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Fathelrahman AI, Almalki HA, Bajunaid HR, Al-Harthi GK, Aljuaid MO, Majrashi RY, Alsuwat MA. Assessing the Presence of the Joint Commission International Accreditation Requirements in Western Saudi Arabia Hospital Pharmacies: A Cross-sectional Study. J Res Pharm Pract 2023; 12:1-8. [PMID: 38213607 PMCID: PMC10779688 DOI: 10.4103/jrpp.jrpp_5_23] [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: 10/13/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2024] Open
Abstract
Objective The Central Board of Accreditation for Healthcare Institutions (CBAHI) the national Saudi accreditation body accredited most hospitals in Saudi Arabia whereas, the Joint Commission International (JCI) a well-known international accreditation body accredited some hospitals. We assessed Western Saudi Arabia hospital pharmacists' knowledge, opinions, and observations about pharmacy-related JCI accreditation criteria needed for hospitals. Methods This was a cross-sectional survey-based study conducted among pharmacy personnel working in the Ministry of Health (MOH), Military, and private hospitals in the Makkah region in western Saudi Arabia. The present report represents the findings of descriptive and comparative analyses. Comparative analyses were tested by Student's t-test, analysis of variance, and Chi-square when applicable and a P ≤ 0.05 was considered statistically significant. Findings One hundred and one pharmacists completed the survey; most of them were from Taif (53.5%) and Jeddah (37.6%) and fewer from Makkah (8.9%). The highest proportions were from MOH (55.4%), private (29.7%), and some from military (14.9%) hospitals. They worked mostly in hospitals accredited with CBAHI (93.1%) than JCI (58.4%) and only (41.6%) worked with quality units. Correct answers on knowledge items ranged from 14.9% to 65.3%. On five-point Likert Scale, they showed supportive ratings on how they perceived the importance of JCI statement provided (overall average score: 3.78) and on how statement criteria are implemented in their hospitals (overall average score: 3.76). Higher proportions of those working in quality units compared to their counterparts were aware that accreditation cycles for JCI and CBAHI are identical (66.7% vs. 55.9%, P = 0.009) and that JCI criteria are more concise than CBAHI (59.5% vs. 52.5%, P = 0.007). Higher proportions of those working in JCI-accredited hospitals compared to their counterparts were aware that JCI criteria are clearer than CBAHI (55.9% vs. 33.3%, P = 0.021) and that JCI criteria are more concise than CBAHI (61% vs. 47.6%, P = 0.012). Conclusion To a high extent, pharmacists were supportive of JCI criteria and considered the criteria to be implemented in their hospitals. There is a room for improvement to enhance awareness and support of JCI quality criteria among pharmacists.
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Araujo CAS, Siqueira MM, Malik AM. Hospital accreditation impact on healthcare quality dimensions: a systematic review. Int J Qual Health Care 2021; 32:531-544. [PMID: 32780858 DOI: 10.1093/intqhc/mzaa090] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 05/06/2020] [Revised: 07/06/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To systematically review the impact of hospital accreditation on healthcare quality indicators, as classified into seven healthcare quality dimensions. DATA SOURCE We searched eight databases in June 2020: EBSCO, PubMed, Web of Science, Emerald, ProQuest, Science Direct, Scopus and Virtual Health Library. Search terms were conceptualized into three groups: hospitals, accreditation and terms relating to healthcare quality. The eligibility criteria included academic articles that applied quantitative methods to examine the impact of hospital accreditation on healthcare quality indicators. STUDY SELECTION We applied the PICO framework to select the articles according to the following criteria: Population-all types of hospitals; Intervention-hospital accreditation; Comparison-quantitative method applied to compare accredited vs. nonaccredited hospitals, or hospitals before vs. after accreditation; Outcomes-regarding the seven healthcare quality dimensions. After a critical appraisal of the 943 citations initially retrieved, 36 studies were included in this review. RESULTS OF DATA SYNTHESIS Overall results suggest that accreditation may have a positive impact on efficiency, safety, effectiveness, timeliness and patient-centeredness. In turn, only one study analyzes the impact on access, and no study has investigated the impact on equity dimension yet. CONCLUSION Mainly due to the methodological shortcomings, the positive impact of accreditation on healthcare dimensions should be interpreted with caution. This study provides an up-to-date overview of the main themes examined in the literature, highlighting critical knowledge-gaps and methodological flaws. The findings may provide value to healthcare stakeholders in terms of improving their ability to assess the relevance of accreditation processes.
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Affiliation(s)
- Claudia A S Araujo
- COPPEAD Graduate School of Business, Federal University of Rio de Janeiro-RJ, Rio de Janeir, Brazil.,Fundação Getulio Vargas's Sao Paulo School of Business Administration-FGV/EAESP, São Paulo-SP, Rio de Janeir, Brazil
| | - Marina Martins Siqueira
- COPPEAD Graduate School of Business, Federal University of Rio de Janeiro-RJ, Rio de Janeir, Brazil
| | - Ana Maria Malik
- Fundação Getulio Vargas's Sao Paulo School of Business Administration-FGV/EAESP, São Paulo-SP, Rio de Janeir, Brazil
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Koeck JA, Young NJ, Kontny U, Orlikowsky T, Bassler D, Eisert A. Interventions to Reduce Pediatric Prescribing Errors in Professional Healthcare Settings: A Systematic Review of the Last Decade. Paediatr Drugs 2021; 23:223-40. [PMID: 33959936 DOI: 10.1007/s40272-021-00450-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pediatric medication therapy is prone to errors due to the need for pharmacokinetic and pharmacodynamic individualization and the diverse settings in which pediatric patients are treated. Prescribing errors have been reported as the most common medication error. OBJECTIVES The aim of this review was to systematically identify interventions to reduce prescribing errors and corresponding patient harm in pediatric healthcare settings and to evaluate their impact. METHODS Four databases were systematically screened (time range November 2011 to December 2019), and experimental studies were included. Interventions to reduce prescribing errors were extracted and classified according to a 'hierarchy of controls' model. RESULTS Forty-five studies were included, and 70 individual interventions were identified. A bundle of interventions was more likely to reduce prescribing errors than a single intervention. Interventions classified as 'substitution or engineering controls' were more likely to reduce errors in comparison with 'administrative controls', as is expected from the hierarchy of controls model. Fourteen interventions were classified as substitution or engineering controls, including computerized physician order entry (CPOE) and clinical decision support (CDS) systems. Administrative controls, including education, expert consultations, and guidelines, were more commonly identified than higher level controls, although they may be less likely to reduce errors. Of the administrative controls, expert consultations were most likely to reduce errors. CONCLUSIONS Interventions to reduce pediatric prescribing errors are more likely to be successful when implemented as part of a bundle of interventions. Interventions including CPOE and CDS that substitute risks or provide engineering controls should be prioritized and implemented with appropriate administrative controls including expert consultation.
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Koeck JA, Young NJ, Kontny U, Orlikowsky T, Bassler D, Eisert A. Interventions to Reduce Medication Dispensing, Administration, and Monitoring Errors in Pediatric Professional Healthcare Settings: A Systematic Review. Front Pediatr 2021; 9:633064. [PMID: 34123962 PMCID: PMC8187621 DOI: 10.3389/fped.2021.633064] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Pediatric patients cared for in professional healthcare settings are at high risk of medication errors. Interventions to improve patient safety often focus on prescribing; however, the subsequent stages in the medication use process (dispensing, drug administration, and monitoring) are also error-prone. This systematic review aims to identify and analyze interventions to reduce dispensing, drug administration, and monitoring errors in professional pediatric healthcare settings. Methods: Four databases were searched for experimental studies with separate control and intervention groups, published in English between 2011 and 2019. Interventions were classified for the first time in pediatric medication safety according to the "hierarchy of controls" model, which predicts that interventions at higher levels are more likely to bring about change. Higher-level interventions aim to reduce risks through elimination, substitution, or engineering controls. Examples of these include the introduction of smart pumps instead of standard pumps (a substitution control) and the introduction of mandatory barcode scanning for drug administration (an engineering control). Administrative controls such as guidelines, warning signs, and educational approaches are lower on the hierarchy and therefore predicted by this model to be less likely to be successful. Results: Twenty studies met the inclusion criteria, including 1 study of dispensing errors, 7 studies of drug administration errors, and 12 studies targeting multiple steps of the medication use process. A total of 44 interventions were identified. Eleven of these were considered higher-level controls (four substitution and seven engineering controls). The majority of interventions (n = 33) were considered "administrative controls" indicating a potential reliance on these measures. Studies that implemented higher-level controls were observed to be more likely to reduce errors, confirming that the hierarchy of controls model may be useful in this setting. Heterogeneous study methods, definitions, and outcome measures meant that a meta-analysis was not appropriate. Conclusions: When designing interventions to reduce pediatric dispensing, drug administration, and monitoring errors, the hierarchy of controls model should be considered, with a focus placed on the introduction of higher-level controls, which may be more likely to reduce errors than the administrative controls often seen in practice. Trial Registration Prospero Identifier: CRD42016047127.
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Affiliation(s)
- Joachim A Koeck
- Hospital Pharmacy, Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany
| | - Nicola J Young
- Hospital Pharmacy, Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany
| | - Udo Kontny
- Section of Pediatric Hematology, Department of Pediatric and Adolescent Medicine, Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany
| | - Thorsten Orlikowsky
- Section of Neonatology, Department of Pediatric and Adolescent Medicine, Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Albrecht Eisert
- Hospital Pharmacy, Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany.,Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
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Poremski D, Lim ISH, Wei X, Fang T. The Perspective of Key Stakeholders on the Impact of Reaccreditation in a Large National Mental Health Institute. Jt Comm J Qual Patient Saf 2020; 46:699-705. [PMID: 33127333 DOI: 10.1016/j.jcjq.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Obtaining and maintaining accreditation is an important component of high-quality mental health care services. However, research is lacking, and explanations for quantitative observations surrounding the sustainability of improvements are unfounded in qualitative data. The aim of this study was to explore how accreditation, specifically that provided by Joint Commission International, affects service quality at the Institute of Mental Health in Singapore to advance our understanding of its effects and the durability of improvements. METHODS Researchers conducted 21 qualitative semistructured interviews with key informants to understand how obtaining reaccreditation was affecting the institute. The data were analyzed thematically to produce an understanding of the various ways in which accreditation improved care quality. RESULTS Accreditation contributed to the improvement of care via several mechanisms. Although participants universally endorsed the positive impact of accreditation on safety, it was harder to pinpoint specific outcomes that improved because of it. Accreditation, however, had unintended consequences: Unnecessary processes arising from overinterpretation of standards led to several staff behaviors that might ultimately compromise the sustainability of new processes. CONCLUSION Although accreditation drives improvement via clear mechanisms, policy makers must be aware of unintended consequences. Organizations struggling with accreditation must clearly communicate the rationale for the implementation of new processes linked to reaccreditation. With a clear purpose, changes may be more sustainable.
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Gates PJ, Baysari MT, Gazarian M, Raban MZ, Meyerson S, Westbrook JI. Prevalence of Medication Errors Among Paediatric Inpatients: Systematic Review and Meta-Analysis. Drug Saf 2020; 42:1329-1342. [PMID: 31290127 DOI: 10.1007/s40264-019-00850-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The risk of medication errors is high in paediatric inpatient settings. However, estimates of the prevalence of medication errors have not accounted for heterogeneity across studies in error identification methods and definitions, nor contextual differences across wards and the use of electronic or paper medication charts. OBJECTIVE Our aim was to conduct a systematic review and meta-analysis to provide separate estimates of the prevalence of medication errors among paediatric inpatients, depending on hospital ward and the use of electronic or paper medication charts, that address differences in error identification methods and definitions. METHODS We systematically searched five databases to identify studies published between January 2000 and December 2018 that assessed medication error rates by medication chart audit, direct observation or a combination of methods. RESULTS We identified 71 studies, 19 involved paediatric wards using electronic charts. Most studies assessed prescribing errors with few studies assessing administration errors. Estimates varied by ward type. Studies of paediatric wards using electronic charts generally reported a reduced error prevalence compared to those using paper, although there were some inconsistencies. Error detection methods impacted the rate of administration errors in studies of multiple wards, however, no other difference was found. Definition of medication error did not have a consistent impact on reported error rates. CONCLUSIONS Medication errors are a frequent occurrence in paediatric inpatient settings, particularly in intensive care wards and emergency departments. Hospitals using electronic charts tended to have a lower rate of medication errors compared to those using paper charts. Future research employing controlled designs is needed to determine the true impact of electronic charts and other interventions on medication errors and associated harm among hospitalized children.
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Affiliation(s)
- Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia.
| | - Melissa T Baysari
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Madlen Gazarian
- School of Medical Sciences, Faculty of Medicine, University of NSW Sydney, Sydney, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Sophie Meyerson
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
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Gates PJ, Meyerson SA, Baysari MT, Westbrook JI. The Prevalence of Dose Errors Among Paediatric Patients in Hospital Wards with and without Health Information Technology: A Systematic Review and Meta-Analysis. Drug Saf 2019; 42:13-25. [PMID: 30117051 DOI: 10.1007/s40264-018-0715-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The risk of dose errors is high in paediatric inpatient settings. Computerized provider order entry (CPOE) systems with clinical decision support (CDS) may assist in reducing the risk of dosing errors. Although a frequent type of medication error, the prevalence of dose errors is not well described. Dosing error rates in hospitals with or without CPOE have not been compared. OBJECTIVE Our aim was to conduct a systematic review assessing the prevalence and impact of dose errors in paediatric wards with and without CPOE and/or CDS. METHODS We systematically searched five databases to identify studies published between January 2000 and December 2017 that assessed dose error rates by medication chart audit or direct observation. RESULTS We identified 39 studies, nine of which involved paediatric wards using CPOE with or without CDS. Studies of paediatric wards using paper medication charts reported approximately 8-25% of patients experiencing a dose error, and approximately 2-6% of medication orders and approximately 3-8% of dose administrations contained a dose error, with estimates varying by ward type. The nine studies of paediatric wards using CPOE reported approximately 22% of patients experiencing a dose error, and approximately 1-6% of medication orders and approximately 3-8% of dose administrations contained a dose error. Few studies provided data for individual wards. The severity and prevalence of harm associated with dose errors was rarely assessed and showed inconsistent results. CONCLUSIONS Dose errors occur in approximately 1 in 20 medication orders. Hospitals using CPOE with or without CDS had a lower rate of dose errors compared with those using paper charts. However, few pre/post studies have been conducted and none reported a significant reduction in dose error rates associated with the introduction of CPOE. Future research employing controlled designs is needed to determine the true impact of CPOE on dosing errors among children, and any associated patient harm.
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Affiliation(s)
- Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia.
| | - Sophie A Meyerson
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Melissa T Baysari
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
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Dombrádi V, Margitai B, Dózsa C, Bárdos-Csenteri OK, Sándor J, Gáll T, Gődény S. Investigation of the conditions affecting the joining of Hungarian hospitals to an accreditation programme: a cross-sectional study. BMJ Open 2018; 8:e019232. [PMID: 29391381 PMCID: PMC5829870 DOI: 10.1136/bmjopen-2017-019232] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Quantitative studies have shown the various benefits for having accreditation in hospitals. However, neither of these explored the general conditions before applying for an accreditation. To close this gap, this study aimed to investigate the possible association between joining an accreditation programme with various hospital characteristics. DESIGN A cross-sectional study was implemented using the databases of the 2013 Hungarian hospital survey and of the Hungarian State Treasury. SETTING Public general hospitals in Hungary. PARTICIPANTS The analysis involved 44 public general hospitals, 14 of which joined the preparatory project for a newly developed accreditation programme. MAIN OUTCOME MEASURES The outcomes included the percentage of compliance in quality management, patient information and identification, internal professional regulation, safe surgery, pressure sore prevention, infection control, the opinions of the heads of quality management regarding the usefulness of quality management and clinical audits, and finally, the total debt of the hospital per bed and per discharged patient. RESULTS According to our findings, the general hospitals joining the preparatory project of the accreditation programme performed better in four of the six investigated activities, the head of quality management had a better opinion on the usefulness of quality management, and both the debt per bed number and the debt per discharged patient were lower than those who did not join. However, no statistically significant differences between the two groups were found in any of the examined outcomes. CONCLUSIONS The findings suggest that hospitals applying for an accreditation programme do not differ significantly in characteristics from those which did not apply. This means that if in the future the accredited hospitals become better than other hospitals, then the improvement could be solely contributed to the accreditation.
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Affiliation(s)
- Viktor Dombrádi
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Barnabás Margitai
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Csaba Dózsa
- Institute of Theoretical Health Sciences, Faculty of Health Care, University of Miskolc, Miskolc, Hungary
| | | | - János Sándor
- Division of Biostatistics and Epidemiology, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Tibor Gáll
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Sándor Gődény
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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