Errors In Emergency Department Research Articles

KNOWLEDGE AND ATTITUDES OF EMERGENCY NURSES REGARDING MEDICATION ERRORS

Medication errors in emergency departments can lead to significant patient harm. Understanding the knowledge and attitudes of healthcare professionals regarding these errors is critical for developing effective prevention strategies. Objective: To assess the knowledge and attitudes of emergency department nurses regarding medication errors. Methods: A descriptive, cross-sectional study was conducted in the Emergency Department of Sheikh Zayed Hospital, Rahim Yar Khan, from March 2023 to March 2024. A total of 150 nurses participated in the study. Data were collected using a 43-item questionnaire available in both Urdu and English. The questionnaire comprised six sections, focusing on knowledge, attitudes, and behaviors regarding medication errors. Responses were recorded on a Likert scale ranging from 1 (totally disagree) to 5 (totally agree). Statistical analysis included descriptive statistics to summarize the responses. Results: The mean age of the nurses was 43.6 ± 16.6 years, with 70% being female and 30% male. A majority of nurses agreed that medication errors can be reduced by calculating drug dosages beforehand (76%), using prepackaged drugs from the pharmacy (62%), and utilizing informative brochures and guidebooks (66%). Attitudes towards error reduction were positive, with recommendations for systematic training of healthcare staff (94%), raising awareness about risk management and prevention (90%), evaluating staff for eligibility (90%), and the importance of reporting and assessing errors (94%). Conclusion: Nurses in the emergency department possess sufficient knowledge and exhibit positive attitudes toward medication errors in the management and administration of IV drugs. However, ongoing training programs and awareness initiatives are essential to update nurses' knowledge and enhance patient safety.

KNOWLEDGE AND ATTITUDES OF EMERGENCY NURSES REGARDING MEDICATION ERRORS

Medication errors in emergency departments can lead to significant patient harm. Understanding the knowledge and attitudes of healthcare professionals regarding these errors is critical for developing effective prevention strategies. Objective: To assess the knowledge and attitudes of emergency department nurses regarding medication errors. Methods: A descriptive, cross-sectional study was conducted in the Emergency Department of Sheikh Zayed Hospital, Rahim Yar Khan, from March 2023 to March 2024. A total of 150 nurses participated in the study. Data were collected using a 43-item questionnaire available in both Urdu and English. The questionnaire comprised six sections, focusing on knowledge, attitudes, and behaviors regarding medication errors. Responses were recorded on a Likert scale ranging from 1 (totally disagree) to 5 (totally agree). Statistical analysis included descriptive statistics to summarize the responses. Results: The mean age of the nurses was 43.6 ± 16.6 years, with 70% being female and 30% male. A majority of nurses agreed that medication errors can be reduced by calculating drug dosages beforehand (76%), using prepackaged drugs from the pharmacy (62%), and utilizing informative brochures and guidebooks (66%). Attitudes towards error reduction were positive, with recommendations for systematic training of healthcare staff (94%), raising awareness about risk management and prevention (90%), evaluating staff for eligibility (90%), and the importance of reporting and assessing errors (94%). Conclusion: Nurses in the emergency department possess sufficient knowledge and exhibit positive attitudes toward medication errors in the management and administration of IV drugs. However, ongoing training programs and awareness initiatives are essential to update nurses' knowledge and enhance patient safety.

Medication errors in emergency departments: a systematic review and meta-analysis of prevalence and severity.

Medication errors significantly compromise patient safety in emergency departments. Although previous studies have investigated the prevalence of these errors in this setting, results have varied widely. The aim was to report pooled data on the prevalence and severity of medication errors in emergency departments, as well as the proportion of patients affected by these errors. Systematic searches were conducted in Embase, PubMed, and the Cochrane Library from database inception until June 2023. Studies provided numerical data on medication errors within emergency departments were eligible for inclusion. Random-effects meta-analysis was employed to pool the prevalence of medication errors, the proportion of patients experiencing these errors, and the error severity levels. Heterogeneity among studies was assessed using the I2 statistic and Cochran's Q test. Twenty-four studies met the inclusion criteria. The meta-analysis gave a pooled prevalence of medication errors in emergency departments of 22.6% (95% Confidence Interval [CI] 19.2-25.9%, I2 = 99.9%, p < 0.001). The estimated proportion of patients experiencing medication errors was 36.3% (95% CI 28.3-44.3%, I2 = 99.8%, p < 0.001). Of these errors, 42.6% (95% CI 5.0-80.1%) were potentially harmful but not life-threatening, while no-harm errors accounted for 57.3% (95% CI 14.1-100.0%). The prevalence of medication errors, particularly those potentially harmful, underscores potential safety issues in emergency departments. It is imperative to develop and implement effective interventions aimed at reducing medication errors and enhancing patient safety in this setting.

The Role of clinical pharmacists’ interventions and prevention of medication errors in emergency departments

Clinical pharmacists play a vital role in mitigating medication errors within the high-pressure setting of emergency departments (EDs). This study underscores the significance of their interventions in elevating patient safety and reducing adverse drug events. Medication errors in the ED often stem from factors such as time constraints, incomplete patient information, and complex drug regimens. Clinical pharmacists address these challenges by conducting comprehensive medication reconciliation, assessing drug interactions, and adjusting dosages to align with each patient's specific requirements. Their presence in EDs facilitates real-time verification of medication orders, immediate correction of errors, and close collaboration with the healthcare team. Furthermore, clinical pharmacists provide invaluable drug information and education to patients and medical staff, thereby lowering the risk of inappropriate drug usage and promoting safer administration practices. Existing literature affirms that clinical pharmacist interventions in EDs lead to a notable reduction in medication errors, adverse drug events, and subsequent healthcare costs. In summary, the integration of clinical pharmacists in the ED is indispensable for augmenting patient safety, averting medication errors, and ultimately enhancing patient outcomes. Keywords: medication errors, clinical pharmacists, emergency departments, patient safety, healthcare.

Interprofessional team membership stability and medical errors in emergency departments

IntroductionDelays to care and treatment in emergency departments (EDs) can lead to medical errors that harm patients. To optimize ED outcomes, indicators exist that define time frames within which patients should be assessed, receive care, and be discharged and they include time to triage, time to physician assessment (PIA), and time to discharge. The purpose of this study was to examine the relationship between temporal TMS and medical errors as delays to care in EDs. Methods: A nonexperimental, quantitative, cross-sectional, and correlational research design was used to study the relationship between differences in IP team membership due to shift work schedules (i.e., TMS) and medical errors as patient outcomes within EDs. Fifteen EDs and urgent care centres (referred collectively as EDs) located in the province of Manitoba, Canada were selected for this study. Results: medical errors occurred at each ED but to different extents; ED teams had low temporal stability; TMS and medical errors were not statistically significant, but worked experience captured by the individual team competence index (ITCI) decreased time to physician and length of stay was. TMS had a negative moderating effect on ITCI and neither TMS nor ITCI were statistically significant when patient volumes and levels of acuity were controlled. In contrast, when team size was controlled, TMS had a large effect size on time to physician. Conclusion: low TMS was not a significant factor in medical errors measured as delays to care but probably related to other organizational factors and team dynamics.

"Strategic reduction of medication errors in Emergency Department At Mabarah Hospital in Port Said city"

"Strategic reduction of medication errors in Emergency Department At Mabarah Hospital in Port Said city"

Identification and assessment of nursing task errors in emergency department using SHERPA technique and offering remedial strategies

BackgroundImproving health care quality is a global concern, and providing patients with safe healthcare is a WHO Patient Safety priority. The technological revolution in health services has highlighted the role of human factors in committing such errors, and since the number of medical errors, including nursing errors, increases on a daily basis. ObjectivesThis research aimed to identify the causes of Nursing Task Errors in Emergency Department Using SHERPA Technique and adopt strategies to prevent and reduce them.Participants were 47 nurses (24 women and 23 men), who worked morning, evening and night shifts. The nurses were taught the methodology and talked about the objective of the study; they were then interviewed and observed for six months while working. This way, their tasks and subtasks were demarcated and the Hierarchical Task Analysis (HTA) was performed. SHERPA Error Mode Checklist was used to identify errors and their various types and then risk assessment was conducted. ResultsA total of 45 tasks, 234 subtasks, and 326 errors in regard to nursing activities were identified in the emergency department, with the highest frequency for action errors (61.34%) and the lowest for communication errors (1.84%). Also, there were 7.24 errors per task. The highest and lowest number of errors were at the ‘unfavorable’ (19.07%) and,‘acceptable (safe)’ (6.15%) risk levels, respectively. Based on the finding staff training, workload elimination,work process modification and updating guidelines are recommended. ConclusionThe results of present study were also submitted to the University Medical Executive management Committee to make individual, educational and organizational reforms (guidelines and instructions) in order to optimize the situation.

Investigation of Human Errors in Emergency Department of Imam Khomeini Hospital Emergency Department of Jiroft Using Systematic Human Error Reduction and Prediction Approach

Introduction: In examining the unfortunate events that have taken place in the industrial and health sectors, human error is considered as the main cause of these events. Given the sensitivity and importance of medical careers, the occurrence of errors can lead to irreparable consequences. The purpose of this study was to investigate the human error in the emergency department of Imam Khomeini Hospital in Jiroft.&#x0D; Methods: This study was a cross-sectional and descriptive one. Emergency nurses' job duties have been analyzed by interviewing emergency nurses and studying nursing job guidelines and procedures using hierarchical task analysis. Finally, using the Systematic Human Error Reduction and Prediction Approach, human errors in nursing care were analyzed.&#x0D; Results: Generally, 4 tasks, 18 sub-tasks and 91 types of errors related to nursing activities were identified. Number of errors found, 27 (30%) Action errors, 18 (20%) Checking errors, 19 (21%) Retrieval errors, 12 (13%) communication errors, and 15 (16%) selection errors Were. As can be seen, the largest number of errors was related to the type of Action errors.&#x0D; Conclusion: Considering the results of the present study, the highest numbers of errors were related to Action and Checking errors respectively, which due to the sensitivity of nursing jobs and especially in the emergency department, require the use of highly skilled people to perform tasks that require high concentration and accuracy.

Monitoring Diagnostic Safety Risks in Emergency Departments: Protocol for a Machine Learning Study.

BackgroundDiagnostic decision making, especially in emergency departments, is a highly complex cognitive process that involves uncertainty and susceptibility to errors. A combination of factors, including patient factors (eg, history, behaviors, complexity, and comorbidity), provider-care team factors (eg, cognitive load and information gathering and synthesis), and system factors (eg, health information technology, crowding, shift-based work, and interruptions) may contribute to diagnostic errors. Using electronic triggers to identify records of patients with certain patterns of care, such as escalation of care, has been useful to screen for diagnostic errors. Once errors are identified, sophisticated data analytics and machine learning techniques can be applied to existing electronic health record (EHR) data sets to shed light on potential risk factors influencing diagnostic decision making.ObjectiveThis study aims to identify variables associated with diagnostic errors in emergency departments using large-scale EHR data and machine learning techniques.MethodsThis study plans to use trigger algorithms within EHR data repositories to generate a large data set of records that are labeled trigger-positive or trigger-negative, depending on whether they meet certain criteria. Samples from both data sets will be validated using medical record reviews, upon which we expect to find a higher number of diagnostic safety events in the trigger-positive subset. Machine learning will be used to evaluate relationships between certain patient factors, provider-care team factors, and system-level risk factors and diagnostic safety signals in the statistically matched groups of trigger-positive and trigger-negative charts.ResultsThis federally funded study was approved by the institutional review board of 2 academic medical centers with affiliated community hospitals. Trigger queries are being developed at both organizations, and sample cohorts will be labeled using the triggers. Machine learning techniques such as association rule mining, chi-square automated interaction detection, and classification and regression trees will be used to discover important variables that could be incorporated within future clinical decision support systems to help identify and reduce risks that contribute to diagnostic errors.ConclusionsThe use of large EHR data sets and machine learning to investigate risk factors (related to the patient, provider-care team, and system-level) in the diagnostic process may help create future mechanisms for monitoring diagnostic safety.International Registered Report Identifier (IRRID)DERR1-10.2196/24642

Be aware of critical drugs in emergency departments: An extreme iatrogenic insulin overdose via subcutaneous and intramuscular routes

Introduction: Insulin is a highly used parenteral medication in emergency departments. Although most severe insulin overdoses occur as suicide attempts, medication errors can be the reason. We aimed to highlight the potential medication errors in emergency departments due to the poor control of critical drugs like insulin and the similarities between the brand names of drugs, as we experienced during this case. &#x0D; Case Report: We present a 75-year-old diabetic woman with an extreme insulin overdose. A total of 3000 UI of insulin was administered by subcutaneous and intramuscular routes. She developed typical and atypical episodes of hypoglycemia requiring intravenous dextrose, a high-calorie diet, and glucagon administration. Almost all of the classic side effects of glucagon occurred during her intensive care unit follow-up. She recovered without any sequela or recurrence of hypoglycemia at the end of 5 days of admission.&#x0D; Conclusion: Insulin overdose can be a life-threatening condition by causing hypoglycemia. Albeit rare, insulin overdose can occur as a medication error in hospitals. To prevent such incidents for emergency departments, the medication errors should be objectively laid out, and proactive strategies should be integrated without adversely affecting acute care.

A study to assess the knowledge of staff nurses regarding medical errors in emergency department in selected Hospitals at Bharuch

A Medical Error is a preventable adverse effect of care, whether or not it is evident or dangerous to the patient. Patient safety is one of the main concepts in the field of health care provision and a major element of health services quality.

Assessment of a deep-learning system for fracture detection in musculoskeletal radiographs

Missed fractures are the most common diagnostic error in emergency departments and can lead to treatment delays and long-term disability. Here we show through a multi-site study that a deep-learning system can accurately identify fractures throughout the adult musculoskeletal system. This approach may have the potential to reduce future diagnostic errors in radiograph interpretation.

Development and psychometric evaluation of triage questionnaire (QTrix): Exploratory factor analysis and item response theory analysis

Introduction:Triage errors can occur in all emergency departments, regardless of the type of triage system being used. One way to minimize triaging errors is by enhancing the triage officers’ knowledge and attitude on triage. The assessment of knowledge and attitude can be carried out by questionnaire assessment. This study aims to perform content, face, and construct validation on a newly developed triage questionnaire, QTrix, which is designed for healthcare personnel in a tertiary teaching hospital in Kelantan, Malaysia, that uses the three-tier Malaysian Triage Category system.Methods:This study consisted of two phases: the first phase was the questionnaire development phase, which included the content validity with the expert panel and the face validity using 30 respondents; and the second phase was the psychometric assessment phase, which included the item response theory and the exploratory factor analysis using 139 respondents.Results:The knowledge section with 12 remaining items was considered unidimensional by item response theory after removing items with extreme difficulty coefficients (outside the range of −3 to +3) and items with very low discrimination values (&lt;0.35). After exploratory factor analysis, two items in the attitude section were removed due to low factor loadings (&lt;0.3) and high item complexity. The reliability of the remaining 13 items in the attitude section was very good as shown by Cronbach’s alpha values of more than 0.8.Conclusion:The QTrix questionnaire is a well-validated and reliable tool to assess the knowledge and the attitude on triage. Its use among healthcare personnel can help minimize triaging errors in emergency departments that utilize the Malaysian Triage Category system.

Diagnostic error in the emergency department: learning from national patient safety incident report analysis

BackgroundDiagnostic error occurs more frequently in the emergency department than in regular in-patient hospital care. We sought to characterise the nature of reported diagnostic error in hospital emergency departments in England and Wales from 2013 to 2015 and to identify the priority areas for intervention to reduce their occurrence.MethodsA cross-sectional mixed-methods design using an exploratory descriptive analysis and thematic analysis of patient safety incident reports. Primary data were extracted from a national database of patient safety incidents. Reports were filtered for emergency department settings, diagnostic error (as classified by the reporter), from 2013 to 2015. These were analysed for the chain of events, contributory factors and harm outcomes.ResultsThere were 2288 cases of confirmed diagnostic error: 1973 (86%) delayed and 315 (14%) wrong diagnoses. One in seven incidents were reported to have severe harm or death. Fractures were the most common condition (44%), with cervical-spine and neck of femur the most frequent types. Other common conditions included myocardial infarctions (7%) and intracranial bleeds (6%). Incidents involving both delayed and wrong diagnoses were associated with insufficient assessment, misinterpretation of diagnostic investigations and failure to order investigations. Contributory factors were predominantly human factors, including staff mistakes, healthcare professionals’ inadequate skillset or knowledge and not following protocols.ConclusionsSystems modifications are needed that provide clinicians with better support in performing patient assessment and investigation interpretation. Interventions to reduce diagnostic error need to be evaluated in the emergency department setting, and could include standardised checklists, structured reporting and technological investigation improvements.

An Operational Framework to Study Diagnostic Errors in Emergency Departments: Findings From A Consensus Panel.

To create an operational definition and framework to study diagnostic error in the emergency department setting. We convened a 17-member multidisciplinary panel with expertise in general and pediatric emergency medicine, nursing, patient safety, informatics, cognitive psychology, social sciences, human factors, and risk management and a patient/caregiver advocate. We used a modified nominal group technique to develop a shared understanding to operationally define diagnostic errors in emergency care and modify the National Academies of Sciences, Engineering, and Medicine's conceptual process framework to this setting. The expert panel defined diagnostic errors as "a divergence from evidence-based processes that increases the risk of poor outcomes despite the availability of sufficient information to provide a timely and accurate explanation of the patient's health problem(s)." Diagnostic processes include tasks related to (a) acuity recognition, information and synthesis, evaluation coordination, and (b) communication with patients/caregivers and other diagnostic team members. The expert panel also modified the National Academies of Sciences, Engineering, and Medicine's diagnostic process framework to incorporate influence of mode of arrival, triage level, and interventions during emergency care and underscored the importance of outcome feedback to emergency department providers to promote learning and improvement related to diagnosis. The proposed operational definition and modified diagnostic process framework can potentially inform the development of measurement tools and strategies to study the epidemiology and interventions to improve emergency care diagnosis.

The nature of errors in emergency department and the role of detectors: A qualitative study

Abstract Objectives: Understanding the nature of errors and the way errors are detected by nurses has a major role in preventing and reducing complications of errors. The present study aims to investigate the nature of errors and identify factors detecting errors in the emergency department. Methods: The present qualitative study was conducted with participation of 20 emergency department nurses according to Elo & Kyngas (2008) content analysis method. Data were collected through semi-structured in-depth interviews. Sampling began purposively and continued until data saturation was reached. Results: Analysis of data led to the extraction of two main categories, including nature of errors and error detectors. The nature of errors consisted of two subcategories, namely, lurking errors and indistinguishable of errors. Error detectors comprised four subcategories, namely, personal detectors, team detectors, client detectors, and organizational detectors. Conclusion: The present study results showed that errors in the emergency department are vague in nature and difficult to detect. Nurses use various sources to identify errors. In the context of the present study, human sources, especially nurses and patients have a key role in identifying and detecting errors. These sources of error detection should be reinforced by health organizations.

What interventions could reduce diagnostic error in emergency departments? A review of evidence, practice and consumer perspectives.

The purpose of this article is to synthesise review evidence, practice and patient perspectives on interventions to reduce diagnostic error in emergency departments (EDs). A rapid review methodology identified nine systematic reviews for inclusion. Six practice interviews were conducted to identify local contextual insights and implementation considerations. Finally, patient perspectives were explored through a citizen panel with 11 participants. The rapid review found evidence for the following interventions: second opinion, decision aids, guided reflection and education. Practitioners suggested three of the four interventions from the academic review: second opinion, decision aids and education. Practitioners suggested four additional interventions: improving teamwork, engaging patients, learning from mistakes and scheduled test follow-up. Patients most favoured interventions that improved communication through education and patient engagement, while also suggesting that implementation of state-wide standards to reduce variability in care and sufficient staffing are important to address diagnostic errors. Triangulating these three perspectives on the evidence allows for the intersections to be highlighted and demonstrates the usefulness of incorporating practitioner reflections and patient values in developing potential interventions.

Cognitive error in an academic emergency department.

Abstract Background Medical error is a leading cause of death nationwide. While systems issues have been closely investigated as a contributor to error, little is known about the cognitive factors that contribute to diagnostic error in an emergency department (ED) environment. Methods Eight months of patient revisits within 72 h where patients were admitted on their second visit were examined. Fifty-two cases of confirmed error were identified and classified using a modified version of the Australian Patient Safety Foundation classification system for medical errors by a group of trained physicians. Results Faulty information processing was the most frequently identified category of error (45% of cases), followed by faulty verification (31%). Faulty knowledge (6%) and faulty information gathering (18%) occurred relatively infrequently. “Misjudging the salience of a finding” and “premature closure” were the individual errors that occurred most frequently (13%). Conclusions Despite the complex nature of diagnostic reasoning, cognitive errors of information processing appear to occur at higher rates than other errors, and in a similar pattern to an internal medicine service despite a different clinical environment. Further research is needed to elucidate why these errors occur and how to mitigate them.

Medical Errors in Emergency Department; a Letter to Editor.

Medical error is the third leading cause of death in the United States of America and almost 100000 patients lose their life due to medical errors every year.

Emergency Nurses as Second Victims of Error: A Qualitative Study.

There are many nurses who are victims of errors in the hospital environment. It is quite essential to perceive the outcome of mistakes in nurses' profession. The aim of this scientific study was to interpret the causes that place nurses in danger of errors in emergency departments and also the consequences resulting from confronting the errors in the job environment. This research was designed to pursue a qualitative approach following content analysis. Through the purposeful sampling, 18 emergency nurses were selected to participate in this study. In-depth semi-structured interviews were used for data collection. Participants were selected by purposive sampling. Data collection continued until saturation was reached. The results of data analysis were presented in three different categories: the psychological reactions to error, learning from errors, and avoiding reactions. The current study revealed that errors could create positive and negative impacts on the emergency nurses' attitude. Confronting the errors through learning from the mistakes can result in the improvement of patients' safety whereas the negative outcomes can provoke destructive effects on nurses' career. Nurses are considered as victims of errors; therefore, they need support and protection to enhance their career.