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Nguyen PTL, Phan TAT, Vo VBN, Ngo NTN, Nguyen HT, Phung TL, Kieu MTT, Nguyen TH, Duong KNC. Medication errors in emergency departments: a systematic review and meta-analysis of prevalence and severity. Int J Clin Pharm 2024; 46:1024-1033. [PMID: 38734867 DOI: 10.1007/s11096-024-01742-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/15/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Medication errors significantly compromise patient safety in emergency departments. Although previous studies have investigated the prevalence of these errors in this setting, results have varied widely. AIM The aim was to report pooled data on the prevalence and severity of medication errors in emergency departments, as well as the proportion of patients affected by these errors. METHOD Systematic searches were conducted in Embase, PubMed, and the Cochrane Library from database inception until June 2023. Studies provided numerical data on medication errors within emergency departments were eligible for inclusion. Random-effects meta-analysis was employed to pool the prevalence of medication errors, the proportion of patients experiencing these errors, and the error severity levels. Heterogeneity among studies was assessed using the I2 statistic and Cochran's Q test. RESULTS Twenty-four studies met the inclusion criteria. The meta-analysis gave a pooled prevalence of medication errors in emergency departments of 22.6% (95% Confidence Interval [CI] 19.2-25.9%, I2 = 99.9%, p < 0.001). The estimated proportion of patients experiencing medication errors was 36.3% (95% CI 28.3-44.3%, I2 = 99.8%, p < 0.001). Of these errors, 42.6% (95% CI 5.0-80.1%) were potentially harmful but not life-threatening, while no-harm errors accounted for 57.3% (95% CI 14.1-100.0%). CONCLUSION The prevalence of medication errors, particularly those potentially harmful, underscores potential safety issues in emergency departments. It is imperative to develop and implement effective interventions aimed at reducing medication errors and enhancing patient safety in this setting.
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Affiliation(s)
- Phuong Thi Lan Nguyen
- School of Medicine, Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thu Anh Thi Phan
- School of Medicine, Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Van Bich Ngoc Vo
- School of Medicine, Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nhi T N Ngo
- Health Technology Assessment Program, Mahidol University, Bangkok, Thailand
| | - Ha Thi Nguyen
- School of Medicine, Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Toi Lam Phung
- Health Strategy and Policy Institute, Ministry of Health, Hanoi, Vietnam
| | - Mai Thi Tuyet Kieu
- Faculty of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Thao Huong Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Khanh N C Duong
- School of Medicine, Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam.
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
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Oyibo K, Gonzalez PA, Ejaz S, Naheyan T, Beaton C, O'Donnell D, Barker JR. Exploring the Use of Persuasive System Design Principles to Enhance Medication Incident Reporting and Learning Systems: Scoping Reviews and Persuasive Design Assessment. JMIR Hum Factors 2024; 11:e41557. [PMID: 38512325 PMCID: PMC10995789 DOI: 10.2196/41557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/29/2023] [Accepted: 11/20/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Medication incidents (MIs) causing harm to patients have far-reaching consequences for patients, pharmacists, public health, business practice, and governance policy. Medication Incident Reporting and Learning Systems (MIRLS) have been implemented to mitigate such incidents and promote continuous quality improvement in community pharmacies in Canada. They aim to collect and analyze MIs for the implementation of incident preventive strategies to increase safety in community pharmacy practice. However, this goal remains inhibited owing to the persistent barriers that pharmacies face when using these systems. OBJECTIVE This study aims to investigate the harms caused by medication incidents and technological barriers to reporting and identify opportunities to incorporate persuasive design strategies in MIRLS to motivate reporting. METHODS We conducted 2 scoping reviews to provide insights on the relationship between medication errors and patient harm and the information system-based barriers militating against reporting. Seven databases were searched in each scoping review, including PubMed, Public Health Database, ProQuest, Scopus, ACM Library, Global Health, and Google Scholar. Next, we analyzed one of the most widely used MIRLS in Canada using the Persuasive System Design (PSD) taxonomy-a framework for analyzing, designing, and evaluating persuasive systems. This framework applies behavioral theories from social psychology in the design of technology-based systems to motivate behavior change. Independent assessors familiar with MIRLS reported the degree of persuasion built into the system using the 4 categories of PSD strategies: primary task, dialogue, social, and credibility support. RESULTS Overall, 17 articles were included in the first scoping review, and 1 article was included in the second scoping review. In the first review, significant or serious harm was the most frequent harm (11/17, 65%), followed by death or fatal harm (7/17, 41%). In the second review, the authors found that iterative design could improve the usability of an MIRLS; however, data security and validation of reports remained an issue to be addressed. Regarding the MIRLS that we assessed, participants considered most of the primary task, dialogue, and credibility support strategies in the PSD taxonomy as important and useful; however, they were not comfortable with some of the social strategies such as cooperation. We found that the assessed system supported a number of persuasive strategies from the PSD taxonomy; however, we identified additional strategies such as tunneling, simulation, suggestion, praise, reward, reminder, authority, and verifiability that could further enhance the perceived persuasiveness and value of the system. CONCLUSIONS MIRLS, equipped with persuasive features, can become powerful motivational tools to promote safer medication practices in community pharmacies. They have the potential to highlight the value of MI reporting and increase the readiness of pharmacists to report incidents. The proposed persuasive design guidelines can help system developers and community pharmacy managers realize more effective MIRLS.
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Affiliation(s)
- Kiemute Oyibo
- Department of Electrical Engineering and Computer Science, Lassonde Research Centre, York University, North York, ON, Canada
| | - Paola A Gonzalez
- Faculty of Management, Dalhousie University, Halifax, NS, Canada
| | - Sarah Ejaz
- Department of Electrical Engineering and Computer Science, Lassonde Research Centre, York University, North York, ON, Canada
| | - Tasneem Naheyan
- Department of Electrical Engineering and Computer Science, Lassonde Research Centre, York University, North York, ON, Canada
| | - Carla Beaton
- Pharmapod, Think Research Corporation, Toronto, ON, Canada
| | | | - James R Barker
- Faculty of Management, Dalhousie University, Halifax, NS, Canada
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Sadeghi A, Masjedi Arani A, Karami Khaman H, Qadimi A, Ghafouri R. Patient safety improvement in the gastroenterology department: An action research. PLoS One 2023; 18:e0289511. [PMID: 37582075 PMCID: PMC10426960 DOI: 10.1371/journal.pone.0289511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Patient safety is a global concern. Safe and effective care can shorten hospital stays and prevent or minimize unintentional harm to patients. Therefore, it is necessary to continuously monitor and improve patient safety in all medical environments. This study is aimed at improving patient safety in gastroenterology departments. METHODS The study was carried out as action research. The participants were patients, nurses and doctors of the gastroenterology department of Ayatollah Taleghani Hospital in Tehran in 2021-2022. Data were collected using questionnaires (medication adherence tool, patient education effectiveness evaluation checklist, and medication evidence-based checklist), individual interviews and focus groups. The quantitative data analysis was done using SPSS (v.20) and qualitative data analysis was done through content analysis method using MAXQDA analytic pro 2022 software. RESULTS The majority of errors were related to medication and the patient's fault due to their lack of education and prevention strategy were active supervision, modification of clinical processes, improvement of patient education, and promotion of error reporting culture. The findings of the research showed that the presence of an active supervisor led to the identification and prevention of more errors (P<0.01). Regarding the improvement of clinical processes, elimination of reworks can increase satisfaction in nurses (P<0.01). In terms of patient education, the difference was not statistically significant (P>0.01); however, the mean medication adherence score was significantly different (P<0.01). CONCLUSION The improvement strategies of patient safety in Gastroenterology department included the modification of ward monitoring processes, improving/modification clinical processes, improvement of patient education, and development of error reporting culture. Identifying inappropriate processes and adjusting them based on the opinion of the stakeholders, proper patient education regarding self-care, careful monitoring using appropriate checklists, and presence of a supervisor in the departments can be effective in reducing the incidence rate. A comprehensive error reporting program provides an opportunity for employees to report errors.
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Affiliation(s)
- Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Masjedi Arani
- Department of Clinical Psychology, Medical School, Center for the Study of Religion and Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hosna Karami Khaman
- Student Research Committee, Urology Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Qadimi
- Student Research Committee, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Raziyeh Ghafouri
- Department of Medical and Surgical Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Intercepting Medication Errors in Pediatric In-patients Using a Prescription Pre-audit Intelligent Decision System: A Single-center Study. Paediatr Drugs 2022; 24:555-562. [PMID: 35906499 DOI: 10.1007/s40272-022-00521-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Medication errors can happen at any phase of the medication process at health care settings. The objective of this study is to identify the characteristics of severe prescribing errors at a pediatric hospital in the inpatient setting and to provide recommendations to improve medication safety and rational drug use. METHODS This descriptive retrospective study was conducted at a tertiary pediatric hospital using data collected from Jan. 1st, 2019 to Dec. 31st, 2020. During this period, the Prescription Pre-audit Intelligent Decision System was implemented. Medication orders with potential severe errors would trigger a Level 7 alert and would be intercepted before it reached the pharmacy. Trained pharmacists maintained the system and facilitated decision making when necessary. For each order intercepted by the system the following patient details were recorded and analyzed: patient age, patient's department, drug classification, dosage forms, route of administration, and the type of error. RESULTS A total of 2176 Level 7 medication orders were intercepted. The most common errors were associated with drug dosage, administration route, and dose frequency, accounting for 35.2%, 32.8% and 13.2%, respectively. Of all the intercepted oerrors. 53.6% occurred in infants aged < 1 year. Administration routes involved were mainly intravenous, oral and external use drugs. Most alerts came from the neonatology department and constituted 40.5% of the total alerts, followed by the nephrology department 15.9% and pediatric intensive care unit (PICU) 11.3%. As to dosage forms, injections accounted for 50.4% of alerts, with 21.3% attributable to topical solutions, 9.1% to tablets, and 5.7% to inhalation. Anti-infective agents were the most common therapeutic drugs prescribed with errors. CONCLUSIONS The Prescription Pre-audit Intelligent Decision System, with the supervision of trained pharmacists can validate prescriptions, increase prescription accuracy, and improve drug safety for hospitalized children. It is a medical service model worthy of consideration.
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Gampetro PJ, Segvich JP, Hughes AM, Kanich C, Schlaeger JM, McFarlin BL. Associations between safety outcomes and communication practices among pediatric nurses in the United States. J Pediatr Nurs 2022; 63:20-27. [PMID: 34942469 DOI: 10.1016/j.pedn.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To gain a deeper understanding of RNs communication related to patient safety. RESEARCH AIMS To determine: (1) the associations between the communication of registered nurses (RNs) within their health care teams and the frequency that they reported safety events; (2) the associations between RNs' communication within their health care teams and their perceptions of safety within the hospital unit; and (3) whether RNs' communication had improved from 2016 to 2018. THEORETICAL FRAMEWORK AND METHODS We used the United Kingdom's Safety Culture model as the theoretical framework for this study. Our secondary data analysis from the Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture included 2016 (n = 5298) and 2018 (n = 3476) using multiple regression models to determine associations between responses for Communication Openness and Feedback & Communication About Error, and outcome responses for Frequency of Events Reported and Overall Perceptions of Safety. RESULTS Our findings were: 1). In both 2016 and 2018 datasets, Feedback About Error had a greater impact on Reporting Frequency than Open Communication; 2). Feedback About Error had a greater impact on Safety Perceptions than Open Communication; 3). Open Communication and Feedback About Error and their associations with Reporting Frequency and Safety Perceptions showed little change; and, 4). The proportion of variance was low, indicating factors other than Open Communication and Feedback About Error were involved with Reporting Frequency and Safety Perceptions. CONCLUSION Pediatric RNs' communication, reporting, and perceptions of patient safety have not improved. (245 words).
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Affiliation(s)
- Pamela J Gampetro
- University of Illinois Chicago, College of Nursing, Department of Human Development Nursing Science, 845 S. Damen Avenue, Chicago, IL 60612, United States.
| | - John P Segvich
- Statistical Consultant, 14524 Kolin Avenue, Midlothian, IL 60445, United States
| | - Ashley M Hughes
- University of Illinois Chicago, College of Applied Health Sciences, Department of Biomedical & Health Information Sciences, Director, Systems-based Approach for Enhancing Teamwork (SAFE-T) lab, 1919 W. Taylor Street, Chicago, IL 60612, United States.
| | - Chris Kanich
- University of Illinois Chicago, College of Engineering, Department of Computer Science, 851 S. Morgan Street, Chicago, IL 60607, United States.
| | - Judith M Schlaeger
- University of Illinois Chicago, College of Nursing, Department of Human Development Nursing Science, 845 S. Damen Avenue, Chicago, IL 60612, United States.
| | - Barbara L McFarlin
- University of Illinois Chicago, College of Nursing, Department of Human Development Nursing Science, 845 S. Damen Avenue, Chicago, IL 60612, United States.
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Dosing Accuracy of Oral Extemporaneous Suspensions of Antibiotics: Measuring Procedures and Administration Devices. Pharmaceutics 2021; 13:pharmaceutics13040528. [PMID: 33920192 PMCID: PMC8068927 DOI: 10.3390/pharmaceutics13040528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 12/05/2022] Open
Abstract
Extemporaneous suspensions are often marketed with several administration devices that can be freely used by patients/caregivers. The homogeneity of suspensions requires shaking before use. Hence, it is crucial to assess the precision of all devices and the users’ awareness of the shaking procedure. This study was conducted at University Institute Egas Moniz with 40 pharmacy students who were asked to measure 2.5 and 5 mL of two extemporaneous azithromycin suspensions. Formulation A is marketed with a double-dosing spoon and oral syringe, whereas B includes a transparent dosing spoon. Both have a reconstitution cup. The user’s preference for administration devices, the degree of compliance with the ‘shake before use’ instruction and the accuracy of the manipulation were assessed. The double-dosing spoon was the preferred device. The “shake before use” instruction was overlooked by most volunteers. The average measured volumes obtained with the double-dosing spoon were significantly different from the ones obtained with the oral syringe (p < 0.001) and significantly lower than the reference dose (p < 0.001). The oral syringe originates significantly higher values than the reference dose (p < 0.001). The dosing spoons values were significantly different from each other (p < 0.001). Liquid medicines containing several administration devices may be a challenge since they are nonequivalent.
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