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Yusof MM, Takeda T, Shimai Y, Mihara N, Matsumura Y. Evaluating health information systems-related errors using the human, organization, process, technology-fit (HOPT-fit) framework. Health Informatics J 2024; 30:14604582241252763. [PMID: 38805345 DOI: 10.1177/14604582241252763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Complex socio-technical health information systems (HIS) issues can create new error risks. Therefore, we evaluated the management of HIS-related errors using the proposed human, organization, process, and technology-fit framework to identify the lessons learned. Qualitative case study methodology through observation, interview, and document analysis was conducted at a 1000-bed Japanese specialist teaching hospital. Effective management of HIS-related errors was attributable to many socio-technical factors including continuous improvement, safety culture, strong management and leadership, effective communication, preventive and corrective mechanisms, an incident reporting system, and closed feedback loops. Enablers of medication errors include system sophistication and process factors like workarounds, variance, clinical workload, slips and mistakes, and miscommunication. The case management effectiveness in handling the HIS-related errors can guide other clinical settings. The potential of HIS to minimize errors can be achieved through continual, systematic, and structured evaluation. The case study validated the applicability of the proposed evaluation framework that can be applied flexibly according to study contexts to inform HIS stakeholders in decision-making. The comprehensive and specific measures of the proposed framework and approach can be a useful guide for evaluating complex HIS-related errors. Leaner and fitter socio-technical components of HIS can yield safer system use.
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Affiliation(s)
- Maryati Mohd Yusof
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia(UKM), Bangi, Malaysia
| | - Toshihiro Takeda
- Department of Medical Informatics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yoshie Shimai
- Department of Medical Informatics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Naoki Mihara
- Medical Informatics & Systems Management, Hiroshima UniversityHospital, Hiroshima, Japan
| | - Yasuhsi Matsumura
- National Hospital Organization, Osaka National Hospital, Osaka, Japan
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Recsky C, Stowe M, Rush KL, MacPhee M, Blackburn L, Muniak A, Currie LM. Characterization of Safety Events Involving Technology in Primary and Community Care. Appl Clin Inform 2023; 14:1008-1017. [PMID: 38151041 PMCID: PMC10752655 DOI: 10.1055/s-0043-1777454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/10/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND The adoption of technology in health care settings is often touted as an opportunity to improve patient safety. While some adverse events can be reduced by health information technologies, technology has also been implicated in or attributed to safety events. To date, most studies on this topic have focused on acute care settings. OBJECTIVES To describe voluntarily reported safety events that involved health information technology in community and primary care settings in a large Canadian health care organization. METHODS Two years of safety events involving health information technology (2016-2018) were extracted from an online voluntary safety event reporting system. Events from primary and community care settings were categorized according to clinical setting, type of event, and level of harm. The Sittig and Singh sociotechnical system model was then used to identify the most prominent sociotechnical dimensions of each event. RESULTS Of 104 reported events, most (n = 85, 82%) indicated the event resulted in no harm. Public health had the highest number of reports (n = 45, 43%), whereas home health had the fewest (n = 7, 7%). Of the 182 sociotechnical concepts identified, many events (n = 61, 59%) mapped to more than one dimension. Personnel (n = 48, 46%), Workflow and Communication (n = 37, 36%), and Content (n = 30, 29%) were the most common. Personnel and Content together was the most common combination of dimensions. CONCLUSION Most reported events featured both technical and social dimensions, suggesting that the nature of these events is multifaceted. Leveraging existing safety event reporting systems to screen for safety events involving health information technology, and applying a sociotechnical analytic framework can aid health organizations in identifying, responding to, and learning from reported events.
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Affiliation(s)
- Chantelle Recsky
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Megan Stowe
- Regional Digital Solutions, Digital Health, Provincial Health Services Authority, Vancouver, Canada
| | - Kathy L. Rush
- School of Nursing, University of British Columbia Okanagan, Kelowna, Canada
| | - Maura MacPhee
- School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - Allison Muniak
- Human Factors and Administrative Burdens, Health Quality BC, Vancouver, Canada
| | - Leanne M. Currie
- School of Nursing, University of British Columbia, Vancouver, Canada
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Roberts J, Jaam M, Paudyal V, Hadi MA. Minimizing prescribing errors: A phenomenological exploration of the views and experiences of independent prescribing pharmacists. Br J Clin Pharmacol 2023; 89:2747-2756. [PMID: 37105534 DOI: 10.1111/bcp.15758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 04/29/2023] Open
Abstract
AIMS This study aims to explore the views and experiences of independent prescribing (IP) pharmacists regarding prescribing errors and strategies to mitigate errors in practice. METHODS One-to-one online semi-structured interviews were conducted with IP pharmacists across the United Kingdom. Verbatim transcripts of the interview were generated and coded using NVivo® 12 software for thematic analysis. A mixed inductive and deductive approach was used to generate themes and sub-themes which were then mapped onto the framework of factors that influence clinical practice proposed by Vincent et al. RESULTS: A total of 14 interviews were conducted. Participants linked the risk-averse nature of a pharmacist, self-perception of their roles as medicines experts, and previous experience of keeping checks on doctors' prescriptions as a dispenser often made them feel confident in prescribing. However, lacking adequate diagnostic skills, inadequate prescribing training programmes, and dealing with complex patients often made them feel vulnerable to committing errors. Organizational and system-related factors such as work interruptions and increased workload were identified as other factors linked to prescribing errors. CONCLUSIONS Independent prescribing pharmacists use a variety of strategies to reduce the risk of prescribing errors. Promoting diagnostic competency in their area of practice, strengthening undergraduate and prescribing curricula, and addressing known organizational and system-related factors linked to prescribing errors can minimize errors and promote patient safety.
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Affiliation(s)
- Joshua Roberts
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Myriam Jaam
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Vibhu Paudyal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Muhammad Abdul Hadi
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
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Ayre MJ, Lewis PJ, Keers RN. Understanding the medication safety challenges for patients with mental illness in primary care: a scoping review. BMC Psychiatry 2023; 23:417. [PMID: 37308835 DOI: 10.1186/s12888-023-04850-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/06/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Mental illness and medication safety are key priorities for healthcare systems around the world. Despite most patients with mental illness being treated exclusively in primary care, our understanding of medication safety challenges in this setting is fragmented. METHOD Six electronic databases were searched between January 2000-January 2023. Google Scholar and reference lists of relevant/included studies were also screened for studies. Included studies reported data on epidemiology, aetiology, or interventions related to medication safety for patients with mental illness in primary care. Medication safety challenges were defined using the drug-related problems (DRPs) categorisation. RESULTS Seventy-nine studies were included with 77 (97.5%) reporting on epidemiology, 25 (31.6%) on aetiology, and 18 (22.8%) evaluated an intervention. Studies most commonly (33/79, 41.8%) originated from the United States of America (USA) with the most investigated DRP being non-adherence (62/79, 78.5%). General practice was the most common study setting (31/79, 39.2%) and patients with depression were a common focus (48/79, 60.8%). Aetiological data was presented as either causal (15/25, 60.0%) or as risk factors (10/25, 40.0%). Prescriber-related risk factors/causes were reported in 8/25 (32.0%) studies and patient-related risk factors/causes in 23/25 (92.0%) studies. Interventions to improve adherence rates (11/18, 61.1%) were the most evaluated. Specialist pharmacists provided the majority of interventions (10/18, 55.6%) with eight of these studies involving a medication review/monitoring service. All 18 interventions reported positive improvements on some medication safety outcomes but 6/18 reported little difference between groups for certain medication safety measures. CONCLUSION Patients with mental illness are at risk of a variety of DRPs in primary care. However, to date, available research exploring DRPs has focused attention on non-adherence and potential prescribing safety issues in older patients with dementia. Our findings highlight the need for further research on the causes of preventable medication incidents and targeted interventions to improve medication safety for patients with mental illness in primary care.
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Affiliation(s)
- Matthew J Ayre
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Penny J Lewis
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard N Keers
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
- Suicide, Risk and Safety Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Jeffries M, Salema NE, Laing L, Shamsuddin A, Sheikh A, Avery T, Chuter A, Waring J, Keers RN. Using sociotechnical theory to understand medication safety work in primary care and prescribers' use of clinical decision support: a qualitative study. BMJ Open 2023; 13:e068798. [PMID: 37105697 PMCID: PMC10151989 DOI: 10.1136/bmjopen-2022-068798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES The concept of safety work draws attention to the intentional work of ensuring safety within care systems. Clinical decision support (CDS) has been designed to enhance medication safety in primary care by providing decision-making support to prescribers. Sociotechnical theory understands that healthcare settings are complex and dynamically connected systems of fluid networks, human agents, changing relationships and social processes. This study aimed to understand the relationship between safety work and the use of CDS. DESIGN AND SETTING This qualitative study took place across nine different general practices in England. Stakeholders included general practitioners (GPs) and general practice-based pharmacists and nurse prescribers. Semi-structured interviews were conducted to illicit how the system was used by the participants in the context of medication safety work. Data analysis conducted alongside data collection was thematic and drew on socio-technical theory. PARTICIPANTS Twenty-three interviews were conducted with 14 GPs, three nurse prescribers and three practice pharmacists between February 2018 and June 2020. RESULTS Safety work was contextually situated in a complex network of relationships. Three interconnected themes were interpreted from the data: (1) the use of CDS within organisational and social practices and workflows; (2) safety work and the use of CDS within the interplay between prescribers, patients and populations; and (3) the affordances embedded in CDS systems. CONCLUSION The use of sociotechnical theory here extends current thinking in patient safety particularly in the ways that safety work was co-constituted with the use of CDS alerts. This has implications for implementation and use to ensure that the contexts into which such CDS systems are implemented are taken into account. Understanding how alerts can adapt safety culture will help improve the efficacy of CDS systems, enhance prescribing safety and help to further understand how safety work is achieved in primary care.
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Affiliation(s)
- Mark Jeffries
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Nde-Eshimuni Salema
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Libby Laing
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Aziz Sheikh
- Division of Community Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Tony Avery
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Antony Chuter
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Justin Waring
- School of Social Policy, Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Richard Neil Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
- Suicide, Risk and Safety Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Bante A, Mersha A, Aschalew Z, Ayele A. Medication errors and associated factors among pediatric inpatients in public hospitals of gamo zone, southern Ethiopia. Heliyon 2023; 9:e15375. [PMID: 37123938 PMCID: PMC10130860 DOI: 10.1016/j.heliyon.2023.e15375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Background Medication errors are the most common medical errors in the world. In particular, pediatric patients are more susceptible to severe injuries and death. Despite their multidimensional impact, medication errors are not recognized well in developing nations, including Ethiopia. Thus, this study aimed to assess the prevalence of medication errors and associated factors among pediatric inpatients in public hospitals of Gamo zone, southern Ethiopia. Methods A facility-based cross-sectional study was conducted among 416 pediatric inpatients from August 1, 2020, to February 30, 2021. Open data kit tools and Stata version 16.0 were used for data collection and analysis, respectively. Bivariable and multivariable analyses were performed to identify factors associated with medication errors. An adjusted odds ratio with a 95% confidence interval was computed and a P-value of <0.05 in the multivariable analysis was set to declare statistical significance. Results Overall, 69.5% (95% CI: 64.80, 73.86) of pediatric inpatients experienced medication errors. Unsuitable working environment (aOR: 2.40, 95% CI: 1.48, 3.91), child weight <5 Kg (aOR: 3.72, 95% CI: 1.79, 7.73), medication administered by diploma professionals (aOR: 2.10, 95% CI: 1.31, 3.36), parent involvement (aOR: 0.55, 95% CI: 0.33, 0.95), non-adherence with medication administration rights (aOR: 2.68, 95% CI: 1.32, 5.44) and hospital stay for >5 days (aOR: 1.83, 95% CI: 1.15, 2.93) were significantly associated with medication errors. Conclusion Medication errors were high among pediatric inpatients as compared to previous national studies. To reduce the occurrences of medication errors, it is critical to create a suitable working environment, arrange education and training opportunities for providers, involve families in the medication administration process, and strictly adhere to medication administration rights.
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Affiliation(s)
- Agegnehu Bante
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- Corresponding author.
| | - Abera Mersha
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Zeleke Aschalew
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Aklilu Ayele
- Department of Pharmacy, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Grimes TC, Guinan EM. Interprofessional education focused on medication safety: a systematic review. J Interprof Care 2023; 37:131-149. [PMID: 35050843 DOI: 10.1080/13561820.2021.2015301] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Safe medication use necessitates interprofessional working, with calls to enhance interprofessional education (IPE) focusing on medication safety (MS) in healthcare professional (HCP) curricula. Little is known about the design, delivery or evaluation of such activities. This systematic literature review describes MS-focused IPE activities in pre-qualification HCP programmes. MedLine, EMBASE, CINAHL and ERIC were searched, relevant studies identified and data extracted. The McGill Mixed Methods Appraisal Tool was employed. The 3P (presage-process-product) theory structured deductive analysis. Thirty-one studies were included, reporting on 30 activities, mostly undertaken in North America or United Kingdom. Presage/Design: Most reported activities involved pharmacy, nursing, medical or physician assistant students learning with one or more other HCP group. Few studies matched student groups' skills or experiences. Few studies reported theoretical underpinnings. Process/Delivery: Multiple pedagogical approaches were employed, mostly social construction, and low- and high-fidelity simulation-based learning. Few studies reported learning outcomes or summative assessment, more reported formative assessment. Product/evaluation: Outcomes measured were learners' opinions, satisfaction or attitudes toward interprofessional working and findings were generally positive. Few studies reported on student development or outcomes specific to medication safety. Lack of integration of qualitative/quantitative components of mixed methods studies and limited outcome measurements' validity or reliability weakened study quality. MS-focused IPE for pre-qualification HCPs is well received by students. Design of future activities could be enhanced by employing theory and ensuring matching of students' and groups' skills, professional identity and learner attributes to enhance learning in an interprofessional setting. Future delivery should embed MS-focused IPE into the standard curricula to optimize constructive alignment, learner engagement, quality and drive development. The required skillset in pre-qualification HCP programmes to facilitate future safe medication practice, together with the associated learning outcomes and assessment approaches, should be defined. The quality of scholarly studies examining these activities needs improvement.
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Affiliation(s)
- T C Grimes
- School of Pharmacy and Pharmaceutical Sciences, Panoz Institute, Trinity College Dublin, Dublin 2, Ireland
| | - E M Guinan
- School of Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
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Donker EM, Brinkman DJ, van Rosse F, Janssen B, Knol W, Dumont G, Jorens PG, Dupont A, Christiaens T, van Smeden J, de Waard‐Siebinga I, Peeters LEJ, Goorden R, Hessel M, Lissenberg‐Witte B, Richir M, van Agtmael MA, Kramers C, Tichelaar J. Do we become better prescribers after graduation: A 1-year international follow-up study among junior doctors. Br J Clin Pharmacol 2022; 88:5218-5226. [PMID: 35716366 PMCID: PMC9796721 DOI: 10.1111/bcp.15443] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 01/07/2023] Open
Abstract
AIM The aim of this study was to investigate how the prescribing knowledge and skills of junior doctors in the Netherlands and Belgium develop in the year after graduation. We also analysed differences in knowledge and skills between surgical and nonsurgical junior doctors. METHODS This international, multicentre (n = 11), longitudinal study analysed the learning curves of junior doctors working in various specialties via three validated assessments at about the time of graduation, and 6 months and 1 year after graduation. Each assessment contained 35 multiple choice questions (MCQs) on medication safety (passing grade ≥85%) and three clinical scenarios. RESULTS In total, 556 junior doctors participated, 326 (58.6%) of whom completed the MCQs and 325 (58.5%) the clinical case scenarios of all three assessments. Mean prescribing knowledge was stable in the year after graduation, with 69% (SD 13) correctly answering questions at assessment 1 and 71% (SD 14) at assessment 3, whereas prescribing skills decreased: 63% of treatment plans were considered adequate at assessment 1 but only 40% at assessment 3 (P < .001). While nonsurgical doctors had similar learning curves for knowledge and skills as surgical doctors (P = .53 and P = .56 respectively), their overall level was higher at all three assessments (all P < .05). CONCLUSION These results show that junior doctors' prescribing knowledge and skills did not improve while they were working in clinical practice. Moreover, their level was under the predefined passing grade. As this might adversely affect patient safety, educational interventions should be introduced to improve the prescribing competence of junior doctors.
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Affiliation(s)
- Erik M. Donker
- Department of Internal Medicine, Section PharmacotherapyAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands,Research and Expertise Centre in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
| | - David J. Brinkman
- Department of Internal Medicine, Section PharmacotherapyAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands,Research and Expertise Centre in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
| | - Floor van Rosse
- Department of Hospital PharmacyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Ben Janssen
- Department of Pharmacology and ToxicologyMaastricht UniversityMaastrichtThe Netherlands
| | - Wilma Knol
- University Medical Center Utrecht, Department of Geriatric MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Glenn Dumont
- Department of Hospital Pharmacy and Clinical PharmacologyAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Philippe G. Jorens
- Antwerp University Hospital, Department of PharmacotherapyUniversity of AntwerpAntwerpBelgium
| | - Alain Dupont
- Department of Clinical PharmacologyFree University of BrusselsBrusselsBelgium
| | - Thierry Christiaens
- Clinical Pharmacology, Department of Basic and Applied Medical SciencesGhent UniversityGhentBelgium
| | - Jeroen van Smeden
- Department of EducationCentre for Human Drug ResearchLeidenThe Netherlands,Leiden University Medical CenterLeidenThe Netherlands
| | - Itte de Waard‐Siebinga
- Department of Clinical Pharmacy and Pharmacology GroningenUniversity Medical Center GroningenThe Netherlands
| | - Laura E. J. Peeters
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands,Department of Internal MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Ronald Goorden
- Radboud University Medical CenterNijmegenThe Netherlands
| | | | - Birgit Lissenberg‐Witte
- Department of Epidemiology and Data ScienceAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Milan Richir
- Department of Internal Medicine, Section PharmacotherapyAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands,Research and Expertise Centre in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands,Department of SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Michiel A. van Agtmael
- Department of Internal Medicine, Section PharmacotherapyAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands,Research and Expertise Centre in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
| | - Cornelis Kramers
- Pharmacology‐Toxicology and Internal Medicine NijmegenRadboud University Medical CenterThe Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, Section PharmacotherapyAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands,Research and Expertise Centre in Pharmacotherapy Education (RECIPE)AmsterdamThe Netherlands
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Kinlay M, Yi Zheng W, Burke R, Juraskova I, Ho LMR, Turton H, Trinh J, Baysari M. Stakeholder perspectives of system-related errors: Types, contributing factors, and consequences. Int J Med Inform 2022; 165:104821. [PMID: 35738163 DOI: 10.1016/j.ijmedinf.2022.104821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite growing evidence of the benefits of electronic medication management systems (EMMS), research has also identified a range of new safety risks linked with their use. There is limited qualitative research focusing on system-related errors that result from use of EMMS. The aim of this study was to explore in-depth stakeholders' perceptions and experiences of system-related errors. METHODS Semi-structured interviews were conducted with EMMS users and other relevant staff (e.g. supporting roles in EMMS) across a local health district in Sydney, Australia. Analysis was conducted iteratively using a general inductive approach, and then mapped to Reason's accident causation model, where codes were categorized as 1) unsafe acts (i.e. what error occurred), 2) latent conditions (i.e. what factors contributed to errors), and 3) consequences resulting from the error. RESULTS Twenty-five participants were interviewed between September 2020 and May 2021. Participants most frequently described omission errors (e.g. failure to check for duplicate orders) as unsafe acts, although commission errors and workarounds were also reported. Poor EMMS design was reported to be a significant workplace factor contributing to system-related errors, however participants also described user factors, such as an overreliance on the system, and organizational factors, such as system downtime, as contributing to errors. Reported consequences of system-related errors included medication errors, but also impacts to the EMMS and on workers. CONCLUSIONS EMMS design is a significant contributor to system-related errors, but this research showed that user and organizational factors are also at play. As these factors are not independent, minimizing system-related errors requires a multi-faceted approach, where mitigation strategies target not only the EMMS, but also the context in which the system has been implemented.
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Affiliation(s)
- Madaline Kinlay
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | | | - Rosemary Burke
- Pharmacy Services, Sydney Local Health District, Sydney, Australia
| | - Ilona Juraskova
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | | | - Hannah Turton
- Pharmacy Services, Sydney Local Health District, Sydney, Australia
| | - Jason Trinh
- Pharmacy Services, Sydney Local Health District, Sydney, Australia
| | - Melissa Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Caracterização da produção científica sobre erro no trabalho em saúde. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ar03563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hall N, Bullen K, Sherwood J, Wake N, Wilkes S, Donovan G. Exploration of prescribing error reporting across primary care: a qualitative study. BMJ Open 2022; 12:e050283. [PMID: 35078837 PMCID: PMC8796229 DOI: 10.1136/bmjopen-2021-050283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To explore barriers and facilitators to prescribing error reporting across primary care. DESIGN Qualitative semi-structured face-to-face and telephone interviews were conducted to explore facilitators and barriers to reporting prescribing errors. Data collection and thematic analysis were informed by the COM-B model of behaviour change. Framework analysis was used for coding and charting the data with the assistance of NVivo software (V.12). General and context specific influences on prescribing error reporting were mapped to constructs from the COM-B model (ie, capability, opportunity and motivation). SETTING Primary care organisations, including community pharmacy, general practice and community care from North East England. PARTICIPANTS We interviewed a maximal variation purposive sample of 25 participants, including prescribers, community pharmacists and key stakeholders with primary care or medicines safety roles at local, regional and national levels. RESULTS Our findings describe a range of factors that influence the capability, opportunity and motivation to report prescribing errors in primary care. Three key contextual factors are also highlighted that were found to underpin many of the behavioural influences on reporting in this setting: the nature of prescribing; heterogeneous priorities for error reporting across and within different primary care organisations; and the complex infrastructure of reporting and learning pathways across primary care. Findings suggest that there is a lack of consistency in how, when and by whom, prescribing errors are reported across primary care. CONCLUSIONS Further research is needed to identify cross-organisational and interprofessional consensus on agreed reporting thresholds and how best to facilitate a more collaborative approach to reporting and learning, that is, sensitive to the needs and priorities of disparate organisations across primary care. Despite acknowledged challenges, there may be potential for an increased role of community pharmacy in prescribing error reporting to support future learning.
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Affiliation(s)
- Nicola Hall
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Kathryn Bullen
- School of Pharmacy, University of Sunderland, Sunderland, Tyne and Wear, UK
| | - John Sherwood
- School of Pharmacy, University of Sunderland, Sunderland, Tyne and Wear, UK
| | - Nicola Wake
- Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK
- NHS Specialist Pharmacy Service, London North West Healthcare NHS Trust Pharmacy Service, Harrow, London, UK
| | - Scott Wilkes
- School of Pharmacy, University of Sunderland, Sunderland, Tyne and Wear, UK
| | - Gemma Donovan
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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12
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Direct phone communication to primary care physician to plan discharge from hospital: feasibility and benefits. BMC Health Serv Res 2021; 21:1352. [PMID: 34922549 PMCID: PMC8684651 DOI: 10.1186/s12913-021-07398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The discharge summary is the main vector of communication at the time of hospital discharge, but it is known to be insufficient. Direct phone contact between hospitalist and primary care physician (PCP) at discharge could ensure rapid transmission of information, improve patient safety and promote interprofessional collaboration. The objective of this study was to evaluate the feasibility and benefit of a phone call from hospitalist to PCP to plan discharge. METHODS This study was a prospective, single-center, cross-sectional observational study. It took place in an acute medicine unit of a French university hospital. The hospitalist had to contact the PCP by telephone within 72 h prior discharge, making a maximum of 3 call attempts. The primary endpoint was the proportion of patients whose primary care physician could be reached by telephone at the time of discharge. The other criteria were the physicians' opinions on the benefits of this contact and its effect on readmission rates. RESULTS 275 patients were eligible. 8 hospitalists and 130 PCPs gave their opinion. Calls attempts were made for 71% of eligible patients. Call attempts resulted in successful contact with the PCP 157 times, representing 80% of call attempts and 57% of eligible patients. The average call completion rate was 47%. The telephone contact was perceived by hospitalist as useful and providing security. The PCPs were satisfied and wanted this intervention to become systematic. Telephone contact did not reduce the readmission rate. CONCLUSIONS Despite the implementation of a standardized process, the feasibility of the intervention was modest. The main obstacle was hospitalists lacking time and facing difficulties in reaching the PCPs. However, physicians showed desire to communicate directly by telephone at the time of discharge. TRIAL REGISTRATION French C.N.I.L. registration number 2108852. Registration date October 12, 2017.
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Fiol-deRoque MA, Serrano-Ripol MJ, Gens-Barberà M, Sánchez E, Mayer MA, Martín-Luján F, Valderas JM, Ricci-Cabello I. [Impact of the COVID-19 pandemic on patient-reported patient safety in Primary Care]. Aten Primaria 2021; 53 Suppl 1:102222. [PMID: 34961582 PMCID: PMC8708814 DOI: 10.1016/j.aprim.2021.102222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate the impact of the changes introduced in response to the pandemic on patient-reported patient safety in Primary Care. DESIGN Prospective observational panel study (health center) based on two cross-sectional surveys. SETTING 29 Primary Health Care centers from three Spanish health regions (Mallorca, Catalunya Central and Camp de Tarragona). PARTICIPANTS Random sample of patients visiting their centers before (n=2199 patients) and during the pandemic (n=1955 patients) MAIN MEASUREMENTS: We used the PREOS-PC questionnaire, a validated instrument which assesses patient-reported patient safety in Primary Care. We compared mean scores of the "experiences of errors" and "harm" scales in both periods, and built multilevel regression analyzes to study the variations in patient and center characteristics associated with worse levels of safety. A qualitative (content) analysis of patients' experiences during the pandemic was also performed. RESULTS The "experiences of errors" and "harm" scales scores significantly worsened during the COVID-19 period (92.65 to 88.81 (Cohen's d=0.27); and 96.92 to 79.97 (d=0.70), respectively). Patient and center characteristics associated to worsened scores were: women, people with a lower educational level, worse health status, more years assigned to the center, and health region. CONCLUSIONS During the pandemic, a perceptible worsening in patient safety perceived by patients treated in Primary Care has been observed, which has differentially affected patients according to their sociodemographic characteristics or health center profiles.
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Affiliation(s)
- Maria A Fiol-deRoque
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Gerencia de Atención Primaria de Mallorca, Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España
| | - Maria J Serrano-Ripol
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Gerencia de Atención Primaria de Mallorca, Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Universidad de las Islas Baleares (UIB), Departamento de Psicología, Palma, Islas Baleares, España.
| | - Montserrat Gens-Barberà
- Unitat de Qualitat i Seguretat dels Pacients, Gerència Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Encarna Sánchez
- Unitat de Qualitat i Seguretat, Gerència Territorial Catalunya Central, Institut Català de la Salut, Departament de Salut, Barcelona, España
| | - Miguel A Mayer
- Research Programme on Biomedical Informatics (GRIB) del Instituto Hospital del Mar de Investigaciones Médicas y la Universitat Pompeu Fabra, Barcelona, España
| | - Francisco Martín-Luján
- Unitat de Suport a la Recerca de Tarragona, Institut de d'investigació en l'Atenció Primària Jordi Gol (IDIAP Jordi Gol), Institut Català de la Salut, Tarragona, España
| | - José M Valderas
- Health Services & Polic Research Group, Exeter Collaboration for Academic Primary Care, University of Exeter, National Institute for Health Research School for Primary Care Research
| | - Ignacio Ricci-Cabello
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Gerencia de Atención Primaria de Mallorca, Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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14
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Rivers PH, Langford N, Whitehead A, Harrison T. What influences prescribing decisions in a multimorbidity and polypharmacy context on the acute medical unit? An interprofessional, qualitative study. J Eval Clin Pract 2021; 27:1076-1084. [PMID: 33314589 DOI: 10.1111/jep.13519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The primary aim of the study was to understand the mindset of doctors and pharmacists, as they embark upon prescribing in a multimorbidity and polypharmacy context during routine practice at a hospital acute admissions unit. The study also aimed to evaluate to what extent attitudes, embedded within real-life decision-making scenarios, relate to existing theory and models of prescribing decisions. METHODS Anonymized case studies were identified from the medical notes of patients aged 65 and over with conditions likely to be associated with multimorbidity, medication issues and polypharmacy: namely: fall, urinary tract infection, confusion or lower respiratory tract infection. A total of 39 doctors based on the acute medical admissions unit and 9 pharmacists were recruited to one of three focus groups. Patient case-studies provided the context for discussion from which verbatim transcripts were thematically analyzed using an interpretative, qualitative approach. Sub-themes were matched to Murshid and Mohaidin's proposed model of physician prescribing decisions. RESULTS Seven principal themes were identified that were associated with prescribing decisions on the acute medical unit, namely, "patient characteristics," "drug characteristics," "pharmacist factors," "trustworthiness," "reliability of medication history," "competing priorities" and "responsibilities of prescribers." CONCLUSION Prescribing decisions on the acute medical admissions unit were influenced by a variety of factors, some of which have already been acknowledged within existing theories and models. The findings provisionally offer new insights, which, subject to confirmation by further research, bring to light three attitudinal characteristics that may impact negatively upon the quality of prescribing decisions. These include, first, how perceived poor reliability of medication history may result in information gaps that compromise prescribing decisions; second, how competing priorities restrict doctors' aptitude to conduct a review of medication and finally, how doctors may rationalize the assignment of medication review to the GP.
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Affiliation(s)
- Peter H Rivers
- School of Pharmacy, Hawthorn Building, De Montfort University, Leicester, UK
| | - Nigel Langford
- Consultant Clinical Pharmacologist and Acute and General Physician, University of Leicester, Leicester, UK
| | - Andrew Whitehead
- Intensive Care Medicine and Anaesthesia Specialty Registrar, Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Tim Harrison
- School of Pharmacy, Hawthorn Building, De Montfort University, Leicester, UK
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Sugihara T, Kanehira T, Suzuki M, Araki K. Behavioral signs of an unintended error in nursing information sharing with electronic clinical pathways: a mixed research approach. Inform Health Soc Care 2021; 47:159-174. [PMID: 34428108 DOI: 10.1080/17538157.2021.1966015] [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: 10/20/2022]
Abstract
Electronic clinical pathways (ECPs) strongly encourage the standardization of medical treatment and the sharing of information among medical staff. The goal of this study was to determine the influence of ECPs on information sharing among nurses in a university hospital. Four experienced nurses, selected based on ECP composing and operation experience, were recruited from the department with the most frequent users in the first-round interview, 132 nurses' questionnaire answers were analyzed, and eight nurses participated in the second-round interview. This study conducted a mixed-method (interview-questionnaire-interview) investigation to extract the behavioral signs of unintended errors in information sharing after the ethical approval was obtained. On the basis of ANOVA and t-test for the questionnaire and constant comparison for interview, this study found that the greater extent of user dependency on convenient ECPs in the frequent-use group led to mistakes under hectic conditions. This study also found evidence of poor management of ECPs when problems occurred. The immature design of ECPs provoked inappropriate behaviors among nurses even though they brought about some benefits such as mitigation of the burden of daily recording tasks. The findings empirically showed the ECP user's behavioral changes regarding the technology-induced error.
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Affiliation(s)
- Taro Sugihara
- Department of Innovation Science, School of Environment and Society, Tokyo Institute of Technology, Tokyo, Japan
| | - Tadashi Kanehira
- Division of Medical Bioengineering, Graduate School of Natural Science and Technology, Okayama University, Okayama, Japan
| | - Muneou Suzuki
- Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kenji Araki
- Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Strategies supporting sustainable prescribing safety improvement interventions in English primary care: a qualitative study. BJGP Open 2021; 5:BJGPO.2021.0109. [PMID: 34226173 PMCID: PMC8596313 DOI: 10.3399/bjgpo.2021.0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 02/05/2023] Open
Abstract
Background While the use of prescribing safety indicators (PSI) can reduce potentially hazardous prescribing, there is a need to identify actionable strategies for the successful implementation and sustainable delivery of PSI-based interventions in general practice. Aim To identify strategies for the successful implementation and sustainable use of PSI-based interventions in routine primary care. Design & setting Qualitative study in primary care settings across England. Method Anchoring on a complex pharmacist-led IT-based intervention (PINCER) and clinical decision support (CDS) for prescribing and medicines management, a qualitative study was conducted using sequential, multiple methods. The methods comprised documentary analysis, semi-structured interviews, and online workshops to identify challenges and possible solutions to the longer-term sustainability of PINCER and CDS. Thematic analysis was used for the documentary analysis and stakeholder workshops, while template analysis was used for the semi-structured interviews. Findings across the three methods were synthesised using the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework. Results Forty-eight documents were analysed, and 27 interviews and two workshops involving 20 participants were undertaken. Five main issues were identified, which aligned with the adoption and maintenance dimensions of RE-AIM: fitting into current context (adoption); engaging hearts and minds (maintenance); building resilience (maintenance); achieving engagement with secondary care (maintenance); and emphasising complementarity (maintenance). Conclusion Extending ownership of prescribing safety beyond primary care-based pharmacists, and achieving greater alignment between general practice and hospital prescribing safety initiatives, is fundamental to achieve sustained impact of PSI-based interventions in primary care.
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AL-Mutairi A, AlFayyad I, Altannir Y, Al-Tannir M. Medication safety knowledge, attitude, and practice among hospital pharmacists in tertiary care hospitals in Saudi Arabia: a multi-center study. Arch Public Health 2021; 79:130. [PMID: 34253257 PMCID: PMC8274029 DOI: 10.1186/s13690-021-00616-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 05/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pharmacovigilance (PV) demarcates all actions involving the detection and prevention of adverse drug reactions (ADR) for marketed drugs. However, ADRs are considerably underreported worldwide and continue to be a major concern to health care systems. This study aims to assess the knowledge, attitude, and perception of hospital pharmacists regarding medication safety concerning PV and ADRs across multiple tertiary care centers around Saudi Arabia. METHODS This cross-sectional study was conducted between July 2019 and January 2020. Pharmacists working in the tertiary care centers of Riyadh City, Saudi Arabia were asked to participate in the study. A self-administered questionnaire was used to conduct this study, it consisted of: 63 questions out of which 19 questions were knowledge-based, 15 were attitude-based, and 29 were practice-based questions. RESULTS A total of 350 pharmacists were distributed and 289 agreed to participate, giving a response rate of 82.6%. Most pharmacists were aware of the concept of VP and its functions (96.5%) and (87.2%), respectively. Moreover, 90% said that ADR can be preventable and non-preventable. However, the findings revealed inadequate knowledge about the overall PV field, where the majority of the pharmacists failed to correctly answer questions related to independent ADRs treatment, Augmented drug reaction, the international location of ADR, and the World Health Organization "online database" for reporting ADRs. Moreover, incomplete and/or wrong answers were recorded for questions that included single or multiple correct answers. Regarding the participants" attitude, 96.9% were interested in ADR reporting, agreeing that ADR is important to enable safe drug usage. Although a general positive attitude was recorded, pharmacists have stated that the three main barriers that hinder reporting ADRs are: unavailability of information about ADRs, lack of awareness about the need to report ADRs, and lack of time. Concerning practice, 69.2% said they received training in ADRs reporting, and 70% have reported ADRs more than once a week. CONCLUSION Surveyed pharmacists from Riyadh hospitals showed narrow knowledge of the PV field. However, a positive attitude and satisfactory practice was observed among pharmacists. These findings warrant the need for educational programs and an encouraging environment for ADR reporting to increase ADR reporting rates and support PV activities in Saudi Arabia.
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Affiliation(s)
- Azizah AL-Mutairi
- Pharmacy Administration, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525 Kingdom of Saudi Arabia
| | - Isamme AlFayyad
- Research Center, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525 Kingdom of Saudi Arabia
| | - Youssef Altannir
- College of Medicine, AlFaisal University, P.O. Box 50927, Takhasusi Road, Riyadh, 11533 Kingdom of Saudi Arabia
| | - Mohamad Al-Tannir
- Research Center, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525 Kingdom of Saudi Arabia
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18
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Adie K, Fois RA, McLachlan AJ, Walpola RL, Chen TF. The nature, severity and causes of medication incidents from an Australian community pharmacy incident reporting system: The QUMwatch study. Br J Clin Pharmacol 2021; 87:4809-4822. [PMID: 34022060 DOI: 10.1111/bcp.14924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 04/07/2021] [Accepted: 05/04/2021] [Indexed: 12/01/2022] Open
Abstract
AIMS Most research into medication safety has been conducted in hospital settings with less known about primary care. The aim of this study was to characterise the nature and causes of medication incidents (MIs) in the community using a pharmacy incident reporting programme. METHODS Thirty community pharmacies participated in an anonymous or confidential MI spontaneous reporting programme in Sydney, Australia. The Advanced Incident Management System was used to record and classify incident characteristics, contributing factors, severity and frequency ratings. RESULTS In total, 1013 incidents were reported over 30 months, 831 of which were near misses while 165 reports involved patient harm. The largest proportion of cases pertained to patients aged >65 years (35.7%). Most incidents involved errors during the prescribing stage (61.1%), followed by dispensing (25.7%) and administration (23.5%), while some errors occurred at multiple stages (17.9%). Systemic antibacterials (12.2%), analgesics (11.8%) and renin-angiotensin medicines (11.7%) formed the majority of implicated classes. Participants identified diverse and interrelating contributing factors: those concerning healthcare providers included violations to procedures/guidelines (75.6%), rule-based mistakes (55.6%) and communication (50.6%); those concerning patients included cognitive factors (31.9%), communication (25.5%) and behaviour (6.1%). Organisational safety culture and inadequate risk management processes were rated as suboptimal. CONCLUSION An MI reporting programme can capture and characterise medication safety problems in the community and identify the human and system factors that contribute to errors. Since medicine use is ubiquitous in the community, morbidity and mortality from MIs may be reduced by addressing the prioritised risks and contributing factors identified in this study.
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Affiliation(s)
- Khaled Adie
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Romano A Fois
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ramesh L Walpola
- School of Public Health and Community Medicine, Sydney, Australia
| | - Timothy F Chen
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Shiima Y, Malik M, Okorie M. Medication Without Harm: Developing optimal medication error reporting systems. Curr Drug Saf 2021; 17:7-12. [PMID: 33902416 DOI: 10.2174/1574886316666210423115029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/29/2020] [Accepted: 02/16/2021] [Indexed: 11/22/2022]
Abstract
Medication errors are amongst the most frequently occurring health care related incidents and have the potential to lead to life-threatening harm to patients. An incident reporting system is a traditional approach to improvement of patient safety and entails the retrieval of information from incident reports. This not only provides a better understanding of causes and contributing factors but also enables the collection of data on the severity of incidents, system deficiencies and the role of human factors in safety incidents. Medication error reporting systems are often developed as a part of larger incident reporting systems which deal with other types of incidents. Although a rise in the prevalence of medication errors has led to an increased demand for medication error reporting, little is known about characteristics and limitations of medication error reporting systems. The authors broach the subject of medication error reporting systems and propose a more robust and standardized approach.
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Affiliation(s)
- Yuko Shiima
- Brighton and Sussex Medical School, Falmer, Brighton, UK; 2 Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Muzaffar Malik
- Brighton and Sussex Medical School, Falmer, Brighton, UK; 2 Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Michael Okorie
- Brighton and Sussex Medical School, Falmer, Brighton, UK; 2 Brighton and Sussex University Hospitals, Brighton, United Kingdom
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20
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Ricci-Cabello I, Yañez-Juan AM, Fiol-deRoque MA, Leiva A, Llobera Canaves J, Parmentier FBR, Valderas JM. Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data. J Clin Med 2021; 10:1782. [PMID: 33923906 PMCID: PMC8073542 DOI: 10.3390/jcm10081782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 01/02/2023] Open
Abstract
We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men.
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Affiliation(s)
- Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, 07002 Palma, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Aina María Yañez-Juan
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Department of Nursing and Physiotherapy and Global Health Research Group, University of the Balearic Islands, 07122 Palma, Spain
| | - Maria A. Fiol-deRoque
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, 07002 Palma, Spain
| | - Alfonso Leiva
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, 07002 Palma, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
| | - Joan Llobera Canaves
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, 07002 Palma, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
| | - Fabrice B. R. Parmentier
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Department of Psychology and Institute of Health Sciences (iUNICS), University of the Balearic Islands, 07122 Palma, Spain
- School of Psychology, The University of Western Australia, Perth, WA 6009, Australia
| | - Jose M. Valderas
- Health Services & Policy Research Group, Exeter Collaboration for Academic Primary Care, NIHR School for Primary Care Research, University of Exeter, Exeter EX1 2HZ, UK
- NIHR South West Peninsula Applied Research Collaboration, University of Exeter, Exeter EX1 2HZ, UK
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
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Kane-Gill SL, Barreto EF, Bihorac A, Kellum JA. Development of a Theory-Informed Behavior Change Intervention to Reduce Inappropriate Prescribing of Nephrotoxins and Renally Eliminated Drugs. Ann Pharmacother 2021; 55:1474-1485. [PMID: 33855858 DOI: 10.1177/10600280211009567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Goals of managing patients with acute kidney injury (AKI) are mitigating disease progression and ensuring safety while providing supportive care because no effective treatment exists. One strategy recommended in guidelines to meet these goals is optimizing medication management. Unfortunately, guideline implementation appears to be lacking as observed by the frequent occurrence of medication errors and adverse drug events. OBJECTIVE To address this performance gap in the care of hospitalized patients receiving nephrotoxins and renally eliminated drugs, we sought to provide a potential intervention based on theory-informed behavior change. METHODS Formative research with a qualitative analysis identifying what needs to change in patient care was completed by obtaining clinician opinion and expert opinion and reviewing the published literature. Frontline providers, including 8 physicians, 4 pharmacists, and a multiprofessional group of authors, provided insight into possible barriers to appropriate prescribing. Capability, Opportunity, Motivation and Behavior model and Theoretical Domain Framework were applied to characterize behavior change interventions and inform a potential implementation intervention for changing inappropriate prescribing behaviors. RESULTS Lack of knowledge about appropriate drug management in patients at risk for adverse outcomes was provided as a major barrier. Other reported barriers included a lack of: (1) tools to assist with drug management, (2) motivation to make changes, (3) routinization, and (4) an accountable clinician. CONCLUSIONS AND RELEVANCE Assigning a designated clinician to execute a stepwise, routine care process following the checklist provided is a recommended intervention to overcome barriers. The intended impact is behavior change that reduces inappropriate prescribing.
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Affiliation(s)
- Sandra L Kane-Gill
- School of Pharmacy, Pittsburgh, PA, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - John A Kellum
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Adie K, Fois RA, McLachlan AJ, Chen TF. Medication incident recovery and prevention utilising an Australian community pharmacy incident reporting system: the QUMwatch study. Eur J Clin Pharmacol 2021; 77:1381-1395. [PMID: 33646375 DOI: 10.1007/s00228-020-03075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify factors in community pharmacy that facilitate error recovery from medication incidents (MIs) and explore medication safety prevention strategies from the pharmacist perspective. METHODS Thirty community pharmacies in Sydney, Australia, participated in a 30-month prospective incident reporting program of MIs classified in the Advanced Incident Management System (AIMS) and the analysis triangulated with case studies. The main outcome measures were the relative frequencies and patterns in MI detection, minimisation, restorative actions and prevention recommendations of community pharmacists. RESULTS Participants reported 1013 incidents with 831 recovered near misses and 165 purported patient harm. MIs were mainly initiated at the prescribing (68.2%) and dispensing (22.6%) stages, and most were resolved at the pharmacy (76.9%). Detection was efficient within the first 24 h in 54.6% of MIs, but 26.1% required one month or longer; 37.2% occurred after the patient consumed the medicine. The combination of specific actions/attributes (85.5%), appropriate interventions (81.6%) and effective communication (77.7%) minimised MIs. An array of remedial actions were conducted by participants including notification, referral, advice, modification of medication regimen, risk management and documentation corrections. Recommended prevention strategies involved espousal of medication safety culture (97.8%), better application of policies/procedures (84.6%) and improvements in healthcare providers' education (79.9%). CONCLUSION Incident reporting provided insights on the human and organisational factors involved in the recovery of MIs in community pharmacy. Optimising existing safeguards and redesigning certain structures and processes may enhance the resilience of the medication use system in primary care.
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Affiliation(s)
- Khaled Adie
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Romano A Fois
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy F Chen
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Cornet L, Gervaise C, Hugues M, Menguy S, Macé A, Tinquaut F, Forges F, Simoens X. How human activity impacted manufacturing non-compliances: A multivariate analysis in a centralized cytotoxic preparation unit. J Oncol Pharm Pract 2020; 27:1896-1903. [PMID: 33203300 DOI: 10.1177/1078155220973065] [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: 11/15/2022]
Abstract
INTRODUCTION The aim of the study was to identify risk factors related to human errors in the preparation of anticancer drugs in order to improve the pharmaceutical process by setting corrective actions. METHOD Risk factors which could increase the probability of error were identified: daily workload, workload on the previous day and subcontractors' workload, time slot of the preparation, understaffing, incidents which could affect workflow, individual experience of technicians and cleanrooms layout. Drug reconstitution or complex fabrications were also considered as risk factors. We used univariate and multivariate logistic regression analyses to screen for correlation between risks and errors. RESULT Among 11 278 preparations analyzed, 115 were non-compliant. Univariate analysis shows significant variables: individual experience of technicians, technicians working in the same cleanrooms and technicians' rotations. 2 technicians are significantly associated with a higher risk of error and 5 with a lower risk. The multivariate analysis confirmed the conclusions of the univariate. DISCUSSION As expected, time slot of the manufacture, cleanrooms layout and some technicians increase the risk of error. Surprisingly, technicians' experience led to increase the risk. This study is a first approach to evaluate the human error aspect in non-compliant preparations, in order to optimize security of antineoplastic drugs preparations.
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Affiliation(s)
- Lucie Cornet
- Department of Pharmacy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Caroline Gervaise
- Department of Pharmacy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Marion Hugues
- Department of Pharmacy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Sandrine Menguy
- Department of Pharmacy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Agnès Macé
- Department of Pharmacy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | | | - Fabien Forges
- Department of Pharmacy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Xavier Simoens
- Department of Pharmacy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
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Abstract
BACKGROUND A nonroutine event is any aspect of clinical care perceived by clinicians or trained observers as a deviation from optimal care based on the context of the clinical situation. The authors sought to delineate the incidence and nature of intraoperative nonroutine events during anesthesia care. METHODS The authors prospectively collected audio, video, and relevant clinical information on 556 cases at three academic hospitals from 1998 to 2004. In addition to direct observation, anesthesia providers were surveyed for nonroutine event occurrence and details at the end of each study case. For the 511 cases with reviewable video, 400 cases had no reported nonroutine events and 111 cases had at least one nonroutine event reported. Each nonroutine event was analyzed by trained anesthesiologists. Rater reliability assessment, comparisons (nonroutine event vs. no event) of patient and case variables were performed. RESULTS Of 511 cases, 111 (21.7%) contained 173 nonroutine events; 35.1% of event-containing cases had more than one nonroutine event. Of the 173 events, 69.4% were rated as having patient impact and 12.7% involved patient injury. Longer case duration (25th vs. 75th percentile; odds ratio, 1.83; 95% CI, 1.15 to 2.93; P = 0.032) and presence of a comorbid diagnosis (odds ratio, 2.14; 95% CI, 1.35 to 3.40; P = 0.001) were associated with nonroutine events. Common contributory factors were related to the patient (63.6% [110 of 173]) and anesthesia provider (59.0% [102 of 173]) categories. The most common patient impact events involved the cardiovascular system (37.4% [64 of 171]), airway (33.3% [57 of 171]), and human factors, drugs, or equipment (31.0% [53 of 171]). CONCLUSIONS This study describes characteristics of intraoperative nonroutine events in a cohort of cases at three academic hospitals. Nonroutine event-containing cases were commonly associated with patient impact and injury. Thus, nonroutine event monitoring in conjunction with traditional error reporting may enhance our understanding of potential intraoperative failure modes to guide prospective safety interventions.
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Feyissa D, Kebede B, Zewudie A, Mamo Y. Medication Error and Its Contributing Factors Among Pediatric Patients Diagnosed with Infectious Diseases Admitted to Jimma University Medical Center, Southwest Ethiopia: Prospective Observational Study. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2020; 9:147-153. [PMID: 32983947 PMCID: PMC7501953 DOI: 10.2147/iprp.s264941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background Medication errors in pediatric patients are grossly underreported. Pediatric patients are quite susceptible to medication errors. Potential injury by medication error is higher in young children and infants. It results in serious morbidity and mortality. Thus, this study aimed to assess medication error and its contributing factors among pediatric patients diagnosed with infectious diseases admitted to Jimma University Medical Center. Methods A prospective observational study was conducted among pediatric patients with infectious diseases admitted from April 1 to June 30, 2018. The patient’s written informed consent was obtained after explaining the purpose of the study. The data were collected by structured questionnaire. Data were entered into EpiData version 4.0.2 and then exported to SPSS version 21.0 for analysis. To identify the predictors of medication error, backward logistic regression analysis was done. Results From a total of the 325 study participants, 136 (41.8%) patients had at least one medication error during their hospital stay. A total of 273 medication errors were identified among 136 patients. Medication errors frequently occurred at prescribing stage 94 (34.4%). The most common types of medication errors were wrong dosing 72 (26.4%) and wrong frequency 47 (17.2%). Presence of disease comorbidity (AOR=1.64, 95%CI=1.01–2.67), being male (AOR=1.79, 95%CI:1.13–2.86) and presence of two infectious diseases (AOR=1.96, 95%CI: 1.20–3.23) and more than three infectious diseases (AOR=2.04, 95%CI: 1.03–4.01) were independent predictors of medication error occurrence. Conclusion and Recommendation Medication errors were common in pediatric patients with infectious diseases in the study area. Presence of comorbidities, being male and the number of infectious diseases were associated with the occurrence of medication errors. Therefore, to reduce medication errors in the study setting, e-prescribing, computerized provider order entry, medication reconciliation, and collaboration of clinical pharmacists with other health professionals are needed.
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Affiliation(s)
- Desalegn Feyissa
- Department of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Bezie Kebede
- Department of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Ameha Zewudie
- Department of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Yitagesu Mamo
- Department of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Ritchie O, Shetty V, Prabhu S, Shetty AK. Confidence in Antibiotic Prescribing Intentions among Senior Medical Students in India. Am J Trop Med Hyg 2020; 103:2561-2567. [PMID: 32901598 DOI: 10.4269/ajtmh.20-0193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Antimicrobial resistance (AMR) is a major public health problem in India. We surveyed medical students to assess their knowledge, attitudes, and factors associated with confidence in antibiotic prescribing intent. In this cross-sectional study, a convenience sample of 356 students were surveyed in July-August 2017 on AMR-related knowledge, attitudes, information sources and antimicrobial training. Antimicrobial resistance knowledge and attitude scores were calculated. Bivariate analysis using the chi-square test of independence and multivariate binary logistic regression analysis were used to investigate factors associated with confidence in antibiotic prescribing intent. A total of 347 students completed the survey; 64% agreed that strong knowledge of antibiotics is important in their medical careers; 61% stated that they would like more education regarding appropriate use of antibiotics. The mean total knowledge score was 11.5 out of 31 (SD = 3.4), and the mean attitude score was 6.0 out of 16 (SD = 4.2). Although 13% of students were "very familiar"/"familiar" with the term "antimicrobial stewardship," only 35% of students felt "very confident" or "confident" in antimicrobial prescribing to patients in the future. On multivariate analysis, female gender, clinical vignette antimicrobial knowledge scores, positive attitude scores, awareness of Infection Control Policy, and > 3 years of antimicrobial prescribing clinical training were predictors of confidence in antimicrobial prescribing. A higher attitude score was independently associated with decreased confidence in antimicrobial prescribing intent. There is a need to improve education regarding AMR in the curriculum, and increase awareness of infection control policies and antimicrobial stewardship program in clinical settings.
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Affiliation(s)
| | | | - Sumathi Prabhu
- Department of Mathematics, Manipal Institute of Technology, Manipal, India
| | - Avinash K Shetty
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Siregar AS, Werdhani RA, Ascobat P, Nafrialdi N, Syam AF, Hidayat R, Wangge G. Development of a module for the prevention of nonsteroidal anti-inflammatory drugs-associated gastrointestinal adverse reactions in the elderly at a primary health center. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2020; 32:61-73. [PMID: 32894252 DOI: 10.3233/jrs-200008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prevention of nonsteroidal anti-inflammatory drugs (NSAIDs) adverse reactions should start from the primary health center (PHC), as the first gatekeeper in community health services. However, there is no specific module available for health care professionals (HCPs) in Indonesia for the prevention of adverse drug reactions (ADR) at PHCs. NSAID is commonly used for the elderly treated at PHC in Indonesia, even though the ADR risk is well-known. OBJECTIVE We aimed to develop a module to be used in PHC for preventing NSAID-associated upper gastrointestinal (GI) ADRs in elderly patients treated for musculoskeletal diseases. METHODS The module was developed based on inputs from focus group discussions (FGD) among government health officers, PHC representatives, clinical pharmacologists, internal medicine and community medicine clinicians, pharmacovigilance experts, and professional organizations. A pilot implementation was conducted to test its feasibility and its effect on the HCPs' knowledge. RESULTS Capacity building of HCPs, development of intra-HCP cooperation, as well as standard operating procedure (SOP) for the prescription of NSAID constituted important components of the module. A pilot study of the module in two PHCs showed that it was applicable with some recommendations for improvement in duration, number of participants, room space, presentation, and use of credit points as compliments. The HCPs' knowledge was improved after following the module. CONCLUSIONS Our study showed that the module is feasible in PHC in Indonesia and useful in improving knowledge of HPC.
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Affiliation(s)
- Alyya Siddiqa Siregar
- Doctoral Program in Medical Sciences, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.,Department of Pharmacology, Faculty of Medicine, State Islamic University Syarif Hidayatullah Jakarta, Jakarta, Indonesia
| | - Retno Asti Werdhani
- Department of Community Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Purwantyastuti Ascobat
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Nafrialdi Nafrialdi
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Ari Fahrial Syam
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Rudy Hidayat
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Grace Wangge
- South East Asian Ministers of Education Organization - Regional Center for Food and Nutrition (SEAMEO-RECFON), Pusat Kajian Gizi Regional University of Indonesia (PKGR UI), Jakarta, Indonesia
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Karaben VE, Pomarada ME, Rea AE, Morales SD. Observación e intervención educativa para modificar la prescripción de antibióticos en un instituto social de la ciudad de Corrientes, Argentina. ACTA ODONTOLÓGICA COLOMBIANA 2020. [DOI: 10.15446/aoc.v10n2.85636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: analizar y mejorar las prescripciones de antibióticos por parte de odontólogos, a través de una intervención educativa. Método: se realizó un estudio analizando las recetas de prescripción de medicamentos antes y después de la intervención educativa, en el Instituto de Servicios Sociales de la Universidad Nacional del Nordeste. El estudio comprendió tres etapas; en la etapa A se identificaron problemas de prescripción, que fueron socializados con los profesionales durante la intervención educativa como parte de la etapa B, cuya modalidad consistió en dos entrevistas presenciales, con talleres de discusión y debate. En esta se trabajó, además, con el informe de los resultados obtenidos en el análisis de situación de la etapa A. En la etapa C se analizó el impacto de la intervención educativa. Resultados: en la etapa A se observaron 417 recetas con 202 prescripciones de antibióticos, los más indicados fueron azitromicina (31%), amoxicilina con clavulánico (10%) y amoxicilina (8%). La adecuación de prescripción en relación a la indicación fue del 26%. En la etapa C, de un total de 191 recetas, se analizaron 107 recetas con prescripción de antibióticos. La amoxicilina fue el medicamento más prescripto (37%); la prescripción de azitromicina disminuyó a 14% y su adecuación fue del 46%. Ello evidenció una mejoría del 20%, la cual fue validada a través del test chi2 (p=0,00). Conclusión: por medio de la intervención educativa presencial es posible mejorar las prescripciones de antibióticos, no obstante se desconoce si el cambio de conducta prescriptiva se mantiene en el tiempo.El estudio comprendió tres etapas, la primera para identificar problemas de prescripción a fin de ser socializado con los profesionales durante la intervención educativa, que incluía procedimientos educativos presenciales. En la última etapa se analizó el impacto de la intervención educativa. Resultados: Etapa A: se observaron 417 recetas con 202 prescripciones de antibióticos, los más indicados fueron azitromicina (31%); amoxicilina con clavulánico (10%) y amoxicilina (8%). La adecuación de prescripción en relación a la indicación fue del 26%; la etapa B correspondió a la intervención educativa, a través de discusión y análisis de la situación. En la etapa C se analizaron 107 recetas con prescripción de antibióticos, se observó que el más prescrito fue amoxicilina (37%) y la prescripción de azitromicina disminuyó a 14%. La adecuación fue del 46%, evidenciándose una mejoría del 20%, validado a través del test chi2 (p=0,00). En conclusión se observó que a través de una intervención educativa con los profesionales prescriptores, se pudo mejorar las prescripciones de antibióticos, no obstante se desconoce si el cambio de conducta prescriptiva se mantiene en el tiempo.
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Shao SC, Chan YY, Lin SJ, Li CY, Kao Yang YH, Chen YH, Chen HY, Lai ECC. Workload of pharmacists and the performance of pharmacy services. PLoS One 2020; 15:e0231482. [PMID: 32315319 PMCID: PMC7173874 DOI: 10.1371/journal.pone.0231482] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/24/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the influence of pharmacists’ dispensing workload (PDW) on pharmacy services as measured by prescription suggestion rate (PSR) and dispensing error rate (DER). Method This was an observational study in northern and southern Taiwan’s two largest medical centers, from 2012 to 2018. We calculated monthly PDW as number of prescriptions divided by number of pharmacist working days. We used monthly PSR and DER as outcome indicators for pharmacists’ review and dispensing services, respectively. We used Poisson regression model with generalized estimation equation methods to evaluate the influence of PDW on PSR and DER. Results The monthly mean of 463,587 (SD 32,898) prescriptions yielded mean PDW, PSR and DER of 52 (SD 3) prescriptions per pharmacist working days, 30 (SD 7) and 8 (SD 2) per 10,000 prescriptions monthly, respectively. There was significant negative impact of PDW on PSR (adjusted rate ratio, aRR: 0.9786; 95%CI: 0.9744–0.9829) and DER (aRR: 0.9567; 95%CI: 0.9477–0.9658). Stratified analyses by time periods (2012–2015 and 2016–2018) revealed the impact of PDW on PSR to be similar in both periods; but with positive association between PDW and DER in the more recent one (aRR: 1.0086, 95%CI: 1.0003–1.0169). Conclusions Reduced pharmacist workload was associated with re-allocation of pharmacy time to provide prescription suggestions and, more recently, decrease dispensing errors. Continuous efforts to maintain appropriate workload for pharmacists are recommended to ensure prescription quality.
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Affiliation(s)
- Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuk-Ying Chan
- Department of Pharmaceutical Material Management, Chang Gung Medical Foundation, Taoyuan, Taiwan
| | - Swu-Jane Lin
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yea-Huei Kao Yang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Hua Chen
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Hui-Yu Chen
- Department of Pharmacy, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan
- * E-mail:
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O' Neill SB, Vijayasarathi A, Nicolaou S, Walstra F, Salamon N, Munk PL, Khosa F. Evaluating Radiology Result Communication in the Emergency Department. Can Assoc Radiol J 2020; 72:846-853. [PMID: 32063052 DOI: 10.1177/0846537119899268] [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: 11/16/2022] Open
Abstract
PURPOSE To assess the pattern of result communication that occurs between radiologists and referring physicians in the emergency department setting. METHODS An institutional review board-approved prospective study was performed at a large academic medical center with 24/7 emergency radiology cover. Emergency radiologists logged information regarding all result-reporting communication events that occurred over a 168-hour period. RESULTS A total of 286 independent result communication events occurred during the study period, the vast majority of which occurred via telephone (232/286). Emergency radiologists spent 10% of their working time communicating results. Similar amounts of time were spent discussing negative and positive cross-sectional imaging examinations. In a small minority of communication events, additional information was gathered through communication that resulted in a change of interpretation from a normal to an abnormal study. CONCLUSIONS Effective and efficient result communication is critical to care delivery in the emergency department setting. Discussion regarding abnormal cases, both in person and over the phone, is encouraged. However, in the emergency setting, time spent on routine direct communication of negative examination results in advance of the final report may lead to increased disruptions, longer turnaround times, and negatively impact patient care. In very few instances, does the additional information gained from the communication event result in a change of interpretation?
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Affiliation(s)
- Siobhan B O' Neill
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arvind Vijayasarathi
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Savvas Nicolaou
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frances Walstra
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Noriko Salamon
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Peter L Munk
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Faisal Khosa
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Serrano-Ripoll MJ, Ripoll J, Llobera J, Valderas JM, Pastor-Moreno G, Olry de Labry Lima A, Ricci-Cabello I. Development and evaluation of an intervention based on the provision of patient feedback to improve patient safety in Spanish primary healthcare centres: study protocol. BMJ Open 2019; 9:e031367. [PMID: 31874872 PMCID: PMC7008422 DOI: 10.1136/bmjopen-2019-031367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Despite the enormous potential for adverse events in primary healthcare (PHC), the knowledge about how to improve patient safety in this context is still sparse. We describe the methods for the development and evaluation of an intervention targeted at PHC professionals to improve patient safety in Spanish PHC centres. METHODS AND ANALYSIS The intervention will consist in using the patient reported experiences and outcomes of safety in primary care (PREOS-PC) survey to gather patient-reported experiences and outcomes concerning the safety of the healthcare patients receive in their PHC centres, and feed that information back to the PHC professionals to help them identify opportunities for safer healthcare provision. The study will involve three stages. Stage 1 (developing the intervention) will involve: (i) qualitative study with 40 PHC providers to optimise the acceptability and perceived utility of the proposed intervention; (ii) Spanish translation, cross-cultural adaptation and validation of the PREOS-PC survey; (iii) developing the intervention components; and (iv) developing an online tool to electronically administrate PREOS-PC and automatically generate feedback reports to PHC centres. Stage 2 (piloting the intervention) will involve a 3-month feasibility (one group pre-post) study in 10 PHC centres (500 patients, 260 providers). Stage 3 (evaluating the intervention) will involve: (i) a 12-month, two-arm, two-level cluster randomised controlled trial (1248 PHC professionals within 48 PHC centres; with randomisation at the centre level in a 1:1 ratio) to evaluate the impact of the intervention on patient safety culture (primary outcome), patient-reported safety experiences and outcomes (using the PREOS-PC survey), and avoidable hospitalisations; (ii) qualitative study with 20 PHC providers to evaluate the acceptability and perceived utility of the intervention and identify implementation barriers. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the Balearic Islands (CEI IB: 3686/18) with the 1964 Helsinki Declaration and its later amendments. The results will be disseminated in peer-reviewed publications and national and international conferences. TRIAL REGISTRATION NUMBER NCT03837912; pre-results.
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Affiliation(s)
- Maria J Serrano-Ripoll
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Balearic Islands, Spain
- GRAPP-caIB, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
- Psychology, University of Balearic Islands, Palma, Balearic Islands, Spain
| | - Joana Ripoll
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Balearic Islands, Spain
- GRAPP-caIB, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
- Primary Care Prevention and Health Promotion Network, RedIAPP, Barcelona, Spain
| | - Joan Llobera
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Balearic Islands, Spain
- GRAPP-caIB, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
- Primary Care Prevention and Health Promotion Network, RedIAPP, Barcelona, Spain
| | - Jose Maria Valderas
- Health Services and Policy Research, Medical School, University of Exeter, Exeter, Devon, UK
| | - Guadalupe Pastor-Moreno
- CIBER Epidemiology and Public Health. CIBERESP, Madrid, Spain
- Andalusian School of Public Health, Granada, Andalusia, Spain
| | - Antonio Olry de Labry Lima
- CIBER Epidemiology and Public Health. CIBERESP, Madrid, Spain
- Andalusian School of Public Health, Granada, Andalusia, Spain
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Balearic Islands, Spain
- GRAPP-caIB, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
- CIBER Epidemiology and Public Health. CIBERESP, Madrid, Spain
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Rosa MB, Nascimento MMGD, Cirilio PB, Santos RDA, Batista LF, Perini E, Couto RC. Electronic prescription: frequency and severity of medication errors. Rev Assoc Med Bras (1992) 2019; 65:1349-1355. [PMID: 31800895 DOI: 10.1590/1806-9282.65.11.1349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/11/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the frequency and severity of prescriptions errors with potentially dangerous drugs (heparin and potassium chloride for injection concentrate) before and after the introduction of a computerized provider order entry (CPOE) system. METHODS This is a retrospective study that compared errors in manual/pre-typed prescriptions in 2007 (Stage 1) with CPOE prescriptions in 2014 (Stage 2) (Total = 1,028 prescriptions), in two high-complexity hospitals of Belo Horizonte, Brasil. RESULTS An increase of 25% in the frequency of errors in Hospital 1 was observed after the intervention (p<0.001). In contrast, a decreased error frequency of 85% was observed in Hospital 2 (p<0.001). Regarding potassium chloride, the error rate remained unchanged in Hospital 1 (p>0.05). In Hospital 2, a significant decrease was recorded in Stage 2 (p<0.001). A reduced error severity with heparin (p<0.001) was noted, while potassium chloride-related prescription severity remain unchanged (p> 0.05). CONCLUSIONS The frequency and severity of medication errors after the introduction of CPOE was affected differently in the two hospitals, which shows a need for thorough observation when the prescription system is modified. Control of new potential errors introduced and their causes for the adoption of measures to prevent these events must be in place during and after the implementation of this technology.
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Affiliation(s)
- Mário Borges Rosa
- Instituto para Práticas Seguras no Uso de Medicamentos (ISMP-Brasil), Belo Horizonte, MG, Brasil.,Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Mariana Martins Gonzaga do Nascimento
- Instituto para Práticas Seguras no Uso de Medicamentos (ISMP-Brasil), Belo Horizonte, MG, Brasil.,Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | | | | | - Edson Perini
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Sabir FRN, Tomlinson J, Strickland-Hodge B, Smith H. Evaluating the Connect with Pharmacy web-based intervention to reduce hospital readmission for older people. Int J Clin Pharm 2019; 41:1239-1246. [PMID: 31392581 PMCID: PMC6800861 DOI: 10.1007/s11096-019-00887-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/27/2019] [Indexed: 11/28/2022]
Abstract
Background The patient transition from a hospital to a post-discharge healthcare setting has potential to disrupt continuity of medication management and increase the risk of harm. “Connect with Pharmacy” is a new electronic web-based transfer of care initiative employed by Leeds Teaching Hospitals NHS Trust. This allows the sharing of discharge information between the hospital and a patient’s chosen community pharmacy. Objective We investigated whether the timely sharing of discharge information with community pharmacies via “Connect with Pharmacy” reduced hospital readmission rates in older patients. Method To evaluate intervention efficacy, hospital admission data was retrospectively collected. For primary analysis, admission rates were tracked 6-months prior (baseline) and 6-months post-intervention. Secondary measures included effect on total length of stay if readmitted, emergency department attendance and duration, and impact of polypharmacy. Main outcome measure The rate of non-elective hospital readmissions, 6-months post-intervention. Results In the sample (n = 627 patients; Mean age = 81 years), emergency readmission rates following the intervention (M = 1.1, 95% CI [0.98, 1.22]) reduced by 16.16% relative to baseline (M = 1.31, 95% CI [1.21, 1.42]) (W = 54,725; p < 0.001). There was no reduction in total length of stay. Subsidiary analysis revealed a post-intervention reduction in number of days spent in hospital lasting more than three days (χ2 = 13.37, df = 1, p < 0 .001). There were no statistically reliable differences in the remaining secondary measures. Conclusion The results showed a reduction in readmissions and potential post-intervention length of stay, indicating there may be further benefits for our older patients’ experiences and hospital flow.
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Affiliation(s)
- Fatima R N Sabir
- Medicines Management and Pharmacy Services, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | - Justine Tomlinson
- Medicines Management and Pharmacy Services, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK. .,School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK.
| | | | - Heather Smith
- Medicines Management and Pharmacy Services, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
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Bediako-Bowan AAA, Owusu E, Labi AK, Obeng-Nkrumah N, Sunkwa-Mills G, Bjerrum S, Opintan JA, Bannerman C, Mølbak K, Kurtzhals JAL, Newman MJ. Antibiotic use in surgical units of selected hospitals in Ghana: a multi-centre point prevalence survey. BMC Public Health 2019; 19:797. [PMID: 31226974 PMCID: PMC6588883 DOI: 10.1186/s12889-019-7162-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 06/13/2019] [Indexed: 01/21/2023] Open
Abstract
Background Improper use of antibiotics leads to the emergence of resistant microorganisms as well as drug toxicity, increased healthcare costs, morbidity and mortality. Globally, an estimated 25–68% of hospitalized patients receive suboptimal antibiotic regimes. Information on the extent of this problem in Ghana is currently limited, particularly in surgical units. To strategize for interventions, we estimated the antibiotic use prevalence in surgical departments in a country-wide point prevalence survey (PPS) in Ghana. Methods Between October 2016 and December 2016, we conducted a cross-sectional multi-center country-wide PPS. This involved an audit of in-patients’ records from all units/departments of ten systematically selected hospitals in Ghana. Data were collected with a standardized questionnaire, adopted from the European Centre for Disease Prevention and Control. In this report, we present data on antibiotic use from the surgical units. Results Of 2107 eligible patients included in the PPS, 540 patients were identified in surgical units, of which 70.7% (382/540) received antibiotic therapy. A total of 636 antibiotic prescriptions were issued to these surgical patients; 224 (58.6%) for treatment, including 50 for treatment of hospital-acquired infections, and 144 (37.7%) for prophylaxis (medical and surgical). Median duration of antibiotic therapy prior to the survey was 5 days (interquartile range (IQR): 3-8 days). Surgical prophylaxis was administered for longer than the recommended one day in 107 of 144 (88.4%) patients. The choice of antibiotics was largely similar for community- and hospital-acquired infections as well as for prophylaxis. Only 3.7% of patients had microbiological analysis done on clinical samples. Conclusion We found a high prevalence of antibiotic use, with the choice of antibiotics, in some cases, inconsistent with the country’s treatment guidelines. Antibiotics were administered for long duration including antibiotics for prophylactic purposes and the majority was started without supporting microbiological analysis. Prescription practices that encourage rational use of antibiotics guided by microbiology and enforcement of antibiotic policy guidelines should be the target for future interventions. Electronic supplementary material The online version of this article (10.1186/s12889-019-7162-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antoinette A A Bediako-Bowan
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana. .,Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana. .,Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark. .,Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark.
| | - Enid Owusu
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Appiah-Korang Labi
- Department of Microbiology, Korle Bu Teaching Hospital, P.O. Box 77, Accra, Ghana.,Department of Clinical Microbiology, Copenhagen University Hospital (Righospitalet), Copenhagen, Denmark.,Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Noah Obeng-Nkrumah
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Gifty Sunkwa-Mills
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana.,Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Stephanie Bjerrum
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Japheth Awuletey Opintan
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Cynthia Bannerman
- Formerly Institutional Care Division, Ghana Health Service, Accra, Ghana.,Discipline of Community Health, Accra College of Medicine, P. O. Box CT 9828, Cantonments, Accra, Ghana
| | - Kåre Mølbak
- Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark.,Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Jørgen Anders Lindholm Kurtzhals
- Department of Clinical Microbiology, Copenhagen University Hospital (Righospitalet), Copenhagen, Denmark.,Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Mercy Jemima Newman
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
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Ambwani S, Misra AK, Kumar R. Medication Errors: Is it the Hidden Part of the Submerged Iceberg in Our Health-care System? Int J Appl Basic Med Res 2019; 9:135-142. [PMID: 31392175 PMCID: PMC6652282 DOI: 10.4103/ijabmr.ijabmr_96_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Medication error (ME) is an adverse preventable event which happens due to the inappropriate use of medication that leads to patient harm. Such events may be related to professional practice, health-care products, procedures, and systems including prescribing, communication, product labeling, packaging, and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use. A major ME is the one, which results in either permanent harm or transfer to the intensive care units or death. When an error is identified, it shall be reported immediately. It must also be nonpunitive so that staff does not have to be afraid of repercussions. An error shall be reported to the concerned consultant immediately. Continuous monitoring and frequent assessments shall be done for the patient. A root cause analysis shall be done for all serious MEs.
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Affiliation(s)
- Sneha Ambwani
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arup Kumar Misra
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rajesh Kumar
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Adisa R, Orherhe OM, Fakeye TO. Evaluation of antibiotic prescriptions and use in under-five children in Ibadan, SouthWestern Nigeria. Afr Health Sci 2018; 18:1189-1201. [PMID: 30766585 PMCID: PMC6354862 DOI: 10.4314/ahs.v18i4.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Irrational antibiotic prescriptions for children is a global concern requiring periodic evaluation and monitoring. Objectives To assess appropriateness of antibiotic prescribing for under-five children, as well as evaluating mothers' usage of antibiotics for their under-five and reason(s) for use. Method Cross-sectional review of out-patient case-notes of under-five using principles of antibiotic prescribing and a questionnaire-guided interaction with under-five mothers. Results Nearly all (445;98.9%) antibiotic prescriptions were based on signs and symptoms indicative of bacterial infection. Only 3(0.7%) had the initial antibiotic regimen modified. Nine (2.0%) had documented evidence of sensitivity test requested before antibiotic prescribing. Presence of infection or need for antibiotic therapy was established in 190(42.2%). Majority (324;72.0%) of mothers had administered antibiotics to their under-five. Of these, 157(48.5%) were prescribed by physicians and 79(24.4%) were self-recommended. Educational status of mothers significantly influenced antibiotic usage. Conclusion Antibiotic prescriptions for under-fives was largely based on symptoms indicative of bacterial infections, thereby corroborating the widespread empirical antibiotic prescribing. Considerable number of mothers engaged in self-recommendation of antibiotics for their under-fives. Thus, there is a need for continuous enlightenment of prescribers and mothers on rational use of antibiotics, while microbiological confirmation of clinical diagnosis is encouraged for evidence-based antibiotic prescribing.
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Affiliation(s)
- Rasaq Adisa
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Ochuko M Orherhe
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Titilayo O Fakeye
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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Zavala-González MA, Covarrubias-Bermúdez MDLÁ, Cabrera-Pivaral CE, Ramos-Herrera IM, Celis-de-la-Rosa ADJ, Orozco-Valerio MDJ. Prescripción inadecuada de medicamentos: aportaciones de los paradigmas científicos a su conocimiento. SAUDE E SOCIEDADE 2018. [DOI: 10.1590/s0104-12902018180857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumen Se realizó una revisión narrativa con análisis temático sobre las aportaciones de los paradigmas científicos al conocimiento de la prescripción inadecuada de medicamentos. Se buscaron artículos de acceso abierto indexados en PubMed© entre 2010-2014, y se sistematizó información sobre el paradigma, tipo de publicación, perspectiva teórica, objetivo, método y resultados. De los 992 artículos encontrados, se seleccionaron 118, y se tomó una muestra propositiva de 15, según su diseño, representando los cuatro paradigmas. Los artículos positivistas reportaron prevalencia, factores asociados, efectividad de intervenciones y criterios de evaluación; los interpretativos explicaron las causas del problema según los involucrados; los críticos denunciaron la influencia de la industria farmacéutica; y el participativo abordó el problema secundariamente y lo solucionó en un escenario para una enfermedad y grupo farmacológico específicos. Se concluyó que la prescripción inadecuada de medicamentos como problema de investigación en salud pública recibe aportes de los cuatro paradigmas, con dominio del positivismo, lo que se atribuye al carácter paradigmático de la ciencia desde la que se le aborda habitualmente, y que una perspectiva multi-paradigmática es el mejor abordaje.
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Bell L, James R, Rosa J, Pollentine A, Pettet G, McCoubrie P. Reducing interruptions during duty radiology shifts, assessment of its benefits and review of factors affecting the radiology working environment. Clin Radiol 2018; 73:759.e19-759.e25. [DOI: 10.1016/j.crad.2018.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/11/2018] [Indexed: 11/28/2022]
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Laidig F, May M, Brinkmann J, Schneider N, Stichtenoth DO. Evaluation of potential prescribing errors in patients with polypharmacy: a method to improve medication safety in ambulatory care. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0507-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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40
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Komwong D, Greenfield G, Zaman H, Majeed A, Hayhoe B. Clinical pharmacists in primary care: a safe solution to the workforce crisis? J R Soc Med 2018; 111:120-124. [PMID: 29480743 DOI: 10.1177/0141076818756618] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Daoroong Komwong
- 1 Department of Pharmacy, 293644 Sirindhorn College of Public Health , Praboromarajchanok Institute of Health Workforce Development, Chon Buri 20000, Thailand
| | - Geva Greenfield
- 2 Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Hadar Zaman
- 3 School of Pharmacy and Medical Sciences, Faculty of Life Sciences, 1905 University of Bradford , West Yorkshire BD7 1DP, UK
| | - Azeem Majeed
- 2 Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Benedict Hayhoe
- 2 Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
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Brown CL, Mulcaster HL, Triffitt KL, Sittig DF, Ash JS, Reygate K, Husband AK, Bates DW, Slight SP. A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care. J Am Med Inform Assoc 2017; 24:432-440. [PMID: 27582471 DOI: 10.1093/jamia/ocw119] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/08/2016] [Indexed: 02/05/2023] Open
Abstract
Objective To understand the different types and causes of prescribing errors associated with computerized provider order entry (CPOE) systems, and recommend improvements in these systems. Materials and Methods We conducted a systematic review of the literature published between January 2004 and June 2015 using three large databases: the Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline. Studies that reported qualitative data about the types and causes of these errors were included. A narrative synthesis of all eligible studies was undertaken. Results A total of 1185 publications were identified, of which 34 were included in the review. We identified 8 key themes associated with CPOE-related prescribing errors: computer screen display, drop-down menus and auto-population, wording, default settings, nonintuitive or inflexible ordering, repeat prescriptions and automated processes, users' work processes, and clinical decision support systems. Displaying an incomplete list of a patient's medications on the computer screen often contributed to prescribing errors. Lack of system flexibility resulted in users employing error-prone workarounds, such as the addition of contradictory free-text comments. Users' misinterpretations of how text was presented in CPOE systems were also linked with the occurrence of prescribing errors. Discussion and Conclusions Human factors design is important to reduce error rates. Drop-down menus should be designed with safeguards to decrease the likelihood of selection errors. Development of more sophisticated clinical decision support, which can perform checks on free-text, may also prevent errors. Further research is needed to ensure that systems minimize error likelihood and meet users' workflow expectations.
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Affiliation(s)
- Clare L Brown
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, Durham, UK.,Newcastle upon Tyne hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, Tyne and Wear, UK
| | - Helen L Mulcaster
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, Durham, UK
| | - Katherine L Triffitt
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, Durham, UK
| | - Dean F Sittig
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, TX, USA
| | - Joan S Ash
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Katie Reygate
- Health Education KSS Pharmacy, Downsmere Building, Princess Royal Hospital, West Sussex, UK
| | - Andrew K Husband
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, Durham, UK
| | - David W Bates
- The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA.,Harvard School of Public Health, Harvard University, Boston, MA, USA
| | - Sarah P Slight
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, Durham, UK.,Newcastle upon Tyne hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, Tyne and Wear, UK.,The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Kim MO, Coiera E, Magrabi F. Problems with health information technology and their effects on care delivery and patient outcomes: a systematic review. J Am Med Inform Assoc 2017; 24:246-250. [PMID: 28011595 DOI: 10.1093/jamia/ocw154] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To systematically review studies reporting problems with information technology (IT) in health care and their effects on care delivery and patient outcomes. Materials and methods We searched bibliographic databases including Scopus, PubMed, and Science Citation Index Expanded from January 2004 to December 2015 for studies reporting problems with IT and their effects. A framework called the information value chain, which connects technology use to final outcome, was used to assess how IT problems affect user interaction, information receipt, decision-making, care processes, and patient outcomes. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results Of the 34 studies identified, the majority ( n = 14, 41%) were analyses of incidents reported from 6 countries. There were 7 descriptive studies, 9 ethnographic studies, and 4 case reports. The types of IT problems were similar to those described in earlier classifications of safety problems associated with health IT. The frequency, scale, and severity of IT problems were not adequately captured within these studies. Use errors and poor user interfaces interfered with the receipt of information and led to errors of commission when making decisions. Clinical errors involving medications were well characterized. Issues with system functionality, including poor user interfaces and fragmented displays, delayed care delivery. Issues with system access, system configuration, and software updates also delayed care. In 18 studies (53%), IT problems were linked to patient harm and death. Near-miss events were reported in 10 studies (29%). Discussion and conclusion The research evidence describing problems with health IT remains largely qualitative, and many opportunities remain to systematically study and quantify risks and benefits with regard to patient safety. The information value chain, when used in conjunction with existing classifications for health IT safety problems, can enhance measurement and should facilitate identification of the most significant risks to patient safety.
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Affiliation(s)
- Mi Ok Kim
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Farah Magrabi
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Price A, Majeed A. Improving how secondary care and general practice in England work together: requirements in the NHS Standard Contract. J R Soc Med 2017; 111:42-46. [PMID: 29035668 DOI: 10.1177/0141076817738504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Amy Price
- Department of Primary Care and Public Health, 4615 Imperial College London , London W6 8RP, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, 4615 Imperial College London , London W6 8RP, UK
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Puaar SJ, Franklin BD. Impact of an inpatient electronic prescribing system on prescribing error causation: a qualitative evaluation in an English hospital. BMJ Qual Saf 2017; 27:529-538. [PMID: 29018058 DOI: 10.1136/bmjqs-2017-006631] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/26/2017] [Accepted: 09/16/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Few studies have applied a systems approach to understanding the causes of specific prescribing errors in the context of hospital electronic prescribing (EP). A comprehensive understanding of underlying causes is essential for developing effective interventions to improve prescribing safety. Our objectives were to explore prescribers' perspectives of the causes of errors occurring with EP and to make recommendations to maximise benefits and minimise risks. METHODS We studied a large hospital using inpatient EP. From April to June 2016, semistructured interviews were conducted with purposively sampled prescribers involved with a prescribing error. Interviews explored prescribers' perceived causes of the error and views about EP; they were audio-recorded and transcribed verbatim. Data were thematically analysed against a framework based on Reason's accident causation model, with a focus on identifying latent conditions. RESULTS Twenty-five interviews explored causes of 32 errors. Slips and rule-based mistakes were the most common active failures. Error causation was multifactorial; environmental, individual, team, task and technology error-producing conditions were all influenced by EP. There were three broad groups of latent conditions: the EP system's functionality and design; the organisation's decisions around EP implementation and use; and prescribing behaviours in the context of EP. CONCLUSIONS Errors were associated with the design of EP itself and its integration within the healthcare environment. Findings suggest that EP vendors should focus on revolutionising interface design and usability issues, bearing in mind the wider healthcare context in which such software is used. Healthcare organisations should draw upon human factors principles when implementing EP. Consideration of work environment, infrastructure, training, prescribing responsibilities and behaviours should be considered to address local issues identified.
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Affiliation(s)
- Seetal Jheeta Puaar
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.,Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
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Weier N, Thursky K, Zaidi STR. Antimicrobial knowledge and confidence amongst final year medical students in Australia. PLoS One 2017; 12:e0182460. [PMID: 28771549 PMCID: PMC5542537 DOI: 10.1371/journal.pone.0182460] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/18/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Inappropriate use of antimicrobials is one of the major modifiable contributors to antimicrobial resistance. There is currently no validated survey tool available to assess knowledge and confidence of medical students in infectious diseases (ID) compared to other diseases states, and little is known about this topic. MATERIALS AND METHODS A cross-sectional survey of final year medical students attending universities around Australia was conducted between August and September, 2015. A survey unique from other published studies was developed to survey satisfaction in education, confidence and knowledge in ID, and how this compared to these factors in cardiovascular diseases. RESULTS Reliability and validity was demonstrated in the survey tool used. Students were more likely to rate university education as sufficient for cardiovascular diseases (91.3%) compared to ID (72.5%), and were more confident in their knowledge of cardiovascular diseases compared to ID (74.38% vs. 53.76%). Students tended to answer more cardiovascular disease related clinical questions correctly (mean score 78%), compared to questions on antimicrobial use (mean score 45%). CONCLUSIONS Poor knowledge and confidence amongst final year medical students in Australia were observed in ID. Antimicrobial stewardship agenda should include the provision of additional training in antimicrobial prescribing to the future medical workforce.
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Affiliation(s)
- Naomi Weier
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Karin Thursky
- Doherty Institute, Melbourne, Victoria, Australia
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Syed Tabish R. Zaidi
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- * E-mail:
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A tailored programme to implement recommendations for multimorbid patients with polypharmacy in primary care practices-process evaluation of a cluster randomized trial. Implement Sci 2017; 12:31. [PMID: 28264693 PMCID: PMC5339959 DOI: 10.1186/s13012-017-0559-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background We developed and evaluated a tailored programme to implement three evidence-based recommendations for multimorbid patients with polypharmacy into primary care practices: structured medication counselling including brown bag reviews, the use of medication lists and medication reviews. No effect on the primary outcome was found. This process evaluation aimed to identify factors associated with outcomes by exploring nine hypotheses specified in the logic model of the tailored programme. Methods The tailored programme was developed with respect to identified determinants of practice and consisted of a workshop for practice teams, elaboration of implementation action plans, aids for medication reviews, a multilingual info-tool for patients on a tablet PC, posters and brown paper bags as reminders for patients. The tailored programme was evaluated in a cluster randomized trial. The process evaluation was based on various data sources: interviews with general practitioners and medical assistants of the intervention group and a survey with general practitioners of the intervention and control group, written reports on the implementation action plans, documentation forms for structured medication counselling and the log file of the info-tool. Results We analyzed 12 interviews, 21 questionnaires, 120 documentation forms for medication counselling, 5 implementation action plans and one log file of the info-tool. The most frequently reported effect of the tailored programme was the increase of awareness for the health problem and the recommendations, while implementation of routine processes was only reported for structured medication counselling. The survey largely confirmed the usefulness of the applied strategies, yet the interviews provided a more detailed understanding of the actual use of the strategies and several suggestions for modifications of the tailored programme. Conclusions The tailored programme seemed to have induced awareness as a first step of behaviour change. Several modifications of the tailored programme may enhance its effectiveness such as conducting outreach visits instead of a workshop, improved targeting, provision of evidence, integration of tools into the practice software and information materials in tailored formats. Trial registration This study is linked to an outcome evaluation study with the registration ISRCTN34664024, assigned 14/08/2013. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0559-y) contains supplementary material, which is available to authorized users.
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Tudor Car L, Papachristou N, Gallagher J, Samra R, Wazny K, El-Khatib M, Bull A, Majeed A, Aylin P, Atun R, Rudan I, Car J, Bell H, Vincent C, Franklin BD. Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study. BMC FAMILY PRACTICE 2016; 17:160. [PMID: 27852240 PMCID: PMC5112691 DOI: 10.1186/s12875-016-0552-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care. METHODS We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians' scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014. RESULTS The top three problems were incomplete reconciliation of medication during patient 'hand-overs', inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score. CONCLUSIONS Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method, and merits further exploration with a view to becoming a part of a routine preventative patient safety monitoring mechanism.
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Affiliation(s)
- Lorainne Tudor Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Nikolaos Papachristou
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Joseph Gallagher
- UCD Conway Institute, gHealth Research Group, The University College Dublin School of Medicine, Dublin, Ireland
| | - Rajvinder Samra
- Faculty of Health & Social Care, Health & Social Care Programme, The Open University, Milton Keynes, UK
| | - Kerri Wazny
- Usher Institute of Population Health Sciences and Informatics, Centre for Global Health Research, The University of Edinburgh Medical School, Edinburgh, UK
| | - Mona El-Khatib
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Adrian Bull
- Imperial College Health Partners, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Paul Aylin
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Rifat Atun
- Department of Global Health and Population & Department of Health Policy and Management, Harvard, Boston USA
| | - Igor Rudan
- Usher Institute of Population Health Sciences and Informatics, Centre for Global Health Research, The University of Edinburgh Medical School, Edinburgh, UK
| | - Josip Car
- Health Services and Outcomes Research Programme, LKCMedicine, Nanyang Technological University, Singapore, Singapore
| | - Helen Bell
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
| | - Charles Vincent
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust/UCL School of Pharmacy, London, UK
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Ricci-Cabello I, Pons-Vigués M, Berenguera A, Pujol-Ribera E, Slight SP, Valderas JM. Patients' perceptions and experiences of patient safety in primary care in England. Fam Pract 2016; 33:535-42. [PMID: 27312563 DOI: 10.1093/fampra/cmw046] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND One of the most remarkable features of patient safety research in primary care is the sparse attention paid to patients' own experiences. OBJECTIVE To explore patient's perceptions and experiences of patient safety in primary care in England. METHODS We conducted a qualitative study in the South of England with an opportunistic sample of 27 primary care users. Information was obtained from four patient focus groups. A thematic content analysis was conducted by three analysts and consensus reached within the research team on the key themes that emerged. RESULTS Participants' conceptualizations of patient safety referred to high standards of health care delivery within a relationship of trust. Participants identified four main factors that they believed could potentially affect patient safety. These included factors related to (i) the patient (attitudes, behaviours and health literacy); (ii) the health professional (attitudes, behaviours and accuracy of diagnoses); (iii) the relationship between patients and health professionals (communication and trust); and (iv) the health care system (workload, resources, care coordination, accessibility, interdisciplinary teamwork and accuracy of health care records). Confidentiality, continuity of care and treatment-related safety emerged as cross-cutting major threats to patient safety. CONCLUSIONS The exploration of participants' perceptions and experiences allowed the identification of a wide variety of themes that were perceived to impact on patient safety in primary care. The findings of this study could be used to enrich current frameworks that are exclusively based on professional or health care system perspectives.
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Affiliation(s)
- Ignacio Ricci-Cabello
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK,
| | - Mariona Pons-Vigués
- Àrea de recerca. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain, Centre de recerca adscrit. Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Anna Berenguera
- Àrea de recerca. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain, Centre de recerca adscrit. Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Enriqueta Pujol-Ribera
- Àrea de recerca. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain, Centre de recerca adscrit. Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Sarah Patricia Slight
- Department of Pharmacy, School of Medicine Pharmacy and Health, Durham University, Durham, UK, Department of Pharmacy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA and
| | - Jose Maria Valderas
- Institute for Health Research, University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter, UK
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Improving prescribing and medicine use. J Health Serv Res Policy 2016; 21:272-8. [PMID: 27688521 DOI: 10.1177/1355819616666487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Riordan CO, Delaney T, Grimes T. Exploring discharge prescribing errors and their propagation post-discharge: an observational study. Int J Clin Pharm 2016; 38:1172-81. [DOI: 10.1007/s11096-016-0349-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 07/06/2016] [Indexed: 11/30/2022]
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