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Anis A, Heneghan C, Aronson JK, DeVito NJ, Richards GC. Deaths from cardiovascular disease involving anticoagulants: a systematic synthesis of coroners' case reports. BJGP Open 2021:BJGPO. [PMID: 34620599 DOI: 10.3399/BJGPO.2021.0150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/26/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The global burden of cardiovascular disease (CVD) is forecast to increase, and anticoagulants will remain important medicines for its management. Coroners' Prevention of Future Death reports (PFDs) provide valuable insights that may enable safer and more effective use of these agents. AIM To identify CVD-related PFDs involving anticoagulants. DESIGN & SETTING Case series of coronial reports in England and Wales between 2013 and 2019. METHOD A total of 3037 PFDs were screened for eligibility. PFDs were included where CVD and an anticoagulant caused or contributed to the death. Included cases were descriptively analysed and content analysis was used to assess concerns raised by coroners and who had responded to them. RESULTS The study identified 113 CVD-related PFDs involving anticoagulants. Warfarin (36%, n = 41), enoxaparin (11%, n = 12), and rivaroxaban (11%, n = 12) were the most common anticoagulants reported. Concerns most frequently raised by coroners included poor systems (31%), poor communication (25%), and failures to keep accurate medical records (25%). These concerns were most often directed to NHS trusts (29%), hospitals (10%), and general practices (8%). Nearly two-thirds (60%) of PFDs had not received responses from such organisations, which are mandatory under regulation 28 of the Coroners' (Investigations) Regulations 2013. A publicly available tool has been created by the authors (https://preventabledeathstracker.net), which displays coroners' reports in England and Wales to streamline access, and identify important lessons to prevent future deaths. CONCLUSION National organisations, healthcare professionals, and prescribers should take actions to address the concerns of coroners in PFDs to improve the safe use of anticoagulants in patients with CVD.
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152
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Kim JY, Moore MR, Culwick MD, Hannam JA, Webster CS, Merry AF. Analysis of medication errors during anaesthesia in the first 4000 incidents reported to webAIRS. Anaesth Intensive Care 2021; 50:204-219. [PMID: 34871511 DOI: 10.1177/0310057x211027578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medication error is a well-recognised cause of harm to patients undergoing anaesthesia. From the first 4000 reports in the webAIRS anaesthetic incident reporting system, we identified 462 reports of medication errors. These reports were reviewed iteratively by several reviewers paying particular attention to their narratives. The commonest error category was incorrect dose (29.4%), followed by substitution (28.1%), incorrect route (7.6%), omission (6.5%), inappropriate choice (5.8%), repetition (5.4%), insertion (4.1%), wrong timing (3.5%), wrong patient (1.5%), wrong side (1.5%) and others (6.5%). Most (58.9%) of the errors resulted in at least some harm (20.8% mild, 31.0% moderate and 7.1% severe). Contributing factors to the medication errors included the presence of look-alike medications, storage of medications in the incorrect compartment, inadequate labelling of medications, pressure of time, anaesthetist fatigue, unfamiliarity with the medication, distraction, involvement of multiple people and poor communication. These data add to current evidence suggesting a persistent and concerning failure effectively to address medication safety in anaesthesia. The wide variation in the nature of the errors and contributing factors underline the need for increased systematic and multifaceted efforts underpinned by a strengthening of the current focus on safety culture to improve medication safety in anaesthesia. This will require the concerted and committed engagement of all concerned, from practitioners at the clinical workface, to those who fund and manage healthcare.
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Affiliation(s)
- Jee Young Kim
- Department of Anaesthesia and Perioperative Medicine, 58991Auckland City Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Matthew R Moore
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Martin D Culwick
- Department of Anaesthesia, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jacqueline A Hannam
- Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand
| | - Craig S Webster
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Alan F Merry
- Department of Anaesthesia and Perioperative Medicine, 58991Auckland City Hospital, Auckland City Hospital, Auckland, New Zealand.,Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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153
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Abstract
OBJECTIVES Delivery of intravenous medications in hospitals is a complex process posing to systemic risks for errors. The aim of this study was to identify systemic causes of in-hospital intravenous medication errors. METHODS A systematic review adhering to PRISMA guidelines was conducted. We searched MEDLINE (Ovid), Scopus, CINAHL, and EMB reviews for articles published between January 2005 and June 2016. Peer-reviewed journal articles published in English were included. Two reviewers independently selected articles according to a predetermined PICO tool. The quality of studies was assessed using the GRADE system and the evidence analyzed using qualitative content analysis. RESULTS Eleven studies from six countries were included in the analysis. We identified systemic causes related to prescribing (n = 6 studies), preparation (n = 6), administration (n = 6), dispensing and storage (n = 5), and treatment monitoring (n = 2). Administration, prescribing, and preparation were the process phases most prone to systemic errors. Insufficient actions to secure safe use of high-alert medications, lack of knowledge of the drug, calculation tasks, failure in double-checking procedures, and confusion between look-alike, sound-alike medications were the leading causes of intravenous medication errors. The number of the included studies was limited, all of them being observational studies and graded as low quality. CONCLUSIONS Current intravenous medication systems remain vulnerable, which can result in patient harm. Our findings suggest further focus on medication safety activities related to administration, prescribing, and preparation of intravenous medications. This study provides healthcare organizations with preliminary knowledge about systemic causes of intravenous medication errors, but more rigorous evidence is needed.
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Affiliation(s)
- Sini Kuitunen
- From the HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS), Finland
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Ilona Niittynen
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Anna-Riia Holmström
- From the HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS), Finland
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
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154
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Kaufmann J, Uhl S, Singer E, Eifinger F, Klein T, Lechleuthner A, Engelhardt T, Wappler F, Böhmer A. Improving Pediatric Drug Safety in Prehospital Emergency Care-10 Years on. J Patient Saf 2021; 17:e1241-e1246. [PMID: 34570000 PMCID: PMC8612892 DOI: 10.1097/pts.0000000000000915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Pediatric Emergency Ruler (PaedER) is a height-based drug dose recommendation tool that was reported to reduce life-threatening medication errors by 90%. The PaedER was introduced into the Cologne Emergency Medical Service (EMS) in 2008 along with educational measures, publications, and lectures for pediatric drug safety. We reviewed the impact of these continuously ongoing measures on medication errors after 10 years. METHODS The PaedER was introduced and distributed to all 14 emergency ambulances and 2 helicopters staffed with emergency physicians in the city of Cologne in November 2008. Electronic records and medical protocols of the Cologne EMS over two 20-month periods from March 2007 to October 2008 and March 2018 to October 2019 data sets were retrieved. The administered doses of either intravenous, intraosseous, intranasal, or buccal fentanyl, midazolam, ketamine, or epinephrine were recorded. Primary outcome measure was the rate of severe drug dosing errors with a deviation from the recommended dose of greater than 300%. RESULTS A total of 59 and 443 drug administrations were analyzed for 2007/08 and 2018/19, respectively. The overall rate of drug dosing errors decreased from 22.0% to 9.9% (P = 0.014; relative risk reduction, 55%). Four of 5 severe dosing errors for epinephrine were avoided (P < 0.021; relative risk reduction, 78%). Documentation of patient's weight increased from 3.2% in 2007/08 to 30.5% in 2018/19 (P < 0.001). CONCLUSIONS The distribution of the PaedER combined by educational measures significantly reduced the rates of life-threatening medication errors in a large EMS. Those results should motivate further initiatives on pediatric drug safety in prehospital emergency care.
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Affiliation(s)
- Jost Kaufmann
- From the Department for pediatric anesthesia, Children’s Hospital Cologne
- Fire Department, Center of Emergency Medicine, City of Cologne, Cologne
- Faculty for Health, University Witten/Herdecke, Witten
| | - Stefanie Uhl
- Faculty for Health, University Witten/Herdecke, Witten
| | - Eva Singer
- Fire Department, Center of Emergency Medicine, City of Cologne, Cologne
| | - Frank Eifinger
- Department of Neonatology and Pediatric Intensive Care, Clinic for Pediatrics, University Hospital of Cologne
| | - Tobias Klein
- Department for Pediatric Surgery and Urology, Children’s Hospital Cologne, Cologne, Germany
| | - Alex Lechleuthner
- Fire Department, Center of Emergency Medicine, City of Cologne, Cologne
| | - Thomas Engelhardt
- Division of Pediatric Anesthesia, Montreal Children’s Hospital, McGill University, Montréal, Quebec, Canada
| | - Frank Wappler
- From the Department for pediatric anesthesia, Children’s Hospital Cologne
- Faculty for Health, University Witten/Herdecke, Witten
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne–Merheim, Cologne, Germany
| | - Andreas Böhmer
- Faculty for Health, University Witten/Herdecke, Witten
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne–Merheim, Cologne, Germany
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155
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Jani YH, Chumbley GM, Furniss D, Blandford A, Franklin B. The Potential Role of Smart Infusion Devices in Preventing or Contributing to Medication Administration Errors: A Descriptive Study of 2 Data Sets. J Patient Saf 2021; 17:e1894-e1900. [PMID: 32842073 PMCID: PMC8612907 DOI: 10.1097/pts.0000000000000751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Errors in medication administration are common, with many interventions suggested to reduce them. For intravenous infusion-related errors, "smart infusion devices" incorporating dose error reduction software are widely advocated. Our aim was to explore the role of smart infusion devices in preventing or contributing to medication administration errors using retrospective review of 2 complementary data sets that collectively included a wide range of errors with different levels of actual or potential harm. METHODS We reviewed 216 medication administration errors identified from an observational study in clinical practice and 123 medication incidents involving infusion devices reported to a national reporting system. The impact of smart infusion devices in preventing or contributing to these errors was assessed by the research team and an expert panel. RESULTS The data suggest that use of any infusion device rather than gravitational administration may have prevented 13% of observed errors and 8% of reported incidents; additional reductions may be possible with standalone smart infusion devices, and further potential reductions with smart infusion devices integrated with electronic prescribing and barcode administration systems. An estimated 52% to 73% of errors that occurred with traditional infusion pumps could be prevented with such integrated smart infusion devices. In the few cases where smart infusion devices were used, these contributed to errors in 2 of 58 observed errors and 7 of 8 reported incidents. CONCLUSIONS Smart infusion devices not only prevent some medication administration errors but can also contribute to them. Further evaluation of such systems is required to make recommendations for policy and practice.
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Affiliation(s)
- Yogini H. Jani
- From the Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust
- UCL School of Pharmacy
| | - Gillian M. Chumbley
- Imperial College Healthcare NHS Trust, Pain Management Centre, Charing Cross Hospital, London, United Kingdom
| | - Dominic Furniss
- UCL (Department of Computer Science and Institute of Healthcare Engineering), London, United Kingdom
| | - Ann Blandford
- UCL (Department of Computer Science and Institute of Healthcare Engineering), London, United Kingdom
| | - Bryony Franklin
- Imperial College Healthcare NHS Trust, Pain Management Centre, Charing Cross Hospital, London, United Kingdom
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
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156
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Jomaa C, Dubois CA, Caron I, Prud'Homme A. Staffing, teamwork and scope of practice: Analysis of the association with patient safety in the context of rehabilitation. J Adv Nurs 2021; 78:2015-2029. [PMID: 34841549 PMCID: PMC9300032 DOI: 10.1111/jan.15112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/12/2021] [Revised: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Abstract
Aims To describe the organization of nursing services (staffing, scope of practice, teamwork) and its association with medication errors and falls, in rehabilitation units. Background The healthcare system is greatly impacted by the ageing population and the complexity of care associated with chronic diseases. It is therefore necessary to have enough staff who are using their full scope of practice and who are operating in a favourable working environment. However, these conditions are not always met, which can lead to threats to patient safety. Design A correlational descriptive study. Methods Staffing data and reported safety incidents were collected by shift from 01 October 2019 until 15 January 2020 in five rehabilitation units. In addition, a total of 75 nursing staff members responded to a missed care and teamwork survey. Descriptive analysis and logistic regression analysis were performed. Results The mean staff hours per patient shift was 1.39 (SD = 0.60). The teams reported a global missed care score as ‘rarely missed’ at 1.14 (SD = 0.07) and a moderate teamwork score at 3.36 (SD = 0.58) on a five‐point scale. The safety incidents decreased 10‐fold with a predominance of bachelor compared with technician nurses and decreased by 67% when there was an increase of 1 h of care per patient shift. Conclusions This study showed that the organization of nursing services in the observed rehabilitation units is characterized by a moderate staffing intensity, a moderate perception of teamwork level and a relatively low level of missed care. It indicated the key role of the staffing in reducing the risk of occurrence of safety incidents. Future research specific to rehabilitation hospitals are greatly needed to improve patient outcomes in this setting. Impact Nurse Managers should consider all the aspects of the organization of nursing services (staffing, scope of practice and teamwork) in their efforts to improve patient safety in rehabilitation settings. A central finding of this study is that the staffing intensity, the proportion of bachelor prepared nurses and the proportion of agency staff were positively associated with a reduction of safety incidents.
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Affiliation(s)
- Carla Jomaa
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada.,Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Ouest de l'île de Montréal, Montreal, QC, Canada
| | - Carl-Ardy Dubois
- School of Public Health, University of Montreal (ESPUM), Montreal, QC, Canada
| | - Isabelle Caron
- Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Ouest de l'île de Montréal, Montreal, QC, Canada
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Beuhler MC, Spiller HA, Alwasiyah D, Bassett R, Trella J, Huecker M, Webb AN. Adverse effects associated with bupropion therapeutic errors in adults reported to four United States Poison Centers. Clin Toxicol (Phila) 2021; 60:623-627. [PMID: 34812101 DOI: 10.1080/15563650.2021.2002353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONTEXT Bupropion is a frequently used medication. Excessive doses may cause altered mental status, seizures, and dysrhythmias. There is a need for accurate estimate of seizure risk with therapeutic errors and determination if minor symptoms are harbingers of more severe effects. METHODS A retrospective review of adult, acute, unintentional therapeutic error, single substance bupropion ingestions with known outcome reported to four poison centers from January 1, 2004 to December 31, 2016. Data included age, gender, single error dose, total bupropion dose over 18 h, prior history of seizure, management site, observation time, occurrence of an out-of-hospital adverse event, "jittery"/anxious/agitated, tachycardia/palpitations, seizures, and dysrhythmias. We recorded the total bupropion dose over 18 h if known; otherwise, we used the single error dose. We compared means for parametric data. We used Fisher's exact test and Mann-Whitney for nonparametric data. RESULTS We identified 754 potential cases, of which 637 met inclusion criteria after case review. Median age was 42 years, and 76.1% were female. Cases were predominantly managed at home (56.2%). Outcomes were no effect (50.1%), minor (45.5%) and moderate (4.4%). The reported dose with no effect/minor outcome was 694 (±297) mg, and for moderate outcome was 1250 (±815) mg (p < 0.0001). Seizures occurred in four patients with median onset time of 7 h [range 2-21.5 h]. The median reported dose in patients who seized was 900 mg [range 600-3000 mg]. Of patients who developed a seizure and/or an out-of-hospital adverse event, 83% were "jittery"/anxious/agitated whereas "jittery"/anxious/agitated was present in 27% of cases that did not (p = 0.008). Tachycardia/palpitations was reported in 12% of cases; more serious dysrhythmias were not reported. CONCLUSIONS Outcomes from single unintentional ingestions of bupropion in adults are overall mild and appear to be dose related. Home management may be an option with doses up to 900 mg in an appropriate patient population.
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Affiliation(s)
| | | | - Dalia Alwasiyah
- North Carolina Poison Control, Atrium Health, Charlotte, NC, USA
| | - Robert Bassett
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Martin Huecker
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA
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158
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Ibarra Mira ML, Caro-Teller JM, Rodríguez Quesada PP, Garcia-Muñoz C, Añino Alba A, Ferrari Piquero JM. Impact of a Pharmaceutical Care Program at Discharge on Patients at High Risk of Readmission According to the Hospital Score. J Pharm Technol 2021; 37:310-315. [PMID: 34790969 DOI: 10.1177/87551225211047607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: A significant percentage of hospital readmissions within 30 days of discharge are a result of avoidable drug-related problems. Stratifying patients according to readmission risk is key to pharmaceutical intervention (PI) design strategies to improve treatment outcomes. Objective: To assess whether a pharmaceutical care (PC) program at discharge in polymedicated patients at high potentially avoidable readmission (PAR) risk, according to the HOSPITAL score, improves 30-day readmission rate (30-dRR). Methods: This prospective controlled, quasi-experimental, 11-month study included 163 chronic polymedicated patients (>5 medications) at high PAR risk according to the HOSPITAL score. We calculated the 30-dRR and number of medication variations and Medication Regimen Complexity Index-E (MRCI-E) after PI. Results were compared with a retrospective cohort of chronic patients at high PAR risk. Results: The 30-dRR was 18.4% in the intervention group and 25.6% in the control group (odds ratio [OR] = 0.66; 95% CI = 0.38 to 1.14). Total medication reduction (-1.28; 95% CI = -1.88 to -0.68), number of high-risk medications in chronic patients (-0.58; 95% CI = -0.9 to -0.26), and MRCI-E (-6.42; 95% CI = -8.07 to -4.76) were statistically significant (P < .001). The number of medications at discharge was associated with an increased readmission risk (OR = 1.07; 95% CI = 1.01 to 1.14). Conclusions: The degree of polypharmacy and patients' treatment complexity after hospital discharge significantly reduced as a result of the PC program compared with the control group. This highlights the need for patient selection and prioritization strategies for implementing PIs focused on reducing polypharmacy and preventing drug-related problems that may cause PAR.
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159
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Jessurun JG, Hunfeld NGM, Van Rosmalen J, Van Dijk M, Van Den Bemt PMLA. Effect of automated unit dose dispensing with barcode scanning on medication administration errors: an uncontrolled before-and-after study. Int J Qual Health Care 2021; 33:6400413. [PMID: 34662396 PMCID: PMC8678992 DOI: 10.1093/intqhc/mzab142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/28/2021] [Accepted: 10/18/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Medication administration errors (MAEs) occur frequently in hospitals and may compromise patient safety. Preventive strategies are needed to reduce the risk of MAEs. OBJECTIVE The primary aim of this study was to assess the effect of central automated unit dose dispensing with barcode-assisted medication administration on the prevalence of MAEs. Secondary aims were to assess the effect on the type and potential severity of MAEs. Furthermore, compliance with procedures regarding scanning of patient and medication barcodes and nursing staff satisfaction with the medication administration system were assessed. METHODS We performed a prospective uncontrolled before-and-after study in six clinical wards in a Dutch university hospital from 2018 to 2020. MAE data were collected by observation. The primary outcome was the proportion of medication administrations with one or more MAEs. Secondary outcomes were the type and potential severity of MAEs, rates of compliance with patient identification and signing of administered medication by scanning and nursing staff satisfaction with the medication administration system. Multivariable mixed-effects logistic regression analyses were used for the primary outcome to adjust for confounding and for clustering on nurse and patient level. RESULTS One or more MAEs occurred in 291 of 1490 administrations (19.5%) pre-intervention and in 258 of 1630 administrations (15.8%) post-intervention (adjusted odds ratio 0.70, 95% confidence interval 0.51-0.96). The rate of omission fell from 4.6% to 2.0% and of wrong dose from 3.8% to 2.1%, whereas rates of other MAE types were similar. The rate of potentially harmful MAEs fell from 3.0% (n = 44) to 0.3% (n = 5). The rates of compliance with scanning of patient and medication barcode post-intervention were 13.6% and 55.9%, respectively.The median overall satisfaction score of the nurses with the medication administration system on a 100-point scale was 70 (interquartile range 63-75, n = 193) pre-intervention and 70 (interquartile range 60-78, n = 145) post-intervention (P = 0.626, Mann-Whitney U test). CONCLUSION The implementation of central automated unit dose dispensing with barcode-assisted medication administration was associated with a lower probability of MAEs, including potentially harmful errors, but more compliance with scanning procedures is needed. Nurses were moderately satisfied with the medication administration system, both before and after implementation. In conclusion, despite low compliance with scanning procedures, this study shows that this intervention contributes to the improvement of medication safety in hospitals.
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Affiliation(s)
- Janique Gabriëlle Jessurun
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Nicole Geertruida Maria Hunfeld
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands.,Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Joost Van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Monique Van Dijk
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Patricia Maria Lucia Adriana Van Den Bemt
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, P.O. Box 30.001, Groningen, RB 9700, The Netherlands
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160
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Abdel-Qader DH, Saadi Ismael N, Al Meslamani AZ, Albassam A, El-Shara' AA, Lewis PJ, Hamadi S, Al Mazrouei N. The Role of Clinical Pharmacy in Preventing Prescribing Errors in the Emergency Department of a Governmental Hospital in Jordan: A Pre-Post Study. Hosp Pharm 2021; 56:681-689. [PMID: 34732922 DOI: 10.1177/0018578720942231] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Clinical pharmacists have a vital role in intercepting prescribing errors (PEs) but their impact within a Jordanian hospital emergency department (ED) has never been studied. Objective: To evaluate the impact of clinical pharmacy services on PEs and assess predictors of physicians' acceptance of clinical pharmacists' interventions. Setting: This study was conducted in the ED of the largest governmental hospital in Jordan. Method: This was a pre-post study conducted in October and November 2019 using a disguised observational method. There were 2 phases: control phase (P0) with no clinical interventions, and active phase (P1) where clinical pharmacists prospectively intervened upon errors. The clinical significance of errors was determined by a multidisciplinary committee. The SPSS software version 24 was used for data analysis. Main Outcome Measure: PEs incidence, type, severity, and predictors for physicians' acceptance. Results: Of 18003 patients, 8732 were included in P0 and 9271 in P1. PEs incidence decreased from 24.6% to 5.4%. Contraindication, drug selection, and dosage form error types were significantly reduced from 32.6%, 9.1%, and 3.7% (P0) to 12.6%, 0.0%, and 0.0% (P1), respectively. Albeit not statistically significant, drug-drug interaction, drug frequency, and allergy error types were reduced from 4.9%, 3.1%, and 0.1% to 4.5%, 2.5%, and 0.0%, respectively. Significant and serious errors were significantly reduced from 68.7% and 3.0% (P0) to 8.9% and 1.8% (P1), respectively. During P1, most errors were minor (89.3%, 1574/1763), and lethal errors ceased. Predictors for physicians' acceptance were: significant errors (OR 3.1; 95% CI 2.6-4.3; P = 0.03) and non-busy physicians (OR 2.1; 95% CI 1.6-2.7; P = 0.04). Conclusion: Clinical pharmacists significantly reduced PEs in the ED by 76%; most of interventions were significant. Policymakers are advised to implement active clinical pharmacy in the ED.
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Affiliation(s)
- Derar H Abdel-Qader
- Department of Pharmacology and Biomedical Sciences, University of Petra, Amman, Jordan
| | | | - Ahmad Z Al Meslamani
- Department of Pharmacology and Biomedical Sciences, University of Petra, Amman, Jordan
| | | | - Asma' A El-Shara'
- Department of Clinical Sciences, Philadelphia University, Amman, Jordan
| | - Penny J Lewis
- Division of Pharmacy & Optometry, The University of Manchester, UK
| | - Salim Hamadi
- Department of Pharmacology and Biomedical Sciences, University of Petra, Amman, Jordan
| | - Nadia Al Mazrouei
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, UAE
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161
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Abstract
Objectives: This study assessed the impact transitions of care (TOC) pharmacists have on optimizing antimicrobial use for patients at high risk for mortality at hospital discharge. In addition, this study aimed to summarize and categorize the types of interventions made. Methods: This was a retrospective descriptive study that included adult patients 18 years of age or older who were at high risk for readmission and mortality. Participants were selected if they had a hospital discharge date between January 2017 and June 2018, but were excluded if they were discharged to a facility where medications were managed by healthcare employees or if they were hospice eligible. TOC pharmacists identified eligible participants and reviewed their discharge medication lists to optimize pharmacological therapy, contacting the discharging prescriber if therapy changes were identified. The therapy recommendations made by TOC pharmacists were documented in an internal database for further analysis. Results: A total of 1100 patients were analyzed by TOC pharmacists during the studied timeframe and a total of 2066 interventions were made. With respect to study objectives, 298 (14.4%) of the interventions made by TOC pharmacists involved antimicrobial recommendations, affecting 255 (23.2%) patients. Recommendations involving dosing (89, 29.9%), treatment duration (74, 24.8%), and drug interactions (41, 13.8%) were the most frequent types of interventions made. Sixty-six (25.9%) patients received multiple interventions and 240 (80.5%) recommendations were accepted by the provider. Conclusion: An opportunity exists to optimize antimicrobial therapy surrounding the time of hospital discharge.
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Affiliation(s)
- Noah Leja
- University of Michigan Health Systems, MI, USA.,Saint Joseph Mercy Hospital, Ann Arbor, MI, USA
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162
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AlAzmi A, Alasmari Z, Yousef C, Alenazi A, AlOtaibi M, AlSaedi H, AlShaikh A, AlObathani A, Ahmed O, Goronfolah L, Alahmari M. Off-Label Drug Use in Pediatric Out-Patient Care: A Multi-Center Observational Study. Hosp Pharm 2021; 56:690-696. [PMID: 34732923 DOI: 10.1177/0018578720942226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Prescribing a drug for a child is not an easy task and requires using the best available evidence as a guide, especially when a drug is used off-label. The practice of prescribing a drug for off-label use is fairly widespread worldwide. The FDA does not regulate prescribing patterns or practices of individual practitioners and, therefore, allows off-label use. The main objective of this study is to evaluate off-label prescribing among the pediatric population in the Kingdom of Saudi Arabia (KSA). Method This is a retrospective, simple random selection observational study of children (≤15 years) who visited pediatric clinics and had at least 1 drug prescribed over a 12-month period (January to December 2018). Results A total of 865 drugs (mean 1 and SD 0.24) were prescribed to 326 children. Off-label was identified in 39.4% of the drugs with a frequency of 512 (as 1 drug may belong to more than 1 off-label category). The most common reason for off-label prescribing was related to doses that were "higher or lower than the recommended use" (48.6%), and the most frequently identified drug class prescribed for off-label use was anti-infective drugs for systemic use (39.9%). The percentage of off-label drug use was found to be higher in girls and in the age group of 1 month to 2 years (P = .001) for both variables. In addition, a significant association was found between off label drug use and the total number of drugs prescribed, P < .001. Conclusion The findings of this study showed a high incidence of off-label prescribing mainly related to dosing and indication. The results of this observational study support the need to establish a unified national pediatric dosing formulary guide to ensure safe drug use in pediatrics.
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Affiliation(s)
- Aeshah AlAzmi
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
- Princes Noorah Oncology Center, Pediatric Oncology/Hematology/BMT Section, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia
| | - Zahra Alasmari
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
- Specialized Poly Clinic, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Consuela Yousef
- Imam Abdulrahman Bin Faisal Hospital, MNGHA, Dammam, Saudi Arabia
| | - Ahmed Alenazi
- Imam Abdulrahman Bin Faisal Hospital, MNGHA, Dammam, Saudi Arabia
| | - Mohammed AlOtaibi
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Hani AlSaedi
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Adnan AlShaikh
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Department of Pediatrics, Chemistry Laboratory, Community Medicine, Jeddah, Saudi Arabia
| | - Amani AlObathani
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Omaima Ahmed
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
- Princes Noorah Oncology Center, Pediatric Oncology/Hematology/BMT Section, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Loie Goronfolah
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Mousa Alahmari
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
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163
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Keuler N, Bouwer A, Coetzee R. Pharmacists' Approach to Optimise Safe Medication Use in Paediatric Patients. Pharmacy (Basel) 2021; 9:pharmacy9040180. [PMID: 34842828 PMCID: PMC8628964 DOI: 10.3390/pharmacy9040180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/02/2021] [Accepted: 10/09/2021] [Indexed: 11/22/2022] Open
Abstract
Paediatric patients are unique, yet challenging patients to care for by pharmacists. Paediatric medicine use requires special consideration. Pharmacists play an important role in educating and counselling patients, carers, and healthcare workers. Further, pharmacists have the necessary knowledge and skills to optimise safe medicine use in paediatric patients. This article provides basic principles for safe practices in paediatric medicine by following the nine rights of medication administration.
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Affiliation(s)
- Nicole Keuler
- School of Pharmacy, University of the Western Cape, Cape Town 7535, South Africa;
- Correspondence:
| | - Annatjie Bouwer
- Centralized Monitoring Solutions, IQVIA, Bloemfontein 9301, South Africa;
| | - Renier Coetzee
- School of Pharmacy, University of the Western Cape, Cape Town 7535, South Africa;
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164
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Bassett E, Frantzen L, Zabel K. Evaluation of Pharmacist Renal Dose Adjustments and Planning for Future Evaluations of Pharmacist Services. Hosp Pharm 2021; 56:416-423. [PMID: 34720140 DOI: 10.1177/0018578720918363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Clinical pharmacy services are known to improve patient outcomes. Pharmacists contribute to patient care in the acute care setting in multiple ways, including providing advice and information to patients and the health care team, performing medication histories to prevent waste and support medication adherence, analyzing the cost-effectiveness of medications, and ensuring patient safety through patient monitoring and medication review. Specific clinical pharmacist services include managing intravenous to oral medication adjustments, renal dose adjustments, and performing pharmacokinetic dosing of medications, among others. Many of these clinical services are performed daily but are not evaluated for clinical quality or compliance with policies. Evaluating these clinical services may provide a multitude of benefits to pharmacy departments, health systems, and patients. Methods: The purpose of this study was to evaluate pharmacist use and percent compliance of a renal dose adjustment policy upon initial order verification and discharge. This was completed through retrospective chart review to determine if dose adjustments were made appropriately and descriptive statistics were used to establish pharmacist compliance. Those orders that were inappropriately adjusted were analyzed for trends that could lead to possible policy improvements or pharmacist education opportunities. The completed evaluation also led to the development of an evaluation system that can be utilized to routinely assess clinical pharmacist services. Conclusions: The results of this study are being used to develop and support future clinical service evaluations, inspire process improvements, and improve patient outcomes and pharmacist accountability.
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Affiliation(s)
| | | | - Katie Zabel
- HealthEast St. Joseph's Hospital, St. Paul, MN, USA
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165
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Mulac A, Taxis K, Hagesaether E, Gerd Granas A. Severe and fatal medication errors in hospitals: findings from the Norwegian Incident Reporting System. Eur J Hosp Pharm 2021; 28:e56-e61. [PMID: 32576572 PMCID: PMC8640408 DOI: 10.1136/ejhpharm-2020-002298] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Even with global efforts to prevent medication errors, they still occur and cause patient harm. Little systematic research has been done in Norway to address this issue. OBJECTIVES To describe the frequency, stage and types of medication errors in Norwegian hospitals, with emphasis on the most severe and fatal medication errors. METHODS Medication errors reported in 2016 and 2017 (n=3557) were obtained from the Norwegian Incident Reporting System, based on reports from 64 hospitals in 2016 and 55 in 2017. Reports contained categorical data (eg, patient age, incident date) and free text data describing the incident. The errors were classified by error type, stage in the medication process, therapeutic area and degree of harm, using a modified version of the WHO Conceptual Framework for the International Classification for Patient Safety. RESULTS Overall, 3372 reports were included in the study. Most medication errors occurred during administration (68%) and prescribing (24%). The leading types of errors were dosing errors (38%), omissions (23%) and wrong drug (15%). The therapeutic areas most commonly involved were analgesics, antibacterials and antithrombotics. Over half of all errors were harmful (62%), of which 5.2% caused severe harm, and 0.8% were fatal. CONCLUSIONS Medication errors most commonly occurred during medication administration. Dosing errors were the most common error type. The substantial number of severe and fatal errors causing preventable patient harm and death emphasises an urgent need for error-prevention strategies. Additional studies and interventions should further investigate the error-prone medication administration stage in hospitals and explore the dynamics of severe incidents.
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Affiliation(s)
- Alma Mulac
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Katja Taxis
- Unit of Pharmacotherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Ellen Hagesaether
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anne Gerd Granas
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
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166
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Menon LU, Xavier AM, Shaikh SA, Sunny SM. Medication Errors: Common Pitfalls and Recommendations in Pediatric Dentistry Practice. J Clin Pediatr Dent 2021; 45:291-7. [PMID: 34740267 DOI: 10.17796/1053-4625-45.5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Parallel to the development of new medications for various diseases run the threat of medication errors. These errors though common, very few are fatal and so goes unnoticed. Such errors occurring with pediatric population can be a major predicament. This review aims to address the various parametric variations and considerations in pediatric population so as to minimize medication errors. A detailing about various causes, types and levels of errors, ways of analysing the amount of error and the essential knowledge about prescription writing which could reduce the incidents have been paid attention to. The article also discusses possible recommendations to the stakeholders and caregivers that could encompass the reason of lack of information for the ever-increasing medication errors.
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167
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Attia E, Fuentes A, Vassallo M, Dobbs S, Nguyen P, Baker K. Establishing a multidisciplinary taskforce to improve anticoagulation safety at a large health system. Am J Health Syst Pharm 2021; 79:297-305. [PMID: 34724061 DOI: 10.1093/ajhp/zxab411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To describe the development of a multidisciplinary anticoagulant safety taskforce (ASTF) to address anticoagulation-related issues across the medication-use system. SUMMARY Oral and parenteral anticoagulants have been classified as high-alert medications because of their potential for harm. Errors at the point of prescribing, monitoring, and administering therapy have been noted in safety literature. Our hospital system, which includes 1 academic medical center, 6 community hospitals, and 1 long-term care facility, designed a multidisciplinary ASTF to address anticoagulation-related issues. The ASTF used the 2017 Institute for Safe Medication Practices (ISMP) Medication Safety Self-Assessment for Antithrombotic Therapy as the primary tool for reviewing current practices, performing gap analyses, and identifying our greatest areas of opportunity. The top 8 best practice elements related to anticoagulant use were identified for initial efforts of ASTF activity. Meetings were led by a medication safety pharmacist who reviewed process opportunities and actions to address gaps. The hospital chief quality and patient safety officer and the vice president of quality were the executive sponsors of the ASTF. Key stakeholders such as the medication safety committee chair and the president of the medical staff were instrumental in leading the initiative. Recommendations from the ASTF were reviewed and approved by the system medication safety committee and the system pharmacy and therapeutics committee to support system-wide implementation. The ASTF accomplished more than initially planned within its first year. Error mitigation occurred through policy revisions, order set development and modification, and implementation of practice changes to comply with each best practice. The ISMP antithrombotic self-assessment score improved from 67% to 87%, surpassing the initially targeted score of 75%. To overcome implementation barriers with the electronic health record, we enlisted support from our informatics leadership to leverage information technology. Overall, the success of the taskforce was attributed to the teamwork and leadership of key individuals within the organization. CONCLUSION Leveraging interest from key stakeholders across multiple disciplines with an established assessment tool was key to developing a productive and successful ASTF. The group came together to evaluate anticoagulant-related issues and implement sustainable changes to decrease anticoagulation error potential.
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Affiliation(s)
- Engie Attia
- Houston Methodist Hospital, Houston, TX, USA
| | - Amaris Fuentes
- System Quality Department, Houston Methodist, Pearland, TX, USA
| | | | | | | | - Kelty Baker
- Houston Methodist Hospital, Houston, TX, USA
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168
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Barral M, Martin J, Carre E, Janoly-Dumenil A, Ranchon F, Parat S, Rioufol C, Goutelle S, Bourguignon L, Novais T, Doh S, Malatray M, Chaudier P, Gauthier J, Pivot C, Mouchoux C, Hoegy D. How a Patient Personalised Clinical Pharmacy Programme Can Secure Therapeutic Care in an Orthogeriatric Care Pathway (5P Project)? Clin Interv Aging 2021; 16:1857-1867. [PMID: 34707352 PMCID: PMC8544550 DOI: 10.2147/cia.s325035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/19/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023] Open
Abstract
Background A new model was developed for integrating a personalised clinical pharmacy programme (5P project) into the orthogeriatric care pathway. Objective To secure the therapeutic care of orthogeriatric patients. Design and Setting Prospective descriptive study in a multisite teaching hospital from June 2019 to January 2020. Subjects Patients aged ≥75 years admitted for hip fracture. Methods A prescription review was performed for all patients at inclusion. Other clinical pharmacy activities (additional prescription review, pharmaceutical interviews, medication reconciliation) were dedicated to “high-risk” patients. Potential medication errors (ME), either pharmaceutical interventions (PI) or unintentional discrepancies (UID), were recorded. The potential clinical impact of PI was evaluated by a pluriprofessional expert panel using a validated tool. Results In the 455 patients included, 955 potential ME were detected, that is ≥1 potential ME for 324/455 (71%) patients. In acute care, 561 PI were formulated during prescription review for 440/455 (97%) patients and 348/561 (62%) were accepted by physicians. Medication reconciliation was performed for 213 patients, 316 UID were identified. In rehabilitation units, a second prescription review was performed for 112/122 (92%) “high-risk” patients, leading to 61 PI. The clinical impact was evaluated for 519/622 (83%) PI. A consensus was obtained for 310/519 (60%) PI: 147/310 (47%) were rated as having minor clinical impact, 138/310 (45%) moderate, 22/310 (7%) major, 2/310 (0.6%) vital, and 1/310 (0.3%) null. Conclusion The 5P project secured the orthogeriatric care pathway by detecting a great number of potential ME, including PI mostly considered as having a significant clinical impact.
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Affiliation(s)
| | - Julie Martin
- Pharmacie, Hospices Civils de Lyon, Lyon, France
| | - Emmanuelle Carre
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Audrey Janoly-Dumenil
- Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,6-EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Florence Ranchon
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,EA3738, CICLY Centre pour l'Innovation en cancérologie de Lyon, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Stéphanie Parat
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Catherine Rioufol
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,EA3738, CICLY Centre pour l'Innovation en cancérologie de Lyon, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Sylvain Goutelle
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Villeurbanne, France
| | - Laurent Bourguignon
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Villeurbanne, France
| | - Teddy Novais
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Sebastien Doh
- Service de Gériatrie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Matthieu Malatray
- Service de Chirurgie Orthopédique Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Philippe Chaudier
- Service de Chirurgie Orthopédique Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jerome Gauthier
- Service d'anesthésie et réanimation Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Christine Pivot
- Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Christelle Mouchoux
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, Lyon, France
| | - Delphine Hoegy
- Pharmacie, Hospices Civils de Lyon, Lyon, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,6-EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
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169
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Alruthea S, Bowman P, Tariq A, Hinchcliff R. Interventions to Enhance Medication Safety in Residential Aged-care Settings: An Umbrella Review. Br J Clin Pharmacol 2021; 88:1630-1643. [PMID: 34652833 DOI: 10.1111/bcp.15109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/03/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022] Open
Abstract
AIM To conduct a systematic synthesis of existing evidence reviews on interventions to enhance medication safety in residential aged-care settings (RACS) to establish and compare their effectiveness. METHOD This umbrella review included examination of meta-analyses, scoping and systematic reviews. Four electronic databases were examined for eligible reviews. Two authors critically appraised those meeting the inclusion criteria using the Joanna Briggs Institute Critical Appraisal Instrument. RESULTS Fifteen reviews covering 171 unique, primary studies were included. Of the variety of interventions identified in the literature, five main categories of interventions were commonly reported to be effective in promoting medication safety in RACS (medication review, staff education, multidisciplinary team meetings, computerised clinical decision support systems and miscellaneous). Most reviews showed mixed evidence to support intervention effectiveness due to the significant heterogeneity between studies in their sites, sample sizes and intervention periods. In all intervention categories, pharmacists' collaboration was most beneficial, showing definitive evidence for improving medication safety and quality of prescribing in RACS. Eight reviews recommended multicomponent interventions, particularly medication reviews and staff education, but specific details were infrequently provided. Only five reviews presented insights into implementation facilitators and barriers, while the sustainability of interventions was only discussed in one review. CONCLUSION There is strong evidence to support the four main categories of interventions identified. However, limited details are available regarding the most appropriate design and implementation of multicomponent interventions and the sustainability of all interventions, thus solid recommendations cannot be made. Future research in this field should focus on producing theoretically informed, methodologically robust, original research, particularly regarding the design, implementation and sustainability of multicomponent interventions, which appears the most promising approach.
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Affiliation(s)
- Shadi Alruthea
- Department of Health Administration, College of Public Health and Health Informatics, Al Bukayriyah, Qassim University, Saudi Arabia.,School of Public Health & Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Paula Bowman
- School of Public Health & Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Amina Tariq
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Reece Hinchcliff
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Centre for Health Management, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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170
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Lacour M, Bloudeau L, Combescure C, Haddad K, Hugon F, Suppan L, Rodieux F, Lovis C, Gervaix A, Ehrler F, Manzano S, Siebert JN. Impact of a Mobile App on Paramedics' Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within a Multicenter Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e31748. [PMID: 34617916 PMCID: PMC8532016 DOI: 10.2196/31748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrests (OHCAs) are stressful, high-stake events that are associated with low survival rates. Acute stress experienced in this situation is associated with lower cardiopulmonary resuscitation performance in calculating drug dosages by emergency medical services. Children are particularly vulnerable to such errors. To date, no app has been validated to specifically support emergency drug preparation by paramedics through reducing the stress level of this procedure and medication errors. OBJECTIVE This study aims to determine the effectiveness of an evidence-based mobile app compared with that of the conventional preparation methods in reducing acute stress in paramedics at the psychological and physiological levels while safely preparing emergency drugs during simulated pediatric OHCA scenarios. METHODS In a parent, multicenter, randomized controlled trial of 14 emergency medical services, perceived and physiologic stress of advanced paramedics with drug preparation autonomy was assessed during a 20-minute, standardized, fully video-recorded, and highly realistic pediatric OHCA scenario in an 18-month-old child. The primary outcome was participants' self-reported psychological stress perceived during sequential preparations of 4 intravenous emergency drugs (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate) with the support of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app designed to help pediatric drug preparation (intervention) or conventional methods (control). The State-Trait Anxiety Inventory and Visual Analog Scale questionnaires were used to measure perceived stress. The secondary outcome was physiologic stress, measured by a single continuous measurement of the participants' heart rate with optical photoplethysmography. RESULTS From September 3, 2019, to January 21, 2020, 150 advanced paramedics underwent randomization. A total of 74 participants were assigned to the mobile app (intervention group), and 76 did not use the app (control group). A total of 600 drug doses were prepared. Higher State-Trait Anxiety Inventory-perceived stress increase from baseline was observed during the scenario using the conventional methods (mean 35.4, SD 8.2 to mean 49.8, SD 13.2; a 41.3%, 35.0 increase) than when using the app (mean 36.1, SD 8.1 to mean 39.0, SD 8.4; a 12.3%, 29.0 increase). This revealed a 30.1% (95% CI 20.5%-39.8%; P<.001) lower relative change in stress response in participants who used the app. On the Visual Analog Scale questionnaire, participants in the control group reported a higher increase in stress at the peak of the scenario (mean 7.1, SD 1.8 vs mean 6.4, SD 1.9; difference: -0.8, 95% CI -1.3 to -0.2; P=.005). Increase in heart rate during the scenario and over the 4 drugs was not different between the 2 groups. CONCLUSIONS Compared with the conventional method, dedicated mobile apps can reduce acute perceived stress during the preparation of emergency drugs in the prehospital setting during critical situations. These findings can help advance the development and evaluation of mobile apps for OHCA management and should be encouraged. TRIAL REGISTRATION ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-019-3726-4.
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Affiliation(s)
- Matthieu Lacour
- University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | | | - Christophe Combescure
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Kevin Haddad
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Florence Hugon
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Suppan
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédérique Rodieux
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Lovis
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Alain Gervaix
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Ehrler
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Sergio Manzano
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Johan N Siebert
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
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- See Authors' Contributions,
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171
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Chen X, Li X, Liu Y, Yao G, Yang J, Li J, Qiu F. Preventing dispensing errors through the utilization of lean six sigma and failure model and effect analysis: A prospective exploratory study in China. J Eval Clin Pract 2021; 27:1134-1142. [PMID: 33327041 DOI: 10.1111/jep.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/29/2020] [Accepted: 11/21/2020] [Indexed: 11/28/2022]
Abstract
AIMS To utilize lean six sigma (LSS) and failure model and effect analysis (FMEA) to prevent dispensing errors in a Chinese teaching hospital. METHODS Medication errors (MEs) reported to the China Core Group of the international network for the rational use of drugs (INRUD) by pharmacists at the hospital were collected. Following LSS methodology, the data analysis was structured according to define, measure, analyse, improve, and control (DMAIC) phases, and typical LSS tools (Pareto diagrams, brainstorming sessions) were used to determine the risk factors leading to dispensing errors. FMEA was applied to generate the risk priority numbers (RPNs) of MEs events, and key medications targeted for error prevention strategies were identified through quantitative analysis of the impacts of failure. Finally, corrective measures to prevent MEs were implemented and monitored for efficacy. RESULTS Before the implementation of this programme, a total of 603 cases of dispensing errors were reported from the Year 1 to Year 6, reaching an average rate of incidence of 0.33 cases per 10 000 medication orders delivered, and no difference was found between these years (P = .9424). There was also no difference as location, error type, contributing factors, cause classification were considered. We then determined the real cause behind dispensing errors, and a total of 67 medications were targeted for specific error prevention strategies. One year after intervention, progress had been achieved in the following aspects: the incidence rate of dispensing errors was significantly decreased compared with the previous years (0.19, P = .007). Simultaneously, the incidence rate of dispensing errors occurred in outpatient pharmacy (0.04, P = .0008), with junior pharmacists (0.15, P = .0258), with LASA medications (0.06, P = .0319), as well as with memory-based errors were significantly decreased (0.03, P = .0191). CONCLUSION The combination of LSS and the FMEA tool can be an efficient approach for helping reduce MEs in pharmacy dispensing.
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Affiliation(s)
- Xue Chen
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Pharmacy, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Xinyu Li
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Liu
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gaoqiong Yao
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiadan Yang
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Li
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Qiu
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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172
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Wang YC, Tsan CY, Chen MC. Implementation of an Automated Dispensing Cabinet System and Its Impact on Drug Administration: Longitudinal Study. JMIR Form Res 2021; 5:e24542. [PMID: 34533467 PMCID: PMC8486989 DOI: 10.2196/24542] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/23/2020] [Revised: 04/28/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background A technology that has been widely implemented in hospitals in the United States is the automated dispensing cabinet (ADC), which has been shown to reduce nurse drug administration errors and the time nurses spend administering drugs. Objective This study aimed to determine the impact of an ADC system on medication administration by nurses as well as safety before and after ADC implementation. Methods We conducted a 24-month-long longitudinal study at the National Taiwan University Hospital in Taipei, Taiwan. Clinical observations and questionnaires were used to evaluate the time differences in drug preparation, delivery, and returns in the inpatient ward by nurses before and after using the ADC. Drug errors recorded in the Medical Incident Events system were assessed the year before and after ADC implementation. Results The drug preparation time of the wards increased significantly (all P<.005). On average, 2 minutes of preparation time is needed for each patient. Only 1 unit showed an increase in the drug return time, but this was not significant. There were 9 (45%) adverse events during the drug administration phase, and 11 (55%) events occurred during the drug-dispensing phase. Although a decrease in the mean number of events reported was observed during the ADC implementation period, this difference was not significant. As for the questionnaire that were administered to the nurses, the overall mean score was 3.90; the highest score was for the item “I now spend less time waiting for medications that come from the pharmacy than before the ADC was implemented” (score=4.24). The item with the lowest score was “I have to wait in line to get my patient medications” (score=3.32). Conclusions The nurses were generally satisfied with ADC use over the 9 months following complete implementation and integration of the system. It was acknowledged that the ADC offers benefits in terms of pharmaceutical stock management; however, this comes at the cost of increased nursing time. In general, the nurses remained supportive of the benefits for their patients, despite consequences to their workflows. Their acceptance of the ADC system in this study demonstrates this.
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Affiliation(s)
- Yi-Chen Wang
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chin-Yuan Tsan
- Department of Nursing, National Taiwan University Hospital, Yunlin Branch, Yunlin County, Taiwan
| | - Meng-Chun Chen
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan
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173
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Parks LK, McGrane IR, Hartzell JL. A prospective assessment of the Medicaid Web portal for admission medication reconciliation at a community hospital in Montana. Am J Health Syst Pharm 2021; 78:S71-S75. [PMID: 33744932 DOI: 10.1093/ajhp/zxab108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Medication reconciliation (MR) is a complicated and tedious process but is crucial to prevent errors when ordering patients' discharge medications during a hospital admission. Our institution currently uses a variety of methods to gather a patient's medication history, including review of the medical records and electronic pharmaceutical claims data (EPCD) from a commercial health information exchange organization, as well as a patient or caregiver interview. Occasionally, more information is needed to obtain the most accurate history. To augment current methods, EPCD can also be accessed for patients with Medicaid insurance using a state Medicaid Web portal. We aimed to evaluate the utility of the Medicaid Web portal for reducing medication errors during the MR process at hospital admission. SUMMARY A single-center, prospective, quality improvement initiative was conducted to evaluate 100 patient medication lists for all nonobstetric Medicaid patients admitted to our institution to identify discrepancies in medication lists when the state Medicaid Web portal was used in addition to standard MR methods. We found that, when EPCD from commercial organizations were available, they matched the patient's current medication list 64% of the time. One in 4 patients had at least 1 discrepancy on their verified medication list that was identified using the Medicaid Web portal. The discrepancies identified were addressed and corrected in real time to improve patient care. CONCLUSION EPCD from the state Medicaid Web portal could supplement the use of current methods to obtain a more accurate medication history and reduce the number of erroneously ordered discharge medications during hospital admission.
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Affiliation(s)
- Lauren K Parks
- Providence Health & Services, St. Patrick Hospital, Missoula, MT, USA
| | - Ian R McGrane
- Skaggs School of Pharmacy, College of Health, The University of Montana, Missoula, MT, USA
| | - Jayme L Hartzell
- Providence Health & Services, St. Patrick Hospital, Missoula, MT, USA
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174
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Daliri S, Kooij MJ, Scholte Op Reimer WJM, Ter Riet G, Jepma P, Verweij L, Peters RJG, Buurman BM, Karapinar-Çarkit F. Effects of a transitional care programme on medication adherence in an older cardiac population: A randomized clinical trial. Br J Clin Pharmacol 2021; 88:965-982. [PMID: 34410011 DOI: 10.1111/bcp.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/21/2021] [Accepted: 07/31/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS Medication non-adherence post-discharge is common among patients, especially those suffering from chronic medical conditions, and contributes to hospital admissions and mortality. This study aimed to evaluate the effect of the Cardiac Care Bridge (CCB) intervention on medication adherence post-discharge. METHODS We performed a secondary analysis of the CCB randomized single-blind trial, a study in patients ≥70 years, at high risk of functional loss and admitted to cardiology departments in six hospitals. In this multi-component intervention study, community nurses performed medication reconciliation and observed medication-related problems (MRPs) during post-discharge home visits, and pharmacists provided recommendations to resolve MRPs. Adherence to high-risk medications was measured using the proportion of days covered (PDC), using pharmacy refill data. Furthermore, MRPs were assessed in the intervention group. RESULTS For 198 (64.7%) of 306 CCB patients, data were available on adherence (mean age: 82 years; 58.9% of patients used a multidose drug dispensing [MDD] system). The mean PDC before admission was 92.3% in the intervention group (n = 99) and 88.5% in the control group (n = 99), decreasing to 85.2% and 84.1% post-discharge, respectively (unadjusted difference: -2.6% (95% CI -9.8 to 4.6, P = .473); adjusted difference -3.3 (95% CI -10.3 to 3.7, P = .353)). Post-hoc analysis indicated that a modest beneficial intervention effect may be restricted to MDD non-users (Pinteraction = .085). In total, 77.0% of the patients had at least one MRP post-discharge. CONCLUSIONS Our findings indicate that a multi-component intervention, including several components targeting medication adherence in older cardiac patients discharged from hospital back home, did not benefit their medication adherence levels. A modest positive effect on adherence may potentially exist in those patients not using an MDD system. This finding needs replication.
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Affiliation(s)
- Sara Daliri
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands.,Department of Internal Medicine, section of Geriatric Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marcel J Kooij
- Community pharmacy, Service Apotheek Koning, Amsterdam, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.,University of Applied Sciences Utrecht, Research Group Chronic Diseases, Utrecht, The Netherlands
| | - Gerben Ter Riet
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Patricia Jepma
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lotte Verweij
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, section of Geriatric Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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175
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Yoon S, Sohng K. Factors causing medication errors in an electronic reporting system. Nurs Open 2021; 8:3251-3260. [PMID: 34392612 PMCID: PMC8510738 DOI: 10.1002/nop2.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/03/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022] Open
Abstract
Aim To analyse medication error data from a hospital's electronic reporting system and identify the factors affecting error types and harmfulness. Design A retrospective study. Methods The 805 near misses and adverse events reported to the hospital's electronic reporting system between January 2014 and December 2018 were analysed using descriptive statistics, chi‐square tests and logistic regression analyses. Results A total of 632 near misses and 173 adverse events were reported. Near misses and adverse events were the most common error type during the dispensing stage and medication administration, respectively. The odds of medication errors reported by nurses with 1–9 years of clinical experience were relatively low. After adjusting for confounders, the odds of medication errors directly observed by nurses were 65% lower than the odds of medication errors not directly detected. In clinical practice, nurses must be educated about errors in reporting depending on their degree of clinical experience.
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Affiliation(s)
- Seonhee Yoon
- Department of Performance Improvement, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Kyeongyae Sohng
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
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176
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Russ-Jara AL, Luckhurst CL, Dismore RA, Arthur KJ, Ifeachor AP, Militello LG, Glassman PA, Zillich AJ, Weiner M. Care Coordination Strategies and Barriers during Medication Safety Incidents: a Qualitative, Cognitive Task Analysis. J Gen Intern Med 2021; 36:2212-2220. [PMID: 33479924 PMCID: PMC8342616 DOI: 10.1007/s11606-020-06386-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Medication errors are prevalent in healthcare institutions worldwide, often arising from difficulties in care coordination among primary care providers, specialists, and pharmacists. Greater knowledge about care coordination surrounding medication safety incidents can inform efforts to improve patient safety. OBJECTIVES To identify strategies that hospital and outpatient healthcare professionals (HCPs) use, and barriers encountered, when they coordinate care during a medication safety incident involving an adverse drug reaction, drug-drug interaction, or drug-renal concern. DESIGN We asked HCPs to complete a form whenever they encountered these incidents and intervened to prevent or mitigate patient harm. We stratified incidents across HCP roles and incident categories to conduct follow-up cognitive task analysis interviews with HCPs. PARTICIPANTS We invited all physicians and pharmacists working in inpatient or outpatient care at a tertiary Veterans Affairs Medical Center. We examined 24 incidents: 12 from physicians and 12 from pharmacists, with a total of 8 incidents per category. APPROACH Interviews were transcribed and analyzed via a two-stage inductive, qualitative analysis. In stage 1, we analyzed each incident to identify decision requirements. In stage 2, we analyzed results across incidents to identify emergent themes. KEY RESULTS Most incidents (19, 79%) were from outpatient care. HCPs relied on four main strategies to coordinate care: cognitive decentering; collaborative decision-making; back-up behaviors; and contingency planning. HCPs encountered four main barriers: role ambiguity and constraints, breakdowns (e.g., delays) in care, challenges related to the electronic health record, and factors that increased coordination complexity. Each strategy and barrier occurred across all incident categories and HCP groups. Pharmacists went to extra effort to ensure safety plans were implemented. CONCLUSIONS Similar strategies and barriers were evident across HCP groups and incident types. Strategies for enhancing patient safety may be strengthened by deliberate organizational support. Some barriers could be addressed by improving work systems.
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Affiliation(s)
- Alissa L Russ-Jara
- Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, IN, USA. .,Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA. .,Regenstrief Institute, Inc., Indianapolis, IN, USA.
| | - Cherie L Luckhurst
- Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, IN, USA
| | - Rachel A Dismore
- Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, IN, USA
| | - Karen J Arthur
- Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
| | - Amanda P Ifeachor
- Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
| | | | - Peter A Glassman
- Pharmacy Benefits Management Services, Department of Veterans Affairs, Washington DC, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alan J Zillich
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Michael Weiner
- Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA.,Indiana University Center for Health Services and Outcomes Research, Indianapolis, IN, USA
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177
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Carayon P, Wetterneck TB, Cartmill R, Blosky MA, Brown R, Hoonakker P, Kim R, Kukreja S, Johnson M, Paris BL, Wood KE, Walker JM. Medication Safety in Two Intensive Care Units of a Community Teaching Hospital After Electronic Health Record Implementation: Sociotechnical and Human Factors Engineering Considerations. J Patient Saf 2021; 17:e429-e439. [PMID: 28248749 PMCID: PMC5573668 DOI: 10.1097/pts.0000000000000358] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of the study was to assess the impact of Electronic Health Record (EHR) implementation on medication safety in two intensive care units (ICUs). METHODS Using a prospective pre-post design, we assessed 1254 consecutive admissions to two ICUs before and after an EHR implementation. Each medication event was evaluated with regard to medication error (error type, medication-management stage) and impact on patient (severity of potential or actual harm). RESULTS We identified 4063 medication-related events either pre-implementation (2074 events) or post-implementation (1989 events). Although the overall potential for harm due to medication errors decreased post-implementation only 2 of the 3 error rates were significantly lower post-implementation. After EHR implementation, we observed reductions in rates of medication errors per admission at the stages of transcription (0.13-0, P < 0.001), dispensing (0.49-0.16, P < 0.001), and administration (0.83-0.56, P = 0.011). Within the ordering stage, 4 error types decreased post-implementation (orders with omitted information, error-prone abbreviations, illegible orders, failure to renew orders) and 4 error types increased post-implementation (orders of wrong drug, orders containing a wrong start or stop time, duplicate orders, orders with inappropriate or wrong information). Within the administration stage, we observed a reduction of late administrations and increases in omitted administrations and incorrect documentation. CONCLUSIONS Electronic Health Record implementation in two ICUs was associated with both improvement and worsening in rates of specific error types. Further safety improvements require a nuanced understanding of how various error types are influenced by the technology and the sociotechnical work system of the technology implementation. Recommendations based on human factors engineering principles are provided for reducing medication errors.
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Affiliation(s)
- Pascale Carayon
- Center for Quality and Productivity Improvement, University of
Wisconsin-Madison
- Department of Industrial and Systems Engineering, University of
Wisconsin-Madison
| | - Tosha B. Wetterneck
- Center for Quality and Productivity Improvement, University of
Wisconsin-Madison
- Department of Industrial and Systems Engineering, University of
Wisconsin-Madison
- Department of Medicine, University of Wisconsin School of Medicine
and Public Health
| | - Randi Cartmill
- Department of Surgery, University of Wisconsin School of Medicine
and Public Health
| | | | - Roger Brown
- Center for Quality and Productivity Improvement, University of
Wisconsin-Madison
- University of Wisconsin School of Nursing
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of
Wisconsin-Madison
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178
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Küng K, Aeschbacher K, Rütsche A, Goette J, Zürcher S, Schmidli J, Schwendimann R. Effect of barcode technology on medication preparation safety: a quasi-experimental study. Int J Qual Health Care 2021; 33:6203751. [PMID: 33783482 DOI: 10.1093/intqhc/mzab043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/21/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Medication errors are a common problem in hospitals and a major driver of adverse patient outcomes. Barcode verification technology is a promising strategy to help ensure safe medication preparation practices. OBJECTIVES The objectives of this study were (i) to assess the effects of a barcode-assisted medication preparation and administration system regarding the rate of medication preparation errors and (ii) to compare the time spent on medication preparation tasks by medical staff. METHODS A quasi-experimental study with a pre-post design was conducted, from August 2017 to July 2018, in two mixed medical/surgical units of a tertiary teaching hospital. The primary aim was to assess the effects of a barcode-based electronically assisted medication preparation and administration system linked to the hospital's electronic medication administration record regarding the rate of medication preparation errors and time-based staff performance. Data were collected using direct observation. Adjusted and unadjusted logistic models were used for error frequencies and linear regression models for time performance. RESULTS 5932 instances of medication selection and dosing during 79 medication preparation procedures were observed. The overall medication preparation error incidence decreased from 9.9% at baseline to 4.5% at post-intervention, corresponding to a relative risk reduction of 54.5% (P < 0.001). However, the adjusted effect by registered nurses (RNs) and nurses' work experience of total medication preparation errors showed only borderline significance (odds ratio [OR] 0.64, P = 0.051). For adjusted error-specific analyses, significant error reductions were found in wrong medication errors (OR 0.38, P < 0.010) and wrong dosage errors (OR 0.12, P = 0.004). Wrong patient, wrong form and ambiguous dispenser errors did not occur at post-intervention. Errors of omission (OR 1.53, P = 0.17), additional doses (OR 0.63, P = 0.64) and wrong dispenser boxes (OR 0.51, P = 0.11) did not change significantly. The time necessary to prepare medications for a 24-h period also decreased significantly-from 30.2 min to 17.2 min (beta = -6.5, P = 0.047), while mean preparation time per individual medication dose fell from 24.3 s to 15.1 s (beta = -5.0, P = 0.002). CONCLUSION Use of the new barcode technology significantly reduced the rate of some medication preparation errors in our sample. Moreover, the time necessary for medication preparation, both per 24-h period and per single-medication dose, was significantly reduced.
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Affiliation(s)
- Kaspar Küng
- Institute of Hospital Pharmacy, University Hospital Bern, Freiburgstrasse 8, Bern 3010, Switzerland.,Department of Cardiovascular Surgery, University Hospital Bern, Freiburgstrasse 8, Bern 3010, Switzerland.,University of Applied Science-Health, Murtenstrasse 10, Bern 3010, Switzerland
| | - Katrin Aeschbacher
- Institute of Hospital Pharmacy, University Hospital Bern, Freiburgstrasse 8, Bern 3010, Switzerland
| | - Adrian Rütsche
- Direction of Technology and Innovation, University Hospital Bern, Freiburgstrasse 8, Bern 3010, Switzerland
| | - Jeannette Goette
- Institute of Hospital Pharmacy, University Hospital Bern, Freiburgstrasse 8, Bern 3010, Switzerland
| | - Simeon Zürcher
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich 8001, Switzerland
| | - Jürg Schmidli
- Department of Cardiovascular Surgery, University Hospital Bern, Freiburgstrasse 8, Bern 3010, Switzerland
| | - René Schwendimann
- Patient Safety Office, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland.,Institute of Nursing Science, University of Basel, Bernoullistrasse 28, Basel-Stadt 4056, Switzerland
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179
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Paradissis C, Cottrell N, Coombes I, Scott I, Wang W, Barras M. Patient harm from cardiovascular medications. Ther Adv Drug Saf 2021; 12:20420986211027451. [PMID: 34367546 PMCID: PMC8317255 DOI: 10.1177/20420986211027451] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/23/2020] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Medication harm can lead to hospital admission, prolonged hospital stay and poor patient outcomes. Reducing medication harm is a priority for healthcare organisations worldwide. Recent Australian studies demonstrate cardiovascular (CV) medications are a leading cause of harm. However, they appear to receive less recognition as ‘high risk’ medications compared with those classified by the medication safety acronym, ‘APINCH’ (antimicrobials, potassium, insulin, narcotics, chemotherapeutics, heparin). Our aim was to determine the scale and type of medication harm caused by CV medications in healthcare. Methods A narrative review of adult (>16 years) medication harm literature identified from PubMed and CINAHL databases was undertaken. Studies with the primary outcome of measuring the incidence of medication harm were included. Harm caused by CV medications was described and ranked against other medication classes at four key stages of a patient’s healthcare journey. Where specified, the implicated medications and type of harm were investigated. Results A total of 75 studies were identified, including seven systematic reviews and three meta-analyses, with most focussing on harm causing hospital admission. CV medications were responsible for approximately 20% of medication harm; however, this proportion increased to 50% in older populations. CV medications were consistently ranked in the top five medication categories causing harm and were often listed as the leading cause. Conclusion CV medications are a leading cause of medication harm, particularly in older adults, and should be the focus of harm mitigation strategies. A practical approach to generate awareness among health professionals is to incorporate ‘C’ (for CV medications) into the ‘APINCH’ acronym. Plain language summary
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Affiliation(s)
- Chariclia Paradissis
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Coombes
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Scott
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - William Wang
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Barras
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
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180
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Bengaard AK, Iversen E, Kallemose T, Juul-Larsen HG, Rasmussen LJH, Dalhoff KP, Andersen O, Eugen-Olsen J, Houlind MB. Using soluble urokinase plasminogen activator receptor to stratify patients for medication review in the emergency department. Br J Clin Pharmacol 2021; 88:1679-1690. [PMID: 34242432 DOI: 10.1111/bcp.14982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS To investigate whether the association between levels of medication use (including polypharmacy and potentially inappropriate medications [PIMs]) and health outcomes such as readmission and mortality is dependent on baseline soluble urokinase plasminogen activator receptor (suPAR). METHODS This registry-based cohort study included medical patients admitted to the emergency department at Copenhagen University Hospital Hvidovre, Denmark. Patients were grouped according to their admission suPAR levels: low (0-3 ng/mL), intermediate (3-6 ng/mL), or high (>6 ng/mL). Hyper-polypharmacy was defined as ≥10 prescribed medications. PIMs were identified based on the EU(7)-PIM list, and data on admissions and mortality were obtained from national registries. Risk of 90-day readmission and mortality was assessed by Cox regression analysis adjusted for sex, age and Charlson comorbidity index. Results were reported as hazard ratios within 90 days of index discharge. RESULTS In total, 26 291 patients (median age 57.3 y; 52.7% female) were included. Risk of 90-day readmission and mortality increased significantly for patients with higher suPAR or higher number of medications. Among patients with low suPAR, patients with ≥10 prescribed medications had a hazard ratio of 2.41 (95% confidence interval = 2.09-2.78) for 90-day readmission and 8.46 (95% confidence interval = 2.53-28.28) for 90-day mortality compared to patients with 0 medications. Patients with high suPAR generally had high risk of readmission and mortality, and the impact of medication use was less pronounced in this group. Similar, but weaker, association patterns were observed between suPAR and PIMs. CONCLUSION The association between levels of medication use and health outcomes is dependent on baseline suPAR.
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Affiliation(s)
- Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,The Capital Region Pharmacy, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Kim Peder Dalhoff
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Emergency Department, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,The Capital Region Pharmacy, Herlev, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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181
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Høj K, Pedersen HS, Lundberg ASB, Bro F, Nielsen LP, Saedder EA. External validation of the Medication Risk Score in polypharmacy patients in general practice: A tool for prioritizing patients at greatest risk of potential drug-related problems. Basic Clin Pharmacol Toxicol 2021; 129:319-331. [PMID: 34237199 DOI: 10.1111/bcpt.13636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
Drug-related problems are important causes of patient harm and increased healthcare costs. To assist general practitioners in prioritizing patients in need of a critical medication review, we aimed to assess the ability of the Medication Risk Score (MERIS) to stratify patients with polypharmacy in general practice according to their risk of drug-related problems. We conducted a cross-sectional multi-centre external validation study. Patients receiving more than five concomitant medications (polypharmacy) were eligible. The outcome was potentially serious drug-related problems as evaluated by expert consensus. Performance was assessed in terms of calibration and discrimination indices. Of 497 patients, 489 were included in the main analysis. The median age (interquartile range) was 70.5 years (60-79). In total, 372 potentially serious drug-related problems were observed in 253 patients (52%). The MERIS was well calibrated above a score level of 10. The area under the receiver operating characteristic curve was 0.70 (95% confidence interval: 0.65-0.74). The performance of the MERIS was fair in patients with polypharmacy in general practice. Given the scale of drug-related problems and the lack of efficient prioritization tools in this setting, the MERIS could be a useful risk indicator to complement usual practice.
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Affiliation(s)
- Kirsten Høj
- Research Unit for General Practice, Aarhus, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Flemming Bro
- Research Unit for General Practice, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lars Peter Nielsen
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Eva Aggerholm Saedder
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
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182
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Dionisi S, Giannetta N, Maselli N, Di Muzio M, Di Simone E. Medication errors in homecare setting: An Italian validation study. Public Health Nurs 2021; 38:1116-1125. [PMID: 34231262 DOI: 10.1111/phn.12946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Medication errors are a concern in overall the world. Although there are studies that investigate what may be the main causes that lead to the genesis of the medication error in the home care setting, there is no tool that correlates knowledge, attitudes, and behavior to medication errors in the context of home care. This study aimed to psychometrically test to the questionnaire on knowledge, attitudes, and behaviors in the administration of medication in the new setting: home care setting. DESIGN This observational study was reported according to the STROBE checklist. SAMPLE Sixty two nurses working in home care setting responded to the online survey. MEASUREMENT The face and content validity of the items generated was assessed. An Exploratory Factorial Analysis descriptive statistical analysis was conducted. The final questionnaire is composed of 20 items. RESULTS The results of the statistical analyses allowed to validate the questionnaire, ensuring good internal consistency and reliability. Most of the sample pointed out that the use of electronic health record, medication reconciliation and the pharmacist's figure are all useful strategies for reducing the risk of medication errors. CONCLUSION The questionnaire is reliable to measure knowledge, attitude, and behavior about medication errors prevention in home care settings.
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Affiliation(s)
- Sara Dionisi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Lazio, Italy
| | - Noemi Giannetta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Lazio, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Nicoletta Maselli
- Provincial Agency for Health Services of the Autonomous Province of Trento, Trento, Italy
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Lazio, Italy
| | - Emanuele Di Simone
- Nursing, Technical, Rehabilitation, Assistance and Research Department, IRCCS Istituti Fisioterapici Ospitalieri, IFO, Rome, Italy
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183
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Ali L, Saifan A, Alrimawi I, Atout M. Nurses' perceptions toward factors that cause medication errors in Jordan: A qualitative study. Perspect Psychiatr Care 2021; 57:1417-1424. [PMID: 33285009 DOI: 10.1111/ppc.12707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/23/2020] [Accepted: 11/22/2020] [Indexed: 12/01/2022] Open
Abstract
AIMS The aim of this study was to investigate nurses' experiences related to medication errors (MEs) from the perspective of Jordanian nurses. This article reports the findings concerning the factors that cause MEs from the perspectives of Jordanian nurses. BACKGROUND MEs are critical issues facing healthcare providers and health institutions. Most of the studies on MEs were conducted in Western countries. However, there is little research that seeks to understand this issue in the developing countries and Jordan is one of these countries. DESIGN A qualitative descriptive approach was used in three hospitals in different clinical settings in Jordan. METHODS Individual semi-structured face-to-face interviews were conducted with 24 nurses. RESULTS The data that emerged from the interviews was arranged and contextualized in two major themes, individual and systemic factors, that explained the main causes of MEs. From the individual side, lack of knowledge and experience ranked as the highest concerns, and from the systematic side workload was the most important factor. CONCLUSION This study provides an opportunity for stakeholders and Jordanian managers to increase their awareness of these factors and address them in the future, thereby increasing the level of care provided in their health organizations.
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Affiliation(s)
- Luma Ali
- Nursing Department, Arab University College of Technology, Amman, Jordan
| | - Ahmad Saifan
- Nursing Department, Applied Science Private University, Amman, Jordan
| | - Intima Alrimawi
- School of Nursing and Health Professions, Trinity Washington University, Washinton, NE Washington, USA
| | - Maha Atout
- Faculty of Nursing, Philadelphia university, Amman, Jordan, Jordan
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184
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Parthasarathi A, Puvvada R, Patel H, Bhandari P, Nagpal S. Evaluation of Medication Errors in a Tertiary Care Hospital of a Low- to Middle-Income Country. Cureus 2021; 13:e16769. [PMID: 34354894 PMCID: PMC8328840 DOI: 10.7759/cureus.16769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Medication errors (MEs) are a major public health concern as they are detrimental to patient safety, compromise patients' confidence in the healthcare system, increase healthcare costs, and adversely affect the patient's quality of life. This is especially true in low to middle-income countries where the significance of MEs is largely undervalued. This study aims to investigate the prevalence of MEs and analyze the causes, medicines involved, reporting, and severity of MEs in a tertiary care setting. Methods A prospective observational study was conducted from March 2020 to February 2021 in a tertiary care teaching hospital in South India. The data was collected after reviewing patient medical records, by interviewing patients and healthcare professionals. National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index was used to evaluate MEs. Results A total of 557 MEs were identified from 3798 patients with a prevalence of 14.6%. Prescribing errors were the most commonly observed ME followed by errors related to documentation of medical records, administration-related errors, and dispensing errors. Lack of time for documentation of medication records, shift change and work overload were common causes of MEs. The majority of MEs were category A and B of the NCC MERP severity index. Conclusion Antibiotics and proton pump inhibitors were the most common medicines involved in MEs. Prescribing and documentation errors were most prevalent. Implementation of systems like strict adherence to treatment guidelines, computerized provider order entry (CPOE), barcode medication administration, and closed-loop electronic medication management systems may greatly help reduce MEs. All healthcare institutions should undertake routine audits to determine the prevalence and causes of medication errors.
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Affiliation(s)
| | - Rahul Puvvada
- Physiology, Anatomy, and Microbiology, College of Science, Health and Engineering, La Trobe University, Melbourne, AUS
| | - Himanshu Patel
- Pharmacology and Therapeutics, International Society of Oncology Pharmacy Practitioners, North Vancouver, CAN
| | - Pooja Bhandari
- Public Health, Madhavnagar Government Hospital, Ujjain, IND
| | - Sagar Nagpal
- Internal Medicine, Erie County Medical Center, Buffalo, USA
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185
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Mira JJ. How to reduce medication errors in patients over the age of 65? Expert Opin Pharmacother 2021; 22:2417-2421. [PMID: 34187264 DOI: 10.1080/14656566.2021.1947241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- José Joaquín Mira
- Health Psychology Department, Universidad Miguel Hernandez de Elche, Elche, Spain.,Alicante-Sant Joan Health District, Alicante, Spain
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186
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Aljuaid M, Alajman N, Alsafadi A, Alnajjar F, Alshaikh M. Medication Error During the Day and Night Shift on Weekdays and Weekends: A Single Teaching Hospital Experience in Riyadh, Saudi Arabia. Risk Manag Healthc Policy 2021; 14:2571-2578. [PMID: 34188568 PMCID: PMC8232963 DOI: 10.2147/rmhp.s311638] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/18/2021] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background The association between medication error incidence and time (day shift vs night shift) have not been extensively studied in Saudi Arabia, this study aimed to answer this question: is there a relationship between medication error incidence and time of the day (day shifts vs night shifts) on weekdays and weekends?. Objective To identify whether medication errors and their sub-categories are significantly different between day shifts, night shifts, during weekdays and weekends. Methods A retrospective analysis of medication errors reported by health-care practitioners from January 2018 to December 2019 through the Electronic-Occurrence Variance Reporting System (E-OVR) of a university teaching hospital in Riyadh, Saudi Arabia. Statistical analysis was used to determine the differences between the medication errors and their sub-categories and day and night shifts during weekdays (from Sunday to Thursday) and weekends (Friday and Saturday). Results A total of 2626 medication errors were reported over 2 years from January 2018 to December 2019. The most prevalent sub-category of medication errors was prescribing errors (55%), while the least common sub-category of medication errors was administration errors (0.6%). There was a statistically significant difference between medication errors and day of the week. Medication errors that happened on weekdays were greater than at weekends (P = 0.01). During weekends, medication errors were more likely to occur at the night shift compared to the day shift (P < 0.05). Conclusion Timing of medication errors incidence is an important factor to be considered for improving the medication use process and improving patient safety. Further researches are needed that focus on intervention to reduce these errors, especially during night shifts.
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Affiliation(s)
- Mohammed Aljuaid
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Najla Alajman
- Department of Rehabilitation, Sultan Bin Abdualaziz Humanitarian City, Riyadh, Saudi Arabia
| | - Afraa Alsafadi
- Department of Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Farrah Alnajjar
- Yanbu General Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Mashael Alshaikh
- Department of Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia
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187
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Abstract
BACKGROUND Due to the need for early and effective medications for coronavirus disease (COVID-19), less attention may have been paid to medication safety during this pandemic. OBJECTIVES This study aimed to examine the incidence, nature, and seriousness of medication errors (MEs) and adverse drug reactions (ADRs) among hospitalized patients with COVID-19. MATERIALS AND METHODS This is a retrospective study of MEs and ADRs reported at the King Saud Medical City (KSMC) between April 2020 and September 2020. RESULTS A total of 343 MEs and 416 ADRs were reported during the study period. The incidence of MEs was 19% (19/100). Seventy-five MEs (21.5%) reached the patient but did not cause any harm. Wrong dose (n=101, 29.4%) was the most common type of MEs. Physicians were the most common source of MEs (87.5%). Antibiotics (32%) and antineoplastics (25%) were the most common drug categories involved in MEs and ADRs, respectively. Thirty-nine percent (n=163) of the ADRs were of serious nature. 24% (n=100) required hospitalization, 5% (n=21) were life-threatening, 16 (3.8%) required intervention to prevent permanent impairment or damage, and 6.2% (n=26) resulted in the discontinuation of treatment. CONCLUSION The reporting of MEs appears to be high among COVID-19 patients in a large tertiary care setting in the Kingdom of Saudi Arabia (KSA). The majority of MEs were caused by dosing errors and errors in drug frequency, mostly ascribed to physicians, which may be indicative of burnout or stress among them. The reporting of MEs and ADRs can be improved by providing incentives to healthcare professionals (HCPs) and promoting a non-punitive culture. Further studies should explore the clinical consequences of medication misadventures in hospitalized COVID-19 patients.
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Affiliation(s)
- Dlal Almazrou
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh, SAU
| | - Oluwaseun Egunsola
- Department of Community Health Sciences, University of Calgary, Calgary, CAN
| | - Sheraz Ali
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, AUS
| | - Amal Bagalb
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh, SAU
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188
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Alshammari FM, Alanazi EJ, Alanazi AM, Alturifi AK, Alshammari TM. Medication Error Concept and Reporting Practices in Saudi Arabia: A Multiregional Study Among Healthcare Professionals. Risk Manag Healthc Policy 2021; 14:2395-2406. [PMID: 34113194 PMCID: PMC8187088 DOI: 10.2147/rmhp.s281154] [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: 09/11/2020] [Accepted: 04/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Medication errors pose a risk for individual patients and for public health, with the misuse and overuse of medications being linked to severe patient safety problems. Therefore, the objective of this study was to investigate healthcare professionals’ (HCPs’) knowledge about medication errors, their knowledge about medication error reporting systems, and predictors for HCPs to report medication errors in Saudi Arabia. Methods An observational cross-sectional study was conducted among HCPs (physicians, pharmacists, and nurses) between January and March 2020. The study included 6 distinct locations in the Saudi Arabian regions of Hail, Al-Qassim, Al-Jouf, Al-Madinah, the eastern region, and the western region. Descriptive statistical and inferential analyses were computed using Statistical Package for the Social Sciences (SPSS) v.22. Results In total, 980 questionnaires for 348 (35.5%) physicians, 144 (14.7%) pharmacists, and 488 (49.8%) nurses were distributed with a response rate of 100%. Interestingly, only 277 (28.3%) of the HCPs had a good understanding of the stages of medication errors. With regard to reporting practices, a high number of the HCPs, 576 (58.8%), had not reported medication errors in their workplaces, and nearly 369 (37.7%) of respondents said they believe that legal implications are a major barrier to the reporting of medication errors. More than half, 524 (53.5%), of HCPs revealed that no clear electronic system is available for the reporting of medication errors in most hospitals. In addition, 537 (54.8%), of the HCPs had not attended any training programs regarding medication error reporting systems within the past year, which is alarming. Conclusion Our study identified a huge lack of the reporting of medication errors, knowledge about medication error stages, and training on medication errors. Therefore, an urgent need to address these weaknesses exists.
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Affiliation(s)
- Faizah M Alshammari
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Entisar J Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Afnan M Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Abdulrahman K Alturifi
- Department of Infection Prevention and Control, Hail Health Affairs, Ministry of Health, Hail, Saudi Arabia
| | - Thamir M Alshammari
- Department of Pharmacy Practice, College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
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189
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Hada A, Coyer F. Shift-to-shift nursing handover interventions associated with improved inpatient outcomes-Falls, pressure injuries and medication administration errors: An integrative review. Nurs Health Sci 2021; 23:337-351. [PMID: 33665950 DOI: 10.1111/nhs.12825] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
The aim of this integrative review was to identify which nursing handover interventions were associated with improved patient outcomes, specifically patients' falls, pressure injuries and medication administration errors, in the hospital setting. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the review. A systematic search of seven electronic databases was conducted, and retrieved articles were assessed by two independent reviewers. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Eight studies met the inclusion criteria. The findings of this review indicate that improvements in handover communication had a clinically important positive effect on patient outcomes. Across the studies, reductions in falls varied from 9.3 to 80%, pressure injuries from 45 to 75%, and medication errors from 11.1 to greater than 50%. This review highlights that the implementation of bedside nursing handover and the adoption of standardized handover tools to improve nursing handover communication reduce patient adverse events, specifically falls, pressure injuries, and medication errors. These findings should be considered by clinicians to inform their clinical handover practice.
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Affiliation(s)
- Adriana Hada
- Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Fiona Coyer
- Joint appointment with School of Nursing, Queensland University of Technology and Royal Brisbane and Women's Hospital, Metro North Hospital Health Service, Brisbane, Queensland, Australia
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190
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Massah L, Mohammadi R, Namnabati M. Improvement of medication error reporting: An applied motivation program in pediatric units. J Educ Health Promot 2021; 10:189. [PMID: 34250123 PMCID: PMC8249978 DOI: 10.4103/jehp.jehp_1025_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/12/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND The rate of reporting medication errors is lower than the actual rate. The role of education, encouragement, and promotion of reporting culture can contribute to the increase of errors reporting. This study was to investigate the effect of motivational program on reporting of medication errors in the pediatric units. MATERIALS AND METHODS A quasi-experimental study with pre- and post-test design was done through 60 nurses working in the pediatric wards of the selected hospital in Isfahan, Iran in 2018-2019. Nurses participated in the study through the census sampling method. Data were collected using a questionnaire based on eight medication principles completed by the nurses before and after the intervention. The intervention was conducted through a motivational program in two parts of training and positive reinforcement. Data were analyzed through the descriptive statistics (frequency, mean, and standard deviation [SD]) as well as inferential statistics (Wilcoxon test and paired t-test). RESULTS After the intervention, the most medication error reports (60%) were in the principle of right medication (similar name). Furthermore, the total score (SD) of medication error reporting was significantly increased from 7.35 (2.43) before the intervention to 17.04 (5.59) after the intervention, (t = 8.03, P < 0.001). CONCLUSIONS Motivational program increased medication error reports. Therefore, the managers can improve medication care and the safety of children through continuous education and encouragement in the hospitals.
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Affiliation(s)
- Laleh Massah
- Pediatric Department, Gharazi Hospital, Isfahan, Iran
| | - Rouhangiz Mohammadi
- Pediatric Department, Emam Hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboobeh Namnabati
- Department of Pediatric and Neonates, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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191
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Patanwala AE, Narayan SW, Haas CE, Abraham I, Sanders A, Erstad BL. Proposed guidance on cost-avoidance studies in pharmacy practice. Am J Health Syst Pharm 2021; 78:1559-1567. [PMID: 34007979 DOI: 10.1093/ajhp/zxab211] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Cost-avoidance studies of pharmacist interventions are common and often the first type of study conducted by investigators to quantify the economic impact of clinical pharmacy services. The purpose of this primer is to provide guidance for conducting cost-avoidance studies pertaining to clinical pharmacy practice. SUMMARY Cost-avoidance studies represent a paradigm conceptually different from traditional pharmacoeconomic analysis. A cost-avoidance study reports on cost savings from a given intervention, where the savings is estimated based on a counterfactual scenario. Investigators need to determine what specifically would have happened to the patient if the intervention did not occur. This assessment can be fundamentally flawed, depending on underlying assumptions regarding the pharmacists' action and the patient trajectory. It requires careful identification of the potential consequence of nonaction, as well as probability and cost assessment. Given the uncertainty of assumptions, sensitivity analyses should be performed. A step-by-step methodology, formula for calculations, and best practice guidance is provided. CONCLUSIONS Cost-avoidance studies focused on pharmacist interventions should be considered low-level evidence. These studies are acceptable to provide pilot data for the planning of future clinical trials. The guidance provided in this article should be followed to improve the quality and validity of such investigations.
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Affiliation(s)
- Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia, and Royal Prince Alfred Hospital, Sydney, Australia
| | - Sujita W Narayan
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia
| | - Curtis E Haas
- University of Rochester Medical Center, Rochester, NY, USA
| | - Ivo Abraham
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Arthur Sanders
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Brian L Erstad
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
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192
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Narayan SW, Abraham I, Erstad BL, Haas CE, Sanders A, Patanwala AE. Methods used to attribute costs avoided from pharmacist interventions in acute care: A scoping review. Am J Health Syst Pharm 2021; 78:1576-1590. [PMID: 34003209 DOI: 10.1093/ajhp/zxab214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Cost-avoidance studies are common in pharmacy practice literature. This scoping review summarizes, critiques, and identifies current limitations of the methods that have been used to determine cost avoidance associated with pharmacists' interventions in acute care settings. METHODS An Embase and MEDLINE search was conducted to identify studies that estimated cost avoidance from pharmacist interventions in acute care settings. We included studies with human participants and articles published in English from July 2010 to January 2021, with the intent of summarizing the evidence most relevant to contemporary practice. RESULTS The database search retrieved 129 articles, of which 39 were included. Among these publications, less than half (18 of 39) mentioned whether the researchers assigned a probability for the occurrence of a harmful consequence in the absence of an intervention; thus, a 100% probability of a harmful consequence was assumed. Eleven of the 39 articles identified the specific harm that would occur in the absence of intervention. No clear methods of estimating cost avoidance could be identified for 7 studies. Among all 39 included articles, only 1 attributed both a probability to the potential harm and identified the cost specific to that harm. CONCLUSION Cost-avoidance studies of pharmacists' interventions in acute care settings over the last decade have common flaws and provide estimates that are likely to be inflated. There is a need for guidance on consistent methodology for such investigations for reporting of results and to confirm the validity of their economic implications.
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Affiliation(s)
- Sujita W Narayan
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia
| | - Ivo Abraham
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Brian L Erstad
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Curtis E Haas
- University of Rochester Medical Center, Rochester, NY, USA
| | - Arthur Sanders
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia, and Royal Prince Alfred Hospital, Sydney, Australia
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193
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Martin CE, Lanham M, Almgren-Bell A, Marsh C, Omurtag K. A randomized controlled trial to evaluate the use of a web-based application to manage medications during in vitro fertilization. Fertil Steril 2021; 116:793-800. [PMID: 34016436 DOI: 10.1016/j.fertnstert.2021.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the use of a web-based application that assists in medication management during in vitro fertilization (IVF) treatment. DESIGN Multicenter randomized controlled trial. SETTING University hospitals. PATIENT(S) Women undergoing IVF. INTERVENTION(S) Subjects were recruited to assess quality of life during IVF and were randomly assigned to use either the OnTrack application to assist with medication management or conventional medication management. Surveys were administered at four time points. MAIN OUTCOME MEASURE(S) Medication surplus, incidence of medication errors, amount of patient-initiated communication, and patient satisfaction. RESULT(S) A total of 153 women participated. The average number of portal messages and telephone calls was similar between groups. Twelve patients in the control group (12/69, 17.4%) and 8 patients in the case group (8/72, 11.1%) made medication errors. There were similar amounts of medication surplus in the two groups. The estimated cost of medication waste was $2,578 ± $2,056 in the control group and $2,554 ± $1,855 in the case group. Patient satisfaction was similar between the two groups. CONCLUSION(S) Use of a web-based application did not decrease medication errors, medication surplus, or patient-initiated messages. Many patients had a medication surplus, which can be an area of cost reduction during IVF. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT03383848.
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Affiliation(s)
- Caitlin Elizabeth Martin
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
| | - Michael Lanham
- Department of Learning Health Sciences, Michigan Medicine, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
| | | | - Courtney Marsh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Kansas Health System, Overland Park, Kansas
| | - Kenan Omurtag
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
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194
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Jang SJ, Lee H, Son YJ. Perceptions of Patient Safety Culture and Medication Error Reporting among Early- and Mid-Career Female Nurses in South Korea. Int J Environ Res Public Health 2021; 18:4853. [PMID: 34062845 PMCID: PMC8124773 DOI: 10.3390/ijerph18094853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 04/24/2021] [Accepted: 04/29/2021] [Indexed: 02/02/2023]
Abstract
Reporting medication errors is crucial for improving quality of care and patient safety in acute care settings. To date, little is known about how reporting varies between early and mid-career nurses. Thus, this study used a cross-sectional, secondary data analysis design to investigate the differences between early (under the age of 35) and mid-career (ages 35-54) female nurses by examining their perceptions of patient safety culture using the Korean Hospital Survey on Patient Safety Culture (HSPSC) and single-item self-report measure of medication error reporting. A total of 311 hospital nurses (260 early-career and 51 mid-career nurses) completed questionnaires on perceived patient safety culture and medication error reporting. Early-career nurses had lower levels of perception regarding patient safety culture (p = 0.034) compared to mid-career nurses. A multiple logistic regression analysis showed that relatively short clinical experience (<3 years) and a higher level of perceived patient safety culture increased the rate of appropriate medication error reporting among early-career nurses. However, there was no significant association between perception of patient safety culture and medication error reporting among mid-career nurses. Future studies should investigate the role of positive perception of patient safety culture on reporting errors considering multidimensional aspects, and include hospital contextual factors among early-, mid-, and late-career nurses.
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Affiliation(s)
| | | | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea; (S.-J.J.); (H.L.)
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195
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Ebbens MM, Gombert-Handoko KB, Wesselink EJ, van den Bemt PMLA. The Effect of Medication Reconciliation via a Patient Portal on Medication Discrepancies: A Randomized Noninferiority Study. J Am Med Dir Assoc 2021; 22:2553-2558.e1. [PMID: 33905738 DOI: 10.1016/j.jamda.2021.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medication reconciliation has become standard care to prevent medication transfer errors. However, this process is time-consuming but could be more efficient when patients are engaged in medication reconciliation via a patient portal. OBJECTIVES To explore whether medication reconciliation by the patient via a patient portal is noninferior to medication reconciliation by a pharmacy technician. DESIGN (INCLUDING INTERVENTION) Open randomized controlled noninferiority trial. Patients were randomized between medication reconciliation via a patient portal (intervention) or medication reconciliation by a pharmacy technician at the preoperative screening (usual care). SETTING AND PARTICIPANTS Patients scheduled for elective surgery using at least 1 chronic medication were included. MEASURES The primary endpoint was the number of medication discrepancies compared to the electronic nationwide medication record system (NMRS). For the secondary endpoint, time investment of the pharmacy technician for the medication reconciliation interview and patient satisfaction were studied. Noninferiority was analyzed with an independent t test, and the margin was set at 20%. RESULTS A total of 499 patients were included. The patient portal group contained 241 patients; the usual care group contained 258 patients. The number of medication discrepancies was 2.6 ± 2.5 in the patient portal group and 2.8 ± 2.7 in the usual care group. This was not statistically different and within the predefined noninferiority margin. Patients were satisfied with the use of the patient portal tool. Also, the use of the portal can save on average 6.8 minutes per patient compared with usual care. CONCLUSIONS AND IMPLICATIONS Medication reconciliation using a patient portal is noninferior to medication reconciliation by a pharmacy technician with respect to medication discrepancies, and saves time in the medication reconciliation process. Future studies should focus on identifying patient characteristics for successful implementation of patient portal medication reconciliation.
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Affiliation(s)
- Marieke M Ebbens
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands; Department of Hospital Pharmacy, St Jansdal Hospital, Harderwijk, the Netherlands; Department of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Kim B Gombert-Handoko
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elsbeth J Wesselink
- Department of Clinical Pharmacy, Zaans Medical Centre, Zaandam, the Netherlands
| | - Patricia M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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196
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Mrayyan MT, Al-Atiyyat N, Al-Rawashdeh S, Sawalha M, Awwad M. Comparing rates and causes of, and views on reporting of medication errors among nurses working in different-sized hospitals. Nurs Forum 2021; 56:560-570. [PMID: 33884638 DOI: 10.1111/nuf.12581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Medication errors are detrimental to patient safety and the quality of hospital services. PURPOSE The purpose of the study was to compare registered nurses working in the small-, medium-, and large-sized Jordanian hospitals' responses in terms of reported rate and cause of medication errors and their views on medication error reporting. METHODS This was a cross-sectional comparative design, with a total sample of 229 nurses working in different-sized hospitals. RESULTS The rates of reported medication errors were significantly different across hospitals representing 53.5% in small-sized, 41.8% in medium-sized, and 32.8% in large-sized hospitals. No significant differences between hospitals regarding the nurses' reported causes of medication errors. Nurses' views were significantly different in all aspects of their reporting except in their failure to report (drug) error. CONCLUSIONS The hospital's size may associate with nurses' reporting rate and nurses' views on reporting such errors. There is an urgent need for more diligent systematic efforts to prevent, detect, and report medication errors. Collaboration with other health team members, including information technology members, will enhance the outcomes associated with medication administration. The findings of this study warranted further investigations.
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Affiliation(s)
- Majd T Mrayyan
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Nijmeh Al-Atiyyat
- Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Sami Al-Rawashdeh
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Murad Sawalha
- Department of Maternal, Child, and Family Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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197
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Hada A, Jones LV, Jack LC, Coyer F. Translating evidence-based nursing clinical handover practice in an acute care setting: A quasi-experimental study. Nurs Health Sci 2021; 23:466-476. [PMID: 33797197 DOI: 10.1111/nhs.12836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/20/2021] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
Effective transfer of information during the nursing handover contributes to patient safety. This study aimed to translate the best practice nursing shift handover recommendations in an acute care setting using the Ottawa Model for Research Use and to explore its effect on patient adverse outcomes (falls, pressure injuries, and medication errors). Using a quasi-experimental design, the study was conducted in four internal medicine wards in a major tertiary hospital. A total of 88 nurses and 110 patients participated in 152 handover observations. The findings showed clinically important increases in percentages and odds of nurses' compliance with shift handover recommendations after the intervention. The patient adverse outcomes after the intervention were compared to the corresponding period of previous year. A reduction was observed for all adverse patient outcomes with incident rate ratios of 0.762 (p = 0.027) for falls, 0.624 for pressure injuries (p = 0.010), and 0.782 for medication errors (p = 0.023). Replicating this study's methodology across multiple clinical settings will increase the generalizability of findings and provide further evidence to inform nursing practice and policy.
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Affiliation(s)
- Adriana Hada
- Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Lee V Jones
- Biostatistician, Research Methods Group, Centre for Healthcare Transformation, Queensland University of Technology (QUT)
| | - Leanne C Jack
- Post Graduate Study Area Coordinator Intensive Care Nursing and Emergency Nursing, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fiona Coyer
- Joint appointment with School of Nursing, Queensland University of Technology and Royal Brisbane and Women's Hospital, Metro North Hospital Health Service, Brisbane, Queensland, Australia
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198
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Corny J, Rajkumar A, Martin O, Dode X, Lajonchère JP, Billuart O, Bézie Y, Buronfosse A. A machine learning-based clinical decision support system to identify prescriptions with a high risk of medication error. J Am Med Inform Assoc 2021; 27:1688-1694. [PMID: 32984901 PMCID: PMC7671619 DOI: 10.1093/jamia/ocaa154] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 04/03/2020] [Revised: 06/10/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To improve patient safety and clinical outcomes by reducing the risk of prescribing errors, we tested the accuracy of a hybrid clinical decision support system in prioritizing prescription checks. Materials and Methods Data from electronic health records were collated over a period of 18 months. Inferred scores at a patient level (probability of a patient’s set of active orders to require a pharmacist review) were calculated using a hybrid approach (machine learning and a rule-based expert system). A clinical pharmacist analyzed randomly selected prescription orders over a 2-week period to corroborate our findings. Predicted scores were compared with the pharmacist’s review using the area under the receiving-operating characteristic curve and area under the precision-recall curve. These metrics were compared with existing tools: computerized alerts generated by a clinical decision support (CDS) system and a literature-based multicriteria query prioritization technique. Data from 10 716 individual patients (133 179 prescription orders) were used to train the algorithm on the basis of 25 features in a development dataset. Results While the pharmacist analyzed 412 individual patients (3364 prescription orders) in an independent validation dataset, the areas under the receiving-operating characteristic and precision-recall curves of our digital system were 0.81 and 0.75, respectively, thus demonstrating greater accuracy than the CDS system (0.65 and 0.56, respectively) and multicriteria query techniques (0.68 and 0.56, respectively). Discussion Our innovative digital tool was notably more accurate than existing techniques (CDS system and multicriteria query) at intercepting potential prescription errors. Conclusions By primarily targeting high-risk patients, this novel hybrid decision support system improved the accuracy and reliability of prescription checks in a hospital setting.
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Affiliation(s)
- Jennifer Corny
- Pharmacy Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Asok Rajkumar
- Pharmacy Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Xavier Dode
- Centre National Hospitalier d'Information sur le Médicament, Paris, France.,Pharmacy Department, Hospices Civils de Lyon University Hospital, Lyon, France
| | | | - Olivier Billuart
- Medical Information Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Yvonnick Bézie
- Pharmacy Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Anne Buronfosse
- Medical Information Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
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199
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Wagner LA, Fink JC. Digital Solutions to Improve Medication Safety in CKD. Clin J Am Soc Nephrol 2021; 16:499-501. [PMID: 33737322 PMCID: PMC8092064 DOI: 10.2215/cjn.01680221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Lee-Ann Wagner
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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200
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Khasawneh EA, Gosling CM, Williams BA. Ten-Year Comparison of Medication Complications Rates in Public and Private Hospitals in Victoria, Australia. Hosp Top 2021; 99:37-43. [PMID: 33793391 DOI: 10.1080/00185868.2020.1828011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Medication errors occur as a result of failure in the treatment process at any point in the healthcare system. This is a retrospective study aimed at determining the rates of medication-related errors over a 10-year period in hospitals in Victoria, Australia. From 2009 to 2019, the overall rate for adverse drug events, accidental poisoning and undetermined intent were 86.15, 1.3 and 0.17 per 10,000 hospital separations, respectively. Medication complications occurred more in public hospitals. Adverse drug events account for less than 1% of all hospital separations. Medication errors contributing factors should be investigated in out of hospital environment.
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Affiliation(s)
- Eihab A Khasawneh
- Department of Paramedicine, Monash University, Victoria, Australia.,Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Brett A Williams
- Department of Paramedicine, Monash University, Victoria, Australia
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