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Al-Majarfi WK. A Need for Daycare Unit for Sickle Cell Disease Patients in Oman. Sultan Qaboos Univ Med J 2024; 24:4-6. [PMID: 38434450 PMCID: PMC10906766 DOI: 10.18295/squmj.2.2024.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/03/2023] [Accepted: 01/09/2024] [Indexed: 03/05/2024] Open
Affiliation(s)
- Wafa K Al-Majarfi
- Professional Development and Career Guidance Department, Ibri Hospital, Ibri, Oman
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Owen S, Menzies J, Pontefract S. Educational interventions to reduce nurse medication interruptions: A scoping review. NURSE EDUCATION TODAY 2023; 121:105665. [PMID: 36527755 DOI: 10.1016/j.nedt.2022.105665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Preventable harm from medicines is a global problem creating huge economic and social burden. Interruptions occur frequently in clinical environments causing medication episodes to take longer and having a cognitive cost on the nurse. AIM The aim of this scoping review is to identify and evaluate educational interventions that have been employed to reduce medication interruptions and improve medication safety. METHODS Six databases were searched for the scoping review (PubMed, Embase, Cochrane Library, CINAHL, Pishin and Medline) along with reference lists and grey literature searches. Articles were included if they were written in English, published between 2010 and 2020 and employed an education intervention (including bundled interventions). Databases were searched using keywords and Boolean operators. RESULTS Eight studies met the inclusion criteria. Seven of these studies were conducted in hospital (adults n = 6, paediatric n = 1) and one study in a university with undergraduate nurses. Four studies used a combined intervention and four exclusively employed an education intervention. Five studies found a significant decrease in the number of interruptions post intervention, but one of the studies that exclusively employed an education intervention found no significant difference. Changes in the nurses' behaviour post intervention were also cited in two studies. IMPLICATIONS FOR FUTURE RESEARCH There was a lack of exclusive education interventions, making it difficult to determine the effectiveness of education at reducing medication interruptions. This review highlights the necessity of some interruptions when performing tasks, for example, to make a nurse aware of a deteriorating patient. However, as the majority of studies used the number of interruptions to determine the effectiveness of the intervention, there is uncertainty as to whether this is the right outcome measure to use. In the future, a focus on outcome measures reflecting change in nurse behaviour may be more effective in determining the strength of an educational intervention.
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Affiliation(s)
- Samantha Owen
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham, UK.
| | | | - Sarah Pontefract
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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Dupree LH, Schmittgen J, Taylor TH. Teaching pharmacy students a systematic approach to medication order verification. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1015-1020. [PMID: 36055691 DOI: 10.1016/j.cptl.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 05/28/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE Inpatient medication order verification is an important skill for pharmacy students to learn for patient safety. This article describes a systematic approach to order verification that enables students to apply didactic knowledge and determine the presence of drug therapy problems during verification decisions. EDUCATIONAL ACTIVITY AND SETTING At two different colleges of pharmacy, an order verification module for second-year pharmacy students introduced a checklist for reviewing medication orders in a patient chart and identifying the presence of drug therapy problems. Students had to make a "verify or not" decision for each non-verified order and document their decision in both the chart and on a game-based learning platform. FINDINGS Over four academic years, 756 students participated in the module. With the checklist approach to order verification, students were able to identify the drug therapy problems of "dose too high" and "no drug therapy problem present" but were challenged by "wrong drug," "dose too low/renal dosing," and "duplication of therapy." SUMMARY The order verification checklist was a beneficial tool for teaching a systematic approach to inpatient medication order verification.
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Affiliation(s)
- Lori H Dupree
- Department of Pharmacy Practice, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341, United States.
| | - Janet Schmittgen
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, 1225 Center Drive, Gainesville, FL 32611, United States.
| | - Thomas H Taylor
- Department of Pharmacy Practice, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341, United States.
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Alsabri M, Castillo FB, Wiredu S, Soliman A, Dowlat T, Kusum V, Kupferman FE. Assessment of Patient Safety Culture in a Pediatric Department. Cureus 2021; 13:e14646. [PMID: 34046278 PMCID: PMC8141290 DOI: 10.7759/cureus.14646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 11/05/2022] Open
Abstract
Background An assessment of the prevalent culture needs to be the first step when building patient safety programs in healthcare organizations to achieve high-quality health care. Objective To conduct a baseline assessment of patient safety culture, to provide insight into the factors that contribute to patient safety, and to use the information to make improvements. Methods The Hospital Survey on Patient Safety Culture (PSC) questionnaire was conducted from October through December 2020 at the Brookdale Hospital Medical Center (BHMC) Pediatric departments (Pediatric Inpatient Unit, Neonatal Intensive Care Unit [NICU], Pediatric Intensive Care Unit [PICU], and Pediatric Emergency Department) and four community-based ambulatory pediatric practices (Brookdale Family Care Centers [BFCC]). The percentages of positive responses on the 12 patient-safety dimensions and the summation of PSC and two outcomes (overall patient safety grade and adverse events reported in the past year) were assessed. Factors associated with PSC aggregate score were analyzed. Results From the 385 emails that were sent, 136 surveys were considered for analysis. This gives us a response rate of 35.3%. Most of the participants were nurses (58%) with direct contact with patients (94.2%). Most respondents did not report any events (60.7%), whereas 30.3% reported 1-2 events in the past year. The patient safety composites with the highest positive scores were teamwork within units (78%), supervisor/manager expectations and actions promoting patient safety (71.2%), and organizational learning--continuous improvement (66.8%). The composites with the lowest scores were non-punitive response to error (35.9%) and staffing (38%). Conclusions All of our composite measures, with the exception of teamwork within units, appear to be low, which means that all the other composite measures require interventions for improvement of overall safety culture. In order for healthcare leaders and policymakers to establish a culture of safety and improvement, they must create a climate of open communication, continuous learning, and eliminate the fear of blame and punitive feedback.
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Affiliation(s)
- Mohammed Alsabri
- Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, USA
| | | | - Salome Wiredu
- Pediatrics, Brookdale University Hospital Medical Center, brooklyn, USA
| | - Ahmad Soliman
- Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Tracy Dowlat
- Clinical Risk Management and Corporate Compliance, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Viswanathan Kusum
- Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, USA
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Machen S, Jani Y, Turner S, Marshall M, Fulop NJ. The role of organizational and professional cultures in medication safety: a scoping review of the literature. Int J Qual Health Care 2019; 31:G146-G157. [PMID: 31822887 PMCID: PMC7097989 DOI: 10.1093/intqhc/mzz111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/16/2019] [Accepted: 10/08/2019] [Indexed: 01/22/2023] Open
Abstract
PURPOSE This scoping review explores what is known about the role of organizational and professional cultures in medication safety. The aim is to increase our understanding of 'cultures' within medication safety and provide an evidence base to shape governance arrangements. DATA SOURCES Databases searched are ASSIA, CINAHL, EMBASE, HMIC, IPA, MEDLINE, PsycINFO and SCOPUS. STUDY SELECTION Inclusion criteria were original research and grey literature articles written in English and reporting the role of culture in medication safety on either organizational or professional levels, with a focus on nursing, medical and pharmacy professions. Articles were excluded if they did not conceptualize what was meant by 'culture' or its impact was not discussed. DATA EXTRACTION Data were extracted for the following characteristics: author(s), title, location, methods, medication safety focus, professional group and role of culture in medication safety. RESULTS OF DATA SYNTHESIS A total of 1272 citations were reviewed, of which, 42 full-text articles were included in the synthesis. Four key themes were identified which influenced medication safety: professional identity, fear of litigation and punishment, hierarchy and pressure to conform to established culture. At times, the term 'culture' was used in a non-specific and arbitrary way, for example, as a metaphor for improving medication safety, but with little focus on what this meant in practice. CONCLUSIONS Organizational and professional cultures influence aspects of medication safety. Understanding the role these cultures play can help shape both local governance arrangements and the development of interventions which take into account the impact of these aspects of culture.
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Affiliation(s)
| | - Yogini Jani
- Centre for Medicines Optimisation Research and Education, UCLH NHS Foundation Trust, UCL School of Pharmacy, UK
| | - Simon Turner
- School of Management, University of Los Andes, Colombia
| | - Martin Marshall
- UCL Research Department of Primary Care & Population Health, UK
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Bower RA, Coad JE, Manning JC, Pengelly TA. A qualitative, exploratory study of nurses’ decision-making when interrupted during medication administration within the Paediatric Intensive Care Unit. Intensive Crit Care Nurs 2018; 44:11-17. [DOI: 10.1016/j.iccn.2017.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/21/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
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Occurrence of Potential Adverse Drug Events from Prescribing Errors in a Pediatric Intensive and High Dependency Unit in Hong Kong: An Observational Study. Paediatr Drugs 2017; 19:347-355. [PMID: 28353155 DOI: 10.1007/s40272-017-0222-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Critically ill pediatric patients are considered at high risk for medication errors. Although much research focuses on the actual errors, equally important are medication errors that, although intercepted, carried the potential for an adverse drug event. The aim of this study was to determine the occurrence of prescribing errors and potential adverse drug events (pADEs) in a local pediatric intensive and critical care unit (PICU) in Hong Kong. Our secondary objective was to determine the type of error, nature of medication involved and the time of error occurrence. METHODS We conducted a prospective observational chart review among patients in a pediatric intensive and high dependency unit between January 16, 2015 and April 20, 2015. Medical charts for each patient were reviewed for the occurrence of a prescribing error or pADE. Each pADE was assessed for the type of error, the classification of agent involved, clinical severity of the error, and the time the error occurred. RESULTS Forty-one patients with a mean age of 3.2 years were included in our study. Of these patients, 19 (46.3%) experienced at least one pADE. We identified 131 pADEs, 129 of which were prescribing errors conferring a rate of 6.8 errors per affected patient or 3.1 errors per patient admitted to the PICU. The most common error found in the study was incorrect dose calculation (48.1%), with intravenous fluids (41.7%), cardiovascular agents (15.0%), and anti-infectives (12.5%) the most common agents involved with an error. The majority of the pADEs in our study were either clinically serious (33.1%) or significant (44.9%) in nature. Nearly one in every four errors required monitoring and/or intervention to prevent harm, and almost all (96.9%) of the prescribing errors were intercepted before reaching the patient. CONCLUSION This study highlights incorrect dose calculation as the most common prescribing error in a pediatric critical care setting. Intravenous fluids, cardiovascular agents, and anti-infectives were the classes of medication most commonly involved with a pADE. Due to the high-risk nature of medications used and the critical condition of these patients, more than three-quarters of pADEs were considered to be clinically serious or significant in causing patient harm.
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Garcia BH, Elenjord R, Bjornstad C, Halvorsen KH, Hortemo S, Madsen S. Safety and efficiency of a new generic package labelling: a before and after study in a simulated setting. BMJ Qual Saf 2017; 26:817-823. [PMID: 28432189 PMCID: PMC5739837 DOI: 10.1136/bmjqs-2016-006422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/10/2017] [Accepted: 03/22/2017] [Indexed: 12/03/2022]
Abstract
Background Medication errors are frequent and may cause harm to patients and increase healthcare expenses. Aim To explore whether a new labelling influences time and errors when preparing medications in accordance with medication charts in an experimental setting. Method We carried out an uncontrolled before and after study with 3 months inbetween experiments. Phase I used original labelling and phase II used new generic labelling. We set up an experimental medicine room, simulating a real-life setting. Twenty-five nurses and ten pharmacy technicians participated in the study. We asked them to prepare medications in accordance with medication charts, place packages on a desk and document the package prepared. We timed the operation. Participants were asked to prepare medications in accordance with as many charts as possible within 30 min. Results Nurses prepared significantly more medication charts with the generic labelling compared with the original 3.3 versus 2.6 (p=0.009). Mean time per medication chart was significantly lower with the generic labelling 6.9 min/chart versus 8.5 min/chart (p<0.001). Pharmacy technicians were significantly faster than the nurses in both phase I (6.8 min/chart vs 9.5 min/chart; p<0.001) and phase II (6.1 min/chart vs 7.2 min/chart; p=0.013). The number of errors was low and not significantly different between the two labellings, with errors affecting 9.1% of charts in phase I versus 6.5% in phase II (p=0.5). Conclusions A new labelling of medication packages with prominent placement of the active substance(s) and strength(s) in the front of the medication package may reduce time for nurses when preparing medications, without increasing medication errors.
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Affiliation(s)
- Beate Hennie Garcia
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway.,Hospital Pharmacy of North Norway Trust, Tromso, Norway
| | | | | | - Kjell Hermann Halvorsen
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
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Bower R, Jackson C, Manning JC. Interruptions and medication administration in critical care. Nurs Crit Care 2016; 20:183-95. [PMID: 26084432 DOI: 10.1111/nicc.12185] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/19/2015] [Accepted: 04/01/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medication administration has inherent risks, with errors having enormous impact on the quality and efficiency of patient care, particularly in relation to experience, outcomes and safety. Nurses are pivotal to the medication administration process and therefore must demonstrate safe and reliable practice. However, interruptions can lead to mistakes and omissions. AIM To critique and synthesize the existing literature relating to the impact that interruptions have during medication administration within the paediatric critical care (PCC) setting. SEARCH STRATEGY Key terms identified from background literature were used to search three electronic databases (Medline, CINHAL and BNI). Selected sources were critically appraised using the Critical Appraisal Skills Programme (CASP) tool. FINDINGS There is confusion within the literature concerning the definition of interruption. Moreover, an assumption that all interruptions have a negative impact on patient safety exists. The literature identifies the multi-dimensional nature of interruptions and their impact on medication administration and patient safety. The cumulative effect of interruptions depends on what type of task is being completed, when it occurs, what the interruption is and which method of handling is utilized. A conceptual schema has been developed in order to explicate the themes and concepts that emerged. CONCLUSIONS This review summarizes debates within the international arena concerning the impact of interruptions on medication administration. However, conclusions drawn appear applicable in relation to practice, education and future research to other critical care settings. RELEVANCE TO CLINICAL PRACTICE Findings show that no single strategy is likely to improve the negative effect of interruptions without focus on patient safety. Practice education to improve team building interactions is required that equips nurses with the skills in managing interruptions and delegating high priority secondary tasks.
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Affiliation(s)
- Rachel Bower
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Christine Jackson
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Joseph C Manning
- Nottingham Children's Hospital & Neonatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,School of Health Sciences, Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, UK
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Azevedo Filho FMD, Pinho DLM, Bezerra ALQ, Amaral RT, Silva MED. Prevalência de incidentes relacionados à medicação em unidade de terapia intensiva. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Objetivo Estimar a prevalência de incidentes relacionados à medicação em uma Unidade de Terapia Intensiva. Métodos Estudo transversal que incluiu 116 registros de internações hospitalares no período de 12 meses. O instrumento de pesquisa foi elaborado com base nas variáveis de estudo e validado por dois experts. A prevalência foi calculada considerando o número de internações expostas como numerador e o total de internações investigadas como denominador, calculando intervalo de confiança de 95%. Para a verificação de associação significativa entre as variáveis, utilizou-se o Teste Exato de Fisher, assumindo nível de significância máximo de 5% (p<0,05). Resultados Verificou-se que 113 internações foram expostas a pelo menos um tipo de incidente, totalizando 2.869 ocorrências, sendo 1.437 circunstâncias notificáveis, 1.418 incidentes sem dano, nove potenciais eventos adversos e cinco eventos adversos. Os incidentes aconteceram durante a fase da prescrição (45,4%) e a ausência de conduta dos profissionais de saúde frente aos incidentes foi identificada em 99% dos registros. Conclusão Estimou-se prevalência de 97,4% incidentes relacionados à medicação.
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Guérin A, Bussières JF, Boulkedid R, Bourdon O, Prot-Labarthe S. Development of a consensus-base list of criteria for prescribing medication in a pediatric population. Int J Clin Pharm 2015; 37:883-94. [PMID: 26017398 DOI: 10.1007/s11096-015-0139-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 05/19/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although many people are involved in the optimal use of a medication within this process, the use of medications carries risks of adverse events, which are greater in the pediatric population because of many factors. OBJECTIVE In this context, our aim was to develop a consensus-based list of criteria for the safety of the pediatric medication-use process or circuit (referred to from now on as the CIRCUS tool: CIRcuit-of-Child-drug-USe). SETTING Multicenter with a trio of experts from eight university hospitals. METHODS A literature search (1998-2013) was conducted in order to identify the different safety practice domains for the pediatric medication use process. Twenty-six safety practice domains were identified and 48 compliance criteria were formulated. In order to reach a consensus on the most relevant compliance criteria for safety practices, an international 24 French-speaking multidisciplinary panelists (8 doctors, 8 pharmacists and 8 nurses) selected to represent a broad range of experience levels and specialties took part in a two round Delphi survey which was conducted between March and July 2013. Each panelist was asked to rate each proposed criterion on a 1-9 Likert scale in order to show their level of agreement (i.e. 1 reflects strong disagreement and 9 reflects strong agreement). MAIN OUTCOME MEASURE Development of a consensus-base list for safety practices in pediatrics. RESULTS Twenty-two of the 24 professionals invited to take part in this survey (92% participation rate) completed the two Delphi rounds. At the end of the two Delphi rounds, a total of 38/48 (79%) safety practice compliance criteria achieved consensus by the panelists. The criteria were grouped into 23 domains. CONCLUSION This study presents the development of a self-assessment tool for safety practices in the pediatric drug-use process using a Delphi method. This tool may be used in order to record and compare the prevalence of best safety practices in the pediatric drug-use process.
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Affiliation(s)
- A Guérin
- Pharmacy Practice Research Unit, Pharmacy Department, Sainte-Justine University Health Center, 3175, chemin de la Côte Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
| | - J F Bussières
- Pharmacy Department, Sainte-Justine University Health Center, Montreal, Quebec, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - R Boulkedid
- Clinical Epidemiology Unit, APHP, Robert Debré University Health Center, 75019, Paris, France
- INSERM, U 1123 and CIC 1426, Robert Debré University Health Center, 75019, Paris, France
| | - O Bourdon
- Pharmacy Department, APHP, Robert Debré University Health Center, Paris, France
- Department of Clinical Pharmacy, Faculty of Pharmacy, Université Paris Descartes, Sorbonne Paris Cité, France
- Laboratory Education and Health Practices EA 3412, Université Paris 13, Sorbonne Paris Cité, France
- French Society of Clinical Pharmacy, Paris, France
| | - S Prot-Labarthe
- Pharmacy Department, APHP, Robert Debré University Health Center, Paris, France
- French Society of Clinical Pharmacy, Paris, France
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Wolf LA, Carman MJ, Henderson D, Kamienski M, Koziol-McLain J, Manton A, Moon MD. Ten Things We Might Not Want to Do Anymore: How Research Changes Nursing Practice. J Emerg Nurs 2012; 38:589-91. [DOI: 10.1016/j.jen.2012.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Breeding J, Welch S, Whittam S, Buscher H, Burrows F, Frost C, Jonkman M, Mathews N, Wong KS, Wong A. Medication Error Minimization Scheme (MEMS) in an adult tertiary intensive care unit (ICU) 2009-2011. Aust Crit Care 2012; 26:58-75. [PMID: 22898357 DOI: 10.1016/j.aucc.2012.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 07/12/2012] [Accepted: 07/17/2012] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION The Medication Error Minimisation Scheme (MEMS) is a locally based ongoing multidisciplinary, multifaceted quality improvement (QI) project within an Australian adult tertiary level Intensive Care Unit (ICU). The project commenced in 2009. Its primary aim is to enhance medication safety within this ICU by utilising existing resources. The aim of this paper is to provide a descriptive account of the various activities, interventions and results of this project within the first three years. METHODS The research design for this project was based upon Plan-Do-Study-Act (PDSA) cycles associated with QI projects. Medication error rates and audits of: intravenous infusions, incompatible intravenous medications and incorrect documentation of withheld medications were analyzed according to simple statistical techniques. Initial and follow up medication safety surveys were compared using basic statistical analysis. Focus groups exploring barriers and enablers of medication incident reporting were analyzed according to qualitative techniques associated with focus group discussions. Other interventions included: regular education sessions; discussions within other departmental meetings such as nursing staff meetings and Morbidity and Mortality meetings; and bedside discussions and demonstrations. Promotion of medication safety occurred within a number of forums; activities and findings were advertised and displayed; a recognizable Logo for MEMS was employed; and incentives were provided for staff. RESULTS Reported Medication Incidents (MIs) increased from 6.2 to 14.9 MIs per 1000 patient days. Audits and chart reviews confirmed that more MIs are uncovered by employing a variety of techniques in addition to incident reporting. Staff surveys provided a rich source of information regarding medication safety. Audits of intravenous infusions revealed a reduced error rate from 38/331 (11.5%) to 15/468 (3.2%). Chart review of incorrect documentation of omitted medications decreased from 105/347 (30.3%) to 104/486 (21.4%). Focus groups provided information that was able to be used in a number of hospital forums in order to explain the impact of existing systems upon ICU staff. CONCLUSION This ongoing QI project was able to achieve its targeted goals. The MI reporting rate was increased. This project demonstrated that measurable, "non-incident report" errors can be reduced by focusing upon and promoting medication safety in the ICU. These activities demonstrated a workplace that values medication safety, the discovery of shortfalls and the benefits of ongoing improvement.
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Affiliation(s)
- Jeff Breeding
- Intensive Care Unit, St Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW 2010, Australia.
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