A Quality Improvement Initiative to Reduce Prescription Error in a Pediatrics Outpatient Department at a Secondary-Level Community Hospital

Background Medication errors are common, especially by new trainees in primary care settings. Our study aimed at reducing the rate of prescription error in the pediatric outpatient department (OPD) of a secondary healthcare center in suburban north India using a quality improvement methodology. Methods Based on a survey and focused group discussion (FGD) involving all stakeholders, the identified problems and difficulties faced during outpatient prescriptions, interventions, and outcome parameters were drafted. The primary outcome measure was the prescription error rate evaluated by a senior resident (SR) of pediatrics, and the secondary outcome measures included the frequency of antibiotic prescriptions and investigations. Intervention Two cycles of Plan-Do-Study-Act (PDSA) were conducted on accessible drug formularies and standard treatment protocols for common pediatric conditions. Results The mean baseline prescription error was 72.2% (95% confidence interval (CI): 63.2-81.1). After the implementation of the first PDSA cycle, the mean error rate was 46.5% (95% CI: 36.6-56.5). There were eight consecutive points of prescription error below the control limit (63.2% and 81.1%) of the baseline. The PDSA-2 cycle showed the same shift to below the control limit (36.6% and 56.5%). The mean error rate found at the end of the PDSA-2 cycle was 22.5% (95% CI 15.7-29.5). There was no clinically significant difference in the number of investigations or antibiotics prescribed. Conclusion The application of standardized drug formularies and standard treatment protocols (STPs) can help reduce prescription errors, especially in a primary care setting. Expansion of such techniques to other centers could be particularly useful.

A 10-Year Retrospective Analysis of Medication Errors among Adult Patients: Characteristics and Outcomes

Medication errors (MEs) are a global health problem. We conducted this study to clarify the clinical characteristics, outcomes, and factors associated with MEs that caused harm to adult patients (>15 years of age) who were managed in hospitals or healthcare facilities. We performed a 10-year retrospective study (2011-2020) by analyzing data from the Ramathibodi Poison Center (RPC) database (RPC Toxic Exposure Surveillance System). There were a total of 112 patients included in this study. Most were women (59.8%) and had underlying diseases (53.6%). The mean patient age was 50.5 years. Most MEs occurred during the afternoon shift (51.8%) and in the outpatient department (65.2%). The most common type of ME was a dose error (40.2%). Local anesthetic was the most common class of ME-related drug. Five patients died due to MEs. We analyzed the factors associated with MEs that caused patient harm, including death (categories E-I). The presence of underlying diseases was the single factor that was statistically significantly different between groups. Clinical characteristics showed no significant difference between patients aged 15-65 years and those aged >65 years. In conclusion, our findings emphasized that MEs can cause harm and even death in some adult patients. Local anesthetics were the most commonly involved in MEs. Having an underlying disease might contribute to severe consequences from MEs. Preventive measures and safety systems must be highlighted and applied to prevent or minimize the occurrence of MEs.

Nurses competence in the reporting of medication-related incidents: An intervention study

Objectives

Less than 5% of all harmful medicine‐related incidents (MIs) or adverse drug reactions received by the Spanish Pharmacovigilance system are notified by Registered Nurses (RNs). The main objective of this study was to determine the impact of a multifaceted institutional intervention (MII) in patient safety on the reporting competence of medication incidents of hospital RNs.

Design

One‐group pre‐test–posttest design.

Setting

Tertiary, public, teaching hospital in Spain.

Participants

A total of 139 RNs responded to pre‐ and postintervention questionnaires constituting the paired sample subjected to analysis.

Intervention

A MII, consisting of educational activities and materials, change in MI reporting form from paper to electronic and appointment of reporting support services, was designed and directed to all hospital RNs and midwifes.

Main outcome measures

Overall MIs reporting competence (OC) and its dimensions (attitudes, knowledge and skills) were measured through a synthetic variable (total OC value range: 34–170 points) by means of an electronic questionnaire.

Results

A statistically significant 7.96‐point increase in OC from baseline to the final measurement was obtained (CI: 5.05–10.85). There was an increase of 7.38 points in the skills dimension (CI: 5.06–9.68). After the MII, 73.4% nurses improved their OC and 33.8% reported at least one no‐harm MI postintervention compared to 4.4% pre‐intervention (p < .001). A one‐point increase in OC improved the probability of becoming reporter by 2.9% and a one‐point increase in skills by 6.4%.

Conclusion

MIs reporting competence among RNs increased after a multifaceted institutional intervention, due to an improvement in the skills dimension. The MII was also effective in raising both, the rate of RNs who become reporters and the number of no‐harm MIs reported.

Do patients realize about medication safety implementation?

OBJECTIVE

To explore medication safety implementation based on patient perception.

METHOD

An observational analytic study with a cross-sectional approach was performed with 748 patients as the respondents who were selected from 15 hospitals in Malang, Indonesia. Patient perception of five moments for medication safety was measured using a 4-point Likert scale close-ended questionnaire.

RESULT

Most of the respondents (>50%) had been asked about the history of allergies and drugs they had taken, pregnancy and breastfeeding conditions, and informed about medication plan, drug administration time. Some areas that remain lacking were: information about drug function, side effect, dosage, and duration. Result reveals that 43-47% of patients had experienced a drug allergic reaction and side effects.

CONCLUSION

The lowest medication safety implementation is in the starting medicine stage, which is the drug side effects, while the highest is about the history of allergies.

The use of robots and other automated devices in nurses' work: An integrative review

BACKGROUND

Future nursing shortages and advanced technological developments mean that robots and automated devices could play a valuable role in nursing, but little has been published on their use, and outcomes, to date.

AIM

This integrative review identified how robots are currently used in nursing and the outcomes of those initiatives.

DESIGN

This study used integrative review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

DATA SOURCES

We searched the CINAHL, PubMed, Web of Science, and Scopus databases for peer-reviewed papers published in English from January 2010 to August 2018.

REVIEW METHODS

The five-stage review process by Whittemore and Knafl was used.

RESULTS

The 25 included papers showed that robots and automated devices were mainly used in nursing to deliver medication, monitor patients, and provide nursing treatments. The outcomes were evaluated in relation to patient safety, working time and workload, usability, and the end users' satisfaction. In addition, the costs, care outcomes, nurses' behaviour, and changes in working procedures were considered.

CONCLUSIONS

Robots and automated devices have the potential to develop nurses' work, but more research and critical evaluations are needed to find the most suitable devices and focus on the functions that will provide the best outcomes for nurses' work.

Understanding the human and system factors involved in medication errors

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.

Application of the SEIPS Model to Analyze Medication Safety in a Crisis Residential Center

PURPOSE

Medication safety and error reduction has been studied in acute and long-term care settings, but little research is found in the literature regarding mental health settings. Because mental health settings are complex, medication administration is vulnerable to a variety of errors from transcription to administration. The purpose of this study was to analyze critical factors related to a mental health work system structure and processes that threaten safe medication administration practices.

BACKGROUND

The Systems Engineering Initiative for Patient Safety (SEIPS) model provides a framework to analyze factors affecting medication safety. The model approach analyzes the work system concepts of technology, tasks, persons, environment, and organization to guide the collection of data.

METHODS

In the study, the Lean methodology tools were used to identify vulnerabilities in the system that could be targeted later for improvement activities. The project director completed face-to-face interviews, asked nurses to record disruptions in a log, and administered a questionnaire to nursing staff. The project director also conducted medication chart reviews and recorded medication errors using a standardized taxonomy for errors that allowed categorization of the prevalent types of medication errors.

RESULTS

Results of the study revealed disruptions during the medication process, pharmacology training needs, and documentation processes as the primary opportunities for improvement. The project engaged nurses to identify sustainable quality improvement strategies to improve patient safety.

CONCLUSION

The mental health setting carries challenges for safe medication administration practices. Through analysis of the structure, process, and outcomes of medication administration, opportunities for quality improvement and sustainable interventions were identified, including minimizing the number of distractions during medication administration, training nurses on psychotropic medications, and improving the documentation system. A task force was created to analyze the descriptive data and to establish objectives aimed at improving efficiency of the work system and care process involved in medication administration at the end of the project.

Impact of Interruptions, Distractions, and Cognitive Load on Procedure Failures and Medication Administration Errors

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.

Elderly patients with inappropriate medication correlations with adverse drug events or unexpected illnesses in long-term care institutions

INTRODUCTION

The elderly are subject to natural aging and the health problems caused by the recession of physical and mental functions. Elderly patients are also more susceptible to adverse reactions of medication, drug interactions and other drug problems than the young. We then investigated patients with adverse drug events (ADEs) or unexpected illnesses transferred to our hospital during the whole year of 2010.

METHODS

We analyzed the medicine of elderly patients in long-term care institutions. Four long-term care institutions with different types and sizes located near Fong-Yuan Hospital in downtown Fong-Yuan were investigated. In this study, the researchers divided potentially inappropriate medications (PIMs) into two categories: (a) those with or without the drug-drug interaction (DDI) and (b) those with narrow therapeutic index drugs. Variables were reclassified as inferential statistics for analysis by using the independent t-test or Mantel-Haenszel test.

RESULTS

The data for age, gender, presence or absence of dementia, brain damage and Parkinson's disease were divided into two groups for those patients with or without PIMs. There were no statistically significant differences among the groups. However, the numbers of chronic diseases for the group with PIMs were higher, and the numbers of drug items with PIMs were also higher. In addition, we investigated the presence or absence of PIMs for patients transferred to our hospital with ADEs and unexpected illnesses. The results showed no statistically significant differences among the groups.

CONCLUSIONS

Our results showed that elderly patients who had consultations with doctors and the hidden problems about medication were detected by pharmacists in the privileged hospital had no direct risk with DDI or narrow therapeutic index drugs. However, other potential drug risks remain to be further analyzed and more samples should be surveyed.

A structural equation modeling of the factors affecting student nurses' medication errors

Across medication error literature, much attention has been given to incidence, types, causes and prevention of medication errors. Despite these efforts, medication errors continue to occur among registered and student nurses. Considering the numerous studies on medication errors committed by registered nurses, little is known on the nature of student nurses' medication error. This study employed factor analysis and structural equation modeling to explore the factors affecting medication errors by student nurses. With the participation of 329 junior and senior student nurses recruited from a comprehensive university in the Philippines, five factor dimensions of the causes of student nurses' medication error were identified, namely: In-violation, In-writing, In-excess, In-experience and In-tension. Results of path analysis showed an interaction among these variables. Additionally, poor adherence to the "five rights" was identified as an important mediator between In-violation, In-writing, In-excess, In-experience and In-tension and student nurses' medication error. By developing a model to explain how student nurses' medication errors occur, this study sheds light on the nature of student nurses' medication error and provides a basis for error prevention strategies.

Medication errors in university-affiliated teaching hospitals as compared to non-university-affiliated teaching hospitals in Jordan

BACKGROUND

"Medication errors" is a serious underreported practice issue. This is the first study in Jordan and other countries that compare medication errors between university-affiliated teaching hospitals (UATHs) and non-university-affiliated teaching hospitals (NUATHs).

DESIGN AND SAMPLE

Survey method was used to collect data of the current study. A convenience sample of 171 nurses was recruited from two UATHs and a sample of 98 nurses from two NUATHs.

RESULTS

There were significant differences between the two types of hospitals in terms of causes, percentage, and reporting of medication errors. More medication errors are committed in NUATHs, thus immediate interventions are needed. Nurses in NUATHs should be encouraged to report medication errors; those nurses were more subjected to disciplinary actions or at the risk of losing their jobs.

CONCLUSIONS

Medication errors are escalating, and is a matter that requires immediate interventions in all types of hospitals, especially in NUATHs. More reporting methods should be established in NUATHs.

Factors affecting registered nurses' use of medication administration technology in acute care settings: A systematic review

BACKGROUND

Information technology to aid reduction in medication errors has been encouraged over the years and one of them is the medication administration technology. It consists of the electronic Medication Administration Record, Bar-Code Medication Administration system and Automated Medication Dispensing system. Studies had examined the effectiveness and impact of this technology to reduce medication error. However, user's acceptance towards this technology has often been neglected. To date, no systematic review has been undertaken to examine the possible factors that affect nurses' use of this technology in the acute care settings.

OBJECTIVES

The objective of this systematic review was to explore and determine the factors that affect nurses' use of medication administration technology in the acute care settings.

INCLUSION CRITERIA

All quantitative studies published in English which examined factors affecting nurses' use of the medication administration technology were considered.Primary focus was on registered nurses with experience of operating medication administration technology in the acute care settings. Other healthcare personnel were excluded.This review considered studies that evaluated factors affecting nurses' use of the medication administration technology.The outcome measures of interest were the factors that affect nurses' use of the medication administration technology in the acute care settings.

SEARCH STRATEGY

The search was conducted across published and unpublished databases. A search was conducted in JBI Library of Systematic Reviews, The Cochrane Library, CINAHL, MEDLINE, Scopus, ScienceDirect, Wiley InterScience, SpringerLink, PsycINFO (ovid), Web of science, ProQuest Dissertations and Theses, and MedNar.

METHODOLOGICAL QUALITY

Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review, using the standardised critical appraisal instruments developed by the Joanna Briggs Institute.

DATA COLLECTION/ EXTRACTION

Quantitative data were extracted from papers included in the review using a standardised data extraction tool developed by the JBI.

DATA SYNTHESIS

Findings were presented in narrative summary due to heterogeneity of the study designs.

RESULTS

Six descriptive studies were included in this review. Nurses' use of the technology can be influenced by a combination of complex and inter-related factors, such as organisational factors, and user and system characteristics.

CONCLUSIONS

In order to successfully implement medication administration technology, system, user and organisational factors have to be collaborated concurrently.Users' needs should be accommodated when designing the system features. Prior to system implementation, institutions should consider the users' demographical characteristics and provide adequate preparations and training. A supportive culture from the institution and colleagues is also important.There is a significant need for further research in this field. Further research to discover potential factors in different settings, locations and countries are suggested. Studies to evaluate nurses' use of the technology at regular intervals are also required.