards system-based medication safety work: e.g. developing instructions for medication-use (91% of the responding units), creating and updating medication safety plans (87%) and using medication error reports in developing the process of medication use safer (78%). Pharmacists' participation in long-term continuing education became more common in 2016, which was perceived as helpful in extending their responsibilities to improve medication safety. CONCLUSION Pharmacists' involvement in patient care and system-based medication safety work was reported to become more common in Finnish hospitals during 2011-2016. This development is in line with patient safety policy initiatives and its impact on patient care outcomes should be followed up.
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Affiliation(s)
- Lotta Schepel
- HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS), Finland; Specialization Program of Hospital and Health Centre Pharmacy, Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland.
| | - Kirsi Aronpuro
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Kirsi Kvarnström
- HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS), Finland; Specialization Program of Hospital and Health Centre Pharmacy, Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Anna-Riia Holmström
- HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS), Finland; Specialization Program of Hospital and Health Centre Pharmacy, Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland; Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Lasse Lehtonen
- Helsinki University Hospital and University of Helsinki, Finland
| | | | - Raisa Laaksonen
- Specialization Program of Hospital and Health Centre Pharmacy, Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland; Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Kerstin Carlsson
- HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS), Finland
| | - Marja Airaksinen
- Specialization Program of Hospital and Health Centre Pharmacy, Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland; Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
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Yu AY, Rogers Van Katwyk S, Hoffman SJ. Probing popular and political discourse on antimicrobial resistance in China. Glob Health Res Policy 2019; 4:6. [PMID: 30859138 PMCID: PMC6394084 DOI: 10.1186/s41256-019-0097-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/19/2019] [Indexed: 12/29/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is an increasing threat to global public health that is largely exacerbated by the overuse and misuse of antimicrobial medicines. As the largest antimicrobials producer and user in the world, China has a critical role to play in combatting AMR. By examining Chinese news articles and policy statements, we aim to provide an authentic understanding of public discourse in China on AMR. Methods A search was conducted using two of the most comprehensive digital libraries for Chinese news media documents. Chinese policy documents were retrieved from official Chinese government websites. Records from June 2016 to May 2017 were included. Grounded theory was used to analyze included records, and we followed an iterative thematic synthesis process to categorize the key themes of each document. Results Across 64 news articles, most articles delivered general knowledge about AMR and debunked AMR-related myths, explored the implications of AMR-relevant policies, and discussed the misuse of antimicrobials in the agricultural sector. All policy documents provided guidance for healthcare workers, encouraging them to better manage antimicrobial prescriptions and usage. Conclusions While the Chinese media actively educates the public on strategies for AMR prevention, certain news articles risk misleading readers by downplaying the hazards of domestic AMR issues. Further, although several national policies are geared towards combatting AMR, the government faces difficult challenges in overcoming public misconceptions regarding antimicrobial use. Records from the regional level should also be examined to further explore China’s public discourse on AMR. Electronic supplementary material The online version of this article (10.1186/s41256-019-0097-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- An Yi Yu
- 1Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, ON Canada.,2Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
| | - Susan Rogers Van Katwyk
- 1Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, ON Canada.,3School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
| | - Steven J Hoffman
- 1Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, ON Canada.,2Faculty of Health Sciences, McMaster University, Hamilton, ON Canada.,4Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA USA
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83
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Davies KM, Coombes ID, Keogh S, Whitfield KM. Medication administration evaluation tool design: An expert panel review. Collegian 2019. [DOI: 10.1016/j.colegn.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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84
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Larmené-Beld KHM, Frijlink HW, Taxis K. A systematic review and meta-analysis of microbial contamination of parenteral medication prepared in a clinical versus pharmacy environment. Eur J Clin Pharmacol 2019; 75:609-617. [PMID: 30683970 DOI: 10.1007/s00228-019-02631-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/28/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Preparation of parenteral medication in hospitals is a complex process with a risk of microbial contamination of the product, especially when inappropriately prepared. Contaminated parenteral medications can cause severe complications to patients and increase morbidity in hospitals. The aim of this literature review is to systematically evaluate the contamination rate of parenteral medications in hospitals prepared in a pharmacy environment and a clinical environment. METHODS A literature search of PubMed and EMBASE from 2000 to 2018 was performed. Two different environments where preparation may be carried out were defined. Point estimates and 95% confidence intervals for contamination rates were calculated for each environment of medication preparation. The meta-analysis was performed using a random effects model. RESULTS The contamination rates in the clinical environment (n = 13 studies) varied between 1.09 and 20.70%. In the pharmacy environment (n = 5), all contamination rates were 0.00% except for one study (0.66%). The point estimates (random effect model) for the overall contamination rate of doses prepared in the clinical environment was 7.47% (5.16-9.79%), and 0.08% for doses prepared in the pharmacy environment. The point estimates (random effect model) for the overall contamination rate of doses prepared by nursing/ medical staff was 7.85% (5.18-10.53%), and 0.08% for doses prepared by pharmacy staff. CONCLUSIONS Significantly higher contamination rates were found for the preparation of parenteral medication in the clinical environment compared to pharmacy environment. In accordance with recent guidance, the almost 100-fold higher changes of contamination when reconstitution is performed in the clinical environment should urge hospitals to review their reconstitution process and apply risk-reducing measures to improve patient safety of parenteral therapy.
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Affiliation(s)
- Karin H M Larmené-Beld
- Department of Clinical pharmacy, Isala Hospital, Dokter van Heesweg 2, 8025, AB, Zwolle, The Netherlands. .,Department of Pharmacotherapy, Epidemiology and Economics, Groningen Research institute of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Henderik W Frijlink
- Department of Pharmaceutical Technology and Biopharmacy-Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Katja Taxis
- Department of Pharmacotherapy, Epidemiology and Economics, Groningen Research institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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Saint-Marc P, Ratiney R, Schlatter J. Challenges in Implementing an E-Learning Education Program for Syringe Pump Use. Int J Nurs Educ Scholarsh 2019; 16:ijnes-2017-0079. [PMID: 30673627 DOI: 10.1515/ijnes-2017-0079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 09/04/2018] [Indexed: 11/15/2022]
Abstract
To prevent the incidence of risks imputable to human error during the process of preparing the infusion pump, clarity in teaching and learning are required. Because traditional classroom training is difficult and time-consuming, the aim of the present study was to challenge the implementation of an e-learning education program for syringe pump use. The impact of the e-learning program was evaluated with 100 nurses between March and June 2016. The e-learning program significantly increased general baseline knowledge in syringe pump use; however, aspects of the program confused participants. The feedback from 98 % of nurses on the e-learning program was that it was effective in helping them with this skill. However, only 54 % opted for the e-learning program versus traditional training. The present study showed nurses preferred a blended learning format. Based on our hospital incident and error reports, this study shows local training requires a specific approach strategy for syringe pump education.
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Affiliation(s)
| | | | - Joël Schlatter
- Hopital universitaire Necker-Enfants Malades, Pharmacie, 75743Paris, France
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86
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Franzese C, Thomas C, Rinaldi A, Constable K, Nakamura K, Kalbermatten A, Coyne M. The burden of at-home preparation of lyophilized parenteral medications: an analysis of contributing factors and implications for chronic disease patients and caregivers. Expert Opin Drug Deliv 2019; 16:187-198. [PMID: 30636541 DOI: 10.1080/17425247.2019.1569626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the acute care setting, parenteral medication errors are well-studied. However, there is comparatively little research on how these issues translate to patient- or caregiver-prepared medications in the home, particularly with reconstituted medications. METHODS This was an ethnographic study designed to identify issues associated with four reconstitution use scenarios. Preparation burden was determined by measuring the time and manipulations required to prepare reconstituted medications across three preparation phases (assembly, reconstitution, and transfer). Deviations from product instructions for use, sterility breaches, self-reported preparation complications, and supply storage conditions were also analyzed. RESULTS A total of 14 participants completed the study. Overall, preparation burden was markedly higher when purpose-built reconstitution devices were not available. The majority of participants reported experiencing at least one complication associated with their medication preparation process; the reconstitution phase was the most significant source of both instructions for use deviations and breaches in sterility. Participants reported that the volume and variety of medication preparation supplies were a significant source of burden. CONCLUSIONS At-home preparation of reconstituted medications poses several challenges for patients and caregivers. As parenteral medications continue to shift towards self-administration, manufacturers should carefully consider the usability of such products and employ purpose-built reconstitution devices whenever possible.
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Affiliation(s)
| | | | | | | | - Koji Nakamura
- b Terumo Pharmaceutical Solutions , Somerset , NJ , USA
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87
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Perception and contributing factors to medication administration errors among nurses in Nigeria. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.100153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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88
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Azar AT, Hassan H, Razali MSAB, de Brito Silva G, Ali HR. Two-Degree of Freedom Proportional Integral Derivative (2-DOF PID) Controller for Robotic Infusion Stand. ADVANCES IN INTELLIGENT SYSTEMS AND COMPUTING 2019:13-25. [DOI: 10.1007/978-3-319-99010-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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89
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Rodriguez R. The Safety of Intravenous Drug Delivery Systems: Update on Current Issues Since the 2009 Consensus Development Conference. Hosp Pharm 2018; 53:408-414. [PMID: 30559529 PMCID: PMC6293390 DOI: 10.1177/0018578718798638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review was prepared in advance of the Third Consensus Development Conference on the Safety of Intravenous Drug Delivery Systems that was held at the W Hotel in Chicago, Illinois, from November 1 through 3, 2018. The purpose of this conference was to evaluate the safety of intravenous (IV) infusion systems used for medication administration. The expert panel of pharmacists, physicians, and nurses updated the findings of the Second Consensus Development Conference in 2009 that reviewed 5 IV drug delivery systems (manufacturer ready to use, outsourced ready to use, point-of-care activated, pharmacy compounded, and nonpharmacy compounded at point of care) with regard to applicability, ease of use, regulatory compliance, cost, safety, and implementation. The Third Consensus Development Conference expanded on previous findings by reviewing proceedings related to new standards, legislation, technologies, and shortage-related challenges related to IV medication administration that have been published since 2009. Invited faculty and audience members participated in revising a preliminary report summarizing these changes during the meeting.
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Jedwab RM, Hutchinson AM, Redley B. Magnesium sulphate replacement therapy in cardiac surgery patients: A systematic review. Aust Crit Care 2018; 32:421-433. [PMID: 30501993 DOI: 10.1016/j.aucc.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 09/06/2018] [Accepted: 09/24/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this review was to identify evidence to inform clinical practice guidelines for magnesium sulphate (MgSO4) replacement therapy for postoperative cardiac surgery patients. DATA SOURCES Three databases were systematically searched: CINAHL Complete, MEDLINE Complete, and EmBase. REVIEW METHOD USED A systematic literature review method was used to locate, appraise, and synthesise available evidence for each step of the medication management cycle (indication, prescription, preparation, administration, and monitoring) for MgSO4 replacement therapy. Database searches used combinations of synonyms for postoperation or surgery, cardiac, heart, arrhythmia, atrial fibrillation, and magnesium sulphate. Search results were independently screened for inclusion by two researchers at title, abstract, and full-text stages with good statistical agreement (kappa scores of 0.99, 0.87, and 1.00, respectively). RESULTS Twenty-four included studies reported varying methodologies, data collected, and medication management practices. Of these, 23 studies (95.8%) excluded patients with comorbidities commonly observed in clinical practice. This review identified low-level evidence for two practice recommendations: (i) concurrent administration of MgSO4 with medications recommended as the best practice for prevention of postoperative atrial fibrillation and (ii) clinical and laboratory monitoring of magnesium blood serum levels, vital signs, and electrocardiography should be performed during MgSO4 replacement therapy. Evidence to inform MgSO4 replacement therapy for each medication management cycle step was limited; therefore, a guideline could not be developed. CONCLUSIONS Although MgSO4 is routinely administered to prevent hypomagnesaemia in postoperative cardiac surgery patients, there was insufficient evidence to guide critical care nurses in each medication management cycle step for MgSO4 replacement therapy. These findings precluded the development of comprehensive recommendations to standardise this practice. Poor standardisation can increase the risk for patient harm related to variation in clinical processes and procedural errors. In light of this evidence gap, consensus of expert opinion should be used as a strategy to guide MgSO4 medication management.
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Affiliation(s)
- Rebecca M Jedwab
- Centre for Quality and Patient Safety Research - Monash Health Partnership, 246 Clayton Road, Clayton, Victoria, 3168, Australia; Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
| | - Alison M Hutchinson
- Centre for Quality and Patient Safety Research - Monash Health Partnership, 246 Clayton Road, Clayton, Victoria, 3168, Australia; Deakin University, School of Nursing and Midwifery, Geelong, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Bernice Redley
- Centre for Quality and Patient Safety Research - Monash Health Partnership, 246 Clayton Road, Clayton, Victoria, 3168, Australia; Deakin University, School of Nursing and Midwifery, Geelong, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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Grissinger M. Selected Medication Safety Risks That Can Easily Fall Off the Radar Screen-Part 3. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2018; 43:645-666. [PMID: 30410277 PMCID: PMC6205125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The final part of a 3-part series discusses medication safety risks related to labeling, patient education, and medication storage.
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Exploring healthcare professionals' perceptions of medication errors in an adult oncology department in Saudi Arabia: A qualitative study. Saudi Pharm J 2018; 27:176-181. [PMID: 30766427 PMCID: PMC6362166 DOI: 10.1016/j.jsps.2018.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022] Open
Abstract
Objective Adverse events which result from medication errors are considered to be one of the most frequently encountered patient safety issues in clinical settings. We undertook a qualitative investigation to identify and explore factors relating to medication error in an adult oncology department in Saudi Arabia from the perspective of healthcare professionals. Methods This was a qualitative study conducted in an adult oncology department in Saudi Arabia. After obtaining required ethical approvals and written consents from the participants, semi-structured interviews and focus group discussions were carried out for data collection. A stratified purposive sampling strategy was used to recruit medical doctors, pharmacists, and nurses. NVivo Pro version 11 was used for data analyses. Inductive thematic analysis was adopted in the primary coding of data while secondary coding of data was carried out deductively applying the Hospital Survey of Patient Safety Culture (HSOPSC) framework. Result The total number of participants were 38. Majority of the participants were nurses (n = 24), females (n = 30), and not of Saudi nationality (n = 31) with an average age of 36 years old. Causes of medication errors were categorized into 6 themes. These causes were related teamwork across units, staffing, handover of medication related information, accepted behavioural norms, frequency of events reported, and non-punitive response to error. Conclusion There were numerous causes for medication errors in the adult oncology department. This means substantive improvement in medication safety is likely to require multiple, inter-relating, complex interventions. More research should be conducted to examine context-specific interventions that may have the potential to improve medication safety in this and similar departments.
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93
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Treiber LA, Jones JH. After the Medication Error: Recent Nursing Graduates' Reflections on Adequacy of Education. J Nurs Educ 2018; 57:275-280. [PMID: 29718516 DOI: 10.3928/01484834-20180420-04] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/13/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study was to better understand individual- and system-level factors surrounding making a medication error from the perspective of recent Bachelor of Science in Nursing graduates. METHOD Online survey mixed-methods items included perceptions of adequacy of preparatory nursing education, contributory variables, emotional responses, and treatment by employer following the error. RESULTS Of the 168 respondents, 55% had made a medication error. Errors resulted from inexperience, rushing, technology, staffing, and patient acuity. Twenty-four percent did not report their errors. Key themes for improving education included more practice in varied clinical areas, intensive pharmacological preparation, practical instruction in functioning within the health care environment, and coping after making medication errors. CONCLUSION Errors generally caused emotional distress in the error maker. Overall, perceived treatment after the error reflected supportive environments, where nurses were generally treated with respect, fair treatment, and understanding. Opportunities for nursing education include second victim awareness and reinforcing professional practice standards. [J Nurs Educ. 2018;57(5):275-280.].
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Malfait S, Eeckloo K, Van Biesen W, Deryckere M, Lust E, Van Hecke A. Compliance with a structured bedside handover protocol: An observational, multicentred study. Int J Nurs Stud 2018; 84:12-18. [DOI: 10.1016/j.ijnurstu.2018.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/27/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
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Biltoft J, Finneman L. Clinical and financial effects of smart pump–electronic medical record interoperability at a hospital in a regional health system. Am J Health Syst Pharm 2018; 75:1064-1068. [DOI: 10.2146/ajhp161058] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Al Khawaldeh TA, Wazaify M. Intravenous cancer chemotherapy administration errors: An observational study at referral hospital in Jordan. Eur J Cancer Care (Engl) 2018; 27:e12863. [PMID: 29873424 DOI: 10.1111/ecc.12863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 03/31/2018] [Accepted: 04/17/2018] [Indexed: 10/14/2022]
Abstract
This study aimed to describe types, frequencies and stages of errors which occurred during administration of commonly used intravenous (IV) cancer chemotherapy medications inclusive of "aseptic technique." A disguised direct observational cross-sectional prospective study was performed. A checklist consisting of appropriate process of administration of injectable chemotherapy agents along with the "aseptic technique" was developed and used. The study was conducted at the haematology and oncology wards at King Hussein Medical Centre/Jordanian Royal Medical Services (KHMC/JRMS). In all, 10 nurses who administrated IV chemotherapy in both inpatient and outpatient settings were observed. Overall, administration processes of 654 cases, consisting of 15,042 error opportunities, were observed of which 4112 (27.3%) errors were detected. A total of 19.9% (2217/11,118) and 48.3% (1895/3924) of the errors were in the administration process and "aseptic techniques," respectively. Nurses who had finished a cancer chemotherapy medication preparation and administration training course committed significantly (p > 0.05) more medication administration errors compared to those who had not completed such course. This study highlighted a significant incidence of medication errors during administration of injectable chemotherapy agents. Educational programmes are required for safe administration of IV chemotherapy agents in some settings in Jordan.
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Affiliation(s)
- Thamer Ali Al Khawaldeh
- Clinical Pharmacist, Department of Pharmacy, Jordan Royal Medical Services (JRMS), Amman, Jordan
| | - Mayyada Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
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Hassen Y, Singh P, Pucher PH, Johnston MJ, Darzi A. Identifying quality markers of a safe surgical ward: An interview study of patients, clinical staff, and administrators. Surgery 2018; 163:1226-1233. [DOI: 10.1016/j.surg.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/09/2017] [Accepted: 12/02/2017] [Indexed: 11/30/2022]
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100
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Ni Y, Lingren T, Hall ES, Leonard M, Melton K, Kirkendall ES. Designing and evaluating an automated system for real-time medication administration error detection in a neonatal intensive care unit. J Am Med Inform Assoc 2018; 25:555-563. [PMID: 29329456 PMCID: PMC6018990 DOI: 10.1093/jamia/ocx156] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/05/2017] [Accepted: 12/18/2017] [Indexed: 11/12/2022] Open
Abstract
Background Timely identification of medication administration errors (MAEs) promises great benefits for mitigating medication errors and associated harm. Despite previous efforts utilizing computerized methods to monitor medication errors, sustaining effective and accurate detection of MAEs remains challenging. In this study, we developed a real-time MAE detection system and evaluated its performance prior to system integration into institutional workflows. Methods Our prospective observational study included automated MAE detection of 10 high-risk medications and fluids for patients admitted to the neonatal intensive care unit at Cincinnati Children's Hospital Medical Center during a 4-month period. The automated system extracted real-time medication use information from the institutional electronic health records and identified MAEs using logic-based rules and natural language processing techniques. The MAE summary was delivered via a real-time messaging platform to promote reduction of patient exposure to potential harm. System performance was validated using a physician-generated gold standard of MAE events, and results were compared with those of current practice (incident reporting and trigger tools). Results Physicians identified 116 MAEs from 10 104 medication administrations during the study period. Compared to current practice, the sensitivity with automated MAE detection was improved significantly from 4.3% to 85.3% (P = .009), with a positive predictive value of 78.0%. Furthermore, the system showed potential to reduce patient exposure to harm, from 256 min to 35 min (P < .001). Conclusions The automated system demonstrated improved capacity for identifying MAEs while guarding against alert fatigue. It also showed promise for reducing patient exposure to potential harm following MAE events.
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Affiliation(s)
- Yizhao Ni
- Department of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Todd Lingren
- Department of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Eric S Hall
- Department of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Matthew Leonard
- Department of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Kristin Melton
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Eric S Kirkendall
- Department of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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