Drug Administration Errors Research Articles

In Response.

In Response.

Catastrophic Drug Errors Involving Tranexamic Acid Administered During Spinal Anesthesia

(Anaesthesia. 2019;74:904–914) Drug administration errors during neuraxial anesthesia can result in dire outcomes. These authors had previously reported on neuraxial drug administration errors, but have since learned of several incidents of accidental intrathecal administration of tranexamic acid during spinal anesthesia. This article reviewed reports of these occurrences, identified contributing factors to the drug errors, and discussed prevention strategies.

Quality Management of Inpatient Medication Administration in Hong Kong Public Hospitals

Medicine maladministration can result in various side effects to patients, including serious complications, extended medical care, incapacity and death. In Hong Kong public hospitals, the pattern of medication error consists of prescribing error usually made by physicians, dispensing error resulted from pharmacists and dispensers, drug administration error caused by nurses and patient-care workers and technology-related error associated with technology used in the drug administration process. Medication Administration Record (MAR) and ward stock are the usual inpatient medication system within Hospital Authority public hospitals before the development of the electronic system, while the Inpatient Medication Order Entry (IPMOE) functions to provide real-time accessibility in patients’ medication profiles by different professions and health units. However, several factors are related with medication errors. For instance, the ambiguous handwriting orders in the MAR prescribed by physicians affect the transcription by pharmacists and the administration procedures in ward by nurses. Administering medicines in ward stock before pharmacists vetting increase the chance of making errors. Poor interface issues between users and system, and the computer over-reliance are also contributed in resultant technology-related errors. In order to reduce the occurrence of medication incidents, implementation of Automated Pharmacy Distribution Systems helps moving towards a closed loop medication management system. Modifying technologies in barcode assisted medication administration and enhancing the IPMOE with a pop-up message could help intercepting drug administration errors to patients.. The elimination of the potential risks arising from the prescribing, dispensing and drug administration processes brings the achievement of medication safety in Hong Kong public hospitals.

Comparative Cross-Sectional Pharmacovigilance Study of Medication Errors in Children and Adults in Community-Based Hospitals

Objective: To compare medication errors that reached pediatric and adult patients during hospitalization. Methods: Observational, non-experimental, cross-sectional study from January 2011 to March 2015 at two community-based, teaching hospitals. Results: Over a 4-year period, there were 4.2 and 13.3 million doses dispensed in pediatrics and adults, respectively. Less than 0.25% of doses dispensed contributed to medication errors, with 9.6% of these medication errors reaching patients and 0.04% causing harm. There was no statistical difference in medication error rates based on doses dispensed, patient-days, admission rate, and severity. However, significantly more errors in the documentation and prescribing processes occurred in adults (21.9% vs 6.5% and 37.4% vs 29.8% respectively, p<.001) versus administration in pediatrics (42.5 vs 29.8% in adults, p <0.001). Errors in drug administration that occurred in pediatrics consisted of infusion devices, incorrect dose, the omission of medication, and time of administration. Pediatrics had higher medication errors related to electrolytes and total parenteral nutrition. Independent of age, there were more medication errors that caused harm in patients residing in the intensive care unit (5.5% of 769 vs 3.5% of 2800 patients, respectively, p =0.006). Conclusion: While the prevalence of medication errors that reached patients and caused harm were similar between adults and pediatrics, the types of errors within the medication use process, class of drugs, and severity of the mediation errors varied between the groups. Given these differences, it is quintessential to develop population-specific medication safety programs aimed at addressing the needs of pediatric patients to enhance safe medication use.

Study on the application of root cause analysis risk nursing management in clinical nursing

Objective To investigate the effect of root cause analysis (RCA) risk nursing management in clinical nursing. Methods RCA method was adopted to analyze proximal causes and root causes of 124 clinical nursing problems occurred in this hospital from January to June in 2017, formulate and implement corrective measures. The incidence of adverse nursing events before and after implementation, the risk perception of nursing staff and patients' satisfaction with nursing quality were compared. Results The most common adverse events in clinical nursing mainly included treatment errors of doctor's orders, drug administration errors, venous puncture bleeding, pipe loss and skin compression, accounting for 18.55%, 14.52%, 13.71%, 9.68% and 6.45%, respectively.Proximal causes of adverse events include personnel factors and environmental factors, and the root cause is management factors (including unblocked communication channels, inadequate learning and training, unclear management process and imperfect management mechanism). RCA after implementation of nursing risk management, the incidence of adverse events by before the implementation of 4.817‰ after the introduction of reduced to 3.595‰ significantly lower incidence, and the difference was statistically significant (P=0.036). After the introduction of management, nursing risk perceptions implementation was obviously better than the former, patients satisfaction of nursing quality is obviously higher than that of before the implementation, and the difference was statistically significant (P<0.05). Conclusions Root cause analysis risk nursing management application in clinical nursing, can significantly reduce the incidence of adverse events, improve nursing staff risk awareness and patient satisfaction, the application effect is good. Key words: Root cause analysis; Risk management; Proximal cause; Root cause; Quality of care

A segurança do doente é influenciada pelo ambiente da prática de cuidados dos enfermeiros que trabalham em serviço de urgência? Uma revisão integrativa

Introduction: The identification of factors that may influence patient safety makes it possible to implement improvements in the care provided, reducing the occurrence of possible damage to patients. The aim of this study is related to the need to identify errors that occurred in the provision of care to patients in an emergency department. Aim: Identify the factors that influence patient safety in emergency services. Materials and Methods: Integrative review carried out on the Ebsco database from 2017 to 2019, using MeSH descriptors combined by a boolean operator AND: “medication errors or drug errors or medication administration errors or drug administration errors”, “emergency room or emergency department” and “nurse or nurses or nursing”. As inclusion criteria were defined the articles that fit the objective of this study and all duplicate articles, articles referring to intensive care units and pediatrics and articles that did not fit the study objective were excluded. Results: The 17 articles analyzed revealed that the factors related to the high influx of patients to the emergency department, the work overload, the shortage of human resources and the constant interruptions lead to the occurrence of errors and the consequent risk to patient safety. Conclusion: Physical and human conditions must be created for the safe practice of care, reducing the occurrence of errors and ensuring the safety of the patient in emergency services.

Penggunaan Electronic Medication Management (EMM) dalam Menurunkan Kejadian Medication Error di Keperawatan

Errors in drug administration are adverse events for patients. Reducing the incidence of medication errors will significantly improve patient safety and quality of medication use. The traditional system makes staff spend time searching through notes on a compilation paper of what drugs patients must pay throughout the treatment process that is given. This process is not only lengthy, but also can easily increase opportunities for differences and mistakes. Many hospitals and health services are turning to digital systems as a solution. The EMM system supports the improvement of quality, safety, and support for drug management in hospitals. This includes providing support for doctors, nurses and pharmacists to prescribe, order, accept, reconcile, issue and install digital drug administration. EMM covers the entire treatment cycle in the hospital including prescribing by doctors, approved and issued drug orders by pharmacists, and administration of drugs by nurses. The use of EMM can provide benefits that are improving the quality of patient-oriented nursing care, the quality of clinical services and the use of information technology. Nurses as health workers with the largest

Stent thrombosis during and after acute coronary syndromes: patient-related factors and operator-related factors

Objective:Stent thrombosis (ST) is a common phenomenon in acute coronary syndromes (ACS) when compared to stable coronary artery disease. This study analyzed the patient- and operator-related risk factors of ST in ACS.Methods:Coronary angiograms of 1738 consecutive ACS patients admitted in a large tertiary center between year 2014 and 2016 were analyzed retrospectively for the presence of ST. The paired angiograms [ST in ACS during and after percutaneous coronary intervention (PCI)] of the patients were analyzed by two independent observers, with focus on lesion characteristics and procedure techniques. Clinical and laboratory data were collected.Results:Stent thrombosis was found in 29 (1.6%) ACS patients, with a combination of at least one clinical/laboratory risk factor and one lesion/operator risk factor identified in 28 (96%) out of the 29 ACS patients with ST. The following risk factors for ST were found: Renal insufficiency (OR=4.14, p<0.001, 95% CI=1.73-9.88), type 2 diabetes (OR=2.21, p=0.034, 95% CI=1.06-4.61), excessive alcohol consumption (OR=3.12, p=0.023, 95% CI=1.17-8.33), stent implantation for ST-elevation myocardial infarction (STEMI) (OR=2.28, p=0.029, 95% CI=1.08-4.81), left main (LM) or left anterior descending artery (LAD) as culprit lesion (OR=2.80, p=0.010, CI 95%=1.27-5.95), and absence of antiplatelet therapy prior to ST (OR=3.58, p=0.002, 95% CI=1.60-7.96). The following lesion/operator possible risk factors were identified: Bifurcation lesion (n=7; 24%), heavy coronary calcifications (n=13; 44%), in-stent restenosis with secondary plate rupture (n=6, 20%), inappropriate stent size selection (n=6, 20%), and errors in periprocedural drug administration (n=4, 14%).Conclusion:ST occurred in 1/62 ACS patients after PCI. A combination of clinical/laboratory and lesion/operator risk factors were present in almost all ACS patients with ST. This finding may support the search for strictly individualized strategies for the treatment of ACS patients with ST after PCI.

Assessment of Intravenous Drugs Admixtures Incompatibilities at Nekemte Referral Hospital, West Ethiopia

Intravenous admixtures are the preparations consisting of sterile drug products added to an IV fluid (s) for medication purposes. Especial concerns are required for such drugs since the reversal of toxicity and/or unwanted effects following incompatibilities are cumbersome to deal with. Concern drugs that may cause irritation or toxicity when given as a rapid direct IV injection are also prepared as IV admixtures. The ultimate goal of this assessment was to figure out the actual practices on the ground in IV medications administered in NRH with IV fluids emphasizing on incidence and prevalence of incompatibility between drugs themselves or with IV fluids. This study was a cross-sectional prospective observational study which investigated the potential incompatibilities associated with IV admixture, & the incidence of IV drug administration errors using available evidence-based medicine sources at Nekemte Referral Hospital in West Ethiopia. The data was collected from patient medication Charts and prescription papers for patients treated within a period of 2 months. The study period was from February 2017 to April 2017 at the medical and pediatrics wards of NRH. About patients using IV admixtures were followed within this study period. The prevalence of identified incompatibility among IV admixtures ingredients was 28.94%. The identified compatibility was only 25.43%, while 38.59%were undocumented combinations, and 7.01% were variable. The most commonly encountered incompatible drug-solute combinations were Ringer lactate (61.8%), Insulin + DNS (29.4) and Ceftriaxone + Phenytoin + 0.9% NaCl (8.8%). Also, the incompatible drug-drug combinations detected in this study were Ceftriaxone+ heparin and clopidgrel+cimetidine combinations. Based on the findings of this study, the following can be concluded; there is a high prevalence of incompatibilities among IV admixtures. The types of incompatibilities were both drug-solute and drug-drug incompatibilities. Prescribers and administrators of IV admixtures were recommended to check plausibility before administration to prevent such incompatibilities which can compromise the treatment outcome of patients.

Ebe ve Hemşirelerin Akılcı İlaç Kullanımına Yönelik Bilgi ve Davranışlarının İncelenmesi

OBJECTIVE: This study was conducted to examine the knowledge and behaviors of midwives and nurses in regards to rational drug utilization. METHOD: The descriptive and cross-sectional study was conducted in a training and research hospital of obstetrics and pediatrics, which accommodates 86 midwives and 49 nurses, from September 1 through October 1, 2017, with the participation of 27 midwives and 25 nurses (38.5%) totaling to 52 people. Granted the necessary permissions, data were collected by “Nurse / Midwife Self-Descriptive Form” and through face-to-face interviews, and were evaluated using descriptive statistical methods. FINDINGS: Of the participants of the research, 50.9% were midwives and 47.2% were nurses. The most frequent drug administration error encountered by 48% of the midwives and 32% of the nurses was found to be untimely administration of medication. It was determined that 81.5% of the midwives and 80% of the nurses know how to report side effects and that 77.8% of the midwives and 96% of the nurses have never reported any side effects. 81.5% and 80% of the midwives and the nurses, respectively, stated that prior to administering medication, they inquire whether patients have drug or food allergies; 34.6% of the midwives and 30.8% of the nurses stated that unused drugs were delivered back to the pharmacy; and all participants confirmed checking the expiration dates of drugs used in the medical service. Midwives and nurses were seen to consider good their level of knowledge in intended utilization of drugs, administration routes, and duration of the effects. CONCLUSION: It has been concluded that the knowledge and behaviors of midwives and nurses in regards to rational drug utilization are satisfactory but that there is a general need for training about rational drug utilization, especially drug administration and side effect notification.

Description of the Risk Management of Medication Errors for Centrally Authorised Products in the European Union.

IntroductionMedication errors can have serious consequences for patients. To prevent the occurrence of medication errors in clinical practice, safety concerns may be included in the risk management plan and subsequently be addressed with routine and/or additional risk minimisation measures.ObjectiveThis study aims to describe safety concerns around medication errors and the risk minimisation measures for centrally authorised products in the European Union.MethodsAll safety concerns included in the risk management plans of originator centrally authorised products, authorised between 1 January, 2010 and 31 December, 2017, were collected from the European Public Assessment Report registry. Medication error safety concerns were categorised by Anatomical Therapeutic Classification code, year of authorisation, type of medication error and type of risk minimisation measure.ResultsDuring the study period, 311 centrally authorised products were approved, of which 84 had at least one medication error safety concern. The proportion of centrally authorised products with medication error safety concerns showed variation between 2010 and 2017 ranging from 15.2% to 36.4%. In total, 95 medication error safety concerns were identified. The type of medication error was highly variable, drug administration error was listed most frequently (n = 17). For 27 out of 95 medication error safety concerns, corresponding to 23 centrally authorised products, additional risk minimisation measures were required. All additional risk minimisation measures consisted of educational material targeted at healthcare professionals (85.2%) and/or patients (51.9%). For 78.3% of centrally authorised products with additional risk minimisation measures for medication errors, studies to evaluate the effectiveness of the additional risk minimisation measures were agreed upon.ConclusionsMedication error safety concerns were listed for almost a quarter of centrally authorised products approved during the study period. Further research is needed to evaluate the effectiveness and continued need for additional risk minimisation measures for medication errors.Electronic supplementary materialThe online version of this article (10.1007/s40264-019-00874-7) contains supplementary material, which is available to authorized users.

Introduction of a teaching module on intravenous drug administration and communication skills in pharmacology

Background: Pharmacology practicals mainly focus on increasing the knowledge component but teaching on psychomotor and soft skills is largely lacking. Teaching correct method of intravenous drug administration and the communication skills about drug therapy in Pharmacology practical classes can help in minimizing the errors in drug administration and improving the patient compliance and adherence to the therapy. Objectives of this study were teaching module on intravenous drug administration and communication skills to undergraduate students in Pharmacology and to evaluate the perceptions of students and teachers towards the new teaching module.Methods: Correct methods of intravenous drug administration were demonstrated in practical classes. Role play was done to teach about communication skills regarding right method of using an inhaler and also about prescribing the correct dosage regimens. Perceptions of students and teaching staff members were collected on the teaching module.Results: Almost all of the students (&gt;96 %) were of the opinion that learning correct drug administration methods and communication skills was relevant to the future practice and 95% students felt that after the role play sessions, they were better equipped in communicating with the patients about the medication use and were in favour of teaching these to all the medical students.Conclusions: Our study concludes that the teaching module on intravenous drug administration and communication skills was well accepted by both the teaching staff and the students and was found feasible and relevant to be introduced in the curriculum by both of them.

Cost-effectiveness of infusion pumps to reduce errors in a Pediatric ICU.

To analyze cost-effectiveness and to calculate incremental cost-effectiveness ratio of the use of infusion pumps with drug library to reduce errors in intravenous drug administration in pediatric and neonatal patients in Intensive Care Units. Mathematical modeling for economic analysis of the decision tree type. The base case was composed of reference and alternative settings. The target population was neonates and pediatric patients hospitalized in Pediatric and Neonatal Intensive Care Units, comprising a cohort of 15,034 patients. The cost estimate was based on the bottom-up and top-down approaches. The decision tree, after RollBack, showed that the infusion pump with drug library may be the best strategy to avoid errors in intravenous drugs administration. The analysis revealed that the conventional pump, although it has the lowest cost, also has lower effectiveness.

Drug preparation and administration errors during simulated paediatric resuscitations

IntroductionVery few studies have assessed drug preparation and administration errors during paediatric resuscitation. Current evidence suggests that medication errors in paediatrics are a serious problem. The aim of this study...

Oncology Pharmacist’s Role and Impact on the Multidisciplinary Patient-Centre Practice of Oncology Clinic in Public Hospitals

Oncology pharmacy service was developed and integrated into the multidisciplinary team of oncology clinic in 2013 at the United Christian Hospital aiming to enhance the holistic patient-centre practice of the clinic through the optimization of the safety and efficacy of anti-cancer treatment. This review aims to describe the role and impact of oncology pharmacists (OPs) in clinical setting to optimize anti-cancer treatment for cancer patients in a multidisciplinary care approach. From selection, prescribing, procurement to monitoring and patient education, OPs significantly contribute to the safety and effective use of anti-neoplastics in any circumstances. OPs provide professional advices to oncologists in choosing the appropriate anti-cancer agents for specific cancer and designing personalized anti-cancer treatment according to patients’ fitness and appropriateness for chemotherapy. Parenteral and oral chemotherapeutic agents carry heightened risk of causing significant patient harm when they are used in errors. Thus, OPs also develop standardized chemotherapy orders and ensure the final dose is appropriate in terms of both hematological and non-hematological responses and tolerability. Moreover, OPs play an important role in procuring anti-cancer drugs and sourcing alternative drug choices that will deliver similar clinical outcomes. In addition, OPs also assure the clinical integrity of anti-cancer drugs for full anti-neoplastic activity and safe administration of these drugs by nursing staff to minimize potential occupational risk. Most importantly, OPs play a vital role in providing direct patient care functions such as drug therapy monitoring and management (e.g. ensure that patients receive sufficient pre-medications for administration of anti-cancer drugs), and medication counseling for patients and their carers to better understand their anti-cancer treatment. The positive impact of integrating OPs into the multidisciplinary patient-center practice of oncology clinic includes (1) reduction in potentially life-threatening medication incidents and cancer drug administration errors in public hospitals; (2) collaboration with oncologists to select the most suitable cancer drug regimens for patients; (3) prevention of potential occupational risk to the healthcare professionals who handle cancer drugs; and (4) provision of optimal therapy treatment, monitoring and counseling to patients to reduce side effects and hospital readmission. The professional drug knowledge of OPs adds value to the multidisciplinary team in oncology clinics and the growth of OPs into effective direct patient care in oncology clinics should be encouraged to optimize medication-related outcomes.

Reproducibility and accuracy of measurement of oral liquid pharmaceutical forms, using a dosing spoon

Introduction: Dose measurement is a common cause of error in drug administration, especially in the case of liquid formulations, such as sticky, sugary syrups, which are hard to measure accurately [1]. Our goal was to study the ability of pharmacy students to accurately measure syrup using a dosing spoon, over several days. Materials and methods: This pilot study was conducted at IUEM, with 26 randomly selected pharmacy students that were asked to measure 5 mL of 20% (w/v) chloral hydrate syrup using a metered dose spoon, as if they were to take it. Participants repeated the procedure during five days. Error magnitude was determined by an established protocol. The weight of the measured dose was compared with a reference weight (5 mL syrup = 6.2642 g), accurately measured with a volumetric pipette. All these measurements were done in triplicate, using analytical balance (KERN ABJ, d = 0.0001 g). Participants provided written, informed, consent and their visual problems were registered. Data analysis was performed using IBM SPSS Statistics v. 24.0 for Windows (Armonk, NY: IBM Corp.). The statistical analysis comprised descriptive measures of experimental outcomes, such as means and standard deviations. Inferential statistics were applied for group comparisons (t-Student’s test) and time-dependent comparisons (repeated measures ANOVA). Test assumptions were verified and validated for each inferential procedure. The level of significance was set at 5%, in all comparative statistical inference analysis. Results: Average measured values ranged from 4.89 (±0.55) g (5th measure) to 5.30 (±0.66) g (2nd measure). All average daily values were significantly lower than the reference dose (p<0.001). Additionally, time was shown to be a significant factor when comparing the average daily measurements (p = 0.007). Last average measured value was significantly lower than the first two (1st measure, p = 0.050) and (2nd measure, p = 0.005). Subject reported eyesight problems did not influence the measurement outcome (p = 0.506). Discussion and conclusions: Despite the use of a dosing spoon, the measurement accuracy of syrup doses, was poor, resulting in significant underdosing. Time affected the participant’s ability to measure doses. This study shows that the use of dosing accessories accompanying liquid dosage forms does not guarantee their desirable dosage accuracy. Clinicians should always consider the possibility of a medication dosing error when faced with an apparent treatment failure.

Medication Risk Management: A Subjective Review of Present Scenario

Historically, the FDA has interpreted the requirement that a drug must be “safe” to mean that the benefits of a drug outweigh its risks. The determination was made on a “categorical” basis, where the totality of risks was weighted against the totality of benefits when considered for the purposes outlined in the drug product’s labeling. If a drug did not meet this criterion, it was not approved or its label was rewritten to narrow the conditions for use. This logic was endemic in the FDA for most of the 20th century. On average, two to four drugs over each 5-year period were withdrawn from the marketplace after post-marketing surveillance data uncovered new risks. Similarly, on occasion, the FDA would require some special “tool” or intervention to improve a product’s safety profile. Harm associated with medication remains the second most common type of incident in hospitals, as reported by the Clinical Excellence Commission. Health services actively review medication safety. The vast majority of medication errors result in no injury. A minor injury may result, for example, in a patient needing an increased level of monitoring. Even if incidents result in minor injury, managers and staff still take any errors very seriously, reviewing the actions around the incident and making improvements as a result. FDA’s new concepts for risk management amount to a “cultural shift” in the logic of drug approval and the FDA’s role. The key events that led to this change can be traced to a series of reports that highlighted the need for improved medical safety. In 1999, the IOM released a report entitled, “To Err is Human.” This report reviewed the nature and cause of medication errors, estimating that up to 98,000 people died each year due to these errors. In their assessment the IOM included both adverse drug reactions and human errors in drug administration. The report captured the attention of news reporters and the government. Headlines proclaimed alarm at the larger number of fatalities caused by medical errors. Consequently, there was a government-wide initiative started to develop methods and institute procedures to reduce medical errors. Statements made by FDA officials regarding some of these withdrawals suggested that the FDA no longer believed that passive oversight and re-labeling drugs with new warnings was sufficient. Furthermore, the FDA no longer believed that it was sufficient to identify safe conditions of use in the label and that healthcare professionals and patients had to comply with advocated directions of use for the drug to remain on the market.

Medication Risk Management.

Historically, the FDA has interpreted the requirement that a drug must be "safe" to mean that the benefits of a drug outweigh its risks. The determination was made on a "categorical" basis, where the totality of risks was weighted against the totality of benefits when considered for the purposes outlined in the drug product's labeling. If a drug did not meet this criterion, it was not approved or its label was rewritten to narrow the conditions for use. This logic was endemic in the FDA for most of the 20th century. On average, two to four drugs over each 5-year period were withdrawn from the marketplace after post-marketing surveillance data uncovered new risks. Similarly, on occasion, the FDA would require some special "tool" or intervention to improve a product's safety profile. Harm associated with medication remains the second most common type of incident in hospitals, as reported by the Clinical Excellence Commission. Health services actively review medication safety. The vast majority of medication errors result in no injury. A minor injury may result, for example, in a patient needing an increased level of monitoring. Even if incidents result in minor injury, managers and staff still take any errors very seriously, reviewing the actions around the incident and making improvements as a result. FDA's new concepts for risk management amount to a "cultural shift" in the logic of drug approval and the FDA's role. The key events that led to this change can be traced to a series of reports that highlighted the need for improved medical safety. In 1999, the IOM released a report entitled, "To Err is Human." This report reviewed the nature and cause of medication errors, estimating that up to 98,000 people died each year due to these errors. In their assessment, the IOM included both adverse drug reactions and human errors in drug administration. The report captured the attention of news reporters and the government. Headlines proclaimed alarm at the larger number of fatalities caused by medical errors. Consequently, there was a government-wide initiative started to develop methods and institute procedures to reduce medical errors. Statements made by FDA officials regarding some of these withdrawals suggested that the FDA no longer believed that passive oversight and re-labeling drugs with new warnings was sufficient. Furthermore, the FDA no longer believed that it was sufficient to identify safe conditions of use in the label and that healthcare professionals and patients had to comply with advocated directions of use for the drug to remain on the market.

PATIENT SAFETY IN THE ADMINISTRATION OF ANTINEOPLASTIC CHEMOTHERAPY AND OF IMMUNOTHERAPICS FOR ONCOLOGICAL TREATMENT: SCOPING REVIEW

ABSTRACT Objective: to identify and synthesize the scientific evidence on cancer patient safety in the administration of antineoplastic and immunotherapeutic chemotherapeutic agents. Method: a scoping review, according to the Joanna Briggs Institute and to the recommendations of the PRISMA-ScR international guide. The research was conducted in five electronic databases, the Cochrane Library and eight catalogs of theses and dissertations. The inclusion criteria were the following: studies related to patient safety in the administration of antineoplastic and immunotherapeutic chemotherapy by nurses in places where cancer care occurs, published entirely in Portuguese, Spanish and/or English, with no time limit. The extracted data were analyzed and synthesized in narrative form. Results: a total of 14,444 records were retrieved and 47 studies were kept for review. Most publications (44.7%) had a qualitative approach, while 40.4% were quantitative and 14.9%, mixed. When summarizing the findings, the following themes emerged: Safety standards in parenteral administration of antineoplastic chemotherapy; Good practices for patient safety using oral antineoplastic therapy; Administration and safe handling of immunotherapies; Prevention and management of errors related to the administration of antineoplastic and immunotherapeutic chemotherapeutic agents. Conclusion: patients safety with cancer in the administration of antineoplastic therapy occurs when there is implementation of evidence-based protocols, continuing education of nurses and implementation of safety standards and processes, as a strategy to prevent errors in drug administration.

Drug administration errors among anesthesiologists: The burden in India - A questionnaire-based survey.

Background and Aims:Safe medication is an important part of anesthesia practice. Even though anesthesia practice has become safer with various patient safety initiatives, it is not completely secure from errors which can sometimes lead to devastating complications. Multiple reports on medication errors have been published; yet, there exists a lacuna regarding the quantum of these events occurring in our country or the preventive measures taken. Hence, we conducted a survey to study the occurrence of medication errors, incident reporting, and preventive measures taken by anesthesiologists in our country.Material and Methods:A self-reporting survey questionnaire (24 questions, 4 parts) was mailed to 9000 anesthesiologists registered in Indian Society of Anaesthesiologists via Survey Monkey Website.Results:A total of 978 completed surveys were returned for analysis (response rate = 9.2%). More than two-thirds (75.6%, n = 740) had experienced drug administration error and 7.7% (57) of respondents faced major morbidity and complications. Haste/Hurry (23.4%) was identified as the most common contributor to medication errors in the operation theater. Loading and double-checking of drugs before administration by concerned anesthesiologist were identified as safety measures to reduce drug errors.Conclusion:Majority of our respondents have experienced drug administration error at some point in their career. A small yet important proportion of these errors have caused morbidity/mortality to patients. The critical incident reporting system should be established for regular audits, an effective root cause analysis of critical events, and to propose measures to prevent the same in future.