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Jeffrey E, Walsh Á, Hague J, Lai K. Comparing nursing medication rounds before and after implementation of automated dispensing cabinets: A time and motion study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 16:100504. [PMID: 39308556 PMCID: PMC11416501 DOI: 10.1016/j.rcsop.2024.100504] [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: 07/09/2024] [Revised: 09/03/2024] [Accepted: 09/03/2024] [Indexed: 09/25/2024] Open
Abstract
Nursing medication administration is an integral, albeit time consuming component of a nursing shift. Automated dispensing cabinets (ADCs) are a medicines management solution designed to improve both efficiency and patient safety. This study aimed to evaluate the time taken to undertake a medication round including the number of locations visited to retrieve medicines, across four different clinical specialties within one hospital. Studies to date have investigated the effect of ADCs on nursing medication rounds centred around one clinical specialty, in hospitals with varying levels of digital maturity. This study adds to the existing body of evidence by investigating multiple clinical specialties where EPMA in use throughout the study period. In this study, prior to ADC implementation nurses retrieved required medicines from shelves in the medication room, mobile medication carts, and patients' own drug (POD) lockers. Post-ADC implementation, medicines were retrieved exclusively from the ADC and POD lockers only. Nurses were observed on each ward completing medication rounds, using the data collection tool designed for this study. Pre-implementation data was collected between February and June 2023, and post-implementation data collected between July and September 2023. There was a statistically significant reduction in the time required for medicines retrieval on the surgical ward only, post- ADC implementation. The time taken to retrieve each medication went from a mean of 98.1 s to 47.2 s (p = 0.0255). When comparing all four specialties as a whole, there was a reduction in the mean time required to issue each medicine preversus post-ADC implementation, from 83.3 s to 62.6 s respectively, however this difference was not shown to be statistically significant. The mean number of locations visited to obtain all required medicines for each patient reduced significantly from 1.73 to 1.04 (p < 0.01). There is potential for improved efficiency as nurses become more familiar with new workflows. It may be of benefit to repeat this study to ascertain whether time savings have been further improved.
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Affiliation(s)
- Emma Jeffrey
- Pharmacy Department, Level 1 Cheyne Wing, King's College Hospital NHS Foundation Trust, SE59RS London, United Kingdom
| | - Áine Walsh
- Pharmacy Department, Level 1 Cheyne Wing, King's College Hospital NHS Foundation Trust, SE59RS London, United Kingdom
| | - Joseph Hague
- Corporate Nursing, King's College Hospital NHS Foundation Trust, SE59RS London, United Kingdom
| | - Kit Lai
- Pharmacy Department, Level 1 Cheyne Wing, King's College Hospital NHS Foundation Trust, SE59RS London, United Kingdom
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Graudins LV, Crute S, Poole SG, Bingham G, Dooley MJ. Reduction in preventable time-critical dose omissions: impact of electronic medication management systems on in-patients. Contemp Nurse 2024:1-9. [PMID: 39116073 DOI: 10.1080/10376178.2024.2384735] [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: 02/28/2024] [Accepted: 07/19/2024] [Indexed: 08/10/2024]
Abstract
Background: The omission of time-critical medication doses may result in poor patient outcomes. There are few publications about the influence of electronic medication management (EMM) systems, including automated dispensing cabinets (ADC), on timely medication administration. The study aimed to evaluate the influence of EMM systems, including ADCs, on timely medication administration 6 and 30 months after EMM implementation, focussing on preventable time-critical medication dose omissions and documented reasons for not administering a dose.Methods: Data on doses of regular inpatient medications not administered were obtained from electronic medication records (EMR) over 1 week in March 2019 and 4 weeks in March 2021. An omission was a dose not administered before the next due dose. Time-critical medications were defined using the health service's guidelines. Reasons for doses not being administered were obtained from nursing documentation in the EMR collated from digital health reports. Reasons for time-critical medication doses not given were defined as 'valid' or 'preventable'.Results: In 2019 and 2021, 620 and 2524 patients with 44,756 and 146,940 scheduled medication doses were reviewed. Of these, 4385 (9.8%) and 19,610 (13.4%) doses were not administered. In 2019 and 2021, there were 593 (1.3%) and 1811 (1.2%), p < 0.0001, time-critical doses not administered. Preventable time-critical dose omissions decreased from 0.20% in 2019 to 0.15% (p = 0.015) in 2021. Wards with ADCs had a significantly lower rate of time-critical dose omissions compared to those without ADCs (1.1% vs 1.3%, p = 0.014).Conclusion: With the introduction of an EMM system, there was a decrease in the rate of time-critical medications not administered, including a reduced rate of preventable omissions over the 24-month period. Regular assessment of time-critical medication administration will help target patient safety improvements.
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Affiliation(s)
- Linda V Graudins
- Pharmacy Department, Alfred Health, Melbourne, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | | | - Susan G Poole
- Pharmacy Department, Alfred Health, Melbourne, Australia
| | | | - Michael J Dooley
- Pharmacy Department, Alfred Health, Melbourne, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
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Joseph B, Plummer V, Cross W. Mental health nurses perceptions of missed nursing care in acute inpatient units: A multi-method approach. Int J Ment Health Nurs 2022; 31:697-707. [PMID: 35294094 PMCID: PMC9314997 DOI: 10.1111/inm.12990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
Nurses have key roles in caring for hospitalized patients. Missed nursing care can lead to adverse outcomes, from minor discomfort to patient death. Mental health nurses have a significant role in advancing knowledge and practice due to missed, delayed, or unfinished nursing care. They are identifying, escalating, and managing warning signs of mental and physical health deterioration where the risk to patients is high in terms of compromised care quality and neglect and the evidence is scant. This study aimed to examine mental health nurses' perceptions of missed nursing care in acute mental health inpatient units in an Australian regional health service. A cross-sectional survey was undertaken using a modified Kalisch Phelan MISSCARE questionnaire and a qualitative content analysis was undertaken for narrative responses. Of 70 participants, the majority were aged 30-44 years, with >5 years of experience. The results indicated that care planning, safety audits, communication, and assessment of oral intake were perceived as care most frequently missed. Factors contributing to missed care need urgent exploration to ensure timely reduction of patient risk and enhancements to safe quality care.
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Affiliation(s)
- Bindu Joseph
- School of Health, Federation University, Berwick, Victoria, Australia
| | - Virginia Plummer
- School of Health, Federation University, Berwick, Victoria, Australia
| | - Wendy Cross
- School of Health, Federation University, Berwick, Victoria, Australia
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Schubert M, Ausserhofer D, Bragadóttir H, Rochefort CM, Bruyneel L, Stemmer R, Andreou P, Leppée M, Palese A. Interventions to prevent or reduce rationing or missed nursing care: A scoping review. J Adv Nurs 2020; 77:550-564. [PMID: 33089553 DOI: 10.1111/jan.14596] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 08/15/2020] [Accepted: 08/27/2020] [Indexed: 11/26/2022]
Abstract
AIMS To collate and synthesize published research on interventions developed and tested to prevent or reduce the rates of rationed or missed nursing care in healthcare institutions. BACKGROUND Rationed and missed nursing care has been widely studied, including its predictors and associations with patient and nurse outcomes. DESIGN Scoping review. DATA SOURCES We searched for eligible studies, published between 1980-2019, in six electronic databases. REVIEW METHODS Researchers independently screened the abstracts of the retrieved studies using the inclusion and exclusion criteria. The decision of whether or not to include any given study was consensus-based. RESULTS The search yielded 1,815 records, of which 13 were included. Three studies reported structural interventions, namely increased nurse staffing and improved nursing teamwork, both resulted in significant reductions in the rates of rationed or missed nursing care. The remaining 10 studies reported on process interventions: four concerned reminders (via technology or designated persons) and seven described interventions to change or optimize the relevant care processes. All 10 process interventions contributed to significant reductions in the rates of missed nursing care. CONCLUSIONS The results of the scoping review indicate that specific interventions can positively influence the performance of a selected nursing care activity, for example fall prevention. There is no evidence of a global reduction of rationed and missed nursing care through these interventions. IMPACT Clinicians, managers and researchers can use the results for adapting and implementing interventions to reduce rationed and missed nursing care.
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Affiliation(s)
- Maria Schubert
- School of Health Professions, ZHAW - Zurich University of Applied Science, Institute of Nursing, Winterthur, Switzerland
| | - Dietmar Ausserhofer
- Nursing Science, Faculty of Medicine, Department of Public Health, University of Basel, Basel, Switzerland.,Claudiana College of Health-Care Professions, Bolzano, Italy
| | - Helga Bragadóttir
- Faculty of Nursing, School of Health Sciences and Landspítali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Christian M Rochefort
- School of Nursing, Faculty of Medicine and Health Sciences - Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CR-CHUS), University of Sherbrooke, Longueuil, Canada
| | - Luk Bruyneel
- Department for Public Health and Primary Care, KU Leuven - University of Leuven, Leuven Institute for Healthcare Policy, Leuven, Belgium
| | - Renate Stemmer
- Faculty of Health and Nursing, Catholic University of Applied Sciences Mainz, Mainz, Germany
| | | | - Marcel Leppée
- Project Department, Institute for Healthy Ageing, Zagreb, Croatia
| | - Alvisa Palese
- Department of Medical Science, University Udine, Udine, Italy
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Keers RN, Hann M, Alshehri GH, Bennett K, Miller J, Prescott L, Brown P, Ashcroft DM. Prevalence, nature and predictors of omitted medication doses in mental health hospitals: A multi-centre study. PLoS One 2020; 15:e0228868. [PMID: 32027720 PMCID: PMC7004323 DOI: 10.1371/journal.pone.0228868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/24/2020] [Indexed: 12/02/2022] Open
Abstract
Objective Limited evidence concerning the burden and predictors of omitted medication doses within mental health hospitals could severely limit improvement efforts in this specialist setting. This study aimed to determine the prevalence, nature and predictors of omitted medication doses affecting hospital inpatients in two English National Health Service (NHS) mental health trusts. Methods Over 6 data collection days trained pharmacy teams screened inpatient prescription charts for scheduled and omitted medication doses within 27 adult and elderly wards across 9 psychiatric hospitals. Data were collected for inpatients admitted up to two weeks prior to each data collection day. Omitted doses were classified as ‘time critical’ and ‘preventable’ based on established criteria. Omitted dose frequencies were presented with 95% confidence intervals (CI). Multilevel logistic regression analyses determined the predictors of omitted dose occurrence, with omission risks presented as adjusted odds ratios (OR) with 95% CI. Results 18,664 scheduled medication doses were screened for 444 inpatients and 2,717 omissions were identified, resulting in a rate of 14.6% (95% CI 14.1–15.1). The rate of ‘time critical’ omitted doses was 19.3% (95% CI 16.3–22.6%). ‘Preventable’ omitted doses comprised one third of all omissions (34.5%, 930/2694). Logistic regression analysis revealed that medicines affecting the central nervous system were 55% less likely to be omitted compared to all other medication classes (9.9% vs. 18.8%, OR 0.45 (0.40–0.52)) and that scheduled doses administered using non-oral routes were more likely to be omitted compared the oral route (inhaled OR 3.47 (2.64–4.57), topical 2.71 (2.11–3.46), ‘other’ 2.15 (1.19–3.90)). ‘Preventable’ dose omissions were more than twice as likely to occur for ‘time critical’ medications than non-time critical medications (50.4% vs. 33.8%, OR 2.24 (1.22–4.11)). Conclusions Omitted medication doses occur commonly in mental health hospitals with ‘preventable’ omissions a key contributor to this burden. Important targets for remedial intervention have been identified.
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Affiliation(s)
- Richard N. Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM PSTRC), Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- * E-mail:
| | - Mark Hann
- Primary Care Research Group, School of Community Based Medicine, The University of Manchester, Manchester, United Kingdom
| | - Ghadah H. Alshehri
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Karen Bennett
- School of Health and Human Sciences, The University of Bolton, Bolton, United Kingdom
| | - Joan Miller
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Lorraine Prescott
- North West Boroughs Health Care NHS Foundation Trust, Warrington, United Kingdom
| | - Petra Brown
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Pennine Care NHS Foundation Trust, Aston-Under-Lyne, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM PSTRC), Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
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Hunt KV, Harding AM, Taylor SE, Curtain C. Evaluation of medication dose omissions amongst inpatients in a hospital using an electronic Medication Management System. J Eval Clin Pract 2018; 24:688-694. [PMID: 29786928 DOI: 10.1111/jep.12944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/18/2018] [Indexed: 12/13/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Whilst many dose omissions cause no patient harm, inappropriate dose omissions have been associated with increased length of hospital stay, risk of sepsis, and mortality. This study aimed to comprehensively describe the prevalence and nature of omitted doses overall and of high risk medication dose omissions in an organization using an electronic Medication Management System. METHODS A retrospective cross-sectional study was undertaken in an Australian tertiary referral health service. All routinely documented electronic inpatient dose administration records from 1st July 2014 to 30th June 2015 were included. Period prevalence and characteristics of dose omissions overall and of high-risk medication dose omissions were determined. RESULTS During the study period, 3.3 million inpatient doses were scheduled for administration, with doses endorsed as "not given" comprising 6.2% of all scheduled doses. Non-valid dose omissions (medication not available or no justification documented) comprised 1.2% of scheduled doses. Patient refusal accounted for one third of all dose omissions, while for 12% no explanation was provided and 7% were endorsed "medication not available". High-risk medications accounted for 20% of all dose omissions. One in 20 antimicrobial doses scheduled were omitted, and of these, 17% were due to patient refusal. CONCLUSION The period prevalence of dose omissions in this large study after electronic Medication Management System implementation is similar to that found when paper charts were used. Although most dose omissions appear appropriate, many orders were not given due to patient refusal or with no documented justification. Interventions to minimize unintentional dose omissions are indicated.
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Affiliation(s)
- Katherine V Hunt
- Pharmacy Department, Austin Health, Studley Rd, Heidelberg, Victoria, Australia, 3084
| | - Andrew M Harding
- Pharmacy Department, Austin Health, Studley Rd, Heidelberg, Victoria, Australia, 3084
| | - Simone E Taylor
- Pharmacy Department, Austin Health, Studley Rd, Heidelberg, Victoria, Australia, 3084
| | - Colin Curtain
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
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Lau BD, Streiff MB, Pronovost PJ, Haut ER. Venous Thromboembolism Quality Measures Fail to Accurately Measure Quality. Circulation 2018; 137:1278-1284. [DOI: 10.1161/circulationaha.116.026897] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Venous thromboembolism (VTE) is 1 of the most common causes of preventable harm for patients in hospitals. Consequently, the Joint Commission, the Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality, the United Kingdom Care Quality Commission, the Australian Commission on Safety and Quality in Health Care, the Maryland Health Services Cost Review Commission, and the American College of Surgeons have prioritized measuring and reporting VTE outcomes with the goal of reducing the incidence of and preventable harm from VTE. We developed a rubric for defect-free VTE prevention, graded each organizational VTE quality measure, and found that none of the current VTE-related quality measures adequately characterizes VTE prevention efforts or outcomes in hospitalized patients. Effective VTE prevention is multifactorial: clinicians must assess patients’ risk for VTE and prescribe therapy appropriate for each patient’s risk profile, patients must accept the prescribed therapy, and nurses must administer the therapy as prescribed. First, an ideal, defect-free VTE prevention process measure requires: (1) documentation of a standardized VTE risk assessment; (2) prescription of optimal, risk-appropriate VTE prophylaxis; and (3) administration of all risk-appropriate VTE prophylaxis as prescribed. Second, an ideal VTE outcome measure should define potentially preventable VTE as VTE that developed in patients who experienced any VTE prevention process failures.
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Affiliation(s)
- Brandyn D. Lau
- Russell H. Morgan Department of Radiology and Radiological Science (B.D.L.)
- Division of Health Sciences Informatics (B.D.L.)
- Armstrong Institute for Patient Safety (B.D.L., M.B.S., P.J.P., E.R.H.)
- Johns Hopkins University School of Medicine, Baltimore, MD. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.D.L., P.J.P., E.R.H.)
| | - Michael B. Streiff
- Armstrong Institute for Patient Safety (B.D.L., M.B.S., P.J.P., E.R.H.)
- Department of Medicine (M.B.S.)
- Department of Pathology (M.B.S.)
| | - Peter J. Pronovost
- Armstrong Institute for Patient Safety (B.D.L., M.B.S., P.J.P., E.R.H.)
- Department of Anesthesiology and Critical Care Medicine (P.J.P., E.R.H.)
- Johns Hopkins University School of Medicine, Baltimore, MD. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.D.L., P.J.P., E.R.H.)
| | - Elliott R. Haut
- Armstrong Institute for Patient Safety (B.D.L., M.B.S., P.J.P., E.R.H.)
- Department of Anesthesiology and Critical Care Medicine (P.J.P., E.R.H.)
- Department of Surgery (E.R.H.)
- Johns Hopkins University School of Medicine, Baltimore, MD. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.D.L., P.J.P., E.R.H.)
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Graudins LV, Dooley MJ. Medication Safety: Experiential Learning for Pharmacy Students and Staff in a Hospital Setting. PHARMACY 2016; 4:E38. [PMID: 28970411 PMCID: PMC5419372 DOI: 10.3390/pharmacy4040038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/01/2016] [Accepted: 11/05/2016] [Indexed: 01/26/2023] Open
Abstract
Medication Safety has been an established pharmacy specialty in Australian hospitals since the early 2000s and is now one of the ten Australian hospital accreditation standards. Although advances have occurred, medication-related patient harm has not been eradicated. Victorian undergraduate pharmacy programs include some aspects of medication safety, however clinical pharmacy experience, along with interpersonal and project management skills, are required to prepare pharmacists to be confident medication safety practitioners. This article outlines the range of medication safety-related training offered at an Australian tertiary teaching hospital, including; on-site tutorial for undergraduate students, experiential placement for pharmacy interns, orientation for pharmacy staff and resources for credentialing pharmacists for extended roles. Improvements continue to be made, such as electronic medication management systems, which increase the safe use of medications and facilitate patient care. Implementation and evaluation of these systems require medication safety expertise. Patients' engaging in their own care is an acknowledged safety improvement strategy and is enhanced by pharmacist facilitation. Building educator skills and integrating experiential teaching with university curricula should ensure pharmacists have both the knowledge and experience early in their careers, in order to have a leading role in future medication management.
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Affiliation(s)
- Linda V Graudins
- Pharmacy Department, Alfred Health, Melbourne 3004, Victoria, Australia.
| | - Michael J Dooley
- Pharmacy Department, Alfred Health, Melbourne 3004, Victoria, Australia.
- Centre for Medicine Use and Safety, Monash University, Melbourne 3052, Victoria, Australia.
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Reducing dose omission of prescribed medications in the hospital setting: a narrative review. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0289-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Leite B, Mistro S, Carvalho C, Mehta SR, Badaro R. Cohort study for evaluation of dose omission without justification in a teaching general hospital in Bahia, Brazil. Int J Qual Health Care 2016; 28:288-93. [PMID: 26874010 DOI: 10.1093/intqhc/mzw016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2016] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To evaluate the incidence of medication errors due to dose omissions and the reasons for non-administration of medications. DESIGN A cohort study blinded to the nursing staff was conducted for 5 consecutive days to evaluate administration of prescribed medications to selected inpatients. SETTING A major academic teaching hospital in Brazil. PARTICIPANTS Dispensed doses to patients in medical and surgical wards. MAIN OUTCOME MEASURES Doses returned to pharmacy were evaluated to identify the rate of dose omission without a justification for omission. RESULTS Information was collected from 117 patients in 11 wards and 1119 doses of prescribed medications were monitored. Overall, 238/1119 (21%) dispensed doses were not administered to the patients. Among these 238 doses, 138 (58%) had no justification for not being administered. Failure in the administration of at least 1 dose occurred for 58/117 (49.6%) patients. Surgical wards had significantly more missed doses than that in medical wards (P = 0.048). The daily presence of a pharmacist in the wards was significantly correlated with lower frequency of omission errors (P = 0.019). Nervous system medications were missed more significantly than other medications (P < 0.001). No difference was noted in the omission doses in terms of route of administration. CONCLUSIONS High incidence of omission errors occurs in our institution. Factors such as the deficit of nursing staff and clinical pharmacists and a weak medication dispensing system, probably contributed to incidence detected. Blinding nursing staff was essential to improve the sensibility of the method for detecting omission errors.
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Affiliation(s)
- Bartyra Leite
- Pharmacy Department, University Hospital Professor Edgard Santos, Bahia, Brazil
| | - Sostenes Mistro
- Multidisciplinary Institute of Health, Federal University of Bahia, Brazil
| | - Camile Carvalho
- Pharmacy Department, University Hospital Professor Edgard Santos, Bahia, Brazil
| | - Sanjay R Mehta
- Department of Medicine, University of California, San Diego, CA, USA
| | - Roberto Badaro
- Department of Medicine and Diagnostic, Federal University of Bahia, Salvador, Brazil
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Cottney A. Using league tables to reduce missed dose medication errors on mental healthcare of older people wards. BMJ QUALITY IMPROVEMENT REPORTS 2015; 4:bmjquality_uu204237.w3567. [PMID: 26734424 PMCID: PMC4693080 DOI: 10.1136/bmjquality.u204237.w3567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/20/2015] [Indexed: 12/03/2022]
Abstract
The unintentional omission of medication is one of the most commonly-reported administration errors on hospital wards throughout the world. The omission of a dose of medication can severely harm the patient affected, but to date there is limited evidence about cost-effective means for reducing the incidence of such errors. The current report describes a quality improvement project, conducted on the mental healthcare of older people (MHCOP) wards in East London NHS Foundation Trust, which led to a greater than 90% reduction in the rate of unintentionally omitted doses of medication. The project involved the publication of a fortnightly league table which ranked each of the wards by how many doses they had missed, with the ward missing the fewest doses receiving a prize. PDSA cycles were used to refine the concept, with the final incarnation of the fortnightly league table also incorporating the publication of a poster for each ward which showed how many weeks it had been since the ward missed a dose, and the ward's overall trend in missed doses. The project has resulted in the average missed dose rate on the MCHOP wards decreasing from 1.07% to 0.07%. In real terms, this represents a reduction from an estimated 2878 to 188 missed doses per year on the six MHCOP wards. By greatly reducing the risk of patients experiencing adverse drug events as a result of missed doses, this project has given rise to a potential cost-saving of around £34,000 per year across the wards studied. The use of league tables represents a simple, cost-effective means of tackling the problem of doses of medication being unintentionally omitted on hospital wards.
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