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Grailey K, Brazier A, Franklin BD, McCrudden C, Fernandez Crespo R, Brown H, Bird J, Acharya A, Gregory A, Darzi A, Huf S. Raising the barcode: improving medication safety behaviours through a behavioural science-informed feedback intervention. A quality improvement project and difference-in-difference analysis. BMJ Qual Saf 2024:bmjqs-2023-016868. [PMID: 38902018 DOI: 10.1136/bmjqs-2023-016868] [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: 10/30/2023] [Accepted: 05/13/2024] [Indexed: 06/22/2024]
Abstract
Barcode medication administration (BCMA) technology can improve patient safety by using scanning technology to ensure the right drug and dose are given to the right patient. Implementation can be challenging, requiring adoption of different workflows by nursing staff. In one London National Health Service trust scanning rates were lower than desired at around 0-20% of doses per ward. Our objective was to encourage patient safety behaviours in the form of medication scanning through implementation of a feedback intervention. This was informed by behavioural science, codesigned with nurses and informed by known barriers to use. Five wards were selected to trial the intervention over an 18-week period beginning August 2021. The remaining 14 hospital wards acted as controls. Intervention wards had varying uptake of BCMA at baseline and represented a range of specialties. A bespoke feedback intervention comprising three behavioural science constructs (gamification, the messenger effect and framing) was delivered to each intervention ward each week. A linear difference-in-difference analysis was used to evaluate the impact of our intervention on scan rates, both for the overall 18-week period and at two weekly intervals within this timeframe. We identified a 23.1 percentage point increase in medication scan rates (from an average baseline of 15.0% to 38.1%) on the intervention wards compared with control (p<0.001) following implementation of the intervention. Feedback had most impact in the first 6 weeks, with an initial percentage point increase of 26.3 (p<0.001), which subsequently plateaued. Neither clinical specialty nor number of beds on each ward were significant factors in our models. Our study demonstrated that a feedback intervention, codesigned with end users and incorporating behavioural science constructs, can lead to a significant increase in the adoption of BCMA scanning.
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Affiliation(s)
- Kate Grailey
- Centre for Health Policy, Imperial College London Institute of Global Health Innovation, London, UK
| | | | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Clare McCrudden
- Helix Centre, Imperial College London Institute of Global Health Innovation, London, UK
| | - Roberto Fernandez Crespo
- Centre for Health Policy, Imperial College London Institute of Global Health Innovation, London, UK
| | | | - James Bird
- Imperial College Healthcare NHS Trust, London, UK
| | - Amish Acharya
- Centre for Health Policy, Imperial College London Institute of Global Health Innovation, London, UK
| | - Alice Gregory
- Helix Centre, Imperial College London Institute of Global Health Innovation, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College London Institute of Global Health Innovation, London, UK
| | - Sarah Huf
- Imperial College London Institute of Global Health Innovation, London, UK
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Lei KC, Loi CI, Cen Z, Li J, Liang Z, Hu H, Chan TF, Ung COL. Adopting an electronic medication administration system in long-term care facilities: a key stakeholder interview study in Macao. Inform Health Soc Care 2023:1-15. [PMID: 36650719 DOI: 10.1080/17538157.2023.2165084] [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: 01/19/2023]
Abstract
To improve medication safety for residents in long-term care facilities (LTCFs), electronic medication administration records (eMARs) are widely adopted in Macao. This study aimed to (1) develop a logic model for adopting eMAR in LTCFs and (2) explore the contextual factors relevant to the implementation. Semi-structured interviews were conducted with key stakeholders (managers, doctors, nurses, pharmacy staff and other frontline workers) experienced with eMAR in LTCFs in Macao between February and March 2021. Purposive sampling was used for recruitment and thematic analysis followed the theoretical framework of the logic model. All 57 participants were positive about eMAR. Financial and nonfinancial resources were critical to adopting eMAR. eMAR was mostly used for its functions in documentation, e-prescribing and monitoring. Immediate output included simplified working process, reduced errors, closer monitoring of residents' conditions, and timely communication among staff. The outcomes mainly related to efficiency, safety and quality of care, workload redundancy, and data unification. Key influencing factors included eMAR flexibility, stability, and technical support. Adopting eMARs is highly consuming and the benefits in improving quality of care can only be realized with appropriate implementation, precise execution, regular evaluation and responsive adjustment. The proposed logic model framework serves as a roadmap for LTCFs, both current and future users of eMAR.
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Affiliation(s)
- Ka Cheng Lei
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, SAR, China
| | - Cheng I Loi
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, SAR, China
| | - Zhifeng Cen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, SAR, China
| | - Junlei Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, SAR, China
| | - Zuanji Liang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, SAR, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, SAR, China.,Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao, SAR, China
| | - Tek Fai Chan
- Macao Society for Medicinal Administration, Macao, SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, SAR, China.,Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao, SAR, China
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Nurses' Perceptions of Using Personal Digital Assistants in Tertiary Hospitals. Comput Inform Nurs 2022; 40:682-690. [PMID: 35475919 DOI: 10.1097/cin.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Personal digital assistants can perform multiple functions such as Internet search, documentation, calculating, and barcode scanning. This study examined nurses' perceptions of personal digital assistants used as a barcode scanner for medication administration, blood transfusions, and blood collection. A total of 236 nurses participated in the survey using the instrument developed by the researchers. The data collected were analyzed using descriptive statistics, one-way analysis of variance, and the Scheffe test. Written responses to the advantages and drawbacks of using personal digital assistants were categorized by meaning. The results showed that the nurses perceived more drawbacks than advantages in using personal digital assistants because of nonworking barcodes, prescription practice requiring additional scanning, poor interfacing between personal digital assistants and the EMR, and frequent Wi-Fi disconnection. The drawbacks resulted in delays in nursing workflow for patient care. Therefore, increasing the availability of barcode scanning for all medications applicable to personal digital assistant use, redesigning the practice of current prescriptions to eliminate additional scanning, and seamless interfacing between personal digital assistants and EMRs should be considered. This enables the nurses to use personal digital assistants more efficiently and effectively for patient care.
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Altyar A, Sadoun SA, Aljohani SS, Alradadi RS. Evaluating Pharmacy Practice in Hospital Settings in Jeddah City, Saudi Arabia: Dispensing and Administration-2019. Hosp Pharm 2022; 57:32-37. [PMID: 35521022 PMCID: PMC9065526 DOI: 10.1177/0018578720970470] [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: 02/03/2023]
Abstract
Purpose: To evaluate the dispensing and administration processes in hospital settings in Jeddah city, Saudi Arabia. Method: A questionnaire based on the annual ASHP national survey was distributed among 35 hospitals. The response rate was 60%. After a follow-up period of 6 months, the final questionnaire was collected in November 2019. Result: The survey had a 60% response rate. Most surveyed hospitals have centralized pharmacies (76.2%). Few hospitals reported the use of the Bar Code Medication Administration BCMA system (19.0%) to verify doses during dispensing, and only 28.6% use automated dispensing cabinets. The main method to check unit doses in pharmacies is the "technician fills/pharmacist checks" method, as reported by 76.2% of hospitals. Conclusion: The new technologies in the field of healthcare are impacting the practice of medication distribution. Hospital pharmacies in Jeddah, Saudi Arabia are implementing many changes to improve the medication-use system. However, more work has to be done to follow the leaders in the area of pharmacy practice.
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Affiliation(s)
- Ahmed Altyar
- King Abdulaziz University, Jeddah, Saudi Arabia,Ahmed Altyar, Faculty of Pharmacy, King Abdulaziz University, P.O. Box 80260, Jeddah 21441, Saudi Arabia.
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Mulac A, Hagesaether E, Granas AG. Medication dose calculation errors and other numeracy mishaps in hospitals: Analysis of the nature and enablers of incident reports. J Adv Nurs 2022; 78:224-238. [PMID: 34632614 DOI: 10.1111/jan.15072] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/30/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
AIMS To investigate medication dose calculation errors and other numeracy mishaps in hospitals and examine mechanisms and enablers which lead to such errors. DESIGN A retrospective study using descriptive statistics and thematic analysis of the nature and enablers of reported incidents. METHODS Medication dose calculation errors and other numeracy mishaps were identified from medication-related incidents reported to the Norwegian Incident Reporting System in 2016 and 2017. The main outcome measures were medications and medication classes involved, severity of harm, outcome, and error enablers. RESULTS In total, we identified 100 numeracy errors, of which most involved intravenous administration route (n = 70). Analgesics were the most commonly reported drug class and morphine was the most common individual medication. Overall, 78 incidents described patient harm. Frequent mechanisms were 10- or 100-fold errors, mixing up units, and incorrect strength/rate entered into infusion pumps. The most frequent error enablers were: double check omitted or deviated (n = 40), lack of safety barriers to intercept prescribing errors (n = 25), and emergency/stress (n = 21). CONCLUSION Numeracy errors due to lack of or improper safeguards occurred during all medication management stages. Dose miscalculation after dilution of intravenous solutions, infusion pump programming, and double-checking were identified as unsafe practices. We discuss measures to prevent future calculation and numeracy errors. IMPACT Our analysis of medication dose calculation errors and other numeracy mishaps demonstrates the need for improving safety steps and increase standardization for medication management procedures. We discuss organizational, technological, and educational measures to prevent harm from numeracy errors.
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Affiliation(s)
- Alma Mulac
- Department of Pharmacy, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Ellen Hagesaether
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anne Gerd Granas
- Department of Pharmacy, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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Mulac A, Mathiesen L, Taxis K, Gerd Granås A. Barcode medication administration technology use in hospital practice: a mixed-methods observational study of policy deviations. BMJ Qual Saf 2021; 30:1021-1030. [PMID: 34285114 PMCID: PMC8606443 DOI: 10.1136/bmjqs-2021-013223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Abstract
Introduction Barcode medication administration (BCMA) can, if poorly implemented, cause disrupted workflow, increased workload and cause medication errors. Further exploration is needed of the causes of BCMA policy deviations. Objective To gain an insight into nurses’ use of barcode technology during medication dispensing and administration; to record the number and type of BCMA policy deviations, and to investigate their causes. Methods We conducted a prospective, mixed-methods study. Medication administration rounds on two hospital wards were observed using a digital tool and field notes. The SEIPS (Systems Engineering Initiative for Patient Safety) model was used to analyse the data. Results We observed 44 nurses administering 884 medications to 213 patients. We identified BCMA policy deviations for more than half of the observations; these related to the level of tasks, organisation, technology, environment and nurses. Task-related policy deviations occurred with 140 patients (66%) during dispensing and 152 patients (71%) during administration. Organisational deviations included failure to scan 29% of medications and 20% of patient’s wristbands. Policy deviations also arose due to technological factors (eg, low laptop battery, system freezing), as well as environmental factors (eg, medication room location, patient drawer size). Most deviations were caused by policies that interfere with proper and safe BCMA use and suboptimal technology design. Conclusion Our findings indicate that adaptations of the work system are needed, particularly in relation to policies and technology, to optimise the use of BCMA by nurses during medication dispensing and administration. These adaptations should lead to enhanced patient safety, as the absolute goal with BCMA implementation.
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Affiliation(s)
- Alma Mulac
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Liv Mathiesen
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Katja Taxis
- Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands
| | - Anne Gerd Granås
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
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Alrabadi N, Shawagfeh S, Haddad R, Mukattash T, Abuhammad S, Al-rabadi D, Abu Farha R, AlRabadi S, Al-Faouri I. Medication errors: a focus on nursing practice. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Abstract
Objectives
Health departments endeavor to give care to individuals to remain in healthy conditions. Medications errors (MEs), one of the most types of medical errors, could be venomous in clinical settings. Patients will be harmed physically and psychologically, in addition to adverse economic consequences. Reviewing and understanding the topic of medication error especially by nurses can help in advancing the medical services to patients.
Methods
A search using search engines such as PubMed and Google scholar were used in finding articles related to the review topic.
Key findings
This review highlighted the classifications of MEs, their types, outcomes, reporting process, and the strategies of error avoidance. This summary can bridge and open gates of awareness on how to deal with and prevent error occurrences. It highlights the importance of reporting strategies as mainstay prevention methods for medication errors.
Conclusions
Medication errors are classified based on multifaceted criteria and there is a need to standardize the recommendations and make them a central goal all over the globe for the best practice. Nurses are the frontlines of clinical settings, encouraged to be one integrated body to prevent the occurrence of medication errors. Thus, systemizing the guidelines are required such as education and training, independent double checks, standardized procedures, follow the five rights, documentation, keep lines of communication open, inform patients of drug they receive, follow strict guidelines, improve labeling and package format, focus on the work environment, reduce workload, ways to avoid distraction, fix the faulty system, enhancing job security for nurses, create a cultural blame-free workspace, as well as hospital administration, should support and revise processes of error reporting, and spread the awareness of the importance of reporting.
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Affiliation(s)
- Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Shaima Shawagfeh
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Razan Haddad
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Tareq Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Sawsan Abuhammad
- Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Daher Al-rabadi
- Department of Nursing, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Rana Abu Farha
- Department of Pharmacology and Pharmacotherapy, Applied Science Private University, Amman, Jordan
| | - Suzan AlRabadi
- Faculty of Pharmacy, Philadelphia University, Amman, Jordan
| | - Ibrahim Al-Faouri
- Department of Nursing, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
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