Causes Of Medication Errors Research Articles

Cognitive Errors Associated With Medical Decision-Making: A Systematic Review

Background and Objective Decision-making in the medical profession is full of uncertainty. This review aimed to identify cognitive errors associated with physicians’ decisions. Materials & Method PubMed and Medline databases were searched for English articles on cognitive biases published from 2000 to 2022. Among 235 found publications, 19 met the inclusion criteria. Results Of the 19 analyzed studies, 40 cognitive errors were extracted, and 11 cognitive errors had maximum repetitions. These are availability, confirmation, overconfidence, anchoring, framing effect, omission, search satisficing, representativeness, premature closure, diagnosis momentum, and commission. Conclusion In medical students’ curricula, moral and clinical decision-making are marginalized by teaching professors. However, teaching humanities, psychology, and even literature are required, along with critical thinking and cognitive errors. Understanding cognitive errors are the first step towards training cognition strategies, which may improve patient safety. To reduce medical errors and their huge loss of life and money, the causes of medical errors must be known. Cognitive errors are among them, and by reducing cognitive errors, medical decision-making can be improved.

Self-reported unsafe medication behaviour among clinical nurses in China: A nationwide survey.

Unsafe medication behaviour was the direct cause of medication error, while the current status of unsafe medication behaviour among Chinese clinical nurses remains uncertain. To investigate unsafe medication behaviour among Chinese nurses and to analyse its associated factors. A cross-sectional online study was conducted in 31 provinces and municipalities of mainland China. The electronic self-administered questionnaire was used to collect data from July-August 2020, including demographic information (age, gender, initial degree, ultimate education degree, hospital levels, unit nature, professional position, duty, departments, working years and working regions) and an adapted nurse unsafe medication behaviour scale measuring self-reported nurse unsafe medication behaviour (SR-NUMB). A generalized linear mixed model was applied to determine the influencing factors. A total of 10,153 Chinese nurses responded online, and 7,873 responses that met the time control requirements were included finally. It turned out that 80.49% of Chinese nurses had SR-NUMB. Specifically, 72.81% of them had unsafe medication behaviours in the process of medication administration, followed by medication monitoring (53.09%), medication preservation and dispensing (47.42%), and medical order processing (44.53%). A generalized linear mixed model demonstrated that male nurses and nurses who work in secondary hospitals or general hospitals, those who have higher professional positions or duties, those who have been working for 5-10 years, and those who are working in emergency and intensive critical units may have higher level of SR-NUMB compared to other nurses. Suboptimal SR-NUMB among Chinese nurses was identified in our findings. Associated factors, such as gender, hospital levels, unit nature, professional position, duty, working years and departments, should be targeted in future prevention and intervention efforts for safe medication management among Chinese nurses.

The public’s views on responsibility for medical errors in Kazakhstan

ABSTRACT Introduction Patients’ attitudes toward medical errors (MEs) have been studied relatively extensively in developed countries around the world, but little is known about Central Asian countries, especially post-Soviet states. The growing importance of patient safety has raised concerns about who should be held accountable for MEs. Due to a lack of research, this issue is poorly understood in Kazakhstan. Materials and Methods This study examines respondents’ attitudes toward MEs based on whether they had this experience in Kazakhstan between 2019 and 2021. The statistical analysis of data on MEs was carried out for the whole country. Respondents were asked about the causes of and solutions to the problem of preventable medical errors, as well as what the consequences of MEs should be. Results In total, 40.8% of the respondents confirmed that they had experienced problems with MEs. Nearly one-third of Kazakhstani adults agree that the lack of professional qualifications of health professionals is the root cause of MEs. Conclusions Differences existed among the regions in the opinion of the public and indicators of the degree of responsibility for and response to MEs. Further study of the causes and attitudes of the public is warranted, which will help better understand the problem of MEs in Kazakhstan.

EVALUATING THE IMPACT OF ELECTRONIC HEALTH RECORD SYSTEMS ON REDUCING MEDICATION ERRORS: A STUDY AT LADY READING HOSPITAL, PESHAWAR

Medication mistakes significantly threaten hospitals, leading to adverse events and increased healthcare costs. Electronic health records (EHRs) have been introduced to reduce the frequency of errors and mitigate these issues. This study aimed to determine if the EHR system reduced medical errors at Lady Reading Hospital (LRH) in Peshawar, Pakistan, thereby enhancing patient safety. A retrospective study was conducted from January 3, 2021, to July 3, 2021. The assessment involved a detailed analysis of medication error incidents at LRH, recorded during this period, involving 200 patients. Data from the Department of Pharmacy were collected and analyzed concerning the occurrence, types, and possible contributing causes of medication errors. The results showed a significant reduction in medication error rates following the implementation of the EHR system. The number of medication errors decreased from 80 incidents to 30 occurrences. Specifically, overall mistakes dropped from 25 to 5, omissions from 15 to 10, and wrong medication reports from 20 to 8. The most common types of errors included dosage errors (accounting for 50 incidents), followed by wrong medication (30 incidents), and omissions (25 incidents). Factors contributing to these errors included communication gaps (20 incidents), transcribing errors (15 incidents), and inadequate training (10 incidents). An evaluation of the severity of these errors revealed 15 minor, 25 moderate, and 10 severe problems. Implementing the EHR system significantly enhanced patient safety by improving communication and providing continuous access to accurate patient information. The findings indicate that EHRs are a crucial component of hospital drug safety, significantly reducing medication errors. Integrating electronic record-keeping facilitates medication management processes, provides real-time information access, and improves communication among healthcare professionals. However, addressing other aspects of system malfunctions and ensuring effective system distribution is essential for successful EHR implementation in healthcare facilities. Future research should focus on designing longitudinal studies to evaluate the long-term safety of medications, the use of EHR systems, and strategies to further improve patient care quality.

A new model for categorizing cognitive biases and debiasing strategies in dermatology.

Cognitive biases are a significant cause of medical error. They arise from "system 1" thinking, which depends on heuristics to make quick decisions in complex situations. Heuristics make us "predictably irrational," distorting our ability to accurately assess probabilities in clinical scenarios. It is well reported in the literature that metacognition, the art of reflecting on one's thought processes, is the optimal way to deal with cognitive biases. However, it is unclear how this can be consistently implemented in dermatological practice. Our debiasing attempts thus far have been sporadic at best. This article categorizes important cognitive biases according to each stage of the doctor-patient interaction (history taking, clinical examination, investigations, diagnosis, and management). We hope that providing this clinically relevant framework can foster metacognition and a platform for algorithmic debiasing. This will enable us to engage "system 2" (analytical thinking) in a targeted way, thereby avoiding excessive cognitive load. Organization-level interventions should also be implemented to free up the cognitive capacity of an individual and to enable them to employ system 2 thinking more regularly.

North-African doctors as second victims of medical errors: a cross sectional survey

IntroductionPhysicians involved in medical errors (MEs) can experience loss of self-esteem and negative psychological experiences. They are called “second victims” of the ME.AimsTo i) describe the profile, the types and the severity of MEs, and ii) explore the psychological impact on “second victims” to better understand how they cope.MethodsIt was a cross sectional retrospective study conducted from March to August 2018. All physicians working at Farhat Hached and Sahloul University hospitals were asked to complete a questionnaire about their possible MEs. The impact of MEs was evaluated using the Impact of Event Scale-Revised (IES-R) (scoring, 0–88) (subscales ranges; intrusion, (0–32); avoidance, (0–32); hyperarousal, (0–24)). The diagnosis of post-traumatic stress disorder (PTSD) was made when the total IES-R score exceeded 33. The coping strategies were evaluated using Ways of Coping Checklist Revised (WCC-R) scale (scoring, problem-focused, (10–40); emotion focused, (9–36); seeking social support, (8–32)).ResultsAmong 393 responders, 268(68.2%) reported MEs. Wrong diagnosis (40.5%), faulty treatment (34.6%), preventive errors (13.5%) and faulty communication (6.4%) were the main frequent types of MEs. The most common related causes of MEs were inexperience (47.3%) and job overload (40.2%). The physicians’ median (range) score of the IES-R was 19(0–69). According to the IES-R score, the most frequent psychological impacts were median (range): intrusion, 7(0–28) and avoidance symptoms, 7(0–24). PTSD symptoms affected 23.5% of physicians. Female sex and serious MEs were identified as predictors of PTSD. On the WCC-R check list, coping was balanced between the three coping strategies median (range), problem focused, 28.5(10–40); emotion-focused, 24(9–36) and seeking social support 21(8–32).ConclusionThere is a relatively high impact of ME within these North-African university hospital physicians. Coping was balanced within different three strategies as reported worldwide. Physicians adopted more likely constructive changes than defensive ones.

A Review of Investigating Causes of Medication Errors among Nurses of Emergency and Intensive Care Unit

Introduction: Medication errors are common in the emergency department and intensive care units, but they can be reduced with a series of appropriate planning. The study goal was to investigate the causes and extent of medication errors among the emergency and intensive care unit nurses.
 Material and Methods: This study was done as a review. In the present study, the studies were searched in Persian and English language databases such as SID, Magiran, Iran medex, Scopus and PubMed with the keywords such as medication error, nurses, emergency department, intensive care unit, nurse department, wrong medication, emergency nurse, and special department were searched in databases. The inclusion criteria were the articles dealing with the medication errors among the ICU nurses and the emergency departments. In order to review the present study articles, the year limit from 2014-2022 were applied. The exclusion criteria were the review articles.
 Results: The results showed that overwork, fatigue, deficiency of staff, illegible instructions, insufficient knowledge, physicians’ illegible handwriting, and night shifts, similar classification of drugs have been the causes of medication errors among the nurses.
 Conclusion: According to the findings of the study, it is suggested to hold re-training classes periodically and to have the number of staff proportionate to the needs of the department so that imposing too much workload on staff is avoided.

Improving Clinical Efficiency and Reducing Medical Errors through NLP-enabled Diagnosis of Health Conditions from Transcription Reports

Misdiagnosis rates are one of the leading causes of medical errors in hospitals, affecting over 12 million adults across the US. To address the high rate of misdiagnosis, this study utilizes 4 NLP-based algorithms to determine the appropriate health condition based on an unstructured transcription report. From the Logistic Regression, Random Forest, LSTM, and CNN-LSTM models, the CNN-LSTM model performed the best with an accuracy of 97.89%. We packaged this model into a authenticated web platform for accessible assistance to clinicians. Overall, by standardizing health care diagnosis and structuring transcription reports, our NLP platform drastically improves the clinical efficiency and accuracy of hospitals worldwide.

OBSERVASI PENGKAJIAN KELENGKAPAN RESEP OBAT BATUK SECARA ADMINISTRATIF DAN FARMASETIK PADA PUSKESMAS CILAMAYA DI KABUPATEN KARAWANG

An incomplete prescription has the potential to be one of the causes of medication errors. This incident can be avoided by conducting prescription screening by pharmacists which includes a review of administrative and pharmaceutical aspects. The purpose of this study was to determine the administrative and pharmaceutical completeness of prescriptions for the period January – May 2021 at the Cilamaya Health Center in Karawang Regency. The research method is descriptive quantitative with retrospective data collection. The sampling technique was simple random sampling, and 428 prescription sheets were obtained that met the inclusion criteria. The results showed that the administrative completeness of the prescription consisted of: patient's name 100%, patient age 96%, gender 0%, weight 96%, doctor's name 8%, doctor's initials 43%, prescription date 99%, and room of origin. prescription 76%. Meanwhile, pharmaceutically it consists of: 100% dosage form and strength, 96% drug dosage, 99% drug amount, 100% stability and availability, 96% usage rules and 100% compatibility. It can be concluded that based on Permenkes No. 74 of 2016, prescriptions at the Cilamaya Health Center for the period January – May 2021 are not administratively and pharmaceutically complete.

Loss of information in cross-sectoral treatment: causes and solutions

Missing information on patients and their medication is a leading cause of medication errors and preventable harm. The TOP Projects uses pharmacy claim data and electronic decision support to improve quality and safety of care on hospital admission. In a survey 100 % of responding hospitals in Germany consider this approach helpful and important to improve availability of necessary information and medication safety and to reduce workload.

Causesof Medication Error in Nursing

Causesof Medication Error in Nursing

Medical errors — causes and contradictions

Studying and improving the theory of errors of doctors has always been important, and today it has become especially relevant.The article lists the main provisions of the advanced version of the theory of errors of doctors. The main content of the articleis devoted to four important aspects of the problem of physician errors. The article states the main contradiction of the problemof errors in medicine. The structure of general objective and subjective causes of medical errors is shown. The main optionsfor doctors to experience errors that complicate doctors’ mutual understanding in this problem are formulated. For the fi rsttime, the reasons for the denial of errors by doctors are summarized. These aspects and conclusions on them are the result ofan analysis of publications on the problem of errors in medicine, repeated discussions of the problem on professional medicalsites. The content of these aspects was based on its own material on error analysis and observation from practice. The aboveaspects and their conclusions need not so much to be confi rmed by special studies, but rather to refl ect on their role and placein the problem of errors. The general objective and subjective reasons for the occurrence of medical errors are shown inconnection with their possible "guilt". Lack of experience is presented as the most common cause of medical errors. Variousoption for doctors to experience errors are presented as a reason that makes it diffi cult for doctors to understand this problem.

Relationship Between Pharmaceutical Knowledge and Probability of Medication Errors Among Nurses: A Cross-sectional Study in the Northwest of Iran in 2020

Background: Patient safety is a major concern for health care professionals. Medication errors have been considered a major indicator of health care quality. The lack of pharmacological knowledge is a cause of medication error among nurses. Objectives: The purpose of this study was to investigate the relationship between pharmacological knowledge and the probability of medical errors in nurses working in Urmia hospitals in 2020. Methods: This cross-sectional study included 490 nurses randomly selected from among those working in hospitals of Urmia in 2020. The data collection tool was a multiple-choice questionnaire about knowledge and pharmacological skills consisting of 3 sections: demographic information, nurses’ drug knowledge, and the confidence level of response in nurses. To analyze questions and hypotheses via SPSS version 21, the t-test and analysis of variance (ANOVA) were employed. Results: The highest pharmaceutical knowledge scores of nurses were related to methods of administration (2.9 ± 1.01 [72.56%]), and the lowest score was related to drug management (1.05 ± 0.63 [52.84%]). The mean of error probability was very low in 28.81% of nurses, low in 37.66%, high in 11.34%, and very high in 22.85%. Pharmaceutical knowledge had a significant relationship with gender, wards, type of hospital, and number of children (P < 0.05 for all). Conclusions: Since the nurses’ level of pharmaceutical knowledge has an important role in the correct prescription of medicine, we suggest that nurse managers and educational supervisors in the field of nursing use in-service training programs and prepare training booklets and posters to promote nurses’ pharmaceutical knowledge in this field.

Medical Error and Under-Reporting Causes from the Viewpoints of Nursing Managers: A Qualitative Study.

Background:Patient safety as a goal can be achieved by reporting medical errors (ME); however, most errors are never reported. The aim of this study is to explore the causes of ME, and the obstacles in reporting them amongst nurses.Methods:We conducted semi-structural interviews, with 12 nursing managers in the biggest teaching hospital in southern Iran (2015-2016). The interview guide concentrated on the causes of ME and barriers in reporting them. All face-to-face interviews were recorded and transcribed verbatim and analysed using thematic analysis.Results:In this study 4 main themes were extracted for the causes of ME: personal/social characteristics, nonprofessional practice, hospital related factors/organization contextual factors, and poor management. Also, 5 main themes (such as; personal characteristics, fear from reporting, nonprofessional practices, cultural and social factors, and error surveillance system features) were obtained with regards to barriers in reporting.Conclusions:ME can be reduced by improving professional practice and better human resource management. Also, reporting errors can be increased by focusing on cultural and social factors.

Evaluation of the incidence of errors and related factors in the use of blood glucose control medications in an elderly population with type 2 diabetes

Context: The pace of population aging is increasing around the world. Medication errors are more common among the elderly for a variety of reasons and can lead to serious complications.Aims: The aim of this study was to determine the incidence of errors and related factors in the use of blood glucose control medications in a diabetic elderly population in Qom, Iran.Setting and Design: This descriptive, correlational study was conducted on the elderly with type II diabetes, who were referred to the diabetes centers of Qom. The sample size was measured to be 200, based on the available sampling method.Materials and Methods: Data were collected using a demographic questionnaire, as well as a researcher-made Medication errors questionnaire.Statistical Analysis Used: SPSS version 20 was used to analyze the data.Results: Overall, 69% of the samples were female, and the mean age of the participants was 63.59 ± 4.84 years. The incidence of medication errors was 69% among older patients. There was a significant relationship between medication error and polypharmacy (P < 0.001), comorbidities (P < 0.025), duration of diabetes (P < 0.026), and use of aids (P < 0.038). Forgetfulness (26.33%) and lack of drug information (12.61%) were the most common causes of medication errors in patients.Conclusion: The results showed that the incidence of medication errors, which was influenced by various factors, was high among the elderly. Therefore, to prevent and reduce the incidence of medication misuse, proper measures should be taken.

COMMUNICATIVE FACTORS OF MEDICAL ERRORS

Abstract. Medical errors are an actual medical and social problem. More and more doctors are retiring from medical work due to psychoemotional stress associated with numerous complaints from patients and their relatives, which often reach court proceedings. The patient takes care of his health and expects understanding, attention and kind attitude from the doctor. The doctor should pay attention not only to the therapeutic and diagnostic practice, but also to the psychoemotional state of the patient. Currently, the authoritarian type of interaction between the doctor and the patient has been replaced by the dialogic type, which implies equality of the parties, which is the key to quality medical care. There are two main approaches to the study of the causes of medical errors. One of them considers a personal approach to the personality of the doctor, and focuses on his incorrect work with the patient. In this case, the analysis of the negative personal qualities of the practitioner is carried out. The systematic approach focuses on the factors surrounding the doctor. The analysis of medical errors using both approaches allows you to get the most complete information. Misunderstandings between medical professionals also lead to medical errors. It is especially important to exclude this factor during surgical interventions. Another problem is the process of the doctor's awareness of the error, while both external and internal factors should not prevent this. Thus, the problems of doctor - patient communication, doctor - medical staff are extremely important for successful medical practice. Compliance with the rules of communication and interaction in medical practice is the key to proper and fruitful work.

Medication Errors in Secondary Care Hospitals in Kuwait: The Perspectives of Healthcare Professionals.

Objectives: Medication errors (MEs) are the most common cause of adverse drug events (ADEs) and one of the most encountered patient safety issues in clinical settings. This study aimed to determine the types of MEs in secondary care hospitals in Kuwait and identify their causes. Also, it sought to determine the existing system of error reporting in Kuwait and identify reporting barriers from the perspectives of healthcare professionals (HCPs).Material and Methods: A descriptive cross-sectional study was conducted using a pre-tested self-administered questionnaire. Full-time physicians, pharmacists, and nurses (aged 21 years and older) working in secondary care governmental hospitals in Kuwait were considered eligible to participate in the study. Descriptive statistics and the Statistical Package for Social Science Software (SPSS), version 27 were used to analyze the data.Results: A total of 215 HCPs were approached and asked to take part in the study, of which 208 agreed, giving a response rate of 96.7%. Most HCPs (n = 129, 62.0%) reported that the most common type of ME is “prescribing error,” followed by “compliance error” (n = 83; 39.9%). Most HCPs thought that a high workload and lack of enough breaks (n = 128; 61.5%) were the most common causes of MEs, followed by miscommunication, either among medical staff or between staff and patients, which scored (n = 89; 42.8%) and (n = 82; 39.4%), respectively. In the past 12 months, 77.4% (n = 161) of HCPs reported that they did not fill out any ME incident reports. The lack of feedback (n = 65; 31.3%), as well as the length and complexity of the existing incident reporting forms (n = 63; 30.3%), were the major barriers against reporting any identified MEs.Conclusions: MEs are common in secondary care hospitals in Kuwait and can be found at many stages of practice. HCPs suggested many strategies to help reduce MEs, including proper communication between HCPs; double-checking every step of the process before administering medications to patients; providing training to keep HCPs up to date on any new treatment guidelines, and computerizing the health system.

Identifying the Factors Affecting the Incidence of Medication Errors of Nurses in Teaching Hospitals of Shiraz University of Medical Sciences

Background: Medication errors are one of the major causes of injury to patients while receiving medical care. This study aimed to investigate the effective causes of medication errors in nurses in educational hospitals affiliated with Shiraz University of Medical Sciences. Methods: This descriptive-analytical and cross-sectional study was conducted in 2020 on 340 nurses from 10 educational hospitals affiliated to Shiraz University of Medical Sciences. The data collection tool was a questionnaire. Data were analyzed using t-test, ANOVA and Pearson correlation coefficient were analyzed using SPSS23 software . Results: According to the results, human factors have been the most important factor in the occurrence of medication errors. The most important causes of medication errors with respect to human, managerial and environmental factors include fatigue due to overwork (3.13 ± 1.16), method of supervision (3.06 ± 0.98) ,and heavy workload (3.00 ± 1.19), respectively. There was a statistically significant relationship between human factors and age (p = 0.024), gender (p = 0.013), employment relationship (p = 0.016), and marital status (p = 0.027), and between management factors and employment relationship (p = 0.034) and the number of patients under observation (p = 0.011). Conclusion: Considering the most important causes of medication errors, including fatigue due to overload, supervision methods, and heavy workload, using strategies to reduce fatigue due to workload, such as balancing nurses' work shifts and also holding workshops on supervision methods is recommended in order to improve the level of managerial competencies of nurses.

A Blindfolded Pediatric Trauma Simulation and Its Effect on Communication and Crisis Resource Management Skills.

Background Miscommunication is a common cause of medical errors and patient harm. Simulation is a good tool to improve communication skills, but there is little literature on advanced techniques to improve closed loop communication (CLC) in an effort to minimize medical errors. This study looks to evaluate whether blindfolding simulation participants is an effective tool in improving communication, and whether this advanced teaching technique is useful for critical pediatric scenarios.MethodsParticipants included Emergency Medicine (EM) residents and Pediatric EM fellows with Advanced Trauma Life Support (ATLS) certification. Participants were randomized into groups and completed a pediatric trauma scenario. Recorded simulations were reviewed by three independent faculty for primary objective measures of total instances of communication and CLC utilization during critical actions in the simulation. The secondary objective was the perceived stress load by participants when utilizing this teaching methodology. Wilcoxon rank sum test (WRS), Fisher’s exact test (FET), and Cochran-Armitage test (CAT) were utilized for statistical analysis.ResultsStatistically significant differences were noted in total communication between groups. Median and interquartile ranges (IQR) of total instances of communication were 17.0 (14.7-17.1) in non-blindfolded groups versus 21.0 (19.0-22.0) in blindfolded groups (p-value=0.002). Statistically significant increase in CLC was noted during the critical action of monitor placement in the blindfolded group (OR=13.7, 95% CI=1.4-133.8). No differences were noted in crisis resource management (CRM) scores. NASA Task Load Index (NASA-TLX) scores of both groups revealed similar stress levels. Statistical testing based upon the year of training was limited by small sample size and large number of categories.ConclusionsBlindfolded simulations increased total instances of communication overall and improved CLC in one critical action without increasing stress levels. The blindfolded trauma simulation exercise is an effective advanced technique to reinforce CLC utilization and communication skills.

Atrial fibrillation treatment in Russia: work on bugs

The article discusses the results of a survey of doctors in the Russian Federation with the aim of studying approaches to the treatment of atrial fibrillation in real clinical practice and comparing the results obtained with the current clinical guidelines. Some new data are presented that could change the recommendations in the future; possible causes of medical errors and ways to correct them are discussed.