Factors Associated with Reported Preventable Adverse Drug Events: A Retrospective, Case-Control Study

National Amoxicillin-Clavulanate Formulation Use Pattern: A Survey

OBJECTIVE

Five commercially available amoxicillin-clavulanate (AMC) ratio formulations contribute to ratio selection variability with efficacy and toxicity implications. The objective of this survey was to determine AMC formulation use patterns across the United States.

METHODS

A multicenter practitioner survey was distributed to multiple listservs (American College of Clinical Pharmacy pediatrics, infectious diseases, ambulatory care, pharmacy administration; American Society of Health-System Pharmacists; Pediatric Pharmacy Association members), and selected pediatric Vizient members in June 2019. Responses were screened for multiples within institutions. Repeated organization responses were identified (n = 37) and excluded if the duplicate matched another response from the same organization exactly (n = 0).

RESULTS

One hundred ninety independent responses were received. Nearly 62% of respondents represented a children's hospital within an acute care hospital; remainder being from stand-alone children's hospitals. Around 55% of respondents indicated prescribers were responsible for choosing the patient-specific formulation for inpatients. Nearly 70% of respondents indicated multiple formulations were available due to clinical need (efficacy, toxicity, measurable volume), whereas over 40% responded that the number of liquid formulations were limited to decrease the potential for error. Variability was demonstrated among institutions using ≥ 2 different formulations for acute otitis media (AOM), sinusitis, lower respiratory tract infection, skin and soft tissue infection, and urinary tract infection (33.6%, 37.3%, 41.5%, 35.8%, and 35.8%, respectively). The 14:1 formulation was the most common, but not exclusive, for AOM, sinusitis, and lower respiratory tract infections with 2.1%, 2.1%, and 2.6% of respondents indicating use of the 2:1 formulation and 10.9%, 15%, and 16.6% of respondents indicating use of the 4:1 formulation.

CONCLUSIONS

Significant AMC formulation selection variability exists across the United States.

What to learn from analysis of medical disputes related to medication errors in nursing care

BACKGROUND

Nurses, who are the last safeguard against and have the final opportunity to prevent medication errors (MEs), play a vital role in patient safety by managing medications.

OBJECTIVE

This study described the characteristics of medical dispute cases, medication information, and stage and types of MEs in Korea.

METHODS

We performed a descriptive analysis of 27 medical dispute cases related to MEs in nursing care in Korea.

RESULTS

Around 77.7% of patients suffered serious harm or died due to MEs in this study. The types of medications included anxiolytics and analgesics, and 51.9% of them were high-alert medications. Among cases of administration errors, failure to patient assessment before and after administration was the most common error followed by administering the wrong dose.

CONCLUSION

Nurses should perform their duties to ensure safety and improve the quality of nursing care by monitoring patients after administering medications and should be prepared to take quick action to reduce harm.

Prevalence of potential drug - drug interactions in the cardiothoracic intensive care unit patients in a Chinese tertiary care teaching hospital

Background

With an increasing number of reviews describing clinically significant drug–drug interactions (DDIs), the scope and severity of interactions involving commonly used drugs in cardiothoracic intensive care units (CCUs) remain unclear. This study aims to identify risk factors and determine the incidence of potential DDIs in intensive care units.

Methods

DDIs were identified based on the profile of the prescribed drug and classified according to the Micromedex drug interaction database. Potential risk factors associated with DDIs have been identified.

Results

A total of 3193 medication episodes were evaluated, and 680 DDIs (21.3%) were found. A total of 203 patients were recruited into the study, with an average of 3.4 DDIs per patient [95% confidence interval (3.2 − 3.6)]. A total of 84.2% of the patients experienced at least one DDI. Anticoagulant and antiplatelet agents were involved in 33.5% (228/680) of the potential drug − drug interactions in the CCU. Univariate analysis and multiple logistic regression analysis showed that the age of the patient and the number of medications prescribed were significantly correlated with the occurrence of DDIs. In multiple linear regression analysis, the number of DDIs had a significant correlation only with the number of prescription drugs.

Conclusions

A high prevalence of DDIs was observed, especially in intensive care units without pharmacist intervention and computerized drug monitoring systems, highlighting the need for active surveillance to prevent potential adverse events.

Identifying High-alert Medications in a University Hospital by Applying Data From the Medication Error Reporting System

OBJECTIVES

To facilitate safe use of high-alert medications, lists of medications posing higher risks for medication errors (MEs) and harmful effects have been compiled. These lists can be general or reflect clinical practices in specific settings. Less common has been to compile a hospital-specific list applying data from the organization's ME reporting system. Our objective was to demonstrate a method for compiling such a high-alert medication list in a university hospital.

METHODS

Of the eighteen 136 MEs reported during 2007 to 2013, ME reports with medications coded as a contributing factor to the incident were included (n = 249). The involved medications were identified and compared with the hospital's drug consumption and Institute for Safe Medication Practice's List of High-Alert Medications. The report narratives of MEs with most reported and high-alert medications (120 reports) were qualitatively content analyzed.

RESULTS

The included 249 reports concerned 280 medications, of which 33% were classified as high-alert medications by the Institute for Safe Medication Practice. The most common therapeutic groups were antibacterials for systemic use (13%), psycholeptics (10%), analgesics (9%), and antithrombotic agents (9%). The most common high-alert medications were oxycodone (5%), enoxaparin (3%), and noradrenaline (3%). Serious patient harm (3%) was related to cefuroxime, enoxaparin, ibuprofen, midazolam, propofol, and warfarin. A half of the MEs were related to parenteral preparations. The qualitative content analysis revealed the key process safety risks of the most reported and high-alert medications.

CONCLUSIONS

The method is applicable for compiling a hospital-specific high-alert medication list and related analysis of key process safety risks contributing to MEs.

Harm Prevalence Due to Medication Errors Involving High-Alert Medications: A Systematic Review

OBJECTIVE

The aim of the study was to determine the prevalence and main types of harm caused by high-alert medication after medication errors (MEs) in hospitals.

METHOD

A literature systematic review was conducted on PubMed, Scopus, Web of Science, and Lilacs. Eligible studies published until June 2017 were included.

RESULT

Of 6244 studies identified through searching four electronic databases, five studies meeting the selection criteria of this study were analyzed. There was wide variation in the overall prevalence of harm due to MEs involving HAM, from 3.8% to 100%, whereas the pooled prevalence was 16.3%. Overall, 0.01% of harm caused by MEs involving HAM resulted in death. The severity of errors ranged from 0.1% to 19.2% for moderate errors, 0.2% to 15.4% for serious errors, and 1.9% lethal to the patients. The highest prevalences of harm occurred after errors involving potassium chloride 15%, insulin, and epoprostenol. The lowest prevalence of harm was related to errors of anticoagulants administration. The methodological heterogeneity limited direct comparisons among the studies.

CONCLUSIONS

Of the 15 drugs on the list of Institute for Safe Medication Practices HAMs in the United States and Brazil, nine did not present scientific evidence of the potential for harm. In general, few studies, characterized by methodological and conceptual heterogeneity, were performed to determine the harm prevalence resulting from errors involving these drugs.

Psychometric Properties of the Brazilian Version of the Nurses' Knowledge of High-Alert Medications Scale: A Pilot Study

BACKGROUND AND PURPOSE

High-alert medication is considered to be a medication that presents a high risk of causing significant patient harm when used erroneously and its consequences can be fatal. The Nurses' Knowledge of High-Alert Medication scale (NKHAM) is a tool available to evaluate the knowledge of nurses in practice about this issue.

AIM

This pilot study aimed to measure the reliability and known-groups validity of the Brazilian version of the NKHAM.

METHODS

This pilot psychometric study was carried out at the Faculty of Nursing and University Hospital of the University of Campinas, São Paulo, Brazil. Forty nursing students and 44 registered nurses working in complex clinical or surgical settings completed a sociodemographic questionnaire and the Brazilian version of the NKHAM. The Kuder-Richardson 20 (KR-20) coefficient and Mann-Whitney test were used to establish reliability and known-groups validity. A significance level of ≤ 0.05 was adopted for all the analyses.

RESULTS

Analyses demonstrated preliminary acceptable reliability scores of 0.55 and 0.60 in domains A and B of NKHAM, respectively. A significant difference was found between the nursing students' and the registered nurses' knowledge of high-alert medications, demonstrating the scale's ability to discriminate between the two groups.

IMPLICATIONS FOR PRACTICE

Although this is pilot study, results suggest that the Brazilian version of the NKHAM might be a reliable and valid tool to measure nurses' knowledge of high-alert medications.

Medication Discrepancies in Discharge Summaries and Associated Risk Factors for Elderly Patients with Many Drugs

Background and Objective

Elderly patients are at high risk for medication errors in care transitions. The discharge summary aims to counteract drug-related problems due to insufficient information transfer in care transitions, hence the accuracy of its medication information is of utmost importance. The purpose of this study was to describe the medication discrepancy rate and associated risk factors in discharge summaries for elderly patients.

Methods

Pharmacists collected random samples of discharge summaries from ten hospitals in southern Sweden. Medication discrepancies, organisational, and patient- and care-specific factors were noted. Patients aged ≥ 75 years with five or more drugs were further included. Descriptive and logistic regression analyses were performed.

Results

Discharge summaries for a total of 933 patients were included. Average age was 83.1 years, and 515 patients (55%) were women. Medication discrepancies were noted for 353 patients (38%) (mean 0.87 discrepancies per discharged patient, 95% confidence interval 0.76–0.98). Unintentional addition of a drug was the most common discrepancy type. Central nervous system drugs/analgesics were most commonly affected. Major risk factors for the presence of discrepancies were multi-dose drug dispensing (adjusted odds ratio 3.42, 95% confidence interval 2.48–4.74), an increasing number of drugs in the discharge summary (adjusted odds ratio 1.09, 95% confidence interval 1.05–1.13) and discharge from departments of surgery (adjusted odds ratio 2.96, 95% confidence interval 1.55–5.66). By contrast, an increasing number of drug changes reduced the odds of a discrepancy (adjusted odds ratio 0.93, 95% confidence interval 0.88–0.99).

Conclusions

Medication discrepancies were common. In addition, we identified certain circumstances in which greater vigilance may be of considerable value for increased medication safety for elderly patients in care transitions.

Medication errors in primary health care records; a cross-sectional study in Southern Sweden

Background

Drug-related problems due to medication errors are common and have the potential to cause harm. This study, which was conducted in Swedish primary health care, aimed to assess how well the medication lists in the medical records tally with the medications used by patients and to explore what type of medication errors are present.

Methods

We reviewed the electronic medical records (EMRs) at ten primary health care centers in Skåne county, Sweden. The medication lists in the EMRs were compared with the results of medication reconciliations, which were performed telephonically in a structured manner by a physician, two weeks after a follow-up visit to a general practitioner. Of 76 patients aged ≥18 years, who on a certain day in 2016 were visiting one of the included primary health care centers, a total of 56 were included. Descriptive statistics were used. The chi2-test and the Mann Whitney U-test were used for comparisons. The main outcome measure was the proportion of correctly updated medication lists.

Results

Following a recent visit to the general practitioner, a total of 16% of the medication lists in the medical records were consistent with the patients’ actual medication use. The mean number of medication errors in the medical records was 3.8 (SD 3.8). Incorrect dose was the most common error, followed by additional drugs without indication/documentation. The most common medication group among all errors was analgesics and among dose errors the most common medication group was cardiovascular drugs.

Conclusion

A total of 84% of the medication lists used by the general practitioners in the assessment and follow-up of the patients were not updated; this implies a great safety risk since medication errors are potentially harmful. Ensuring medication reconciliations in daily clinical practice is important for patient safety.

Electronic supplementary material

The online version of this article (10.1186/s12875-019-1001-0) contains supplementary material, which is available to authorized users.

Is Mindful Reflective Practice the way forward to reduce medication errors?

Background

Medication errors can seriously affect patients and healthcare professionals. In over 60% of cases, medication errors are associated with one or more contributory; individual factors including staff being forgetful, stressed, tired or engaged in multiple tasks simultaneously, often alongside being distracted or interrupted. Routinised hospital practice can lead professionals to work in a state of mindlessness, where it is easy to be unaware of how both body and mind are functioning.

Objective

Mindfulness, defined as moment-to-moment awareness of the everyday experience, could represent a useful strategy to improve reflection in pharmacy practice. The importance of reflection to reduce diagnostic errors in medicine has been supported in the literature; however, in pharmaceutical care, reflection has also only been discussed to a limited extent. There is expanding evidence on the effectiveness of mindfulness in the treatment of many mental and physical health problems in the general population, as well as its role in enhancing decision making, empathy and reducing burnout or fatigue in medical staff.

Considering the benefits of mindfulness, the authors suggest that healthcare professionals should be encouraged to develop their practice of mindfulness. This would not only be beneficial in relieving stress, increasing attention levels and awareness, but it is believed that the integration of mindfulness and reflective practice in a ‘Mindful Reflective Practice’ could minimise some of the individual factors that lead to medication errors.

Conclusions

Mindfulness Reflective Practice could therefore represent an important element in pre-registration education and continual professional development for pharmacists and other healthcare professionals.