Medication Errors In Practice Research Articles

Think fast and slow in the cognitive process for decision making in medicine

Being a doctor requires making quick and accurate decisions, whether it is diagnosis or therapy, and has implications for patient safety. Several theories have been proposed to explain how clinicians make their reasoning, pointing out differences between skilled and inexperienced clinicians. Our brain has two systems of thought: fast and slow. Fast is associated with intuitive and automatic decisions, requires little energy or attention, allows decisions to be made with little information. Slow cognitive processing involves deeper, more analytical cognitive processing, requires effort, and can be strenuous. Recent research indicates that quick thinking is used in most medical decisions. This form of intuitive thinking is part of the process is very effective, but it is also vulnerable to cognitive errors. The dual theory of reasoning, reflecting the great importance of intuition in most decisions, allows us to better understand how we doctors think in our daily practice. Medical schools should use new didactic spaces in which problem-based learning is greatly facilitated, in subjects such as integrated workshops, medical practice, or integrative sessions, with similar methodology, that provide our students with opportunities to obtain knowledge and critical thinking skills to solve medical problems in a holistic way, in any context, with both systems of thought. More years in the classroom, continuing medical education, certification by advice do not solve the problem, there are those who invoke to eliminate cognitive errors in medical practice, that it must be redesigned and reinvented.

LEGAL LIABILITY OF ACUPUNCTURE THERAPIST FOR PATIENT SAFETY INCIDENTS IN TRADITIONAL MEDICINE SERVICES REVIEWED BY HEALTH WORKERS LAW AND REGULATION OF THE MINISTER OF HEALTH ABOUT CONCERNING LICENSING AND IMPLEMENTATION OF ACUPUNCTURE THERAPIST PRACTICES

Traditional medicine services are one of the treatments and treatment efforts other than medical science and / or nursing science which is carried out by traditional health workers. Acupuncturists are skilled traditional healers who perform invasive procedures on patients that can cause patient safety incidents or potentially result in injury to the patient. But in fact, if there is a loss due to an error in treatment, the client / patient and / or the client / patient's family do not know the legal consequences for the acupuncturist who provides their therapist services. The purpose of this study is to gain a comprehension of acupuncture therapist authority on the medical service and to acquire a description of acupuncture therapist responsibility on patient safety incident on the medical treatment. This research article was carried out using normative juridical methods with secondary data through literature studies which were analyzed qualitatively. The results showed that the authority of the acupuncture therapist as a traditional skilled health worker was in accordance with the standard of expertise and skills as evidenced by STPT and SIPT. If a patient safety incident occurs due to an error in medical practice, it means that the acupuncturist has committed an illegal act and is responsible for paying compensation to the patient and / or the patient's family.

Assessment of Awareness, Perceptions, and Opinions towards Artificial Intelligence among Healthcare Students in Riyadh, Saudi Arabia.

Background and Objective: The role of the pharmacist in healthcare society is unique, since they are providers of health information and medication counseling to patients. Hence, this study aimed to evaluate Awareness, Perceptions, and Opinions towards Artificial intelligence (AI) among pharmacy undergraduate students at King Saud University (KSU), Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional, questionnaire-based study was conducted between December 2022 and January 2023 using online questionnaires. The data collection was carried out using convenience sampling methods among senior pharmacy students at the College of Pharmacy, King Saud University. Statistical Package for the Social Sciences version 26 was used to analyze the data (SPSS). Results: A total of one hundred and fifty-seven pharmacy students completed the questionnaires. Of these, most of them (n = 118; 75.2%) were males. About 42%, (n = 65) were in their fourth year of study. Most of the students (n = 116; 73.9%) knew about AI. In addition, 69.4% (n = 109) of the students thought that AI is a tool that helps healthcare professionals (HCP). However, more than half 57.3% (n = 90) of the students were aware that AI would assist healthcare professionals in becoming better with the widespread use of AI. Furthermore, 75.1% of the students agreed that AI reduces errors in medical practice. The mean positive perception score was 29.8 (SD = 9.63; range-0-38). The mean score was significantly associated with age (p = 0.030), year of study (p = 0.040), and nationality (p = 0.013). The gender of the participants was found to have no significant association with the mean positive perception score (p = 0.916). Conclusions: Overall, pharmacy students showed good awareness of AI in Saudi Arabia. Moreover, the majority of the students had positive perceptions about the concepts, benefits, and implementation of AI. Moreover, most students indicated that there is a need for more education and training in the field of AI. Consequently, early exposure to content related to AI in the curriculum of pharmacy is an important step to help in the wide use of these technologies in the graduates' future careers.

Intuitive concepts in internal medicine and their occurrence in undergraduate medical students in different semesters.

Background: Dealing with errors in medical practice is of great importance for patient safety. In the natural sciences, intuitive concepts, so-called misconceptions, are increasingly coming into focus of teaching because they lead to a faulty understanding of contexts and thus to faulty scientific reasoning. In medicine, intuitive concepts still play a subordinate role. However, once intuitive concepts have been memorized, they can become firmly established and, under certain circumstances, lead to diagnostic and treatment errors in medical practice. The aim of this study was to identify potential intuitive concepts in internal medicine and to analyze their occurrence in medical students from different semesters.Methods: Eight internists from different subspecialties were asked about intuitive concepts by means of a structured interview. A total of 17 intuitive concepts were identified. Using these concepts, a multiple-choice test was created with 17 patient cases. For each case, there were four possible answers: the correct answer, an incorrect answer that included the intuitive concept, the answer “both are incorrect”, and the answer “I am not sure”, which is to be understood in the sense of “I do not know whether one of the three answers is correct”. As an online multiple-choice test, these 17 cases were made available to all 2nd, 6th, and 12th semester students (N=1170, n=418 from the 2nd semester, n=425 from the 6th semester, and n=327 from the 12th semester, i.e., the final year) for four weeks in June 2015. The test had to be answered within nine minutes. A mixed logistic regression model was used for evaluation.Results: Of the N=317 participating students (n=97 from the 2nd semester, n=124 from the 6th semester, and n=96 from the internship year, overall response rate 27.1%), on average, students from all three groups chose the intuitive concept most often, approximately 40%, although the correct answer increased toward the final year with simultaneously decreasing uncertainty and decreasing feeling of not knowing, respectively. In the final year, compared to the 2nd semester, the intuitive concept was selected significantly more often for two questions (p<0.01). For four questions, the intuitive concept was selected significantly less frequently in the final year (p<0.01).Conclusion: Intuitive concepts can be identified in internal medicine and do not appear to be significantly reduced in students during the course of their studies. This suggests that this could also be the case for other medical subjects. Therefore, similar studies should be conducted for other medical subjects in order to identify potential sources of error in clinical work. In addition, suitable didactic methods should be developed and tested with which students learn not to succumb to intuitive concepts as far as possible in order to prevent diagnostic or therapeutic errors in later medical practice.

Reducing medication errors in practice: part 2

In part 1 of this article, the authors looked at the enormous possibilities for medication errors to occur ( https://doi.org/10.12968/coan.2021.0033 ). In this second part, the authors consider what can be done to avoid medication errors happening in veterinary practice and how systems of work can be used to help. As identified in the Institute of Medicine's report To Err Is Human, most errors result from faulty systems and processes, not individuals. Before steps can be put in place to avoid medication errors, it must be acknowledged that we are all human and thus susceptible to cognitive biases and external influences that cause us to make mistakes. Hence, any interventions put in place should focus on adjusting systems of work to make it easier to do things right and more difficult to do things wrong.

A descriptive evaluation of resident prescription writing errors and self‐perceived learning needs in dermatology

Prescribing errors in medical practice are common and may be preventable in a significant proportion of cases. Literature on dermatologic prescription errors is scarce. We sought to determine the rate and causes of resident prescribing errors in an outpatient dermatology practice and surveyed residents' self-perceived prescription writing learning needs. All prescription errors were tabulated at Women College Hospital's Ricky Kanee Schachter Dermatology Clinic from November 2019 to January 2020. There was an overall prescribing error rate of 1.58% (23/1457), with no significant difference between topical and systemic drugs (1.85% and 0.86%, respectively; p=0.20) or written prescriptions and electronic-medical record created prescriptions (1.66% and 1.29%, respectively; p=0.84). 26.2% (22/82) of residents responded to the survey reporting overall confidence in dermatology prescription writing as 7.14±1.75 out of 10. While the resident prescribing error rate was relatively low, multiple errors were avoidable, and residents agree targeted dermatology-specific training in prescription writing is needed.

INTEGRATION OF DECISION SUPPORT SYSTEMS IN MEDICAL PRACTICE: PREDICTION OF OSTEOPOROSIS IN DIABETIC PATIENTS

Currently, large amounts of information is available to clinical specialists ranging from clinical symptoms to various types of biochemical data and results of instrumental methods of diagnostics. In order to optimize decision making and to avoid treatment errors in medical practice, decision support systems based on artificial intelligence methods including artificial neural networks are becoming widely used in diagnostic procedures. Such systems allow increasing the efficiency of clinical analysis due to the processing of complex and interrelated medical data and integrating them into the results of diagnostics carried out by a clinician. This article describes the application of the methodology of artificial neural networks in medical diagnostics on the example of modeling and analyzing the risk of osteoporosis in diabetic patients.

Attitudes of doctors and nurses to patient safety and errors in medical practice in the Gaza-Strip: a cross-sectional study

ObjectivesThis study examined the attitudes of nurses and doctors to key patient safety concepts, evaluated differences and similarities between professional groups and assessed positive and negative attitudes to identify target...

Opening Access To Practice-based Evidence in Clinical Decision Support Systems with Natural Query Language

&lt;p&gt;Evidence-based medicine can be effective only if constantly tested against errors in medical practice. Clinical record database summarization supported by a machine allows allow to detect anomalies and therefore help detect the errors in early phases of care. Summarization system is a part of Clinical Decision Support Systems however it cannot be used directly by the stakeholder as long as s/he is not able to query the clinical record database. Natural Query Languages allow opening access to data for clinical practitioners, that usually do not have knowledge about articial query languages. Results: We have developed general purpose reporting system called Ask Data Anything (ADA) that we applied to a particular CDSS implementation. As a result, we obtained summarization system that opens the access for these of clinical researchers that were excluded from the meaningful summary of clinical records stored in a given clinical database. The most significant part of the component - NQL parser - is a hybrid of Controlled Natural Language (CNL) and pattern matching with a prior error repair phase. Equipped with reasoning capabilities due to the intensive use of semantic technologies, our hybrid approach allows one to use very simple, keyword-based (even erroneous) queries as well as complex CNL ones with the support of a predictive editor. By using ADA sophisticated summarizations of clinical data are produced as a result of NQL query execution. In this paper, we will present the main ideas underlying ADA component in the context of CDSS.&lt;/p&gt;

Characteristics of Nurses in Japanese Hospitals Who Detect Errors of One-self and Others

Background: Nurses who often detect errors in medical practice are highly esteemed for their capacity to prevent medical accidents. However, information on particular characteristics of such nurses is limited at this time. The aim of this study was to identify characteristics of nurses who are able to detect errors during medical practice, both their own and those of others. Methods: Anonymous questionnaires were distributed to 2908 nurses in 11 Japanese hospitals whose working career was three years and longer to collect information regarding experiences in detecting errors of one’s own making and errors of others during medical practice, the actual experiences of making errors, social skills, a safety climate in the wards, and general characteristics of the participants. The valid response rate was 64.0 %. Principal component analysis was used to form composite measures using a smaller set of error experiences (clinical errors). Multiple logistic regression analysis was performed to determine factors related to experiences in detecting errors. Results: Of the participants, 77.4% had experienced detecting their own errors, and 84.1% had experienced detecting errors of others. Significant factors related to the experience of detecting one’s own errors were: having experienced their own errors detected by others, clinical errors, feedback and communication about errors, and a medical accident. Significant factors related to the experience of detecting errors of others were: the experience of having their own errors detected by others, experience of detecting one’s own errors, communication openness, night shift duty, experience as a safety committee member, and planning skills. Conclusion: Experiencing errors plays a role in detecting future errors of one’s own making and of others. Adequate feedback is preferable for detecting one’s own errors. Open communication in the ward is recommended for detecting errors of others, as one facet of medical safety control.

How doctors diagnose diseases and prescribe treatments: an fMRI study of diagnostic salience

Understanding the brain mechanisms involved in diagnostic reasoning may contribute to the development of methods that reduce errors in medical practice. In this study we identified similar brain systems for diagnosing diseases, prescribing treatments, and naming animals and objects using written information as stimuli. Employing time resolved modeling of blood oxygen level dependent (BOLD) responses enabled time resolved (400 milliseconds epochs) analyses. With this approach it was possible to study neural processes during successive stages of decision making. Our results showed that highly diagnostic information, reducing uncertainty about the diagnosis, decreased monitoring activity in the frontoparietal attentional network and may contribute to premature diagnostic closure, an important cause of diagnostic errors. We observed an unexpected and remarkable switch of BOLD activity within a right lateralized set of brain regions related to awareness and auditory monitoring at the point of responding. We propose that this neurophysiological response is the neural substrate of awareness of one’s own (verbal) response. Our results highlight the intimate relation between attentional mechanisms, uncertainty, and decision making and may assist the advance of approaches to prevent premature diagnostic closure.

Use of Dimensional Analysis in an Associate Degree Nursing Program

The aim of this retrospective study was to show the use of dimensional analysis increased associate degree nursing students’ mathematical computation competency and may reduce nursing medication errors in practice. A recent report compiled by Mackary and Daniel from John Hopkins, stated that medical error is the third leading cause of death in the United States [1]. The most commonly cited estimate of annual deaths from medical error in the United States is a 1999 Institute of Medicine (IOM) report which is possibly limited and now outdated [2]. Medication errors contribute to patients’ deaths, whereas nurses administer either incorrect medication, or incorrect doses of medication. Human error is inevitable, however designing safer systems to administer medication such as the use of a bar code system, and the standardization of academic medication calculation teaching may decrease these errors. According to a report from a major insurance company that insures a large percentage of nurses, malpractice claims in nursing is on the rise [3]. Claim settlements and court judgments for 2015 against nurses include: failure to communicate, medication errors, charting by exception, and legal risks. Medication calculation errors can be one of three categories, conceptual, mathematical, and measurement, with conceptual errors (setup of the calculation equation) accounting for 68% of all errors [4]. Nursing textbook publications teaching dose calculation often use multiple methods: ratio-proportion, “desired over have”, and various formulas to calculate medication dosage. Students then need to use the appropriate formula to solve the problem with fractions often leading to miscalculations with added or dropped zeroes. The use of dimensional analysis (DA) only requires the student to use a single equation, and learn one calculation process, rather than several steps required by other methods or even memorization of multiple formulas [5].

Overcoming Diagnostic Errors in Medical Practice

Overcoming Diagnostic Errors in Medical Practice

Prevalence and risk factors for modified prescriptions in an Irish community pharmacy

Background:Despite a dearth of knowledge on the causes of prescribing errors in medical practice, and the rates of prescribing errors among certain patient groups, little Irish research exists to address this issue. One possible reason for this is that the analysis of prescription modification is not part of the recognised job description of a pharmacist. Aims:To investigate the prevalence, nature and risk factors for prescription modifications in an Irish community pharmacy. Methods:A cross-sectional study was performed to examine prescriptions dispensed in an Irish community pharmacy over a period of five weeks. Results:In total, 866 prescriptions were examined. The overall prevalence of prescribing errors and prescription modifications was 17.9% (155), with a mean of 31 modifications per week. Prescription only medicines (POM) comprised 94.8% (147) of the modifications, of which 87% (128/147) were prescription errors requiring a simple clerical clarification before dispensing could occur. The remaining 13% (19; average of 3.8 per week) were prescribing faults with potential clinical consequences if left unaltered. Half (51%) of all POM modifications occurred through consultation with the patient or their representative. The following factors were associated with increased risk of POM modifications: being a female patient (OR=1.605, 95% CI 1.104-2.333, p=0.013); and, being prescribed drugs in the following therapeutic areas ‐ musculoskeletal (OR=1.906, 95% CI 1.023-3.551, p=0.042), and genitourinary system and sex hormones (OR=3.691, 95% CI 2.255-6.042, p<0.001). Subsequent multivariate analysis confirmed these as significant independent risk factors for POM modifications. Conclusions:The majority of prescribing errors modified involved non-serious clerical errors. However, an average of 3.8 POM prescriptions with potential clinical consequences were modified weekly.

Using simulation to address hierarchy-related errors in medical practice.

Hierarchy, the unavoidable authority gradients that exist within and between clinical disciplines, can lead to significant patient harm in high-risk situations if not mitigated. High-fidelity simulation is a powerful means of addressing this issue in a reproducible manner, but participant psychological safety must be assured. Our institution experienced a hierarchy-related medication error that we subsequently addressed using simulation. The purpose of this article is to discuss the implementation and outcome of these simulations. Script and simulation flowcharts were developed to replicate the case. Each session included the use of faculty misdirection to precipitate the error. Care was taken to assure psychological safety via carefully conducted briefing and debriefing periods. Case outcomes were assessed using the validated Team Performance During Simulated Crises Instrument. Gap analysis was used to quantify team self-insight. Session content was analyzed via video review. Five sessions were conducted (3 in the pediatric intensive care unit and 2 in the Pediatric Emergency Department). The team was unsuccessful at addressing the error in 4 (80%) of 5 cases. Trends toward lower communication scores (3.4/5 vs 2.3/5), as well as poor team self-assessment of communicative ability, were noted in unsuccessful sessions. Learners had a positive impression of the case. Simulation is a useful means to replicate hierarchy error in an educational environment. This methodology was viewed positively by learner teams, suggesting that psychological safety was maintained. Teams that did not address the error successfully may have impaired self-assessment ability in the communication skill domain.

SAT0453 Why do we make diagnostic errors? A delphy exercise to identify potential causes of diagnostic errors

BackgroundDiagnostic errors in medical practice are neither rare nor minor. Diagnoses that are delayed, wrong or missed entirely result in 40,000 to 80,000 U.S. hospital deaths annually [1]. In USA,...

Let's do no harm: Medication errors in nursing: Part 1

In the current climate of global economic chaos and increasing healthcare litigation, it is perhaps simultaneously unsurprising and yet perplexing that patients continue to fall foul of healthcare systems worldwide. Major incidents in patient care such as serious misdiagnoses, medication errors, the proliferation of superbugs and malpractice persist leading to injury or death of patients, emotional trauma to their families and, understandably, a reduction in the public's confidence in the healthcare system not to mention the financial consequences. Many, if not most or indeed all, of these incidents are preventable and should not happen. Yet the systems in place within healthcare permit their occurrence, with worrying regularity, it would appear. The area that this paper will focus on specifically is that of medication errors. The worrying trends with regard to medication errors will be presented. Potential contributing factors will be examined. The specific aim of this paper is to illuminate the extent and severity of the problem of medication errors in practice and to explore elements within the practice setting that can compound the problem. The multi-faceted nature of the problem will also be considered.

The Patient Safety Perspective: Health Information and Resources Online and In Print

The Institute of Medicine's (IOM's) 1999 publication, To Err Is Human, marked the watershed period for patient safety. The Medical Library Association position statement on the “Role of Health Sciences Librarians in Patient Safety” clearly advocates for the necessity of involving and including librarians in the patient safety initiatives of all health care institutions. Holly Ann Burt's MLA BibKit, The Patient Safety Perspective: Health Information and Resources Online and In Print, is an invaluable and outstanding reference guide not only for medical librarians, but also for anyone interested in and/or involved in patient safety, including health professionals, patients and their families, researchers, and academics. All will be well served by this seemingly exhaustive work. As Burt states in her introduction, “This book grew out of the need for a single comprehensive collection of materials, links, agencies, and publications for everyone focused on improving the quality of our health care system” (p. 5). She aptly describes this superior work as providing “one-stop access to the rich diversity of patient safety information available online and in print. Individuals from all areas of health care will find vital information here” (p. 5). This work goes beyond expectations of a reference work on patient safety. Six chapters and six appendixes cover an amazing amount of useful and interesting information. Chapter 1, “Highlights in Patient Safety History: Noted Publications from Hippocrates to the Present that Have Shaped and Focused the Patient Safety Movement,” includes references from Hippocrates (400 BCE), to Florence Nightingale, to F. B. Gilbreth's “Motion Study in Surgery” (Can J Med Surg 1916;40:22–31), to current studies borne out of modern noteworthy errors in medical practice. Chapter 2, “Once Is Only the Beginning: Recommended Reading and Bibliographies,” lists “Books and articles of special interest to the patient safety community and how to find more” (p. 31). As Burt points out, “Keeping up on the literature can be a daunting task” ( p. 31), so she includes clearly defined letter-designations for each citation (e.g., “F” for freely available online and “P” helpful for patients). Also included in this meticulously written work are such designations as “Online but Unmaintained.” Included in chapter 2 are sections on the Quality Chasm Series, “Readings for Patients and Patient Advocates,” and “Libraries and Librarians Involved in Patient Safety.” Chapter 3, “Keep the Information Coming: Journals and Other Periodic Publications,” allows the reader to “stay abreast of news, events and opportunities in patient safety with journals, newsletters, blogs, webcasts, alerts, and email lists” (p. 63). Another fine example of the meticulous care that went into this publication is evidenced in such sections as “Discontinued—but Still Online.” Chapter 4, “Available Online: Links to Information and Media,” devotes nearly forty pages to online information with truly something for everyone, including a section, “Especially for Librarians.” Chapter 5, “Celebrating Leadership, Encouraging Research and Education,” offers vital but often overlooked sources of “award and recognition programs, campaigns, funding and conference opportunities, and educational options from free online tutorials to masters' degrees” (p. 123). Chapter 6, “Agencies, Boards and Coalitions: Organizations Working to Improve Healthcare,” includes much-needed “State and country lists of departments of health and patient safety-oriented organizations, plus where to find reporting, licensing, and accrediting agencies” (p. 145). Six outstanding appendixes include “Searching the Literature for Patient Safety,” where Burt includes detailed information on searching using PubMed/MEDLINE, Ovid MEDLINE, CINAHL, and EMBASE databases; “Health Literacy Highlights”; “Highlights in Evidence-Based Medicine”; “Personal Health Information Online”; “Patient Safety Timeline” (from 400 BCE to the present); and “Alphabet Soup: All Those Abbreviations,” with eleven pages of acronyms. As Burt observes in her introduction to Chapter 5, “If we are to solve the issues related to patient safety, we cannot work in isolated silos” (p. 123). This outstanding work is truly a necessity for all involved in patient safety, and ultimately that is each and every one of us, isn't it?

Analysis of Doctors' Errors in Medical Practice

The paper presents information on the studies of poor outcomes in medical practice and that from expert practice. Key words: poor outcome, iatrogenia, forensic medical examination.

Vivamos a la vista de todos

For many years attempts have been made to avoid and correct unprofessional behavior and errors in medical practice. The literature on what has been called professionalism is extensive, including narratives on the breaching of those values that guide the practice of medicine. Expectations for professional behaviour must be high, but there should also be an understanding of the failure to meet those expectations. The healing process should include the identification by the professional of the harm that he or she has done to others (accounting for your actions) and a genuine repentance which leads to the possibility of forgiveness - forgiveness, not in a religious sense - but in the social context of interaction between those who have caused harm and those who have been harmed.The challenge to academic institutions is to include in their curricula the development of attitudes and professional values.