Medication Errors in the Emergency Department: Knowledge, Attitude, Behavior, and Training Needs of Nurses

The factors influencing patient safety management as perceived by emergency department nurses: A qualitative study

AIM

One of the most important, unpredictable and stressful areas in hospitals is the emergency department (ED) where seconds are crucial for providing immediate care and saving the patients' lives. Therefore, the present study aimed to identify the factors which impact the patient safety management as perceived by the ED nurses in Southern Iran.

DESIGN

This is a qualitative, descriptive study.

METHODS

The participants were 23 ED nurses selected via purposeful sampling who were asked to take part in an interview. Data were collected using semi-structured, individual, in-depth interviews and analysed via content analysis.

RESULTS

Analysis of the qualitative data yielded 4 themes and 12 subthemes. The four main themes were: negligence of safety standards and standard precautions, disregard of ethical principles, professional challenges and inefficient organizational management.

Frequency and influential factors on occurrence of medical errors: A three-year cross-sectional study

BACKGROUND

Despite efforts to improve patient safety, medical errors (MEs) continue to recur. Proper utilization of reported MEs can be effective in preventing their recurrence. This study investigated the errors reported in 3 years and examined the factors affecting them.

MATERIALS AND METHODS

This descriptive analytical study was conducted using the errors reported in 20 hospitals under the auspices of one of Iran's medical universities from 2018 to 2020. All reported errors were investigated by an expert panel.

RESULTS

In total, 6584 reported errors were grouped into four main categories based on the type of error. The highest reported errors were related to the management and treatment procedures. Analyses of the factors influencing medical errors revealed that 15 factors affected the occurrence of errors. An increasing trend of error was found in 9 of the 15 identified factors. Incorrect documenting of the physician's order in the nursing Kardex and noncompliance with the patient identification guide were the highest with 16.03 and 15.47%, respectively.

CONCLUSION

The most identified factor was the incorrect registration of the physician's prescription on the nursing card; therefore, it seems that the use of computerized physician order entry should be considered. Furthermore, the mere existence and training of patient safety guides cannot help prevent errors. Not only should the underlying causes of errors be carefully identified and investigated but it also requires serious determination to follow the patient's safety instructions from the highest to the lowest levels of the health system.

Investigating safe nursing care and medication safety competence in nursing students: a multicenter cross-sectional study in Iran

BACKGROUND

Medication safety competence is very important as one of the clinical skills among nursing students to provide safe nursing care. The lack of medication safety competence in nursing students leads to occurrence of medication errors subsequently jeopardizing patient safety. Thus, the present study was conducted to investigate safe nursing care and medication safety competence among nursing students in the south of Iran.

METHODS

A descriptive cross-sectional multicenter study was conducted from September to December 2022. The research population included nursing students of three universities of medical sciences in Fars Province, Southern Iran. A total of 310 nursing students who were selected through convenience sampling participated in the study. The data collection instruments consisted of a demographics survey, Medication Safety Competence Scale (MSCS), and a Safe Nursing Care Scale (SNCS). The collected data were analyzed using descriptive statistics (absolute and relative frequency, mean and standard deviation) and inferential statistics (Independent t-test, Analysis of variance and Pearson correlation coefficient). The data were analyzed in SPSS 23 and the level of significance was considered 0.05.

RESULTS

The mean age of the participants was 22.53 ± 1.69 years. The total mean scores for medication safety competence and safe nursing care were found to be 111.97 ± 11.85 and 105.12 ± 11.64, respectively. There was a statistically significant positive correlation between safe nursing care and medication safety competence (r = 0.084, P < 0.001).

CONCLUSION

The mean scores of nursing students' medication safety competence and safe nursing care were at an average level. To maintain patient safety, nursing instructors and managers are recommended to employ appropriate strategies to improve medication safety competence and safe nursing care in nursing students.

Enhancing Patient Safety: A Cross-Sectional Study to Assess Medical Interns' Attitude and Knowledge About Medication Safety in Saudi Arabia

Introduction and aim Medication errors (MEs) pose a severe threat in the medical field. Since such errors are preventable, it is paramount for all healthcare workers to be educated on the matter. This study aimed to assess medical interns' attitudes and knowledge of medication safety and errors. We also aimed to validate current university programs to educate students about medication safety and errors. Methods A cross-sectional study that utilized a self-administered online questionnaire comprised 31 questions. The questionnaire was distributed via social media networks, such as WhatsApp, Twitter, email, Instagram, and Snapchat among 100 medical, pharmacy, and nursing interns in Saudi Arabia. The study population included both Saudi and non-Saudi interns. Results The majority of participants, comprising 92% (n=92), indicated that they were familiar with the definition of medication errors (ME). Additionally, 85% (n=85) expressed their willingness to report instances of MEs when medications were not prescribed but required. Moreover, 90% (n=90) of the surveyed individuals expressed their willingness to report MEs in situations where patients did not receive medications as prescribed. In cases where patients experienced harm and required treatment due to an ME, 91% (n=91) of respondents committed to reporting such incidents. A total of 52 (52%) respondents stated that they would report MEs regardless of whether they reached/harmed the patient. A good ME knowledge level was observed in 48% of respondents. A higher likelihood of good ME knowledge was significantly associated with safety reporting system (SRS) awareness and reporting MEs regardless of whether they reached/harmed the patient (p<0.05). College, awareness/attitude, or other demographic factors were not significantly related to ME knowledge (p>0.05). Conclusion This study showed that although interns in the healthcare field do have some knowledge about MEs, there is still a significant need to improve their knowledge. This can be achieved through various ways, one of which is by implementing this topic into the university curricula.

Knowledge, Attitudes, and Behavior in the administration of medication in the home care setting: Cross-cultural Spanish adaptation

OBJECTIVE

The aim of the study is to validate and adapt the "Knowledge Attitute and Behaviour in the administration of medication in the home care setting questionnaire" in the home care setting in Cordoba, Spain, through a cross-validation process.

DESIGN

Cross-sectional study SAMPLE: 106 community nurses provide home care in Cordoba, and are involved in the management of the medication process in the patient's home.

MEASUREMENTS

Community nurses' knowledge, attitudes, and behaviors toward medication error prevention strategies in-home care.

RESULTS

For the evaluation of psychometric properties, Cronbach's α was calculated, which returned a value of 0.639, showing good internal consistency. Most participants agreed that the home care setting increases the risk of medication errors.

CONCLUSION

The study, underscores the importance of analyzing the phenomenon of medication errors in the home care setting. The characteristics and peculiarities of a home care setting are different from a hospital setting, which means that factors such as the environment, the figures involved in the care process (caregivers and/or family members), and the way in which they communicate with the rest of the multi-professional team can influence both the type of errors and the likelihood of their occurrence.

Evaluation of nurses' knowledge and performance regarding preparation and injection of intravenous drugs in pediatric wards in Iran

BACKGROUND

A error in intravenous injection in pediatric wards can cause irreparable injuries. This study aimed to determine the level of knowledge and performance of nurses in terms of preparation and injection of intravenous drugs in pediatric wards of hospitals affiliated to Isfahan University of Medical Sciences.

METHODS

This cross-sectional study was conducted in 2022 on 156 nurses working in pediatric wards. The data was collected with demographic information questionnaire and the knowledge and performance of the participants were determined using a researcher-made questionnaire, including the five rights of medication administration (preparation and injection, medication error, drug side effects, family empowerment, and documentation) using self-reporting and observation methods. Formal and content validity was calculated using the opinions of 10 experts and Cronbach's alpha with 40 samples.

RESULTS

The mean and standard deviation of total nurses' knowledge and performance scores were 58.31 + 10.1 and 66.1 + 14.4, respectively. Moreover, the mean and standard deviation of nurses' knowledge scores were 63.55 + 14.3 for documentation, 46.1 + 7.9 for preparation and injection, 73.9 + 12.3 for drug side effects, 58.4 + 10.2 for medication error, and 69.4 + 9.4 for family empowerment. Besides, the mean performance was 69.1 + 17.6 for documentation, 61.3 ± 9.9 for preparation and injection, 78.21 + 12 for drug side effects, 58.6 + 15 for medication error, and 65.4 + 17.7 for family empowerment.

CONCLUSION

The results showed that the mean knowledge and pharmacological performance of nurses working in pediatric wards in different areas of the principles of medicine were not at the desired level, and this can affect children adversely.

A qualitative study of the reasons for low patient safety incident reporting among Indonesian nurses

OBJECTIVES

to investigate the reasons for low patient safety incident reporting among Indonesian nurses.

METHODS

this qualitative case study was conducted among 15 clinical nurses selected purposively from a public hospital in Lampung, Indonesia. Interview guidelines were used for data collection through face-to-face in-depth interviews in July 2022. The thematic approach was used to analyze the data.

RESULTS

in this present study, seven themes emerged (1) Understanding incident reporting; (2) The culture; (3) Consequences of reporting; (4) Socialization and training; (5) Facilities; (6) Feedback; and (7) Rewards and punishments.

FINAL CONSIDERATIONS

these findings should be considered challenges for the patient safety committee and hospital management to increase patient safety incident reporting, particularly among nurses in the hospital.

The effect of virtual reality on cognitive, affective, and psychomotor outcomes in nursing staffs: systematic review and meta-analysis

BACKGROUND

In the healthcare systems of the world, reinforcing the competence and professionalism of nurses has become a concern. Gaining clinical nursing competence in the healthcare system requires more effort, and additional training is required. Medical education and training have begun using digital technologies, such as virtual reality (VR). The purpose of this research was to examine the efficacy of VR in terms of cognitive, emotional, and psychomotor outcomes and learning satisfaction in nurses.

METHOD

The study searched eight databases (Cochrane library, EBSCOHost, Embase, OVID MEDLINE, ProQuest, PubMed, Scopus, and Web of Science) for articles that met these criteria: (i) nursing staff, (ii) any virtual reality technology intervention for education, all levels of immersion, [1] randomized control trial and quasi-experiment study, and (iv) published articles and unpublished theses. The standardized mean difference was measured. The random effect model was applied to measure the main outcome of the study with a significance level of p < .05. The I² statistic assessment was applied to identify the level of heterogeneity of the study.

RESULTS

A total of 6740 studies were identified, of which 12 studies with 1470 participants met the criteria for inclusion. The meta-analysis showed a significant improvement in the cognitive aspect (standardized mean difference [SMD] = 1.48; 95% CI = 0.33-2.63; p = .011, I² = 94.88%), the affective aspect (SMD = 0.59; 95% CI = 0.34-0.86; p < .001, I² = 34.33%), the psychomotor aspect (SMD = 0.901; 95% CI = 0.49-1.31; p < .001, I² = 80.33%), and learning satisfaction (SMD = 0.47; 95% CI = 0.17-0.77; p = .002, I² = 0%) aspects of the groups that received the VR intervention compared to the control groups. Subgroup analysis found that dependent variables (e.g., level of immersion) did not improve study outcomes. The quality of evidence was low which is affected by major methodological issues.

CONCLUSIONS

VR may favorable as alternative method to increase nurse competencies. Randomized controlled trials (RCTs) on larger samples are needed to strengthen the evidence for the effect of VR in various clinical nurse settings. ROSPERO registration number: CRD42022301260.

A cross-sectional study of the knowledge, skills, and 6 rights on medication administration by nurses at emergency department

Introduction: Medication errors occur when a patient is given the wrong drug or receives incorrect pharmacological therapy. Incorrect drug administration can cause fatal errors resulting in the patient’s death. Approximately 44,000-98,000 patients die each year due to medication errors and this condition is found often in the Emergency Room (ER) due to the complexity. Therefore, this study aims to analyze the relationship between nurses’ knowledge, skills, and 6 rights on medication at Emergency Department. Design and Methods: This is an analytical observational study involving 70 nurses randomly selected using consecutive sampling and working at the ER department of Saiful Anwar Hospital Malang. Data were collected through a questionnaire and analyzed descriptively to determine the knowledge and skills of nurses and the implementation of the correct principles of medication administration. Results: The results showed that most of the emergency room nurses had good knowledge and skills in applying the correct principles of medicine. However, the majority could not calculate the drug dose accurately. The spearman rank results showed that there was a relationship between knowledge and the 6 correct drug principles (p<0.001, α= 0,05; r = 0.491) with a percentage of 44%. This indicates that a higher knowledge results in the correct implementation of the drug. Similarly, there was a significant positive correlation between skills and proper medicine (p<0.001, α= 0,05; r = 0.378). Conclusions: It can be inferred that a higher nurse’s knowledge and skill results in a better administration of medicine.

Swedish emergency nurses' experiences of the preconditions for the safe collection of blood culture in the emergency department during the COVID-19 pandemic

AIM

To describe how Swedish emergency nurses experience the preconditions of providing safe care during the COVID-19 pandemic when collecting blood culture in the emergency department.

DESIGN

A qualitative exploratory design using content analysis with a manifest approach.

METHOD

Semi-structured interviews were conducted with 13 emergency nurses working in the emergency department.

RESULTS

The analysis resulted in one main category: unprecedented preconditions create extraordinary stress and jeopardize safe care when collecting blood culture. This main category includes four additional categories: organizational changes, challenges in the isolation room, heavy workload creates great stress, and continuous learning.

CONCLUSION

The COVID-19 outbreak has made the emergency department a workplace where constant changes of routines combined with new information and reorganization risk jeopardize safe care during blood culture sampling. Accordingly, high workload and stress have been identified as a reason for emergency nurses not following guidelines. It is therefore necessary to optimize the preconditions during blood culture sampling and identify situations where there are shortcomings.

Root Cause Analysis (RCA) of Adverse Events in One of the Biggest Western Iranian General Hospitals: Short Communication

Background: In developing and underdeveloped countries, medical error is often either not reported or reported improperly for various reasons. Root cause analysis (RCA) is a systematic method to determine how various factors contribute to the occurrence of medical errors. Objectives: The current study analyzed the root cause of one of western Iran’s biggest general hospitals. Methods: This retrospective RCA was conducted through a qualitative approach in 2019 following the National Patient Safety Agency (NPSA) protocol in seven steps: Initialization of the process, collecting and mapping information, identifying issues related to care delivery problems (CDP) or service delivery problems (SDP), event analysis, identifying the involved factors in the event - root causes, providing solutions, implementing solutions, and submission of reports. Results: According to the results of this study, 61 cases were examined, and committees accepted the errors in 11 cases. Here, 49 CDP and 13 SDP factors were identified. Care delivery problems factors were selected for all events based on the team’s viewpoints. Overall, task-related causes (20 cases), individual causes (17 cases), management-related causes (14 cases), training-related causes (8 cases), and causes related to work environment and conditions (7 cases) were specified. Conclusions: Accepting mistakes is the first step in the hope of improvement. In this hospital, only 11 cases of mistakes had been accepted by the authorities. In most cases, the proposed solutions to this issue included personnel training, monitoring system strengthening, and developing and standardizing processes. Overall, this study and other similar studies showed errors during service delivery and through service providers.

Factors influencing patient safety culture in operating room in a teaching hospital in Jordan: a qualitative descriptive study

Purpose

To explore the perceptions of surgical team members in a tertiary hospital in Jordan toward the factors influencing patient safety culture (PSC).

Design/methodology/approach

This was a qualitative descriptive study intended to characterize the factors that influence PSC. Interviews were conducted with health-care providers in the operation room (OR) in a tertiary Jordanian hospital. Participants included surgeons, anesthetists, nurses and senior surgical residents who had worked for three years minimum in the OR. Thematic analysis was used to analyze the data.

Findings

A total of 33 interviews were conducted. Thematic analysis of the content yielded four major themes: (1) operational factors, (2) organizational factors, (3) health-care professionals factors and (4) patient factors. The respondents emphasized the role of the physical layout of the OR, implementing new techniques and new equipment, and management support to establish a safety culture in the operating room setting.

Originality/value

The present research study will have implications for hospitals and health-care providers in Jordan for developing organizational strategies to eliminate or decrease the occurrence of adverse events and improve patient safety in the OR.

Exploring Nurses' Attitudes, Skills, and Beliefs of Medication Safety Practices

BACKGROUND

Medication errors exist within health care systems despite efforts to reduce their incidence. These errors may result in patient harm including morbidity, mortality, and increased health care costs.

PURPOSE

The purpose of this study was to explore direct care nurses' attitudes, skills, and beliefs about medication safety practice.

METHODS

Researchers conducted a descriptive exploratory study using the Nurses' Attitudes and Skills around Updated Safety Concepts (NASUS) scale and the Nurse Beliefs about Errors Questionnaire (NBEQ).

RESULTS

Responses from 191 surveys were analyzed. Of the participants, 70% were bachelor's prepared registered nurses and 88% were female. Results of the NASUS scale revealed the median of means of the Perceived Skills subscale was 79.2 out of 100 and the Attitudes subscale was 65.8 out of 100. The mean of the belief questions related to severity of error was 7.66 out of 10; most participants agreed with reporting of severe errors, reporting errors with moderate or major adverse events, and reporting of incorrect intravenous fluids.

CONCLUSIONS

Understanding direct care nurses' attitudes, skills, and beliefs about medication safety practices provides a foundation for development of improvement strategies.

Barcode Medication Administration Software Technology Use in the Emergency Department and Medication Error Rates

High-quality care during and after a medication process requires complete and accurate medication administration documentation. Veterans Affairs Medical Centers use barcode medication administration technology to document medication administered to Veterans throughout the inpatient and long-term care areas of the hospital. Barcode medication administration has demonstrated a reduction in medication administration errors; however, it is not commonly used in Veterans Affairs Medical Center clinical areas or emergency departments. During this study, only 39% of the recorded 165 Veterans Affairs Medical Centers that use barcode medication administration technology in their inpatient areas stated that barcode medication administration was also used in clinical areas of the hospital. Of these facilities, only 14% had implemented barcode medication administration in their emergency department. This study evaluated medication error rates before and after barcode medication administration technology was implemented in the emergency department of a Veterans Affairs Medical Center located in the Southeastern region of the United States. A total of 258 charts, 129 before and 129 after barcode medication administration technology implementation in the emergency department, were reviewed for Veterans who were evaluated and ordered to receive medication in the emergency department before transferring to an inpatient unit at the Veterans Affairs Medical Center where this study was conducted. A quantitative nonexperimental descriptive comparison demonstrated a 10.8% reduction in medication error rates and 21% reduction in the average number of medications given in error per chart after barcode medication administration technology was implemented in the emergency department. In addition to the study outcome, a potentially unsafe workaround was identified. Stakeholders that use barcode medication administration technology in their emergency departments would benefit from assessing the association between barcode medication administration use and medication administration error rates. However, assessing whether barcode medication administration technology remains useful and continues to provide safe medication administration practices for our Veterans is also recommended.

Nurses' knowledge and understanding of obstacles encountered them when administering resuscitation medications: a cross-sectional study from Palestine

BACKGROUND

Medication errors (ME) are one of the most important reasons for patient morbidity and mortality, but insufficient drug knowledge among nurses is considered a major factor in drug administration errors. Furthermore, the complex and stressful systems surrounding resuscitation events increase nursing errors.

AIMS

This study aimed to assess the knowledge about resuscitation medications and understand the obstacles faced by nurses when giving resuscitation medications. Additionally, errors in the reporting of resuscitation medication administration and the reasons that prevented nurses from reporting errors were investigated.

METHODS

A cross-sectional study was conducted in the West Bank, Palestine. Convenient sampling was used to collect data, which was collected via a face-to-face interview questionnaire taken from a previous study. The questionnaire consisted of five parts: demographic data, knowledge of resuscitation medications (20 true/false questions), self-evaluation and causes behind not reporting ME, with suggestions to decrease ME.

RESULTS

A total of 200 nurses participated in the study. Nurses were found to have insufficient knowledge about resuscitation medications (58.6%). A high knowledge score was associated with male nurses, those working in the general ward, the cardiac care unit (CCU), the intensive care unit (ICU) and the general ward. The main obstacles nurses faced when administering resuscitation medication were the chaotic environment in cardiopulmonary resuscitation (62%), the unavailability of pharmacists for a whole day (61%), and different medications that look alike in the packaging (61%). Most nurses (70.5%) hoped to gain additional training. In our study, we found no compatibility in the definition of ME between nurses and hospitals (43.5%).

CONCLUSIONS

Nurses had insufficient knowledge of resuscitation medications. One of the obstacles nurses faced was that pharmacists should appropriately arrange medications, and nurses wanted continuous learning and additional training about resuscitation medications to decrease ME.

Tackling the Italian emergency 2019-nCoV: nurses' knowledge, attitudes and behaviors

Background and aim:

The aim was to understand the knowledge, attitudes, and behaviors of Health Care workers regarding the Novel Coronavirus 2019 cases at the start of the diffusion of the disease in Italy.

Methods:

Cross-sectional survey of nurses working in Italian hospitals.

Results:

Most of the sample showed good knowledge and behaviors about the new virus and good attitudes. Logistic regression analysis demonstrated that predictive variables of knowledge, attitude, and behavior were: educational background, work experience years and age of nurses.

Conclusions:

This study is the first one in a time of a full health emergency. It would be appropriate to develop further studies to better analyze the skills implemented to tackle Novel Coronavirus 2019 disease. Novel Coronavirus 2019 pandemic has put on health personnel a considerable workload. Despite this, the Italian nursing staff has been showing excellent knowledge, attitude, and good behavior in the management of this pandemic. (www.actabiomedica.it)

Educational intervention to improve the safety medication process: a review using the GRADE approach

Objectives

Medication errors are frequent and affect patient safety in all the world. This review using the GRADE approach aims to identify the educational intervention which improves nursing medication competences and knowledge.

Methods

According to PRISMA statement, a review was conducted.

Key findings

In this review of nine studies, we determined that there is a lot of educational intervention aimed to improve nursing knowledge, such as traditional classroom training, simulation, e-learning, slide show presentations and the use of posters and pamphlets or mobile application. All of these can improve the medication process and nursing skills. Only three studies reached moderate, and two studies reached low-quality ratings.

Conclusions

Our findings show that all educational interventions can lead to medication without harm. This work will inform regulators, public health initiatives and policy makers considering the nursing educational intervention for increasing patient safety and improve medication competence and knowledge.

Individual Circadian Preference, Shift Work, and Risk of Medication Errors: A Cross-Sectional Web Survey among Italian Midwives

Background: In order to explore the possible association between chronotype and risk of medication errors and chronotype in Italian midwives, we conducted a web-based survey. The questionnaire comprised three main components: (1) demographic information, previous working experience, actual working schedule; (2) individual chronotype, either calculated by Morningness–Eveningness Questionnaire (MEQ); (3) self-perception of risk of medication error. Results: Midwives (n = 401) responded “yes, at least once” to the question dealing with self-perception of risk of medication error in 48.1% of cases. Cluster analysis showed that perception of risk of medication errors was associated with class of age 31–35 years, shift work schedule, working experience 6–10 years, and Intermediate-type MEQ score. Conclusions: Perception of the risk of medication errors is present in near one out of two midwives in Italy. In particular, younger midwives with lower working experience, engaged in shift work, and belonging to an Intermediate chronotype, seem to be at higher risk of potential medication error. Since early morning hours seem to represent highest risk frame for female healthcare workers, shift work is not always aligned with individual circadian preference. Assessment of chronotype could represent a method to identify healthcare personnel at higher risk of circadian disruption.

The application of the Theory of Planned Behaviour to prevent medication errors: a scoping review

BACKGROUND AND AIM OF THE WORK

A safer drug therapy is a relevant aspect of nursing care and an essential component of the clinical governance function. Nurses are key players in the identification and prevention of medication errors that could occur in the drug management process. In the literature there is a particular interest to environmental and organizational factors, while, as we know, the subjective components are little considered. In psychology, the theory that prefers individual factor, at the expense of the environmental one, is Theory of Planned Behavior (TPB), although it has been  little applied in the health field. The aim is to search the existing literature on the medication errors and the TPB to predict the intentions that foreshadow risk behaviours of nursing interns.

METHODS

This scoping review is grounded by Arksey and O'Malley's framework.

RESULTS

Attitude is the most determining predictor of intention. For many students reporting an error would lead to a loss of trust in the nursing profession and this could prevent the report. Nevertheless, some of them affirmed to be positively judged when they did it. It was then observed that a better education on safety raised the level of self-confidence and the sense of responsibility of the students, making them more inclined to the drug therapy management.

CONCLUSIONS

The Theory of planned behaviour  is essential to forerun the behavioural intention of students on the pharmacological safety and the collaborative practice through predictive factors, as attitude, subjective norms and perceived behavioural control.

Medication errors among Iranian emergency nurses: A systematic review

OBJECTIVES

Medication errors (MEs) made by nurses are the most common errors in emergency departments (EDs). Identifying the factors responsible for MEs is crucial in designing optimal strategies for reducing such occurrences. The present study aimed to review the literature describing the prevalence and factors affecting MEs among emergency ward nurses in Iran.

METHODS

We searched electronic databases, including the Scientific Information Database, PubMed, Cochrane Library, Web of Science, Scopus, and Google Scholar, for scientific studies conducted among emergency ward nurses in Iran. The studies were restricted to full-text, peer-reviewed studies published from inception to December 2019, in the Persian and English languages, that evaluated MEs among emergency ward nurses in Iran.

RESULTS

Eight studies met the inclusion criteria. Most of the nurses (58.9%) had committed MEs only once. The overall mean rate of MEs was 46.2%, and errors made during drug administration accounted for 41.7% of MEs. The most common type of administration error was drug omission (17.8%), followed by administering drugs at the wrong time (17.5%) and at an incorrect dosage (10.6%). The lack of an adequate nursing workforce during shifts and improper nurse-patient ratios were the most critical factors affecting the occurrence of MEs by nurses.

CONCLUSIONS

Despite the increased attention on patient safety in Iran, MEs by nurses remain a significant concern in EDs. Therefore, nurse managers and policy-makers must take adequate measures to reduce the incidence of MEs and their potential negative consequences.

Evaluation of Medication Use Pattern Among Patients Presenting to the Emergency Department of Hiwot Fana Specialized University Hospital, Using WHO Prescribing Indicators

Background

Ensuring rational drug use requires ongoing evaluation of drug prescribing, dispensing, and use by patients. Health care providers working in an emergency department face unique challenges, including making urgent decisions, patient overload, and limited resources, which contribute to inappropriate drug use. Rational medication use should be an important aspect of emergency care to improve patient outcomes. Thus, this study was conducted to assess medication utilization patterns using World Health Organization (WHO) prescribing indicators in the emergency department.

Methods

A cross-sectional study design was implemented among patients presenting at the emergency department of Hiwot Fana Specialized University Hospital (HFSUH) from January to March 2018. The data were collected from the medical charts of a total of 342 patients using a pre-prepared structured format according to WHO recommendations. The data were analyzed using SPSS version 21 software and presented in tables and figures.

Results

The most commonly reported clinical diagnosis was found to be soft tissue laceration or abrasion, in 75 patients (21.9%), followed by dyspepsia, in 50 (14.6%), and severe pneumonia, in 44 (12.9%). A total of 810 drugs were prescribed for the 342 patients. The main category of drugs prescribed were analgesics, constituting 125 (29.2%), followed by antibiotics, 120 (28.0%). Regarding WHO prescribing indicators, the average number of drugs prescribed per encounter was 2.36, the number of encounters at which antibiotics were prescribed was 127 (37.13%), and injections were prescribed at 300 (87.7%) encounters. All of the drugs prescribed were from the National Essential Medicine List (NEML) of Ethiopia, and 780 (98.1%) of the drugs were prescribed by international nonproprietary name.

Conclusion

Overall, there were inflated use of antibiotics and injection drugs, whereas prescribing by international nonproprietary name and prescribing from NEML were according to the recommendations. Hence, the hospital should work to ensure the judicious use of antibiotics and injection drugs.

First year undergraduate nursing students' perceptions of the effectiveness of blended learning approaches for nursing numeracy

The ability to safely calculate and administer medications are indispensable, core nursing skills in nursing education and practice. Therefore, it is imperative that nursing students are adequately prepared with the necessary numeracy skills during their undergraduate nursing studies. The focus of this study, conducted at a single multi-campus university in the western Sydney region of Australia, was to determine the effectiveness of a suite of blended learning approaches on numeracy self-efficacy from the students' perspective. Surveys were administered as part of the study and included open-ended questions. 525 students provided open-ended responses that were analysed by the research team. Four main themes were identified from the open-ended responses: (i) Self-realisation; (ii) Practice, practice, practice; (iii) Boosting confidence; and (iv) Wanting more. The themes captured students' perceptions of the benefits of having a rigorous learning design in blended learning approaches. The study showed that a structured pedagogical approach to nursing numeracy in undergraduate programs improved students' self-reported self-efficacy with mathematics and assisted students in realising the importance of learning and applying these skills as nursing clinicians.

Accuracy and knowledge in 12-lead ECG placement among nursing students and nurses: a web-based Italian study

BACKGROUND AND AIM

Electrocardiogram (ECG) is considered the most used diagnostic tool to identify many cardiological disease and conditions that require the monitoring and recording of heart's electric activity. The aim of this study is the validation and application of a web-survey, addressed to nursing students and nurses, in order to evaluate the degree of accuracy and the knowledge on the correct positioning of the 12-leads ECG.

METHODS

The study was a cross-sectional questionnaire-based study. The survey comprised 30 items, mainly multiple-choice questions.  The participants were 484 nurses and nursing students. In the study, no exclusion criteria were adopted, but fill in the questionnaire any nurse on duty during the data collection period and/or any nursing student during the data collection period. Statistical analyses were performed using the SAS v. 9.4. In the study, no exclusion criteria were adopted.

RESULTS

A total of 484 nursing students and nurses comprising of 149 males (30.79%) and 335 females (69.21%) responded. In full findings showed good psychometric properties and good reliability. The Cronbach's alpha coefficient for the study is 0.76 (number of items = 17, number of obs= 484). The mean age of responders was 32.01 (Standard deviation (SD) 9.63). A logistic multivariate regression demonstrated significant differences.

CONCLUSIONS

It is evident from our findings and those from other countries, that more education is required to ensure that mistaken interpretation, misdiagnosis, patient mismanagement and/or inappropriate procedures due to 12 leads ECG misplacement does not occur.

Learning from Patient Safety Incidents in the Emergency Department: A Systematic Review

BACKGROUND

Patient safety incidents are commonly observed in critical and high demanding care settings, including the emergency department. There is a need to understand what causes patient safety incidents in emergency departments and determine the implications for excellence in practice.

OBJECTIVE

Our aim was to systematically review the international literature on patient safety incidents in emergency departments and determine what can be learned from reported incidents to inform and improve practice.

DISCUSSION

Patient safety incidents in emergency departments have a number of recognized contributing factors. These can be used as groundwork for the development of effective tools to systematically identify incident risk. Participation in efforts to diminish risk and improve patient safety through appropriate incident reporting is critical for removing barriers to safe care.

CONCLUSIONS

This review enhances our awareness of contributing factors to patient safety incidents within emergency departments and encourages researchers from different disciplines to investigate the causes of practice errors and formulate safety improvement strategies.

Health Workers' Perceptions and Expectations of the Role of the Pharmacist in Emergency Units: A Qualitative Study in Kupang, Indonesia

Background. An essential way to ensure patient safety in the hospital is by applying pharmacy services in emergency units. This strategy was implemented in Indonesia several years ago, with the aim of ensuring that adequate pharmacy services are given to patients in hospitals. To achieve this, pharmacists are required to cooperate with other health workers via inter-professional teamwork. This study intended to identify the perceptions and expectations of health workers with respect to pharmacy services in emergency units. Methods. This was a qualitative study, using a phenomenological approach with a semi-structured interview technique to obtain data. This study was performed at the Prof. Dr. W.Z. Johannes Hospital Kupang from June to September 2018. The results of the interviews were thematically analyzed using QSR NVivo software 11. Results. The themes identified in this study included: (1) The positive impact of pharmacists in service; (2) Badan Penyelenggara Jaminan Sosial (BPJS) influence; (3) Acceptance of health workers; (4) Medication administration information; and (5) Expectations of health workers. Various perceptions were conveyed by participants regarding the emergency unit services in the hospital’s pharmaceutical department. Data obtained proved that the existence of a pharmacist increased the efficiency of time for services and prevented human error. Conclusion. Pharmacists and policy-makers play a significant role in providing appropriate pharmaceutical services in emergency units. Pharmacists also need to improve their quality of practice in accordance with their competence. They must review the patient medical history and physician’s prescriptions, educate the patients and other health workers, so that the workload and service time will be reduced.