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Rosenberg S, Södergård B, Rosenholm J, Rauha JP. Sustainability challenges concerning the effects of high-priced drugs on the day-to-day operations of community pharmacies in Finland. Eur J Pharm Sci 2024; 199:106816. [PMID: 38821247 DOI: 10.1016/j.ejps.2024.106816] [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: 12/29/2023] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND High-priced drugs pose a challenge for health budgets, policies, and patient safety. One of the key roles of community pharmacies is to ensure availability to prescription drugs regardless of their price. This has been identified as challenging in certain situations concerning high-priced drugs. OBJECTIVES The aim is to investigate the views of proprietary pharmacists regarding the effects of high-priced drugs on the day-to-day operations of pharmacies. METHODS The data collection of the study was performed as a national cross-sectional online survey. The inclusion criteria were being a proprietary pharmacist and a member of the Association of Finnish Pharmacies. The survey contained questions yielding both quantitative and qualitative answers. The study focused on the qualitative data which was analysed by deductive thematic analysis. RESULTS In total 604 proprietary pharmacists were sent the survey, and 174 eligible answers were included in the study, giving a response rate of 29%. The result describes the relationships between the economic, social, and environmental dimensions of sustainable development based on a framework by Wanamaker, with respect to high-priced drugs and community pharmacy operations as viewed by proprietary pharmacists. The main findings of the study show that proprietary pharmacists find the implementation of real-time reimbursement payments, a further reform of the pharmacy tax, and the abolishment of return bans to the wholesaler as risk mitigations and means to attain sustainability with respect to high-priced drugs and pharmacy practice. They experience that these changes would diminish high-priced drugs unnecessarily ending up as medical waste and improve the working conditions of the pharmacy staff by alleviating stress. CONCLUSIONS According to the respondents, high-priced drugs pose challenges for community pharmacies and the legislation and reimbursement system need to adapt to these challenges. If not, community pharmacies in Finland continue to face severe financial declines based on the study results.
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Affiliation(s)
- Sara Rosenberg
- Pharmaceutical Sciences Laboratory, Faculty of Science and Engineering, Åbo Akademi University, Turku, Finland.
| | - Björn Södergård
- Pharmaceutical Sciences Laboratory, Faculty of Science and Engineering, Åbo Akademi University, Turku, Finland
| | - Jessica Rosenholm
- Pharmaceutical Sciences Laboratory, Faculty of Science and Engineering, Åbo Akademi University, Turku, Finland
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2
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Henry Basil J, Mohd Tahir NA, Menon Premakumar C, Mhd Ali A, Seman Z, Ishak S, See KC, Mohamed M, Lee KY, Ibrahim NA, Jegatheesan KV, Mohamed Shah N. Clinical and economic impact of medication administration errors among neonates in neonatal intensive care units. PLoS One 2024; 19:e0305538. [PMID: 38990851 PMCID: PMC11239004 DOI: 10.1371/journal.pone.0305538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 06/01/2024] [Indexed: 07/13/2024] Open
Abstract
Despite efforts in improving medication safety, medication administration errors are still common, resulting in significant clinical and economic impact. Studies conducted using a valid and reliable tool to assess clinical impact are lacking, and to the best of our knowledge, studies evaluating the economic impact of medication administration errors among neonates are not yet available. Therefore, this study aimed to determine the potential clinical and economic impact of medication administration errors in neonatal intensive care units and identify the factors associated with these errors. A national level, multi centre, prospective direct observational study was conducted in the neonatal intensive care units of five Malaysian public hospitals. The nurses preparing and administering the medications were directly observed. After the data were collected, two clinical pharmacists conducted independent assessments to identify errors. An expert panel of healthcare professionals assessed each medication administration error for its potential clinical and economic outcome. A validated visual analogue scale was used to ascertain the potential clinical outcome. The mean severity index for each error was subsequently calculated. The potential economic impact of each error was determined by averaging each expert's input. Multinomial logistic regression and multiple linear regression were used to identify factors associated with the severity and cost of the errors, respectively. A total of 1,018 out of 1,288 (79.0%) errors were found to be potentially moderate in severity, while only 30 (2.3%) were found to be potentially severe. The potential economic impact was estimated at USD 27,452.10. Factors significantly associated with severe medication administration errors were the medications administered intravenously, the presence of high-alert medications, unavailability of a protocol, and younger neonates. Moreover, factors significantly associated with moderately severe errors were intravenous medication administration, younger neonates, and an increased number of medications administered. In the multiple linear regression analysis, the independent variables found to be significantly associated with cost were the intravenous route of administration and the use of high-alert medications. In conclusion, medication administration errors were judged to be mainly moderate in severity costing USD 14.04 (2.22-22.53) per error. This study revealed important insights and highlights the need to implement effective error reducing strategies to improve patient safety among neonates in the neonatal intensive care unit.
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Affiliation(s)
- Josephine Henry Basil
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nurul Ain Mohd Tahir
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chandini Menon Premakumar
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Zamtira Seman
- Sector for Biostatistics & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Shareena Ishak
- Department of Pediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kwee Ching See
- Department of Pediatrics, Hospital Sungai Buloh, Ministry of Health Malaysia, Selangor, Malaysia
| | - Maslina Mohamed
- Department of Pediatrics, Hospital Putrajaya, Ministry of Health Malaysia, Wilayah Persekutuan Putrajaya, Malaysia
| | - Khai Yin Lee
- Department of Pediatrics, Faculty of Medicine, Universiti Pertahanan Nasional Malaysia, Kuala Lumpur, Malaysia
| | - Nazedah Ain Ibrahim
- Department of Pharmacy, Hospital Tunku Azizah, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Kokila Vani Jegatheesan
- Department of Paediatrics, Hospital Cyberjaya, Ministry of Health Malaysia, Cyberjaya, Malaysia
| | - Noraida Mohamed Shah
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Atay E, Bahadır Yılmaz E, Atay M. Analysis of dementia research trends in nursing using text mining approach. Psychogeriatrics 2024; 24:675-687. [PMID: 38403288 DOI: 10.1111/psyg.13097] [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] [Received: 12/11/2023] [Revised: 02/01/2024] [Accepted: 02/11/2024] [Indexed: 02/27/2024]
Abstract
This research aimed to analyze dementia research trends in nursing using a text mining approach. In this study, text mining approach was used to analyze the studies on dementia in the field of nursing around the world. In this study, summaries of all available publications in English between the years 1990-2023 were extracted from the database and transferred to an Excel table by using the 'Nursing' AND 'Dementia' query from the Thomson Reuters-ISI Web of Science database. According to the results of this research, a total of 21 concept groups were identified, four of which were the most important. It was determined that the most frequently used word in all of the studies obtained from the database was 'cost'. In this direction, scientific research on dementia in the field of nursing can be planned by evaluating the most frequently used concepts.
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Affiliation(s)
- Eda Atay
- Faculty of Health Sciences, Nursing Department, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Emel Bahadır Yılmaz
- Faculty of Health Sciences, Nursing Department, Giresun University, Giresun, Turkey
| | - Metehan Atay
- Department of UAV Technology and Operation Department, Hasan Kalyoncu University, Gaziantep, Turkey
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Moldovan F, Moldovan L. Assessment of Patient Matters in Healthcare Facilities. Healthcare (Basel) 2024; 12:325. [PMID: 38338210 PMCID: PMC10855928 DOI: 10.3390/healthcare12030325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Ensuring the sustainability of healthcare facilities requires the evaluation of patient matters with appropriate methods and tools. The objective of this research is to develop a new tool for assessing patient matters as a component of social responsibility requirements that contribute to the sustainability of healthcare facilities. MATERIALS AND METHODS We carried out an analytical observational study in which, starting from the domains of the reference framework for the sustainability of health facilities (economic, environmental, social, provision of sustainable medical care services and management processes), we designed indicators that describe patient matters. To achieve this, we extracted from the scientific literature the most recent data and aspects related to patient matters that have been reported by representative hospitals from all over the world. These were organized into the four sequences of the quality cycle. We designed the method of evaluating the indicators based on the information couple achievement degree-importance of the indicator. In the experimental part of the study, we validated the indicators for the evaluation of patient matters and the evaluation method at an emergency hospital with an orthopedic profile. RESULTS We developed the patient matters indicator matrix, the content of the 8 indicators that make it up, questions for the evaluation of the indicators, and the evaluation grids of the indicators. They describe five levels for each variable of the achievement degree-importance couple. The practical testing of the indicators at the emergency hospital allowed the calculation of sustainability indicators and the development of a prioritization matrix for improvement measures. CONCLUSIONS Indicators designed in this research cover social responsibility requirements that describe patient matters. They are compatible and can be used by health facilities along with other implemented national and international requirements. Their added value consists in promoting social responsibility and sustainable development of healthcare facilities.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics—Traumatology Department, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Liviu Moldovan
- Faculty of Engineering and Information Technology, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania;
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Kuppadakkath SC, Bhowmik J, Olasoji M, Garvey L. Nurses' perspectives on medication errors and prevention strategies in residential aged care facilities through a national survey. Int J Older People Nurs 2023; 18:e12567. [PMID: 37587743 DOI: 10.1111/opn.12567] [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: 12/10/2022] [Revised: 06/21/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Medication errors are common in residential aged care facilities (RACFs) due to several factors. Effective medication management is essential to prevent medication errors among older people particularly due to the complexity of co-morbidities they can experience. OBJECTIVES This study aimed to examine and quantify the contributing factors of medication errors from nurses' perspectives and the prevention strategies to reduce medication errors among older adults living in RACFs. METHODS A survey with 140 completed responses from registered nurses (RNs) and endorsed enrolled nurses (EENs) working in RACFs across Australia were included in the study. The survey had 24 items, related to contributing factors of medication errors, and the prevention strategies. Descriptive statistics and exploratory factor analysis were used in the data analysis process. RESULTS The study identified medication errors are caused by contributing factors such as use of agency staffing (70.4%) and delays in receipt of laboratory results (94.3%). However, it also identified suggestions to reduce medication errors in RACFs, for example use of electronic alerts (88.3%), and efficient laboratory communication (91.8%). Our results revealed three key factors for causes (workload, interprofessional involvement and interruptions) and suggestions (medication safety alerts, medication process improvement and effective reporting). CONCLUSION Medication errors in RACFs are a global problem being one of the leading causes of morbidity and mortality. The knowledge and awareness of the factors associated with medication errors and the prevention strategies can guide potential quality improvement plans and contribute to minimisation of risk associated with medication safety in RACFs. IMPLICATIONS FOR PRACTICE The study recommends strategies for best practices in medication management such as interprofessional collaboration, implementing standardised policies and electronic alerts to reduce medication errors in RACFs.
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Affiliation(s)
- Subhash Chandran Kuppadakkath
- BlueCross Community and Residential Services, Burnley, Victoria, Australia
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Jahar Bhowmik
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | | | - Loretta Garvey
- Swinburne University of Technology, Hawthorn, Victoria, Australia
- Federation University, Berwick, Victoria, Australia
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Paulamäki J, Jyrkkä J, Hyttinen V, Huhtala H, Jämsen E. Regional variation of potentially inappropriate medication use and associated factors among older adults: A nationwide register study. Res Social Adm Pharm 2023; 19:1372-1379. [PMID: 37355437 DOI: 10.1016/j.sapharm.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/06/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Certain medications should be used with caution in older persons, which challenges rational prescribing. Potentially inappropriate medications (PIMs) are defined as medicines whose potential risk of harm typically outweighs the clinical benefits in geriatric population. Earlier studies have found regional differences in PIM use, but the factors underlying this phenomenon are unclear. OBJECTIVE To compare prescription PIM prevalence among Finnish hospital districts and determine which population characteristics and factors related to social and health care are associated with regional variation. METHODS This nationwide register study was based on the Prescription Centre data on all people aged ≥75 years in 2017-2019. Hospital district (n = 20) characteristics were drawn from the Finnish Institute for Health and Welfare's, Finnish Medical Association's, and Finnish Medicines Agency's publicly open data. PIMs were defined according to the Finnish Meds75+ database. A linear mixed-effect model was used to analyze potential associations of regional characteristics with PIM prevalence. RESULTS Prevalence of PIMs varied between 16.4% and 24.8% across regions. The highest prevalence was observed in the southern regions, while the lowest prevalence was on the west coast. Hospital district characteristics associated with higher PIM prevalence were higher share of population living alone, with excessive polypharmacy, or assessed using the Resident Assessment Instrument, shortage of general practitioners in municipal health centers, and low share of home care personnel. Waiting time in health care or share of population with morbidities were not associated with PIM use. Of the total variance in PIM prevalence, 86% was explained by group-level factors related to hospital districts. The regional variables explained 75% of this hospital-district-level variation. CONCLUSIONS PIM prevalence varied significantly across hospital districts. Findings suggest that higher PIM prevalence may be related to challenges in the continuity of care rather than differences in health care accessibility or share of the population with morbidities.
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Affiliation(s)
- Jasmin Paulamäki
- Faculty of Medicine and Health Technology, Clinical Medicine, Tampere University, FI-33014, Tampere University, Finland; Development and Information Services, Finnish Medicines Agency Fimea, P.O. Box 55, FI-00034, FIMEA, Finland.
| | - Johanna Jyrkkä
- Development and Information Services, Finnish Medicines Agency Fimea, P.O. Box 55, FI-00034, FIMEA, Finland.
| | - Virva Hyttinen
- Department of Health and Social Management, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
| | - Heini Huhtala
- Faculty of Social Sciences, Health Sciences, Tampere University, FI-33014, Tampere University, Finland.
| | - Esa Jämsen
- Faculty of Medicine (Clinicum), University of Helsinki, P.O. Box 63, FI-00014, University of Helsinki, Finland; Department of Geriatrics, Helsinki University Hospital, P.O. Box 340, FI-00029, Helsinki, HUS, Finland.
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7
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Goodwin J, White S, O'Malley M, Hurley E, O'Donovan A, Kelly P. 'It's good to have the knowledge and the confidence': Mental health student nurses' views of a medication workshop. Int J Ment Health Nurs 2022; 31:1011-1020. [PMID: 35567299 PMCID: PMC9325031 DOI: 10.1111/inm.13012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/17/2022]
Abstract
The administration of medication in a safe manner is a key nursing role and nursing regulatory bodies mandate that it is part of undergraduate training. However, it has been noted that qualified nursing staff are dissatisfied with the knowledge demonstrated by students. As such, a 2-day evidence-based workshop on medication management for final-year nursing students was facilitated to address knowledge deficits. Content was delivered by academics and practicing nurses. The aims of this study were to evaluate internship mental health student nurses' experiences of a 2-day medication management workshop. A qualitative descriptive design was adopted. Three focus group interviews were held with student nurses who partook in the workshop. Data were analysed using reflexive thematic analysis. Three themes were identified: Developing Confidence around Medication Management, Reflections on Learning Gained from the Workshop, and Enhancing Awareness and Vigilance of Medication Errors. Overall, participation in the workshop was identified as having a positive impact on students' knowledge, competence, and confidence in relation to becoming a safe practitioner. Students reported that the timing of the workshop - during internship - was appropriate for their knowledge needs. Findings indicate that the right amount of information was delivered by the right people, at the right time, in the right way. This study has highlighted the positive impact of a 2-day workshop delivered in the final year of mental health student nurse training, on their confidence and competence in the area of medication management. It provides some insight into how a practical collaborative approach to this type of education between academics and clinicians can help students bridge the theory-practice gap.
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Affiliation(s)
- John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sheila White
- Cork/Kerry Mental Health Services, Cork, Ireland
| | - Maria O'Malley
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Emma Hurley
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Aine O'Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Peter Kelly
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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8
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Nursing Shortage Creating Patient Safety Concerns. J Perianesth Nurs 2022; 37:565-567. [PMID: 35786503 DOI: 10.1016/j.jopan.2022.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022]
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9
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Nurses’ experience of medication errors in residential aged care facilities: An exploratory descriptive study. Collegian 2022. [DOI: 10.1016/j.colegn.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tetzlaff L, Heinrich AS, Schadewitz R, Thomeczek C, Schrader T. [The analysis of CIRSmedical.de using Natural Language Processing]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 169:1-11. [PMID: 35184999 DOI: 10.1016/j.zefq.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/17/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND CIRSmedical.de is a publicly accessible, cross-institutional reporting and learning system, which is organized by the German Agency for Quality in Medicine (ÄZQ). CIRSmedical.de has existed since 2005 and has published more than 6,000 event reports. Up to now it has been common practice to analyse these reports in detail or carry out systematic evaluations focusing on specific topics. A systematic evaluation of all case reports has not yet been conducted. Natural Language Processing (NLP) is an analysis strategy from the field of Artificial Intelligence for indexing texts. The examination of case reports using NLP was carried out to describe the characteristics of event reports and comments. MATERIALS AND METHODS For this analysis 6,480 case reports from CIRSmedical.de (as of December 10, 2019) were provided by the ÄZQ as Excel files. Several free text fields were included in the analysis as well as the feedback of the CIRS team (expert commentary). Text lengths, reporting behaviour, sentiment values and keywords were examined. The algorithms for the analysis were developed with the programming language Python and the corresponding libraries NLTK and SpaCy. RESULTS The comparison of report lengths depending on the different subject groups presented a heterogeneous picture, in terms of both the number of reports and the number of words. There are more than 4,000 reports from the field of anaesthesiology, whereby text lengths vary particularly strongly with a right-skewed distribution. There are only a few reports from the field of psychotherapy, and these are also very short. The different professional groups (nurses, doctors, other staff) write reports of about the same length. Reports and expert commentaries also differ in terms of sentiment values. Due to the length of the comments, they are more negative in terms of sentiment. Keywords can be identified but show a high heterogeneity. DISCUSSION Systematic analysis using NLP allows for the description of text properties in event reports and comments. It is now possible to draw a conclusion about the reporters' intention, focus and mood when they report in CIRS. The sentiment analysis is an indication of the mood which the texts convey, both as a report and as a commentary. Text length analysis draws attention to different problems and tendencies: event reports are usually much shorter. Texts that are too short, however, run the risk that the information will not be readily usable for analysis. Comments are often longer, but here one faces the opposite problem: texts that are too long may not be read. The examination of texts by means of NLP helps to rethink the reason for and the form of input, both when reporting and when commenting. It is a first step in the automatic, supportive classification of texts and an improvement of the interaction between reporters and the system.
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Affiliation(s)
- Laura Tetzlaff
- Technische Hochschule Brandenburg, Fachbereich Informatik und Medien, Brandenburg, Deutschland.
| | - Andrea Sanguino Heinrich
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ). Gemeinsames Institut von BÄK und KBV, Berlin, Deutschland
| | - Romy Schadewitz
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ). Gemeinsames Institut von BÄK und KBV, Berlin, Deutschland
| | - Christian Thomeczek
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ). Gemeinsames Institut von BÄK und KBV, Berlin, Deutschland
| | - Thomas Schrader
- Technische Hochschule Brandenburg, Fachbereich Informatik und Medien, Brandenburg, Deutschland
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11
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Savva G, Papastavrou E, Charalambous A, Vryonides S, Merkouris A. Exploring Nurses' Perceptions of Medication Error Risk Factors: Findings From a Sequential Qualitative Study. Glob Qual Nurs Res 2022; 9:23333936221094857. [PMID: 35782105 PMCID: PMC9243474 DOI: 10.1177/23333936221094857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 03/26/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
A focus group study was conducted to explore nurses’ perceptions of
medication administration error associated factors in two medical
wards of a tertiary hospital. Nurses were invited to participate in
focus group discussions. Thematic analysis was employed and identified
four themes: professional practice environment related factors,
person-related factors, drug-related factors, and processes and
procedures. Staffing, interruptions, system failures, insufficient
leadership, and patient acuity were perceived as risk factors for
medication errors. The findings of this study complement the findings
of an observational study which investigated medication administration
errors in the same setting. Although some findings were similar,
important risk factors were identified only through focus group
discussions with nurses. Nurses’ perceptions of factors influencing
medication administration errors provide important considerations in
addressing factors that contribute to errors and for improving patient
safety.
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Affiliation(s)
| | | | - Andreas Charalambous
- Cyprus University of Technology, Limassol, Republic of Cyprus.,University of Turku, Finland
| | - Stavros Vryonides
- Cyprus University of Technology, Limassol, Republic of Cyprus.,State Health Services Organization, Limassol, Republic of Cyprus
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Artificial Intelligence for Identifying the Prevention of Medication Incidents Causing Serious or Moderate Harm: An Analysis Using Incident Reporters' Views. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179206. [PMID: 34501795 PMCID: PMC8431329 DOI: 10.3390/ijerph18179206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/04/2022]
Abstract
The purpose of this study was to describe incident reporters’ views identified by artificial intelligence concerning the prevention of medication incidents that were assessed, causing serious or moderate harm to patients. The information identified the most important risk management areas in these medication incidents. This was a retrospective record review using medication-related incident reports from one university hospital in Finland between January 2017 and December 2019 (n = 3496). Of these, incidents that caused serious or moderate harm to patients (n = 137) were analysed using artificial intelligence. Artificial intelligence classified reporters’ views on preventing incidents under the following main categories: (1) treatment, (2) working, (3) practices, and (4) setting and multiple sub-categories. The following risk management areas were identified: (1) verification, documentation and up-to-date drug doses, drug lists and other medication information, (2) carefulness and accuracy in managing medications, (3) ensuring the flow of information and communication regarding medication information and safeguarding continuity of patient care, (4) availability, update and compliance with instructions and guidelines, (5) multi-professional cooperation, and (6) adequate human resources, competence and suitable workload. Artificial intelligence was found to be useful and effective to classifying text-based data, such as the free text of incident reports.
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13
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Borjali A, Magnéli M, Shin D, Malchau H, Muratoglu OK, Varadarajan KM. Natural language processing with deep learning for medical adverse event detection from free-text medical narratives: A case study of detecting total hip replacement dislocation. Comput Biol Med 2020; 129:104140. [PMID: 33278631 DOI: 10.1016/j.compbiomed.2020.104140] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Accurate and timely detection of medical adverse events (AEs) from free-text medical narratives can be challenging. Natural language processing (NLP) with deep learning has already shown great potential for analyzing free-text data, but its application for medical AE detection has been limited. METHOD In this study, we developed deep learning based NLP (DL-NLP) models for efficient and accurate hip dislocation AE detection following primary total hip replacement from standard (radiology notes) and non-standard (follow-up telephone notes) free-text medical narratives. We benchmarked these proposed models with traditional machine learning based NLP (ML-NLP) models, and also assessed the accuracy of International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes in capturing these hip dislocation AEs in a multi-center orthopaedic registry. RESULTS All DL-NLP models outperformed all of the ML-NLP models, with a convolutional neural network (CNN) model achieving the best overall performance (Kappa = 0.97 for radiology notes, and Kappa = 1.00 for follow-up telephone notes). On the other hand, the ICD/CPT codes of the patients who sustained a hip dislocation AE were only 75.24% accurate. CONCLUSIONS We demonstrated that a DL-NLP model can be used in largescale orthopaedic registries for accurate and efficient detection of hip dislocation AEs. The NLP model in this study was developed with data from the most frequently used electronic medical record (EMR) system in the U.S., Epic. This NLP model could potentially be implemented in other Epic-based EMR systems to improve AE detection, and consequently, quality of care and patient outcomes.
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Affiliation(s)
- Alireza Borjali
- Department of Orthopaedic Surgery, Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Martin Magnéli
- Department of Orthopaedic Surgery, Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA; Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - David Shin
- Department of Orthopaedic Surgery, Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Henrik Malchau
- Department of Orthopaedic Surgery, Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopaedic Surgery, Sahlgrenska University Hospital, Sweden
| | - Orhun K Muratoglu
- Department of Orthopaedic Surgery, Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Kartik M Varadarajan
- Department of Orthopaedic Surgery, Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.
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14
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Härkänen M, Franklin BD, Murrells T, Rafferty AM, Vehviläinen-Julkunen K. Factors contributing to reported medication administration incidents in patients' homes - A text mining analysis. J Adv Nurs 2020; 76:3573-3583. [PMID: 33048380 PMCID: PMC7702090 DOI: 10.1111/jan.14532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/03/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
AIMS To describe the characteristics of medication administration (MA) incidents reported to have occurred in patients' own homes (reporters' profession, incident types, contributing factors, patient consequence, and most common medications involved) and to identify the connection terms related to the most common contributing factors based on free text descriptions. DESIGN A retrospective study using descriptive statistical analysis and text mining. METHODS Medication administration incidents (N = 19,725) reported to have occurred in patients' homes between 2013-2018 in one district in Finland were analysed, describing the data by the reporters' occupation, incident type, contributing factors, and patient consequence. SAS® Text Miner was used to analyse free text descriptions of the MA incidents to understand contributing factors, using concept linking. RESULTS Most MA incidents were reported by practical (lower level) nurses (77.8%, N = 15,349). The most common category of harm was 'mild harm' (40.1%, N = 7,915) and the most common error type was omissions of drug doses (47.4%, N = 9,343). The medications most commonly described were Marevan [warfarin] (N = 2,668), insulin (N = 811), Furesis [furosemide] (N = 590), antibiotic (N = 446), and Panadol [paracetamol] (N = 416). The contributing factors most commonly reported were 'communication and flow of information' (25.5%, N = 5,038), 'patient and relatives' (22.6%, N = 4,451), 'practices' (9.9%, N = 1,959), 'education and training' (4.8%, N = 949), and 'work environment and resources' (3.0%, N = 598). CONCLUSION There is need for effective communication and clear responsibilities between home care patients and their relatives and health providers, about MA and its challenges in home environments. Knowledge and skills relating to safe MA are also essential. IMPACT These findings about MA incidents that have occurred in patients' homes and have been reported by home care professionals demonstrate the need for medication safety improvement in home care.
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Affiliation(s)
- Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College London Healthcare NHS Trust, London, UK.,UCL School of Pharmacy, London, UK
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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15
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Cottell M, Wätterbjörk I, Hälleberg Nyman M. Medication-related incidents at 19 hospitals: A retrospective register study using incident reports. Nurs Open 2020; 7:1526-1535. [PMID: 32802373 PMCID: PMC7424444 DOI: 10.1002/nop2.534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/18/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022] Open
Abstract
Aim To examine (a) when medication incidents occur and which type is most frequent; (b) consequences for patients; (c) incident reporters' perceptions of causes; and (d) professional categories reporting the incidents. Design A descriptive multicentre register study. Methods This study included 775 medication incident reports from 19 Swedish hospitals during 2016-2017. From the 775 reports, 128 were chosen to establish the third aim. Incidents were classified and analysed statistically. Perceived causes of incidents were analysed using content analysis. Results Incidents occurred as often in prescribing as in administering. Wrong dose was the most common error, followed by missed dose and lack of prescription. Most incidents did not harm the patients. Errors in administering reached the patients more often than errors in prescribing. The most frequently perceived causes were shortcomings in knowledge, skills and abilities, followed by workload. Most medication incidents were reported by nurses.
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Affiliation(s)
- Maria Cottell
- Department of Patient SafetyÖrebro University HospitalÖrebroSweden
| | - Inger Wätterbjörk
- School of Health SciencesFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Maria Hälleberg Nyman
- School of Health SciencesFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
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16
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Cappadona R, Di Simone E, De Giorgi A, Boari B, Di Muzio M, Greco P, Manfredini R, Rodríguez-Borrego MA, Fabbian F, López-Soto PJ. Individual Circadian Preference, Shift Work, and Risk of Medication Errors: A Cross-Sectional Web Survey among Italian Midwives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165810. [PMID: 32796648 PMCID: PMC7460124 DOI: 10.3390/ijerph17165810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/19/2022]
Abstract
Background: In order to explore the possible association between chronotype and risk of medication errors and chronotype in Italian midwives, we conducted a web-based survey. The questionnaire comprised three main components: (1) demographic information, previous working experience, actual working schedule; (2) individual chronotype, either calculated by Morningness–Eveningness Questionnaire (MEQ); (3) self-perception of risk of medication error. Results: Midwives (n = 401) responded “yes, at least once” to the question dealing with self-perception of risk of medication error in 48.1% of cases. Cluster analysis showed that perception of risk of medication errors was associated with class of age 31–35 years, shift work schedule, working experience 6–10 years, and Intermediate-type MEQ score. Conclusions: Perception of the risk of medication errors is present in near one out of two midwives in Italy. In particular, younger midwives with lower working experience, engaged in shift work, and belonging to an Intermediate chronotype, seem to be at higher risk of potential medication error. Since early morning hours seem to represent highest risk frame for female healthcare workers, shift work is not always aligned with individual circadian preference. Assessment of chronotype could represent a method to identify healthcare personnel at higher risk of circadian disruption.
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Affiliation(s)
- Rosaria Cappadona
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (P.G.); (R.M.)
- Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria S. Anna, 44121 Ferrara, Italy
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14071 Córdoba, Spain; (M.A.R.-B.); (P.J.L.-S.)
| | - Emanuele Di Simone
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (E.D.S.); (M.D.M.)
- Clinica Medica Unit, Azienda Ospedaliero-Universitaria S. Anna, 44121 Ferrara, Italy; (A.D.G.); (B.B.)
| | - Alfredo De Giorgi
- Clinica Medica Unit, Azienda Ospedaliero-Universitaria S. Anna, 44121 Ferrara, Italy; (A.D.G.); (B.B.)
| | - Benedetta Boari
- Clinica Medica Unit, Azienda Ospedaliero-Universitaria S. Anna, 44121 Ferrara, Italy; (A.D.G.); (B.B.)
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (E.D.S.); (M.D.M.)
| | - Pantaleo Greco
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (P.G.); (R.M.)
- Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria S. Anna, 44121 Ferrara, Italy
| | - Roberto Manfredini
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (P.G.); (R.M.)
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14071 Córdoba, Spain; (M.A.R.-B.); (P.J.L.-S.)
- Clinica Medica Unit, Azienda Ospedaliero-Universitaria S. Anna, 44121 Ferrara, Italy; (A.D.G.); (B.B.)
| | - María Aurora Rodríguez-Borrego
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14071 Córdoba, Spain; (M.A.R.-B.); (P.J.L.-S.)
- Department of Nursing Pharmacology and Physiotherapy, University of Córdoba, 14071 Córdoba, Spain
| | - Fabio Fabbian
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (P.G.); (R.M.)
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14071 Córdoba, Spain; (M.A.R.-B.); (P.J.L.-S.)
- Clinica Medica Unit, Azienda Ospedaliero-Universitaria S. Anna, 44121 Ferrara, Italy; (A.D.G.); (B.B.)
- Correspondence: ; Tel.: +39-0532-237071
| | - Pablo Jesús López-Soto
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14071 Córdoba, Spain; (M.A.R.-B.); (P.J.L.-S.)
- Department of Nursing Pharmacology and Physiotherapy, University of Córdoba, 14071 Córdoba, Spain
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17
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Vázquez-Sánchez MA, Jiménez-Arcos M, Aguilar-Trujillo P, Guardiola-Cardenas M, Damián-Jiménez F, Casals C. Characteristics of recovery from near misses in primary health care nursing: A Prospective descriptive study. J Nurs Manag 2020; 28:2007-2016. [PMID: 32378748 DOI: 10.1111/jonm.13039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/09/2020] [Accepted: 04/28/2020] [Indexed: 01/17/2023]
Abstract
AIM To describe the frequency and types of near misses and the recovery strategies employed by nurses in primary health care. BACKGROUND Insufficient data are available on the role of nurses in near miss events and related factors in primary health care. METHOD A prospective descriptive study was carried out at one Urban Primary Health Care Centre, within the Málaga-Guadalhorce Health District (Malaga, Spain), from January to December 2018. Four of the ten nurses volunteered to take part. RESULTS The nurses recovered 185 near misses, prevailing administrative or communication-related errors, followed by medication-related errors. No near misses were reported on the centre's anonymous error information platform. CONCLUSIONS A significant number of near misses occurred which could have been avoided with better communication among health care personnel. A striking finding is the failure to inform the health centre, which suggests that improvements in safety culture are needed. IMPLICATIONS FOR NURSING MANAGEMENT It is the responsibility and the duty of nursing management to be aware of the characteristics and frequency of near misses in primary health care, to implement strategies for improvement and to foster a culture in which the necessary information on actual or potential errors is supplied.
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Affiliation(s)
| | | | | | | | | | - Cristina Casals
- MOVE-IT Research group and Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cadiz, Spain.,Research Unit, Biomedical Research and Innovation Institute of Cadiz (INiBICA), Puerta del Mar University Hospital, University of Cadiz, Cadiz, Spain
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