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Ramos SF, do Sacramento LG, de Silva ROS, Aires-Moreno GT, Dos Santos Gomes J, Mesquita AR, Lima EC, de Lyra DP. Moderate and serious adverse reactions to antimicrobials among hospitalized children: A systematic review. Br J Clin Pharmacol 2024; 90:2092-2110. [PMID: 38957966 DOI: 10.1111/bcp.16153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024] Open
Abstract
AIMS This systematic review aimed to investigate the occurrence of moderate and severe adverse drug reactions (ADRs) to antimicrobials among hospitalized children. METHODS The PubMed/Medline, Cochrane Library, Embase, Web of Science, Scopus, Lilacs and CINAHL databases were searched in April 2023 to systematically review the published data describing the characteristics of moderate and severe ADRs to antimicrobials among hospitalized children. The search was carried out without date restrictions, up to the search date (April, 2023). RESULTS At the end of the selection process, 30 articles met the inclusion criteria. Cutaneous reactions were the primary serious clinical manifestations in most articles (19/30), followed by erythema multiforme (71 cases), Stevens-Johnson syndrome (72 cases), and toxic epidermal necrolysis (22 cases). The main antimicrobials involved in moderate and severe ADRs were penicillins, cephalosporins and sulfonamides. Regarding the primary outcomes, 30% (9/30) of the articles reported deaths, and 46.7% (14/30) of studies reported increased lengths of hospital stay, need for intensive care, and transfer to another hospital. Regarding the main interventions, 10% (3/30) of the articles mentioned greater monitoring, suspension, medication substitution or prescription of specific medications for the symptomatology. CONCLUSIONS The findings of this review could be used to identify areas for improvement and help health professionals and policymakers develop strategies. In addition, we emphasize the importance of knowing about ADRs so that there is adequate management to avoid undesirable consequences.
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Affiliation(s)
- Sheila Feitosa Ramos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Health Sciences Graduate Program, Federal University of Sergipe, São Cristóvão, Brazil
| | - Letícia Gomes do Sacramento
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Health Sciences Graduate Program, Federal University of Sergipe, São Cristóvão, Brazil
| | - Rafaella Oliveira Santos de Silva
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Health Sciences Graduate Program, Federal University of Sergipe, São Cristóvão, Brazil
| | - Giulyane Targino Aires-Moreno
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Health Sciences Graduate Program, Federal University of Sergipe, São Cristóvão, Brazil
| | - Jonas Dos Santos Gomes
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Health Sciences Graduate Program, Federal University of Sergipe, São Cristóvão, Brazil
| | - Alessandra Rezende Mesquita
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Health Sciences Graduate Program, Federal University of Sergipe, São Cristóvão, Brazil
| | | | - Divaldo Pereira de Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Health Sciences Graduate Program, Federal University of Sergipe, São Cristóvão, Brazil
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Rout J, Essack S. Nurses' antimicrobial infusion practice under the spotlight. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S6-S7. [PMID: 39023023 DOI: 10.12968/bjon.2024.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Affiliation(s)
- Joan Rout
- Advanced Critical Care Nurse Specialist
| | - Sabiha Essack
- Professor and Head, Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Westbrook JI, Li L, Woods A, Badgery-Parker T, Mumford V, Merchant A, Fitzpatrick E, Raban MZ. Risk Factors Associated with Medication Administration Errors in Children: A Prospective Direct Observational Study of Paediatric Inpatients. Drug Saf 2024; 47:545-556. [PMID: 38443625 PMCID: PMC11116173 DOI: 10.1007/s40264-024-01408-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Limited evidence exists regarding medication administration errors (MAEs) on general paediatric wards or associated risk factors exists. OBJECTIVE The aim of this study was to identify nurse, medication, and work-environment factors associated with MAEs among paediatric inpatients. METHODS This was a prospective, direct observational study of 298 nurses in a paediatric referral hospital in Sydney, Australia. Trained observers recorded details of 5137 doses prepared and administered to 1530 children between 07:00 h and 22:00 h on weekdays and weekends. Observation data were compared with medication charts to identify errors. Clinical errors, potential severity and actual harm were assessed. Nurse characteristics (e.g. age, sex, experience), medication type (route, high-risk medications, use of solvent/diluent), and work variables (e.g. time of administration, weekday/weekend, use of an electronic medication management system [eMM], presence of a parent/carer) were collected. Multivariable models assessed MAE risk factors for any error, errors by route, potentially serious errors, and errors involving high-risk medication or causing actual harm. RESULTS Errors occurred in 37.0% (n = 1899; 95% confidence interval [CI] 35.7-38.3) of administrations, 25.8% (n = 489; 95% CI 23.8-27.9) of which were rated as potentially serious. Intravenous infusions and injections had high error rates (64.7% [n = 514], 95% CI 61.3-68.0; and 77.4% [n = 188], 95% CI 71.7-82.2, respectively). For intravenous injections, 59.7% (95% CI 53.4-65.6) had potentially serious errors. No nurse characteristics were associated with MAEs. Intravenous route, early morning and weekend administrations, patient age ≥ 11 years, oral medications requiring solvents/diluents and eMM use were all significant risk factors. MAEs causing actual harm were 45% lower using an eMM compared with paper charts. CONCLUSION Medication error prevention strategies should target intravenous administrations and not neglect older children in hospital. Attention to nurses' work environments, including improved design and integration of medication technologies, is warranted.
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Affiliation(s)
- Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia.
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
| | - Amanda Woods
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
| | - Tim Badgery-Parker
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
| | - Virginia Mumford
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
| | - Alison Merchant
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
| | - Erin Fitzpatrick
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
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Kuitunen S, Airaksinen M, Holmström AR. Evolution of Intravenous Medication Errors and Preventive Systemic Defenses in Hospital Settings-A Narrative Review of Recent Evidence. J Patient Saf 2024; 20:e29-e39. [PMID: 38536101 DOI: 10.1097/pts.0000000000001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Intravenous drug administration has been associated with severe medication errors in hospitals. The present narrative review is based on a systematic literature search, and aimed to describe the recent evolution in research on systemic causes and defenses in intravenous medication errors in hospitals. METHODS This narrative review was based on Reason's theory of systems-based risk management. A systematic literature search covering the period from June 2016 to October 2021 was conducted on Medline (Ovid). We used the search strategy and selection criteria developed for our previous systematic reviews. The included articles were analyzed and compared to our previous reviews. RESULTS The updated search found 435 articles. Of the 63 included articles, 16 focused on systemic causes of intravenous medication errors, and 47 on systemic defenses. A high proportion (n = 24, 38%) of the studies were conducted in the United States or Canada. Most of the studies focused on drug administration (n = 21/63, 33%) and preparation (n = 19/63, 30%). Compared to our previous review of error causes, more studies (n = 5/16, 31%) utilized research designs with a prospective risk management approach. Within articles related to systemic defenses, smart infusion pumps remained most widely studied (n = 10/47, 21%), while those related to preparation technologies (n = 7/47, 15%) had increased. CONCLUSIONS This narrative review demonstrates a growing interest in systems-based risk management for intravenous drug therapy and in introducing new technology, particularly smart infusion pumps and preparation systems, as systemic defenses. When introducing new technologies, prospective assessment and continuous monitoring of emerging safety risks should be conducted.
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Affiliation(s)
- Sini Kuitunen
- From the HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS)
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Anna-Riia Holmström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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Henry Basil J, Premakumar CM, Mhd Ali A, Mohd Tahir NA, Seman Z, Voo JYH, Ishak S, Mohamed Shah N. Prevalence and factors associated with medication administration errors in the neonatal intensive care unit: A multicentre, nationwide direct observational study. J Adv Nurs 2024. [PMID: 38803148 DOI: 10.1111/jan.16247] [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: 07/20/2023] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
AIM(S) To determine the prevalence of medication administration errors and identify factors associated with medication administration errors among neonates in the neonatal intensive care units. DESIGN Prospective direct observational study. METHODS The study was conducted in the neonatal intensive care units of five public hospitals in Malaysia from April 2022 to March 2023. The preparation and administration of medications were observed using a standardized data collection form followed by chart review. After data collection, error identification was independently performed by two clinical pharmacists. Multivariable logistic regression was used to identify factors associated with medication administration errors. RESULTS A total of 743 out of 1093 observed doses had at least one error, affecting 92.4% (157/170) neonates. The rate of medication administration errors was 68.0%. The top three most frequently occurring types of medication administration errors were wrong rate of administration (21.2%), wrong drug preparation (17.9%) and wrong dose (17.0%). Factors significantly associated with medication administration errors were medications administered intravenously, unavailability of a protocol, the number of prescribed medications, nursing experience, non-ventilated neonates and gestational age in weeks. CONCLUSION Medication administration errors among neonates in the neonatal intensive care units are still common. The intravenous route of administration, absence of a protocol, younger gestational age, non-ventilated neonates, higher number of medications prescribed and increased years of nursing experience were significantly associated with medication administration errors. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The findings of this study will enable the implementation of effective and sustainable interventions to target the factors identified in reducing medication administration errors among neonates in the neonatal intensive care unit. REPORTING METHOD We adhered to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION An expert panel consisting of healthcare professionals was involved in the identification of independent variables.
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Affiliation(s)
- Josephine Henry Basil
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chandini Menon Premakumar
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nurul Ain Mohd Tahir
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Zamtira Seman
- Sector for Biostatistics & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - James Yau Hon Voo
- Department of Pharmacy, Hospital Duchess of Kent, Ministry of Health Malaysia, Sabah, Malaysia
| | - Shareena Ishak
- Department of Pediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Aceves-Gonzalez C, Caro-Rojas A, Rey-Galindo JA, Aristizabal-Ruiz L, Hernández-Cruz K. Estimating the impact of label design on reducing the risk of medication errors by applying HEART in drug administration. Eur J Clin Pharmacol 2024; 80:575-588. [PMID: 38282080 PMCID: PMC10937752 DOI: 10.1007/s00228-024-03619-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
Medication errors are one of the biggest problems in healthcare. The medicines' poor labelling design (i.e. look-alike labels) is a well-recognised risk for potential confusion, wrong administration, and patient damage. Human factors and ergonomics (HFE) encourages the human-centred design of system elements, which might reduce medication errors and improve people's well-being and system performance. OBJECTIVE The aim of the present study is twofold: (i) to use a human reliability analysis technique to evaluate a medication administration task within a simulated scenario of a neonatal intensive care unit (NICU) and (ii) to estimate the impact of a human-centred design (HCD) label in medication administration compared to a look-alike (LA) label. METHOD This paper used a modified version of the human error assessment and reduction technique (HEART) to analyse a medication administration task in a simulated NICU scenario. The modified technique involved expert nurses quantifying the likelihood of unreliability of a task and rating the conditions, including medicine labels, which most affect the successful completion of the task. RESULTS Findings suggest that error producing conditions (EPCs), such as a shortage of time available for error detection and correction, no independent checking of output, and distractions, might increase human error probability (HEP) in administering medications. Results also showed that the assessed HEP and the relative percentage of contribution to unreliability reduced by more than 40% when the HCD label was evaluated compared to the LA label. CONCLUSION Including labelling design based on HFE might help increase human reliability when administering medications under critical conditions.
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Nunes GDK, Antunes LMS, da Silva RN, da Silva RC. Labelling of intravenous drug delivery devices in critically ill patients: A scoping review. Nurs Crit Care 2024; 29:274-286. [PMID: 37882508 DOI: 10.1111/nicc.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Labelling is a strategy that contributes to the correct and faster identification of drugs, minimizing misidentification. There is a gap in knowledge on optimal labelling standards for intravenous (IV) devices applied to the care of critically ill patients. AIM The goal of this article was to map existing knowledge on the labelling of IV drug delivery devices in critically ill patients for the prevention of medication errors. STUDY DESIGN This was a scoping review conducted according to the JBI methodology in the LILACS, MEDLINE, CINAHL, IBECS, Scopus, Embase and Web of Science databases, and on the websites of specialized institutions. Searches were conducted up to December 2022 for scientific articles and grey literature that addressed the labelling of IV devices in intensive care units, emergency departments, and anaesthesia units. The data were collected using a structured form and were later classified, summarized, and aggregated to map the knowledge related to the review question. RESULTS Twenty-one documents were included, which demonstrated variability in label use with IV drug delivery devices. The following features of structure and design stood out: printed format, colour coding, letter size differentiation, and the use of sturdy material. In terms of information, the name of the drug, dose, date and time of preparation, identification of the patient, and who prepared it were found. CONCLUSIONS The identified patterns contributed to the reduction of drug misidentification and the development of timelier drug labelling and administration. RELEVANCE TO CLINICAL PRACTICE The evidence supports the development of standardized labels for the prevention of medication errors.
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Affiliation(s)
- Geovane de Kassio Nunes
- Federal University of Rio de Janeiro, Anna Nery School of Nursing, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucas Malta Souza Antunes
- Federal University of Rio de Janeiro, Anna Nery School of Nursing, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo Nogueira da Silva
- Federal University of Rio de Janeiro, Anna Nery School of Nursing, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Celestino da Silva
- Federal University of Rio de Janeiro, Anna Nery School of Nursing, Rio de Janeiro, Rio de Janeiro, Brazil
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Gilliot S, Martin Mena A, Genay S, Masse M, Thibaut M, Carta N, Lannoy D, Négrier L, Barthélémy C, Décaudin B, Odou P. Factors influencing accuracy when preparing injectable drug concentrations in appliance with clinical practice: a norepinephrine case study. Eur J Hosp Pharm 2024; 31:168-170. [PMID: 35882533 PMCID: PMC10895172 DOI: 10.1136/ejhpharm-2022-003358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022] Open
Abstract
Errors in injectable preparations with high-risk drugs can be fatal. This study aimed to identify the factors influencing the accuracy of high-risk injectable drug concentrations in appliances used for intensive care unit preparation practices. Norepinephrine (NE) was chosen as an example of a high-risk medication drug. The concentration (0.2 and 0.5 mg/mL), the diluent (sodium chloride 0.9% and 5% dextrose), and the container type (prefilled- and empty-infusion bag and syringe) were tested as potential variability factors. An ultraviolet spectrophotometric method was used for NE dosage. 108 NE solutions were prepared by five individuals (pharmacists or laboratory technicians) with clinical experience as well as experience in the aseptic preparation of solutions. The container type was found to be the only factor influencing the accuracy of NE concentration. NE solutions in syringes proved to be the most accurate while preparations in prefilled bags tended to underdose NE.
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Affiliation(s)
- Sixtine Gilliot
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Anthony Martin Mena
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Stéphanie Genay
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Morgane Masse
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Manon Thibaut
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Natacha Carta
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Damien Lannoy
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Laura Négrier
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Christine Barthélémy
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Bertrand Décaudin
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Pascal Odou
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
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Meesters K, Chappell F, Demirjian A. Trends in Antibiotic Use in a Large Children's Hospital in London (United Kingdom): 5 Years of Point Prevalence Surveys. Antibiotics (Basel) 2024; 13:172. [PMID: 38391558 PMCID: PMC10886203 DOI: 10.3390/antibiotics13020172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
Background: Antibiotics are commonly prescribed in paediatrics. As their excessive use contributes to adverse drug events, increased healthcare costs, and antimicrobial resistance, antimicrobial stewardship initiatives are essential to optimising medical care. These single-centre point prevalence surveys aimed to provide insights into antibiotic prescribing trends and identify targets for paediatric AMS activities. Methods: 14 point prevalence surveys were conducted from March 2016-April 2021, collecting data on antibiotic prescriptions, indication, adherence to guidelines, and route of administration. The UK adapted the World Health Organisation's AWaRe classification-guided antibiotic categorization. Results: 32.5% of all inpatients were on at least one antimicrobial; this remained stable during all surveys (range: 20-44%, p = 0.448). Of all prescriptions, 67.2% had an end- or review-date, and the majority was for agents in the Watch category (46.8-70.5%). Amoxicillin and clavulanate were the most frequently prescribed antibiotics (20.8%), followed by gentamicin (15.3%). Approximately 28.8% of all prescriptions were for prophylactic indications, while 7.6% of the prescriptions were not adherent to the hospital guidelines. Conclusions: This study highlights the importance of ongoing monitoring and robust AMS initiatives to ensure prudent antibiotic prescribing in paediatric healthcare. It underscores the need for tailored guidelines, educational efforts, and targeted interventions to enhance the quality of antibiotic usage, ultimately benefiting both individual patients and public health.
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Affiliation(s)
- Kevin Meesters
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London SE1 7EH, UK
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - Faye Chappell
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London SE1 7EH, UK
| | - Alicia Demirjian
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London SE1 7EH, UK
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London NW9 5EQ, UK
- Faculty of Life Sciences & Medicine, King's College London, London WC2R 2LS, UK
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Kemp I, McKenzie C. Intravenous antimicrobial infusions: Getting it right every time, some of the time. Intensive Crit Care Nurs 2024; 80:103569. [PMID: 37925814 DOI: 10.1016/j.iccn.2023.103569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Ivan Kemp
- Department of Pharmacy and Critical Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Cathrine McKenzie
- Department of Pharmacy and Critical Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Medicine, University of Southampton, National Institute of Health and Care Research (NIHR), Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, and NIHR Wessex Applied Research Collaborative, Southampton, UK; Institute of Pharmaceutical Sciences, School of Cancer and Pharmacy, King's College, London, UK
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11
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Allison Rout J, Yusuf Essack S, Brysiewicz P. Evaluation of intermittent antimicrobial infusion documentation practices in intensive care units: A cross-sectional study. Intensive Crit Care Nurs 2023; 79:103527. [PMID: 37651822 DOI: 10.1016/j.iccn.2023.103527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To observe nurse administration of carbapenem antibiotics, in the context of medication safety measures, in intensive care units. RESEARCH METHODOLOGY/DESIGN A quantitative study was conducted using observation principles. SETTING Three adult private and public Intensive Care Units in the health district of a capital city in KwaZulu-Natal, South Africa. MAIN OUTCOME MEASURES Nurse practices were observed for double-checking of the medication order, medication vial, and method of preparation and administration. Infusion bags were inspected for nurse labelling of medication and patient details. Patient medication treatment charts were inspected for nurse signature. RESULTS Carbapenem infusion administrations (n = 223) to twenty patients were observed. Adherence to the scheduled time occurred in 34.9% administrations, 5.4% doses were not given, and an incorrect dose given on 1.4% administrations. One hundred and forty-four (64.6%) infusion bags were inspected during the administrations: there was no medication label affixed to 21.5% bags, and only 8.3% of bags were labelled with essential details; the patient's name, drug, dose, date, time, signature of the nurse mixing and administering the dose, and signature of the secondary nurse. CONCLUSION There was a lack of compliance with accepted medication risk mitigation measures. Sub-optimal double-checking resulted in the incorrect dose given, missed dose, and non-adherence to scheduled administration time. This has implications for the optimal administration of antimicrobial medications, raising concerns about the efficacy of treatment for critically ill patients. IMPLICATIONS FOR CLINICAL PRACTICE Parenteral administration errors pose a challenge in acute care areas. Risk mitigation measures include double-checking of medications. If antimicrobial treatment is not administered at the prescribed dosing intervals, this may have implications for the efficacy of time-dependent broad-spectrum antibiotics such as carbapenems. Medication administration errors involving antimicrobial medications should therefore be considered as high-risk errors, with the potential to contribute towards antimicrobial resistance.
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Affiliation(s)
- Joan Allison Rout
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Sabiha Yusuf Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Petra Brysiewicz
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Chang CWJ, Provencio JJ, Pascual J, Heavner MS, Olson D, Livesay SL, Kaplan LJ. State-of-the-Art Evaluation of Acute Adult Disorders of Consciousness for the General Intensivist. Crit Care Med 2023; 51:948-963. [PMID: 37070819 DOI: 10.1097/ccm.0000000000005893] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVES To provide a concise review of knowledge and practice pertaining to the diagnosis and initial management of unanticipated adult patient disorders of consciousness (DoC) by the general intensivist. DATA SOURCES Detailed search strategy using PubMed and OVID Medline for English language articles describing adult patient acute DoC diagnostic evaluation and initial management strategies including indications for transfer. STUDY SELECTION Descriptive and interventional studies that address acute adult DoC, their evaluation and initial management, indications for transfer, as well as outcome prognostication. DATA EXTRACTION Relevant descriptions or studies were reviewed, and the following aspects of each manuscript were identified, abstracted, and analyzed: setting, study population, aims, methods, results, and relevant implications for adult critical care practice. DATA SYNTHESIS Acute adult DoC may be categorized by etiology including structural, functional, infectious, inflammatory, and pharmacologic, the understanding of which drives diagnostic investigation, monitoring, acute therapy, and subsequent specialist care decisions including team-based local care as well as intra- and inter-facility transfer. CONCLUSIONS Acute adult DoC may be initially comprehensively addressed by the general intensivist using an etiology-driven and team-based approach. Certain clinical conditions, procedural expertise needs, or resource limitations inform transfer decision-making within a complex care facility or to one with greater complexity. Emerging collaborative science helps improve our current knowledge of acute DoC to better align therapies with underpinning etiologies.
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Affiliation(s)
| | | | - Jose Pascual
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mojdeh S Heavner
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - DaiWai Olson
- Departments of Neurology and Neurosurgery, University of Texas Southwestern, Dallas, TX
| | - Sarah L Livesay
- Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University, Chicago, IL
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Jessurun JG, Hunfeld NGM, de Roo M, van Onzenoort HAW, van Rosmalen J, van Dijk M, van den Bemt PMLA. Prevalence and determinants of medication administration errors in clinical wards: A two-centre prospective observational study. J Clin Nurs 2023; 32:208-220. [PMID: 35068001 DOI: 10.1111/jocn.16215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/21/2021] [Accepted: 01/02/2022] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To identify the prevalence and determinants of medication administration errors (MAEs). BACKGROUND Insight into determinants of MAEs is necessary to identify interventions to prevent MAEs. DESIGN A prospective observational study in two Dutch hospitals, a university and teaching hospital. METHODS Data were collected by observation. The primary outcome was the proportion of administrations with one or more MAEs. Secondary outcomes were the type, severity and determinants of MAEs. Multivariable mixed-effects logistic regression analyses were used for determinant analysis. Reporting adheres to the STROBE guideline. RESULTS MAEs occurred in 352 of 2576 medication administrations (13.7%). Of all MAEs (n = 380), the most prevalent types were omission (n = 87) and wrong medication handling (n = 75). Forty-five MAEs (11.8%) were potentially harmful. The pharmaceutical forms oral liquid (odds ratio [OR] 3.22, 95% confidence interval [CI] 1.43-7.25), infusion (OR 1.73, CI 1.02-2.94), injection (OR 3.52, CI 2.00-6.21), ointment (OR 10.78, CI 2.10-55.26), suppository/enema (OR 6.39, CI 1.13-36.03) and miscellaneous (OR 6.17, CI 1.90-20.04) were more prone to MAEs compared to oral solid. MAEs were more likely to occur when medication was administered between 10 a.m.-2 p.m. (OR 1.91, CI 1.06-3.46) and 6 p.m.-7 a.m. (OR 1.88, CI 1.00-3.52) compared to 7 a.m.-10 a.m. and when administered by staff with higher professional education compared to staff with secondary vocational education (OR 1.68, CI 1.03-2.74). MAEs were less likely to occur in the teaching hospital (OR 0.17, CI 0.08-0.33). Day of the week, patient-to-nurse ratio, interruptions and other nurse characteristics (degree, experience, employment type) were not associated with MAEs. CONCLUSIONS This study identified a high MAE prevalence. Identified determinants suggest that focusing interventions on complex pharmaceutical forms and error-prone administration times may contribute to MAE reduction. RELEVANCE TO CLINICAL PRACTICE The findings of this study can be used to develop targeted interventions to improve patient safety.
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Affiliation(s)
- Janique Gabriëlle Jessurun
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicole Geertruida Maria Hunfeld
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michelle de Roo
- Department of Clinical Pharmacy, Amphia Hospital, Breda, The Netherlands
| | | | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Patricia Maria Lucia Adriana van den Bemt
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
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14
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Jessurun JG, Hunfeld NG, van Rosmalen J, van Dijk M, van den Bemt PM. Effect of a Pharmacy-based Centralized Intravenous Admixture Service on the Prevalence of Medication Errors: A Before-and-After Study. J Patient Saf 2022; 18:e1181-e1188. [PMID: 35786788 PMCID: PMC9698191 DOI: 10.1097/pts.0000000000001047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Intravenous admixture preparation errors (IAPEs) may lead to patient harm. The primary aim of this study was to assess the effect of a pharmacy-based centralized intravenous admixture service (CIVAS) on IAPEs. METHODS We conducted a before-and-after study in 3 clinical wards before CIVAS implementation and in the CIVAS unit 18 months after implementation. Intravenous admixture preparation error data were collected by disguised observation. The primary outcome was the proportion of admixtures with 1 or more IAPEs. Secondary outcomes were the type and potential severity of IAPEs, noncompliance to hygiene procedures, and nursing staff satisfaction with the CIVAS. The primary outcome was analyzed using a multivariable mixed-effects logistic regression model. RESULTS One or more IAPEs were identified in 14 of 543 admixtures (2.6%) in the CIVAS unit and in 148 of 282 admixtures (52.5%) in the clinical wards (odds ratio, 0.02; 95% confidence interval, 0.004-0.05). The most common IAPE types were wrong solvent or diluent (n = 95) and wrong volume of infusion fluid (n = 45). No potentially harmful IAPEs occurred in the CIVAS unit as opposed to 22 (7.8%) in the clinical wards. Disinfection procedures were better adhered to in the CIVAS unit. Overall nurse satisfaction with the CIVAS increased from a median of 70 (n = 166) 5 months after intervention to 77 (n = 115) 18 months after intervention ( P < 0.001) on a 100-point scale. CONCLUSIONS Centralized intravenous admixture service performed notably better than the clinical wards with regard to IAPEs and noncompliance to hygiene procedures. Nurses were satisfied with the CIVAS. Hence, the implementation of CIVAS is an important strategy to improve medication safety in hospitals.
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Affiliation(s)
| | | | - Joost van Rosmalen
- Biostatistics
- Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam
| | - Monique van Dijk
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen
| | - Patricia M.L.A. van den Bemt
- From the Departments of Hospital Pharmacy
- Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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15
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Naseralallah L, Stewart D, Azfar Ali R, Paudyal V. An umbrella review of systematic reviews on contributory factors to medication errors in healthcare settings. Expert Opin Drug Saf 2022; 21:1379-1399. [DOI: 10.1080/14740338.2022.2147921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Lina Naseralallah
- School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Derek Stewart
- Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Ruba Azfar Ali
- School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
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16
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Park J, You SB, Kim H, Park C, Ryu GW, Kwon S, Kim Y, Lee S, Lee K. Experience of Nurses with Intravenous Fluid Monitoring for Patient Safety: A Qualitative Descriptive Study. Risk Manag Healthc Policy 2022; 15:1783-1793. [PMID: 36171867 PMCID: PMC9512022 DOI: 10.2147/rmhp.s374563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/12/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Medication administration is a complex process and constitutes a substantial component of nursing practice that is closely linked to patient safety. Although intravenous fluid administration is one of the most frequently performed nursing tasks, nurses’ experiences with intravenous rate control have not been adequately studied. This study aimed to explore nurses’ experiences with infusion nursing practice to identify insights that could be used in interventions to promote safe medication administration. Patients and methods This qualitative descriptive study used focus group interviews of 20 registered nurses who frequently administered medications in tertiary hospitals in South Korea. Data were collected through five semi-structured focus group interviews, with four nurses participating in each interview. We conducted inductive and deductive content analysis based on the 11 key topics of patient safety identified by the World Health Organization. Reporting followed the consolidated criteria for reporting qualitative research (COREQ) checklist. Results Participants administered infusions in emergency rooms, general wards, and intensive care units, including patients ranging from children to older adults. Two central themes were revealed: human factors and systems. Human factors consisted of two sub-themes including individuals and team players, while systems encompassed three sub-themes including institutional policy, culture, and equipment. Conclusion This study found that nurses experienced high levels of stress when administering infusions in the correct dose and rate for patient safety. Administering and monitoring infusions were complicated because nursing processes interplay with human and system factors. Future research is needed to develop nursing interventions that include human and system factors to promote patient safety by reducing infusion-related errors.
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Affiliation(s)
- Jeongok Park
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
| | - Sang Bin You
- Yonsei University College of Nursing, Seoul, South Korea
| | - Hyejin Kim
- Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Cheolmin Park
- Department of Materials Science and Engineering, Yonsei University, Seoul, South Korea
| | - Gi Wook Ryu
- Department of Nursing, Hansei University, Gunpo-si, South Korea
| | - Seongae Kwon
- Yonsei University College of Nursing, Seoul, South Korea
| | - Youngkyung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Sejeong Lee
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Kayoung Lee
- Gachon University College of Nursing, Incheon, South Korea
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17
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Arslan S, Fidan Ö, Şanlialp Zeyrek A, Ok D. Intravenous medication errors in the emergency department, knowledge, tendency to make errors and affecting factors: An observational study. Int Emerg Nurs 2022; 63:101190. [PMID: 35809484 DOI: 10.1016/j.ienj.2022.101190] [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: 11/29/2021] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intravenous medication errors are common in hospital settings particularly emergency department. This study aimed to determine intravenous medication preparation and administration errors, contributing factors, tendency towards making errors and knowledge level of emergency department healthcare workers. METHODS A cross-sectional study using a structured, direct observation method was conducted. It was conducted with 23 emergency healthcare workers working in the emergency department of a university hospital in Turkey. Data were collected by questionnaires: Knowledge Test on Intravenous Medication Administration, Intravenous Drug Administration Standard Observation Form, Drug and Transfusion Administration Sub-Dimension scale, Perceived Stress Scale and Pittsburgh Sleep Quality Index. RESULTS It was determined that the knowledge level of the emergency healthcare workers about intravenous medication administration was moderate, and the tendency mistakes regarding drug and transfusion applications was very low. There was no relationship between education level, years of work, years of work in the emergency department, perceived stress level and sleep quality, and the tendency of making mistakes in drug and transfusion applications. CONCLUSION It is important for patient safety to prevent medication errors by determining the factors affecting intravenous medication administration, tendency to make mistakes and knowledge levels, which are frequently used in emergency department.
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Affiliation(s)
| | - Özlem Fidan
- Pamukkale University: Pamukkale Universitesi, Turkey.
| | | | - Durdu Ok
- Pamukkale University: Pamukkale Universitesi, Turkey
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18
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Qedan RI, Daibes MA, Al-Jabi SW, Koni AA, Zyoud SH. Nurses' knowledge and understanding of obstacles encountered them when administering resuscitation medications: a cross-sectional study from Palestine. BMC Nurs 2022; 21:116. [PMID: 35578234 PMCID: PMC9109424 DOI: 10.1186/s12912-022-00895-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 05/09/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Medication errors (ME) are one of the most important reasons for patient morbidity and mortality, but insufficient drug knowledge among nurses is considered a major factor in drug administration errors. Furthermore, the complex and stressful systems surrounding resuscitation events increase nursing errors. AIMS This study aimed to assess the knowledge about resuscitation medications and understand the obstacles faced by nurses when giving resuscitation medications. Additionally, errors in the reporting of resuscitation medication administration and the reasons that prevented nurses from reporting errors were investigated. METHODS A cross-sectional study was conducted in the West Bank, Palestine. Convenient sampling was used to collect data, which was collected via a face-to-face interview questionnaire taken from a previous study. The questionnaire consisted of five parts: demographic data, knowledge of resuscitation medications (20 true/false questions), self-evaluation and causes behind not reporting ME, with suggestions to decrease ME. RESULTS A total of 200 nurses participated in the study. Nurses were found to have insufficient knowledge about resuscitation medications (58.6%). A high knowledge score was associated with male nurses, those working in the general ward, the cardiac care unit (CCU), the intensive care unit (ICU) and the general ward. The main obstacles nurses faced when administering resuscitation medication were the chaotic environment in cardiopulmonary resuscitation (62%), the unavailability of pharmacists for a whole day (61%), and different medications that look alike in the packaging (61%). Most nurses (70.5%) hoped to gain additional training. In our study, we found no compatibility in the definition of ME between nurses and hospitals (43.5%). CONCLUSIONS Nurses had insufficient knowledge of resuscitation medications. One of the obstacles nurses faced was that pharmacists should appropriately arrange medications, and nurses wanted continuous learning and additional training about resuscitation medications to decrease ME.
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Affiliation(s)
- Rawan I Qedan
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Marah A Daibes
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Samah W Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Amer A Koni
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Division of Clinical Pharmacy, Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
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19
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Trikha A, Kaur M, Yalla B. Medication errors in a parturient: A huge cost to two lives. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.4103/joacc.joacc_17_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Prevalence and determinants of intravenous admixture preparation errors: A prospective observational study in a university hospital. Int J Clin Pharm 2021; 44:44-52. [PMID: 34363192 PMCID: PMC8866293 DOI: 10.1007/s11096-021-01310-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/22/2021] [Indexed: 11/22/2022]
Abstract
Background Intravenous admixture preparation errors (IAPEs) may lead to patient harm. Insight into the prevalence as well as the determinants associated with these IAPEs is needed to elicit preventive measures. Aim The primary aim of this study was to assess the prevalence of IAPEs. Secondary aims were to identify the type, severity, and determinants of IAPEs. Method A prospective observational study was performed in a Dutch university hospital. IAPE data were collected by disguised observation. The primary outcome was the proportion of admixtures with one or more IAPEs. Descriptive statistics were used for the prevalence, type, and severity of IAPEs. Mixed-effects logistic regression analyses were used to estimate the determinants of IAPEs. Results A total of 533 IAPEs occurred in 367 of 614 admixtures (59.8%) prepared by nursing staff. The most prevalent errors were wrong preparation technique (n = 257) and wrong volume of infusion fluid (n = 107). Fifty-nine IAPEs (11.1%) were potentially harmful. The following variables were associated with IAPEs: multistep versus single-step preparations (adjusted odds ratio [ORadj] 4.08, 95% confidence interval [CI] 2.27–7.35); interruption versus no interruption (ORadj 2.32, CI 1.13–4.74); weekend versus weekdays (ORadj 2.12, CI 1.14–3.95); time window 2 p.m.-6 p.m. versus 7 a.m.-10 a.m. (ORadj 3.38, CI 1.60–7.15); and paediatric versus adult wards (ORadj 0.14, CI 0.06–0.37). Conclusion IAPEs, including harmful IAPEs, occurred frequently. The determinants associated with IAPEs point to factors associated with preparation complexity and working conditions. Strategies to reduce the occurrence of IAPEs and therefore patient harm should target the identified determinants.
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21
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Elonen I, Salminen L, Brasaitė-Abromė I, Fuster P, Kukkonen P, Leino-Kilpi H, Löyttyniemi E, Noonan B, Stubner J, Svavarsdóttir MH, Thorsteinsson H, Koskinen S. Medication calculation skills of graduating nursing students within European context. J Clin Nurs 2021; 31:548-558. [PMID: 34101280 DOI: 10.1111/jocn.15908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/29/2021] [Accepted: 05/07/2021] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study is to evaluate the medication calculation skills of graduating nursing students in six European countries and analyse the associated factors. BACKGROUND Medication calculation skills are fundamental to medication safety, which is a substantial part of patient safety. Previous studies have raised concerns about the medication calculation skills of nurses and nursing students. DESIGN As part of a broader research project, this study applies a multinational cross-sectional survey design with three populations: graduating nursing students, nurse managers and patients. METHODS The students performed two calculations (tablet and fluid) testing medication calculation skills requiring different levels of conceptual understanding and arithmetic. The managers and patients answered one question about the students' medication kills. In total, 1,796 students, 538 managers and 1,327 patients participated the study. The data were analysed statistically. The STROBE guideline for cross-sectional studies was applied. RESULTS Almost all (99%) of the students performed the tablet calculation correctly, and the majority (71%) answered the fluid calculation correctly. Older age, a previous degree in health care and satisfaction with their current degree programme was positively associated with correct fluid calculations. The patients evaluated the students' medication skills higher than the nurse managers did and the evaluations were not systematically aligned with the calculation skills tested. CONCLUSIONS Nursing students have the skills to perform simple medication calculations, but a significant number of students have difficulties with calculations involving multiple operations and a higher level of conceptual understanding. Due to the variation in students' medication calculation skills and the unalignment between the managers' and patients' evaluations and the calculation tests, further research is needed. RELEVANCE TO CLINICAL PRACTICE Graduating nursing students enter clinical field as qualified professionals, but there is still room for improvement in their medication calculation skills. This calls for attention in the fields of clinical nursing, education and research.
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Affiliation(s)
- Imane Elonen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Leena Salminen
- Department of Nursing Science and Nurse Director, University of Turku, Turku University Hospital, Turku, Finland
| | | | - Pilar Fuster
- Nursing Department, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
| | - Pia Kukkonen
- Department of Nursing Science, University of Turku, Finland, Turku University Hospital, Turku, Finland
| | - Helena Leino-Kilpi
- FAAN, FEANS, University of Turku and Nurse Director, Turku University Hospital, Turku, Finland
| | | | - Brendan Noonan
- University College Cork, School of Nursing and Midwifery, Cork, Ireland
| | - Juliane Stubner
- Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Science, Halle, Germany
| | | | - Hrund Thorsteinsson
- Faculty of Nursing, Department of Development and Education, University of Iceland, Landspitali University Hospital, Reykjavik, Iceland
| | - Sanna Koskinen
- Department of Nursing Science, University of Turku, Turku, Finland
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22
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Campbell AA, Harlan T, Campbell M, Mulekar MS, Wang B. Nurse's Achilles Heel: Using Big Data to Determine Workload Factors That Impact Near Misses. J Nurs Scholarsh 2021; 53:333-342. [PMID: 33786985 DOI: 10.1111/jnu.12652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore how big data can be used to identify the contribution or influence of six specific workload variables: patient count, medication count, task count call lights, patient sepsis score, and hours worked on the occurrence of a near miss (NM) by individual nurses. DESIGN A correlational and cross-section research design was used to collect over 82,000 useable data points of historical workload data from the three unique systems on a medical-surgical unit in a midsized hospital in the southeast United States over a 60-day period. Data were collected prior to the start of the Covid-19 pandemic in the United States. METHODS Combined data were analyzed using JMP Pro version 12. Mean responses from two groups were compared using a t-test and those from more than two groups using analysis of variance. Logistic regression was used to determine the significance of impact each workload variable had on individual nurses' ability to administer medications successfully as measured by occurrence of NMs. FINDINGS The mean outcome of each of the six workload factors measured differed significantly (p < .0001) among nurses. The mean outcome for all workload factors except the hours worked was found to be significantly higher (p < .0001) for those who committed an NM compared to those who did not. At least one workload variable was observed to be significantly associated (p < .05) with the occurrence or nonoccurrence of NMs in 82.6% of the nurses in the study. CONCLUSIONS For the majority of the nurses in our study, the occurrence of an NM was significantly impacted by at least one workload variable. Because the specific variables that impact performance are different for each individual nurse, decreasing only one variable, such as patient load, will not adequately address the risk for NMs. Other variables not studied here, such as education and experience, might be associated with the occurrence of NMs. CLINICAL RELEVANCE In the majority of nurses, different workload variables increase their risk for an NM, suggesting that interventions addressing medication errors should be implemented based on the individual's risk profile.
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Affiliation(s)
- Amy A Campbell
- Professor, College of Nursing, Department of Community Mental Health, University of South Alabama, Mobile, AL, USA
| | - Todd Harlan
- Chair and Professor, College of Nursing, Department of Community Mental Health, University of South Alabama, Mobile, AL, USA
| | - Matt Campbell
- Professor, School of Computing, Department of Information Systems Technology, University of South Alabama, Mobile, AL, USA
| | - Madhuri S Mulekar
- Chair and Professor, Department of Mathematics and Statistics, University of South Alabama, Mobile, AL, USA
| | - Bin Wang
- Professor, Department of Mathematics and Statistics, University of South Alabama, Mobile, AL, USA
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Giuliano KK, Blake JW. Nurse and Pharmacist Knowledge of Intravenous Smart Pump System Setup Requirements. Biomed Instrum Technol 2021; 55:51-58. [PMID: 33751021 PMCID: PMC8641421 DOI: 10.2345/0899-8205-55.1.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The primary purpose of this research was to describe nurse and pharmacist knowledge of setup requirements for intravenous (IV) smart pumps that require head height differentials for accurate fluid flow. METHODS A secondary analysis of anonymous electronic survey data using a database of prerecruited clinicians was conducted. A survey was sent by email to 173 pharmacists and 960 nurses. The response rate for pharmacists was 58% (100 of 173), and the response rate for nurses was 52% (500 of 960). After removing respondents who did not provide direct care and who did not use a head height differential IV infusion system, the final sample for analysis was 186 nurses and 25 pharmacists. RESULTS Overall, less than one-half of respondents (40%) were aware that manufacturer guidelines for positioning the primary infusion bag relative to the infusion pump were available. Slightly more (49.5%) were aware of the required head height differentials for secondary infusion. Only five respondents selected the correct primary head height, eight respondents selected the correct secondary head height, and one respondent selected both the correct primary and secondary head heights. CONCLUSION The results of this study identify a substantial lack of knowledge among frontline clinicians regarding manufacturer recommendations for accurate IV administration of primary and secondary infusions for head height differential infusion systems. Both increased clinician education and innovative technology solutions are needed to improve IV smart pump safety and usability.
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Affiliation(s)
- Karen K. Giuliano
- Karen K. Giuliano, PhD, RN, FAAN, is an associate professor (joint) in the Institute for Applied Life Sciences and College of Nursing at the University of Massachusetts Amherst.
| | - Jeannine W.C. Blake
- Jeannine W.C. Blake, MS, RN, is a doctoral student in the Institute for Applied Life Sciences and College of Nursing at the University of Massachusetts Amherst.
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