Medication administration technologies and patient safety: a mixed-method systematic review

Quality and Safety in Nursing: Recommendations From a Systematic Review

ABSTRACT

As a consistent 24-hour presence in hospitals, nurses play a pivotal role in ensuring the quality and safety (Q&S) of patient care. However, a comprehensive review of evidence-based recommendations to guide nursing interventions that enhance the Q&S of patient care is lacking. Therefore, the purpose of our systematic review was to create evidence-based recommendations for the Q&S component of a nursing professional practice model for military hospitals. To accomplish this, a triservice military nursing team used Covidence software to conduct a systematic review of the literature across five databases. Two hundred forty-nine articles met inclusion criteria. From these articles, we created 94 recommendations for practice and identified eight focus areas from the literature: (1) communication; (2) adverse events; (3) leadership; (4) patient experience; (5) quality improvement; (6) safety culture/committees; (7) staffing/workload/work environment; and (8) technology/electronic health record. These findings provide suggestions for implementing Q&S practices that could be adapted to many healthcare delivery systems.

Formal nursing focused academic practice partnerships for advancing nursing research and scholarship: a scoping review protocol

INTRODUCTION

This scoping review protocol will be used to map the evidence regarding structure and organization of formal nursing undergraduate focused academic practice partnerships in Canada and globally.

DESIGN

This scoping review will adhere to guidance provided by Chapter 11 of the JBI Manual for Evidence Synthesis: Scoping Reviews guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension checklist.

METHODS

Evidence will be eligible for inclusion if published in English, within the last 10 years, and available in full text. Databases will be searched for published literature and unpublished grey literature.

DISCUSSION

This protocol provides guidance on conducting a scoping review on formal nursing undergraduate focused academic practice partnerships. The review will enhance understanding of the structure and organization of formal nursing undergraduate focused academic practice partnerships, informing the design and work of future partnerships. This protocol is registered in the Open Science Framework https://doi.org/10.17605/OSF.IO/JCTRM.

Patients' perspectives on medication for inflammatory bowel disease: a mixed-method systematic review

Inflammatory bowel disease (IBD) is a lifelong chronic disease that frequently requires long-term medical treatment to maintain remission. Patient perspectives on IBD medication are important to understand as nonadherence to IBD medication is common. We aim to synthesize the evidence about patients' perspectives on medication for IBD. A mixed-method systematic review was conducted on Scopus, EMBASE, Web of Science, and CINAHL. The convergent integrated approach to synthesis and integration of qualitative and quantitative findings was used for data analysis. Twenty-five articles from 20 countries were included in this review (20 quantitative, 3 qualitative, and 2 mixed-method studies). Patients have identified a lack of knowledge in the areas of efficacy, side effects, and characteristics of medications as key elements. Some negative views on IBD medication may also be present (e.g. the high number of pills and potential side effects). Lack of knowledge about medication for IBD was identified as a common issue for patients. Health services delivery for IBD should take into consideration these patients' perspectives. A focus on improving patient education in these areas could help empower patients and alleviate doubts resulting in better disease management and improved healthcare outcomes.

Plant-derived exosome-like nanoparticles and their therapeutic activities

Nanotechnologies have been successfully applied to the treatment of various diseases. Plant-derived exosome-like nanoparticles (PENs) are expected to become effective therapeutic modalities for treating disease or in drug-delivery. PENs are minimally cytotoxic to healthy tissues, with which they show excellent biocompatibility, and are biased towards tumors by targeting specific tissues through special endocytosis mechanisms. Thus, the use of these PENs may expand the scope of drug therapies while reducing the off-target effects. In this review, we summarize the fundamental features and bioactivities of PENs extracted from the grape, grapefruit, ginger, lemon, and broccoli and discuss the applications of these particles as therapeutics and nanocarriers.

Implementation of distributed automated medication dispensing units in a new hospital: Nursing and pharmacy experience

AIMS AND OBJECTIVES

To explore the structures, processes and outcomes involved in an Automated Medication Dispensing system implementation and its impact on patient safety.

BACKGROUND

Increasing digitalisation of medication prescribing, dispensing, administration and stock management has occurred over the past two decades. While automated medication dispensing units aim to provide safe, high-quality, patient-centred care, the implementation may result in unintended consequences leading to suboptimal outcomes.

DESIGN

This study uses a qualitative approach guided by Donabedian's structure, process and outcome framework.

METHODS

Twenty-six registered nurses and pharmacy assistant staff, from clinical areas equipped with automated medication dispensing cabinets, participated in semi-structured interviews. In-depth, thematic analysis explored the structures and processes. Together with interview data, content analysis of text data generated by internal risk management and critical incident reporting systems was undertaken to evaluate outcomes. Findings were considered in light of the Interactive Sociotechnical Analysis approach to health information technology. The COREQ checklist was used in preparation of this article.

RESULTS

Pharmacy assistants reported better satisfaction with the system at implementation than nurses. Training provided for nurses and their involvement in system implementation was reported as insufficient; however, nurses' use of and satisfaction with the system improved over time. A recursive relationship between the changes imposed by the system and nurses' creative problem solving (workarounds) used to manage these changes, impacted work productivity for nurses and safety for patients.

CONCLUSIONS

The individualised nature of "workarounds" employed offered both risks and opportunities which require further identification, investigation and management.

RELEVANCE TO CLINICAL PRACTICE

Nurses are the majority of the health workforce. Digitalisation of traditionally paper-based activities in health care, impacting nursing work, requires similar strategies to any practice change.

Medication Without Harm: Developing optimal medication error reporting systems

Medication errors are amongst the most frequently occurring health care related incidents and have the potential to lead to life-threatening harm to patients. An incident reporting system is a traditional approach to improvement of patient safety and entails the retrieval of information from incident reports. This not only provides a better understanding of causes and contributing factors but also enables the collection of data on the severity of incidents, system deficiencies and the role of human factors in safety incidents. Medication error reporting systems are often developed as a part of larger incident reporting systems which deal with other types of incidents. Although a rise in the prevalence of medication errors has led to an increased demand for medication error reporting, little is known about characteristics and limitations of medication error reporting systems. The authors broach the subject of medication error reporting systems and propose a more robust and standardized approach.

Nurses' knowledge and deliberations crucial to Barcoded Medication Administration technology in a Dutch hospital: Discovering nurses' agency inside ruling

This article shows how Barcoded Medication Administration technology institutionally organizes and rules the daily actions of nurses. Although it is widely assumed that Barcoded Medication Administration technology improves quality and safety by reducing the risk of human error, little research has been done on how this technology alters the work of nurses. Drawing on empirical and conceptual strategies of analysis, this qualitative study used certain tools of institutional ethnography to provide a view of how nurses negotiate Barcoded Medication Administration technology. The approach also uses elements from practice theory in order to discern how technology operates as a player on the field instead of being viewed as a 'mere' tool. A literature review preceded participant observation, whereby 17 nurses were followed and data on an orthopaedic ward were collected over a period of 9 months in 2011 and 2012. Barcoded Medication Administration technology relies on nurses' knowledge to mediate between the embedded logics of its design and the unpredictable needs of patients. Nurses negotiate their own professional logic of care in the form of moment-to-moment deliberations which subvert the ruling frame of the barcoded system and its objectified model of patient safety. The logic of Barcoded Medication Administration technology differs from the logic of nursing care, as this technology presumes medication distribution to be linear, even though nurses follow another line of actor-bound safety practices that we characterize as 'deliberations'.

Strategies to Reduce Patient Harm From Infusion-Associated Medication Errors: A Scoping Review

A scoping review of the literature examined strategies to prevent infusion-associated medication errors. Twenty articles were appraised and revealed studies using different research designs and types of literature reviews. Most were rated low quality. Observations in clinical agencies and laboratory settings were sites of some investigations. The work environment-including staffing, health care providers' education and supervision, standardizing equipment, protocols that supported medication decision-making and administration processes, medication lists, computerized devices, and cognitive aids-were addressed as strategies. The array of studies points to aspects of the complexity of the administration process for infusion-associated medications.

Association Between Workarounds and Medication Administration Errors in Bar Code-Assisted Medication Administration: Protocol of a Multicenter Study

Background

Information technology-based methods such as bar code-assisted medication administration (BCMA) systems have the potential to reduce medication administration errors (MAEs) in hospitalized patients. In practice, however, systems are often not used as intended, leading to workarounds. Workarounds may result in MAEs that may harm patients.

Objective

The primary aim is to study the association of workarounds with MAEs in the BCMA process. Second, we will determine the frequency and type of workarounds and MAEs and explore the potential risk factors (determinants) for workarounds.

Methods

This is a multicenter prospective study on internal medicine and surgical wards of 4 Dutch hospitals using BCMA systems to administer medication. We will include a total of 6000 individual drug administrations using direct observation to collect data.

Results

The project was funded in 2014 and enrollment was completed at the end of 2016. Data analysis is under way and the first results are expected to be submitted for publication at the end of 2017.

Conclusions

If an association between workarounds and MAEs is established, this information can be used to reduce the frequency of MAEs. Information on determinants of workarounds can aid in a focused approach to reduce workarounds and thus increase patient safety.

Trial Registration

Netherlands Trial Register NTR4355; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4355 (Archived by WebCite at http://www.webcitation.org/6pqTLxc6i).

The use of a contextual, modal and psychological classification of medication errors in the emergency department: a retrospective descriptive study

AIMS AND OBJECTIVES

To describe the contextual, modal and psychological classification of medication errors in the emergency department to know the factors associated with the reported medication errors.

BACKGROUND

The causes of medication errors are unique in every clinical setting; hence, error minimisation strategies are not always effective. For this reason, it is fundamental to understand the causes specific to the emergency department so that targeted strategies can be implemented.

DESIGN

Retrospective analysis of reported medication errors in the emergency department.

METHODS

All voluntarily staff-reported medication-related incidents from 2010-2015 from the hospital's electronic incident management system were retrieved for analysis. Contextual classification involved the time, place and the type of medications involved. Modal classification pertained to the stage and issue (e.g. wrong medication, wrong patient). Psychological classification categorised the errors in planning (knowledge-based and rule-based errors) and skill (slips and lapses).

RESULTS

There were 405 errors reported. Most errors occurred in the acute care area, short-stay unit and resuscitation area, during the busiest shifts (0800-1559, 1600-2259). Half of the errors involved high-alert medications. Many of the errors occurred during administration (62·7%), prescribing (28·6%) and commonly during both stages (18·5%). Wrong dose, wrong medication and omission were the issues that dominated. Knowledge-based errors characterised the errors that occurred in prescribing and administration. The highest proportion of slips (79·5%) and lapses (76·1%) occurred during medication administration. It is likely that some of the errors occurred due to the lack of adherence to safety protocols.

CONCLUSION

Technology such as computerised prescribing, barcode medication administration and reminder systems could potentially decrease the medication errors in the emergency department. There was a possibility that some of the errors could be prevented if safety protocols were adhered to, which highlights the need to also address clinicians' attitudes towards safety.

RELEVANCE TO CLINICAL PRACTICE

Technology can be implemented to help minimise errors in the ED, but this must be coupled with efforts to enhance the culture of safety.

The effectiveness of interventions designed to reduce medication administration errors: a synthesis of findings from systematic reviews

AIM

The aim of this overview was to examine the effectiveness of interventions designed to improve patient safety by reducing medication administration errors using data from systematic reviews.

BACKGROUND

Medication administration errors remain unacceptably high despite the introduction of a range of interventions aimed at enhancing patient safety. Systematic reviews of strategies designed to improve medication safety report contradictory findings. A critical appraisal and synthesis of these findings are, therefore, warranted.

METHODS

A comprehensive three-step search strategy was employed to search across 10 electronic databases. Two reviewers independently examined the methodological rigour and scientific quality of included systematic reviews using the Assessment of Multiple Systematic Reviews protocol.

RESULTS

Sixteen systematic reviews were eligible for inclusion. Evidence suggest that multifaceted approaches involving a combination education and risk management strategies and the use of bar code technology are effective in reducing medication errors.

CONCLUSION

More research is needed to determine the benefits of routine double-checking of medications during administration by nurses, outcomes of self-administration of medications by capable patients, and associations between interruptions and medications errors.

IMPLICATIONS FOR NURSING MANAGEMENT

Medication-related incidents must be captured in a way that facilitates meaningful categorisation including contributing factors, potential and actual/risk of harm and contextual information on the incident.

Is technology the best medicine? Three practice theoretical perspectives on medication administration technologies in nursing

Even though it is often presumed that the use of technology like medication administration technology is both safer and more effective, the importance of nurses' know-how is not to be underestimated. In this article, we accordingly try to argue that nurses' labor, including their different forms of knowledge, must play a crucial role in the development, implementation and use of medication administration technology. Using three different theoretical perspectives ('heuristic lenses') and integrating this with our own ethnographic research, we will explore how nursing practices change through the use of medication technology. Ultimately, we will argue that ignoring (institutional) complexity and the various types of important knowledge that nurses have, will seriously complicate the implementation of medication administration technology.

Impact of interventions designed to reduce medication administration errors in hospitals: a systematic review

BACKGROUND

There is a need to identify effective interventions to minimize the threat posed by medication administration errors (MAEs).

OBJECTIVE

Our objective was to review and critically appraise interventions designed to reduce MAEs in the hospital setting.

DATA SOURCES

Ten electronic databases were searched between 1985 and November 2013.

METHODS

Randomized controlled trials (RCTs) and controlled trials (CTs) reporting rates of MAEs or related adverse drug events between an intervention group and a comparator group were included. Data from each study were independently extracted and assessed for potential risk of bias by two authors. Risk ratios (RRs, with 95 % confidence intervals [CIs]) were used to examine the effect of an intervention.

RESULTS

Six RCTs and seven CTs were included. Types of interventions clustered around four main themes: medication use technology (n = 4); nurse education and training (n = 3); changing practice in anesthesia (n = 2); and ward system changes (n = 4). Reductions in MAE rates were reported by five studies; these included automated drug dispensing (RR 0.72, 95 % CI 0.53-1.00), computerized physician order entry (RR 0.51, 95 % 0.40-0.66), barcode-assisted medication administration with electronic administration records (RR 0.71, 95 % CI 0.53-0.95), nursing education/training using simulation (RR 0.17, 95 % CI 0.08-0.38), and clinical pharmacist-led training (RR 0.76, 95 % CI 0.67-0.87). Increased or equivocal outcome rates were found for the remaining studies. Weaknesses in the internal or external validity were apparent for most included studies.

LIMITATIONS

Theses and conference proceedings were excluded and data produced outside commercial publishing were not searched.

CONCLUSIONS

There is emerging evidence of the impact of specific interventions to reduce MAEs in hospitals, which warrant further investigation using rigorous and standardized study designs. Theory-driven efforts to understand the underlying causes of MAEs may lead to more effective interventions in the future.

Medication administration accuracy: using clinical observation and review of patient records to assess safety and guide performance improvement

RATIONALE, AIMS AND OBJECTIVES

Medication-related errors are common and can occur at every step of the medication process. The aim was to explore (1) the extent to which nurses perform fundamental safe practices related to medication administration (MA); (2) the frequency and characteristics of MA errors; and (3) the clinical significance of medication types (classes) subject to error.

METHODS

A descriptive, exploratory cross sectional design with point in time sampling was used combining direct observations, conducted by naïve observers, and medical record review. A convenience sample of three adult surgical units was drawn from a 1000-bed university hospital. Seventy-two patient-nurse MA encounters were observed including 306 MA doses based on a minimum sample of 100 doses per unit. The Medication Administration Accuracy Assessment developed by the Collaborative Alliance for Nursing Outcomes in the United States was used.

RESULTS

Observed adherence to MA safe practices varied between units. Identity control (9%), explaining medication to patient (11%) and medication labelled throughout the process (25%) were found to be safe practices with greatest deviation. 18% of doses involved a MA error (n = 54). Wrong time (9%) was the most common MA error, typically involving analgesics.

CONCLUSIONS

Given recent reports suggesting MA safe practices are strongly associated with MA errors, it is timely to strengthen RN awareness of the critical role of safe practices in MA safety. In nursing education, clinical examination using the six safe practices studied herein may enhance medication administration accuracy.

Predictors of unit-level medication administration accuracy: microsystem impacts on medication safety

OBJECTIVE

This study tested multivariate models exploring unit-level predictors of medication administration (MA) accuracy.

BACKGROUND

During MA, nurses are both the last line of defense from medication-related errors and a potential perpetrator of error. Direct observation reveals safe practices and the accuracy of medication delivery.

METHODS

Using a direct-observation, cross-sectional design, data submitted by 124 adult patient care units for 15600 medication doses, from January 2009 to April 2010, were studied.

RESULTS

Distractions and interruptions were the most common safe practice deviation. Characteristics of patient care units and RN hours of care affected nurses' safe practices and MA accuracy. Safe practices predict and mediate MA accuracy. A 5% decrease in safe practice deviations would reduce MA errors by 46% without any change in RN hours of care.

CONCLUSION

Nurses' adherence to MA safe practices, combined with unit characteristics and staffing factors, has the potential to dramatically improve MA accuracy.

Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence

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.

Patient safety in nursing education: contexts, tensions and feeling safe to learn

Education is crucial to how nurses practice, talk and write about keeping patients safe. The aim of this multisite study was to explore the formal and informal ways the pre-registration medical, nursing, pharmacy and physiotherapy students learn about patient safety. This paper focuses on findings from nursing. A multi-method design underpinned by the concept of knowledge contexts and illuminative evaluation was employed. Scoping of nursing curricula from four UK university programmes was followed by in-depth case studies of two programmes. Scoping involved analysing curriculum documents and interviews with 8 programme leaders. Case-study data collection included focus groups (24 students, 12 qualified nurses, 6 service users); practice placement observation (4 episodes=19 hrs) and interviews (4 Health Service managers). Within academic contexts patient safety was not visible as a curricular theme: programme leaders struggled to define it and some felt labelling to be problematic. Litigation and the risk of losing authorisation to practise were drivers to update safety in the programmes. Students reported being taught idealised skills in university with an emphasis on 'what not to do'. In organisational contexts patient safety was conceptualised as a complicated problem, addressed via strategies, systems and procedures. A tension emerged between creating a 'no blame' culture and performance management. Few formal mechanisms appeared to exist for students to learn about organisational systems and procedures. In practice, students learnt by observing staff who acted as variable role models; challenging practice was problematic, since they needed to 'fit in' and mentors were viewed as deciding whether they passed or failed their placements. The study highlights tensions both between and across contexts, which link to formal and informal patient safety education and impact negatively on students' feelings of emotional safety in their learning.

Nursing Perception of the Impact of Automated Dispensing Cabinets on Patient Safety and Ergonomics in a Teaching Health Care Center

Purpose:

To evaluate how nursing staff felt about the impact of automated dispensing cabinets (ADCs) on the safe delivery of health care and workplace ergonomics. To identify the main issues involved in the use of this technology and to describe the corrective measures implemented.

Methods:

Cross-sectional descriptive study with quantitative and qualitative components. A questionnaire that consisted of 33 statements about ADC was distributed from May 24 to June 3, 2011.

Results:

A total of 172 (46%) of 375 nurses completed the questionnaire. Nursing staff considered the introduction of ADC made their work easier (level of agreement of 90%), helped to safely provide patients with care (91%), and helped to reduce medication incidents/accidents (81%). Nursing staff was particularly satisfied by the narcotic drugs management with the ADCs. Nursing staff were not satisfied with the additional delays in the preparation and administration of a medication dose and the inability to prevent a medication from being administered when stopped on the medication administration record (48%).

Conclusion:

The nursing staff members were satisfied with the use of ADC and believed it made their work easier, promoted safe patient care, and were perceived to reduce medication incidents/accidents.

Safeguarding the process of drug administration with an emphasis on electronic support tools

AIMS

The aim of this work is to understand the process of drug administration and identify points in the workflow that resulted in interventions by clinical information systems in order to improve patient safety.

METHODS

To identify a generic way to structure the drug administration process we performed peer-group discussions and supplemented these discussions with a literature search for studies reporting errors in drug administration and strategies for their prevention.

RESULTS

We concluded that the drug administration process might consist of up to 11 sub-steps, which can be grouped into the four sub-processes of preparation, personalization, application and follow-up. Errors in drug handling and administration are diverse and frequent and in many cases not caused by the patient him/herself, but by family members or nurses. Accordingly, different prevention strategies have been set in place with relatively few approaches involving e-health technology.

CONCLUSIONS

A generic structuring of the administration process and particular error-prone sub-steps may facilitate the allocation of prevention strategies and help to identify research gaps.

A systematic review of the association between obesity and asthma in children

AIM

To provide a comprehensive integration of contemporary studies focusing on the relationship between obesity and asthma in paediatric populations.

BACKGROUND

The simultaneous increase in asthma and obesity prevalence has been widely discussed over the past 20 years. Although studies have discovered a positive correlation between the two, evidence-based findings are needed to develop nursing interventions.

DESIGN

A quantitative systematic review on the literature was conducted from June-December 2011.

DATA SOURCES

An electronic database search was conducted for studies published between January 1966-May 2011. Additional articles were identified through the reference lists of reviewed papers.

REVIEW METHODS

Inclusion/exclusion criteria and quality appraisal were applied to ensure research primarily designed to study the relationship between obesity and asthma in children was included.

RESULTS

The majority of studies support a positive association between obesity and asthma in children. Among correlates recognized as important effect modifiers, gender was the most prominent, with obese girls more likely to have asthma diagnoses than obese boys. Scrutinization of covariates in selected studies revealed that most related to children's demographic characteristics and were inconsistent across the studies.

CONCLUSIONS

This review was designed to integrate contemporary scientific findings on the association between obesity and asthma by including a large number of studies with variant research designs. To identify high-risk groups and develop nursing interventions to help children affected by both epidemics, more interdisciplinary and well-designed investigations focusing on an expanded spectrum of correlates including demographic and behavioural factors are warranted.

Quality: performance improvement, teamwork, information technology and protocols

Using the Institute of Medicine framework that outlines the domains of quality, this article considers four key aspects of health care delivery which have the potential to significantly affect the quality of health care within the pediatric intensive care unit. The discussion covers: performance improvement and how existing methods for reporting, review, and analysis of medical error relate to patient care; team composition and workflow; and the impact of information technologies on clinical practice. Also considered is how protocol-driven and standardized practice affects both patients and the fiscal interests of the health care system.

[Medication error management climate and perception for system use according to construction of medication error prevention system]

PURPOSE

The purpose of this cross-sectional study was to examine current status of IT-based medication error prevention system construction and the relationships among system construction, medication error management climate and perception for system use.

METHODS

The participants were 124 patient safety chief managers working for 124 hospitals with over 300 beds in Korea. The characteristics of the participants, construction status and perception of systems (electric pharmacopoeia, electric drug dosage calculation system, computer-based patient safety reporting and bar-code system) and medication error management climate were measured in this study. The data were collected between June and August 2011. Descriptive statistics, partial Pearson correlation and MANCOVA were used for data analysis.

RESULTS

Electric pharmacopoeia were constructed in 67.7% of participating hospitals, computer-based patient safety reporting systems were constructed in 50.8%, electric drug dosage calculation systems were in use in 32.3%. Bar-code systems showed up the lowest construction rate at 16.1% of Korean hospitals. Higher rates of construction of IT-based medication error prevention systems resulted in greater safety and a more positive error management climate prevailed.

CONCLUSION

The supportive strategies for improving perception for use of IT-based systems would add to system construction, and positive error management climate would be more easily promoted.

Hospital pharmacy practice in Saudi Arabia: Dispensing and administration in the Riyadh region

BACKGROUND

There is very little published data assessing hospital pharmacy practice in Saudi Arabia. Hence, a comprehensive survey has been undertaken to evaluate hospital pharmacy services of the Kingdom of Saudi Arabia. Recently, we published the survey results on the prescribing and transcribing steps of the medication use process. This paper focuses on dispensing and administration.

METHODS

A modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire was personally delivered to the pharmacy directors of 48 hospitals in the Riyadh region. Three attempted follow-ups were made within 3 months to non-responders and the surveys were collected upon completion. The survey was conducted using similar methods to those of the ASHP surveys.

RESULTS

Twenty-nine hospitals participated in the survey with a response rate of 60.4%. Centralized distribution (74%) is the most commonly used model for inpatient pharmacies. Overall, 21% of hospitals routinely use bar coding technology in medication dispensing. None of the hospitals are using a robotic distribution system to automate the dispensing of unit doses. Automated dispensing cabinets (ADCs) are used by 21% of hospitals as part of their decentralized distribution model. Sixty-one percent of hospital pharmacies have IV admixture preparation area in their facility. In the use of safety technology for medication administration, only one third of hospitals are using electronic medication administration records (eMARs), 7.4% had bar-code-assisted medication administration (BCMA) and 12% had smart infusion pumps.

CONCLUSION

Hospital pharmacies in the Riyadh region are fairly well developed in providing dispensing and administration services. Further improvement can be achieved by increasing the use of new technologies such as bar-code technology, unit dose drug distribution systems, pharmacy-based IV admixture services, smart infusion pumps, and automated medication distribution.

A systematic integrated literature review of systematic integrated literature reviews in nursing

As faculty members, we frequently find that first-year doctoral students in nursing are confused about how to conduct a systematic integrated literature review. This could be due to its vague definition and a lack of recent literature that provides directions for conducting a systematic integrated literature review. This article aims to provide directions for conducting a systematic integrated literature review by identifying the essential components of published literature reviews in nursing. To achieve this goal, the literature was searched by using the keywords nursing, systematic, and review in multiple databases. A total of 267 articles were selected and are included in this systematic integrated literature review. The articles were then sorted by study design and analyzed in six areas of interests. Finally, a practical guideline for conducting systematic integrated literature reviews is proposed based on the analysis of the literature.