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Fan M, Yang D, Ng B, Jackson J, Bouris K, Eng S, Rolko E, Trbovich P. Impact of technology-assisted versus manual sterile compounding on safety and efficiency in a Canadian community hospital. Am J Health Syst Pharm 2022; 79:1685-1696. [PMID: 35700925 PMCID: PMC9494253 DOI: 10.1093/ajhp/zxac167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Interventions to improve the safety and efficiency of manual sterile compounding are needed. This study evaluated the impact of a technology-assisted workflow system (TAWS) on sterile compounding safety (checks, traceability, and error detection), and efficiency (task time). Methods Observations were conducted in an oncology pharmacy transitioning from a manual to a TAWS process for sterile compounding. Process maps were generated to compare manual and TAWS checks and traceability. The numbers and types of errors detected were collected, and task times were observed directly or via TAWS data logs. Results Analysis of safety outcomes showed that, depending on preparation type, 3 to 4 product checks occurred in the manual process, compared to 6 to 10 checks with TAWS use. TAWS checks (barcoding and gravimetric verification) produced better traceability (documentation). The rate of incorrect-drug errors decreased with technology-assisted compounding (from 0.4% [5 of 1,350 preparations] with the manual process to 0% [0 of 1,565 preparations] with TAWS use; P < 0.02). The TAWS increased detection of (1) errors in the amount of drug withdrawn from vials (manual vs TAWS, 0.4% [5/1,350] vs 1.2% [18/1565]; P < 0.02), and (2) errors in the amount of drug injected into the final container (manual vs TAWS, 0% [0/1,236] vs 0.9% [11/1,272]; P < 0.002). With regard to efficiency outcomes, TAWS use increased the mean mixing time (manual vs TAWS, 275 seconds vs 355 seconds; P < 0.001), had no significant impact on average visual checking time (manual vs TAWS, 21.4 seconds vs 21.6 seconds), and decreased average physical checking time (manual vs TAWS, 58.6 seconds vs 50.9 seconds; P < 0.001). Conclusion In comparison to manual sterile compounding, use of the TAWS improved safety through more frequent and rigorous checks, improved traceability (via superior documentation), and enhanced error detection. Results related to efficiency were mixed.
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Affiliation(s)
- Mark Fan
- Research and Innovation, North York General Hospital, Toronto, ON, Canada
| | - Danny Yang
- Research and Innovation, North York General Hospital, Toronto, ON, Canada
| | - Becky Ng
- Research and Innovation, North York General Hospital, Toronto, ON, Canada
| | | | | | - Sharon Eng
- Pharmacy, North York General Hospital, Toronto, ON, Canada
| | - Edith Rolko
- Pharmacy, North York General Hospital, Toronto, ON, Canada
| | - Patricia Trbovich
- Research and Innovation, North York General Hospital, Toronto, ON.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Machen S. Governing patient safety in field hospitals: lessons for the future. BMJ Open Qual 2021; 10:bmjoq-2021-001541. [PMID: 34315775 PMCID: PMC8317068 DOI: 10.1136/bmjoq-2021-001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/19/2021] [Indexed: 11/04/2022] Open
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Weingart SN, Zhang L, Sweeney M, Hassett M. Chemotherapy medication errors. Lancet Oncol 2019; 19:e191-e199. [PMID: 29611527 DOI: 10.1016/s1470-2045(18)30094-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 11/26/2022]
Abstract
Although chemotherapy is a well established treatment modality, chemotherapy errors represent a potentially serious risk of patient harm. We reviewed published research from 1980 to 2017 to understand the extent and nature of medication errors in cancer chemotherapy, and to identify effective interventions to help prevent mistakes. Chemotherapy errors occur at a rate of about one to four per 1000 orders, affect at least 1-3% of adult and paediatric oncology patients, and occur at all stages of the medication use process. Oral chemotherapy use is a particular area of growing risk. Our knowledge of chemotherapy errors is drawn primarily from single-institution studies at university hospitals and referral centres, with a particular focus on prescription orders and pharmacy practices. Although the heterogeneity of research methods and measures used in these studies limits our understanding of this issue, the rate of chemotherapy error-related injuries is generally lower than those seen in comparable studies of general medical patients. Although many interventions show promise in reducing chemotherapy errors, most have little empirical support. Additional research is needed to understand and to mitigate the risk of chemotherapy medication errors.
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Affiliation(s)
- Saul N Weingart
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA.
| | - Lulu Zhang
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Megan Sweeney
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Michael Hassett
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Exploring healthcare professionals' perceptions of medication errors in an adult oncology department in Saudi Arabia: A qualitative study. Saudi Pharm J 2018; 27:176-181. [PMID: 30766427 PMCID: PMC6362166 DOI: 10.1016/j.jsps.2018.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022] Open
Abstract
Objective Adverse events which result from medication errors are considered to be one of the most frequently encountered patient safety issues in clinical settings. We undertook a qualitative investigation to identify and explore factors relating to medication error in an adult oncology department in Saudi Arabia from the perspective of healthcare professionals. Methods This was a qualitative study conducted in an adult oncology department in Saudi Arabia. After obtaining required ethical approvals and written consents from the participants, semi-structured interviews and focus group discussions were carried out for data collection. A stratified purposive sampling strategy was used to recruit medical doctors, pharmacists, and nurses. NVivo Pro version 11 was used for data analyses. Inductive thematic analysis was adopted in the primary coding of data while secondary coding of data was carried out deductively applying the Hospital Survey of Patient Safety Culture (HSOPSC) framework. Result The total number of participants were 38. Majority of the participants were nurses (n = 24), females (n = 30), and not of Saudi nationality (n = 31) with an average age of 36 years old. Causes of medication errors were categorized into 6 themes. These causes were related teamwork across units, staffing, handover of medication related information, accepted behavioural norms, frequency of events reported, and non-punitive response to error. Conclusion There were numerous causes for medication errors in the adult oncology department. This means substantive improvement in medication safety is likely to require multiple, inter-relating, complex interventions. More research should be conducted to examine context-specific interventions that may have the potential to improve medication safety in this and similar departments.
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Podtschaske BV, Salazar N, Rao MB. Proactive, Transdisciplinary Safer-System Redesign. A Field Report from the Hospital Frontline. IISE Trans Occup Ergon Hum Factors 2018. [DOI: 10.1080/24725838.2018.1450794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Noraliza Salazar
- Clinical Specialist/Simulationist in Patient Safety, Stanford Health Care, Stanford, CA, USA
| | - Mitesh B. Rao
- System Patient Safety Officer, Stanford Health Care, Assistant Professor of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Stojković T, Rose O, Woltersdorf R, Marinković V, Manser T, Jaehde U. Prospective systemic risk analysis of the dispensing process in German community pharmacies. Int J Health Plann Manage 2017; 33:e320-e332. [DOI: 10.1002/hpm.2479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/25/2017] [Accepted: 11/03/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Tatjana Stojković
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy; University of Belgrade; Belgrade Serbia
| | - Olaf Rose
- Institute of Pharmacy, Clinical Pharmacy; University of Bonn; Bonn Germany
| | - Ronja Woltersdorf
- Institute of Pharmacy, Clinical Pharmacy; University of Bonn; Bonn Germany
| | - Valentina Marinković
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy; University of Belgrade; Belgrade Serbia
| | - Tanja Manser
- Institute for Patient Safety; University of Bonn; Bonn Germany
| | - Ulrich Jaehde
- Institute of Pharmacy, Clinical Pharmacy; University of Bonn; Bonn Germany
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Iwamoto T, Morikawa T, Hioki M, Sudo H, Paolucci D, Okuda M. Performance evaluation of the compounding robot, APOTECAchemo, for injectable anticancer drugs in a Japanese hospital. J Pharm Health Care Sci 2017; 3:12. [PMID: 28451441 PMCID: PMC5402647 DOI: 10.1186/s40780-017-0081-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 04/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The accuracy, safety and feasibility of, the compounding robot APOTECAchemo were evaluated in the clinical practice of Japan. METHODS Accuracy and precision of robotic preparations by APOTECAchemo was evaluated in 20 preparations of fluorouracil (FU) and cyclophosphamide (CPA) infusions by four pharmacists. Environmental and product contaminations with FU and CPA were evaluated by wipe testing. Robotic performance was compared with manual preparation in a biological safety cabinet. The number of robotic products, total compounding time and total pre-reconstitution time of lyophilized drugs between January 1, 2014 to December 31, 2015 were investigated. RESULTS Robotic preparation resulted more accurate and precise (mean absolute dose error and coefficient of variation were 0.83 and 1.04% for FU and 0.52 and 0.59% for CPA) than those of manual preparation (respective values were 1.20 and 1.46% for FU and 1.70 and 2.20% for CPA). Drug residue was not detected from any of the prepared infusion bags with the robotic preparation, whereas FU was detected in two of four analyzed infusion bags with manual preparation. Average total time to make single anticancer drug preparation (compounding plus reconstitution of lyophilized drugs) was 6.11 min in the second half of 2015. During the study period, the highest percentage of production covered by APOTECAchemo was 70.4% of the total inpatient pharmacy activity. CONCLUSION Robotic preparation using APOTECAchemo should give substantial advantages in drug compounding for accuracy and safety and was able to be successfully worked in Mie university hospital.
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Affiliation(s)
- Takuya Iwamoto
- Department of Pharmacy, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Takuya Morikawa
- Department of Pharmacy, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Miki Hioki
- Department of Pharmacy, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Hirofumi Sudo
- Department of Pharmacy, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | | | - Masahiro Okuda
- Department of Pharmacy, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
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Fyhr A, Ternov S, Ek Å. From a reactive to a proactive safety approach. Analysis of medication errors in chemotherapy using general failure types. Eur J Cancer Care (Engl) 2015; 26. [PMID: 26239427 PMCID: PMC5298025 DOI: 10.1111/ecc.12348] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 11/30/2022]
Abstract
A better understanding of why medication errors (MEs) occur will mean that we can work proactively to minimise them. This study developed a proactive tool to identify general failure types (GFTs) in the process of managing cytotoxic drugs in healthcare. The tool is based on Reason's Tripod Delta tool. The GFTs and active failures were identified in 60 cases of MEs reported to the Swedish national authorities. The most frequently encountered GFTs were defences, procedures, organisation and design. Working conditions were often the common denominator underlying the MEs. Among the active failures identified, a majority were classified as slips, one‐third as mistakes, and for a few no active failure or error could be determined. It was found that the tool facilitated the qualitative understanding of how the organisational weaknesses and local characteristics influence the risks. It is recommended that the tool be used regularly. We propose further development of the GFT tool. We also propose a tool to be further developed into a proactive self‐evaluation tool that would work as a complement to already incident reporting and event and risk analyses.
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Affiliation(s)
- A Fyhr
- Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | | | - Å Ek
- Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
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