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Neyens DM, Yin R, Abernathy JH, Tobin C, Jaruzel C, Catchpole K. The movement of syringes and medication during anesthesiology delivery: An observational study in laparoscopic surgeries. APPLIED ERGONOMICS 2024; 118:104263. [PMID: 38537520 PMCID: PMC11230132 DOI: 10.1016/j.apergo.2024.104263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/06/2024] [Accepted: 02/26/2024] [Indexed: 05/03/2024]
Abstract
The movements of syringes and medications during an anesthetic case have yet to be systematically documented. We examine how syringes and medication move through the anesthesia work area during a case. We conducted a video-based observational study of 14 laparoscopic surgeries. We defined 'syringe events' as when syringe was picked up and moved. Medications were administered to the patient in only 48 (23.6%) of the 203 medication or syringe events. On average, 14.5 syringe movements occurred in each case. We estimate approximately 4.2 syringe movements for each medication administration. When a medication was administered to the patient (either through the IV pump or the patient port), it was picked up from one of 8 locations in the work area. Our study suggests that the syringe storage locations vary and include irregular locations (e.g., patient bed or provider's pockets). Our study contributes to understanding the complexity in the anesthesia work practices.
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Affiliation(s)
| | - Rong Yin
- Sichuan University-Pittsburgh Institue (SCUPI), Sichuan University, China
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Costa L, Costa M, Martins J, Castro R. Polymyoclonus, ventricular fibrillation and Takotsubo after accidental spinal injection of tranexamic acid. BMJ Case Rep 2023; 16:e251814. [PMID: 37463777 PMCID: PMC10357813 DOI: 10.1136/bcr-2022-251814] [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] [Indexed: 07/20/2023] Open
Abstract
Several factors have been identified as contributing to medication administration errors, including look-alike, sound-alike (LASA) errors. LASA errors are important causes of serious adverse events arising from spinal injection of tranexamic acid, which can be confused with ampoules of local anaesthesia.We present a case of accidental injection of 250 mg of tranexamic acid rather than prilocaine during spinal anaesthesia. The patient developed lower extremities myoclonus, followed by generalised convulsions and ventricular fibrillation, that was reverted within 6 min. Severe cardiogenic shock requiring both inotropic and vasopressor therapy followed, along with a classic apical ballooning pattern on echocardiography and elevated myocardial injury markers, indicating Takotsubo cardiomyopathy. The patient's condition progressively improved to full recovery, and she was discharged from hospital after 1 month with no neurological deficit or cardiac dysfunction.To our knowledge, this is the 28th reported case of accidental spinal injection of tranexamic acid. We present a brief review of previously published cases.
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Affiliation(s)
- Laura Costa
- Intensive Care Medicine, Hospital of Braga, Braga, Portugal
| | - Marina Costa
- Intensive Care Medicine, Hospital of Braga, Braga, Portugal
| | - José Martins
- Intensive Care Medicine, Hospital of Braga, Braga, Portugal
| | - Rui Castro
- Intensive Care Medicine, Hospital of Braga, Braga, Portugal
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Rowily AA, Jalal Z, Paudyal V. Contributory factors and patient harm including deaths associated direct acting oral anticoagulants (DOACs) medication incidents: evaluation of real world data reported to the National Reporting and Learning System. Expert Opin Drug Saf 2023; 22:1113-1125. [PMID: 37313587 DOI: 10.1080/14740338.2023.2223947] [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: 11/27/2022] [Accepted: 03/27/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Direct oral anticoagulants (DOACs) are considered high risk medicines and are frequently associated with medication errors. The nature of incidents and associated outcomes of such incidents are poorly understood. AREAS COVERED Using a national patient safety reporting database, the National Reporting and Learning System (NRLS), this study aimed to report the contributory factors and outcomes including severe harm and deaths related to all safety incidents involving DOACs reported in England and Wales between 2017-2019. Reason's accident causation model was used to classify the incidents. EXPERT OPINION A total of 15,730 incident reports were analyzed. A total of 25 deaths were reported with a further 270 and 55 incidents leading to moderate and severe harm, respectively. A further 8.8% (n = 1381) of incidents were associated with low degree of harm. The majority of the incidents involved active failures (n = 13776; 87.58) including duplication of anticoagulant therapies, patients being discharged without DOACs, non-consideration of renal function, and lack of commencement of DOACs post-surgery suggesting preventability of such reported incidents. This study shows that medication incidents involving DOACs have the potential to cause severe harm and deaths, and there is a need to promote guideline adherence through education, training, and decision support technologies.
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Affiliation(s)
- Abdulrhman Al Rowily
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Zahraa Jalal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Skalafouris C, Samer C, Stirnemann J, Grosgurin O, Eggimann F, Grauser D, Reny JL, Bonnabry P, Guignard B. Electronic monitoring of potential adverse drug events related to lopinavir/ritonavir and hydroxychloroquine during the first wave of COVID-19. Eur J Hosp Pharm 2023; 30:113-116. [PMID: 33832918 PMCID: PMC9986913 DOI: 10.1136/ejhpharm-2020-002667] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 11/04/2022] Open
Abstract
During Switzerland's first wave of COVID-19, clinical pharmacy activities during medical rounds in Geneva University Hospitals were replaced by targeted remote interventions. We describe using the electronic PharmaCheck system to screen high-risk situations of adverse drug events (ADEs), particularly targeting prescriptions of lopinavir/ritonavir (LPVr) and hydroxychloroquine (HCQ) in the presence of contraindications or prescriptions outside institutional guidelines. Of 416 patients receiving LPVr and/or HCQ, 182 alerts were triggered for 164 (39.4%) patients. The main associated risk factors of ADEs were drug-drug interactions, QTc interval prolongation, electrolyte disorder and inadequate LPVr dosage. Therapeutic optimisation recommended by a pharmacist or proposals for additional monitoring were accepted in 80% (n=36) of cases. Combined with pharmacist contextualisation to the clinical context, PharmaCheck made it possible to successfully adapt clinical pharmacist activities by switching from a global to a targeted analysis mode in an emergency context.
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Affiliation(s)
- Christian Skalafouris
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), School of pharmaceutical sciences, University of Geneva, Geneva, Switzerland
| | - Caroline Samer
- Clinical Pharmacology and Toxicology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Jerome Stirnemann
- General Internal Medicine Division, Geneva University Hospitals, Geneve, Switzerland
| | - Olivier Grosgurin
- General Internal Medicine Division, Geneva University Hospitals, Geneve, Switzerland
| | - François Eggimann
- Information Systems Department, Geneva University Hospitals, Geneva, Switzerland
| | - Damien Grauser
- Information Systems Department, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- General Internal Medicine Division, Geneva University Hospitals, Geneve, Switzerland
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), School of pharmaceutical sciences, University of Geneva, Geneva, Switzerland
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Tang C, Chen X, Gong G, Guan C, Liu C. Self-reported work-related accumulative fatigue of nurses: A cross-sectional study in public hospitals in China. Front Public Health 2022; 10:1019092. [PMID: 36276360 PMCID: PMC9582430 DOI: 10.3389/fpubh.2022.1019092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/20/2022] [Indexed: 01/28/2023] Open
Abstract
Objectives Work-related fatigue is a serious safety risk to nurses and their patients. This study aimed to assess self-reported work-related accumulative fatigue of nurses and its associated factors. Methods A questionnaire survey of 2,918 clinical nurses conveniently sampled from 48 public hospitals across six provinces in China was conducted. The "Self-diagnosis Checklist for Assessment of Workers' Accumulated Fatigue" was adopted to assess the level of work-related accumulative fatigue of the study participants. Chi-square tests and ordinal regression analyses were performed to determine the sociodemographic characteristics associated with work-related accumulative fatigue. Results About one third of respondents reported low work-related accumulative fatigue, compared with 23.1% reporting high and 24.6% reporting very high levels of work-related accumulative fatigue. Higher levels of work-related accumulative fatigue were associated with female gender (AOR = 0.614 for male relative to female, p = 0.005), age between 30 and 40 years (AOR = 1.346 relative to >40 years, p = 0.034), 5-10 years of work experience (AOR = 1.277 relative to >10 years, p = 0.034), and bachelor or above degree qualifications (AOR = 0.806 for associate degree relative to bachelor or above degree, p = 0.007). Those who worked in rural county hospitals (AOR = 0.816 for metropolitan relative to rural county hospitals, p = 0.006) and resided in central China (AOR = 1.276 relative to western China, p = 0.004) had higher odds of reporting higher levels of work-related accumulative fatigue. Conclusion High levels of work-related accumulative fatigue are evident in nurses of public hospitals in China. The problem is more serious in the female nurses in their mid-career and those who worked in the central region and rural setting.
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Affiliation(s)
- Changmin Tang
- School of Management, Hubei University of Chinese Medicine, Wuhan, China,*Correspondence: Changmin Tang
| | - Xin Chen
- School of Management, Hubei University of Chinese Medicine, Wuhan, China
| | - Guangwen Gong
- School of Management, Hubei University of Chinese Medicine, Wuhan, China
| | - Cuiling Guan
- School of Management, Hubei University of Chinese Medicine, Wuhan, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia,Chaojie Liu
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Martínez-Domínguez J, Sierra-Martínez O, Galindo-Fraga A, Trejo-Mejía JA, Sánchez-Mendiola M, Ochoa-Hein E, Vázquez-Rivera M, Gutiérrez-Cirlos C, Naveja J, Martínez-González A. Antibiotic prescription errors: the relationship with clinical competence in junior medical residents. BMC MEDICAL EDUCATION 2022; 22:456. [PMID: 35701813 PMCID: PMC9199232 DOI: 10.1186/s12909-022-03499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND A large portion of prescribing errors can be attributed to deficiencies in medication knowledge. These errors are preventable and most often occur at the time of prescription. Antimicrobials are the drug class most common incorrectly prescribed. OBJECTIVE To characterize the relationship between clinical competence and antibiotic prescription errors. We also investigated the frequency and severity of antibiotic prescription errors to identify items and attributes of clinical competence which are correlated with the antibiotic prescription error ratio. METHOD A cross-sectional study was applied to assess clinical competence of junior medical residents in two reference academic hospitals and a regional hospital in Mexico City. It was conducted during February 2019. We used an infectious disease Objective Structured Clinical Examination (OSCE) to assess clinical competence and a measure of frequency, and severity of antibiotic prescription errors. RESULTS The number of eligible participants was ~ 255 (hospital meeting attendance), and the number of residents in this study were 51 (~ 20%), 31 were female (60.8%). The mean OSCE score was 0.692 ± 0.073. The inter-item (Cronbach's alpha = 0.927) and inter-station internal consistency was adequate (Cronbach's alpha = 0.774). The G coefficient in generalizability theory analysis was 0.84. The antibiotic prescription error ratio was 45.1% ± 7%. The most frequent category of severity of antibiotic prescription errors was category E (errors that may contribute to or result in temporary harm to the patient and require intervention), 235 (65.2%). We observed a negative and significant correlation between clinical competence and antibiotic prescription errors (r = -0.33, p < 0.05, CI95% -0.57 to -0.07), which remained significant after controlling for the effect of gender and time since graduation from medical school (r = -0.39, p < 0.01, CI95% -0.625 to -0.118). Using exploratory factor analysis we identified two factors, which explained 69% of the variance in clinical competence, factor 1 evaluated socio-clinical skills and factor 2 evaluated diagnostic-therapeutic skills. Factor 2 was correlated with antibiotic prescription error ratio (r = -0.536, p < 0.001). CONCLUSIONS We observed a negative correlation between clinical competence and antibiotic prescription error ratio in graduated physicians who have been accepted in a medical specialty. The therapeutic plan, which is a component of the clinical competence score, and the prescription skills had a negative correlation with antibiotic prescription errors. The most frequent errors in antibiotic prescriptions would require a second intervention.
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Affiliation(s)
- Joshua Martínez-Domínguez
- Coordination of Educational Development and Curricular Innovation (CODEIC), National Autonomous University of Mexico (UNAM), Mexico City, México
- Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, México
| | | | - Arturo Galindo-Fraga
- Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México
| | | | - Melchor Sánchez-Mendiola
- Coordination of Educational Development and Curricular Innovation (CODEIC), National Autonomous University of Mexico (UNAM), Mexico City, México
| | - Eric Ochoa-Hein
- Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México
| | | | - Carlos Gutiérrez-Cirlos
- Internal Medicine, Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México
- Internship and Social Service, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, México
| | - Jesús Naveja
- Chemistry Institute, National Autonomous University of Mexico (UNAM), Mexico City, México
| | - Adrián Martínez-González
- Coordination of Educational Development and Curricular Innovation (CODEIC), National Autonomous University of Mexico (UNAM), Mexico City, México.
- Public Health Department, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, México.
- Consejos académicos, Circuito exterior, Ciudad Universitaria, C. P. 04510, Coyoacán, Ciudad de México, México.
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Ziaie S, Mehralian G, Talebi Z. Evaluation of medication reconciliation process in internal medicine wards of an academic medical center by a pharmacist: errors and risk factors. Intern Emerg Med 2022; 17:377-386. [PMID: 34342787 DOI: 10.1007/s11739-021-02811-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
Medication reconciliation based on complete medication histories has been introduced to minimize medication errors and its associated healthcare costs in the transitions of care. In this study, to evaluate the routine process of medication reconciliation in an academic medical center, medication history taken at the time of admission by physicians and the first order prescribed in the hospital was compared to a comprehensive reconciliation form filled by a pharmacist using direct interview of the patients and caregivers, patient's insurance records and medication packages they brought from home. Two hundred and fifty-seven patients admitted in the internal wards of an academic medical center between June and September 2019 were investigated. In 6% of the patients, drug history was not included in the medical history form. Other patients were using 8.59 drugs in average, with a mean of 3.55 medication discrepancies in the history-taking process. Most commonly occurring errors were drug omissions (2.23 per patient on average) and incorrect frequency (0.96 per patient on average). There was a mean of 0.7 potentially harmful discrepancies for each patient. The mean number of drug discrepancies in new prescriptions from the hospital was 1.25, and almost half of patients had a potentially harmful discrepancies reordered in the hospital. There was no statistically meaningful relationship between patients' gender, physicians' gender, or the time of history taking and the total number of medication errors. History of ischemic heart disease was significantly associated with higher number of medication errors (p = 0.05). The results suggest that the medication reconciliation process in this academic center is inefficient. Using a systematic approach in medication reconciliation and gathering the best possible medication history, with a pharmacist who has better understanding of drugs' potential interactions and harmful errors can improve this process and prevent such errors in the future.
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Affiliation(s)
- Shadi Ziaie
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamhossein Mehralian
- Department of Pharmacoeconomy and Administrative Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Talebi
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, 500 12th 13 avenue, Columbus, OH, 43210, USA.
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Fuentes A, Truong M, Salfivar V, Adeola M. Integration of Medication Safety Training and Development of a Culture of Safety in Pharmacy Education. PATIENT SAFETY 2022. [DOI: 10.33940/culture/2022.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Medication safety events with the potential for patient harm do occur in health care settings. Pharmacists are regularly tasked with utilizing their medication knowledge to optimize the medication use process and reduce the likelihood of error.
To prepare for these responsibilities in professional practice, it is important to introduce patient safety principles during educational experiences. The Accreditation Council for Pharmacy Education (ACPE) and the American Society of Health-System Pharmacists (ASHP) have set forth accreditation standards focused on the management of medication use processes to ensure these competencies during pharmacy didactic learning and postgraduate training.
The experience described here provides perspective on educational and experiential opportunities across the continuum of pharmacy education, with a focus on a relationship between a college of pharmacy and healthcare system. Various activities, including discussions, medication event reviews, audits, and continuous quality improvement efforts, have provided the experiences to achieve standards for these pharmacy learners. These activities support a culture of safety from early training.
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Lacour M, Bloudeau L, Combescure C, Haddad K, Hugon F, Suppan L, Rodieux F, Lovis C, Gervaix A, Ehrler F, Manzano S, Siebert JN. Impact of a Mobile App on Paramedics' Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within a Multicenter Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e31748. [PMID: 34617916 PMCID: PMC8532016 DOI: 10.2196/31748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrests (OHCAs) are stressful, high-stake events that are associated with low survival rates. Acute stress experienced in this situation is associated with lower cardiopulmonary resuscitation performance in calculating drug dosages by emergency medical services. Children are particularly vulnerable to such errors. To date, no app has been validated to specifically support emergency drug preparation by paramedics through reducing the stress level of this procedure and medication errors. OBJECTIVE This study aims to determine the effectiveness of an evidence-based mobile app compared with that of the conventional preparation methods in reducing acute stress in paramedics at the psychological and physiological levels while safely preparing emergency drugs during simulated pediatric OHCA scenarios. METHODS In a parent, multicenter, randomized controlled trial of 14 emergency medical services, perceived and physiologic stress of advanced paramedics with drug preparation autonomy was assessed during a 20-minute, standardized, fully video-recorded, and highly realistic pediatric OHCA scenario in an 18-month-old child. The primary outcome was participants' self-reported psychological stress perceived during sequential preparations of 4 intravenous emergency drugs (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate) with the support of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app designed to help pediatric drug preparation (intervention) or conventional methods (control). The State-Trait Anxiety Inventory and Visual Analog Scale questionnaires were used to measure perceived stress. The secondary outcome was physiologic stress, measured by a single continuous measurement of the participants' heart rate with optical photoplethysmography. RESULTS From September 3, 2019, to January 21, 2020, 150 advanced paramedics underwent randomization. A total of 74 participants were assigned to the mobile app (intervention group), and 76 did not use the app (control group). A total of 600 drug doses were prepared. Higher State-Trait Anxiety Inventory-perceived stress increase from baseline was observed during the scenario using the conventional methods (mean 35.4, SD 8.2 to mean 49.8, SD 13.2; a 41.3%, 35.0 increase) than when using the app (mean 36.1, SD 8.1 to mean 39.0, SD 8.4; a 12.3%, 29.0 increase). This revealed a 30.1% (95% CI 20.5%-39.8%; P<.001) lower relative change in stress response in participants who used the app. On the Visual Analog Scale questionnaire, participants in the control group reported a higher increase in stress at the peak of the scenario (mean 7.1, SD 1.8 vs mean 6.4, SD 1.9; difference: -0.8, 95% CI -1.3 to -0.2; P=.005). Increase in heart rate during the scenario and over the 4 drugs was not different between the 2 groups. CONCLUSIONS Compared with the conventional method, dedicated mobile apps can reduce acute perceived stress during the preparation of emergency drugs in the prehospital setting during critical situations. These findings can help advance the development and evaluation of mobile apps for OHCA management and should be encouraged. TRIAL REGISTRATION ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-019-3726-4.
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Affiliation(s)
- Matthieu Lacour
- University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | | | - Christophe Combescure
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Kevin Haddad
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Florence Hugon
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Suppan
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédérique Rodieux
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Lovis
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Alain Gervaix
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Ehrler
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Sergio Manzano
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Johan N Siebert
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
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- See Authors' Contributions,
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Leviatan I, Oberman B, Zimlichman E, Stein GY. Associations of physicians' prescribing experience, work hours, and workload with prescription errors. J Am Med Inform Assoc 2021; 28:1074-1080. [PMID: 33120412 DOI: 10.1093/jamia/ocaa219] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We aimed to assess associations of physician's work overload, successive work shifts, and work experience with physicians' risk to err. MATERIALS AND METHODS This large-scale study included physicians who prescribed at least 100 systemic medications at Sheba Medical Center during 2012-2017 in all acute care departments, excluding intensive care units. Presumed medication errors were flagged by a high-accuracy computerized decision support system that uses machine-learning algorithms to detect potential medication prescription errors. Physicians' successive work shifts (first or only shift, second, and third shifts), workload (assessed by the number of prescriptions during a shift) and work-experience, as well as a novel measurement of physicians' prescribing experience with a specific drug, were assessed per prescription. The risk to err was determined for various work conditions. RESULTS 1 652 896 medical orders were prescribed by 1066 physicians; The system flagged 3738 (0.23%) prescriptions as erroneous. Physicians were 8.2 times more likely to err during high than normal-low workload shifts (5.19% vs 0.63%, P < .0001). Physicians on their third or second successive shift (compared to a first or single shift) were more likely to err (2.1%, 1.8%, and 0.88%, respectively, P < .001). Lack of experience in prescribing a specific medication was associated with higher error rate (0.37% for the first 5 prescriptions vs 0.13% after over 40, P < .001). DISCUSSION Longer hours and less experience in prescribing a specific medication increase risk of erroneous prescribing. CONCLUSION Restricting successive shifts, reducing workload, increasing training and supervision, and implementing smart clinical decision support systems may help reduce prescription errors.
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Affiliation(s)
- Ilona Leviatan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bernice Oberman
- Gertner Institute for Epidemiology and Health Policy Research, Tel HaShomer, Ramat Gan, Israel
| | - Eyal Zimlichman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Management Wing, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | - Gideon Y Stein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Internal Medicine "A," Meir Medical Center, Clalit Health Services, Kfar Saba, Israel
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11
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Alyahya MS, Hijazi HH, Alolayyan MN, Ajayneh FJ, Khader YS, Al-Sheyab NA. The Association Between Cognitive Medical Errors and Their Contributing Organizational and Individual Factors. Risk Manag Healthc Policy 2021; 14:415-430. [PMID: 33568959 PMCID: PMC7868240 DOI: 10.2147/rmhp.s293110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/18/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Examining cognitive medical errors (MEs) and their contributing factors is vital in health systems research, as it provides baseline data that can be used to develop appropriate interventions to prevent and/or minimize errors. The primary aim of this study was to investigate the association between cognitive MEs and hospitals' organizational factors and the individual psychological and functional factors. METHODS This cross-sectional study was conducted in three main hospitals in Northern Jordan. A proportional sampling technique was employed to decide the number of participants from each hospital. Data from physicians and nurses (n=400) were collected using a self-administered questionnaire, which was developed based on pertinent literature review. Exploratory and confirmatory factor analyses were conducted to validate the study instrument. The relationships between the variables were analyzed through structural equation modeling (SEM) using AMOS. Multi-group analysis was also performed to examine the differences in the participants' perceptions towards the respective variables between the three selected hospitals. RESULTS Our results showed a non-significant negative association between MEs and hospital organizational factors. Also, the SEM analysis showed a positive significant correlation between MEs and psychological and functional factors, whereby excessive workload, complexity of tasks, stress, sleep deprivation, and fatigue were found to be predictors of MEs occurrence. In comparison to the results from the university hospital, the multi-group analysis results from the governmental public hospital and the private hospital showed a significant impact of psychological and functional factors on MEs. CONCLUSION To reduce the occurrence of MEs in hospitals, there is a need to enhance organizational safety culture. Efforts should be directed at both organizational and individual levels. Also, it is essential that health decision makers develop strategies to reduce work-related stress and improve healthcare staff well-being, as work stress may cause cognitive impairments among healthcare workers and hence threaten patients' safety.
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Affiliation(s)
- Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Heba H Hijazi
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Main Naser Alolayyan
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Farah Jehad Ajayneh
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Yousef S Khader
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Nihaya A Al-Sheyab
- Allied Medical Sciences Department, Faculty of Applied Medical Sciences, Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, 22110, Jordan
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COŞKUN F, VURAL S, EROĞLU O, CÖMERTPAY E, ARIKAN DURMAZ Ş. Be aware of critical drugs in emergency departments: An extreme iatrogenic insulin overdose via subcutaneous and intramuscular routes. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2021. [DOI: 10.33706/jemcr.834296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ruutiainen HK, Kallio MM, Kuitunen SK. Identification and safe storage of look-alike, sound-alike medicines in automated dispensing cabinets. Eur J Hosp Pharm 2021; 28:e151-e156. [PMID: 33452109 DOI: 10.1136/ejhpharm-2020-002531] [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: 10/06/2020] [Revised: 11/25/2020] [Accepted: 12/08/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Automated dispensing cabinets (ADCs) are used in hospitals to improve medication safety and decrease costs. However, ADCs do not completely eliminate the risk of mistakes between look-alike, sound-alike (LASA) medicines. The aim of this study was to identify the characteristics of LASA medicines and determine the factors related to their safe storage in ADCs. METHODS The medication selection of one hospital pharmacy's ADC located in an intensive care unit was observed. The study consisted of five parts: a determination of criteria to identify LASA medications, an analysis of an ADCs' inventory reports, assessment of the storage of identified LASA medicines, a visual observation of the medicine packages stored in the same storage compartment and qualitative analysis of the medication-use process from prescribing a medicine to removing it from an ADC. RESULTS Approximately 70% (n=355/488) of the ADCs selection had a LASA risk with at least one product. Moreover, 20% (n=84/355) of the LASA medicines identified were high-alert medications. Approximately 16% (n=58/355) of the identified LASA medicines were stored unsafely close to at least one other LASA medicine. Less than 4% (n=13/355) of the LASA medicines were unsafely stored high-alert medications. CONCLUSIONS ADCs reduce the risks of LASA medication errors when used correctly, but automation can also increase them, for example, when placing multiple LASA medicines in the same storage compartment. Attention should be paid to the identification and safe storage of LASA medicines to promote safe use of ADCs in hospitals.
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Affiliation(s)
- Henna Karoliina Ruutiainen
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland .,HUS Pharmacy, HYKS, Helsinki, Uusimaa, Finland
| | - Miia Marjukka Kallio
- HUS Pharmacy, HYKS, Helsinki, Uusimaa, Finland.,Clinical Pharmacy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Sini Karoliina Kuitunen
- HUS Pharmacy, HYKS, Helsinki, Uusimaa, Finland.,Clinical Pharmacy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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14
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Cicero MX, Adelgais K, Hoyle JD, Lyng JW, Harris M, Moore B, Gausche-Hill M. Medication Dosing Safety for Pediatric Patients: Recognizing Gaps, Safety Threats, and Best Practices in the Emergency Medical Services Setting. A Position Statement and Resource Document from NAEMSP. PREHOSP EMERG CARE 2020; 25:294-306. [PMID: 32644857 DOI: 10.1080/10903127.2020.1794085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Millions of patients receive medications in the Emergency Medical Services (EMS) setting annually, and dosing safety is critically important. The need for weight-based dosing in pediatric patients and variability in medication concentrations available in the EMS setting may require EMS providers to perform complex calculations to derive the appropriate dose to deliver. These factors can significantly increase the risk for harm when dose calculations are inaccurate or incorrect. METHODS We conducted a scoping review of the EMS, interfacility transport and emergency medicine literature regarding pediatric medication dosing safety. A priori, the authors identified four research topics: (1) what are the greatest safety threats that result in significant dosing errors that potentially result in harm to patients, (2) what practices or technologies are known to enhance dosing safety, (3) can data from other settings be extrapolated to the EMS environment to inform dosing safety, and (4) what impact could standardization of medication formularies have on enhancing dosing safety. To address these topics, 17 PICO (Patient, Intervention, Comparison, Outcome) questions were developed and a literature search was performed. RESULTS After applying exclusion criteria, 70 articles were reviewed. The methods for the investigation, findings from these articles and how they inform EMS medication dosing safety are summarized here. This review yielded 11 recommendations to improve safety of medication delivery in the EMS setting. CONCLUSION These recommendations are summarized in the National Association of EMS Physicians® position statement: Medication Dosing Safety for Pediatric Patients in Emergency Medical Services.
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15
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Mani S, Nisha M, Varghese J, Johny S, Mathew A. Cost-effective innovation of locally assembled mannequins for undergraduate skill development in parenteral drug administration. Indian J Pharmacol 2020; 52:39-43. [PMID: 32201445 PMCID: PMC7074425 DOI: 10.4103/ijp.ijp_279_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/23/2019] [Accepted: 01/31/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION: The new competencybased curriculum for undergraduate medical education by the Medical Council of India mandates simulation using mannequins for teaching parenteral drug administration. Traditional education tends to focus on textbook learning, whereas competencybased education concentrates on the outcomes that directly guide the assessment of learners. OBJECTIVE: To introduce a module for the development of the core competency of parenteral drug administration using costeffective locally assembled mannequins for handson skill development in administering injections to be assessed using objective structured practical examination (OSPE). MATERIALS AND METHODS: Costeffective and durable fiberglass arms from mannequins used for fashion display were prepared for parenteral drug administration. The padding is easily done with wadding and gauze/crepe bandages, and the assembling requires only 15 minutes per arm. The training can be conducted in the department, giving students adequate opportunity for handson learning on individual arms during the practical sessions. As initial investment and recurring costs are low, it is possible for the department to obtain enough number of mannequins for each student to practice individually on an injection arm. RESULTS: Students practice injection technique freely, without fear of damaging the mannequin or having to do it on a patient. This helps them to assimilate the steps and sub-steps of doing the task in a much more realistic way and builds their confidence. Assessment of the performance of injection technique, infection control practices, and drug delivery are possible. CONCLUSION: We have observed a greater trend toward selflearning and selfefficacy and better adherence to the protocol of injection technique because of the handson training the students receive.
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Affiliation(s)
- Susan Mani
- Department of Pharmacology, MOSC Medical College, Kochi, Kerala, India
| | - M Nisha
- Department of Pharmacology, MOSC Medical College, Kochi, Kerala, India
| | - Jolly Varghese
- Department of Pharmacology, MOSC Medical College, Kochi, Kerala, India
| | - Serah Johny
- Department of Pharmacology, MOSC Medical College, Kochi, Kerala, India
| | - Anna Mathew
- Department of Pharmacology, MOSC Medical College, Kochi, Kerala, India
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16
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Catton H, Geoghegan L, Goss AJ, Adami RZ, Rodrigues JN. Foundation doctor knowledge of wounds and dressings is improved by a simple intervention: An audit cycle-based quality improvement study. Ann Med Surg (Lond) 2020; 51:24-27. [PMID: 32021687 PMCID: PMC6994401 DOI: 10.1016/j.amsu.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/01/2020] [Accepted: 01/07/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many foundation year 1 and 2 doctors (FYs) have limited knowledge experience in wound management. Wound dressing formularies exist in many NHS Trusts, though awareness of and adherence to them by FYs is not known. This quality improvement study described baseline FY knowledge of wound management, and investigated whether this could be improved through educational intervention. METHODS A single-centre, prospective, baseline audit was conducted following local approval. This assessed knowledge of wound types and appropriate dressings alongside individual confidence providing wound care. The educational intervention involved the distribution of an ID-badge sized quick reference guide that could be attached to the FYs' lanyards, and an introduction to the formulary during routine teaching. The audit loop was closed by repeating the questionnaire. RESULTS Pre- (n = 43) and post- (n = 35) intervention questions were completed by FYs. The mean score post-intervention was significantly higher than the pre-intervention score across all knowledge questions (from 32% correct to 71% correct, p < 0.0001). There was no change in participant confidence, which remained low. CONCLUSION FYs lack confidence and knowledge about wounds and dressings. The latter can be improved through a simple and practical educational intervention that could be deployed nationally.
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Affiliation(s)
| | - Luke Geoghegan
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | | | | | - Jeremy N. Rodrigues
- Stoke Mandeville Hospital, Aylesbury, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Rothkötter JH, Fischer D, Schmidt-Torner S. Notfallnarkose – Vorbereitung und Assistenz im Rettungsdienst. Notf Rett Med 2020. [DOI: 10.1007/s10049-019-0608-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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18
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Black S, Lerman J, Banks SE, Noghrehkar D, Curia L, Mai CL, Schwengel D, Nelson CK, Foster JMT, Breneman S, Arheart KL. Drug Calculation Errors in Anesthesiology Residents and Faculty: An Analysis of Contributing Factors. Anesth Analg 2019; 128:1292-1299. [PMID: 31094802 DOI: 10.1213/ane.0000000000004013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Limited data exist regarding computational drug error rates in anesthesia residents and faculty. We investigated the frequency and magnitude of computational errors in a sample of anesthesia residents and faculty. METHODS With institutional review board approval from 7 academic institutions in the United States, a 15-question computational test was distributed during rounds. Error rates and the magnitude of the errors were analyzed according to resident versus faculty, years of practice (or residency training), duration of sleep, type of question, and institution. RESULTS A total of 371 completed the test: 209 residents and 162 faculty. Both groups committed 2 errors (median value) per test, for a mean error rate of 17.0%. Twenty percent of residents and 25% of faculty scored 100% correct answers. The error rate for postgraduate year 2 residents was less than for postgraduate year 1 (P = .012). The error rate for faculty increased with years of experience, with a weak correlation (R = 0.22; P = .007). The error rates were independent of the number of hours of sleep. The error rate for percentage-type questions was greater than for rate, dose, and ratio questions (P = .001). The error rates varied with the number of operations needed to calculate the answer (P < .001). The frequency of large errors (100-fold greater or less than the correct answer) by residents was twice that of faculty. Error rates varied among institutions ranged from 12% to 22% (P = .021). CONCLUSIONS Anesthesiology residents and faculty erred frequently on a computational test, with junior residents and faculty with more experience committing errors more frequently. Residents committed more serious errors twice as frequently as faculty.
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Affiliation(s)
- Shira Black
- From the Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Jerrold Lerman
- From the Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
- Department of Anesthesiology, John R. Oishei Children's Hospital, Buffalo, New York
| | - Shawn E Banks
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami-Miller School of Medicine, Miami, Florida
| | - Dena Noghrehkar
- Department of Anesthesiology, John R. Oishei Children's Hospital, Buffalo, New York
| | - Luciana Curia
- From the Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Christine L Mai
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Deborah Schwengel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Corey K Nelson
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, California
| | - James M T Foster
- Department of Anesthesiology, State University of New York Upstate, Syracuse, New York
| | - Stephen Breneman
- From the Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Kris L Arheart
- Department of Public Health Sciences, Division of Biostatistics, University of Miami School of Medicine, Miami, Florida
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O'Mara K, Gattoline SJ, Campbell CT. Female low dose tip syringes-increased complexity of use may compromise dosing accuracy in paediatric patients. J Clin Pharm Ther 2019; 44:463-470. [PMID: 30763471 DOI: 10.1111/jcpt.12810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/28/2018] [Accepted: 01/10/2019] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The International Organization for Standardization (ISO) created enteral device specifications to reduce tubing misconnections. The Global Enteral Device Supplier Association (GEDSA) supports a female design: standard and low dose tip (LDT). Concerns include increased complexity of use with adapters, dosing accuracy and workflow. No peer-reviewed studies have evaluated dosing accuracy of the complete female system with adapters. The objective of this study was to compare dosing accuracy of the female design to legacy syringes. METHODS An in vitro study was conducted at the University of Florida College of Pharmacy pharmaceutics laboratory. Assessments were completed for syringe size, dispense methods and volumes, and adapters when applicable. A gravimetric scale and specific gravity were used to calculate administration volumes. The primary outcome was frequency administration volume exceeded 10% expected amount. RESULTS AND DISCUSSION A total of 576 tests were performed. The LDT resulted in significantly higher rates of unacceptable dosing variance compared to legacy (21.2% vs 7.4%, P = 0.003). Variance exceeding 10% occurred more frequently with LDT 0.5 and 1 mL syringes, medication cup dispensing (liquid or tablet) and inappropriate LDT adapter use. Unapproved adapter processes compared to FDA-approved processes held a higher likelihood of unacceptable dosing variance (28% vs 7.4%, P < 0.001). FDA-approved use of adapters with prefilled syringes compared to bedside administration may result in higher rates of dosing inaccuracy (18.8% vs 5.6%, P = 0.06). WHAT IS NEW AND CONCLUSIONS This study raises clinical concerns of dosing inaccuracies with the LDT syringes, particularly with 0.5 and 1 mL sizes. The use of adapters significantly increases the opportunity for inaccurate dosing.
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Affiliation(s)
- Keliana O'Mara
- Department of Pharmacy, UF Health Shands Children's Hospital, Newberry, Florida
| | | | - Christopher T Campbell
- Department of Pharmacy, UF Health Shands Children's Hospital, Newberry, Florida
- University of Florida College of Pharmacy, Gainesville, Florida
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21
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Yailian AL, Revel E, Tardy C, Fontana A, Estublier C, Decullier E, Dussart C, Chapurlat R, Pivot C, Janoly-Dumenil A. Assessment of the clinical relevance of pharmacists' interventions performed during medication review in a rheumatology ward. Eur J Intern Med 2019; 59:91-96. [PMID: 30482636 DOI: 10.1016/j.ejim.2018.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pharmacists contribute to reduce the number of medication errors during medication review. Nevertheless, few French studies report the potential clinical impact of pharmacists' interventions performed after detecting drug-related problems. The objective was to evaluate the clinical relevance of pharmacists' interventions in a rheumatology ward from medical and pharmaceutical perspectives. METHOD The analysis was conducted on pharmacists' interventions performed between January 1 and December 31, 2015 in a French teaching hospital. Similar pharmacists' interventions were grouped in one item and they were analysed according to 11 drug categories. The clinical significance of pharmacists' interventions was considered independently by a pharmacist and a rheumatologist using a validated French scale that categorises drug-related problems from minor to catastrophic. The agreement between the two professionals was analysed using the weighted kappa coefficient. RESULTS Of 1313 prescriptions reviewed, 461 pharmacists' interventions (171 items) were formulated for drug-related problems with an acceptance rate of 67.2%. Of the 418 interventions selected for clinical significance analysis, 235 interventions (56.2%) for the physician and 400 interventions (95.7%) for the pharmacist were at least significant. The two professionals evaluated equally the clinical relevance of 90 items (50.6%). The categories with the most similarities were the analgesics/anti-inflammatory drugs (78.1%), the antidiabetics (75.0%) and the anticoagulants (71.4%). The agreement was estimated by a weighted kappa coefficient of 0.29. CONCLUSION This work highlights the positive clinical relevance of pharmacists' interventions in rheumatology and the importance of medico-pharmaceutical collaboration to prevent medication errors.
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Affiliation(s)
- Anne-Laure Yailian
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France; Claude Bernard University Lyon 1, EA 4129 P2S Parcours Santé Systémique, 7-11 rue Guilllaume Paradin, 69008 Lyon, France.
| | - Elsa Revel
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France
| | - Cléa Tardy
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France
| | - Aurélie Fontana
- Department of Rheumatology, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France; INSERM UMR 1033, Claude Bernard University Lyon 1, Laennec Faculty of Medicine, 7-11 rue Guillaume Paradin, 69008 Lyon, France
| | - Charline Estublier
- Department of Rheumatology, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France; INSERM UMR 1033, Claude Bernard University Lyon 1, Laennec Faculty of Medicine, 7-11 rue Guillaume Paradin, 69008 Lyon, France
| | - Evelyne Decullier
- Department of Medical Information, Evaluation and Research, Clinical Research Unit, Hospices Civils de Lyon, 162 avenue Lacassagne, 69003 Lyon, France
| | - Claude Dussart
- Claude Bernard University Lyon 1, EA 4129 P2S Parcours Santé Systémique, 7-11 rue Guilllaume Paradin, 69008 Lyon, France
| | - Roland Chapurlat
- Department of Rheumatology, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France; INSERM UMR 1033, Claude Bernard University Lyon 1, Laennec Faculty of Medicine, 7-11 rue Guillaume Paradin, 69008 Lyon, France
| | - Christine Pivot
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France
| | - Audrey Janoly-Dumenil
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France; Claude Bernard University Lyon 1, EA 4129 P2S Parcours Santé Systémique, 7-11 rue Guilllaume Paradin, 69008 Lyon, France; Claude Bernard University Lyon 1, Faculty of Pharmacy, 8 avenue Rockefeller, 69008 Lyon, France
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22
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Ku LC, Hornik CP, Beechinor RJ, Chamberlain JM, Guptill JT, Harper B, Capparelli EV, Martz K, Anand R, Cohen-Wolkowiez M, Gonzalez D. Population Pharmacokinetics and Exploratory Exposure-Response Relationships of Diazepam in Children Treated for Status Epilepticus. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2018; 7:718-727. [PMID: 30267478 PMCID: PMC6263663 DOI: 10.1002/psp4.12349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/08/2018] [Indexed: 11/19/2022]
Abstract
Diazepam is labeled for status epilepticus (SE) in children, but there are limited data characterizing its disposition in pediatric patients. We developed a population pharmacokinetic (PK) model of i.v. diazepam in children with SE. We evaluated relationships between PK parameters and both safety and efficacy, and simulated exposures using dosing regimens from the product label and clinical practice. The model was developed using prospective data from a pediatric clinical trial comparing diazepam to lorazepam for treatment of SE. Altogether, 87 patients aged ≥ 3 months to < 18 years contributed 162 diazepam concentrations. Diazepam PKs were well characterized by a two‐compartment model scaled by body size. No significant or clinically important relationships were observed between diazepam PKs and safety or efficacy. Simulations demonstrated that, compared with label dosing, the study dose (0.2 mg/kg i.v., maximum 8 mg) resulted in greater frequency in rapidly achieving the target therapeutic range of 200–600 ng/mL.
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Affiliation(s)
- Lawrence C Ku
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christoph P Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ryan J Beechinor
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James M Chamberlain
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC, USA
| | - Jeffrey T Guptill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Barrie Harper
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Edmund V Capparelli
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California, USA
| | | | | | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Lesselroth BJ, Adams K, Church VL, Tallett S, Russ Y, Wiedrick J, Forsberg C, Dorr DA. Evaluation of Multimedia Medication Reconciliation Software: A Randomized Controlled, Single-Blind Trial to Measure Diagnostic Accuracy for Discrepancy Detection. Appl Clin Inform 2018; 9:285-301. [PMID: 29719884 DOI: 10.1055/s-0038-1645889] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Veterans Affairs Portland Healthcare System developed a medication history collection software that displays prescription names and medication images. OBJECTIVE This article measures the frequency of medication discrepancy reporting using the medication history collection software and compares with the frequency of reporting using a paper-based process. This article also determines the accuracy of each method by comparing both strategies to a best possible medication history. STUDY DESIGN Randomized, controlled, single-blind trial. SETTING Three community-based primary care clinics associated with the Veterans Affairs Portland Healthcare System: a 300-bed teaching facility and ambulatory care network serving Veteran soldiers in the Pacific Northwest United States. PARTICIPANTS Of 212 patients with primary care appointments, 209 patients fulfilled the study requirements. INTERVENTION Patients randomized to a software-directed medication history or a paper-based medication history. Randomization and allocation to treatment groups were performed using a computer-based random number generator. Assignments were placed in a sealed envelope and opened after participant consent. The research coordinator did not know or have access to the treatment assignment until the time of presentation. MAIN OUTCOME MEASURES The primary analysis compared the discrepancy detection rates between groups with respect to the health record and a best possible medication history. RESULTS Of 3,500 medications reviewed, we detected 1,435 discrepancies. Forty-six percent of those discrepancies were potentially high risk for causing an adverse drug event. There was no difference in detection rates between treatment arms. Software sensitivity was 83% and specificity was 91%; paper sensitivity was 81% and specificity was 94%. No participants were lost to follow-up. CONCLUSION The medication history collection software is an efficient and scalable method for gathering a medication history and detecting high-risk discrepancies. Although it included medication images, the technology did not improve accuracy over a paper list when compared with a best possible medication history. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02135731.
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Affiliation(s)
- Blake J Lesselroth
- NorthWest Innovation Center, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Kathleen Adams
- NorthWest Innovation Center, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - Victoria L Church
- NorthWest Innovation Center, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - Stephanie Tallett
- NorthWest Innovation Center, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - Yelizaveta Russ
- Division of Primary Care, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - Jack Wiedrick
- Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, Oregon, United States
| | - Christopher Forsberg
- Center of Innovation, Veterans' Affairs Portland Healthcare System, Portland, Oregon, United States
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
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SHEIKHTAHERI A, SADEQI-JABALI M, HASHEMI-DEHAGHI Z. Physicians' Perspectives on Causes of Health Care Errors and Preventive Strategies: A Study in a Developing Country. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:720-728. [PMID: 29922615 PMCID: PMC6005985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND To prevent health care errors, the main causes and preventive strategies should be identified. The purpose of this study was to identify the causes and preventive strategies of health care errors from the perspectives of physicians. METHODS We surveyed 250 randomly selected physicians in five teaching hospitals in Tehran, Iran, in 2015. We used a questionnaire with 29 questions regarding causes and 17 ones regarding the preventive strategies. The participants were asked to answer the questions based on Likert's five-point score (1=very low to 5= very high). The data was analyzed using descriptive (frequency, and mean scores) and inferential statistics in SPSS. RESULTS Managerial factors (3.6±0.7), personal factors of providers (3.5±0.6), factors related to the patients (3.4±0.71), and the factors pertinent to laboratory and pharmacy (3.2±0.8) were the main causes respectively. The most important preventive strategies were improvement of academic education, better taking past medical history, implementing electronic prescription and increasing healthcare budget. CONCLUSION Heavy workloads, long work shifts, failure to do thorough examination and to collect detailed history information, providers' fatigue, patients' reluctance to follow orders or to give their complete information, failure to give detailed instruction to patients about the medications, lack or insufficient monitoring and supervising systems, and lack of enough budget were some of the most important causes of errors. Using IT to access patients' information, improving patients' adherence, reducing workload, developing efficient methods for collecting patients' information, dedicating adequate budget for improvement programs are recommended.
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Affiliation(s)
- Abbas SHEIKHTAHERI
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran, Dept. of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran,Corresponding Author:
| | - Monireh SADEQI-JABALI
- Dept. of Health Information Technology, Faculty of Paramedical, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra HASHEMI-DEHAGHI
- Dept. of Management and Accounting, School of Management, Islamic Azad University, South Tehran Branch, Tehran, Iran, Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Bower RA, Coad JE, Manning JC, Pengelly TA. A qualitative, exploratory study of nurses’ decision-making when interrupted during medication administration within the Paediatric Intensive Care Unit. Intensive Crit Care Nurs 2018; 44:11-17. [DOI: 10.1016/j.iccn.2017.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/21/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
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Gerges S, Peter E, Bowles SK, Diamond S, Bucci LM, Resnick A, Taddio A. Pharmacists as vaccinators: An analysis of their experiences and perceptions of their new role. Hum Vaccin Immunother 2017; 14:471-477. [PMID: 29140749 DOI: 10.1080/21645515.2017.1403695] [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] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES In 2012, Ontario pharmacists were granted immunization privileges to administer influenza vaccines to the public. This study explored the experiences and practices of pharmacist vaccinators and the impact of vaccination pain on their practice. METHODS Semi-structured interviews were conducted with 12 pharmacists in the Greater Toronto Area. Transcribed interview data were coded and analyzed via thematic analysis. KEY FINDINGS Data analysis revealed 4 main themes: 1) expanded scope of practice as an enhancement and challenge to relationships; 2) professional satisfaction and workload demands; 3) knowledge and attitudes regarding pain and fear; 4) practices regarding pain and fear management. Pharmacists reported satisfaction in their new role, despite the associated increased workload. Pharmacists felt that vaccination pain was not a key consideration when administering vaccines and that pain management was generally not necessary. Fear was identified as more important than pain and vaccinating children was challenging and time intensive. Pharmacists' main focus was on injection techniques in managing pain. CONCLUSION These findings suggest that pharmacists are accepting of their role as vaccinators but more research is needed to examine impact on workload and pharmacist knowledge and perceptions of injection-related pain and fear.
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Affiliation(s)
- Sandra Gerges
- a Sunnybrook Health Sciences Centre , Toronto , Ontario , Canada
| | - Elizabeth Peter
- b Lawrence S. Bloomberg Faculty of Nursing, University of Toronto , Toronto , Ontario , Canada
| | - Susan K Bowles
- c Nova Scotia Health Authority , Halifax , Nova Scotia , Canada
| | | | | | - Anne Resnick
- f Ontario College of Pharmacists , Toronto , Ontario , Canada
| | - Anna Taddio
- g Leslie Dan Faculty of Pharmacy , Univeristy of Toronto , Toronto , Ontario , Canada
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The application of a “6S Lean” initiative to improve workflow for emergency eye examination rooms. Can J Ophthalmol 2017; 52:435-440. [DOI: 10.1016/j.jcjo.2017.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/22/2017] [Indexed: 11/19/2022]
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Sheikh D, Mateti UV, Kabekkodu S, Sanal T. Assessment of medication errors and adherence to WHO prescription writing guidelines in a tertiary care hospital. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2017. [DOI: 10.1016/j.fjps.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Cabilan CJ, Hughes JA, Shannon C. The use of a contextual, modal and psychological classification of medication errors in the emergency department: a retrospective descriptive study. J Clin Nurs 2017; 26:4335-4343. [PMID: 28207996 DOI: 10.1111/jocn.13760] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To describe the contextual, modal and psychological classification of medication errors in the emergency department to know the factors associated with the reported medication errors. BACKGROUND The causes of medication errors are unique in every clinical setting; hence, error minimisation strategies are not always effective. For this reason, it is fundamental to understand the causes specific to the emergency department so that targeted strategies can be implemented. DESIGN Retrospective analysis of reported medication errors in the emergency department. METHODS All voluntarily staff-reported medication-related incidents from 2010-2015 from the hospital's electronic incident management system were retrieved for analysis. Contextual classification involved the time, place and the type of medications involved. Modal classification pertained to the stage and issue (e.g. wrong medication, wrong patient). Psychological classification categorised the errors in planning (knowledge-based and rule-based errors) and skill (slips and lapses). RESULTS There were 405 errors reported. Most errors occurred in the acute care area, short-stay unit and resuscitation area, during the busiest shifts (0800-1559, 1600-2259). Half of the errors involved high-alert medications. Many of the errors occurred during administration (62·7%), prescribing (28·6%) and commonly during both stages (18·5%). Wrong dose, wrong medication and omission were the issues that dominated. Knowledge-based errors characterised the errors that occurred in prescribing and administration. The highest proportion of slips (79·5%) and lapses (76·1%) occurred during medication administration. It is likely that some of the errors occurred due to the lack of adherence to safety protocols. CONCLUSION Technology such as computerised prescribing, barcode medication administration and reminder systems could potentially decrease the medication errors in the emergency department. There was a possibility that some of the errors could be prevented if safety protocols were adhered to, which highlights the need to also address clinicians' attitudes towards safety. RELEVANCE TO CLINICAL PRACTICE Technology can be implemented to help minimise errors in the ED, but this must be coupled with efforts to enhance the culture of safety.
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Affiliation(s)
- C J Cabilan
- Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - James A Hughes
- Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Carl Shannon
- Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Qld, Australia
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Rodrigues AT, Stahlschmidt R, Granja S, Pilger D, Falcão ALE, Mazzola PG. Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital. BRAZ J PHARM SCI 2017. [DOI: 10.1590/s2175-97902017000116109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Higuchi A, Higami Y, Takahama M, Yamakawa M, Makimoto K. Potential underreporting of medication errors in a psychiatric general hospital in Japan. Int J Nurs Pract 2016; 21 Suppl 2:2-8. [PMID: 26125569 DOI: 10.1111/ijn.12169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to explore a pattern of underreporting within a psychiatric general hospital in Japan. All the medication errors reported online in 2010 were analysed. This research was approved by the university and the study hospital. There were 651 incidents related to medication errors. Medication error rate per 1000 patient days was 2.14 (range: 0.45-6.05). Medication error rates between two acute care wards with comparable case and staff mix differed. A low proportion of intercepted near-misses and low medication error rates around mealtime in acute care 1 were suggestive of under-reporting. Two dementia care wards with low medication error rates had no report of intercepted errors, which was also suggestive of underreporting. Ward-specific medication error rates and patterns are useful to identify wards with potential underreporting of medication error within the hospital.
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Affiliation(s)
- Akari Higuchi
- Department of Nursing, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Yoko Higami
- Department of Nursing, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Masakazu Takahama
- Patient Safety and Infection Control Department, Asakayama General Psychiatric Hospital, Osaka, Japan
| | - Miyae Yamakawa
- Department of Nursing, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Kiyoko Makimoto
- Graduate School of Medicine, Department of Nursing, Osaka University, Suita City, Osaka, Japan
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Hancey S. To care for others, we must take care of ourselves. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2016. [DOI: 10.1002/jppr.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Castillo-Guzman S, González-Santiago O, Delgado-Leal IA, Lozano-Luévano GE, Reyes-Rodríguez MJ, Elizondo-Solis CV, Nava-Obregón TA, Palacios-Ríos D. Perception of the risk of adverse reactions to analgesics: differences between medical students and residents. PeerJ 2016; 4:e2255. [PMID: 27547561 PMCID: PMC4974922 DOI: 10.7717/peerj.2255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 06/23/2016] [Indexed: 12/05/2022] Open
Abstract
Background. Medications are not exempt from adverse drug reactions (ADR) and how the physician perceives the risk of prescription drugs could influence their availability to report ADR and their prescription behavior. Methods. We assess the perception of risk and the perception of ADR associated with COX2-Inbitors, paracetamol, NSAIDs, and morphine in medical students and residents of northeast of Mexico. Results. The analgesic with the highest risk perception in both group of students was morphine, while the drug with the least risk perceived was paracetamol. Addiction and gastrointestinal bleeding were the ADR with the highest score for morphine and NSAIDs respectively. Discussion. Our findings show that medical students give higher risk scores than residents toward risk due to analgesics. Continuing training and informing physicians about ADRs is necessary since the lack of training is known to induce inadequate use of drugs.
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Affiliation(s)
- Sandra Castillo-Guzman
- Pain and Palliative Care Clinic, Anesthesiology Service, University Hospital Dr Jose E Gonzalez, Universidad Autonoma de Nuevo Leon , Monterrey , Nuevo León , Mexico
| | - Omar González-Santiago
- Posgraduate Division of the Faculty of Chemical Science, Universidad Autonoma de Nuevo Leon , Monterrey , Nuevo León , Mexico
| | - Ismael A Delgado-Leal
- Pain and Palliative Care Clinic, Anesthesiology Service, University Hospital Dr Jose E Gonzalez, Universidad Autonoma de Nuevo Leon , Monterrey , Nuevo León , Mexico
| | - Gerardo E Lozano-Luévano
- Pain and Palliative Care Clinic, Anesthesiology Service, University Hospital Dr Jose E Gonzalez, Universidad Autonoma de Nuevo Leon , Monterrey , Nuevo León , Mexico
| | - Misael J Reyes-Rodríguez
- Pain and Palliative Care Clinic, Anesthesiology Service, University Hospital Dr Jose E Gonzalez, Universidad Autonoma de Nuevo Leon , Monterrey , Nuevo León , Mexico
| | - César V Elizondo-Solis
- Pain and Palliative Care Clinic, Anesthesiology Service, University Hospital Dr Jose E Gonzalez, Universidad Autonoma de Nuevo Leon , Monterrey , Nuevo León , Mexico
| | - Teresa A Nava-Obregón
- Pain and Palliative Care Clinic, Anesthesiology Service, University Hospital Dr Jose E Gonzalez, Universidad Autonoma de Nuevo Leon , Monterrey , Nuevo León , Mexico
| | - Dionicio Palacios-Ríos
- Pain and Palliative Care Clinic, Anesthesiology Service, University Hospital Dr Jose E Gonzalez, Universidad Autonoma de Nuevo Leon , Monterrey , Nuevo León , Mexico
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Affiliation(s)
- Marianne Pop
- Marianne Pop is Clinical Assistant Professor/Emergency Medicine Clinical Pharmacist, Department of Pharmacy Practice, University of Illinois-Rockford, 1601 Parkview Ave, Room A301, Rockford, IL 61107 . Mary Finocchi is Emergency Department/Operating Room Pharmacy Satellite Operations Supervisor, Department of Pharmacy Services, Tampa General Hospital, Tampa, Florida
| | - Mary Finocchi
- Marianne Pop is Clinical Assistant Professor/Emergency Medicine Clinical Pharmacist, Department of Pharmacy Practice, University of Illinois-Rockford, 1601 Parkview Ave, Room A301, Rockford, IL 61107 . Mary Finocchi is Emergency Department/Operating Room Pharmacy Satellite Operations Supervisor, Department of Pharmacy Services, Tampa General Hospital, Tampa, Florida
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Allison GM, Weigel B, Holcroft C. Does electronic medication reconciliation at hospital discharge decrease prescription medication errors? Int J Health Care Qual Assur 2015; 28:564-73. [PMID: 26156431 DOI: 10.1108/ijhcqa-12-2014-0113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Medication errors are an important patient safety issue. Electronic medication reconciliation is a system designed to correct medication discrepancies at transitions in healthcare. The purpose of this paper is to measure types and prevalence of intravenous antibiotic errors at hospital discharge before and after the addition of an electronic discharge medication reconciliation tool (EDMRT). DESIGN/METHODOLOGY/APPROACH A retrospective study was conducted at a tertiary hospital where house officers order discharge medications. In total, 100 pre-EDMRT and 100 post-EDMRT subjects were randomly recruited from the study center's clinical Outpatient Parenteral Antimicrobial Therapy (OPAT) program. Using infectious disease consultant recommendations as gold standard, each antibiotic listed in these consultant notes was compared to the hospital discharge orders to ascertain the primary outcome: presence of an intravenous antibiotic error in the discharge orders. The primary covariate of interest was pre- vs post-EDMRT group. After generating the crude prevalence of antibiotic errors, logistic regression accounted for potential confounding: discharge day (weekend vs weekday), average years of practice by prescribing physician, inpatient service (medicine vs surgery) and number of discharge mediations per patient. FINDINGS Prevalence of medication errors decreased from 30 percent (30/100) among pre-EDMRT subjects to 15 percent (15/100) errors among post-EDMRT subjects. Dosage errors were the most common type of medication error. The adjusted odds ratio of discharge with intravenous antibiotic error in the post-EDMRT era was 0.39 (0.18, 0.87) compared to the pre-EDMRT era. In the adjusted model, the total number of discharge medications was associated with increased OR of discharge error. ORIGINALITY/VALUE To the authors' knowledge, no other study has examined the impact of reconciliation on types and prevalence of medication errors at hospital discharge. The focus on intravenous antibiotics as a class of high-stakes medications with serious risks to patient safety during error events highlights the clinical importance of the findings. Electronic medication reconciliation may be an important tool in efforts to improve patient safety.
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Affiliation(s)
- Geneve M Allison
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
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Trainee Occupational Therapists Scoring the Barthel ADL. J Med Syst 2015; 39:93. [DOI: 10.1007/s10916-015-0293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
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Hernandez F, Majoul E, Montes-Palacios C, Antignac M, Cherrier B, Doursounian L, Feron JM, Robert C, Hejblum G, Fernandez C, Hindlet P. An Observational Study of the Impact of a Computerized Physician Order Entry System on the Rate of Medication Errors in an Orthopaedic Surgery Unit. PLoS One 2015. [PMID: 26207363 PMCID: PMC4514799 DOI: 10.1371/journal.pone.0134101] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To assess the impact of the implementation of a Computerized Physician Order Entry (CPOE) associated with a pharmaceutical checking of medication orders on medication errors in the 3 stages of drug management (i.e. prescription, dispensing and administration) in an orthopaedic surgery unit. Methods A before-after observational study was conducted in the 66-bed orthopaedic surgery unit of a teaching hospital (700 beds) in Paris France. Direct disguised observation was used to detect errors in prescription, dispensing and administration of drugs, before and after the introduction of computerized prescriptions. Compliance between dispensing and administration on the one hand and the medical prescription on the other hand was studied. The frequencies and types of errors in prescribing, dispensing and administration were investigated. Results During the pre and post-CPOE period (two days for each period) 111 and 86 patients were observed, respectively, with corresponding 1,593 and 1,388 prescribed drugs. The use of electronic prescribing led to a significant 92% decrease in prescribing errors (479/1593 prescribed drugs (30.1%) vs 33/1388 (2.4%), p < 0.0001) and to a 17.5% significant decrease in administration errors (209/1222 opportunities (17.1%) vs 200/1413 (14.2%), p < 0.05). No significant difference was found in regards to dispensing errors (430/1219 opportunities (35.3%) vs 449/1407 (31.9%), p = 0.07). Conclusion The use of CPOE and a pharmacist checking medication orders in an orthopaedic surgery unit reduced the incidence of medication errors in the prescribing and administration stages. The study results suggest that CPOE is a convenient system for improving the quality and safety of drug management.
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Affiliation(s)
- Fabien Hernandez
- AP–HP, Saint Antoine Hospital, Pharmacy Department, Paris, France
| | - Elyes Majoul
- AP–HP, Saint Antoine Hospital, Pharmacy Department, Paris, France
| | | | - Marie Antignac
- AP–HP, Saint Antoine Hospital, Pharmacy Department, Paris, France
| | - Bertrand Cherrier
- AP–HP, Saint Antoine Hospital, Orthopaedic Surgery Department, Paris, France
| | - Levon Doursounian
- AP–HP, Saint Antoine Hospital, Orthopaedic Surgery Department, Paris, France
| | - Jean-Marc Feron
- AP–HP, Saint Antoine Hospital, Orthopaedic Surgery Department, Paris, France
| | - Cyrille Robert
- AP-HP, Saint Antoine Hospital, Anaesthetics and Intensive Care Department, Paris, France
| | - Gilles Hejblum
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Christine Fernandez
- AP–HP, Saint Antoine Hospital, Pharmacy Department, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
- Univ Paris-Sud, Faculty of Pharmacy, Chatenay-Malabry, France
| | - Patrick Hindlet
- AP–HP, Saint Antoine Hospital, Pharmacy Department, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
- Univ Paris-Sud, Faculty of Pharmacy, Chatenay-Malabry, France
- * E-mail:
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Cottney A, Innes J. Medication-administration errors in an urban mental health hospital: a direct observation study. Int J Ment Health Nurs 2015; 24:65-74. [PMID: 25394525 DOI: 10.1111/inm.12096] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the present study, we aimed to identify the incidence, type, and potential clinical consequence of medication-administration errors made in a mental health hospital, and to investigate factors that might increase the risk of error. A prospective, direct observational technique was used to collect data from nurse medication rounds on each of the hospital's 43 inpatient wards. Regression analysis was used to identify potential error predictors. During the 172 medication rounds observed, 139 errors were detected in 4177 (3.3%) opportunities. The most common error was incorrect dose omission (52/139, 37%). Other common errors included incorrect dose (25/139, 18%), incorrect form (16/139, 12%), and incorrect time (12/139, 9%). Fifteen (11%) of the errors were of serious clinical severity; the rest were of negligible or minor severity. Factors that increased the risk of error included the nurse interrupting the medication round to attend to another activity, an increased number of 'when required' doses of medication administered, a higher number of patients on the ward, and an increased number of doses of medication due. These findings suggest that providers of inpatient mental health-care services should adopt medicine-administration systems that minimize task interruption and the use of 'when required' medication, as well as taking steps to reduce nursing workload.
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Affiliation(s)
- Alan Cottney
- East London National Health Service Foundation Trust, London, UK
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Cheng YH, Roach GD, Petrilli RM. Current and future directions in clinical fatigue management: An update for emergency medicine practitioners. Emerg Med Australas 2014; 26:640-4. [PMID: 25394226 DOI: 10.1111/1742-6723.12319] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2014] [Indexed: 12/15/2022]
Abstract
Physicians worldwide are working round the clock to meet the demands of healthcare systems, especially in acute medical settings such as EDs. Demanding shift work schedules cause fatigue and thus deterioration in mood and motor performance. This article explores the effects of sleep deprivation, focusing on cognition, executive decision-making and the implications for clinical care. Humans are capable of functioning and even adapting to sleep restriction; however, clinicians should be aware of pitfalls and absolute minimums for sleep. Fatigue management training shows promise in enhancing safety in aviation and might have a role in medical shift work. Strategic napping improves performance during night shift in the ED, but does not fully negate fatigue. Drugs offer limited benefit for performance under sleep-deprived conditions, and whenever possible, sleep and/or strategic napping takes precedence.
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Affiliation(s)
- Yi Han Cheng
- Appleton Institute, Central Queensland University, Adelaide, South Australia, Australia
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Antonucci R, Porcella A. Preventing medication errors in neonatology: Is it a dream? World J Clin Pediatr 2014; 3:37-44. [PMID: 25254183 PMCID: PMC4162440 DOI: 10.5409/wjcp.v3.i3.37] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 05/31/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Since 1999, the problem of patient safety has drawn particular attention, becoming a priority in health care. A “medication error” (ME) is any preventable event occurring at any phase of the pharmacotherapy process (ordering, transcribing, dispensing, administering, and monitoring) that leads to, or can lead to, harm to the patient. Hence, MEs can involve every professional of the clinical team. MEs range from those with severe consequences to those with little or no impact on the patient. Although a high ME rate has been found in neonatal wards, newborn safety issues have not been adequately studied until now. Healthcare professionals working in neonatal wards are particularly susceptible to committing MEs due to the peculiarities of newborn patients and of the neonatal intensive care unit (NICU) environment. Current neonatal prevention strategies for MEs have been borrowed from adult wards, but many factors such as high costs and organizational barriers have hindered their diffusion. In general, two types of strategies have been proposed: the first strategy consists of identifying human factors that result in errors and redesigning the work in the NICU in order to minimize them; the second one suggests to design and implement effective systems for preventing errors or intercepting them before reaching the patient. In the future, prevention strategies for MEs need to be improved and tailored to the special neonatal population and the NICU environment and, at the same time, every effort will have to be made to support their clinical application.
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Podtschaske B, Fuchs D, Friesdorf W. Integrated therapy safety management system. Br J Clin Pharmacol 2014; 76 Suppl 1:5-13. [PMID: 24007448 DOI: 10.1111/bcp.12155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 04/28/2013] [Indexed: 11/30/2022] Open
Abstract
AIMS The aim is to demonstrate the benefit of the medico-ergonomic approach for the redesign of clinical work systems. Based on the six layer model, a concept for an 'integrated therapy safety management' is drafted. This concept could serve as a basis to improve resilience. METHODS The concept is developed through a concept-based approach. The state of the art of safety and complexity research in human factors and ergonomics forms the basis. The findings are synthesized to a concept for 'integrated therapy safety management'. The concept is applied by way of example for the 'medication process' to demonstrate its practical implementation. RESULTS The 'integrated therapy safety management' is drafted in accordance with the six layer model. This model supports a detailed description of specific work tasks, the corresponding responsibilities and related workflows at different layers by using the concept of 'bridge managers'. 'Bridge managers' anticipate potential errors and monitor the controlled system continuously. If disruptions or disturbances occur, they respond with corrective actions which ensure that no harm results and they initiate preventive measures for future procedures. The concept demonstrates that in a complex work system, the human factor is the key element and final authority to cope with the residual complexity. The expertise of the 'bridge managers' and the recursive hierarchical structure results in highly adaptive clinical work systems and increases their resilience. CONCLUSIONS The medico-ergonomic approach is a highly promising way of coping with two complexities. It offers a systematic framework for comprehensive analyses of clinical work systems and promotes interdisciplinary collaboration.
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Affiliation(s)
- Beatrice Podtschaske
- Department of Human Factors Engineering and Ergonomics, Berlin Institute of Technology, Berlin, Germany.
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Hemingway S, McCann T, Baxter H, Smith G, Burgess-Dawson R, Dewhirst K. The perceptions of nurses towards barriers to the safe administration of medicines in mental health settings. Int J Nurs Pract 2014; 21:733-40. [PMID: 24666641 DOI: 10.1111/ijn.12266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Steve Hemingway
- Mental Health, School of Health and Human Sciences; University of Huddersfield; Huddersfield UK
| | - Terence McCann
- Nursing Research; Victoria University; Melbourne Victoria Australia
| | - Hazel Baxter
- Older Peoples and Learning Disabilities Service Clinical Governance Support Team, Fieldhead Hospital; South West Yorkshire Partnership Foundation Health Trust; Wakefield UK
| | - George Smith
- Nurse Education Leadership and Development, Fieldhead Hospital; South West Yorkshire Partnership Foundation Health Trust; Wakefield UK
| | - Rebecca Burgess-Dawson
- Practice Learning Facilitation Office, Castleford & Normanton District Hospital; South West Yorkshire Partnership NHS Foundation Trust; Castleford UK
| | - Kate Dewhirst
- Fieldhead Hospital; South West Yorkshire Partnership Foundation Health Trust; Wakefield UK
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Mansouri A, Ahmadvand A, Hadjibabaie M, Javadi M, Khoee SH, Dastan F, Gholami K. A review of medication errors in iran: sources, underreporting reasons and preventive measures. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2014; 13:3-17. [PMID: 24734052 PMCID: PMC3985240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medication error (ME) is the most common preventable cause of adverse drug events which negatively affects patient safety. Inadequate, low-quality studies plus wide estimation variations in ME from developing countries including Iran, decreases the reliability of ME evaluations. To clarify sources, underreporting reasons and preventive measures of MEs, we reviewed Iran current available literature. We searched Scopus, WOS, PubMed, CINAHL, EBSCOHOST and Persian databases (IranMedex, and SID) up to October 2012. Two authors independently selected and one reviewed and extracted data. Results reported by more than 30% of studies considered as the most important topics. Finally 25 articles were included. All study designs were cross-sectional (except for two interventional studies) and in hospital settings. Nursing staff and students were the most observed populations. Individual factor, with "inadequate knowledge of medication" as its most frequent reason, were the mostly reported source of MEs. Fear and reporting process were two most important reporting barriers. The sense of being reprimanded and ignoring to report respectively were their most frequent factors. Anti-infectives were the most frequent drugs involved in MEs. Preventive measures were varied and reporting of their effectiveness was inconsistent. There are still many research gaps which need to be explored by further studies. Based on our findings, further researches may be focused on design, implementation, and evaluation of a ME reporting system as groundwork, assessing systems-related factors to ME alongside individual factors and evaluating the effectiveness of preventive measures for MEs in trials.
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Affiliation(s)
- Ava Mansouri
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ahmadvand
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Molouk Hadjibabaie
- Faculty of Pharmacy, and Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Javadi
- Faculty of Pharmacy, and Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding author:
E-mail:
| | - Seyed Hamid Khoee
- Faculty of Pharmacy, and Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Dastan
- Clinical Pharmacy Department, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kheirollah Gholami
- Faculty of Pharmacy, and Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
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44
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Devi V, Upadhye P, Ram P, Menezes RG. Development of a teaching module for parenteral drug administration and objective structured practical examination stations in pharmacology. Indian J Pharmacol 2013; 45:587-92. [PMID: 24347766 PMCID: PMC3847248 DOI: 10.4103/0253-7613.121369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 07/11/2013] [Accepted: 08/14/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Safe parenteral drug administration includes preparation of safe medication for administration. Training medical students is crucial to minimize medication administration errors. The study aims to develop a module to teach drug preparation skills and to develop objective structured practical examination (OSPE) stations to assess these skills. Students' perceptions regarding the module were also assessed. MATERIALS AND METHODS A module was developed to teach following skills to 2(nd) year medical students: Aspiration of a drug from the ampule, aspiration of the drug from the vial, aspiration of the drug in powdered form from vial (reconstitution), and setting up an intravenous (IV) infusion. A randomized case control study design was used to establish the validity of OSPE stations. Student volunteers were grouped into case (n = 20) and control groups (n = 20) by simple randomization. The test group watched videos of skills and received demonstration of skills and a practice session before OSPE, whereas the control group watched videos before the OSPE and received demonstration and a practice session only after the OSPE. Each student was assessed by two faculty members during OSPE using a validated checklist. Mean OSPE scores of control and test groups were compared using independent samples t-test. Interrater reliability and concurrent validity of stations were analyzed using interclass correlation coefficient (ICC) and Pearson correlation, respectively. Students' responses were expressed as median and interquartile range. RESULTS The response rate in the questionnaire was 100%. Significant difference between mean scores (P < 0.05) of test and control groups revealed fulfillment of construct validity of OSPE stations. Interrater reliability (ICC > 0.7) and concurrent validity (r value > 7) of all the stations was high. Perceptions revealed acceptability of module and OSPE stations by students (median 4, scale 1-5). CONCLUSIONS A module to teach drug preparation skills was developed and along with valid and reliable OSPE stations that were acceptable to students. The study demonstrated that students acquire better skills through teaching than merely watching these skills in videos.
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Affiliation(s)
- Vasudha Devi
- Department of Pharmacology, Melaka Manipal Medical College, Manipal Campus, Manipal University, Manipal, India
| | - Prachitee Upadhye
- Department of Pharmacology, Melaka Manipal Medical College, Manipal Campus, Manipal University, Manipal, India
| | - Pradhum Ram
- Department of Pharmacology, Undergraduate Medical Student, Kasturba Medical College, Mangalore, India
| | - Ritesh G. Menezes
- Department of Forensic Medicine and Toxicology, ESIC Medical College and PGIMSR, Bangalore, Karnataka, India
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45
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Barras M, Moore D, Pocock D, Sweedman M, Wilkinson C, Taylor K, Morton J. Reducing the risk of harm from intravenous potassium: a multi-factorial approach in the haematology setting. J Oncol Pharm Pract 2013; 20:323-31. [PMID: 24057453 DOI: 10.1177/1078155213504443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To describe the implementation of safety systems for the use of intravenous potassium chloride in haematology patients. METHODS We assessed the use of intravenous potassium in a haematology ward at a tertiary hospital. Initially, we prospectively analysed the prescribing and administration of intravenous potassium to all patients over a two-week period. To complement this data, we retrospectively analysed all clinical incidents involving intravenous potassium and the dispensing patterns of potassium ampoules for the past 12 months. Drawing on evidence and recommendations from international safety literature, gaps in the safe use of potassium were identified, and a multi-factorial approach to system change was implemented. RESULTS A total of 18 patients were analysed with 90 intravenous bags of potassium prepared on the ward using 624 ampoules. We identified multiple opportunities for error and a lack of standardisation of therapy. The following safety systems were introduced: (i) a new prescribing and monitoring form that included dose calculation, prescriber support and pre-printed orders; (ii) removal of potassium ampoules and introduction of premixed bags; (iii) independent double checking by nursing staff at point of administration; (iv) dedicated labelling of intravenous lines; (v) extensive clinician training supported by guidelines; and (vi) introduction of 'smart pump' infusion software. The number of incidents significantly reduced from 23 to 9 (p < 0.001), and the number of ampoules dispensed reduced from 10,100 to 0. CONCLUSIONS A multi-factorial approach to the safe prescribing, dispensing and administration of intravenous potassium has reduced the potential for patient harm in the haematology setting.
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Affiliation(s)
- Michael Barras
- Medication Safety and Quality Unit, Mater Health Services; Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Diana Moore
- Mater Private Hospital, South Brisbane, Australia
| | | | | | | | - Kerry Taylor
- Mater Medical Centre, Centre for Haematology, South Brisbane, Australia
| | - James Morton
- Mater Medical Centre for Haematology, South Brisbane, Australia
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46
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Affiliation(s)
- Kristine L Cookson
- Family Birthing Center of Promedica St. Luke's Hospital in Maumee, Ohio, USA
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47
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Breeding J, Welch S, Whittam S, Buscher H, Burrows F, Frost C, Jonkman M, Mathews N, Wong KS, Wong A. Medication Error Minimization Scheme (MEMS) in an adult tertiary intensive care unit (ICU) 2009-2011. Aust Crit Care 2012; 26:58-75. [PMID: 22898357 DOI: 10.1016/j.aucc.2012.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 07/12/2012] [Accepted: 07/17/2012] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION The Medication Error Minimisation Scheme (MEMS) is a locally based ongoing multidisciplinary, multifaceted quality improvement (QI) project within an Australian adult tertiary level Intensive Care Unit (ICU). The project commenced in 2009. Its primary aim is to enhance medication safety within this ICU by utilising existing resources. The aim of this paper is to provide a descriptive account of the various activities, interventions and results of this project within the first three years. METHODS The research design for this project was based upon Plan-Do-Study-Act (PDSA) cycles associated with QI projects. Medication error rates and audits of: intravenous infusions, incompatible intravenous medications and incorrect documentation of withheld medications were analyzed according to simple statistical techniques. Initial and follow up medication safety surveys were compared using basic statistical analysis. Focus groups exploring barriers and enablers of medication incident reporting were analyzed according to qualitative techniques associated with focus group discussions. Other interventions included: regular education sessions; discussions within other departmental meetings such as nursing staff meetings and Morbidity and Mortality meetings; and bedside discussions and demonstrations. Promotion of medication safety occurred within a number of forums; activities and findings were advertised and displayed; a recognizable Logo for MEMS was employed; and incentives were provided for staff. RESULTS Reported Medication Incidents (MIs) increased from 6.2 to 14.9 MIs per 1000 patient days. Audits and chart reviews confirmed that more MIs are uncovered by employing a variety of techniques in addition to incident reporting. Staff surveys provided a rich source of information regarding medication safety. Audits of intravenous infusions revealed a reduced error rate from 38/331 (11.5%) to 15/468 (3.2%). Chart review of incorrect documentation of omitted medications decreased from 105/347 (30.3%) to 104/486 (21.4%). Focus groups provided information that was able to be used in a number of hospital forums in order to explain the impact of existing systems upon ICU staff. CONCLUSION This ongoing QI project was able to achieve its targeted goals. The MI reporting rate was increased. This project demonstrated that measurable, "non-incident report" errors can be reduced by focusing upon and promoting medication safety in the ICU. These activities demonstrated a workplace that values medication safety, the discovery of shortfalls and the benefits of ongoing improvement.
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Affiliation(s)
- Jeff Breeding
- Intensive Care Unit, St Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW 2010, Australia.
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48
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Zero tolerance prescribing: a strategy to reduce prescribing errors on the paediatric intensive care unit. Intensive Care Med 2012; 38:1858-67. [PMID: 22885650 DOI: 10.1007/s00134-012-2660-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 07/11/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To establish the baseline prescribing error rate in a tertiary paediatric intensive care unit (PICU) and to determine the impact of a zero tolerance prescribing (ZTP) policy incorporating a dedicated prescribing area and daily feedback of prescribing errors. METHODS A prospective, non-blinded, observational study was undertaken in a 12-bed tertiary PICU over a period of 134 weeks. Baseline prescribing error data were collected on weekdays for all patients for a period of 32 weeks, following which the ZTP policy was introduced. Daily error feedback was introduced after a further 12 months. Errors were sub-classified as 'clinical', 'non-clinical' and 'infusion prescription' errors and the effects of interventions considered separately. RESULTS The baseline combined prescribing error rate was 892 (95 % confidence interval (CI) 765-1,019) errors per 1,000 PICU occupied bed days (OBDs), comprising 25.6 % clinical, 44 % non-clinical and 30.4 % infusion prescription errors. The combined interventions of ZTP plus daily error feedback were associated with a reduction in the combined prescribing error rate to 447 (95 % CI 389-504) errors per 1,000 OBDs (p < 0.0001), an absolute risk reduction of 44.5 % (95 % CI 40.8-48.0 %). Introduction of the ZTP policy was associated with a significant decrease in clinical and infusion prescription errors, while the introduction of daily error feedback was associated with a significant reduction in non-clinical prescribing errors. CONCLUSION The combined interventions of ZTP and daily error feedback were associated with a significant reduction in prescribing errors in the PICU, in line with Department of Health requirements of a 40 % reduction within 5 years.
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49
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Adapa RM, Mani V, Murray LJ, Degnan BA, Ercole A, Cadman B, Williams CE, Gupta AK, Wheeler DW. Errors during the preparation of drug infusions: a randomized controlled trial. Br J Anaesth 2012; 109:729-34. [PMID: 22850220 DOI: 10.1093/bja/aes257] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We investigated the extent and frequency of dose errors and treatment delays made as a consequence of preparing drug infusions at the bedside, rather than using pre-filled syringes. METHODS Forty-eight nurses with critical care experience volunteered to take part in this randomized, blinded, controlled study conducted in the simulation centre of an urban hospital. They assisted in the management of a simulated patient with septic shock. Vasopressor infusions were prepared either by diluting concentrated drugs from ampoules or were provided in syringes pre-filled beforehand by an intensive care unit resident. RESULTS The time taken for the infusion to be started and the final concentration of the drugs were measured. We also measured the concentration of infusions prepared by a pharmacist and a pharmaceutical company. Nurses took 156 s to start infusions when using pre-filled syringes compared with 276 s when preparing them de novo, a mean delay of 106 s [95% confidence interval (CI) 73-140 s, P<0.0001]. One infusion prepared from ampoules contained one-fifth of the expected concentration of epinephrine; another contained none at all. Medication errors were 17.0 times less likely when pre-filled syringes were used (95% CI 5.2-55.5), and infusions prepared by pharmacy and industry were significantly more likely to contain the expected concentration (P<0.001 for norepinephrine and P=0.001 for epinephrine). CONCLUSIONS Providing drug infusions in syringes pre-filled by pharmacists or pharmaceutical companies would reduce medication errors and treatment delays, and improve patient safety. However, this approach would have substantial financial implications for healthcare providers, especially in less developed countries.
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Affiliation(s)
- R M Adapa
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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50
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The effectiveness and clinical usability of a handheld information appliance. Nurs Res Pract 2012; 2012:307258. [PMID: 22548159 PMCID: PMC3324168 DOI: 10.1155/2012/307258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 01/09/2012] [Indexed: 11/17/2022] Open
Abstract
Clinical environments are complex, stressful, and safety critical—heightening the demand for technological solutions that will help clinicians manage health information efficiently and safely. The industry has responded by creating numerous, increasingly compact and powerful health IT devices that fit in a pocket, hook to a belt, attach to eyeglasses, or wheel around on a cart. Untethering a provider from a physical “place” with compact, mobile technology while delivering the right information at the right time and at the right location are generally welcomed in clinical environments. These developments however, must be looked at ecumenically. The cognitive load of clinicians who are occupied with managing or operating several different devices during the process of a patient encounter is increased, and we know from decades of research that cognitive overload frequently leads to error. “Technology crowding,” enhanced by the plethora of mobile health IT, can actually become an additional millstone for busy clinicians. This study was designed to gain a deeper understanding of clinicians' interactions with a mobile clinical computing appliance (Motion Computing C5) designed to consolidate numerous technological functions into an all-in-one device. Features of usability and comparisons to current methods of documentation and task performance were undertaken and results are described.
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