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Ng SJY, Goh ML. Reducing insulin omission errors among patients with diabetes mellitus in general surgical wards: a best practice implementation project. JBI Evid Implement 2024; 22:291-302. [PMID: 38912640 DOI: 10.1097/xeb.0000000000000437] [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: 06/25/2024]
Abstract
INTRODUCTION AND OBJECTIVES Omission of insulin, a high-alert medication with one of the highest locally reported errors, could lead to severe hyperglycemia, which could result in coma or death if not treated timeously. This study aimed to identify, evaluate, and implement strategies to reduce the occurrence of insulin omission errors in diabetic adult patients requiring insulin. METHODS This project followed the JBI Evidence Implementation Framework and conducted context analysis, strategy implementation, and evaluation of outcomes according to evidence-based quality indicators. The JBI PACES and JBI GRiP situational analysis tools were used to support data collection and implementation planning. There was one evidence-based criterion and five sub-criteria, with a sample size of 22 patients. RESULTS There was increased compliance with best practices to reduce interruptions and distractions from baseline audit (50%) to follow-up audits 1 (45.4%) and 2 (31.8%), and no insulin omission incidences during the implementation period. In the post-implementation analysis, there were notable improvements in compliance with strategies related to nurses; however, reduced compliance was observed related to patients. Key barriers to implementation included patients still disturbing nurses despite the nurses wearing the medication vests and patients forgetting instructions not to disturb nurses during medication administration. Strategies to improve compliance included ensuring coverage in each cubicle during insulin preparation and administration, tending to patients' needs prior to insulin administration, and use of posters as reminders. CONCLUSIONS There was an overall increase in compliance with best practice to reduce interruptions and distractions and no insulin omission incidences related to interruptions and distractions during the implementation phase. SPANISH ABSTRACT http://links.lww.com/IJEBH/A219.
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Affiliation(s)
| | - Mien Li Goh
- Singapore National University Hospital Centre for Evidence-Based Nursing: A JBI Centre of Excellence, Singapore
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Chance EA, Florence D, Sardi Abdoul I. The effectiveness of checklists and error reporting systems in enhancing patient safety and reducing medical errors in hospital settings: A narrative review. Int J Nurs Sci 2024; 11:387-398. [PMID: 39156684 PMCID: PMC11329062 DOI: 10.1016/j.ijnss.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 05/10/2024] [Accepted: 06/06/2024] [Indexed: 08/20/2024] Open
Abstract
Objectives This narrative review aimed to explore the impact of checklists and error reporting systems on hospital patient safety and medical errors. Methods A systematic search of academic databases from 2013 to 2023 was conducted, and peer-reviewed studies meeting inclusion criteria were assessed for methodological rigor. The review highlights evidence supporting the efficacy of checklists in reducing medication errors, surgical complications, and other adverse events. Error reporting systems foster transparency, encouraging professionals to report incidents and identify systemic vulnerabilities. Results Checklists and error reporting systems are interconnected. Interprofessional collaboration is emphasized in checklist implementation. In this review, limitations arise due to the different methodologies used in the articles and potential publication bias. In addition, language restrictions may exclude valuable non-English research. While positive impacts are evident, success depends on organizational culture and resources. Conclusions This review contributes to patient safety knowledge by examining the relevant literature, emphasizing the importance of interventions, and calling for further research into their effectiveness across diverse healthcare and cultural settings. Understanding these dynamics is crucial for healthcare providers to optimize patient safety outcomes.
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Patrician PA, Campbell CM, Javed M, Williams KM, Foots L, Hamilton WM, House S, Swiger PA. Quality and Safety in Nursing: Recommendations From a Systematic Review. J Healthc Qual 2024; 46:203-219. [PMID: 38717788 PMCID: PMC11198958 DOI: 10.1097/jhq.0000000000000430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
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.
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Aceves-Gonzalez C, Caro-Rojas A, Rey-Galindo JA, Aristizabal-Ruiz L, Hernández-Cruz K. Estimating the impact of label design on reducing the risk of medication errors by applying HEART in drug administration. Eur J Clin Pharmacol 2024; 80:575-588. [PMID: 38282080 PMCID: PMC10937752 DOI: 10.1007/s00228-024-03619-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
Medication errors are one of the biggest problems in healthcare. The medicines' poor labelling design (i.e. look-alike labels) is a well-recognised risk for potential confusion, wrong administration, and patient damage. Human factors and ergonomics (HFE) encourages the human-centred design of system elements, which might reduce medication errors and improve people's well-being and system performance. OBJECTIVE The aim of the present study is twofold: (i) to use a human reliability analysis technique to evaluate a medication administration task within a simulated scenario of a neonatal intensive care unit (NICU) and (ii) to estimate the impact of a human-centred design (HCD) label in medication administration compared to a look-alike (LA) label. METHOD This paper used a modified version of the human error assessment and reduction technique (HEART) to analyse a medication administration task in a simulated NICU scenario. The modified technique involved expert nurses quantifying the likelihood of unreliability of a task and rating the conditions, including medicine labels, which most affect the successful completion of the task. RESULTS Findings suggest that error producing conditions (EPCs), such as a shortage of time available for error detection and correction, no independent checking of output, and distractions, might increase human error probability (HEP) in administering medications. Results also showed that the assessed HEP and the relative percentage of contribution to unreliability reduced by more than 40% when the HCD label was evaluated compared to the LA label. CONCLUSION Including labelling design based on HFE might help increase human reliability when administering medications under critical conditions.
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Cohen TN, Berdahl CT, Coleman BL, Seferian EG, Henreid AJ, Leang DW, Nuckols TK. Medication Safety Event Reporting: Factors That Contribute to Safety Events During Times of Organizational Stress. J Nurs Care Qual 2024; 39:51-57. [PMID: 37163722 PMCID: PMC10632541 DOI: 10.1097/ncq.0000000000000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Incident reports submitted during times of organizational stress may reveal unique insights. PURPOSE To understand the insights conveyed in hospital incident reports about how work system factors affected medication safety during a coronavirus disease-2019 (COVID-19) surge. METHODS We randomly selected 100 medication safety incident reports from an academic medical center (December 2020 to January 2021), identified near misses and errors, and classified contributing work system factors using the Human Factors Analysis and Classification System-Healthcare. RESULTS Among 35 near misses/errors, incident reports described contributing factors (mean 1.3/report) involving skill-based errors (n = 20), communication (n = 8), and tools/technology (n = 4). Reporters linked 7 events to COVID-19. CONCLUSIONS Skill-based errors were the most common contributing factors for medication safety events during a COVID-19 surge. Reporters rarely deemed events to be related to COVID-19, despite the tremendous strain of the surge on nurses. Future efforts to improve the utility of incident reports should emphasize the importance of describing work system factors.
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Affiliation(s)
- Tara N Cohen
- Departments of Surgery (Dr Cohen), Medicine and Emergency Medicine (Dr Berdahl), Nursing (Dr Coleman), Patient Safety (Dr Seferian), Internal Medicine (Mr Henreid and Dr Nuckols), and Pharmacy (Dr Leang), Cedars-Sinai Medical Center, Los Angeles, California
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Arkin L, Schuermann AA, Loerzel V, Penoyer D. Original Research: Exploring Medication Safety Practices from the Nurse's Perspective. Am J Nurs 2023; 123:18-28. [PMID: 37934872 DOI: 10.1097/01.naj.0000996552.02491.7d] [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: 11/09/2023]
Abstract
BACKGROUND Medication preparation and administration are complex tasks that nurses must perform daily within today's complicated health care environment. Despite more than two decades of efforts to reduce medication errors, it's well known that such errors remain prevalent. Obtaining insight from direct care nurses may clarify where opportunities for improvement exist and guide future efforts to do so. PURPOSE The study purpose was to explore direct care nurses' perspectives on and experiences with medication safety practices and errors. METHODS A qualitative descriptive study was conducted among direct care nurses employed across a large health care system. Data were collected using semistructured interview questions with participants in focus groups and one-on-one meetings and were analyzed using qualitative direct content analysis. RESULTS A total of 21 direct care nurses participated. Four major themes emerged that impact the medication safety practices of and errors by nurses: the care environment, nurse competency, system influences, and the error paradigm. These themes were often interrelated. Most participants depicted chaotic environments, heavy nursing workloads, and distractions and interruptions as increasing the risk of medication errors. Many seemed unsure about what an error was or could be. CONCLUSIONS The complexity of medication safety practices makes it difficult to implement improvement strategies. Understanding the perspectives and experiences of direct care nurses is imperative to implementing such strategies effectively. Based on the study findings, potential solutions should include actively addressing environmental barriers to safe medication practices, ensuring more robust medication management education and training (including guidance regarding the definition of medication errors and the importance of reporting), and revising policies and procedures with input from direct care nurses.
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Affiliation(s)
- Laura Arkin
- Laura Arkin is the director of quality services at the Orlando Health Jewett Orthopedic Institute, Orlando, FL. Daleen Penoyer is the director of the Center for Nursing Research at Orlando Health, Orlando, FL. Andrea A. Schuermann is the manager of quality process improvement and patient safety at Orlando Health South Seminole Hospital, Longwood, FL. Victoria Loerzel is a professor and the Beat M. and Jill L. Kahli Endowed Professor in Oncology Nursing in the College of Nursing at the University of Central Florida, Orlando. The authors receive ongoing support through a research grant from Sigma Theta Tau International Nursing Honor Society, Theta Epsilon chapter. Contact author: Laura Arkin, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Dick-Smith F, Fry MF, Salter R, Tinker M, Leith G, Donoghoe S, Harris C, Murphy S, Elliott R. Barriers and enablers for safe medication administration in adult and neonatal intensive care units mapped to the behaviour change wheel. Nurs Crit Care 2023; 28:1184-1195. [PMID: 37614015 DOI: 10.1111/nicc.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Intensive care settings have high rates of medication administration errors. Medications are often administered by nurses and midwives using a specified process (the '5 rights'). Understanding where medication errors occur, the contributing factors and how best practice is delivered may assist in developing interventions to improve medication safety. AIMS To identify medication administration errors and context specific barriers and enablers for best practice in an adult and a neonatal intensive care unit. Secondary aims were to identify intervention functions (through the Behaviour Change Wheel). STUDY DESIGN A dual methods exploratory descriptive study was conducted (May to June 2021) in a mixed 56-bedded adult intensive care unit and a 6-bedded neonatal intensive care unit in Sydney, Australia. Incident monitoring data were examined. Direct semi-covert observational medication administration audits using the 5 rights (n = 39) were conducted. Brief interviews with patients, parents and nurses were conducted. Data were mapped to the Behaviour Change Wheel. RESULTS No medication administration incidents were recorded. Audits (n = 3) for the neonatal intensive care unit revealed no areas for improvement. Adult intensive care unit nurses (n = 36) performed checks for the right medication 35 times (97%) and patient identity 25 times (69%). Sixteen administrations (44%) were interrupted. Four themes were synthesized from the interview data: Trust in the nursing profession; Availability of policies and procedures; Adherence to the '5 rights' and departmental culture; and Adequate staffing. The interventional functions most likely to bring about behaviour change were environmental restructuring, enablement, restrictions, education, persuasion and modelling. CONCLUSIONS This study reveals insights about the medication administration practices of nurses in intensive care. Although there were areas for improvement there was widespread awareness among nurses regarding their responsibilities to safely administer medications. Interview data indicated high levels of trust among patients and parents in the nurses. RELEVANCE TO CLINICAL PRACTICE This novel study indicated that nurses in intensive care are aware of their responsibilities to safely administer medications. Mapping of contextual data to the Behaviour Change Wheel resulted in the identification of Intervention functions most likely to change medication administration practices in the adult intensive care setting that is environmental restructuring, enablement, restrictions, education, persuasion and modelling.
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Affiliation(s)
- Felicity Dick-Smith
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Margaret Fry Fry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Rachel Salter
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Matthew Tinker
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Grace Leith
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Stephanie Donoghoe
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Claire Harris
- Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Sandra Murphy
- Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Rosalind Elliott
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
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Milic V, Cameron L, Jones C. Identifying barriers and enablers for a robust independent second check of medication in adult intensive care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:840-848. [PMID: 37737849 DOI: 10.12968/bjon.2023.32.17.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Independent second-checking of medication is part of everyday practice across many parts of the NHS. A robust, independent second check is built into medication administration protocols to reduce the risk of drug errors affecting patients. AIM This work aims to determine the barriers and facilitators regarding a robust independent second check of medication before administration to patients within adult critical care. METHOD Nurses in adult critical care were invited to participate in focus groups. They were asked to discuss factors that they felt enabled or prevented a robust second check of medication. Thematic analysis was undertaken by three critical care pharmacists. FINDINGS The major themes identified as barriers to an independent second check were: geography of the critical care unit; IT; routine; complex process; and personnel. CONCLUSION There are complex barriers to undertaking a robust second check and addressing some of these could improve patient safety.
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Affiliation(s)
- Vladimir Milic
- Highly Specialist Pharmacist, Critical Care Adult Intensive Care, Guy's and St Thomas' Hospital, London
| | - Lynda Cameron
- Expert Pharmacist, Critical Care, Adult Intensive Care, Guy's and St Thomas' Hospital, London
| | - Carol Jones
- Highly Specialist Pharmacist, Critical Care, Adult Intensive Care, Guy's and St Thomas' Hospital, London
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Stangl FJ, Riedl R. Interruption science as a research field: Towards a taxonomy of interruptions as a foundation for the field. Front Psychol 2023; 14:1043426. [PMID: 37034958 PMCID: PMC10074991 DOI: 10.3389/fpsyg.2023.1043426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/30/2023] [Indexed: 04/11/2023] Open
Abstract
Interruptions have become ubiquitous in both our personal and professional lives. Accordingly, research on interruptions has also increased steadily over time, and research published in various scientific disciplines has produced different perspectives, fundamental ideas, and conceptualizations of interruptions. However, the current state of research hampers a comprehensive overview of the concept of interruption, predominantly due to the fragmented nature of the existing literature. Reflecting on its genesis in the 1920s and the longstanding research on interruptions, along with recent technological, behavioral, and organizational developments, this paper provides a comprehensive interdisciplinary overview of the various attributes of an interruption, which facilitates the establishment of interruption science as an interdisciplinary research field in the scientific landscape. To obtain an overview of the different interruption attributes, we conducted a systematic literature review with the goal of classifying interruptions. The outcome of our research process is a taxonomy of interruptions, constituting an important foundation for the field. Based on the taxonomy, we also present possible avenues for future research.
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Affiliation(s)
- Fabian J. Stangl
- Digital Business Institute, School of Business and Management, University of Applied Sciences Upper Austria, Steyr, Austria
- *Correspondence: Fabian J. Stangl,
| | - René Riedl
- Digital Business Institute, School of Business and Management, University of Applied Sciences Upper Austria, Steyr, Austria
- Institute of Business Informatics – Information Engineering, Johannes Kepler University Linz, Linz, Austria
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Knox MK, Mehta PD, Dorsey LE, Yang C, Petersen LA. A Novel Use of Bar Code Medication Administration Data to Assess Nurse Staffing and Workload. Appl Clin Inform 2023; 14:76-90. [PMID: 36473498 PMCID: PMC9891851 DOI: 10.1055/a-1993-7627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of the study is to introduce an innovative use of bar code medication administration (BCMA) data, medication pass analysis, that allows for the examination of nurse staffing and workload using data generated during regular nursing workflow. METHODS Using 1 year (October 1, 2014-September 30, 2015) of BCMA data for 11 acute care units in one Veterans Affairs Medical Center, we determined the peak time for scheduled medications and included medications scheduled for and administered within 2 hours of that time in analyses. We established for each staff member their daily peak-time medication pass characteristics (number of patients, number of peak-time scheduled medications, duration, start time), generated unit-level descriptive statistics, examined staffing trends, and estimated linear mixed-effects models of duration and start time. RESULTS As the most frequent (39.7%) scheduled medication time, 9:00 was the peak-time medication pass; 98.3% of patients (87.3% of patient-days) had a 9:00 medication. Use of nursing roles and number of patients per staff varied across units and over time. Number of patients, number of medications, and unit-level factors explained significant variability in registered nurse (RN) medication pass duration (conditional R2 = 0.237; marginal R2 = 0.199; intraclass correlation = 0.05). On average, an RN and a licensed practical nurse (LPN) with four patients, each with six medications, would be expected to take 70 and 74 minutes, respectively, to complete the medication pass. On a unit with median 10 patients per LPN, the median duration (127 minutes) represents untimely medication administration on more than half of staff days. With each additional patient assigned to a nurse, average start time was earlier by 4.2 minutes for RNs and 1.4 minutes for LPNs. CONCLUSION Medication pass analysis of BCMA data can provide health systems a means for assessing variations in staffing, workload, and nursing practice using data generated during routine patient care activities.
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Affiliation(s)
- Melissa K. Knox
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Paras D. Mehta
- Department of Medicine, University of Houston, Houston, Texas, United States
| | | | - Christine Yang
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Laura A. Petersen
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
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Lin S, Wang N, Ren B, Lei S, Feng B. Use of Failure Mode and Effects Analysis (FMEA) for Risk Analysis of Drug Use in Patients with Lung Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15428. [PMID: 36497503 PMCID: PMC9739421 DOI: 10.3390/ijerph192315428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/17/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
It is crucial to investigate the risk factors inherent in the medication process for cancer patients since improper antineoplastic drug use frequently has serious consequences. As a result, the Severity, Occurrence, and Detection rate of each potential failure mode in the drug administration process for patients with lung cancer were scored using the Failure Mode and Effect Analysis (FMEA) model in this study. Then, the risk level of each failure mode and the direction of improvement were investigated using the Slacks-based measure data envelopment analysis (SBM-DEA) model. According to the findings, the medicine administration process for lung cancer patients could be classified into five links, with a total of 60 failure modes. The risk of failure modes for patient medication and post-medication monitoring ranked highly, with unauthorized use of traditional Chinese medicine and folk prescription and unauthorized drug addition (incorrect self-medication) ranking first (1/60); doctor prescription was also prone to errors. The study advises actively looking at ways to decrease the occurrence and difficulty of failure mode detection to continually enhance patient safety when using medications.
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Affiliation(s)
- Shuzhi Lin
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
- The Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Ningsheng Wang
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
- The Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Biqi Ren
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
- The Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Shuang Lei
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
- The Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Bianling Feng
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
- The Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
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Townley JN, Pogue CA, McHugh MD. Criminal prosecution of clinician errors: A setback to the progress toward safe hospital work environments. J Hosp Med 2022; 17:850-853. [PMID: 36031735 PMCID: PMC9720757 DOI: 10.1002/jhm.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Jacqueline N Townley
- School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colleen A Pogue
- School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew D McHugh
- School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Park J, You SB, Kim H, Park C, Ryu GW, Kwon S, Kim Y, Lee S, Lee K. Experience of Nurses with Intravenous Fluid Monitoring for Patient Safety: A Qualitative Descriptive Study. Risk Manag Healthc Policy 2022; 15:1783-1793. [PMID: 36171867 PMCID: PMC9512022 DOI: 10.2147/rmhp.s374563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/12/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Medication administration is a complex process and constitutes a substantial component of nursing practice that is closely linked to patient safety. Although intravenous fluid administration is one of the most frequently performed nursing tasks, nurses’ experiences with intravenous rate control have not been adequately studied. This study aimed to explore nurses’ experiences with infusion nursing practice to identify insights that could be used in interventions to promote safe medication administration. Patients and methods This qualitative descriptive study used focus group interviews of 20 registered nurses who frequently administered medications in tertiary hospitals in South Korea. Data were collected through five semi-structured focus group interviews, with four nurses participating in each interview. We conducted inductive and deductive content analysis based on the 11 key topics of patient safety identified by the World Health Organization. Reporting followed the consolidated criteria for reporting qualitative research (COREQ) checklist. Results Participants administered infusions in emergency rooms, general wards, and intensive care units, including patients ranging from children to older adults. Two central themes were revealed: human factors and systems. Human factors consisted of two sub-themes including individuals and team players, while systems encompassed three sub-themes including institutional policy, culture, and equipment. Conclusion This study found that nurses experienced high levels of stress when administering infusions in the correct dose and rate for patient safety. Administering and monitoring infusions were complicated because nursing processes interplay with human and system factors. Future research is needed to develop nursing interventions that include human and system factors to promote patient safety by reducing infusion-related errors.
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Affiliation(s)
- Jeongok Park
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
| | - Sang Bin You
- Yonsei University College of Nursing, Seoul, South Korea
| | - Hyejin Kim
- Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Cheolmin Park
- Department of Materials Science and Engineering, Yonsei University, Seoul, South Korea
| | - Gi Wook Ryu
- Department of Nursing, Hansei University, Gunpo-si, South Korea
| | - Seongae Kwon
- Yonsei University College of Nursing, Seoul, South Korea
| | - Youngkyung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Sejeong Lee
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Kayoung Lee
- Gachon University College of Nursing, Incheon, South Korea
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Schroers G, Ross JG, Moriarty H. Medication administration errors made among undergraduate nursing students: A need for change in teaching methods. J Prof Nurs 2022; 42:26-33. [DOI: 10.1016/j.profnurs.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022]
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Ghasemi F, Babamiri M, Pashootan Z. A comprehensive method for the quantification of medication error probability based on fuzzy SLIM. PLoS One 2022; 17:e0264303. [PMID: 35213625 PMCID: PMC8880918 DOI: 10.1371/journal.pone.0264303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/09/2022] [Indexed: 12/28/2022] Open
Abstract
Medication errors can endanger the health and safety of patients and need to be managed appropriately. This study aimed at developing a new and comprehensive method for estimating the probability of medication errors in hospitals. An extensive literature review was conducted to identify factors affecting medication errors. Success Likelihood Index Methodology was employed for calculating the probability of medication errors. For weighting and rating of factors, the Fuzzy multiple attributive group decision making methodology and Fuzzy analytical hierarchical process were used, respectively. A case study in an emergency department was conducted using the framework. A total number of 17 factors affecting medication error were identified. Workload, patient safety climate, and fatigue were the most important ones. The case study showed that subtasks requiring nurses to read the handwritten of other nurses and physicians are more prone to human error. As there is no specific method for assessing the risk of medication errors, the framework developed in this study can be very useful in this regard. The developed technique was very easy to administer.
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Affiliation(s)
- Fakhradin Ghasemi
- Department of Occupational Health and Safety Engineering, Abadan University of Medical Sciences, Abadan, Iran
- Department of Ergonomics, Occupational Health & Safety Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Babamiri
- Department of Ergonomics, Research Center for Health Sciences, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Pashootan
- Department of Ergonomics, Occupational Health & Safety Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- * E-mail:
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Abdelhadi N, Drach‐Zahavy A, Srulovici E. Work interruptions and missed nursing care: A necessary evil or an opportunity? The role of nurses' sense of controllability. Nurs Open 2022; 9:309-319. [PMID: 34612602 PMCID: PMC8685781 DOI: 10.1002/nop2.1064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/29/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
AIM To explore nurses' experiences with work interruptions (WIs) through the lens of missed nursing care (MNC). DESIGN A qualitative descriptive design. METHODS Eleven small focus groups involving 34 nurses (three nurses per group on average) from acute-care hospital wards were conducted. Nurses shared their experiences with WIs (sources, reactions and decisions) from the MNC perspective. Data analysis was conducted via content analysis. RESULTS A preponderant theme emerged-the dynamic of controllability. Nurses who perceived a sense of controllability felt that they could decide whether to accept or reject the WI, regardless of WI type, and emotions of anger emerged. Conversely, nurses who did not perceive sense of controllability attended the secondary task: MNC occurred, and distress emotions emerged. Results emphasized that nurses are active agents prioritizing whether to omit or complete care in the face of WIs. Controllability, accompanied by active negative emotions, perpetuate a prioritization process that makes it less probable that MNC occurs.
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Affiliation(s)
- Nasra Abdelhadi
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
| | - Anat Drach‐Zahavy
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
| | - Einav Srulovici
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
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Lake S, West S, Rudge T. Making things work: Using Bourdieu's theory of practice to uncover an ontology of everyday nursing in practice. Nurs Philos 2021; 23:e12377. [PMID: 34865279 DOI: 10.1111/nup.12377] [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: 06/29/2021] [Revised: 09/12/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022]
Abstract
Seeking to answer the question of what it is that nurses do, scholars researching nursing have worked with theoretical approaches ranging from the more abstract to the concrete: from philosophizing the nature of nursing to emphasizing the interpersonal nature of nursing practice to exploring processes of clinical decision-making. In this paper, we engage with Bourdieu's theory of practice as an alternative approach that helps to understand the finer points of nurses' everyday practices of nursing as being grounded in an ontology of practice. We first outline the foundations of Bourdieu's thinking as he established both a relational philosophy of science and an embodied philosophy of action to develop the theory of practice around notions of habitus, capital and field. Then, using the inter-relationships of these key elements of the theory of practice as a 'toolkit to think with', we explore an instance of nursing in practice in an acute care setting and show how, in taking account of social context, the dialectics between the elements reveal the social interactions that are accomplished in the doing. Moving to the relationships of these three elements with Bourdieu's further notions of illusio, symbolic power and symbolic violence, we uncover an ontology of nursing practices in the everyday. We conclude by summarising what this ontology of practice has to offer investigations into practices of nursing in any social context.
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Affiliation(s)
- Sarah Lake
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sandra West
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Trudy Rudge
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Freitas WCJD, Menezes AC, Mata LRFD, Lira ALBDC, Januário LH, Ribeiro HCTC. Interruption in the work of nursing professionals: conceptual analysis. Rev Bras Enferm 2021; 75:e20201392. [PMID: 34705993 DOI: 10.1590/0034-7167-2020-1392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/18/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the concept of "interruption in the work of nursing professionals". METHODS conceptual study according to the method proposed by Walker and Avant through integrative literature review. The study searched the databases using the descriptors: "Attention", "Attention Bias", "Health Personnel", "Nurses", "Patient Safety" and "Medical Malpractices". The sample consisted of 36 studies. RESULTS the antecedents were alarms, answering phone calls, providing patient care, and lack of material/medicine. The defining attributes were pause, suspension, breakage, and intrusion. In relation to the consequences, the study highlighted the increase in frequency and severity of medication errors and change of focus. FINAL CONSIDERATIONS theconceptual analysis identified the attributes, antecedents, and consequences and allowed to build an operational definition for "interruption in the work of nursing professionals". It will contribute to the improvement of the work process and the creation of strategies that ensure safer care for the patient.
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Prevalence and determinants of intravenous admixture preparation errors: A prospective observational study in a university hospital. Int J Clin Pharm 2021; 44:44-52. [PMID: 34363192 PMCID: PMC8866293 DOI: 10.1007/s11096-021-01310-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/22/2021] [Indexed: 11/22/2022]
Abstract
Background Intravenous admixture preparation errors (IAPEs) may lead to patient harm. Insight into the prevalence as well as the determinants associated with these IAPEs is needed to elicit preventive measures. Aim The primary aim of this study was to assess the prevalence of IAPEs. Secondary aims were to identify the type, severity, and determinants of IAPEs. Method A prospective observational study was performed in a Dutch university hospital. IAPE data were collected by disguised observation. The primary outcome was the proportion of admixtures with one or more IAPEs. Descriptive statistics were used for the prevalence, type, and severity of IAPEs. Mixed-effects logistic regression analyses were used to estimate the determinants of IAPEs. Results A total of 533 IAPEs occurred in 367 of 614 admixtures (59.8%) prepared by nursing staff. The most prevalent errors were wrong preparation technique (n = 257) and wrong volume of infusion fluid (n = 107). Fifty-nine IAPEs (11.1%) were potentially harmful. The following variables were associated with IAPEs: multistep versus single-step preparations (adjusted odds ratio [ORadj] 4.08, 95% confidence interval [CI] 2.27–7.35); interruption versus no interruption (ORadj 2.32, CI 1.13–4.74); weekend versus weekdays (ORadj 2.12, CI 1.14–3.95); time window 2 p.m.-6 p.m. versus 7 a.m.-10 a.m. (ORadj 3.38, CI 1.60–7.15); and paediatric versus adult wards (ORadj 0.14, CI 0.06–0.37). Conclusion IAPEs, including harmful IAPEs, occurred frequently. The determinants associated with IAPEs point to factors associated with preparation complexity and working conditions. Strategies to reduce the occurrence of IAPEs and therefore patient harm should target the identified determinants.
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Arvidsson L, Lindberg M, Skytt B, Lindberg M. Healthcare personnel's working conditions in relation to risk behaviours for organism transmission: A mixed-methods study. J Clin Nurs 2021; 31:878-894. [PMID: 34219318 DOI: 10.1111/jocn.15940] [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: 05/06/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To investigate healthcare personnel's working conditions in relation to risk behaviours for organism transmission. BACKGROUND Healthcare personnel's behaviour is often influenced by working conditions that in turn can impact the development of healthcare-associated infections. Observational studies are scarce, and further understanding of working conditions in relation to behaviour is essential for the benefit of the healthcare personnel and the safety of the patients. DESIGN A mixed-methods convergent design. METHODS Data were collected during 104 h of observation at eight hospital units. All 79 observed healthcare personnel were interviewed. Structured interviews covering aspects of working conditions were performed with the respective first-line manager. The qualitative and quantitative data were collected concurrently and given equal priority. Data were analysed separately and then merged. The study follows the GRAMMS guidelines for reporting mixed-methods research. RESULTS Regardless of measurable and perceived working conditions, risk behaviours frequently occurred especially missed hand disinfection. Healthcare personnel described staffing levels, patient-level workload, physical factors and interruptions as important conditions that influence infection prevention behaviours. The statistical analyses confirmed that interruptions increase the frequency of risk behaviours. Significantly higher frequencies of risk behaviours also occurred in activities where healthcare personnel worked together, which in the interviews was described as a consequence of caring for high-need patients. CONCLUSIONS These mixed-methods findings illustrate that healthcare personnel's perceptions do not always correspond to the observed results since risk behaviours frequently occurred regardless of the observed and perceived working conditions. Facilitating the possibility for healthcare personnel to work undisturbed when needed is essential for their benefit and for patient safety. RELEVANCE FOR CLINICAL PRACTICE The results can be used to enlighten healthcare personnel and managers and when designing future infection prevention work.
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Affiliation(s)
- Lisa Arvidsson
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Gävle, Sweden
| | - Magnus Lindberg
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Gävle, Sweden
| | - Bernice Skytt
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Lindberg
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
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21
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Trent JD, Barron LG. Multitasking as a predictor of simulated unmanned aircraft mission performance: Incremental validity beyond cognitive ability. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1897450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Isaacs AN, Ch'ng K, Delhiwale N, Taylor K, Kent B, Raymond A. Hospital medication errors: a cross-sectional study. Int J Qual Health Care 2021; 33:5925732. [PMID: 33064797 DOI: 10.1093/intqhc/mzaa136] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Medication errors (MEs) are among the most common types of incidents reported in Australian and international hospitals. There is no uniform method of reporting and reducing these errors. This study aims to identify the incidence, time trends, types and factors associated with MEs in a large regional hospital in Australia. METHODS A 5-year cross-sectional study. RESULTS The incidence of MEs was 1.05 per 100 admitted patients. The highest frequency of errors was observed during the colder months of May-August. When distributed by day of the week, Mondays and Tuesdays had the highest frequency of errors. When distributed by hour of the day, time intervals from 7 am to 8 am and from 7 pm to 8 pm showed a sharp increase in the frequency of errors. One thousand and eighty-eight (57.8%) MEs belonged to incidence severity rating (ISR) level 4 and 787 (41.8%) belonged to ISR level 3. There were six incidents of ISR level 2 and only one incident of ISR level 1 reported during the five-year period 2014-2018. Administration-only errors were the most common accounting for 1070 (56.8%) followed by prescribing-only errors (433, 23%). High-risk medications were associated with half the number of errors, the most common of which were narcotics (17.9%) and antimicrobials (13.2%). CONCLUSIONS MEs continue to be a problem faced by international hospitals. Inexperience of health professionals and nurse-patient ratios might be the fundamental challenges to overcome. Specific training of junior staff in prescribing and administering medication and nurse workload management could be possible solutions to reducing MEs in hospitals.
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Affiliation(s)
- Anton N Isaacs
- Monash University, School of Rural Health, Traralgon, VIC 3844, Australia
| | - Kenneth Ch'ng
- Latrobe Regional Hospital, Traralgon, VIC 3844, Australia
| | - Naaz Delhiwale
- Latrobe Regional Hospital, Traralgon, VIC 3844, Australia
| | | | - Bethany Kent
- Latrobe Regional Hospital, Traralgon, VIC 3844, Australia
| | - Anita Raymond
- Latrobe Regional Hospital, Traralgon, VIC 3844, Australia
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Schroers G, Ross JG, Moriarty H. Nurses' Perceived Causes of Medication Administration Errors: A Qualitative Systematic Review. Jt Comm J Qual Patient Saf 2020; 47:S1553-7250(20)30247-6. [PMID: 33153914 DOI: 10.1016/j.jcjq.2020.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Medication administration errors (MAEs) are a critical patient safety issue. Nurses are often responsible for administering medication to patients, thus their perceptions of causes of errors can provide valuable guidance for the development of interventions aimed to mitigate errors. Quantitative research can overlook less overt causes; therefore, a qualitative systematic review was conducted to present a synthesis of qualitative evidence of nurses' perceived causes of MAEs. METHODS Publications from 2000 to February 2019 were searched using four electronic databases. Inclusion criteria were articles that (1) presented results from studies that used a qualitative or mixed methods design, (2) reported qualitative data on nurses' perceived causes of MAEs in health care settings, and (3) were published in the English language. Sixteen individual articles satisfied the inclusion criteria. Methodological quality of each article was assessed using the Critical Appraisal Skills Programme (CASP) tool. Thematic analysis of the data was performed. Perceived causes of errors were labeled as knowledge-based, personal, and contextual factors. RESULTS The primary knowledge-based factor was lack of medication knowledge. Personal factors included fatigue and complacency. Contextual factors included heavy workloads and interruptions. Contextual factors were reported in all the studies reviewed and were often interconnected with personal and knowledge-based factors. CONCLUSION Causes of MAEs are perceived by nurses to be multifactorial and interconnected and often stem from systems issues. Multifactorial interventions aimed at mitigating medication errors are required with an emphasis on systems changes. Findings in this review can be used to guide efforts aimed at identifying and modifying factors contributing to MAEs.
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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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25
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Hosseini Marznaki Z, Pouy S, Salisu WJ, Emami Zeydi A. Medication errors among Iranian emergency nurses: A systematic review. Epidemiol Health 2020; 42:e2020030. [PMID: 32512668 PMCID: PMC7644927 DOI: 10.4178/epih.e2020030] [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: 03/29/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Medication errors (MEs) made by nurses are the most common errors in emergency departments (EDs). Identifying the factors responsible for MEs is crucial in designing optimal strategies for reducing such occurrences. The present study aimed to review the literature describing the prevalence and factors affecting MEs among emergency ward nurses in Iran. METHODS We searched electronic databases, including the Scientific Information Database, PubMed, Cochrane Library, Web of Science, Scopus, and Google Scholar, for scientific studies conducted among emergency ward nurses in Iran. The studies were restricted to full-text, peer-reviewed studies published from inception to December 2019, in the Persian and English languages, that evaluated MEs among emergency ward nurses in Iran. RESULTS Eight studies met the inclusion criteria. Most of the nurses (58.9%) had committed MEs only once. The overall mean rate of MEs was 46.2%, and errors made during drug administration accounted for 41.7% of MEs. The most common type of administration error was drug omission (17.8%), followed by administering drugs at the wrong time (17.5%) and at an incorrect dosage (10.6%). The lack of an adequate nursing workforce during shifts and improper nurse-patient ratios were the most critical factors affecting the occurrence of MEs by nurses. CONCLUSIONS Despite the increased attention on patient safety in Iran, MEs by nurses remain a significant concern in EDs. Therefore, nurse managers and policy-makers must take adequate measures to reduce the incidence of MEs and their potential negative consequences.
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Affiliation(s)
- Zohreh Hosseini Marznaki
- Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Somaye Pouy
- Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Amir Emami Zeydi
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
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Gates PJ, Baysari MT, Gazarian M, Raban MZ, Meyerson S, Westbrook JI. Prevalence of Medication Errors Among Paediatric Inpatients: Systematic Review and Meta-Analysis. Drug Saf 2020; 42:1329-1342. [PMID: 31290127 DOI: 10.1007/s40264-019-00850-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The risk of medication errors is high in paediatric inpatient settings. However, estimates of the prevalence of medication errors have not accounted for heterogeneity across studies in error identification methods and definitions, nor contextual differences across wards and the use of electronic or paper medication charts. OBJECTIVE Our aim was to conduct a systematic review and meta-analysis to provide separate estimates of the prevalence of medication errors among paediatric inpatients, depending on hospital ward and the use of electronic or paper medication charts, that address differences in error identification methods and definitions. METHODS We systematically searched five databases to identify studies published between January 2000 and December 2018 that assessed medication error rates by medication chart audit, direct observation or a combination of methods. RESULTS We identified 71 studies, 19 involved paediatric wards using electronic charts. Most studies assessed prescribing errors with few studies assessing administration errors. Estimates varied by ward type. Studies of paediatric wards using electronic charts generally reported a reduced error prevalence compared to those using paper, although there were some inconsistencies. Error detection methods impacted the rate of administration errors in studies of multiple wards, however, no other difference was found. Definition of medication error did not have a consistent impact on reported error rates. CONCLUSIONS Medication errors are a frequent occurrence in paediatric inpatient settings, particularly in intensive care wards and emergency departments. Hospitals using electronic charts tended to have a lower rate of medication errors compared to those using paper charts. Future research employing controlled designs is needed to determine the true impact of electronic charts and other interventions on medication errors and associated harm among hospitalized children.
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Affiliation(s)
- Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia.
| | - Melissa T Baysari
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Madlen Gazarian
- School of Medical Sciences, Faculty of Medicine, University of NSW Sydney, Sydney, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Sophie Meyerson
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
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Bonafide CP, Miller JM, Localio AR, Khan A, Dziorny AC, Mai M, Stemler S, Chen W, Holmes JH, Nadkarni VM, Keren R. Association Between Mobile Telephone Interruptions and Medication Administration Errors in a Pediatric Intensive Care Unit. JAMA Pediatr 2020; 174:162-169. [PMID: 31860017 PMCID: PMC6990809 DOI: 10.1001/jamapediatrics.2019.5001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Incoming text messages and calls on nurses' mobile telephones may interrupt medication administration, but whether such interruptions are associated with errors has not been established. OBJECTIVE To assess whether a temporal association exists between mobile telephone interruptions and subsequent errors by pediatric intensive care unit (PICU) nurses during medication administration. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was performed using telecommunications and electronic health record data from a PICU in a children's hospital. Data were collected from August 1, 2016, through September 30, 2017. Participants included 257 nurses and the 3308 patients to whom they administered medications. EXPOSURES Primary exposures were incoming telephone calls and text messages received on the institutional mobile telephone assigned to the nurse in the 10 minutes leading up to a medication administration attempt. Secondary exposures were the nurse's PICU experience, work shift (day vs night), nurse to patient ratio, and level of patient care required. MAIN OUTCOMES AND MEASURES Primary outcome, errors during medication administration, was a composite of reported medication administration errors and bar code medication administration error alerts generated when nurses attempted to give medications without active orders for the patient whose bar code they scanned. RESULTS Participants included 257 nurses, of whom 168 (65.4%) had 6 months or more of PICU experience; and 3308 patients, of whom 1839 (55.6%) were male, 1539 (46.5%) were white, and 2880 (87.1%) were non-Hispanic. The overall rate of errors during 238 540 medication administration attempts was 3.1% (95% CI, 3.0%-3.3%) when nurses were uninterrupted by incoming telephone calls and 3.7% (95% CI, 3.4%-4.0%) when they were interrupted by such calls. During day shift, the odds ratios (ORs) for error when interrupted by calls (compared with uninterrupted) were 1.02 (95% CI, 0.92-1.13; P = .73) among nurses with 6 months or more of PICU experience and 1.22 (95% CI, 1.00-1.47; P = .046) among nurses with less than 6 months of experience. During night shift, the ORs for error when interrupted by calls were 1.35 (95% CI, 1.16-1.57; P < .001) among nurses with 6 months or more of PICU experience and 1.53 (95% CI, 1.16-2.03; P = .003) among nurses with less than 6 months of experience. Nurses administering medications to 1 or more patients receiving mechanical ventilation and arterial catheterization while caring for at least 1 other patient had an increased risk of error (OR, 1.21; 95% CI, 1.03-1.42; P = .02). Incoming text messages were not associated with error (OR, 0.97; 95% CI, 0.92-1.02; P = .22). CONCLUSIONS AND RELEVANCE This study's findings suggest that incoming telephone call interruptions may be temporally associated with medication administration errors among PICU nurses. Risk of error varied by shift, experience, nurse to patient ratio, and level of patient care required.
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Affiliation(s)
- Christopher P. Bonafide
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jeffrey M. Miller
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A. Russell Localio
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Amina Khan
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Healthcare Quality and Analytics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adam C. Dziorny
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Division of Pediatric Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mark Mai
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Division of Pediatric Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Shannon Stemler
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Nursing, Christiana Care Health System, Newark, Delaware
| | - Wanxin Chen
- Department of Mathematics, Temple University, Philadelphia, Pennsylvania
| | - John H. Holmes
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Vinay M. Nadkarni
- Division of Pediatric Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ron Keren
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Center for Healthcare Quality and Analytics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Deputy Editor, JAMA Pediatrics
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Panduwal CA, Bilaut EC. The Effectiveness of Interventions to Reduce the Nurses’ Distractions during Medication Administration: A Systematic Review. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Nurses constitute the largest group of health professionals who work in the hospital setting and most of the medications in the setting are administered by nurses. Errors related to medication conducted by a nurse frequently occur during medication administration. Interruptions or distractions during medication administration have been identified as significant contributory factors to medication administration errors (MAEs).Methods: This systematic review critically reviewed the evidence of the effectiveness of the interventions that aim to reduce nurse interruptions or distractions during medication administration. The search for the relevant literature was conducted in August 2018 using three databases; Medline, Cinahl and Embase.Results: Nineteen full text articles were retrieved and reviewed, and 7 articles were included in this review. Five of these studies showed evidence of a reduction in the interruption or distraction rates in post-intervention measurements, while 4 studies reported a statistically significant reduction in the interruption or distraction rates, with p values between 0.0005 and 0.002.Conclusion: There was limited evidence available to support the effectiveness of the interventions in terms of either reducing the interruptions or distractions of the nurses during the medication administration or in terms of reducing the medication administration error rates.
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Bertolazzi LG, Perroca MG. Impact of interruptions on the duration of nursing interventions: A study in a chemotherapy unit. Rev Esc Enferm USP 2020; 54:e03551. [DOI: 10.1590/s1980-220x2018047503551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 06/11/2019] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: To investigate interruptions during nursing interventions in a chemotherapy unit (sources and causes); measure their frequency, duration and the total elapsed time to complete the interventions. Method: This is an observational analytical study performed using a digital stopwatch. It was conducted in a teaching hospital between 2015/2016. The interventions performed and their interruptions were mapped and classified according to the Nursing Interventions Classifications (NIC) taxonomy. Results: There were 492 interruptions recorded in the 107 hours observed, especially in indirect care interventions. They were mainly caused by nursing professionals (n = 289; 57.3%) to supply materials (n = 65; 12.8%) and exchange care information (n = 65; 12.8%). The duration of interruptions ranged from 0:08 to 9:09 (average 1:15; SD 1:03) minutes. On average, interventions took 2:16 (SD 0:27) minutes to complete without interruption; however, the average was 5:59 (SD 3:01) minutes when interrupted. Conclusion: The interruptions were constant during the nursing work in the chemotherapy unit, including during the preparation and administration of medications, and increased the time to complete the interventions by an average of 163.9%.
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Johnson M, Langdon R, Levett-Jones T, Weidemann G, Manias E, Everett B. A cluster randomised controlled feasibility study of nurse-initiated behavioural strategies to manage interruptions during medication administration. Int J Qual Health Care 2019; 31:G67-G73. [PMID: 30834932 DOI: 10.1093/intqhc/mzz007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/09/2018] [Accepted: 01/29/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To examine the feasibility of a behavioural e-learning intervention to support nurses to manage interruptions during medication administration. DESIGN A cluster randomised feasibility trial. SETTING The cluster trial included four intervention and four control wards randomly selected across four metropolitan hospitals in Sydney, Australia. PARTICIPANTS We observed 806 (402 pre-intervention and 404 post-intervention) medication events, where nurses prepared and administered medications to patients within the cluster wards. MAIN OUTCOME MEASURES The primary outcome measured was the observed number of interruptions occurring during administration, with secondary outcomes being the number of clinical errors and procedural failures. Changes in the use of behavioural strategies to manage interruptions, targeted by the e-learning intervention, were also assessed. RESULTS No significant differences were found in the number of interruptions (P = 0.82), procedural failures (P = 0.19) or clinical errors per 100 medications (P = 0.32), between the intervention and control wards. Differences in the use of specific behavioural strategies (engagement and multitasking) were found in the intervention wards. CONCLUSION This behavioural e-learning intervention has not been found to significantly reduce interruptions, however, changes in the use of strategies did occur. Careful selection of clinical settings where there is a high number of predictable interruptions is recommended for further research into the impact of the behavioural e-learning intervention. An increase in the intensity of this intervention is recommended with training undertaken away from the clinical setting. Further research on additional consumer-sensitive interventions is urgently needed.
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Affiliation(s)
- Maree Johnson
- Office of the Executive Dean, Faculty of Health Sciences, Australian Catholic University, PO Box 968, North Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, Australia
| | - Rachel Langdon
- Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research, Western Sydney University, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Tracy Levett-Jones
- Nursing Education, University of Technology, 235 Jones St, Ultimo, NSW, Sydney, Australia
| | - Gabrielle Weidemann
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag, Penrith, NSW 2751, Australia
| | - Elizabeth Manias
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Centre for Quality and Patient Safety Research.,221 Burwood Highway, Burwood, Victoria, Australia, Department of Medicine, University of Melbourne, The Royal Melbourne Hospital, Honorary Professor, The University of Melbourne, Melbourne School of Health Sciences, Royal Parade, Parkville, Victoria 3052, Australia
| | - Bronwyn Everett
- Western Sydney University, School of Nursing and Midwifery, Centre for Applied Nursing Research, Ingham Institute for Applied Medical Research
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Ragau S, Hitchcock R, Craft J, Christensen M. Using the HALT model in an exploratory quality improvement initiative to reduce medication errors. ACTA ACUST UNITED AC 2019; 27:1330-1335. [PMID: 30525975 DOI: 10.12968/bjon.2018.27.22.1330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medication errors can have deleterious effects on patient safety and care. Interruptions, patient acuity and time pressures have all been cited as contributing factors in the incidence of medication errors. Yet, despite the number of different strategies that can be taken to reduce the incidence of medication errors, they still occur. The strategies often focus on refining systems and processes, depending on the root cause of the error. However, less recognised as contributory elements are human factors such as anger, hunger or tiredness. The aim of this quality improvement initiative was to reduce medication errors by 25% on a medical ward, through the introduction of the hunger, angry, lonely, tired (HALT) model to address the human factors associated with medication errors. Post-implementation, the HALT model appeared to have resulted in a total reduction in medication errors over a 2-month period by 31%. Mistakes related to human error were reduced by 25%, and those linked to communication and documentation errors by 22%. While this was a small-scale study, this is a significant reduction in medication errors. However, caution should be used when addressing other contributing factors associated with medication errors as using HALT alone will not address these.
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Affiliation(s)
- Sharon Ragau
- Nurse Educator, Caboolture and Kilcoy Hospitals, Metro North Hospital and Health Service, Caboolture, Queensland, Australia
| | - Rebecca Hitchcock
- Acting Assistant Director of Nursing, Safety and Quality, Caboolture and Kilcoy Hospitals, Metro North Hospital and Health Service, Caboolture, Queensland, Australia
| | - Judy Craft
- Senior Fellow of the UK Higher Education Academy and Senior Lecturer, School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Martin Christensen
- Professor of Nursing and Director of the Centre for Applied Nursing Research, Ingham Institute for Applied Medical Research, Western Sydney University, Liverpool, New South Wales, Australia
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Raja, Badil, Ali S, Sherali S. Association of medication administration errors with interruption among nurses in public sector tertiary care hospitals. Pak J Med Sci 2019; 35:1318-1321. [PMID: 31488999 PMCID: PMC6717478 DOI: 10.12669/pjms.35.5.287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To determine the association of medication administration errors with interruption among nurses working at public sector tertiary care hospitals in Karachi, Pakistan. Methods: An analytical cross-sectional study was accomplished at two public sector healthcare facilities Civil Hospital, and Dow University Hospital, Karachi. The study was carried out from October 2017 to July 2018 over a period of 10 months. The sample was calculated by using OpenEpi version 3.0. By taking 56.4% of medication administration errors, 5% margin of error and 95% confidence level. The calculated sample size was 204 of both genders. The subjects both male and female nurses having a valid license from Pakistan Nursing Council and one year of clinical experience were enrolled in the study. The subjects were approached by using non-probability purposive sampling method. Validated and adapted questionnaire utilized to gather the data. Data was entered and analyzed by using SPSS version 21.0. Results: In this study, total 204 nurses were included, almost half (52%) of them were male. Majority of (82.3%) study participants had age between 25-35 years old. There were total 716 medications given by 204 nurses. Out of these, 295 (41.2%) were antibiotics, other common medications were acid-suppressive, analgesic and antiemetic 14.5%, 15.9% and 11.2% respectively. Among all 716 medications, 644 (89.9%) were given intravenously whereas only 6.7% drugs given orally. A significant association has been found between medication administration errors and interruption like talking with other health care personnel, patients or attendant queries, phone calls (p-value=<0.001). Nearly 91% of the study nurses who were interrupted during medication committed medication errors. Conclusion: It is concluded that there is a significant association between medication administration errors with interruption among nurses.
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Affiliation(s)
- Raja
- Raja, MS. Nursing. Staff Nurse, Department of Plastic and Reconstructive Surgery, Dr. Ruth K.M. Pfau, Civil Hospital, Karachi, Pakistan
| | - Badil
- Badil, MS. Nursing. Assistant Professor, Institute of Nursing, Dow University of Health Sciences, Karachi, Pakistan
| | - Sajid Ali
- Sajid Ali, BSc. Nursing. Lecturer, Liaquat National College of Nursing, Karachi, Pakistan
| | - Shaheen Sherali
- Shaheen Sherali, MS. Nursing. Vice Principal, Indus College of Nursing & Midwifery, Karachi, Pakistan
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Sassaki RL, Cucolo DF, Perroca MG. Interruptions and nursing workload during medication administration process. Rev Bras Enferm 2019; 72:1001-1006. [PMID: 31432958 DOI: 10.1590/0034-7167-2018-0680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/28/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the sources and causes of interruptions during the medication administration process performed by a nursing team and measure its frequency, duration and impact on the team's workload. MÉTODOS This is an observational study that timed 121 medication rounds (preparation, administration and documentation) performed by 15 nurses and nine nursing technicians in a Neonatal Intensive Care Unit in the countryside of the state of São Paulo. RESULTADOS 63 (52.1%) interruptions were observed. In each round, the number of interruptions that happened ranged from 1-7, for 127 in total; these occurred mainly during the preparation phase, 97 (76.4%). The main interruption sources were: nursing staff - 48 (37.8%) - and self-interruptions - 29 (22.8%). The main causes were: information exchanges - 54 (42.5%) - and parallel conversations - 28 (22%). The increase in the mean time ranged from 53.7 to 64.3% (preparation) and from 18.3 to 19.2% (administration) - p≤0.05. CONCLUSÃO Interruptions in the medication process are frequent, interfere in the workload of the nursing team and may reflect on the safety of care.
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Affiliation(s)
| | | | - Marcia Galan Perroca
- Faculdade de Medicina de São José do Rio Preto. São José do Rio Preto, São Paulo, Brazil
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Lappalainen M, Härkänen M, Kvist T. The relationship between nurse manager's transformational leadership style and medication safety. Scand J Caring Sci 2019; 34:357-369. [DOI: 10.1111/scs.12737] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/18/2019] [Accepted: 06/25/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Margit Lappalainen
- Department of Nursing Science University of Eastern Finland Kuopio Finland
| | - Marja Härkänen
- Department of Nursing Science University of Eastern Finland Kuopio Finland
| | - Tarja Kvist
- Department of Nursing Science University of Eastern Finland Kuopio Finland
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Koyama AK, Maddox CSS, Li L, Bucknall T, Westbrook JI. Effectiveness of double checking to reduce medication administration errors: a systematic review. BMJ Qual Saf 2019; 29:595-603. [PMID: 31391315 PMCID: PMC7362775 DOI: 10.1136/bmjqs-2019-009552] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 12/04/2022]
Abstract
Background Double checking medication administration in hospitals is often standard practice, particularly for high-risk drugs, yet its effectiveness in reducing medication administration errors (MAEs) and improving patient outcomes remains unclear. We conducted a systematic review of studies evaluating evidence of the effectiveness of double checking to reduce MAEs. Methods Five databases (PubMed, Embase, CINAHL, Ovid@Journals, OpenGrey) were searched for studies evaluating the use and effectiveness of double checking on reducing medication administration errors in a hospital setting. Included studies were required to report any of three outcome measures: an effect estimate such as a risk ratio or risk difference representing the association between double checking and MAEs, or between double checking and patient harm; or a rate representing adherence to the hospital’s double checking policy. Results Thirteen studies were identified, including 10 studies using an observational study design, two randomised controlled trials and one randomised trial in a simulated setting. Studies included both paediatric and adult inpatient populations and varied considerably in quality. Among three good quality studies, only one showed a significant association between double checking and a reduction in MAEs, another showed no association, and the third study reported only adherence rates. No studies investigated changes in medication-related harm associated with double checking. Reported double checking adherence rates ranged from 52% to 97% of administrations. Only three studies reported if and how independent and primed double checking were differentiated. Conclusion There is insufficient evidence that double versus single checking of medication administration is associated with lower rates of MAEs or reduced harm. Most comparative studies fail to define or investigate the level of adherence to independent double checking, further limiting conclusions regarding effectiveness in error prevention. Higher-quality studies are needed to determine if, and in what context (eg, drug type, setting), double checking produces sufficient benefits in patient safety to warrant the considerable resources required. CRD42018103436.
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Affiliation(s)
- Alain K Koyama
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Claire-Sophie Sheridan Maddox
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,Alfred Health, Melbourne, VIC, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
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Holland K, Sun S, Gackle M, Goldring C, Osmar K. A Qualitative Analysis of Human Error During the DIBH Procedure. J Med Imaging Radiat Sci 2019; 50:369-377.e1. [PMID: 31362870 DOI: 10.1016/j.jmir.2019.06.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This quality assurance study analyzed human errors that occurred during the radiation treatment delivery of the deep-inspiration breath hold (DIBH) technique at a tertiary cancer centre. The intention is to recommend solutions and system changes that have the potential to decrease the frequency of errors based on human factors principles. METHODS Eighty-two incident reports from January 2012 to July 2017 were retrieved and analysed to determine theme bins of performance-influencing factors contributing to the error. Performance-influencing factors were generated from the incident reports and from focus group discussions with volunteer radiation therapists in the department. Potential solutions to mitigate the error were sought from incident reports, focus groups, literature search, and an interview with a human factors specialist. The solutions were ranked based on the hierarchy of effectiveness, and recommendations were classified using a priority matrix. RESULTS Eighty-nine percent of the errors captured in the incident reports were defined as a slip or lapse error type, and 11% of the remaining errors were defined as a mistake error type. Treatment-related problem solving and distractions/interruptions were the highest frequency causative factors that contributed to the observed error. Potential solutions that were suggested across sources included implementing a forcing function, such as the real-time position management system, adding reminders, such as a console sign-off, and updating the current task checklist. DISCUSSION The potential solutions generated were summarized into four recommendations that have varying degrees of association with known causative factors. The four recommendations include investing in (1) a forcing function, (2) updating/reinforcing the procedure, (3) managing workload, and (4) updating the checklist. A priority matrix was used to assess both potential effectiveness and cost/effort of each recommendation. Ideally, recommendation 1 would be implemented; however, it is understood that there would be an associated cost. It is therefore suggested that recommendations 2, 3, and 4 are implemented together to increase the effectiveness of the intervention until recommendation 1 can be achieved. CONCLUSION This qualitative study introduced a method that analyzed human factors in a specialized procedure used in the treatment of a specific population of patients with cancer. Recommendations were formulated and proposed to the radiation therapy department in hopes of potentially decreasing the frequency of this specific error in the future.
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Affiliation(s)
- Kennedy Holland
- Radiation Therapy Program, University of Alberta, Edmonton, Alberta, Canada; Radiation Therapy, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
| | - Sarah Sun
- Radiation Therapy Program, University of Alberta, Edmonton, Alberta, Canada; Radiation Therapy, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Marilyn Gackle
- Radiation Therapy, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Claire Goldring
- Human Factors Safety Specialist, Alberta Health Services, Calgary, Alberta, Canada
| | - Kari Osmar
- Radiation Therapy Program, University of Alberta, Edmonton, Alberta, Canada
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Santana BS, Rodrigues BS, Stival Lima MM, Rehem TCMSB, Lima LR, Volpe CRG. Interrupções no trabalho da enfermagem como fator de risco para erros de medicação. AVANCES EN ENFERMERÍA 2019. [DOI: 10.15446/av.enferm.v37n1.71178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: verificar a associação entre as interrupções e os erros de medicação nas doses preparadas e administradas por profissionais de enfermagem das unidades de internação de clínica médica de dois hospitais públicos localizados no Distrito Federal, Brasil. Método: estudo exploratório, de delineamento transversal e caráter quantitativo realizado em dois hospitais públicos no Distrito Federal, Brasil. A amostra foi de conveniência, sendo 8 profissionais do Hospital 1 e 18 profissionais do Hospital 2. Os dados foram coletados a partir de observação direta e aplicação de questionário e instrumento para identificação dos fatores de risco para erros de medicação. Foram considerados significativos os resultados com valores de p < 0,05 e o índice de confiança estabelecido foi de 95 %.Resultados: em ambos os hospitais verificou-se um perfil majoritariamente de técnicos de enfermagem (H1 = 100 %; H2 = 94,4 %), do sexo feminino (H1 = 75,0 %; H2 = 88,1 %), com idade superior aos 30 anos (H1 = 75,0 %; H2 = 61,0 %). Foram observadas 899 doses no Hospital 1 e Hospital 2, que resultaram em 921 e 648 erros respectivamente, dos quais 464 (53,6 %) no Hospital 1 e 118 (24,4 %) no Hospital 2 estiveram diretamente relacionados à presença de interrupções no trabalho. Cada dose observada sofreu aproximadamente 1,7 erro e percebeu-se uma frequência de aproximadamente 26 (H1) e 16,2 (H2) erros por hora. Conclusões: verifica-se uma forte associação entre as interrupções no trabalho da equipe de enfermagem e os erros de medicação nas unidades de internação estudadas, caracterizando as interrupções como importante fator de risco.
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Morrison M, Cope V, Murray M. The underreporting of medication errors: A retrospective and comparative root cause analysis in an acute mental health unit over a 3-year period. Int J Ment Health Nurs 2018; 27:1719-1728. [PMID: 29762887 DOI: 10.1111/inm.12475] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
Medication errors remain a commonly reported clinical incident in health care as highlighted by the World Health Organization's focus to reduce medication-related harm. This retrospective quantitative analysis examined medication errors reported by staff using an electronic Clinical Incident Management System (CIMS) during a 3-year period from April 2014 to April 2017 at a metropolitan mental health ward in Western Australia. The aim of the project was to identify types of medication errors and the context in which they occur and to consider recourse so that medication errors can be reduced. Data were retrieved from the Clinical Incident Management System database and concerned medication incidents from categorized tiers within the system. Areas requiring improvement were identified, and the quality of the documented data captured in the database was reviewed for themes pertaining to medication errors. Content analysis provided insight into the following issues: (i) frequency of problem, (ii) when the problem was detected, and (iii) characteristics of the error (classification of drug/s, where the error occurred, what time the error occurred, what day of the week it occurred, and patient outcome). Data were compared to the state-wide results published in the Your Safety in Our Hands (2016) report. Results indicated several areas upon which quality improvement activities could be focused. These include the following: structural changes; changes to policy and practice; changes to individual responsibilities; improving workplace culture to counteract underreporting of medication errors; and improvement in safety and quality administration of medications within a mental health setting.
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Affiliation(s)
- Maeve Morrison
- School of Health Professions, Murdoch University, Murdoch, Western Australia, Australia
| | - Vicki Cope
- School of Health Professions, Murdoch University, Murdoch, Western Australia, Australia
| | - Melanie Murray
- School of Health Professions, Murdoch University, Murdoch, Western Australia, Australia
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Schutijser BCFM, Klopotowska JE, Jongerden IP, Spreeuwenberg PMM, De Bruijne MC, Wagner C. Interruptions during intravenous medication administration: A multicentre observational study. J Adv Nurs 2018; 75:555-562. [PMID: 30334590 DOI: 10.1111/jan.13880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/25/2018] [Accepted: 10/02/2018] [Indexed: 11/27/2022]
Abstract
AIMS The aim of this study was to determine the frequency and cause of interruptions during intravenous medication administration, which factors are associated with interruptions and to what extent interruptions influence protocol compliance. BACKGROUND Hospital nurses are frequently interrupted during medication administration, which contributes to the occurrence of administration errors. Errors with intravenous medication are especially worrisome, given their immediate therapeutic effects. However, knowledge about the extent and type of interruptions during intravenous medication administration is limited. DESIGN Multicentre observational study. METHODS Data were collected during two national evaluation studies (2011 - 2012 & 2015 - 2016). Nurses were directly observed during intravenous medication administration. An interruption was defined as a situation where a break during the administration was needed or where a nurse was distracted but could process without a break. Interruptions were categorized according to source and cause. Multilevel logistic regression analyses were conducted to assess the associations between explanatory variables and interruptions or complete protocol compliance. RESULTS In total, 2,526 intravenous medication administration processes were observed. During 291 (12%) observations, nurses were interrupted 321 times. Most interruptions were externally initiated by other nurses (19%) or patients (19%). Less interruptions occurred during the evening (odds ratio: 0.23 [95% confidence interval: 0.08-0.62]). Do-not-disturb vests were worn by 61 (2%) nurses. No significant association was found between being interrupted and complete protocol compliance. CONCLUSION An interruption occurred in every eight observed intravenous medication administration, mainly caused by other nurses or patients. One needs to consider critically which strategies effectively improve safety during the high-risk nursing-task of intravenous medication administration.
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Affiliation(s)
- Bernadette C F M Schutijser
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joanna E Klopotowska
- Department of Medical Informatics, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Irene P Jongerden
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Martine C De Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Johnson M, Levett-Jones T, Langdon R, Weidemann G, Manias E, Everett B. A qualitative study of nurses' perceptions of a behavioural strategies e-learning program to reduce interruptions during medication administration. NURSE EDUCATION TODAY 2018; 69:41-47. [PMID: 30007146 DOI: 10.1016/j.nedt.2018.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/14/2018] [Accepted: 06/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES We sought to evaluate the perceptions of nurses of an e-learning educational program to encourage the use of behavioural strategies-blocking, engaging, mediating, multitasking, and preventing-to reduce the negative effects of interruptions during medication administration. DESIGN A qualitative design was used to evaluate the impact of this e-learning educational intervention on nurses' behaviour. SETTINGS Two wards (palliative care and aged care) from two different hospitals within a large local health service within Sydney Australia, were included in the study. These wards were also involved in a cluster randomised trial to test the effectiveness of the program. PARTICIPANTS A purposive sample participated comprising nine registered and enrolled nurses certified to conduct medication administration, who had reviewed the educational modules. METHODS Two focus groups were conducted and these sessions were digitally recorded and transcribed verbatim. Thematic analysis identified seven themes. RESULTS The major themes identified included: perceptions of interruptions, accessing the program, content of the program, impact, maintaining good practice and facilitators and barriers to changing behaviour. CONCLUSIONS The use of embedded authentic images of patient interruptions and management strategies increased some nurses' perceived use of strategies to manage interruptions. Nurses varied in their perception as to whether they could change their behaviour with some describing change at the individual and ward team levels, while others described patient caseload and other health professionals as a barrier. The use of this innovative educational intervention is recommended for staff orientation, student nurses, medical officers and allied health staff. Further research is required in how this e-learning program can be used in combination with other effective interventions to reduce interruptions.
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Affiliation(s)
- Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, PO Box 968, North Sydney, NSW 2059, Australia.
| | - Tracy Levett-Jones
- University of Technology Sydney, 235 Jones St, Ultimo, NSW 2007, Australia.
| | - R Langdon
- Centre for Applied Nursing Research (CANR), Ingham Institute of Applied Medical Research, Western Sydney University, Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
| | - Gabrielle Weidemann
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Elizabeth Manias
- Deakin University, Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Australia; The University of Melbourne, The Royal Melbourne Hospital, Australia; The University of Melbourne, Melbourne School of Health Sciences, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
| | - Bronwyn Everett
- Centre for Applied Nursing Research (a joint initiative of the Western Sydney University and South Western Sydney Local Health District), School of Nursing and Midwifery, Ingham Institute of Applied Medical Research, Australia.
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Hayes C, Power T, Davidson PM, Daly J, Jackson D. Learning to liaise: using medication administration role-play to develop teamwork in undergraduate nurses. Contemp Nurse 2018; 55:278-287. [PMID: 30092706 DOI: 10.1080/10376178.2018.1505435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aim: To describe undergraduate nursing students' situational awareness and understanding of effective liaison and collaboration within the nursing team during interrupted medication administration.Background: Medication errors related to interruptions are a major problem in health care, impacting on patient morbidity and mortality and increasing the burden of related costs. Effective liaison, teamwork and situation awareness are requisite skills for nurses to facilitate the safe management of interruptions during medication administration.Method: A role-play simulation was offered to 528 second-year undergraduate Bachelor of Nursing students. Qualitative written reflective responses were subsequently collected and subject to thematic analysis to derive themes.Results: Participants (451:528) reported an improved understanding of an unfamiliar and challenging situation that required cooperation and collaboration amongst the nursing team to improve outcomes.Conclusion(s): This simulation exposed undergraduate nurses with limited clinical experience to a situation otherwise unavailable to them. The skills required to engage in effective liaison and teamwork in dynamic situations are vital elements in achieving quality care and must begin to be taught at an undergraduate level.
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Affiliation(s)
- Carolyn Hayes
- Faculty of Health, University of Technology Sydney, Building 10 level 6, 235 Jones Street, Broadway, NSW, 2007, Australia
| | - Tamara Power
- Faculty of Health, University of Technology Sydney, Building 10 level 7, 235 Jones Street, Broadway, NSW, 2007, Australia
| | - Patricia M Davidson
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205-2110, USA
| | - John Daly
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
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Schroers G. Characteristics of interruptions during medication administration: An integrative review of direct observational studies. J Clin Nurs 2018; 27:3462-3471. [DOI: 10.1111/jocn.14587] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/11/2018] [Accepted: 06/16/2018] [Indexed: 11/28/2022]
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Hayes C. Simulation: Smoothing the transition from undergraduate to new graduate. J Nurs Manag 2018; 26:495-497. [DOI: 10.1111/jonm.12676] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Carolyn Hayes
- Faculty of Health; University of Technology; Sydney NSW Australia
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Gluyas H. Understanding the human and system factors involved in medication errors. Nurs Stand 2018:e11176. [PMID: 30020567 DOI: 10.7748/ns.2018.e11176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Abstract
Medication errors involving patients are a serious concern in healthcare practice. Nurses, more than any other healthcare professional group, are principally involved in medicines administration. This article recognises the complexity of why medication errors occur and considers the many factors involved, including those from an individual and organisational system perspective. It adopts a solution-focused approach, based on the evidence underpinning the knowledge of medication errors.
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Affiliation(s)
- Heather Gluyas
- School of Health Professions, Murdoch University, Perth, Australia
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45
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Petersson E, Wångdahl L, Olausson S. ICU nurses' experiences of environmental elements and their meaning for patient care at an ICU: A qualitative content analysis. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2057158518778997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In an intensive care unit (ICU), the environment is highly technological and staff are constantly present. The aim of this study was to describe environmental elements of an ICU room that nurses consider central for their provision of care. Data were collected using photovoice – photographs and in-depth interviews – and analysed using a qualitative content analysis approach. The care environment highly affected ICU nurses, in particular some elements such as medical equipment, work stations and beds. These were considered as an aid, but due to confined space some care was abstained from, maintaining privacy and confidentiality were a challenge, which led to frustration and stress. To provide care in an environment with good lightning, reduced noise and adequate space increases the wellbeing of the nurses, which indicates that an investment in a better care environment would be worthwhile.
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Affiliation(s)
| | | | - Sepideh Olausson
- Institute of Health and Care Sciences,The Sahlgrenska Academy at Gothenburg University, Sweden
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46
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Zarea K, Mohammadi A, Beiranvand S, Hassani F, Baraz S. Iranian nurses’ medication errors: A survey of the types, the causes, and the related factors. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Getnet MA, Bifftu BB. Work Interruption Experienced by Nurses during Medication Administration Process and Associated Factors, Northwest Ethiopia. Nurs Res Pract 2017; 2017:8937490. [PMID: 29359042 PMCID: PMC5735655 DOI: 10.1155/2017/8937490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 10/30/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND During medication administration process, including preparation, administration, and documentation, there is high proportion of work interruption that results in medication administration errors that consequently affect the safety of patients. Thus, the main purpose of this study was to assess the prevalence of work interruption and associated factors during medication administration process. METHODS A prospective, observation-based, cross-sectional study was conducted on 278 nurses. Structure observational sheet was utilized to collect data. EPI Info version 3.5.3 and SPSS version 20 software were utilized for data entry and analysis, respectively. Binary and multivariable logistic regression were fitted to identify the associated factors using an odds ratio and 95% CI. RESULTS The incidence of work interruption was found to be 1,152 during medication administration process. Of this, 579 (50.3%) were major/severe work interruptions. Unit of work, day of the week, professional experience, perceived severity of work interruption, source/initiator of interruption, and secondary tasks were factors significantly associated with major work interruptions at p < 0.05. CONCLUSION In this study, more than half of work interruption was major/severe. Thus, the authors suggest raising the awareness of nurses regarding the severity of work interruptions, with special attention to those who have lower work experience, sources of interruption, and secondary tasks by assigning additional nurses who manage secondary tasks and supportive supervision.
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Affiliation(s)
- Mehammed Adem Getnet
- Department of Nursing, University of Gondar College of Medicine and Health Science, Gondar, Ethiopia
| | - Berhanu Boru Bifftu
- Department of Nursing, University of Gondar College of Medicine and Health Science, Gondar, Ethiopia
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Impact of Interruptions, Distractions, and Cognitive Load on Procedure Failures and Medication Administration Errors. J Nurs Care Qual 2017; 32:309-317. [PMID: 28448299 DOI: 10.1097/ncq.0000000000000256] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Medication administration errors are difficult to intercept since they occur at the end of the process. The study describes interruptions, distractions, and cognitive load experienced by registered nurses during medication administration and explores their impact on procedure failures and medication administration errors. The focus of this study was unique as it investigated how known individual and environmental factors interacted and culminated in errors.
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Hayes C, Jackson D, Davidson PM, Daly J, Power T. Pondering practice: Enhancing the art of reflection. J Clin Nurs 2017; 27:e345-e353. [PMID: 28493618 DOI: 10.1111/jocn.13876] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to describe the effect that immersive simulation experiences and guided reflection can have on the undergraduate nurses' understanding of how stressful environments impact their emotions, performance and ability to implement safe administration of medications. BACKGROUND Patient safety can be jeopardised if nurses are unsure of how to appropriately manage and respond to interruptions. Medication administration errors are a major patient safety issue and often occur as a consequence of ineffective interruption management. The skills associated with medication administration are most often taught to, and performed by, undergraduate nurses in a controlled environment. However, the clinical environment in which nurses are expected to administer medications is often highly stressed and nurses are frequently interrupted. DESIGN/METHODS This study used role-play simulation and written reflections to facilitate deeper levels of student self-awareness. A qualitative approach was taken to explore students' understanding of the effects of interruptions on their ability to undertake safe medication administration. Convenience sampling of second-year undergraduate nursing students enrolled in a medical-surgical subject was used in this study. Data were obtained from 451:528 (85.42%) of those students and analysed using thematic analysis. RESULTS Students reported increasing consciousness and the importance of reflection for evaluating performance and gaining self-awareness. They described self-awareness, effective communication, compassion and empathy as significant factors in facilitating self-efficacy and improved patient care outcomes. CONCLUSIONS Following a role-play simulation experience, student nurses reported new knowledge and skill acquisition related to patient safety, and new awareness of the need for empathetic and compassionate care during medication administration. Practicing medication administration in realistic settings adds to current strategies that aim to reduce medication errors by allowing students to reflect on and in practice and develop strategies to ensure patient safety. RELEVANCE TO CLINICAL PRACTICE Experiencing clinical scenarios within the safety of simulated environments, offers undergraduate student nurses an opportunity to reflect on practice to provide safer, more empathetic and compassionate care for patients in the future.
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Affiliation(s)
- Carolyn Hayes
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Oxford Brookes University, Oxford, UK.,University of New England, Armidale, NSW, Australia
| | | | - John Daly
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Tamara Power
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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50
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Hayes C, Jackson D, Davidson PM, Daly J, Power T. Calm to chaos: Engaging undergraduate nursing students with the complex nature of interruptions during medication administration. J Clin Nurs 2017; 26:4839-4847. [PMID: 28445621 DOI: 10.1111/jocn.13866] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe undergraduate student nurse responses to a simulated role-play experience focussing on managing interruptions during medication administration. BACKGROUND Improving patient safety requires that we find creative and innovative methods of teaching medication administration to undergraduate nurses in real-world conditions. Nurses are responsible for the majority of medication administrations in health care. Incidents and errors associated with medications are a significant patient safety issue and often occur as a result of interruptions. Undergraduate nursing students are generally taught medication administration skills in a calm and uninterrupted simulated environment. However, in the clinical environment medication administration is challenged by multiple interruptions. DESIGN/METHODS A qualitative study using convenience sampling was used to examine student perceptions of a simulated role-play experience. Data were collected from 451 of a possible 528 student written reflective responses and subject to thematic analysis. RESULTS Students reported an increased understanding of the impacts of interruptions while administering medications and an improved awareness of how to manage disruptions. This study reports on one of three emergent themes: "Calm to chaos: engaging with the complex nature of clinical practice." CONCLUSIONS Interrupting medication administration in realistic and safe settings facilitates awareness, allows for students to begin to develop management strategies in relation to interruption and increases their confidence. Students were given the opportunity to consolidate and integrate prior and new knowledge and skills through this role-play simulation.
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Affiliation(s)
- Carolyn Hayes
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia.,Faculty of Health & Life Sciences, Oxford Brookes University, Oxford, UK.,Faculty of Health, Head, WHO UTS Collaborating Centre for Nursing, Midwifery & Health Development, University of Technology Sydney, Broadway, NSW, Australia
| | | | - John Daly
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia.,Faculty of Health, Head, WHO UTS Collaborating Centre for Nursing, Midwifery & Health Development, University of Technology Sydney, Broadway, NSW, Australia
| | - Tamara Power
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
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