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Berdot S, Vilfaillot A, Bezie Y, Perrin G, Berge M, Corny J, Thi TTP, Depoisson M, Guihaire C, Valin N, Decelle C, Karras A, Durieux P, Lê LMM, Sabatier B. Effectiveness of a 'do not interrupt' vest intervention to reduce medication errors during medication administration: a multicenter cluster randomized controlled trial. BMC Nurs 2021; 20:153. [PMID: 34429095 PMCID: PMC8383384 DOI: 10.1186/s12912-021-00671-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background The use of a ‘do not interrupt’ vest during medication administration rounds is recommended but there have been no controlled randomized studies to evaluate its impact on reducing administration errors. We aimed to evaluate the impact of wearing such a vest on reducing such errors. The secondary objectives were to evaluate the types and potential clinical impact of errors, the association between errors and several risk factors (such as interruptions), and nurses’ experiences. Methods This was a multicenter, cluster, controlled, randomized study (March–July 2017) in 29 adult units (4 hospitals). Data were collected by direct observation by trained observers. All nurses from selected units were informed. A ‘Do not interrupt’ vest was implemented in all units of the experimental group. A poster was placed at the entrance of these units to inform patients and relatives. The main outcome was the administration error rate (number of Opportunities for Error (OE), calculated as one or more errors divided by the Total Opportunities for Error (TOE) and multiplied by 100). Results We enrolled 178 nurses and 1346 patients during 383 medication rounds in 14 units in the experimental group and 15 units in the control group. During the intervention period, the administration error rates were 7.09% (188 OE with at least one error/2653 TOE) for the experimental group and 6.23% (210 OE with at least one error/3373 TOE) for the control group (p = 0.192). Identified risk factors (patient age, nurses’ experience, nurses’ workload, unit exposition, and interruption) were not associated with the error rate. The main error type observed for both groups was wrong dosage-form. Most errors had no clinical impact for the patient and the interruption rates were 15.04% for the experimental group and 20.75% for the control group. Conclusions The intervention vest had no impact on medication administration error or interruption rates. Further studies need to be performed taking into consideration the limitations of our study and other risk factors associated with other interventions, such as nurse’s training and/or a barcode system. Trial registration The PERMIS study protocol (V2–1, 11/04/2017) was approved by institutional review boards and ethics committees (CPP Ile de France number 2016-A00211–50, CNIL 21/03/2017, CCTIRS 11/04/2016). It is registered at ClinicalTrials.gov (registration number: NCT03062852, date of first registration: 23/02/2017). Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00671-7.
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Affiliation(s)
- Sarah Berdot
- Pharmacy Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France. .,INSERM, UMRS1138, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France.
| | - Aurélie Vilfaillot
- Clinical Research Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France
| | - Yvonnick Bezie
- Pharmacy Department, Paris Saint Joseph Hôpital, Paris, France
| | - Germain Perrin
- Pharmacy Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France.,INSERM, UMRS1138, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France
| | - Marion Berge
- Pharmacy Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France
| | - Jennifer Corny
- Pharmacy Department, Paris Saint Joseph Hôpital, Paris, France
| | | | - Mathieu Depoisson
- Pharmacy Department, Hôpital Vaugirard and Hôpital Corentin Celton, APHP, Paris, France
| | - Claudine Guihaire
- DSAP, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France
| | - Nathalie Valin
- Pharmacy Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France
| | - Claudine Decelle
- Department of Nephrology, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France.,Paris Descartes University, Paris, France.,INSERM, PARCC, Paris, France
| | - Pierre Durieux
- INSERM, UMRS1138, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France
| | - Laetitia Minh Maï Lê
- Pharmacy Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France.,Lip(Sys)2, EA7357, UFR Pharmacie, U-Psud, University of Paris-Saclay, Paris, France
| | - Brigitte Sabatier
- Pharmacy Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France.,INSERM, UMRS1138, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France
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Belissa E, Vallet T, Laribe-Caget S, Chevallier A, Chedhomme FX, Abdallah F, Bachalat N, Belbachir SA, Boulaich I, Bloch V, Delahaye A, Depoisson M, Wojcicki AD, Gibaud S, Grancher AS, Guinot C, Lachuer C, Lechowski L, Leglise P, Mahiou A, Meaume S, Michel C, Michelon H, Orven Y, Perquy I, Piccoli M, Rabus M, Ribemont AC, Rwabihama JP, Trouvin JH, Ruiz F, Boudy V. Acceptability of oral liquid pharmaceutical products in older adults: palatability and swallowability issues. BMC Geriatr 2019; 19:344. [PMID: 31810442 PMCID: PMC6898963 DOI: 10.1186/s12877-019-1337-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022] Open
Abstract
Background In institutional care, oral liquid pharmaceutical products are widely prescribed for older patients, especially for those with swallowing disorders. As medicines acceptability is a key factor for compliance in the older population, this study investigated the acceptability of oral liquid pharmaceutical products in this targeted population. Methods An observational, multicenter, prospective study was conducted in eight geriatric hospitals and eight nursing homes in France. Observers reported several behaviours/events describing the many aspects of acceptability for various pharmaceutical products’ uses in patients aged 65 and older. Acceptability scores of oral liquid pharmaceutical products were obtained using an acceptability reference framework (CAST - ClinSearch Acceptability Score Test®): a 3D-map summarizing the different users’ behaviors, with two clusters defining the positively and negatively accepted profiles materialized by the green and red zones, respectively. Results Among 1288 patients included in the core study and supporting the acceptability reference framework, 340 assessments were related to the administration of an oral liquid pharmaceutical product. The mean age of these patients was 87 (Range [66-104y]; SD = 6.7), 68% were women and 16% had swallowing disorders. Globally, the oral liquid pharmaceutical products were classified as “positively accepted,” the barycenter of the 340 assessments, along with the entire confidence ellipses surrounding it, were positioned on the green zone of the map. Sub-populations presenting a different acceptability profile have also been identified. For patients with swallowing disorders, the oral liquid pharmaceutical products were classified as “negatively accepted,” the barycenter of the 53 assessments along with 87% of its confidence ellipses were associated with this profile. A gender difference was observed for unflavored oral liquids. In women, they were classified “negatively accepted,” the barycenter of the 68 assessments with 75% of its confidence ellipses were located in the red zone, while they were classified “positively accepted” in men. Conclusion This study showed that oral liquid pharmaceutical products are a suboptimal alternative to solid oral dosage forms in patients with swallowing disorders. To ensure an optimal acceptability, prescribers should also consider the presence of a taste-masker in these oral liquids. As highlighted herein, palatability remains crucial in older populations, especially for women.
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Affiliation(s)
- Emilie Belissa
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France
| | - Thibault Vallet
- ClinSearch, 110 avenue Pierre Brossolette, 92240, Malakoff, France
| | - Sandra Laribe-Caget
- Hôpital Rothschild, Groupe Hospitalier Universitaire Est Parisien, AP-HP, 5 rue Santerre, 75012, Paris, France
| | - Alain Chevallier
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - François-Xavier Chedhomme
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - Fattima Abdallah
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Nathalie Bachalat
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Sid-Ahmed Belbachir
- Hôpital René Muret, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, AP-HP, avenue du Dr Schaeffner, 93270, Sevran, France
| | - Imad Boulaich
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Vanessa Bloch
- Hôpital Fernand Widal, Groupe Hospitalier Universitaire Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, 200 rue du Faubourg Saint-Denis, 75010, Paris, France
| | - Anne Delahaye
- Hôpital Sainte Périne, Groupe Hospitalier Universitaire Paris Ile-de-France Ouest, AP-HP, 11 rue Chardon Lagache, 75016, Paris, France
| | - Mathieu Depoisson
- Hôpital Vaugirard, Groupe Hospitalier Universitaire Paris Ouest, AP-HP, 10 rue Vaugelas, 75015, Paris, France
| | - Amélie Dufaÿ Wojcicki
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France
| | - Stéphane Gibaud
- Centre Hospitalier de l'Ouest Vosgien, 1280 avenue division Leclerc, 88300, Neufchâteau, France
| | - Anne-Sophie Grancher
- Hôpital Rothschild, Groupe Hospitalier Universitaire Est Parisien, AP-HP, 5 rue Santerre, 75012, Paris, France
| | - Caroline Guinot
- Hôpital Fernand Widal, Groupe Hospitalier Universitaire Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, 200 rue du Faubourg Saint-Denis, 75010, Paris, France
| | - Celia Lachuer
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Laurent Lechowski
- Hôpital Sainte Périne, Groupe Hospitalier Universitaire Paris Ile-de-France Ouest, AP-HP, 11 rue Chardon Lagache, 75016, Paris, France
| | - Patrick Leglise
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Abdel Mahiou
- Hôpital René Muret, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, AP-HP, avenue du Dr Schaeffner, 93270, Sevran, France
| | - Sylvie Meaume
- Hôpital Rothschild, Groupe Hospitalier Universitaire Est Parisien, AP-HP, 5 rue Santerre, 75012, Paris, France
| | - Corinne Michel
- Hôpital René Muret, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, AP-HP, avenue du Dr Schaeffner, 93270, Sevran, France
| | - Hugues Michelon
- Hôpital Sainte Périne, Groupe Hospitalier Universitaire Paris Ile-de-France Ouest, AP-HP, 11 rue Chardon Lagache, 75016, Paris, France
| | - Yann Orven
- Hôpital Vaugirard, Groupe Hospitalier Universitaire Paris Ouest, AP-HP, 10 rue Vaugelas, 75015, Paris, France
| | - Ines Perquy
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - Matthieu Piccoli
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - Maïté Rabus
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Annie-Claude Ribemont
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Jean-Paul Rwabihama
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Jean-Hugues Trouvin
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France
| | - Fabrice Ruiz
- ClinSearch, 110 avenue Pierre Brossolette, 92240, Malakoff, France
| | - Vincent Boudy
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France.
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Berdot S, Boussadi A, Vilfaillot A, Depoisson M, Guihaire C, Durieux P, Le LMM, Sabatier B. Integration of a Commercial Barcode-Assisted Medication Dispensing System in a Teaching Hospital. Appl Clin Inform 2019; 10:615-624. [PMID: 31434161 DOI: 10.1055/s-0039-1694749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES A commercial barcode-assisted medication administration (BCMA) system was integrated to secure the medication process and particularly the dispensing stage by technicians and the administration stage with nurses. We aimed to assess the impact of this system on medication dispensing errors and barriers encountered during integration process. METHODS We conducted a controlled randomized study in a teaching hospital, during dispensing process at the pharmacy department. Four wards were randomized in the experimental group and control group, with two wards using the system during 3 days with dedicated pharmacy technicians. The system was a closed loop system without information return to the computerized physician order entry system. The two dedicated technicians had a 1-week training session. Observations were performed by one observer among the four potential observers previously trained. The main outcomes assessed were dispensing error rates and the identification of barriers encountered to expose lessons learned from this study. RESULTS There was no difference between the dispensing error rate of the control and experimental groups (7.9% for both, p = 0.927). We identified 10 barriers to pharmacy barcode-assisted system technology deployment. They concerned technical (problems with semantic interoperability interfaces, bad user interface, false errors generated, lack of barcodes), structural (poor integration with local information technology), work force (short staff training period, insufficient workforce), and strategic issues (system performance problems, insufficient budget). CONCLUSION This study highlights the difficulties encountered in integrating a commercial system in current hospital information systems. Several issues need to be taken into consideration before the integration of a commercial barcode-assisted system in a teaching hospital. In our experience, interoperability of this system with the electronic health record is the key for the success of this process with an entire closed loop system from prescription to administration. BCMA system at the dispensing process remains essential to purchase securing medication administration process.
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Affiliation(s)
- Sarah Berdot
- Department of Pharmacy, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Equipe 22, Centre de Recherche des Cordeliers, UMR 1138 INSERM, Paris, France.,Department of Clinical Pharmacy, Faculty of Pharmacy, EA EA4123, Université Paris Sud, Châtenay-Malabry, France
| | - Abdelali Boussadi
- Equipe 22, Centre de Recherche des Cordeliers, UMR 1138 INSERM, Paris, France.,Département de Santé Publique et Informatique Médicale, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélie Vilfaillot
- Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM, Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Mathieu Depoisson
- Department of Pharmacy, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Claudine Guihaire
- Hospital Nursing staff (DSAP), Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Durieux
- Equipe 22, Centre de Recherche des Cordeliers, UMR 1138 INSERM, Paris, France.,Département de Santé Publique et Informatique Médicale, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laetitia Minh Maï Le
- Department of Pharmacy, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Lip(Sys)2, EA7357, UFR Pharmacie, U-Psud, Université Paris-Saclay, Paris, France
| | - Brigitte Sabatier
- Department of Pharmacy, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Equipe 22, Centre de Recherche des Cordeliers, UMR 1138 INSERM, Paris, France
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