-
Paediatric Anaesthesia Dec 2018Clinical evidence shows that pediatric anesthesia patients are subject to a higher rate of life-threatening medical errors than their adult counterparts. Medication... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Clinical evidence shows that pediatric anesthesia patients are subject to a higher rate of life-threatening medical errors than their adult counterparts. Medication error in adult anesthesia is estimated to occur to 1 in 133 anesthetic administrations, but such a figure has not been determined for pediatric anesthesia patients. Individual studies of medication error in pediatric anesthesia have ranged from rates of 0.01% to 1.92% of anesthetic uses. The present study is a systematic review that employs a meta-analytic estimate to determine the rate of medication error in pediatric anesthesia.
METHODS
A systematic review of the literature on pediatric anesthesia medication error was conducted using Medline, Cochrane Database, PROSPERO, and Clinicaltrials.gov. A meta-analytic estimate was used to determine the medication error rate for all of the included studies. Subgroup sensitivity analysis was used to evaluate possible sources of heterogeneity in included studies.
RESULTS
Of the 433 initially screened records, 13 studies met inclusion criteria. Meta-analytic estimate of medication error rate across all studies was 0.08% (95% CI 0.05%-0.10%), or 1 out of 1250 anesthetics. Ten different countries were represented in the studies. Sample size of anesthetics reported on ranged from 296 to 2 316 635. Data collecting periods ranged from 3 months to 15 years. Six included studies individually reported higher rates of medication error in patients under 1 year of age.
CONCLUSION
The present systematic review revealed a medication error rate of 1 per 1250 anesthetic administrations in pediatric anesthesia. This result is significantly lower than would be expected given reported rates of medication error in adult anesthesia, which raises questions regarding the validity of research methods and reporting of medication error in pediatric anesthesia. Future investigations of medication error should employ methodologies other than self-reporting of error, such as retrospective chart review.
Topics: Anesthesia; Anesthetics; Child; Cohort Studies; Humans; Medication Errors; Pediatrics; Randomized Controlled Trials as Topic; Retrospective Studies
PubMed: 30375106
DOI: 10.1111/pan.13521 -
Drug Safety Dec 2014Smart infusion pumps have been introduced to prevent medication errors and have been widely adopted nationally in the USA, though they are not always used in Europe or... (Review)
Review
BACKGROUND
Smart infusion pumps have been introduced to prevent medication errors and have been widely adopted nationally in the USA, though they are not always used in Europe or other regions. Despite widespread usage of smart pumps, intravenous medication errors have not been fully eliminated.
OBJECTIVE
Through a systematic review of recent studies and reports regarding smart pump implementation and use, we aimed to identify the impact of smart pumps on error reduction and on the complex process of medication administration, and strategies to maximize the benefits of smart pumps.
METHODS
The medical literature related to the effects of smart pumps for improving patient safety was searched in PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) (2000-2014) and relevant papers were selected by two researchers.
RESULTS
After the literature search, 231 papers were identified and the full texts of 138 articles were assessed for eligibility. Of these, 22 were included after removal of papers that did not meet the inclusion criteria. We assessed both the benefits and negative effects of smart pumps from these studies. One of the benefits of using smart pumps was intercepting errors such as the wrong rate, wrong dose, and pump setting errors. Other benefits include reduction of adverse drug event rates, practice improvements, and cost effectiveness. Meanwhile, the current issues or negative effects related to using smart pumps were lower compliance rates of using smart pumps, the overriding of soft alerts, non-intercepted errors, or the possibility of using the wrong drug library.
CONCLUSION
The literature suggests that smart pumps reduce but do not eliminate programming errors. Although the hard limits of a drug library play a main role in intercepting medication errors, soft limits were still not as effective as hard limits because of high override rates. Compliance in using smart pumps is key towards effectively preventing errors. Opportunities for improvement include upgrading drug libraries, developing standardized drug libraries, decreasing the number of unnecessary warnings, and developing stronger approaches to minimize workarounds. Also, as with other clinical information systems, smart pumps should be implemented with the idea of using continuous quality improvement processes to iteratively improve their use.
Topics: Analgesia, Patient-Controlled; Analgesics, Opioid; Equipment Safety; Humans; Infusion Pumps; Infusions, Intravenous; Medication Errors
PubMed: 25294653
DOI: 10.1007/s40264-014-0232-1 -
BMJ Open Dec 2019Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology.
DESIGN
Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model.
RESULTS
Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control.
CONCLUSIONS
Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice.
PROSPERO REGISTRATION NUMBER
CRD42016034057.
Topics: Biomedical Research; Humans; Inpatients; Patient Safety; Psychiatric Department, Hospital
PubMed: 31874869
DOI: 10.1136/bmjopen-2019-030230 -
Journal of the American Geriatrics... Apr 2012Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor... (Review)
Review
Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIMs in older adults. PIMs now form an integral part of policy and practice and are incorporated into several quality measures. The specific aim of this project was to update the previous Beers Criteria using a comprehensive, systematic review and grading of the evidence on drug-related problems and adverse drug events (ADEs) in older adults. This was accomplished through the support of The American Geriatrics Society (AGS) and the work of an interdisciplinary panel of 11 experts in geriatric care and pharmacotherapy who applied a modified Delphi method to the systematic review and grading to reach consensus on the updated 2012 AGS Beers Criteria. Fifty-three medications or medication classes encompass the final updated Criteria, which are divided into three categories: potentially inappropriate medications and classes to avoid in older adults, potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate, and finally medications to be used with caution in older adults. This update has much strength, including the use of an evidence-based approach using the Institute of Medicine standards and the development of a partnership to regularly update the Criteria. Thoughtful application of the Criteria will allow for (a) closer monitoring of drug use, (b) application of real-time e-prescribing and interventions to decrease ADEs in older adults, and (c) better patient outcomes.
Topics: Aged; Drug Prescriptions; Geriatrics; Humans; Medication Errors; Practice Patterns, Physicians'; Societies, Medical; United States
PubMed: 22376048
DOI: 10.1111/j.1532-5415.2012.03923.x -
British Journal of Clinical Pharmacology Sep 2016Medication reconciliation is a part of the medication management process and facilitates improved patient safety during care transitions. The aims of the study were to... (Review)
Review
AIMS
Medication reconciliation is a part of the medication management process and facilitates improved patient safety during care transitions. The aims of the study were to evaluate how medication reconciliation has been conducted and how medication discrepancies have been classified.
METHODS
We searched MEDLINE, EMBASE, CINAHL, PubMed, International Pharmaceutical Abstracts (IPA), and Web of Science (WOS), in accordance with the PRISMA statement up to April 2016. Studies were eligible for inclusion if they evaluated the types of medication discrepancy found through the medication reconciliation process and contained a classification system for discrepancies. Data were extracted by one author based on a predefined table, and 10% of included studies were verified by two authors.
RESULTS
Ninety-five studies met the inclusion criteria. Approximately one-third of included studies (n = 35, 36.8%) utilized a 'gold' standard medication list. The majority of studies (n = 57, 60%) used an empirical classification system and the number of classification terms ranged from 2 to 50 terms. Whilst we identified three taxonomies, only eight studies utilized these tools to categorize discrepancies, and 11.6% of included studies used different patient safety related terms rather than discrepancy to describe the disagreement between the medication lists.
CONCLUSIONS
We suggest that clear and consistent information on prevalence, types, causes and contributory factors of medication discrepancy are required to develop suitable strategies to reduce the risk of adverse consequences on patient safety. Therefore, to obtain that information, we need a well-designed taxonomy to be able to accurately measure, report and classify medication discrepancies in clinical practice.
Topics: Humans; Medication Errors; Medication Reconciliation; Patient Safety
PubMed: 27198753
DOI: 10.1111/bcp.13017 -
Journal of Education and Health... 2021Medication errors (MEs) are a critical worldwide concern and can cause genuine clinical ramifications for patients. Studies concerning such errors have not been... (Review)
Review
Medication errors (MEs) are a critical worldwide concern and can cause genuine clinical ramifications for patients. Studies concerning such errors have not been undertaken as much in the Middle Eastern region. The aim of this study was to systematically review and identify studies done in the Middle Eastern nations to recognize the principle contributory factors included and to estimate the prevalence in the region. A review of the retrospective, prospective, cohort, and case-control studies based on MEs in the Middle Eastern nations was directed in January 2020 utilizing the accompanying databases: Embase, Medline, PubMed, Ebsco, Cochrane, Scopus, and Prospero. The search methodology incorporated all ages and in English only dating back to 2010. The search methodology included articles about MEs in the Middle East with errors in people of all ages, articles in English, and articles dating back to 2010. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses appraisal instrument was used to assess the quality of the included articles. Individual data extraction, pooled analysis, and the accompanying databases were used for data analysis of the MEs in eligible studies. Fifteen of the 18 articles reviewed from four Middle Eastern countries had low risk of bias, while three out of 18 had medium risk of bias. A total of 58,221 reported people were studied, with a total of 34,730.9 reported MEs. The pooled analysis showed that numbers of errors were mainly prescribing errors ( = 22,715.25), general prescription errors ( = 8097.16), and commission errors ( = 158.2). Iran had the highest rate amid the reported administration errors, at 25.07% (599.11/2388.9). Measuring a patient's clinical laboratory values was another less common type of prescription ME. Lebanon reported to have the highest monitoring errors, with a rate of 13.13% (277.91/2117). A negative trend was shown in the amount of MEs in the vast majority of the nations under the examination. The under-reporting or uncertain information recommended that significan changes are needed in the healthcare sector. There is solid need of literature on healthcare services in the region to completely understand and address the MEs and issues.
PubMed: 34395664
DOI: 10.4103/jehp.jehp_1549_20 -
BMC Health Services Research Jul 2016Suboptimal medication adherence is a significant threat to public health and resources. Devices that organise weekly doses by time and day are commonly used to reduce... (Review)
Review
BACKGROUND
Suboptimal medication adherence is a significant threat to public health and resources. Devices that organise weekly doses by time and day are commonly used to reduce unintentional non-adherence. However, there is limited evidence to support their use. This systematic review was conducted to evaluate current evidence for their efficacy, safety and costs.
METHODS
A pre-defined search of electronic databases from inception to January 2013 augmented with hand-searching was conducted. No limits were placed on publication date. Studies that compared organisation devices used by patients administering their own medication with standard medication packaging regardless of study design were eligible for inclusion. Studies that solely explored dispensing aspects of organisation devices were included whether or not they compared this to standard care. Screening of articles for inclusion and data extraction were completed independently by two reviewers with disagreements resolved by discussion. Outcomes were categorised into impact on health, medication adherence, healthcare utilisation, dispensing errors, supply procedures and costs. Risk of bias was also assessed.
RESULTS
Seventeen studies met the inclusion criteria. Health outcomes were investigated in seven studies of which three reported a positive effect associated with organisation devices. Medication adherence was reported in eight studies of which three reported a positive effect. Three studies reported health care utilisation data but overall results are inconclusive. No optimal dispensing or supply procedures were identified. Economic assessment of the impact of organisation devices is lacking. All studies were subject to a high risk of bias.
CONCLUSIONS
Evidence regarding the effects of medication organisation devices was limited, and the available evidence was susceptible to a high risk of bias. Organisation devices may help unintentional medication non-adherence and could improve health outcomes. There is a strong need for more studies that explore the impact of such devices on patients, and an equally pressing need for studies that explore the impacts on healthcare services.
TRIAL REGISTRATION
This systematic review is registered with PROSPERO (Registration number CRD42011001718 ).
Topics: Drug Packaging; Humans; Medication Adherence; Medication Errors; Pharmacies; Quality of Life; Reminder Systems; Treatment Outcome
PubMed: 27381448
DOI: 10.1186/s12913-016-1446-y -
The Cochrane Database of Systematic... Aug 2018Transitional care provides for the continuity of care as patients move between different stages and settings of care. Medication discrepancies arising at care... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Transitional care provides for the continuity of care as patients move between different stages and settings of care. Medication discrepancies arising at care transitions have been reported as prevalent and are linked with adverse drug events (ADEs) (e.g. rehospitalisation).Medication reconciliation is a process to prevent medication errors at transitions. Reconciliation involves building a complete list of a person's medications, checking them for accuracy, reconciling and documenting any changes. Despite reconciliation being recognised as a key aspect of patient safety, there remains a lack of consensus and evidence about the most effective methods of implementing reconciliation and calls have been made to strengthen the evidence base prior to widespread adoption.
OBJECTIVES
To assess the effect of medication reconciliation on medication discrepancies, patient-related outcomes and healthcare utilisation in people receiving this intervention during care transitions compared to people not receiving medication reconciliation.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, seven other databases and two trials registers on 18 January 2018 together with reference checking, citation searching, grey literature searches and contact with study authors to identify additional studies.
SELECTION CRITERIA
We included only randomised trials. Eligible studies described interventions fulfilling the Institute for Healthcare Improvement definition of medication reconciliation aimed at all patients experiencing a transition of care as compared to standard care in that institution. Included studies had to report on medication discrepancies as an outcome.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened titles and abstracts, assessed studies for eligibility, assessed risk of bias and extracted data. Study-specific estimates were pooled, using a random-effects model to yield summary estimates of effect and 95% confidence intervals (CI). We used the GRADE approach to assess the overall certainty of evidence for each pooled outcome.
MAIN RESULTS
We identified 25 randomised trials involving 6995 participants. All studies were conducted in hospital or immediately related settings in eight countries. Twenty-three studies were provider orientated (pharmacist mediated) and two were structural (an electronic reconciliation tool and medical record changes). A pooled result of 20 studies comparing medication reconciliation interventions to standard care of participants with at least one medication discrepancy showed a risk ratio (RR) of 0.53 (95% CI 0.42 to 0.67; 4629 participants). The certainty of the evidence on this outcome was very low and therefore the effect of medication reconciliation to reduce discrepancies was uncertain. Similarly, reconciliation's effect on the number of reported discrepancies per participant was also uncertain (mean difference (MD) -1.18, 95% CI -2.58 to 0.23; 4 studies; 1963 participants), as well as its effect on the number of medication discrepancies per participant medication (RR 0.13, 95% CI 0.01 to 1.29; 2 studies; 3595 participants) as the certainty of the evidence for both outcomes was very low.Reconciliation may also have had little or no effect on preventable adverse drug events (PADEs) due to the very low certainty of the available evidence (RR 0.37. 95% CI 0.09 to 1.57; 3 studies; 1253 participants), with again uncertainty on its effect on ADE (RR 1.09, 95% CI 0.91 to 1.30; 4 studies; 1363 participants; low-certainty evidence). Evidence of the effect of the interventions on healthcare utilisation was conflicting; it probably made little or no difference on unplanned rehospitalisation when reported alone (RR 0.72, 95% CI 0.44 to 1.18; 5 studies; 1206 participants; moderate-certainty evidence), and had an uncertain effect on a composite measure of hospital utilisation (emergency department, rehospitalisation RR 0.78, 95% CI 0.50 to 1.22; 4 studies; 597 participants; very low-certainty evidence).
AUTHORS' CONCLUSIONS
The impact of medication reconciliation interventions, in particular pharmacist-mediated interventions, on medication discrepancies is uncertain due to the certainty of the evidence being very low. There was also no certainty of the effect of the interventions on the secondary clinical outcomes of ADEs, PADEs and healthcare utilisation.
Topics: Drug-Related Side Effects and Adverse Reactions; Humans; Medication Errors; Medication Reconciliation; Patient Readmission; Pharmacists; Quality Improvement; Randomized Controlled Trials as Topic; Transitional Care
PubMed: 30136718
DOI: 10.1002/14651858.CD010791.pub2 -
Expert Opinion on Drug Safety Jun 2015Medication errors have been analyzed as a health professionals' responsibility (due to mistakes in prescription, preparation or dispensing). However, sometimes, patients... (Review)
Review
INTRODUCTION
Medication errors have been analyzed as a health professionals' responsibility (due to mistakes in prescription, preparation or dispensing). However, sometimes, patients themselves (or their caregivers) make mistakes in the administration of the medication. The epidemiology of patient medication errors (PEs) has been scarcely reviewed in spite of its impact on people, on therapeutic effectiveness and on incremental cost for the health systems.
AREAS COVERED
This study reviews and describes the methodological approaches and results of published studies on the frequency, causes and consequences of medication errors committed by patients at home. A review of research articles published between 1990 and 2014 was carried out using MEDLINE, Web-of-Knowledge, Scopus, Tripdatabase and Index Medicus.
EXPERT OPINION
The frequency of PE was situated between 19 and 59%. The elderly and the preschooler population constituted a higher number of mistakes than others. The most common were: incorrect dosage, forgetting, mixing up medications, failing to recall indications and taking out-of-date or inappropriately stored drugs. The majority of these mistakes have no negative consequences. Health literacy, information and communication and complexity of use of dispensing devices were identified as causes of PEs. Apps and other new technologies offer several opportunities for improving drug safety.
Topics: Aged; Child, Preschool; Communication; Health Literacy; Humans; Medication Errors; Patient Education as Topic; Pharmaceutical Preparations; Self Administration
PubMed: 25774444
DOI: 10.1517/14740338.2015.1026326 -
Journal of Advanced Nursing Oct 2011Healthcare leaders need evidence-based information on nursing medication administration technologies to guide the design of improvements to patient safety. (Review)
Review
BACKGROUND
Healthcare leaders need evidence-based information on nursing medication administration technologies to guide the design of improvements to patient safety.
AIM
The aim of this study was to evaluate the research evidence on relationships between the use of medication administration technologies and incidence of medication administration incidents and preventable adverse drug events to inform decision-making about existing technology options.
DATA SOURCES
Thirteen electronic databases and seven relevant patient safety websites were searched for the years 1980-2009.
REVIEW METHODS
A mixed-method systematic literature review of research on medication administration technologies and associated links to patient safety, operationalized as medication administration incidents and preventable adverse drug events, was conducted.
RESULTS
Twelve studies (two qualitative, five pre- and postinterventions and five correlational) met the inclusion criteria. All were assessed as medium quality with low generalizability of study findings. Only two studies sampled more than one hospital and none of the studies was driven by an explicit theoretical framework. The studies included in this review are generally positive towards medication administration technologies and their potential benefits, yet the level of evidence overall is equivocal. The majority of studies pointed to the development of workarounds by nurses following medication administration technology implementation that could compromise patient safety.
CONCLUSION
More theoretically driven research is needed to determine which medication administration technologies should be implemented in what ways to most effectively reduce medication administration incidents and preventable adverse drug events and minimize the development of potentially unsafe workarounds. Further evidence is required to accurately assess the actual contribution of medication administration technologies for improving patient safety.
Topics: Attitude of Health Personnel; Decision Making; Diffusion of Innovation; Drug Delivery Systems; Evidence-Based Practice; Humans; Incidence; Medication Errors; Medication Systems, Hospital; Nursing Research; Outcome Assessment, Health Care; Patient Safety; Safety Management
PubMed: 21545642
DOI: 10.1111/j.1365-2648.2011.05676.x