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Ottosen K, Bucknall T. Understanding an epidemiological view of a retrospective audit of medication errors in an intensive care unit. Aust Crit Care 2024; 37:429-435. [PMID: 37280136 DOI: 10.1016/j.aucc.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Medication errors in the intensive care setting continue to occur at significant rates and are often associated with adverse events and potentially life-threatening repercussions. AIM/OBJECTIVE The aim of this study was to (i) determine the frequency and severity of medication errors reported in the incident management reporting system; (ii) examine the antecedent events, their nature, the circumstances, risk factors, and contributing factors leading to medication errors; and (iii) identify strategies to improve medication safety in the intensive care unit (ICU). METHOD A retrospective, exploratory, descriptive design was selected. Retrospective data were collected from the incident report management system and electronic medical records over a 13-month period from a major metropolitan teaching hospital ICU. RESULTS A total of 162 medication errors were reported during a 13-month period, of which, 150 were eligible for inclusion. Most medication errors occurred during the administration (89.4%) and dispensing phases (23.3%). The highest reported errors included incorrect doses (25.3%), incorrect medications (12.7%), omissions (10.7%), and documentation errors (9.3%). Narcotic analgesics (20%), anaesthetics (13.3%), and immunomodifiers (10.7%) were the most frequently reported medication classes associated with medication errors. Prevention strategies were found to be focussed on active errors (67.7%) as opposed to latent errors (32.3%) and included various and infrequent levels of education and follow-up. Active antecedent events included action-based errors (39%) and rule-based errors (29.5%), whereas latent antecedent events were most associated with a breakdown in system safety (39.3%) and education (25%). CONCLUSION This study presents an epidemiological view and understanding of medication errors in an Australian ICU. This study highlighted the preventable nature of most medication errors in this study. Improving administration-checking procedures would prevent the occurrence of many medication errors. Approaches aimed at both individual- and organisational-level improvements are recommended to address administration errors and inconsistent medication-checking procedures. Areas for further research include determining the most effective system developments for improving administration-checking procedures and verifying the risk and prevalence of immunomodifier administration errors in the ICU as this is an area not reported previously in the literature. In addition, the impact of single- versus two-person checking procedures on medication errors in the ICU should be prioritised to address current evidence gaps.
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Affiliation(s)
- Kelly Ottosen
- Alfred Health Partnership, Melbourne, VIC, Australia.
| | - Tracey Bucknall
- Alfred Health Partnership, Melbourne, VIC, Australia; Centre for Quality and Patient Safety Research (QPS), Alfred Health Partnership, Melbourne, VIC, Australia; School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, VIC, Australia
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2
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Pintado Delgado MC, Sánchez Navarro IM, Baldominos Utrilla G. Medication errors reported in an adult Intensive Care Unit in a level 2 hospital in Spain. Med Intensiva 2023; 47:736-738. [PMID: 37867117 DOI: 10.1016/j.medine.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/31/2023] [Accepted: 08/20/2023] [Indexed: 10/24/2023]
Affiliation(s)
| | | | - Gemma Baldominos Utrilla
- Hospital Pharmacy Service, Príncipe de Asturias Universitary Hospital, Alcalá de Henares, Madrid, Spain
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3
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Otero MJ, Merino de Cos P, Aquerreta Gónzalez I, Bodí M, Domingo Chiva E, Marrero Penichet SM, Martín Muñoz R, Martín Delgado MC. Assessment of the implementation of safe medication practices in Intensive Medicine Units. Med Intensiva 2022; 46:680-689. [PMID: 35660285 DOI: 10.1016/j.medine.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the level of implementation of medication safety practices in Intensive Care Units (ICUs) and to identify opportunities for improvement. DESIGN A descriptive multicenter study was carried out. SETTING Intensive Care Units. PARTICIPANTS/PROCEDURE A total of 40 ICUs voluntarily completed the "Medication use-system safety self-assessment for Intensive Care Units" between March and September 2020. The survey comprised 147 items for evaluation grouped into 10 key elements. MAIN VARIABLES Calculation was made of the mean scores and mean percentages based on the maximum possible values for the overall survey, referred to the key elements and to each individual item for evaluation. RESULTS The mean score of the overall questionnaire among the participating ICUs was 436.8 (49.2% of the maximum possible score). No differences were found according to functional dependence, size of the hospital or type of ICU. The key elements referred to the incorporation of clinical pharmacists in these Units, as well as the competence and training of the professionals in safety practices yielded the lowest values (31.2% and 33.2%, respectively). Three other key elements related to accessibility to information about patients and medicines; to the standardization, storage and distribution of medicines; and to the quality and risk management programs, yielded percentages <50%. CONCLUSIONS Numerous effective safety medication practices have been identified with a low level of implementation in ICUs. This situation must be addressed in order to reduce medication errors in critically ill patients.
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Affiliation(s)
- M J Otero
- Instituto para el Uso Seguro de los Medicamentos (ISMP-España), IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain.
| | - P Merino de Cos
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, Balearic Islands, Spain
| | | | - M Bodí
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, Spain
| | - E Domingo Chiva
- Servicio de Farmacia, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - S M Marrero Penichet
- Servicio de Farmacia, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - R Martín Muñoz
- Instituto para el Uso Seguro de los Medicamentos (ISMP-España), IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital de Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
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Juneja D, Mishra A. Medication Prescription Errors in Intensive Care Unit: An Avoidable Menace. Indian J Crit Care Med 2022; 26:541-542. [PMID: 35719448 PMCID: PMC9160622 DOI: 10.5005/jp-journals-10071-24215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Juneja D, Mishra A. Medication Prescription Errors in Intensive Care Unit: An Avoidable Menace. Indian J Crit Care Med 2022;26(5):541–542.
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Affiliation(s)
- Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
- Deven Juneja, Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India, Phone: +91 9818290380, e-mail:
| | - Anjali Mishra
- Department of Critical Care Medicine, Holy Family Hospital, New Delhi, India
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5
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Otero MJ, Merino de Cos P, Aquerreta González I, Bodí M, Domingo Chiva E, Marrero Penichet SM, Martín Muñoz R, Martín Delgado MC. Assessment of the implementation of safe medication practices in Intensive Medicine Units. Med Intensiva 2021; 46:S0210-5691(21)00176-5. [PMID: 34452772 DOI: 10.1016/j.medin.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the level of implementation of medication safety practices in Intensive Care Units (ICUs) and to identify opportunities for improvement. DESIGN A descriptive multicenter study was carried out. SETTING Intensive Care Units. PARTICIPANTS/PROCEDURE A total of 40 ICUs voluntarily completed the "Medication use-system safety self-assessment for Intensive Care Units" between March and September 2020. The survey comprised 147 items for evaluation grouped into 10 key elements. MAIN VARIABLES Calculation was made of the mean scores and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item for evaluation. RESULTS The mean score of the overall questionnaire among the participating ICUs was 436.8 (49.2% of the maximum possible score). No differences were found according to functional dependence, size of the hospital or type of ICU. The key elements referred to the incorporation of clinical pharmacists in these units, as well as the competence and training of the professionals in safety practices yielded the lowest values (31.2% and 33.2%, respectively). Three other key elements related to accessibility to information about patients and medicines; to the standardization, storage and distribution of medicines; and to the quality and risk management programs, yielded percentages below 50%. CONCLUSIONS Numerous effective safety medication practices have been identified with a low level of implementation in ICUs. This situation must be addressed in order to reduce medication errors in critically ill patients.
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Affiliation(s)
- M J Otero
- Instituto para el Uso Seguro de los Medicamentos (ISMP-España), IBSAL-Hospital Universitario de Salamanca, Salamanca, España.
| | - P Merino de Cos
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, Islas Baleares, España
| | | | - M Bodí
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
| | - E Domingo Chiva
- Servicio de Farmacia, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - S M Marrero Penichet
- Servicio de Farmacia, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - R Martín Muñoz
- Instituto para el Uso Seguro de los Medicamentos (ISMP-España), IBSAL-Hospital Universitario de Salamanca, Salamanca, España
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital de Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
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Johnston K, Ankravs MJ, Badman B, Choo CL, Cree M, Fyfe R, Roberts JA, Xu J, Munro C. Standard of practice in intensive care for pharmacy services. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Karlee Johnston
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Australian National University Medical School Garran Australia
- Canberra Hospital Garran Australia
| | - Melissa J. Ankravs
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department and Intensive Care Unit Royal Melbourne Hospital Parkville Australia
- Department of Medicine and Radiology Melbourne Medical School Royal Melbourne Hospital The University of Melbourne Parkville Australia
| | - Belinda Badman
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Princess Alexandra Hospital Metro South Health Service Brisbane Australia
| | - Chui Lynn Choo
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department and Intensive Care Services John Hunter Hospital New Lambton Heights Australia
| | - Michele Cree
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Queensland Children’s Hospital and Children’s Health Brisbane Australia
| | - Rachel Fyfe
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department and Intensive Care Unit Barwon Health Geelong Australia
| | - Jason A. Roberts
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Faculty of Medicine & Centre for Translational Anti‐infective Pharmacodynamics School of Pharmacy The University of Queensland Centre for Clinical Research The University of Queensland Brisbane Australia
- Departments of Pharmacy and Intensive Care Medicine Royal Brisbane and Women’s Hospital Brisbane Australia
| | - Jessica Xu
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department Fiona Stanley Hospital Perth Australia
| | - Courtney Munro
- The Society of Hospital Pharmacists of Australia Collingwood Australia
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7
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Bosma BE, Hunfeld NGM, Roobol-Meuwese E, Dijkstra T, Coenradie SM, Blenke A, Bult W, Melief PHGJ, Dixhoorn MPV, van den Bemt PMLA. Voluntarily reported prescribing, monitoring and medication transfer errors in intensive care units in The Netherlands. Int J Clin Pharm 2020; 43:66-76. [PMID: 32812096 DOI: 10.1007/s11096-020-01101-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/08/2020] [Indexed: 12/11/2022]
Abstract
Background Medication errors occur frequently in intensive care units (ICU). Voluntarily reported medication errors form an easily available source of information. Objective This study aimed to characterize prescribing, monitoring and medication transfer errors that were voluntarily reported in the ICU, in order to reveal medication safety issues. Setting This retrospective data analysis study included reports of medication errors from eleven Dutch ICU's from January 2016 to December 2017. Method We used data extractions from the incident reporting systems of the participating ICU's. The reports were transferred into one database and categorized into type of error, cause, medication (groups), and patient harm. Descriptive statistics were used to calculate the proportion of medication errors and the distribution of subcategories. Based on the analysis, ICU medication safety issues were revealed. Main outcome measure The main outcome measure was the proportion of prescribing, monitoring and medication transfer error reports. Results Prescribing errors were reported most frequently (n = 233, 33%), followed by medication transfer errors (n = 85, 12%) and monitoring errors (n = 27, 4%). Other findings were: medication transfer errors frequently caused serious harm, especially the omission of home medication involving the central nervous system and proton pump inhibitors; omissions and dosing errors occurred most frequently; protocol problems caused a quarter of the medication errors; and medications needing blood level monitoring (e.g. tacrolimus, vancomycin, heparin and insulin) were frequently involved. Conclusion This analysis of voluntarily reported prescribing, monitoring and medication transfer errors warrants several improvement measures in these processes, which may help to increase medication safety in the ICU.
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Affiliation(s)
- B E Bosma
- Department of Pharmacy, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 CH, The Hague, The Netherlands. .,Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - N G M Hunfeld
- Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - E Roobol-Meuwese
- Department of Hospital Pharmacy, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
| | - T Dijkstra
- Department of Pharmacy, Franciscus Gasthuis and Vlietland, Vlietlandplein 2, 3118 JH, Schiedam, The Netherlands
| | - S M Coenradie
- Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - A Blenke
- Department of Clinical Pharmacy, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands
| | - W Bult
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P H G J Melief
- Department of Critical Care, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 CH, The Hague, The Netherlands
| | - M Perenboom-Van Dixhoorn
- Department of Critical Care, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 CH, The Hague, The Netherlands
| | - P M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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8
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Text Mining Method for Studying Medication Administration Incidents and Nurse-Staffing Contributing Factors: A Pilot Study. Comput Inform Nurs 2019; 37:357-365. [PMID: 30870188 DOI: 10.1097/cin.0000000000000518] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Incident reporting systems are being implemented globally, thus increasing the profile and prevalence of incidents, but the analysis of free-text descriptions remains largely hidden. The aims of the study were to explore the extent to which incident reports recorded staffing issues as contributors to medication administration incidents. Incident reports related to medication administration (N = 1012) were collected from two hospitals in Finland between January 1, 2013, and December 31, 2014. The SAS Enterprise Miner 13.2 and its Text Miner tool were used to excavate terms and descriptors and to uncover themes and concepts in the free-text descriptions of incidents with (n = 194) and without (n = 818) nurse staffing-related contributing factors. Text mining included (1) text parsing, (2) text filtering, and (3) modeling text clusters and text topics. The term "rush/hurry" was the sixth most common term used in incidents where nurse-staffing was identified as a contributing factor. Nurse-staffing factors, however, were not pronounced in clusters or in text topics of either data set. Text mining offers the opportunity to analyze large free-text mass and holds promise for providing insight into the antecedents of medication administration incidents.
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9
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Xie S, Braga-Neto UM. On the Bias of Precision Estimation Under Separate Sampling. Cancer Inform 2019; 18:1176935119860822. [PMID: 31360060 PMCID: PMC6636226 DOI: 10.1177/1176935119860822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/02/2019] [Indexed: 11/29/2022] Open
Abstract
Observational case-control studies for biomarker discovery in cancer studies often collect data that are sampled separately from the case and control populations. We present an analysis of the bias in the estimation of the precision of classifiers designed on separately sampled data. The analysis consists of both theoretical and numerical results, which show that classifier precision estimates can display strong bias under separating sampling, with the bias magnitude depending on the difference between the true case prevalence in the population and the sample prevalence in the data. We show that this bias is systematic in the sense that it cannot be reduced by increasing sample size. If information about the true case prevalence is available from public health records, then a modified precision estimator that uses the known prevalence displays smaller bias, which can in fact be reduced to zero as sample size increases under regularity conditions on the classification algorithm. The accuracy of the theoretical analysis and the performance of the precision estimators under separate sampling are confirmed by numerical experiments using synthetic and real data from published observational case-control studies. The results with real data confirmed that under separately sampled data, the usual estimator produces larger, ie, more optimistic, precision estimates than the estimator using the true prevalence value.
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Affiliation(s)
- Shuilian Xie
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Ulisses M Braga-Neto
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
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10
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Evans HP, Anastasiou A, Edwards A, Hibbert P, Makeham M, Luz S, Sheikh A, Donaldson L, Carson-Stevens A. Automated classification of primary care patient safety incident report content and severity using supervised machine learning (ML) approaches. Health Informatics J 2019; 26:3123-3139. [PMID: 30843455 DOI: 10.1177/1460458219833102] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Learning from patient safety incident reports is a vital part of improving healthcare. However, the volume of reports and their largely free-text nature poses a major analytic challenge. The objective of this study was to test the capability of autonomous classifying of free text within patient safety incident reports to determine incident type and the severity of harm outcome. Primary care patient safety incident reports (n=31333) previously expert-categorised by clinicians (training data) were processed using J48, SVM and Naïve Bayes.The SVM classifier was the highest scoring classifier for incident type (AUROC, 0.891) and severity of harm (AUROC, 0.708). Incident reports containing deaths were most easily classified, correctly identifying 72.82% of reports. In conclusion, supervised ML can be used to classify patient safety incident report categories. The severity classifier, whilst not accurate enough to replace manual processing, could provide a valuable screening tool for this critical aspect of patient safety.
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Affiliation(s)
| | | | | | - Peter Hibbert
- Macquarie University, Australia; University of South Australia, Australia
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11
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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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12
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Lalande J, Vrignaud B, Navas D, Levieux K, Herbreteau B, Guillou A, Gras-Le Guen C, Launay E. A prospective observational study of medication errors in a pediatric emergency department. Arch Pediatr 2018; 25:355-358. [PMID: 30064711 DOI: 10.1016/j.arcped.2018.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/02/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022]
Abstract
We present a prospective, observational study evaluating the incidence of medication errors (ME) in a university hospital pediatric emergency department and describe their characteristics and determinants. A systematic analysis of the handwritten prescriptions was conducted by a clinician and pharmacist. Of 11,573 consecutively studied prescriptions in children under 15 years of age, the ME incidence was 0.9% (n=102). The incidence of errors found was statistically significantly higher in children older than 5 years (OR=2.05; P=0.026). There was no significant difference regarding the time of admission (P=0.544), the day of the week (P=0.940), or the affluence of people in attendance at the emergency department. The errors observed were all prescription errors. Most errors were related to analgesic (51%) and antibiotic (30%) treatments. No serious errors were reported. CONCLUSION We found a low incidence of medication errors in this study. The validation of prescriptions by a senior multidisciplinary staff could contribute to limited medication errors. Measures should be continued to further reduce the incidence of drug errors by calling the attention of prescribers to the most common situations at risk of ME.
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Affiliation(s)
- J Lalande
- Pediatric emergency department, University hospital of Nantes, Hôpital Mère-Enfant, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France.
| | - B Vrignaud
- Pediatric emergency department, University hospital of Nantes, Hôpital Mère-Enfant, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France
| | - D Navas
- Pharmacy, University hospital of Nantes, 9, rue Bias, 44000 Nantes, France
| | - K Levieux
- Pediatric emergency department, University hospital of Nantes, Hôpital Mère-Enfant, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France
| | - B Herbreteau
- Pharmacy, University hospital of Nantes, 9, rue Bias, 44000 Nantes, France
| | - A Guillou
- Pharmacy, University hospital of Nantes, 9, rue Bias, 44000 Nantes, France
| | - C Gras-Le Guen
- Pediatric emergency department, University hospital of Nantes, Hôpital Mère-Enfant, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France; Pharmacy, University hospital of Nantes, 9, rue Bias, 44000 Nantes, France; Pediatric department, University hospital NANTES, Hôpital Mère Enfant CHU NANTES, Quai Moncousu, 44093 Nantes Cedex 1, France
| | - E Launay
- Pharmacy, University hospital of Nantes, 9, rue Bias, 44000 Nantes, France; Pediatric department, University hospital NANTES, Hôpital Mère Enfant CHU NANTES, Quai Moncousu, 44093 Nantes Cedex 1, France
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13
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Härkänen M, Blignaut A, Vehviläinen-Julkunen K. Focus group discussions of registered nurses' perceptions of challenges in the medication administration process. Nurs Health Sci 2018; 20:431-437. [PMID: 29745001 DOI: 10.1111/nhs.12432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/16/2018] [Accepted: 03/23/2018] [Indexed: 11/30/2022]
Abstract
Medication administration (MA) holds a great threat to patient safety, as MA errors remain a global problem. Nurses are key role players in the MA process and can give valuable information from the grassroots level. The aim of the present study was to describe registered nurses' perceptions related to challenges in the MA process. Focus group interviews with registered nurses (n = 20) in two central hospitals in Finland were conducted in 2015. Inductive content analysis was performed. Nurses described multiple challenges during MA, which made the process demanding. These were organized under five themes: (i) medications; (ii) collaboration between health-care professionals; (iii) resources and work environment; (iv) skills and education; and (v) patient-related factors. The MA process is prone to errors, and registered nurses described many challenges related to MA. While nurses are responsible for their various work-related tasks and the maintenance of patient safety through applicable procedures and effective collaboration, health systems and hospital management should be stewards of patient safety by ensuring adequate staffing levels and providing educational resources related to the MA process.
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Affiliation(s)
- Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Alwiena Blignaut
- School of Nursing Science, North-West University, Potchefstroom, South Africa
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
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14
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Härkänen M, Tiainen M, Haatainen K. Wrong-patient incidents during medication administrations. J Clin Nurs 2017; 27:715-724. [PMID: 28815817 DOI: 10.1111/jocn.14021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe the factors pertaining to medication being administered to the wrong patient and to describe how patient identification is mentioned in wrong-patient incident reports. BACKGROUND Although patient identification has been given high priority to improve patient safety, patient misidentifications occur, and wrong-patient incidents are common. DESIGN A descriptive content analysis. METHODS Incident reports related to medication administration (n = 1,012) were collected from two hospitals in Finland between 1 January 2013-31 December 2014. Of those, only incidents involving wrong-patient medication administration (n = 103) were included in this study. RESULTS Wrong-patient incidents occurred due for many reasons, including nurse-related factors (such as tiredness, a lack of skills or negligence) but also system-related factors (such as rushing or heavy workloads). In 77% (n = 79) of wrong-patient incident reports, the process of identifying of the patient was not described at all. CONCLUSIONS There is need to pay more attention to and increase training in correct identification processes to prevent wrong-patient incidents, and it is important to adjust system factors to support nurses. RELEVANCE TO CLINICAL PRACTICE Active patient identification procedures, double-checking and verification at each stage of the medication process should be implemented. More attention should also be paid to organisational factors, such as division of work, rushing and workload, as well as to correct communication. The active participation of nurses in handling incidents could increase risk awareness and facilitate useful protection actions.
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Affiliation(s)
- Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | | | - Kaisa Haatainen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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Abstract
OBJECTIVE To provide ICU clinicians with evidence-based guidance on safe medication use practices for the critically ill. DATA SOURCES PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and ISI Web of Science for relevant material to December 2015. STUDY SELECTION Based on three key components: 1) environment and patients, 2) the medication use process, and 3) the patient safety surveillance system. The committee collectively developed Population, Intervention, Comparator, Outcome questions and quality of evidence statements pertaining to medication errors and adverse drug events addressing the key components. A total of 34 Population, Intervention, Comparator, Outcome questions, five quality of evidence statements, and one commentary on disclosure was developed. DATA EXTRACTION Subcommittee members were assigned selected Population, Intervention, Comparator, Outcome questions or quality of evidence statements. Subcommittee members completed their Grading of Recommendations Assessment, Development, and Evaluation of the question with his/her quality of evidence assessment and proposed strength of recommendation, then the draft was reviewed by the relevant subcommittee. The subcommittee collectively reviewed the evidence profiles for each question they developed. After the draft was discussed and approved by the entire committee, then the document was circulated among all members for voting on the quality of evidence and strength of recommendation. DATA SYNTHESIS The committee followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation system to determine quality of evidence and strength of recommendations. CONCLUSIONS This guideline evaluates the ICU environment as a risk for medication-related events and the environmental changes that are possible to improve safe medication use. Prevention strategies for medication-related events are reviewed by medication use process node (prescribing, distribution, administration, monitoring). Detailed considerations to an active surveillance system that includes reporting, identification, and evaluation are discussed. Also, highlighted is the need for future research for safe medication practices that is specific to critically ill patients.
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Adamson RT, Lew I, Beyzarov E, Amara S, Reitan J. Clinical and Economic Implications of Postsurgical Use of Opioid Therapy. Hosp Pharm 2017. [DOI: 10.1310/hpj4606-s4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Indu Lew
- Saint Barnabas Health Care System, South Plainfield, New Jersey
| | - Elena Beyzarov
- Saint Barnabas Health Care System, South Plainfield, New Jersey
| | - Shilpa Amara
- Saint Barnabas Health Care System, South Plainfield, New Jersey
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17
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Härkänen M, Saano S, Vehviläinen-Julkunen K. Using incident reports to inform the prevention of medication administration errors. J Clin Nurs 2017; 26:3486-3499. [DOI: 10.1111/jocn.13713] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Marja Härkänen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
| | | | - Katri Vehviläinen-Julkunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Kuopio University Hospital; Kuopio Finland
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18
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Guest C, Sobotka F, Karavasopoulou A, Ward S, Bantel C. Nurses and opioids: results of a bi-national survey on mental models regarding opioid administration in hospitals. J Pain Res 2017; 10:481-493. [PMID: 28280383 PMCID: PMC5338981 DOI: 10.2147/jpr.s127939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Pain remains insufficiently treated in hospitals. Increasing evidence suggests human factors contribute to this, due to nurses failing to administer opioids. This behavior might be the consequence of nurses’ mental models about opioids. As personal experience and conceptions shape these models, the aim of this prospective survey was to identify model-influencing factors. Material and methods A questionnaire was developed comprising of 14 statements concerning ideations about opioids and seven questions concerning demographics, indicators of adult learning, and strength of religious beliefs. Latent variables that may underlie nurses’ mental models were identified using undirected graphical dependence models. Representative items of latent variables were employed for ordinal regression analysis. Questionnaires were distributed to 1,379 nurses in two London, UK, hospitals (n=580) and one German (n=799) hospital between September 2014 and February 2015. Results A total of 511 (37.1%) questionnaires were returned. Mean (standard deviation) age of participants were 37 (11) years; 83.5% participants were female; 45.2% worked in critical care; and 51.5% had more than 10 years experience. Of the nurses, 84% were not scared of opioids, 87% did not regard opioids as drugs to help patients die, and 72% did not view them as drugs of abuse. More English (41%) than German (28%) nurses were afraid of criminal investigations and were constantly aware of side effects (UK, 94%; Germany, 38%) when using opioids. Four latent variables were identified which likely influence nurses’ mental models: “conscious decision-making”; “medication-related fears”; “practice-based observations”; and “risk assessment”. They were predicted by strength of religious beliefs and indicators of informal learning such as experience but not by indicators of formal learning such as conference attendance. Conclusion Nurses in both countries employ analytical and affective mental models when administering the opioids and seem to learn from experience rather than from formal teaching. Additionally, some attitudes and emotions towards opioids are likely the result of nurses’ cultural background.
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Affiliation(s)
- Charlotte Guest
- Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Fabian Sobotka
- Division of Epidemiology and Biometry, Department of Health Services Research, Faculty 6, Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | | | - Stephen Ward
- Pain Service, Barts Health, St Bartholomew's Hospital, London, UK
| | - Carsten Bantel
- Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Oldenburg University, Klinikum Oldenburg Campus, Oldenburg, Germany; Department of Surgery and Cancer, Anaesthetics Section, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
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Kane-Gill SL, Achanta A, Kellum JA, Handler SM. Clinical decision support for drug related events: Moving towards better prevention. World J Crit Care Med 2016; 5:204-211. [PMID: 27896144 PMCID: PMC5109919 DOI: 10.5492/wjccm.v5.i4.204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/17/2016] [Accepted: 10/18/2016] [Indexed: 02/06/2023] Open
Abstract
Clinical decision support (CDS) systems with automated alerts integrated into electronic medical records demonstrate efficacy for detecting medication errors (ME) and adverse drug events (ADEs). Critically ill patients are at increased risk for ME, ADEs and serious negative outcomes related to these events. Capitalizing on CDS to detect ME and prevent adverse drug related events has the potential to improve patient outcomes. The key to an effective medication safety surveillance system incorporating CDS is advancing the signals for alerts by using trajectory analyses to predict clinical events, instead of waiting for these events to occur. Additionally, incorporating cutting-edge biomarkers into alert knowledge in an effort to identify the need to adjust medication therapy portending harm will advance the current state of CDS. CDS can be taken a step further to identify drug related physiological events, which are less commonly included in surveillance systems. Predictive models for adverse events that combine patient factors with laboratory values and biomarkers are being established and these models can be the foundation for individualized CDS alerts to prevent impending ADEs.
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Kane-Gill SL, MacLasco AM, Saul MI, Politz Smith TR, Kloet MA, Kim C, Anthes AM, Smithburger PL, Seybert AL. Use of Text Searching for Trigger Words in Medical Records to Identify Adverse Drug Reactions within an Intensive Care Unit Discharge Summary. Appl Clin Inform 2016; 7:660-71. [PMID: 27453336 DOI: 10.4338/aci-2016-03-ra-0031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/08/2016] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To evaluate the performance of using trigger words (e.g. clues to an adverse drug reaction) in unstructured, narrative text to detect adverse drug reactions (ADRs) and compare the use of these trigger words to a targeted chart review for ADR detection within the intensive care unit (ICU) discharge summary note. MATERIALS A retrospective medical record review was conducted. Evaluation of ADRs occurred in two phases - targeted chart review of the ICU discharge summary notes in Phase 1 and targeted chart review using specific words and phrases as triggers for ADRs in Phase 2. RESULTS Four hundred ADRs were documented in 223 patients for Phase 1. For Phase 2, there were 219 ADRs identified in 120 patients. 138 real or accurate ADRs were identified from Phase 1 and 47 duplicate events. 34 ADRs from Phase 2 were not identified in Phase 1. Fifteen of the ADRs were inaccurately presumed in Phase 2. Fifty-eight of 127 text triggers identified at least one ADR. Low and moderate frequency trigger words were more likely to have PPVs > 5%. CONCLUSIONS Targeted chart review using specific words and phrases as triggers for ADRs is a reasonable approach to identify ADRs and may save time compared to other methods after further refinement leads to a more accurately performing trigger word list.
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Affiliation(s)
- Sandra L Kane-Gill
- Sandra L. Kane-Gill, PharmD, MSc, FCCM, FCCP, University of Pittsburgh, School of Pharmacy, 918 Salk Hall, 3501 Terrace St., Pittsburgh, PA 15261, , Phone: 412-624-5150
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Härkänen M, Voutilainen A, Turunen E, Vehviläinen-Julkunen K. Systematic review and meta-analysis of educational interventions designed to improve medication administration skills and safety of registered nurses. NURSE EDUCATION TODAY 2016; 41:36-43. [PMID: 27138480 DOI: 10.1016/j.nedt.2016.03.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/10/2016] [Accepted: 03/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The aim of this study is to evaluate the nature, quality and effectiveness of educational interventions designed to increase the medication administration skills and safety of registered nurses working in hospitals. DESIGN A systematic review with meta-analysis. DATA SOURCES Intervention studies designed to increase the medication administration skills and safety of nurses, indexed in one or more databases (CINAHL, PubMed, Scopus, Cochrane, PsycInfo, or Medic), and published in peer-reviewed journals between January 2000 and April 2015. REVIEW METHODS The nature of the interventions was evaluated by narrative analysis, the quality of studies was assessed using the Effective Public Health Practise Project Quality Assessment Tool and the effectiveness of the interventions was ascertained by calculating effect sizes and conducting a meta-analysis. RESULTS A total of 755 studies were identified and 14 intervention studies were reviewed. Interventions differed by their nature, including traditional classroom training, simulation, e-learning, slide show presentations, interactive CD-ROM programme, and the use of posters and pamphlets. All interventions appeared to improve medication administration safety and skills based on original p-values. Only five studies reached strong (n=1) or moderate (n=4) quality ratings and one of them had to be omitted from the meta-analysis due unclear measures of dispersion. The meta-analysis favoured the interventions, the pooled effect size (Hedges' g) was large, 1.06. The most effective interventions were a blended learning programme including e-learning and a 60-min PowerPoint presentation. The least effective educational intervention, an interactive internet-based e-learning course, was reported in the study that achieved the only strong quality rating. CONCLUSIONS It is challenging to recommend any specific intervention, because all educational interventions seem to have a positive effect, although the size of the effect greatly varies. In the future, studies sharing similar contents and methods should be compared with each other.
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Affiliation(s)
- Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.
| | - Ari Voutilainen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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MacFie CC, Baudouin SV, Messer PB. An integrative review of drug errors in critical care. J Intensive Care Soc 2016; 17:63-72. [PMID: 28979459 PMCID: PMC5606383 DOI: 10.1177/1751143715605119] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Medication error is the commonest cause of medical error and the consequences can be grave. This integrative review was undertaken to critically appraise recent literature to further define prevalence, most frequently-implicated drugs and effects on patient morbidity and mortality in the critical care environment. Forty studies were compared revealing a markedly heterogeneous data set with significant variability in reported incidence. There is an important differentiation to be made between medication error (incidence 5.1-967 per 1000 patient days) and adverse drug event (incidence 1-96.5 per 1000 patient days) with significant ramifications for patient outcome and cost. The most commonly implicated drugs were cardiovascular, gastrointestinal, antimicrobial and hypoglycaemic agents. Beneficial interventions to reduce such errors include computerised prescribing, education and pharmacist input. The studies described provide insight into suboptimal management in the critical care environment and have implications for the development of specific improvement strategies and future training.
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Affiliation(s)
- Caroline C MacFie
- Department of Anaesthesia & Critical Care, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Evaluation of an automated surveillance system using trigger alerts to prevent adverse drug events in the intensive care unit and general ward. Drug Saf 2015; 38:311-7. [PMID: 25711668 DOI: 10.1007/s40264-015-0272-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Adverse events in the intensive care unit (ICU) may be associated with several possible causes, so determining a drug-related causal assessment is more challenging than in general ward patients. Therefore, the hypothesis was that automated trigger alerts may perform differently in various patient care settings. The purpose of this study was to compare the frequency and type of clinically significant automated trigger alerts in critically ill and general ward patients as well as evaluate the performance of alerts for drug-related hazardous conditions (DRHCs). METHODS A retrospective cohort study was conducted in adult ICU and general ward patients at three institutions (academic, community, and rural hospital) in a health system. Automated trigger alerts generated during two nonconsecutive months were obtained from a centralized database. Pharmacist responses to alerts and prescriber response to recommendations were evaluated for all alerts. A clinical significant event was defined as an actionable intervention requiring drug therapy changes that the pharmacist determined to be appropriate for patient safety and where the physician accepted the pharmacist's recommendation. The positive predictive value (PPV) was calculated for each trigger alert considered a DRHC (i.e., abnormal laboratory values and suspected drug causes). RESULTS A total of 751 alerts were generated in 623 patients during the study period. Pharmacists intervened on 39.8 and 44.8 % alerts generated in the ICU and general ward, respectively. Overall, the physician acceptance rate of approximately 90 % was comparable irrespective of patient care setting. Therefore, the number of clinically significant alerts was 88.9 and 83.4 % for the ICU and non-ICU, respectively. The types of drug therapy changes were similar between settings. The PPV of alerts identifying a DRHC was 0.66 in the ICU and 0.76 in general ward patients. CONCLUSIONS The number and type of clinically significant alerts were similar irrespective of patient population, suggesting that the alerts may be equally as beneficial in the ICU population, despite the challenges in drug-related event adjudication. An opportunity exists to improve the performance of alerts in both settings, so quality improvement programs for measuring alert performance and making refinements is needed.
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Brunsveld-Reinders AH, Arbous MS, De Vos R, De Jonge E. Incident and error reporting systems in intensive care: a systematic review of the literature. Int J Qual Health Care 2015; 28:2-13. [DOI: 10.1093/intqhc/mzv100] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 01/19/2023] Open
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Feleke SA, Mulatu MA, Yesmaw YS. Medication administration error: magnitude and associated factors among nurses in Ethiopia. BMC Nurs 2015; 14:53. [PMID: 26500449 PMCID: PMC4618536 DOI: 10.1186/s12912-015-0099-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 09/30/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The significant impact of medication administration errors affect patients in terms of morbidity, mortality, adverse drug events, and increased length of hospital stay. It also increases costs for clinicians and healthcare systems. Due to this, assessing the magnitude and associated factors of medication administration error has a significant contribution for improving the quality of patient care. The aim of this study was to assess the magnitude and associated factors of medication administration errors among nurses at the Felege Hiwot Referral Hospital inpatient department. METHODS A prospective, observation-based, cross-sectional study was conducted from March 24-April 7, 2014 at the Felege Hiwot Referral Hospital inpatient department. A total of 82 nurses were interviewed using a pre-tested structured questionnaire, and observed while administering 360 medications by using a checklist supplemented with a review of medication charts. Data were analyzed by using SPSS version 20 software package and logistic regression was done to identify possible factors associated with medication administration error. RESULT The incidence of medication administration error was 199 (56.4 %). The majority (87.5 %) of the medications have documentation error, followed by technique error 263 (73.1 %) and time error 193 (53.6 %). Variables which were significantly associated with medication administration error include nurses between the ages of 18-25 years [Adjusted Odds Ratio (AOR) = 2.9, 95 % CI (1.65,6.38)], 26-30 years [AOR = 2.3, 95 % CI (1.55, 7.26)] and 31-40 years [AOR = 2.1, 95 % CI (1.07, 4.12)], work experience of less than or equal to 10 years [AOR = 1.7, 95 % CI (1.33, 4.99)], nurse to patient ratio of 7-10 [AOR = 1.6, 95 % CI (1.44, 3.19)] and greater than 10 [AOR = 1.5, 95 % CI (1.38, 3.89)], interruption of the respondent at the time of medication administration [AOR = 1.5, 95 % CI (1.14, 3.21)], night shift of medication administration [AOR = 3.1, 95 % CI (1.38, 9.66)] and age of the patients with less than 18 years [AOR = 2.3, 95 % CI (1.17, 4.62)]. CONCLUSION In general, medication errors at the administration phase were highly prevalent in Felege Hiwot Referral Hospital. Documentation error is the most dominant type of error observed during the study. Increasing nurses' staffing levels, minimizing distraction and interruptions during medication administration by using no interruptions zones and "No-Talk" signage are recommended to overcome medication administration errors. Retaining experienced nurses from leaving to train and supervise inexperienced nurses with the focus on medication safety, in addition providing convenient sleep hours for nurses would be helpful in ensuring that medication errors don't occur as frequently as observed in this study.
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Affiliation(s)
- Senafikish Amsalu Feleke
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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26
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Smithburger PL, Buckley MS, Culver MA, Sokol S, Lat I, Handler SM, Kirisci L, Kane-Gill SL. A Multicenter Evaluation of Off-Label Medication Use and Associated Adverse Drug Reactions in Adult Medical ICUs. Crit Care Med 2015; 43:1612-21. [PMID: 25855897 PMCID: PMC4868132 DOI: 10.1097/ccm.0000000000001022] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Prior research indicates that off-label use is common in the ICU; however, the safety of off-label use has not been assessed. The study objective was to determine the prevalence of adverse drug reactions associated with off-label use and evaluate off-label use as a risk factor for the development of adverse drug reactions in an adult ICU population. DESIGN Multicenter, observational study SETTING : Medical ICUs at three academic medical centers. PATIENTS Adult patients (age ≥ 18 yr old) receiving medication therapy. INTERVENTIONS All administered medications were evaluated for Food and Drug Administration-approved or off-label use. Patients were assessed daily for the development of an adverse drug reaction through active surveillance. Three adverse drug reaction assessment instruments were used to determine the probability of an adverse drug reaction resulting from drug therapy. Severity and harm of the adverse drug reaction were also assessed. Cox proportional hazard regression was used to identify a set of covariates that influenced the rate of adverse drug reactions. MEASUREMENTS AND MAIN RESULTS Overall, 1,654 patient-days (327 patients) and 16,391 medications were evaluated, with 43% of medications being used off-label. One hundred and sixteen adverse drug reactions were categorized dichotomously (Food and Drug Administration or off-label), with 56% and 44% being associated with Food and Drug Administration-approved and off-label use, respectively. The number of adverse drug reactions for medications administered and the number of harmful and severe adverse drug reactions did not differ for medications used for Food and Drug Administration-approved or off-label use (0.74% vs 0.67%; p = 0.336; 33 vs 31 events, p = 0.567; 24 vs 24 events, p = 0.276). Age, sex, number of high-risk medications, number of off-label medications, and severity of illness score were included in the Cox proportional hazard regression. It was found that the rate of adverse drug reactions increases by 8% for every one additional off-label medication (hazard ratio = 1.08; 95% CI, 1.018-1.154). CONCLUSION Although adverse drug reactions do not occur more frequently with off-label use, adverse drug reaction risk increases with each additional off-label medication used.
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Affiliation(s)
- Pamela L Smithburger
- 1Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA. 2Department of Pharmacy, Banner Good Samaritan Medical Center, Phoenix, AZ. 3Department of Pharmaceutical Services, University of Chicago Medical Center, Chicago, IL. 4Department of Pharmacy, Rush University Medical Center, Chicago, IL. 5Department of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 6Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA. 7Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA
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Fong A, Ratwani R. An Evaluation of Patient Safety Event Report Categories Using Unsupervised Topic Modeling. Methods Inf Med 2015; 54:338-45. [PMID: 25833655 DOI: 10.3414/me15-01-0010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/27/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Patient safety event data repositories have the potential to dramatically improve safety if analyzed and leveraged appropriately. These safety event reports often consist of both structured data, such as general event type categories, and unstructured data, such as free text descriptions of the event. Analyzing these data, particularly the rich free text narratives, can be challenging, especially with tens of thousands of reports. To overcome the resource intensive manual review process of the free text descriptions, we demonstrate the effectiveness of using an unsupervised natural language processing approach. METHODS An unsupervised natural language processing technique, called topic modeling, was applied to a large repository of patient safety event data to identify topics, or themes, from the free text descriptions of the data. Entropy measures were used to evaluate and compare these topics to the general event type categories that were originally assigned by the event reporter. RESULTS Measures of entropy demonstrated that some topics generated from the unsupervised modeling approach aligned with the clinical general event type categories that were originally selected by the individual entering the report. Importantly, several new latent topics emerged that were not originally identified. The new topics provide additional insights into the patient safety event data that would not otherwise easily be detected. CONCLUSION The topic modeling approach provides a method to identify topics or themes that may not be immediately apparent and has the potential to allow for automatic reclassification of events that are ambiguously classified by the event re- porter.
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Affiliation(s)
- A Fong
- Allan Fong, MS, MedStar Institute for Innovation - National Center for Human Factors in Healthcare, 3007 Tilden St. NW, Suite 7M, Washington, D.C. 20008, USA, E-mail:
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Jiang SP, Chen J, Zhang XG, Lu XY, Zhao QW. Implementation of pharmacists' interventions and assessment of medication errors in an intensive care unit of a Chinese tertiary hospital. Ther Clin Risk Manag 2014; 10:861-6. [PMID: 25328401 PMCID: PMC4199561 DOI: 10.2147/tcrm.s69585] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Pharmacist interventions and medication errors potentially differ between the People’s Republic of China and other countries. This study aimed to report interventions administered by clinical pharmacists and analyze medication errors in an intensive care unit (ICU) in a tertiary hospital in People’s Republic of China. Method A prospective, noncomparative, 6-month observational study was conducted in a general ICU of a tertiary hospital in the People’s Republic of China. Clinical pharmacists performed interventions to prevent or resolve medication errors during daily rounds and documented all of these interventions and medication errors. Such interventions and medication errors were categorized and then analyzed. Results During the 6-month observation period, a total of 489 pharmacist interventions were reported. Approximately 407 (83.2%) pharmacist interventions were accepted by ICU physicians. The incidence rate of medication errors was 124.7 per 1,000 patient-days. Improper drug frequency or dosing (n=152, 37.3%), drug omission (n=83, 20.4%), and potential or actual occurrence of adverse drug reaction (n=54, 13.3%) were the three most commonly committed medication errors. Approximately 339 (83.4%) medication errors did not pose any risks to the patients. Antimicrobials (n=171, 35.0%) were the most frequent type of medication associated with errors. Conclusion Medication errors during prescription frequently occurred in an ICU of a tertiary hospital in the People’s Republic of China. Pharmacist interventions were also efficient in preventing medication errors.
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Affiliation(s)
- Sai-Ping Jiang
- Department of Pharmacy, Zhejiang University, Hangzhou, People's Republic of China
| | - Jian Chen
- Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xing-Guo Zhang
- Department of Pharmacy, Zhejiang University, Hangzhou, People's Republic of China
| | - Xiao-Yang Lu
- Department of Pharmacy, Zhejiang University, Hangzhou, People's Republic of China
| | - Qing-Wei Zhao
- Department of Pharmacy, Zhejiang University, Hangzhou, People's Republic of China
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Härkänen M, Ahonen J, Kervinen M, Turunen H, Vehviläinen-Julkunen K. The factors associated with medication errors in adult medical and surgical inpatients: a direct observation approach with medication record reviews. Scand J Caring Sci 2014; 29:297-306. [DOI: 10.1111/scs.12163] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/15/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Marja Härkänen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Finnish Doctoral Programme in Nursing Science; Finland
| | - Jouni Ahonen
- Pharmacy; Kuopio University Hospital; Kuopio Finland
| | - Marjo Kervinen
- Department of Medicine; Kuopio University Hospital; Kuopio Finland
| | - Hannele Turunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Kuopio University Hospital; Kuopio Finland
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Kuopio University Hospital; Kuopio Finland
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Armahizer MJ, Kane-Gill SL, Smithburger PL, Anthes AM, Seybert AL. Comparing Drug-Drug Interaction Severity Ratings between Bedside Clinicians and Proprietary Databases. ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/347346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose. The purpose of this project was to compare DDI severity for clinician opinion in the context of the patient’s clinical status to the severity of proprietary databases. Methods. This was a single-center, prospective evaluation of DDIs at a large, tertiary care academic medical center in a 10-bed cardiac intensive care unit (CCU). A pharmacist identified DDIs using two proprietary databases. The physicians and pharmacists caring for the patients evaluated the DDIs for severity while incorporating their clinical knowledge of the patient. Results. A total of 61 patients were included in the evaluation and experienced 769 DDIs. The most common DDIs included: aspirin/clopidogrel, aspirin/insulin, and aspirin/furosemide. Pharmacists ranked the DDIs identically 73.8% of the time, compared to the physicians who agreed 42.2% of the time. Pharmacists agreed with the more severe proprietary database scores for 14.8% of DDIs versus physicians at 7.3%. Overall, clinicians agreed with the proprietary database 20.6% of the time while clinicians ranked the DDIs lower than the database 77.3% of the time. Conclusions. Proprietary DDI databases generally label DDIs with a higher severity rating than bedside clinicians. Developing a DDI knowledgebase for CDSS requires consideration of the severity information source and should include the clinician.
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Affiliation(s)
- Michael J. Armahizer
- Cardiothoracic Intensive Care Unit and Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15261, USA
| | - Sandra L. Kane-Gill
- Department of Pharmacy and Therapeutics and Critical Care Medicine, Clinical Translational Science Institute and School of Pharmacy, Center for Pharmacoinformatics and Outcomes Research, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Pharmacy, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15261, USA
| | - Pamela L. Smithburger
- Medical Intensive Care Unit and Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15261, USA
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Ananth M. Anthes
- Surgical Intensive Care Unit and Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15261, USA
| | - Amy L. Seybert
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Buckley MS, Harinstein LM, Clark KB, Smithburger PL, Eckhardt DJ, Alexander E, Devabhakthuni S, Westley CA, David B, Kane-Gill SL. Impact of a Clinical Pharmacy Admission Medication Reconciliation Program on Medication Errors in “High-Risk” Patients. Ann Pharmacother 2013; 47:1599-610. [DOI: 10.1177/1060028013507428] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Pamela L. Smithburger
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
- University Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | | | - Butch David
- Banner Good Samaritan Medical Center, Phoenix, AZ, USA
| | - Sandra L. Kane-Gill
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
- University Pittsburgh Medical Center, Pittsburgh, PA, USA
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Institutional and National MEDMARX Data Have Differences in Causes and Types of Medication Errors but Agree on the Higher Propensity for Harm in the ICU. Crit Care Med 2013; 41:e234-5. [DOI: 10.1097/ccm.0b013e3182916fc0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Anthes AM, Harinstein LM, Smithburger PL, Seybert AL, Kane-Gill SL. Improving adverse drug event detection in critically ill patients through screening intensive care unit transfer summaries. Pharmacoepidemiol Drug Saf 2013; 22:510-6. [PMID: 23440931 DOI: 10.1002/pds.3422] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 01/10/2013] [Accepted: 01/28/2013] [Indexed: 01/28/2023]
Abstract
PURPOSE This study aimed to determine the frequency and type of adverse drug events (ADEs) identified in intensive care unit (ICU) transfer summaries and in the hospital discharge summaries to demonstrate the effectiveness of ICU transfer summary surveillance in the identification of ADEs. METHODS A retrospective electronic medical record review was conducted for medical ICU patients admitted between January 2009 and April 2009 to a large, academic medical center. The Harvard Practice Scale and the modified Leonard Assessment Scale were used to evaluate the presence of an ADE from the ICU transfer and hospital discharge summaries. RESULTS Two hundred and fifty-four patients were identified for inclusion with a median medical ICU length of stay of 4.5 days and hospital length of stay of 13 days. The ICU transfer summary review revealed 173 ADEs among 124 unique patients with a rate of 33.9 ADEs per 1000 hospital patient days. Sixty-nine ADEs among 63 unique patients were identified through the hospital discharge summary with a rate of 13.5 ADEs per 1000 hospital patient days. Only 23.1% of ADEs discussed in the ICU transfer summary were also discussed in the hospital discharge summary. CONCLUSIONS The use of ICU transfer summaries is an effective tool to increase ADE detection. The use of an ICU transfer summary should be considered as an adjunct method to an existing ADE surveillance system for heightened pharmacovigilance.
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Affiliation(s)
- Ananth M Anthes
- Surgical Intensive Care Unit, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Bloch-Teitelbaum A, Lüde S, Rauber-Lüthy C, Kupferschmidt H, Russmann S, Kullak-Ublick GA, Ceschi A. Medication wrong route administration: a poisons center-based study. Expert Opin Drug Saf 2013; 12:145-52. [PMID: 23421948 DOI: 10.1517/14740338.2013.770468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To describe clinical effects, circumstances of occurrence, management and outcomes of cases of inadvertent administration of medications by an incorrect parenteral route. METHODS Retrospective single-center consecutive review of parenteral route errors of medications, reported to our center between January 2006 and June 2010. We collected demographic data and information on medications, route and time of administration, severity of symptoms/signs, treatment, and outcome. RESULTS Seventy-eight cases (68 adults, 10 children) were available for analysis. The following wrong administration routes were recorded: paravenous (51%), intravenous (33%), subcutaneous (8%), and others (8%). Medications most frequently involved were iodinated x-ray contrast media (11%) and iron infusions (9%). Twenty-eight percent of the patients were asymptomatic and 54% showed mild symptoms; moderate and severe symptoms were observed in 9% and 7.7%, respectively, and were mostly due to intravenous administration errors. There was no fatal outcome. In most symptomatic cases local nonspecific treatment was performed. CONCLUSIONS Enquiries concerning administration of medicines by an incorrect parenteral route were rare, and mainly involved iodinated x-ray contrast media and iron infusions. Most events occurred in adults and showed a benign clinical course. Although the majority of exposures concerned the paravenous route, the occasional severe cases were observed mainly after inadvertent intravenous administration.
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Affiliation(s)
- Alexandra Bloch-Teitelbaum
- Associated Institute of the University of Zurich, Swiss Toxicological Information Centre, Zurich, Switzerland
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LeBlanc JM, Kane-Gill SL, Pohlman AS, Herr DL. Multiprofessional survey of protocol use in the intensive care unit. J Crit Care 2012; 27:738.e9-17. [DOI: 10.1016/j.jcrc.2012.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 05/30/2012] [Accepted: 07/07/2012] [Indexed: 01/22/2023]
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Agalu A, Ayele Y, Bedada W, Woldie M. Medication administration errors in an intensive care unit in Ethiopia. Int Arch Med 2012; 5:15. [PMID: 22559252 PMCID: PMC3536604 DOI: 10.1186/1755-7682-5-15] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 04/25/2012] [Indexed: 01/09/2023] Open
Abstract
UNLABELLED BACKGROUND Medication administration errors in patient care have been shown to be frequent and serious. Such errors are particularly prevalent in highly technical specialties such as the intensive care unit (ICU). In Ethiopia, the prevalence of medication administration errors in the ICU is not studied. OBJECTIVE To assess medication administration errors in the intensive care unit of Jimma University Specialized Hospital (JUSH), Southwest Ethiopia. METHODS Prospective observation based cross-sectional study was conducted in the ICU of JUSH from February 7 to March 24, 2011. All medication interventions administered by the nurses to all patients admitted to the ICU during the study period were included in the study. Data were collected by directly observing drug administration by the nurses supplemented with review of medication charts. Data was edited, coded and entered in to SPSS for windows version 16.0. Descriptive statistics was used to measure the magnitude and type of the problem under study. RESULTS Prevalence of medication administration errors in the ICU of JUSH was 621 (51.8%). Common administration errors were attributed to wrong timing (30.3%), omission due to unavailability (29.0%) and missed doses (18.3%) among others. Errors associated with antibiotics took the lion's share in medication administration errors (36.7%). CONCLUSION Medication errors at the administration phase were highly prevalent in the ICU of Jimma University Specialized Hospital. Supervision to the nurses administering medications by more experienced ICU nurses or other relevant professionals in regular intervals is helpful in ensuring that medication errors don't occur as frequently as observed in this study.
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Affiliation(s)
- Asrat Agalu
- Department of Pharmacy, Wollo University, College medicine and Health Sciences, P, O, Box 11 45, Dessie, Ethiopia.
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Abstract
OBJECTIVES An evaluation of risk factors for adverse drug events in critically ill patients has not been previously studied. The purpose of this original study was to determine risk factors for adverse drug events in critically ill adult patients. DESIGN This retrospective case-control study includes patients who were admitted to the intensive care unit during a 7.5-yr period. SETTING Academic medical center with 647 beds that contains approximately 120 intensive care unit beds. PATIENTS Patients in the case group experienced an adverse drug event as documented in the hospital's database. The control group comprised the next two patients admitted to the same intensive care unit by the same admitting service. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Twenty-nine suspected risk factors identified from the literature were evaluated, including patient characteristics, drug characteristics, and laboratory values using a multiple logistic regression. A sample of 1101 cases and controls (54% male), with a mean age of 59.4 ± 17.5 yrs, were identified. In 367 cases, there was a total of 499 documented adverse drug events. Patients with kidney injury, thrombocytopenia, and those admitted emergently were 16-times, 3-times, and 2-times more likely to have an adverse drug event, respectively. Patients who were administered intravenous medications had a 3% higher risk of having an adverse drug event for each drug dispensed. Overall, the case group received more drugs per intensive care unit day and more drugs per intensive care unit stay. CONCLUSIONS Several patient and drug-related characteristics contribute to the risk of adverse drug events in critically ill patients. Diligent monitoring of factors that can influence the pharmacokinetic properties for existing drug therapies is necessary. Drug regimens should be evaluated daily for minimization. Based on previous studies, pharmacists as part of the interdisciplinary team could help to manage these risks.
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Gokhman R, Seybert AL, Phrampus P, Darby J, Kane-Gill SL. Medication errors during medical emergencies in a large, tertiary care, academic medical center. Resuscitation 2012; 83:482-7. [DOI: 10.1016/j.resuscitation.2011.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 07/21/2011] [Accepted: 10/03/2011] [Indexed: 11/15/2022]
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Agalu A, Ayele Y, Bedada W, Woldie M. Medication prescribing errors in the intensive care unit of Jimma University Specialized Hospital, Southwest Ethiopia. J Multidiscip Healthc 2011; 4:377-82. [PMID: 22135494 PMCID: PMC3215350 DOI: 10.2147/jmdh.s24671] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background A number of studies indicated that prescribing errors in the intensive care unit (ICU) are frequent and lead to patient morbidity and mortality, increased length of stay, and substantial extra costs. In Ethiopia, the prevalence of medication prescribing errors in the ICU has not previously been studied. Objective To assess medication prescribing errors in the ICU of Jimma University Specialized Hospital (JUSH), Southwest Ethiopia. Methods A cross-sectional study was conducted in the ICU of Jimma University Specialized Hospital from February 7 to April 15, 2011. All medication-prescribing interventions by physicians during the study period were included in the study. Data regarding prescribing interventions were collected from patient cards and medication charts. Prescribing errors were determined by comparing prescribed drugs with standard treatment guidelines, textbooks, handbooks, and software. Descriptive statistics were generated to meet the study objective. Results The prevalence of medication prescribing errors in the ICU of Jimma University Specialized Hospital was 209/398 (52.5%). Common prescribing errors were using the wrong combinations of drugs (25.7%), wrong frequency (15.5%), and wrong dose (15.1%). Errors associated with antibiotics represented a major part of the medication prescribing errors (32.5%). Conclusion Medication errors at the prescribing phase were highly prevalent in the ICU of Jimma University Specialized Hospital. Health care providers need to establish a system which can support the prescribing physicians to ensure appropriate medication prescribing practices.
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Affiliation(s)
- Asrat Agalu
- Wollo University, College of Health Sciences, Department of Pharmacy, Dessie, Ethiopia
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Kane-Gill SL, Visweswaran S, Saul MI, Wong AKI, Penrod LE, Handler SM. Computerized detection of adverse drug reactions in the medical intensive care unit. Int J Med Inform 2011; 80:570-8. [PMID: 21621453 DOI: 10.1016/j.ijmedinf.2011.04.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 02/21/2011] [Accepted: 04/22/2011] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Clinical event monitors are a type of active medication monitoring system that can use signals to alert clinicians to possible adverse drug reactions. The primary goal was to evaluate the positive predictive values of select signals used to automate the detection of ADRs in the medical intensive care unit. METHOD This is a prospective, case series of adult patients in the medical intensive care unit during a six-week period who had one of five signals presents: an elevated blood urea nitrogen, vancomycin, or quinidine concentration, or a low sodium or glucose concentration. Alerts were assessed using 3 objective published adverse drug reaction determination instruments. An event was considered an adverse drug reaction when 2 out of 3 instruments had agreement of possible, probable or definite. Positive predictive values were calculated as the proportion of alerts that occurred, divided by the number of times that alerts occurred and adverse drug reactions were confirmed. RESULTS 145 patients were eligible for evaluation. For the 48 patients (50% male) having an alert, the mean±SD age was 62±19 years. A total of 253 alerts were generated. Positive predictive values were 1.0, 0.55, 0.38 and 0.33 for vancomycin, glucose, sodium, and blood urea nitrogen, respectively. A quinidine alert was not generated during the evaluation. CONCLUSIONS Computerized clinical event monitoring systems should be considered when developing methods to detect adverse drug reactions as part of intensive care unit patient safety surveillance systems, since they can automate the detection of these events using signals that have good performance characteristics by processing commonly available laboratory and medication information.
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Affiliation(s)
- Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University Pittsburgh, Pittsburgh, PA 15261, United States.
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Popescu A, Currey J, Botti M. Multifactorial influences on and deviations from medication administration safety and quality in the acute medical/surgical context. Worldviews Evid Based Nurs 2011; 8:15-24. [PMID: 21210951 DOI: 10.1111/j.1741-6787.2010.00212.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Although numerous factors influence medication administration, our understanding of the interplay of these factors on medication quality and safety is limited. The aim of this study was to explore the multifactorial influences on medication quality and safety in the context of a single checking policy for medication administration in acute care. APPROACH An exploratory/descriptive study using non-participant observation and follow-up interview was used to identify factors influencing medication quality and safety in medication administration episodes (n=30). Observations focused on nurses' interactions with patients during medication administration, and the characteristics of the environment in which these took place. Confirmation of observed data occurred on completion of the observation period during short semi-structured interviews with participant nurses. FINDINGS Findings showed nurses developed therapeutic relationships with patients in terms of assessing patients before administering medications and educating patients about drugs during medication administration. Nurses experienced more frequent distractions when medications were stored and prepared in a communal drug room according to ward design. Nurses deviated from best-practice guidelines during medication administration. IMPLICATIONS Nurses' abilities and readiness to develop therapeutic relationships with patients increased medication quality and safety, thereby protecting patients from potential adverse events. Deviations from best-practice medication administration had the potential to decrease medication safety. System factors such as ward design determining medication storage areas can be readily addressed to minimise potential error. CONCLUSIONS Nurses displayed behaviours that increased medication administration quality and safety; however, violations of practice standards were observed. These findings will inform future intervention studies to improve medication quality and safety.
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Taib IA, McIntosh AS. On the integration and standardization of medication error data: taxonomies, terminologies, causes and contributing factors. Ther Adv Drug Saf 2010; 1:53-63. [PMID: 25083195 PMCID: PMC4110805 DOI: 10.1177/2042098610389850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE A reliable database on the causes and contributing factors of medication errors can inform strategies for their prevention. To form a single database from multiple databases requires a process of integration that both maximizes the utility of the new data and minimizes the loss of information. Unfortunately, the terminologies used by different studies and databases may limit integration; therefore, terminologies must be standardized prior to integration. METHODS The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Taxonomy of Medication Errors was applied to standardize the different terminologies in 11 studies that reported the causes or contributing factors of medication errors. RESULTS After standardization, 57% of the reported causes and contributing factors were integrated to form a database while 43% were not integrated because the terminologies could not be standardized or were not similar to the taxonomy. CONCLUSIONS This study highlights the challenges to standardizing and integrating databases and the importance of adopting and applying a standardized terminology to record medical errors.
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Affiliation(s)
- Ibrahim Adham Taib
- School of Risk and Safety Sciences, UNSW, Kensington, Australia and Department of Biomedical Sciences, Faculty of Science, International Islamic University Malaysia (IIUM), Malaysia
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Developing a patient safety surveillance system to identify adverse events in the intensive care unit. Crit Care Med 2010; 38:S117-25. [PMID: 20502165 DOI: 10.1097/ccm.0b013e3181dde2d9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aggregation of adverse drug event data has evolved in the last decade. Several approaches are available to augment the standard voluntary incident reporting system. Most of these methods are applicable to nonmedication adverse events as well. To identify appropriately system trends as well as process failures, intensive care units should participate in various collection methods. Several different methods are available for robust adverse drug event data collection, such as target chart review, nontargeted chart review, and direct observation. As the various methods usually capture different types of events, employing more than one technique will improve the assessment of intensive care unit care. Some of these surveillance methods offer real-time or near real-time identification of adverse drug events and potentially afford the practitioner time for intervention. Continued development of adverse drug event detection will allow for further quality improvement efforts and preventive strategies to be utilized.
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