Medication Error Management Research Articles

Pediatric emergency department management benefits from appropriate early redirection of nonurgent visits.

Overcrowding at pediatric emergency departments (EDs) may result in delayed clinical management and higher risks of medical error. This study was designed to prospectively evaluate what parents of sick children seek emergency care for and how these patients are being assessed and managed. Patients aged 0 to 17 years seeking ED care at an urban Swedish university hospital, from 8 AM to 9 PM on 25 consecutive days, were included. Clinical urgency and further level of medical care were determined by experienced nurses based on individual clinical signs and vital parameters. Information on presenting problem, medical priority, gender, age, waiting time, day of week, time of day, and further management was recorded. Among 1057 included children, two thirds were assessed by physicians, whereas one third were referred directly by nurses for other ED (n = 54) or primary care (n = 114), or sent home with medical advice (n = 176), more often during evenings and weekends. Of primarily referred patients, 7.6% returned within 72 hours, and three of them were admitted. Young infants, patients with respiratory or neurological problems, and sicker patients with fever or infections were mainly assessed by physicians, within desired priority time. More than one fourth of pediatric ED patients might rapidly, appropriately, and safely be referred for primary care or sent home by experienced pediatric nurses soon after arrival, thereby facilitating management of urgent and more appropriate patients. Evaluations by physicians were primarily required in young infants and for urgent medical conditions demanding qualified pediatric skills.

Driven to distraction: a prospective controlled study of a simulated ward round experience to improve patient safety teaching for medical students

BackgroundDistraction and interruption are endemic in the clinical environment and contribute to error. This study assesses whether simulation-based training with targeted feedback can improve undergraduate management of distractions and interruptions...

Factor analysis of nursing students' perception of patient safety education

The aim of this study is to investigate the factor structure of the Health Care Professionals Patient Safety Assessment Curriculum Survey (HPPSACS) when completed by a group of nursing students from one University in the UK. The quality, content and delivery of nursing education can have a significant impact on the future students' safety behaviours in clinical settings. The Health Care Professionals Patient Safety Assessment Curriculum Survey HPPSACS has been developed in the US to establish undergraduate nursing students' perceived awareness, skills, and attitudes toward patient safety education. The instrument has not been reported to be used elsewhere; therefore, some psychometric properties remain untested. Pre-registration nursing students (n=272) from three campuses of a university in East of England completed the HPPSACS in 2012. Principal component analysis was conducted to explore the factors emerging from the students' responses. 222 students (82%) returned the questionnaires. Constraining data to a 4-factor solution explained 52% of the variance. Factors identified were: "Willingness to disclose errors", "Recognition and management of medical errors", "The Perceived interprofessional context of patient safety" and "The perceived support and understanding for improving patient safety". The overall Cronbach's alpha was 0.64, indicating moderate internal consistency of the instrument. Some demographical and descriptive questions on the HPPSACS instrument were modified to accommodate the participants' educational context. However, all items in the HPPSACS which were included in the factor analysis remain identical to the original tool. The study offers empirical findings of how patient safety education is contextualised in the undergraduate, pre-registration nursing curriculum. Further research is required to refine and improve the overall reliability of the Health Care Professionals Patient Safety Assessment Curriculum Survey (HPPSACS' instrument).

Role of Transformational-leadership in the Relationship between Medication Error Management Climate and Error Reporting Intention of Nurse

Purpose: The objective of this study was to identify the moderating and mediating effects of transformational-leadership in the relationship between medication error management climate and error reporting intention. Methods: Participants in this study were 118 nurses from 11 hospitals in Korea. The scales of medication error management climate, transformational-leadership and error reporting intention of nurses were used in this study. Descriptive statistics, t-test, ANOVA, partial Pearson correlation coefficient, and stepwise multiple regression were used for data analysis. Results: Higher transformational leadership group members had higher error management climate (t=3.88~4.64, p<.001) and higher intention to error reporting (t=2.49, p=.014). There were significant positive correlations between subcategories of medication error management climate and transformational leadership (r=.37~.51, p<.001). But error reporting intention was related to the transformational leadership (r=.28 p=.002), two subcategories such as 'learn from error' (r=.26, p=.004) and 'medication error competence' (r=.25, p=.008) of medication error management climate. Transformational-leadership was a moderator and a mediator between medication error management climate and error reporting intention. Conclusion: Based on the results of this study, transformational-leadership promotion training program to construct medication error management climate and to improve error reporting intention should be needed.

약물계산 오류예방을 위한 간호사의 역량과 투약안전과 관련된 병원조직풍토간의 정준상관관계

Purpose: The purpose of this study was to investigate the relationship between drug dosage calculation error prevention competence and medication safety organizational climate. Methods: We surveyed 207 nurses from 15 hospitals. An assessment survey was designed to assess the medication safety organizational climate which consisted of four subcategories including medication safety cultures, medication safety initiatives, medication error communication, and medication error management competence. The drug dosage calculation error prevention competence contains two subcategories; Dosage calculation habits and ability. The data were collected from July to August 2011. Descriptive statistics, t-test, ANOVA, partial Pearson correlation coefficient, canonical correlation were used. Results: Organizational climate was related to dosage calculation error prevention competence with two significant canonical variables. The first canonical correlation coefficient was .53 (Wilks' λ=0.71, df=8, p<.001) and that of the second was .21 (Wilks' λ=0.96, df=3, p = .027). The first variate indicated higher perception of medication safety cultures, safety initiatives, error communication and error management competence were related to better dosage calculation habits. The second variate showed higher perception of medication safety cultures and lower medication error management competence were related to higher calculation ability. Conclusion: Continuous supporting strategies for medication safety organizational climate should be implemented to improve drug dosage calculation habits.

Fehlermanagement: Kulturwandel für mehr Patientensicherheit

From the investigations by Mr. Scheidegger (nestor of medical error management for over 20 years) it is known that in the past patient safety has not received sufficient attention during a treatment process even though it had been known for many years that more than 10% of patients will suffer an adverse event during hospitalization. If one realizes how many patients receive inpatient and outpatient treatment in Germany alone it becomes evident how relevant this problem is and what enormous costs (extended hospital stay, continued morbidity, reduced productivity, liability etc.) result for the healthcare system and for society. The critical incident reporting system (CIRS) would enable physicians to reduce the error rate and in particular the sometimes tragic consequences for patients.

Medical error disclosure: the gap between attitude and practice

BackgroundThis study aims to evaluate the attending surgeons' and residents' attitudes towards error disclosure and factors that can potentially affect these tendencies in major academic hospitals affiliated with Tehran University...

Patient safety management in the medication use process: prevention and management of medication error

Medication errors, resulting in risks to patient safety, occur throughout the entire medication use process, and include prescribing errors, dispensing errors, administering errors, and patient compliance errors. The results of many reports and studies on medication errors in several countries including the United States show that medication errors occur commonly, are costly and are often preventable. Medication errors involve a breakdown in more than one aspect of the medication use system such as lack of knowledge, standard performance and mental lapses, and defects or failure in the organizational system. Such medication errors compromise patient confidence in the healthcare system and increase healthcare costs. Hospitals must take a medication error prevention approach and also prepare various methods of managing medication errors once they have occurred. The necessity of a medication error reporting system should be emphasized. In Korea, with regard to medication errors, we have a long way to go. We have no documented data available on error rates, no published studies, and no error reporting system. In conclusion, medication errors are no longer a guarded, guilty-ridden professional secret in Korea. They should be considered problems in public healthcare policy. Therefore, we need to establish a medication error prevention and management system at the national level including a national error reporting system in the near future.

Medication Error Management Climate and Perception for System Use according to Construction of Medication Error Prevention System

The purpose of this cross-sectional study was to examine current status of IT-based medication error prevention system construction and the relationships among system construction, medication error management climate and perception for system use. The participants were 124 patient safety chief managers working for 124 hospitals with over 300 beds in Korea. The characteristics of the participants, construction status and perception of systems (electric pharmacopoeia, electric drug dosage calculation system, computer-based patient safety reporting and bar-code system) and medication error management climate were measured in this study. The data were collected between June and August 2011. Descriptive statistics, partial Pearson correlation and MANCOVA were used for data analysis. Electric pharmacopoeia were constructed in 67.7% of participating hospitals, computer-based patient safety reporting systems were constructed in 50.8%, electric drug dosage calculation systems were in use in 32.3%. Bar-code systems showed up the lowest construction rate at 16.1% of Korean hospitals. Higher rates of construction of IT-based medication error prevention systems resulted in greater safety and a more positive error management climate prevailed. The supportive strategies for improving perception for use of IT-based systems would add to system construction, and positive error management climate would be more easily promoted.

Medication error management around the globe: An overview

Medical mistakes that include medication errors have raised concerns about medication safety. Due to high consumption of medicines and self-treatment by all, especially the aging population, the issue of proper medication use and safety is at the forefront of public health concerns globally. Each country has a different approach towards medication event monitoring that is compliant with its own health care system. This paper focuses on the efforts and endeavors of some of the countries around the world to create an efficient error reporting systems to ensure public safety. Our analysis indicates that there are established and effective medication vigilance systems in many developed countries. The different countries undertake activities which range from collecting information about prescriptions, surveying physicians about adverse drug events, and conducting sophisticated post-marketing surveillance studies. There is still need for such sophisticated system in India; however recent promising developments are occurring towards building a medication vigilance system. Development of these systems may eventually contribute to a global medication vigilance system, which could reduce concern with medication errors and safety.

Information management of medical errors in Greece: The MERIS proposal

There is a substantial amount of public concern about patient safety, as, according to estimates from major studies, hundreds of thousands die in hospitals each year all over the developed world as a result of medical errors that could have been prevented. Unprecedented research commissioned by the EU has found that almost one out of every four families has experienced a serious medical error. Greek citizens concerning about serious medical errors in the hospital environment, were at the top of the list. Greek Ombudsman's report on medical errors has raised the debate among health policy makers as to the appropriate response to the problem. Proposals range from the implementation of nationwide mandatory reporting with public release of performance data, to voluntary reporting and quality-assurance efforts that protect the confidentiality of error-related data. Any successful safety program will first require a national effort to make significant investments in information systems, along with providing an environment and education that enables to contribute to an active quality improvement process. In this paper we propose the development and implementation of Medical Error Reporting Information System ( MERIS), in order to identify, collect, analyse and report medical errors and patient adverse events, as a tool for enhancing patient safety and health care quality. We also describe the necessary organisational structure and the infrastructure environment of the system and the barriers to its successful implementation.

Nova Scotia spearheads unique research into quality improvement and medication error management

Nova Scotia spearheads unique research into quality improvement and medication error management

A novel interactive program for medical error management and disclosure

A novel interactive program for medical error management and disclosure

Medical Professional Liability Insurance and its Relation to Medical Error and Healthcare Risk Management for the Practicing Physician

Medical Professional Liability Insurance and its Relation to Medical Error and Healthcare Risk Management for the Practicing Physician

Workflow modeling in critical care: Piecing together your own puzzle

The intensive care unit (ICU) is an instance of a very dynamic health care setting where critically ill patients are being managed. To provide good care, an extensive and coordinated communication amongst the role players, use of numerous information systems and operation of devices for monitoring and treatment purposes are required. The purpose of this research is to study error evolution and management within this environment. The focus is on representing the workflow of critical care environment, which emphasizes the importance such a representation may play in strategizing the management of medical errors. We used ethnographic observation and interview data to build individual pieces of the workflow, dependent on the individual and the activity concerned. Key personnel were intensively followed during their respective patient care activities and the related actions. All interactions were recorded for analysis. These clinicians and nurses were interviewed to complement the observation data and to delineate their individual workflows. These pieces of the ICU workflow were used to develop a generalize-able cognitive model to represent the intricate workflow applicable to other health care settings. The proposed model can be used to identify and characterize medical errors and for error prediction in practice.

Medical Professional Liability Insurance and its Relation to Medical Error and Healthcare Risk Management for the Practicing Physician

To review the history and current issues surrounding medical professional liability insurance and its relationship to medical error and healthcare risk management. Focused literature review and authors' experience. Medical professional liability insurance issues are reviewed in association with the occurrence of medical error and the role of healthcare risk management. The rising frequency and severity of claims and lawsuits incurred by physicians, as well as escalating defense costs, have dramatically increased over the past several years and have resulted in accelerated efforts to reduce medical errors and control practice risk for physicians. Medical error reduction and improved patient outcomes are closely linked to the goals of the medical risk manager by reducing exposure to adverse medical events. Management of professional liability risk by the physician-led malpractice insurance company not only protects the economic viability of physicians, but also addresses patient safety concerns. Physician-owned malpractice liability insurance companies will continue to be the dominant providers of insurance for practicing physicians and will serve as the primary source for loss prevention and risk management services. To succeed in the marketplace, the emergence and importance of the risk manager and incorporation of risk management principles throughout the professional liability company has become crucial to the financial stability and success of the insurance company. The risk manager provides the necessary advice and support requested by physicians to minimize medical liability risk in their daily practice.

Pearls and Pitfalls in Patient Care: Need to Revive Traditional Clinical Values

Medicine has achieved phenomenal progress in recent years, yet there is ample evidence of dysfunction, reflected in persistently high rates of misdiagnosis, frequent iatrogenic illness, the popularity of 'alternative' medicine, and rising healthcare costs. An urgent need for a change is indicated. True adherence to basic clinical and personal values may avoid significant pitfalls in patient care. These include the immense value of a really careful history and physical examination; the wealth of information that can be obtained through patient's families, physicians, past records, and a search of electronic databases for the best evidence; restraint in management decisions; making the most of simple preventive measures and effective nonpharmacological interventions; appropriate "bed-to-door" intervals; a more personal care of the patient as a unique person, paying more attention to emotional factors that affect medical illness; constructive management of medical errors; and humility. The great potential of the many recent advances in medicine may be more fully realized if we accept that new capabilities should complement, not replace, old values and skills, which still make the essential foundation for medical decision making and patient care.

Gone But Not Forgotten: The Search for the Lost Surgical Specimens: Application of Quality Improvement Techniques in Reducing Medical Error

A lost surgical specimen prompted an investigation of both the human processes and the systemic factors involved in surgical specimen handling regarding how health care organizations approach medical error prevention and patient safety promotion. Quality improvement techniques and the conceptual error model of James Reasons were employed to understand the interaction between the local process of specimen handling and the systemic influences to medical error management. Error management recognizes the inevitability of both individual and systemic error. Through the use of quality improvement techniques and models of error analysis, health care organizations can investigate the error potential of health care delivery and address the human and organizational interaction necessary to improve patient safety and manage medical error.

Gone but not forgotten: the search for the lost surgical specimens: application of quality improvement techniques in reducing medical error.

A lost surgical specimen prompted an investigation of both the human processes and the systemic factors involved in surgical specimen handling regarding how health care organizations approach medical error prevention and patient safety promotion. Quality improvement techniques and the conceptual error model of James Reasons were employed to understand the interaction between the local process of specimen handling and the systemic influences to medical error management. Error management recognizes the inevitability of both individual and systemic error. Through the use of quality improvement techniques and models of error analysis, health care organizations can investigate the error potential of health care delivery and address the human and organizational interaction necessary to improve patient safety and manage medical error.

Accreditation's role in reducing medical errors.

Accreditation's role in reducing medical errors.