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Bergon-Sendin E, Perez-Grande C, Lora-Pablos D, Moral-Pumarega MT, Melgar-Bonis A, Peña-Peloche C, Diezma-Rodino M, García-San Jose L, Cabañes-Alonso E, Pallas-Alonso CR. Smart pumps and random safety audits in a Neonatal Intensive Care Unit: a new challenge for patient safety. BMC Pediatr 2015; 15:206. [PMID: 26654316 PMCID: PMC4676130 DOI: 10.1186/s12887-015-0521-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/03/2015] [Indexed: 11/30/2022] Open
Abstract
Background Random safety audits (RSA) are a safety tool enabling prevention of adverse events, but they have not been widely used in hospitals. The aim of this study was to use RSAs to assess and compare the frequency of appropriate use of infusion pump safety systems in a Neonatal Intensive Care Unit (NICU) before and after quality improvement interventions and to analyse the intravenous medication programming data. Methods Prospective, observational study comparing the frequency of appropriate use of Alaris® CC smart pumps through RSAs over two periods, from 1 January to 31 December 2012 and from 1 November 2014 to 31 January 2015. Appropriate use was defined as all evaluated variables being correctly programmed into the same device. Between the two periods they were established interventions to improve the use of pumps. The information recorded at the pumps with the new security system, also extracted for one year. Results Fifty-two measurements were collected during the first period and 160 measurements during the second period. The frequency of appropriate use was 73.13 % (117/160) in the second period versus 0 % (0/52) in the first period (p < 0.0001). Information was recorded on 44,924 infusions; in 46.03 % (20,680/44,924) of cases the drug name was recorded. In 2.5 % (532/20,680) of cases there was an attempt to exceed the absolute limit. Conclusions Random Safety Audits were a very useful tool for detecting inappropriate use of pumps in the NICU. The improvement strategies were effective for improving appropriate use and programming of the intravenous medication infusion pumps in our NICU.
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Affiliation(s)
- Elena Bergon-Sendin
- Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain.
| | - Carmen Perez-Grande
- Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain.
| | - David Lora-Pablos
- Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain.
| | - María Teresa Moral-Pumarega
- Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain.
| | - Ana Melgar-Bonis
- Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain.
| | - Carmen Peña-Peloche
- Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain.
| | - Mercedes Diezma-Rodino
- Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain.
| | - Lidia García-San Jose
- Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain.
| | - Esther Cabañes-Alonso
- Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain.
| | - Carmen Rosa Pallas-Alonso
- Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain.
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152
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Giuliano KK. IV Smart Pumps: The Impact of a Simplified User Interface on Clinical Use. Biomed Instrum Technol 2015; Suppl:13-21. [PMID: 26444045 DOI: 10.2345/0899-8205-49.s4.13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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153
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Hecq JD, Godet M, Jamart J, Galanti L. Microwave freeze-thaw technique of injectable drugs. A review from 1980 to 2014. ANNALES PHARMACEUTIQUES FRANÇAISES 2015; 73:436-41. [DOI: 10.1016/j.pharma.2015.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/20/2015] [Accepted: 04/22/2015] [Indexed: 11/17/2022]
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154
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Feleke SA, Mulatu MA, Yesmaw YS. Medication administration error: magnitude and associated factors among nurses in Ethiopia. BMC Nurs 2015; 14:53. [PMID: 26500449 PMCID: PMC4618536 DOI: 10.1186/s12912-015-0099-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 09/30/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The significant impact of medication administration errors affect patients in terms of morbidity, mortality, adverse drug events, and increased length of hospital stay. It also increases costs for clinicians and healthcare systems. Due to this, assessing the magnitude and associated factors of medication administration error has a significant contribution for improving the quality of patient care. The aim of this study was to assess the magnitude and associated factors of medication administration errors among nurses at the Felege Hiwot Referral Hospital inpatient department. METHODS A prospective, observation-based, cross-sectional study was conducted from March 24-April 7, 2014 at the Felege Hiwot Referral Hospital inpatient department. A total of 82 nurses were interviewed using a pre-tested structured questionnaire, and observed while administering 360 medications by using a checklist supplemented with a review of medication charts. Data were analyzed by using SPSS version 20 software package and logistic regression was done to identify possible factors associated with medication administration error. RESULT The incidence of medication administration error was 199 (56.4 %). The majority (87.5 %) of the medications have documentation error, followed by technique error 263 (73.1 %) and time error 193 (53.6 %). Variables which were significantly associated with medication administration error include nurses between the ages of 18-25 years [Adjusted Odds Ratio (AOR) = 2.9, 95 % CI (1.65,6.38)], 26-30 years [AOR = 2.3, 95 % CI (1.55, 7.26)] and 31-40 years [AOR = 2.1, 95 % CI (1.07, 4.12)], work experience of less than or equal to 10 years [AOR = 1.7, 95 % CI (1.33, 4.99)], nurse to patient ratio of 7-10 [AOR = 1.6, 95 % CI (1.44, 3.19)] and greater than 10 [AOR = 1.5, 95 % CI (1.38, 3.89)], interruption of the respondent at the time of medication administration [AOR = 1.5, 95 % CI (1.14, 3.21)], night shift of medication administration [AOR = 3.1, 95 % CI (1.38, 9.66)] and age of the patients with less than 18 years [AOR = 2.3, 95 % CI (1.17, 4.62)]. CONCLUSION In general, medication errors at the administration phase were highly prevalent in Felege Hiwot Referral Hospital. Documentation error is the most dominant type of error observed during the study. Increasing nurses' staffing levels, minimizing distraction and interruptions during medication administration by using no interruptions zones and "No-Talk" signage are recommended to overcome medication administration errors. Retaining experienced nurses from leaving to train and supervise inexperienced nurses with the focus on medication safety, in addition providing convenient sleep hours for nurses would be helpful in ensuring that medication errors don't occur as frequently as observed in this study.
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Affiliation(s)
- Senafikish Amsalu Feleke
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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155
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Nguyen HT, Nguyen TD, van den Heuvel ER, Haaijer-Ruskamp FM, Taxis K. Medication Errors in Vietnamese Hospitals: Prevalence, Potential Outcome and Associated Factors. PLoS One 2015; 10:e0138284. [PMID: 26383873 PMCID: PMC4575184 DOI: 10.1371/journal.pone.0138284] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 08/29/2015] [Indexed: 11/21/2022] Open
Abstract
Background Evidence from developed countries showed that medication errors are common and harmful. Little is known about medication errors in resource-restricted settings, including Vietnam. Objectives To determine the prevalence and potential clinical outcome of medication preparation and administration errors, and to identify factors associated with errors. Methods This was a prospective study conducted on six wards in two urban public hospitals in Vietnam. Data of preparation and administration errors of oral and intravenous medications was collected by direct observation, 12 hours per day on 7 consecutive days, on each ward. Multivariable logistic regression was applied to identify factors contributing to errors. Results In total, 2060 out of 5271 doses had at least one error. The error rate was 39.1% (95% confidence interval 37.8%- 40.4%). Experts judged potential clinical outcomes as minor, moderate, and severe in 72 (1.4%), 1806 (34.2%) and 182 (3.5%) doses. Factors associated with errors were drug characteristics (administration route, complexity of preparation, drug class; all p values < 0.001), and administration time (drug round, p = 0.023; day of the week, p = 0.024). Several interactions between these factors were also significant. Nurse experience was not significant. Higher error rates were observed for intravenous medications involving complex preparation procedures and for anti-infective drugs. Slightly lower medication error rates were observed during afternoon rounds compared to other rounds. Conclusions Potentially clinically relevant errors occurred in more than a third of all medications in this large study conducted in a resource-restricted setting. Educational interventions, focusing on intravenous medications with complex preparation procedure, particularly antibiotics, are likely to improve patient safety.
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Affiliation(s)
- Huong-Thao Nguyen
- Department of Clinical Pharmacy, School of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh city, Ho Chi Minh, Vietnam
- Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, the Netherlands
| | - Tuan-Dung Nguyen
- Department of Clinical Pharmacy, School of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh city, Ho Chi Minh, Vietnam
| | - Edwin R. van den Heuvel
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Flora M. Haaijer-Ruskamp
- Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Katja Taxis
- Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, the Netherlands
- * E-mail:
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156
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You MA, Choe MH, Park GO, Kim SH, Son YJ. Perceptions regarding medication administration errors among hospital staff nurses of South Korea. Int J Qual Health Care 2015; 27:276-83. [PMID: 26054575 DOI: 10.1093/intqhc/mzv036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To identify reasons for medication administration errors (MAEs) and why they are unreported, and estimate the percentage of MAEs actually reported among hospital nurses. DESIGN A cross-sectional survey design. SETTING Three university hospitals in three South Korean provinces. PARTICIPANTS A total of 312 hospital staff nurses were included in this study. MAIN OUTCOME Medication administration errors. RESULTS Actual MAEs were experienced by 217 nurses (69.6%) during their clinical career, whereas 149 nurses (47.8%) perceived that MAEs only occur less than 20% rate. MAEs occurred mostly during intravenous (IV) administrations. Nurses perceived that the most common reasons for MAEs were inadequate number of nurses in each working shift (4.88 ± 1.05) and administering drugs with similar names or labels (4.49 ± 0.94). The most prevalent reasons for unreported MAEs included fears of being blamed (4.36 ± 1.10) and having too much emphasis on MAEs as a measure of nursing care quality (4.32 ± 1.02). The three most frequent errors perceived by nurses for non-IV related MAEs included administering medications to the incorrect patients and incorrect medication doses and drug choices. The three most frequent IV related MAEs included incorrect infusion rates, patients and medication doses. CONCLUSIONS Nurse-staffing adequacy could be helpful to prevent MAEs among nurses as well ongoing education, and training regarding safe medication administration using the problem-based simulation education. In addition, encouraging nurses to identify and report work related errors in a non-punitive milieu will increase error reporting.
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Affiliation(s)
- Mi-Ae You
- College of Nursing, Ajou University, Suwon, South Korea
| | - Mi-Hyeon Choe
- Soonchunhyang University Hospital, Cheonan, South Korea
| | - Geun-Ok Park
- Soonchunhyang University Hospital, Cheonan, South Korea
| | - Sang-Hee Kim
- Soonchunhyang University Hospital, Cheonan, South Korea
| | - Youn-Jung Son
- Department of Nursing, Soonchunhyang University, Cheonan, South Korea
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157
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Theissen A, Orban JC, Fuz F, Guerin JP, Flavin P, Albertini S, Maricic S, Saquet D, Niccolai P. [Responsibility due to medication errors in France: a study based on SHAM insurance data]. ANNALES PHARMACEUTIQUES FRANÇAISES 2015; 73:133-8. [PMID: 25745944 DOI: 10.1016/j.pharma.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/02/2014] [Accepted: 07/04/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The safe medication practices at the hospital constitute a major public health problem. Drug supply chain is a complex process, potentially source of errors and damages for the patient. SHAM insurances are the biggest French provider of medical liability insurances and a relevant source of data on the health care complications. METHODS The main objective of the study was to analyze the type and cause of medication errors declared to SHAM and having led to a conviction by a court. We did a retrospective study on insurance claims provided by SHAM insurances with a medication error and leading to a condemnation over a 6-year period (between 2005 and 2010). RESULTS Thirty-one cases were analysed, 21 for scheduled activity and 10 for emergency activity. Consequences of claims were mostly serious (12 deaths, 14 serious complications, 5 simple complications). The types of medication errors were a drug monitoring error (11 cases), an administration error (5 cases), an overdose (6 cases), an allergy (4 cases), a contraindication (3 cases) and an omission (2 cases). Intravenous route of administration was involved in 19 of 31 cases (61%). The causes identified by the court expert were an error related to service organization (11), an error related to medical practice (11) or nursing practice (13). Only one claim was due to the hospital pharmacy. CONCLUSION The claim related to drug supply chain is infrequent but potentially serious. These data should help strengthen quality approach in risk management.
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Affiliation(s)
- A Theissen
- Service d'anesthésie réanimation, centre hospitalier Princesse Grace, avenue Pasteur, 98000 Monaco, Monaco.
| | - J-C Orban
- Réanimation médico-chirurgicale, hôpital Saint-Roch, CHU de Nice, rue Pierre-Dévoluy, 06000 Nice, France
| | - F Fuz
- SHAM assurances, 18, rue Édouard-Rochet, 69372 Lyon cedex 08, France
| | - J-P Guerin
- Service d'anesthésie réanimation, centre hospitalier Princesse Grace, avenue Pasteur, 98000 Monaco, Monaco
| | - P Flavin
- SHAM assurances, 18, rue Édouard-Rochet, 69372 Lyon cedex 08, France
| | - S Albertini
- Service d'anesthésie réanimation, centre hospitalier Princesse Grace, avenue Pasteur, 98000 Monaco, Monaco
| | - S Maricic
- Pharmacie, centre hospitalier Princesse Grace, 98000 Monaco, Monaco
| | - D Saquet
- Direction qualité gestion des risques, centre hospitalier Princesse Grace, 98000 Monaco, Monaco
| | - P Niccolai
- Service d'anesthésie et chirurgie ambulatoire, centre hospitalier Princesse Grace, 98000 Monaco, Monaco
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158
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Fahimi F, Sefidani Forough A, Taghikhani S, Saliminejad L. The Rate of Physicochemical Incompatibilities, Administration Errors. Factors Correlating with Nurses' Errors. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2015; 14:87-93. [PMID: 26185509 PMCID: PMC4499430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Medication errors are commonly encountered in hospital setting. Intravenous medications pose particular risks because of their greater complexity and the multiple steps required in their preparation, administration and monitoring. We aimed to determine the rate of errors during the preparation and administration phase of intravenous medications and the correlation of these errors with the demographics of nurses involved in the process. One hundred patients who were receiving IV medications were monitored by a trained pharmacist. The researcher accompanied the nurses during the preparation and administration process of IV medications. Collected data were compared with the acceptable guidelines. A checklist was filled for each IV medication. Demographic data of the nurses were collected as well. A total of 454 IV medications were recorded. Inappropriate administration rate constituted a large proportion of errors in our study (35.3%). No significant or life threatening drug interaction was recorded during the study. Evaluating the impact of the nurses' demographic characteristics on the incidence of medication errors showed that there is a direct correlation between nurses' employment status and the rate of medication errors, while other characteristics did not show a significant impact on the rate of administration errors. Administration errors were significantly higher in temporary 1-year contract group than other groups (p-value < 0.0001). Study results show that there should be more vigilance on administration rate of IV medications to prevent negative consequences especially by pharmacists. Optimizing the working conditions of nurses may play a crucial role.
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Affiliation(s)
- Fanak Fahimi
- Clinical Pharmacy Department, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Chronic Respiratory Disease Research Center (CRDRC), NRITLD, Masih Daneshvari Hospital, Tehran, Iran.,Corresponding author: E-mail:
| | - Aida Sefidani Forough
- Clinical Pharmacy Department, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Sepideh Taghikhani
- Chronic Respiratory Disease Research Center (CRDRC), NRITLD, Masih Daneshvari Hospital, Tehran, Iran.
| | - Leila Saliminejad
- Lung Transplantation Research Center, NRITLD, Masih Daneshvari Hospital, Tehran, Iran.
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159
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Machotka O, Manak J, Kubena A, Vlcek J. Incidence of intravenous drug incompatibilities in intensive care units. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 159:652-6. [PMID: 25482735 DOI: 10.5507/bp.2014.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 10/16/2014] [Indexed: 11/23/2022] Open
Abstract
AIMS Drug incompatibilities are relatively common in inpatients and this may result in increased morbidity/mortality as well as add to costs. The aim of this 12 month study was to identify real incidences of drug incompatibilities in intravenous lines in critically ill patients in two intensive care units (ICUs). METHODS A prospective cross sectional study of 82 patients in 2 ICUs, one medical and one surgical in a 1500-bed university hospital. One monitor carried out observations during busy hours with frequent drug administration. Patients included in both ICUs were those receiving at least two different intravenous drugs. RESULTS 6.82% and 2.16% of drug pairs were found to be incompatible in the two ICUs respectively. Among the most frequent incompatible drugs found were insulin, ranitidine and furosemide. CONCLUSIONS The study showed that a significant number of drug incompatibilities occur in both medical and surgical ICUs. It follows that the incidence of incompatibilities could be diminished by adhering to a few simple rules for medication administration, following by recommendations for multiple lumen catheter use. Future prospective studies should demonstrate the effect of applying these policies in practice.
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Affiliation(s)
- Ondrej Machotka
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Jan Manak
- Department of Gerontology and Metabolism, University Hospital Hradec Kralove
| | - Ales Kubena
- The Institute of Information Theory and Automation, Academy of Sciences of the Czech Republic, Prague
| | - Jiri Vlcek
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
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160
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Härkänen M, Ahonen J, Kervinen M, Turunen H, Vehviläinen-Julkunen K. The factors associated with medication errors in adult medical and surgical inpatients: a direct observation approach with medication record reviews. Scand J Caring Sci 2014; 29:297-306. [DOI: 10.1111/scs.12163] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/15/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Marja Härkänen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Finnish Doctoral Programme in Nursing Science; Finland
| | - Jouni Ahonen
- Pharmacy; Kuopio University Hospital; Kuopio Finland
| | - Marjo Kervinen
- Department of Medicine; Kuopio University Hospital; Kuopio Finland
| | - Hannele Turunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Kuopio University Hospital; Kuopio Finland
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Kuopio University Hospital; Kuopio Finland
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161
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Rashed AN, Whittlesea C, Forbes B, Tomlin S. The feasibility of using dose-banded syringes to improve the safety and availability of patient-controlled opioid analgesic infusions in children. Eur J Hosp Pharm 2014; 21:306-308. [PMID: 25285212 PMCID: PMC4174165 DOI: 10.1136/ejhpharm-2014-000441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 06/17/2014] [Accepted: 07/02/2014] [Indexed: 11/04/2022] Open
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
| | - Cate Whittlesea
- School of Medicine, Pharmacy and Health, Durham University , Durham , UK
| | - Ben Forbes
- Institute of Pharmaceutical Science, King's College London, 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
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162
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Lehnbom EC, Stewart MJ, Manias E, Westbrook JI. Impact of Medication Reconciliation and Review on Clinical Outcomes. Ann Pharmacother 2014; 48:1298-312. [DOI: 10.1177/1060028014543485] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine the evidence regarding the effectiveness of medication reconciliation and review and to improve clinical outcomes in hospitals, the community, and aged care facilities. Data Source: This systematic review was undertaken in concordance with the PRISMA statement. Electronic databases, including MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for relevant articles published between January 2000 and March 2014. Study Selection and Data Extraction: Randomized and nonrandomized studies rating the severity of medication discrepancies and medication-related problems identified during medication reconciliation and/or review were considered for inclusion. Data were extracted independently by 2 authors using a data collection form. Data Synthesis: Of the 5292 articles identified, 83 articles met the inclusion criteria. Medication reconciliation identified unintentional medication discrepancies in 3.4% to 98.2% of patients. There is limited evidence of the potential of these discrepancies to cause harm. Medication reviews identified medication-related problems or possible adverse drug reactions in 17.2% to 94.0% of patients. The studies reported conflicting findings regarding the impact of medication review on length of stays, readmissions, and mortality. Conclusions: The evidence demonstrates that medication reconciliation has the potential to identify many medication discrepancies and reduce potential harm, but the impact on clinical outcomes is less clear. Similarly, medication review can detect medication-related problems in many patients, but evidence of clinical impact is scant. Overall, there is limited evidence that medication reconciliation and medication review processes, as currently performed, significantly improve clinical outcomes, such as reductions in hospital readmissions.
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Affiliation(s)
- Elin C. Lehnbom
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia
| | - Michael J. Stewart
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Burwood, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Johanna I. Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia
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163
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Parry AM, Barriball KL, While AE. Factors contributing to registered nurse medication administration error: a narrative review. Int J Nurs Stud 2014; 52:403-20. [PMID: 25443300 DOI: 10.1016/j.ijnurstu.2014.07.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 07/02/2014] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the factors contributing to Registered Nurse medication administration error behaviour. DESIGN A narrative review. DATA SOURCES Electronic databases (Cochrane, CINAHL, MEDLINE, BNI, EmBase, and PsycINFO) were searched from 1 January 1999 to 31 December 2012 in the English language. 1127 papers were identified and 26 papers were included in the review. Data were extracted by one reviewer and checked by a second reviewer. REVIEW METHODS A thematic analysis and narrative synthesis of the factors contributing to Registered Nurses' medication administration behaviour. Bandura's (1986) theory of reciprocal determinism was used as an organising framework. This theory proposes that there is a reciprocal interplay between the environment, the person and their behaviour. Medication administration error is an outcome of RN behaviour. RESULTS The 26 papers reported studies conducted in 4 continents across 11 countries predominantly in North America and Europe, with one multi-national study incorporating 27 countries. Within both the environment and person domain of the reciprocal determinism framework, a number of factors emerged as influencing Registered Nurse medication administration error behaviour. Within the environment domain, two key themes of clinical workload and work setting emerged, and within the person domain the Registered Nurses' characteristics and their lived experience of work emerged as themes. Overall, greater attention has been given to the contribution of the environment domain rather than the person domain as contributing to error, with the literature viewing an error as an event rather than the outcome of behaviour. CONCLUSION The interplay between factors that influence behaviour were poorly accounted for within the selected studies. It is proposed that a shift away from error as an event to a focus on the relationships between the person, the environment and Registered Nurse medication administration behaviour is needed to better understand medication administration error.
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Affiliation(s)
- Angela M Parry
- King's College London, Florence Nightingale School of Nursing and Midwifery, UK.
| | - K Louise Barriball
- King's College London, Florence Nightingale School of Nursing and Midwifery, UK
| | - Alison E While
- King's College London, Florence Nightingale School of Nursing and Midwifery, UK
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164
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Vijayakumar A, Sharon EV, Teena J, Nobil S, Nazeer I. A clinical study on drug-related problems associated with intravenous drug administration. J Basic Clin Pharm 2014; 5:49-53. [PMID: 25031500 PMCID: PMC4074696 DOI: 10.4103/0976-0105.134984] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Infusion therapy through intravenous (IV) access is a therapeutic option used in the treatment of many hospitalized patients. IV therapy is complex, potentially dangerous and error prone. The objectives were to ascertain the drug-related problems (DRPs) involved in IV medication administration and further to develop strategies to reduce and prevent the occurrence of DRPs during IV administration. Materials and Methods: A prospective observational study was carried out for a period of 4 months. Patients receiving more than two medications through IV route were included and studied. Results: Of 110 patients, 76 (69.09%) were male and the rest were female. Nearly, half of the patients (46.3%, n = 51) were reported with DRPs. Of the 80 DRPs (72.72%) documented, 61 problems (55.4%) were seen in patients given IV medications through peripheral line. Among the DRPs majority seen were incompatibilities (40.9%, n = 45), followed by complications developed (12.7%, n = 14), errors in rate of administration (10.9%), and dilution errors (8%). To study the association of DRPs among gender, statistical analysis was performed and significant association was seen between DRPs and gender (P = 0.03). Conclusion: Among the reported DRPs, simultaneous IV administration of two incompatible drugs was the main predicament faced.
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Affiliation(s)
- A Vijayakumar
- Drug and Poison Information Center, Department of Pharmacy Practice, KMCH College of Pharmacy, Coimbatore, Tamil Nadu, India
| | - E V Sharon
- Drug and Poison Information Center, Department of Pharmacy Practice, KMCH College of Pharmacy, Coimbatore, Tamil Nadu, India
| | - J Teena
- Drug and Poison Information Center, Department of Pharmacy Practice, KMCH College of Pharmacy, Coimbatore, Tamil Nadu, India
| | - S Nobil
- Drug and Poison Information Center, Department of Pharmacy Practice, KMCH College of Pharmacy, Coimbatore, Tamil Nadu, India
| | - I Nazeer
- Drug and Poison Information Center, Department of Pharmacy Practice, KMCH College of Pharmacy, Coimbatore, Tamil Nadu, India
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165
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Härkänen M, Kervinen M, Ahonen J, Turunen H, Vehviläinen-Julkunen K. An observational study of how patients are identified before medication administrations in medical and surgical wards. Nurs Health Sci 2014; 17:188-94. [PMID: 25040901 DOI: 10.1111/nhs.12158] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/15/2014] [Accepted: 05/20/2014] [Indexed: 11/30/2022]
Abstract
The aims of this study were to clarify how a patient's identity was verified before the administration of medication in medical and surgical wards in a hospital, as well as to study the association between patient identification and the registered nurse's work experience, observed interruptions, and distractions. The study material was collected during April and May 2012 in two surgical and two medical wards in one university hospital in Finland, using a direct, structured observation method. A total of 32 registered nurses were observed while they administered 1058 medications to 122 patients. Patients were not identified at all in 66.8% (n = 707) of medication administrations. Patient identifications were made more often by nurses with shorter work experience in the nursing profession or in the wards (4 years or less), or if distractions existed during medication administration. According to the results, patient identification was not adequately conducted. There is a need for education and change in the culture of medication processes and nursing practice.
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Affiliation(s)
- Marja Härkänen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Finnish Doctoral Programme in Nursing Sciences, Kuopio, Finland
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166
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Renata Grou Volpe C, Moura Pinho DL, Morato Stival M, Gomes de Oliveira Karnikowski M. Medication errors in a public hospital in Brazil. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:552-559. [PMID: 24933543 DOI: 10.12968/bjon.2014.23.11.552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article describes the analysis of the frequency, type and risk factors relating to errors in the preparation and administration of medications in patients admitted to a public hospital in Brasilia Federal District, Brazil, which serves a population of approximately 500,000 inhabitants. Patients are commonly affected and harmed by medication errors, almost half of which are preventable. This is a cross-sectional, descriptive and exploratory study conducted in a clinical medicine unit. Direct observations were made by eight nurse technicians. The type of error, the type of drug involved and associated risk factors were analysed. Relationships between the occurrence of errors and risk factors were studied with logistic regression models. Of the 484 observed doses, 69.5% errors occurred during drug administration, 69.6% during the preparation stage, 48.6% were timing errors, 1.7% were dose-related errors and 9.5% were errors of omission. More than one error was detected in 34.5% of occasions. Unlabelled drugs increased the risk of timing errors by a factor of 13.72. Interruptions in preparation increased the risk of errors by a factor of 3.75. Caring for a larger number of patients (8-9) increased the risk of timing errors by a factor of 8.27. The research shows the need to manage the risk of medication errors in their real-life contexts by interposing safety barriers between the hazards and potential errors.
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167
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Niemann D, Bertsche A, Meyrath D, Koepf ED, Traiser C, Seebald K, Schmitt CP, Hoffmann GF, Haefeli WE, Bertsche T. A prospective three-step intervention study to prevent medication errors in drug handling in paediatric care. J Clin Nurs 2014; 24:101-14. [PMID: 24890332 DOI: 10.1111/jocn.12592] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2014] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To prevent medication errors in drug handling in a paediatric ward. BACKGROUND One in five preventable adverse drug events in hospitalised children is caused by medication errors. Errors in drug prescription have been studied frequently, but data regarding drug handling, including drug preparation and administration, are scarce. DESIGN A three-step intervention study including monitoring procedure was used to detect and prevent medication errors in drug handling. METHODS After approval by the ethics committee, pharmacists monitored drug handling by nurses on an 18-bed paediatric ward in a university hospital prior to and following each intervention step. They also conducted a questionnaire survey aimed at identifying knowledge deficits. Each intervention step targeted different causes of errors. The handout mainly addressed knowledge deficits, the training course addressed errors caused by rule violations and slips, and the reference book addressed knowledge-, memory- and rule-based errors. RESULTS The number of patients who were subjected to at least one medication error in drug handling decreased from 38/43 (88%) to 25/51 (49%) following the third intervention, and the overall frequency of errors decreased from 527 errors in 581 processes (91%) to 116/441 (26%). The issue of the handout reduced medication errors caused by knowledge deficits regarding, for instance, the correct 'volume of solvent for IV drugs' from 49-25%. CONCLUSION Paediatric drug handling is prone to errors. A three-step intervention effectively decreased the high frequency of medication errors by addressing the diversity of their causes. RELEVANCE TO CLINICAL PRACTICE Worldwide, nurses are in charge of drug handling, which constitutes an error-prone but often-neglected step in drug therapy. Detection and prevention of errors in daily routine is necessary for a safe and effective drug therapy. Our three-step intervention reduced errors and is suitable to be tested in other wards and settings.
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Affiliation(s)
- Dorothee Niemann
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany; Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany
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168
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Guillaudin M, Griveaux A, Te Bonle F, Jandard V, Paillet M, Camus G, Galvez O, Bohand X. [Preparation and administration of injectable antibiotics: a tool for nurses]. REVUE DE L'INFIRMIERE 2013; 62:38-40. [PMID: 24427920 DOI: 10.1016/j.revinf.2013.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Nurses, the main caregivers to administer medications, often find themselves lacking the information which is nevertheless essential for the preparation of injectable antibiotics. This problem, frequent in hospitals, impacts on patient safety. On the initiative of the pharmacy and nursing staff, a tool has been created in the Percy Army Teaching Hospital in Clamart.
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Affiliation(s)
- Morgane Guillaudin
- Hôpital d'Instruction des Armies Percy, 101 avenue Henry Barbusse, 92140 Clamart, France.
| | - Aude Griveaux
- Hôpital d'Instruction des Armies Percy, 101 avenue Henry Barbusse, 92140 Clamart, France
| | - Franck Te Bonle
- Hôpital d'Instruction des Armies Percy, 101 avenue Henry Barbusse, 92140 Clamart, France
| | - Vincent Jandard
- Hôpital d'Instruction des Armies Percy, 101 avenue Henry Barbusse, 92140 Clamart, France
| | - Michel Paillet
- Hôpital d'Instruction des Armies Percy, 101 avenue Henry Barbusse, 92140 Clamart, France
| | - Gisèle Camus
- Hôpital d'Instruction des Armies Percy, 101 avenue Henry Barbusse, 92140 Clamart, France
| | - Olivier Galvez
- Hôpital d'Instruction des Armies Percy, 101 avenue Henry Barbusse, 92140 Clamart, France
| | - Xavier Bohand
- Hôpital d'Instruction des Armies Percy, 101 avenue Henry Barbusse, 92140 Clamart, France
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169
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Härkänen M, Turunen H, Saano S, Vehviläinen-Julkunen K. Detecting medication errors: Analysis based on a hospital's incident reports. Int J Nurs Pract 2013; 21:141-6. [DOI: 10.1111/ijn.12227] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marja Härkänen
- Finnish Doctoral Programme in Nursing Sciences; Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
| | - Hannele Turunen
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
- Kuopio University Hospital; Kuopio Finland
| | | | - Katri Vehviläinen-Julkunen
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
- Kuopio University Hospital; Kuopio Finland
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170
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Nguyen HT, Pham HT, Vo DK, Nguyen TD, van den Heuvel ER, Haaijer-Ruskamp FM, Taxis K. The effect of a clinical pharmacist-led training programme on intravenous medication errors: a controlled before and after study. BMJ Qual Saf 2013; 23:319-24. [PMID: 24195894 DOI: 10.1136/bmjqs-2013-002357] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Little is known about interventions to reduce intravenous medication administration errors in hospitals, especially in low- and middle-income countries. OBJECTIVE To assess the effect of a clinical pharmacist-led training programme on clinically relevant errors during intravenous medication preparation and administration in a Vietnamese hospital. METHODS A controlled before and after study with baseline and follow-up measurements was conducted in an intensive care unit (ICU) and a post-surgical unit (PSU). The intervention comprised lectures, practical ward-based teaching sessions and protocols/guidelines, and was conducted by a clinical pharmacist and a nurse. Data on intravenous medication preparation and administration errors were collected by direct observation 12 h/day for seven consecutive days. Generalised estimating equations (GEE) were used to assess the effect of the intervention on the prevalence of clinically relevant erroneous doses, corrected for confounding factors. RESULTS 1204 intravenous doses were included, 516 during the baseline period (236 on ICU and 280 on PSU) and 688 during the follow-up period (407 on ICU and 281 on PSU). The prevalence of clinically relevant erroneous doses decreased significantly on the intervention ward (ICU) from 64.0% to 48.9% (p<0.001) but was unchanged on the control ward (PSU) (57.9% vs 64.1%; p=0.132). GEE analysis showed that doses on the intervention ward were 2.60 (1.27-5.31) times less likely to have clinically relevant errors (p=0.013). CONCLUSIONS The pharmacist-led training programme was effective, but the error rate remained relatively high. Further quality improvement strategies are needed, including changes to the working environment and promotion of a safety culture.
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Affiliation(s)
- Huong-Thao Nguyen
- Department of Clinical Pharmacy, School of Pharmacy, University of Medicine and Pharmacy, , Ho Chi Minh City, Vietnam
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171
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Barras M, Moore D, Pocock D, Sweedman M, Wilkinson C, Taylor K, Morton J. Reducing the risk of harm from intravenous potassium: a multi-factorial approach in the haematology setting. J Oncol Pharm Pract 2013; 20:323-31. [PMID: 24057453 DOI: 10.1177/1078155213504443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To describe the implementation of safety systems for the use of intravenous potassium chloride in haematology patients. METHODS We assessed the use of intravenous potassium in a haematology ward at a tertiary hospital. Initially, we prospectively analysed the prescribing and administration of intravenous potassium to all patients over a two-week period. To complement this data, we retrospectively analysed all clinical incidents involving intravenous potassium and the dispensing patterns of potassium ampoules for the past 12 months. Drawing on evidence and recommendations from international safety literature, gaps in the safe use of potassium were identified, and a multi-factorial approach to system change was implemented. RESULTS A total of 18 patients were analysed with 90 intravenous bags of potassium prepared on the ward using 624 ampoules. We identified multiple opportunities for error and a lack of standardisation of therapy. The following safety systems were introduced: (i) a new prescribing and monitoring form that included dose calculation, prescriber support and pre-printed orders; (ii) removal of potassium ampoules and introduction of premixed bags; (iii) independent double checking by nursing staff at point of administration; (iv) dedicated labelling of intravenous lines; (v) extensive clinician training supported by guidelines; and (vi) introduction of 'smart pump' infusion software. The number of incidents significantly reduced from 23 to 9 (p < 0.001), and the number of ampoules dispensed reduced from 10,100 to 0. CONCLUSIONS A multi-factorial approach to the safe prescribing, dispensing and administration of intravenous potassium has reduced the potential for patient harm in the haematology setting.
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Affiliation(s)
- Michael Barras
- Medication Safety and Quality Unit, Mater Health Services; Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Diana Moore
- Mater Private Hospital, South Brisbane, Australia
| | | | | | | | - Kerry Taylor
- Mater Medical Centre, Centre for Haematology, South Brisbane, Australia
| | - James Morton
- Mater Medical Centre for Haematology, South Brisbane, Australia
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172
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Seidling HM, Lampert A, Lohmann K, Schiele JT, Send AJF, Witticke D, Haefeli WE. Safeguarding the process of drug administration with an emphasis on electronic support tools. Br J Clin Pharmacol 2013; 76 Suppl 1:25-36. [PMID: 24007450 DOI: 10.1111/bcp.12191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 03/20/2013] [Indexed: 12/24/2022] Open
Abstract
AIMS The aim of this work is to understand the process of drug administration and identify points in the workflow that resulted in interventions by clinical information systems in order to improve patient safety. METHODS To identify a generic way to structure the drug administration process we performed peer-group discussions and supplemented these discussions with a literature search for studies reporting errors in drug administration and strategies for their prevention. RESULTS We concluded that the drug administration process might consist of up to 11 sub-steps, which can be grouped into the four sub-processes of preparation, personalization, application and follow-up. Errors in drug handling and administration are diverse and frequent and in many cases not caused by the patient him/herself, but by family members or nurses. Accordingly, different prevention strategies have been set in place with relatively few approaches involving e-health technology. CONCLUSIONS A generic structuring of the administration process and particular error-prone sub-steps may facilitate the allocation of prevention strategies and help to identify research gaps.
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Affiliation(s)
- Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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174
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Andrew S, Mansour M. Safeguarding in medication administration: understanding pre-registration nursing students' survey response to patient safety and peer reporting issues. J Nurs Manag 2013; 22:311-21. [DOI: 10.1111/jonm.12134] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Sharon Andrew
- Professor of Nursing, Senior Lecturer; Faculty of Health, Social Care and Education; Rivermead Campus; Anglia Ruskin University; Chelmsford Essex UK
| | - Mansour Mansour
- Professor of Nursing, Senior Lecturer; Faculty of Health, Social Care and Education; Rivermead Campus; Anglia Ruskin University; Chelmsford Essex UK
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175
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Klein M, Cohen H. Survey of feasibility of a peelable and point-of-use labelling system. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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176
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Affiliation(s)
- David Upton
- Medication Safety Pharmacist, Director of Pharmacy and Medicines Management, Sheffield Children's NHS Foundation Trust
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177
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Berdot S, Gillaizeau F, Caruba T, Prognon P, Durieux P, Sabatier B. Drug administration errors in hospital inpatients: a systematic review. PLoS One 2013; 8:e68856. [PMID: 23818992 PMCID: PMC3688612 DOI: 10.1371/journal.pone.0068856] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 06/04/2013] [Indexed: 11/19/2022] Open
Abstract
CONTEXT Drug administration in the hospital setting is the last barrier before a possible error reaches the patient. OBJECTIVES We aimed to analyze the prevalence and nature of administration error rate detected by the observation method. DATA SOURCES Embase, MEDLINE, Cochrane Library from 1966 to December 2011 and reference lists of included studies. STUDY SELECTION Observational studies, cross-sectional studies, before-and-after studies, and randomized controlled trials that measured the rate of administration errors in inpatients were included. DATA EXTRACTION Two reviewers (senior pharmacists) independently identified studies for inclusion. One reviewer extracted the data; the second reviewer checked the data. The main outcome was the error rate calculated as being the number of errors without wrong time errors divided by the Total Opportunity for Errors (TOE, sum of the total number of doses ordered plus the unordered doses given), and multiplied by 100. For studies that reported it, clinical impact was reclassified into four categories from fatal to minor or no impact. Due to a large heterogeneity, results were expressed as median values (interquartile range, IQR), according to their study design. RESULTS Among 2088 studies, a total of 52 reported TOE. Most of the studies were cross-sectional studies (N=46). The median error rate without wrong time errors for the cross-sectional studies using TOE was 10.5% [IQR: 7.3%-21.7%]. No fatal error was observed and most errors were classified as minor in the 18 studies in which clinical impact was analyzed. We did not find any evidence of publication bias. CONCLUSIONS Administration errors are frequent among inpatients. The median error rate without wrong time errors for the cross-sectional studies using TOE was about 10%. A standardization of administration error rate using the same denominator (TOE), numerator and types of errors is essential for further publications.
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Affiliation(s)
- Sarah Berdot
- Department of Pharmacy, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM, UMR S 872, Equipe 22, Centre de Recherche des Cordeliers, Paris, France
| | | | - Thibaut Caruba
- Department of Pharmacy, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Laboratoire Interdisciplinaire de Recherche en Economie de Santé, EA4410, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Patrice Prognon
- Department of Pharmacy, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université Paris-Sud 11, Chatenay-Malabry, France
| | - Pierre Durieux
- INSERM, UMR S 872, Equipe 22, Centre de Recherche des Cordeliers, Paris, France
- INSERM, Centre d’Investigation Épidémiologique 4, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Department of Medical Informatics, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Brigitte Sabatier
- Department of Pharmacy, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM, UMR S 872, Equipe 22, Centre de Recherche des Cordeliers, Paris, France
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Debono DS, Greenfield D, Travaglia JF, Long JC, Black D, Johnson J, Braithwaite J. Nurses' workarounds in acute healthcare settings: a scoping review. BMC Health Serv Res 2013; 13:175. [PMID: 23663305 PMCID: PMC3663687 DOI: 10.1186/1472-6963-13-175] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 05/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Workarounds circumvent or temporarily 'fix' perceived workflow hindrances to meet a goal or to achieve it more readily. Behaviours fitting the definition of workarounds often include violations, deviations, problem solving, improvisations, procedural failures and shortcuts. Clinicians implement workarounds in response to the complexity of delivering patient care. One imperative to understand workarounds lies in their influence on patient safety. This paper assesses the peer reviewed empirical evidence available on the use, proliferation, conceptualisation, rationalisation and perceived impact of nurses' use of workarounds in acute care settings. METHODS A literature assessment was undertaken in 2011-2012. Snowballing technique, reference tracking, and a systematic search of twelve academic databases were conducted to identify peer reviewed published studies in acute care settings examining nurses' workarounds. Selection criteria were applied across three phases. 58 studies were included in the final analysis and synthesis. Using an analytic frame, these studies were interrogated for: workarounds implemented in acute care settings by nurses; factors contributing to the development and proliferation of workarounds; the perceived impact of workarounds; and empirical evidence of nurses' conceptualisation and rationalisation of workarounds. RESULTS The majority of studies examining nurses' workarounds have been published since 2008, predominantly in the United States. Studies conducted across a variety of acute care settings use diverse data collection methods. Nurses' workarounds, primarily perceived negatively, are both individually and collectively enacted. Organisational, work process, patient-related, individual, social and professional factors contribute to the proliferation of workarounds. Group norms, local and organisational culture, 'being competent', and collegiality influence the implementation of workarounds. CONCLUSION Workarounds enable, yet potentially compromise, the execution of patient care. In some contexts such improvisations may be deemed necessary to the successful implementation of quality care, in others they are counterproductive. Workarounds have individual and cooperative characteristics. Few studies examine nurses' individual and collective conceptualisation and rationalisation of workarounds or measure their impact. The importance of displaying competency (image management), collegiality and organisational and cultural norms play a role in nurses' use of workarounds.
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Affiliation(s)
- Deborah S Debono
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW 2052, Australia.
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179
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Keers RN, Williams SD, Cooke J, Ashcroft DM. Prevalence and Nature of Medication Administration Errors in Health Care Settings: A Systematic Review of Direct Observational Evidence. Ann Pharmacother 2013; 47:237-56. [DOI: 10.1345/aph.1r147] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To systematically review empirical evidence on the prevalence and nature of medication administration errors (MAEs) in health care settings. DATA SOURCES: Ten electronic databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts, Scopus, Applied Social Sciences Index and Abstracts, PsycINFO, Cochrane Reviews and Trials, British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, and Health Management Information Consortium) were searched (1985-May 2012). STUDY SELECTION AND DATA EXTRACTION: English-language publications reporting MAE data using the direct observation method were included, providing an error rate could be determined. Reference lists of all included articles were screened for additional studies. DATA SYNTHESIS: In all, 91 unique studies were included. The median error rate (interquartile range) was 19.6% (8.6–28.3%) of total opportunities for error including wrong-time errors and 8.0% (5.1–10.9%) without timing errors, when each dose could be considered only correct or incorrect. The median rate of error when more than 1 error could be counted per dose was 25.6% (20.8–41.7%) and 20.7% (9.7–30.3%), excluding wrong-time errors. A higher median MAE rate was observed for the intravenous route (53.3% excluding timing errors (IQR 26.6–57.9%)) compared to when all administration routes were studied (20.1%; 9.0–24.6%), where each dose could accumulate more than one error. Studies consistently reported wrong time, omission, and wrong dosage among the 3 most common MAE subtypes. Common medication groups associated with MAEs were those affecting nutrition and blood, gastrointestinal system, cardiovascular system, central nervous system, and antiinfectives. Medication administration error rates varied greatly as a product of differing medication error definitions, data collection methods, and settings of included studies. Although MAEs remained a common occurrence in health care settings throughout the time covered by this review, potential targets for intervention to minimize MAEs were identified. CONCLUSIONS: Future research should attend to the wide methodological inconsistencies between studies to gain a greater measure of comparability to help guide any forthcoming interventions.
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Affiliation(s)
- Richard N Keers
- Richard N Keers MPharm, Postgraduate Research Student, Centre for Pharmacoepidemiology and Drug Safety Research, School of Pharmacy and Pharmaceutical Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, England
| | - Steven D Williams
- Steven D Williams MPhil, Consultant Pharmacist and Honorary Clinical Lecturer, School of Pharmacy and Pharmaceutical Sciences, University of Manchester
| | - Jonathan Cooke
- Jonathan Cooke PhD, Honorary Professor, School of Pharmacy and Pharmaceutical Sciences, University of Manchester
| | - Darren M Ashcroft
- Darren M Ashcroft PhD, Professor of Pharmacoepidemiology, Centre for Pharmacoepidemiology and Drug Safety Research, School of Pharmacy and Pharmaceutical Sciences, Manchester Academic Health Sciences Centre, University of Manchester
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180
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Medication errors in a swiss cardiovascular surgery department: a cross-sectional study based on a novel medication error report method. Nurs Res Pract 2013; 2013:671820. [PMID: 23431431 PMCID: PMC3574748 DOI: 10.1155/2013/671820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 12/30/2012] [Accepted: 01/13/2013] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was (1) to determine frequency and type of medication errors (MEs), (2) to assess the number of MEs prevented by registered nurses, (3) to assess the consequences of ME for patients, and (4) to compare the number of MEs reported by a newly developed medication error self-reporting tool to the number reported by the traditional incident reporting system. We conducted a cross-sectional study on ME in the Cardiovascular Surgery Department of Bern University Hospital in Switzerland. Eligible registered nurses (n = 119) involving in the medication process were included. Data on ME were collected using an investigator-developed medication error self reporting tool (MESRT) that asked about the occurrence and characteristics of ME. Registered nurses were instructed to complete a MESRT at the end of each shift even if there was no ME. All MESRTs were completed anonymously. During the one-month study period, a total of 987 MESRTs were returned. Of the 987 completed MESRTs, 288 (29%) indicated that there had been an ME. Registered nurses reported preventing 49 (5%) MEs. Overall, eight (2.8%) MEs had patient consequences. The high response rate suggests that this new method may be a very effective approach to detect, report, and describe ME in hospitals.
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Rozenbaum H, Gordon L, Brezis M, Porat N. The use of a standard design medication room to promote medication safety: organizational implications. Int J Qual Health Care 2013; 25:188-96. [DOI: 10.1093/intqhc/mzt005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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182
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Hirose M. [Patient safety and quality of medical care. Topics: I. Incident and accident in hospital: Current situation: 2. Severity of medication error and its preventive measures]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2012; 101:3379-3385. [PMID: 23356155 DOI: 10.2169/naika.101.3379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Masahiro Hirose
- Shimane University Hospital, Center for Education on Hospital Medicine, Japan
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183
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Barthélémy I, Huet E, Guilbeault M, Bussières JF. Compliance with inpatient drug use process steps: a cross-sectional observational study. J Pharm Pract 2012; 26:551-5. [PMID: 23172898 DOI: 10.1177/0897190012465951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim was to compare nursing staff compliance over the years, per health care unit, and per drug use process step. METHODS Compliance assessment was performed by nursing consultants with direct observation of the registered nurses and nursing assistants during the performance of 7 steps of the drug use process. A total of 36 compliance criteria were developed. The compliance to drug use process criteria was measured in 2007 (Prephase), 2008 (post 1), and 2011 (post 2). Totally, 10 health care units were evaluated, with a minimum of 10 doses evaluated per health care unit, including a minimum of 5 parental doses and a total of 100 nurses observed. RESULTS A total of 142 nurses were observed in the prephase, 140 nurses in the post 1 phase, and 98 in the post 2 phase (90% regular staff and 10% float staff). The overall compliance rates went from 77% in 2007 up to 87% in 2008 and down to 78% in 2011. CONCLUSIONS This cross-sectional observational study revealed a significant difference in the drug use process compliance in terms of drug preparation and drug administration for inpatients at the bedside, between 2007 and 2011.
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Affiliation(s)
- Isabelle Barthélémy
- Département de Pharmacie, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
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184
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Gill FJ, Leslie GD, Grech C, Latour JM. A review of critical care nursing staffing, education and practice standards. Aust Crit Care 2012; 25:224-37. [DOI: 10.1016/j.aucc.2011.12.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 12/12/2011] [Accepted: 12/16/2011] [Indexed: 10/14/2022] Open
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185
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Westbrook JI, Duffield C, Li L, Creswick NJ. How much time do nurses have for patients? A longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals. BMC Health Serv Res 2011; 11:319. [PMID: 22111656 PMCID: PMC3238335 DOI: 10.1186/1472-6963-11-319] [Citation(s) in RCA: 195] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 11/24/2011] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Time nurses spend with patients is associated with improved patient outcomes, reduced errors, and patient and nurse satisfaction. Few studies have measured how nurses distribute their time across tasks. We aimed to quantify how nurses distribute their time across tasks, with patients, in individual tasks, and engagement with other health care providers; and how work patterns changed over a two year period. METHODS Prospective observational study of 57 nurses for 191.3 hours (109.8 hours in 2005/2006 and 81.5 in 2008), on two wards in a teaching hospital in Australia. The validated Work Observation Method by Activity Timing (WOMBAT) method was applied. Proportions of time in 10 categories of work, average time per task, time with patients and others, information tools used, and rates of interruptions and multi-tasking were calculated. RESULTS Nurses spent 37.0%[95%CI: 34.5, 39.3] of their time with patients, which did not change in year 3 [35.7%; 95%CI: 33.3, 38.0]. Direct care, indirect care, medication tasks and professional communication together consumed 76.4% of nurses' time in year 1 and 81.0% in year 3. Time on direct and indirect care increased significantly (respectively 20.4% to 24.8%, P < 0.01;13.0% to 16.1%, P < 0.01). Proportion of time on medication tasks (19.0%) did not change. Time in professional communication declined (24.0% to 19.2%, P < 0.05). Nurses completed an average of 72.3 tasks per hour, with a mean task length of 55 seconds. Interruptions arose at an average rate of two per hour, but medication tasks incurred 27% of all interruptions. In 25% of medication tasks nurses multi-tasked. Between years 1 and 3 nurses spent more time alone, from 27.5%[95%CI 24.5, 30.6] to 39.4%[34.9, 43.9]. Time with health professionals other than nurses was low and did not change. CONCLUSIONS Nurses spent around 37% of their time with patients which did not change. Work patterns were increasingly fragmented with rapid changes between tasks of short length. Interruptions were modest but their substantial over-representation among medication tasks raises potential safety concerns. There was no evidence of an increase in team-based, multi-disciplinary care. Over time nurses spent significantly less time talking with colleagues and more time alone.
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Affiliation(s)
- Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Christine Duffield
- Centre for Health Services Management; and WHO Collaborating Centre for Nursing, Midwifery and Health Development, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, 2007, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Nerida J Creswick
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, 2052, Australia
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