A comprehensive method for the quantification of medication error probability based on fuzzy SLIM

Reducing insulin omission errors among patients with diabetes mellitus in general surgical wards: a best practice implementation project

INTRODUCTION AND OBJECTIVES

Omission of insulin, a high-alert medication with one of the highest locally reported errors, could lead to severe hyperglycemia, which could result in coma or death if not treated timeously. This study aimed to identify, evaluate, and implement strategies to reduce the occurrence of insulin omission errors in diabetic adult patients requiring insulin.

METHODS

This project followed the JBI Evidence Implementation Framework and conducted context analysis, strategy implementation, and evaluation of outcomes according to evidence-based quality indicators. The JBI PACES and JBI GRiP situational analysis tools were used to support data collection and implementation planning. There was one evidence-based criterion and five sub-criteria, with a sample size of 22 patients.

RESULTS

There was increased compliance with best practices to reduce interruptions and distractions from baseline audit (50%) to follow-up audits 1 (45.4%) and 2 (31.8%), and no insulin omission incidences during the implementation period. In the post-implementation analysis, there were notable improvements in compliance with strategies related to nurses; however, reduced compliance was observed related to patients. Key barriers to implementation included patients still disturbing nurses despite the nurses wearing the medication vests and patients forgetting instructions not to disturb nurses during medication administration. Strategies to improve compliance included ensuring coverage in each cubicle during insulin preparation and administration, tending to patients' needs prior to insulin administration, and use of posters as reminders.

CONCLUSIONS

There was an overall increase in compliance with best practice to reduce interruptions and distractions and no insulin omission incidences related to interruptions and distractions during the implementation phase.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A219.

Self-administration medication errors at home and its predictors among illiterate and low-literate community-dwelling older adults with polypharmacy: A negative binomial hierarchical regression

BACKGROUND

Older adults with polypharmacy are more prone to medication errors. People with low educational attainment have more difficulties in taking their medications.

OBJECTIVES

This study aimed to identify the extent of medication self-administration errors (MSEs) and the contributing factors among illiterate and low-literate community-dwelling older adults with polypharmacy.

METHOD

The present cross-sectional study was conducted among people aged 60 and above. The data were collected using the sociodemographic, clinical, and Belief about Medicines Questionnaires (BMQ). To determine the extent of MSE, a medication error checklist was used. The negative binomial hierarchical regression model in the five blocks was performed.

RESULTS

The final sample size was 276 people. The frequency of MSEs in the last 6 months was 69.2%. Sixteen percent of participants had made four or more mistakes. The most common MSEs were forgetting, improper taking of medications with food, improper timing, incorrect dosage (lower dose), and forgetting the doctor's instructions. Near 18% of participants reported adverse events following their mistakes. The significant predictors of MSEs were being completely illiterate (p = 0.021), the higher number of doctor visits per year (p = 0.014), irregularly seeing doctors (p < .001), the higher number of medications (p < .001), and having poor medication beliefs (p < .001).

CONCLUSION

Despite the high prevalence of MSEs among older patients, practical strategies to deal with them at their homes have not been established among health systems. MSE as a multifactorial event can be caused by a collection of internal and external factors. Further studies to identify the role of patients, clinicians, procedures, and systems in developing MSEs as interconnected components are needed.

Failure mode and Effect Analysis of personal fall arrest system under the intuitionistic fuzzy environment

Background and aims

Intuitionistic fuzzy sets (IFS) theory is more powerful than classic fuzzy sets theory in handling uncertainty. A new approach for Failure Mode and Effect Analysis (FMEA) was developed based on IFS and group decision-making (known as IF-FMEA) for investigating Personal Fall Arrest System (PFAS).

Method

FMEA parameters, including occurrence, consequence, and detection, were re-defined based on a seven-point linguistic scale. Each linguistic term was associated with an intuitionistic triangular fuzzy set. Opinions on the parameters were gathered from a panel of experts, integrated using the similarity aggregation method, and defuzzified utilizing the center of gravity approach.

Results

Nine failure modes were identified and analyzed using both FMEA and IF-FMEA. The risk priority numbers (RPNs) and prioritization obtained from the two approaches were different, highlighting the importance of using IFS. The highest RPN was associated with the lanyard web failure, while the failure of the anchor D-ring had the least RPN. Detection score was higher for metal parts of the PFAS, suggesting that failures in these parts are harder to detect.

Conclusion

In addition to being economical in terms of calculations, the proposed method was efficient in handling uncertainty. Different parts of a PFAS create different levels of risk.

Research on Comprehensive Evaluation of Equipment for the Tea Processing Craft

Chinese tea has a long history, and the development level of tea mechanization in this country is in the leading position internationally. Equipment for the tea processing craft is one of the most widely used types in China; indispensable technology is used for high-quality tea in the relevant tea processing equipment. The performance of tea processing equipment is always a focus when it is being used. Meanwhile, research evaluating the performance of tea processing equipment has been rarely reported. Thus, it is important to find a methodology to evaluate the performance of equipment for the tea processing craft. In this paper, a new method of rough set theory, as well as a radar chart for quality evaluation of tea processed by different tea processing crafts, is created. Firstly, the important indexes of processed tea are presented, including moisture, tea polyphenols, free amino acids, caffeine, and vitamin C. Then, these indexes for nine different types of processed tea based on different tea processing crafts are experimented and detected. Thirdly, rough set theory and radar chart are adopted to solving the weight of each index and establishing comprehensive evaluation diagram of all kinds of samples. Then, the merit of samples can be achieved. Meanwhile, the best tea processing equipment craft can be also obtained through comparisons between the sensory evaluation and the radar chart. It is concluded that sample 2, sample 3 and sample 4 belong to the best processing samples, and it is verified that the far-infrared radiation tea green removing machine has a significant influence on tea processing equipment craft. In addition, from the comprehensive analysis of green tea sample, not only tea quality but equipment craft of tea processing can be analyzed.

Problematic internet use and safety behavior: The moderating role of safety climate

Problematic internet use (PIU) can cause mental and physical harm to individuals and may be an emerging factor contributing to unsafe work behavior. In this study, the relationship between PIU and safety behavior was investigated. Moreover, it was hypothesized that safety climate can moderate the relationship between PIU and safety behavior. Participants were employees from a mining industry in Iran. Three validated questionnaires were distributed to gather the required data regarding PIU, safety climate, and safety behavior. Hierarchical regression analysis was used to assess the moderating effect of safety climate on the relationship between PIU and safety behavior. The size of moderation effect was assessed using f2 index. Four hundred eighty-five employees participated in this study. The results demonstrated a negative relationship between PIU and safety behavior. The moderating effect of safety climate on the relationship between PIU and safety behavior was supported. The f2 index was 0.027 which demonstrates a small moderation effect. In conclusion, PIU has a significant negative effect on the safety behavior of employees. Providing a strong safety climate can be a long-term solution for reducing the negative effect of PIU on safety behavior.

Occurrence and types of medication error and its associated factors in a reference teaching hospital in northeastern Iran: a retrospective study of medical records

BACKGROUND

Medication errors are categorized among the most common medical errors that may lead to irreparable damages to patients and impose huge costs on the health system. A correct understanding of the prevalence of medication errors and the factors affecting their occurrence is indispensable to prevent such errors. The purpose of this study was to investigate the prevalence and types of medication errors among nurses in a hospital in northeastern Iran.

METHODS

The present descriptive-analytical research was conducted on 147 medical records of patients admitted to the Department of Internal Medicine at a hospital in northeastern Iran in 2019, selected by systematic sampling. The data were collected through a researcher-made checklist containing the demographic profiles of the nurses, the number of doctor's orders, the number of medication errors and the type of medication error, and were finally analyzed using STATA version 11 software at a significance level of 0.05.

RESULTS

Based on the findings of this study, the mean prevalence of medication error per each medical case was 2.42. Giving non-prescription medicine (47.8%) was the highest and using the wrong form of the drug (3.9%) was the lowest medication error. In addition, there was no statistically significant relationship between medication error and the age, gender and marital status of nurses (p > 0.05), while the prevalence of medication error in corporate nurses was 1.76 times higher than that of nurses with permanent employment status (IRR = 1.76, p = 0.009). The prevalence of medication error in the morning shift (IRR = 0.65, p = 0.001) and evening shift (IRR = 0.69, p = 0.011) was significantly lower than that in the night shift.

CONCLUSION

Estimating the prevalence and types of medication errors and identified risk factors allows for more targeted interventions. According to the findings of the study, training nurses, adopting an evidence-based care approach and creating interaction and coordination between nurses and pharmacists in the hospital can play an effective role in reducing the medication error of nurses. However, further research is needed to evaluate the effectiveness of interventions to reduce the prevalence of medication errors.