Likelihood Of Medication Errors Research Articles

Replace government healthcare with patient-controlled health care

The purpose of the article is to analyse the shortcomings of the state-run healthcare systems and to substantiate the need for and feasibility of transition to a patient-controlled model. It is shown that patient-controlled health care, free from centralised domination, can provide timely, high-quality, compassionate medical care at an affordable price for both individuals and the nation. It significantly expands the patient’s rights and opportunities to choose a doctor according to their own preferences and financial capabilities. The patient pays for the medical service provided directly to the doctor, who no longer has restrictions on choice of treatment protocols or prescription of medicines. The analysis in the article is based mainly on the example of the United States, where federal control for residents is both direct (194 million Americans are covered by Medicaid, Medicare, Tricare or EMTALA) and indirect (138 Americans have private insurance). In addition, aspects of the article analysis also apply to single-payer countries (Canada, the United Kingdom, France and Spain). The article examines the shortcomings of the current US model of its healthcare system in terms of its compliance with the Constitution. It is noted that, according to the Tenth Amendment to the US Constitution, healthcare powers are not among the 18 powers delegated to the federal government. Also, non-compliance with the law is also observed: government control or administration of state Medicaid programmes is contrary to US law; medical autonomy as the patient’s ability to make personal medical decisions without undue influence from the state. Another disadvantage of state-run healthcare system is that state-controlled healthcare payment structure violates the fiduciary relationship between doctor and patient, as doctors’ authority to make medical decisions is limited. It also calls into question the observance in the United States of the citizen’s “right” to receive medical care in its interpretation as a personal service of a professional caregiver when a patient can demand the desired care and the service provider cannot refuse. The article emphasises that state-run healthcare systems create a conflict between efficient use of financial resources and effective provision of medical care. This issue is considered through the prism of the interests of the main stakeholders: shareholders of companies operating in this area, politicians, patients, healthcare providers and administrators. As evidence of the inefficiency of the existing US healthcare system in comparison with other countries, comparative data for different countries on life expectancy and incidence rates of a number of diseases are provided. The author also discusses the problem of limiting access to medical care (rationing) for patients with public health insurance due to a shortage of healthcare professionals accepting new Medicaid patients. This is caused by low reimbursement rates, overly bureaucratic verification procedures for obtaining payment, overregulation of requirements for doctor-patient relations and procedures for reviewing medical errors, the need to comply with population-based clinical algorithms, etc. It leads to a decrease in the quality of medical care, an increase in patient deaths while waiting for medical care, the risk of disease complications due to delays in diagnosis and timely treatment, ignoring the needs of unique, individual patients, and an increase in the likelihood of medical errors. All of the above disadvantages of state-run healthcare are obviated when the patient is in charge, patient-controlled health care.

Medication errors by caregivers in the homes of children discharged from a pediatric department in Ghana.

Medication errors (MEs) by caregivers at home are a cause of morbidity and mortality, shortly after discharge from the hospital. The objective of this study was to determine the rate and types of MEs at the homes of children discharged from a hospital in Ghana and to explore the factors associated with these errors. This was a cross-sectional study of infants and children discharged from the hospital to review medication administration practices. Caregivers of children discharged from the hospital after at least 24 hours of admission were interviewed at their homes about medication administration practices. The study assessed potential harm associated with MEs made by caregivers using the Harm Associated with Medication Error Classification tool. The Least Absolute Shrinkage and Selection Operator regression were used to identify the variables associated with MEs. A total of 95 children (mean age: 28.6 months, 52.6% female) and their caregivers were included. Overall, 65 (68.4%) children experienced one or more MEs. Out of a total of 232 medications reviewed, 102 (44.0%) (95% CI: 37.6-50.4) were associated with a ME. The top two errors, wrong time errors and errors in the frequency of dosing were, 45.1% and 21.6%, respectively. Understanding the information on the disease condition being treated and the medicines dispensed was associated with committing fewer MEs. The number of medicines prescribed was associated with a higher likelihood of MEs. Out of 102 MEs, 48 (47.1%) were assessed as posing potentially no harm, 26 (25.5%) minor harm, 15 (14.7%) moderate harm, and 13 (12.8%) serious harm to the patients. Importantly, none of the MEs were assessed as posing potentially severe or life-threatening harm to the patients. MEs in children following discharge are high, and systems should be developed to prevent these errors.

The Impact of Resident Duty Hour Reform on Family Medicine Residency Training: Residents' Points of View

<p>目的：本研究探討家庭醫學科住院醫師自2019年適用勞動基準法規定後，對工時規範之滿意度、健康影響、學習成效、醫療品質與病人安全層面進行調查，並進一步比較不同訓練職級、不同醫院訓練容額、與不同醫院層級住院醫師在工時規定影響看法上的差異。</p> <p>方法：以2017至2019訓練年度進入家庭醫學專科醫師訓練計畫的住院醫師為對象，以問卷調查工時限制所造成的影響。結果：共有286位家庭醫學住院醫師參與研究，其中有近九成滿意目前工時限制規定，且普遍認為工時限制不會降低訓練品質。其中第一年住院醫師超時的比例較高，較資深住院醫師同意工時規定會減少教學指導與學習體驗的比例較高，但多數還是認為並不影響教學品質。超過半數第一年住院醫師認為醫療錯誤發生率會降低，資深住院醫師則多認為不變。雖然所有醫院層級的住院醫師都認為工作時疲勞情況與嗜睡程度有所改善，但地區與區域級醫院仍有少部分住院醫師認為工作時疲勞及嗜睡程度更明顯。</p> <p>結論：實施工時限制後，大部分家庭醫學科住院醫師滿意目前工時限制規定，認為工時限制不會降低訓練品質，也不需要延長受訓年限。學員普遍認為對於工時限制對住院醫師的身心健康有正向影響，對於病人受到的醫療品質與病人安全則不受影響。</p> <p> </p><p>Objective: The study assessed family medicine residents’ overall satisfaction with the resident duty hour restriction implemented in 2019 and explored their perceptions of the impacts of the restriction on their well-being, education, and patient safety. The study further compared the differences in residents’ perceptions based on the level of residency training, size of residency training program, and level of training hospital.</p> <p>Methods: Residents admitted to the family medicine residency training program by the Taiwan Association of Family Medicine from 2017 to 2019 were selected to participate in this study. A prospective anonymous questionnaire survey was administered to family medicine residents nationwide to gather their opinions and suggestions regarding the newly implemented resident duty hour reform.</p> <p>Results: A total of 286 family medicine residents responded to the questionnaire survey. Nearly 90% of the residents were satisfied with the current duty hour regulations and found the restriction unlikely to compromise the quality of residency training. First-year residents reported a greater frequency of working overtime, compared to residents of other levels. The more senior the residents, the stronger the belief that duty hour restriction reduced time for learning and faculty guidance; however, the majority of the responding residents were of the opinion that the restriction did not affect the overall quality of residence training. Over 50% of the first-year residents felt the restriction helped reduced the likelihood of medical error, while more senior residents found the likelihood unchanged. Regardless of the levels of their training hospitals, a great part of the residents found the problems of fatigue and daytime sleepiness alleviated, yet there was still a minority of residents in regional and district hospitals felt the problems aggravated.</p> <p>Conclusion: After the implementation of duty hour restriction, most family medicine residents are satisfied with the current regulations and feel no significant impact of the restriction on the quality of residency training. In their opinion, there is no need to extend the length of residency training. The duty hour reform does exert positive influences on their physical and mental health and bring about no impact on patients’ safety and quality of care.</p> <p> </p>

Investigating The Effect of of Pharmacist Educational Intervention on the Proper Use of Insulin Pen in Older Patients with Type 2 Diabetes Mellitus in Primary Health Care and Diabetic Centres in Makkah Al-Mukarramah, Saudi Arabia

Objective: Diabetes mellitus (DM) is one of the fastest-growing health problems in the world, which is nowreaching an epidemic proportion in some countries. There were around 3,852,000 cases of diabetes in SaudiArabia in 2017. Geriatric patients are at particularly high risk, especially those who lack the knowledge ofself-care to control their blood glucose levels. When reviewing the literature, we did not find any focus oneducational interventions to reduce the errors related to the use of an insulin pen. Therefore, it is essential toconduct research to measure these outcomes and apply the applicable intervention if needed. Aim: The aimof this study was to evaluate the impact of pharmacist-conducted educational intervention on reducing theerrors related to inappropriate insulin pen use. Methods: A multicentred, prospective, before-and-after studywith an educational intervention component was carried out. The study was conducted on (n = 1500) elderlytype 2 diabetic patients. Results: The patients’ mean age was approximately 65.2 ± 3.5 years old with a maleto female ratio of 60:40. Around 95.5% of patients stated that they had received instructions for insulin penuse from their physicians. The average duration of their diabetes was approximately 15 ± 2.8 years. Aftergiving complete instructions to the patients, we found an improvement in insulin pen use by approximately30 %, and a significant decrease in the rate of errors. Conclusion: Pharmacists can play an important role inthe safety and efficiency of the use of insulin pens in elderly diabetic patients by decreasing the likelihoodof medication errors associated with them.

Factors determining the effectiveness of nursing work

The requirements towards nursing professional activities are increasingly rising. The quality of the activities is expected to improve and expand constantly. Nursing is associated with high levels of stress stemming from the specificity of the different professional roles. A study among 191 nurses working in surgical, therapeutic, intensive care units and children's hospital wards was conducted. The aim of the study was to identify factors affecting work efficiency of nurses. Daily nursing activities in hospital wards include implementation of highly intensive tasks. The data show that for a significant proportion of respondents their professional work is very intensive (59.00%), with increased physical (34.50%) and mental (55.80%) workload. Not a small proportion of nurses report being distracted at work. More than half have an alarming sense of omission at the end of the working day (54.70%). Almost half of nurses report frequent cases of headache (44.20%) and (57.70%) sleep disorders. Part of the respondents assess their mood as depressed. These specificities of the profession are a prerequisite for reduced work efficiency and likelihood of medical errors.

Reporting medication errors: residents with diabetes

Medication errors are common in health and social care settings. This article discusses nursing home residents with diabetes and how to lessen the likelihood of medication errors occurring during their treatment

Implementation of an Enteral Nutrition and Medication Administration System Utilizing Oral Syringes in the NICU

NICU patients are at particularly high risk of harm and even death from medical error. In one NICU, a process change was undertaken to minimize the risk of errors resulting in the intravenous (IV) administration of enteral formulas and oral medications. In addition, a double-check system for medication doses was introduced to reduce the likelihood of medication errors. The previous practice was to deliver enteral formulas via syringe pump using TV syringes and tubing and to dispense medications in bulk bottles, drawing up patient-specific doses at the bedside. Converting to oral syringe delivery of medications and enteral formulas utilizing enteral-only tubing eliminated the necessity for Luer-Lok IV tubing and syringes, thereby reducing the potential for wrong-route error. Converting from dispensing medications in bulk to a unit-dose system permitted establishment of a double-check system in which doses are first checked by a pharmacist and then checked by the nurse before they are administered. This article describes the planning, implementation, and postimplementation process required to make this change in practice a success.

Agreement between pediatric medication orders and medication cardex.

This study examined the individual and temporal factors that explain whether the medication cardex agrees with a physician's pediatric medication order. After controlling for several potentially confounding factors, it was found that, among other things, pediatric intensive care unit cardexes were 62% less likely to agree with the physician order than cardexes from other units. Cardexes for "stat" orders were twice as likely to agree with the physician order. These data support the possibility that "low-tech" changes in the process of providing care can improve the likelihood that the medication order will agree with the cardex and, as a result, reduce the likelihood of medication errors.

Impairment of anesthesia task performance by laser protection goggles.

This study was designed to determine whether the wearing of colored goggles, commonly used during laser surgery, increased the time needed to perform simple tasks or the likelihood of medication errors. The Stromberg Dexterity Test and the Medication Sorting Task (MST), a test of our own design, were used to measure the speed and accuracy of identifying medications. Thirty anesthesia care providers performed the tests twice, once with colored goggles and once without. Ambient light during the test was controlled to approximate that in the operating room during laser surgery. Times required to complete the tests improved with repetition of the test. When colored goggles were worn, more time was needed to complete the tests. More errors, especially serious errors in medication sorting, occurred when goggles were worn than when they were not. The wearing of colored goggles in combination with low levels of illumination and stress due to time constraints, may increase the potential for medication errors.