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Klein P, Bonhomme J, Bourne C, Hellot-Guersing M, Marcucci C, Rodier S, Charpiat B. [Inability of hospital computerised physician order entry systems to secure the use of concentrated potassium intravenous solutions]. ANNALES PHARMACEUTIQUES FRANÇAISES 2024; 82:359-368. [PMID: 37879563 DOI: 10.1016/j.pharma.2023.06.007] [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: 06/04/2022] [Revised: 05/29/2023] [Accepted: 06/12/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES To determine whether hospital computerised physician order entry (CPOE) systems contribute to securing intravenous potassium chloride (KCl) prescriptions with reference to the recommendations issued by French healthcare agencies. METHODS We sent a questionnaire to the members of the Association pour le Digital et l'Information en Pharmacie. RESULTS More than three quarters of the 84 responses received involving 23 CPOE systems indicate that it is possible to: prescribe an ampoule of concentrated potassium chloride 10% 10mL intravenously without any diluents (80%); prescribe 4g of KCl in a bag of 500mL of NaCl 0,9% (98%); prescribe a solution that contains 6 grams of KCl per liter (94%); prescribe the administration of an injectable ampoule orally by means of a free text comment (83%). Nearly half of the responses indicate that it is possible to prescribe: concentrated KCl ampoules as administration solvent (50%); an injectable vial to be administered by oral route (52%). CONCLUSION At least 23 hospital CPOE systems are unable to secure the prescriptions of injectable KCl. This finding lifts the veil on an unthought, namely the role of CPOE systems in securing high-risk medications. In order to solve this problem, it should be mandatory that health information technology vendors pay particular attention to these drugs. With regard to injectable KCl, the utilisation of a dilution vehicle, maximum concentration and maximum infusion flow rate are the first four constraints to be satisfied.
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Affiliation(s)
- Pauline Klein
- Service pharmaceutique, hôpital de la Croix-Rousse, groupement hospitalier Nord, hospices civils de Lyon, 103, grande rue de la Croix Rousse, 69317 Lyon cedex 04, France.
| | - Jeremy Bonhomme
- OMEDIT Océan Indien - ARS La Réunion, 2bis, avenue Georges-Brassens CS 61002, 97743 Saint-Denis cedex 9, Réunion
| | - Cindy Bourne
- Service pharmaceutique, centre hospitalier de Crest, rue Paul-Goy, 26400 Crest, France
| | - Magali Hellot-Guersing
- Service pharmaceutique, centre hospitalier Lucien-Hussel, montée du Dr-Chapuis, 38200 Vienne, France
| | - Charles Marcucci
- Service pharmaceutique, centre hospitalier de Clermont de l'Oise, rue Frédéric-Raboisson, BP 40024, 60607 Clermont Cedex, France
| | - Simon Rodier
- Service pharmaceutique, centre hospitalier intercommunal Alençon-Mamers, 25, rue de Fresnay, 61000 Alençon, France
| | - Bruno Charpiat
- Service pharmaceutique, hôpital de la Croix-Rousse, groupement hospitalier Nord, hospices civils de Lyon, 103, grande rue de la Croix Rousse, 69317 Lyon cedex 04, France
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Salman M, Mustafa ZU, Shehzadi N, Mallhi TH, Asif N, Khan YH, Khan TM, Hussain K. Evaluation of knowledge and practices about administration and regulations of high alert medications among hospital pharmacists in Pakistan: findings and implications. Curr Med Res Opin 2022; 38:1967-1975. [PMID: 36111419 DOI: 10.1080/03007995.2022.2124063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND A death of a nine months old child in Pakistan following the rapid administration of potassium chloride raised serious concerns on the awareness of appropriate use of high alert medications (HAMs) among healthcare professionals (HCPs). This study aimed to ascertain HAMs-related knowledge among hospital pharmacists in Pakistan. METHODOLOGY A cross-sectional study using exponential non-discriminative snowball sampling was conducted among hospital pharmacists in healthcare settings in Punjab, Pakistan. A validated study tool was used to determine knowledge on administration, regulation, and practices related to the HAMs. Barriers to conducting HAMs training in the hospitals were assessed from an open-ended question. All quantitative data were analyzed using SPSS 22.0 while the content analysis was performed on the qualitative data. RESULTS A total of 202 hospital pharmacists were included in the study. The mean knowledge score for HAMs administration and regulation were 5.86 ± 1.89 (95% CI 5.60-6.12) and 7.25 ± 1.70 (95% CI 7.02-7.49), respectively. Approximately half of the respondents (49.5%) achieved scores ≥ 70%, demonstrating sufficient knowledge of HAMs. In the multivariable-adjusted model, increasing age and work experience were found to be the positive predictors of good HAMs knowledge. The mean practice score was 36.42 ± 1.97 (95% CI 34.05-38.77), with 62.4% of pharmacists following good HAMs-related practices. We identified several barriers to conducting HAMs training through qualitative analysis. These barriers included lack of knowledge, poor attitude and behavior of medical and paramedical staff, false beliefs, lack of active support by hospital administration, lack of cooperation between HCPs, lack of opportunities, heavy workload, insufficient human resources, financial constraints, and lack of motivation. CONCLUSIONS A significant proportion of the hospital pharmacists had unsatisfactory knowledge and practices of HAMs. These findings underscore that training on HAMs should be conducted periodically as a part of hospital-based pharmacy education to maximize drug safety.
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Affiliation(s)
- Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Zia Ul Mustafa
- Department of Pharmacy Services, District Headquarter Hospital, Pakpattan, Pakistan
| | - Naureen Shehzadi
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Kingdom of Saudi Arabia
| | - Noman Asif
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Kingdom of Saudi Arabia
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Science, University of Veterinary and Animal Science, City Campus, Outfall Road Civil line Lahore, Lahore, Pakistan
| | - Khalid Hussain
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
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He M, Huang Q, Lu H, Gu Y, Hu Y, Zhang X. Call for Decision Support for High-Alert Medication Administration Among Pediatric Nurses: Findings From a Large, Multicenter, Cross-Sectional Survey in China. Front Pharmacol 2022; 13:860438. [PMID: 35928259 PMCID: PMC9343802 DOI: 10.3389/fphar.2022.860438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Children have a higher risk of medication errors (MEs) than adults. The Institute for Safe Medication Practice (ISMP) defined high-alert medications (HAMs) as a group of medications that could cause significant patient harm or even death when they are used in error. Nurses are actively involved in and responsible for patient care, especially in medication administration. This study aimed to estimate the knowledge, decision-making basis and confidence and decision support needs related to HAMs among pediatric nurses in China. Methods: A web-based, cross-sectional survey was conducted among pediatric nurses who were recruited from 14 member hospitals of the Pediatric Nursing Alliance of National Children’s Medical Center in China using a convenient sampling technique. Data were collected using a self-administered instrument composed of four parts: the demographic characteristics of participants, participants’ knowledge about HAMs, participants’ self-evaluation of the basis of and confidence in decision-making, and decision support needs regarding HAMs. Among the participants, the maximum score for HAM knowledge was 100. All data were entered and analyzed using SPSS 20.0. Results: A total of 966 nurses participated in this study. Nurses were found to have insufficient knowledge about HAMs, with a median (IQR) of 75.0 (70.0, 80.0), out of a maximum score of 100. Knowledge about HAM administration was significantly higher than that about HAM regulation, with a p value < 0.001. The three lowest-scoring items concerned HAM regulation, and the “Treat fentanyl skin patches as a regulated narcotic” item obtained the lowest score, with only 1/5 of respondents answering it correctly. Most participants reported that their basis for decision-making about HAMs was drug instructions (90.0%) or drug handbooks (81.9%) and evaluated their confidence in decision-making about HAMs as high or relatively high (84.6%). The decision-making difficulties when encountering HAMs focused on most stages of HAM administration, especially the appropriateness of prescriptions, checks, preparation and administration. The vast majority of participants assessed decision support as necessary or very necessary (92.0%), and the most popular options for decision support were computerized clinical decision support systems (46.4%) and real-time online communication with pharmacists (23.9%). Conclusion: Our study demonstrated the inadequacies in HAM knowledge, the basis and difficulty of decision-making, and decision support needs regarding HAMs in Chinese pediatric nurses. Nurses need greater support in HAM administration, including not only training but also adequate technology, mutually beneficial interprofessional collaboration, and a positive institutional culture.
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Affiliation(s)
- Mengxue He
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, China
- Shanghai Children’s Medical Center, Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Qin Huang
- Children's Hospital, Fudan University, Shanghai, China
| | - Hong Lu
- Shanghai Children’s Medical Center, Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Ying Gu
- Children's Hospital, Fudan University, Shanghai, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, China
- *Correspondence: Yan Hu, ; Xiaobo Zhang,
| | - Xiaobo Zhang
- Children's Hospital, Fudan University, Shanghai, China
- *Correspondence: Yan Hu, ; Xiaobo Zhang,
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Roman Jones J, Boltz M, Allen R, Van Haitsma K, Leslie D. Nursing Students' Knowledge, Personality Traits, and Self-Efficacy Related to Medication Administration Error. J Nurs Educ 2022; 61:367-374. [PMID: 35858129 DOI: 10.3928/01484834-20220610-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nursing education influences medication administration practices, which involve clinical decision making and risk perceptions. METHOD This mixed-methods concurrent nested study explored the relationship among knowledge, personality traits, and self-efficacy related to medication administration error in fourth-year, prelicen-sure nursing students (n = 60) who were recruited from three campuses of a large university. RESULTS Results indicated low mean knowledge (70.75) and neuroticism (2.44) scores, and high mean self-efficacy and confidence (5.78) and conscientiousness (4.51) scores. Conscientiousness was correlated with both knowledge (r = .271, p = .036) and neuroticism (r = -.313, p = .015). Thematic analysis yielded four themes: nature of risk perceptions, more opportunities to learn, experiences with medication administration error, and intrinsic characteristics influence errors. Convergence was evident in both knowledge and personality data; self-efficacy/confidence and risk perceptions data diverged. CONCLUSION Knowledge, personality traits, and self-efficacy appear to influence nursing students' risk perceptions of medication administration error, indicating an area for future research. [J Nurs Educ. 2022;61(7):367-374.].
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Qedan RI, Daibes MA, Al-Jabi SW, Koni AA, Zyoud SH. Nurses' knowledge and understanding of obstacles encountered them when administering resuscitation medications: a cross-sectional study from Palestine. BMC Nurs 2022; 21:116. [PMID: 35578234 PMCID: PMC9109424 DOI: 10.1186/s12912-022-00895-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 05/09/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Medication errors (ME) are one of the most important reasons for patient morbidity and mortality, but insufficient drug knowledge among nurses is considered a major factor in drug administration errors. Furthermore, the complex and stressful systems surrounding resuscitation events increase nursing errors. AIMS This study aimed to assess the knowledge about resuscitation medications and understand the obstacles faced by nurses when giving resuscitation medications. Additionally, errors in the reporting of resuscitation medication administration and the reasons that prevented nurses from reporting errors were investigated. METHODS A cross-sectional study was conducted in the West Bank, Palestine. Convenient sampling was used to collect data, which was collected via a face-to-face interview questionnaire taken from a previous study. The questionnaire consisted of five parts: demographic data, knowledge of resuscitation medications (20 true/false questions), self-evaluation and causes behind not reporting ME, with suggestions to decrease ME. RESULTS A total of 200 nurses participated in the study. Nurses were found to have insufficient knowledge about resuscitation medications (58.6%). A high knowledge score was associated with male nurses, those working in the general ward, the cardiac care unit (CCU), the intensive care unit (ICU) and the general ward. The main obstacles nurses faced when administering resuscitation medication were the chaotic environment in cardiopulmonary resuscitation (62%), the unavailability of pharmacists for a whole day (61%), and different medications that look alike in the packaging (61%). Most nurses (70.5%) hoped to gain additional training. In our study, we found no compatibility in the definition of ME between nurses and hospitals (43.5%). CONCLUSIONS Nurses had insufficient knowledge of resuscitation medications. One of the obstacles nurses faced was that pharmacists should appropriately arrange medications, and nurses wanted continuous learning and additional training about resuscitation medications to decrease ME.
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Affiliation(s)
- Rawan I Qedan
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Marah A Daibes
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Samah W Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Amer A Koni
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Division of Clinical Pharmacy, Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
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Mustafa ZU, Haroon S, Aslam N, Saeed A, Salman M, Hayat K, Shehzadi N, Hussain K, Khan AH. Exploring Pakistani Physicians' Knowledge and Practices Regarding High Alert Medications: Findings and Implications. Front Pharmacol 2022; 13:744038. [PMID: 35359861 PMCID: PMC8960238 DOI: 10.3389/fphar.2022.744038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/24/2022] [Indexed: 12/16/2022] Open
Abstract
Introduction: While many low-middle income countries (LMICs), including Pakistan, try and ensure patient safety within available resources, there are considerable concerns with medication use. Unsafe and inappropriate medication use, especially high alert medications (HAMs), is one of the important factors compromising patient safety and quality of care. Besides economic loss, HAMs contribute to greater morbidity, hospitalization, and mortality. Physicians as key members of the provision of healthcare are expected to be well aware of the administration and regulations surrounding HAMs. However, the current status is unknown in Pakistan. Consequently, the objectives of this study were to evaluate the knowledge of Pakistani physicians about the administration, regulation, and practices related to HAMs. This builds on our recently published study with nurses. Methods: An online cross-sectional study design was used, and data were gathered from the physicians throughout Pakistan using previously used self-administered questionnaires during a period of 5 months (January 1 to May 30, 2021). All data were entered and analyzed using SPSS 22 for Windows. Results: Physicians (847) who provided consent were enrolled in the study. Most physicians (62.2%) were male, aged between 25 and 30 years (75.2%) and had 2- to 5-year work experience (50.9%). About 27% were working in the emergency departments. The median (IQR) knowledge score for HAMs administration and regulation was 5 (3) and 5 (2), respectively. About 46.4% of respondents were found to have moderate knowledge about HAMs; increasing age, work experience, and higher qualifications were significantly associated (p < 0.05) with better HAMs knowledge. Around 58% had good practices relating to HAMs during their routine work. Median practice scores increased significantly (p < 0.05) with age, work experience, and postgraduate qualification. Conclusion: Most Pakistani physicians possess moderate knowledge about HAMs administration and regulations. However, their practices relating to the HAMs administration and regulations are typically sub-optimal. Consequently, HAMs awareness needs to be improved by including course content in the current curriculum, provision of hospital-based continuous training programs about patient safety and care, and establishment of multi-disciplinary health care teams, including board-certified pharmacists and specialized nurses, for the effective execution of medication use process in Pakistani hospitals in the future.
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Affiliation(s)
- Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, Pakistan
- *Correspondence: Zia Ul Mustafa, ; Muhammad Salman,
| | - Shahzaib Haroon
- Department of Medicine, Faisalabad Medical University, Faisalabad, Pakistan
| | - Naeem Aslam
- Department of Surgery and Allied, District Headquarter Hospital (DHQ), Pakpattan, Pakistan
| | - Ahsan Saeed
- Department of Surgery and Allied, DHQ Teaching Hospital, Sahiwal, Pakistan
| | - Muhammad Salman
- Department of Pharmacy, The University of Lahore, Lahore, Pakistan
- *Correspondence: Zia Ul Mustafa, ; Muhammad Salman,
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and AnimalSciences, Lahore, Pakistan
| | | | - Khalid Hussain
- College of Pharmacy, Punjab University, Lahore, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
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ÖZTÜRK F, ALTIPARMAK Ö, TORUN B, BEKTAY MY, SANCAR M, OKUYAN B. Reliability of High-Alert Medications Questionnaire in Turkish Healthcare Professionals. BEZMIALEM SCIENCE 2022. [DOI: 10.14235/bas.galenos.2020.5238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Dionisi S, Giannetta N, Maselli N, Di Muzio M, Di Simone E. Medication errors in homecare setting: An Italian validation study. Public Health Nurs 2021; 38:1116-1125. [PMID: 34231262 DOI: 10.1111/phn.12946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Medication errors are a concern in overall the world. Although there are studies that investigate what may be the main causes that lead to the genesis of the medication error in the home care setting, there is no tool that correlates knowledge, attitudes, and behavior to medication errors in the context of home care. This study aimed to psychometrically test to the questionnaire on knowledge, attitudes, and behaviors in the administration of medication in the new setting: home care setting. DESIGN This observational study was reported according to the STROBE checklist. SAMPLE Sixty two nurses working in home care setting responded to the online survey. MEASUREMENT The face and content validity of the items generated was assessed. An Exploratory Factorial Analysis descriptive statistical analysis was conducted. The final questionnaire is composed of 20 items. RESULTS The results of the statistical analyses allowed to validate the questionnaire, ensuring good internal consistency and reliability. Most of the sample pointed out that the use of electronic health record, medication reconciliation and the pharmacist's figure are all useful strategies for reducing the risk of medication errors. CONCLUSION The questionnaire is reliable to measure knowledge, attitude, and behavior about medication errors prevention in home care settings.
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Affiliation(s)
- Sara Dionisi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Lazio, Italy
| | - Noemi Giannetta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Lazio, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Nicoletta Maselli
- Provincial Agency for Health Services of the Autonomous Province of Trento, Trento, Italy
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Lazio, Italy
| | - Emanuele Di Simone
- Nursing, Technical, Rehabilitation, Assistance and Research Department, IRCCS Istituti Fisioterapici Ospitalieri, IFO, Rome, Italy
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Mostafa LS, Sabri NA, El-Anwar AM, Shaheen SM. Evaluation of pharmacist-led educational interventions to reduce medication errors in emergency hospitals: a new insight into patient care. J Public Health (Oxf) 2021; 42:169-174. [PMID: 30608549 DOI: 10.1093/pubmed/fdy216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 11/13/2018] [Accepted: 11/30/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Medication errors made by nurses are common in general practice and can lead to harm in patients. The aim of this study was to evaluate the impact of pharmacist-led educational implementations in reducing medication errors made by nurses in an emergency hospital in Cairo, Egypt. METHODS A prospective pre-post-interventional study was conducted in an emergency hospital using direct observation for the detection of errors. The rate and severity of medication errors were determined before and after the implementation of educational tools. RESULTS In total, 1025 and 1024 patients were examined pre- and post-intervention, respectively. Pharmacist interventions resulted in a significant reduction in the medication error rate from 351 (34.2%) in the pre-intervention phase to 157 (15.3%) in the post-intervention phase (P < 0.001). In both the pre- and post-intervention phases, none of the medication errors were associated with harm/death. Furthermore, all types of medication errors declined as a result of the interventions. CONCLUSION Clinical pharmacists' interventions focusing on improving nurses' drug knowledge and awareness of errors were shown to be effective in reducing the rate and severity of medication administration errors among nurses in an emergency hospital environment.
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Affiliation(s)
- Lobna S Mostafa
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Nagwa Ali Sabri
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Ali M El-Anwar
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sara M Shaheen
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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Sullivan KM, Le PL, Ditoro MJ, Andree JT, Charest DJ, Tuiskula KA. Enhancing High Alert Medication Knowledge Among Pharmacy, Nursing, and Medical Staff. J Patient Saf 2021; 17:311-315. [PMID: 33994533 DOI: 10.1097/pts.0b013e3182878113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Limited data exist regarding staff's knowledge and perceptions of high alert medications (HAMs) and associated procedures. Objectives of this study were to conduct an initial assessment of institution-specific HAM knowledge among pharmacy, nursing, and medical staff; implement interventions to enhance staff knowledge of HAMs; and conduct a similar assessment 1 year later to determine if interventions successfully enhanced HAM knowledge. METHODS A 6-question electronic survey was distributed to 1006 pharmacy staff, nurses, and physicians in June 2009. In response to results achieved, HAM-related interventions were implemented over a 6-month period. A similar electronic survey was distributed to hospital staff 1 year later to determine any change in HAM knowledge. RESULTS A total of 203 staff completed the presurvey (20% response rate), whereas 170 completed the postsurvey (17% response rate). Before the HAM interventions, 42.9% of respondents expressed confidence in their knowledge of HAMs and the procedures defined by the institution. This increased to 73.5% after the interventions (P < 0.001). More respondents correctly identified HAMs and safety procedures on postsurveys: insulin IV bolus (83.3% vs. 92.4%; P < 0.01), neonatal medications (79.3% vs. 88.2%; P < 0.05), total parenteral nutrition (57.1% vs. 73.5%; P = 0.001), and "documentation of 2 independent registered nurse checks for HAM IV infusion rate changes" (76.4% vs. 92.9%; P < 0.001). CONCLUSIONS An assessment of staff HAM knowledge and handling procedures allows for customized interventions for institution-specific HAM improvements. Hospital staff knowledge of HAMs increased 1 year after implementing interventions.
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Affiliation(s)
- Karyn M Sullivan
- From the Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts
| | - Phuoc Lynsey Le
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Escrivá Gracia J, Aparisi Sanz Á, Brage Serrano R, Fernández Garrido J. Medication errors and risk areas in a critical care unit. J Adv Nurs 2020; 77:286-295. [PMID: 33107622 DOI: 10.1111/jan.14612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/03/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to identify the main medication errors, their causality and the highest risk areas in critical care. DESIGN A descriptive, longitudinal and retrospective study. METHODS We performed a systematic analysis of the prescription, transcription and administration records of 2,634 dose units of medications that were administered to a total of 87 critically ill patients during 2018. RESULTS Final results have shown important medication errors and a high number of significant drug interactions; prescription phase had the highest mistake rate (71%) and cause of errors (68%); transcription stage had a more variable error typology. A significant correlation was observed between the presence of causes and contributing factors to error during the prescription and the commission of errors during the nurse transcription, being the main risk areas the time of antibiotic administration, dilution errors, concentration and speed of administration of high-risk medications and the technique used for nasogastric tube drug administration. CONCLUSION In critical care, an intolerable number of medication errors are still committed, placing the origin of many of them in the causality and contributing factors identified in the prescription stage. IMPACT The origin of many of the medication errors and most interactions is in the prescription stage, being the nurse transcription (nurse intervention) in an important filter that prevents a considerable number of errors from finally reaching the patient. The schedule of administration of time-dependent antibiotics, high-risk medications and the technique of administering medications through a nasogastric tube are important risk areas for the commission of medication errors.
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Affiliation(s)
| | - Álvaro Aparisi Sanz
- Cardiology Department, Valladolid University Clinical Hospital, Valladolid, Spain
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Use of Simulation-Based Learning to Teach High-Alert Medication Safety: A Feasibility Study. Clin Simul Nurs 2020. [DOI: 10.1016/j.ecns.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Salman M, Mustafa ZU, Rao AZ, Khan QUA, Asif N, Hussain K, Shehzadi N, Khan MFA, Rashid A. Serious Inadequacies in High Alert Medication-Related Knowledge Among Pakistani Nurses: Findings of a Large, Multicenter, Cross-sectional Survey. Front Pharmacol 2020; 11:1026. [PMID: 32765259 PMCID: PMC7381221 DOI: 10.3389/fphar.2020.01026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Deaths-related to medications errors are common in Pakistan but these are not accurately reported. Recently, the death of a 9 months old baby due to abrupt administration of 15% potassium chloride injection sparked the issue of high alert medications (HAMs) related errors in the country. Since drug administration is the prime responsibility of the nurses, it is pivotal that they possess good knowledge of HAMs. Since there is no published data regarding the knowledge of HAMs among Pakistani nurses, we aimed to assess knowledge of HAMs among registered nurses of Pakistan. Methods A cross-sectional study was conducted among registered nurses, recruited using a convenient sampling technique, from 29 hospitals all over the Punjab Province. Data were collected using a validated self-administered instrument. All data were entered and analyzed using SPSS version 22. Results The study sample was comprised of 2,363 registered nurses (staff nurses = 94.8%, head nurses = 5.2%). Around 63% were working in tertiary hospitals whereas almost 25 and 12% were from district headquarter hospitals and tehsil headquarter hospitals, respectively. Around 84% of the study participants achieved scores <70%, indicating majority of Pakistani nurses having poor knowledge of HAMs administration as well as regulation. There was no significant difference of overall knowledge among age, hospitals, departments, training, designations, qualification, and experience categories. Major obstacles encountered during HAMs administration were "getting uncertain answers from colleagues" (72.9%), "unavailability of suitable person to consult" (61.1%) and "receiving verbal orders" (55.6%). Conclusion Our study revealed the serious inadequacies in HAMs knowledge among Pakistani nurses which may lead to adverse patient outcomes. Nurses should receive comprehensive pharmacology knowledge not only during in-school nursing education but also as hospital-based continuing education. Moreover, it is of immense importance to bridge the gaps between physicians, clinical pharmacists, and nurses through effective communication as this will help reduce medication errors and improve patient care.
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Affiliation(s)
- Muhammad Salman
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Zia Ul Mustafa
- Department of Pharmacy, District Headquarter Hospital, Pakpattan, Pakistan
| | - Alina Zeeshan Rao
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Qurat-Ul-Ain Khan
- Department of Pharmacy, Punjab Institute of Cardiology, Lahore, Pakistan
| | - Noman Asif
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Khalid Hussain
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Naureen Shehzadi
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | | | - Amir Rashid
- Department of Pharmacology, Faculty of Pharmacy, The University of Lahore, Islamabad, Pakistan
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Psychometric Properties of the Brazilian Version of the Nurses' Knowledge of High-Alert Medications Scale: A Pilot Study. Res Theory Nurs Pract 2020; 33:23-38. [PMID: 30796146 DOI: 10.1891/1541-6577.33.1.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE High-alert medication is considered to be a medication that presents a high risk of causing significant patient harm when used erroneously and its consequences can be fatal. The Nurses' Knowledge of High-Alert Medication scale (NKHAM) is a tool available to evaluate the knowledge of nurses in practice about this issue. AIM This pilot study aimed to measure the reliability and known-groups validity of the Brazilian version of the NKHAM. METHODS This pilot psychometric study was carried out at the Faculty of Nursing and University Hospital of the University of Campinas, São Paulo, Brazil. Forty nursing students and 44 registered nurses working in complex clinical or surgical settings completed a sociodemographic questionnaire and the Brazilian version of the NKHAM. The Kuder-Richardson 20 (KR-20) coefficient and Mann-Whitney test were used to establish reliability and known-groups validity. A significance level of ≤ 0.05 was adopted for all the analyses. RESULTS Analyses demonstrated preliminary acceptable reliability scores of 0.55 and 0.60 in domains A and B of NKHAM, respectively. A significant difference was found between the nursing students' and the registered nurses' knowledge of high-alert medications, demonstrating the scale's ability to discriminate between the two groups. IMPLICATIONS FOR PRACTICE Although this is pilot study, results suggest that the Brazilian version of the NKHAM might be a reliable and valid tool to measure nurses' knowledge of high-alert medications.
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Luokkamäki S, Härkänen M, Saano S, Vehviläinen-Julkunen K. Registered Nurses' medication administration skills: a systematic review. Scand J Caring Sci 2020; 35:37-54. [PMID: 32168398 DOI: 10.1111/scs.12835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/09/2020] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this review was to identify methods for measuring Registered Nurses' medication administration skills and to describe these skills. DESIGN A systematic literature review. DATA SOURCES The CINAHL, PubMed, Scopus, Cochrane, PsycInfo and Medic databases were searched for articles from the period 2007-2018. REVIEW METHODS Two researchers independently selected the articles and evaluated their quality using the National Heart, Lung and Blood Institute study quality assessment tools. The data were analysed using content analysis. RESULTS A total of 727 studies were identified of which 22 studies were included in this review. A total of six different measurement methods were identified: questionnaire or survey, observation, knowledge test or exam, focus group interviews, chart reviews and voluntarily reported errors. Different methods provided different information on medication administration skills. Medication administration skills were classified under nine areas: (1) safe ordering, handling, storing and discarding of medications, (2) preparing of medications, (3) the administration of medications to patients, (4) documentation, (5) evaluation and assessment of medication-related issues, (6) drug calculation skills, (7) cooperation with other professionals and (8) with the patients and (9) reporting of medication information. The results demonstrated that there are many areas that need to be improved to increase medication safety. CONCLUSIONS Medication administration includes many different phases, as a result of which nurses need to have many various skills to cope with medication administration as required by their profession. This review shows that nurses' medication administration skills need to be developed, and special attention should be paid to the preparation and administration phases. It is important to regularly utilise different teaching strategies and verify nurses' medication competence. As each research method has different limitations, it is vital that further studies combine different methods to form a comprehensive picture of nurses' medication administration skills.
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Affiliation(s)
- Sanna Luokkamäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | | | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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Escrivá Gracia J, Brage Serrano R, Fernández Garrido J. Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC Health Serv Res 2019; 19:640. [PMID: 31492188 PMCID: PMC6729050 DOI: 10.1186/s12913-019-4481-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 08/28/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Medication errors are a serious and complex problem in clinical practice, especially in intensive care units whose patients can suffer potentially very serious consequences because of the critical nature of their diseases and the pharmacotherapy programs implemented in these patients. The origins of these errors discussed in the literature are wide-ranging, although far-reaching variables are of particular special interest to those involved in training nurses. The main objective of this research was to study if the level of knowledge that critical-care nurses have about the use and administration of medications is related to the most common medication errors. METHODS This was a mixed (multi-method) study with three phases that combined quantitative and qualitative techniques. In phase 1 patient medical records were reviewed; phase 2 consisted of an interview with a focus group; and an ad hoc questionnaire was carried out in phase 3. RESULTS The global medication error index was 1.93%. The main risk areas were errors in the interval of administration of antibiotics (8.15% error rate); high-risk medication dilution, concentration, and infusion-rate errors (2.94% error rate); and errors in the administration of medications via nasogastric tubes (11.16% error rate). CONCLUSIONS Nurses have a low level of knowledge of the drugs they use the most and with which a greater number of medication errors are committed in the ICU.
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Affiliation(s)
- Juan Escrivá Gracia
- Department of nursing, University of Valencia, 46001 Jaume Roig St, Valencia, Spain
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17
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Sessions LC, Nemeth LS, Catchpole K, Kelechi TJ. Nurses' perceptions of high-alert medication administration safety: A qualitative descriptive study. J Adv Nurs 2019; 75:3654-3667. [PMID: 31423633 DOI: 10.1111/jan.14173] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/28/2019] [Accepted: 08/05/2019] [Indexed: 11/27/2022]
Abstract
AIMS The aim of this study was to determine nurses' perceptions of supports and barriers to high-alert medication (HAM) administration safety. DESIGN A qualitative descriptive design was used. METHODS Eighteen acute care nurses were interviewed about HAM administration practices. Registered nurses (RNs) working with acutely ill adults in two hospitals participated in one-on-one interviews from July-September, 2017. Content analysis was conducted for data analysis. RESULTS Three themes contributed to HAM administration safety: Organizational Culture of Safety, Collaboration, and RN Competence and Engagement. Error factors included distractions, workload and acuity. Work arounds bypassing bar code scanning and independent double check procedures were common. Findings highlighted the importance of intra- and interprofessional collaboration, nurse engagement and incorporating the patient in HAM safety. CONCLUSIONS Current HAM safety strategies are not consistently used. An organizational culture that supports collaboration, education on safe HAM practices, pragmatic HAM policies and enhanced technology are recommended to prevent HAM errors. IMPACT Hospitals incorporating these findings could reduce HAM errors. Research on nurse engagement, intra- and interprofessional collaboration and inclusion of patients in HAM safety strategies is needed.
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Affiliation(s)
- Laura C Sessions
- College of Health Professions, Towson University, Towson, Maryland
| | - Lynne S Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Kenneth Catchpole
- College of Health Professions, Towson University, Towson, Maryland.,College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Teresa J Kelechi
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
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Kim MS, Kim CH. Canonical correlations between individual self-efficacy/organizational bottom-up approach and perceived barriers to reporting medication errors: a multicenter study. BMC Health Serv Res 2019; 19:495. [PMID: 31311542 PMCID: PMC6636092 DOI: 10.1186/s12913-019-4194-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/28/2019] [Indexed: 11/23/2022] Open
Abstract
Background Individual and organizational factors correlate with perceived barriers to error reporting. Understanding medication administration errors (MAEs) reduces confusion about error definitions, raises perceptions of MAEs, and allows healthcare providers to report perceived and identified errors more frequently. Therefore, an emphasis must be placed on medication competence, including medication administration knowledge and decision-making. It can be helpful to utilize an organizational approach, such as collaboration between nurses and physicians, but this type of approach is difficult to establish and maintain because patient-safety culture starts at the highest levels of the healthcare organization. This study aimed to examine the canonical correlations of an individual self-efficacy/bottom-up organizational approach variable set with perceived barriers to reporting MAEs among nurses. Methods We surveyed 218 staff nurses in Korea. The measurement tools included a questionnaire on knowledge of high-alert medication, nursing decision-making, nurse-physician collaboration satisfaction, and barriers to reporting MAEs. Descriptive statistics, t-tests, analysis of variance (ANOVA), Pearson’s correlation coefficient, and canonical correlations were used to analyze results. Results Two canonical variables were significant. The first variate indicated that less knowledge about medication administration (− 0.83) and a higher perception of nurse-physician collaboration (0.42) were related to higher disagreement over medication error (0.64). The second variate showed that intuitive clinical decision-making (− 0.57) and a higher perception of nurse-physician collaboration (0.84) were related to lower perceived barriers to reporting MAEs. Conclusions Enhancing positive collaboration among healthcare professionals and promoting analytic decision-making supported by sufficient knowledge could facilitate MAE reporting by nurses. In the clinical phase, providing medication administration education and improving collaboration may reduce disagreement about the occurrence of errors and facilitate MAE reporting. In the policy phase, developing an evidence-based reporting system that informs analytic decision-making may reduce the perceived barriers to MAE reporting.
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Affiliation(s)
- Myoung Soo Kim
- Department of Nursing, Pukyong National University, 599-1, Daeyeon 3 dong, Namgu, Busan, 48513, South Korea
| | - Chul-Hoon Kim
- College of Medicine, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan, 49201, South Korea.
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19
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Zyoud SH, Khaled SM, Kawasmi BM, Habeba AM, Hamadneh AT, Anabosi HH, Fadel AB, Sweileh WM, Awang R, Al-Jabi SW. Knowledge about the administration and regulation of high alert medications among nurses in Palestine: a cross-sectional study. BMC Nurs 2019; 18:11. [PMID: 30936779 PMCID: PMC6425670 DOI: 10.1186/s12912-019-0336-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Medication errors (MEs) are unintended failures in the drug treatment process that can occur during prescription, dispensing, storing, preparation or administration of medications. High alert medications (HAMs) are defined as those medications that bear the highest risk of causing significant patient harm when used incorrectly, either due to their serious adverse events or to a narrow therapeutic window. Nurses are responsible for administration of HAMs; incorrect administration can have a significant clinical outcome. This study aimed to assess the level of knowledge of HAMs among nurses in government hospitals in West Bank, Palestine. METHODS A cross-sectional study was conducted in 2015, in West Bank, Palestine. Data were collected via a face to face interview questionnaire, which was taken from a previous study. Data were collected by convenient sampling. The questionnaire consisted of four parts: demographic characteristics of the nurses, drug administration knowledge (10 true-false questions), drug regulation knowledge (10 true-false questions), and self-evaluation. RESULTS A total of 280 nurses participated in the study; these nurses were working in the emergency room (ER), intensive care unit (ICU), paediatric or medical ward. The response rate was 93%. Nurses were found to have insufficient knowledge about HAMs; 67.1% of participants had a score of less than 70%, with a mean total score of 59.9 ± 15.1. Factors associated with sufficient knowledge among nurses were HAMs training and ICU training, both with p-values of 0.002. Nurses with a master degree, those working in the ICU ward, head nurses, and male nurses were the most knowledgeable groups, with a p-values < 0.001. 81.8% of respondents hoped to obtain additional training. The leading obstacles reported were inconsistent opinions between doctors and nurses (37.9%), and no established standard operating procedure for HAMs (37.1%). CONCLUSIONS Lack of knowledge was one of the obstacles that nurses encountered during administration of HAMs which might result in MEs. Nurses reported that they would like to have additional training to update their pharmacology knowledge. Nurses could benefit from additional continuing education and training programs.
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Affiliation(s)
- Sa’ed H. Zyoud
- 0000 0004 0631 5695grid.11942.3fPoison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- 0000 0004 0631 5695grid.11942.3fDivision of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Samar M. Khaled
- 0000 0004 0631 5695grid.11942.3fPharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Baraa M. Kawasmi
- 0000 0004 0631 5695grid.11942.3fPharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ahed M. Habeba
- 0000 0004 0631 5695grid.11942.3fPharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ayat T. Hamadneh
- 0000 0004 0631 5695grid.11942.3fPharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Hanan H. Anabosi
- 0000 0004 0631 5695grid.11942.3fPharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Asma’a Bani Fadel
- 0000 0004 0631 5695grid.11942.3fPharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Waleed M. Sweileh
- 0000 0004 0631 5695grid.11942.3fDepartment of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Rahmat Awang
- 0000 0001 2294 3534grid.11875.3aWHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), 11800 Penang, Malaysia
| | - Samah W. Al-Jabi
- 0000 0004 0631 5695grid.11942.3fDivision of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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20
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Dirik HF, Samur M, Seren Intepeler S, Hewison A. Nurses’ identification and reporting of medication errors. J Clin Nurs 2018; 28:931-938. [DOI: 10.1111/jocn.14716] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/30/2018] [Accepted: 11/03/2018] [Indexed: 12/13/2022]
Affiliation(s)
| | - Menevse Samur
- Faculty of Nursing Dokuz Eylul University Izmir Turkey
| | | | - Alistair Hewison
- School of Nursing, Institute of Clinical Sciences University of Birmingham Birmingham UK
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21
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Bryant R, Chaar B, Schneider C. Differing clinical pharmacy service models: Quantitative and qualitative analysis of nurse perceptions of support from pharmacists. Int J Nurs Stud 2018; 86:90-98. [DOI: 10.1016/j.ijnurstu.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 03/31/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
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Di Simone E, Giannetta N, Auddino F, Cicotto A, Grilli D, Di Muzio M. Medication Errors in the Emergency Department: Knowledge, Attitude, Behavior, and Training Needs of Nurses. Indian J Crit Care Med 2018; 22:346-352. [PMID: 29910545 PMCID: PMC5971644 DOI: 10.4103/ijccm.ijccm_63_18] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: The aim was to describe which elements of nurses' knowledge, training needs, behavior, and attitude can prevent Medication errors (Acronym MEs) in the emergency department during all steps of the administration of intravenous (IV) medications. Methods: An anonymous questionnaire made up of 43 items has been drafted and delivered to a sample of 103 nurses of a university hospital in Rome. The study has been supported by specific literature review. Results: Majority of the sample (94%) answered that topics related to the preparation and administration of IV medications were covered during the basic course while 63.2% only during the postbasic course. Only 15.6% of nurses judged excellent their level of knowledge about preparation and administration of IV medications while 89.3% considered that it is important to improve their knowledge; 85.6% said that the teaching about the use of IV medications should be increased during the degree course they attended; 30.3% agreed that specific postgraduate courses on the use of IV drugs should be designed. Moreover, only 22% of the sample believed that the coaching of new recruit nurses is critical to prevent errors. Conclusion: The sample showed appropriate knowledge, positive attitudes, and right behavior related to the preparation and administration of IV medications. The skills that nurses must have in pharmacology are still rising, both due to the safety of drug therapy and to the increasing number of drugs available; the result is that nurses have to update their knowledge regularly.
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Affiliation(s)
- Emanuele Di Simone
- Department of Biomedicine and Prevention - University of Rome Tor Vergata, Italy
| | - Noemi Giannetta
- Department of Biomedicine and Prevention - University of Rome Tor Vergata, Italy
| | | | | | | | - Marco Di Muzio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
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23
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Lee E. Reporting of medication administration errors by nurses in South Korean hospitals. Int J Qual Health Care 2017; 29:728-734. [DOI: 10.1093/intqhc/mzx096] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 07/12/2017] [Indexed: 11/14/2022] Open
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Berland A, Bentsen SB. Medication errors in home care: a qualitative focus group study. J Clin Nurs 2017; 26:3734-3741. [PMID: 28152226 DOI: 10.1111/jocn.13745] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore registered nurses' experiences of medication errors and patient safety in home care. BACKGROUND The focus of care for older patients has shifted from institutional care towards a model of home care. Medication errors are common in this situation and can result in patient morbidity and mortality. DESIGN An exploratory qualitative design with focus group interviews was used. METHODS Four focus group interviews were conducted with 20 registered nurses in home care. The data were analysed using content analysis. RESULTS Five categories were identified as follows: lack of information, lack of competence, reporting medication errors, trade name products vs. generic name products, and improving routines. CONCLUSION Medication errors occur frequently in home care and can threaten the safety of patients. Insufficient exchange of information and poor communication between the specialist and home-care health services, and between general practitioners and healthcare workers can lead to medication errors. A lack of competence in healthcare workers can also lead to medication errors. To prevent these, it is important that there should be up-to-date information and communication between healthcare workers during the transfer of patients from specialist to home care. Ensuring competence among healthcare workers with regard to medication is also important. In addition, there should be openness and accurate reporting of medication errors, as well as in setting routines for the preparation, alteration and administration of medicines. RELEVANCE TO CLINICAL PRACTICE To prevent medication errors in home care, up-to-date information and communication between healthcare workers is important when patients are transferred from specialist to home care. It is also important to ensure adequate competence with regard to medication, and that there should be openness when medication errors occur, as well as in setting routines for the preparation, alteration and administration of medications.
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Affiliation(s)
- Astrid Berland
- Department of Health Education, Stord/Haugesund University College, Haugesund, Norway
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Chan C, Fung HW, Choi TM, Ross CA. Using Online Methods to Develop and Examine the Hong Kong Chinese Translation of the Dissociative Experiences Scale. ACTA ACUST UNITED AC 2017; 14:70-85. [PMID: 28339326 DOI: 10.1080/23761407.2017.1298073] [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] [Indexed: 10/19/2022]
Abstract
Identifying dissociation is important for mental health services because it could fundamentally affect one's diagnosis and treatment plan. The Dissociative Experiences Scale (DES) is a widely-used self-report scale for measuring dissociative experiences. It has been translated into many languages and used in many countries. However, there is no validated Hong Kong Chinese version of the DES available in the field, and there is no other validated Hong Kong Chinese instrument for assessing dissociative disorders. This pilot study used online methods to translate the DES to Hong Kong Chinese (HKC-DES). The results indicated that the HKC-DES has excellent internal consistency (α = .953) and very good test-retest reliability (r = .797). Bilingual participants' responses to the DES and HKC-DES indicated high similarity, and were significantly correlated (r = .960). These results initially verified the reliability and cross-language equivalence of the scale. Implications for healthcare practice and research are discussed.
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Affiliation(s)
- Chitat Chan
- a Department of Applied Social Sciences , The Hong Kong Polytechnic University , Hung Hom , Hong Kong
| | - Hong Wang Fung
- a Department of Applied Social Sciences , The Hong Kong Polytechnic University , Hung Hom , Hong Kong
| | - Tat Ming Choi
- b Department of Psychology , The Chinese University of Hong Kong , Shatin , Hong Kong
| | - Colin A Ross
- c The Colin A. Ross Institute for Psychological Trauma , Richardson , Texas , USA
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Svitlica B, Simin D, Milutinović D. Potential causes of medication errors: perceptions of Serbian nurses. Int Nurs Rev 2017; 64:421-427. [DOI: 10.1111/inr.12355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- B.B. Svitlica
- Department of Nursing; Faculty of Medicine; University of Novi Sad; Novi Sad Serbia
- Clinic of the Pediatrics; Institute for Child and Youth Health Care of Vojvodina; Serbia
| | - D. Simin
- Department of Nursing; Faculty of Medicine; University of Novi Sad, Secondary Medical School Novi Sad; Novi Sad Serbia
| | - D. Milutinović
- Department of Nursing; Faculty of Medicine; University of Novi Sad; Novi Sad Serbia
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Brasaite I, Kaunonen M, Martinkenas A, Mockiene V, Suominen T. Health Care Professionals' Knowledge Regarding Patient Safety. Clin Nurs Res 2016; 26:285-300. [PMID: 26826140 DOI: 10.1177/1054773816628796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study looks to describe health care professionals' knowledge regarding patient safety. A quantitative study using questionnaires was conducted in three multi-disciplinary hospitals in Western Lithuania. Data were collected in 2014 from physicians, nurses, and nurse assistants. The overall results indicated quite a low level of safety knowledge, especially in regard to knowledge concerning general patient safety. The health care professionals' background factors such as their profession, education, the information about patient safety they were given during their vocational and continuing education, as well as their experience in their primary speciality seemed to be associated with several patient safety knowledge areas. Despite a wide variation in background factors, the knowledge level of respondents was generally found to be low. This requires that further research into health care professionals' safety knowledge related to specific issues such as medication, infection, falls, and pressure sore prevention should be undertaken in Lithuania.
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Affiliation(s)
- Indre Brasaite
- 1 University of Tampere, Tampere, Finland.,2 Klaipeda University, Klaipeda, Lithuania
| | - Marja Kaunonen
- 1 University of Tampere, Tampere, Finland.,3 Pirkanmaa Hospital District, Tampere, Finland
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Zanetti ACB, Gabriel CS, Bernardes A, Pereira LRL. Tradução para português do Brasil e adaptação cultural de um questionário sobre medicamentos potencialmente perigosos. Rev Gaucha Enferm 2016; 37:e59200. [DOI: 10.1590/1983-1447.2016.03.59200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 09/21/2016] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Descrever os processos de tradução para a língua portuguesa e adaptação cultural do Questionário de Medicamentos Potencialmente Perigosos para o contexto brasileiro. Métodos Estudo metodológico compreendendo as etapas de tradução do chinês para o português brasileiro, síntese das traduções, retrotradução para a língua de origem, comitê de juízes e pré-teste, procedendo à versão final do questionário. Resultados No processo de tradução, variações vocabulares mínimas foram solucionadas após consenso entre os tradutores. O comitê de juízes considerou que a versão traduzida para o português apresentou equivalência semântica, idiomática, cultural e conceitual, mas 50% dos itens necessitaram de ajustes. No pré-teste 30 enfermeiros de um hospital de ensino avaliaram os itens como compreensíveis. Conclusões Houve equivalência semântica, idiomática, cultural e conceitual satisfatória entre as versões do questionário, o qual é pertinente à cultura brasileira e facilmente compreensível. Entretanto, para que se disponibilize o questionário adaptado, faz-se imprescindível avaliar suas propriedades psicométricas.
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Ockhuis D, Kyriacos U. Renal unit practitioners' knowledge, attitudes and practice regarding the safety of unfractionated heparin for chronic haemodialysis. Curationis 2015; 38. [PMID: 26841913 PMCID: PMC6091600 DOI: 10.4102/curationis.v38i1.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 06/03/2015] [Accepted: 05/18/2015] [Indexed: 11/18/2022] Open
Abstract
Background Chronic haemodialysis for adult patients with end-stage kidney failure requires a patent extracorporeal circuit, maintained by anticoagulants such as unfractionated heparin (UFH). Incorrect administration of UFH has safety implications for patients. Objectives Firstly, to describe renal practitioners’ self-reported knowledge, attitudes and practice (KAP) regarding the safe use of UFH and its effects; secondly, to determine an association between KAP and selected independent variables. Method A cross-sectional descriptive survey by self-administered questionnaire and non-probability convenience sampling was conducted in two tertiary hospital dialysis units and five private dialysis units in 2013. Results The mean age of 74/77 respondents (96.1%), was 41.1 years. Most (41/77, 53.2%) had 0–5 years of renal experience. The odds of enrolled nurses having poorer knowledge of UFH than registered nurses were 18.7 times higher at a 95% Confidence Interval (CI) (1.9–187.4) and statistically significant (P = 0.013). The odds of delivering poor practice having ≤ five years of experience and no in-service education were 4.6 times higher at a 95% CI (1.4–15.6), than for respondents who had ≥ six years of experience (P = 0.014) and 4.3 times higher (95% CI 1.1–16.5) than for respondents who received in-service education (P = 0.032), the difference reaching statistical significance in both cases. Conclusion Results suggest that the category of the professional influences knowledge and, thus, safe use of UFH, and that there is a direct relationship between years of experience and quality of haemodialysis practice and between having in-service education and quality of practice.
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Affiliation(s)
- Debra Ockhuis
- Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, University of Cape Town.
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Charpiat B, Magdinier C, Leboucher G, Aubrun F. [Medication errors with concentrated potassium intravenous solutions: Data of the literature, context and prevention]. ANNALES PHARMACEUTIQUES FRANÇAISES 2015; 74:3-11. [PMID: 26298848 DOI: 10.1016/j.pharma.2015.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 06/23/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
Accidental direct intravenous injection of a concentrated solution of potassium often leads to patient death. In France, recommendations of healthcare agencies to prevent such accidents cover only preparation and intravenous infusion conditions. Accidents continue to occur in French hospitals. These facts demonstrate that these recommendations are insufficient and ineffective to prevent such deaths, especially those occurring during a catheter flushing. This article reviews the measures able to reduce the number of accidents. Countries which removed concentrated ampoules from ward stocks observed a decrease of the number of accidental deaths. This withdrawal, recommended by the World Health Organization, is now part of standards in studies aimed at determining the safety of care in hospitals. However, removal alone is insufficient to eliminate the risk. The combination with other measures should be considered. These measures are the provision of a combination of diluted intravenous ready to use solutions, the promotion of the oral route with tablets and oral solutions for potassium replenishment and to make available products with safeguards to prevent single shot intravenous injection. Studies aimed at determining the consequences on preventing concentrated potassium accidents of a widespread distribution of isotonic sodium chloride pre-filled ready-to-use syringes for catheter flushing should be performed.
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Affiliation(s)
- B Charpiat
- Service de pharmacie, hôpital de la Croix-Rousse, groupement hospitalier Nord, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
| | - C Magdinier
- Service de pharmacie, hôpital de la Croix-Rousse, groupement hospitalier Nord, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - G Leboucher
- Service de pharmacie, hôpital de la Croix-Rousse, groupement hospitalier Nord, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - F Aubrun
- Service d'anesthésie et de réanimation, hôpital de la Croix-Rousse, groupement hospitalier Nord, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
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Tang SF, Wang X, Zhang Y, Hou J, Ji L, Wang ML, Huang R. Analysis of high alert medication knowledge of medical staff in Tianjin: A convenient sampling survey in China. ACTA ACUST UNITED AC 2015; 35:176-182. [PMID: 25877348 DOI: 10.1007/s11596-015-1407-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 03/07/2015] [Indexed: 10/23/2022]
Abstract
The current situation of medical staff's awareness about high alert medication was investigated in order to promote safe medication and standardized management of the high alert medication in China. Twenty questions were designed concerning elementary knowledge of high alert medications, storage management, medication issues and risks. In order to understand the knowledge level and education status of high alert medication, a convenient survey was conducted among 300 medical staffs in Tianjin. Medical staff's average score of high alert medication knowledge was 12.43±0.27, and the average scores of elementary knowledge of high alert medication, storage management, medication issues and risks were 3.38±0.11, 2.46±0.14, 3.17±0.11 and 3.41±0.12 respectively. Occupation (F=4.86, P=0.003), education background (F=5.57, P=0.019) and professional titles (F=13.44, P≤0.001) contributed to the high alert medications knowledge scores. Currently, the most important channel to obtain high alert medication knowledge was hospital files or administrative rules, and clinical pharmacist seminars were the most popular education form. It was suggested that the high alert medication knowledge level of the medical staff needs to increase, and it might benefit from targeted, systematic and diverse training to the medical staff working in the different circulation nodes of the medications. Further research to develop and validate the instrument is needed.
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Affiliation(s)
- Shang-Feng Tang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xin Wang
- Department of Pharmacy, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Ye Zhang
- Department of Pharmacy, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Jie Hou
- Department of Pharmacy, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Lu Ji
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Man-Li Wang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Rui Huang
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Engels MJ, Ciarkowski SL. Nursing, Pharmacy, and Prescriber Knowledge and Perceptions of High-Alert Medications in a Large, Academic Medical Hospital. Hosp Pharm 2015; 50:287-95. [PMID: 26446747 PMCID: PMC4585568 DOI: 10.1310/hpj5004-287] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND High-alert medications pose a greater risk of causing significant harm to patients if used in error. The Joint Commission requires that hospitals define institution-specific high-alert medications and implement processes to ensure safe medication use. METHOD Nursing, pharmacy, and prescribers were asked to voluntarily complete a 34-question survey to assess their knowledge, experience, and perceptions regarding high-alert medications in an academic hospital. RESULTS The majority of respondents identified the organization's high-alert medications, the consequences of an error involving a high-alert medication, and the reversal agent. Most of the risk-reduction strategies within the institution were viewed as being effective by respondents. Forty-five percent of the respondents utilized a high-alert medication in the previous 24 hours. Only 14.2% had experienced an error with a high-alert medication in the previous 12 months, with 46% being near misses. The survey found the 5 rights for medication administration were not being utilized consistently. Respondents indicated that work experience or hospital orientation is the preferred learning experience for high-alert medications. CONCLUSIONS This study assessed all disciplines involved in the medication use process. Perceptions about high-alert medications differ between disciplines. Ongoing discipline-specific education is required to ensure that individuals accept accountability in the medication use process and to close knowledge gaps on high-alert medications and risk-reduction strategies.
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Affiliation(s)
- Melanie J. Engels
- University of Michigan Health System, Ann Arbor, Michigan
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Scott L. Ciarkowski
- University of Michigan Health System, Ann Arbor, Michigan
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
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Johansson-Pajala RM, Martin L, Fastbom J, Jorsäter Blomgren K. Nurses' self-reported medication competence in relation to their pharmacovigilant activities in clinical practice. J Eval Clin Pract 2015; 21:145-52. [PMID: 25327625 DOI: 10.1111/jep.12263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Adverse drug reactions (ADRs) represent a major health problem and previous studies show that nurses can have an active role in promoting medication safety. The aim of this study was to describe and evaluate nurses' self-reported competence and pharmacovigilant activities in clinical practice and also to explore the impact of age, education, workplace and nursing experience on these matters. METHODS This cross-sectional study was based on a questionnaire covering areas related to nurses' medication competence, including knowledge, assessment and information retrieval, and pharmacovigilant activities within these areas, for example, the detection and assessment of ADRs. A 45-item questionnaire was 2013 sent out to 296 nurses in different settings and counties in Sweden. They were selected on the basis of having applied to a university course including pharmacovigilance during 2008-2011. One hundred twenty-four had participated in the courses (exposed) and 172 had applied to the courses but not participated (unexposed). RESULTS Completed questionnaires were obtained from 75 exposed (60%) and 93 unexposed (54%) nurses. Overall nurses rated themselves high in medication competence but low in pharmacovigilant activities. Significant (P ≤ 0.001) differences between groups were observed regarding medication competence. The exposure of completed dedicated courses in pharmacovigilance was the strongest factor for self-reported medication competence when adjusted for age, other education, workplace and experience. No significant differences between the groups were found regarding the number of pharmacovigilant activities during the 6 months prior to answering the questionnaire. CONCLUSION Dedicated university courses improved nurses' self-reported competence in pharmacovigilance but did not increase the number of related activities. Education per se seems to be not sufficient to generate pharmacovigilant activities among nurses.
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Abstract
Objective: The aim of this study was to determine oncology nurses awareness of drug interactions. Methods: This descriptive study was conducted with nurses working in the oncology clinics who are a member of Oncology Nursing Association of Turkey. A total of 115 nurses (response rate %20) were responded to the online survey that consists of 28 questions. Results: The mean age of the nurses was 33 ± 6.8. The majority of nurses work in university hospital (60%) as a clinical nurse (62.6%) and have a Bachelor Degree in Nursing (63.5%). The mean working years in oncology was 4 years. Half of them stated receiving information on drug interactions mostly through in-service education and courses/congresses in last 5 years. The majority of them (84.3%) indicated that they are considering the possibility of drug interactions when they are scheduling the medication administration time. More than half of the responders (59.1%) encountered drug interactions; however, few explored drug interactions with food, drinks, and nutritional supplements. Their practices to assess possibility of drug interactions were reviewing the drug prospectus (78.3%); consulting with their colleagues (58.3%) and searching on the available website (42.6%) and looking at the drug interaction (39.1%). More than half (65.2%) stated lack of any system to identify drug interactions in their workplace. Nearly half of them indicated to including the drug interaction into patient education mostly for food-drug (73.9%) and drug-drug (63.5%) interactions. Conclusions: Almost all indicated the needs for further education on drug interactions and suggested to have guideline/packet guide.
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Affiliation(s)
- Azize Karahan
- Department of Nursing, Baskent University, Faculty of Health Sciences, Ankara, Turkey
| | - Sevcan Avcı Isik
- Department of Nursing, Baskent University, Faculty of Health Sciences, Ankara, Turkey
| | - Sultan Kav
- Department of Nursing, Baskent University, Faculty of Health Sciences, Ankara, Turkey
| | - Aysel Abbasoglu
- Department of Nursing, Baskent University, Faculty of Health Sciences, Ankara, Turkey
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Keers RN, Williams SD, Cooke J, Ashcroft DM. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug Saf 2014; 36:1045-67. [PMID: 23975331 PMCID: PMC3824584 DOI: 10.1007/s40264-013-0090-2] [Citation(s) in RCA: 262] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Underlying systems factors have been seen to be crucial contributors to the occurrence of medication errors. By understanding the causes of these errors, the most appropriate interventions can be designed and implemented to minimise their occurrence. OBJECTIVE This study aimed to systematically review and appraise empirical evidence relating to the causes of medication administration errors (MAEs) in hospital settings. DATA SOURCES Nine electronic databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts, ASSIA, PsycINFO, British Nursing Index, CINAHL, Health Management Information Consortium and Social Science Citations Index) were searched between 1985 and May 2013. STUDY SELECTION Inclusion and exclusion criteria were applied to identify eligible publications through title analysis followed by abstract and then full text examination. English language publications reporting empirical data on causes of MAEs were included. Reference lists of included articles and relevant review papers were hand searched for additional studies. Studies were excluded if they did not report data on specific MAEs, used accounts from individuals not directly involved in the MAE concerned or were presented as conference abstracts with insufficient detail. DATA APPRAISAL AND SYNTHESIS METHODS A total of 54 unique studies were included. Causes of MAEs were categorised according to Reason's model of accident causation. Studies were assessed to determine relevance to the research question and how likely the results were to reflect the potential underlying causes of MAEs based on the method(s) used. RESULTS Slips and lapses were the most commonly reported unsafe acts, followed by knowledge-based mistakes and deliberate violations. Error-provoking conditions influencing administration errors included inadequate written communication (prescriptions, documentation, transcription), problems with medicines supply and storage (pharmacy dispensing errors and ward stock management), high perceived workload, problems with ward-based equipment (access, functionality), patient factors (availability, acuity), staff health status (fatigue, stress) and interruptions/distractions during drug administration. Few studies sought to determine the causes of intravenous MAEs. A number of latent pathway conditions were less well explored, including local working culture and high-level managerial decisions. Causes were often described superficially; this may be related to the use of quantitative surveys and observation methods in many studies, limited use of established error causation frameworks to analyse data and a predominant focus on issues other than the causes of MAEs among studies. LIMITATIONS As only English language publications were included, some relevant studies may have been missed. CONCLUSIONS Limited evidence from studies included in this systematic review suggests that MAEs are influenced by multiple systems factors, but if and how these arise and interconnect to lead to errors remains to be fully determined. Further research with a theoretical focus is needed to investigate the MAE causation pathway, with an emphasis on ensuring interventions designed to minimise MAEs target recognised underlying causes of errors to maximise their impact.
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Affiliation(s)
- Richard N Keers
- Manchester Pharmacy School, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, M13 9PT, UK,
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Lan YH, Wang KWK, Yu S, Chen IJ, Wu HF, Tang FI. Medication errors in pediatric nursing: assessment of nurses' knowledge and analysis of the consequences of errors. NURSE EDUCATION TODAY 2014; 34:821-828. [PMID: 23938094 DOI: 10.1016/j.nedt.2013.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/03/2013] [Accepted: 07/22/2013] [Indexed: 06/02/2023]
Abstract
AIM The purposes of this study were (i) to evaluate pediatric nurses' knowledge of pharmacology, and (ii) to analyze known pediatric administration errors. BACKGROUND Medication errors occur frequently and ubiquitously, but medication errors involving pediatric patients attract special attention for their high incidence and injury rates. METHODS A cross-sectional study was conducted. A questionnaire with 20 true-false questions regarding pharmacology was used to evaluate nurses' knowledge, and the known pediatric administration errors were reported by nurses. FINDINGS The overall correct answer rate on the knowledge of pharmacology was 72.9% (n=262). Insufficient knowledge (61.5%) was the leading obstacle nurses encountered when administering medications. Of 141 pediatric medication errors, more than 60% (61.0%) of which were wrong doses, 9.2% of the children involved suffered serious consequences. CONCLUSIONS Evidence-based results demonstrate that pediatric nurses have insufficient knowledge of pharmacology. Such strategies as providing continuing education and double-checking dosages are suggested.
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Affiliation(s)
- Ya-Hui Lan
- Tri-service General Hospital, Taipei, Taiwan
| | - Kai-Wei K Wang
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Shu Yu
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - I-Ju Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | | | - Fu-In Tang
- School of Nursing, National Yang-Ming University, Taipei, Taiwan.
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Medication errors in the intensive care unit: literature review using the SEIPS model. AACN Adv Crit Care 2014; 24:389-404. [PMID: 24153217 DOI: 10.1097/nci.0b013e3182a8b516] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medication errors in intensive care units put patients at risk for injury or death every day. Safety requires an organized and systematic approach to improving the tasks, technology, environment, and organizational culture associated with medication systems. The Systems Engineering Initiative for Patient Safety model can help leaders and health care providers understand the complicated and high-risk work associated with critical care. Using this model, the author combines a human factors approach with the well-known structure-process-outcome model of quality improvement to examine research literature. The literature review reveals that human factors, including stress, high workloads, knowledge deficits, and performance deficits, are associated with medication errors. Factors contributing to medication errors are frequent interruptions, communication problems, and poor fit of health information technology to the workflow of providers. Multifaceted medication safety interventions are needed so that human factors and system problems can be addressed simultaneously.
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Chen MJ, Yu S, Chen IJ, Wang KWK, Lan YH, Tang FI. Evaluation of nurses' knowledge and understanding of obstacles encountered when administering resuscitation medications. NURSE EDUCATION TODAY 2014; 34:177-184. [PMID: 23660241 DOI: 10.1016/j.nedt.2013.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 03/08/2013] [Accepted: 04/08/2013] [Indexed: 06/02/2023]
Abstract
AIM The aim of the study was to develop and validate an instrument to evaluate nurses' knowledge and to understand the obstacles that they encounter when administering resuscitation medications. BACKGROUND Insufficient knowledge is a major factor in nurses' drug administration errors. Resuscitation involves situations in which doctors issue oral orders, and is inherently highly stressful. Sufficient knowledge is vital for nurses if they are to respond quickly and accurately when administering resuscitation medications. METHODS A cross-sectional study was conducted. A questionnaire (20 true-false questions) developed from literature and expert input, and validated by subject experts and one pilot study, was used to evaluate nurses' knowledge of resuscitation medications. Stratified sampling and descriptive statistics were applied. RESULTS A total of 188 nurses participated. The overall correct answer rate was 70.5% and the greater the nurse's work experience the higher the score. Only 8% of nurses considered themselves to have sufficient knowledge and 73.9% hoped to gain more training about resuscitation medications. The leading obstacle reported was "interruption of the drug administration procedure on resuscitation" (62.8%). Seventeen out of 20 questions achieved a discriminatory power of over 0.36, indicating good to excellent questions. In the study, a total of 16 resuscitation medication errors were reported by the participants, in which the errors involved atropine (five cases), epinephrine (three cases) and others (eight cases). The errors mainly involved misinterpretation of orders, insufficient knowledge and confusing certain drugs for other look-alike drugs. CONCLUSION Evidence-based results strongly suggest that nurses have insufficient knowledge and could benefit from longer working experience and additional training about resuscitation medications. Further research to validate the instrument is needed and the education of nurses regarding resuscitation medications is recommended.
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Affiliation(s)
| | - Shu Yu
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - I-Ju Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Wei K Wang
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Hui Lan
- Tri-service General Hospital, Taipei, Taiwan
| | - Fu-In Tang
- School of Nursing, National Yang-Ming University, Taipei, Taiwan.
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Kim MS. Development and Effectiveness of Smartphone Application for the Medication Confirmation of High-alert Medications. ACTA ACUST UNITED AC 2014. [DOI: 10.7475/kjan.2014.26.3.253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Myoung Soo Kim
- Department of Nursing, Pukyong National University, Busan, Korea
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Abstract
Medication errors in intensive care units put patients at risk for injury or death every day. Safety requires an organized and systematic approach to improving the tasks, technology, environment, and organizational culture associated with medication systems. The Systems Engineering Initiative for Patient Safety model can help leaders and health care providers understand the complicated and high-risk work associated with critical care. Using this model, the author combines a human factors approach with the well-known structure-process-outcome model of quality improvement to examine research literature. The literature review reveals that human factors, including stress, high workloads, knowledge deficits, and performance deficits, are associated with medication errors. Factors contributing to medication errors are frequent interruptions, communication problems, and poor fit of health information technology to the workflow of providers. Multifaceted medication safety interventions are needed so that human factors and system problems can be addressed simultaneously.
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Affiliation(s)
- Karen H. Frith
- Karen H. Frith is Professor, College of Nursing, University of Alabama in Huntsville, 301 Sparkman Dr, Huntsville, AL 35899
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Lo TF, Yu S, Chen IJ, Wang KWK, Tang FI. Faculties' and nurses' perspectives regarding knowledge of high-alert medications. NURSE EDUCATION TODAY 2013; 33:214-221. [PMID: 22322071 DOI: 10.1016/j.nedt.2012.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 12/28/2011] [Accepted: 01/14/2012] [Indexed: 05/31/2023]
Abstract
The incorrect administration of high-alert medications can have serious consequences. A previous study by the authors of this study developed and validated 20 true-false questions concerning high-alert medications and suggested that the topic be taught to nurses. The perspectives of faculty and nurses, however, needed to be assessed before such teaching could be implemented. The aim of this study was to understand the views of faculty and nurses about training in high-alert medications: its importance, the frequency with which it is provided, and the ideal stage at which it should be provided. A cross-sectional study was conducted in 2008 in Taiwan. A questionnaire was used to determine whether the 20 questions are important, whether its content was being taught, and the ideal time for teaching it. Snowball sampling and descriptive statistics were used. A total of 136 faculty and 199 nurses participated. From the perspectives of faculty and nurses, all 20 questions regarding high-alert medications were important (faculty vs. nurses: 4.65±0.35 vs. 4.45±0.67) but the issues to which they related were insufficiently taught (faculty vs. nurses: 3.88±0.87 vs. 3.06±0.94). Faculty believed that the ideal stage at which to provide training on high-alert medications was during formal, in-school nursing education (94.3%) while nurses believed that the ideal stage was during in-hospital continuing education (48.9%). For training in high-alert medications, the researchers recommended the inclusion of classes on the subject as part of formal, in-school nursing education, as well as of hospital-based continuing education. The instrument's questions highlight the important concepts concerning high-alert medications which should be taught to nurses and nursing students.
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Lu MC, Yu S, Chen IJ, Wang KWK, Wu HF, Tang FI. Nurses' knowledge of high-alert medications: a randomized controlled trial. NURSE EDUCATION TODAY 2013; 33:24-30. [PMID: 22178145 DOI: 10.1016/j.nedt.2011.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 11/14/2011] [Accepted: 11/17/2011] [Indexed: 05/31/2023]
Abstract
AIM This study explores the effectiveness of an educational intervention on nurses' knowledge regarding the administration of high-alert medications. BACKGROUND Nurses' insufficient knowledge is considered to be one of the most significant factors contributing to medication errors. Most medication errors cause no harm to patients, but the incorrect administration of high-alert medications can result in serious consequences. A previous study by the same authors validated 20 true/false questions concerning high-alert medications and suggested that the topic be taught to nurses (Hsaio, et al., 2010. Nurses' knowledge of high-alert medications: Instrument development and validation. Journal of Advanced Nursing, 66(1), 177-199.). METHODS A randomized controlled trial was employed in 2009 in Taiwan. Twenty-one hospital wards and 232 nurses were randomized to control and intervention groups. The sixty-minute educational intervention was based on the viewing of a Powerpoint file developed for this study. The results were compared pre-intervention and six weeks post-intervention by means of a test comprising the 20 questions regarding high-alert medications. FINDINGS The pre-intervention baseline data for correct answer rate was 75.8% (mean; n=232). After the intervention, the post-test showed significant improvement in the intervention group (n=113) (pre vs. post; 77.2±15.5 vs. 94.7±7.6; paired t=10.82, p<0.0001) but not in the control group (n=112) (pre vs. post; 74.3±14.7 vs. 75.5±14.2; paired t=0.60; p=0.247). CONCLUSIONS Educational intervention appears to be effective in strengthening nurses' knowledge of high-alert medications. The Powerpoint file presented teaching material which is both suitable and feasible for hospital-based continuing education.
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Affiliation(s)
- Min-Chin Lu
- Tri-service General Hospital, Taipei, Taiwan
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Hashemi F, Nasrabadi AN, Asghari F. Factors associated with reporting nursing errors in Iran: a qualitative study. BMC Nurs 2012; 11:20. [PMID: 23078517 PMCID: PMC3534596 DOI: 10.1186/1472-6955-11-20] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 09/14/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND Reporting the professional errors for improving patient safety is considered essential not only in hospitals, but also in ambulatory care centers. Unfortunately, a great number of nurses, similar to most clinicians, do not report their errors. Therefore, the present study aimed to clarify the factors associated with reporting the nursing errors through the experiences of clinical nurses and nursing managers. METHODS A total of 115 nurses working in the hospitals and specialized clinics affiliated to Tehran and Shiraz Universities of Medical Sciences, Iran participated in this qualitative study. The study data were collected through a semi-structured group discussion conducted in 17 sessions and analyzed by inductive content analysis approach. RESULTS The main categories emerged in this study were: a) general approaches of the nurses towards errors, b) barriers in reporting the nursing errors, and c) motivators in error reporting. CONCLUSION Error reporting provides extremely valuable information for preventing future errors and improving the patient safety. Overall, regarding motivators and barriers in reporting the nursing errors, it is necessary to enact regulations in which the ways of reporting the error and its constituent elements, such as the notion of the error, are clearly identified.
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Affiliation(s)
- Fatemeh Hashemi
- Fatemeh (P,B,U,H) College of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Chang CW, Huang HC, Chiang CY, Hsu CP, Chang CC. Social capital and knowledge sharing: effects on patient safety. J Adv Nurs 2011; 68:1793-803. [DOI: 10.1111/j.1365-2648.2011.05871.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gabe ME, Davies GA, Murphy F, Davies M, Johnstone L, Jordan S. Adverse drug reactions: treatment burdens and nurse-led medication monitoring. J Nurs Manag 2011; 19:377-92. [PMID: 21507109 DOI: 10.1111/j.1365-2834.2011.01204.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marie E Gabe
- Research Capacity Building Collaboration (RCBC) Wales, College of Human and Health Sciences, Swansea University, Swansea, UK.
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