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Asadi M, Ahmadi F, Mohammadi E, Vaismoradi M. Unsafe doctor-nurse interactions in the process of implementing medical orders: A qualitative study. Nurs Open 2023; 10:6808-6816. [PMID: 37353880 PMCID: PMC10495711 DOI: 10.1002/nop2.1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/25/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023] Open
Abstract
AIM This study aimed to explore challenges faced by clinical nurses in the process of implementing medical orders. DESIGN A qualitative study using inductive content analysis. METHODS Semi-structured individual interviews were carried out with 17 participants including nurses, nurse managers and medical doctors who were purposefully selected. The collected data underwent inductive qualitative content analysis. RESULTS The main research finding was the category of 'unsafe doctor-nurse interaction'. It included three subcategories: 'conflicts in documenting and executing orders', 'not accepting the nurse's suggestions for writing and correcting orders' and 'failure to accept the responsibility of orders by the doctor'. Challenges in the professional relationship between doctors and nurses cause mistrust and conflict. They also enhance nurses' concerns about professional and legal issues in the workplace and endanger patient safety.
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Affiliation(s)
- Monireh Asadi
- Department of Nursing, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
| | - Easa Mohammadi
- Department of Nursing, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
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Abdel-Qader DH, Saadi Ismael N, Al Meslamani AZ, Albassam A, El-Shara' AA, Lewis PJ, Hamadi S, Al Mazrouei N. The Role of Clinical Pharmacy in Preventing Prescribing Errors in the Emergency Department of a Governmental Hospital in Jordan: A Pre-Post Study. Hosp Pharm 2021; 56:681-689. [PMID: 34732922 DOI: 10.1177/0018578720942231] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Clinical pharmacists have a vital role in intercepting prescribing errors (PEs) but their impact within a Jordanian hospital emergency department (ED) has never been studied. Objective: To evaluate the impact of clinical pharmacy services on PEs and assess predictors of physicians' acceptance of clinical pharmacists' interventions. Setting: This study was conducted in the ED of the largest governmental hospital in Jordan. Method: This was a pre-post study conducted in October and November 2019 using a disguised observational method. There were 2 phases: control phase (P0) with no clinical interventions, and active phase (P1) where clinical pharmacists prospectively intervened upon errors. The clinical significance of errors was determined by a multidisciplinary committee. The SPSS software version 24 was used for data analysis. Main Outcome Measure: PEs incidence, type, severity, and predictors for physicians' acceptance. Results: Of 18003 patients, 8732 were included in P0 and 9271 in P1. PEs incidence decreased from 24.6% to 5.4%. Contraindication, drug selection, and dosage form error types were significantly reduced from 32.6%, 9.1%, and 3.7% (P0) to 12.6%, 0.0%, and 0.0% (P1), respectively. Albeit not statistically significant, drug-drug interaction, drug frequency, and allergy error types were reduced from 4.9%, 3.1%, and 0.1% to 4.5%, 2.5%, and 0.0%, respectively. Significant and serious errors were significantly reduced from 68.7% and 3.0% (P0) to 8.9% and 1.8% (P1), respectively. During P1, most errors were minor (89.3%, 1574/1763), and lethal errors ceased. Predictors for physicians' acceptance were: significant errors (OR 3.1; 95% CI 2.6-4.3; P = 0.03) and non-busy physicians (OR 2.1; 95% CI 1.6-2.7; P = 0.04). Conclusion: Clinical pharmacists significantly reduced PEs in the ED by 76%; most of interventions were significant. Policymakers are advised to implement active clinical pharmacy in the ED.
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Affiliation(s)
- Derar H Abdel-Qader
- Department of Pharmacology and Biomedical Sciences, University of Petra, Amman, Jordan
| | | | - Ahmad Z Al Meslamani
- Department of Pharmacology and Biomedical Sciences, University of Petra, Amman, Jordan
| | | | - Asma' A El-Shara'
- Department of Clinical Sciences, Philadelphia University, Amman, Jordan
| | - Penny J Lewis
- Division of Pharmacy & Optometry, The University of Manchester, UK
| | - Salim Hamadi
- Department of Pharmacology and Biomedical Sciences, University of Petra, Amman, Jordan
| | - Nadia Al Mazrouei
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, UAE
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Evaluating Leadership Behaviors and Patient Safety Competencies During a Timed Multiple-Patient Simulation. Nurs Educ Perspect 2021; 42:E46-E48. [PMID: 34698478 DOI: 10.1097/01.nep.0000000000000800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A digital count-up clock was incorporated into a multiple-patient simulation that required nursing students to respond to laboratory values and administer medications in a timely fashion. This study utilized observational methodology to analyze student response times and leadership behaviors. Results indicated a count-up clock can be utilized to assess attainment of patient safety competencies. Leadership behaviors observed included time management and collaboration. Utilization of the count-up clock enabled faculty to determine that quality and safety measures were being achieved. This pilot study sets precedence for more rigorous research to measure nursing student competencies where time matters.
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Stephen G, Moran D, Broderick J, Shaikh HA, Tschudy MM, Connors C, Williams T, Pham JC. A Quality Improvement Intervention Reduces the Time to Administration of Stat Medications. Pediatr Qual Saf 2017; 2:e021. [PMID: 30229159 PMCID: PMC6132455 DOI: 10.1097/pq9.0000000000000021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/13/2017] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The delivery of urgent ("stat") medications to hospitalized children is important for safe quality care. The goal of this study was to evaluate the effect of a set of interventions on the percentage of stat medications administered within 30 minutes of ordering. METHODS A pre-post study in 2 pediatric units (36 beds) in a private hospital in Saudi Arabia between January 2015 and September 2016. Interventions included structured communication requirements, introduction of a dedicated electronic inbox for stat medication orders sent by nurses to the pharmacy, and the use of a pink envelope for the delivery of stat medications. A multivariate logistic regression model was used to model percentage of medications administered within goal. RESULTS Three hundred four stat orders met inclusion criteria. The proportion of orders meeting the 30-minute goal increased from a mean of 20% to a mean of 49% after the interventions (P < 0.001). In the final month of the study, compliance reached a peak of 67%. The mean turnaround time from ordering to the administration of the medication decreased from 59.7 to 40.7 minutes (P < 0.001). On multivariate analysis, medication type and unit-based availability of medications were statistically significant predictors of turnaround time. The odds of compliance being achieved was 0.3 times less if the medication was not available on the unit. CONCLUSIONS A set of interventions significantly increased the percentage of stat medications delivered within 30 minutes.
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Affiliation(s)
- Gigimol Stephen
- From the Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Md.; Johns Hopkins University School of Medicine, Baltimore, Md.; and University of Hawaii School of Medicine, Honolulu, Hawaii
| | - Dane Moran
- From the Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Md.; Johns Hopkins University School of Medicine, Baltimore, Md.; and University of Hawaii School of Medicine, Honolulu, Hawaii
| | - Joan Broderick
- From the Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Md.; Johns Hopkins University School of Medicine, Baltimore, Md.; and University of Hawaii School of Medicine, Honolulu, Hawaii
| | - Hanan A. Shaikh
- From the Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Md.; Johns Hopkins University School of Medicine, Baltimore, Md.; and University of Hawaii School of Medicine, Honolulu, Hawaii
| | - Megan M. Tschudy
- From the Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Md.; Johns Hopkins University School of Medicine, Baltimore, Md.; and University of Hawaii School of Medicine, Honolulu, Hawaii
| | - Cheryl Connors
- From the Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Md.; Johns Hopkins University School of Medicine, Baltimore, Md.; and University of Hawaii School of Medicine, Honolulu, Hawaii
| | - Tammy Williams
- From the Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Md.; Johns Hopkins University School of Medicine, Baltimore, Md.; and University of Hawaii School of Medicine, Honolulu, Hawaii
| | - Julius C. Pham
- From the Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Md.; Johns Hopkins University School of Medicine, Baltimore, Md.; and University of Hawaii School of Medicine, Honolulu, Hawaii
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