1
|
Xie DS, Xie XH, Yang LH, Li N, Zhang X, Xie YT, Yang W, Ning YJ, Xie J, Cheng XJ, Duan SJ, Wang SW, Hao LH, Shi P. Development and validation of a nomogram to predict medication risk based on a knowledge, attitude and practice (KAP) survey of residents in Shanxi Province, China. Front Pharmacol 2024; 15:1302274. [PMID: 38711987 PMCID: PMC11070833 DOI: 10.3389/fphar.2024.1302274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/28/2024] [Indexed: 05/08/2024] Open
Abstract
Objective Unsafe medication practices and medication errors are a major cause of harm in healthcare systems around the world. This study aimed to explore the factors that influence the risk of medication and provide medication risk evaluation model for adults in Shanxi province, China. Methods The data was obtained from the provincial questionnaire from May to December 2022, relying on the random distribution of questionnaires and online questionnaires by four hospitals in Shanxi Province. Multiple linear regression analysis was used to explore the factors affecting the KAP score of residents. Univariate and multivariate logistic regression was used to determine the independent risk factors, and the nomogram was verified by receiver operating characteristic curve, calibration and decision curve analysis. Results A total of 3,388 questionnaires were collected, including 3,272 valid questionnaires. The average scores of drugs KAP were 63.2 ± 23.04, 33.05 ± 9.60, 23.67 ± 6.75 and 33.16 ± 10.87, respectively. On the evaluation criteria of the questionnaire, knowledge was scored "fair", attitude and practice were scored "good". Sex, monthly income, place of residence, insurance status, education level, and employment were regarded as independent risk factors for medication and a nomogram was established by them. Conclusion Males, low-income, and low-educated people are important factors affecting the risk of medication. The application of the model can help residents understand the risk of their own medication behavior and reduce the harm of medication.
Collapse
Affiliation(s)
- Da-shuai Xie
- Department of Pharmacy, Yuncheng Central Hospital Affiliated to Shanxi Medical University, Yuncheng, China
| | - Xue-hu Xie
- National Drug Clinical Trial Institution, Shanxi Province Hospital of Traditional Chinese Medicine, Taiyuan, China
| | - Li-hua Yang
- Department of Pharmacy, Jincheng People’s Hospital, Jincheng, China
| | - Na Li
- Department of Gynecologic, Yuncheng Central Hospital Affiliated to Shanxi Medical University, Yuncheng, China
| | - Xiao Zhang
- Department of Pharmacy, Yuncheng Central Hospital Affiliated to Shanxi Medical University, Yuncheng, China
| | - Yi-tong Xie
- Department of Pharmacy, Yuncheng Central Hospital Affiliated to Shanxi Medical University, Yuncheng, China
| | - Wei Yang
- Department of Pharmacy, Yuncheng Central Hospital Affiliated to Shanxi Medical University, Yuncheng, China
| | - Yao-jun Ning
- Department of Pharmacy, Yuncheng Central Hospital Affiliated to Shanxi Medical University, Yuncheng, China
| | - Jun Xie
- Department of Pharmacy, Yuncheng Central Hospital Affiliated to Shanxi Medical University, Yuncheng, China
| | - Xiao-jun Cheng
- Department of Pharmacy, Yuncheng Central Hospital Affiliated to Shanxi Medical University, Yuncheng, China
| | - Shao-jun Duan
- Department of Pharmacy, Jincheng People’s Hospital, Jincheng, China
| | - Shi-wei Wang
- Department of Pharmacy, Shanxi Province Hospital of Traditional Chinese Medicine, Taiyuan, China
| | - Li-hong Hao
- Department of Pharmacy, Yangquan Coal Industry (Group) General Hospital, Yangquan, China
| | - Ping Shi
- Department of Pharmacy, Yuncheng Central Hospital Affiliated to Shanxi Medical University, Yuncheng, China
| |
Collapse
|
2
|
Selzer A, Eibensteiner F, Kaltenegger L, Hana M, Laml-Wallner G, Geist MB, Mandler C, Valent I, Arbeiter K, Mueller-Sacherer T, Herle M, Aufricht C, Boehm M. Parents' understanding of medication at discharge and potential harm in children with medical complexity. Arch Dis Child 2024; 109:215-221. [PMID: 38041681 DOI: 10.1136/archdischild-2022-325119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Children with medical complexity (CMC) are among the most vulnerable patient groups. This study aimed to evaluate their prevalence and risk factors for medication misunderstanding and potential harm (PH) at discharge. DESIGN AND SETTING Cross-sectional study at a tertiary care centre. STUDY POPULATION CMC admitted at Medical University of Vienna between May 2018 and January 2019. INTERVENTION CMC and caregivers underwent a structured interview at discharge; medication understanding and PH for adverse events were assessed by a hybrid approach. MAIN OUTCOME MEASURES Medication misunderstanding rate; PH. RESULTS For 106 included children (median age 9.6 years), a median number of 5.0 (IQR 3.0-8.0) different medications were prescribed. 83 CMC (78.3%) demonstrated at least one misunderstanding, in 33 CMC (31.1%), potential harm was detected, 5 of them severe. Misunderstandings were associated with more medications (r=0.24, p=0.013), new prescriptions (r=0.23, p=0.019), quality of medication-related communication (r=-0.21, p=0.032), low level of education (p=0.013), low language skills (p=0.002) and migratory background (p=0.001). Relative risk of PH was 2.27 times increased (95% CI 1.23 to 4.22) with new medications, 2.14 times increased (95% CI 1.10 to 4.17) with migratory background. CONCLUSION Despite continuous care at a tertiary care centre and high level of subjective satisfaction, high prevalence of medication misunderstanding with relevant risk for PH was discovered in CMC and their caregivers. This demonstrates the need of interventions to improve patient safety, with stratification of medication-related communication for high-risk groups and a restructured discharge process focusing on detection of misunderstandings ('unknown unknowns').
Collapse
Affiliation(s)
- Axana Selzer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Fabian Eibensteiner
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Lukas Kaltenegger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Michelle Hana
- Drug Information and Clinical Pharmacy, Institutional Pharmacy, University Hospital Vienna, Vienna, Austria
| | - Gerda Laml-Wallner
- Drug Information and Clinical Pharmacy, Institutional Pharmacy, University Hospital Vienna, Vienna, Austria
| | - Matthias Benjamin Geist
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Christopher Mandler
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Isabella Valent
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Klaus Arbeiter
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Thomas Mueller-Sacherer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Marion Herle
- Drug Information and Clinical Pharmacy, Institutional Pharmacy, University Hospital Vienna, Vienna, Austria
| | - Christoph Aufricht
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Michael Boehm
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| |
Collapse
|
3
|
Cassidy CE, Boulos L, McConnell E, Barber B, Delahunty-Pike A, Bishop A, Fatima N, Higgins A, Churchill M, Lively A, MacPhee SP, Misener RM, Sarty R, Wells R, Curran JA. E-prescribing and medication safety in community settings: A rapid scoping review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100365. [PMID: 38023632 PMCID: PMC10679534 DOI: 10.1016/j.rcsop.2023.100365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Background Medication prescribing is essential for the treatment, curing, maintenance, and/or prevention of an illness and disease, however, medication errors remain common. Common errors including prescribing and administration, pose significant risk to patients. Electronic prescribing (e-prescribing) is one intervention used to enhance the safety and quality of prescribing by decreasing medication errors and reducing harm. E-prescribing in community-based settings has not been extensively examined. Objective To map and characterize the current evidence on e-prescribing and medication safety in community pharmacy settings. Methods We conducted a rapid scoping review of quantitative, qualitative, and mixed methods studies reporting on e-prescribing and medication safety. MEDLINE All (OVID), Embase (Elsevier), CINAHL Full Text (EBSCOHost), and Scopus (Elsevier) databases were searched December 2022 using keywords and MeSH terms related to e-prescribing, medication safety, efficiency, and uptake. Articles were imported to Covidence and screened by two reviewers. Data were extracted by a single reviewer and verified by a second reviewer using a standardized data extraction form. Findings are reported in accordance with JBI Manual for Evidence Synthesis following thematic analysis to narratively describe results. Results Thirty-five studies were included in this review. Most studies were quantitative (n = 22), non-experimental study designs (n = 16) and were conducted in the United States (n = 18). Half of included studies reported physicians as the prescriber (n = 18), while the remaining reported a mix of nurse practitioners, pharmacists, and physician assistants (n = 6). Studies reported on types of errors, including prescription errors (n = 20), medication safety errors (n = 9), dispensing errors (n = 2), and administration errors (n = 1). Few studies examined patient health outcomes, such as adverse drug events (n = 5). Conclusions Findings indicate that most research is descriptive in nature and focused primarily on rates of prescription errors. Further research, such as experimental, implementation, and evaluation mixed-methods research, is needed to investigate the effects of e-prescribing on reducing error rates and improving patient and health system outcomes.
Collapse
Affiliation(s)
- Christine E. Cassidy
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | | | | | - Andrea Bishop
- Nova Scotia College of Pharmacists, Halifax, Nova Scotia, Canada
| | - Nawal Fatima
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Rowan Sarty
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | | | - Janet A. Curran
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health, Halifax, Nova Scotia, Canada
| |
Collapse
|
4
|
Henry Basil J, Premakumar CM, Mhd Ali A, Mohd Tahir NA, Mohamed Shah N. Prevalence, Causes and Severity of Medication Administration Errors in the Neonatal Intensive Care Unit: A Systematic Review and Meta-Analysis. Drug Saf 2022; 45:1457-1476. [PMID: 36192535 DOI: 10.1007/s40264-022-01236-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Neonates are at greater risk of preventable adverse drug events as compared to children and adults. OBJECTIVE This study aimed to estimate and critically appraise the evidence on the prevalence, causes and severity of medication administration errors (MAEs) amongst neonates in Neonatal Intensive Care Units (NICUs). METHODS A systematic review and meta-analysis was conducted by searching nine electronic databases and the grey literature for studies, without language and publication date restrictions. The pooled prevalence of MAEs was estimated using a random-effects model. Data on error causation were synthesised using Reason's model of accident causation. RESULTS Twenty unique studies were included. Amongst direct observation studies reporting total opportunity for errors as the denominator for MAEs, the pooled prevalence was 59.3% (95% confidence interval [CI] 35.4-81.3, I2 = 99.5%). Whereas, the non-direct observation studies reporting medication error reports as the denominator yielded a pooled prevalence of 64.8% (95% CI 46.6-81.1, I2 = 98.2%). The common reported causes were error-provoking environments (five studies), while active failures were reported by three studies. Only three studies examined the severity of MAEs, and each utilised a different method of assessment. CONCLUSIONS This is the first comprehensive systematic review and meta-analysis estimating the prevalence, causes and severity of MAEs amongst neonates. There is a need to improve the quality and reporting of studies to produce a better estimate of the prevalence of MAEs amongst neonates. Important targets such as wrong administration-technique, wrong drug-preparation and wrong time errors have been identified to guide the implementation of remedial measures.
Collapse
Affiliation(s)
- Josephine Henry Basil
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Chandini Menon Premakumar
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Nurul Ain Mohd Tahir
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| |
Collapse
|
5
|
Alshammari FM, Alanazi EJ, Alanazi AM, Alturifi AK, Alshammari TM. Medication Error Concept and Reporting Practices in Saudi Arabia: A Multiregional Study Among Healthcare Professionals. Risk Manag Healthc Policy 2021; 14:2395-2406. [PMID: 34113194 PMCID: PMC8187088 DOI: 10.2147/rmhp.s281154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Medication errors pose a risk for individual patients and for public health, with the misuse and overuse of medications being linked to severe patient safety problems. Therefore, the objective of this study was to investigate healthcare professionals’ (HCPs’) knowledge about medication errors, their knowledge about medication error reporting systems, and predictors for HCPs to report medication errors in Saudi Arabia. Methods An observational cross-sectional study was conducted among HCPs (physicians, pharmacists, and nurses) between January and March 2020. The study included 6 distinct locations in the Saudi Arabian regions of Hail, Al-Qassim, Al-Jouf, Al-Madinah, the eastern region, and the western region. Descriptive statistical and inferential analyses were computed using Statistical Package for the Social Sciences (SPSS) v.22. Results In total, 980 questionnaires for 348 (35.5%) physicians, 144 (14.7%) pharmacists, and 488 (49.8%) nurses were distributed with a response rate of 100%. Interestingly, only 277 (28.3%) of the HCPs had a good understanding of the stages of medication errors. With regard to reporting practices, a high number of the HCPs, 576 (58.8%), had not reported medication errors in their workplaces, and nearly 369 (37.7%) of respondents said they believe that legal implications are a major barrier to the reporting of medication errors. More than half, 524 (53.5%), of HCPs revealed that no clear electronic system is available for the reporting of medication errors in most hospitals. In addition, 537 (54.8%), of the HCPs had not attended any training programs regarding medication error reporting systems within the past year, which is alarming. Conclusion Our study identified a huge lack of the reporting of medication errors, knowledge about medication error stages, and training on medication errors. Therefore, an urgent need to address these weaknesses exists.
Collapse
Affiliation(s)
- Faizah M Alshammari
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Entisar J Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Afnan M Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Abdulrahman K Alturifi
- Department of Infection Prevention and Control, Hail Health Affairs, Ministry of Health, Hail, Saudi Arabia
| | - Thamir M Alshammari
- Department of Pharmacy Practice, College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
6
|
Noailly J, Sadozaï L, Hurtaud-Roux MF, Naudin J, Bonnefoy R, Farnoux C, Kwon T, Bourdon O, Prot-Labarthe S. [Enoxaparin and tinzaparin in pediatrics: Impact of recommendation on prescription quality and anti-Xa levels]. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 79:710-719. [PMID: 33675741 DOI: 10.1016/j.pharma.2021.02.007] [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: 11/02/2020] [Revised: 01/27/2021] [Accepted: 02/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A protocol has been written and distributed in May 2017 to all prescribers in a pediatric hospital to standardize and to secure the prescriptions of enoxaparin and tinzaparin considered as two high risk medications. The aim of this study is to evaluate the impact of the protocol on those prescriptions in a pediatric population. METHODS This is a monocentric retrospective study comparing prescriptions of this two low-molecular-weight heparins for patients under 18 years old in 2016 and 2018, thus before and after the protocol redaction. RESULTS In 2016, 2246 prescriptions of enoxaparin and tinzaparin were analyzed for 627 patients. Among them, 142 (22.6%) patients have had at least one anti-Xa level dosed. On the other hand, in 2018, 2061 prescriptions were written for 628 patients including 96 (15.3%) who have had at least one anti-Xa level dosed. The conformity rate of the first dose in IU/kg/administration of the first enoxaparin prescription goes from 36.3% before protocol to 52.1% after (P=0.03*). Concerning tinzaparin, the conformity rate goes from 69.2% to 83.3%. (P=0.19). The rate of first anti-Xa level in the range 0.4 to 1.2 IU/ml increase between 2016 and 2018 from 27.7% to 43.8% (P<0.001*). CONCLUSION This protocol enabled to improve the quality of prescriptions in terms of: dosage written in IU/kg/administration, frequency of administration, dilution conformity, and result of the first anti-Xa level. Some efforts must be made in writing the dose in IU not in mg or ml.
Collapse
Affiliation(s)
- J Noailly
- Service de Pharmacie, AP-HP, Hôpital Robert-Debré, Paris, France
| | - L Sadozaï
- Service de Pharmacie, AP-HP, Hôpital Robert-Debré, Paris, France
| | - M-F Hurtaud-Roux
- Service d'Hématologie Biologique, AP-HP, Hôpital Robert-Debré, Paris, France
| | - J Naudin
- Service de Réanimation et surveillance continue Pédiatrique, AP-HP, Hôpital Robert-Debré, Paris, France
| | - R Bonnefoy
- Service de Cardiologie Pédiatrique, AP-HP, Hôpital Robert-Debré, Paris, France
| | - C Farnoux
- Service de Néonatologie, AP-HP, Hôpital Robert-Debré, Paris, France
| | - T Kwon
- Service de Néphrologie Pédiatrique, AP-HP, Hôpital Robert-Debré, Paris, France
| | - O Bourdon
- Service de Pharmacie, AP-HP, Hôpital Robert-Debré, Paris, France; Département de pharmacie clinique, Université Paris Descartes, Paris, France; Laboratoire Educations et Pratiques de Santé, Université Paris XIII, Bobigny, France
| | - S Prot-Labarthe
- Service de Pharmacie, AP-HP, Hôpital Robert-Debré, Paris, France; Université de Paris, ECEVE, Inserm, 75010 Paris, France.
| |
Collapse
|
7
|
Brennan-Bourdon LM, Vázquez-Alvarez AO, Gallegos-Llamas J, Koninckx-Cañada M, Marco-Garbayo JL, Huerta-Olvera SG. A study of medication errors during the prescription stage in the pediatric critical care services of a secondary-tertiary level public hospital. BMC Pediatr 2020; 20:549. [PMID: 33278900 PMCID: PMC7718655 DOI: 10.1186/s12887-020-02442-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 11/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Medication Errors (MEs) are considered the most common type of error in pediatric critical care services. Moreover, the ME rate in pediatric patients is up to three times higher than the rate for adults. Nevertheless, information in pediatric population is still limited, particularly in emergency/critical care practice. The purpose of this study was to describe and analyze MEs in the pediatric critical care services during the prescription stage in a Mexican secondary-tertiary level public hospital. Methods A cross-sectional study to detect MEs was performed in all pediatric critical care services [pediatric emergency care (PEC), pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), and neonatal intermediate care unit (NIMCU)] of a public teaching hospital. A pharmacist identified MEs by direct observation as the error detection method and MEs were classified according to the updated classification for medication errors by the Ruíz-Jarabo 2000 working group. Thereafter, these were subclassified in clinically relevant MEs. Results In 2347 prescriptions from 301 patients from all critical care services, a total of 1252 potential MEs (72%) were identified, and of these 379 were considered as clinically relevant due to their potential harm. The area with the highest number of MEs was PICU (n = 867). The ME rate was > 50% in all pediatric critical care services and PICU had the highest ME/patient index (13.1). The most frequent MEs were use of abbreviations (50.9%) and wrong speed rate of administration (11.4%), and only 11.7% of the total drugs were considered as ideal medication orders. Conclusion Clinically relevant medication errors can range from mild skin reactions to severe conditions that place the patient’s life at risk. The role of pharmacists through the detection and timely intervention during the prescription and other stages of the medication use process can improve drug safety in pediatric critical care services.
Collapse
Affiliation(s)
| | - Alan O Vázquez-Alvarez
- Instituto de Terapéutica Experimental y Clínica (INTEC). Departamento de Fisiología. Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Jahaira Gallegos-Llamas
- Egresada de la Licenciatura en Químico Fármaco Biólogo, Centro Universitario de la Ciénega, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | | | - Selene G Huerta-Olvera
- Departamento de Ciencias Médicas y de la Vida. Centro Universitario de la Ciénega. Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Shawahna R. Merits, features, and desiderata to be considered when developing electronic health records with embedded clinical decision support systems in Palestinian hospitals: a consensus study. BMC Med Inform Decis Mak 2019; 19:216. [PMID: 31703675 PMCID: PMC6842153 DOI: 10.1186/s12911-019-0928-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/14/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Electronic health records (EHRs) with embedded clinical decision support systems (CDSSs) have the potential to improve healthcare delivery. This study was conducted to explore merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs. METHODS A mixed-method combining the Delphi technique and Analytic Hierarchy Process was used. Potentially important items were collected after a thorough search of the literature and from interviews with key contact experts (n = 19). Opinions and views of the 76 panelists on the use of EHRs were also explored. Iterative Delphi rounds were conducted to achieve consensus on 122 potentially important items by a panel of 76 participants. Items on which consensus was achieved were ranked in the order of their importance using the Analytic Hierarchy Process. RESULTS Of the 122 potentially important items presented to the panelists in the Delphi rounds, consensus was achieved on 110 (90.2%) items. Of these, 16 (14.5%) items were related to the demographic characteristics of the patient, 16 (14.5%) were related to prescribing medications, 16 (14.5%) were related to checking prescriptions and alerts, 14 (12.7%) items were related to the patient's identity, 13 (11.8%) items were related to patient assessment, 12 (10.9%) items were related to the quality of alerts, 11 (10%) items were related to admission and discharge of the patient, 9 (8.2%) items were general features, and 3 (2.7%) items were related to diseases and making diagnosis. CONCLUSIONS In this study, merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs were explored. Considering items on which consensus was achieved might promote congruence and safe use of EHRs. Further studies are still needed to determine if these recommendations can improve patient safety and outcomes in Palestinian hospitals.
Collapse
Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
- An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
| |
Collapse
|
10
|
Foster M, Tagg A. A systems-centred approach to reducing medication error: Should pre-hospital providers and emergency departments dose children by age during resuscitation? J Paediatr Child Health 2019; 55:1299-1303. [PMID: 31517422 DOI: 10.1111/jpc.14626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022]
Abstract
The high-risk, high-stress and high-stakes environment of out-of-hospital or emergency department paediatric resuscitation is prone to human error, and medication errors are common. This could be contributing to the difference in survival rate of resuscitation in the out-of-hospital versus inpatient setting. Medication for children during resuscitation requires estimation of the child's weight and calculation of the corresponding drug dose. Whilst both of these steps can lead to error, calculation errors (including 10-fold errors) are much more common and harmful than weight errors. Previous solutions aim to optimise each stage of the medication dosing process. Currently, Australian guidelines suggest using the highly inaccurate original advanced paediatric life support formula, weight = 2 × (age + 4), to dose medications in these settings. This means age is converted to weight, which is then converted to dose. There is no evidence that this is causing harm to patients. Therefore, it could be suggested that age could safely be converted straight to dose according to preset doses. This eliminates the need for any weight estimation or dose calculation, thus reducing the potential for error and harm.
Collapse
Affiliation(s)
- Mieke Foster
- Deakin University School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Andrew Tagg
- Sunshine Hospital Emergency Department, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Hermanspann T, van der Linden E, Schoberer M, Fitzner C, Orlikowsky T, Marx G, Eisert A. Evaluation to improve the quality of medication preparation and administration in pediatric and adult intensive care units. DRUG HEALTHCARE AND PATIENT SAFETY 2019; 11:11-18. [PMID: 30936751 PMCID: PMC6429998 DOI: 10.2147/dhps.s184479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose To determine the type, frequency, and factors associated with medication preparation and administration errors in adult intensive care units (ICUs) and neonatal ICUs (NICUs)/pediatric ICUs (PICUs). Patients and methods We conducted a prospective direct observation study in an adult ICU and NICU/PICU in a tertiary university hospital. Between June 2012 and June 2013, a clinical pharmacist and medical student observed the nursing care staff on weekdays during the preparation and administration of intravenous drugs. We analyzed the frequency and type of preparation and administration errors and factors associated with errors. Results Six hundred and three preparations in the adult ICU and 281 in the NICU/PICU were observed. Three hundred and eighty-five errors occurred in the adult ICU and 38 in the NICU/PICU. There were 5,040 and 2,514 error opportunities, with overall error rates of 7.6% and 1.5%, respectively. The total opportunities for error meant each single step of preparation and administration that was relevant for the drug. Most errors applied to the category “uniform mixing” (adult ICU: n=227, 59%; NICU/PICU: n=14, 37%). The multivariate logistic regression results showed a significantly different influence of the “preparation type” for the adult ICU compared with the NICU/PICU with regard to the occurrence of an error. Preparations for adult patients of the LCD type (liquid concentrate with diluent into syringe or infusion bag) were more often associated with errors than the P (powder in a glass vial that must be reconstituted and diluted if necessary), P=0.012, and LC (liquid concentrate into syringe), P=0.002 type. Conclusion “Uniform mixing” was the most erroneous preparation step in intravenous drug preparations in two ICUs. Improvement of nurse training and the preparation of prefilled syringes in the pharmacy might reduce errors and improve the quality and safety of drug therapy.
Collapse
Affiliation(s)
- Theresa Hermanspann
- Hospital Pharmacy, RWTH Aachen University Hospital, Aachen, Germany, .,Department of Pediatric and Adolescent Medicine, Section of Neonatology, RWTH Aachen University Hospital, Aachen, Germany,
| | - Eva van der Linden
- Department of Pediatric and Adolescent Medicine, Section of Neonatology, RWTH Aachen University Hospital, Aachen, Germany,
| | - Mark Schoberer
- Department of Pediatric and Adolescent Medicine, Section of Neonatology, RWTH Aachen University Hospital, Aachen, Germany,
| | - Christina Fitzner
- Department of Medical Statistics, Medical Faculty RWTH Aachen University, Aachen, Germany.,Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Thorsten Orlikowsky
- Department of Pediatric and Adolescent Medicine, Section of Neonatology, RWTH Aachen University Hospital, Aachen, Germany,
| | - Gernot Marx
- Department of Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Albrecht Eisert
- Hospital Pharmacy, RWTH Aachen University Hospital, Aachen, Germany, .,Institute of Pharmacology and Toxicology, Medical Faculty RWTH Aachen University, Aachen, Germany
| |
Collapse
|