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Walker D, Moloney C, SueSee B, Sharples R, Blackman R, Long D, Hou XY. Factors Influencing Medication Errors in the Prehospital Paramedic Environment: A Mixed Method Systematic Review. PREHOSP EMERG CARE 2022:1-18. [PMID: 35579544 DOI: 10.1080/10903127.2022.2068089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There is limited research available on safe medication management practices in EMS practice, with most evidence-based medication safety guidelines based on research in nursing, operating theatre and pharmacy settings. Prevention of errors requires recognition of contributing factors across the spectrum from the organizational level to procedural elements and patient characteristics. Evidence is inconsistent regarding the incidence of medication errors and multiple sources also state that errors are under-reported, making the true magnitude of the problem difficult to quantify. Definitions of error also vary, with the specific context of medication errors in prehospital practice yet to be established. The objective of this review is to identify the factors influencing the occurrence of medication errors by EMS personnel in the prehospital environment. METHODS AND ANALYSIS The review included both qualitative and quantitative research involving interventions or phenomena related to medication safety or medication error by EMS personnel in the prehospital environment. A search of multiple databases was conducted to identify studies meeting these inclusion criteria. All studies selected were assessed for methodological quality, however this was not used as a basis for exclusion. Each stage of study selection, appraisal and data extraction was conducted by two independent reviewers, with a third reviewer deciding any unresolved conflicts. The review follows a convergent integrated approach, conducting a single qualitative synthesis of qualitative and "qualitized" quantitative data. RESULTS 56 articles were included in the review, with case reports and qualitative studies being the most frequent study types. Qualitative analysis revealed seven major themes: organizational factors (with reporting as a sub-theme), equipment/medications, environmental factors, procedure-related factors, communication, patient-related factors (with pediatrics as a sub-theme) and cognitive factors. Both contributing factors and protective factors were identified. DISCUSSION The body of evidence regarding medication errors is heterogenous and limited in both quantity and quality. Multiple factors influence medication errors occurrence; knowledge of these is necessary to mitigate the risk of errors. Medication error incidence is difficult to quantify due to inconsistent measure, definitions and contexts of research conducted to date. Further research is required to quantify the prevalence of identified factors in specific practice settings.
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Affiliation(s)
- Dennis Walker
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Australia
| | - Clint Moloney
- Program of Nursing and Midwifery, College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Brendan SueSee
- School of Linguistics, Adult and Special Education, University of Southern Queensland, Springfield, Australia
| | - Renee Sharples
- College of Science, Health, and Engineering, LaTrobe University, Bendigo, Australia
| | - Rosanna Blackman
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Australia
| | - David Long
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Australia
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, St Lucia, Australia
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Apiratwarakul K, Ienghong K, Suzuki T, Celebi I, Bhudhisawasdi V, Tiamkao S. Using Routine Ambulance Inspection Report Application to Reduce Wasted Time in Emergency Medical Services. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6022] [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] Open
Abstract
BACKGROUND: Ambulance inspections make up part of the emergency medical services (EMS) to keep operations running smoothly as well as to maximize and maintain the safety of vehicles used for delivery of both staff and patients. The EMS of Srinagarind Hospital has been using an ambulance inspection report application since January 2020. Nevertheless, there has been no comparative study of the benefits associated with the use of this specification.
AIM: The aim of this study was to compare the advantages of an ambulance inspection report application and paper checklist.
METHODS: This cross-sectional study was conducted amid the EMS at a university hospital in Thailand. Data gathering was carried out by employing the Srinagarind Hospital database and ambulance inspection report application throughout January 1, 2019, and December 31, 2020.
RESULTS: A total of 2350 ambulance inspections were recorded during the 2-year study period. Recognition times for ambulance inspections incorporating paper checklist and inspection with application were 35.5 ± 9.4 min and 1.02 ± 0.5 min, respectively (P < 0.001). Action times were 25.2 ± 5.1 min and 1.04 ± 0.2 min, respectively. Ambulance inspection compliance rate with the application was 95.3% and 70.1% with a paper checklist.
CONCLUSION: Ambulance inspections carried out with an application can reduce recognition and action time, and increase ambulance inspection compliance rate.
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Bitan Y, Ramey S, Milgram P. Ergonomic design of new paramedic response bags. APPLIED ERGONOMICS 2019; 81:102890. [PMID: 31422279 DOI: 10.1016/j.apergo.2019.102890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/02/2019] [Accepted: 06/30/2019] [Indexed: 06/10/2023]
Abstract
A two phase project is described for redesigning and evaluating paramedic response bags, one of the key pieces of equipment used by emergency medical services. Adopting a user-centred approach, Phase I involved first educating active service paramedics about ergonomic principles, and then collaborating with them to conceptualise a new type of response bag, based on separate colour coded kits, each containing related equipment items. Phase II describes a formal evaluation study, involving simulated procedures with a patient mannequin and active service paramedics in a real ambulance. Results indicated subjective preferences for the new bags, where 62% of the paramedics believed it was easier to find equipment in the new bag and 65% preferred the new bags overall. No detrimental effects were attributed to the transition to the new bag. Also discussed are the advantages of the participatory design approach, as well as design guidelines and implications for paramedic operations.
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Affiliation(s)
- Yuval Bitan
- Ben-Gurion University of the Negev, Israel; University of Toronto, ON, Canada.
| | - Scott Ramey
- British Columbia Emergency Health Services, BC, Canada
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Du B, Boileau M, Wierts K, Hignett S, Fischer S, Yazdani A. Existing Science on Human Factors and Ergonomics in the Design of Ambulances and EMS Equipment. PREHOSP EMERG CARE 2019; 23:631-646. [DOI: 10.1080/10903127.2019.1568651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Strand MA, Tellers J, Patterson A, Ross A, Palombi L. The achievement of public health services in pharmacy practice: A literature review. Res Social Adm Pharm 2015. [PMID: 26215337 DOI: 10.1016/j.sapharm.2015.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is known that pharmacists are currently contributing to public health; however, the extent of this contribution as reported in the literature has not been examined. Investigating the ways that pharmacists are currently participating in public health is critical for the profession of pharmacy, pharmacy educators, and the public health community. OBJECTIVES The purpose of this study was to determine the reported contributions of pharmacy to each of the ten essential services of public health, and which of the five core competencies of public health were most frequently utilized in those contributions. METHODS A PubMed search was used to extract references that included both the words pharmacy and services in the title or abstract, and the words public health in any part of the document. A total of 247 references were extracted and categorized into the essential services and core competencies. RESULTS The essential services Inform, Educate, and Empower, and Link to/Provide Care were more frequently represented in the literature, and the core competency of Health Policy and Administration was most frequently utilized. CONCLUSION To further contribute to and integrate their contributions within population health, pharmacists must consider ways to strategically contribute to the essential services of public health and seek to increase competency in public health.
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Affiliation(s)
- Mark A Strand
- Pharmacy Practice Department, College of Health Professions, North Dakota State University, Fargo, ND, USA; School of Pharmacy, College of Health Professions, North Dakota State University, Fargo, ND, USA.
| | - Jackie Tellers
- Pharmacy Practice Department, College of Health Professions, North Dakota State University, Fargo, ND, USA
| | - Alan Patterson
- Pharmacy Practice Department, College of Health Professions, North Dakota State University, Fargo, ND, USA
| | - Alex Ross
- Pharmacy Practice Department, College of Health Professions, North Dakota State University, Fargo, ND, USA
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Fisher JD, Freeman K, Clarke A, Spurgeon P, Smyth M, Perkins GD, Sujan MA, Cooke MW. Patient safety in ambulance services: a scoping review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03210] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BackgroundThe role of ambulance services has changed dramatically over the last few decades with the introduction of paramedics able to provide life-saving interventions, thanks to sophisticated equipment and treatments available. The number of 999 calls continues to increase, with adverse events theoretically possible with each one. Most patient safety research is based on hospital data, but little is known concerning patient safety when using ambulance services, when things can be very different. There is an urgent need to characterise the evidence base for patient safety in NHS ambulance services.ObjectiveTo identify and map available evidence relating to patient safety when using ambulance services.DesignMixed-methods design including systematic review and review of ambulance service documentation, with areas for future research prioritised using a Delphi process.Setting and participantsAmbulance services, their staff and service users in UK.Data sourcesA wide range of data sources were explored. Multiple databases, reference lists from key papers and citations, Google and the NHS Confederation website were searched, and experts contacted to ensure that new data were included in the review. The databases MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Science Direct, Emerald, Education Resources Information Center (ERIC), Applied Social Sciences Index and Abstracts, Social Services Abstracts, Sociological Abstracts, International Bibliography of the Social Sciences (IBSS), PsycINFO, PsycARTICLES, Health Management Information Consortium (HMIC), NHS Evidence, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED),Health Technology Assessment, the FADE library, Current Awareness Service for Health (CASH), OpenDOAR (Directory of Open Access Repositories) and Open System for Information on Grey Literature in Europe (OpenSIGLE) and Zetoc (The British Library's Electronic Table of Contents) were searched from 1 January 1980 to 12 October 2011. Publicly available documents and issues identified by National Patient Safety Agency (NPSA), NHS Litigation Authority (NHSLA) and coroners’ reports were considered. Opinions and perceptions of senior managers, ambulance staff and service users were solicited.Review methodsData were extracted from annual reports using two-stage thematic analysis, data from quality accounts were collated with safety priorities tabulated and considered using thematic analysis, NPSA incident report data were collated and displayed comparatively using descriptive statistics, claims reported to NHSLA were analysed to identify number and cost of claims from mistakes and/or poor service, and summaries of coroners’ reports were assessed using thematic analysis to identify underlying safety issues. The depth of analysis is limited by the remit of a scoping exercise and availability of data.ResultsWe identified studies exploring different aspects of safety, which were of variable quality and with little evidence to support activities currently undertaken by ambulance services. Adequately powered studies are required to address issues of patient safety in this service, and it appeared that national priorities were what determined safety activities, rather than patient need. There was inconsistency of information on attitudes and approaches to patient safety, exacerbated by a lack of common terminology.ConclusionPatient safety needs to become a more prominent consideration for ambulance services, rather than operational pressures, including targets and driving the service. Development of new models of working must include adequate training and monitoring of clinical risks. Providers and commissioners need a full understanding of the safety implications of introducing new models of care, particularly to a mobile workforce often isolated from colleagues, which requires a body of supportive evidence and an inherent critical evaluation culture. It is difficult to extrapolate findings of clinical studies undertaken in secondary care to ambulance service practice and current national guidelines often rely on consensus opinion regarding applicability to the pre-hospital environment. Areas requiring further work include the safety surrounding discharging patients, patient accidents, equipment and treatment, delays in transfer/admission to hospital, and treatment and diagnosis, with a clear need for increased reliability and training for improving handover to hospital.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Joanne D Fisher
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | - Karoline Freeman
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | - Aileen Clarke
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | - Peter Spurgeon
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | - Mike Smyth
- West Midlands Ambulance Service, Millennium Point, Waterfront Business Park, Brierley Hill, West Midlands, UK
| | - Gavin D Perkins
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | | | - Matthew W Cooke
- Department of Health Sciences, Warwick Medical School, Coventry, UK
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McMullan JT, Jones E, Barnhart B, Denninghoff K, Spaite D, Zaleski E, Silbergleit R. Degradation of benzodiazepines after 120 days of EMS deployment. PREHOSP EMERG CARE 2014; 18:368-74. [PMID: 24548058 DOI: 10.3109/10903127.2013.869642] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION EMS treatment of status epilepticus improves outcomes, but the benzodiazepine best suited for EMS use is unclear, given potential high environmental temperature exposures. OBJECTIVE To describe the degradation of diazepam, lorazepam, and midazolam as a function of temperature exposure and time over 120 days of storage on active EMS units. METHODS Study boxes containing vials of diazepam, lorazepam, and midazolam were distributed to 4 active EMS units in each of 2 EMS systems in the southwestern United States during May-August 2011. The boxes logged temperature every minute and were stored in EMS units per local agency policy. Two vials of each drug were removed from each box at 30-day intervals and underwent high-performance liquid chromatography to determine drug concentration. Concentration was analyzed as mean (and 95%CI) percent of initial labeled concentration as a function of time and mean kinetic temperature (MKT). RESULTS 192 samples were collected (2 samples of each drug from each of 4 units per city at 4 time-points). After 120 days, the mean relative concentration (95%CI) of diazepam was 97.0% (95.7-98.2%) and of midazolam was 99.0% (97.7-100.2%). Lorazepam experienced modest degradation by 60 days (95.6% [91.6-99.5%]) and substantial degradation at 90 days (90.3% [85.2-95.4%]) and 120 days (86.5% [80.7-92.3%]). Mean MKT was 31.6°C (95%CI 27.1-36.1). Increasing MKT was associated with greater degradation of lorazepam, but not midazolam or diazepam. CONCLUSIONS Midazolam and diazepam experienced minimal degradation throughout 120 days of EMS deployment in high-heat environments. Lorazepam experienced significant degradation over 120 days and appeared especially sensitive to higher MKT exposure.
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Lammers R, Willoughby-Byrwa M, Fales W. Medication Errors in Prehospital Management of Simulated Pediatric Anaphylaxis. PREHOSP EMERG CARE 2014; 18:295-304. [DOI: 10.3109/10903127.2013.856501] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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