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Zheng Y, Rowell B, Chen Q, Kim JY, Kontar RA, Yang XJ, Lester CA. Designing Human-Centered AI to Prevent Medication Dispensing Errors: Focus Group Study With Pharmacists. JMIR Form Res 2023; 7:e51921. [PMID: 38145475 PMCID: PMC10775023 DOI: 10.2196/51921] [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: 08/17/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Medication errors, including dispensing errors, represent a substantial worldwide health risk with significant implications in terms of morbidity, mortality, and financial costs. Although pharmacists use methods like barcode scanning and double-checking for dispensing verification, these measures exhibit limitations. The application of artificial intelligence (AI) in pharmacy verification emerges as a potential solution, offering precision, rapid data analysis, and the ability to recognize medications through computer vision. For AI to be embraced, it must be designed with the end user in mind, fostering trust, clear communication, and seamless collaboration between AI and pharmacists. OBJECTIVE This study aimed to gather pharmacists' feedback in a focus group setting to help inform the initial design of the user interface and iterative designs of the AI prototype. METHODS A multidisciplinary research team engaged pharmacists in a 3-stage process to develop a human-centered AI system for medication dispensing verification. To design the AI model, we used a Bayesian neural network that predicts the dispensed pills' National Drug Code (NDC). Discussion scripts regarding how to design the system and feedback in focus groups were collected through audio recordings and professionally transcribed, followed by a content analysis guided by the Systems Engineering Initiative for Patient Safety and Human-Machine Teaming theoretical frameworks. RESULTS A total of 8 pharmacists participated in 3 rounds of focus groups to identify current challenges in medication dispensing verification, brainstorm solutions, and provide feedback on our AI prototype. Participants considered several teaming scenarios, generally favoring a hybrid teaming model where the AI assists in the verification process and a pharmacist intervenes based on medication risk level and the AI's confidence level. Pharmacists highlighted the need for improving the interpretability of AI systems, such as adding stepwise checkmarks, probability scores, and details about drugs the AI model frequently confuses with the target drug. Pharmacists emphasized the need for simplicity and accessibility. They favored displaying only essential information to prevent overwhelming users with excessive data. Specific design features, such as juxtaposing pill images with their packaging for quick comparisons, were requested. Pharmacists preferred accept, reject, or unsure options. The final prototype interface included (1) checkmarks to compare pill characteristics between the AI-predicted NDC and the prescription's expected NDC, (2) a histogram showing predicted probabilities for the AI-identified NDC, (3) an image of an AI-provided "confused" pill, and (4) an NDC match status (ie, match, unmatched, or unsure). CONCLUSIONS In partnership with pharmacists, we developed a human-centered AI prototype designed to enhance AI interpretability and foster trust. This initiative emphasized human-machine collaboration and positioned AI as an augmentative tool rather than a replacement. This study highlights the process of designing a human-centered AI for dispensing verification, emphasizing its interpretability, confidence visualization, and collaborative human-machine teaming styles.
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Affiliation(s)
- Yifan Zheng
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Brigid Rowell
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Qiyuan Chen
- Department of Industrial and Operations Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Jin Yong Kim
- Department of Industrial and Operations Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Raed Al Kontar
- Department of Industrial and Operations Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, United States
| | - X Jessie Yang
- Department of Industrial and Operations Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Corey A Lester
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
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2
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Baartmans MC, Van Schoten SM, Wagner C. Generic analysis method to learn from serious adverse events in Dutch hospitals: a human factors perspective. BMJ Open Qual 2022; 11:bmjoq-2021-001637. [PMID: 35105550 PMCID: PMC8808443 DOI: 10.1136/bmjoq-2021-001637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Hospitals in various countries such as the Netherlands investigate and analyse serious adverse events (SAEs) to learn from previous events and attempt to prevent recurrence. However, current methods for SAE analysis do not address the complexity of healthcare and investigations typically focus on single events on the hospital level. This hampers hospitals in their ambition to learn from SAEs. Integrating human factors thinking and using a holistic and more consistent method could improve learning from SAEs. Aim This study aims to develop a novel generic analysis method (GAM) to: (1) facilitate a holistic event analysis using a human factors perspective and (2) ease aggregate analysis of events across hospitals. Methods Multiple steps of carefully evaluating, testing and continuously refining prototypes of the method were performed. Various Dutch stakeholders in the field of patient safety were involved in each step. Theoretical experts were consulted, and the prototype was pretested using information-rich SAE reports from Dutch hospitals. Expert panels, engaging quality and safety experts and medical specialists from various hospitals were consulted for face and content validity evaluation. User test sessions concluded the development of the method. Results The final version of the GAM consists of a framework and affiliated questionnaire. GAM combines elements of three methods for SAE analysis currently practised by Dutch hospitals. It is structured according to the Systems Engineering Initiative for Patient Safety model, which incorporates a human factors perspective into the analysis. These eases aggregated analysis of SAEs across hospitals and helps to consider the complexity of healthcare work systems. Conclusion The GAM is a valuable new tool for hospitals to learn from SAEs. The method can facilitate a holistic aggregate analysis of SAEs across hospitals using a human factors perspective, and is now ready for further extensive testing.
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Affiliation(s)
- Mees Casper Baartmans
- Department of Organisation and Quality of Care, Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Steffie Marijke Van Schoten
- Department of Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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3
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Abraham J, Galanter WL, Touchette D, Xia Y, Holzer KJ, Leung V, Kannampallil T. Risk factors associated with medication ordering errors. J Am Med Inform Assoc 2021; 28:86-94. [PMID: 33221852 DOI: 10.1093/jamia/ocaa264] [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] [Received: 09/03/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE We utilized a computerized order entry system-integrated function referred to as "void" to identify erroneous orders (ie, a "void" order). Using voided orders, we aimed to (1) identify the nature and characteristics of medication ordering errors, (2) investigate the risk factors associated with medication ordering errors, and (3) explore potential strategies to mitigate these risk factors. MATERIALS AND METHODS We collected data on voided orders using clinician interviews and surveys within 24 hours of the voided order and using chart reviews. Interviews were informed by the human factors-based SEIPS (Systems Engineering Initiative for Patient Safety) model to characterize the work systems-based risk factors contributing to ordering errors; chart reviews were used to establish whether a voided order was a true medication ordering error and ascertain its impact on patient safety. RESULTS During the 16-month study period (August 25, 2017, to December 31, 2018), 1074 medication orders were voided; 842 voided orders were true medication errors (positive predictive value = 78.3 ± 1.2%). A total of 22% (n = 190) of the medication ordering errors reached the patient, with at least a single administration, without causing patient harm. Interviews were conducted on 355 voided orders (33% response). Errors were not uniquely associated with a single risk factor, but the causal contributors of medication ordering errors were multifactorial, arising from a combination of technological-, cognitive-, environmental-, social-, and organizational-level factors. CONCLUSIONS The void function offers a practical, standardized method to create a rich database of medication ordering errors. We highlight implications for utilizing the void function for future research, practice and learning opportunities.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine in St. Louis,St. Louis, Missouri, USA.,Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - William L Galanter
- Department of Medicine, College of Medicine, University of Illinois at Chicago,Chicago, Illinois, USA.,Department of Pharmacy Systems, Outcome and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Daniel Touchette
- Department of Pharmacy Systems, Outcome and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Yinglin Xia
- Department of Medicine, College of Medicine, University of Illinois at Chicago,Chicago, Illinois, USA
| | - Katherine J Holzer
- Department of Anesthesiology, Washington University School of Medicine in St. Louis,St. Louis, Missouri, USA
| | - Vania Leung
- Department of Medicine, College of Medicine, University of Illinois at Chicago,Chicago, Illinois, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine in St. Louis,St. Louis, Missouri, USA.,Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Suclupe S, Martinez-Zapata MJ, Mancebo J, Font-Vaquer A, Castillo-Masa AM, Viñolas I, Morán I, Robleda G. Medication errors in prescription and administration in critically ill patients. J Adv Nurs 2020; 76:1192-1200. [PMID: 32030796 DOI: 10.1111/jan.14322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/16/2019] [Accepted: 01/29/2020] [Indexed: 11/28/2022]
Abstract
AIM To determine the prevalence and magnitude of medication errors and their association with patients' sociodemographic and clinical characteristics and nurses' work conditions. DESIGN An observational, analytical, cross-sectional and ambispective study was conducted in critically ill adult patients. METHODS Data concerning prescription errors were collected retrospectively from medical records and administration errors were identified through direct observation of nurses during drug administration. Those data were collected between April and July 2015. RESULTS A total of 650 prescription errors were identified for 961 drugs in 90 patients (mean error 7[SD 4.1] per patient) and prevalence of 47.1% (95% CI 44-50). The most frequent error was omission of the prescribed medication. Intensive care unit stay was a risk factor associated with omission error (OR 2.14; 1.46-3.14: p < .01). A total of 294 administration errors were identified for 249 drugs in 52 patients (mean error 6 [SD 6.7] per patient) and prevalence of 73.5% (95% CI 68-79). The most frequent error was interruption during drug administration. Admission to the intensive care unit (OR 0.37; 0.21-0.66: p < .01), nurses' morning shift (OR 2.15; 1.10-4.18: p = .02) and workload perception (OR 3.64; 2.09-6.35: p < .01) were risk factors associated with interruption. CONCLUSIONS Medication errors in prescription and administration were frequent. Timely detection of errors and promotion of a medication safety culture are necessary to reduce them and ensure the quality of care in critically ill patients. IMPACT Medication errors occur frequently in the intensive care unit but are not always identified. Due to the vulnerability of seriously ill patients and the specialized care they require, an error can result in serious adverse events. The study shows that medication errors in prescription and administration are recurrent but preventable. These findings contribute to promote awareness in the proper use of medications and guarantee the quality of nursing care.
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Affiliation(s)
- Stefanie Suclupe
- Iberoamerican Cochrane Centre, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Jose Martinez-Zapata
- Iberoamerican Cochrane Centre, Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.,Instituto de Investigación Biomédica Sant Pau, (IIB Sant Pau), Barcelona, Spain
| | - Jordi Mancebo
- Intensive Care Unit, University Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Assumpta Font-Vaquer
- Intermediate Care Unit, University Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Iris Viñolas
- Intensive Care Unit, University Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Indalecio Morán
- Intensive Care Unit, University Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Gemma Robleda
- Iberoamerican Cochrane Centre, Barcelona, Spain.,Mar University School of Nursing - Pompeu Fabra University, Barcelona, Spain
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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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Knobloch MJ, Thomas KV, Musuuza J, Safdar N. Exploring leadership within a systems approach to reduce health care-associated infections: A scoping review of one work system model. Am J Infect Control 2019; 47:633-637. [PMID: 30765147 DOI: 10.1016/j.ajic.2018.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite efforts to prevent health care-associated infections (HAIs), these infections continue to challenge health care systems. The Centers for Disease Control and Prevention emphasizes implementation of evidence-based practices. Within the complex health care environment, sustained implementation calls for work systems that harness expertise of interprofessional teams, which, in turn, calls for suitable executive, mid-level, and local leadership. The purpose of this review is to highlight the need to study leadership when using a systems approach to reduce HAIs. METHODS This is a scoping review of HAI studies that used a systems engineering model called the Systems Engineering Initiative for Patient Safety model. We examined if and how leadership was addressed within 1 systems approach. RESULTS We found 15 studies using the Systems Engineering Initiative for Patient Safety model and, of these, leadership was directly mentioned in 3 studies. In the remaining studies, reference to leadership may be inferred by use of terms such as teamwork, managerial oversight, climate and culture, staffing support, and institutional/administrative support. CONCLUSIONS Research is needed to bring recognition of the role of leadership within a work systems approach to reducing HAIs. We need further examination of leadership attributes and communication behaviors that allow staff to diffuse and sustain best practices to prevent HAIs.
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Affiliation(s)
- Mary Jo Knobloch
- Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI.
| | | | - Jackson Musuuza
- Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Nasia Safdar
- Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI
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7
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Steele ML, Talley B, Frith KH. Application of the SEIPS Model to Analyze Medication Safety in a Crisis Residential Center. Arch Psychiatr Nurs 2018; 32:7-11. [PMID: 29413076 DOI: 10.1016/j.apnu.2017.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 08/30/2017] [Accepted: 09/03/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE Medication safety and error reduction has been studied in acute and long-term care settings, but little research is found in the literature regarding mental health settings. Because mental health settings are complex, medication administration is vulnerable to a variety of errors from transcription to administration. The purpose of this study was to analyze critical factors related to a mental health work system structure and processes that threaten safe medication administration practices. BACKGROUND The Systems Engineering Initiative for Patient Safety (SEIPS) model provides a framework to analyze factors affecting medication safety. The model approach analyzes the work system concepts of technology, tasks, persons, environment, and organization to guide the collection of data. METHODS In the study, the Lean methodology tools were used to identify vulnerabilities in the system that could be targeted later for improvement activities. The project director completed face-to-face interviews, asked nurses to record disruptions in a log, and administered a questionnaire to nursing staff. The project director also conducted medication chart reviews and recorded medication errors using a standardized taxonomy for errors that allowed categorization of the prevalent types of medication errors. RESULTS Results of the study revealed disruptions during the medication process, pharmacology training needs, and documentation processes as the primary opportunities for improvement. The project engaged nurses to identify sustainable quality improvement strategies to improve patient safety. CONCLUSION The mental health setting carries challenges for safe medication administration practices. Through analysis of the structure, process, and outcomes of medication administration, opportunities for quality improvement and sustainable interventions were identified, including minimizing the number of distractions during medication administration, training nurses on psychotropic medications, and improving the documentation system. A task force was created to analyze the descriptive data and to establish objectives aimed at improving efficiency of the work system and care process involved in medication administration at the end of the project.
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Affiliation(s)
- Maria L Steele
- College of Nursing, The University of Alabama in Huntsville, AL, United States.
| | - Brenda Talley
- College of Nursing, The University of Alabama in Huntsville, AL, United States
| | - Karen H Frith
- College of Nursing, The University of Alabama in Huntsville, AL, United States
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Schutijser B, Klopotowska JE, Jongerden I, Spreeuwenberg P, Wagner C, de Bruijne M. Nurse compliance with a protocol for safe injectable medication administration: comparison of two multicentre observational studies. BMJ Open 2018; 8:e019648. [PMID: 29306893 PMCID: PMC5781013 DOI: 10.1136/bmjopen-2017-019648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Medication administration errors with injectable medication have a high risk of causing patient harm. To reduce this risk, all Dutch hospitals implemented a protocol for safe injectable medication administration. Nurse compliance with this protocol was evaluated as low as 19% in 2012. The aim of this second evaluation study was to determine whether nurse compliance had changed over a 4-year period, what factors were associated over time with protocol compliance and which strategies have been implemented by hospitals to increase protocol compliance. METHODS In this prospective observational study, conducted between November 2015 and September 2016, nurses from 16 Dutch hospitals were directly observed during intravenous medication administration. Protocol compliance was complete if nine protocol proceedings were conducted correctly. Protocol compliance was compared with results from the first evaluation. Multilevel logistic regression analyses were used to assess the associations over time between explanatory variables and complete protocol compliance. Implemented strategies were classified according to the five components of the Systems Engineering Initiative for Patient Safety (SEIPS) model. RESULTS A total of 372 intravenous medication administrations were observed. In comparison with 2012, more proceedings per administration were conducted (mean 7.6, 95% CI 7.5 to 7.7 vs mean 7.3, 95% CI 7.3 to 7.4). No significant change was seen in complete protocol compliance (22% in 2016); compliance with the proceedings 'hand hygiene' and 'check by a second nurse' remained low. In contrast to 2012, the majority of the variance was caused by differences between wards rather than between hospitals. Most implemented improvement strategies targeted the organisation component of the SEIPS model. CONCLUSIONS Compliance with 'hand hygiene' and 'check by a second nurse' needs to be further improved in order to increase complete protocol compliance. To do so, interventions focused on nurses and individually tailored to each ward are needed.
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Affiliation(s)
- Bernadette Schutijser
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Joanna Ewa Klopotowska
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Irene Jongerden
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Martine de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
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Di Muzio M, De Vito C, Tartaglini D, Villari P. Knowledge, behaviours, training and attitudes of nurses during preparation and administration of intravenous medications in intensive care units (ICU). A multicenter Italian study. Appl Nurs Res 2017; 38:129-133. [PMID: 29241505 DOI: 10.1016/j.apnr.2017.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/22/2017] [Accepted: 10/12/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medication errors can put at risk the life of patients hospitalized in the ICUs. These errors occur more frequently in the ICUs due to their peculiar medical framework. There is not much information about the knowledge, attitudes, behaviours and training needs of the nurses who work in ICUs towards the medication errors. OBJECTIVE This study aims at describing the knowledge, attitudes, behaviours and training needs of the Italian nurses who work in ICUs towards the use of IV drugs, and identifying the strategies that nurses can adopt to prevent the occurrence of medication errors. MATERIALS AND METHODS Cross-sectional study. The survey was carried out through a self-administrated questionnaire and it was addressed to 529 Italian nurses who work in the ICUs of Southern, Centre and Northern Italy hospitals (average age of the sample 39.9, SD=9.1, 68.1% females). The questionnaire, made of 36 items divided into 7 sections, was validated after the results of the pilot study. RESULTS The study highlighted the importance of the role, behaviours and knowledge of the nurses to prevent the medication errors. The results of the multivariate analysis of the multicentre study show a relation among correct behaviours and positive attitudes, even if it is not statistically significant. Worth mentioning is the fact that the achievement of a university degree affects negatively the correct behaviours (OR 0.56, 95% CI 0.34-0.95), as well as the years of work (OR 0.97, 95% CI 0.94-0.99). CONCLUSIONS The results of this multicentre study are encouraging. Nurses who have a good command of the English language (sufficient, good, and excellent) dedicate more than an hour per week to the bibliography update. Extending and deepening the knowledge of the nurses in a cyclical way might be an effective strategy to keep a high level of security of the drugs in the ICUs. The study highlighted that almost all the surveyed nurses (93%) are aware that an adequate knowledge of the drugs dosage calculation is essential to reduce the occurrence of medication errors in the drugs preparation phase.
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Affiliation(s)
- Marco Di Muzio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | | | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
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Hopkinson SG, Wiegand DL. The culture contributing to interruptions in the nursing work environment: An ethnography. J Clin Nurs 2017; 26:5093-5102. [PMID: 28833728 DOI: 10.1111/jocn.14052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2017] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To understand the occurrence of interruptions within the culture of the medical nursing unit work environment. BACKGROUND Interruptions may lead to errors in nursing work. Little is known about how the culture of the nursing work environment contributes to interruptions. DESIGN A micro-focused ethnographic study was conducted. METHOD Data collection involved extensive observation of a nursing unit, 1:1 observations of nurses and follow-up interviews with the nurses. Data were analysed from unstructured field notes and interview transcripts. The definitions of interruption and culture guided coding, categorising and identification of themes. RESULTS A framework was developed that describes the medical nursing unit as a complex culture full of unpredictable, nonlinear changes that affect the entire interconnected system, often in the form of an interruption. The cultural elements contributing to interruptions included (i) the value placed on excellence in patient care and meeting personal needs, (ii) the beliefs that the nurses had to do everything by themselves and that every phone call was important, (iii) the patterns of changing patients, patient transport and coordination of resources and (iv) the normative practices of communicating and adapting. CONCLUSIONS Interruptions are an integral part of the culture of a medical nursing unit. Uniformly decreasing interruptions may disrupt current practices, such as communication to coordinate care, that are central to nursing work. In future research, the nursing work environment must be looked at through the lens of a complex system. RELEVANCE TO CLINICAL PRACTICE Interventions to minimise the negative impact of interruptions must take into account the culture of the nursing as a complex adaptive system. Nurses should be educated on their own contribution to interruptions and issues addressed at a system level, rather than isolating the interruption as the central issue.
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Affiliation(s)
- Susan G Hopkinson
- School of Nursing, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Debra L Wiegand
- School of Nursing, University of Maryland, Baltimore, Baltimore, MD, USA
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Xu J, Reale C, Slagle JM, Anders S, Shotwell MS, Dresselhaus T, Weinger MB. Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units. Nurs Res 2017; 66:337-349. [PMID: 28858143 PMCID: PMC5679090 DOI: 10.1097/nnr.0000000000000240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. OBJECTIVES The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. METHODS We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. RESULTS MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. DISCUSSION Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.
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Affiliation(s)
- Jie Xu
- Jie Xu, PhD, is Research Instructor, Department of Anesthesiology, School of Medicine, Vanderbilt University, and The Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee. Carrie Reale, RN-BC, MSN, is Informatics Nurse Specialist, Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee. Jason M. Slagle, PhD, is Associate Professor of Anesthesiology; and Shilo Anders, PhD, is Assistant Professor of Anesthesiology, School of Medicine, Vanderbilt University, and The Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee. Matthew S. Shotwell, PhD, is Assistant Professor of Anesthesiology and Biostatistics School of Medicine, Vanderbilt University, and The Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee. Timothy Dresselhaus, MD, MPH, is Chief of Primary Care Service, VA San Diego Healthcare System, and Clinical Professor, Department of Medicine, University of California, San Diego. Matthew B. Weinger, MD, is Professor and Vice Chair of Anesthesiology, Professor of Biomedical Informatics and Medical Education, Norman Ty Smith Chair in Patient Safety and Medical Simulation, School of Medicine, Vanderbilt University; Director, The Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center; and Senior Physician Scientist, Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
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12
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Häggström M, Bergsman AC, Månsson U, Holmström MR. Learning to manage vasoactive drugs-A qualitative interview study with critical care nurses. Intensive Crit Care Nurs 2017; 39:1-8. [PMID: 28108169 DOI: 10.1016/j.iccn.2016.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 09/14/2016] [Accepted: 09/17/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Being a nurse in an intensive care unit entails caring for seriously ill patients. Vasoactive drugs are one of the tools that are used to restore adequate circulation. Critical care nurses often manage and administer these potent drugs after medical advice from physicians. AIM To describe the experiences of critical care nurses learning to manage vasoactive drugs, and to highlight the competence required to manage vasoactive drugs. RESEARCH METHODOLOGY/SETTING Twelve critical care nurses from three hospitals in Sweden were interviewed. Qualitative content analysis was applied. RESULTS The theme "becoming proficient requires accuracy, practice and precaution" illustrated how critical care nurses learn to manage vasoactive drugs. Learning included developing cognitive, psychomotor, and effective skills. Sources for knowledge refers to specialist education combined with practical exercises, collegial support, and accessible routine documents. The competence required to manage vasoactive drugs encompassed well-developed safety thinking that included being careful, in control, and communicating failures. Specific skills were required such as titrating doses, being able to analyse and evaluate the technological assessments, adapting to the situation, and staying calm. CONCLUSION Learning to manage vasoactive drugs requires a supportive introduction for novices, collegial support, lifelong learning, and a culture of safety.
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Omura M, Levett-Jones T, Stone TE, Maguire J, Lapkin S. Measuring the impact of an interprofessional multimedia learning resource on Japanese nurses and nursing students using the Theory of Planned Behavior Medication Safety Questionnaire. Nurs Health Sci 2015; 17:500-6. [PMID: 26138636 DOI: 10.1111/nhs.12224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 04/01/2015] [Indexed: 11/30/2022]
Abstract
Interprofessional communication and teamwork are essential for medication safety; however, limited educational opportunities for health professionals and students to develop these skills exist in Japan. This study evaluated the impact of an interprofessional multimedia learning resource on registered nurses' and nursing students' intention to practice in a manner promoting medication safety. Using a quasi-experimental design, Japanese registered nurses and nursing students (n = 203) were allocated to an experimental (n = 109) or control group (n = 94). Behavioral intentions of medication safety and the predictor variables of attitudes, perceived behavioral control, and subjective norms were measured using a Japanese version of the Theory of Planned Behavior Medication Safety Questionnaire. Registered nurses in the experimental group demonstrated a greater intention to collaborate and practice in a manner that enhanced medication safety, evidenced by higher scores than the control group on all predictor variables. The results demonstrate the potential for interprofessional multimedia learning resources to positively impact the behaviors of Japanese registered nurses in relation to safe medication practices. Further research in other contexts and with other cohorts is warranted.
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Affiliation(s)
- Mieko Omura
- School of Nursing and Midwifery, The University of Newcastle, Australia
| | | | - Teresa Elizabeth Stone
- Faculty of Nursing and Health Sciences, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Jane Maguire
- School of Nursing and Midwifery, The University of Newcastle, Australia
| | - Samuel Lapkin
- Faculty of Health, University of Technology, Sydney, NSW, Australia
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15
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Ayoubian A, Habibi M, Yazdian P, Bagherian-Mahmoodabadi H, Arasteh P, Eghbali T, Emami Meybodi T. Survey of Nursery Errors in Healthcare Centers, Isfahan, Iran. Glob J Health Sci 2015; 8:43-8. [PMID: 26493426 PMCID: PMC4803973 DOI: 10.5539/gjhs.v8n3p43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 05/21/2015] [Indexed: 12/02/2022] Open
Abstract
Background & Aim: Nurse's mistakes usually have a strong effect on the patients trust and satisfaction in the health services systems, and it can also lead to stress and moral contradicts among nurses. This study has aimed to survey the rate of nurses’ mistakes, according to documents in the Isfahan Province during 2007-2012. Methods: The study was a descriptive cross-sectional study. The sample population consisted of all complaints concerning nursing services provided in hospitals, private clinics and other health service centers between 2007 and 2012, submitted to the Forensic Medicine Commission Office, in Isfahan. The data were collected by a cheklist and analyzed using SPSS version 16.0 software. Results: Out of 708 complaints, 70 (9.8%) cases were related to nurses. Twenty-four cases led to awards. The age range of nurses was 35-40 (25.7%). Out of 70 nurses with a record, 75% (53 people) were female and the rest were male. Sixty four nurses (91.4%) were working in hospitals. Negligence was the first basis of the court rulings (16 cases out of 24). Nurses’ recklessness in providing services was due to their convictions among 66.7% of the cases Conclusion: Although efforts to reduce and control nurses’ faults and mistakes depends on using a system for studying and removing the factors which lead to faults, human error is inevitable in every occupation and a 100% accurate operation is unreachable.
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Jiang SP, Chen J, Zhang XG, Lu XY, Zhao QW. Implementation of pharmacists' interventions and assessment of medication errors in an intensive care unit of a Chinese tertiary hospital. Ther Clin Risk Manag 2014; 10:861-6. [PMID: 25328401 PMCID: PMC4199561 DOI: 10.2147/tcrm.s69585] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Pharmacist interventions and medication errors potentially differ between the People’s Republic of China and other countries. This study aimed to report interventions administered by clinical pharmacists and analyze medication errors in an intensive care unit (ICU) in a tertiary hospital in People’s Republic of China. Method A prospective, noncomparative, 6-month observational study was conducted in a general ICU of a tertiary hospital in the People’s Republic of China. Clinical pharmacists performed interventions to prevent or resolve medication errors during daily rounds and documented all of these interventions and medication errors. Such interventions and medication errors were categorized and then analyzed. Results During the 6-month observation period, a total of 489 pharmacist interventions were reported. Approximately 407 (83.2%) pharmacist interventions were accepted by ICU physicians. The incidence rate of medication errors was 124.7 per 1,000 patient-days. Improper drug frequency or dosing (n=152, 37.3%), drug omission (n=83, 20.4%), and potential or actual occurrence of adverse drug reaction (n=54, 13.3%) were the three most commonly committed medication errors. Approximately 339 (83.4%) medication errors did not pose any risks to the patients. Antimicrobials (n=171, 35.0%) were the most frequent type of medication associated with errors. Conclusion Medication errors during prescription frequently occurred in an ICU of a tertiary hospital in the People’s Republic of China. Pharmacist interventions were also efficient in preventing medication errors.
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Affiliation(s)
- Sai-Ping Jiang
- Department of Pharmacy, Zhejiang University, Hangzhou, People's Republic of China
| | - Jian Chen
- Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xing-Guo Zhang
- Department of Pharmacy, Zhejiang University, Hangzhou, People's Republic of China
| | - Xiao-Yang Lu
- Department of Pharmacy, Zhejiang University, Hangzhou, People's Republic of China
| | - Qing-Wei Zhao
- Department of Pharmacy, Zhejiang University, Hangzhou, People's Republic of China
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