1
|
Baehr A, Grohmann M, Guberina M, Schulze K, Lange T, Nestle U, Ernst P. Usability and usefulness of (electronic) patient identification systems-A cross-sectional evaluation in German-speaking radiation oncology departments. Strahlenther Onkol 2024; 200:468-474. [PMID: 37713170 PMCID: PMC11111529 DOI: 10.1007/s00066-023-02148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/13/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE Patient misidentification in radiation oncology (RO) is a significant concern due to the potential harm to patient health and the burden on healthcare systems. Electronic patient identification systems (ePIS) are increasingly being used as an alternative or supplement to organizational systems (oPIS). The objective of this study was to assess the usability and usefulness of ePIS and oPIS in German-speaking countries. METHODS A cross-sectional survey was designed by a group of experts from various professional backgrounds in RO. The survey consisted of 38 questions encompassing quantitative and qualitative data on usability, user experience, and usefulness of PIS. It was available between August and October 2022. RESULTS Of 118 eligible participants, 37% had implemented some kind of ePIS. Overall, 22% of participants who use an oPIS vs. 10% of participants who use an ePIS reported adverse events in terms of patients' misidentification in the past 5 years. Frequent or very frequent drop-outs of electronic systems were reported by 31% of ePIS users. Users of ePIS significantly more often affirmed a positive cost-benefit ratio of ePIS as well as an improvement of workflow, whereas users of oPIS more frequently apprehended a decrease in staffs' attention through ePIS. The response rate was 8%. CONCLUSION The implementation of ePIS can contribute to efficient PI and improved processes. Apprehensions by oPIS users and assessments of ePIS users differ significantly in aspects of the perceived usefulness of ePIS. However, technical problems need to be addressed to ensure the reliability of ePIS. Further research is needed to assess the impact of different PIS on patient safety in RO.
Collapse
Affiliation(s)
- Andrea Baehr
- Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
- Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Maximilian Grohmann
- Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Maja Guberina
- Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Katrin Schulze
- Department of Radiation Oncology, Fulda Community Hospital, Fulda, Germany
| | - Tim Lange
- Clinic for Radiotherapy, Hannover, Medical School, Hannover, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf GmbH, Moenchengladbach, Germany
| | - Philipp Ernst
- Department of Radiation Oncology, Kliniken Maria Hilf GmbH, Moenchengladbach, Germany
| |
Collapse
|
2
|
Reza F, Jones C, Reed JH. Improving Immunization Health Care Data Quality using Two-Dimensional Barcoding and Barcode Scanning Practices. Appl Clin Inform 2024; 15:265-273. [PMID: 38286429 PMCID: PMC10990595 DOI: 10.1055/a-2255-9749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/25/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Manual data entry is time-consuming, inefficient, and error prone. In contrast, leveraging two-dimensional (2D) barcodes and barcode scanning tools is a rapid and effective practice for automatically entering vaccine data accurately and completely. CDC pilots documented clinical and public health impacts of 2D barcode scanning practices on data quality and completeness, time savings, workflow efficiencies, and staff experience. OBJECTIVES Data entry practices and entered records from routine and mass vaccination settings were analyzed. Data quality improvement opportunities were identified. METHODS A sample of 50 million emergency use authorization (EUA) coronavirus disease 2019 (COVID-19) vaccine records were analyzed for accuracy and completeness across three data fields: lot number, expiration date, and National Drug Code (NDC). The EUA COVID-19 vaccines lacked a 2D barcode containing these data fields, which necessitated manual data entry at administration. A CDC pilot at clinic compared scanned and manually entered data for routine vaccines across these same data fields. RESULTS Analysis of 50 million manually entered EUA COVID-19 vaccine administration records indicated significant gaps in data accuracy and completeness across three data fields. Over half of the analyzed EUA vaccine NDCs (53%) and one-third of the expiration dates (35%) had missing or inaccurate data recorded. Pilot data also showed many errors when manually entered. However, when the pilot's routine vaccines were scanned (out of 71,969 records), nearly all entries were complete and accurate across all three data fields (ranging from 99.7% to 99.999% accurate). CONCLUSION Vaccine 2D barcode scanning practices increased data accuracy and completeness (up to 99.999% accurate) across data fields assessed. When used consistently, vaccine 2D barcode scanning can resolve issues demonstrated in manually entered data. To realize these benefits, the immunization community should widely use scanning practices. To increase use, CDC developed a Vaccine 2D Barcode National Adoption Strategy and implementation resources.
Collapse
Affiliation(s)
- Faisal Reza
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Centers for Disease Control and Prevention Vaccine 2D Barcodes Team, Atlanta, Georgia, United States
- Centers for Disease Control and Prevention Novel Coronavirus (COVID-19) Public Health Emergency Response Team, Atlanta, Georgia, United States
| | - Caroline Jones
- Deloitte Consulting LLP, Alexandria, Virginia, United States
- Centers for Disease Control and Prevention Vaccine 2D Barcodes Team, Atlanta, Georgia, United States
- Centers for Disease Control and Prevention Novel Coronavirus (COVID-19) Public Health Emergency Response Team, Atlanta, Georgia, United States
| | - Jenica H. Reed
- Deloitte Consulting LLP, Alexandria, Virginia, United States
- Centers for Disease Control and Prevention Vaccine 2D Barcodes Team, Atlanta, Georgia, United States
- Centers for Disease Control and Prevention Novel Coronavirus (COVID-19) Public Health Emergency Response Team, Atlanta, Georgia, United States
| |
Collapse
|
3
|
Stendardo G, Nuccetelli C, Grande S, Palma A, Venoso G, Zicari C, Andenna C, Frau G, Bonanno I, Landoni V, Sciuto R, Bruzzaniti V, Cassano B, Iaccarino G, Murtas F, Canzi C, Zito F, Fattibene P. A real-time system to report abnormal events involving staff in a nuclear medicine therapy unit. RADIATION PROTECTION DOSIMETRY 2023; 199:962-969. [PMID: 37225203 DOI: 10.1093/rpd/ncad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A system for internal and voluntary reporting of abnormal events in a Nuclear Medicine Therapy Unit is described. This system is based on the Internet of Things and is composed of an application for mobile devices and a wireless network of detectors. The application is addressed to healthcare professionals and is intended to be a user-friendly tool to make the reporting procedure little laborious. The network of detectors allows for a real-time measurement of the dose distribution in the patient's room. The staff was involved in all stages, from the design of the dosimetry system and mobile application up to their final testing. Face-to-face interviews were carried out with 24 operators in different roles in the Unit (radiation protection experts, physicians, physicists, nuclear medicine technicians and nurses). The preliminary results of the interviews and the current state of development of the application and the detection network will be described.
Collapse
Affiliation(s)
| | - Cristina Nuccetelli
- Istituto Superiore di Sanità, National Center for Radiation Protection and Computational Physics, Rome 00161, Italy
| | - Sveva Grande
- Istituto Superiore di Sanità, National Centre for Innovative Technologies in Public Health, Rome 00161, Italy
| | - Alessandra Palma
- Istituto Superiore di Sanità, National Centre for Innovative Technologies in Public Health, Rome 00161, Italy
| | - Gennaro Venoso
- Istituto Superiore di Sanità, National Center for Radiation Protection and Computational Physics, Rome 00161, Italy
| | - Carmine Zicari
- National Institute for Insurance against Accidents at Work, Department of Technological Innovations and Safety of Plants, Products and Anthropics settlements, Rome 00153, Italy
| | - Claudio Andenna
- National Institute for Insurance against Accidents at Work, Department of Technological Innovations and Safety of Plants, Products and Anthropics settlements, Rome 00153, Italy
| | | | | | - Valeria Landoni
- IRCCS Regina Elena National Cancer Institute, Department of research and advanced technology, Rome 00144, Italy
| | - Rosa Sciuto
- IRCCS Regina Elena National Cancer Institute, Department of research and advanced technology, Rome 00144, Italy
| | - Vicente Bruzzaniti
- IRCCS Regina Elena National Cancer Institute, Department of research and advanced technology, Rome 00144, Italy
| | - Bartolomeo Cassano
- IRCCS Regina Elena National Cancer Institute, Department of research and advanced technology, Rome 00144, Italy
| | - Giuseppe Iaccarino
- IRCCS Regina Elena National Cancer Institute, Department of research and advanced technology, Rome 00144, Italy
| | - Federica Murtas
- IRCCS Regina Elena National Cancer Institute, Department of research and advanced technology, Rome 00144, Italy
| | - Cristina Canzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Felicia Zito
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Paola Fattibene
- Istituto Superiore di Sanità, Core Facilities, Rome 00161, Italy
| |
Collapse
|
4
|
Erdfelder F, Ebach F, Zoller R, Walterscheid V, Weiss C, Kappler J, Görtzen-Patin J, Schmitt J, Freudenthal NJ, Müller A, Ksellmann A, Grigutsch D, Külshammer M, Füssel M, Zenker S. Implementation of 2D Barcode Medication Labels and Smart Pumps in Pediatric Acute Care: Lessons Learned. Appl Clin Inform 2023; 14:503-512. [PMID: 37075805 PMCID: PMC10322227 DOI: 10.1055/a-2077-2457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/19/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND In pediatric intensive care, prescription, administration, and interpretation of drug doses are weight dependent. The use of standardized concentrations simplifies the preparation of drugs and increases safety. For safe administration as well as easy interpretation of intravenous drug dosing regimens with standardized concentrations, the display of weight-related dose rates on the infusion device is of pivotal significance. OBJECTIVES We report on challenges in the implementation of a new information technology-supported medication workflow. The workflow was introduced on eight beds in the pediatric heart surgery intensive care unit as well as in the pediatric anesthesia at the University of Bonn Medical Center. The proposed workflow utilizes medication labels generated from prescription data from the electronic health record. The generated labels include a two-dimensional barcode to transfer data to the infusion devices. METHODS Clinical and technical processes were agilely developed. The reliability of the system under real-life conditions was monitored. User satisfaction and potential for improvement were assessed. In addition, a structured survey among the nursing staff was performed. The questionnaire addressed usability as well as the end-users' perception of the effects on patient safety. RESULTS The workflow has been applied 44,111 times during the pilot phase. A total of 114 known failures in the technical infrastructure were observed. The survey showed good ratings for usability and safety (median "school grade" 2 or B for patient safety, intelligibility, patient identification, and handling). The medical management of the involved acute care facilities rated the process as clearly beneficial regarding patient safety, suggesting a rollout to all pediatric intensive care areas. CONCLUSION A medical information technology-supported medication workflow can increase user satisfaction and patient safety as perceived by the clinical end-users in pediatric acute care. The successful implementation benefits from an interdisciplinary team, active investigation of possible associated risks, and technical redundancy.
Collapse
Affiliation(s)
- Felix Erdfelder
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Mathematical Physiology (AMP) Lab, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Fabian Ebach
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Richard Zoller
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
| | - Verena Walterscheid
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Claudia Weiss
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Jochen Kappler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Jan Görtzen-Patin
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
- Department of Internal Medicine I - Gastroenterology and Hepatology, Nephrology, Infectious Diseases, Endocrinology and Diabetology, University Hospital Bonn, Bonn, Germany
| | - Joachim Schmitt
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Noa J. Freudenthal
- Pediatric Cardiac Surgery at the German Pediatric Heart Centre in Bonn, University Hospital Bonn, Bonn, Germany
| | - A. Müller
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Anne Ksellmann
- Pediatric Cardiac Surgery at the German Pediatric Heart Centre in Bonn, University Hospital Bonn, Bonn, Germany
| | - Daniel Grigutsch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Manuel Külshammer
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Maike Füssel
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Sven Zenker
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Mathematical Physiology (AMP) Lab, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
5
|
Pruitt ZM, Kazi S, Weir C, Taft T, Busog DN, Ratwani R, Hettinger AZ. A Systematic Review of Quantitative Methods for Evaluating Electronic Medication Administration Record and Bar-Coded Medication Administration Usability. Appl Clin Inform 2023; 14:185-198. [PMID: 36889339 PMCID: PMC9995218 DOI: 10.1055/s-0043-1761435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/20/2022] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Although electronic medication administration records (eMARs) and bar-coded medication administration (BCMA) have improved medication safety, poor usability of these technologies can increase patient safety risks. OBJECTIVES The objective of our systematic review was to identify the impact of eMAR and BCMA design on usability, operationalized as efficiency, effectiveness, and satisfaction. METHODS We retrieved peer-reviewed journal articles on BCMA and eMAR quantitative usability measures from PsycInfo and MEDLINE (1946-August 20, 2019), and EMBASE (1976-October 23, 2019). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we screened articles, extracted and categorized data into the usability categories of effectiveness, efficiency, and satisfaction, and evaluated article quality. RESULTS We identified 1,922 articles and extracted data from 41 articles. Twenty-four articles (58.5%) investigated BCMA only, 10 (24.4%) eMAR only, and seven (17.1%) both BCMA and eMAR. Twenty-four articles (58.5%) measured effectiveness, 8 (19.5%) efficiency, and 17 (41.5%) satisfaction. Study designs included randomized controlled trial (n = 1; 2.4%), interrupted time series (n = 1; 2.4%), pretest/posttest (n = 21; 51.2%), posttest only (n = 14; 34.1%), and pretest/posttest and posttest only for different dependent variables (n = 4; 9.8%). Data collection occurred through observations (n = 19, 46.3%), surveys (n = 17, 41.5%), patient safety event reports (n = 9, 22.0%), surveillance (n = 6, 14.6%), and audits (n = 3, 7.3%). CONCLUSION Of the 100 measures across the 41 articles, implementing BCMA and/or eMAR broadly resulted in an increase in measures of effectiveness (n = 23, 52.3%) and satisfaction (n = 28, 62.2%) compared to measures of efficiency (n = 3, 27.3%). Future research should focus on eMAR efficiency measures, utilize rigorous study designs, and generate specific design requirements.
Collapse
Affiliation(s)
- Zoe M. Pruitt
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
| | - Sadaf Kazi
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, United States
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
| | - Deanna-Nicole Busog
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
| | - Raj Ratwani
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, United States
| | - Aaron Z. Hettinger
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, United States
| |
Collapse
|
6
|
Knox MK, Mehta PD, Dorsey LE, Yang C, Petersen LA. A Novel Use of Bar Code Medication Administration Data to Assess Nurse Staffing and Workload. Appl Clin Inform 2023; 14:76-90. [PMID: 36473498 PMCID: PMC9891851 DOI: 10.1055/a-1993-7627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of the study is to introduce an innovative use of bar code medication administration (BCMA) data, medication pass analysis, that allows for the examination of nurse staffing and workload using data generated during regular nursing workflow. METHODS Using 1 year (October 1, 2014-September 30, 2015) of BCMA data for 11 acute care units in one Veterans Affairs Medical Center, we determined the peak time for scheduled medications and included medications scheduled for and administered within 2 hours of that time in analyses. We established for each staff member their daily peak-time medication pass characteristics (number of patients, number of peak-time scheduled medications, duration, start time), generated unit-level descriptive statistics, examined staffing trends, and estimated linear mixed-effects models of duration and start time. RESULTS As the most frequent (39.7%) scheduled medication time, 9:00 was the peak-time medication pass; 98.3% of patients (87.3% of patient-days) had a 9:00 medication. Use of nursing roles and number of patients per staff varied across units and over time. Number of patients, number of medications, and unit-level factors explained significant variability in registered nurse (RN) medication pass duration (conditional R2 = 0.237; marginal R2 = 0.199; intraclass correlation = 0.05). On average, an RN and a licensed practical nurse (LPN) with four patients, each with six medications, would be expected to take 70 and 74 minutes, respectively, to complete the medication pass. On a unit with median 10 patients per LPN, the median duration (127 minutes) represents untimely medication administration on more than half of staff days. With each additional patient assigned to a nurse, average start time was earlier by 4.2 minutes for RNs and 1.4 minutes for LPNs. CONCLUSION Medication pass analysis of BCMA data can provide health systems a means for assessing variations in staffing, workload, and nursing practice using data generated during routine patient care activities.
Collapse
Affiliation(s)
- Melissa K. Knox
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Paras D. Mehta
- Department of Medicine, University of Houston, Houston, Texas, United States
| | | | - Christine Yang
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Laura A. Petersen
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| |
Collapse
|
7
|
Identification and analysis of human errors in emergency department nurses using SHERPA method. Int Emerg Nurs 2022; 62:101159. [DOI: 10.1016/j.ienj.2022.101159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/05/2022] [Accepted: 02/28/2022] [Indexed: 12/15/2022]
|
8
|
Crispin P, Akers C, Brown K, Delaforce A, Keegan A, King F, Ormerod A, Verrall T. A review of electronic medical records and safe transfusion practice for guideline development. Vox Sang 2022; 117:761-768. [PMID: 35089600 DOI: 10.1111/vox.13254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/22/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Electronic medical records (EMRs) are often composed of multiple interlinking systems, each serving a particular task, including transfusion ordering and administration. Transfusion may not be prioritized when developing or implementing electronic platforms. Uniform guidelines may assist information technology (IT) developers, institutions and healthcare workforces to progress with shared goals. MATERIALS AND METHODS A narrative review of current clinical guidance, benefits and risks of electronic systems for clinical transfusion practice was combined with feedback from experienced transfusion practitioners. RESULTS There is opportunity to improve the safety, quality and efficiency of transfusion practice, particularly through decision support and better identification procedures, by incorporating transfusion practice into EMRs. However, these benefits should not be assumed, as poorly designed processes within the electronic systems and the critically important electronic-human process interfaces may increase risk while creating the impression of safety. CONCLUSION Guidelines should enable healthcare and IT industries to work constructively together so that each implementation provides assurance of safe practice.
Collapse
Affiliation(s)
- Philip Crispin
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,Department of Haematology, Canberra Hospital, Garran, ACT, Australia.,Australian National University Medical School, Acton, ACT, Australia
| | - Christine Akers
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,Victorian Department of Health and Human Services, Blood Matters Program, Melbourne, Victoria, Australia
| | - Kristen Brown
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,Medical Services, Murrumbidgee Area Health Service, Wagga Wagga, NSW, Australia
| | - Alana Delaforce
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,Mater Health Services, South Brisbane, QLD, Australia.,Mater Research Institute-UQ, South Brisbane, QLD, Australia.,School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia
| | - Anastazia Keegan
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,Transfusion Policy and Education, Australian Red Cross Lifeblood, Perth, Western Australia, Australia.,Department of Haematology, Nepean Hospital, New South Wales, Australia
| | - Fiona King
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,New Zealand Blood Service, Wellington, New Zealand
| | - Amanda Ormerod
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,Department of Haematology, Latrobe Regional Health, Traralgon, Victoria, Australia
| | - Trudi Verrall
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,BloodSafe eLearning, Adelaide, South Australia, Australia
| |
Collapse
|
9
|
Marengo M, Martin CJ, Rubow S, Sera T, Amador Z, Torres L. Radiation Safety and Accidental Radiation Exposures in Nuclear Medicine. Semin Nucl Med 2021; 52:94-113. [PMID: 34916044 DOI: 10.1053/j.semnuclmed.2021.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medical radiation accidents and unintended events may lead to accidental or unintended medical exposure of patients and exposure of staff or the public. Most unintended exposures in nuclear medicine will lead to a small increase in risk; nevertheless, these require investigation and a clinical and dosimetric assessment. Nuclear medicine staff are exposed to radiation emitted directly by radiopharmaceuticals and by patients after administration of radiopharmaceuticals. This is particularly relevant in PET, due to the penetrating 511 keV γ-rays. Dose constraints should be set for planning the exposure of individuals. Staff body doses of 1-25 µSv/GBq are reported for PET imaging, the largest component being from the injection. The preparation and administration of radiopharmaceuticals can lead to high doses to the hands, challenging dose limits for radionuclides such as 90Y and even 18F. The risks of contamination can be minimized by basic precautions, such as carrying out manipulations in purpose-built facilities, wearing protective clothing, especially gloves, and removing contaminated gloves or any skin contamination as quickly as possible. Airborne contamination is a potential problem when handling radioisotopes of iodine or administering radioaerosols. Manipulating radiopharmaceuticals in laminar air flow cabinets, and appropriate premises ventilation are necessary to improve safety levels. Ensuring patient safety and minimizing the risk of incidents require efficient overall quality management. Critical aspects include: the booking process, particularly if qualified medical supervision is not present; administration of radiopharmaceuticals to patients, with the risk of misadministration or extravasation; management of patients' data and images by information technology systems, considering the possibility of misalignment between patient personal data and clinical information. Prevention of possible mistakes in patient identification or in the management of patients with similar names requires particular attention. Appropriate management of pregnant or breast-feeding patients is another important aspect of radiation safety. In radiopharmacy activities, strict quality assurance should be implemented at all operational levels, in addition to adherence to national and international regulations and guidelines. This includes not only administrative aspects, like checking the request/prescription, patient's data and the details of the requested procedure, but also quantitative tests according to national/international pharmacopoeias, and measuring the dispensed activity with a calibrated activity meter prior to administration. In therapy with radionuclides, skin tissue reactions can occur following extravasation, which can result in localized doses of tens of Grays. Other relevant incidents include confusion of products for patients administered at the same time or malfunction of administration devices. Furthermore, errors in internal radiation dosimetry calculations for treatment planning may lead to under or over-treatment. According to literature, proper instructions are fundamental to keep effective dose to caregivers and family members after patient discharge below the Dose constraints. The IAEA Basic Safety Standards require measures to minimize the likelihood of any unintended or accidental medical exposures and reporting any radiation incident. The relative complexity of nuclear medicine practice presents many possibilities for errors. It is therefore important that all activities are performed according to well established procedures, and that all actions are supported by regular quality assurance/QC procedures.
Collapse
Affiliation(s)
- Mario Marengo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
| | - Colin J Martin
- Department of Clinical Physics and Bioengineering, University of Glasgow, UK
| | - Sietske Rubow
- Nuclear Medicine Division, Stellenbosch University, Stellenbosch, South Africa
| | - Terez Sera
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Zayda Amador
- Radiation Protection Department, Centre of Isotopes, Havana, Cuba
| | - Leonel Torres
- Nuclear Medicine Department, Centre of Isotopes, Havana, Cuba
| |
Collapse
|
10
|
De Rezende H, Melleiro MM, O. Marques PA, Barker TH. Interventions to Reduce Patient Identification Errors in the Hospital Setting: A Systematic Review. Open Nurs J 2021. [DOI: 10.2174/1874434602115010109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Patient identification is considered as a fundamental part of the care process and a relevant resource for safety practices in hospital settings.
Objective:
We aimed to review the literature on interventions to reduce patient identification errors in hospital settings.
Methods:
A systematic review of effectiveness using The Joanna Briggs Institute (JBI) methodology was conducted. A three-step search strategy was utilised to explore primary research published up to March 2020 in English, Spanish, and Portuguese across eight databases. Grey literature was also assessed. The titles and abstracts of the studies were screened for assessment of the inclusion criteria. Two reviewers independently appraised the full text of the selected studies and extracted data using standardised tools from JBI. Due to the heterogeneity of studies and insufficient data for statistical pooling, meta-analysis was not feasible. Therefore, the results were synthesised narratively.
Results:
Twelve studies met the review criteria; all were rated at a moderate risk of bias and four different groups of interventions were identified: educational staff interventions alone and those combined with a partnership with families and patients through education; and information technology interventions alone, and combined with an educational staff strategy. Although most studies showed a statistically significant reduction in patient identification errors, the overall quality of the evidence was considered very low.
Conclusion:
High-quality research is needed to understand the real impact of interventions to reduce patient identification errors. Nurses should recognise the importance of patient identification practices as a part of their overall commitment to improving patient safety.
PROSPERO Registration Number: CRD42018085236
Collapse
|
11
|
A Systematic Review and Meta-analysis of the Medical Error Rate in Iran: 2005-2019. Qual Manag Health Care 2021; 30:166-175. [PMID: 34086653 DOI: 10.1097/qmh.0000000000000304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Medical errors (MEs) are one of the main factors affecting the quality of hospital services and reducing patient safety in health care systems, especially in developing countries. The aim of this study was to determine the rate of ME in Iran. METHODS This is a systematic literature review and meta-analysis of extracted data. The databases MEDLINE, EMBASE, Scopus, Cochrane, SID, Magiran, and Medlib were searched in Persian and English, using a combination of medical subject heading terms ("Medical Error" [Mesh] OR "Medication error" [Mesh] OR "Hospital Error" AND ("Iran" [Mesh]) for observational and interventional studies that reported ME rate in Iran from January 1995 to April 2019. We followed the STROBE checklist for the purpose of this review. RESULTS The search yielded a total of 435 records, of which 74 articles were included in the systematic review. The rate of MEs in Iran was determined as 0.35%. The rates of errors among physicians and nurses were 31% and 37%, respectively. The error rates during the medication process, including prescription, recording, and administration, were 31%, 27%, and 35%, respectively. Also, incidence of MEs in night shifts was higher than in any other shift (odds ratio [OR] = 38%; 95% confidence interval [CI]: 31%-45%). Moreover, newer nurses were responsible for more errors within hospitals than other nurses (OR = 57%; 95% CI: 41%-80%). The rate of reported error after the Health Transformation Plan was higher than before the Health Transformation Plan (OR = 40%; CI: 33%-49% vs OR = 30%; CI: 25%-35%). CONCLUSION This systematic review has demonstrated the high ME rate in Iranian hospitals. Based on the error rate attributed solely to night shifts, more attention to the holistic treatment process is required. Errors can be decreased through a variety of strategies, such as training clinical and support staff regarding safe practices and updating and adapting systems and technologies.
Collapse
|
12
|
Evanson HV, Reed JH, Cox R, Clinthorne AD, Williams WW, Vallero J, Rodgers L, Greene M, Koeppl P, Gerlach K. Improving Staff Experience With Vaccine Data Entry With 2D Barcode Scanning. J Nurs Care Qual 2021; 36:143-148. [PMID: 32541427 DOI: 10.1097/ncq.0000000000000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Small fonts on vaccine labels make manually recording vaccine data in patient records time-consuming and challenging. Vaccine 2-dimensional (2D) barcode scanning is a promising alternative to manually recording these data. PROBLEM While vaccine 2D barcode scanning assists in data entry, adoption of scanning technology is still low. APPROACH Pilot sites (n = 27) within a health system scanned 2D barcodes to record vaccine data for 6 months. The time to record through scanning and nonscanning methods was measured for 13 vaccinators at 9 sites. A survey was administered to participants across all sites about their experience. OUTCOMES On average, 22 seconds were saved per vaccine scanned versus entered manually (7 vs 29 seconds, respectively). Participants reported preference for scanning over other vaccine entry options and identified benefits of scanning. CONCLUSION Expanded use of 2D barcode scanning can meaningfully improve clinical practices by improving efficiency and staff satisfaction during vaccine data entry.
Collapse
Affiliation(s)
- Heather V Evanson
- Deloitte Consulting LLP, Arlington, Virginia (Ms Evanson); Deloitte Consulting LLP, Sacramento, California (Dr Reed); Deloitte Consulting LLP, Atlanta, Georgia (Ms Cox); Deloitte Consulting LLP, Denver, Colorado (when work was completed) (Dr Clinthorne); Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, Georgia (Messrs Williams and Gerlach); Pediatrics & Dermatology Sutter Medical Group, Davis, California (Dr Vallero); Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology, and Laboratory Services, Division of Health Informatics and Surveillance, Surveillance and Data Branch, Atlanta, Georgia (Dr Rodgers); Deloitte Consulting LLP, Boston, Massachusetts (Mr Greene); and Deloitte Consulting LLP, Pittsburgh, Pennsylvania (Dr Koeppl)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Kakemam E, Hajizadeh A, Azarmi M, Zahedi H, Gholizadeh M, Roh YS. Nurses' perception of teamwork and its relationship with the occurrence and reporting of adverse events: A questionnaire survey in teaching hospitals. J Nurs Manag 2021; 29:1189-1198. [PMID: 33480125 DOI: 10.1111/jonm.13257] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/31/2020] [Accepted: 01/15/2021] [Indexed: 11/26/2022]
Abstract
AIMS To identify the levels of teamwork and its relationship with the occurrence and reporting of adverse events among Iranian nurses. BACKGROUND Strengthening teamwork is emphasized worldwide for enhancing quality care and patient safety. METHODS This study applied a cross-sectional survey design. A total of 327 Iranian nurses from eight teaching hospitals participated in a self-administered survey using simple random sampling. The Teamwork Perceptions Questionnaire was used to measure the teamwork. The frequency of occurrence and reporting of adverse events were measured with two questions. Data were analysed using descriptive analyses, independent t tests and logistic regression analysis. RESULTS The mean teamwork score was 3.81 out of 5. Among the nurses, 48.0% had experienced adverse events in the past 6 months and 79.8% reported having an appropriate performance in adverse events reporting. Teamwork was significantly associated with lower occurrences of adverse events and better adverse events reporting. Specifically, nurses with higher situation monitoring (odds ratio (OR) = 0.47), mutual support (OR = 3.18) and team leadership (OR = 2.09) scores were more likely to report adverse events. Nurses with higher situation monitoring scores were less likely to experience the occurrence of adverse events (OR = 0.38). CONCLUSIONS Nurses' perception of teamwork was moderate to high. Teamwork was associated with the occurrence and reporting of adverse events. Further study is needed to identify the effects of teamwork training on the learning outcomes, including teamwork, occurrence and the reporting of adverse events among nurses. IMPLICATIOS FOR NURSING MANAGEMENT Nursing managers should consider multiple educational strategies including structured teamwork training to improve staff nurses' teamwork competency. Administrative initiatives and quality improvement projects are needed to increase nurses' performance in the reporting of adverse events through an accreditation process.
Collapse
Affiliation(s)
- Edris Kakemam
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Hajizadeh
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Azarmi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamideh Zahedi
- Department of Community Health Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoumeh Gholizadeh
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| |
Collapse
|
14
|
Reed JH, Evanson HV, Cox R, Williams WW, Vallero J, Caughron S, Rodgers L, Greene M, Koeppl P, Gerlach K. Improving Utilization of Vaccine Two-Dimensional (2D) Barcode Scanning Technology Maximizes Accuracy Benefits. J Healthc Qual 2021; 43:39-47. [PMID: 32544140 DOI: 10.1097/jhq.0000000000000265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Recording vaccine data accurately can be problematic in medical documentation, including blank and inaccurate records. Vaccine two-dimensional (2D) barcode scanning has shown promise, yet scanner use to record vaccine data is limited. We sought to identify strategies to improve scanning rates and assess changes in accuracy. METHODS Between January and June 2017, 27 pilot sites within a large health system were assigned to one of four groups to test strategies to maximize scanner use: training only, commitment card, scanning report, or combination. Seventy-two thousand vaccine records were assessed for completeness, accuracy, and scanning. RESULTS Significant increases in vaccinator scanning rates found with commitment card and scanning report inclusion (alone and paired) compared with the training-only group. Record completeness and accuracy significantly improved with use of scanning. When manually entered, about 1 in 9 records had a missing or inaccurate expiration date; when scanned, this dropped to 1 in 5,000. CONCLUSIONS Pilot findings indicate 2D scanning has the potential to eliminate most omissions and inaccuracies in vaccine records. Such data are critical during a recall or need to trace specific vaccines or patients. IMPLICATIONS Consistent use and expanded adoption of 2D scanning can meaningfully improve the quality of vaccine records and clinical practices.
Collapse
|
15
|
Bird J. Using change management to implement barcode medicines administration technology. Nurs Manag (Harrow) 2020; 27:30-34. [PMID: 32779450 DOI: 10.7748/nm.2020.e1945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 11/09/2022]
Abstract
Confirming the patient's identity is one of the most important elements in medicines administration, with research showing that medication errors are one of the most common sources of harm caused to patients. This article discusses the implementation of a barcode medicines administration system using two change management models. A complex project such as the implementation of barcode medicines administration technology, requires staff engagement at all levels. The adoption rates of the new workflow patterns in this project showed the benefits of using various change management models during different phases of a project. The project also demonstrated how nurse leaders must use a range of resources to effectively implement a new project.
Collapse
Affiliation(s)
- James Bird
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, England
| |
Collapse
|
16
|
Bylsma LC, Gillezeau C, Garawin TA, Kelsh MA, Fryzek JP, Sangaré L, Lowe KA. Prevalence of RAS and BRAF mutations in metastatic colorectal cancer patients by tumor sidedness: A systematic review and meta-analysis. Cancer Med 2019; 9:1044-1057. [PMID: 31856410 PMCID: PMC6997095 DOI: 10.1002/cam4.2747] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/23/2019] [Accepted: 10/29/2019] [Indexed: 12/12/2022] Open
Abstract
Studies have shown that the prevalence of RAS and BRAF mutations may differ by tumor sidedness among metastatic colorectal cancer (mCRC) patients. Both mutation status and tumor sidedness may impact survival and disease progression and RAS mutation status has been shown to predict response to anti‐epidermal growth factor receptor (EGFR) therapy. A systematic literature review and meta‐analysis were conducted to estimate the pooled prevalence of RAS and BRAF mutations by tumor sidedness in studies of mCRC patients. Forty‐four studies comprising 15 981 mCRC patients tested for RAS and/or BRAF mutations were included in the meta‐analyses. The prevalence of RAS mutations differed significantly by tumor side (32.4% among left‐sided tumors, 41.3% among right‐sided tumors; P = .017), as did the prevalence of KRAS mutations (35.8% among left‐sided tumors, 46.3% among right‐sided tumors; P < .0001) and BRAF mutations (4.3% among left‐sided tumors, 16.3% among right‐sided tumors; P < .0001). Among right‐sided tumors, the prevalence of RAS and KRAS mutations varied significantly by study design, with higher prevalence among observational studies than clinical trials, and there was significant variation by study location for the prevalence of KRAS mutations in left‐sided tumors and the prevalence of BRAF mutations in right‐sided tumors. These results help to better characterize the mCRC population to better inform clinicians and researchers. Few of the included studies reported overall or progression‐free survival (PFS) by both tumor sidedness and mutation status. As both of these factors may have prognostic impact, future studies should consider evaluating survival by these variables.
Collapse
|
17
|
Chou SS, Chen YJ, Shen YT, Yen HF, Kuo SC. Implementation and Effectiveness of a Bar Code-Based Transfusion Management System for Transfusion Safety in a Tertiary Hospital: Retrospective Quality Improvement Study. JMIR Med Inform 2019; 7:e14192. [PMID: 31452517 PMCID: PMC6732972 DOI: 10.2196/14192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/02/2019] [Accepted: 08/07/2019] [Indexed: 12/17/2022] Open
Abstract
Background Large-scale and long-term studies are not sufficient to determine the efficiency that IT solutions can bring to transfusion safety. Objective This quality-improvement report describes our continuous efforts to implement and upgrade a bar code–based transfusion management (BCTM) system since 2011 and examines its effectiveness and sustainability in reducing blood transfusion errors, in a 3000-bed tertiary hospital, where more than 60,000 prescriptions of blood transfusion are covered by 2500 nurses each year. Methods The BCTM system uses barcodes for patient identification, onsite labeling, and blood product verification, through wireless connection to the hospital information systems. Plan-Do-Study-Act (PDSA) cycles were used to improve the process. Process maps before and after implementation of the BCTM system in 2011 were drawn to highlight the changes. The numbers of incorrect labeling or wrong blood in tube incidents that occurred quarterly were plotted on a run chart to monitor the quality changes of each intervention introduced. The annual occurrences of error events from 2011 to 2017 were compared with the mean occurrence of 2008-2010 to determine whether implementation of the BCTM system could effectively reduce the number of errors in 2016 and whether this reduction could persist in 2017. Results The error rate decreased from 0.03% in 2008-2010 to 0.002% in 2016 (P<.001) and 0.001% in 2017 (P<.001) after implementation of the BTCM system. Only one incorrect labeling incident was noted among the 68,324 samples for blood typing, and no incorrect transfusions occurred among 67,423 transfusion orders in 2017. Conclusions This report demonstrates that continuous efforts to upgrade the existing process is critical to reduce errors in transfusion therapy, with support from information technology.
Collapse
Affiliation(s)
- Shin-Shang Chou
- Department of Nursing, Taipei Veterans General Hospital, Taipei City, Taiwan.,School of Nursing, National Yang-Ming University, Taipei, Taiwan.,School of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Ying-Ju Chen
- Section of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Te Shen
- Department of Information Management, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Fang Yen
- Department of Nursing, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Shu-Chen Kuo
- Department of Nursing, Taipei Veterans General Hospital, Taipei City, Taiwan.,School of Nursing, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
18
|
A convolutional neural network-based system to prevent patient misidentification in FDG-PET examinations. Sci Rep 2019; 9:7192. [PMID: 31076620 PMCID: PMC6510755 DOI: 10.1038/s41598-019-43656-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022] Open
Abstract
Patient misidentification in imaging examinations has become a serious problem in clinical settings. Such misidentification could be prevented if patient characteristics such as sex, age, and body weight could be predicted based on an image of the patient, with an alert issued when a mismatch between the predicted and actual patient characteristic is detected. Here, we tested a simple convolutional neural network (CNN)-based system that predicts patient sex from FDG PET-CT images. This retrospective study included 6,462 consecutive patients who underwent whole-body FDG PET-CT at our institute. The CNN system was used for classifying these patients by sex. Seventy percent of the randomly selected images were used to train and validate the system; the remaining 30% were used for testing. The training process was repeated five times to calculate the system's accuracy. When images for the testing were given to the learned CNN model, the sex of 99% of the patients was correctly categorized. We then performed an image-masking simulation to investigate the body parts that are significant for patient classification. The image-masking simulation indicated the pelvic region as the most important feature for classification. Finally, we showed that the system was also able to predict age and body weight. Our findings demonstrate that a CNN-based system would be effective to predict the sex of patients, with or without age and body weight prediction, and thereby prevent patient misidentification in clinical settings.
Collapse
|
19
|
Wang J, Liang H, Kang H, Gong Y. Understanding Health Information Technology Induced Medication Safety Events by Two Conceptual Frameworks. Appl Clin Inform 2019; 10:158-167. [PMID: 30841006 PMCID: PMC6402944 DOI: 10.1055/s-0039-1678693] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND While health information technology (health IT) is able to prevent medication errors in many ways, it may also potentially introduce new paths to errors. To understand the impact of health IT induced medication errors, this study aims to conduct a retrospective analysis of medication safety reports. METHODS From the U.S. Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience database, we identified reports in which health IT is a contributing factor to medication errors. We applied two conceptual frameworks, Sittig and Singh's sociotechnical model and Coiera's information value chain, to examine the identified reports. RESULTS We identified 152 unique reports on health IT induced medication errors as the final report set for review. The majority (65.13%) of the reports involved multiple contributing factors according to the sociotechnical model. Three dimensions, that is, clinical content, human-computer interface, and people, were involved in more reports than the others. The transition of the effects of health IT on medication practice was summarized using information value chain. Health IT related contributing factors may lead to receiving wrong information, missing information, receiving partial information and delayed information, and receiving wrong information and missing information tend to cause the commission errors in decision-making. CONCLUSION The two frameworks provide an opportunity to understand a comprehensive context of safety event and the impact of health IT induced errors on medication safety. The sociotechnical model helps identify the aspects causing medication safety issues. The information value chain helps uncover the effect of the health IT induced medication errors on health care process and patient outcomes.
Collapse
Affiliation(s)
- Ju Wang
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, United States
| | - Hongyuan Liang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hong Kang
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, United States
| | - Yang Gong
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, United States
| |
Collapse
|
20
|
De Rezende HA, Melleiro MM, Shimoda GT. Interventions to reduce patient identification errors in the hospital setting: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:37-42. [PMID: 30629041 DOI: 10.11124/jbisrir-2017-003895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
REVIEW QUESTION The question of this review is: how effective are the interventions that may prevent or reduce patient identification errors in the hospital setting?
Collapse
Affiliation(s)
- Helena Aparecida De Rezende
- School of Nursing, Buckinghamshire New University, Uxbridge, United Kingdom
- School of Nursing, University of São Paulo, São Paulo, Brazil
| | | | - Gilceria Tochika Shimoda
- University Hospital, University of São Paulo, São Paulo, Brazil
- The Brazilian Centre for Evidence-based Healthcare: a Joanna Briggs Institute Centre of Excellence
| |
Collapse
|
21
|
Abstract
Since the original Institute of Medicine (IOM) report was published there has been an accelerated development and adoption of health information technology with varying degrees of evidence about the impact of health information technology on patient safety. This article is intended to review the current available scientific evidence on the impact of different health information technologies on improving patient safety outcomes. We conclude that health information technology improves patient's safety by reducing medication errors, reducing adverse drug reactions, and improving compliance to practice guidelines. There should be no doubt that health information technology is an important tool for improving healthcare quality and safety. Healthcare organizations need to be selective in which technology to invest in, as literature shows that some technologies have limited evidence in improving patient safety outcomes.
Collapse
Affiliation(s)
- Yasser K Alotaibi
- Continuous Quality Improvement and Patient Safety Department, Medical Services General Directorate, Ministry of Defense, Riyadh, Kingdom of Saudi Arabia. E-mail.
| | | |
Collapse
|
22
|
|