1
|
Menezes MS, Doria GAA, Valença-Feitosa F, Pereira SN, Silvestre CC, de Oliveira Filho AD, Lobo IMF, Quintans-Júnior LJ. Incidence of drug-related adverse events related to the use of high-alert drugs: A systematic review of randomized controlled trials. Explor Res Clin Soc Pharm 2024; 14:100435. [PMID: 38646469 PMCID: PMC11031819 DOI: 10.1016/j.rcsop.2024.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Background High-alert medication (HAM) is more predictable to cause significant harm to the patient, even when used as intended. The damage related to the HAM lead not only suffering to the patient, but also raise the additional costs associated with care. Objective Evaluate the incidence of drug-related adverse events related to the use of high-alert medications. Methods It was conducted an active search for information through COCHRANE databases, LILACS, SciELO, SCOPUS, PubMed/MEDLINE and WEB OF SCIENCE. The search strategy included the following terms: "Patient safety", "Medication errors" and "Hospital" and "High Alert Medications" or "Dangerous Drugs" in different combinations. Then two reviewers independently conducted a preliminary evaluation of relevant titles, abstracts and finally full-text. Studies quality was evaluated according to PRISMA declaration. Results The systematic review evaluated seven articles, which showed that only 11 HAM identified in the literature could have serious events. The most frequently cited were warfarin (22.2%) which progressed from deep vein thrombosis to gangrene, suggesting lower initial doses, followed by cyclophosphamide (22.2%) and cyclosporine (22.2%) which presented invasive fungal infection and death. In addition to these, morphine was compared with its active metabolite (M6G), with M6G causing fewer serious clinical events related to nausea and vomiting, reducing the need for concomitant use of antiemetics. Conclusions The most reported drug classes in the articles included that were related to incidence of drug-related adverse events in use of high-alert medications: morphine, M6G-glucuronide, haloperidol, promethazine, ivabradine, digoxin, warfarin, ximelagatran, cyclophosphamide, cyclosporine, and ATG. The formulate protocols for the use of these medications, with importance placed on evaluating, among the classes, the medication that causes the least harm.
Collapse
Affiliation(s)
- Michelle Santos Menezes
- Federal University of Sergipe (UFS), Cidade Universitária “Prof. José Aloísio Campos”, Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil
| | - Grace Anne Azevedo Doria
- Federal University of Sergipe (UFS), Cidade Universitária “Prof. José Aloísio Campos”, Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil
| | - Fernanda Valença-Feitosa
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária “Prof. José Aloísio Campos”, Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil
| | - Sylmara Nayara Pereira
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária “Prof. José Aloísio Campos”, Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil
| | - Carina Carvalho Silvestre
- Federal University of Juiz de Fora - Governador Valadares Campus, Minas Gerais, University Campus, Rua José Lourenço Kelmer, s/n - São Pedro, Juiz de Fora, MG, 36036-900, Brazil
| | - Alfredo Dias de Oliveira Filho
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária “Prof. José Aloísio Campos”, Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil
| | - Iza Maria Fraga Lobo
- Federal University of Bahia (2003). Infectologist, Head of the Risk Management Unit (UGRA) and Risk Manager of the University Hospital of the Federal University of Sergipe, R. Cláudio Batista - Palestine, Aracaju - SE, 49060-676, Brazil
| | - Lucindo José Quintans-Júnior
- Physiology Department, Federal University of Sergipe (DFS/UFS)
- Laboratory of Neurosciences and Pharmacological Tests (LANEF), Federal University of Sergipe, Rua Marechal Rondon, s/n. University City "Prof. José Aloísio Campos ", Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil
| |
Collapse
|
2
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
3
|
Mikkelsen TH, Søndergaard J, Kjær NK, Nielsen JB, Ryg J, Kjeldsen LJ, Mogensen CB. Designing a tool ensuring older patients the right medication at the right time after discharge from hospital- the first step in a participatory design process. BMC Health Serv Res 2024; 24:511. [PMID: 38658997 PMCID: PMC11040918 DOI: 10.1186/s12913-024-10992-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND On average, older patients use five or more medications daily, increasing the risk of adverse drug reactions, interactions, or medication errors. Healthcare sector transitions increase the risk of information loss, misunderstandings, unclear treatment responsibilities, and medication errors. Therefore, it is crucial to identify possible solutions to decrease these risks. Patients, relatives, and healthcare professionals were asked to design the solution they need. METHODS We conducted a participatory design approach to collect information from patients, relatives, and healthcare professionals. The informants were asked to design their take on a tool ensuring that patients received the correct medication after discharge from the hospital. We included two patients using five or more medications daily, one relative, three general practitioners, four nurses from different healthcare sectors, two hospital physicians, and three pharmacists. RESULTS The patients' solution was a physical location providing a medication overview, including side effects and interactions. Healthcare professionals suggested different solutions, including targeted and timely information that provided an overview of the patient's diagnoses, treatment and medication. The common themes identified across all sub-groups were: (1) Overview of medications, side effects, and diagnoses, (2) Sharing knowledge among healthcare professionals, (3) Timely discharge letters, (4) Does the shared medication record and existing communication platforms provide relevant information to the patient or healthcare professional? CONCLUSION All study participants describe the need for a more concise, relevant overview of information. This study describes elements for further elaboration in future participatory design processes aimed at creating a tool to ensure older patients receive the correct medication at the correct time.
Collapse
Affiliation(s)
- Thorbjørn Hougaard Mikkelsen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Kristian Kjær
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Lene Juel Kjeldsen
- The hospital pharmacy research unit, Hospital Sønderjylland, Aabenraa, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Matava CT, Bordini M, Jasudavisius A, Santos C, Caldeira-Kulbakas M. Comparing the Effectiveness of a Clinical Decision Support Tool in Reducing Pediatric Opioid Dose Calculation Errors: PediPain App vs. Traditional Calculators - A Simulation-Based Randomised Controlled Study. J Med Syst 2024; 48:43. [PMID: 38630157 DOI: 10.1007/s10916-024-02060-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
Wrong dose calculation medication errors are widespread in pediatric patients mainly due to weight-based dosing. PediPain app is a clinical decision support tool that provides weight- and age- based dosages for various analgesics. We hypothesized that the use of a clinical decision support tool, the PediPain app versus pocket calculators for calculating pain medication dosages in children reduces the incidence of wrong dosage calculations and shortens the time taken for calculations. The study was a randomised controlled trial comparing the PediPain app vs. pocket calculator for performing eight weight-based calculations for opioids and other analgesics. Participants were healthcare providers routinely administering opioids and other analgesics in their practice. The primary outcome was the incidence of wrong dose calculations. Secondary outcomes were the incidence of wrong dose calculations in simple versus complex calculations; time taken to complete calculations; the occurrence of tenfold; hundredfold errors; and wrong-key presses. A total of 140 residents, fellows and nurses were recruited between June 2018 and November 2019; 70 participants were randomized to control group (pocket calculator) and 70 to the intervention group (PediPain App). After randomization two participants assigned to PediPain group completed the simulation in the control group by mistake. Analysis was by intention-to-treat (PediPain app = 68 participants, pocket calculator = 72 participants). The overall incidence of wrong dose calculation was 178/576 (30.9%) for the control and 23/544 (4.23%) for PediPain App, P < 0·001. The risk difference was - 32.8% [-38.7%, -26.9%] for complex and - 20.5% [-26.3%, -14.8%] for simple calculations. Calculations took longer within control group (median of 69 Sects. [50, 96]) compared to PediPain app group, (median 48 Sects. [38, 63]), P < 0.001. There were no differences in other secondary outcomes. A weight-based clinical decision support tool, the PediPain app reduced the incidence of wrong doses calculation. Clinical decision support tools calculating medications may be valuable instruments for reducing medication errors, especially in the pediatric population.
Collapse
Affiliation(s)
- Clyde T Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON), Canada.
| | - Martina Bordini
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON), Canada
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Amanda Jasudavisius
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, ON), Canada
| | - Carmina Santos
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Monica Caldeira-Kulbakas
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| |
Collapse
|
5
|
Johnsgård T, Elenjord R, Holis RV, Waaseth M, Zahl-Holmstad B, Fagerli M, Svendsen K, Lehnbom EC, Ofstad EH, Risør T, Garcia BH. How much time do emergency department physicians spend on medication-related tasks? A time- and-motion study. BMC Emerg Med 2024; 24:56. [PMID: 38594615 PMCID: PMC11003058 DOI: 10.1186/s12873-024-00974-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Medication-related problems are an important cause of emergency department (ED) visits, and medication errors are reported in up to 60% of ED patients. Procedures such as medication reconciliation and medication review can identify and prevent medication-related problems and medication errors. However, this work is often time-consuming. In EDs without pharmacists, medication reconciliation is the physician's responsibility, in addition to the primary assignments of examining and diagnosing the patient. The aim of this study was to identify how much time ED physicians spend on medication-related tasks when no pharmacists are present in the EDs. METHODS An observational time-and-motion study of physicians in three EDs in Northern Norway was conducted using Work Observation Method by Activity Timing (WOMBAT) to collect and time-stamp data. Observations were conducted in predefined two-hour observation sessions with a 1:1 relationship between observer and participant, during Monday to Friday between 8 am and 8 pm, from November 2020 to October 2021. RESULTS In total, 386 h of observations were collected during 225 observation sessions. A total of 8.7% of the physicians' work time was spent on medication-related tasks, of which most time was spent on oral communication about medications with other physicians (3.0%) and medication-related documentation (3.2%). Physicians spent 2.2 min per hour on medication reconciliation tasks, which includes retrieving medication-related information directly from the patient, reading/retrieving written medication-related information, and medication-related documentation. Physicians spent 85.6% of the observed time on non-medication-related clinical or administrative tasks, and the remaining time was spent standby or moving between tasks. CONCLUSION In three Norwegian EDs, physicians spent 8.7% of their work time on medication-related tasks, and 85.6% on other clinical or administrative tasks. Physicians spent 2.2 min per hour on tasks related to medication reconciliation. We worry that patient safety related tasks in the EDs receive little attention. Allocating dedicated resources like pharmacists to contribute with medication-related tasks could benefit both physicians and patients.
Collapse
Affiliation(s)
- Tine Johnsgård
- Hospital Pharmacy of North Norway Trust, Tromsø, Norway.
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
| | - Renate Elenjord
- Hospital Pharmacy of North Norway Trust, Tromsø, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | | | - Marit Waaseth
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Birgitte Zahl-Holmstad
- Hospital Pharmacy of North Norway Trust, Tromsø, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Marie Fagerli
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kristian Svendsen
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Elin Christina Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Eirik Hugaas Ofstad
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Medicine, Nordland Hospital Trust, Bodø, Norway
| | - Torsten Risør
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Beate Hennie Garcia
- Hospital Pharmacy of North Norway Trust, Tromsø, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
6
|
Aceves-Gonzalez C, Caro-Rojas A, Rey-Galindo JA, Aristizabal-Ruiz L, Hernández-Cruz K. Estimating the impact of label design on reducing the risk of medication errors by applying HEART in drug administration. Eur J Clin Pharmacol 2024; 80:575-588. [PMID: 38282080 PMCID: PMC10937752 DOI: 10.1007/s00228-024-03619-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
Medication errors are one of the biggest problems in healthcare. The medicines' poor labelling design (i.e. look-alike labels) is a well-recognised risk for potential confusion, wrong administration, and patient damage. Human factors and ergonomics (HFE) encourages the human-centred design of system elements, which might reduce medication errors and improve people's well-being and system performance. OBJECTIVE The aim of the present study is twofold: (i) to use a human reliability analysis technique to evaluate a medication administration task within a simulated scenario of a neonatal intensive care unit (NICU) and (ii) to estimate the impact of a human-centred design (HCD) label in medication administration compared to a look-alike (LA) label. METHOD This paper used a modified version of the human error assessment and reduction technique (HEART) to analyse a medication administration task in a simulated NICU scenario. The modified technique involved expert nurses quantifying the likelihood of unreliability of a task and rating the conditions, including medicine labels, which most affect the successful completion of the task. RESULTS Findings suggest that error producing conditions (EPCs), such as a shortage of time available for error detection and correction, no independent checking of output, and distractions, might increase human error probability (HEP) in administering medications. Results also showed that the assessed HEP and the relative percentage of contribution to unreliability reduced by more than 40% when the HCD label was evaluated compared to the LA label. CONCLUSION Including labelling design based on HFE might help increase human reliability when administering medications under critical conditions.
Collapse
|
7
|
Gama DON, Melo CMMD, Santos TAD, Silva-Santos H, Reddy N, Ortega J, Gusmão MEN. A cross exploratory analysis between nursing working conditions and the occurrence of errors in the northeast region of Brazil. Appl Nurs Res 2024; 76:151784. [PMID: 38641381 DOI: 10.1016/j.apnr.2024.151784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES Analyze and verify the association between working conditions and the occurrence of errors in nursing work. BACKGROUND Many of the known errors in nursing are based on the structural failure of the complex health service system. Our study addresses the question "Is there an association between errors made by nursing workers and working conditions?" METHODS The study was carried out through a cross-sectional exploratory analysis of 19 ethical-disciplinary processes focused on errors made by nursing workers. The articles were processed, judged, and archived at the Regional Nursing Councils of the Northeast Region of Brazil from 2000 to 2018. The chi-square test or Fisher's exact test was used to verify the relationship between the variables through multivariate analysis. RESULTS The analyzes show that working conditions can interfere at occurrence in error. This increases the chance of an "inconsequential" error occurring for the patient in poor/very poor working conditions. The most serious errors, "with consequences irreversible" for the patient, only occur from more severe working conditions. Adversely, it was found that there is no statistically significant difference in the frequency of errors in hospitals (33.33 %) compared to "other places" (28.58 %) when these occurred in poor working conditions. When conducting the incident in poor working conditions, there was a minimum of 52 % protection OR = 0.48 % [0.16; 11.80]; (1-0.48)) against these errors in general in the nursing area. CONCLUSION The strong association was exposed in working conditions classified as bad/very bad/very bad, resulting in the most serious errors and with irreversible consequences for patients. However, a level of protection for different types of workers was noticed in the field, which shows that there is hope that if the work environment changes with more organization, management, and standards of care, we can prevent future errors.
Collapse
Affiliation(s)
| | | | | | - Handerson Silva-Santos
- School of Nursing, Universidade Federal da Bahia, Salvador, Brazil; School of Nursing, University of Miami, Miami, United States of America
| | - Neha Reddy
- School of Nursing, University of Miami, Miami, United States of America
| | - Johis Ortega
- School of Nursing, University of Miami, Miami, United States of America
| | | |
Collapse
|
8
|
Alanazi SA, Al Amri A, Almuqbil M, Alroumi A, Gamal Mohamed Alahmadi M, Obaid Ayesh Alotaibi J, Mohammed Sulaiman Alenazi M, Hassan Mossad Alahmadi W, Hassan Saleh Al Bannay A, Khaled Ahmad Marai S, AlKhatham SM, Al-kanhal S, Asdaq SMB. Use of potentially inappropriate medication for elderly patients in tertiary care hospital of Riyadh, Saudi Arabia. Saudi Pharm J 2024; 32:102015. [PMID: 38497086 PMCID: PMC10940805 DOI: 10.1016/j.jsps.2024.102015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/24/2024] [Indexed: 03/19/2024] Open
Abstract
Background and objectives The elderly population is affected by chronic diseases and lifelong medication. The American Geriatrics Society (AGS) Beers Criteria is a comprehensive approach to medication usage in the older population to reduce potentially inappropriate medication (PIM) use. The purpose of this study was to assess the usage of PIMs in elderly patients upon discharge from tertiary care hospital settings in Riyadh, Saudi Arabia, using the AGS Beers Criteria 2019. Methods The data was obtained from the medical records of 1237 patients (>65 years) who were discharged from medical or surgical wards at two hospitals affiliated with King Abdulaziz Medical City. The data was analyzed to determine the prevalence of PIM prescription, and the proportional odds of the independent factors influencing outcomes were estimated using ordinal regression analysis for criteria 1 and 2, while Binary regression analysis was conducted for criterion 3. Results There were approximately equal numbers of male and female participants in our study (male: 50.8 % vs. female: 49.2 %). One-third of the patients were above the age of 80 years, with 41 % being between the ages of 70 and 80 years. Moreover, almost 70 % of the samples had chronic illnesses. The overall prevalence of PIMs was 29.2 %, with 11 % of PIMs to be avoided in elderly patients and 17 % to be used with caution in the elderly, while disease-specific PIMs were identified in 1.2 % of the patients. The most common PIM class was proton pump inhibitors (44.41 %), and patients discharged from the surgical unit were more likely to be prescribed PIMs. Proton pump inhibitors (44.41 %) were the most inappropriately prescribed drug class, and patients discharged from the surgical unit were more likely to be prescribed PIMs. Conclusion The study noticed that male gender, the presence of multiple diseases, and obesity are associated with more than one PIM prescription. There is a need to streamline the surgical department's prescription procedure to eliminate prescription disparities. Prescription monitoring is recommended to avoid medication errors, particularly in patients who are taking multiple medications.
Collapse
Affiliation(s)
- Saleh A. Alanazi
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulrahman Al Amri
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mansour Almuqbil
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Abdullah Alroumi
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Joud Obaid Ayesh Alotaibi
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | | | | | | | - Shorooq Khaled Ahmad Marai
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | | | - Sarah Al-kanhal
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | | |
Collapse
|
9
|
Fathizadeh H, Mousavi SS, Gharibi Z, Rezaeipour H, Biojmajd AR. Prevalence of medication errors and its related factors in Iranian nurses: an updated systematic review and meta-analysis. BMC Nurs 2024; 23:175. [PMID: 38481264 PMCID: PMC10938711 DOI: 10.1186/s12912-024-01836-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Nurses may make medication errors during the implementation of therapeutic interventions, which initially threaten the patient's health and safety and prolong their hospital stay. These errors have always been a challenge for healthcare systems. Given that factors such as the timing, type, and causes of medication errors can serve as suitable predictors for their occurrence, we have decided to conduct a review study aiming to investigate the prevalence of medication errors and the associated factors among Iranian nurses. METHODS In this systematic review and meta-analysis, studies were searched on PubMed, Web of Science, Scopus, Google Scholar, IranMedex, Magiran, and SID databases using a combination of keywords and Boolean functions. The study that reported the prevalence of medication errors among nurses in Iran without time limitation up to May 2023 was included in this study. RESULTS A total of 36 studies were included in the analysis. The analysis indicates that 54% (95% CI: 43, 65; I2 = 99.3%) of Iranian nurses experienced medication errors. The most common types of medication errors by nurses were wrong timing 27.3% (95% CI: 19, 36; I2 = 95.8%), and wrong dosage 26.4% (95% CI: 20, 33; I2 = 91%). Additionally, the main causes of medication errors among nurses were workload 43%, fatigue 42.7%, and nursing shortage 38.8%. In this study, just 39% (95% CI: 27, 50; I2 = 97.1%) of nurses with medication errors did report their errors. Moreover, the prevalence of medication errors was more in the night shift at 41.1%. The results of the meta-regression showed that publication year and the female-to-male ratio are good predictors of medical errors, but they are not statistically significant(p > 0.05). CONCLUSIONS To reduce medication errors, nurses need to work in a calm environment that allows for proper nursing interventions and prevents overcrowding in departments. Additionally, considering the low reporting of medication errors to managers, support should be provided to nurses who report medication errors, in order to promote a culture of reporting these errors among Iranian nurses and ensure patient safety is not compromised.
Collapse
Affiliation(s)
- Hadis Fathizadeh
- Department of Laboratory Sciences, Sirjan School of Medical Sciences, Sirjan, Iran
| | | | - Zahra Gharibi
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | | |
Collapse
|
10
|
Mortelmans L, Dilles T. The development and evaluation of a medication diary to report problems with medication use. Heliyon 2024; 10:e26127. [PMID: 38375256 PMCID: PMC10875575 DOI: 10.1016/j.heliyon.2024.e26127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose The study aimed to develop and evaluate a medication diary for patients to report problems with medication use to enable shared-decision making and improve medication adherence. Methods Based on a search for existing diaries, a review of the content, and a list of medication self-management problems compiled from previous research, a paper and pencil version of a medication diary was developed. The diary was reviewed for clarity and overall presentation by five healthcare providers and nine patients. Afterwards, user-friendliness was evaluated by 69 patients with polypharmacy discharged from hospital during a quantitative prospective study. Results The medication diary consists of several parts: (1) a medication schedule allowing patients to list their medicines, (2) information sheets allowing patients to write down specific medication-related information, (3) a monthly overview to indicate daily whether medication-related problems were experienced, (4) problem sheets elaborating on the problems encountered, (5) space for specific medication-related questions for healthcare providers to facilitate shared-decision making. The review phase resulted in minor textual adjustments and one extra problem in the problem sheet. Most participants, who tested the medication diary for two months, found the diary user-friendly (80%) and easy to fill in (89%). About 40% of participants reported problems with medication use. Half of the patients indicated that the diary can facilitate discussing problems with healthcare providers. Conclusion The medication diary offers patients the opportunity to report problems regarding their medication use in a proven user-friendly manner and to discuss these problems with healthcare providers. Reporting and discussing problems with medication use can serve as a first step towards making shared decisions on how to address the problems encountered.
Collapse
Affiliation(s)
- Laura Mortelmans
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Tinne Dilles
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
11
|
Kunwor P, Basyal B, Pathak N, Vaidya P, Shrestha S. Study to evaluate awareness about medication errors and impact of an educational intervention among healthcare personnel in a cancer hospital. J Oncol Pharm Pract 2024:10781552241235898. [PMID: 38404015 DOI: 10.1177/10781552241235898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Medication errors (MEs) are preventable incidents that can result in harm to patients. Therefore, it is essential for healthcare professionals (HCPs) to be well-informed about MEs. This study aims to assess the awareness levels of HCPs and the impact of educational intervention on their understanding of MEs. METHODS Responses to a 17-question structured, self-administered questionnaire assessing the awareness of HCPs regarding fundamental aspects of MEs, ME reporting systems, and their ability to make recommendations for improving the system for handling the MEs were collected both before and after two weeks of educational intervention administration. RESULTS Of a total of 114 HCPs who initially participated in the study, six dropped following the intervention. The awareness regarding the Class A questionnaire was good in most physicians (60%), nurses (60%), and pharmacists (57%) before the intervention, which improved postintervention, with physicians (80%), nurses (32%), and pharmacists (78%) demonstrating excellent awareness. The awareness level in the Class B questionnaire was also improved to excellent in most physicians (70%), pharmacists (85%), and nurses (85%) following the intervention, while it was excellent only in 50%, 35%, and 1% of physicians, pharmacists, and nurses, respectively, preintervention. In the Class C questionnaire, most physicians (40%) and nurses (60%) had good awareness, while pharmacists (35%) demonstrated excellent awareness preintervention. Postintervention, most physicians (70%), nurses (77%), and pharmacists (64%) exhibited excellent awareness. CONCLUSION Most oncology practice HCPs demonstrate a good to average level of awareness regarding MEs. Clinical pharmacists' educational interventions can significantly enhance awareness among HCPs concerning MEs.
Collapse
Affiliation(s)
- Puskar Kunwor
- Department of Clinical Pharmacy, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
| | - Bijaya Basyal
- Pharmaceutical Sciences Program, School of Health and Allied Sciences, Faculty of Health Sciences, Pokhara University, Kaski, Nepal
| | - Nabin Pathak
- Pharmaceutical Sciences Program, School of Health and Allied Sciences, Faculty of Health Sciences, Pokhara University, Kaski, Nepal
| | - Pankaj Vaidya
- Department of Hospital Pharmacy, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
| | - Sudip Shrestha
- Department of Medical Oncology, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
| |
Collapse
|
12
|
Balıkçı BB, Güneş Ü. Accuracy of liquid drug dose measurements using different tools by caregivers: a prospective observational study. Eur J Pediatr 2024; 183:853-862. [PMID: 37875630 DOI: 10.1007/s00431-023-05293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 10/07/2023] [Accepted: 10/15/2023] [Indexed: 10/26/2023]
Abstract
This study aimed to assess the accuracy of liquid drug dose measurements made by caregivers and explore the factors influencing these measurements. Caregivers (n = 176) of children aged less than 8 years, who were treated at the pediatric clinic of a university hospital in Turkey between July and October 2019, were eligible to participate in this study. The caregivers' ability to accurately measure a 2.5-mL dose of medication was observed using standardized measurement instruments, including 15-mL and 30-mL dosing cups, a 3-mL dropper, a 5-mL dose spoon, and a 5-mL oral syringe. A comparison was made with the reference weight determined for the 2.5-mL dose to calculate the margin of error. A dose of ± 20% of the reference value was considered a clinically significant error. The chi-square test was used to examine differences in dose error rates concerning individual characteristics. Caregivers exhibited a dosing error rate exceeding 20%. Specifically, 43% of the errors occurred when using 15-mL cups, 37% with 30-mL cups, 22% with 3-mL droppers, 4.5% with 5-mL spoons, and 4% with 5-mL syringes. In cases where errors were under 20%, the rates were as follows: 1.1% with 15-mL cups, 2.8% with 30-mL cups, 19% with 3-mL droppers, 3.4% with 5-mL spoons, and 4% with 5-mL syringes. The dosing errors were not affected by the role and health literacy level of caregivers, regardless of the type of dosing tool they used (all p values > 0.05). The study found that oral syringes and dosing spoons had the lowest error rates, whereas dosing cups had the highest error rates. Conclusion: Healthcare providers in family health centers and pediatric clinics should educate caregivers about proper drug administration with oral syringes and dosing spoons, even if dosing cups are included. What is Known: • Dose calculation errors and incorrect measurement tools are the leading factors causing errors. • Liquid medicine bottles are still often accompanied by dosing cups as measuring instruments. • Both the American Academy of Pediatrics (AAP) and the U.S. Food and Drug Administration (FDA) recommend that parents use standard measuring instruments such as oral syringes, droppers, and measuring spoons instead of kitchen spoons for administering the correct dose to children. What is New: • The measuring tool with the maximum errors was the dosing cup, whereas oral syringes and dosing spoons were more accurate. • Individual administering medication at home and the health literacy level had no effect on the accuracy of dose measurement. • Pediatric nurses, in particular, should incorporate safe liquid medication measurement tools into parental education.
Collapse
Affiliation(s)
- Burcu Bayraktar Balıkçı
- Department of Anesthesiology and Reanimation, Faculty of Medicine Hospital, Ege University, 35040, Izmir, Turkey.
| | - Ülkü Güneş
- Department of Fundamentals of Nursing, Faculty of Nursing, Ege University, 35040, Izmir, Turkey
| |
Collapse
|
13
|
Howlett MM, Sutton S, McGrath EL, Breatnach CV. Implementation of a national system for best practice delivery of paediatric infusions. Int J Clin Pharm 2024; 46:4-13. [PMID: 37971685 DOI: 10.1007/s11096-023-01652-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/11/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Standard concentration infusions and 'smart-pumps' are recognised as best practice in the paediatric setting. Implementation rates in European hospitals remain low. Children's Health Ireland (CHI) developed a paediatric 'smart-pump' drug library using standardised concentrations. At time of development, other Irish hospitals continued to use traditional pumps and weight-based paediatric infusions. AIM To expand best paediatric infusion practices by nationalising use of the CHI drug library. SETTING Tertiary paediatric, maternity and general acute hospitals, and associated transport services in Ireland. DEVELOPMENT The CHI drug library was first developed for paediatric intensive care and then adapted over a 10-year period for use in emergency departments, general paediatric wards, neonatal units, adult intensive care and transport services. The original library (42 drug lines, 1 'care-unit') was substantially expanded (223 drug lines, 6 'care-units'). A neonatal sub-library was created. IMPLEMENTATION Executive support, dedicated resources and governance structures were secured. Implementation and training packages were developed. Implementation has occurred across CHI, in paediatric and neonatal transport services, 58% (n = 11) of neonatal units, and 23% (n = 6) of paediatric sites. EVALUATION A before and after study demonstrated significant reductions in infusion prescribing errors (29.0% versus 8.4%, p < 0.001). Direct observation of infusions (n = 1023) found high compliance rates (98.9%) and low programming errors (1.6%). 100% of nurses (n = 132) surveyed 9 months after general ward implementation considered the drug library had enhanced patient safety. CONCLUSION Strategic planning and collaboration can standardise infusion practices. The CHI drug library has been approved as a National Standard of Care, with implementation continuing.
Collapse
Affiliation(s)
- Moninne M Howlett
- Children's Health Ireland, Dublin 2, D12 N512, Ireland.
- Royal College of Surgeons in Ireland, Dublin 2, D02 YN77, Ireland.
| | - Sharon Sutton
- Children's Health Ireland, Dublin 2, D12 N512, Ireland
- Royal College of Surgeons in Ireland, Dublin 2, D02 YN77, Ireland
| | | | | |
Collapse
|
14
|
Rosen C, Jacqmart C, Charlier C, Beghetti M, Seghaye MC. [Risks of magistral preparations in pediatrics]. Rev Med Liege 2024; 79:104-109. [PMID: 38356427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Vasoreactive pulmonary arterial hypertension (PAH) in children is a form of idiopathic PAH that responds to vasoreactive testing with nitric oxide (NO) by a significant decrease of pulmonary vascular resistances and pressure. Oral calcium channel antagonists (CCA) that allow pulmonary arterial vasodilation are the treatment of choice. The therapeutic effect is strongly depending on adequate drug intake. In growing children, drug dose must be adapted to weight. In case of unavailability of low-dose pharmaceutical preparations, officinal formulations become mandatory. Officinal formulations may be related to a multitude of errors at different steps including prescription, transcription, preparation and administration. This may have life-threatening consequences for the child.To illustrate this, we report a case of a compounding error with underdosage of CCA, leading to acute cardiovascular failure in an adolescent with vasoreactive PAH.
Collapse
Affiliation(s)
| | | | - Corinne Charlier
- Service de Pédiatrie, CHU Liège, Belgique
- Service de Toxicologie clinique, médicolégale, de l'Environnement et en Entreprise, CHU Liège, Belgique
| | | | | |
Collapse
|
15
|
Mumford V, Raban MZ, Li L, Merchant A, Fitzpatrick E, Badgery-Parker T, Westbrook JI. The Economics of Medication Safety: A Cost-Benefits Analysis Framework for Evaluating an Electronic Medication System. Stud Health Technol Inform 2024; 310:1390-1391. [PMID: 38269661 DOI: 10.3233/shti231209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Medication prescribing in paediatrics is complex and compounded by the need to provide age and weight related doses, and errors continue to be problematic. Electronic medication systems (EMS) can reduce errors through dosing calculators and computerised decision support. However, evidence on costs and benefits of these systems is limited, particularly in paediatric hospitals. This paper presents the development of a cost-benefit analysis (CBA) framework to assess the impact of an EMS implementation in a paediatric tertiary hospital. An innovative component of the framework is the incorporation of the impact of the effects of the EMS for both the health system as well as for patients and their wider family networks, allowing a net social benefit assessment. We describe the impact of non-clinical out-of-pocket costs of admission and use discrete choice experiments to measure both medication related harm and the importance of medication safety to families and members of the community.
Collapse
Affiliation(s)
- Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, NSW, Australia
| | - Magdalena Z Raban
- Australian Institute of Health Innovation, Macquarie University, NSW, Australia
| | - Ling Li
- Australian Institute of Health Innovation, Macquarie University, NSW, Australia
| | - Alison Merchant
- Australian Institute of Health Innovation, Macquarie University, NSW, Australia
| | - Erin Fitzpatrick
- Australian Institute of Health Innovation, Macquarie University, NSW, Australia
| | - Tim Badgery-Parker
- Australian Institute of Health Innovation, Macquarie University, NSW, Australia
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, Macquarie University, NSW, Australia
| |
Collapse
|
16
|
González Suárez S, Marín Romero AM, Ballesteros Cabañas GI, Rial Domínguez Y, Soy Muner D, Juncos Pereira R, Lesta Domene C, López-Cabezas C. Trazam project: A mobile application for the tracking of compounded preparations in a Pharmacy Department. Farm Hosp 2024; 48:23-28. [PMID: 37516613 DOI: 10.1016/j.farma.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 07/31/2023] Open
Abstract
INTRODUCTION The primary objective of this study is to describe the design and implementation of a mobile application (App) for tracking preparations compounded in the Pharmacy Department. Secondary objectives include evaluating the time spent on resolving incidents related to the distribution of preparations before and after implementation, assessing users satisfaction with the application, and establishing a panel of quality indicators based on the data extracted from the App. METHODS Defining application requirements, identifying drugs to be included in the software and outlining different workflows. Developing the App in collaboration with the supplier and integrating it with the computer programs involved in prescription and validation. Additionally, QR codes were created to identify delivery points at destination units, and suitable mobile devices were acquired. The initial phase involved user training in the application and a pilot test conducted in a hospital ward. The subsequent phase focused on expansion and consolidation. RESULTS The system includes 86.9% of all sterile preparations prepared in the Hospital Pharmacy, encompassing chemotherapy, adult parenteral nutrition, and other non-hazardous sterile preparations. Furthermore, the application has been implemented in all hospitalization wards, day care units and two external sites. On average, 5,403 preparations were tracked per month (SD = 297.3). The time required to address incidents related to the distribution of preparations has decreased by 83% (from 38.9 to 6.6 minutes per day). The App regularly provides valuable management data for optimizing workflow in the compounding area. Additionally, users have expressed satisfaction with the application. DISCUSION The proposed application enables hospital staff to easily and intuitively track preparations compounded in the pharmacy, irrespective of the computer program used for prescription. It has significantly reduced the need for manual record-keeping and has mitigated incidents associated with the distribution of sterile preparations.
Collapse
|
17
|
Um IS, Clough A, Tan ECK. Dispensing error rates in pharmacy: A systematic review and meta-analysis. Res Social Adm Pharm 2024; 20:1-9. [PMID: 37848350 DOI: 10.1016/j.sapharm.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND/OBJECTIVES Dispensing errors can cause preventable patient harm such as adverse drug events, hospitalisation, or death. The aim of this study was to systematically review the literature and quantify the global prevalence of dispensing errors across pharmacy settings. METHODS Electronic databases including EMBASE, MEDLINE, and CINAHL were searched between January 2010 and September 2023. Studies published in English, from all pharmacy settings, with data that could be used to calculate the prevalence of dispensing errors were included. Studies were excluded if they did not report true dispensing errors. Data including study characteristics and dispensing error characteristics were extracted. The quality of the studies was assessed using 10 criteria. Random-effects meta-analysis was employed to estimate pooled prevalences and heterogeneity was quantified using the I2 statistic. Subgroup analyses were performed according to sample size, study design, setting, error identification method, location, and study quality. PROSPERO CRD42020197860. RESULTS Of the 4216 articles, 62 studies were included. Hospital was the most common pharmacy setting (n = 44, 71.0%) and 15 studies were based in the community. The type of denominator used to report dispensing errors varied between studies, such as dispensed items (n = 45, 72.6%), doses (n = 7, 11.3%), or patients (n = 5, 8.1%). The prevalence of dispensing errors ranged from 0 to 33.3% (n = 62 studies with 64 prevalence estimates). The pooled prevalence for dispensing errors across all studies was 1.6% (95% CI 1.2%-2.1%, I2 = 100%). A majority of studies were of moderate methodological quality (n = 36, 58.1%) and interrater reliability was applied in eight studies. CONCLUSIONS The worldwide prevalence of dispensing errors was 1.6% across community, hospital and other pharmacy settings. This varied depending on the type of denominator used, study design and how the error was identified. This review highlights the need for consistent definitions and standardised classifications of dispensing errors worldwide to reduce heterogeneity.
Collapse
Affiliation(s)
- Irene S Um
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Australia
| | - Alexander Clough
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Australia
| | - Edwin C K Tan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Australia.
| |
Collapse
|
18
|
Westman J, Johnson KD, Smith CR, Kelcey B. The contributors to dosage calculation ability and its applicability to nursing education: An integrative review. J Prof Nurs 2024; 50:8-15. [PMID: 38369376 DOI: 10.1016/j.profnurs.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 02/20/2024]
Abstract
Medication errors are a major patient safety issue and account for 1-2 million hospitalizations and between 100,000 and 200,000 deaths annually. Approximately 41 % of all medication errors are due to improper dose calculations. Studies have shown mean scores on the medication dosage calculation test for nursing students range from 35 to 71 %. Despite new technology created to aid in dosage calculations, the issue is still prevalent among nurses. It is critical that the elements contributing to the nurses' ability to complete dosage calculations be determined so that calculation curriculum in nursing schools can be updated to better prepare students for practice. An integrative review was completed using the databases of PubMed, CINAHL, and Embase to answer the research question: What contributors impact nurses' and nursing students' ability to complete dosage calculations? Four articles met the specified inclusion criteria and were used for this review. The three most common contributing themes among the review sample included mathematical medication calculation ability, medication calculation frequencies, and dosage calculation education. Results from this review can inform the issue of dosage calculations and highlight the need for further research regarding the medication administration competencies taught in undergraduate nursing studies.
Collapse
Affiliation(s)
- Jessica Westman
- Seneca College, Nanji Foundation School of Nursing, 13990 Dufferin St. King City, Ontario, L3Y 0G4 Canada.
| | - Kimberly D Johnson
- College of Nursing, University of Cincinnati, 3110 Vine St. Cincinnati, OH 45221, USA
| | - Carolyn R Smith
- College of Nursing, University of Cincinnati, 3110 Vine St. Cincinnati, OH 45221, USA
| | - Benjamin Kelcey
- College of Education, University of Cincinnati, 3110 Vine St. Cincinnati, OH 45221, USA
| |
Collapse
|
19
|
Suárez SG, Romero AMM, Cabañas GIB, Domínguez YR, Muner DS, Pereira RJ, Domene CL, Cabezas CL. [Translated article] Trazam project: A mobile application for tracking preparations compounded in a pharmacy department. Farm Hosp 2024; 48:T23-T28. [PMID: 37833158 DOI: 10.1016/j.farma.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION The primary objective of this study is to describe the design and implementation of a mobile application (App) for tracking preparations compounded in the Pharmacy Department. Secondary objectives include: i) evaluating the time spent on resolving incidents related to the distribution of preparations before and after implementation, ii) assessing users satisfaction with the application, and iii) establishing a panel of quality indicators based on the data extracted from the App. METHODS 1) Defining application requirements, identifying drugs to be included in the software and outlining different workflows. 2) Developing the App in collaboration with the supplier and integrating it with the computer programs involved in prescription and validation. Additionally, QR codes were created to identify delivery points at destination units, and suitable mobile devices were acquired. The initial phase involved user training in the application and a pilot test conducted in a hospital ward. 3) The subsequent phase focused on expansion and consolidation. RESULTS The system includes 86.9% of all sterile preparations prepared in the Hospital Pharmacy, encompassing chemotherapy, adult parenteral nutrition, and other non-hazardous sterile preparations. Furthermore, the application has been implemented in all hospitalisation wards, day care units and two external sites. On average, 5403 preparations were tracked per month (SD = 297.3). The time required to address incidents related to the distribution of preparations has decreased by 83% (from 38.9 to 6.6 min per day). The App regularly provides valuable management data for optimising workflow in the compounding area. Additionally, users have expressed satisfaction with the application. DISCUSION The proposed application enables hospital staff to easily and intuitively track preparations compounded in the Pharmacy, irrespective of the computer program used for prescription. It has significantly reduced the need for manual record-keeping and has mitigated incidents associated with the distribution of sterile preparations.
Collapse
Affiliation(s)
| | | | | | | | - Dolors Soy Muner
- Servicio de Farmacia. Hospital Clínic Barcelona. Barcelona, Spain
| | | | | | | |
Collapse
|
20
|
Shaker HO, Sabry AAF, Salah A, Ragab GM, Sedik NA, Ali Z, Magdy D, Alkafafy AM. The impact of clinical pharmacists' medication reconciliation upon patients' admission to reduce medication discrepancies in the emergency department: a prospective quasi-interventional study. Int J Emerg Med 2023; 16:89. [PMID: 38102544 PMCID: PMC10725006 DOI: 10.1186/s12245-023-00568-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The role of the clinical pharmacist in medication reconciliation is well established. Upon patients' admission, the reconciliation service mainly focuses on achieving an accurate and full drug history. This will achieve the best treatment plan and reduce medication discrepancies. Upon the recent implementation of clinical pharmacy services in the emergency department at Alexandria Main University Hospital, medication reconciliation was one of the most important duties that needed to be focused on. We hypothesized that clinical pharmacists are able to achieve patients' drug history lists with higher accuracy than emergency physicians. RESULTS A total number of 161 patients were included. Age was 58.59 ± (13.78) years, number of comorbidities was 2.39 ± (1.22) and number of home medications was 4.51 ± (2.72). Clinical pharmacists' fulfillment of patients' drug history was significantly more accurate than the emergency physicians (75.16% and 50.3% of the total number of revised patients' profiles respectively). The clinical pharmacists could put a written copy of the accurate patients' drug history list in only 50.93% of the revised patients' profiles. Five hundred eighty-five medication discrepancies were detected which represent an average of 3.63 discrepancies/medication sheet. Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for medication reconciliation and the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index were used to categorize discrepancies. Categories A, B, and C represented (66.5%), while categories D, E, and F represented (33.5%) of the total discrepancies. There was a significant direct relationship between the total number of discrepancies and both the number of comorbidities and the number of drugs administered before hospital admission. CONCLUSION The clinical pharmacists are the main members of the emergency health care team. One of their fundamental services is medication reconciliation. The establishment of a complete drug history list and physicians' discussion about the current treatment plan can obviously detect and reduce medication errors. TRIAL REGISTRATION NCT04395443. Registered 16 May 2020.
Collapse
Affiliation(s)
| | | | - Asmaa Salah
- Alexandria Main University Hospital, Alexandria, Egypt
| | | | | | - Zahraa Ali
- Alexandria Main University Hospital, Alexandria, Egypt
| | - Doha Magdy
- Alexandria Main University Hospital, Alexandria, Egypt
| | | |
Collapse
|
21
|
Allison Rout J, Yusuf Essack S, Brysiewicz P. Evaluation of intermittent antimicrobial infusion documentation practices in intensive care units: A cross-sectional study. Intensive Crit Care Nurs 2023; 79:103527. [PMID: 37651822 DOI: 10.1016/j.iccn.2023.103527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To observe nurse administration of carbapenem antibiotics, in the context of medication safety measures, in intensive care units. RESEARCH METHODOLOGY/DESIGN A quantitative study was conducted using observation principles. SETTING Three adult private and public Intensive Care Units in the health district of a capital city in KwaZulu-Natal, South Africa. MAIN OUTCOME MEASURES Nurse practices were observed for double-checking of the medication order, medication vial, and method of preparation and administration. Infusion bags were inspected for nurse labelling of medication and patient details. Patient medication treatment charts were inspected for nurse signature. RESULTS Carbapenem infusion administrations (n = 223) to twenty patients were observed. Adherence to the scheduled time occurred in 34.9% administrations, 5.4% doses were not given, and an incorrect dose given on 1.4% administrations. One hundred and forty-four (64.6%) infusion bags were inspected during the administrations: there was no medication label affixed to 21.5% bags, and only 8.3% of bags were labelled with essential details; the patient's name, drug, dose, date, time, signature of the nurse mixing and administering the dose, and signature of the secondary nurse. CONCLUSION There was a lack of compliance with accepted medication risk mitigation measures. Sub-optimal double-checking resulted in the incorrect dose given, missed dose, and non-adherence to scheduled administration time. This has implications for the optimal administration of antimicrobial medications, raising concerns about the efficacy of treatment for critically ill patients. IMPLICATIONS FOR CLINICAL PRACTICE Parenteral administration errors pose a challenge in acute care areas. Risk mitigation measures include double-checking of medications. If antimicrobial treatment is not administered at the prescribed dosing intervals, this may have implications for the efficacy of time-dependent broad-spectrum antibiotics such as carbapenems. Medication administration errors involving antimicrobial medications should therefore be considered as high-risk errors, with the potential to contribute towards antimicrobial resistance.
Collapse
Affiliation(s)
- Joan Allison Rout
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Sabiha Yusuf Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Petra Brysiewicz
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
22
|
Cuervas-Mons Vendrell M, Iturgoyen Fuentes DP, Arrojo Suárez J, Jimenez Lozano I, Fernandez-Llamazares CM, Tristancho-Perez A, Yunquera Romero L, Martínez Roca C, Otero Villalustre C, García Robles A, Garrido Corro B, Rodríguez Marrodán B. Medication reconciliation on admission in paediatric chronic patients: A multicentre study. An Pediatr (Barc) 2023; 99:376-384. [PMID: 38036314 DOI: 10.1016/j.anpede.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Medication reconciliation (MC) is one of the main strategies to reduce medication errors in care transitions. In Spain, several guidelines have been published with recommendations for the implementation and development of MC aimed at the adult population, although paediatric patients are not included. In 2018, a study was carried out that led to the subsequent publication of a document with criteria for selecting paediatric patients in whom CM should be prioritised. OBJECTIVES To describe the characteristics of paediatric patients most likely to suffer from errors of reconciliation (EC), to confirm whether the results of a previous study can be extrapolated. METHODOLOGY Prospective, multicentre study of paediatric inpatients. We analysed the CE detected during the performance of the CM on admission. The best possible pharmacotherapeutic history of the patient was obtained using different sources of information and confirmed by an interview with the patient/caregiver. RESULTS 1043 discrepancies were detected, 544 were identified as CD, affecting 317 patients (43%). Omission of a drug was the most common error (51%). The majority of CD were associated with drugs in groups A (31%), N (23%) and R (11%) of the ATC classification. Polymedication and onco-haematological based disease were the risk factors associated with the presence of CD with statistical significance. CONCLUSIONS The findings of this study allow prioritisation of CM in a specific group of paediatric patients, favouring the efficiency of the process. Onco-haematological patients and polymedication are confirmed as the main risk factors for the appearance of CD in the paediatric population.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ana García Robles
- Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | |
Collapse
|
23
|
Cassidy CE, Boulos L, McConnell E, Barber B, Delahunty-Pike A, Bishop A, Fatima N, Higgins A, Churchill M, Lively A, MacPhee SP, Misener RM, Sarty R, Wells R, Curran JA. E-prescribing and medication safety in community settings: A rapid scoping review. Explor Res Clin Soc Pharm 2023; 12:100365. [PMID: 38023632 PMCID: PMC10679534 DOI: 10.1016/j.rcsop.2023.100365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Background Medication prescribing is essential for the treatment, curing, maintenance, and/or prevention of an illness and disease, however, medication errors remain common. Common errors including prescribing and administration, pose significant risk to patients. Electronic prescribing (e-prescribing) is one intervention used to enhance the safety and quality of prescribing by decreasing medication errors and reducing harm. E-prescribing in community-based settings has not been extensively examined. Objective To map and characterize the current evidence on e-prescribing and medication safety in community pharmacy settings. Methods We conducted a rapid scoping review of quantitative, qualitative, and mixed methods studies reporting on e-prescribing and medication safety. MEDLINE All (OVID), Embase (Elsevier), CINAHL Full Text (EBSCOHost), and Scopus (Elsevier) databases were searched December 2022 using keywords and MeSH terms related to e-prescribing, medication safety, efficiency, and uptake. Articles were imported to Covidence and screened by two reviewers. Data were extracted by a single reviewer and verified by a second reviewer using a standardized data extraction form. Findings are reported in accordance with JBI Manual for Evidence Synthesis following thematic analysis to narratively describe results. Results Thirty-five studies were included in this review. Most studies were quantitative (n = 22), non-experimental study designs (n = 16) and were conducted in the United States (n = 18). Half of included studies reported physicians as the prescriber (n = 18), while the remaining reported a mix of nurse practitioners, pharmacists, and physician assistants (n = 6). Studies reported on types of errors, including prescription errors (n = 20), medication safety errors (n = 9), dispensing errors (n = 2), and administration errors (n = 1). Few studies examined patient health outcomes, such as adverse drug events (n = 5). Conclusions Findings indicate that most research is descriptive in nature and focused primarily on rates of prescription errors. Further research, such as experimental, implementation, and evaluation mixed-methods research, is needed to investigate the effects of e-prescribing on reducing error rates and improving patient and health system outcomes.
Collapse
Affiliation(s)
- Christine E. Cassidy
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | | | | | - Andrea Bishop
- Nova Scotia College of Pharmacists, Halifax, Nova Scotia, Canada
| | - Nawal Fatima
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Rowan Sarty
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | | | - Janet A. Curran
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health, Halifax, Nova Scotia, Canada
| |
Collapse
|
24
|
Loehfelm AM, Maxfield HA, Wallace LS. Do pediatric oral suspension acetaminophen and ibuprofen product labeling and online resources facilitate intended use? Explor Res Clin Soc Pharm 2023; 12:100360. [PMID: 38054192 PMCID: PMC10694735 DOI: 10.1016/j.rcsop.2023.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/02/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
Background Caregivers often have difficulty administering pediatric medications which frequently results in increased dosing error risk. Objective We examined health literacy characteristics of pediatric over-the-counter (OTC) oral suspension acetaminophen and ibuprofen instructional materials and dosing instruments. Methods We conducted a descriptive analysis of dosing instructions, measuring syringe characteristics, and internet-based resources among a sample of OTC pediatric oral suspension acetaminophen and ibuprofen products (n = 14). Results All products included Drug Facts Panels, employed consistent abbreviation use, and stated measuring dosage with syringe provided. However, oral syringe dosing increment markings did not match box or bottle dosing charts. Most products had supplemental English-language internet-based content resources available. Conclusions While OTC pediatric oral suspension acetaminophen and ibuprofen products labeling included key drug fact elements, there were inconsistencies between medication dosing chart labeling guidelines and oral syringe dosing increments/markings. It is vital that oral dosing syringes are clearly marked to match product dosing chart labeling s as a means of potentially reducing caregiver dosing errors.
Collapse
Affiliation(s)
- Alexis M. Loehfelm
- , West Virginia School of Osteopathic Medicine, United States of America
| | - Hunter A. Maxfield
- The Ohio State University, 400 N Lee Street, Lewisburg, WV 24901, United States of America
| | - Lorraine S. Wallace
- The Ohio State University, College of Medicine, Department of Biomedical Education and Anatomy, 260 Meiling Hall, 370 W. 9 Avenue, Columbus, OH 43210, United States of America
| |
Collapse
|
25
|
Naseralallah L, Stewart D, Price M, Paudyal V. Prevalence, contributing factors, and interventions to reduce medication errors in outpatient and ambulatory settings: a systematic review. Int J Clin Pharm 2023; 45:1359-1377. [PMID: 37682400 PMCID: PMC10682158 DOI: 10.1007/s11096-023-01626-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/12/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Medication errors are common events that compromise patient safety. Outpatient and ambulatory settings enhance access to healthcare which has been linked to favorable outcomes. While medication errors have been extensively researched in inpatient settings, there is dearth of literature from outpatient settings. AIM To synthesize the peer-reviewed literature on the prevalence, nature, contributory factors, and interventions to minimize medication errors in outpatient and ambulatory settings. METHOD A systematic review was conducted using Medline, Embase, CINAHL, and Google Scholar which were searched from 2011 to November 2021. Quality assessment was conducted using the quality assessment checklist for prevalence studies tool. Data related to contributory factors were synthesized according to Reason's accident causation model. RESULTS Twenty-four articles were included in the review. Medication errors were common in outpatient and ambulatory settings (23-92% of prescribed drugs). Prescribing errors were the most common type of errors reported (up to 91% of the prescribed drugs, high variations in the data), with dosing errors being most prevalent (up to 41% of the prescribed drugs). Latent conditions, largely due to inadequate knowledge, were common contributory factors followed by active failures. The seven studies that discussed interventions were of poor quality and none used a randomized design. CONCLUSION Medication errors (particularly prescribing errors and dosing errors) in outpatient settings are prevalent, although reported prevalence range is wide. Future research should be informed by behavioral theories and should use high quality designs. These interventions should encompass system-level strategies, multidisciplinary collaborations, effective integration of pharmacists, health information technology, and educational programs.
Collapse
Affiliation(s)
- Lina Naseralallah
- School of Pharmacy, College of Medical and Dental Science, Institute of Clinical Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Derek Stewart
- Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Malcom Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Science, Institute of Clinical Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| |
Collapse
|
26
|
Assunção-Costa L, Pinto CR, Machado JFF, Valli CG, de Souza LEPF. Assessing the severity of medication administration errors identified in an observational study using a valid and reliable method. J Pharm Policy Pract 2023; 16:143. [PMID: 37964342 PMCID: PMC10648330 DOI: 10.1186/s40545-023-00653-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Epidemiological data on medication errors severity are scarce. The assessment of the prevalence and severity of medication errors may be limited because of several reasons, including a lack of standardization in the method of identifying medication administration errors and little knowledge about the appropriate assessment tools to measure severity. Thus, in this study, we aim to assess the potential severity of errors identified by direct observation in a teaching hospital. METHODS We used a validated method for assessing the potential severity of medication administration errors. Responses are scored on a 10-point scale. The 203 errors identified in a previous study were organized per similarity, resulting in 67 errors. This list was assessed by a panel of a physician, a nurse, and two pharmacists. The average score for each of the 67 errors was estimated considering the scores given by the 4 judges. Errors with a severity index < 3, between 3 and 7, and > 7 were considered minor, moderate, and severe, respectively. RESULTS Professionals classified the potential clinical significance of the errors as minor, moderate, and severe in 8.8% (18/203), 82.8% (168/203), and 8.4% (17/203) of the cases, respectively. Most errors considered potentially serious (41%, 7/17) were technical errors. Most potentially serious errors involved insulin. Regarding the administration route, nine (53%) potentially serious errors involved medications administered intravenously. CONCLUSIONS Most of the errors were considered as potentially moderated by the expert panel; however, the frequency of potentially serious errors was higher than that in previous studies using the same methodology, which highlights the need for strategies to reduce their occurrence.
Collapse
Affiliation(s)
- Lindemberg Assunção-Costa
- Department of Medicine, School of Pharmacy, Federal University of Bahia and National Institute for Phamaceutical Assistence and Pharmacoeconomy - INAFF, Rua Barão de Jeremoabo, 147, 2º andar, Campus Ondina, Salvador, Bahia, 40170-115, Brazil.
| | - Charleston Ribeiro Pinto
- Department of Medicine, School of Pharmacy, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Cleidenete Gomes Valli
- National Institute for Pharmaceutical Assistance and Pharmacoeconomics - INAFF, Salvador, Bahia, Brazil
| | | |
Collapse
|
27
|
Damiaens A, Strauven G, De Lepeleire J, Spinewine A, Foulon V. Stepwise development of a quality assessment instrument for the medicines' pathway in nursing homes. Res Social Adm Pharm 2023; 19:1446-1454. [PMID: 37482481 DOI: 10.1016/j.sapharm.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Quality of care in nursing homes (NHs), and especially the quality of the medicines' pathway, remains a concern. OBJECTIVES To develop a quality assessment instrument to support NHs to evaluate the quality of their medicines' pathway, and to formulate recommendations for its implementation. METHODS A stepwise approach was used. First, a performance questionnaire for coordinating physicians, pharmacists and head nurses was developed, alongside a set of quality indicators (QIs). Next, a feasibility study regarding the QIs was performed in 4 NHs, followed by two pilot studies to optimize the instrument (in 14 and 9 NHs, respectively). Focus groups were held to formulate recommendations for instrument implementation. RESULTS The QI feasibility and first pilot study showed that the clarity and feasibility of QIs was insufficient. All QIs were therefore integrated in the performance questionnaire. The first pilot study also showed low response rates for certain questions in the performance questionnaire and resulted in a revision of questions with the aim to target the right type of healthcare professional, including quality coordinators and general practitioners. The final instrument targets all involved healthcare professionals (i.e. coordinating physicians, pharmacists, head nurses, general practitioners, and quality coordinators), and applies a sequential approach: a quick scan to set priorities, followed by a detailed scan to detect specific working points. The second pilot study showed appreciation for this approach. Last, five recommendations were made to promote the instrument's implementation. CONCLUSIONS A series of feasibility and pilot studies allowed the stepwise optimization of a quality assessment instrument for the medicines' pathway in NHs and resulted in modifications to improve its clarity and feasibility. Participants' recommendations will promote the successful implementation of the quality assessment instrument.
Collapse
Affiliation(s)
- Amber Damiaens
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Herestraat 49 - O&N II - Box 521, B-3000, Leuven, Belgium.
| | - Goedele Strauven
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Herestraat 49 - O&N II - Box 521, B-3000, Leuven, Belgium
| | - Jan De Lepeleire
- KU Leuven, Department of Public Health and Primary Care, Kapucijnenvoer 7 - Blok H - Box 7001, B-3000, Leuven, Belgium
| | - Anne Spinewine
- UCLouvain, Louvain Drug Research Institute, Avenue Mounier 72/B1.72.02, B-1200, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur, Pharmacy Department, Avenue Dr G Therasse 1, B-5530, Yvoir, Belgium
| | - Veerle Foulon
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Herestraat 49 - O&N II - Box 521, B-3000, Leuven, Belgium
| |
Collapse
|
28
|
Martínez-Aguilar L, Sanz-Valero J, Martínez-Martínez F, Faus MJ. Suitability of indexing terms in the MEDLINE bibliographic database on drug-related problems. Res Social Adm Pharm 2023; 19:1440-1445. [PMID: 37481351 DOI: 10.1016/j.sapharm.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/26/2023] [Accepted: 07/12/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND For years, there has been controversy about the meaning of medication-related problems (MRPs). This has led several authors to attempt to redefine and classify this term with the aim of using it correctly in the healthcare setting. So far without achieving the desired objective, resulting in erroneous results in the sources of information and thus in malpractice in the sector. OBJECTIVE To describe and analyze the appropriateness of the existing indexing of scientific publications in the MEDLINE bibliographical database with respect to drug-related problems (DRPs) and to determine whether the descriptors used fulfilled the function of suitably representing this concept. METHODS A descriptive study was conducted, using the following search terms: Medication Errors; Drug Interactions; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Contraindications, Drug. The sample size was calculated by estimating population parameters in an infinite population (expected value = 0.05; precision of interval = 0.05; level of confidence = 0.95) and the selection method was simple random sampling without replacement, taking the total number of bibliographical references in the database as the basis. The agreement of the indexing with DRPs was evaluated with the coefficient of determination (R2), and the Cohen kappa coefficient was used for the association between the definition of the descriptors and the objective of the article. RESULTS The 1930 records analyzed showed a total of 2888 different major topics. These major topics were present, with at least one of the five descriptors studied, in 482 (25.0%; 95% CI 23.0-27.0) documentary files, with statistically significant differences between the two phases analyzed (χ2 = 183.8; degrees of freedom (df) = 1; p < 0.001): 1st phase, 295 (13.3%; 95% CI 13.7-16.9) and 2nd phase, 187 (9.7%; 95% CI 8.4-11.0). Overall scientific output with the five descriptors showed a coefficient of determination (R2) of 0.9 (p < 0.001) and the relationship between the objective of the study and the definitions of the five descriptors was 0.9 (p < 0.001). CONCLUSIONS There was a very good direct exponential trend of the overall scientific output retrieved with the terms associated with DRPs, although the progression of the five descriptors separately did not show a growth model conforming to expectations. There was a moderate agreement between the objective of the study and the definition of each of the five descriptors used and a low relationship between the objective of the study and the concept of DRPs used for this investigation. It is essential to have a descriptor that unifies the terminological diffusion that has existed up till now, since process (causes) and effects (outcomes) have been mixed together under the various definitions and classifications of DRPs found in the studies.
Collapse
Affiliation(s)
- Laura Martínez-Aguilar
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - Javier Sanz-Valero
- Carlos III Health Institute, National School of Occupational Medicine, Madrid, Spain.
| | - Fernando Martínez-Martínez
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - María J Faus
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, University of Granada, Granada, Spain
| |
Collapse
|
29
|
Otero MJ, Pérez-Encinas M, Tortajada-Goitia B, Rodríguez-Camacho JM, Plata Paniagua S, Fernández-Megía MJ, Cartelle HE, Caro-Teller JM. Analysis of the degree of implementation of medication error prevention practices in Spanish hospitals (2022). Farm Hosp 2023; 47:268-276. [PMID: 37778905 DOI: 10.1016/j.farma.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE To assess the degree of implementation of medication error prevention practices in Spanish hospitals. METHOD Descriptive multicenter study of the degree of implementation of the safety practices included in the "Medication use-system safety self-assessment for hospitals. Version. II". Spanish hospitals that completed the questionnaire between October/2021 and September/2022 participated. The survey contains 265 items for evaluation grouped into 10 key elements. Mean score and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item of evaluation were calculated. The results were compared with those of the previous 2011 study. RESULTS A total of 131 hospitals from 15 autonomous regions participated in the study. The mean score of the overall questionnaire in all hospitals was 898.2 (57.4% of the maximum possible score). No differences were found according to dependency, size or type of hospital, either in the overall questionnaire or in the key elements. The lowest values were found for key elements 8, 1 and 6, on competence and training of health professionals in safety practices (45.1%), availability and accessibility of essential information on patients (48%), and devices for administering drugs (52.3%). With respect to 2011, significant increases were found both in the overall questionnaire and in the key elements, except 5 and 7, referring to standardization, storage and distribution of medications, and environmental factors and human resources. Several evaluation items on the safe management of high-risk drugs, medication reconciliation, incorporation of clinical pharmacists into the healthcare teams and implementation of technologies that allow full traceability throughout the medication system, showed low percentages CONCLUSIONS: There has been appreciable progress in the degree of implementation of some medication error prevention practices in Spanish hospitals, but many proven efficacy practices recommended by the World Health Organization and safety organizations are still poorly implemented. The information obtained can be useful for prioritizing the practices to be addressed and as a new baseline for monitoring progress.
Collapse
Affiliation(s)
- María José Otero
- Instituto para el Uso Seguro de los Medicamentos (ISMP-España), Servicio de Farmacia, IBSAL-Hospital Universitario de Salamanca, Salamanca, España.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Otero MJ, Pérez-Encinas M, Tortajada-Goitia B, Rodríguez-Camacho JM, Paniagua SP, Fernández-Megía MJ, Cartelle HE, Caro-Teller JM. [Translated article] Analysis of the degree of implementation of medication error prevention practices in Spanish hospitals (2022). Farm Hosp 2023; 47:T268-T276. [PMID: 37778904 DOI: 10.1016/j.farma.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE To assess the degree of implementation of medication error prevention practices in Spanish hospitals. METHOD Descriptive multicenter study of the degree of implementation of the safety practices included in the "Medication use-system safety self-assessment for hospitals. Version. II". Spanish hospitals that completed the questionnaire between October, 2021 and September, 2022 participated. The survey contains 265 items for evaluation grouped into 10 key elements. Mean score and mean percentages based on the maximum possible values for the overall survey, for the key elements, and for each individual item of evaluation were calculated. The results were compared with those of the previous 2011 study. RESULTS A total of 131 hospitals from 15 autonomous regions participated in the study. The mean score of the overall questionnaire in all hospitals was 898.2 (57.4% of the maximum possible score). No differences were found according to dependency, size, or type of hospital, either in the overall questionnaire or in the key elements. The lowest values were found for key elements VIII, I and VI, on competence and training of health professionals in safety practices (45.1%), availability and accessibility of essential information on patients (48%), and devices for administering drugs (52.3%). With respect to 2011, significant increases were found both in the overall questionnaire and in the key elements, except V and VII, referring to standardization, storage, and distribution of medications, and environmental factors and human resources. Several evaluation items on the safe management of high-risk drugs, medication reconciliation, incorporation of clinical pharmacists into the healthcare teams, and implementation of technologies that allow full traceability throughout the medication system, showed low percentages. CONCLUSIONS There has been appreciable progress in the degree of implementation of some medication error prevention practices in Spanish hospitals, but many proven efficacy practices recommended by the World Health Organization and safety organizations are still poorly implemented. The information obtained can be useful for prioritizing the practices to be addressed and as a new baseline for monitoring progress.
Collapse
Affiliation(s)
- María José Otero
- Instituto para el Uso Seguro de los Medicamentos (ISMP-España), IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain.
| | | | | | | | | | | | - Helena Esteban Cartelle
- Pharmacy Service, Complejo Hospitalario Universitario Santiago de Compostela, Santiago, Spain
| | | |
Collapse
|
31
|
Cuervas-Mons Vendrell M, Iturgoyen Fuentes DP, Villaronga Flaque M, Cabañas Poy MJ, Fernández-Llamazares CM, Álvarez Del Vayo C, Gallego Fernández C, Martínez Roca C, Hernández Gago Y, García Robles A, Garrido Corro B. Multicentre study of medication reconciliation in paediatric onco-hematology. Farm Hosp 2023; 47:261-267. [PMID: 37422402 DOI: 10.1016/j.farma.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/09/2023] [Accepted: 06/07/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVE To determine the prevalence of reconciliation errors (RE) on admission to hospital in the paediatric onco-haematological population in order to check whether they are similarly susceptible to these RE as adults and to describe the characteristics of the patients who suffer them. METHODS A 12-month prospective, multicentre study of medication reconciliation on admission in the paediatric onco-haematological population to assess the incidence of RE and describe the characteristics of the patients in whom they occur. RESULTS Medication reconciliation was performed in 157 patients. At least 1 medication discrepancy was detected in 96 patients. Of the discrepancies detected, 52.1% were justified by the patient's new clinical situation or by the physician, while 48.9% were determined to be RE. The most frequent type of RE was the "omission of a medication", followed by "a different dose, frequency or route of administration". A total of 77 pharmaceutical interventions were carried out, 94.2% of which were accepted. In the group of patients with a number equal to or greater than 4 drugs in home treatment, there was a 2.1-fold increase in the probability of suffering a RE. CONCLUSIONS In order to avoid or reduce errors in one of the critical safety points such as transitions of care, there are measures such as medication reconciliation. In the case of complex chronic paediatric patients, such as onco-haematological patients, the number of drugs as part of home treatment is the variable that has been associated with the presence of medication RE on admission to hospital, with the omission of some medication being the main cause of these errors.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ana García Robles
- Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | |
Collapse
|
32
|
Cuervas-Mons Vendrell M, Iturgoyen Fuentes DP, Villaronga Flaque M, Cabañas Poy MJ, Fernández-Llamazares CM, Álvarez Del Vayo C, Gallego Fernández C, Martínez Roca C, Hernández Gago Y, García Robles A, Garrido Corro B. [Translated article] Medication reconciliation in pediatric hemato-oncologic patients: A multicenter study. Farm Hosp 2023; 47:T261-T267. [PMID: 37716875 DOI: 10.1016/j.farma.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/07/2023] [Indexed: 09/18/2023] Open
Abstract
OBJECTIVE To determine the prevalence of reconciliation errors on admission to hospital in the pediatric onco-hematological population in order to check whether they are similarly susceptible to these reconciliation errors as adults and to describe the characteristics of the patients who suffer them. METHODS A 12-month prospective, multicentre study of medication reconciliation on admission in the pediatric onco-hematological population to assess the incidence of reconciliation errors and to describe the characteristics of the patients. RESULTS Medication reconciliation was performed in 157 patients. At least a medication discrepancy was detected in 96 patients. Of the discrepancies detected, 52.1% were related to patient's new clinical situation or by the physician, while 48.9% were determined to be reconciliation errors. The most frequent type of reconciliation error was the "omission of a medication", followed by "a different dose, frequency or route of administration". A total of 77 pharmaceutical interventions were carried out, 94.2% of which were accepted. In the group of patients with a number equal to or greater than 4 drugs in home treatment, there was a 2.1-fold increase in the probability of suffering a reconciliation error. CONCLUSIONS In order to avoid or reduce errors in one of the critical safety points such as transitions of care, there are measures such as medication reconciliation. In the case of complex chronic pediatric patients, such as onco-hematological patients, the number of drugs as part of home treatment is the variable that has been associated with the presence of medication reconciliation errors on admission to hospital, and the omission of some medication was the main cause of these errors.
Collapse
|
33
|
Shawaqfeh MS, Alangari D, Aldamegh G, Almotairi J, Bin Orayer L, Albekairy NA, Abdel-Razaq W, Mardawi G, Almuqbil F, Aldebasi TM, Albekairy AM. Unveiling medication errors in liver transplant patients towards enhancing the imperative patient safety. Saudi Pharm J 2023; 31:101789. [PMID: 37799574 PMCID: PMC10550402 DOI: 10.1016/j.jsps.2023.101789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
Background Medication errors (MEs) are a significant healthcare problem that can harm patients and increase healthcare expenses. Being immunocompromised, liver-transplant patients are at high risk for complications if MEs inflict harmful or damaging effects. The present study reviewed and analyzed all MEs reported in Liver Transplant Patients. Methods All MEs in the Liver Transplant Patients admitted between January 2016 to August 2022 were retrieved through the computerized physician order entry system, which two expert pharmacists classified according to the type and severity risk index. Results A total of 314 records containing 407 MEs were committed by at least 71 physicians. Most of these errors involved drugs unrelated to managing liver-transplant-related issues. Antibiotic prescriptions had the highest mistake rate (17.0%), whereas immunosuppressants, routinely used in liver transplant patients, rank second with fewer than 14% of the identified MEs. The most often reported MEs (43.2%) are type-C errors, which, despite reaching patients, did not cause patient harm. Subgroup analysis revealed several factors associated with a statistically significant great incidence of MEs among physicians treating liver transplant patients. Conclusion Although a substantial number of MEs occurred with liver transplant patients, the majority are not related to liver-transplant medications, which mainly belonged to type-C errors. This could be attributed to polypharmacy of transplant patients or the heavy workload on health care practitioners. Improving patient safety requires adopting regulations and strategies to promptly identify MEs and address potential errors.
Collapse
Affiliation(s)
- Mohammad S. Shawaqfeh
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia
| | - Dalal Alangari
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Ghaliah Aldamegh
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Jumana Almotairi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Luluh Bin Orayer
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Nataleen A. Albekairy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Wesam Abdel-Razaq
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia
| | - Ghada Mardawi
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi Arabia
| | - Faisal Almuqbil
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Tariq M. Aldebasi
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Abdulkareem M. Albekairy
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia
| |
Collapse
|
34
|
Raymond J, Parrein P, Barat E, Chenailler C, Decreau-Gaillon G, Varin R, Joly LM. Pharmacist tracking and correction of medication errors: An improvement project in the observation ward of the emergency department. Ann Pharm Fr 2023; 81:1007-1017. [PMID: 37356662 DOI: 10.1016/j.pharma.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE The risk of medication errors is high in emergency departments. Implementation of medication reconciliation activity complemented by pharmaceutical analysis of prescription is an effective way to reduce drug related problems. This study aimed to assess the potential clinical impact of these activities to prevent medication errors for the observation ward patients. The secondary objective was to assess these activities' cost-avoidance and benefit-to-cost ratio. MATERIAL AND METHODS This study was conducted in a 16-bed unit, over a 5-month period. The patients' demographic and treatment details, and data from pharmaceutical activities were collected and analyzed by a pharmacist. Two pharmacists and an emergency physician assessed the potential clinical impact of medication errors. RESULTS Medication reconciliation for 250 patients (15.7% of 1589 admitted patients) and pharmaceutical analysis of prescription for 302 patients (19%) were performed by the pharmacist. Medication reconciliation detected 752 errors in 197 patients; 19% were related to high-risk medications and 14% had a potential clinical impact assessed as major, critical or fatal. Pharmaceutical analysis of prescription revealed 159 drug related problems in 118 patients; of which 26% involved high-risk medications and 24% had a potential clinical impact assessed "at least major". In total, 16% of pharmacist interventions had a potential clinical impact assessed "at least major" in 33% of patients: this represents 1.8 pharmacist interventions formulated per day. CONCLUSION The presence of a pharmacist in the observation ward of the emergency department is useful in detecting iatrogenic drug related problems and reducing their medical impact. The benefit-to-cost ratio is favorable for the hospital.
Collapse
Affiliation(s)
- Johanna Raymond
- Pharmacy Department, CHU Rouen, Rouen, France; Observation ward, Adult Emergency Department, CHU Rouen, 76000 Rouen, France.
| | | | - Eric Barat
- Pharmacy Department, CHU Rouen, Rouen, France
| | | | | | - Rémi Varin
- Pharmacy Department, CHU Rouen, Rouen, France
| | - Luc-Marie Joly
- Observation ward, Adult Emergency Department, CHU Rouen, 76000 Rouen, France
| |
Collapse
|
35
|
Gray MP, Dhavalikar N, Boyce RD, Kane-Gill SL. Qualitative analysis of healthcare provider perspectives to evaluating beta-lactam allergies. J Hosp Infect 2023; 141:198-208. [PMID: 37574018 DOI: 10.1016/j.jhin.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND There is a lack of understanding of the barriers reported by healthcare providers when evaluating beta-lactam allergies, but knowledge of these barriers is required for practical and effective implementation interventions. METHODS Twenty-five healthcare providers, consisting of physicians, nurses and pharmacists practicing in the areas of intensive care, emergency medicine, infectious disease and general hospital practice, were interviewed between September 2021 and July 2023. Twenty-three of these providers were practising in the USA. A semi-structured interview guide grounded in the Theoretical Domain Framework was used for the interviews. Deductive and inductive analysis was performed on the interview transcripts, and translated into intervention recommendations using the Behaviour Change Wheel. RESULTS Widely held beliefs included a lack of clear policy for the evaluation of allergies, confusing or missing documentation of allergy information, confidence in their own and their colleagues' ability to evaluate allergies when information is available, and pharmacists as the provider most equipped to evaluate beta-lactam allergies. CONCLUSIONS Health systems should adopt and disseminate policies for the evaluation of beta-lactam allergies, and promote the use of pharmacists in the evaluation of drug allergies when possible. Allergy sections of electronic health records should be reworked to encourage unambiguous documentation of allergy reactions and support using previously tolerated beta-lactam antibiotics.
Collapse
Affiliation(s)
- M P Gray
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.
| | - N Dhavalikar
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - R D Boyce
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - S L Kane-Gill
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| |
Collapse
|
36
|
Mourad N, Younes S, Mourad L, Fahs I, Mayta S, Baalbaki R, El Basset W, Dabbous M, El Akel M, Safwan J, Saade F, Rahal M, Sakr F. Comprehension of prescription orders with and without pictograms: tool validation and comparative assessment among a sample of participants from a developing country. BMC Public Health 2023; 23:1926. [PMID: 37798686 PMCID: PMC10552214 DOI: 10.1186/s12889-023-16856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Medication errors can often occur due to the patient's inability to comprehend written or verbal medication orders. This study aimed to develop pictograms of selected medication orders and to validate the comprehension of prescription orders index and compare the comprehension scores with and without pictograms. In addition to determine the predictors that could be associated with a better or worse comprehension of prescription orders with pictograms versus that of their written counterparts. METHODS A cross-sectional study was conducted using a snowball sampling technique. Six pictograms were developed to depict specific medication orders. The comprehension of prescription orders index was constructed and validated. The study then compared the comprehension scores of prescription orders with and without pictograms, and identified the predicting factors score difference. RESULTS A total of 1848 participants were included in the study. The structure of the comprehension of prescription orders index was validated over a solution of four factors, with an adequate Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.711 and a significant Bartlett's test of sphericity (P < 0.001). The construct validity of the index was further confirmed by highly significant correlations between each item and the full index (P < 0.001). The study also found a significant association between the difference in comprehension scores for prescription orders with and without pictograms and several factors, including age, level of education, area of residence, number of children, and smoking status with the difference of comprehension scores (P < 0.001). CONCLUSION Pictogram-based instructions of medication orders were better understood by the Lebanese population than written instructions, making the incorporation of pictograms in pharmacy practice paramount to optimize medication use by the patient and thus yielding better health outcomes.
Collapse
Affiliation(s)
- Nisreen Mourad
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon.
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon.
| | - Samar Younes
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
| | - Lidia Mourad
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Iqbal Fahs
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Shatha Mayta
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Racha Baalbaki
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Wassim El Basset
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
- Université de Bourgogne Franche-Comté, PEPITE EA4267, Besançon, France
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Marwan El Akel
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- School of Education, Lebanese International University, Beirut, Lebanon
- International Pharmaceutical Federation, The Hague, The Netherlands
| | - Jihan Safwan
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Faraj Saade
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- Alice Ramez Chagoury School of Nursing, Lebanese American University, Byblos, Lebanon
| | - Mohamad Rahal
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Fouad Sakr
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Créteil, France
- Institut Mondor de Recherche Biomédicale, UMR U955 INSERM, Université Paris-Est Créteil, Créteil, France
| |
Collapse
|
37
|
Koning MV, van der Zwan R, Klimek M. Drainage or lavage as a salvage manoeuvre after intrathecal drug errors: A systematic review with therapeutic recommendations. J Clin Anesth 2023; 89:111184. [PMID: 37321124 DOI: 10.1016/j.jclinane.2023.111184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
STUDY OBJECTIVE Cerebrospinal fluid (CSF) drainage and lavage are reported to reduce drug exposure after inadvertant intrathecal drug administration errors. This reviews aims to provide recommendations for this salvage technique, with regard to methodology, effectiveness and adverse events. DESIGN Systematic review. A search in the databases of Embase, Medline, Web of Science, Cochrane Central Register of Randomized Trials and Google Scholar was performed in 2022. STUDY ELIGIBILITY CRITERIA All reports of individual patient data with CSF drainage or lavage with a percutaneous lumbar access for an intrathecal drug error were included. MEASUREMENTS The primary outcome is the description and count of CSF drainage or lavage, such as times and volume of drainage, volume of replacement and type of replacement fluid. Secondary outcomes are the effects, adverse events and overall outcome. MAIN RESULTS 58 cases were found, of which 24 were paediatric cases. There was a large variance in methodology, with regard to volume t and type of replacement fluid. In 45% of the cases the intrathecal drug removal continued. The effects were specifically reported in 27 cases, all demonstrated drug removal based on drug concentrations in the CSF (n = 20) and clinical signs (n = 7). Adverse effects were sought for in 17 cases and found intracranial haemorrhage in 3 cases. No interventions were required for these adverse events and the only reported long-term sequelae in these three patients was short-term memory impairment up to 6 months after the event (n = 1). The overall outcome depended largely on the causative agent. CONCLUSIONS This review shows that CSF drainage or lavage leads to intrathecal drug removal, but it is unsure if this intervention leads to improved overall patient outcome. Based on aggregated data from case reports, we provide recommendations that may guide clinicians. The risk-benefit ratio should be weighed on a case-to-case basis.
Collapse
Affiliation(s)
- Mark V Koning
- Department of Anaesthesiology and Critical Care, Rijnstate Hospital, Arnhem, the Netherlands.
| | - Rene van der Zwan
- Department of Anaesthesiology and Critical Care, Rijnstate Hospital, Arnhem, the Netherlands
| | - Markus Klimek
- Department of Anaesthesiology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
38
|
Breniaux M, Charpiat B. [Nurses and prescribers' choice of an electric syringe pump protocol for intravenous heparin administration]. Ann Cardiol Angeiol (Paris) 2023; 72:101645. [PMID: 37660586 DOI: 10.1016/j.ancard.2023.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/25/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Several protocols for administering heparin by electric syringe pump can coexist within the same hospital. This puts patients at risk of medication errors. In our hospital trust, two preparation protocols coexist (20000UI/48mL and 25000UI/50mL). The objective is to relate the work carried out with prescribers and nurses to retain only one protocol. METHODS We questioned prescribers and nurses about the differences between the two protocols in terms of the simplicity of implementation and the risk of error to which nurses are exposed when preparing the syringe. Contextual information (heparin shortage, waste) was given in order to support the answers. RESULTS According to the 96 nurses and 82 prescribers who responded, the protocol to use is 25000IU/50mL for 98% and 83% of them respectively. The 20000IU/48mL protocol was considered the riskiest due to the possibility of mistakenly collecting 5mL instead of the required 4mL. Given the heparin shortage, the waste inherent to the 20000IU/48mL protocol reinforced this choice. CONCLUSIONS The consultation of nurses and prescribers allowed the choice of a protocol with very strong agreement. This work also brought to light what appears to be a medical misconception, namely that the non-concerted choice by physicians of a mode of administration of a drug can put nurses in a situation to make preparation errors more frequently. This emphasizes that nurses must be stakeholders in the decision-making processes that affect their practice.
Collapse
Affiliation(s)
- Manon Breniaux
- Service pharmaceutique, hôpital de la Croix-Rousse, groupement hospitalier nord, Hospices Civils de Lyon, 103, Grande rue de la Croix-Rousse Lyon cedex 04, 69317, France.
| | - Bruno Charpiat
- Service pharmaceutique, hôpital de la Croix-Rousse, groupement hospitalier nord, Hospices Civils de Lyon, 103, Grande rue de la Croix-Rousse Lyon cedex 04, 69317, France
| |
Collapse
|
39
|
ElLithy MH, Alsamani O, Salah H, Opinion FB, Abdelghani LS. Challenges experienced during pharmacy automation and robotics implementation in JCI accredited hospital in the Arabian Gulf area: FMEA analysis-qualitative approach. Saudi Pharm J 2023; 31:101725. [PMID: 37638225 PMCID: PMC10458704 DOI: 10.1016/j.jsps.2023.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Background Pharmacy automation and robotics implementation are essential aspects of healthcare facilities. It streamlines the medication dispensing process and significantly reduces medication errors. However, implementing automation and robotics in pharmacies comes with its challenges. We aim to detect and rectify potential dangers in the pharmacy workflow by utilizing the Failure Mode and Effects Analysis (FMEA) methodology; this is expected to augment performance and increase profitability. Materials and methods In this study, we conducted an FMEA analysis using a qualitative approach to identify the challenges experienced during pharmacy automation and robotics implementation in a Joint Commission International (JCI) accredited hospital in the Arabian Gulf area. The pharmacy processes and procedures were mapped in a Flow chart to visualize the pharmacy workflow, including highlighting the risks that were found. Then these risks were arranged as Potential failure modes and added to the table as 9 main points for each RPNs were calculated, and then the 9 points were prioritized for the action plans. Results Via applying traditional Risk Priority Number (RPN) FMEA, the Pharmacy board identified the process stages marked risky failure modes through several FMEAs, calculating the total RPNs at the implementation phase. It revealed several challenges, including staff training, technical issues, and inadequate communication. Furthermore, the study resulted in corrective and intervention steps. Conclusion Pharmacy automation and robotics implementation is a complex process that requires proper planning, preparation, and execution. The FMEA approach effectively identifies potential problems and evaluates their impact on the pharmacy system. Nine major failure modes appeared to be risky stages with high RPN scores. Therefore, multiple interventions were done during the implementation to enhance the knowledge of challenges faced during the implementation of the automation process and solve it. Future studies should address the identified challenges and develop strategies to mitigate them.
Collapse
Affiliation(s)
- May Hassan ElLithy
- Head Pharmaceutical Quality Services Department, King Hamad University Hospital, Bahrain, Founder of QuaMay (for Hospital Quality Improvement & Patient Safety Consultation, Training, and Education services), UAE
| | - Omar Alsamani
- Pharmaceutical Services Department, King Hamad University Hospital, Pharmacy Program, Allied Health Department, College of Health Sciences and Sport, University of Bahrain
| | - Hager Salah
- Pharmaceutical Services Department, Research Coordinator –AMS Pharmacist, King Hamad University Hospital, Bahrain
| | - Francis Byron Opinion
- Nursing, Quality and Patient Safety, Informatics, Research & EBP, King Hamad University Hospital, Bahrain. Cheif Nursing Officer, KIMS Health Hospital and Medical Centers, Bahrain
| | | |
Collapse
|
40
|
Kabac T, Le Tohic S, Spadoni S. [Medication reconciliation on admission: One year of practice in health care institutions during the COVID-19 pandemic]. Ann Pharm Fr 2023; 81:863-874. [PMID: 36731628 PMCID: PMC9886383 DOI: 10.1016/j.pharma.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Medication reconciliation is a key point of the v2020 certification. The main objective of this study was to evaluate this activity over one year, including the first epidemic wave at COVID-19. The secondary objectives were to identify the obstacles and levers and to evaluate doctor satisfaction. METHODS This was a retrospective study of drug reconciliations performed on admission during 12 months of the emergence of COVID-19. Patients aged 65 years and older from orthopedic and visceral surgery, acute hospitalization and conventional medicine units were included. Unintentional discrepancies were analyzed. The obstacles and levers were identified by means of a focus group. Doctors' satisfaction was collected using online quiz. RESULTS A total of 760 patients were conciliated, of which 27% (n=208) by hospital pharmacy technicians. A decrease in activity was observed during the first epidemic wave. An unintentional discrepancy was found in 77% of patients, and only 48% were corrected by the prescriber. These results were impacted by the pandemic. The pharmaceutical team was mobilized in the logistical management of the crisis, but it was able to adapt in order to perpetuate the activity. Doctors are satisfied with the process. CONCLUSIONS Medication reconciliation on admission is essential for the prevention of iatrogeny, particularly with the impact of the COVID-19 pandemic in healthcare institutions.
Collapse
Affiliation(s)
- T Kabac
- Service de pharmacie, hôpital d'instruction des armées Laveran, 34, boulevard Laveran, 13013 Marseille, France.
| | - S Le Tohic
- Service de pharmacie, hôpital d'instruction des armées Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - S Spadoni
- Service de pharmacie, hôpital d'instruction des armées Laveran, 34, boulevard Laveran, 13013 Marseille, France
| |
Collapse
|
41
|
Claret PG, Bobbia X, Renia R, Stowell A, Crampagne J, Flechet J, Czeschan C, Sebbane M, Landais P, de La Coussaye JE. Prescription errors by emergency physicians for inpatients are associated with emergency department length of stay. Therapie 2023; 78:S59-S65. [PMID: 27793421 DOI: 10.2515/therapie/2015049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 07/10/2015] [Indexed: 10/15/2023]
Abstract
OBJECTIVES Adverse drug events are the sixth-leading cause of death in Western countries and are also more frequent in emergency departments (EDs). In some hospitals or on some occasions, ED physicians prescribe for patients who they have admitted. These prescriptions are then followed by the wards and can persist for several days. Our objectives were to determine the frequency of prescription errors for patients over 18years old hospitalized from ED to medical or surgical wards, and whether there exists a relationship between those prescription errors and ED LOS. METHODS This was a single center retrospective study that was conduct in the ED of a university hospital with an annual census of 65 000 patients. The population studied consisted of patients over 18years old hospitalized from ED to medical or surgical wards between January 1st, 2012 and January 21st, 2012. RESULTS Six hundred eight patients were included. One hundred fifty-four (25%) patients had prescription errors. Prescription errors were associated with increased ED length of stay (OR=2.47; 95% CIs [1.58; 3.92]) and polypharmacy (OR=1.78; 95% CIs [1.20; 2.66]). Fewer prescription errors were found when the patient was examined in the ED by a consultant (OR=0.61; 95% CIs [0.41; 0.91]) and when the medical history was known (OR=0.28; 95% CIs [0.10; 0.88]). CONCLUSION Prescription errors occurred frequently in the ED. We assume that a clear communication and cooperation between EPs and consultants may help improve prescription accuracy.
Collapse
Affiliation(s)
- Pierre-Géraud Claret
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France; EA 2415, Clinical Research University Institute, centre hospitalier universitaire de Montpellier, 34000 Montpellier, France.
| | - Xavier Bobbia
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| | - Rhoda Renia
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| | - Andrew Stowell
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| | - Jacques Crampagne
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| | - Jean Flechet
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| | - Christian Czeschan
- Département informatique médicale, centre hospitalier universitaire de Nîmes, 30029 Nîmes, France
| | - Mustapha Sebbane
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| | - Paul Landais
- EA 2415, Clinical Research University Institute, centre hospitalier universitaire de Montpellier, 34000 Montpellier, France; Département de biostatistique, épidémiologie, santé publique et informatique médicale, centre hospitalier universitaire de Nîmes, 30029 Nîmes, France
| | - Jean-Emmanuel de La Coussaye
- Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| |
Collapse
|
42
|
Oms Arias M, Pons Mesquida MÀ, Dehesa Camps R, Abizanda Garcia J, Hermosilla Pérez E, Méndez Boo L. [Does recommending the dosing frequency in the electronic prescription improve its adequacy? Before and after study]. Aten Primaria 2023; 55:102683. [PMID: 37320954 PMCID: PMC10460898 DOI: 10.1016/j.aprim.2023.102683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To assess whether reporting the dosing frequency into the prescription module of the Institut Català de la Salut (ICS) primary care electronic clinical workstation improves the dosing frequency's adequacy of the prescriptions. DESIGN Before and after study with non-equivalent control of prescriptions without any change in the dosing frequency. The study periods includes from September 1st, 2019 to February 29th, 2020. LOCATION Primary care setting. PARTICIPANTS Prescriptions issued by ICS General Practitioner, during the study period of those medicines which indications have a single appropriate dosing frequency or mostly appropriate, are included. INTERVENTION Recommendation of the appropriate dosing frequency in the prescription module. MAIN MEASUREMENTS Adequacy defined as the coincidence between the prescribed dosing frequency and the appropriate dosing frequency. RESULTS After the intervention there was a 22.75% increase in prescriptions with adequate dosing frequency. The largest increase occurred in the medicines for the genitourinary system and sex hormones. In absolute terms, the group of anti infective for systemic use is the one that obtained more prescriptions with an adequate dosing frequency between the two periods. CONCLUSIONS The intervention increased the dosing frequency's adequacy leading to improvements in the safety and effectiveness of the treatments. It is evident that the design and implementation of improvements in electronic prescription systems contributes to increasing the quality of the prescription.
Collapse
Affiliation(s)
- Míriam Oms Arias
- Unitat de Coordinació i Estratègia del Medicament (UCEM), Institut Català de la Salut, Barcelona, Catalunya, España.
| | - M Àngels Pons Mesquida
- Unitat de Coordinació i Estratègia del Medicament (UCEM), Institut Català de la Salut, Barcelona, Catalunya, España
| | - Rosa Dehesa Camps
- Unitat de Coordinació i Estratègia del Medicament (UCEM), Institut Català de la Salut, Barcelona, Catalunya, España
| | - Judith Abizanda Garcia
- Unitat de Coordinació i Estratègia del Medicament (UCEM), Institut Català de la Salut, Barcelona, Catalunya, España
| | - Eduardo Hermosilla Pérez
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalunya, España
| | - Leonardo Méndez Boo
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalunya, España
| |
Collapse
|
43
|
Fanikos J, Tawfik Y, Almheiri D, Sylvester K, Buckley LF, Dew C, Dell'Orfano H, Armero A, Bejjani A, Bikdeli B, Campia U, Davies J, Fiumara K, Hogan H, Khairani CD, Krishnathasan D, Lou J, Makawi A, Morrison RH, Porio N, Tristani A, Connors JM, Goldhaber SZ, Piazza G. Anticoagulation-Associated Adverse Drug Events in Hospitalized Patients Across Two Time Periods. Am J Med 2023; 136:927-936.e3. [PMID: 37247752 DOI: 10.1016/j.amjmed.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/05/2023] [Accepted: 05/14/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE Anticoagulants often cause adverse drug events (ADEs), comprised of medication errors and adverse drug reactions, in patients. Our study objective was to determine the clinical characteristics, types, severity, cause, and outcomes of anticoagulation-associated ADEs from 2015-2020 (a contemporary period following implementation of an electronic health record, infusion device technology, and anticoagulant dosing nomograms) and to compare them with those of a historical period (2004-2009). METHODS We reviewed all anticoagulant-associated ADEs reported as part of our hospital-wide safety system. Reviewers classified type, severity, root cause, and outcomes for each ADE according to standard definitions. Reviewers also assessed events for patient harm. Patients were followed up to 30 days after the event. RESULTS Despite implementation of enhanced patient safety technology and procedure, ADEs increased in the contemporary period. In the contemporary period, we found 925 patients who had 984 anticoagulation-associated ADEs, including 811 isolated medication errors (82.4%); 13 isolated adverse drug reactions (1.4%); and 160 combined medication errors, adverse drug reactions, or both (16.2%). Unfractionated heparin was the most frequent ADE-related anticoagulant (77.7%, contemporary period vs 58.3%, historical period). The most frequent anticoagulation-associated medication error in the contemporary period was wrong rate or frequency of administration (26.1%, n = 253), with the most frequent root cause being prescribing errors (21.3%, n = 207). The type, root cause, and harm from ADEs were similar between periods. CONCLUSIONS We found that anticoagulation-associated ADEs occurred despite advances in patient safety technologies and practices. Events were common, suggesting marginal improvements in anticoagulant safety over time and ample opportunities for improvement.
Collapse
Affiliation(s)
- John Fanikos
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Yahya Tawfik
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Danya Almheiri
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Katelyn Sylvester
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Leo F Buckley
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Chris Dew
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Heather Dell'Orfano
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Andre Armero
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Antoine Bejjani
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Behnood Bikdeli
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Umberto Campia
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Julia Davies
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Karen Fiumara
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Heather Hogan
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Candrika Dini Khairani
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Darsiya Krishnathasan
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Junyang Lou
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Alaa Makawi
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Ruth H Morrison
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Nicole Porio
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Anthony Tristani
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Jean M Connors
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Samuel Z Goldhaber
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Gregory Piazza
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| |
Collapse
|
44
|
Amatullah N, Stottlemyer B, Zerfas I, Stevens C, Ozrazgat-Baslanti T, Bihorac A, Kane-Gill SL. Challenges in Pharmacovigilance: Variability in the Criteria for Determining Drug-Associated Acute Kidney Injury in Retrospective, Observational Studies. Nephron Clin Pract 2023; 147:725-732. [PMID: 37607496 PMCID: PMC10776175 DOI: 10.1159/000531916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/30/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Drug-associated acute kidney injury (D-AKI) accounts for 19-26% of acute kidney injury (AKI) events in hospitalized patients and results in outcomes similar to patients with AKI from other etiologies. Diagnosing D-AKI is complex and various criteria have been used. SUMMARY To highlight the variability in D-AKI determination, a review was conducted between January 2017 and December 2022 using PubMed. Search terms included adaptations of "drug associated kidney injury" to identify a sampling of literature discussing definitions and criteria for D-AKI evaluation. The search yielded 291 articles that were uploaded to Rayyan, a software tool used to screen and select studies. Retrospective, observational electronic health record (EHR) studies conducted in hospitalized patients were included. The final sample contained 16 studies for data extraction, representing mostly adult populations (n = 13, 81.3%) in noncritical or unspecified inpatient settings (n = 12, 75%). Nine studies (56.3%) utilized the recommended Kidney Disease: Improving Global Outcome guidelines (KDIGO) criteria to define AKI. Baseline creatinine or laboratory criteria for kidney function were provided in 10 studies (62.5%). Eleven studies (68.8%) established a temporal sequence assessment linking nephrotoxin drug exposure to an AKI event, but these criteria were inconsistent among studies using time frames as soon as 3 months prior to AKI. CONCLUSION This review highlights the substantial variability in D-AKI criteria in select studies. Minimum expectations about what should be reported and criteria for the elements reported are needed to assure transparency, consistency, and standardization of pharmacovigilance strategies.
Collapse
Affiliation(s)
- Nabihah Amatullah
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Britney Stottlemyer
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Isabelle Zerfas
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cole Stevens
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tezcan Ozrazgat-Baslanti
- Intelligent Critical Care Center, University of Florida, Gainesville, Florida, USA
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Azra Bihorac
- Intelligent Critical Care Center, University of Florida, Gainesville, Florida, USA
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Sandra L. Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmacy, UPMC, Pittsburgh, PA, USA
- Department of Critical Care Medicine, Program of Critical Care Nephrology, Pittsburgh, PA, USA
| |
Collapse
|
45
|
Mikkelsen TH, Søndergaard J, Kjaer NK, Nielsen JB, Ryg J, Kjeldsen LJ, Mogensen CB. Handling polypharmacy -a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals. BMC Geriatr 2023; 23:477. [PMID: 37553585 PMCID: PMC10410867 DOI: 10.1186/s12877-023-04131-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/24/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND On average, older patients use five or more medications daily. A consequence is an increased risk of adverse drug reactions, interactions, or medication errors. Therefore, it is important to understand the challenges experienced by the patients, relatives, and healthcare professionals pertinent to the concomitant use of many drugs. METHODS We conducted a qualitative study using focus group interviews to collect information from patients, relatives, and healthcare professionals regarding older patients' management of prescribed medicine. We interviewed seven patients using five or more medications daily, three relatives, three general practitioners, nine nurses from different healthcare sectors, one home care assistant, two hospital physicians, and four pharmacists. RESULTS The following themes were identified: (1) Unintentional non-adherence, (2) Intentional non-adherence, (3) Generic substitution, (4) Medication lists, (5) Timing and medication schedule, (6) Medication reviews and (7) Dose dispensing/pill organizers. CONCLUSION Medication is the subject of concern among patients and relatives. They become confused and insecure about information from different actors and the package leaflets. Therefore, patients often request a thorough medication review to provide an overview, knowledge of possible side effects and interactions, and a clarification of the medication's timing. In addition, patients, relatives and nurses all request an indication of when medicine should be taken, including allowable deviations from this timing. Therefore, prescribing physicians should prioritize communicating information regarding these matters when prescribing.
Collapse
Affiliation(s)
- Thorbjørn Hougaard Mikkelsen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
- Hospital Sønderjylland, Kresten Philipsens vej 15, indgang F, Aabenraa, 6200, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Kristian Kjaer
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, 6 The, Odense, Denmark
| | - Lene Juel Kjeldsen
- Hospital Sønderjylland, Kresten Philipsens vej 15, indgang F, Aabenraa, 6200, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
46
|
Ni J, Tang X, Chen L. Medication overdose data analysis: a review of medication error reports in the FDA adverse event reporting system (FAERS). BMC Pharmacol Toxicol 2023; 24:41. [PMID: 37542326 PMCID: PMC10403938 DOI: 10.1186/s40360-023-00681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 07/28/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND drug overdose is a common type of medication error, which caused significant patient injuries and economic losses. To determine which drugs are reported most frequently in association with drug overdose, a comprehensive search was conducted in the FDA Adverse Event Reporting System (FAERS) database. The study also sought to determine the top 10 drugs reported with drug overdose. METHODS FAERS database was searched for drug overdose records submitted from the first quarter of 2017 to the fourth quarter of 2021. Descriptive analyses were conducted based on the total counts and percentages of reports associated with the drug. Subgroup analyses were performed on drugs of different pharmacological classifications. RESULTS A total of 170,424 drug overdose reports were retrieved. The results revealed that antipyretics and analgesics took the highest risk for overdose, with 63,143 (37.05%) cases reported. Among them, opioids were associated with the most drug overdose events. The top 10 drug classes relating to drug overdose in FAERS were opioid analgesic, anilide antipyretic analgesic, 5-HT reuptake inhibitors, bronchodilators, monoclonal antibodies and antibody-drug conjugates, benzodiazepines, antipsychotics, GABA derivatives, antimanic agents, and propionic acid derivatives. CONCLUSION to reduce the occurrence of drug overdose events, some methods could be considered including applying a pre-prescription review system, drug safety education, developing warning lists, etc.
Collapse
Affiliation(s)
- Jiaqi Ni
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Xinru Tang
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Li Chen
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
| |
Collapse
|
47
|
de Dios JG, López-Pineda A, Juan GMP, Minagorre PJA, Guilabert M, Pérez-Jover V, Carrillo I, Mira JJ. Perceptions and attitudes of pediatricians and families with regard to pediatric medication errors at home. BMC Pediatr 2023; 23:380. [PMID: 37525101 PMCID: PMC10391897 DOI: 10.1186/s12887-023-04106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 06/02/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE This study aimed to identify the perceptions and attitudes of pediatricians and parents/caregivers regarding medication errors at home, and to compare the findings from the two populations. METHODS This was a cross-sectional survey study. We designed a survey for working pediatricians and another one for parents or caregivers of children aged 14 years and younger. The survey's questions were designed to assess provider and parental opinions about the difficulty faced by parents providing medical treatment, specific questions on medication errors, and on a possible intervention program aimed at preventing pediatric medication errors. Pediatrician and parent responses to matching questions in both surveys were compared. RESULTS The surveys were administered in Spain from 2019 to 2021. In total, 182 pediatricians and 194 families took part. Most pediatricians (62.6%) and families (79.3%) considered that managing medical treatment was not among the main difficulties faced by parents in caring for their children. While 79.1% of pediatricians thought that parents consulted the internet to resolve doubts regarding the health of their children, most families (81.1%) said they consulted healthcare professionals. Lack of knowledge among parents and caregivers was one of the causes of medication errors most frequently mentioned by both pediatricians and parents. Most pediatricians (95.1%) said they would recommend a program designed to prevent errors at home. CONCLUSIONS Pediatricians and families think that medical treatment is not among the main difficulties faced by parents in caring for their children. Most pediatricians said they would recommend a medication error reporting and learning system designed for families of their patients to prevent medication errors that might occur in the home environment.
Collapse
Grants
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
Collapse
Affiliation(s)
- Javier González de Dios
- Pharmacology, Pediatrics and Organic Chemistry, Miguel Hernandez University, San Juan de Alicante, Spain
- Paediatrics Department, General University Hospital of Alicante, Alicante, Spain
- Institute of Health and Biomedical Research of Alicante, Alicante Spain General University Hospital of Alicante, Alicante, Spain
| | - Adriana López-Pineda
- Clinical Medicine Department, Miguel Hernández University, San Juan de Alicante, Spain
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, San Juan de Alicante, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), San Juan de Alicante, Spain
| | | | - Pedro J Alcalá Minagorre
- Paediatrics Department, General University Hospital of Alicante, Alicante, Spain
- Institute of Health and Biomedical Research of Alicante, Alicante Spain General University Hospital of Alicante, Alicante, Spain
| | - Mercedes Guilabert
- Health Psychology Department, Miguel Hernandez University, Elche, Spain.
| | - Virtudes Pérez-Jover
- Institute of Health and Biomedical Research of Alicante, Alicante Spain General University Hospital of Alicante, Alicante, Spain
- Health Psychology Department, Miguel Hernandez University, Elche, Spain
| | - Irene Carrillo
- Health Psychology Department, Miguel Hernandez University, Elche, Spain
| | - José Joaquín Mira
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, San Juan de Alicante, Spain
- Health Psychology Department, Miguel Hernandez University, Elche, Spain
- Alicante-Sant Joan d'Alacant Health Department, San Juan de Alicante, Spain
| |
Collapse
|
48
|
Karet GB. Linguistic Analysis of Generic-Generic Drug Name Pairs Prone to Wrong-Drug Errors for which Tall-Man Lettering is Recommended. Ther Innov Regul Sci 2023; 57:751-758. [PMID: 37171707 PMCID: PMC10276790 DOI: 10.1007/s43441-023-00526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/14/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The Institute for Safe Medication Practices (ISMP) and the United States Food and Drug Administration (FDA) disseminated widely used lists of drug name pairs involved in wrong-drug errors, for which they recommended tall-man lettering (TML). Linguistic similarity is believed responsible for confusion of these drugs. This study aims to quantify linguistic similarity and other linguistic properties of these generic-generic name pairs. METHODS The FDA's Phonetic and Orthographic Computer Analysis (POCA) software was used to generate numerical similarity scores for the generic-generic name pairs on these lists and to identify conflicts between these names and the names of other marketed products. Within each pair, differences in name length and the number of identical prefix (initial) letters and suffix (final) letters were determined. RESULTS The selected pairs shared a mean of 2.5 (± 1.8) identical prefix letters and 3.2 (± 2.9) identical suffix letters. The mean POCA score 69.5 (± 9.7), indicated moderate-to-high similarity. POCA scores for individual pairs ranged from 90 (most similar) to 46 (least similar). Individual names averaged 11.2 (± 9.1) high-similarity conflicts with names of other marketed drugs. CONCLUSIONS POCA analysis could be a valuable tool in determining whether linguistic similarity contributes to specific wrong-drug errors. The finding of 11.2 (± 9.1) high-similarity conflicts with names of other marketed drugs is more than for candidate names USAN accepts and suggests the names on the FDA and ISMP lists are linguistically problematic.
Collapse
Affiliation(s)
- Gail B Karet
- Senior Scientist, American Medical Association, United States Adopted Names Program, Suite 39300, 330 N. Wabash Ave, Chicago, IL, 60611-5885, USA.
| |
Collapse
|
49
|
Beatriz GC, María José O, Inés JL, Yolanda HG, Concha ÁDV, Javier TS, Cecilia M FL. Medication errors in children visiting pediatric emergency departments. Farm Hosp 2023; 47:141-147. [PMID: 37164795 DOI: 10.1016/j.farma.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES Medication safety represents an important challenge in children. There are limited studies on medication errors in pediatric patients visiting emergency departments. To help bridge this gap, we characterized the medication errors detected in these patients, determining their severity, the stages of the medication process in which they occurred, the drugs involved, and the types and causes associated with the errors. METHODS We conducted a multicenter prospective observational study in the pediatric emergency departments of 8 Spanish public hospitals over a 4-month period. Medication errors detected by emergency pediatricians in patients between 0 and 16 years of age were evaluated by a clinical pharmacist and a pediatrician. Each medication error was analyzed according to the updated Spanish Taxonomy of Medication Errors. RESULTS In 99,797 visits to pediatric emergency departments, 218 (0.2%) medication errors were detected, of which 74 (33.9%) resulted in harm (adverse drug events). Preschoolers were the age group with the most medication errors (126/218). Errors originated mainly in the prescribing stage (66.1%), and also by self-medication (16.5%) and due to wrong administration of the medication by family members (15.6%). Dosing errors (51.4%) and wrong/improper drugs (46.8%) were the most frequent error types. Anti-infective drugs (63.5%) were the most common drugs implicated in medication errors with harm. Underlying causes associated with a higher proportion of medication errors were "medication knowledge deficit" (63.8%), "deviation from procedures/guidelines" (48.6%) and "lack of patient information" (30.3%). CONCLUSIONS Medication errors presented by children attending emergency departments arise from prescriptions, self-medicationand administration, and lead to patient harm in one third of cases. Developing effective interventions based on the types of errors and the underlying causes identified will improve patient safety.
Collapse
Affiliation(s)
- Garrido-Corro Beatriz
- Pharmacy Department, Virgen de la Arrixaca Clinical University Hospital, Murcia, Spain.
| | - Otero María José
- Pharmacy Department, ISMP-Spain, Salamanca University Hospital-IBSAL, Salamanca, Spain
| | | | - Hernández Gago Yolanda
- Pharmacy Department, Maternal-Insular Hospital Complex of Gran Canaria, Gran Canaria, Spain
| | | | | | | |
Collapse
|
50
|
Patel V, Taylor K, Schlick J, Hertig J. A Comparison of Instructions for Use Documents and Manufacturer Produced Administration Videos for Biological Products. Ther Innov Regul Sci 2023; 57:646-652. [PMID: 37031279 DOI: 10.1007/s43441-023-00516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/21/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVES To compare Instructions for Use (IFU) and Manufacturer Produced Administration Videos (MPAV) for biological products to describe if they are highly similar or different. To identify differences between the two that may lead to medication errors and to point out possible solutions to optimize safety. METHODS We screened 139 biological products having both an IFU and a MPAV. Differences between the IFU and MPAV of each biological product were noted and categorized by importance and how likely it would cause harm to patients. Strategies were discussed based on differences observed. RESULTS Of the products screened, 51 had an IFU and a MPAV available for evaluation. They were primarily made to support the use of auto-injectors (n = 25) and pre-filled syringes (n = 19). Of this group, we found that 11 had no differences between the IFU and MPAV, while the other 40 had at least one or more identifiable differences. Differences were stratified into the following sub-categories from most to least prevalent: word choice differences, supplementary information, missing information, and unaligned directions. We looked at the distribution of differences per biological product and found an average of two differences per MPAV (IQR 1-3). CONCLUSION We suggest that when sponsors create or update MPAVs, to focus on aligning critical content between the respective IFU and MPAV. We believe that it is possible for MPAVs to potentially reduce medication errors as a non-text-based media form and that care should be taken to avoid substantial differences in critical content between the IFU and MPAV.
Collapse
Affiliation(s)
- Vraj Patel
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA.
- Regeneron Pharmaceuticals, Tarrytown, NY, USA.
| | | | | | - John Hertig
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA
| |
Collapse
|