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Marznaki ZH, Zeydi AE, Ghazanfari MJ, Salisu WJ, Amiri MM, Karkhah S. Medication Errors among Iranian Intensive Care Nurses: A Systematic Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:123-131. [PMID: 37332377 PMCID: PMC10275463 DOI: 10.4103/ijnmr.ijnmr_310_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 06/20/2023]
Abstract
Background Medication Error (ME) is a major patient safety concern in Intensive Care Units (ICUs). Critical care nurses play a crucial role in the safe administration of medication. This study was conducted to comprehensively review the literature concerning the prevalence of ME and associated factors and outcomes in Iranian ICU nurses. Materials and Methods An extensive search of the literature was carried in international databases including PubMed, Web of Science, Scopus, and Google Scholar, as well as Persian databases such as Magiran and Scientific Information Database (SID) using ME-related keywords and the Persian equivalent of these keywords, from the first article written in this field to artcles published on March 30, 2021. The appraisal tool (AXIS tool) was used to assess the quality of the included studies. Results Fifteen studies were included in this systematic review. The prevalence of MEs made by ICU nurses was 53.34%. The most common types of MEs were wrong infusion rate (14.12%), unauthorized medication (11.76%), and wrong time (8.49%) errors, respectively. MEs occurred more frequently in morning work shifts (44.44%). MEs happened more frequently for heparin, vancomycin, ranitidine, and amikacin. The most important influential factor in the occurrence of MEs in ICUs was management and human factors. Conclusions The prevalence of MEs made by Iranian ICU nurses is high. Therefore, nurse managers and policymakers should develop appropriate strategies, including training programs, to reduce the occurrence of MEs made by nurses in ICUs.
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Affiliation(s)
| | - Amir Emami Zeydi
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Javad Ghazanfari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Waliu Jawula Salisu
- Clinical Nurse, Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Hills Road, CB2 0QQ, Cambridge, United Kingdom
| | - Mehdi Mohammadian Amiri
- Department of Emergency Medicine, School of Medicine, Babol University of Medical Sciences, Mazandaran, Iran
| | - Samad Karkhah
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Arredondo E, Udeani G, Horseman M, Hintze TD, Surani S. Role of Clinical Pharmacists in Intensive Care Units. Cureus 2021; 13:e17929. [PMID: 34660121 PMCID: PMC8513498 DOI: 10.7759/cureus.17929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 01/22/2023] Open
Abstract
The cost of health care has been rising in the United States and globally and will continue to increase. Intensive care unit (ICU) care carries a significant portion of the cost for the hospitals. The Institute of Medicine and subsequent studies have suggested that medication errors account for significant morbidity, mortality, and cost, frequently encountered in the ICU. Over the past three decades, clinical pharmacists have emerged from dispensing medication to getting involved in direct patient care and have become an integral part of the multidisciplinary critical care team. Clinical pharmacists play a significant role in reducing medication errors and costs, medication reconciliation, antibiotic stewardship, and patient and health care provider education. This review will discuss the health care and ICU cost, the evolving role of clinical pharmacists in managing critically ill patients, and their contributions in the ICU to mitigate the risks, improve patient outcomes, and decrease health care costs.
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Affiliation(s)
- Enrique Arredondo
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - George Udeani
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - Michael Horseman
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - Trager D Hintze
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - Salim Surani
- Anesthesiology, Mayo Clinic, Rochester, USA
- Medicine, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
- Medicine, University of North Texas, Dallas, USA
- Internal Medicine, Pulmonary Associates, Corpus Christi, USA
- Clinical Medicine, University of Houston, Houston, USA
- Medicine, College of Medicine, Texas A&M Health Science Center, Bryan, USA
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Batson S, Herranz A, Rohrbach N, Canobbio M, Mitchell SA, Bonnabry P. Automation of in-hospital pharmacy dispensing: a systematic review. Eur J Hosp Pharm 2021; 28:58-64. [PMID: 32434785 PMCID: PMC7907692 DOI: 10.1136/ejhpharm-2019-002081] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/20/2020] [Accepted: 03/31/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The current systematic review (SR) was undertaken to identify and summarise the published literature reporting on the clinical and economic value of automated in-hospital pharmacy services with a primary focus on systems supporting the dispensing of medicines. METHODS Literature searches were conducted in MEDLINE, Embase and the Cochrane Library on 17 December 2017 to identify English-language publications investigating any automated dispensing systems (ADSs) in the inpatient setting to include central pharmacy and ward-based systems. RESULTS 4320 publications were screened by title and abstract and 45 of 175 full publications screened were included. Grey literature searching identified an additional three publications. Therefore, 48 publications relating to ADSs were eligible for inclusion. Although a relatively large evidence base was identified as part of the current SR, the eligible studies were inconsistent in terms of their design and the format of reporting of outcomes. The studies demonstrate that both pharmacy and ward-based ADSs offer benefits over traditional manual dispensing methods in terms of clinical and economic outcomes. The primary benefits following implementation of an ADS include reductions in medication errors, medication administration time and costs. Studies examining optimisation/inventory management strategies/refill programmes for these systems suggest that optimal implementation of the ADS is required to ensure that clinical success and economic benefits are maximised. CONCLUSIONS The published evidence suggests positive impacts of ADS and should encourage hospitals to invest in automation, with a global strategy to improve the reliability and the efficiency of the medication process. However, one of the key findings of the current SR is the need for further data from adequately powered studies reporting clinically relevant outcomes which would allow for robust, evidence-based recommendations on the return on investment of the technologies. These studies would probably contribute to a larger adoption of these technologies by European hospitals.
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Affiliation(s)
| | - Ana Herranz
- Hospital Pharmacy department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | | | | | | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals (HUG), Geneva, Switzerland
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Martinez DA, Cai J, Oke JB, Jarrell AS, Feijoo F, Appelbaum J, Klein E, Barnes S, Levin SR. Where is my infusion pump? Harnessing network dynamics for improved hospital equipment fleet management. J Am Med Inform Assoc 2020; 27:884-892. [PMID: 32337588 PMCID: PMC7647311 DOI: 10.1093/jamia/ocaa033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/31/2019] [Accepted: 03/11/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Timely availability of intravenous infusion pumps is critical for high-quality care delivery. Pumps are shared among hospital units, often without central management of their distribution. This study seeks to characterize unit-to-unit pump sharing and its impact on shortages, and to evaluate a system-control tool that balances inventory across all care areas, enabling increased availability of pumps. MATERIALS AND METHODS A retrospective study of 3832 pumps moving in a network of 5292 radiofrequency and infrared sensors from January to November 2017 at The Johns Hopkins Hospital in Baltimore, Maryland. We used network analysis to determine whether pump inventory in one unit was associated with inventory fluctuations in others. We used a quasi-experimental design and segmented regressions to evaluate the effect of the system-control tool on enabling safe inventory levels in all care areas. RESULTS We found 93 care areas connected through 67,111 pump transactions and 4 discernible clusters of pump sharing. Up to 17% (95% confidence interval, 7%-27%) of a unit's pump inventory was explained by the inventory of other units within its cluster. The network analysis supported design and deployment of a hospital-wide inventory balancing system, which resulted in a 44% (95% confidence interval, 36%-53%) increase in the number of care areas above safe inventory levels. CONCLUSIONS Network phenomena are essential inputs to hospital equipment fleet management. Consequently, benefits of improved inventory management in strategic unit(s) are capable of spreading safer inventory levels throughout the hospital.
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Affiliation(s)
- Diego A Martinez
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Health Sciences Informatics, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Operations, Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Jiarui Cai
- Department of Operations, Johns Hopkins Health System, Baltimore, Maryland, USA
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jimi B Oke
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Civil and Environmental Engineering, University of Massachusetts Amherst, Massachusetts, USA
| | - Andrew S Jarrell
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Felipe Feijoo
- Escuela de Ingeniería Industrial, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Jeffrey Appelbaum
- Department of Operations, Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Eili Klein
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Disease Dynamics, Economics and Policy, Washington, DC, USA
| | - Sean Barnes
- Department of Decision, Operations and Information Technologies, University of Maryland, College Park, Maryland, USA
| | - Scott R Levin
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Health Sciences Informatics, Johns Hopkins University, Baltimore, Maryland, USA
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Escrivá Gracia J, Brage Serrano R, Fernández Garrido J. Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC Health Serv Res 2019; 19:640. [PMID: 31492188 PMCID: PMC6729050 DOI: 10.1186/s12913-019-4481-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 08/28/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Medication errors are a serious and complex problem in clinical practice, especially in intensive care units whose patients can suffer potentially very serious consequences because of the critical nature of their diseases and the pharmacotherapy programs implemented in these patients. The origins of these errors discussed in the literature are wide-ranging, although far-reaching variables are of particular special interest to those involved in training nurses. The main objective of this research was to study if the level of knowledge that critical-care nurses have about the use and administration of medications is related to the most common medication errors. METHODS This was a mixed (multi-method) study with three phases that combined quantitative and qualitative techniques. In phase 1 patient medical records were reviewed; phase 2 consisted of an interview with a focus group; and an ad hoc questionnaire was carried out in phase 3. RESULTS The global medication error index was 1.93%. The main risk areas were errors in the interval of administration of antibiotics (8.15% error rate); high-risk medication dilution, concentration, and infusion-rate errors (2.94% error rate); and errors in the administration of medications via nasogastric tubes (11.16% error rate). CONCLUSIONS Nurses have a low level of knowledge of the drugs they use the most and with which a greater number of medication errors are committed in the ICU.
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Affiliation(s)
- Juan Escrivá Gracia
- Department of nursing, University of Valencia, 46001 Jaume Roig St, Valencia, Spain
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Abstract
The beginnings of caring for critically ill patients date back to Florence Nightingale's work during the Crimean War in 1854, but the subspecialty of critical care medicine is relatively young. The first US multidisciplinary intensive care unit (ICU) was established in 1958, and the American Board of Medical Subspecialties first recognized the subspecialty of critical care medicine in 1986. Critical care pharmacy services began around the 1970s, growing in the intervening 40 years to become one of the largest practice areas for clinical pharmacists, with its own section in the SCCM, the largest international professional organization in the field. During the next decade, pharmacy services expanded to various ICU settings (both adult and pediatric), the operating room, and the emergency department. In these settings, pharmacists established clinical practices consisting of therapeutic drug monitoring, nutrition support, and participation in patient care rounds. Pharmacists also developed efficient and safe drug delivery systems with the evolution of critical care pharmacy satellites and other innovative programs. In the 1980s, critical care pharmacists designed specialized training programs and increased participation in critical care organizations. The number of critical care residencies and fellowships doubled between the early 1980s and the late 1990s. Standards for critical care residency were developed, and directories of residencies and fellowships were published. In 1989, the Clinical Pharmacy and Pharmacology Section was formed within the Society of Critical Care Medicine, the largest international, multidisciplinary, multispecialty critical care organization. This recognition acknowledged that pharmacists are necessary and valuable members of the physician-led multidisciplinary team. The Society of Critical Care Medicine Guidelines for Critical Care Services and Personnel deem that pharmacists are essential for the delivery of quality care to critically ill patients. These guidelines recommend that a pharmacist monitor drug regimen for dosing, adverse reactions, drug-drug interactions, and cost optimization for all hospitals providing critical care services. The guidelines also advocate that a specialized, decentralized pharmacist provide expertise in nutrition support, cardiorespiratory resuscitation, and clinical research in academic medical centers providing comprehensive critical care.
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Affiliation(s)
- A K Mohiuddin
- Department of Pharmacy, World University of Bangladesh, Bangladesh
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Bagheri-Nesami M, Esmaeili R, Tajari M. INTRAVENOUS MEDICATION ADMINISTRATION ERRORS AND THEIR CAUSES IN CARDIAC CRITICAL CARE UNITS IN IRAN. Mater Sociomed 2016; 27:442-6. [PMID: 26889108 PMCID: PMC4733547 DOI: 10.5455/msm.2015.27.442-446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background and Objectives: The dangerous events caused by medication errors are one of the main challenges faced in critical care units. The present study was conducted to determine the frequency of intravenous medication administration errors and their causes in cardiac critical care units in Iran. Materials and Methods: The present descriptive study was conducted in the critical care units (CCUs and cardiac surgery intensive care units) of 12 teaching hospitals. Of the total of 240 nurses working in these departments, 190 participated in the present study. The data collection tools used in this study included the “nurses’ demographic data questionnaire”, the “patients’ medical and demographic data questionnaire” and the “nurses’ self-reporting questionnaire about the frequency of intravenous medication administration errors and their causes”. The data obtained were analyzed in SPSS-20 using descriptive statistics such as the absolute and relative frequency. Findings: During the 2 months in which this study was being conducted, 2542 patients were admitted to these departments and 20240 doses of intravenous medications were administered to these patients. The nurses reported 262 intravenous medication administration errors. The most common intravenous medication error pertained to administering the wrong medication (n=71 and 27.1%). As for the causes of intravenous medication administration errors, 51.5% of the errors were associated with work conditions, 24% with packaging, 13.4% with communication, 9.9% with transcription and 1.2% with pharmacies. Discussion and Conclusion: According to the results, strategies are recommended to be adopted for reducing or limiting medication errors, such as building a stronger pharmacology knowledge base in nurses and nursing students, improving work conditions and improving communication between the nurses and physicians.
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Affiliation(s)
- Masoumeh Bagheri-Nesami
- School of Nursing and Midwifery. Department of Medical-Surgical Nursing, Mazandaran Pediatric Infectious Disease Research Center (MPIDRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - Ravanbakhsh Esmaeili
- School of Nursing and Midwifery. Department of Medical-Surgical Nursing, Mazandaran Pediatric Infectious Disease Research Center (MPIDRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - Mojdeh Tajari
- Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences. Sari, Iran
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Walsh K. Prescribing pattern of interns: Time for new interventions. J Basic Clin Pharm 2014; 6:44. [PMID: 25538472 PMCID: PMC4268630 DOI: 10.4103/0976-0105.145779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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