Causes of Medication Errors in Intensive Care Units from the Perspective of Healthcare Professionals

Patient and family engagement in patient safety in the Eastern Mediterranean Region: a scoping review

BACKGROUND

Patients can play a key role in delivering safe care by becoming actively involved in their health care. This study aimed at reviewing the literature for evidence of patients' and families' engagement in patient safety in the Eastern Mediterranean Region (EMR).

METHODS

We conducted a scoping review of the literature published in English using PubMed, Medline, CINAHL, Scopus, ISI Web of Science, and PsycINFO until June 2023.

RESULTS

A total of 9019 studies were screened, with 22 meeting the inclusion criteria. Our review found few published studies of patient and family engagement in patient safety research in the EMR. Thirteen studies explored the attitudes, perceptions, and/or experiences / preferences of patients, families, and healthcare providers (HCPs) regarding patient engagement in patient safety. Nine publications reported patient involvement in patient safety activities at varying levels. Three categories of factors were identified that may affect patient involvement: patient-related (e.g., lack of awareness on their role in preventing harms, unwillingness to challenge HCPs' authority, and cultural barriers); HCP-related (e.g., negative attitudes towards patient engagement, poor patient-provider communication, and high workload); and healthcare setting-related (e.g., lack of relevant policies and guidelines, lack of training for patients, and HCPs, and lack of patient-centered approach).

CONCLUSION

This review highlighted limitations in the current literature on patient and family engagement in patient safety in the EMR, including both the depth of evidence and clarity of concepts. Further research is needed to explore how to actively involve patients and their families, as well as to determine whether such involvement translates into improved safety in practice.

Implementation of Interprofessional Pharmaceutical Care Initiatives: Lessons Learned from Successful Bottom-Up Initiatives in Primary Care

Introduction

Although there is evidence that interprofessional, person-centred, integrated care is important for optimising pharmaceutical care of older people with polypharmacy, this way of working is often not implemented in practice. The aim of this study was to identify common characteristics of successful interprofessional initiatives and factors influencing their implementation, in order to close this know-do gap.

Methods

A qualitative, explorative design with in-depth semi-structured interviews was used. Flemish primary healthcare professionals (HCPs) and patients aged over 75, involved in successful initiatives of interprofessional pharmaceutical care for older people with polypharmacy, were included. Inductive analysis was conducted to identify main topics.

Results

Fifteen HCPs and four patients, involved in nine interprofessional initiatives, were interviewed. In all initiatives the HCPs had interprofessional consultations about older people with polypharmacy. The interaction between the characteristics of the initiatives and the context had an important impact on the implementation. These context factors were positioned under the micro-, meso- and macro context. Implementation strategies, actions to enhance the initiatives' adoption, corresponded with three themes: communication and influence, coordination by different stakeholders, and (dis)incentives.

Conclusion

The identification of these success factors might inspire HCPs, providers of interprofessional education and policymakers to facilitate interprofessional pharmaceutical care.

A survey on the effects of patient safety training programs based on SBAR and FMEA techniques on the level of self-efficacy and observance of patient safety culture in Iran hospital, Shiraz in 2022-2023

BACKGROUND AND OBJECTIVE

Patient safety and medical personnel self-efficacy are among the main factors involved in providing quality health services. Moreover, safety culture in an organization is considered one of the most critical factors regarding patients' safety. Therefore, the present study aimed to determine the effects of patient safety programs based on Situation, Background, Assessment, Recommendation (SBAR) and Failure Model Effects Analysis (FMEA) techniques on self-efficacy and patient safety culture in Iran Hospital of Shiraz in 2022-2023.

MATERIALS AND METHODS

This two-stage quasi-experimental study was conducted in 2022-2033. Considering inclusion criteria, the present study included 80 nurses working in Iran Hospital. The participants were divided into groups of SBAR (40 participants) and FMEA (40 participants). All the data were collected using a Hospital Survey on Patient Safety Culture questionnaire and Sherer General Self-Efficacy Scale. Then, the collected data were analyzed using SPSS 13, Fisher's exact test, paired t-test, and independent t-test with a significant level of P < 0.05.

RESULTS

The mean score of total patient safety culture between the two groups was insignificant before the intervention (P = 0.58). However, it was more significant in the FMEA group than the SBAR group after the intervention (P < 0/05). In addition, the mean self-efficacy score between the two groups was insignificant before the intervention (P = 0.80). However, after the intervention, the mean score of the FMEA group was significantly higher than the SBAR group (P < 0.05).

CONCLUSION

According to the findings of this study, there is a meaningful relationship between patient safety training programs based on SBAR and FMEA techniques on patient safety and self-efficacy of nurses; however, FMEA training has more positive effects on self-efficacy and patient safety compared to other techniques. As a result, these techniques, along with other plans, are recommended to authorities in order to help improve patient safety.

Medication Safety Event Reporting: Factors That Contribute to Safety Events During Times of Organizational Stress

BACKGROUND

Incident reports submitted during times of organizational stress may reveal unique insights.

PURPOSE

To understand the insights conveyed in hospital incident reports about how work system factors affected medication safety during a coronavirus disease-2019 (COVID-19) surge.

METHODS

We randomly selected 100 medication safety incident reports from an academic medical center (December 2020 to January 2021), identified near misses and errors, and classified contributing work system factors using the Human Factors Analysis and Classification System-Healthcare.

RESULTS

Among 35 near misses/errors, incident reports described contributing factors (mean 1.3/report) involving skill-based errors (n = 20), communication (n = 8), and tools/technology (n = 4). Reporters linked 7 events to COVID-19.

CONCLUSIONS

Skill-based errors were the most common contributing factors for medication safety events during a COVID-19 surge. Reporters rarely deemed events to be related to COVID-19, despite the tremendous strain of the surge on nurses. Future efforts to improve the utility of incident reports should emphasize the importance of describing work system factors.

Protocolization of Analgesia and Sedation Through Smart Technology in Intensive Care: Improving Patient Safety

BACKGROUND

The risk of medication errors in intensive care units is high, primarily in the drug administration phase.

LOCAL PROBLEM

Management of high-alert medications within intensive care units in the study institution varied widely. The aim of this quality improvement project was to protocolize and centralize the management of high-alert medications in acute care settings and to implement smart intravenous infusion pump technology in intensive care units.

METHODS

The project was conducted in 4 phases: (1) protocolization and standardization of intravenous mixtures, (2) centralization of intravenous mixture preparation in the Pharmacy Department, (3) programming of the smart pumps, and (4) dissemination and staged implementation of intravenous mixture protocols. Smart pumps (Alaris, CareFusion) were used to deliver the medicines, and the manufacturer's software (Alaris Guardrails, CareFusion) was used to analyze data regarding adherence to the drug library and the number of programming errors detected.

RESULTS

Morphine, remifentanil, fentanyl, midazolam, dexmedetomidine, and propofol were included. After implementation of the smart pumps, 3283 infusions were started; of these, 2198 were programmed through the drug library, indicating 67% compliance with the safety software. The pumps intercepted 398 infusion-related programming errors that led to cancellation or reprogramming of drug infusions.

CONCLUSIONS

Protocolization and centralization of the preparation of high-alert sedative and analgesic medications for critically ill patients and the administration of these drugs using smart pump technology decrease variability of clinical practice and intercept potentially serious medication errors.

Investigating Causes of Medical Errors in Intensive Care Units in Iran: A Cross-sectional Study

Background

Medical errors cause disability and mortality in intensive care units (ICUs). We aimed to determine the occurrence and causes of medical errors in the ICUs of Iran.

Methods

In this cross-sectional study, data from the family complaint files referred to The disciplinary authority of Iran Medical Council was retrospectively reviewed to explore the causes of medical errors. Statistical analysis was performed in SPSS Version 26.0.

Results

A total of 293 complaint files were referred to the disciplinary commission from 2014 to 2019, of which 95 files were related to medical errors in ICUs. The median age of patients was 62 years (46-74 years) and 52 (54.7%) patients were men. Also, 37 (38.9%) patients had decreased levels of consciousness and 42 (42.2%) patients had cardiovascular disease. A total of 40 (42.1%) patients experienced a single medical error and 55 (57.9%) patients experienced more than 1. Causes of medical errors in patients were physician's or nurse's negligence in 53 (55.8%) patients, weak interaction of physician and nurse with the patient and family members in 11 (11.6%) patients, weak interprofessional interaction among physicians in 7 (7.4%) patients, equipment and structure of ICUs in 7 (7.4 patients, nature of ICUs and patients in 6 (6.3%) patients, weak physician-nurse interprofessional interaction in 5 (5.2%) patients) patients, low attention of the physician and the nurse to medication safety in 6 (6.3%) patients.

Conclusion

Patient safety is impacted by a variety of medical mistakes. Interprofessional strategies can be developed and put into action to mitigate medical errors in ICUs.

Awareness of reporting practices and barriers to incident reporting among nurses

BACKGROUND

Adequate incident reporting practices for clinical incident among nurses and even all healthcare providers in clinical practice settings is crucial to enhance patient safety and improve the quality of care delivery. This study aimed to investigate the level of awareness of incident reporting practices and identify the barriers that impact incident reporting among Jordanian nurses.

METHODS

A descriptive design using a cross-sectional survey was employed among 308 nurses in 15 different hospitals in Jordan. Data collection was conducted between November 2019 and July 2020 using an Incident Reporting Scale.

RESULTS

The participants showed a high level of awareness of the incident reporting with a mean score of 7.3 (SD = 2.5), representing 94.8% of the highest score. Nurses perceived their reporting practices at the medium level, with a mean score of 2.23 out of 4. The main reporting barriers included worrying about disciplinary actions, fearing being blamed, and forgetting to make a report. In regard to awareness of incident reporting, there were statistically significant differences in the mean for total awareness of the incident reporting system scores according to the type of hospital (p < .005*). In regard to self-perceived reporting practices, nurses working in accredited hospitals demonstrated statistically significant differences in self-perceived reporting practices (t = 0.62, p < .005).

CONCLUSIONS

The current results provide empirical results about perceived incident reporting practices and perceived barriers to reporting frequently. Recommendations are made to urge nursing policymakers and legislators to provide solutions for those barriers, such as managing staffing issues, nursing shortage, nurses' empowerment, and fear of disciplinary actions by front-line nurse managers.

"Attempting to protect self and patient:" A grounded theory study of error recovery by intensive care nurses

AIM

The aim of this study was to explore the process of error recovery (ER) by nurses in intensive care unit (ICU).

DESIGN

This qualitative study was conducted in 2018-2020 using the grounded theory methodology.

METHODS

Participants were 20 staff nurses, head nurses and nursing managers recruited from the ICUs. Sampling was started purposively and continued theoretically. Data were collected using semi-structured interviews and were analysed using the approach proposed by Corbin and Strauss.

RESULTS

The findings indicated that nurses' primary concern was for the patient and their own personal/professional identity. Five strategies were found including evaluating situation, identifying error, analysing error and situation, determining the agent for error correction, and reducing error effects. Contextual factors were also highlighted as being important in the error recovery. Attempting to protect self and patient" was the core category of the study. Nurses' concern about protecting patient life and their own personal/professional identity make them use unprofessional approaches for ER.

Rapid implementation of telepharmacy service to improve patient-centric care and multidisciplinary collaboration across hospitals in a COVID era: A cross-sectional qualitative study

Background and Aim

The COVID‐19 pandemic forced healthcare systems to apply new technology‐based solutions. The main objective of our study was to describe the conceptual model for rapid implementation of telepharmacy service and the main steps that should be considered.

Method

In response to a limited number of on‐site clinical pharmacy specialists and a lack of technology infrastructure, a cross‐sectional telepharmacy program was established to support major teaching hospitals. A store and forward model of teleconsultation was employed using WhatsApp messenger to cover various aspects of multidisciplinary collaboration in COVID‐19 management. All identifiable personal information was removed from all exchanged messages of collaborative consultations. The thematic analysis of consultations was performed to extract the main themes and subthemes that should be considered for designing future telepharmacy systems.

Results

Through telepharmacy service, 600 intensive care unit teleconsultations for COVID‐19 cases were conducted in the residence center and nonresidence centers. In total, 1200 messages were exchanged between specialists in 3 months. The average time taken to respond to a message was 1.30 h. Thematic analysis revealed four main concepts and 15 subconcepts that should be considered in telepharmacy consultations for COVID‐19 management. Based on the extracted themes, a conceptual model for developing a telepharmacy program was devised.

Conclusion

The results showed that by utilizing telehealth, clinical pharmacists could cover critically ill patients who need pharmacotherapy counseling through interdisciplinary collaboration. Moreover, the main features of our service that are represented through this survey can be employed by other researchers for developing telepharmacy services.

Does the Stage of University Education Differentiate Midwifery Students in Terms of Their Behaviors in Certain Situations and Sense of Self-Efficacy?

Midwifery students' behaviors in relevant spheres of their lives, as well as their sense of self-efficacy, can affect the process of training in the midwifery profession. The aim of the study was to determine the behaviors of students in Poland, assessed in a situational context, as well as their sense of self-efficacy in correlation with these behaviors at different levels of education in the midwifery profession. The study group included first- and third-year bachelor's degree (BS) midwifery students, as well as master's degree (MS) midwifery students. The survey was conducted on 1031 students. The 'Inventory for Personality Assessment in Situations' (IPS) and the General Self-Efficacy Scale (GSES) were used in the study. The largest group of students that were categorized as having problematic profiles was observed in the social-communicative domain, which indicates the necessity of introducing corrective and therapeutic actions concerning their interpersonal relations. The leading trait in the social-communicative domain among the BS students was sensitivity to frustration. The lowest self-confidence was observed among the third-year BS students. The average result of generalized self-efficacy among all the respondents was M = 28.36 (SD = 4.41), which indicates the average level of the obtained results. Students at different stages of midwifery programs demonstrate different behaviors when assessed in the situational context.

Should Pharmacists Lead Medication Reconciliation in Critical Care? A One-Stem Interventional Study in an Egyptian Intensive Care Unit

OBJECTIVES

The main objective was to compare physician-obtained medication histories to the practice of medication reconciliation undertaken by a pharmacist in the intensive care unit (ICU).

METHODS

A one-stem interventional study involving 500 adults 18 years and older admitted to the ICU (50 beds) of an Egyptian Joint Commission International-accredited reference hospital was conducted. The primary outcome measure was the proportion of ICU patients with missing medications in the cohorts of physician versus pharmacist-led medication reconciliation. The secondary outcome measure was the percentage of patients who had at least one clinical condition or adverse event (AE) that was left untreated during hospitalization of the 2 arms of patients after reconciliation.

RESULTS

A total of 500 patients received reconciliation. Medication discrepancies in the cohort of physician-led reconciliation were greater than that of the pharmacist (26.1% versus 2.6%, P = 0.001). The most common discrepancy was indication with no medication, which was found to be greater in the physician-led cohort of patients than that of the pharmacist cohort (25.2% versus 2.6%, P = 0.001). Untreated AEs in the former cohort were present in 9.1% of cases versus 1.5% in the pharmacist-led reconciliation cohort ( P = 0.001).

CONCLUSIONS

The present study revealed that pharmacist-led medication reconciliation in ICU has dramatically decreased medication discrepancies and AEs in adults with acute ICU admissions.

Medication Errors in Intensive Care Units: An Umbrella Review of Control Measures

Medication errors are defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.” Such errors account for 30 to 50 percent of all errors in health care. The literature is replete with systematic reviews of medication errors, with a considerable number of studies focusing on systems and strategies to prevent errors in intensive care units, where these errors occur more frequently; however, to date, there appears to be no study that encapsulates and analyzes the various strategies. The aim of this study is to identify the main strategies and interventions for preventing medication errors in intensive care units through an umbrella review. The search was conducted on the following databases: PubMed, CINAHL, PsycInfo, Embase, and Scopus; it was completed in November 2020. Seven systematic reviews were included in this review, with a total of 47 studies selected. All reviews aimed to evaluate the effectiveness of a single intervention or a combination of interventions and strategies to prevent and reduce medication errors. Analysis of the results that emerged identified two macro-areas for the prevention of medication errors: systems and processes. In addition, the findings highlight the importance of adopting an integrated system of interventions in order to protect the system from harm and contain the negative consequences of errors.

Medication Administration Safety Practices and Perceived Barriers Among Nurses: A Cross-Sectional Study in Northern Nigeria

Introduction

Safe medication administration is a vital process that ensures patients' safety and quality of life. However, reports of medication errors and their solutions are lacking. The aim of this study was to examine the correlation between medication administration safety practices and perceived barriers among nurses in northern Nigeria.

Methods

A descriptive approach to research and cross-sectional design was applied to this study. The study population included nurse employees of the Zamfara State Government in northern Nigeria. Simple random sampling and systematic sampling were used in selecting the respondents of the study. Descriptive analysis and the Spearman rank-order correlation were used in data analysis.

Results

Fewer than 50% of the respondents were found to agree or strongly agree that they identify allergic patients before administering medication. Most of the respondents had agreed or strongly agreed with the following as barriers to medication administration safety practices: lack of appropriate coordination between physicians and nurses, and lack of favorable policies and facilities. There was a very weak positive correlation between medication safety practices and barriers to medication safety practices, and the correlation was statistically significant (r_s = 0.180, P = 0.009).

Conclusion

There was a high level of desirable medication administration safety practices that the respondents followed. Nonidentification of a patient's allergic status and inadequate information on the effects of medications were among the identified medication administration practice gaps. There should be policies guiding medication administration in all hospitals in Zamfara, Nigeria.

Workload as the most Important Influencing Factor of Medication Errors by Nurses

Background:

This research is motivated by the fact that medication errors are serious threats to the safety of patients in hospitals. Nurses are one of the health workers who play a significant role in preventing these errors.

Objective:

The aim of this quantitative research is to determine the factors that influence the incidence of medication errors by nurses.

Methods:

The adopted method had a correlative descriptive design and used samples obtained from 164 nurses through a purposive sampling technique. The sample inclusion criteria were the nurses who worked in patient’s rooms, those who were healthy and not sick, not currently in school, and were willing to be respondents. Furthermore, the research instruments were questionnaires, which were developed through the Cronbach's alpha validity and reliability test results of 0.681 and 0.873, respectively. Analysis was conducted using the independent t test, X2 (chi-square) and multiple logistic regressions.

Results:

The results showed that the factors which influenced the incidence of medication errors were work experience, motivation, workload, managerial and environmental elements. Moreover, the variable which contributed the most, with a p-value of 0.004 and OR of 5.387 was workload.

Conclusion:

Finally, the following factors, including nurse's workload, motivation, work experience, good managerial management and environmental elements, should be considered when preventing medication errors.

[Use of the SBAR tool: Assessment of the value of a short training course on the quality of communication between caregivers in the short and long term]

OBJECTIVES

Communication breakdown is one of the main causes of adverse events in clinical routine. The main objective of this study was to assess whether a short training course on medical communication based on the situation-background-assessment-recommendation (SBAR) tool improved the quality of communication in clinical practice.

METHODS

Interventional study, conducted at the Jeanne de Flandre maternity unit (Lille University Hospital, France) between January 2017 and December 2019. The training sessions lasted 1 hour and consisted of a theoretical part, based on the SBAR tool, and of a practical part (video-stimulated recall and role-play case scenarios). The main outcome measure was the evaluation of the quality of the telephone calls made by a caregiver to the on-call doctor, using a questionnaire completed before (Q1) and remotely from training (Q2).

RESULTS

One hundred and twenty health professionals were trained (n=120). Following the trainings, there was an improvement in communication in the short term, whether in terms of relevance (64.9 vs. 52.6, P<0.001) or conciseness of the message (36.9 vs. 32.2, P<0.001), but also in terms of long-term in a real clinical situation (Q2: 3.9 vs. Q1: 3.0, P<0.001). Finally, 81% of participants were satisfied with the training.

CONCLUSIONS

Short training sessions on communication based on the SBAR tool appeared to improve participants' knowledge and skills in the short-term, but also in the longer term in a real clinical situation.

Job stress and its relationship with nurses' autonomy and nurse-physician collaboration in intensive care unit

AIMS

To determine nurses' job stress and its relationship with professional autonomy and nurse-physician collaboration in intensive care unit (ICU).

BACKGROUND

Low professional autonomy, high job stress and lack of nurse-physician collaboration can affect nursing care in ICU and the main reasons ICU nurses leave the occupation or transfer to other clinical units.

METHODS

A cross-sectional, correlational study was conducted on 398 nurses in teaching hospitals in Urmia, Iran, in 2020. Data were collected using the Dempster Practice Behaviors Scale, the Health and Safety Executive tool and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration.

RESULTS

The mean job stress (115.53 ± 12.42) and professional autonomy (102.19 ± 11.88) of ICU nurses were 'moderate', and nurse-physician collaboration (74.25 ± 5.10) was 'good'. There was a positive relationship between professional autonomy and job stress (r = .506) and nurse-physician collaboration (r = .242). Professional autonomy was a predictor of job stress in nurses (p < .000), and work experience in ICU can cause job stress in nurses (p = .024).

CONCLUSION

Increasing nurses' professional autonomy causes an increase in job stress and improves nurse-physician collaboration in ICU.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers should implement practical strategies to improve nurses' autonomy, enhance nurse-physician collaboration and decrease their job stress.

[Critical Incident Reporting on medication errors regarding units of measurement and calculations]

INTRODUCTION

Medication safety is an important hot spot of patient safety. This fact prompted the Swiss Patient Safety Foundation to conduct its annual CIRRNET (Critical Incident Reporting & Reacting NETwork) reporting month on the topic of "Units of measurement of medicines and calculation errors in prescription/dispensing (mg, g, mmol etc.)".

METHODS

During the CIRRNET reporting month 2018, the CIRS (Critical Incident Reporting System) managers of the health institutions participating in CIRRNET forwarded all incident reports on the topic to the CIRRNET database. The archive was also searched for usable reports on the same topic. The reports were analysed according to the type of medication involved (type of application and medication class according to ATC codes), the process stage affected (prescription, preparation, administration and documentation) and the error category.

RESULTS

Of the 110 reports analysed, 27 reports originated directly from the reporting month, 83 reports were additionally extracted from the archive. 67 reports (60 %) concerned intravenously administered medications and analgesics (opioids and non-opioids, such as NSAIDs) were the most frequently affected/involved medication class with 21 reports (18 %). The process step preparation/calculation was the one where most of the errors analysed occurred. With a total of 48 reports (44 %), most of the errors analysed were classified here. Regarding error categories, it becomes apparent that the categories "Derivation of the amount to be administered (volume/number of single doses) from strength or concentration" with 33 (30 %), "Unit of measurement ml - mg" with 20 (18 %) and "Dose/volume per time" with 14 reports (13 %) were reported most frequently.

CONCLUSION

Errors concerning units of measurement or the calculation of medication have been numerously reported by the CIRRNET institutions. Often, these were cases in which, for example, the volume of a drug to be administered was derived incorrectly. Such calculations are demanding, prone to error and represent a system problem. Therefore, good solution strategies need to be implemented in order to sustainably improve medication safety and thus patient safety.

Nurses' Perceived Causes of Medication Administration Errors: A Qualitative Systematic Review

BACKGROUND

Medication administration errors (MAEs) are a critical patient safety issue. Nurses are often responsible for administering medication to patients, thus their perceptions of causes of errors can provide valuable guidance for the development of interventions aimed to mitigate errors. Quantitative research can overlook less overt causes; therefore, a qualitative systematic review was conducted to present a synthesis of qualitative evidence of nurses' perceived causes of MAEs.

METHODS

Publications from 2000 to February 2019 were searched using four electronic databases. Inclusion criteria were articles that (1) presented results from studies that used a qualitative or mixed methods design, (2) reported qualitative data on nurses' perceived causes of MAEs in health care settings, and (3) were published in the English language. Sixteen individual articles satisfied the inclusion criteria. Methodological quality of each article was assessed using the Critical Appraisal Skills Programme (CASP) tool. Thematic analysis of the data was performed. Perceived causes of errors were labeled as knowledge-based, personal, and contextual factors.

RESULTS

The primary knowledge-based factor was lack of medication knowledge. Personal factors included fatigue and complacency. Contextual factors included heavy workloads and interruptions. Contextual factors were reported in all the studies reviewed and were often interconnected with personal and knowledge-based factors.

CONCLUSION

Causes of MAEs are perceived by nurses to be multifactorial and interconnected and often stem from systems issues. Multifactorial interventions aimed at mitigating medication errors are required with an emphasis on systems changes. Findings in this review can be used to guide efforts aimed at identifying and modifying factors contributing to MAEs.

Investigation of the effect of communicational empowerment pattern on nursing student's communicational competency

INTRODUCTION

Today medical education is focusing on teaching human and communicational skills, just like the basic theories in medicine. Making effective and efficient contacts and communications are very important in nursing. Although these studies had shown that these skills are poor among nurses. Due to this, it is important to teach these skills to all health-care providers. This study aimed to investigate the effect of communicational empowerment pattern on nursing student's communicational competency.

MATERIALS AND METHODS

This study was conducted on 78 senior nursing students who were chosen randomly by the census method. Respondents were divided into case and control groups. In case group, the communicational empowerment method was conducted and in control group, no interventions were done. Data were collected by communicational competency questionnaire. Data were analyzed using descriptive statistics, Pearson correlation, and t-test through IBM, SPSS version 19, United States 2016. The significance level was considered 0.05 respectfully.

RESULTS

The mean age was 22.23 ± 1.80. In the case of marital status, a number of 63 respondents were single and 15 were married. The mean score of communicational competency in case group was 112.38 ± 19.20 before intervention and 128.95 ± 11.98 after intervention. In control group, the mean score of communicational competency before intervention was 107.55 ± 14.22 and after intervention, it was 117.11 ± 15.37. There was not any significant relationship between case and control groups in the mean score of communicational competency before intervention (P = 0.0187), but a significant relationship was assessed between case and control groups in the mean score of communicational competency after intervention (P < 0.001). The level named "Good" in communicational competency was increased among respondents from 56.8% to 90.9%.

CONCLUSION

Using the communicational empowerment method in clinical education is possible and it increases the communicational competency.

Effect of interprofessional education of medication safety program on the medication error of physicians and nurses in the intensive care units

BACKGROUND

The safety of hospitalized patients in the intensive care units (ICUs) is threatened due to incidents and adverse events, including medication errors. Medication error refers to any preventable event at different stage of medication process, such as prescription, transcription, distributing medication, and administration, which can lead to incorrect use of medicines or damage to the patient. This study aimed at investigating the effect of the interprofessional education of medication safety program on medication errors of physicians and nurses in the ICUs.

MATERIALS AND METHODS

The study was conducted using a quasi-experimental method (single group, before and after) in 2017. The setting of the study included one ICU of selected teaching hospital affiliated to Isfahan University of Medical Sciences located in the Central Iran with a total of 23 beds. Participants included 50 members of the health-care team (physician, nurse, and clinical pharmacist) with at least 1 year of work experience in the ICUs. Participants were selected using censuses sampling method. Data were collected using a two-section self-made questionnaire. Data were analyzed through descriptive, analytical statistics, and version 16 of the SPSS software (P < 0.05).

RESULTS

According to reporting of physicians, nurses, and clinical pharmacist, the medication error 1 month after implementation, the interprofessional education of medication safety program was significantly lower than before the implementation of it (P < 0.001).

CONCLUSIONS

Interprofessional education helps to improve interprofessional collaboration and patient care through the promotion of various professions of health to increase interprofessional collaboration compared to single profession education, which individuals learn in isolation and merely in their profession. Therefore, interprofessional education of medication safety program can reduce medication error and promote patient safety in the ICUs.

Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study

BACKGROUND

Medication errors are a serious and complex problem in clinical practice, especially in intensive care units whose patients can suffer potentially very serious consequences because of the critical nature of their diseases and the pharmacotherapy programs implemented in these patients. The origins of these errors discussed in the literature are wide-ranging, although far-reaching variables are of particular special interest to those involved in training nurses. The main objective of this research was to study if the level of knowledge that critical-care nurses have about the use and administration of medications is related to the most common medication errors.

METHODS

This was a mixed (multi-method) study with three phases that combined quantitative and qualitative techniques. In phase 1 patient medical records were reviewed; phase 2 consisted of an interview with a focus group; and an ad hoc questionnaire was carried out in phase 3.

RESULTS

The global medication error index was 1.93%. The main risk areas were errors in the interval of administration of antibiotics (8.15% error rate); high-risk medication dilution, concentration, and infusion-rate errors (2.94% error rate); and errors in the administration of medications via nasogastric tubes (11.16% error rate).

CONCLUSIONS

Nurses have a low level of knowledge of the drugs they use the most and with which a greater number of medication errors are committed in the ICU.

Implementation of an SBAR communication program based on experiential learning theory in a pediatric nursing practicum: A quasi-experimental study

BACKGROUND

Effective communication by nurses is crucial to ensure patient safety. A structured communication program increases communication clarity, education satisfaction, and positivity during interprofessional collaboration among students. In an effort to facilitate effective communication between nurses and physicians, the well-known structured communication tool SBAR (Situation, Background, Assessment, and Recommendation) has been extensively used in clinical and educational settings.

OBJECTIVES

The purpose of the study is to investigate the impact of an SBAR communication program on communication performance, perception, and practicum-related outcomes in senior-year nursing students.

METHOD

The study employed a non-equivalent control group quasi-experimental design and implemented the tool in the pediatric nursing practicum of a nursing school. The experimental group participated in a SBAR program, where role playing using SBAR techniques for different scenarios was used to improve practical communication among nursing students. The SBAR program was developed based on Kolb's Experiential Learning Theory. Communication performance was assessed via the SBAR communication tool and the communication clarity scale. Communication perception was measured by handover confidence level. Practicum-related outcomes of clinical practice self-efficacy, perceived nurse-physician collaboration, and practicum satisfaction, were also evaluated.

RESULTS

The experimental group demonstrated significantly higher SBAR communication (p < .001), communication clarity (p < .001), and handover confidence (p < .001) than the control group. Clinical practice self-efficacy, perceived nurse-physician collaboration, and practicum satisfaction did not differ.

CONCLUSIONS

The SBAR program in a pediatric nursing practicum improves SBAR communication, communication clarity, and perceived handover confidence in senior-year nursing students.

Pharmacists in Critical Care

The beginnings of caring for critically ill patients date back to Florence Nightingale's work during the Crimean War in 1854, but the subspecialty of critical care medicine is relatively young. The first US multidisciplinary intensive care unit (ICU) was established in 1958, and the American Board of Medical Subspecialties first recognized the subspecialty of critical care medicine in 1986. Critical care pharmacy services began around the 1970s, growing in the intervening 40 years to become one of the largest practice areas for clinical pharmacists, with its own section in the SCCM, the largest international professional organization in the field. During the next decade, pharmacy services expanded to various ICU settings (both adult and pediatric), the operating room, and the emergency department. In these settings, pharmacists established clinical practices consisting of therapeutic drug monitoring, nutrition support, and participation in patient care rounds. Pharmacists also developed efficient and safe drug delivery systems with the evolution of critical care pharmacy satellites and other innovative programs. In the 1980s, critical care pharmacists designed specialized training programs and increased participation in critical care organizations. The number of critical care residencies and fellowships doubled between the early 1980s and the late 1990s. Standards for critical care residency were developed, and directories of residencies and fellowships were published. In 1989, the Clinical Pharmacy and Pharmacology Section was formed within the Society of Critical Care Medicine, the largest international, multidisciplinary, multispecialty critical care organization. This recognition acknowledged that pharmacists are necessary and valuable members of the physician-led multidisciplinary team. The Society of Critical Care Medicine Guidelines for Critical Care Services and Personnel deem that pharmacists are essential for the delivery of quality care to critically ill patients. These guidelines recommend that a pharmacist monitor drug regimen for dosing, adverse reactions, drug-drug interactions, and cost optimization for all hospitals providing critical care services. The guidelines also advocate that a specialized, decentralized pharmacist provide expertise in nutrition support, cardiorespiratory resuscitation, and clinical research in academic medical centers providing comprehensive critical care.

Medication errors in hospitals in the Middle East: a systematic review of prevalence, nature, severity and contributory factors

PURPOSE

The aim was to critically appraise, synthesise and present the evidence of medication errors amongst hospitalised patients in Middle Eastern countries, specifically prevalence, nature, severity and contributory factors.

METHODS

CINAHL, Embase, Medline, Pubmed and Science Direct were searched for studies published in English from 2000 to March 2018, with no exclusions. Study selection, quality assessment (using adapted STROBE checklists) and data extraction were conducted independently by two reviewers. A narrative approach to data synthesis was adopted; data related to error causation were synthesised according to Reason's Accident Causation model.

RESULTS

Searching yielded 452 articles, which were reduced to 50 following removal of duplicates and screening of titles, abstracts and full-papers. Studies were largely from Iran, Saudi Arabia, Egypt and Jordan. Thirty-two studies quantified errors; definitions of 'medication error' were inconsistent as were approaches to data collection, severity assessment, outcome measures and analysis. Of 13 studies reporting medication errors per 'total number of medication orders'/ 'number of prescriptions', the median across all studies was 10% (IQR 2-35). Twenty-four studies reported contributory factors leading to errors. Synthesis according to Reason's model identified the most common being active failures, largely slips (10 studies); lapses (9) and mistakes (12); error-provoking conditions, particularly lack of knowledge (13) and insufficient staffing levels (13) and latent conditions, commonly heavy workload (9).

CONCLUSION

There is a need to improve the quality and reporting of studies from Middle Eastern countries. A standardised approach to quantifying medication errors' prevalence, severity, outcomes and contributory factors is warranted.

The most frequent and important events that threaten patient safety in intensive care units from the perspective of health-care professionals'

Background

Patient safety is a priority in all health-care centers across the world. This study aimed to determine the frequency of events that threaten patient safety and the grade threating of events from the perspective of the health-care professionals in the intensive care units (ICUs).

Materials and Methods

This cross-sectional study was conducted in 2016. The participants were 306 members of health-care professionals (physicians and nurses) with at least 1 year of work experience in ICUs of educational hospitals affiliated to Isfahan University of Medical Sciences. Data were collected using a three-section self-made questionnaire. Data analysis was done using descriptive statistics (frequency distribution and percentage) and version 16 of SPSS software.

Results

A total of 306 questionnaires were completed out of 320 questionnaires handed out among participants. During the last month, 91.2% of the participants had reported at least a case of medication error, 75.6% had reported at least a case of ventilator-associated pneumonia, and 74.2% had reported at least a case of catheter-induced urinary infection in ICUs.

Conclusion

The occurrence of events threatening the patient safety in ICUs warrants proper planning by administrators of health-care centers. Medication error was the most frequent and important event of threat to patient safety and falling was the least frequent event of threat to patient safety in ICUs. Considering the frequency and magnitude of medication error in ICUs, a well-adjusted preventive plan should be designed and implemented to improve the patient safety.

The effect of nurse empowerment educational program on patient safety culture: a randomized controlled trial

BACKGROUND

The complexity of patients' condition and treatment processes in intensive care units (ICUs) predisposes patients to more hazardous events. Effective patient safety culture is related to lowering the rate of patients' complications and fewer adverse events. The present study aimed to determine the effect of empowering nurses and supervisors through an educational program on patient safety culture in adult ICUs.

METHODS

A randomized controlled trial was conducted during April-September 2015 in 6 adult ICUs at Namazi Hospital, Shiraz, Iran. A total of 60 nurses and 20 supervisors were selected through proportional stratified sampling and census, respectively, and randomly assigned to the experimental and control groups. The intervention consisted of a two-day workshop, hanging posters, and distributing pamphlets that covered topics such as patient safety, patient safety culture, speak up about safety issues, and the skills of Team Strategies and Tools to Enhance Performance and Patient Safety. Data were collected through a hospital survey on patient safety culture. Eventually, 61 participants completed the study. Data were analyzed using descriptive statistics, independent-samples t-test, paired-samples t-test, and Chi-square test. P < 0.05 was considered statistically significant.

RESULTS

In the experimental group, the total post-test mean scores of the patient safety culture (3.46 ± 0.26) was significantly higher than that of the control group (2.84 ± 0.37, P < 0.001). It was also higher than that of the pre-test (2.91 ± 0.4, P < 0.001). Additionally, significant improvements were observed in 5 out of 12 dimensions in the experimental group. However, dimensions such as non-punitive response to errors and the events reported did not improve significantly.

CONCLUSION

Empowering nurses and supervisors could improve the overall patient safety culture. Nonetheless, additional actions are required to improve areas such as reporting the events and non-punitive response to errors.

TRIAL REGISTRATION

IRCT2015053122494N1 . Date registered: March 2, 2016.