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Drug Safety Nov 2013Underlying systems factors have been seen to be crucial contributors to the occurrence of medication errors. By understanding the causes of these errors, the most... (Review)
Review
BACKGROUND
Underlying systems factors have been seen to be crucial contributors to the occurrence of medication errors. By understanding the causes of these errors, the most appropriate interventions can be designed and implemented to minimise their occurrence.
OBJECTIVE
This study aimed to systematically review and appraise empirical evidence relating to the causes of medication administration errors (MAEs) in hospital settings.
DATA SOURCES
Nine electronic databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts, ASSIA, PsycINFO, British Nursing Index, CINAHL, Health Management Information Consortium and Social Science Citations Index) were searched between 1985 and May 2013.
STUDY SELECTION
Inclusion and exclusion criteria were applied to identify eligible publications through title analysis followed by abstract and then full text examination. English language publications reporting empirical data on causes of MAEs were included. Reference lists of included articles and relevant review papers were hand searched for additional studies. Studies were excluded if they did not report data on specific MAEs, used accounts from individuals not directly involved in the MAE concerned or were presented as conference abstracts with insufficient detail.
DATA APPRAISAL AND SYNTHESIS METHODS
A total of 54 unique studies were included. Causes of MAEs were categorised according to Reason's model of accident causation. Studies were assessed to determine relevance to the research question and how likely the results were to reflect the potential underlying causes of MAEs based on the method(s) used.
RESULTS
Slips and lapses were the most commonly reported unsafe acts, followed by knowledge-based mistakes and deliberate violations. Error-provoking conditions influencing administration errors included inadequate written communication (prescriptions, documentation, transcription), problems with medicines supply and storage (pharmacy dispensing errors and ward stock management), high perceived workload, problems with ward-based equipment (access, functionality), patient factors (availability, acuity), staff health status (fatigue, stress) and interruptions/distractions during drug administration. Few studies sought to determine the causes of intravenous MAEs. A number of latent pathway conditions were less well explored, including local working culture and high-level managerial decisions. Causes were often described superficially; this may be related to the use of quantitative surveys and observation methods in many studies, limited use of established error causation frameworks to analyse data and a predominant focus on issues other than the causes of MAEs among studies.
LIMITATIONS
As only English language publications were included, some relevant studies may have been missed.
CONCLUSIONS
Limited evidence from studies included in this systematic review suggests that MAEs are influenced by multiple systems factors, but if and how these arise and interconnect to lead to errors remains to be fully determined. Further research with a theoretical focus is needed to investigate the MAE causation pathway, with an emphasis on ensuring interventions designed to minimise MAEs target recognised underlying causes of errors to maximise their impact.
Topics: Data Collection; Databases, Factual; Drug Prescriptions; Hospitals, Teaching; Humans; Medication Errors; Models, Theoretical; Patient Care Team; Pharmaceutical Preparations; Quality Assurance, Health Care; Workload
PubMed: 23975331
DOI: 10.1007/s40264-013-0090-2 -
Pharmacy (Basel, Switzerland) Aug 2018PRN is the acronym for ',' written against prescriptions whose administration should be based on patients' needs, rather than at set times. The aim of this systematic... (Review)
Review
UNLABELLED
PRN is the acronym for ',' written against prescriptions whose administration should be based on patients' needs, rather than at set times. The aim of this systematic review was to explore safety issues and adverse events arising from PRN prescription and administration. Electronic databases including Scopus, PubMed [including Medline], Embase, Cinahl, Web of Science and ProQuest were systematically searched to retrieve articles published from 2005 to 2017.
SELECTION CRITERIA
we included all randomized controlled trials (RCTs) and studies with comparison groups, comparing PRN prescription and administration with scheduled administration, where safety issues and adverse events were reported. The authors independently assessed titles, abstracts and full-texts of retrieved studies based on inclusion criteria and risk of bias. Results were summarised narratively. The search identified 7699 articles. Title, abstract and full-text appraisals yielded 5 articles. The included studies were RCTs with one exception, a pre-test post-test experimental design. Patient populations, interventions and outcomes varied. Studies compared patient-controlled or routine administration with PRN and one trial assessed the effect of a practice guideline on implementation of PRN administration. More analgesia was administered in the patient-controlled than the PRN arms but pain reduction was similar. However, there was little difference in administration of psychotropic medicines. No differences between patient-controlled and PRN groups were reported for adverse events. The PRN practice guideline improved PRN patient education but non-documentation of PRN administration increased. This systematic review suggests that PRN safety issues and adverse events are an under-researched area of healthcare practice. Variations in the interventions, outcomes and clinical areas make it difficult to judge the overall quality of the evidence. Well-designed RCTs are needed to identify any safety issues and adverse events associated with PRN administration.
PubMed: 30158511
DOI: 10.3390/pharmacy6030095 -
Advances in Medicine 2023Ineffective nursing documentation practices have been reported to negatively impact patient outcomes and health professional efficiency. On the prevalence of nurses'... (Review)
Review
BACKGROUND
Ineffective nursing documentation practices have been reported to negatively impact patient outcomes and health professional efficiency. On the prevalence of nurses' documentation practices in Ethiopia, several separate studies have been carried out. However, there is no pooled prevalence of nurses' documentation practice. Therefore, this systematic review and meta-analysis aimed to assess the overall prevalence of nursing care documentation practice and related factors in Ethiopia.
METHODS AND MATERIALS
This review only included articles that were published. The main databases were Medline/PubMed, Web of Science, Google Scholar, Scopus, Ethiopian University Repository Online, and the Cochrane Library. Cross-sectional studies that satisfy the criteria and are written in English are included in the review. Using a random effects model, the pooled prevalence of nurses' documentation practices was determined. The funnel plot and the Eggers test were also used to look into publication bias. All statistical analyses were done with STATA version 14.
RESULT
This review included nine studies with a total of 2,900 participants. The pooled prevalence of nurses' documentation practice in Ethiopia was 50.01% (95% CI: 42.59 and 57.18; = 93.8%; and ≤ 0.001). In terms of subgroup analysis, Addis Ababa had the highest prevalence of nurses' documentation practice at 84% (95% CI: 77.18 and 90.82), while Southern Ethiopia had the lowest at 40.00% (95% CI: 38.10 and 44.90). Nursing documentation practices were statistically associated with the availability of nursing documentation formats, adequate nurse-to-patient ratio, motivation, and training.
CONCLUSION
This review showed that one in two nurses practiced poor documentation of their daily activities in Ethiopia. Therefore, strict monitoring, evaluation, and supervision of nursing care documentation services are highly recommended for all stakeholders. We strongly recommend improving the identified factors by arranging training for nurses, motivating them, providing adequate documentation formats, and maintaining a nurse-to-patient ratio.
PubMed: 37965424
DOI: 10.1155/2023/5565226 -
Advances in Health Sciences Education :... Oct 2023Therapeutic reasoning is when the purpose, task, or goal for engaging in reasoning is to determine the patient's management plan. As the field's understanding of the... (Review)
Review
Therapeutic reasoning is when the purpose, task, or goal for engaging in reasoning is to determine the patient's management plan. As the field's understanding of the process of therapeutic reasoning is less well understood, we focused on studies that collected data on the process of therapeutic reasoning. To synthesize previous studies of therapeutic reasoning characteristics, methodological approaches, theoretical underpinnings, and results. We conducted a scoping review with systematic searching for English language articles with no date limits. Databases included MEDLINE, CINAHL Plus, Scopus, Embase, Proquest Dissertations and Theses Global, and ERIC. Search terms captured therapeutic reasoning in health professions education research. Initial search yielded 5450 articles. The title and abstract screening yielded 180 articles. After full-text review, 87 studies were included in this review. Articles were excluded if they were outside health professions education, did not collect data on the process of therapeutic reasoning, were not empirical studies, or not focused on therapeutic reasoning. We analyzed the included articles according to scoping questions using qualitative content analysis. 87 articles dated from 1987 to 2019 were included. Several study designs were employed including think-aloud protocol, interview and written documentation. More than half of the articles analyzed the data using qualitative coding. Authors often utilized several middle-range theories to explain therapeutic reasoning processes. The hypothetico-deductive model was most frequently mentioned. The included articles rarely built off the results from previous studies. Six key result categories were found: identifying themes, characterizing and testing previous local theory, exploring factors, developing new local theory, testing tools, and testing hypothesis. Despite the cast body of therapeutic reasoning research, individual study results remain isolated from previous studies. Our future recommendations include synthesizing pre-existing models, developing novel methodologies, and investigating other aspects of therapeutic reasoning.
Topics: Humans; Empirical Research; Health Personnel; Motivation
PubMed: 37043070
DOI: 10.1007/s10459-022-10187-7 -
Journal of Immigrant and Minority Health Feb 2021The medical-legal partnership addresses social and political determinants of health. Yet, relatively little is known about best practices for these two service providers... (Review)
Review
The medical-legal partnership addresses social and political determinants of health. Yet, relatively little is known about best practices for these two service providers collaborating to deliver integrated services, particularly to im/migrant communities. To investigate evaluations of existing medical-legal partnerships in order to understand how they function together, what they provide, and how they define and deliver equitable, integrated care. We searched five databases (PubMed, Medline, Web of Science, HeinOnline, and Nexus Uni) using search terms related to "medical-legal partnerships", "migrants", and "United States". We systematically evaluated ten themes related to how medical and legal teams interacted, were situated, organized, and who they served. Articles were published in English between 2010 and 2019; required discussion about a direct partnership between medical and legal professionals; and focused on providing clinical care and legal services to im/migrant populations. Eighteen articles met our inclusion criteria. The most common form of partnership was a model in which legal clinics make regular referrals to medical clinics, although the reverse was also common. Most services were not co-located. Partnerships often engaged in advocacy work, provided translation services, and referred clients to non-medical providers and legal services. This review demonstrates the benefits of a legal-medical partnership, such as enhancing documentation and care for im/migrants and facilitating a greater attention to political determinants of health. Yet, this review demonstrates that, despite the increasing salience of such partnership, few have written up their lessons learned and best practices.
Topics: Delivery of Health Care; Emigrants and Immigrants; Humans; Legal Services; Transients and Migrants; United States
PubMed: 32978741
DOI: 10.1007/s10903-020-01088-1 -
BMC Geriatrics Feb 2018Advance care planning (ACP) has been identified as particularly relevant for nursing home residents, but it remains unclear how or under what circumstances ACP works and... (Review)
Review
BACKGROUND
Advance care planning (ACP) has been identified as particularly relevant for nursing home residents, but it remains unclear how or under what circumstances ACP works and can best be implemented in such settings. We aimed to develop a theory that outlines the hypothetical causal pathway of ACP in nursing homes, i.e. what changes are expected, by means of which processes and under what circumstances.
METHODS
The Theory of Change approach is a participatory method of programme design and evaluation whose underlying intention is to improve understanding of how and why a programme works. It results in a Theory of Change map that visually represents how, why and under what circumstances ACP is expected to work in nursing home settings in Belgium. Using this approach, we integrated the results of two workshops with stakeholders (n = 27) with the results of a contextual analysis and a systematic literature review.
RESULTS
We identified two long-term outcomes that ACP can achieve: to improve the correspondence between residents’ wishes and the care/treatment they receive and to make sure residents and their family feel involved in planning their future care and are confident their care will be according to their wishes. Besides willingness on the part of nursing home management to implement ACP and act accordingly, other necessary preconditions are identified and put in chronological order. These preconditions serve as precursors to, or requirements for, accomplishing successful ACP. Nine original key intervention components with specific rationales are identified at several levels (resident/family, staff or nursing home) to target the preconditions: selection of a trainer, ensuring engagement by management, training ACP reference persons, in-service education for healthcare staff, information for staff, general practitioners, residents and their family, ACP conversations and documentation, regular reflection sessions, multidisciplinary meetings, and formal monitoring.
ONCLUSIONS
The Theory of Change map presented here illustrates a theory of how ACP is expected to work in order to achieve its desired long-term outcomes while highlighting organisational factors that potentially facilitate the implementation and sustainability of ACP. We provide the first comprehensive rationale of how ACP is expected to work in nursing homes, something that has been called for repeatedly.
Topics: Advance Care Planning; Aged; Belgium; Communication; Documentation; Humans; Nursing Homes; Physicians; Professional-Family Relations; Program Evaluation
PubMed: 29444645
DOI: 10.1186/s12877-018-0723-5 -
Journal of Hospital Medicine Sep 2009Handoffs are ubiquitous to Hospital Medicine and are considered a vulnerable time for patient safety. (Review)
Review
BACKGROUND
Handoffs are ubiquitous to Hospital Medicine and are considered a vulnerable time for patient safety.
PURPOSE
To develop recommendations for hospitalist handoffs during shift change and service change.
DATA SOURCES
PubMed (through January 2007), Agency for Healthcare Research and Quality (AHRQ) Patient Safety Network, white papers, and hand search of article bibliographies.
STUDY SELECTION
Controlled studies evaluating interventions to improve in-hospital handoffs (n = 10).
DATA EXTRACTION
Studies were abstracted for design, setting, target, outcomes (including patient-level, staff-level, or system-level outcomes), and relevance to hospitalists.
DATA SYNTHESIS
Although there were no studies of hospitalist handoffs, the existing literature from related disciplines and expert opinion support the use of a verbal handoff supplemented with written documentation in a structured format or technology solution. Technology solutions were associated with a reduction in preventable adverse events, improved satisfaction with handoff quality, and improved provider identification. Nursing studies demonstrate that supplementing verbal exchange with a written medium leads to improved retention of information. White papers characterized effective verbal exchange, as focusing on ill patients and actions required, with time for questions and minimal interruptions. In addition, content should be updated daily to ensure communication of the latest clinical information. Using this literature, recommendations for hospitalist handoffs are presented with corresponding levels of evidence. Recommendations were reviewed by hospitalists at the Society of Hospital Medicine (SHM) Annual Meeting and by an interdisciplinary team of expert consultants and were endorsed by the SHM governing board.
CONCLUSIONS
The systematic review and resulting recommendations provide hospitalists a starting point from which to improve in-hospital handoffs.
Topics: Attitude of Health Personnel; Continuity of Patient Care; Hospitalists; Humans; Interdisciplinary Communication; Patient Care Team; Quality of Health Care
PubMed: 19753573
DOI: 10.1002/jhm.573 -
Journal of the American Board of Family... 2022To review the literature on medication safety in primary care in the electronic health record era. (Review)
Review
PURPOSE
To review the literature on medication safety in primary care in the electronic health record era.
METHODS
Included studies measured rates and outcomes of medication safety in patients whose prescriptions were written in primary care clinics with electronic prescribing. Four investigators independently reviewed titles and analyzed abstracts with dual-reviewer review for eligibility, characteristics, and risk of bias.
RESULTS
Of 1464 articles identified, 56 met the inclusion criteria. Forty-three studies were noninterventional and 13 included an intervention. The majority of the studies (30) used their own definition of error. The most common outcomes were potentially inappropriate prescribing/medications (PIPs), adverse drug events (ADEs), and potential prescribing omissions (PPOs). Most of the studies only included high-risk subpopulations (39), usually older adults taking > 4 medications. The rate of PIPs varied widely (0.19% to 98.2%). The rate of ADEs was lower (0.47% to 14.7%). There was poor correlation of PIP and PPO with documented ADEs leading to physical harm.
CONCLUSIONS
This literature is limited by its inconsistent and highly variable outcomes. The majority of medication safety studies in primary care were in high-risk populations and measured potential harms rather than actual harms. Applying algorithms to primary care medication lists significantly overestimates rate of actual harms.
Topics: Aged; Ambulatory Care Facilities; Drug-Related Side Effects and Adverse Reactions; Humans; Inappropriate Prescribing; Potentially Inappropriate Medication List; Primary Health Care
PubMed: 35641040
DOI: 10.3122/jabfm.2022.03.210334 -
Orthopaedic Surgery Jan 2023Hyaluronic acid (HA) intra-articular injection after arthroscopic knee surgery has been widely applied but its efficacy and safety remain controversial. The aim of this... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Hyaluronic acid (HA) intra-articular injection after arthroscopic knee surgery has been widely applied but its efficacy and safety remain controversial. The aim of this systematic review is to analyze the efficacy and safety of HA intra-articular injection after arthroscopic knee surgery, and to compare the efficacy of HA with different molecular weights.
METHODS
We conducted a systematic literature search in PubMed, Embase, Google scholar and the Cochrane library from inception to 16 September 2022 for English-written articles, in order to identify randomized controlled trials that evaluated the clinical efficacy and/or safety of HA intra-articular injection after arthroscopic knee surgery. Then we meta-analyzed the outcomes of patients given intra-articular HA injections postoperatively and control patients. We also evaluated the influence of HA with different molecular weights. In every calculation, sensitive analysis was performed. The visual analogue scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and adverse events were selected as the primary outcome measurements, while Lysholm, International Knee Documentation Committee (IKDC) and Tegner score were selected as the secondary outcome measurements. Publication bias of every outcome was evaluated using egger test.
RESULTS
Fifteen studies involving 951 knees were included and 12 of them were used to performed the meta-analysis. The results showed no significant difference between the HA group and control group according to VAS, whether assessed at less (P = 0.90) or more than 6 months (P = 0.55). Besides, there were no statistical differences between the HA group and control group according to subgroup analysis (Ps = 0.77, 0.91 and 0.81 in anterior cruciate ligament reconstruction, meniscectomy and overall groups, respectively). Compared to control group, the overall effect of WOMAC score showed no significant differences (P = 0.25), nor did in two subgroups (P = 0.37 and P = 0.22). Outcomes measured by Lysholm (P = 0.13), IKDC (P = 0.86) and Tegner (P = 0.42) scores showed no significant differences, either. The analysis of the risk of adverse events indicated no increase in HA groups (P = 0.06). We found no significant differences between high- and low-molecular-weight HA at 6 (P = 0.96) or 12 months (P = 0.93) postoperatively. Two studies failed to pass the sensitive analysis and the reasons were discussed detailly and acceptable publication bias was observed.
CONCLUSIONS
Although HA injection after arthroscopic knee surgery is safe, the available evidence does not support its efficacy in pain relief and functional recovery. Therefore, the application of HA injection after arthroscopic knee surgery is not recommended.
Topics: Humans; Hyaluronic Acid; Osteoarthritis, Knee; Injections, Intra-Articular; Knee Joint; Pain; Treatment Outcome; Platelet-Rich Plasma
PubMed: 36411508
DOI: 10.1111/os.13602 -
Knee Surgery, Sports Traumatology,... Dec 2011One of the templates in the development of "anatomic" anterior cruciate ligament (ACL) reconstruction has been basic science studies focusing on comparing various... (Review)
Review
PURPOSE
One of the templates in the development of "anatomic" anterior cruciate ligament (ACL) reconstruction has been basic science studies focusing on comparing various aspects of ACL reconstruction in order to optimize surgical technique. However, often such papers lack necessary data in the methods section to ascertain the proposed surgical technique as anatomic. The goal of this systematic review was to evaluate basic science studies on anatomic ACL reconstruction.
METHODS
A systematic electronic search was performed using the MEDLINE and EMBASE databases. Studies that were published from January 1995 to April 2009 were included. Only basic science studies on human cadavers that reported "anatomic" ACL reconstruction and written in English were included. Variation in surgical technique and reporting of surgical description were assessed.
RESULTS
Eighteen studies were included in this systematic review. Only the fixation method, graft type and tension pattern were reported in the majority studies. Notchplasty and radiographic documentation were grossly underreported. Other surgical data were reported at best in two-thirds of the studies. There was a large variation in the reported surgical techniques among the included studies. Due to the aforementioned, it was not deemed possible to pool data of the included studies.
CONCLUSION
For most variables in the surgical technique description, there was sizeable underreporting resulting in an inability to pool the outcomes. To provide literature that holds up to the current high level of medical research, authors are encouraged to report their surgical technique in a thorough manner, similar to high-level clinical trials.
Topics: Anterior Cruciate Ligament Reconstruction; Cadaver; Humans
PubMed: 21584719
DOI: 10.1007/s00167-011-1544-7