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Williams C, Bennett E. How to administer an intravenous infusion using a gravity administration set or a volumetric pump. Nurs Stand 2024; 39:39-44. [PMID: 38898723 DOI: 10.7748/ns.2024.e12159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 06/21/2024]
Abstract
RATIONALE AND KEY POINTS This article explains how to prepare and administer an intravenous (IV) infusion using a gravity administration (giving) set or a volumetric pump in a safe, effective manner. Nurses undertaking this procedure must ensure they have the knowledge and skills to do so and work within the limits of their competence. This article serves as a revision of best practice in administering IV infusions of fluids and medicines. • IV infusions are delivered directly into the bloodstream, so care must be taken to protect the patient from harm by following the appropriate policies and protocols and monitoring the patient carefully for adverse reactions. • There is a risk of administering large volumes of IV fluid to the patient when using a gravity administration set, so a burette or volumetric pump should be used in patients who may not tolerate this. • Volumetric pumps vary, so it is essential that the nurse is familiar with the device, uses the specific administration set required and follows the manufacturer's instructions. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when preparing and administering an IV infusion. • How you could use this information to educate nursing students or your colleagues on the appropriate methods for preparing and administering an IV infusion.
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Affiliation(s)
| | - Emma Bennett
- Cardiff and Vale University Health Board, Cardiff, Wales
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Alotaibi JS. Causes of medication administration errors and barriers to reporting as perceived by nurses in Saudi Arabia: A qualitative study. BELITUNG NURSING JOURNAL 2024; 10:215-221. [PMID: 38690308 PMCID: PMC11056835 DOI: 10.33546/bnj.3249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/08/2024] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Background Medication administration errors significantly impact patient safety, potentially leading to severe harm or fatality. Reporting such errors through active systems improves medication administration, thereby enhancing patient safety and the quality of care. However, in the context of Saudi Arabia, little is understood about the causes of medication administration errors and the obstacles hindering their reporting. Objective This study aimed to explore nurses' perceptions of the causes of medication administration errors and the barriers to reporting them. Methods The study employed a qualitative descriptive design, conducting face-to-face semi-structured interviews with 43 nurses from three hospitals in Taif Governorate, Saudi Arabia, between October and November 2023. Purposive sampling was used to recruit participants, and thematic analysis was utilized for data analysis. Results The following themes emerged regarding the causes of medication administration errors: order deficiencies, high workloads and staff shortages, and malpractice. Regarding the barriers to reporting errors, the emerging themes were fear of punishment and lack of support, lack of knowledge and awareness about reporting, and lack of feedback. Conclusion This study reveals nurses' perceptions of the causes of medication administration errors and the barriers to reporting them. Recognizing and addressing these causes and barriers are essential for patient safety and the improvement of the healthcare environment. Efforts should be directed toward implementing interventions that address high workloads, enhance staff education and awareness, and promote a workplace culture conducive to reporting errors without fear of repercussions. Additionally, supportive mechanisms, such as feedback systems and resources for professional development, should be implemented to empower nurses to actively participate in error reporting and contribute to continuous improvement in medication administration practices.
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Affiliation(s)
- Jazi Shaydied Alotaibi
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al-Majmaah 11952, Saudi Arabia
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Kim AR, Park AY, Song S, Hong JH, Kim K. A Microlearning-Based Self-directed Learning Chatbot on Medication Administration for New Nurses: A Feasibility Study. Comput Inform Nurs 2024:00024665-990000000-00173. [PMID: 38453464 DOI: 10.1097/cin.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
New nurses must acquire accurate knowledge of medication administration, as it directly affects patient safety. This study aimed to develop a microlearning-based self-directed learning chatbot on medication administration for novice nurses. Furthermore, the study had the objective of evaluating the chatbot feasibility. The chatbot covered two main topics: medication administration processes and drug-specific management, along with 21 subtopics. Fifty-eight newly hired nurses on standby were asked to use the chatbot over a 2-week period. Moreover, we evaluated the chatbot's feasibility through a survey that gauged changes in their confidence in medication administration knowledge, intrinsic learning motivation, satisfaction with the chatbot's learning content, and usability. After using the chatbot, participants' confidence in medication administration knowledge significantly improved in all topics (P < .001) except "Understanding a concept of 5Right" (P = .077). Their intrinsic learning motivation, satisfaction with the learning content, and usability scored above 5 out of 7 in all subdomains, except for pressure/tension (mean, 2.12; median, 1.90). They scored highest on ease of learning (mean, 6.69; median, 7.00). A microlearning-based chatbot can help new nurses improve their knowledge of medication administration through self-directed learning.
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Affiliation(s)
- Ae Ran Kim
- Author Affiliations: Department of Nursing, Samsung Medical Center (Drs A. R. Kim, Hong, and K. Kim, and Mss Park and Song); and Graduate School of Clinical Nursing Science, Sungkyunkwan University (Drs Hong and K. Kim), Seoul, Korea
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Park J, You SB, Ryu GW, Kim Y. Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review. Syst Rev 2023; 12:230. [PMID: 38093372 PMCID: PMC10717502 DOI: 10.1186/s13643-023-02386-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Intravenous (IV) medication is commonly administered and closely associated with patient safety. Although nurses dedicate considerable time and effort to rate the control of IV medications, many medication errors have been linked to the wrong rate of IV medication. Further, there is a lack of comprehensive studies examining the literature on rate control of IV medications. This study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing and synthesizing the existing literature. METHODS This scoping review was conducted using the framework proposed by Arksey and O'Malley and PRISMA-ScR. Overall, four databases-PubMed, Web of Science, EMBASE, and CINAHL-were employed to search for studies published in English before January 2023. We also manually searched reference lists, related journals, and Google Scholar. RESULTS A total of 1211 studies were retrieved from the database searches and 23 studies were identified from manual searches, after which 22 studies were selected for the analysis. Among the nine project or experiment studies, two interventions were effective in decreasing errors related to rate control of IV medications. One of them was prospective, continuous incident reporting followed by prevention strategies, and the other encompassed six interventions to mitigate interruptions in medication verification and administration. Facilitators and barriers related to rate control of IV medications were classified as human, design, and system-related contributing factors. The sub-categories of human factors were classified as knowledge deficit, performance deficit, and incorrect dosage or infusion rate. The sub-category of design factor was device. The system-related contributing factors were classified as frequent interruptions and distractions, training, assignment or placement of healthcare providers (HCPs) or inexperienced personnel, policies and procedures, and communication systems between HCPs. CONCLUSIONS Further research is needed to develop effective interventions to improve IV rate control. Considering the rapid growth of technology in medical settings, interventions and policy changes regarding education and the work environment are necessary. Additionally, each key group such as HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices should perform its role and cooperate for appropriate IV rate control within a structured system.
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Affiliation(s)
- Jeongok Park
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Sang Bin You
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Gi Wook Ryu
- Department of Nursing, Hansei University, 30, Hanse-Ro, Gunpo-Si, 15852, Gyeonggi-Do, Korea.
| | - Youngkyung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea.
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Bell T, Sprajcer M, Flenady T, Sahay A. Fatigue in nurses and medication administration errors: A scoping review. J Clin Nurs 2023; 32:5445-5460. [PMID: 36707921 DOI: 10.1111/jocn.16620] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/19/2022] [Accepted: 01/04/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Medication administration errors (MAEs) cause preventable patient harm and cost billions of dollars from already-strained healthcare budgets. An emerging factor contributing to these errors is nurse fatigue. Given medication administration is the most frequent clinical task nurses undertake; it is vital to understand how fatigue impacts MAEs. OBJECTIVE Examine the evidence on the effect of fatigue on MAEs and near misses by registered nurses working in hospital settings. METHOD Arksey and O'Malley's scoping review framework was used to guide this review and PAGER framework for data extraction and analysis. The PRISMA checklist was completed. Four electronic databases were searched: CINAHL, PubMed, Scopus and PsycINFO. Eligibility criteria included primary peer review papers published in English Language with no date/time limiters applied. The search was completed in August 2021 and focussed on articles that included: (a) registered nurses in hospital settings, (b) MAEs, (c) measures of sleep, hours of work, or fatigue. RESULTS Thirty-eight studies were included in the review. 82% of the studies identified fatigue to be a contributing factor in MAEs and near misses (NMs). Fatigue is associated with reduced cognitive performance and lack of attention and vigilance. It is associated with poor nursing performance and decreased patient safety. Components of shift work, such as disruption to the circadian rhythm and overtime work, were identified as contributing factors. However, there was marked heterogeneity in strategies for measuring fatigue within the included studies. RELEVANCE TO CLINICAL PRACTICE Fatigue is a multidimensional concept that has the capacity to impact nurses' performance when engaged in medication administration. Nurses are susceptible to fatigue due to work characteristics such as nightwork, overtime and the requirement to perform cognitively demanding tasks. The mixed results found within this review indicate that larger scale studies are needed with particular emphasis on the impact of overtime work. Policy around safe working hours need to be re-evaluated and fatigue management systems put in place to ensure delivery of safe and quality patient care.
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Affiliation(s)
- Tracey Bell
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Madeline Sprajcer
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Tracey Flenady
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Ashlyn Sahay
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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Fekonja Z, Kmetec S, Fekonja U, Mlinar Reljić N, Pajnkihar M, Strnad M. Factors contributing to patient safety during triage process in the emergency department: A systematic review. J Clin Nurs 2023; 32:5461-5477. [PMID: 36653922 DOI: 10.1111/jocn.16622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/02/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Triage is a dynamic environment in which large numbers of people can present. It presents a vulnerable assessment point, as a triage nurse must assess a patient's urgency level and analyse their health status and expected resource needs. Given the critical nature of triage, it is necessary to understand the factors contributing to patient safety. OBJECTIVES To identify and examine the factors contributing to patient safety during the triage process. METHODS A systematic review of the literature was undertaken, and a thematic analysis of the factors contributing to patient safety during the triage process. PubMed, CINAHL, Web of Sciences, Science Direct, SAGE, EMBASE and reference lists of relevant studies published in English until March 2022 were searched for relevant studies. The search protocol has been registered at the PROSPERO (CRD42019146616), and the review was conducted using the PRISMA criteria. RESULTS Out of 5366 records, we included 11 papers for thematic synthesis. Identified factors contributing to patient safety in triage are related to the emergency's work environment, such as patient assessment, high workload, frequent interruptions and staffing, and personal factors such as nurse traits, experience, knowledge, triage fatigue and work schedule. CONCLUSIONS This review shows that patient safety is influenced by the attitude, capabilities and experiences of triage nurses, the time when nurses can dedicate themselves to the patient and triage the patient without disruption. It is necessary to raise awareness among nursing administrators and healthcare professionals to provide a safe triage environment for patients. RELEVANCE TO CLINICAL PRACTICE This review highlights the evidence on the factors contributing to patient safety in the triage process. Further research is needed for this cohort of triage nurses in the emergency department concerning ensuring patient safety. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was required to design or undertake this review.
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Affiliation(s)
- Zvonka Fekonja
- Faculty of Health Science, University of Maribor, Maribor, Slovenia
| | - Sergej Kmetec
- Faculty of Health Science, University of Maribor, Maribor, Slovenia
| | - Urška Fekonja
- Emergency Department, University Clinical Centre Maribor, Maribor, Slovenia
| | | | - Majda Pajnkihar
- Faculty of Health Science, University of Maribor, Maribor, Slovenia
| | - Matej Strnad
- Emergency Department, University Clinical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Prehospital Unit, Department for Emergency Medicine, Community Healthcare Center Maribor, Maribor, Slovenia
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Syyrilä T, Vehviläinen-Julkunen K, Mikkonen S, Härkänen M. Measuring health professionals' perceptions of communication contributing to medication incidents in hospitals - scale development and primary results of weekly perceived communication challenges. BMC Nurs 2023; 22:285. [PMID: 37626368 PMCID: PMC10463788 DOI: 10.1186/s12912-023-01455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Communication challenges are one of the main contributors for medication incidents in hospitals, but health professionals' perceptions about variety of the contributing communication factors and the factors' occurrence frequencies are studied little. This cross-sectional descriptive study aimed to (1) operationalize a literature-based framework into a scale for measuring health professionals' perceptions of communication factors, which contribute to medication incidents either directly or indirectly in hospitals, (2) to measure the construct validity and internal consistency of the scale and (3) to describe the primary results of the measured weekly perceived communication challenges. METHODS The structured online questionnaire with 82 communication related items was developed based on a framework in literature. A content validity index of expert panelists' answers was used for item reduction. Data was collected between November 1st, 2019, and January 31st, 2020, by convenience sampling. The study sample (n = 303) included multiple health professional groups in diverse specialties, unit types and organizational levels in two specialized university hospital districts in Finland. Exploratory factor analysis with Maximum Likelihood method and Oblique rotation produced a six factors scale consisting of 57 items and having acceptable construct validity and internal consistency. RESULTS The six communication factors contributing to medication incidents concerned (1) medication prescriptions, (2) guidelines and reporting, (3) patient and family, (4) guideline implementation,5) competencies and responsibilities, and 6) attitude and atmosphere. The most frequently perceived communication challenges belonged to the Medication prescription related factor. Detailed item frequencies suggested that the most usual weekly challenges were: (1) lack or unclarity of communication about medication prescriptions, (2) missing the prescriptions which were written outside of the regular physician-ward-rounds and (3) digital software restricting information transfer. CONCLUSIONS The scale can be used for determining the most frequent detailed communication challenges. Confirmatory factor analysis of the scale is needed with a new sample for the scale validation. The weekly perceived communication challenges suggest that interventions are needed to standardize prescribing documentation and to strengthen communication about prescriptions given outside of regular ward-rounds.
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Affiliation(s)
- Tiina Syyrilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), PO Box 1627, Kuopio, 70211, Finland.
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), PO Box 1627, Kuopio, 70211, Finland
- Kuopio University Hospital (KUH), Kuopio, Finland
| | - Santtu Mikkonen
- Department of Environmental and Biological Sciences, University of Eastern Finland (UEF), Kuopio, Finland
- Department of Technical Physics, Faculty of Science, Forestry and Technology, University of Eastern Finland (UEF), Kuopio, Finland
| | - Marja Härkänen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), PO Box 1627, Kuopio, 70211, Finland
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Alemu W, Cimiotti JP. Meta-Analysis of Medication Administration Errors in African Hospitals. J Healthc Qual 2023; 45:233-241. [PMID: 37276257 DOI: 10.1097/jhq.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ABSTRACT The incidence of medication administration errors (MAEs) and associated patient harm continue to plague hospitals worldwide. Moreover, there is a lack of evidence to address this problem, especially in Africa. This research synthesis was intended to provide current evidence to decrease the incidence of MAEs in Africa. Standardized search criteria were used to identify primary studies that reported the incidence and/or predictors of MAEs in Africa. Included studies met specifications and were validated with a quality-appraisal tool. The pooled incidence of MAEs in African hospitals was estimated to be 0.56 (CI: 0.4324-0.6770) with a 0.13-0.93 prediction interval. The primary estimates were highly heterogeneous. Most MAEs are explained by system failure and patient factors. The contribution of system factors can be minimized through adequate and ongoing training of nurses on the aspects of safe medication administration. In addition, ensuring the availability of drug use guidelines in hospitals, and minimizing disruptions during the medication process can decrease the incidence of MAEs in Africa.
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Jessurun JG, Hunfeld NGM, de Roo M, van Onzenoort HAW, van Rosmalen J, van Dijk M, van den Bemt PMLA. Prevalence and determinants of medication administration errors in clinical wards: A two-centre prospective observational study. J Clin Nurs 2023; 32:208-220. [PMID: 35068001 DOI: 10.1111/jocn.16215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/21/2021] [Accepted: 01/02/2022] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To identify the prevalence and determinants of medication administration errors (MAEs). BACKGROUND Insight into determinants of MAEs is necessary to identify interventions to prevent MAEs. DESIGN A prospective observational study in two Dutch hospitals, a university and teaching hospital. METHODS Data were collected by observation. The primary outcome was the proportion of administrations with one or more MAEs. Secondary outcomes were the type, severity and determinants of MAEs. Multivariable mixed-effects logistic regression analyses were used for determinant analysis. Reporting adheres to the STROBE guideline. RESULTS MAEs occurred in 352 of 2576 medication administrations (13.7%). Of all MAEs (n = 380), the most prevalent types were omission (n = 87) and wrong medication handling (n = 75). Forty-five MAEs (11.8%) were potentially harmful. The pharmaceutical forms oral liquid (odds ratio [OR] 3.22, 95% confidence interval [CI] 1.43-7.25), infusion (OR 1.73, CI 1.02-2.94), injection (OR 3.52, CI 2.00-6.21), ointment (OR 10.78, CI 2.10-55.26), suppository/enema (OR 6.39, CI 1.13-36.03) and miscellaneous (OR 6.17, CI 1.90-20.04) were more prone to MAEs compared to oral solid. MAEs were more likely to occur when medication was administered between 10 a.m.-2 p.m. (OR 1.91, CI 1.06-3.46) and 6 p.m.-7 a.m. (OR 1.88, CI 1.00-3.52) compared to 7 a.m.-10 a.m. and when administered by staff with higher professional education compared to staff with secondary vocational education (OR 1.68, CI 1.03-2.74). MAEs were less likely to occur in the teaching hospital (OR 0.17, CI 0.08-0.33). Day of the week, patient-to-nurse ratio, interruptions and other nurse characteristics (degree, experience, employment type) were not associated with MAEs. CONCLUSIONS This study identified a high MAE prevalence. Identified determinants suggest that focusing interventions on complex pharmaceutical forms and error-prone administration times may contribute to MAE reduction. RELEVANCE TO CLINICAL PRACTICE The findings of this study can be used to develop targeted interventions to improve patient safety.
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Affiliation(s)
- Janique Gabriëlle Jessurun
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicole Geertruida Maria Hunfeld
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michelle de Roo
- Department of Clinical Pharmacy, Amphia Hospital, Breda, The Netherlands
| | | | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Patricia Maria Lucia Adriana van den Bemt
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
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Jessurun JG, Hunfeld NG, van Rosmalen J, van Dijk M, van den Bemt PM. Effect of a Pharmacy-based Centralized Intravenous Admixture Service on the Prevalence of Medication Errors: A Before-and-After Study. J Patient Saf 2022; 18:e1181-e1188. [PMID: 35786788 PMCID: PMC9698191 DOI: 10.1097/pts.0000000000001047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Intravenous admixture preparation errors (IAPEs) may lead to patient harm. The primary aim of this study was to assess the effect of a pharmacy-based centralized intravenous admixture service (CIVAS) on IAPEs. METHODS We conducted a before-and-after study in 3 clinical wards before CIVAS implementation and in the CIVAS unit 18 months after implementation. Intravenous admixture preparation error data were collected by disguised observation. The primary outcome was the proportion of admixtures with 1 or more IAPEs. Secondary outcomes were the type and potential severity of IAPEs, noncompliance to hygiene procedures, and nursing staff satisfaction with the CIVAS. The primary outcome was analyzed using a multivariable mixed-effects logistic regression model. RESULTS One or more IAPEs were identified in 14 of 543 admixtures (2.6%) in the CIVAS unit and in 148 of 282 admixtures (52.5%) in the clinical wards (odds ratio, 0.02; 95% confidence interval, 0.004-0.05). The most common IAPE types were wrong solvent or diluent (n = 95) and wrong volume of infusion fluid (n = 45). No potentially harmful IAPEs occurred in the CIVAS unit as opposed to 22 (7.8%) in the clinical wards. Disinfection procedures were better adhered to in the CIVAS unit. Overall nurse satisfaction with the CIVAS increased from a median of 70 (n = 166) 5 months after intervention to 77 (n = 115) 18 months after intervention ( P < 0.001) on a 100-point scale. CONCLUSIONS Centralized intravenous admixture service performed notably better than the clinical wards with regard to IAPEs and noncompliance to hygiene procedures. Nurses were satisfied with the CIVAS. Hence, the implementation of CIVAS is an important strategy to improve medication safety in hospitals.
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Affiliation(s)
| | | | - Joost van Rosmalen
- Biostatistics
- Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam
| | - Monique van Dijk
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen
| | - Patricia M.L.A. van den Bemt
- From the Departments of Hospital Pharmacy
- Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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11
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Park J, You SB, Kim H, Park C, Ryu GW, Kwon S, Kim Y, Lee S, Lee K. Experience of Nurses with Intravenous Fluid Monitoring for Patient Safety: A Qualitative Descriptive Study. Risk Manag Healthc Policy 2022; 15:1783-1793. [PMID: 36171867 PMCID: PMC9512022 DOI: 10.2147/rmhp.s374563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/12/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Medication administration is a complex process and constitutes a substantial component of nursing practice that is closely linked to patient safety. Although intravenous fluid administration is one of the most frequently performed nursing tasks, nurses’ experiences with intravenous rate control have not been adequately studied. This study aimed to explore nurses’ experiences with infusion nursing practice to identify insights that could be used in interventions to promote safe medication administration. Patients and methods This qualitative descriptive study used focus group interviews of 20 registered nurses who frequently administered medications in tertiary hospitals in South Korea. Data were collected through five semi-structured focus group interviews, with four nurses participating in each interview. We conducted inductive and deductive content analysis based on the 11 key topics of patient safety identified by the World Health Organization. Reporting followed the consolidated criteria for reporting qualitative research (COREQ) checklist. Results Participants administered infusions in emergency rooms, general wards, and intensive care units, including patients ranging from children to older adults. Two central themes were revealed: human factors and systems. Human factors consisted of two sub-themes including individuals and team players, while systems encompassed three sub-themes including institutional policy, culture, and equipment. Conclusion This study found that nurses experienced high levels of stress when administering infusions in the correct dose and rate for patient safety. Administering and monitoring infusions were complicated because nursing processes interplay with human and system factors. Future research is needed to develop nursing interventions that include human and system factors to promote patient safety by reducing infusion-related errors.
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Affiliation(s)
- Jeongok Park
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
| | - Sang Bin You
- Yonsei University College of Nursing, Seoul, South Korea
| | - Hyejin Kim
- Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Cheolmin Park
- Department of Materials Science and Engineering, Yonsei University, Seoul, South Korea
| | - Gi Wook Ryu
- Department of Nursing, Hansei University, Gunpo-si, South Korea
| | - Seongae Kwon
- Yonsei University College of Nursing, Seoul, South Korea
| | - Youngkyung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Sejeong Lee
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Kayoung Lee
- Gachon University College of Nursing, Incheon, South Korea
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Fuster-Linares P, Alfonso-Arias C, Gallart Fernández-Puebla A, Rodríguez-Higueras E, García-Mayor S, Font-Jimenez I, Llaurado-Serra M. Assessing Nursing Students' Self-Perceptions about Safe Medication Management: Design and Validation of a Tool, the NURSPeM. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084663. [PMID: 35457531 PMCID: PMC9028847 DOI: 10.3390/ijerph19084663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/28/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023]
Abstract
Objective: The objective was to design and validate a tool for assessing nursing students’ self-perceptions about safe medication management. Methods: A descriptive instrumental study was conducted involving construct definition, development of the tool, analysis of the content validity, and psychometric evaluation. Consensus regarding the content was obtained through a two-round Delphi process, and the resulting tool (the NURSPeM) was administered to nursing students to examine its internal consistency, temporal stability, and construct validity, the latter through exploratory factor analysis. Results: Thirteen experts participated in the Delphi process, which yielded a tool comprising two questionnaires: (1) Self-perceptions about safe medication management (27 items) and (2) the frequency and learning of drug-dose calculation (13 items). The tool’s psychometric properties were then examined based on responses from 559 nursing students. This analysis led to the elimination of three items from questionnaire 1, leaving a total of 24 items distributed across seven dimensions. All 13 items in questionnaire 2 were retained. Both questionnaires showed good internal consistency (Cronbach’s alpha = 0.894 and 0.893, respectively) and temporal stability (ICC = 0.894 and 0.846, respectively). Conclusions: The NURSPeM is a valid and reliable tool for assessing nursing students’ self-perceptions about safe medication management. It may be used to identify areas in which their training needs to be enhanced, and to evaluate the subsequent impact of new teaching initiatives.
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Affiliation(s)
- Pilar Fuster-Linares
- Nursing Department, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (C.A.-A.); (A.G.F.-P.); (E.R.-H.)
- Correspondence: (P.F.-L.); (M.L.-S.); Tel.: +34-93-504-20-00 (ext. 5631) or +34-626-838-951 (P.F.-L.); +34-93-504-20-00 (ext. 5634) or +34-665-033-050 (M.L.-S.)
| | - Cristina Alfonso-Arias
- Nursing Department, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (C.A.-A.); (A.G.F.-P.); (E.R.-H.)
| | | | - Encarna Rodríguez-Higueras
- Nursing Department, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (C.A.-A.); (A.G.F.-P.); (E.R.-H.)
| | - Silvia García-Mayor
- Nursing Department, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain;
| | | | - Mireia Llaurado-Serra
- Nursing Department, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (C.A.-A.); (A.G.F.-P.); (E.R.-H.)
- Correspondence: (P.F.-L.); (M.L.-S.); Tel.: +34-93-504-20-00 (ext. 5631) or +34-626-838-951 (P.F.-L.); +34-93-504-20-00 (ext. 5634) or +34-665-033-050 (M.L.-S.)
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Jones JR, Boltz M, Allen R, Van Haitsma K, Leslie D. Nursing students' risk perceptions related to medication administration error: A qualitative study. Nurse Educ Pract 2022; 58:103274. [PMID: 34922091 PMCID: PMC8792253 DOI: 10.1016/j.nepr.2021.103274] [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: 04/09/2021] [Revised: 10/06/2021] [Accepted: 12/07/2021] [Indexed: 01/03/2023]
Abstract
AIM The purpose of this study was to explore and describe pre-licensure nursing students' perceptions of risk for medication administration errors in fourth-year baccalaureate student nurses from three campuses at a large central Pennsylvania university. BACKGROUND Medication administration errors continue to be a significant safety concern in healthcare settings. Pre-licensure nursing education is a critical time period during which to have an impact on future medication administration practices. Perception of risk influences decision making and behavior, including nursing clinical decision making. DESIGN This descriptive, exploratory study involved a qualitative design. METHODS A thematic analysis of the qualitative data resulting from 60 individual, in-depth semi-structured interviews was conducted. RESULTS The participants offered rich, detailed narratives which revealed the following themes: (1) the nature of risk perceptions, (2) more opportunities to learn, (3) experiences with medication administration error, and (4) intrinsic characteristics influence errors. CONCLUSIONS The findings provide a broad description of the nature of student nurse risk perceptions for future medication administration errors. Recommendations for nursing education practice and pedagogy include additional clinical experiences, modified pharmacology curricula and instruction, and expanded simulations involving medication administration error.
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Affiliation(s)
- Joanne Roman Jones
- The Pennsylvania State University, College of Nursing, 120 Little
Branch Trail, Chapel Hill, NC 27517
| | - Marie Boltz
- Elouise Ross Eberly and Robert Eberly Endowed Chair, Professor of
Nursing, The Pennsylvania State University, College of Nursing, 306 Nursing
Sciences Building, University Park, PA 16802
| | - Rachel Allen
- Assistant Research Professor of Nursing, The Pennsylvania State
University, College of Nursing
| | | | - Douglas Leslie
- Professor and Vice Chair for Education, Department of Public Health
Sciences, Chief, Division of Health Services and Behavioral Research,
Professor, Department of Psychiatry and Behavioral Health, The Pennsylvania
State University
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Härkänen M, Vehviläinen-Julkunen K, Franklin BD, Murrells T, Rafferty AM. Factors Related to Medication Administration Incidents in England and Wales Between 2007 and 2016: A Retrospective Trend Analysis. J Patient Saf 2021; 17:e850-e857. [PMID: 32168268 DOI: 10.1097/pts.0000000000000639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to describe medication administration incidents reported in England and Wales between 2007 and 2016, to identify which factors (reporting year, type of incident, patients' age) are most strongly related to reported severity of medication administration incidents, and to assess the extent to which relevant information was underreported or indeterminate. METHODS Medication administration incidents reported to the National Reporting & Learning System between January 1, 2007, and December 31, 2016 were obtained. Characteristics of the data were described using frequencies, and relationships between variables were explored using cross-tabulation. RESULTS A total of 517,384 incident reports were analyzed. Of these, 97.1% (n = 502,379) occurred in acute/general hospitals, mostly on wards (69.1%, n = 357,463), with medicine the most common specialty area (44.5%, n = 230,205). Medication errors were most commonly omitted doses (25.8%, n = 133,397). The majority did not cause patient harm (83.5%, n = 432,097). When only incidents causing severe harm or death (n = 1,116) were analyzed, the most common type of error was omitted doses (24.1%). Most incidents causing severe harm or death occurred in patients aged 56 years or older. For the 10-year period, the percentage of incidents with "no harm" increased (74.1% in 2007 to 86.3% in 2016). For some variables, data were often missing or indeterminate, which has implications for data analysis. CONCLUSIONS Medication administration incidents that do not cause harm are increasingly reported, whereas incidents reported as severe harm and death have declined. Data quality needs to be improved. Underreporting and indeterminate data, inaccuracies in reporting, and coding jeopardize the overall usefulness of these data.
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Affiliation(s)
- Marja Härkänen
- From the Department of Nursing Science, University of Eastern Finland
| | | | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Charing Cross Hospital, Imperial College Healthcare NHS Trust and UCL School of Pharmacy
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
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Kuo SY, Thadakant S, Warsini S, Chen HW, Hu SH, Aulawi K, Duangbubpha S, Pangastuti HS, Khuwatsamrit K. Types of medication administration errors and comparisons among nursing graduands in Indonesia, Taiwan, and Thailand: A cross-sectional observational study. NURSE EDUCATION TODAY 2021; 107:105120. [PMID: 34482207 DOI: 10.1016/j.nedt.2021.105120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 05/27/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite medication administration safety having been introduced, practiced, and examined in nursing schools for many years, errors are commonly reported among new nurses. Understanding medication errors that nursing graduands might commit is essential for patient safety and fostering collaboration among neighboring countries. OBJECTIVES To assess and compare types of medication administration errors identified by nursing graduands in Asian countries using a medication errors scenario. DESIGN A cross-sectional observational study. SETTINGS One university four-year nursing program each in Indonesia, Taiwan, and Thailand. PARTICIPANTS A total of 145 baccalaureate nursing graduands in their last semester, including 42 from Indonesia, 35 from Taiwan, and 68 from Thailand. METHODS The medication errors scenario contained 11 errors. The faculty examiner directly observed and graded the graduands' performance in identifying medication errors using an objective structured medication administration checklist. Descriptive and inferential analyses were used. RESULTS Overall, 4.4 ± 1.8 errors on average were identified in the medication errors scenario. The most common types of errors differed among the three countries. More than half of the graduands did not check the patient's wristband (n = 75; 51.7%) or discovered the wrong name on it (n = 88; 60.7%). Giving medication without an indication (n = 129; 89.0%) and giving medication with potential for an allergic reaction (n = 111; 76.6%) were the most common errors. CONCLUSIONS Medication administration errors are common in nursing graduands. Specific types and various frequencies of errors were noted across three countries. Nursing faculties should investigate possible reasons for common types of errors and develop effective education strategies for graduands to prevent errors. Collaboration among neighboring countries is encouraged to improve overall global 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.
| | - Streerut Thadakant
- Ramathibodi School of Nursing, Mahidol University Faculty of Medicine Ramathibodi Hospital, Rama 6 Road, Payathai District, Rachathewi, Bangkok 10400, Thailand.
| | - Sri Warsini
- Department of Mental Health and Community Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Gedung Ismangun, Lt.2 Jl. Farmako, Sekip Utara, Yogyakarta, Indonesia.
| | - Hui-Wen Chen
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, 155 Linong Street, Sec. 2, Taipei 11221, Taiwan
| | - Sophia H Hu
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, 155 Linong Street, Sec. 2, Taipei 11221, Taiwan.
| | - Khudazi Aulawi
- Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Gedung Ismangun, Lt.2 Jl. Farmako, Sekip Utara, Yogyakarta, Indonesia.
| | - Sumolchat Duangbubpha
- Ramathibodi School of Nursing, Mahidol University Faculty of Medicine Ramathibodi Hospital, Rama 6 Road, Payathai District, Rachathewi, Bangkok 10400, Thailand.
| | - Heny S Pangastuti
- Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Gedung Ismangun, Lt.2 Jl. Farmako, Sekip Utara, Yogyakarta, Indonesia.
| | - Kusuma Khuwatsamrit
- Ramathibodi School of Nursing, Mahidol University Faculty of Medicine Ramathibodi Hospital, Rama 6 Road, Payathai District, Rachathewi, Bangkok 10400, Thailand.
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Syyrilä T, Vehviläinen-Julkunen K, Manias E, Bucknall T, Härkänen M. Communication related to medication incidents-A concept analysis and literature review. Scand J Caring Sci 2021; 36:297-319. [PMID: 34779022 DOI: 10.1111/scs.13044] [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: 05/21/2021] [Revised: 09/26/2021] [Accepted: 10/10/2021] [Indexed: 11/29/2022]
Abstract
AIMS (1) To identify and analyse the conceptual framework and operationalise the concept of communication issues related to medication incidents in hospital to facilitate the development of a future tool for measuring frequencies of the communication issues. (2) To determine how the concept is distinct from related concepts. DESIGN Concept analysis. DATA SOURCES Twenty-three articles from seven scientific databases covering the years 2010-2020 and two official documents. METHODS Walker and Avant's concept analysis method was used. That was started by a systematised literature review on 2 November 2020 using specified criteria. Two authors evaluated articles' quality by Joanna Brigg's Institute's criteria. Literature review results were analysed deductive-inductively; conceptual framework was developed and concept defined presenting case scenarios. EQUATOR's standards were used in study reporting. RESULTS A conceptual framework and the concept of 'communication related to medication incidents in hospitals' were defined, comprising six main attribute categories: (1) communication dyads involved in communication, (2) patients' or professionals' individual issues, (3) institutional, (4) contextual and process issues, (5) communication concerning medication prescriptions and (6) qualitative characteristics of communication. The categories consisted of 128 quantitatively measurable and 10 qualitative attributes describing communication issues. The concept is distinct from related concepts by collating fragmented communication issues into the same concept. CONCLUSION The 128-item conceptual framework and the concept of communication related to medication incidents in hospitals were defined, as there was not one. The concept assembled parts of previous theories and fragmented information to one entity. The concept needs further condensing and validation to develop a tool for measuring communication issues. IMPACT ON MEDICATION SAFETY The conceptual framework can be used in practice and education as indicative rationale for reflection of current communication issues. The concept contributes to research by providing necessary grounding for tool development for measuring communication factors relating medication incidents.
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Affiliation(s)
- Tiina Syyrilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland.,Abdominal Center, Helsinki University Hospital (HUS), University of Helsinki, Helsinki, Finland
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland.,Kuopio University Hospital (KUH), Kuopio, Finland
| | - Elizabeth Manias
- School of Nursing & Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Vic., Australia
| | - Tracey Bucknall
- School of Nursing & Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Vic., Australia
| | - Marja Härkänen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland
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Identification and assessment of nursing task errors in emergency department using SHERPA technique and offering remedial strategies. Int Emerg Nurs 2021; 59:101103. [PMID: 34758445 DOI: 10.1016/j.ienj.2021.101103] [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: 12/04/2020] [Revised: 09/19/2021] [Accepted: 09/29/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Improving health care quality is a global concern, and providing patients with safe healthcare is a WHO Patient Safety priority. The technological revolution in health services has highlighted the role of human factors in committing such errors, and since the number of medical errors, including nursing errors, increases on a daily basis. OBJECTIVES This research aimed to identify the causes of Nursing Task Errors in Emergency Department Using SHERPA Technique and adopt strategies to prevent and reduce them. Participants were 47 nurses (24 women and 23 men), who worked morning, evening and night shifts. The nurses were taught the methodology and talked about the objective of the study; they were then interviewed and observed for six months while working. This way, their tasks and subtasks were demarcated and the Hierarchical Task Analysis (HTA) was performed. SHERPA Error Mode Checklist was used to identify errors and their various types and then risk assessment was conducted. RESULTS A total of 45 tasks, 234 subtasks, and 326 errors in regard to nursing activities were identified in the emergency department, with the highest frequency for action errors (61.34%) and the lowest for communication errors (1.84%). Also, there were 7.24 errors per task. The highest and lowest number of errors were at the 'unfavorable' (19.07%) and,'acceptable (safe)' (6.15%) risk levels, respectively. Based on the finding staff training, workload elimination,work process modification and updating guidelines are recommended. CONCLUSION The results of present study were also submitted to the University Medical Executive management Committee to make individual, educational and organizational reforms (guidelines and instructions) in order to optimize the situation.
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18
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Witczak I, Rypicz Ł, Šupínová M, Janiczeková E, Pobrotyn P, Młynarska A, Fedorowicz O. Patient Safety in the Process of Pharmacotherapy Carried Out by Nurses-A Polish-Slovak Prospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910066. [PMID: 34639367 PMCID: PMC8508261 DOI: 10.3390/ijerph181910066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
Pharmacotherapy, i.e., the use of medicines for combating a disease or its symptoms, is one of the crucial elements of patient care. Nursing workloads in the pharmacotherapy process prove that nurses spend 40% of their work on the management of medications. This study was aimed at the determination and comparison of safety levels at the nurse-managed stage of the pharmacotherapy process in Poland and Slovakia by identifying the key risk factors which directly affect patient safety. The study involved a group of 1774 nurses, of whom 1412 were from Poland and 362 were from Slovakia. The original Nursing Risk in Pharmacotherapy (acronym: NURIPH) tool was used. The survey questionnaire was made available online and distributed to nurses. The Cronbach's alpha coefficient was 0.832. Nurses from Slovakia most often, i.e., for six out of nine factors (items: one, five, six, seven, eight, and nine), assessed the risk factors as "significant risk (3)", and Polish nurses most often, i.e., for as many as eight out of nine risk factors (items: one, two, three, four, five, six, seven, and nine), assessed the risk factors as "very significant (5)". It has been found that the safety of the pharmacotherapy process is assessed by Polish nurses to be much lower than by Slovak nurses.
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Affiliation(s)
- Izabela Witczak
- Department of Health Care Economics and Quality, Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Łukasz Rypicz
- Department of Health Care Economics and Quality, Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland;
- Correspondence: ; Tel.: +48-693-251-213
| | - Mária Šupínová
- Faculty of Health, Slovak Medical University, 947-05 Bratislava, Slovakia; (M.Š.); (E.J.)
| | - Elena Janiczeková
- Faculty of Health, Slovak Medical University, 947-05 Bratislava, Slovakia; (M.Š.); (E.J.)
| | | | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Olga Fedorowicz
- Department of Clinical Pharmacology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland;
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Yoon S, Sohng K. Factors causing medication errors in an electronic reporting system. Nurs Open 2021; 8:3251-3260. [PMID: 34392612 PMCID: PMC8510738 DOI: 10.1002/nop2.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022] Open
Abstract
Aim To analyse medication error data from a hospital's electronic reporting system and identify the factors affecting error types and harmfulness. Design A retrospective study. Methods The 805 near misses and adverse events reported to the hospital's electronic reporting system between January 2014 and December 2018 were analysed using descriptive statistics, chi‐square tests and logistic regression analyses. Results A total of 632 near misses and 173 adverse events were reported. Near misses and adverse events were the most common error type during the dispensing stage and medication administration, respectively. The odds of medication errors reported by nurses with 1–9 years of clinical experience were relatively low. After adjusting for confounders, the odds of medication errors directly observed by nurses were 65% lower than the odds of medication errors not directly detected. In clinical practice, nurses must be educated about errors in reporting depending on their degree of clinical experience.
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Affiliation(s)
- Seonhee Yoon
- Department of Performance Improvement, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Kyeongyae Sohng
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
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20
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Prevalence and determinants of intravenous admixture preparation errors: A prospective observational study in a university hospital. Int J Clin Pharm 2021; 44:44-52. [PMID: 34363192 PMCID: PMC8866293 DOI: 10.1007/s11096-021-01310-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/22/2021] [Indexed: 11/22/2022]
Abstract
Background Intravenous admixture preparation errors (IAPEs) may lead to patient harm. Insight into the prevalence as well as the determinants associated with these IAPEs is needed to elicit preventive measures. Aim The primary aim of this study was to assess the prevalence of IAPEs. Secondary aims were to identify the type, severity, and determinants of IAPEs. Method A prospective observational study was performed in a Dutch university hospital. IAPE data were collected by disguised observation. The primary outcome was the proportion of admixtures with one or more IAPEs. Descriptive statistics were used for the prevalence, type, and severity of IAPEs. Mixed-effects logistic regression analyses were used to estimate the determinants of IAPEs. Results A total of 533 IAPEs occurred in 367 of 614 admixtures (59.8%) prepared by nursing staff. The most prevalent errors were wrong preparation technique (n = 257) and wrong volume of infusion fluid (n = 107). Fifty-nine IAPEs (11.1%) were potentially harmful. The following variables were associated with IAPEs: multistep versus single-step preparations (adjusted odds ratio [ORadj] 4.08, 95% confidence interval [CI] 2.27–7.35); interruption versus no interruption (ORadj 2.32, CI 1.13–4.74); weekend versus weekdays (ORadj 2.12, CI 1.14–3.95); time window 2 p.m.-6 p.m. versus 7 a.m.-10 a.m. (ORadj 3.38, CI 1.60–7.15); and paediatric versus adult wards (ORadj 0.14, CI 0.06–0.37). Conclusion IAPEs, including harmful IAPEs, occurred frequently. The determinants associated with IAPEs point to factors associated with preparation complexity and working conditions. Strategies to reduce the occurrence of IAPEs and therefore patient harm should target the identified determinants.
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21
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Westbrook JI, Sunderland NS, Woods A, Raban MZ, Gates P, Li L. Changes in medication administration error rates associated with the introduction of electronic medication systems in hospitals: a multisite controlled before and after study. BMJ Health Care Inform 2021; 27:bmjhci-2020-100170. [PMID: 32796084 PMCID: PMC7430327 DOI: 10.1136/bmjhci-2020-100170] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background Electronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication administration errors (MAEs). Objective To assess changes in MAE rates and types associated with EMS implementation. Methods This was a controlled before and after study (three intervention and three control wards) at two adult teaching hospitals. Intervention wards used an EMS with no bar-coding. Independent, trained observers shadowed nurses and recorded medications administered and compliance with 10 safety procedures. Observational data were compared against medication charts to identify errors (eg, wrong dose). Potential error severity was classified on a 5-point scale, with those scoring ≥3 identified as serious. Changes in MAE rates preintervention and postintervention by study group, accounting for differences at baseline, were calculated. Results 7451 administrations were observed (4176 pre-EMS and 3275 post-EMS). At baseline, 30.2% of administrations contained ≥1 MAE, with wrong intravenous rate, timing, volume and dose the most frequent. Post-EMS, MAEs decreased on intervention wards relative to control wards by 4.2 errors per 100 administrations (95% CI 0.2 to 8.3; p=0.04). Wrong timing errors alone decreased by 3.4 per 100 administrations (95% CI 0.01 to 6.7; p<0.05). EMS use was associated with an absolute decline in potentially serious MAEs by 2.4% (95% CI 0.8 to 3.9; p=0.003), a 56% reduction in the proportion of potentially serious MAEs. At baseline, 74.1% of administrations were non-compliant with ≥1 of 10 procedures and this rate did not significantly improve post-EMS. Conclusions Implementation of EMS was associated with a modest, but significant, reduction in overall MAE rate, but halved the proportion of MAEs rated as potentially serious.
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Affiliation(s)
- Johanna I Westbrook
- Centre for Health Systems and Safety Research, Macquarie University Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Neroli S Sunderland
- Centre for Health Systems and Safety Research, Macquarie University Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Amanda Woods
- Centre for Health Systems and Safety Research, Macquarie University Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Magda Z Raban
- Centre for Health Systems and Safety Research, Macquarie University Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Peter Gates
- Centre for Health Systems and Safety Research, Macquarie University Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Macquarie University Australian Institute of Health Innovation, Sydney, New South Wales, Australia
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22
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Bailey C, Jeffs L. Threats to Narcotic Safety-A Narrative Review of Narcotic Incidents, Discrepancies and Near-Misses Within a Large Canadian Health System. Can J Nurs Res 2021; 54:440-450. [PMID: 34229483 PMCID: PMC9597149 DOI: 10.1177/08445621211028709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Canada is currently experiencing an opioid crisis. Purpose Nurses are the largest number of frontline healthcare professionals in Canada
who administer narcotic pharmacotherapy, hence, they are ideally placed to
improve narcotic stewardship in hospitals. Our study aims to understand the
characteristics of narcotic incidents and hence recommend interventions for
narcotic stewardship. Methods Our study was conducted within a 442-bed academic health sciences center in
Ontario. We extracted anonymized narcotic incident reports which occurred
over a 3-year period from the SAFER System. Descriptive statistics were
utilized to analyze narcotic incidents and their contributory factors. Results 272 narcotic incident reports were submitted to SAFER within the study
period. Most incidents (51%) involved hydromorphone and morphine and were
primarily categorized as Level I (n = 154) and Level II (n = 60). Incorrect
narcotic dosing (44%), and narcotic count discrepancies (27%) were most
commonly reported with active failures being the most commonly reported
contributory factors such as failure to review medication orders prior to
narcotic administration. Conclusions Nurses have an important role in narcotic safety as an intermediary between
narcotic administration and incident reporting. Further research is needed
to understand the enablers, barriers and opportunities for nurses and other
healthcare professionals to improve narcotic stewardship.
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Affiliation(s)
- Chantelle Bailey
- Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, ON, Canada
| | - Lianne Jeffs
- Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, ON, Canada
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Kerari A, Innab A. The Influence of Nurses' Characteristics on Medication Administration Errors: An Integrative Review. SAGE Open Nurs 2021; 7:23779608211025802. [PMID: 34222653 PMCID: PMC8223601 DOI: 10.1177/23779608211025802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background Medication administration errors (MAEs) are a frequent cause of morbidity and mortality in acute care settings and can result in a prolonged hospital stay. The WHO estimated that medication errors cost up to $42 billion globally per a year. Therefore, MAEs was among the most common medical errors to occur in acute care settings. Studies of medication error usually focus on system factors, thus creating a gap between what researchers know about the causes of MAEs, and what frontline nurses actually do in the clinical setting. The purpose of this review is to fill a gap in the existing literature by focusing on the relationship between nurses' characteristics and MAEs. Methods Online databases were accessed, including CINAHL, PsycINFO, PubMed, Scopus, and Google Scholar from 2007-2020 period. This review was guided by the methods described by Whittemore and Knafl. Studies that addressed the occurrence of medication errors based on RN demographics were included in this review. The included studies were reviewed and analyzed by the two authors. Results Of the 1141 publications retrieved, 19 studies met inclusion criteria. The result provided strong evidence that nurses' level of education, length of experience, and attendance at training courses, are directly associated with the occurrence of MAEs. There is weak evidence of MAEs being influenced by the age and gender of nurses. Other nurse characteristics, such as cognitive load, frustration with technology, negligence, lack of attentiveness, and nurse ethnicity, are not adequately examined across the reviewed studies necessitates further research. Conclusion Focusing on nurses' characteristics might facilitate other researchers to suggest appropriate interventions that may reduce the incidence of MAEs. Interventional studies may provide convincing evidence as to whether one variable has a causal effect on another variable, and control the influence of confounding variables to enhance the generalizability of the findings.
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Affiliation(s)
- Ali Kerari
- Medical Surgical Department, School of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Adnan Innab
- Nursing Administration and Education Department, School of Nursing, King Saud University, Riyadh, Saudi Arabia
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Campbell AA, Harlan T, Campbell M, Mulekar MS, Wang B. Nurse's Achilles Heel: Using Big Data to Determine Workload Factors That Impact Near Misses. J Nurs Scholarsh 2021; 53:333-342. [PMID: 33786985 DOI: 10.1111/jnu.12652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore how big data can be used to identify the contribution or influence of six specific workload variables: patient count, medication count, task count call lights, patient sepsis score, and hours worked on the occurrence of a near miss (NM) by individual nurses. DESIGN A correlational and cross-section research design was used to collect over 82,000 useable data points of historical workload data from the three unique systems on a medical-surgical unit in a midsized hospital in the southeast United States over a 60-day period. Data were collected prior to the start of the Covid-19 pandemic in the United States. METHODS Combined data were analyzed using JMP Pro version 12. Mean responses from two groups were compared using a t-test and those from more than two groups using analysis of variance. Logistic regression was used to determine the significance of impact each workload variable had on individual nurses' ability to administer medications successfully as measured by occurrence of NMs. FINDINGS The mean outcome of each of the six workload factors measured differed significantly (p < .0001) among nurses. The mean outcome for all workload factors except the hours worked was found to be significantly higher (p < .0001) for those who committed an NM compared to those who did not. At least one workload variable was observed to be significantly associated (p < .05) with the occurrence or nonoccurrence of NMs in 82.6% of the nurses in the study. CONCLUSIONS For the majority of the nurses in our study, the occurrence of an NM was significantly impacted by at least one workload variable. Because the specific variables that impact performance are different for each individual nurse, decreasing only one variable, such as patient load, will not adequately address the risk for NMs. Other variables not studied here, such as education and experience, might be associated with the occurrence of NMs. CLINICAL RELEVANCE In the majority of nurses, different workload variables increase their risk for an NM, suggesting that interventions addressing medication errors should be implemented based on the individual's risk profile.
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Affiliation(s)
- Amy A Campbell
- Professor, College of Nursing, Department of Community Mental Health, University of South Alabama, Mobile, AL, USA
| | - Todd Harlan
- Chair and Professor, College of Nursing, Department of Community Mental Health, University of South Alabama, Mobile, AL, USA
| | - Matt Campbell
- Professor, School of Computing, Department of Information Systems Technology, University of South Alabama, Mobile, AL, USA
| | - Madhuri S Mulekar
- Chair and Professor, Department of Mathematics and Statistics, University of South Alabama, Mobile, AL, USA
| | - Bin Wang
- Professor, Department of Mathematics and Statistics, University of South Alabama, Mobile, AL, USA
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Intas G, Pagkalou D, Platis C, Chalari E, Ganas A, Stergiannis P. Medication Errors and Their Correlation with Nurse’s Satisfaction. The Case of the Hospitals of Lasithi, Crete. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1337:195-203. [DOI: 10.1007/978-3-030-78771-4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Witczak I, Uchmanowicz I, Tartaglia R, Rypicz Ł. Safety Assessment of the Pharmacotherapy Process at the Nurse and Midwife Level - An Observational Study. Ther Clin Risk Manag 2020; 16:1057-1065. [PMID: 33177830 PMCID: PMC7649244 DOI: 10.2147/tcrm.s276901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/26/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose Pharmacological errors are among the most common in the healthcare system. This study aimed to determine the level of safety of the pharmacotherapy process at the stage performed by nurses and midwives by indicating the key risk factors affecting patients’ safety. Methods A group of 1276 nurses and 136 midwives in Poland participated in the study. The survey was conducted in the period from May 2019 to August 2019. The original Nursing Risk in Pharmacotherapy (NURIPH) tool was used. Results The Cronbach alpha coefficient was 0.832. The low legibility of the medical orders (item 1) was indicated as the highest risk. A mean of 4.50 means that this factor’s significance is assessed between “very significant” and “significant.” The communication between physician, nurse and midwife, time pressure, and work organization were also rated high (Items 2, 3, and 4). The averages for these factors are higher than 4, so their evaluation is more than “significant.”. Conclusion Nurses and midwives involved in the pharmacotherapy process are exposed to many ergonomic factors triggering risk. A huge problem is the lack of readability of medical orders, which may be a factor triggering a medical error.
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Affiliation(s)
- Izabela Witczak
- Department of Health Care Economics and Quality, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Riccardo Tartaglia
- President of the Italian Network for Safety in Health Care, Florence, Italy
| | - Łukasz Rypicz
- Department of Health Care Economics and Quality, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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Berg TA, Li X, Sawhney R, Wyatt T. Agent-Based Modeling Simulation of Nurse Medication Administration Errors. Comput Inform Nurs 2020; 39:187-197. [PMID: 33787523 DOI: 10.1097/cin.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
It has been 20 years since the National Academy of Medicine released its report, "To Err Is Human," which shocked the healthcare community on the pervasiveness of medical error. While errors in medication administration are a significant contributor to medical error, research seeking to understand the complex systems nature and occurrence of medication administration error is limited. Computer modeling is increasingly being used in the healthcare industry to assess the impact of changes made to healthcare processes. The objective of the study is to evaluate the use of agent-based modeling, a type of computer modeling that allows the simulation of virtual individuals and their behavior, to simulate nurse performance in the medication administration process. The model explores the effect of Just-in-Time information, as an intervention, on the occurrence of medication error. The model demonstrated significant utility in understanding the interplay of the system elements of the nurse medication administration process. Therefore this approach, using systems-level computer simulation such as agent-based models, can help administrators understand the effects of changes to the medication administration process as they work to reduce errors and increase performance.
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Affiliation(s)
- Thomas A Berg
- Author Affiliations: Health Innovation Technology Simulation Laboratory, College of Nursing (Drs Berg and Wyatt), and Health Innovation Technology Simulation Laboratory Industrial and Systems Engineering (Dr Li) and Industrial and Systems Engineering (Dr Sawhney), College of Engineering, The University of Tennessee-Knoxville
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Escrivá Gracia J, Aparisi Sanz Á, Brage Serrano R, Fernández Garrido J. Medication errors and risk areas in a critical care unit. J Adv Nurs 2020; 77:286-295. [PMID: 33107622 DOI: 10.1111/jan.14612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/03/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to identify the main medication errors, their causality and the highest risk areas in critical care. DESIGN A descriptive, longitudinal and retrospective study. METHODS We performed a systematic analysis of the prescription, transcription and administration records of 2,634 dose units of medications that were administered to a total of 87 critically ill patients during 2018. RESULTS Final results have shown important medication errors and a high number of significant drug interactions; prescription phase had the highest mistake rate (71%) and cause of errors (68%); transcription stage had a more variable error typology. A significant correlation was observed between the presence of causes and contributing factors to error during the prescription and the commission of errors during the nurse transcription, being the main risk areas the time of antibiotic administration, dilution errors, concentration and speed of administration of high-risk medications and the technique used for nasogastric tube drug administration. CONCLUSION In critical care, an intolerable number of medication errors are still committed, placing the origin of many of them in the causality and contributing factors identified in the prescription stage. IMPACT The origin of many of the medication errors and most interactions is in the prescription stage, being the nurse transcription (nurse intervention) in an important filter that prevents a considerable number of errors from finally reaching the patient. The schedule of administration of time-dependent antibiotics, high-risk medications and the technique of administering medications through a nasogastric tube are important risk areas for the commission of medication errors.
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Affiliation(s)
| | - Álvaro Aparisi Sanz
- Cardiology Department, Valladolid University Clinical Hospital, Valladolid, Spain
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Schroers G, Ross JG, Moriarty H. Nurses' Perceived Causes of Medication Administration Errors: A Qualitative Systematic Review. Jt Comm J Qual Patient Saf 2020; 47:S1553-7250(20)30247-6. [PMID: 33153914 DOI: 10.1016/j.jcjq.2020.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Medication administration errors (MAEs) are a critical patient safety issue. Nurses are often responsible for administering medication to patients, thus their perceptions of causes of errors can provide valuable guidance for the development of interventions aimed to mitigate errors. Quantitative research can overlook less overt causes; therefore, a qualitative systematic review was conducted to present a synthesis of qualitative evidence of nurses' perceived causes of MAEs. METHODS Publications from 2000 to February 2019 were searched using four electronic databases. Inclusion criteria were articles that (1) presented results from studies that used a qualitative or mixed methods design, (2) reported qualitative data on nurses' perceived causes of MAEs in health care settings, and (3) were published in the English language. Sixteen individual articles satisfied the inclusion criteria. Methodological quality of each article was assessed using the Critical Appraisal Skills Programme (CASP) tool. Thematic analysis of the data was performed. Perceived causes of errors were labeled as knowledge-based, personal, and contextual factors. RESULTS The primary knowledge-based factor was lack of medication knowledge. Personal factors included fatigue and complacency. Contextual factors included heavy workloads and interruptions. Contextual factors were reported in all the studies reviewed and were often interconnected with personal and knowledge-based factors. CONCLUSION Causes of MAEs are perceived by nurses to be multifactorial and interconnected and often stem from systems issues. Multifactorial interventions aimed at mitigating medication errors are required with an emphasis on systems changes. Findings in this review can be used to guide efforts aimed at identifying and modifying factors contributing to MAEs.
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Bakhshi F, Mitchell R, Nasrabadi AN, Varaei S, Hajimaghsoudi M. Behavioural changes in medication safety: Consequent to an action research intervention. J Nurs Manag 2020; 29:152-164. [PMID: 32955774 DOI: 10.1111/jonm.13128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/28/2022]
Abstract
AIM To explore the extent to which action research assists developing medication safety behaviours among emergency medicine staff. BACKGROUND Health care staff involved in medication therapy are frequently required to implement progressive changes. To permanently improve medication safety, we must consider staff behaviour. This study utilizes action research to engage health care workers and engender behavioural changes. METHOD Two cycles of action research were implemented. Data were collected through pre- and post-medication safety surveys, unstructured interviews and field notes. Staff in the emergency department worked together to progress the study cycles. RESULTS The pre-evaluation phase revealed deficiencies in staff medication safety behaviour. Subsequent to the implementation of safety initiatives, pre- to post-evaluation comparison indicated significant improvement in medication safety behaviours. In response to qualitative reflection phase data in reflection, ward pharmacists were placed in the emergency department and anew policy on responding to medication error was developed. Analysed field notes revealed improved safe patient care, enhanced pharmaceutical knowledge and changes in the emergency department climate. CONCLUSIONS Through action research, this study introduced actions to improve medication safety behaviours in the emergency department. Staff involvement led to changed safety behaviours. IMPLICATION FOR NURSING MANAGEMENT This study advises nurse managers of the benefit of pharmacist-led medication therapy, interprofessional medication safety courses and active communication between front-line staff and managers regarding medication safety.
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Affiliation(s)
- Fatemeh Bakhshi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.,Macquarie Business School, Macquarie University, Sydney, NSW, Australia
| | - Rebecca Mitchell
- Macquarie Business School, Macquarie University, Sydney, NSW, Australia
| | | | - Shokoh Varaei
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Hajimaghsoudi
- Research Development Center of Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Syyrilä T, Vehviläinen-Julkunen K, Härkänen M. Communication issues contributing to medication incidents: Mixed-method analysis of hospitals' incident reports using indicator phrases based on literature. J Clin Nurs 2020; 29:2466-2481. [PMID: 32243030 DOI: 10.1111/jocn.15263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/28/2020] [Accepted: 03/14/2020] [Indexed: 01/10/2023]
Abstract
AIM To identify the types and frequencies of communication issues (communication pairs, person related, institutional, structural, process and prescription-related issues) detected in medication incident reports and to compare communication issues that caused moderate or serious harm to patients. BACKGROUND Communication issues have been found to be among the main contributing factors of medication incidents, thus necessitating communication enhancement. DESIGN A sequential exploratory mixed-method design. METHODS Medication incident reports from Finland (n = 500) for the year 2015 in which communication was marked as a contributing factor were used as the data source. Indicator phrases were used for searching communication issues from free texts of incident reports. The detected issues were analysed statistically, qualitatively and considering the harm caused to the patient. Citations from free texts were extracted as evidence of issues and were classified following main categories of indicator phrases. The EQUATOR's SRQR checklist was followed in reporting. RESULTS Twenty-eight communication pairs were identified, with nurse-nurse (68.2%; n = 341), nurse-physician (41.6%; n = 208) and nurse-patient (9.6%; n = 48) pairs being the most frequent. Communication issues existed mostly within unit (76.6%, n = 383). The most commonly identified issues were digital communication (68.2%; n = 341), lack of communication within a team (39.6%; n = 198), false assumptions about work processes (25.6%; n = 128) and being unaware of guidelines (25.0%; n = 125). Collegial feedback and communication from patients and relatives were the preventing issues. Moderate harm cases were often linked with lack of communication within the unit, digital communication and not following guidelines. CONCLUSIONS The interventions should be prioritised to (a) enhancing communication about work-processes, (b) verbal communication about digital prescriptions between professionals, (c) feedback among professionals and (f) encouraging patients to communicate about medication. RELEVANCE TO CLINICAL PRACTICE Upon identifying the most harmful and frequent communication issues, interventions to strengthen medication safety can be implemented.
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Affiliation(s)
- Tiina Syyrilä
- Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland.,Helsinki University Hospital (HUS), Helsinki, Finland
| | - Katri Vehviläinen-Julkunen
- Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland.,Kuopio University Hospital (KUH), Kuopio, Finland
| | - Marja Härkänen
- Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland
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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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Park JH, Lee EN. [Influencing Factors and Consequences of Near Miss Experience in Nurses' Medication Error]. J Korean Acad Nurs 2020; 49:631-642. [PMID: 31672955 DOI: 10.4040/jkan.2019.49.5.631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/23/2019] [Accepted: 08/06/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to predict the influencing factors and the consequences of near miss in nurses' medication error based upon Salazar & Primomo's ecological system theory. METHODS A convenience sample of 198 nurses was recruited for the cross-sectional survey design. Data were collected from July to September 2016. Using the collected data, the developed model was verified by structural equation modeling analysis using SPSS and AMOS program. RESULTS For the fitness of the hypothetical model, the results showed that χ² (χ²=258.50, p<.001) was not fit, but standardized χ² (χ²/df=2.35) was a good fit for this model. Additionally, absolute fit index RMR=.06, RMSEA=.08, GFI=.86, AGFI=.81 reached the recommended level, but the Incremental fit index TLI=.82, CFI=.85 was not enough to reach to the recommended level. With the path diagram of the hypothetical model, caution (β=-.29 p<.001), patient safety culture (β=-.20, p=.041), and work load (β=.18, p=.037) had a significant effect on the near miss experiences in nurses' medication error, while fatigue (β=-.06, p=.575) did not affect it. Moreover, the near miss experience had a significant effect on work productivity (β=-.25, p=.001). CONCLUSION These results have shown that to decrease the near miss experience by nurses and increase their work productivity in hospital environments would require both personal and organizational effort.
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Affiliation(s)
- Jin Hee Park
- Department of Nursing, Changshin University, Changwon, Korea
| | - Eun Nam Lee
- College of Nursing, Dong-A University, Busan, Korea.
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Silverio SA, Cope LC, Bracken L, Bellis J, Peak M, Kaehne A. The implementation of a Technician Enhanced Administration of Medications [TEAM] model: An evaluative study of impact on working practices in a children's hospital. Res Social Adm Pharm 2020; 16:1768-1774. [PMID: 32035869 DOI: 10.1016/j.sapharm.2020.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children are frequently prescribed unlicensed and off-label medicines meaning dosing and administration of medicines to children is often based on poor quality guidance. In UK hospitals, nursing staff are often responsible for administering medications. Medication Errors [MEs] are problematic for health services, though are poorly reported and therefore difficult to quantify with confidence. In the UK, children's medicines require administration by at least two members of ward staff, known as a 'second check' system, thought to reduce Medication Administration Errors [MAEs]. OBJECTIVES To assess the impact on working practices of the introduction of a new way of working, using Technician Enhanced Administration of Medications [TEAM] on two specialist wards within a children's' hospital. To evidence any potential impact of a TEAM ward-based pharmacy technician [PhT] on the reporting of MEs. METHODS A TEAM PhT was employed on two wards within the children's hospital and trained in medicines administration. Firstly, an observational pre-and-post cohort design was used to identify the effect of TEAM on MEs. We analysed the hospital's official reporting system for incidents and 'near misses', as well as the personal incident log of the TEAM PhT. Secondly, after implementation, we interviewed staff about their perceptions of TEAM and its impact on working practices. RESULTS We affirm MEs are considerably under-reported in hospital settings, but TEAM PhTs can readily identify them. Further, placing TEAM PhTs on wards may create opportunities for inter-professional knowledge exchange and increase nurses' awareness of potential MAEs, although this requires facilitation. CONCLUSIONS TEAM PhT roles may be beneficial for pharmacy technicians' motivation, job satisfaction, and career development. Hospitals will need to consider the balance between resources invested in TEAM PhTs and the level of impact on reporting MEs. Health economic analyses could provide evidence to fully endorse integration of TEAM PhTs for all hospital settings.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, King's College London, London, UK; Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK; Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
| | - Louise C Cope
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Louise Bracken
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jennifer Bellis
- Pharmacy Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Matthew Peak
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK; Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Axel Kaehne
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
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Vos J, Franklin BD, Chumbley G, Galal-Edeen GH, Furniss D, Blandford A. Nurses as a source of system-level resilience: Secondary analysis of qualitative data from a study of intravenous infusion safety in English hospitals. Int J Nurs Stud 2019; 102:103468. [PMID: 31805449 PMCID: PMC7026708 DOI: 10.1016/j.ijnurstu.2019.103468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 11/21/2022]
Abstract
Background Deviations from local policy and national recommended best practice are common in the administration of intravenous infusions, but not all result in negative consequences. Some are the result of nurses’ clinical judgement. However, little is known about such practices and their effects on the safety of intravenous infusions. Our objective was to explore ways in which nurses contribute to system-level resilience when administering intravenous infusions. Methods We conducted a secondary analysis of qualitative data from debriefs and focus groups from a mixed methods study of errors and policy deviations in intravenous infusion administration across 16 English hospitals. Analysis focused on nurses’ contributions to system-level resilience, drawing on Larcos’s et al. framework of types of resilience. Results Five types of system-level resilience were identified in nurses’ behaviour: anticipatory resilience, responsive resilience, resilience based on past experience, workarounds and nurses performing informal ‘risk assessments’ in relation to how best to treat individual patients. Examples of practices contributing to infusion safety were found for each of these types of resilience. Conclusion Our findings suggest nurses are a key source of system-level resilience. Some behaviours that may be considered deviations from policy or best practice are the result of reasoned clinical judgement to improve infusion safety in response to the specific situation at hand. Adaptive behaviour is necessary to cope with the complexity of practice. There is a tension between standardisation and supporting flexibility in safety management.
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Affiliation(s)
- J Vos
- UCL Interaction Centre, London, UK.
| | - B D Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK; Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - G Chumbley
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
| | - G H Galal-Edeen
- UCL Interaction Centre, London, UK; Faculty of Computers and Information, Cairo University, Cairo, Egypt
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Ragau S, Hitchcock R, Craft J, Christensen M. Using the HALT model in an exploratory quality improvement initiative to reduce medication errors. ACTA ACUST UNITED AC 2019; 27:1330-1335. [PMID: 30525975 DOI: 10.12968/bjon.2018.27.22.1330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medication errors can have deleterious effects on patient safety and care. Interruptions, patient acuity and time pressures have all been cited as contributing factors in the incidence of medication errors. Yet, despite the number of different strategies that can be taken to reduce the incidence of medication errors, they still occur. The strategies often focus on refining systems and processes, depending on the root cause of the error. However, less recognised as contributory elements are human factors such as anger, hunger or tiredness. The aim of this quality improvement initiative was to reduce medication errors by 25% on a medical ward, through the introduction of the hunger, angry, lonely, tired (HALT) model to address the human factors associated with medication errors. Post-implementation, the HALT model appeared to have resulted in a total reduction in medication errors over a 2-month period by 31%. Mistakes related to human error were reduced by 25%, and those linked to communication and documentation errors by 22%. While this was a small-scale study, this is a significant reduction in medication errors. However, caution should be used when addressing other contributing factors associated with medication errors as using HALT alone will not address these.
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Affiliation(s)
- Sharon Ragau
- Nurse Educator, Caboolture and Kilcoy Hospitals, Metro North Hospital and Health Service, Caboolture, Queensland, Australia
| | - Rebecca Hitchcock
- Acting Assistant Director of Nursing, Safety and Quality, Caboolture and Kilcoy Hospitals, Metro North Hospital and Health Service, Caboolture, Queensland, Australia
| | - Judy Craft
- Senior Fellow of the UK Higher Education Academy and Senior Lecturer, School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Martin Christensen
- Professor of Nursing and Director of the Centre for Applied Nursing Research, Ingham Institute for Applied Medical Research, Western Sydney University, Liverpool, New South Wales, Australia
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Escrivá Gracia J, Brage Serrano R, Fernández Garrido J. Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC Health Serv Res 2019; 19:640. [PMID: 31492188 PMCID: PMC6729050 DOI: 10.1186/s12913-019-4481-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 08/28/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Medication errors are a serious and complex problem in clinical practice, especially in intensive care units whose patients can suffer potentially very serious consequences because of the critical nature of their diseases and the pharmacotherapy programs implemented in these patients. The origins of these errors discussed in the literature are wide-ranging, although far-reaching variables are of particular special interest to those involved in training nurses. The main objective of this research was to study if the level of knowledge that critical-care nurses have about the use and administration of medications is related to the most common medication errors. METHODS This was a mixed (multi-method) study with three phases that combined quantitative and qualitative techniques. In phase 1 patient medical records were reviewed; phase 2 consisted of an interview with a focus group; and an ad hoc questionnaire was carried out in phase 3. RESULTS The global medication error index was 1.93%. The main risk areas were errors in the interval of administration of antibiotics (8.15% error rate); high-risk medication dilution, concentration, and infusion-rate errors (2.94% error rate); and errors in the administration of medications via nasogastric tubes (11.16% error rate). CONCLUSIONS Nurses have a low level of knowledge of the drugs they use the most and with which a greater number of medication errors are committed in the ICU.
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Affiliation(s)
- Juan Escrivá Gracia
- Department of nursing, University of Valencia, 46001 Jaume Roig St, Valencia, Spain
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Farre A, Heath G, Shaw K, Bem D, Cummins C. How do stakeholders experience the adoption of electronic prescribing systems in hospitals? A systematic review and thematic synthesis of qualitative studies. BMJ Qual Saf 2019; 28:1021-1031. [PMID: 31358686 PMCID: PMC6934241 DOI: 10.1136/bmjqs-2018-009082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Abstract
Background Electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of health services, but the translation of this into reduced harm for patients remains unclear. This review aimed to synthesise primary qualitative research relating to how stakeholders experience the adoption of ePrescribing/CPOE systems in hospitals, to help better understand why and how healthcare organisations have not yet realised the full potential of such systems and to inform future implementations and research. Methods We systematically searched 10 bibliographic databases and additional sources for citation searching and grey literature, with no restriction on date or publication language. Qualitative studies exploring the perspectives/experiences of stakeholders with the implementation, management, use and/or optimisation of ePrescribing/CPOE systems in hospitals were included. Quality assessment combined criteria from the Critical Appraisal Skills Programme Qualitative Checklist and the Standards for Reporting Qualitative Research guidelines. Data were synthesised thematically. Results 79 articles were included. Stakeholders’ perspectives reflected a mixed set of positive and negative implications of engaging in ePrescribing/CPOE as part of their work. These were underpinned by further-reaching change processes. Impacts reported were largely practice related rather than at the organisational level. Factors affecting the implementation process and actions undertaken prior to implementation were perceived as important in understanding ePrescribing/CPOE adoption and impact. Conclusions Implementing organisations and teams should consider the breadth and depth of changes that ePrescribing/CPOE adoption can trigger rather than focus on discrete benefits/problems and favour implementation strategies that: consider the preimplementation context, are responsive to (and transparent about) organisational and stakeholder needs and agendas and which can be sustained effectively over time as implementations develop and gradually transition to routine use and system optimisation.
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Affiliation(s)
- Albert Farre
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Gemma Heath
- Life and Health Sciences, Aston University, Birmingham, UK
| | - Karen Shaw
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Danai Bem
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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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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Heneka N, Bhattarai P, Shaw T, Rowett D, Lapkin S, Phillips JL. Clinicians' perceptions of opioid error-contributing factors in inpatient palliative care services: A qualitative study. Palliat Med 2019; 33:430-444. [PMID: 30819045 DOI: 10.1177/0269216319832799] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Opioid errors are a leading cause of patient harm and adversely impact palliative care inpatients' pain and symptom management. Yet, the factors contributing to opioid errors in palliative care are poorly understood. Identifying and better understanding the individual and system factors contributing to these errors is required to inform targeted strategies. OBJECTIVES To explore palliative care clinicians' perceptions of the factors contributing to opioid errors in Australian inpatient palliative care services. DESIGN A qualitative study using focus groups or semi-structured interviews. SETTINGS Three specialist palliative care inpatient services in New South Wales, Australia. PARTICIPANTS Inpatient palliative care clinicians who are involved with, and/or have oversight of, the services' opioid delivery or quality and safety processes. METHODS Deductive thematic content analysis of the qualitative data. The Yorkshire Contributory Factors Framework was applied to identify error-contributing factors. FINDINGS A total of 58 clinicians participated in eight focus groups and 20 semi-structured interviews. Nine key error contributory factor domains were identified, including: active failures; task characteristics of opioid preparation; clinician inexperience; sub-optimal skill mix; gaps in support from central functions; the drug preparation environment; and sub-optimal clinical communication. CONCLUSION This study identified multiple system-level factors contributing to opioid errors in inpatient palliative care services. Any quality and safety initiatives targeting safe opioid delivery in specialist palliative care services needs to consider the full range of contributing factors, from individual to systems/latent factors, which promote error-causing conditions.
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Affiliation(s)
- Nicole Heneka
- 1 School of Nursing, The University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | - Priyanka Bhattarai
- 1 School of Nursing, The University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | - Tim Shaw
- 2 Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Debra Rowett
- 3 School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Samuel Lapkin
- 4 Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Jane L Phillips
- 5 Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Farnese ML, Zaghini F, Caruso R, Fida R, Romagnoli M, Sili A. Managing care errors in the wards. LEADERSHIP & ORGANIZATION DEVELOPMENT JOURNAL 2019. [DOI: 10.1108/lodj-04-2018-0152] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The importance of an error management culture (EMC) that integrates error prevention with error management after errors occur has been highlighted in the existing literature. However, few empirical studies currently support the relationship between EMC and errors, while the factors that affect EMC remain underexplored. Drawing on the conceptualisation of organisational cultures, the purpose of this paper is to verify the contribution of authentic leadership in steering EMC, thereby leading to reduced errors.
Design/methodology/approach
The authors conducted a cross-sectional survey study. The sample included 280 nurses.
Findings
Results of a full structural equation model supported the hypothesised model, showing that authentic leadership is positively associated with EMC, which in turn is negatively associated with the frequency of errors.
Practical implications
These results provide initial evidence for the role of authentic leadership in enhancing EMC and consequently, fostering error reduction in the workplace. The tested model suggests that the adoption of an authentic style can promote policies and practices to proactively manage errors, paving the way to error reduction in the workplace.
Originality/value
This study was one of the first to investigate the relationship between authentic leadership, error culture and errors. Further, it contributes to the existing literature by demonstrating both the importance of cultural orientation in protecting the organisation from error occurrence and the key role of authentic leaders in creating an environment for EMC development, thus permitting the organisation to learn from errors and reduce their negative consequences.
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Lee SE, Quinn BL. Incorporating medication administration safety in undergraduate nursing education: A literature review. NURSE EDUCATION TODAY 2019; 72:77-83. [PMID: 30453203 DOI: 10.1016/j.nedt.2018.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/01/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of this review was to identify methods for incorporating medication administration safety in undergraduate nursing education. DESIGN The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines directed this review. DATA SOURCES A search of four electronic databases (Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Google Scholar, and MedLine/PubMed MedLine/PubMed) as well as hand searches were conducted to identify original research published between 2005 and 2018. REVIEW METHODS Original empirical research describing a method for incorporating medication administration safety concepts in nursing education and examining its effectiveness on undergraduate nursing students' outcomes were selected for review. Articles describing medication safety education for graduate students, students other than those in nursing, and practicing nurses were excluded. RESULTS Twelve original research articles were included for review. Three methods for incorporating medication administration safety in undergraduate nursing education were identified: simulation experiences, technology aids, and online learning modules. Most studies were conducted in North America. The use of different interventions as well as different outcome measures was noted as a limitation to the collective body of research in this area. Also, there was a lack of information regarding psychometric properties of instruments used among the studies reviewed. CONCLUSION Simulation experiences, use of technology aids, and online learning modules helped increase medication safety competence of nursing students. However, simulation equipment, select technology aids, and online learning may not be available for all nursing programs; therefore, educators should consider developing and testing classroom-based educational interventions. Moreover, future researchers should use or develop psychometrically sound instruments to measure nursing students' outcomes including competencies about medication administration safety.
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Affiliation(s)
- Seung Eun Lee
- Solomont School of Nursing, University of Massachusetts Lowell, 113 Wilder Street, Suite 200, Lowell, MA 01854, United States of America.
| | - Brenna L Quinn
- Solomont School of Nursing, University of Massachusetts Lowell, 113 Wilder Street, Suite 200, Lowell, MA 01854, United States of America.
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Yu X, Li C, Gao X, Liu F, Lin P. Influence of the medication environment on the unsafe medication behaviour of nurses: A path analysis. J Clin Nurs 2018; 27:2993-3000. [PMID: 29679412 DOI: 10.1111/jocn.14485] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Xi Yu
- College of Nursing of Harbin Medical University; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Ce Li
- Department of Outpatient; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Xueqin Gao
- Department of Cardiology; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Furong Liu
- College of Nursing of Harbin Medical University; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Ping Lin
- College of Nursing of Harbin Medical University; The Second Affiliated Hospital of Harbin Medical University; Harbin China
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Heneka N, Shaw T, Rowett D, Lapkin S, Phillips JL. Exploring Factors Contributing to Medication Errors with Opioids in Australian Specialist Palliative Care Inpatient Services: A Multi-Incident Analysis. J Palliat Med 2018; 21:825-835. [DOI: 10.1089/jpm.2017.0578] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Nicole Heneka
- School of Nursing, University of Notre Dame Australia, Darlinghurst, Australia
| | - Tim Shaw
- Charles Perkins Centre, Faculty of Health Sciences, University of Sydney, Camperdown, Australia
| | - Debra Rowett
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Samuel Lapkin
- Centre for Research in Nursing and Health, St. George Hospital, Kogarah, Australia
| | - Jane L. Phillips
- School of Nursing, University of Notre Dame Australia, Darlinghurst, Australia
- IMPACCT, Faculty of Health, University of Technology Sydney, Broadway, Australia
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Härkänen M, Blignaut A, Vehviläinen-Julkunen K. Focus group discussions of registered nurses' perceptions of challenges in the medication administration process. Nurs Health Sci 2018; 20:431-437. [PMID: 29745001 DOI: 10.1111/nhs.12432] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/16/2018] [Accepted: 03/23/2018] [Indexed: 11/30/2022]
Abstract
Medication administration (MA) holds a great threat to patient safety, as MA errors remain a global problem. Nurses are key role players in the MA process and can give valuable information from the grassroots level. The aim of the present study was to describe registered nurses' perceptions related to challenges in the MA process. Focus group interviews with registered nurses (n = 20) in two central hospitals in Finland were conducted in 2015. Inductive content analysis was performed. Nurses described multiple challenges during MA, which made the process demanding. These were organized under five themes: (i) medications; (ii) collaboration between health-care professionals; (iii) resources and work environment; (iv) skills and education; and (v) patient-related factors. The MA process is prone to errors, and registered nurses described many challenges related to MA. While nurses are responsible for their various work-related tasks and the maintenance of patient safety through applicable procedures and effective collaboration, health systems and hospital management should be stewards of patient safety by ensuring adequate staffing levels and providing educational resources related to the MA process.
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Affiliation(s)
- Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Alwiena Blignaut
- School of Nursing Science, North-West University, Potchefstroom, South Africa
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
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Jones JH, Treiber LA. Nurses' rights of medication administration: Including authority with accountability and responsibility. Nurs Forum 2018; 53:299-303. [PMID: 29687447 DOI: 10.1111/nuf.12252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Medication errors continue to occur too frequently in the United States. Although the five rights of medication administration have expanded to include several others, evidence that the number of errors has decreased is missing. This study suggests that medication rights for nurses as they administer medications are needed. The historical marginalization of the voice of nurses has been perpetuated with detrimental impacts to nurses and patients. In recent years, a focus on the creation of a just culture, with a balance of accountability and responsibility, has sought to bring a fairer and safer construct to the healthcare environment. This paper proposes that in order for a truly just culture to exist, the balance must also include nurses' authority. Only when a triumvirate of responsibility, accountability, and authority exists can an environment that supports reduced medication errors flourish. Through identification and implementation of Nurses Rights of Medication Administration, nurses' authority to control the administration process is both formalized and legitimized. Further study is needed to identify these rights and how to fully implement them.
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Affiliation(s)
- Jackie H Jones
- WellStar School of Nursing, Kennesaw State University, Kennesaw, GA
| | - Linda A Treiber
- Department of Sociology and Criminal Justice, Kennesaw State University, Kennesaw, GA
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Abstract
Medication errors continue to be an issue for the critically ill and are costly to both patients and health care facilities. This article reviews published research about these errors and reports results of observational studies. The types of errors, incidence, and root causes have been considered along with adverse consequences. The implications for bedside practice as a result of this review are fairly straightforward. Medication errors are happening at an alarming rate in the critical care environment, and these errors are preventable. It is imperative that all personnel respect and follow established guidelines and procedural safeguards to ensure flawless drug delivery to patients.
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The Effects of Implementing a Patient Acuity Tool on Nurse Satisfaction in a Pulmonary Medicine Unit. Nurs Adm Q 2017; 41:E5-E14. [PMID: 28859010 DOI: 10.1097/naq.0000000000000254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In response to nurses' concerns of equity and satisfaction with patient assignments in a pulmonary medicine unit, a Patient Acuity Tool (PAT) was implemented. The impact of the PAT on nurse satisfaction and perceived equity of patient assignments was measured using a pre-/postsurvey design. Findings of the investigation indicate that a PAT supports nurse satisfaction and equity. In addition, qualitative data suggested that the PAT improved perceived professional autonomy and nurse-to-nurse communication.
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van de Plas A, Slikkerveer M, Hoen S, Schrijnemakers R, Driessen J, de Vries F, van den Bemt P. Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm. BMJ QUALITY IMPROVEMENT REPORTS 2017; 6:bmjquality_uu215011.w5936. [PMID: 28674608 PMCID: PMC5483528 DOI: 10.1136/bmjquality.u215011.w5936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In this controlled before-after study the effect of improvements, derived from Lean Six Sigma strategy, on parenteral medication administration errors and the potential risk of harm was determined. During baseline measurement, on control versus intervention ward, at least one administration error occurred in 14 (74%) and 6 (46%) administrations with potential risk of harm in 6 (32%) and 1 (8%) administrations. Most administration errors with high potential risk of harm occurred in bolus injections: 8 (57%) versus 2 (67%) bolus injections were injected too fast with a potential risk of harm in 6 (43%) and 1 (33%) bolus injections on control and intervention ward. Implemented improvement strategies, based on major causes of too fast administration of bolus injections, were: Substitution of bolus injections by infusions, education, availability of administration information and drug round tabards. Post intervention, on the control ward in 76 (76%) administrations at least one error was made (RR 1.03; CI95:0.77-1.38), with a potential risk of harm in 14 (14%) administrations (RR 0.45; CI95:0.20-1.02). In 40 (68%) administrations on the intervention ward at least one error occurred (RR 1.47; CI95:0.80-2.71) but no administrations were associated with a potential risk of harm. A shift in wrong duration administration errors from bolus injections to infusions, with a reduction of potential risk of harm, seems to have occurred on the intervention ward. Although data are insufficient to prove an effect, Lean Six Sigma was experienced as a suitable strategy to select tailored improvements. Further studies are required to prove the effect of the strategy on parenteral medication administration errors.
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Farre A, Shaw K, Heath G, Cummins C. On doing ‘risk work’ in the context of successful outcomes: exploring how medication safety is brought into action through health professionals’ everyday working practices. HEALTH RISK & SOCIETY 2017. [DOI: 10.1080/13698575.2017.1336512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Albert Farre
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karen Shaw
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gemma Heath
- Department of Psychology, Aston University, Birmingham, UK
| | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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