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Creating a Stronger Culture of Safety Within US Community Pharmacies. Jt Comm J Qual Patient Saf 2023; 49:280-284. [PMID: 36907723 DOI: 10.1016/j.jcjq.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/12/2023]
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Resident S, Kar B, Choudhury S, Ghosh A, Samanta K, Hazra A. Knowledge, Attitude and Practice Survey Regarding High Alert Medication among Resident Doctors in a Tertiary Care Teaching Hospital in Eastern India. Curr Drug Saf 2022; 17:375-381. [PMID: 35135454 DOI: 10.2174/1574886317666220207123704] [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: 07/27/2021] [Revised: 11/21/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Medication errors are a reality in all settings where medicines are prescribed, dispensed and used. High Alert Medications (HAM) are those that bear a heightened risk of causing significant harm to the patient, if used erroneously. Though mishaps with HAM may not be more common than with other drugs, the consequences of error with them can be especially serious. We conducted a survey on knowledge, attitude and practice, among residents working in a teaching hospital, to assess the ground situation regarding HAM awareness and handling. METHODS We approached 492 residents among the approximately 600 residents currently working through purposive sampling. Residents in all disciplines (clinical, paraclinical and preclinical) were targeted. A structured questionnaire with 54 questions, pilot-tested on 20 volunteer residents, was used for data collection. The questionnaire was administered to residents through face-to-face interview, by two raters, while they were on duty, but not during rush hours. RESULTS Of the total 261 responses received, 32.33% respondents correctly defined or explained the meaning of the term 'medication error'. Knowledge regarding difference between medication error and adverse event did not get reflected in 68.38% of the participants, and only 16.86% were able to name relevant group of medicines as HAM. Regarding attitude in dealing with HAM, majority believed that taking the history of drug allergy and reconciling all prescription and over the counter (OTC) drugs already being used before prescribing or using a medicine, is important. In practice, most respondents followed protocols, but not routinely. Several potential errors in practice were identified. CONCLUSION The current situation requires corrective action. There is an urgent need for improving awareness regarding HAM for the sake of patient safety. The pharmacology department can take the lead in designing awareness campaign with support from the hospital administration.
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Affiliation(s)
- Senior Resident
- Senior Resident, Department of Pharmacology, Diamond Harbour Government Medical College & Hospital, Diamond Harbour, West Bengal, India
| | - Bikashkali Kar
- Junior Resident, Department of Pharmacology, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - Shouvik Choudhury
- Demonstrator, Department of Pharmacology, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - Abhijnan Ghosh
- Junior Resident, Department of Pharmacology, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - Kalyan Samanta
- Junior Resident, Department of Pharmacology, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - Avijit Hazra
- Professor of Pharmacology, Institute of Postgraduate Medical Education & Research, Kolkata, India
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Stojkovic T, Marinkovic V, Manser T. Using Prospective Risk Analysis Tools to Improve Safety in Pharmacy Settings: A Systematic Review and Critical Appraisal. J Patient Saf 2021; 17:e515-e523. [PMID: 28662000 DOI: 10.1097/pts.0000000000000403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to review and critically appraise the published literature on 2 selected prospective risk analysis tools, Failure Mode and Effects Analysis and Socio-Technical Probabilistic Risk Assessment, as applied to the dispensing of medicines in both inpatient and outpatient pharmacy settings. METHODS A comprehensive search of electronic databases (PubMed and Scopus) was conducted (January 1990-March 2016), supplemented by hand search of reference lists. Eligible articles were assessed for data sources used for the risk analysis, uniformity of the risk quantification framework, and whether the analysis teams assembled were multidisciplinary. RESULTS Of 1011 records identified, 11 articles met our inclusion criteria. These studies were mainly focused on dispensing of high-alert medications, and most were conducted in inpatient settings. The main risks identified were transcription, preparation, and selection errors, whereas the most common corrective actions included electronic transmission of prescriptions to the pharmacy, use of barcode, and medication safety training. Significant risk reduction was demonstrated by implementing corrective measures in both inpatient and outpatient pharmacy settings. The main Failure Mode and Effects Analysis limitations were its subjectivity and the lack of common risk quantification criteria. CONCLUSIONS The prospective risk analysis methods included in this review revealed relevant safety issues and hold significant potential for risk reduction. They were deemed suitable for application in both inpatient and outpatient pharmacy settings and should form an integral part of any patient safety improvement strategy.
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Affiliation(s)
- Tatjana Stojkovic
- From the Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Valentina Marinkovic
- From the Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Tanja Manser
- Institute for Patient Safety, University of Bonn, Bonn, Germany
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Bishop MA, Chang HY, Kitchen C, Weiner JP, Kharrazi H, Shermock KM. Development of measurable criteria to identify and prioritize patients for inclusion in comprehensive medication management programs within primary care settings. J Manag Care Spec Pharm 2021; 27:1009-1018. [PMID: 34337988 PMCID: PMC10391295 DOI: 10.18553/jmcp.2021.27.8.1009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Pharmacists optimize medication use and ensure the safe and effective delivery of pharmacotherapy to patients using comprehensive medication management (CMM). Identifying and prioritizing individual patients who will most likely benefit from CMM can be challenging. Health systems have far more candidates for CMM than there are clinical pharmacists to provide this service. Furthermore, current evidence lacks widely accepted standards or automated mechanisms for identifying patients who would likely benefit from a pharmacist consultation. Existing tools to prioritize patients for pharmacist review often require manual chart review by a pharmacist or other clinicians or data collection by patient survey. OBJECTIVES: To (1) create new medication risk markers for identifying and prioritizing patients within a population and (2) identify patients who met these new markers, assess their clinical characteristics, and compare them with criteria that are widely used for medication therapy management (MTM). METHODS: Along with published literature, a panel of subject matter experts informed the development of 3 medication risk markers. To assess the prevalence of markers developed, we used Multum, a medication database, for medication-level characteristics, and for patient-level characteristics, we used QuintilesIMS, an administrative claims database derived from health plans across the United States, with data for 1,541,873 eligible individuals from 2014-2015. We compared the health care costs, utilization, and medication gap among patients identified through MTM criteria (both broad and narrow, as these are provided as ranges) and our new medication management score markers. RESULTS: We developed 3 claims-derivable markers: (1) instances when a patient filled a medication with high complexity that could affect adherence, (2) instances where a patient filled a medication defined as costly within a therapeutic category that could affect access, and (3) instances when a patient filled a medication defined as risky that could increase incidence of adverse drug events. In the QuintilesIMS database, individuals with 2 new medication risk markers plus at least 3 conditions and more than $3,017 in medication costs when compared with individuals meeting narrow MTM eligibility criteria (≥ 8 medications, ≥ 3 conditions, and > $3,017 medication costs) had increased costs ($36,000 vs $26,100 total; $24,800 vs 21,400 medical; $11,300 vs $4,800 pharmacy); acute care utilization (0.328 vs 0.256 inpatient admissions and 0.627 vs 0.579 emergency department visits); and 1 or more gaps in medication adherence(41.5% vs 34.7%). CONCLUSIONS: We identified novel markers of medication use risk that can be determined using insurance claims and can be useful to identify patients for CMM programs and prioritize patients who would benefit from clinical pharmacist intervention. These markers were associated with higher costs, acute care utilization, and gaps in medication use compared with the overall population and within certain subgroups. Providing CMM to these patients may improve health system performance in relevant quality measures. Evaluation of CMM services delivered by a pharmacist using these markers requires further investigation. DISCLOSURES: No outside funding supported this study. All authors are Johns Hopkins employees. The Johns Hopkins University receives royalties for nonacademic use of software based on the Johns Hopkins Adjusted Clinical Group (ACG) methodology. Chang, Kitchen, Weiner, and Kharrazi receive a portion of their salary support from this revenue. The authors have no conflicts of interests relevant to this study.
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Affiliation(s)
- Martin A Bishop
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD
| | - Hsien-Yen Chang
- Center for Population Health Information Technology, Center for Drug Safety and Effectiveness, Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christopher Kitchen
- Center for Population Health Information Technology, Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jonathan P Weiner
- Center for Population Health Information Technology, Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hadi Kharrazi
- Center for Population Health Information Technology, Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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5
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Famiyeh IM, Jobanputra N, McCarthy LM. Best Possible Medication Histories by Registered Pharmacy Technicians in Ambulatory Care. Can J Hosp Pharm 2021; 74:149-155. [PMID: 33896955 PMCID: PMC8042196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Ida-Maisie Famiyeh
- , RPh, BScPhm, ACPR, MSc, is with Women's College Hospital, Toronto, Ontario
| | - Neil Jobanputra
- , RPh, MPharm, HBSc, was, at the time of this study, with Women's College Hospital, Toronto, Ontario. He is now with HealthPRO Procurement Services Inc, Toronto, Ontario
| | - Lisa M McCarthy
- , RPh, BScPhm, PharmD, MSc, was, at the time of this study, with Women's College Hospital, Toronto, Ontario; she is now with the Institute for Better Health and the Pharmacy Department at Trillium Health Partners, Mississauga, Ontario. She maintains her affiliation with the Leslie Dan Faculty of Pharmacy and the Department of Family and Community Medicine, University of Toronto, Toronto, Ontario
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6
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Dumitrescu I, Casteels M, De Vliegher K, Dilles T. High-risk medication in community care: a scoping review. Eur J Clin Pharmacol 2020; 76:623-638. [PMID: 32025751 DOI: 10.1007/s00228-020-02838-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To review the international literature related to high-risk medication (HRM) in community care, in order to (1) define a definition of HRM and (2) list the medication that is considered HRM in community care. METHODS Scoping review: Five databases were systematically searched (MEDLINE, Scopus, CINAHL, Web Of Science, and Cochrane) and extended with a hand search of cited references. Two researchers reviewed the papers independently. All extracted definitions and lists of HRM were subjected to a self-developed quality appraisal. Data were extracted, analysed and summarised in tables. Critical attributes were extracted in order to analyse the definitions. RESULTS Of the 109 papers retrieved, 36 met the inclusion criteria and were included in this review. Definitions for HRM in community care were used inconsistently among the papers, and various recurrent attributes of the concept HRM were used. Taking the recurrent attributes and the quality score of the definitions into account, the following definition could be derived: "High-risk medication are medications with an increased risk of significant harm to the patient. The consequences of this harm can be more serious than those with other medications". A total of 66 specific medications or categories were extracted from the papers. Opioids, insulin, warfarin, heparin, hypnotics and sedatives, chemotherapeutic agents (excluding hormonal agents), methotrexate and hypoglycaemic agents were the most common reported HRM in community care. CONCLUSION The existing literature pertaining to HRM in community care was examined. The definitions and medicines reported as HRM in the literature are used inconsistently. We suggested a definition for more consistent use in future research and policy. Future research is needed to determine more precisely which definitions should be considered for HRM in community care.
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Affiliation(s)
- Irina Dumitrescu
- Department of Nursing Science and Midwifery, Centre For Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. .,White-Yellow Cross of Flanders, Brussels, Belgium.
| | - Minne Casteels
- White-Yellow Cross of Flanders, Brussels, Belgium.,Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | | | - Tinne Dilles
- Department of Nursing Science and Midwifery, Centre For Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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7
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Pino FA, Weidemann DK, Schroeder LL, Pabst DB, Kennedy AR. Failure mode and effects analysis to reduce risk of heparin use. Am J Health Syst Pharm 2019; 76:1972-1979. [DOI: 10.1093/ajhp/zxz229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
Failure mode and effects analysis (FMEA) was used to identify safety risks of unfractionated heparin (UFH) use and to develop and implement countermeasures to improve safety.
Methods
FMEA was used to analyze the transportation, preparation, dispensation, administration, therapeutic monitoring, and disposal of UFH in a tertiary care, freestanding pediatric hospital. The FMEA was conducted in a stepwise fashion. First, frontline staff mapped the different steps within the UFH use process. Next, key stakeholders identified potential failures of each process step. Finally, using calibrated scales, the stakeholders ranked the likelihood of occurrence, severity, and detectability for each potential failure’s cause. The rankings were used to prioritize high-risk areas on which to focus efforts for improvement countermeasures.
Results
The analysis revealed 233 potential failures and 737 unique potential causes. After ranking of all identified potential causes, 45 were deemed high scoring. Those 45 causes were further refined into 13 underlying contributing causes. To address the contributing causes, selected team members developed 22 countermeasures. The FMEA showed that implementation of the countermeasures reduced the level of mathematical risk.
Conclusion
FMEA was helpful in identifying, ranking, and prioritizing medication risks in the UFH use process. Twenty-two countermeasures were developed to reduce potential for error in the riskiest steps of the process.
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Affiliation(s)
- Felicity A Pino
- Children’s Mercy, Kansas City, MO, and Assistant Professor, School of Medicine and Bloch School of Management, University of Missouri-Kansas City, Kansas City, MO
| | - Darcy K Weidemann
- Children’s Mercy, Kansas City, MO, and University of Missouri-Kansas City, Kansas City, MO
| | - Lisa L Schroeder
- Medical Administration, Children’s Mercy, Kansas City, MO, and University of Missouri-Kansas City, Kansas City, MO
| | - Damon B Pabst
- Pharmacy Department, Children’s Mercy, Kansas City, MO, and School of Pharmacy, University of Missouri, Kansas City, MO
| | - Audrey R Kennedy
- Clinical Safety Department, Children’s Mercy, Kansas City, MO, and School of Pharmacy, University of Kansas, Lawrence, KS
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Nickman NA, Drews FA, Tyler LS, Kelly MP, Ragsdale RJ, Rim M. Use of multiple methods to measure impact of a centralized call center on academic health system community pharmacies. Am J Health Syst Pharm 2019; 76:353-359. [DOI: 10.1093/ajhp/zxy068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nancy A Nickman
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT
- Clinical Coordinator, Pharmacy Services, University of Utah Health, Salt Lake City, UT
| | - Frank A Drews
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Linda S Tyler
- Pharmacy Services, University of Utah Health, Salt Lake City, UT
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT
| | - Michael P Kelly
- Ambulatory Pharmacy Services, University of Utah Health, Salt Lake City, UT
| | | | - Matthew Rim
- Ambulatory Pharmacy Services, University of Utah Health, Murray, UT
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The Experience of Management of High-Alert Medications. Am J Med Qual 2017; 32:571. [DOI: 10.1177/1062860617699699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Degnan DD, Hertig JB, Peters MJ, Stevenson JG. Board of Pharmacy Practices Related to Medication Errors and Their Potential Impact on Patient Safety. J Pharm Pract 2017. [PMID: 28629304 DOI: 10.1177/0897190017715562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
State boards of pharmacy are generally responsible for the governance of the practice of pharmacy. While the regulatory process and methods for accomplishing this task may vary by state, all boards of pharmacy must address medication errors committed by pharmacists. The National Association of Boards of Pharmacy (NABP) has recommended that state boards of pharmacy implement best practices and enforcement actions that are aimed to promote patient safety and reduce medication errors. The current study was designed to identify and compare current corrective action practices among boards of pharmacy in response to medication errors. An electronic survey regarding board policies and anticipated board actions in response to hypothetical medication error scenarios was sent to boards of pharmacy for completion. Approximately 45% of pharmacy boards responded. Survey responses demonstrated that corrective actions and consequences were levied against pharmacists inconsistently among state boards. Corrective action plans and process improvement components were lacking in a majority of state board of pharmacy practices. Medication safety education for pharmacists and for members on boards of pharmacy was insufficient in many states. Responses to hypothetical error scenarios indicated that most board actions are educational and punitive in nature, rather than focusing on systems improvement.
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Affiliation(s)
- Daniel D. Degnan
- Center for Medication Safety Advancement, Purdue University College of Pharmacy, West Lafayette, IN, USA
| | - John B. Hertig
- Center for Medication Safety Advancement, Purdue University College of Pharmacy, West Lafayette, IN, USA
| | - Michael J. Peters
- Center for Medication Safety Advancement, Purdue University College of Pharmacy, West Lafayette, IN, USA
| | - James G. Stevenson
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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11
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McElroy LM, Khorzad R, Rowe TA, Abecassis ZA, Apley DW, Barnard C, Holl JL. Fault Tree Analysis. Am J Med Qual 2016; 32:80-86. [PMID: 26646282 DOI: 10.1177/1062860615614944] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The purpose of this study was to use fault tree analysis to evaluate the adequacy of quality reporting programs in identifying root causes of postoperative bloodstream infection (BSI). A systematic review of the literature was used to construct a fault tree to evaluate 3 postoperative BSI reporting programs: National Surgical Quality Improvement Program (NSQIP), Centers for Medicare and Medicaid Services (CMS), and The Joint Commission (JC). The literature review revealed 699 eligible publications, 90 of which were used to create the fault tree containing 105 faults. A total of 14 identified faults are currently mandated for reporting to NSQIP, 5 to CMS, and 3 to JC; 2 or more programs require 4 identified faults. The fault tree identifies numerous contributing faults to postoperative BSI and reveals substantial variation in the requirements and ability of national quality data reporting programs to capture these potential faults. Efforts to prevent postoperative BSI require more comprehensive data collection to identify the root causes and develop high-reliability improvement strategies.
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12
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Bish EK, El-Amine H, Steighner LA, Slonim AD. A socio-technical, probabilistic risk assessment model for surgical site infections in ambulatory surgery centers. Infect Control Hosp Epidemiol 2016; 35 Suppl 3:S133-41. [PMID: 25222892 DOI: 10.1086/677824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND To understand how structural and process elements may affect the risk for surgical site infections (SSIs) in the ambulatory surgery center (ASC) environment, the researchers employed a tool known as socio-technical probabilistic risk assessment (ST-PRA). ST-PRA is particularly helpful for estimating risks in outcomes that are very rare, such as the risk of SSI in ASCs. OBJECTIVE Study objectives were to (1) identify the risk factors associated with SSIs resulting from procedures performed at ASCs and (2) design an intervention to mitigate the likelihood of SSIs for the most common risk factors that were identified by the ST-PRA for a particular surgical procedure. METHODS ST-PRA was used to study the SSI risk in the ASC setting. Both quantitative and qualitative data sources were utilized, and sensitivity analysis was performed to ensure the robustness of the results. RESULTS The event entitled "fail to protect the patient effectively" accounted for 51.9% of SSIs in the ambulatory care setting. Critical components of this event included several failure risk points related to skin preparation, antibiotic administration, staff training, proper response to glove punctures during surgery, and adherence to surgical preparation rules related to the wearing of jewelry, watches, and artificial nails. Assuming a 75% reduction in noncompliance on any combination of 2 of these 5 components, the risk for an SSI decreased from 0.0044 to between 0.0027 and 0.0035. CONCLUSION An intervention that targeted the 5 major components of the major risk point was proposed, and its implications were discussed.
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Affiliation(s)
- Ebru K Bish
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia
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14
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Esfahani AK, Varzaneh FR, Changiz T. The effect of clinical supervision model on high alert medication safety in intensive care units nurses. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:482-486. [PMID: 27904631 PMCID: PMC5114792 DOI: 10.4103/1735-9066.193394] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Medication errors and adverse drug events of high alert medication are one of the major problems in therapeutic system. The purpose of the present study was to investigate ύthe effect of clinical supervision model on high alert medication safety in intensive care units nurses. MATERIALS AND METHODS This was a quasi-experimental study conducted on 32 nurses of intensive care units. The researcher observed the administration of high alert drugs including heparin, warfarin, norepinephrine, dobutamine, and dopamine by nurses and recorded the scores of the work in preventing medication errors, the work in preventing adverse drug events, and medication safety. Then, the researcher performed clinical supervision model and during performance of the model, the researcher reassessed the score of the work in preventing medication errors, The work in preventing adverse drug events and medication safety. Tool of data collection was action plan of high alert medication safety checklists (heparin, warfarin, norepinephrine, dobutamine, and dopamine checklists). RESULTS The result of the statistical trials showed that before and after applying the clinical supervision model, there was a statistically significant difference between the average scores of medication safety of heparin (15.7 vs 18.73), warfarin (11.08 vs 15.67), norepinephrine (14.60 vs 19.72), dobutamine (13.80 vs 19.30), and dopamine (14.25 vs 19.47). CONCLUSIONS Based on the results of this study, it seems that administration of clinical supervision model in intensive care units can lead to improving the status of safety of high alert medication.
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Affiliation(s)
| | | | - Tahereh Changiz
- Medical Education Development Center, Isfahan University of Medical Sciences, Isfahan, Iran
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15
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Holdsworth MT, Benson BE, Dole EJ. Risk-based strategy for outpatient pharmacy practice: Focus on opioids. J Am Pharm Assoc (2003) 2015. [DOI: 10.1331/japha.2015.14286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Tang SF, Wang X, Zhang Y, Hou J, Ji L, Wang ML, Huang R. Analysis of high alert medication knowledge of medical staff in Tianjin: A convenient sampling survey in China. ACTA ACUST UNITED AC 2015; 35:176-182. [PMID: 25877348 DOI: 10.1007/s11596-015-1407-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 03/07/2015] [Indexed: 10/23/2022]
Abstract
The current situation of medical staff's awareness about high alert medication was investigated in order to promote safe medication and standardized management of the high alert medication in China. Twenty questions were designed concerning elementary knowledge of high alert medications, storage management, medication issues and risks. In order to understand the knowledge level and education status of high alert medication, a convenient survey was conducted among 300 medical staffs in Tianjin. Medical staff's average score of high alert medication knowledge was 12.43±0.27, and the average scores of elementary knowledge of high alert medication, storage management, medication issues and risks were 3.38±0.11, 2.46±0.14, 3.17±0.11 and 3.41±0.12 respectively. Occupation (F=4.86, P=0.003), education background (F=5.57, P=0.019) and professional titles (F=13.44, P≤0.001) contributed to the high alert medications knowledge scores. Currently, the most important channel to obtain high alert medication knowledge was hospital files or administrative rules, and clinical pharmacist seminars were the most popular education form. It was suggested that the high alert medication knowledge level of the medical staff needs to increase, and it might benefit from targeted, systematic and diverse training to the medical staff working in the different circulation nodes of the medications. Further research to develop and validate the instrument is needed.
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Affiliation(s)
- Shang-Feng Tang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xin Wang
- Department of Pharmacy, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Ye Zhang
- Department of Pharmacy, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Jie Hou
- Department of Pharmacy, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Lu Ji
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Man-Li Wang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Rui Huang
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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17
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Otero MJ, Moreno-Gómez AM, Santos-Ramos B, Agra Y. Developing a list of high-alert medications for patients with chronic diseases. Eur J Intern Med 2014; 25:900-8. [PMID: 25468740 DOI: 10.1016/j.ejim.2014.10.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/14/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients with chronic diseases often receive multiple medications and are associated with increased vulnerability to medication errors. Identifying high-alert medications for them would help to prioritize the interventions with greatest impact for improving medication safety. The aim of this study was to develop a list of high-alert medications for patients with chronic illnesses (HAMC list) that would prove useful to the Spanish National Health Service strategies on chronicity. METHODS The RAND/UCLA appropriateness method was used. Drug classes/drugs candidates to be included on the HAMC list were identified from a literature search in MedLine, bulletins issued by patient safety organizations, incidents recorded in Spanish incident reporting systems, and previous lists. Eighteen experts in patient/medication safety or in chronic diseases scored candidate drugs for appropriateness according to three criteria (evidence, benefit and feasibility of implementing safety practices). Additionally they rated their priority of inclusion on a Likert scale. RESULTS The final HAMC list includes 14 drug classes (oral anticoagulants, narrow therapeutic range antiepileptics, antiplatelets - including aspirin -, antipsychotics, β-blockers, benzodiazepines and analogues, corticosteroids long-term use, oral cytostatics, oral hypoglycemic drugs, immunosuppressants, insulins, loop diuretics, nonsteroidal anti-inflammatory drugs, and opioid analgesics), and 4 drugs or pairs of drugs (amiodarone/ dronedarone, digoxin, oral methotrexate and spironolactone/eplerenone). CONCLUSIONS An initial list of high-alert medications for patients with chronic diseases has been developed, which can be built into the medication management strategies for chronicity to guide the implementation of efficient safety strategies and to identify those patients at greater risk for preventable adverse drug events.
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Affiliation(s)
- María José Otero
- ISMP-España, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain.
| | - Ana María Moreno-Gómez
- ISMP-España, Servicio de Farmacia, Hospital Santos Reyes, Aranda de Duero, Burgos, Spain.
| | | | - Yolanda Agra
- Dirección General de Salud Pública, Calidad e Innovación, Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, Spain.
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Implementation of information systems at pharmacies - a case study from the re-regulated pharmacy market in Sweden. Res Social Adm Pharm 2014; 11:e85-99. [PMID: 25205612 DOI: 10.1016/j.sapharm.2014.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/04/2014] [Accepted: 08/04/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND When the Swedish pharmacy market was re-regulated in 2009, Sweden moved from one state-owned pharmacy chain to several private pharmacy companies, and four new dispensing systems emerged to replace the one system that had previously been used at all Swedish pharmacies for more than 20 years. OBJECTIVES The aim of this case study was to explore the implementation of the new information systems for dispensing at pharmacies. METHODS The vendors of the four dispensing systems in Sweden were interviewed, and a questionnaire was sent to the managers of the pharmacy companies. In addition, a questionnaire was sent to 350 pharmacists who used the systems for dispensing prescriptions. RESULTS The implementation of four new dispensing systems followed a strict time frame set by political decisions, involved actors completely new to the market, lacked clear regulation and standards for functionality and quality assurance, was complex and resulted in variations in quality. More than half of the pharmacists (58%) perceived their current dispensing system as supporting safe dispensing of medications, 26% were neutral and 15% did not perceive it to support a safe dispensing. Most pharmacists (80%) had experienced problems with their dispensing system during the previous month. The pharmacists experienced problems included reliability issues, usability issues, and missing functionality. CONCLUSION In this case study exploring the implementation of new information systems for dispensing prescriptions at pharmacies in Sweden, weaknesses related to reliability, functionality and usability were identified and could affect patient safety. The weaknesses of the systems seem to result from the limited time for the development and implementation, the lack of comprehensive and evidence-based requirements for dispensing systems, and the unclear distribution of quality assurance responsibilities among involved stakeholders.
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Alshaikh M, Mayet A, Adam M, Ahmed Y, Aljadhey H. Intervention to reduce the use of unsafe abbreviations in a teaching hospital. Saudi Pharm J 2013; 21:277-80. [PMID: 23960844 PMCID: PMC3745070 DOI: 10.1016/j.jsps.2012.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 10/28/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To determine the effectiveness of a two-phase intervention designed to reduce the use of unsafe abbreviations. METHODS An observational prospective study was conducted at the King Khalid University Hospital in Riyadh, Saudi Arabia during May-September 2009. A list of unsafe abbreviations was formulated based on the recommendations of the Institute for Safe Medication Practices. The first 7000 medication orders written at the beginning of each period were collected. Phase one of the intervention involved educating health care professionals about the dangers of using unsafe abbreviations. In the second phase of the intervention, a policy was approved that prohibited the use of unsafe abbreviations hospital-wide. Then, another educational campaign targeted toward prescribers was organized. Descriptive statistics are used in this paper to present the results. RESULTS At baseline, we identified 1980 medication abbreviations used in 7000 medication orders (28.3%). Three months after phase one of the intervention, the number of abbreviations found in 7000 medication orders had decreased to 1489 (21.3%). Six months later, after phase two of the intervention, the number of abbreviations used had decreased to 710 (10%). During this phase, the use of all abbreviations had declined relative to the baseline and phase one use levels. The decrease in the use of abbreviations was statistically significant in all three periods (P < 0.001). CONCLUSION The implementation of a complex intervention program reduced the use of unsafe abbreviations by 65%.
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Affiliation(s)
- Mashael Alshaikh
- King Khalid University Hospital, King Saud University, Saudi Arabia
| | - Ahmed Mayet
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Saudi Arabia
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Saudi Arabia
| | - Mansour Adam
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Saudi Arabia
| | - Yusuf Ahmed
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Saudi Arabia
| | - Hisham Aljadhey
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Saudi Arabia
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Saudi Arabia
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