Medication Errors in Vietnamese Hospitals: Prevalence, Potential Outcome and Associated Factors

Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines

Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

Accuracy of antibiotic concentrations in drug dispensing in neonates: a laboratory-based study

BACKGROUND

Antibacterial therapy plays a crucial role in neonatal infections. The efficacy of antibacterial agents is closely related to the actual dose given to neonates. So we evaluated factors potentially affecting the actual dose of intravenous antibiotics during dispensing process in neonates.

METHODS

Meropenem, cefoperazone/sulbactam and piperacillin/tazobactam with two strengths were used to evaluate three methods. Method A (MA) was diluted once and the volumes of 5% glucose for MA were meropenem 4.00 mL, cefoperazone/sulbactam 3.00 mL, piperacillin/tazobactam 9.00 mL. Method B (MB) differed by doubling the volume of 5% glucose. The difference in method C (MC) involved diluting with 5% glucose twice. The concentrations were measured by high-performance liquid chromatography. Relative error (RE) was used to evaluate the preparation accuracy.

RESULTS

The RE values using MA/MB/MC were: (1) meropenem 0.5 g: 15.1%, 8.0%, 10.4%; 0.25 g: 7.8%, 3.1%, 6.0%; (2) cefoperazone/sulbactam 1.5 g: 13.6%, 4.2%, 3.4%; 0.75 g: 8.8%, 3.5%, 4.0%; (3) piperacillin/tazobactam 4.5 g: 18.2%, 8.7%, 6.3%; 562.5 mg: 8.1%, 2.8%, 6.1%. MB was better than MA in all three drugs. No difference in RE values was found between single and double dilution, except meropenem with 0.25 g. Using MB, meropenem and piperacillin/tazobactam with small drug strength had higher accuracy in preparation.

CONCLUSIONS

MB was suitable for neonatal drug dispensing because of its high accuracy and simple operation. Drugs with small strength were promoted due to the high accuracy.

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.

Preventability of Adverse Drug Reactions Related to Antibiotics: An Assessment Based on Spontaneous Reporting System

BACKGROUND

Antibiotics are commonly used in both outpatient and inpatient settings and are responsible for the majority of adverse drug reaction (ADR) reports. We aimed to characterize spontaneously reported ADRs associated with antibiotics and assessing the preventability of these ADRs in a Vietnamese setting.

MATERIALS AND METHODS

We conducted a retrospective descriptive study based on ADRs related to antibiotics spontaneously reported by healthcare workers to the National Pharmacovigilance Database of Vietnam (NPDV) between June 2018 and May 2019. The characteristics of included reports were descriptively analyzed. The preventability of reported ADRs was assessed using a standardized preventability scale. We identified the leading causes and described the characteristics associated with preventable ADRs (pADRs).

RESULTS

We included 6385 antibiotic-related reports from a total of 12,056 reports submitted to the NPDV during the study period. Beta-lactam antibiotics, mostly broad-spectrum with parenteral route, were suspected in the majority cases. The most commonly reported pADRs were allergic reactions, mostly classified under skin and subcutaneous tissue disorders. Of all included cases, 537 cases (8.4%) were deemed as associated with pADRs. Major causes of pADRs include potentially inappropriate prescribing (352/537, 65.5%) and re-administration of antibiotics causing prior allergy/allergies (99/537, 18.4%). The majority of pADRs involved the use of beta-lactam antibiotics with inappropriate indications.

CONCLUSION

ADRs related to antibiotic use represent more than half of ADRs spontaneously reported in Vietnam. Approximately one in every ten reported cases is associated with pADRs. The majority pADRs can be prevented through simple improvement in antibiotic prescribing practices.

Prevalence and determinants of medication administration errors in clinical wards: A two-centre prospective observational study

AIMS AND OBJECTIVES

To identify the prevalence and determinants of medication administration errors (MAEs).

BACKGROUND

Insight into determinants of MAEs is necessary to identify interventions to prevent MAEs.

DESIGN

A prospective observational study in two Dutch hospitals, a university and teaching hospital.

METHODS

Data were collected by observation. The primary outcome was the proportion of administrations with one or more MAEs. Secondary outcomes were the type, severity and determinants of MAEs. Multivariable mixed-effects logistic regression analyses were used for determinant analysis. Reporting adheres to the STROBE guideline.

RESULTS

MAEs occurred in 352 of 2576 medication administrations (13.7%). Of all MAEs (n = 380), the most prevalent types were omission (n = 87) and wrong medication handling (n = 75). Forty-five MAEs (11.8%) were potentially harmful. The pharmaceutical forms oral liquid (odds ratio [OR] 3.22, 95% confidence interval [CI] 1.43-7.25), infusion (OR 1.73, CI 1.02-2.94), injection (OR 3.52, CI 2.00-6.21), ointment (OR 10.78, CI 2.10-55.26), suppository/enema (OR 6.39, CI 1.13-36.03) and miscellaneous (OR 6.17, CI 1.90-20.04) were more prone to MAEs compared to oral solid. MAEs were more likely to occur when medication was administered between 10 a.m.-2 p.m. (OR 1.91, CI 1.06-3.46) and 6 p.m.-7 a.m. (OR 1.88, CI 1.00-3.52) compared to 7 a.m.-10 a.m. and when administered by staff with higher professional education compared to staff with secondary vocational education (OR 1.68, CI 1.03-2.74). MAEs were less likely to occur in the teaching hospital (OR 0.17, CI 0.08-0.33). Day of the week, patient-to-nurse ratio, interruptions and other nurse characteristics (degree, experience, employment type) were not associated with MAEs.

CONCLUSIONS

This study identified a high MAE prevalence. Identified determinants suggest that focusing interventions on complex pharmaceutical forms and error-prone administration times may contribute to MAE reduction.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study can be used to develop targeted interventions to improve patient safety.

Self-reported unsafe medication behaviour among clinical nurses in China: A nationwide survey

AIM

Unsafe medication behaviour was the direct cause of medication error, while the current status of unsafe medication behaviour among Chinese clinical nurses remains uncertain. To investigate unsafe medication behaviour among Chinese nurses and to analyse its associated factors.

DESIGN

A cross-sectional online study was conducted in 31 provinces and municipalities of mainland China.

METHODS

The electronic self-administered questionnaire was used to collect data from July-August 2020, including demographic information (age, gender, initial degree, ultimate education degree, hospital levels, unit nature, professional position, duty, departments, working years and working regions) and an adapted nurse unsafe medication behaviour scale measuring self-reported nurse unsafe medication behaviour (SR-NUMB). A generalized linear mixed model was applied to determine the influencing factors.

RESULTS

A total of 10,153 Chinese nurses responded online, and 7,873 responses that met the time control requirements were included finally. It turned out that 80.49% of Chinese nurses had SR-NUMB. Specifically, 72.81% of them had unsafe medication behaviours in the process of medication administration, followed by medication monitoring (53.09%), medication preservation and dispensing (47.42%), and medical order processing (44.53%). A generalized linear mixed model demonstrated that male nurses and nurses who work in secondary hospitals or general hospitals, those who have higher professional positions or duties, those who have been working for 5-10 years, and those who are working in emergency and intensive critical units may have higher level of SR-NUMB compared to other nurses.

CONCLUSION

Suboptimal SR-NUMB among Chinese nurses was identified in our findings. Associated factors, such as gender, hospital levels, unit nature, professional position, duty, working years and departments, should be targeted in future prevention and intervention efforts for safe medication management among Chinese nurses.

Observational study on medication administration errors at a University Hospital in Brazil: incidence, nature and associated factors

Background

Medication administration errors are frequent and cause significant harm globally. However, only a few data are available on their prevalence, nature, and severity in developing countries, particularly in Brazil. This study attempts to determine the incidence, nature, and factors associated with medication administration errors observed in a university hospital.

Methods

This was a prospective observational study, conducted in a clinical and surgical unit of a University Hospital in Brazil. Two previously trained professionals directly observed medication preparation and administration for 15 days, 24 h a day, in February 2020. The type of error, the category of the medication involved, according to the anatomical therapeutic chemical classification system, and associated risk factors were analyzed. Multivariate logistic regression was adopted to identify factors associated with errors.

Results

The administration of 561 drug doses was observed. The mean total medication administration error rate was 36.2% (95% confidence interval 32.3–40.2). The main factors associated with time errors were interruptions. Regarding technique errors, the primary factors observed were the route of administration, interruptions, and workload.

Conclusions

Here, we identified a high total medication administration error rate, the most frequent being technique, wrong time, dose, and omission errors. The factors associated with errors were interruptions, route of administration and workload, which agrees well with the results of other national and international studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40545-022-00443-x.

Prevalence and determinants of intravenous admixture preparation errors: A prospective observational study in a university hospital

Background Intravenous admixture preparation errors (IAPEs) may lead to patient harm. Insight into the prevalence as well as the determinants associated with these IAPEs is needed to elicit preventive measures. Aim The primary aim of this study was to assess the prevalence of IAPEs. Secondary aims were to identify the type, severity, and determinants of IAPEs. Method A prospective observational study was performed in a Dutch university hospital. IAPE data were collected by disguised observation. The primary outcome was the proportion of admixtures with one or more IAPEs. Descriptive statistics were used for the prevalence, type, and severity of IAPEs. Mixed-effects logistic regression analyses were used to estimate the determinants of IAPEs. Results A total of 533 IAPEs occurred in 367 of 614 admixtures (59.8%) prepared by nursing staff. The most prevalent errors were wrong preparation technique (n = 257) and wrong volume of infusion fluid (n = 107). Fifty-nine IAPEs (11.1%) were potentially harmful. The following variables were associated with IAPEs: multistep versus single-step preparations (adjusted odds ratio [OR_adj] 4.08, 95% confidence interval [CI] 2.27–7.35); interruption versus no interruption (OR_adj 2.32, CI 1.13–4.74); weekend versus weekdays (OR_adj 2.12, CI 1.14–3.95); time window 2 p.m.-6 p.m. versus 7 a.m.-10 a.m. (OR_adj 3.38, CI 1.60–7.15); and paediatric versus adult wards (OR_adj 0.14, CI 0.06–0.37). Conclusion IAPEs, including harmful IAPEs, occurred frequently. The determinants associated with IAPEs point to factors associated with preparation complexity and working conditions. Strategies to reduce the occurrence of IAPEs and therefore patient harm should target the identified determinants.

Patient-Centered Care: Transforming the Health Care System in Vietnam With Support of Digital Health Technology

Background

Over the recent decades, Vietnam has attained remarkable achievements in all areas of health care. However, shortcomings including health disparities persist particularly with a rapidly aging population. This has resulted in a shift in the disease burden from communicable to noncommunicable diseases such as dementia, cancer, and diabetes. These medical conditions require long-term care, which causes an accelerating crisis for the health sector and society. The current health care system in Vietnam is unlikely to cope with these challenges.

Objective

The aim of this paper was to explore the opportunities, challenges, and necessary conditions for Vietnam in transforming toward a patient-centered care model to produce better health for people and reduce health care costs.

Methods

We examine the applicability of a personalized and integrated Bespoke Health Care System (BHS) for Vietnam using a strength, weakness, opportunity, and threat analysis and examining the successes or failures of digital health care innovations in Vietnam. We then make suggestions for successful adoption of the BHS model in Vietnam.

Results

The BHS model of patient-centered care empowers patients to become active participants in their own health care. Vietnam’s current policy, social, technological, and economic environment favors the transition of its health care system toward the BHS model. Nevertheless, the country is in an early stage of health care digitalization. The legal and regulatory system to protect patient privacy and information security is still lacking. The readiness to implement electronic medical records, a core element of the BHS, varies across health providers and clinical practices. The scarcity of empirical evidence and evaluation regarding the effectiveness and sustainability of digital health initiatives is an obstacle to the Vietnamese government in policymaking, development, and implementation of health care digitalization.

Conclusions

Implementing a personalized and integrated health care system may help Vietnam to address health care needs, reduce pressure on the health care system and society, improve health care delivery, and promote health equity. However, in order to adopt the patient-centered care system and digitalized health care, a whole-system approach in transformation and operation with a co-design in the whole span of a digital health initiative developing process are necessary.

Improving Nursing Students' Medication Safety Knowledge and Skills on Using the 4C/ID Learning Model

Introduction

Learning medication-safety has become a focus in many countries to improve medication-safety competencies in nursing students. Research on instructional design for medication-safety is still limited, especially about the use of the Four Components Instructional Design (4C/ID) model. This study aimed to compare the knowledge and skills in medication safety of nursing students after the medication-safety training using four components of instructional design known as 4C/ID.

Methods

This was a posttest-only quasi-experimental study using an intervention and control group. The participants were the third-semester students of a nursing school at Yogyakarta, Indonesia (intervention: n=55, control: n=40). The intervention group was trained for five weeks using the 4C/ID approach with interactive lectures, small group discussions, reflections, and skills simulation sessions. An observational skills evaluation and Multiple-Choice Questionnaire were administered in the last week after the training completed. Independent sample t-test and Mann Whitney tests were used to analyze the mean differences of knowledge and skills in giving oral medicine and drug injections between the two groups.

Results

The majority of respondents were female (74.1%), aged 19–20 years (77.8%), with GPA >3 (87.37%) and, the majority had never received instruction about patient safety (69%). There were significant mean differences in overall knowledge (p<0.05) and also in the skills of oral drug and intramuscular drug administration (p<0.05) between the intervention and control groups.

Conclusion

Training in medication-safety using the 4C/ID approach could improve the medication-safety knowledge and skills of the nursing students based on simple to complex learning.

Drug-Induced Anaphylaxis in a Vietnamese Pharmacovigilance Database: Trends and Specific Signals from a Disproportionality Analysis

INTRODUCTION

Despite the numerous studies investigating drug-induced anaphylaxis (DIA), understanding and quantitative data analysis in developing countries remain limited. The aim of our study is to describe and quantify DIA using the National Pharmacovigilance Database of Vietnam (NPDV).

METHODS

Spontaneous reporting of adverse drug reactions (ADRs) recorded between 2010 and 2016 were retrospectively analysed to identify DIA reports. The trend and characteristics of DIA cases were described. Multivariate disproportionality analysis was used for signal generation.

RESULTS

Overall, 4873 DIA cases (13.2% of total ADRs) were recorded in the NPDV, 111 of which resulted in death (82% of total ADR-induced deaths) over a 7-year period. There was a remarkable increase in DIA reporting over time (p < 0.001). The incidence rates of DIA reporting per total ADRs and per 100,000 inhabitants remained high (mean rates [95% CI] of 12.06 [9.88-14.24] and 0.77 [0.33-1.20], respectively). Concerning suspected drugs, systemic antibiotics (n = 3318, 68%) were mostly reported with a reporting odds ratio (ROR) and 95% CI of 2.35 [2.20-2.51]. In the case of antibiotic-induced anaphylaxis, the third-generation cephalosporins were predominant (n = 1961, 40.2%, ROR 2.39 [2.24-2.55]). We also noted drugs generally associated with DIA such as contrast agents (ROR 2.43 [2.04-2.88]) and anaesthetics (ROR 4.02 [3.30-4.89]). Furthermore, unexpected signals were observed for alpha-chymotrypsin (ROR 1.75 [1.23-2.44]) and amoxicillin/sulbactam (ROR 1.59 [1.18-2.10]), uncommonly reported in western countries.

CONCLUSION

In recent years, cases of drug-induced DIA have increased in Vietnam, mostly due to antibiotics and third-generation cephalosporins. The inappropriate use of these drugs should be taken into account. Our findings also highlighted typical Vietnamese signals for alpha-chymotrypsin- and amoxicillin/sulbactam-induced anaphylaxis, which may relate to a specific sociological context in resource-limited countries.

COMPLIANCE TO SAFETY BARRIERS IN THE MEDICATION ADMINISTRATION PROCESS IN PEDIATRICS

ABSTRACT Objective: to investigate the compliance to safety barriers adopted in the preparation and administration of intravenous drugs in Pediatric and Pediatric Intensive Care Units. Method: exploratory, observational descriptive study, conducted with the nursing team of a pediatric intensive care unit and a pediatric clinic of a large public hospital in Belo Horizonte, from August to November 2017. Results: the sample consisted of 334 opportunities to observe the preparation and administration of medications in pediatric patients. Most of the actions were performed by female professionals, nursing technicians and civil servants. The professionals did not perform all the necessary safety barriers in any of the procedures. The hygiene of the preparation site, disinfection of the ampoule, connection, conference of the drug/dose/route administered with the prescription and double checking of the drugs were those that had the lowest compliance. Conclusion: the study highlights the fragility regarding compliance to safety barriers in the preparation and administration of medicines, resulting in a risk to the safety of hospitalized children. Continued education based on good practice is believed to be an important strategy for security.

Why do nursing students make medication errors? A qualitative study in Indonesia

Objectives

This study aimed to explore Indonesian nursing students' perceptions of the types and causes of medication errors in clinical rotations.

Methods

This descriptive qualitative study was conducted with 26 nursing students who had completed their final clinical rotations. Data were collected through four focus group discussions and analysed by Colaizzi's method.

Results

Three themes were obtained from the data analysis: important role played by nurses in medication safety, types of medication errors (near misses) committed by nursing students, and the causes of medication errors during clinical rotations.

Conclusion

Nurses play a vital role in dispensing medication and ensuring patient safety, but near misses are still reported during clinical rotations. Lack of knowledge, skills, proper supervision, and appropriate role models during clinical rotations lead to medication errors by nursing students. Appropriate role models and adequate supervision in the clinical education stage are necessary to ensure the achievement of medication safety competencies.

Medication administration safety assessment tool: Construction and validation

OBJECTIVE

To build and validate the Patient Safety Assessment in Medication Administration (ASPAM - Avaliação da Segurança do Paciente na Administração de Medicamentos) tool.

METHOD

Methodological study in which the construction, Content Validation Index (CVI), construct validation (factorial analysis) and reliability were performed in terms of homogeneity (Cronbach's Alpha).

RESULTS

The ASPAM reached CVI of 0.77 for simplicity, 0.76 for clarity and 0.93 for relevance. The exploratory factorial analysis was adequate for the tool (Kaiser-Meyer-Olkim of 0.66 and Bartlett's sphericity with p <0.001). The Cronbach's Alpha end of the scale with 28 items was 0.85.

CONCLUSION

The ASPAM tool was valid and reliable for the identification of risk-generating conditions for the occurrence of Adverse Drug Events.

Evaluation to improve the quality of medication preparation and administration in pediatric and adult intensive care units

Purpose

To determine the type, frequency, and factors associated with medication preparation and administration errors in adult intensive care units (ICUs) and neonatal ICUs (NICUs)/pediatric ICUs (PICUs).

Patients and methods

We conducted a prospective direct observation study in an adult ICU and NICU/PICU in a tertiary university hospital. Between June 2012 and June 2013, a clinical pharmacist and medical student observed the nursing care staff on weekdays during the preparation and administration of intravenous drugs. We analyzed the frequency and type of preparation and administration errors and factors associated with errors.

Results

Six hundred and three preparations in the adult ICU and 281 in the NICU/PICU were observed. Three hundred and eighty-five errors occurred in the adult ICU and 38 in the NICU/PICU. There were 5,040 and 2,514 error opportunities, with overall error rates of 7.6% and 1.5%, respectively. The total opportunities for error meant each single step of preparation and administration that was relevant for the drug. Most errors applied to the category “uniform mixing” (adult ICU: n=227, 59%; NICU/PICU: n=14, 37%). The multivariate logistic regression results showed a significantly different influence of the “preparation type” for the adult ICU compared with the NICU/PICU with regard to the occurrence of an error. Preparations for adult patients of the LCD type (liquid concentrate with diluent into syringe or infusion bag) were more often associated with errors than the P (powder in a glass vial that must be reconstituted and diluted if necessary), P=0.012, and LC (liquid concentrate into syringe), P=0.002 type.

Conclusion

“Uniform mixing” was the most erroneous preparation step in intravenous drug preparations in two ICUs. Improvement of nurse training and the preparation of prefilled syringes in the pharmacy might reduce errors and improve the quality and safety of drug therapy.

Safe patient care in the preparation and administration of medicines

OBJECTIVE To evaluate the compliance with the assistance and the adhesion of nursing professionals for the safe administration of drugs in an Intensive Care Unit of a public hospital in Sergipe, Brazil. METHOD Quantitative, descriptive and cross-sectional study carried out by direct non-participant observation. Data collection performed in 2015. Non-probabilistic sample, for convenience, consisting in the observation of 557 doses of prepared and administered drugs. For data analysis, descriptive statistics were used for data analysis. RESULTS The items classified as safe care were: correct via (85.7%) and correct form (100%). The items classified as undesirable care were: correct patient (33.3%), correct medication (66.67%), correct dose (50%), correct register (33.33%), correct orientation (0%), and correct time (50%). CONCLUSION The practice was evaluated according to Carte's positivity index as undesirable care, considering that six of the eight items had low adhesion. The found weaknesses compromised the whole process of drug administration.

Quality of care: measuring a neglected driver of improved health

The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact.

Effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes: an uncontrolled before and after study

OBJECTIVES

Residents of nursing homes often have difficulty swallowing (dysphagia), which complicates the administration of solid oral dosage formulations. Erroneously crushing medication is common, but few interventions have been tested to improve medication safety. Therefore, we evaluated the effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes.

SETTING

This was a prospective uncontrolled intervention study with a preintervention and postintervention measurement. The study was conducted on 18 wards (total of 200 beds) in 3 nursing homes in the North of the Netherlands.

PARTICIPANTS

We observed 36 nurses/nursing assistants (92% female; 92% nursing assistants) administering medication to 197 patients (62.9% female; mean age 81.6).

INTERVENTION

The intervention consisted of a set of warning symbols printed on each patient's unit dose packaging indicating whether or not a medication could be crushed as well as education of ward staff (lectures, newsletter and poster).

PRIMARY OUTCOME MEASURE

The relative risk (RR) of a crushing error occurring in the postintervention period compared to the preintervention period. A crushing error was defined as the crushing of a medication considered unsuitable to be crushed based on standard reference sources. Data were collected using direct (disguised) observation of nurses during drug administration.

RESULTS

The crushing error rate decreased from 3.1% (21 wrongly crushed medicines out of 681 administrations) to 0.5% (3/636), RR=0.15 (95% CI 0.05 to 0.51). Likewise, there was a significant reduction using data from patients with swallowing difficulties only, 87.5% (21 errors/24 medications) to 30.0% (3/10) (RR 0.34, 95% CI 0.13 to 0.89). Medications which were erroneously crushed included enteric-coated formulations (eg, omeprazole), medication with regulated release systems (eg, Persantin; dipyridamol) and toxic substances (eg, finasteride).

CONCLUSIONS

Warning symbols combined with education reduced erroneous crushing of medication, a well-known and common problem in nursing homes.

Evaluation of an intravenous preparation information system for improving the reconstitution and dilution process

BACKGROUND

There are very few studies reporting the impact of providing intravenous (IV) preparation information on quality use of antimicrobials, particularly regarding their reconstitution and dilution. Therefore, to improve these processes in IV antimicrobial administration, an IV preparation information system (IPIS) was implemented in a hospital.

OBJECTIVE

We aimed to evaluate the effect of improving reconstitution and dilution by implementing an IPIS in the electronic medical record (EMR) system.

METHODS

Prescriptions and activity records of nurses for injectable antimicrobials that required reconstitution and dilution for IV preparation from January 2008 to December 2013 were retrieved from EMR, and assessed based on packaging label information for reconstituting and diluting solutions. We defined proper reconstitution and dilution as occurring when the reconstitution and dilution solutions prescribed were consistent with the nurses' acting records. The types of intervention in the IPIS were as follows: a pop-up alert for proper reconstitution and passive guidance for proper dilution. We calculated the monthly proper reconstitution rate (PRR) and proper dilution rate (PDR) and evaluated the changes in these rates and trends using interrupted time series analyses.

RESULTS

Prior to the initiation of the reconstitution alert and dilution information, the PRR and PDR were 12.7 and 46.1%, respectively. The reconstitution alert of the IPIS rapidly increased the PRR by 41% (p<0.001), after which the PRR decreased by 0.9% (p=0.013) per month after several months. However, there was no significant change in the rate or trend of the PDR during the study period.

CONCLUSIONS

This study demonstrated that the provision of reconstitution alerts by the IPIS contributed to improving the reconstitution process of IV antimicrobial injection administration. However, providing passive information on dilution solutions was ineffective. Furthermore, solutions to ensure the continuous effectiveness of alert systems are warranted and should be actively sought.

Relationship between Work Ability Index and Cognitive Failure among Nurses

INTRODUCTION

Frequent nursing errors are considered as factors that affect the quality of healthcare of patients. Capable nurses who are compatible with work conditions are more focused on their tasks, and this reduces their errors and cognitive failures. Therefore, this study was conducted with the aim of investigating the relationship between work ability index (WAI) and cognitive failures (CFs) as well as some factors that affect them in nurses working in the ICU, CCU, and emergency wards.

METHODS

This descriptive-analytical and cross-sectional study was conducted with 750 nurses at educational hospitals affiliated with the Tehran University of Medical Sciences in 2015. A questionnaire of work ability index and cognitive failures was used to collect data. The data were analyzed using SPSS 20 and the Pearson and Spearman correlation coefficients, chi-squared, ANOVA, and the Kruskal-Wallis tests.

RESULTS

Using the Pearson correlation test, the results of this study showed that there is a significant, inverse relationship between WAI, personal prognosis of work ability, and mental resources with CFs along with all its subscales in nurses (p < 0.05). In addition, there was an inverse and significant relationship between the total score of CFs and the estimated work impairment due to diseases (p < 0.05). There was a significant positive correlation of CFs with age and experience, while WAI was inversely related to age, work experience, and body mass index (BMI) (p < 0.05). WAI and CFs were related significantly to working units (p < 0.05).

CONCLUSION

Considering the results obtained in this study, WAI and the cognitive status of nurses were lower than the specified limit. It is suggested that the work ability of nurses be improved and that their CFs be reduced through various measures, including pre-employment examinations, proper management of work-shift conditions, and using engineering and administrative strategies to ensure the safety of hospitalized patients.