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Nurse Education Today Jan 2020Medication errors are the most common clinical errors in healthcare practice and can lead to serious consequences. Medication error encouragement training (MEET) brings... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Medication errors are the most common clinical errors in healthcare practice and can lead to serious consequences. Medication error encouragement training (MEET) brings students face-to-face with potential errors in the medication process, in a safe environment where they are encouraged to understand both the error and the context in which it occurred.
OBJECTIVES
The study aimed to examine the effects of a MEET intervention on medication safety confidence among nursing undergraduates.
DESIGN
This was a quasi-experimental study with a nonequivalent control group design.
PARTICIPANTS
Our sample was recruited from the nursing education department of a university, with 47 participants randomly assigned to the experimental group, and 50 to the control group.
METHODS
Both groups received theoretical training, followed by applied training. The experimental group received the MEET intervention developed specifically for this study, while the control group received traditional error avoidance training. Participants' medication administration confidence was measured pre- and post-intervention.
RESULTS
Following training, the experimental group's confidence was significantly higher than that of the control group. With regard to individual medication administration procedures, the experimental groups' medication safety confidence increased significantly after training compared to the control group in patient identification, drug information confirmation, and drug preparation.
CONCLUSIONS
Introducing MEET into nursing curricula could reduce medication errors and related complications in healthcare institutions. Further studies are needed to investigate the long-term effects of MEET interventions, as well as the generalizability of our findings.
Topics: Clinical Competence; Curriculum; Education, Nursing, Baccalaureate; Female; Humans; Male; Medication Errors; Patient Safety; Students, Nursing; Young Adult
PubMed: 31698293
DOI: 10.1016/j.nedt.2019.104250 -
Critical Care Nursing Clinics of North... Jun 2018With an estimated 90% of all hospitalized patients receiving intravenous medications via infusion pumps, intravenous infusion pump systems are among the most frequently... (Review)
Review
With an estimated 90% of all hospitalized patients receiving intravenous medications via infusion pumps, intravenous infusion pump systems are among the most frequently used technologies in health care. This article reviews important issues regarding clinical usability, intravenous medication administration error, and patient safety related to the use of intravenous smart pumps. Although it is possible to address some of the issues with changes in clinical processes, the most fundamental challenges need to be addressed through innovation and the development of new technologies using a human factors approach.
Topics: Critical Care Nursing; Drug Therapy, Computer-Assisted; Humans; Infusion Pumps; Infusions, Intravenous; Medication Errors; Patient Safety
PubMed: 29724440
DOI: 10.1016/j.cnc.2018.02.004 -
Mayo Clinic Proceedings Aug 2014Medication error is an important cause of patient morbidity and mortality, yet it can be a confusing and underappreciated concept. This article provides a review for... (Review)
Review
Medication error is an important cause of patient morbidity and mortality, yet it can be a confusing and underappreciated concept. This article provides a review for practicing physicians that focuses on medication error (1) terminology and definitions, (2) incidence, (3) risk factors, (4) avoidance strategies, and (5) disclosure and legal consequences. A medication error is any error that occurs at any point in the medication use process. It has been estimated by the Institute of Medicine that medication errors cause 1 of 131 outpatient and 1 of 854 inpatient deaths. Medication factors (eg, similar sounding names, low therapeutic index), patient factors (eg, poor renal or hepatic function, impaired cognition, polypharmacy), and health care professional factors (eg, use of abbreviations in prescriptions and other communications, cognitive biases) can precipitate medication errors. Consequences faced by physicians after medication errors can include loss of patient trust, civil actions, criminal charges, and medical board discipline. Methods to prevent medication errors from occurring (eg, use of information technology, better drug labeling, and medication reconciliation) have been used with varying success. When an error is discovered, patients expect disclosure that is timely, given in person, and accompanied with an apology and communication of efforts to prevent future errors. Learning more about medication errors may enhance health care professionals' ability to provide safe care to their patients.
Topics: Disclosure; Drug Labeling; Health Personnel; Humans; Incidence; Inpatients; Liability, Legal; Medication Errors; Medication Reconciliation; Outpatients; Patient Education as Topic; Patient Harm; Pharmacovigilance; Risk Factors; Root Cause Analysis; United States
PubMed: 24981217
DOI: 10.1016/j.mayocp.2014.05.007 -
Journal of Paediatrics and Child Health Mar 2019This study aimed to examine reported medication error trends in an Australian paediatric hospital over a 5-year period and to determine the effects of person-related,...
AIM
This study aimed to examine reported medication error trends in an Australian paediatric hospital over a 5-year period and to determine the effects of person-related, environment-related and communication-related factors on the severity of medication outcomes. In particular, the focus was on the influence of changes to a hospital site and structure on the severity of medication errors.
METHODS
A retrospective clinical audit was undertaken over a 5-year period of paediatric medication errors submitted to an online voluntary reporting system of an Australian, tertiary, public teaching paediatric hospital. All medication errors submitted to the online system between 1 July 2010 and 30 June 2015 were included.
RESULTS
A total of 3340 medication errors was reported, which corresponded to 0.56% medication errors per combined admissions and presentations or 5.73 medication errors per 1000 bed days. The most common patient outcomes related to errors requiring monitoring or an intervention to ensure no harm occurred (n = 1631, 48.8%). A new hospital site and structure had 0.354 reduced odds of producing medication errors causing possible or probable harm (95% confidence interval 0.298-0.421, P < 0.0001). Patient and family involvement had 1.270 increased odds of identifying medication errors associated with possible or probable harm compared with those causing no harm (95% confidence interval 1.028-1.568, P = 0.027). Interrupted time series analyses showed that moving to a new hospital site and structure was associated with a reduction in reported medication errors.
CONCLUSION
Encouraging child and family involvement, facilitating hospital redesign and improving communication could help to reduce the harm associated with medication errors.
Topics: Australia; Causality; Child; Health Care Surveys; Hospitalization; Hospitals, Pediatric; Humans; Interdisciplinary Communication; Medication Errors; Retrospective Studies
PubMed: 30168236
DOI: 10.1111/jpc.14193 -
Journal of General Internal Medicine Oct 2019Computerized physician order entry and clinical decision support systems are electronic prescribing strategies that are increasingly used to improve patient safety.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Computerized physician order entry and clinical decision support systems are electronic prescribing strategies that are increasingly used to improve patient safety. Previous reviews show limited effect on patient outcomes. Our objective was to assess the impact of electronic prescribing strategies on medication errors and patient harm in hospitalized patients.
METHODS
MEDLINE, EMBASE, CENTRAL, and CINAHL were searched from January 2007 to January 2018. We included prospective studies that compared hospital-based electronic prescribing strategies with control, and reported on medication error or patient harm. Data were abstracted by two reviewers and pooled using random effects model. Study quality was assessed using the Effective Practice and Organisation of Care and evidence quality was assessed using Grading of Recommendations Assessment, Development, and Evaluation.
RESULTS
Thirty-eight studies were included; comprised of 11 randomized control trials and 27 non-randomized interventional studies. Electronic prescribing strategies reduced medication errors (RR 0.24 (95% CI 0.13, 0.46), I 98%, n = 11) and dosing errors (RR 0.17 (95% CI 0.08, 0.38), I 96%, n = 9), with both risk ratios significantly affected by advancing year of publication. There was a significant effect of electronic prescribing strategies on adverse drug events (ADEs) (RR 0.52 (95% CI 0.40, 0.68), I 0%, n = 2), but not on preventable ADEs (RR 0.55 (95% CI 0.30, 1.01), I 78%, n = 3), hypoglycemia (RR 1.03 (95% CI 0.62-1.70), I 28%, n = 7), length of stay (MD - 0.18 (95% - 1.42, 1.05), I 94%, n = 7), or mortality (RR 0.97 (95% CI 0.79, 1.19), I 74%, n = 9). The quality of evidence was rated very low.
DISCUSSION
Electronic prescribing strategies decrease medication errors and adverse drug events, but had no effect on other patient outcomes. Conservative interpretations of these findings are supported by significant heterogeneity and the preponderance of low-quality studies.
Topics: Decision Support Systems, Clinical; Drug-Related Side Effects and Adverse Reactions; Electronic Prescribing; Humans; Medication Errors; Outcome Assessment, Health Care; Randomized Controlled Trials as Topic
PubMed: 31396810
DOI: 10.1007/s11606-019-05236-8 -
Pharmacoepidemiology and Drug Safety May 2017Medication error is a significant source of morbidity and mortality among patients. Clinical and cost-effectiveness evidence are required for the implementation of... (Review)
Review
PURPOSE
Medication error is a significant source of morbidity and mortality among patients. Clinical and cost-effectiveness evidence are required for the implementation of quality of care interventions. Reduction of error-related cost is a key potential benefit of interventions addressing medication error. The aim of this review was to describe and quantify the economic burden associated with medication error.
METHODS
PubMed, Cochrane, Embase, CINAHL, EconLit, ABI/INFORM, Business Source Complete were searched. Studies published 2004-2016 assessing the economic impact of medication error were included. Cost values were expressed in Euro 2015. A narrative synthesis was performed.
RESULTS
A total of 4572 articles were identified from database searching, and 16 were included in the review. One study met all applicable quality criteria. Fifteen studies expressed economic impact in monetary terms. Mean cost per error per study ranged from €2.58 to €111 727.08. Healthcare costs were used to measure economic impact in 15 of the included studies with one study measuring litigation costs. Four studies included costs incurred in primary care with the remaining 12 measuring hospital costs. Five studies looked at general medication error in a general population with 11 studies reporting the economic impact of an individual type of medication error or error within a specific patient population.
CONCLUSIONS
Considerable variability existed between studies in terms of financial cost, patients, settings and errors included. Many were of poor quality. Assessment of economic impact was conducted predominantly in the hospital setting with little assessment of primary care impact. Limited parameters were used to establish economic impact. Copyright © 2017 John Wiley & Sons, Ltd.
Topics: Cost-Benefit Analysis; Health Care Costs; Hospital Costs; Humans; Medication Errors; Primary Health Care; Research Design
PubMed: 28295821
DOI: 10.1002/pds.4188 -
BMC Health Services Research Oct 2021The aim of the third WHO challenge released in 2017 was to attain a global commitment to lessen the severity and to prevent medication-related harm by 50% within the... (Review)
Review
BACKGROUND
The aim of the third WHO challenge released in 2017 was to attain a global commitment to lessen the severity and to prevent medication-related harm by 50% within the next five years. To achieve this goal, comprehensive identification of barriers to reporting medication errors is imperative.
OBJECTIVE
This review systematically identified and examined the barriers hindering nurses from reporting medication administration errors in the hospital setting.
DESIGN
An integrative review.
REVIEW METHODS
PubMed, Web of Science, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) including Google scholar were searched to identify published studies on barriers to medication administration error reporting from January 2016 to December 2020. Two reviewers (AA, and KDK) independently assessed the quality of all the included studies using the Mixed Methods Appraisal Tool (MMAT) version 2018.
RESULTS
Of the 10, 929 articles retrieved, 14 studies were included in this study. The main themes and subthemes identified as barriers to reporting medication administration errors after the integration of results from qualitative and quantitative studies were: organisational barriers (inadequate reporting systems, management behaviour, and unclear definition of medication error), and professional and individual barriers (fear of management/colleagues/lawsuit, individual reasons, and inadequate knowledge of errors).
CONCLUSION
Providing an enabling environment void of punitive measures and blame culture is imperious for nurses to report medication administration errors. Policymakers, managers, and nurses should agree on a uniform definition of what constitutes medication error to enhance nurses' ability to report medication administration errors.
Topics: Fear; Hospitals; Humans; Medication Errors; Nurses; Patient Safety
PubMed: 34696788
DOI: 10.1186/s12913-021-07187-5 -
Research in Social & Administrative... Jul 2020The impact of medication reconciliation (MR) in low-middle-income countries, including Thailand, may differ from other developed countries. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The impact of medication reconciliation (MR) in low-middle-income countries, including Thailand, may differ from other developed countries.
OBJECTIVE
To evaluate the effect of medication reconciliation (MR) on the reduction of medication error in Thailand.
METHODS
A systematic search was conducted in the following databases: PubMed, CENTRAL, CINAHL, Scopus, Thai Journals Online, Thai index Medicus, Thai Medical Index, and Health Science Journal in Thailand from inception to January 2018. Studies that evaluated the effect of MR compared to usual care within hospitals in Thailand and reported the occurrence of medication error were included. Meta-analyses were performed using random-effects model.
RESULTS
Of the 107 articles retrieved, 7 articles involving 1581 patients were included in quantitative synthesis. Three of the included studies were randomized controlled trials (RCT). Overall, the risk of medication error in patients who received MR in all transitions of care was 75% lower than those receiving usual care (RR 0.25; 95%CI 0.15-0.43). The effect on the reduction of medication error appeared higher when MR was provided to ambulatory patients (RR 0.17 [95%CI 0.04-0.80] compared with hospitalized patients during admission (RR 0.37 [95%CI 0.20-0.65]) and discharge (RR 0.27 [95%CI 0.17-0.43]). Effects on reducing medication error was greater when MR was provided in secondary care hospitals compared with primary care hospitals both during admission (RR 0.49 [95%CI, 0.34-0.69] vs RR 0.25 [95%CI, 0.05-1.26]), and discharge transition (RR 0.19 [95%CI, 0.09-0.39] vs RR 0.30 [95%CI, 0.12-0.79]).
CONCLUSION
Overall, current evidence indicates that the provision of MR in Thailand is effective in reducing medication errors in all transitions of care. However, to promote patient safety, appropriate strategies should be developed to support MR in specific transition of care and hospital setting so patients can benefit most from this service.
Topics: Hospitalization; Humans; Medication Errors; Medication Reconciliation; Patient Discharge; Thailand
PubMed: 31607507
DOI: 10.1016/j.sapharm.2019.10.004 -
BMC Health Services Research Sep 2019Medication errors are a serious and complex problem in clinical practice, especially in intensive care units whose patients can suffer potentially very serious...
BACKGROUND
Medication errors are a serious and complex problem in clinical practice, especially in intensive care units whose patients can suffer potentially very serious consequences because of the critical nature of their diseases and the pharmacotherapy programs implemented in these patients. The origins of these errors discussed in the literature are wide-ranging, although far-reaching variables are of particular special interest to those involved in training nurses. The main objective of this research was to study if the level of knowledge that critical-care nurses have about the use and administration of medications is related to the most common medication errors.
METHODS
This was a mixed (multi-method) study with three phases that combined quantitative and qualitative techniques. In phase 1 patient medical records were reviewed; phase 2 consisted of an interview with a focus group; and an ad hoc questionnaire was carried out in phase 3.
RESULTS
The global medication error index was 1.93%. The main risk areas were errors in the interval of administration of antibiotics (8.15% error rate); high-risk medication dilution, concentration, and infusion-rate errors (2.94% error rate); and errors in the administration of medications via nasogastric tubes (11.16% error rate).
CONCLUSIONS
Nurses have a low level of knowledge of the drugs they use the most and with which a greater number of medication errors are committed in the ICU.
Topics: Critical Care Nursing; Critical Illness; Female; Focus Groups; Health Knowledge, Attitudes, Practice; Humans; Intensive Care Units; Intubation, Gastrointestinal; Male; Medication Errors; Middle Aged; Pharmaceutical Preparations; Surveys and Questionnaires
PubMed: 31492188
DOI: 10.1186/s12913-019-4481-7 -
British Journal of Clinical Pharmacology Jun 20091. To understand medication errors and to identify preventive strategies, we need to classify them and define the terms that describe them. 2. The four main approaches...
1. To understand medication errors and to identify preventive strategies, we need to classify them and define the terms that describe them. 2. The four main approaches to defining technical terms consider etymology, usage, previous definitions, and the Ramsey-Lewis method (based on an understanding of theory and practice). 3. A medication error is 'a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient'. 4. Prescribing faults, a subset of medication errors, should be distinguished from prescription errors. A prescribing fault is 'a failure in the prescribing [decision-making] process that leads to, or has the potential to lead to, harm to the patient'. The converse of this, 'balanced prescribing' is 'the use of a medicine that is appropriate to the patient's condition and, within the limits created by the uncertainty that attends therapeutic decisions, in a dosage regimen that optimizes the balance of benefit to harm'. This excludes all forms of prescribing faults, such as irrational, inappropriate, and ineffective prescribing, underprescribing and overprescribing. 5. A prescription error is 'a failure in the prescription writing process that results in a wrong instruction about one or more of the normal features of a prescription'. The 'normal features' include the identity of the recipient, the identity of the drug, the formulation, dose, route, timing, frequency, and duration of administration. 6. Medication errors can be classified, invoking psychological theory, as knowledge-based mistakes, rule-based mistakes, action-based slips, and memory-based lapses. This classification informs preventive strategies.
Topics: Clinical Competence; Humans; Medication Errors; Terminology as Topic
PubMed: 19594526
DOI: 10.1111/j.1365-2125.2009.03415.x