1
|
Fuller AEC, Guirguis LM, Sadowski CA, Makowsky MJ. Evaluation of Medication Incidents in a Long-term Care Facility Using Electronic Medication Administration Records and Barcode Technology. Sr Care Pharm 2022; 37:421-447. [DOI: 10.4140/tcp.n.2022.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective To describe the frequency, type, and severity of reported medication incidents that occurred at a long-term care facility (LTCF) despite electronic medication administration record and barcode-assisted medication administration (eMAR-BCMA) use. The study also contains
analysis for the contribution of staff workarounds to reported medication administration errors (MAEs) using an established typology for BCMA workarounds, characterize if the eMAR-BCMA technology contributed to MAEs, and explore characteristics influencing incident severity. Design
Retrospective incident report review. Setting A 239-bed LTCF in Alberta, Canada, that implemented eMAR-BCMA in 2013. Participants 270 paper-based, medication incident reports submitted voluntarily between June 2015 and October 2017. Interventions
None. Results Most of the 264 resident-specific medication incidents occurred during the administration (71.9%, 190/264) or dispensing (28.4%, 75/264) phases, and 2.3% (6/264) resulted in temporary harm. Medication omission (43.7%, 83/190) and incorrect time (22.6%,
43/190) were the most common type of MAE. Workarounds occurred in 41.1% (78/190) of MAEs, most commonly documenting administration before the medication was administered (44.9%, 35/78). Of the non-workaround MAEs, 52.7% (59/112) were notassociated with the eMAR-BCMA technology, while 26.8%
(30/112) involved system design shortcomings, most notably lack of a requirement to scan each medication pouch during administration. MAEs involving workarounds were less likely to reach the resident (74.4 vs 88.8%; relative risk = 0.84, 95% CI 0.72-0.97). Conclusion Administration
and dispensing errors were the most reported medication incidents. eMAR-BCMA workarounds, and design shortcomings were involved in a large proportion of reported MAEs. Attention to optimal eMAR-BCMA use and design are required to facilitate medication safety in LTCFs.
Collapse
Affiliation(s)
- Andrew E. C. Fuller
- University of Alberta, College of Health Sciences, Edmonton, Alberta, Canada
| | - Lisa M. Guirguis
- University of Alberta, College of Health Sciences, Edmonton, Alberta, Canada
| | - Cheryl A. Sadowski
- University of Alberta, College of Health Sciences, Edmonton, Alberta, Canada
| | - Mark J. Makowsky
- University of Alberta, College of Health Sciences, Edmonton, Alberta, Canada
| |
Collapse
|
2
|
Singh S, Farrelly A, Chan C, Nicholls B, Nazeri-Rad N, Bellicoso D, Eisen A, Falkson CB, Fox C, Holloway C, Kennedy E, McLeod R, Rothenberger D, Trudeau M, Shanafelt T, Bauman G. Prevalence and Workplace Drivers of Burnout in Cancer Care Physicians in Ontario, Canada. JCO Oncol Pract 2021; 18:e60-e71. [PMID: 34506217 DOI: 10.1200/op.21.00170] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Provider well-being has become the fourth pillar of the quadruple aim for providing quality care. Exacerbated by the global COVID-19 pandemic, provider well-being has become a critical issue for health care systems worldwide. We describe the prevalence and key system-level drivers of burnout in oncologists in Ontario, Canada. METHODS This is a cross-sectional survey study conducted in November-December 2019 of practicing cancer care physicians (surgical, medical, radiation, gynecologic oncology, and hematology) in Ontario, Canada. Ontario is Canada's largest province (with a population of 14.5 million), and has a single-payer publicly funded cancer system. The primary outcome was burnout experience assessed through the Maslach Burnout Inventory. RESULTS A total of 418 physicians completed the questionnaire (response rate was 44% among confirmed oncologists). Seventy-three percent (n = 264 of 362) of oncologists had symptoms of burnout (high emotional exhaustion and/or depersonalization scores). Significant drivers of burnout identified in multivariable regression modeling included working in a hectic or chaotic atmosphere (odds ratio [OR] = 15.5; 95% CI, 3.4 to 71.5; P < .001), feeling unappreciated on the job (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), reporting poor or marginal control over workload (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), and not being comfortable talking to peers about workplace stress (OR = 3.0; 95% CI, 1.1 to 7.9; P < .001). Older age (≥ 56 years) was associated with lower odds of burnout (OR = 0.16; 95% CI, 0.1 to 0.4; P < .001). CONCLUSION Nearly three quarters of participants met predefined standardized criteria for burnout. This number is striking, given the known impact of burnout on provider mental health, patient safety, and quality of care, and suggests Oncologists in Ontario may be a vulnerable group that warrants attention. Health care changes being driven by the COVID-19 pandemic provide an opportunity to rebuild new systems that address drivers of burnout. Creating richer peer-to-peer and leadership engagement opportunities among early- to mid-career individuals may be a worthwhile organizational strategy.
Collapse
Affiliation(s)
- Simron Singh
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ashley Farrelly
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Catherine Chan
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Brett Nicholls
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | | | | | - Andrea Eisen
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Colleen Fox
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | | | - Erin Kennedy
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Robin McLeod
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | | | | | - Tait Shanafelt
- Department of Medicine & WellMD Center, Stanford University, Palo Alto, CA
| | - Glenn Bauman
- Western University, London Regional Cancer Program, London, Ontario, Canada
| |
Collapse
|