Medication Safety Events Research Articles

Patients' Perceptions of Using Technology for Self-Reporting Cancer Medication Safety Events from Home.

Frequent transitions of care among patients with cancer increase their risks for medication safety events (MSEs). Patients and families need to become "vigilant partners" in MSE self-reporting when transitioning back home. However, limited evidence is available to guide patient and family engagement in preventing and managing MSEs. This study explored patients' perceptions of using technology for MSE self-reporting by interviewing 41 patients with breast, prostate, lung, or colorectal cancer. The findings revealed that patients with cancer perceived technology as convenient and easy to use to address urgent MSE concerns. However, the lack of access to technology and being unconfident in using technology can be barriers to using technology for MSE reporting. Personalized support is needed to facilitate patients' engagement in MSE self-reporting. Factors identified in the study will further support the user-centered design and development of technology systems that can support patients' needs and expectations for medication safety.

Oncology patients' willingness to report their medication safety concerns from home: a qualitative study.

Oncology patients often struggle to manage their medications and related adverse events during transitions of care. They are expected to take an active role in self-monitoring and timely reporting of their medication safety events or concerns to clinicians. The purpose of this study was to explore the factors influencing oncology patients' willingness to report adverse events or concerns related to their medication after their transitions back home. A qualitative interview study was conducted with adult patients with breast, prostate, lung, or colorectal cancer who experienced care transitions within the previous year. A semi-structured interview guide was developed to understand patients' perceptions of reporting mediation-related safety events or concerns from home. All interviews were conducted via phone calls, recorded, and transcribed for thematic data analysis. A total of 41 individuals participated in the interviews. Three main themes and six subthemes emerged, including patients' perceived relationship with clinicians (the quality of communication and trust in clinicians), perceived severity of adverse medication events (perceived severe vs. non-severe events), and patient activation in self-management (self-efficacy in self-management and engagement in monitoring health outcomes). The patient-clinician relationship significantly affects patients' reporting behaviors, which can potentially interact with other factors, including the severity of adverse events. It is important to engage oncology patients in medication safety self-reporting from home by enhancing health communication, understanding patients' perceptions of severe events, and promoting patient activation. By addressing these efforts, healthcare providers should adopt a more patient-centered approach to enhance the overall quality and safety of oncological care.

The Acceptance and Use of Digital Technologies for Self-Reporting Medication Safety Events After Care Transitions to Home in Patients With Cancer: Survey Study.

Actively engaging patients with cancer and their families in monitoring and reporting medication safety events during care transitions is indispensable for achieving optimal patient safety outcomes. However, existing patient self-reporting systems often cannot address patients' various experiences and concerns regarding medication safety over time. In addition, these systems are usually not designed for patients' just-in-time reporting. There is a significant knowledge gap in understanding the nature, scope, and causes of medication safety events after patients' transition back home because of a lack of patient engagement in self-monitoring and reporting of safety events. The challenges for patients with cancer in adopting digital technologies and engaging in self-reporting medication safety events during transitions of care have not been fully understood. We aim to assess oncology patients' perceptions of medication and communication safety during care transitions and their willingness to use digital technologies for self-reporting medication safety events and to identify factors associated with their technology acceptance. A cross-sectional survey study was conducted with adult patients with breast, prostate, lung, or colorectal cancer (N=204) who had experienced care transitions from hospitals or clinics to home in the past 1 year. Surveys were conducted via phone, the internet, or email between December 2021 and August 2022. Participants' perceptions of medication and communication safety and perceived usefulness, ease of use, attitude toward use, and intention to use a technology system to report their medication safety events from home were assessed as outcomes. Potential personal, clinical, and psychosocial factors were analyzed for their associations with participants' technology acceptance through bivariate correlation analyses and multiple logistic regressions. Participants reported strong perceptions of medication and communication safety, positively correlated with medication self-management ability and patient activation. Although most participants perceived a medication safety self-reporting system as useful (158/204, 77.5%) and easy to use (157/204, 77%), had a positive attitude toward use (162/204, 79.4%), and were willing to use such a system (129/204, 63.2%), their technology acceptance was associated with their activation levels (odds ratio [OR] 1.83, 95% CI 1.12-2.98), their perceptions of communication safety (OR 1.64, 95% CI 1.08-2.47), and whether they could receive feedback after self-reporting (OR 3.27, 95% CI 1.37-7.78). In general, oncology patients were willing to use digital technologies to report their medication events after care transitions back home because of their high concerns regarding medication safety. As informed and activated patients are more likely to have the knowledge and capability to initiate and engage in self-reporting, developing a patient-centered reporting system to empower patients and their families and facilitate safety health communications will help oncology patients in addressing their medication safety concerns, meeting their care needs, and holding promise to improve the quality of cancer care.

Medication Safety Events After Acute Myocardial Infarction Among Veterans Treated at VA Versus Non-VA Hospitals.

Fragmentation of health care across systems can contribute to mistakes in prescribing and filling medications among patients treated for myocardial infarction (MI). We sought to compare omissions, duplications, and delays in outpatient medications used for secondary prevention among veterans treated for MI at Veterans Affairs (VA) versus non-VA hospitals. We utilized national VA and Centers for Medicare and Medicaid Services data (2012-2018) to identify veterans 65 years or older hospitalized for MI and measured the use of outpatient medications for secondary prevention in the 30 days after MI among those treated at VA versus non-VA hospitals. A total of 118,456 veterans experiencing MI were included; of which 102,209 were hospitalized at non-VA hospitals. An omission in any medication class occurred more frequently among veterans treated at non-VA versus VA hospitals (82.8% vs 67.8%, P < 0.001). In multivariable modeling, the odds of omissions in any medication class were higher among those treated at non-VA versus VA hospitals (odds ratio: 3.04; 95% CI: 2.88-3.20). Duplications occurred more frequently in veterans treated at non-VA versus VA hospitals: 1.9% versus 1.6% had 1 or more for non-VA versus VA hospitals ( P < 0.001). Veterans treated at non-VA hospitals were more likely to have delays of 3 days or more in prescription fills after hospital discharge (88.4% vs 70.6% across all classes, P < 0.001). Omissions, duplications, and delays in outpatient prescribing of secondary prevention medications were more common among 118,456 veterans treated at non-VA versus VA hospitals for MI. Interventions aimed at improving care transitions and optimizing medication use among veterans treated at non-VA hospitals should be implemented.

Medication Safety Event Reporting: Factors That Contribute to Safety Events During Times of Organizational Stress.

Incident reports submitted during times of organizational stress may reveal unique insights. To understand the insights conveyed in hospital incident reports about how work system factors affected medication safety during a coronavirus disease-2019 (COVID-19) surge. We randomly selected 100 medication safety incident reports from an academic medical center (December 2020 to January 2021), identified near misses and errors, and classified contributing work system factors using the Human Factors Analysis and Classification System-Healthcare. Among 35 near misses/errors, incident reports described contributing factors (mean 1.3/report) involving skill-based errors (n = 20), communication (n = 8), and tools/technology (n = 4). Reporters linked 7 events to COVID-19. Skill-based errors were the most common contributing factors for medication safety events during a COVID-19 surge. Reporters rarely deemed events to be related to COVID-19, despite the tremendous strain of the surge on nurses. Future efforts to improve the utility of incident reports should emphasize the importance of describing work system factors.

Integration of Medication Safety Training and Development of a Culture of Safety in Pharmacy Education

Medication safety events with the potential for patient harm do occur in health care settings. Pharmacists are regularly tasked with utilizing their medication knowledge to optimize the medication use process and reduce the likelihood of error. To prepare for these responsibilities in professional practice, it is important to introduce patient safety principles during educational experiences. The Accreditation Council for Pharmacy Education (ACPE) and the American Society of Health-System Pharmacists (ASHP) have set forth accreditation standards focused on the management of medication use processes to ensure these competencies during pharmacy didactic learning and postgraduate training. The experience described here provides perspective on educational and experiential opportunities across the continuum of pharmacy education, with a focus on a relationship between a college of pharmacy and healthcare system. Various activities, including discussions, medication event reviews, audits, and continuous quality improvement efforts, have provided the experiences to achieve standards for these pharmacy learners. These activities support a culture of safety from early training.

Pharmacist-Led Mobile Health Intervention and Transplant Medication Safety: A Randomized Controlled Clinical Trial.

Medication safety events are predominant contributors to suboptimal graft outcomes in kidney transplant recipients. The goal of this study was to examine the efficacy of improving medication safety through a pharmacist-led, mobile health-based intervention. This was a 12-month, single-center, prospective, parallel, two-arm, single-blind, randomized controlled trial. Adult kidney recipients 6-36 months post-transplant were eligible. Participants randomized to intervention received supplemental clinical pharmacist-led medication therapy monitoring and management via a mobile health-based application, integrated with risk-guided televisits and home-based BP and glucose monitoring. The application provided an accurate medication regimen, timely reminders, and side effect surveys. Both the control and intervention arms received usual care, including serial laboratory monitoring and regular clinic visits. The coprimary outcomes were to assess the incidence and severity of medication errors and adverse events. In total, 136 kidney transplant recipients were included, 68 in each arm. The mean age was 51 years, 57% were male, and 64% were Black individuals. Participants receiving the intervention experienced a significant reduction in medication errors (61% reduction in the risk rate; incident risk ratio, 0.39; 95% confidence interval, 0.28 to 0.55; P<0.001) and a significantly lower incidence risk of Grade 3 or higher adverse events (incident risk ratio, 0.55, 95% confidence interval, 0.30 to 0.99; P=0.05). For the secondary outcome of hospitalizations, the intervention arm demonstrated significantly lower rates of hospitalizations (incident risk ratio, 0.46; 95% confidence interval, 0.27 to 0.77; P=0.005). We demonstrated a significant reduction in medication errors, adverse events, and hospitalizations using a pharmacist-led, mobile health-based intervention.

Pharmacist Transition-of-Care Services Improve Patient Satisfaction and Decrease Hospital Readmissions

Background: Pharmacists ability to directly impact patient satisfaction through increases in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys utilizing transitions-of-care (TOC) services is unclear. Methods: Retrospective analysis of TOC patients from 07/01/2018 to 03/31/2019 was conducted. Intervention (INV) patients received pharmacist medication reconciliation and education prior to discharge and post-discharge telephone follow-up. All other patients served as control group (CON). Primary outcome: Evaluate impact of TOC services on HCAHPS scores for “Communication about Medicines” and “Care Transitions.” Secondary outcomes: 30-day readmissions, quantification of prevented potential safety events, assessment of discharge prescriptions sent to the academic medical center outpatient pharmacy (MOP) for TOC patients. Results: Of 1,728 patients screened, 414 patients met inclusion criteria (INV = 414, CON = 1314). A significant improvement (14.7%; p = <0.0001) in overall medication-related HCAHPS results was seen when comparing pre- vs post-implementation of the TOC service. Statistically significant increases for individual questions “staff told you what the medicine was for” (14.2%; p = 0.018), “staff describe possible effects” (21.2%; p = 0.004), and “understood the purpose of taking medications” (11.4%; p = 0.035) were observed. A non-significant decrease in 30-day readmission rates for the groups was observed (CON 16.4%, INV 13.3%; p = 0.133); however, an unplanned subgroup analysis evaluating impact of discharge phone calls on 30-day readmission rates revealed a significant reduction of 17.3% to 12.4% (p = 0.007). One hundred forty-three medication safety event(s) were potentially prevented by the TOC pharmacist. Lastly, 562 prescriptions were captured at the MOP as a result of the TOC initiative. Conclusions: Pharmacy-based TOC models can improve patient satisfaction, prevent hospital readmissions, and generate revenue.

Best Paper Selection

Wang J, Liang H, Kang H, Gong Y. Understanding health information technology induced medication safety events by two conceptual frameworks. Appl Clin Inform 2019;10:158–67 https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0039-1678693 Lee JY, van Karnebeek CDM, Wasserman WW. Development and user evaluation of a rare disease gene prioritization workflow based on cognitive ergonomics. J Am Med Inform Assoc 2019;26(2):124–33 https://academic.oup.com/jamia/article/26/2/124/5235389 Patterson ES, Su G, Sarkar U. Reducing delays to diagnosis in ambulatory care settings: A macrocognition perspective. Appl Ergon 2020 Jan;82:102965 https://www.sciencedirect.com/science/article/pii/S0003687019301826?via%3Dihub

Second victim syndrome and the pharmacy learner

This commentary describes the concept of second victim syndrome and its application to pharmacy learners and preceptors. Although there is published literature regarding implementation of second victim syndrome programs at an institutional level, there is limited guidance regarding the second victim syndrome in the context of a pharmacy training environment; however, there are known risk factors such as medication safety events, failure to rescue events, or overall lack of experience of a clinician. With a growing awareness of the mental health concerns of health care providers, this is a potential area for growth and skill development for pharmacists of all levels. As pharmacy leaders and role models, we have a fundamental ethical responsibility to take care of our learners, particularly when it comes to emotionally challenging patient care scenarios. By giving a name to what our learners may be experiencing, the second victim syndrome, we can progress toward improving the well-being of these learners and increase their ability to be effective pharmacists. Involvement with medication safety events or patients with negative outcomes has been shown to have adverse professional outcomes, and this article describes steps that can be taken by preceptors and peers to help facilitate professional growth and recovery. Second victim is an underappreciated phenomenon that can have a profound impact on pharmacists’ well-being. Strategies for proactive recognition and intervention are vital.

Reducing Medication Error Through a Collaborative Committee Structure: An Effort to Implement Change in a Community-Based Health System.

This article describes a methodology for implementation and sustainment of continuous quality improvement initiatives through committee structures aimed at reducing medication error rates. A committee structure was developed in a collaborative effort to analyze and reduce medication error rates. Interdisciplinary teams comprised of frontline staff met regularly to identify and resolve trending medication safety events and prepare and deliver education for staff. Continuous quality improvement initiatives supported by these committees included technical handling and administration of medication, medication reconciliation, and enhancements to standardized treatment protocols. Data were collected through a voluntary electronic safety event reporting system between March 2013 and March 2016, to evaluate the rate of medication errors and near-misses. A retrospective analysis of reported medication errors and near-misses was conducted. The medication error rate significantly declined over the study period as the rate of near-misses conversely increased. Initiatives supported by the oversight of collaborative committees were successful in decreasing medication error rates.

Improving Transplant Medication Safety Through a Technology and Pharmacist Intervention (ISTEP): Protocol for a Cluster Randomized Controlled Trial.

BackgroundMedication errors, adverse drug events, and nonadherence lead to increased health care utilization and increased risk of adverse clinical outcomes, including graft loss, in solid organ transplant recipients. Veterans living with organ transplants represent a population that is at substantial risk for medication safety events and fragmented care coordination issues. To improve medication safety and long-term clinical outcomes in veteran transplant patients, interventions should address interorganizational system failures and provider-level and patient-level factors.ObjectiveThis study aims to measure the clinical and economic effectiveness of a pharmacist-led, technology-enabled intervention, compared with usual care, in veteran organ transplant recipients.MethodsThis is a 24-month prospective, parallel-arm, cluster-randomized, controlled multicenter study. The pharmacist-led intervention uses an innovative dashboard system to improve medication safety and health outcomes, compared with usual posttransplant care. Pharmacists at 10 study sites will be consented into this study before undergoing randomization, and 5 sites will then be randomized to each study arm. Approximately, 1600 veteran transplant patients will be included in the assessment of the primary outcome across the 10 sites.ResultsThis study is ongoing. Institutional review board approval was received in October 2018 and the study opened in March 2019. To date there are no findings from this study, as the delivery of the intervention is scheduled to occur over a 24-month period. The first results are expected to be submitted for publication in August 2021.ConclusionsWith this report, we describe the study design, methods, and outcome measures that will be used in this ongoing clinical trial. Successful completion of the Improving Transplant Medication Safety through a Technology and Pharmacist Intervention study will provide empirical evidence of the effectiveness of a feasible and scalable technology-enabled intervention on improving medication safety and costs.Clinical TrialClinicalTrials.gov NCT03860818; https://clinicaltrials.gov/ct2/show/NCT03860818International Registered Report Identifier (IRRID)PRR1-10.2196/13821

Understanding Health Information Technology Induced Medication Safety Events by Two Conceptual Frameworks.

While health information technology (health IT) is able to prevent medication errors in many ways, it may also potentially introduce new paths to errors. To understand the impact of health IT induced medication errors, this study aims to conduct a retrospective analysis of medication safety reports. From the U.S. Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience database, we identified reports in which health IT is a contributing factor to medication errors. We applied two conceptual frameworks, Sittig and Singh's sociotechnical model and Coiera's information value chain, to examine the identified reports. We identified 152 unique reports on health IT induced medication errors as the final report set for review. The majority (65.13%) of the reports involved multiple contributing factors according to the sociotechnical model. Three dimensions, that is, clinical content, human-computer interface, and people, were involved in more reports than the others. The transition of the effects of health IT on medication practice was summarized using information value chain. Health IT related contributing factors may lead to receiving wrong information, missing information, receiving partial information and delayed information, and receiving wrong information and missing information tend to cause the commission errors in decision-making. The two frameworks provide an opportunity to understand a comprehensive context of safety event and the impact of health IT induced errors on medication safety. The sociotechnical model helps identify the aspects causing medication safety issues. The information value chain helps uncover the effect of the health IT induced medication errors on health care process and patient outcomes.

Quality improvement interventions to reduce chemotherapy dose-modification ordering errors at a large academic medical center.

264 Background: Despite clear advantages of Electronic Health Records (EHR) systems for safe cancer chemotherapy administration, persistent opportunities exist to further reduce chemotherapy order errors. Unintended dose escalation orders of previously dose reduced chemotherapy were the most commonly reported “near-miss” medication safety events at our institution. This can lead to potential patient harm, delays in care, decreased patient satisfaction, reduced infusion room efficiency, and increased care team workload and decreased satisfaction. We sought to reduce chemotherapy order errors using interventions developed with process improvement techniques. Methods: Unintended dose escalation errors per month (the primary outcome measure) were identified through the hospital safety reporting system and by monitoring the EHR (EPIC) chemotherapy administration reports to identify dose escalations. All cases were confirmed with primary chart review. The pre-intervention baseline assessment period was 6/2017-11/2017, and the post intervention period was 12/2017-5/2018. Two interventions were selected: 1) Revision of the nursing chemotherapy checklist posted on all infusion room workstations for use prior to releasing chemotherapy orders; and 2) educating ordering providers and nurses about new EHR functionality to display prior and future chemotherapy orders. Statistical Process Control chart analysis was conducted with upper (UCL) and lower (LCL) control limits of 3 standard deviations. The primary aim was to reduce the number of chemotherapy errors by 50% in the post-intervention period. Results: The pre-intervention period averaged 3.83 chemotherapy ordering errors per month (UCL = 9.71, LCL = 0). The post-intervention period significantly reduced the average errors per month to 1.33 (UCL = 4.97, LCL = 0). The copy/forward feature in multi-day cycles was the most common source of unintended dose escalations. Conclusions: Implementation of the 2 interventions resulted in a 65% reduction of unintended dose modification errors. Based on successful results and positive staff feedback, we plan to roll out these interventions at additional satellite facilities.

A text mining analysis of medication quality related event reports from community pharmacies.

Medication errors are estimated to cost $42 billion in annual global treatment costs. Pharmacy-based Patient Safety Organizations (PSO) are tasked with collecting and analyzing incidents, near misses, and unsafe condition reports as one way of engaging pharmacies in quality improvement efforts. Collectively, these reports are referred to as quality related events (QREs). Large-scale analysis of typed narratives from QRE reports across organizations has been a missing component of quality improvement programs. To identify topics within the components of a proposed medication safety event framework contained in the free-text narrative of QRE reports. A retrospective, observational analysis of data from a PSOs voluntary reporting system, from January 1, 2011 to December 31, 2014. The dataset contained structured and unstructured data elements. A structural topic model extracted themes from the free-text narrative component of the report. These topics were assigned a human label and mapped onto constructs of the medication safety event framework. A total of 531,555 QREs were analyzed from 1660 pharmacies. 90.6% were near miss and unsafe condition reports. There were 40 topics generated. There were 29 topics identified as QRE types, 3 were identified as contributing factors, and 5 were related to signals/alerts that an incident or near miss had occurred. One topic each was identified as a recovery step and a quality improvement strategy. One topic was not assigned a human label. Examples of topics labeled included incorrect tapering directions, needing to double-check work, and attention-related contributing factor. The free-text narrative provided novel information compared to the structured fields of the reports. Topics were mapped onto a proposed medication safety event framework to advance knowledge of medication QREs and identify ways to improve medication safety in community pharmacy. Future work may focus on communicating these topics to the pharmacies to improve medication safety efforts.

Providing diabetes services on-site: Bridging the gap between the HMO and employer in a medically underserved area

Medication errors are estimated to cost $42 billion in annual global treatment costs. Pharmacy-based Patient Safety Organizations (PSO) are tasked with collecting and analyzing incidents, near misses, and unsafe condition reports as one way of engaging pharmacies in quality improvement efforts. Collectively, these reports are referred to as quality related events (QREs). Large-scale analysis of typed narratives from QRE reports across organizations has been a missing component of quality improvement programs.To identify topics within the components of a proposed medication safety event framework contained in the free-text narrative of QRE reports.A retrospective, observational analysis of data from a PSOs voluntary reporting system, from January 1, 2011 to December 31, 2014. The dataset contained structured and unstructured data elements. A structural topic model extracted themes from the free-text narrative component of the report. These topics were assigned a human label and mapped onto constructs of the medication safety event framework.A total of 531,555 QREs were analyzed from 1660 pharmacies. 90.6% were near miss and unsafe condition reports. There were 40 topics generated. There were 29 topics identified as QRE types, 3 were identified as contributing factors, and 5 were related to signals/alerts that an incident or near miss had occurred. One topic each was identified as a recovery step and a quality improvement strategy. One topic was not assigned a human label. Examples of topics labeled included incorrect tapering directions, needing to double-check work, and attention-related contributing factor.The free-text narrative provided novel information compared to the structured fields of the reports. Topics were mapped onto a proposed medication safety event framework to advance knowledge of medication QREs and identify ways to improve medication safety in community pharmacy. Future work may focus on communicating these topics to the pharmacies to improve medication safety efforts.

A health technology network approach to quality improvement – Optimizing E-prescribing

Medication errors are estimated to cost $42 billion in annual global treatment costs. Pharmacy-based Patient Safety Organizations (PSO) are tasked with collecting and analyzing incidents, near misses, and unsafe condition reports as one way of engaging pharmacies in quality improvement efforts. Collectively, these reports are referred to as quality related events (QREs). Large-scale analysis of typed narratives from QRE reports across organizations has been a missing component of quality improvement programs.To identify topics within the components of a proposed medication safety event framework contained in the free-text narrative of QRE reports.A retrospective, observational analysis of data from a PSOs voluntary reporting system, from January 1, 2011 to December 31, 2014. The dataset contained structured and unstructured data elements. A structural topic model extracted themes from the free-text narrative component of the report. These topics were assigned a human label and mapped onto constructs of the medication safety event framework.A total of 531,555 QREs were analyzed from 1660 pharmacies. 90.6% were near miss and unsafe condition reports. There were 40 topics generated. There were 29 topics identified as QRE types, 3 were identified as contributing factors, and 5 were related to signals/alerts that an incident or near miss had occurred. One topic each was identified as a recovery step and a quality improvement strategy. One topic was not assigned a human label. Examples of topics labeled included incorrect tapering directions, needing to double-check work, and attention-related contributing factor.The free-text narrative provided novel information compared to the structured fields of the reports. Topics were mapped onto a proposed medication safety event framework to advance knowledge of medication QREs and identify ways to improve medication safety in community pharmacy. Future work may focus on communicating these topics to the pharmacies to improve medication safety efforts.

The new Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry: design, rationale, and characteristics of patients enrolled in the first 12\xa0months

BackgroundHerein we describe the history, design, and rationale of the new Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry and present the characteristics of patients with juvenile idiopathic arthritis (JIA) enrolled in the first 12 months of operation.MethodsThe CARRA Registry began prospectively collecting data in the United States and Canada in July 2015 to evaluate the safety of therapeutic agents in persons with childhood-onset rheumatic disease, initially restricted to JIA. Secondary objectives include the evaluation of disease outcomes and their associations with medication use and other factors. Data are collected every 6 months and include clinical assessments, detailed medication use, patient-reported outcomes, and safety events. Follow-up is planned for at least 10 years for each participant and is facilitated by a telephone call center.ResultsAs of July 2016, 1192 patients with JIA were enrolled in the CARRA Registry at 49 clinical sites. At enrollment, their median age was 12.4 years old and median disease duration was 2.6 years. Owing to preferential enrollment, patients with systemic JIA (13%) and with a polyarticular course (75%) were over-represented compared to patients in typical clinical practice. Approximately 49% were currently using biologic agents and ever use of oral glucocorticoids was common (47%). The CARRA Registry provides safety surveillance data to pharmaceutical companies to satisfy their regulatory requirements, and several independently-funded sub-studies that use the Registry infrastructure are underway.ConclusionThe new CARRA Registry successfully enrolled nearly 1200 participants with JIA in the first 12 months of its operation. Sustainable funding has been secured from multiple sources. The CARRA Registry may serve as a model for the study of other uncommon diseases.

EHR-related medication errors in two ICUs.

The objective of this study was to describe the frequency, potential harm, and nature of electronic health record (EHR)-related medication errors in intensive care units (ICUs). Using a secondary data analysis of a large database of medication safety events collected in a study on EHR technology in ICUs, we assessed the EHR relatedness of a total of 1622 potential preventable adverse drug events (ADEs) identified in a sample of 624 patients in 2 ICUs of a medical center. Thirty-four percent of the medication events were found to be EHR related. The EHR-related medication events had greater potential for more serious patient harm and occurred more frequently at the ordering stage as compared to non-EHR-related events. Examples of EHR-related events included orders with omitted information and duplicate orders. The list of EHR-related medication errors can be used by health care delivery organizations to monitor implementation and use of the technology and its impact on patient safety. Health information technology (IT) vendors can use the list to examine whether their technology can mitigate or reduce EHR-related medication errors.

Evaluation of Insulin Delivery Strategies for Bronson Health Group

Purpose: The Institute for Safe Medication Practices has published numerous safety alerts in regards to institutional insulin pen use focused on the misuse of insulin pens and subsequent transmission of infections. Other institutions may use floor-stock insulin; however, The Joint Commission has provided recent guidance against using multiuse vials on multiple patients. The purpose of this study is to evaluate Bronson Healthcare Group’s different methods of insulin administration to determine a cost-effective strategy while meeting regulatory requirements. Secondary endpoints will evaluate safety and nursing preference of different types of insulin delivery. Methods: Retrospective data was collected in the form of medication safety event forms, insulin purchasing records, hospital-wide insulin usage reports, number of patient-days reports, and a nursing survey. Insulin use, purchasing data, and safety event reports were collected from August 2013 to August 2014 from Bronson Methodist Hospital and Bronson Battle Creek Hospital. The nursing survey was distributed to inpatient Bronson facilities from January 22 to February 5, 2015. Aggregate data was collected and analyzed via Microsoft Excel. Descriptive statistics were used to evaluate the primary outcome. Chi squared and t-tests were used for secondary outcomes as appropriate. Results: By switching to short-acting insulin administered from 3 mL single-patient insulin lispro vials and pharmacy-drawn long-acting insulin detemir the hospital system could potentially save approximately $22,000 a year. Data did not support there being a safer method of insulin delivery. Nursing preference data indicated that nurses prefer delivery methods with which they are more familiar. Conclusion: In combination with recommended best safety practices as reported by multiple nationally recognized safety organizations, we can conclude that the most cost-effective methods of insulin delivery for the Bronson Health System would be pharmacy technician drawn single doses of long acting insulin detemir and single patient 3 mL vials of insulin lispro.