Use of a handheld computer application for voluntary medication event reporting by inpatient nurses and physicians

Medication Error Reporting: Underreporting and Acceptability of Smartphone Application for Reporting among Health Care Professionals in Perak, Malaysia

Background and objectives In Malaysia, the national voluntary non-punitive Medication Error Reporting System (MER-S) has been available since 2009, with compiled reports indicating the underreporting of various medication errors (ME). This survey intends to determine the ME reporting practice among healthcare professionals and the acceptance of ME reporting by utilising smartphone application if it is available. Design A cross-sectional survey was conducted for two months in 2017 among doctors and pharmacists in publicly funded healthcare facilities in Perak, Malaysia. The survey was distributed through various professional WhatsApp chat groups, and reminders were sent twice to the respondents. Results A total of 334 doctors and pharmacists responded to the survey; the majority were pharmacists (61.7%) with a median age (in years) of 32 (interquartile range (IQR) 29-36) and work experience (in years) of 7.5 years (IQR 5-11). The rate of respondents being aware of the MER-S and having encountered ME at the workplace was high, at 73.4% and 96.1%, respectively. However, only 44.8% reported using the system. The reason hindering them from reporting ME was primarily being in a busy and hectic work environment. Pharmacists were more likely to report ME compared to doctors (adjusted odds ratio (adj OR) 10.51; 95% Confidence interval (CI): 5.34, 20.6), especially pharmacists who had frequent encounters with ME at work (adj OR 2.84; 95% CI: 1.70, 4.81) and who perceived that ME can be handled well (adj OR 3.52; 95% CI: 1.93, 6.44). They were more likely to report ME. A majority (90.7%) had downloaded one or more digital medical applications to aid their work. The speed of Internet connectivity at the workplace was rated as "fast" or "good" among 136 (40.7%) respondents but among 130 (38.9%), it was "average." The percentage of doctors and pharmacists that would report ME by utilising a smartphone application was 86.5% if one is available, and they preferred an application with a user-friendly interface, anonymity, and limited data-entry requirements. Conclusion Doctors and pharmacists were aware of MER-S and willing to report when they encountered ME. However, less than half of the respondents had used the system. With the primary concern of ME underreporting in a busy and hectic work environment, an alternative smartphone ME reporting application can be developed to complement the current MER-S considering that the respondents had positive responses to this method.

Medication errors reported to the National Medication Error Reporting System in Malaysia: a 4-year retrospective review (2009 to 2012)

PURPOSE

Reporting and analysing the data on medication errors (MEs) is important and contributes to a better understanding of the error-prone environment. This study aims to examine the characteristics of errors submitted to the National Medication Error Reporting System (MERS) in Malaysia.

METHODS

A retrospective review of reports received from 1 January 2009 to 31 December 2012 was undertaken. Descriptive statistics method was applied.

RESULTS

A total of 17,357 MEs reported were reviewed. The majority of errors were from public-funded hospitals. Near misses were classified in 86.3 % of the errors. The majority of errors (98.1 %) had no harmful effects on the patients. Prescribing contributed to more than three-quarters of the overall errors (76.1 %). Pharmacists detected and reported the majority of errors (92.1 %). Cases of erroneous dosage or strength of medicine (30.75 %) were the leading type of error, whilst cardiovascular (25.4 %) was the most common category of drug found.

CONCLUSIONS

MERS provides rich information on the characteristics of reported MEs. Low contribution to reporting from healthcare facilities other than government hospitals and non-pharmacists requires further investigation. Thus, a feasible approach to promote MERS among healthcare providers in both public and private sectors needs to be formulated and strengthened. Preventive measures to minimise MEs should be directed to improve prescribing competency among the fallible prescribers identified.

INTRAVENOUS MEDICATION ADMINISTRATION ERRORS AND THEIR CAUSES IN CARDIAC CRITICAL CARE UNITS IN IRAN

Background and Objectives:

The dangerous events caused by medication errors are one of the main challenges faced in critical care units. The present study was conducted to determine the frequency of intravenous medication administration errors and their causes in cardiac critical care units in Iran.

Materials and Methods:

The present descriptive study was conducted in the critical care units (CCUs and cardiac surgery intensive care units) of 12 teaching hospitals. Of the total of 240 nurses working in these departments, 190 participated in the present study. The data collection tools used in this study included the “nurses’ demographic data questionnaire”, the “patients’ medical and demographic data questionnaire” and the “nurses’ self-reporting questionnaire about the frequency of intravenous medication administration errors and their causes”. The data obtained were analyzed in SPSS-20 using descriptive statistics such as the absolute and relative frequency.

Findings:

During the 2 months in which this study was being conducted, 2542 patients were admitted to these departments and 20240 doses of intravenous medications were administered to these patients. The nurses reported 262 intravenous medication administration errors. The most common intravenous medication error pertained to administering the wrong medication (n=71 and 27.1%). As for the causes of intravenous medication administration errors, 51.5% of the errors were associated with work conditions, 24% with packaging, 13.4% with communication, 9.9% with transcription and 1.2% with pharmacies.

Discussion and Conclusion:

According to the results, strategies are recommended to be adopted for reducing or limiting medication errors, such as building a stronger pharmacology knowledge base in nurses and nursing students, improving work conditions and improving communication between the nurses and physicians.

A real-time assessment of factors influencing medication events

Reducing medical error is critical to improving the safety and quality of healthcare. Physician stress, fatigue, and excessive workload are performance-shaping factors (PSFs) that may influence medical events (actual administration errors and near misses), but direct relationships between these factors and patient safety have not been clearly defined. This study assessed the real-time influence of emotional stress, workload, and sleep deprivation on self-reported medication events by physicians in academic hospitals. During an 18-month study period, 185 physician participants working at four university-affiliated teaching hospitals reported medication events using a confidential reporting application on handheld computers. Emotional stress scores, perceived workload, patient case volume, clinical experience, total sleep, and demographic variables were also captured via the handheld computers. Medication event reports (n = 11) were then correlated with these demographic and PSFs. Medication events were associated with 36.1% higher perceived workload (p < .05), 38.6% higher inpatient caseloads (p < .01), and 55.9% higher emotional stress scores (p < .01). There was a trend for reported events to also be associated with less sleep (p = .10). These results confirm the effect of factors influencing medication events, and support attention to both provider and hospital environmental characteristics for improving patient safety.

Medication incident reporting in residential aged care facilities: limitations and risks to residents' safety

BACKGROUND

Medication incident reporting (MIR) is a key safety critical care process in residential aged care facilities (RACFs). Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents' safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs' devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs.

METHODS

The study was undertaken in three RACFs (part of a large non-profit organisation) in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach.

RESULTS

The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a) design MIR artefacts that facilitate identification of the root causes of medication incidents, b) integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c) support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs.

CONCLUSIONS

This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.

Physician reporting of clinically significant events through a computerized patient sign-out system

OBJECTIVES

: Although electronic reporting systems for near-misses and adverse events have been implemented nationwide, physician participation in such systems has typically been very limited. Previous efforts to improve such rates have met with some success but may be costly and time-consuming. To improve events reporting rates at our academic medical center, we incorporated a physician reporting module into the computer software that house officers already use for their daily sign-out routine.

METHODS

: During the period between January 1 and June 30, 2009, house staff were asked to report a set of 13 predefined "clinically significant events" such as cardiopulmonary arrests and unexpected transfers to the intensive care unit. Entries were maintained in an administrative data collection module and were reviewed daily by the residency program director and chief residents.

RESULTS

: House staff reported approximately 12 incidents per month. A survey of the intern class (the heaviest users of system) showed that the principal barriers to physician reporting at our facility were related to ease of use, time pressure, and fear of disciplinary actions. Information gleaned from the reports has been useful in modifying a number of patient care processes on the medicine service.

CONCLUSIONS

: Our experience suggests that if a training program makes it easy for the house officer to report events during routine work duties, by integrating the reporting system into the tools of daily patient care, physicians will become willing participants in the process. A handheld version of such a reporting system holds promise for even greater physician participation in the future.

A novel approach to increase residents' involvement in reporting adverse events

PURPOSE

In the wake of the Patient Safety and Quality Improvement Act of 2005, national attention has increasingly focused on adverse-event reporting as a means of identifying systems changes to improve patient safety. However, physicians and residents have demonstrated meager involvement in this effort.

METHOD

In 2008-2009, the authors measured participation in adverse-event reporting by 680 residents at Oregon Health & Science University before and after implementing a quality improvement initiative, which consisted of a financial incentive and multifaceted educational campaign. The primary measure of success was an increase in the average monthly adverse-event reports submitted by residents to greater than 5% of the institution's overall report submissions.

RESULTS

The average number of adverse events reported by residents increased from 1.6% to 9.0% of the institution's overall event reports, representing a 5.6-fold increase during the initiative (P < .001). The relative percentage of resident-submitted reports defined as "near-misses" increased from 6% to 27% during the initiative (P < .001).

CONCLUSIONS

The novel approach of integrating a retirement benefit and educational campaign to increase residents' involvement in adverse-event reporting was successful. In addition to increasing residents' contributions to adverse-event reporting to levels higher than any documented in the current literature, there was also a remarkable increase in the relative frequency of near-miss reporting by residents.

Development and performance usability testing of a theory-based, computerized, tailored intervention

Technology offers innovative and promising methods of delivering health messages to provide knowledge and potentially facilitate improved health behaviors. Theory was foundational to the development of a new intervention using a tailored Web site and a handheld computer. A performance usability study was conducted to determine if women could use this newly developed intervention delivered via a Web site and pocket computer accurately and in a timely manner in real-world settings. A convenience sample of 15 women between 35 and 55 years of age were observed as they used "Complete a Task" and "Talk Aloud" performance usability methods. Results identified several problems affecting the ability of participants to use the Web site and handheld computer.

Development of a hand-held computer platform for real-time behavioral assessment of physicians and nurses

We developed a hand-held data collection tool to facilitate real-time collection of data on the factors that affect hospital staff performance. To assure high-yield of data from busy clinicians, the design objectives included low response burden, the ability to collect complex real-time data in dynamic work environments, and automated data integration. Iterative user-centered design of custom interfaces resulted in a dynamic intuitive platform where branching logic was applied to present a series of survey questions dependent on the participant's responses. Over a 12-month period, 304 inpatient physicians and nurses completed (with minimal initial training) a total of 11,381 survey responses. For randomly timed repeated survey prompts, complete (73%) or partial (12%) responses were obtained in a median time of 96s.