Perception of reporting medication errors including near-misses among Korean hospital pharmacists

Exploring the Use of Persuasive System Design Principles to Enhance Medication Incident Reporting and Learning Systems: Scoping Reviews and Persuasive Design Assessment

BACKGROUND

Medication incidents (MIs) causing harm to patients have far-reaching consequences for patients, pharmacists, public health, business practice, and governance policy. Medication Incident Reporting and Learning Systems (MIRLS) have been implemented to mitigate such incidents and promote continuous quality improvement in community pharmacies in Canada. They aim to collect and analyze MIs for the implementation of incident preventive strategies to increase safety in community pharmacy practice. However, this goal remains inhibited owing to the persistent barriers that pharmacies face when using these systems.

OBJECTIVE

This study aims to investigate the harms caused by medication incidents and technological barriers to reporting and identify opportunities to incorporate persuasive design strategies in MIRLS to motivate reporting.

METHODS

We conducted 2 scoping reviews to provide insights on the relationship between medication errors and patient harm and the information system-based barriers militating against reporting. Seven databases were searched in each scoping review, including PubMed, Public Health Database, ProQuest, Scopus, ACM Library, Global Health, and Google Scholar. Next, we analyzed one of the most widely used MIRLS in Canada using the Persuasive System Design (PSD) taxonomy-a framework for analyzing, designing, and evaluating persuasive systems. This framework applies behavioral theories from social psychology in the design of technology-based systems to motivate behavior change. Independent assessors familiar with MIRLS reported the degree of persuasion built into the system using the 4 categories of PSD strategies: primary task, dialogue, social, and credibility support.

RESULTS

Overall, 17 articles were included in the first scoping review, and 1 article was included in the second scoping review. In the first review, significant or serious harm was the most frequent harm (11/17, 65%), followed by death or fatal harm (7/17, 41%). In the second review, the authors found that iterative design could improve the usability of an MIRLS; however, data security and validation of reports remained an issue to be addressed. Regarding the MIRLS that we assessed, participants considered most of the primary task, dialogue, and credibility support strategies in the PSD taxonomy as important and useful; however, they were not comfortable with some of the social strategies such as cooperation. We found that the assessed system supported a number of persuasive strategies from the PSD taxonomy; however, we identified additional strategies such as tunneling, simulation, suggestion, praise, reward, reminder, authority, and verifiability that could further enhance the perceived persuasiveness and value of the system.

CONCLUSIONS

MIRLS, equipped with persuasive features, can become powerful motivational tools to promote safer medication practices in community pharmacies. They have the potential to highlight the value of MI reporting and increase the readiness of pharmacists to report incidents. The proposed persuasive design guidelines can help system developers and community pharmacy managers realize more effective MIRLS.

Knowledge, attitudes and practices of clinical pharmacists to medication error reporting in ministry of health and population hospitals in Egypt

Objective

This study aimed to assess the knowledge, attitudes and practices toward medication errors (MEs) reporting among pharmacists working in Ministry of Health and Population (MOHP) hospitals in Alexandria.

Methods

A cross-sectional study was conducted among all pharmacists who are responsible for reporting medication errors in the Egyptian online reporting system (NO HARMe).

Results

The majority of pharmacists received training on MEs reporting using the Egyptian online reporting system. Around half of the pharmacists knew the correct definition for medication errors. All respondents were aware of the presence of a MEs reporting system in Egypt. Clinical pharmacists’ attitudes towards MEs reporting was favorable with an overall mean score of 4.20 ± 0.73 in a score ranging from 1 (most unfavorable attitudes score) to 5 (most favorable score). Only 60.7% of the surveyed pharmacists used the system to report MEs. Antibiotics were the most frequent drug category reported and the prescribing stage was the stage in which pharmacists perceived the greatest volume of reports were made (89.3% and 71.4%, respectively). Lack of time was the most frequently identified barrier to reporting, followed by lack of feedback to the report submitted (73.2%, 54.5%, respectively). Inconsistent with the results of other studies, fear from legal consequences and being recognized as an incompetent provider was reported by only 12.5% and 11.6% of pharmacists, respectively.

Conclusion

The majority of pharmacists have good knowledge and favorable attitudes towards medication error reporting, however around two fifths do not report medication errors.

Patient Safety Competencies among Senior Students of Health Professions: An Iranian Evaluation Study

Introduction:

Patient safety refers to preventing and reducing adverse events that might harm the patient while providing care. Enhancing patient safety competence upon entering the clinical environment requires introducing and integrating it in health professions' education.

Aim:

This study aimed to investigate patient safety competence among senior health professions students.

Methods:

This study was conducted in 2020 using a cross-sectional study. In total, 390 senior health professions students of Isfahan University of Medical Sciences, Isfahan, Iran, including medicine, nursing, pharmacy, midwifery, surgical technologist (operating room technician), and anesthesia were selected through a stratified convenience method. Data were collected using the Health Professional Education in Patient Safety Survey – H-PEPSS from August to September 2020 and analyzed using descriptive and analytical statistics. All statistical computations were carried out using SPSS version 16. A significant level of 5% was considered (P <0.05).

Results:

The mean scores of patient safety in health professions education in the classroom and clinical setting were 0.51 and 0.47, respectively. Among Health Professional Education in Patient Safety Survey – H-PEPSS domains, the highest mean score was obtained in the effective communication domain (0.61 in the classroom and 0.57 in the clinical setting). In contrast, domains of working in teams with other health professions showed the lowest mean score (0.39 in the classroom and 0.38 in the clinical setting).

Conclusion:

Patient safety in health profession education, particularly working in teams with other health professions, is at a moderate level in the classroom and a weak level in the clinical setting. Regarding the importance of interprofessional collaboration in promoting patient safety, it is recommended that the health sciences curriculum in Iran be reviewed to motivate students for interprofessional collaboration and the perception of its significance in reducing health profession's errors.

A nationwide assessment of community pharmacists’ attitudes towards dispensing errors: A cross-sectional study

Objectives

Dispensing errors (DEs) are common causes of preventable harm to patients. Interestingly, very little is known about their prevalence and types in the community pharmacy setting in Lebanon due to the lack of an effective reporting system. Therefore, this study aims to explore the perceptions of community pharmacists about the types of these errors in Lebanon, the factors behind their occurrence, the reasons for underreporting, and the current practices for reducing them.

Methods

A cross-sectional survey was conducted through a self-administered questionnaire, using a scale of 0–4, distributed among a sample of community pharmacists in Lebanon.

Results

A total of 171 pharmacists responded to the survey, of whom 68% reported that DEs were common, and 52% believed that they were increasing. The main reported contributing factors to DEs were unreadable and incomplete prescriptions (≈3.0 ± 1.0 out of 5), workload, multitasking, interruptions, similarity in names of medications, and fatigue (≈2.5 ± 1.0). Moreover, the perceived strategies to limit the risks of DEs were collaboration with physicians, improving handwriting, double-checking, proper patient counselling, encouraging reporting, and issuance of guidelines (≈3.2 ± 1.0). Finally, the main reasons for underreporting DEs were the lack of obligation to report and the lack of reporting systems (59% and 56%, respectively).

Conclusions

DEs may be very prevalent in Lebanon because they are unmonitored by the authorities. Electronic prescription and fair reporting systems are highly recommended, along with follow-up studies.

Medication Errors in Secondary Care Hospitals in Kuwait: The Perspectives of Healthcare Professionals

Objectives: Medication errors (MEs) are the most common cause of adverse drug events (ADEs) and one of the most encountered patient safety issues in clinical settings. This study aimed to determine the types of MEs in secondary care hospitals in Kuwait and identify their causes. Also, it sought to determine the existing system of error reporting in Kuwait and identify reporting barriers from the perspectives of healthcare professionals (HCPs).

Material and Methods: A descriptive cross-sectional study was conducted using a pre-tested self-administered questionnaire. Full-time physicians, pharmacists, and nurses (aged 21 years and older) working in secondary care governmental hospitals in Kuwait were considered eligible to participate in the study. Descriptive statistics and the Statistical Package for Social Science Software (SPSS), version 27 were used to analyze the data.

Results: A total of 215 HCPs were approached and asked to take part in the study, of which 208 agreed, giving a response rate of 96.7%. Most HCPs (n = 129, 62.0%) reported that the most common type of ME is “prescribing error,” followed by “compliance error” (n = 83; 39.9%). Most HCPs thought that a high workload and lack of enough breaks (n = 128; 61.5%) were the most common causes of MEs, followed by miscommunication, either among medical staff or between staff and patients, which scored (n = 89; 42.8%) and (n = 82; 39.4%), respectively. In the past 12 months, 77.4% (n = 161) of HCPs reported that they did not fill out any ME incident reports. The lack of feedback (n = 65; 31.3%), as well as the length and complexity of the existing incident reporting forms (n = 63; 30.3%), were the major barriers against reporting any identified MEs.

Conclusions: MEs are common in secondary care hospitals in Kuwait and can be found at many stages of practice. HCPs suggested many strategies to help reduce MEs, including proper communication between HCPs; double-checking every step of the process before administering medications to patients; providing training to keep HCPs up to date on any new treatment guidelines, and computerizing the health system.

Knowledge and Attitude toward Medication Error among Pharmacists

Objective: This study aimed to evaluate knowledge and attitude toward medication error (ME) among pharmacists working in public health care institutions. Methods: A cross-sectional study was conducted among pharmacists working in public health care institutions. Respondents were randomly recruited from 5 hospitals and 25 primary healthcare clinics in the state of Pahang, Malaysia. A set of self-administered questionnaires was used to assess their knowledge and attitude, distributed as a web-based survey. Knowledge and attitude toward ME reporting were assessed using five-point Likert-scale. This study was conducted between May and July 2019. Results: A total of 186 respondents participated in the study. A majority of respondents were female (n = 144). About 90% of the respondents had good score on knowledge on ME. Only 25.4% of the respondents had favorable attitude toward ME reporting. Female pharmacists (P = .001), more experienced pharmacists (P = .012) and those working in primary health clinics (P = .014) were associated with more favorable attitude. Knowledge did not correlate well with attitude toward ME reporting (r = 0.08, P = .29). Conclusion: Despite having good knowledge on ME, the attitude toward ME reporting was still very poor among the pharmacists.

New Method of Path Optimization for Medical Logistics Robots

The path planning problem of logistics robots is mainly subjected to the time cost of the operation of the mathematical model. To save the time of refilling process in the fast medicine dispensing system (FMDS), the optimization procedure is divided into two steps in this study. First, a new mathematical model called the multiple steps traveling salesman problem model (MTSPM) is proposed to optimize the replenishment quantity of each picking and establish picking sets. Second, an improved ant colony optimization (IACO) algorithm is employed, considering the effects of velocity, acceleration, and deceleration in the refilling route during the development of the new model. Simulation results and operational results demonstrated that MTSPM-IACO was better than both the order picking model (OPM) and MTSPM-ACO in terms of saving refilling time. Compared to the OPM, the optimization of the refilling time of MTSPM-IACO was more than 1.73% in simulation and 15.26% in operation. Compared to MTSPM-ACO, the optimization of the refilling time of MTSPM-IACO was more than 0.13% in simulation and 1.67% in operation.

Common Barriers to Reporting Medical Errors

BACKGROUND

Medical errors are the third leading cause of death in the United States. Reporting of all medical errors is important to better understand the problem and to implement solutions based on root causes. Underreporting of medical errors is a common and a challenging obstacle in the fight for patient safety. The goal of this study is to review common barriers to reporting medical errors.

METHODS

We systematically reviewed the literature by searching the MEDLINE and SCOPUS databases for studies on barriers to reporting medical errors. The preferred reporting items for systematic reviews and meta-analyses guideline was followed in selecting eligible studies.

RESULTS

Thirty studies were included in the final review, 8 of which were from the United States. The majority of the studies used self-administered questionnaires (75%) to collect data. Nurses were the most studied providers (87%), followed by physicians (27%). Fear of consequences is the most reported barrier (63%), followed by lack of feedback (27%) and work climate/culture (27%). Barriers to reporting were highly variable between different centers.

Factors affecting nursing error communication in intensive care units: A qualitative study

BACKGROUND

Error communication includes both reporting errors to superiors and disclosing their consequences to patients and their families. It significantly contributes to error prevention and safety improvement. Yet, some errors in intensive care units are not communicated.

OBJECTIVES

The aim of the present study was to explore factors affecting error communication in intensive care units.

DESIGN AND PARTICIPANTS

This qualitative study was conducted in 2019. Participants were 17 critical care nurses purposively recruited from the intensive care units of 2 public hospitals affiliated to Iran University of Medical Sciences, Tehran, Iran. Data were collected through in-depth semi-structured interviews and were analyzed through the conventional content analysis method proposed by Graneheim and Lundman.

ETHICAL CONSIDERATIONS

The Ethics Committee of Iran University of Medical Sciences, Tehran, Iran approved the study (code: IR.IUMS. REC.1397.792). Participants were informed about the study aim and methods and were ensured of data confidentiality. They were free to withdraw from the study at will. Written informed consent was obtained from all of them.

FINDINGS

Factors affecting error communication in intensive care units fell into four main categories, namely the culture of error communication (subcategories were error communication organizational atmosphere, clarity of processes and guidelines, managerial support for nurses, and learning organization), the consequences of errors for nurses and nursing (subcategories were fear over being stigmatized as incompetent, fear over punishment, and fear over negative judgments about nursing), the consequences of errors for patients (subcategories were monitoring the effects of errors on patients and predicting the effects of errors on patients), and ethical and professional characteristics (subcategories were ethical characteristics and inter-professional relationships).

DISCUSSION

The results of this study show many factors affect error communication, some facilitate and some prohibit it. Organizational factors such as the culture of error communication and the consequences of error communication for the nurse and the patient, as well as individual and professional characteristics, including ethical characteristics and interprofessional relationship, influence this process.

CONCLUSION

Errors confront nurses with ethical challenges and make them assess error consequences and then, communicate or hide them based on the results of their assessments. Health authorities can promote nurses' error communication through creating a supportive environment for them, developing clear error communication processes and guidelines, and providing them with education about the principles of ethical practice.

A drug identification model developed using deep learning technologies: experience of a medical center in Taiwan

BACKGROUND

Issuing of correct prescriptions is a foundation of patient safety. Medication errors represent one of the most important problems in health care, with 'look-alike and sound-alike' (LASA) being the lead error. Existing solutions to prevent LASA still have their limitations. Deep learning techniques have revolutionized identification classifiers in many fields. In search of better image-based solutions for blister package identification problem, this study using a baseline deep learning drug identification (DLDI) aims to understand how identification confusion of look-alike images by human occurs through the cognitive counterpart of deep learning solutions and thereof to suggest further solutions to approach them.

METHODS

We collected images of 250 types of blister-packaged drug from the Out-Patient Department (OPD) of a medical center for identification. The deep learning framework of You Only Look Once (YOLO) was adopted for implementation of the proposed deep learning. The commonly-used F1 score, defined by precision and recall for large numbers of identification tests, was used as the performance criterion. This study trained and compared the proposed models based on images of either the front-side or back-side of blister-packaged drugs.

RESULTS

Our results showed that the total training time for the front-side model and back-side model was 5 h 34 min and 7 h 42 min, respectively. The F1 score of the back-side model (95.99%) was better than that of the front-side model (93.72%).

CONCLUSIONS

In conclusion, this study constructed a deep learning-based model for blister-packaged drug identification, with an accuracy greater than 90%. This model outperformed identification using conventional computer vision solutions, and could assist pharmacists in identifying drugs while preventing medication errors caused by look-alike blister packages. By integration into existing prescription systems in hospitals, the results of this study indicated that using this model, drugs dispensed could be verified in order to achieve automated prescription and dispensing.

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.