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ÖZTÜRK F, ALTIPARMAK Ö, TORUN B, BEKTAY MY, SANCAR M, OKUYAN B. Reliability of High-Alert Medications Questionnaire in Turkish Healthcare Professionals. BEZMIALEM SCIENCE 2022. [DOI: 10.14235/bas.galenos.2020.5238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Nydert P, Kumlien A, Norman M, Lindemalm S. Cross-sectional study identifying high-alert substances in medication error reporting among Swedish paediatric inpatients. Acta Paediatr 2020; 109:2810-2819. [PMID: 32239536 DOI: 10.1111/apa.15273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 11/28/2022]
Abstract
AIM The aims were to characterise paediatric medication errors and to identify the prevalence of known high-alert substances in these errors. METHODS All paediatric drug-related incident reports and complaints nationally reported to the Health and Social Care Inspectorate in Sweden 2011-2017 regarding inpatients were characterised by context and modal details. In addition, drug use at a university hospital was matched to local incident reports. Drug substances were classified using three high-alert lists. RESULTS On a national level, there were 160 reports (2.5 per 10 000 patients) in which the three high-alert lists were found in different degrees (17/35/47%). Morphine (n = 12), vancomycin (n = 11) and potassium (n = 7) were most frequently involved. Eighty per cent of the reports concerned patients aged 0-6 years. Intravenous was the most common route of administration (66%). On a university hospital level, the prevalence of all types of drug incidents reports was 1.7% among all inpatients. The prevalence of local incident reports involving high-alert substances was almost double that of non-alert substances. CONCLUSION Existing high-alert drug lists are relevant for paediatric inpatients. A higher awareness and usage of such lists among hospital staff prescribing, dispensing and administering drugs to children may have the potential to reduce medication errors.
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Affiliation(s)
- Per Nydert
- Astrid Lindgren's Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Antonia Kumlien
- Department of Pharmaceutical Biosciences Uppsala University Uppsala Sweden
| | - Mikael Norman
- Astrid Lindgren's Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Synnöve Lindemalm
- Astrid Lindgren's Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
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Salman M, Mustafa ZU, Rao AZ, Khan QUA, Asif N, Hussain K, Shehzadi N, Khan MFA, Rashid A. Serious Inadequacies in High Alert Medication-Related Knowledge Among Pakistani Nurses: Findings of a Large, Multicenter, Cross-sectional Survey. Front Pharmacol 2020; 11:1026. [PMID: 32765259 PMCID: PMC7381221 DOI: 10.3389/fphar.2020.01026] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Deaths-related to medications errors are common in Pakistan but these are not accurately reported. Recently, the death of a 9 months old baby due to abrupt administration of 15% potassium chloride injection sparked the issue of high alert medications (HAMs) related errors in the country. Since drug administration is the prime responsibility of the nurses, it is pivotal that they possess good knowledge of HAMs. Since there is no published data regarding the knowledge of HAMs among Pakistani nurses, we aimed to assess knowledge of HAMs among registered nurses of Pakistan. Methods A cross-sectional study was conducted among registered nurses, recruited using a convenient sampling technique, from 29 hospitals all over the Punjab Province. Data were collected using a validated self-administered instrument. All data were entered and analyzed using SPSS version 22. Results The study sample was comprised of 2,363 registered nurses (staff nurses = 94.8%, head nurses = 5.2%). Around 63% were working in tertiary hospitals whereas almost 25 and 12% were from district headquarter hospitals and tehsil headquarter hospitals, respectively. Around 84% of the study participants achieved scores <70%, indicating majority of Pakistani nurses having poor knowledge of HAMs administration as well as regulation. There was no significant difference of overall knowledge among age, hospitals, departments, training, designations, qualification, and experience categories. Major obstacles encountered during HAMs administration were "getting uncertain answers from colleagues" (72.9%), "unavailability of suitable person to consult" (61.1%) and "receiving verbal orders" (55.6%). Conclusion Our study revealed the serious inadequacies in HAMs knowledge among Pakistani nurses which may lead to adverse patient outcomes. Nurses should receive comprehensive pharmacology knowledge not only during in-school nursing education but also as hospital-based continuing education. Moreover, it is of immense importance to bridge the gaps between physicians, clinical pharmacists, and nurses through effective communication as this will help reduce medication errors and improve patient care.
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Affiliation(s)
- Muhammad Salman
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Zia Ul Mustafa
- Department of Pharmacy, District Headquarter Hospital, Pakpattan, Pakistan
| | - Alina Zeeshan Rao
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Qurat-Ul-Ain Khan
- Department of Pharmacy, Punjab Institute of Cardiology, Lahore, Pakistan
| | - Noman Asif
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Khalid Hussain
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Naureen Shehzadi
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | | | - Amir Rashid
- Department of Pharmacology, Faculty of Pharmacy, The University of Lahore, Islamabad, Pakistan
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Psychometric Properties of the Brazilian Version of the Nurses' Knowledge of High-Alert Medications Scale: A Pilot Study. Res Theory Nurs Pract 2020; 33:23-38. [PMID: 30796146 DOI: 10.1891/1541-6577.33.1.23] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE High-alert medication is considered to be a medication that presents a high risk of causing significant patient harm when used erroneously and its consequences can be fatal. The Nurses' Knowledge of High-Alert Medication scale (NKHAM) is a tool available to evaluate the knowledge of nurses in practice about this issue. AIM This pilot study aimed to measure the reliability and known-groups validity of the Brazilian version of the NKHAM. METHODS This pilot psychometric study was carried out at the Faculty of Nursing and University Hospital of the University of Campinas, São Paulo, Brazil. Forty nursing students and 44 registered nurses working in complex clinical or surgical settings completed a sociodemographic questionnaire and the Brazilian version of the NKHAM. The Kuder-Richardson 20 (KR-20) coefficient and Mann-Whitney test were used to establish reliability and known-groups validity. A significance level of ≤ 0.05 was adopted for all the analyses. RESULTS Analyses demonstrated preliminary acceptable reliability scores of 0.55 and 0.60 in domains A and B of NKHAM, respectively. A significant difference was found between the nursing students' and the registered nurses' knowledge of high-alert medications, demonstrating the scale's ability to discriminate between the two groups. IMPLICATIONS FOR PRACTICE Although this is pilot study, results suggest that the Brazilian version of the NKHAM might be a reliable and valid tool to measure nurses' knowledge of high-alert medications.
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Development and validation of an instrument to measure the professional's knowledge of dispensing medication (CDM-51) in community pharmacies. PLoS One 2020; 15:e0229855. [PMID: 32126121 PMCID: PMC7053717 DOI: 10.1371/journal.pone.0229855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/16/2020] [Indexed: 11/19/2022] Open
Abstract
Medication dispensing performed without the necessary information on proper use can result in harmful effects to the individual, and therefore providing this service with quality for the users is necessary to promote the rational use of medication; however, in a developing country this activity is performed largely by unqualified people and in an inappropriate way. This study aims to develop and validate a study instrument that measures the knowledge of medication dispensing for the professionals involved in this practice (pharmacist, pharmacy technician in the pharmacy, and clerk/assistant). The study has methodological design and is characterized by the development and validation of an instrument to measure the knowledge of dispensation. A questionnaire denominated CDM-51 was elaborated and divided in two parts: the first collects the socio-demographic characteristics of the participants, and the second has 51 questions to assess the knowledge construct regarding dispensation. The validity of content was realized through the evaluation by seven experts regarding the relevance and clarity of the items. A pretest and main validation study with 30 and 79 pharmacy professionals respectively, from the city of Ribeirão Preto in the Brazilian state of São Paulo were carried out, and questions presented to the respondents were corrected. The analysis of the internal consistency of the KR-20 (Kuder-Richardson) was 0.837, and validity construct evidence was found (p value: 0.001) that participants with formal education have greater knowledge of medication dispensing. This work contributes to increasing the quality of services provided by dispensing pharmacies and points out the importance of training for formal education to perform this service, thus promoting the rational use of medication.
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Sessions LC, Nemeth LS, Catchpole K, Kelechi TJ. Nurses' perceptions of high-alert medication administration safety: A qualitative descriptive study. J Adv Nurs 2019; 75:3654-3667. [PMID: 31423633 DOI: 10.1111/jan.14173] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/28/2019] [Accepted: 08/05/2019] [Indexed: 11/27/2022]
Abstract
AIMS The aim of this study was to determine nurses' perceptions of supports and barriers to high-alert medication (HAM) administration safety. DESIGN A qualitative descriptive design was used. METHODS Eighteen acute care nurses were interviewed about HAM administration practices. Registered nurses (RNs) working with acutely ill adults in two hospitals participated in one-on-one interviews from July-September, 2017. Content analysis was conducted for data analysis. RESULTS Three themes contributed to HAM administration safety: Organizational Culture of Safety, Collaboration, and RN Competence and Engagement. Error factors included distractions, workload and acuity. Work arounds bypassing bar code scanning and independent double check procedures were common. Findings highlighted the importance of intra- and interprofessional collaboration, nurse engagement and incorporating the patient in HAM safety. CONCLUSIONS Current HAM safety strategies are not consistently used. An organizational culture that supports collaboration, education on safe HAM practices, pragmatic HAM policies and enhanced technology are recommended to prevent HAM errors. IMPACT Hospitals incorporating these findings could reduce HAM errors. Research on nurse engagement, intra- and interprofessional collaboration and inclusion of patients in HAM safety strategies is needed.
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Affiliation(s)
- Laura C Sessions
- College of Health Professions, Towson University, Towson, Maryland
| | - Lynne S Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Kenneth Catchpole
- College of Health Professions, Towson University, Towson, Maryland.,College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Teresa J Kelechi
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
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Zyoud SH, Khaled SM, Kawasmi BM, Habeba AM, Hamadneh AT, Anabosi HH, Fadel AB, Sweileh WM, Awang R, Al-Jabi SW. Knowledge about the administration and regulation of high alert medications among nurses in Palestine: a cross-sectional study. BMC Nurs 2019; 18:11. [PMID: 30936779 PMCID: PMC6425670 DOI: 10.1186/s12912-019-0336-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Medication errors (MEs) are unintended failures in the drug treatment process that can occur during prescription, dispensing, storing, preparation or administration of medications. High alert medications (HAMs) are defined as those medications that bear the highest risk of causing significant patient harm when used incorrectly, either due to their serious adverse events or to a narrow therapeutic window. Nurses are responsible for administration of HAMs; incorrect administration can have a significant clinical outcome. This study aimed to assess the level of knowledge of HAMs among nurses in government hospitals in West Bank, Palestine. METHODS A cross-sectional study was conducted in 2015, in West Bank, Palestine. Data were collected via a face to face interview questionnaire, which was taken from a previous study. Data were collected by convenient sampling. The questionnaire consisted of four parts: demographic characteristics of the nurses, drug administration knowledge (10 true-false questions), drug regulation knowledge (10 true-false questions), and self-evaluation. RESULTS A total of 280 nurses participated in the study; these nurses were working in the emergency room (ER), intensive care unit (ICU), paediatric or medical ward. The response rate was 93%. Nurses were found to have insufficient knowledge about HAMs; 67.1% of participants had a score of less than 70%, with a mean total score of 59.9 ± 15.1. Factors associated with sufficient knowledge among nurses were HAMs training and ICU training, both with p-values of 0.002. Nurses with a master degree, those working in the ICU ward, head nurses, and male nurses were the most knowledgeable groups, with a p-values < 0.001. 81.8% of respondents hoped to obtain additional training. The leading obstacles reported were inconsistent opinions between doctors and nurses (37.9%), and no established standard operating procedure for HAMs (37.1%). CONCLUSIONS Lack of knowledge was one of the obstacles that nurses encountered during administration of HAMs which might result in MEs. Nurses reported that they would like to have additional training to update their pharmacology knowledge. Nurses could benefit from additional continuing education and training programs.
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Affiliation(s)
- Sa’ed H. Zyoud
- 0000 0004 0631 5695grid.11942.3fPoison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- 0000 0004 0631 5695grid.11942.3fDivision of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Samar M. Khaled
- 0000 0004 0631 5695grid.11942.3fPharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Baraa M. Kawasmi
- 0000 0004 0631 5695grid.11942.3fPharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ahed M. Habeba
- 0000 0004 0631 5695grid.11942.3fPharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ayat T. Hamadneh
- 0000 0004 0631 5695grid.11942.3fPharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Hanan H. Anabosi
- 0000 0004 0631 5695grid.11942.3fPharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Asma’a Bani Fadel
- 0000 0004 0631 5695grid.11942.3fPharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Waleed M. Sweileh
- 0000 0004 0631 5695grid.11942.3fDepartment of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Rahmat Awang
- 0000 0001 2294 3534grid.11875.3aWHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), 11800 Penang, Malaysia
| | - Samah W. Al-Jabi
- 0000 0004 0631 5695grid.11942.3fDivision of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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Reis MASD, Gabriel CS, Zanetti ACB, Bernardes A, Laus AM, Pereira LRL. MEDICAMENTOS POTENCIALMENTE PERIGOSOS: IDENTIFICAÇÃO DE RISCOS E BARREIRAS DE PREVENÇÃO DE ERROS EM TERAPIA INTENSIVA. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018005710016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: investigar o conhecimento dos profissionais de enfermagem e farmacêuticos em relação à identificação de medicamentos potencialmente perigosos, bem como verificar o reconhecimento das barreiras de prevenção de erros nas instituições hospitalares. Método: estudo transversal, tipo inquérito, realizado em unidades de terapia intensiva de quatro hospitais. Um questionário construído e validado com base nas informações disponibilizadas pelo Instituto para Práticas Seguras no Uso de Medicamentos foi utilizado para coleta de dados. Para análise dos dados utilizou-se o software Statistical Package for the Social Sciences, versão 22.0 e o teste de Kruskal-Wallis para investigar diferença dos resultados entre as categorias profissionais. Adotou-se o nível significância de 0,05. Resultados: foram incluídos 126 profissionais, entre os elegíveis para participação. Dentre os 33 medicamentos potencialmente perigosos indicados no instrumento, nenhum foi identificado como tal pela totalidade de respondentes, embora 17 fossem utilizados por mais de 95% dos entrevistados. Não foi observada diferença estatisticamente significante nas respostas das diferentes categorias profissionais quanto à identificação desses medicamentos. Em relação às medidas de prevenção de erros, os enfermeiros constituíram a categoria profissional que distinguiu em maior número a existência de barreiras. Conclusão: este estudo apontou importantes lacunas no reconhecimento dos medicamentos potencialmente perigosos e adoção incipiente de barreiras para prevenção de incidentes, caracterizando situações de fragilidade nos hospitais por implicar na ruptura inicial das barreiras, especialmente quando os profissionais de saúde estão inseridos em um ambiente de alta complexidade.
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Tang SF, Wang X, Zhang Y, Hou J, Ji L, Wang ML, Huang R. Analysis of high alert medication knowledge of medical staff in Tianjin: A convenient sampling survey in China. ACTA ACUST UNITED AC 2015; 35:176-182. [PMID: 25877348 DOI: 10.1007/s11596-015-1407-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 03/07/2015] [Indexed: 10/23/2022]
Abstract
The current situation of medical staff's awareness about high alert medication was investigated in order to promote safe medication and standardized management of the high alert medication in China. Twenty questions were designed concerning elementary knowledge of high alert medications, storage management, medication issues and risks. In order to understand the knowledge level and education status of high alert medication, a convenient survey was conducted among 300 medical staffs in Tianjin. Medical staff's average score of high alert medication knowledge was 12.43±0.27, and the average scores of elementary knowledge of high alert medication, storage management, medication issues and risks were 3.38±0.11, 2.46±0.14, 3.17±0.11 and 3.41±0.12 respectively. Occupation (F=4.86, P=0.003), education background (F=5.57, P=0.019) and professional titles (F=13.44, P≤0.001) contributed to the high alert medications knowledge scores. Currently, the most important channel to obtain high alert medication knowledge was hospital files or administrative rules, and clinical pharmacist seminars were the most popular education form. It was suggested that the high alert medication knowledge level of the medical staff needs to increase, and it might benefit from targeted, systematic and diverse training to the medical staff working in the different circulation nodes of the medications. Further research to develop and validate the instrument is needed.
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Affiliation(s)
- Shang-Feng Tang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xin Wang
- Department of Pharmacy, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Ye Zhang
- Department of Pharmacy, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Jie Hou
- Department of Pharmacy, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Lu Ji
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Man-Li Wang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Rui Huang
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Engels MJ, Ciarkowski SL. Nursing, Pharmacy, and Prescriber Knowledge and Perceptions of High-Alert Medications in a Large, Academic Medical Hospital. Hosp Pharm 2015; 50:287-95. [PMID: 26446747 PMCID: PMC4585568 DOI: 10.1310/hpj5004-287] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND High-alert medications pose a greater risk of causing significant harm to patients if used in error. The Joint Commission requires that hospitals define institution-specific high-alert medications and implement processes to ensure safe medication use. METHOD Nursing, pharmacy, and prescribers were asked to voluntarily complete a 34-question survey to assess their knowledge, experience, and perceptions regarding high-alert medications in an academic hospital. RESULTS The majority of respondents identified the organization's high-alert medications, the consequences of an error involving a high-alert medication, and the reversal agent. Most of the risk-reduction strategies within the institution were viewed as being effective by respondents. Forty-five percent of the respondents utilized a high-alert medication in the previous 24 hours. Only 14.2% had experienced an error with a high-alert medication in the previous 12 months, with 46% being near misses. The survey found the 5 rights for medication administration were not being utilized consistently. Respondents indicated that work experience or hospital orientation is the preferred learning experience for high-alert medications. CONCLUSIONS This study assessed all disciplines involved in the medication use process. Perceptions about high-alert medications differ between disciplines. Ongoing discipline-specific education is required to ensure that individuals accept accountability in the medication use process and to close knowledge gaps on high-alert medications and risk-reduction strategies.
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Affiliation(s)
- Melanie J. Engels
- University of Michigan Health System, Ann Arbor, Michigan
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Scott L. Ciarkowski
- University of Michigan Health System, Ann Arbor, Michigan
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
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