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BMJ Health & Care Informatics Aug 2020Electronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication...
Changes in medication administration error rates associated with the introduction of electronic medication systems in hospitals: a multisite controlled before and after study.
BACKGROUND
Electronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication administration errors (MAEs).
OBJECTIVE
To assess changes in MAE rates and types associated with EMS implementation.
METHODS
This was a controlled before and after study (three intervention and three control wards) at two adult teaching hospitals. Intervention wards used an EMS with no bar-coding. Independent, trained observers shadowed nurses and recorded medications administered and compliance with 10 safety procedures. Observational data were compared against medication charts to identify errors (eg, wrong dose). Potential error severity was classified on a 5-point scale, with those scoring ≥3 identified as serious. Changes in MAE rates preintervention and postintervention by study group, accounting for differences at baseline, were calculated.
RESULTS
7451 administrations were observed (4176 pre-EMS and 3275 post-EMS). At baseline, 30.2% of administrations contained ≥1 MAE, with wrong intravenous rate, timing, volume and dose the most frequent. Post-EMS, MAEs decreased on intervention wards relative to control wards by 4.2 errors per 100 administrations (95% CI 0.2 to 8.3; p=0.04). Wrong timing errors alone decreased by 3.4 per 100 administrations (95% CI 0.01 to 6.7; p<0.05). EMS use was associated with an absolute decline in potentially serious MAEs by 2.4% (95% CI 0.8 to 3.9; p=0.003), a 56% reduction in the proportion of potentially serious MAEs. At baseline, 74.1% of administrations were non-compliant with ≥1 of 10 procedures and this rate did not significantly improve post-EMS.
CONCLUSIONS
Implementation of EMS was associated with a modest, but significant, reduction in overall MAE rate, but halved the proportion of MAEs rated as potentially serious.
Topics: Drug Administration Schedule; Efficiency, Organizational; Hospitals, Teaching; Humans; Medication Errors; Medication Systems, Hospital; Pharmaceutical Preparations
PubMed: 32796084
DOI: 10.1136/bmjhci-2020-100170 -
International Journal For Quality in... Nov 2021Medication administration errors (MAEs) occur frequently in hospitals and may compromise patient safety. Preventive strategies are needed to reduce the risk of MAEs.
BACKGROUND
Medication administration errors (MAEs) occur frequently in hospitals and may compromise patient safety. Preventive strategies are needed to reduce the risk of MAEs.
OBJECTIVE
The primary aim of this study was to assess the effect of central automated unit dose dispensing with barcode-assisted medication administration on the prevalence of MAEs. Secondary aims were to assess the effect on the type and potential severity of MAEs. Furthermore, compliance with procedures regarding scanning of patient and medication barcodes and nursing staff satisfaction with the medication administration system were assessed.
METHODS
We performed a prospective uncontrolled before-and-after study in six clinical wards in a Dutch university hospital from 2018 to 2020. MAE data were collected by observation. The primary outcome was the proportion of medication administrations with one or more MAEs. Secondary outcomes were the type and potential severity of MAEs, rates of compliance with patient identification and signing of administered medication by scanning and nursing staff satisfaction with the medication administration system. Multivariable mixed-effects logistic regression analyses were used for the primary outcome to adjust for confounding and for clustering on nurse and patient level.
RESULTS
One or more MAEs occurred in 291 of 1490 administrations (19.5%) pre-intervention and in 258 of 1630 administrations (15.8%) post-intervention (adjusted odds ratio 0.70, 95% confidence interval 0.51-0.96). The rate of omission fell from 4.6% to 2.0% and of wrong dose from 3.8% to 2.1%, whereas rates of other MAE types were similar. The rate of potentially harmful MAEs fell from 3.0% (n = 44) to 0.3% (n = 5). The rates of compliance with scanning of patient and medication barcode post-intervention were 13.6% and 55.9%, respectively.The median overall satisfaction score of the nurses with the medication administration system on a 100-point scale was 70 (interquartile range 63-75, n = 193) pre-intervention and 70 (interquartile range 60-78, n = 145) post-intervention (P = 0.626, Mann-Whitney U test).
CONCLUSION
The implementation of central automated unit dose dispensing with barcode-assisted medication administration was associated with a lower probability of MAEs, including potentially harmful errors, but more compliance with scanning procedures is needed. Nurses were moderately satisfied with the medication administration system, both before and after implementation. In conclusion, despite low compliance with scanning procedures, this study shows that this intervention contributes to the improvement of medication safety in hospitals.
Topics: Hospitals, University; Humans; Medication Errors; Medication Systems, Hospital; Pharmaceutical Preparations; Prospective Studies
PubMed: 34662396
DOI: 10.1093/intqhc/mzab142 -
BMC Health Services Research Apr 2021Nurse managers play a critical role in enhancing nursing and patient outcomes. The work of nurse managers, who can be described as middle-managers at health care...
BACKGROUND
Nurse managers play a critical role in enhancing nursing and patient outcomes. The work of nurse managers, who can be described as middle-managers at health care organizations, is complex and changes on a daily basis. Only a few studies have clarified how nurse managers divide their time across various work activities. This study aimed to describe the relationships between nurse managers' work activities, nurses' job satisfaction, patient satisfaction, and medication errors at the hospital unit level.
METHODS
A cross-sectional and correlational study design was used. The data were collected from nurse managers (n = 29), nursing staff (n = 306), and patients (n = 651) from 28 units across three Finnish acute care hospitals between April and November 2017. In addition, data concerning medication errors (n = 468) over one calendar year (2017) were acquired from the hospitals' incident reporting register. Analysis of covariance (ANCOVA) was used to estimate relationships between data from subareas of Nurse Managers' Work Content Questionnaire, Kuopio University Hospital Job Satisfaction Scale, and Revised Humane Caring Scale, along with medication error reports. A significance level of 95% was applied when estimating the covariances between variables. Unstandardized regression coefficients (B) were used to explain the relationships between variables.
RESULTS
Multiple relationships between nurse managers' work activities, nurses' job satisfaction, patient satisfaction, and medication errors were identified. Nurse managers' work activities had both positive and negative relationships on the other studied variables. The Requiring factors of work (p < .001) subarea of nurses' job satisfaction, total patient satisfaction (p < .001), and medication errors (p < .001) were identified as the variables most significantly affected by other factors.
CONCLUSIONS
The findings suggest that nurse managers should focus on improving nursing practices by managing and organizing nurses' work in a way that makes their employees feel supported, motivated and secure. Furthermore, nurse managers should adopt a leadership style that emphasizes safe and patient-centered care. The results also suggest that the administration of today's health care organizations should actively evaluate nurse managers' share of work activities to ensure that their daily work is in line with the organizational goals.
Topics: Cross-Sectional Studies; Humans; Job Satisfaction; Leadership; Medication Errors; Nurse Administrators; Nursing Staff, Hospital; Patient Satisfaction; Personal Satisfaction; Surveys and Questionnaires
PubMed: 33794875
DOI: 10.1186/s12913-021-06288-5 -
The Journal of Nursing Education May 2024Accuracy is needed with medication administration, a skill that involves rule-based habits and clinical reasoning. This pilot study investigated the use of an...
BACKGROUND
Accuracy is needed with medication administration, a skill that involves rule-based habits and clinical reasoning. This pilot study investigated the use of an evidence-based checklist for accuracy with oral medication administration and error reporting among prelicensure nursing students. Checklist items were anchored in the mnemonic C-MATCH-REASON (Client, Medication, ADRs, Time, Client History, Route, Expiration date, Amount, Site, Outcomes, Notation).
METHOD
Nineteen participants randomly assigned to crossover sequence AB or BA (A: checklist; B: no checklist) practiced simulation scenarios with embedded errors. Nursing faculty used an observation form to track error data.
RESULTS
Using the C-MATCH-REASON checklist compared with not using the checklist supported rule adherence ( = .005), knowledge-based error reduction ( = .011), and total error reduction ( = .010). The null hypothesis was not rejected for errors found ( = .061) nor reported ( = .144), possibly due to sample size.
CONCLUSION
C-MATCH-REASON© was effective for error reduction. Study replication with a larger sample is warranted. .
Topics: Female; Humans; Male; Checklist; Clinical Competence; Competency-Based Education; Cross-Over Studies; Education, Nursing, Baccalaureate; Medication Errors; Nursing Education Research; Pilot Projects; Students, Nursing
PubMed: 38729143
DOI: 10.3928/01484834-20240305-07 -
AORN Journal Dec 2023Medication errors are preventable events that health care professionals, consumers, and medication manufacturers report to the US Food and Drug Administration. The...
Medication errors are preventable events that health care professionals, consumers, and medication manufacturers report to the US Food and Drug Administration. The agency receives more than 100,000 medication-related reports each year, and some reports involve patient death. A variety of sources provide perioperative nurses with information on interventions and practices to prevent medication errors, including the US Pharmacopeia, The Joint Commission, medication manufacturers' instructions for use, safety data sheets, and the updated AORN "Guideline for medication safety." This article provides an overview of the guideline and discusses recommendations for organizational oversight, procurement and storage, retrieval and preparation, labeling, and hazardous medications. It also includes a scenario that illustrates perioperative nursing practices for administering an antineoplastic medication intraoperatively. Perioperative nurses should review the guideline in its entirety and implement recommendations in operative or procedural settings.
Topics: Humans; Medication Errors; Pharmaceutical Preparations; Perioperative Nursing
PubMed: 38011062
DOI: 10.1002/aorn.14034 -
La Revue de Medecine Interne Sep 2023Admission to hospital is a critical transition point for the continuity of care in medication management. Medication reconciliation can identify and resolve errors due... (Review)
Review
Admission to hospital is a critical transition point for the continuity of care in medication management. Medication reconciliation can identify and resolve errors due to inaccurate medication histories. The practice of medication reconciliation is securing for the patient because of the medication errors detected with significant clinical impact. Its implementation must comply with the recommendations of the French National Authority for Health (HAS) and its deployment is now integrated into the contract for improving the quality and efficiency of care (CAQES). However, although it allows to intercept medication errors, its impact on the length of hospitalization, the rate of readmission and/or death following discharge seems limited. Given the limited human resources to carry out this time-consuming activity, patient prioritization should be considered. Studies on the fate of patients and on the medico-economic issues are also necessary in order to make this activity sustainable.
Topics: Humans; Medication Reconciliation; Pharmacists; Medication Errors; Hospitalization; Patient Discharge; Patient Admission
PubMed: 36841717
DOI: 10.1016/j.revmed.2023.02.001 -
Journal of Infusion Nursing : the...
Topics: Humans; Medication Errors; Risk Management
PubMed: 36112870
DOI: 10.1097/NAN.0000000000000485 -
Andes Pediatrica : Revista Chilena de... Apr 2021Medication errors (ME) are preventable incidents of inappropriate use of medications by health per sonnel or by the patient. These events can occur at any stage of drug... (Review)
Review
INTRODUCTION
Medication errors (ME) are preventable incidents of inappropriate use of medications by health per sonnel or by the patient. These events can occur at any stage of drug use generating significant costs to the health system and, in some cases, these can even lead to death. The pediatric population is con sidered susceptible to ME with a prevalence 3 times higher than adult patients.
OBJECTIVE
To identify the prevalence of medication errors in hospitalized pediatric patients, as well as their classification according to the stage of use of the medication when they occurred.
METHOD
A literature review of ME in pediatrics was carried out through a Pubmed / Medline search using Mesh terms ("Medication Errors" and "Pediatrics") in the last 10 years. Three investigators reviewed independently the identi fied articles considering the STROBE checklist for observational studies.
RESULTS
192 bibliographic references were identified, 22 of them were eligible for review and data collection. Studies reported an error rate between 1% and 58% of the evaluated medication indications, with errors reported in different processes of drug use. 9 articles (41%) described errors related only to prescription, mainly associated with incorrect dosage, 6 (27%) errors related to prescription, administration, and other processes, 3 (14%) related to prescription and administration, 2 (9%) related only to administra tion, 1 (4%) article reported errors related to conciliation, and 1 (4%) described errors related to preparation and administration.
CONCLUSION
The studies reported different medication errors in the pediatric population. Most of them reported ME related to prescription followed by ME in the administration. Knowing the proportion of ME allows focusing interventions aimed at reducing their prevalence.
Topics: Child; Child, Hospitalized; Humans; Medication Errors; Pediatrics
PubMed: 34106170
DOI: 10.32641/andespediatr.v92i2.1357 -
Dermatology Online Journal Mar 2021We update and expand our 2010 article in this journal, Patient safety in dermatology: A review of the literature [4][DH1]. (Review)
Review
OBJECTIVE
We update and expand our 2010 article in this journal, Patient safety in dermatology: A review of the literature [4][DH1].
METHODS
PubMed at the National Center for Biotechnology Information (NCBI), United States National Library of Medicine (NLM) was searched September 2019 for English language articles published between 2009 and 2019 concerning patient safety and medical error in dermatology. Potentially relevant articles and communications were critically evaluated by the authors with selected references from 2020 added to include specific topics: medication errors, diagnostic errors including telemedicine, office-based surgery, wrong-site procedures, infections including COVID-19, falls, laser safety, scope of practice, and electronic health records.
SUMMARY
Hospitals and clinics are adopting the methods of high-reliability organizations to identify and change ineffective practice patterns. Although systems issues are emphasized in patient safety, people are critically important to effective teamwork and leadership. Advancements in procedural and cosmetic dermatology, organizational and clinical guidelines, and the revolution in information technology and electronic health records have introduced new sources of potential error.
CONCLUSION
Despite the growing number of dermatologic patient safety studies, our review supports a continuing need for further studies and reports to reduce the number of preventable errors and provide optimal care.
Topics: Accidental Falls; COVID-19; Cross Infection; Dermatologic Agents; Dermatology; Diagnostic Errors; Documentation; Electronic Health Records; Fires; Humans; Infection Control; Lasers; Medical Errors; Medication Errors; Patient Safety; Personal Protective Equipment; Risk Factors
PubMed: 33865273
DOI: No ID Found -
Journal of Patient Safety Apr 2023Knowledge of the prevalence and characteristics of medication errors in pediatric and neonatal patients is limited. This study aimed to evaluate the incidence and...
OBJECTIVES
Knowledge of the prevalence and characteristics of medication errors in pediatric and neonatal patients is limited. This study aimed to evaluate the incidence and medication error characteristics in a pediatric hospital over 5 years and to determine whether serial error prevention programs to optimize a computerized physician order entry (CPOE) system reduce error incidence.
METHODS
We retrospectively reviewed medication errors documented between January 2015 and December 2019.
RESULTS
A total of 2,591,596 prescriptions were checked, and 255 errors were identified. Wrong dose prescriptions constituted the most common errors (56.9%). Medications with the highest rate of errors were antibiotics/antiviral drugs (36.9%). Oral route medications comprised the highest portion (60.8%), followed by intravenous ones (28.6%). The most common stage for medication errors was physician ordering (93.3%). Junior residents were responsible for most errors (45.9%). Most errors occurred in the pediatric ward (53.7%). In total, 221 (86.7%) errors were near misses. Only 4 errors (1.6%) were considered significant and required active monitoring or intervention. Type of error, stage of error, staff composition, and severity level of errors were significantly related to the number of errors in different years. There was a statistically significant decrease in errors per 100,000 prescriptions across different years after optimizing the CPOE system.
CONCLUSIONS
The incidence of medication errors decreased with extensive use of the CPOE system. Continuous application of the CPOE optimization program can effectively reduce medication errors. Further incorporation of pediatric-specific decision-making and support tools and error prevention measures into CPOE systems is needed.
Topics: Infant, Newborn; Child; Humans; Hospitals, Pediatric; Retrospective Studies; Medication Errors; Medical Order Entry Systems; Physicians; Medication Systems, Hospital
PubMed: 36728168
DOI: 10.1097/PTS.0000000000001087