Medication Error Rates Research Articles

A stepped wedge randomised controlled trial assessing the efficacy and patient acceptability of virtual clinical pharmacy in rural and remote Australian hospitals

BackgroundDespite medication being the most common healthcare intervention and medication-related incidents being common in hospitals, many rural and remote hospitals in Australia lack onsite pharmacy services due to resource constraints. A Virtual Clinical Pharmacy Service (VCPS) staffed by two senior, rural generalist hospital pharmacists assigned to four hospitals each was implemented in rural and remote facilities to determine whether the VCPS increased adherence to National Safety and Quality Health Service Standards (NSQHS).MethodsA stepped-wedge randomised controlled trial was employed to sequentially implement a telehealth pharmacy service at one-month intervals in eight hospitals. The primary outcomes were patient-level medication reconciliation completion rates on admission and discharge. Secondary measures evaluated compliance with other NSQHS standards (including Best Possible Medication History, Medication Reconciliation and venous thromboembolism risk assessment), patient outcomes (including representation within 48 h, readmission within 28 days and length of stay), and detection of potential medication-related harms (including pharmacist identified medication related problems, reported medication errors and falls). Patients were invited to complete a patient-reported experience questionnaire. Data were collected from electronic medical records and analysed using mixed logistic regression models to estimate the effectiveness of the VCPS. Antimicrobial usage, falls, and medication errors were analysed at the facility level, while other data were analysed at the patient level.ResultsCompared to control (n = 535), patients in the intervention period (n = 527) were more likely to have an admission medication reconciliation completed (Odds Ratio (OR) 11.16, 95% confidence interval (CI) 5.59–22.30, p < 0.001) in models adjusted for the study period. A similar improvement was observed for discharge medication reconciliation completion (OR 4.07, CI 2.38–6.95, p < 0.001), whereas a 33-fold improvement was seen in Best Possible Medication History completion (OR 33.27, CI 17.53–63.14, p < 0.001). The VCPS documented 879 medication related problems, with 61% of patients having at least one medication-related problem documented by a pharmacist. There was no change in length of stay, falls, readmission rates or reported medication error rates; however, the study was not powered to detect these changes. Patient feedback was positive and comparable to in-person care, with 95% (179/189) reporting their overall experience as ‘good’ or ‘very good.’ No unintended harms were reported.ConclusionsThe VCPS improved compliance with national standards for medication safety, had high patient acceptability and resulted in the detection of clinically relevant medication-related issues in rural and remote settings. The applicability of virtual pharmacy should be explored in further rural and remote locations in addition to other settings such as metropolitan locations with no onsite clinical pharmacists.Ethics numberGWHREC 2019/ETH13355.Trial registrationANZCTR registration number ACTRN12619001757101. Registered on 11/12/2019. Published trial protocol: A stepped wedge trial of efficacy and scalability of a virtual clinical pharmacy service (VCPS) in rural and remote NSW health facilities.

Determination of Nurses' Knowledge toward Medication used in Critical Care Units

Background: The critical care unit is one of the important units in the hospital that receives critical and dangerous cases. There are medications used in these units, including shock medications. The nurse must have enough knowledge about these medications to reduce the rate of medication error and prevent harm that occurs to patients. Aims: to determine nurses' knowledge of drugs used in critical care units and to find the relationship between nurses' knowledge and their demographic data. Methods: A quantitative descriptive study was carried out in Critical Care Units affiliated with Al-Furat Al-Awsat Hospital, Al-Hakim General Hospital, and Al-Saddr Teaching Hospital in Al-Najaf City/Al-Najaf Al-Ashraf Health Directorate. A non-probability (convenience) sample of 77 nurses was obtained from the above settings, regardless of their characteristics. The study began from December 10th, 2022 to April 1st, 2023. Data were collected through a special questionnaire prepared to collect the data which was divided into two parts. The validity of the questionnaire was acquired by examination of (13) experts in different fields, and correlation was utilized as a statistical approach to evaluate the reliability of the study questionnaire. Data were analyzed using descriptive and inferential statistics. Results: The general assessment of the nurses' knowledge regarding drug in intensive care units was fail with an average score of less than (1.50), as the scores were unsatisfactory concerning medication administration. Conclusion: A study concluded that a nurse's knowledge about the medications used in intensive care units was Low, less than (1.50) overall.

Clinical Decision Support as a Prevention Tool for Medication Errors in the Operating Room: A Retrospective Cross-Sectional Study.

Medication errors in the operating room have high potential for patient harm. While electronic clinical decision support (CDS) software has been effective in preventing medication errors in many nonoperating room patient care areas, it is not yet widely used in operating rooms. The purpose of this study was to determine the percentage of self-reported intraoperative medication errors that could be prevented by CDS algorithms. In this retrospective cross-sectional study, we obtained safety reports involving medication errors documented by anesthesia clinicians between August 2020 and August 2022 at a 1046-bed tertiary care academic medical center. Reviewers classified each medication error by its stage in the medication use process, error type, presence of an adverse medication event, and its associated severity and preventability by CDS. Informational gaps were corroborated by retrospective chart review and disagreements between reviewers were resolved by consensus. The primary outcome was the percentage of errors that were preventable by CDS. Secondary outcomes were preventability by CDS stratified by medication error type and severity. We received 127 safety reports involving 80 medication errors, and 76/80 (95%) of the errors were classified as preventable by CDS. Certain error types were more likely to be preventable by CDS than others ( P < .001). The most likely error types to be preventable by CDS were wrong medication (N = 36, 100% rated as preventable), wrong dose (N = 30, 100% rated as preventable), and documentation errors (N = 3, 100% rated as preventable). The least likely error type to be preventable by CDS was inadvertent bolus (N = 3, none rated as preventable). Ninety-five percent of self-reported medication errors in the operating room were classified as preventable by CDS. Future research should include a randomized controlled trial to assess medication error rates and types with and without the use of CDS.

Incidence and type of voluntary reported perianesthetic medication errors in community veterinary clinics in Calgary, Canada.

To collect medication error (ME) data during the perianesthetic period from small animal clinics. 6 small animal general practice veterinary clinics. Small animal general practice veterinary clinics were recruited in this prospective observational study, with staff given a presentation on medical errors and instructed on how to submit medication error reports to an online reporting system. Errors were classified according to type and timing. A total of 2,728 general anesthesia or sedation procedures were performed, with 49 ME reports submitted. One duplicated report of the same error was excluded, resulting in a ME rate of 1.8%. Most reports (69% [33/48]) were near misses. The remaining 31% were MEs that reached the patient but did not cause harm. Wrong dose errors were the most common type (63% [30/48]), of which 80% (24/30) were calculation errors. Premedication/sedation and maintenance were the most reported stages, at 47% (20/43) and 23% (10/43), respectively. None of the MEs reported resulted in an adverse event, with an approximately 2:1 ratio of near-miss to no-harm MEs. The observed patterns of MEs reported, including type and timing, represent a target for further education. These results quantify the ME rate in general practice veterinary clinics, providing an initial benchmark for MEs during the perianesthetic period.

Medication Errors as a Marker of Resident Competency.

Introduction Educators continue to evaluate ways to assess resident performance in conjunction with the Accreditation Council for Graduate Medical Education (ACGME) general surgery milestones. We investigated whether the rate of medication errors could reflect general surgery resident competency. We hypothesized that the identification of increased medication errors made by general surgery residents could be a potential screening tool to identify residents who are academically at risk prior to their formal biannual milestone evaluation by the clinical competency committee. Methods This is a retrospective cohort study comparing rates of medication ordering errors against ACGME core competency scoresover four years in a general surgery residency program at an academic, university-affiliated, level 1 trauma center in the Northeastern United States. Results We identified 95 general surgery residents who inputted 1,164,663 medication orders during the four years studied. There were 1,214 (0.1%) errors identified. Of those, 1,146 (94.4%) were level 3 errors, and 68 (5.6%) were level 4 errors. This represents an error rate of 1.04 errors per 1,000 medication orders. There was a statistically significant decrease in the error rate as the post-graduate year (PGY) level increased (p=0.005). However, there was no correlation between the error rate and individual ACGME milestone competency scores by PGY level. Conclusions We explored whether medication errors may be an early measurement of worsening resident performance as demonstrated by a decrease in ACGME core competency scores. However, the rate of errors did not correlate consistently with these measures. This may underscore that medication errors measure an aspect of resident performance that we do not capture with our current assessments.

Simulated medication administration for vulnerable populations using scanning technology: a quasi-experimental pilot study

BackgroundMedication errors may occur due to shortcuts and pressures on time and resources on nurses. Nursing students are enculturated into these environments where their perceptions of norms around reporting and responding to medication errors are formative, yet simulated medication administration experiences are rarely reflective of the real-world environment. such as the standard use of medication scanning technology. The purpose of the present study is to test a pilot intervention, Medication Quick Response (QR) code scanning, and evaluate its effect on medication errors during simulation when compared to traditional simulation medication administration practices and to assess the students’ perceptions of the intervention.MethodsWe conducted a quasi-experimental, observational study involving Junior and Senior (3rd and 4th year) undergraduate, pre-licensure nursing students from Spring 2022 until Fall 2023. Seven simulations were conducted in pediatric and obstetric courses. The intervention group used non-patented, low cost QR scanning during medication administration. The control group used standard manual administration. Medication errors were measured based on the quantity, type of error, and degree of patient risk. A Qualtrics survey was used to assess the students’ perceptions of the intervention following simulation participation.ResultsA total of 166 students participated in the study. In each course, 7 groups were assigned to the intervention and 8 were assigned to the control. More than half of the groups made at least one medication error (n = 17), one-third of groups (n = 10) made a high-risk medication error. There was no statistically meaningful difference in the rate, type, or potential patient risk of medication errors between the intervention and control groups. The majority of participants (n = 53) felt that QR scanning more closely mimicked medication administration in clinical settings. Half of the participants responded that it improved their safety practices (n = 37).ConclusionsThe results of this pilot study indicate that while there is a high risk for error among pre-licensure nursing students, the use of QR scanning did not increase the risk of medication errors. The next study iteration will build upon these pilot findings to integrate the use of embedded medication errors, time management tasks, and a multi-site implementation.

Pharmacist review of discharge antibiotics for urinary tract infections in the emergency department

AbstractEmergency medicine (EM) pharmacists provide high‐quality patient care in a fast‐paced environment by optimizing pharmacotherapy regimens and reducing medication errors. Current literature demonstrates higher rates of medication errors with antibiotics compared with other medication classes. The aim of this quality improvement (QI) project was to reduce medication errors by 25% from baseline for antibiotic discharge prescriptions for urinary tract infections (UTIs). This QI initiative utilized the Institute for Healthcare Improvement Model for Improvement to implement a UTI stewardship intervention and prospective pharmacist review of discharge prescriptions. Patients discharged from the adult ED with an electronic prescription for UTI treatment with select antibiotics were included. The primary outcome metric was the percent of medication errors, defined as a composite of appropriate antibiotic agent, dose, frequency, and treatment duration based on our local treatment algorithm. The balancing metric was time spent per order reviewed. Data over time were assessed using statistical process control charts. A total of 534 antibiotic prescriptions were reviewed from January 9, 2022 to May 31, 2023. The most common indication was cystitis (70%), followed by pyelonephritis (17.4%) and asymptomatic bacteriuria (12.5%). Composite error rate decreased from 64.2% to 5%. Duration of therapy was the most common baseline error and was reduced from 45.3% to 11.6%. Errors in agent, dose and frequency decreased from 19.7% to 3.5%, 10.3% to 0.8% and from 5.7% to 0%, respectively. The aim of this QI initiative was achieved through a series of interventions, including prospective review of discharge antibiotics for UTIs by EM pharmacists, which reduced medication errors. This project demonstrates EM pharmacists have a positive impact in optimization of antimicrobial therapy for the treatment of UTIs.

Medication error rates in Iranian hospitals: a meta-analysis

Background and aimMedication errors (MEs) in hospitals decrease patient satisfaction, increase hospital mortality, lower hospital productivity, and increase in the costs of the health system. This study was conducted to determine the rate of MEs in Iranian hospitals.MethodIn this meta-analysis, all published articles on ME rates in Iranian hospitals were identified from five databases and Google Scholar and assessed for quality. The heterogeneity of the studies was examined using the I2 index and a meta-regression model was used to evaluate the variables suspected of heterogeneity at the 0.05 significance level. Finally, 17 articles were eligible to be included in this study and were analyzed using the Comprehensive Meta‐Analysis (CMA) software.FindingsBased on the estimation of the random-effects model, the ME rate in Iranian hospitals was 10.9% (5.1%-21.7%; 95% CI). The highest rate was observed in Sanandaj in 2006 at 99.5% (92.6%-100.0%; 95% CI) and the lowest rate was observed in Kashan in 2019 at 0.2% (0.1%-0.3%; 95% CI). In addition, sample size and publication year were significantly correlated with ME rate (P < 0.05).ConclusionAccording to the results of this study; ME rate in Iran is relatvively high based on the synthesis of the research conducted in Iranian hospitals. In addition to being costly, MEs have negative consequences for patients. Thereofore, it is necessary to emphasize the voluntary nature of medication error reporting in health sytem of Iran.

Identifying and Reducing Insulin Errors in the Simulated Military Critical Care Air Transport Environment: A Human Factors Approach.

During high-fidelity simulations in the Critical Care Air Transport (CCAT) Advanced course, we identified a high frequency of insulin medication errors and sought strategies to reduce them using a human factors approach. Of 169 eligible CCAT simulations, 22 were randomly selected for retrospective audio-video review to establish a baseline frequency of insulin medication errors. Using the Human Factors Analysis Classification System, dosing errors, defined as a physician ordering an inappropriate dose, were categorized as decision-based; administration errors, defined as a clinician preparing and administering a dose different than ordered, were categorized as skill-based. Next, 3 a priori interventions were developed to decrease the frequency of insulin medication errors, and these were grouped into 2 study arms. Arm 1 included a didactic session reviewing a sliding-scale insulin (SSI) dosing protocol and a hands-on exercise requiring all CCAT teams to practice preparing 10 units of insulin including a 2-person check. Arm 2 contained arm 1 interventions and added an SSI cognitive aid available to students during simulation. Frequency and type of insulin medication errors were collected for both arms with 93 simulations for arm 1 (January-August 2021) and 139 for arm 2 (August 2021-July 2022). The frequency of decision-based and skill-based errors was compared across control and intervention arms. Baseline insulin medication error rates were as follows: decision-based error occurred in 6/22 (27.3%) simulations and skill-based error occurred in 6/22 (27.3%). Five of the 6 skill-based errors resulted in administration of a 10-fold higher dose than ordered. The post-intervention decision-based error rates were 9/93 (9.7%) and 23/139 (2.2%), respectively, for arms 1 and 2. Compared to baseline error rates, both arm 1 (P = .04) and arm 2 (P < .001) had a significantly lower rate of decision-based errors. Additionally, arm 2 had a significantly lower decision-based error rate compared to arm 1 (P = .015). For skill-based preparation errors, 1/93 (1.1%) occurred in arm 1 and 4/139 (2.9%) occurred in arm 2. Compared to baseline, this represents a significant decrease in skill-based error in both arm 1 (P < .001) and arm 2 (P < .001). There were no significant differences in skill-based error between arms 1 and 2. This study demonstrates the value of descriptive error analysis during high-fidelity simulation using audio-video review and effective risk mitigation using training and cognitive aids to reduce medication errors in CCAT. As demonstrated by post-intervention observations, a human factors approach successfully reduced decision-based error by using didactic training and cognitive aids and reduced skill-based error using hands-on training. We recommend the development of a Clinical Practice Guideline including an SSI protocol, guidelines for a 2-person check, and a cognitive aid for implementation with deployed CCAT teams. Furthermore, hands-on training for insulin preparation and administration should be incorporated into home station sustainment training to reduced medication errors in the operational environment.

Original Research: Addressing Nurse Burnout: The Relationship Between Burnout and Physical Activity.

During the COVID-19 pandemic, nurses have faced innumerable challenges, which have contributed to staggering increases in burnout rates. In the health care arena, burnout has been associated with the onset or exacerbation of physical illness, neglect of self-care, fatigue, decreased patient satisfaction, higher medication error rates, lack of nurse engagement, and increased nurse turnover. This cross-sectional study sought to determine whether a correlation exists between self-reported physical activity and nurses' perception of burnout in a sample of hospital RNs. The secondary aim was to determine whether a correlation exists between the level of perceived burnout and the number of medication errors or near misses. Participants were asked to provide demographic information, complete the Copenhagen Burnout Inventory (CBI) and the Godin Leisure-Time Exercise Questionnaire (GLTEQ), and self-report the number of medication errors or near misses they were involved in during the previous 12 months. Data were analyzed using Stata version 17 software. A total of 216 participants returned usable surveys. Regarding the relationship between burnout and physical activity levels, data analysis was performed for the 210 participants who completed both the CBI and the GLTEQ. Compared with the least physically active nurses, the most active nurses had significantly lower CBI scores, with 68.5% of those reporting low or no burnout also scoring 24 or more on the GLTEQ. The least physically active nurses had significantly higher CBI scores, with 47.6% of those reporting high burnout also scoring 13 or less on the GLTEQ. Moreover, 90% of the nurses with high burnout levels had directly cared for COVID-19 patients at some point between 2020 and 2022. Medical-surgical nurses experienced significantly higher levels of burnout compared with nurses working in other service areas. No significant relationship was found between the number of medication errors or near misses and burnout levels. This study found that the most physically active nurses reported lower levels of burnout, while the highest levels of burnout were found in the least active nurses. Although COVID-19 infection rates have eased, many nurses, particularly those who have cared for COVID-19 patients and those who work in medical-surgical environments, continue to experience burnout. Targeted programs to reduce work-related burnout, as well as organizational sponsorship of and unit-level support for such programs, are urgently needed. This study's findings suggest that promotion of physical activity may be an essential component to alleviating burnout.

Prevalence of Medications Errors and Factors of Harmful Errors in Neonates and Paediatrics at Tertiary and Paediatric Hospitals: A Multicenter Study

Medication errors (ME) are human mistakes that may occur during drug use, prescribing administration or monitoring. This study aimed to determine the Prevalence of MEs among pediatric patients receiving tertiary treatment in pediatric speciality hospitals and describe their patterns and causes. Three institutions participated in a multicenter retrospective analysis. Reports of all MEs involving paediatrics aged ≤13 years who were hospitalised or visited the Emergency Department or outpatient clinics were reviewed 1 January 2019 - 31 December 2019. The National Coordinating Council for Medication Error Reporting and Prevention classification was used to categorise MEs and to define PRME (category CI) and patient–harming MEs (category EI). A retrospective study was conducted with a total of 318 MEs reported, with an overall prevalence of 0.9 per 1,000 patients. The Prevalence was markedly lower in the CHT (0.35 / 1,000 patients) than in KAMC and KFSH&amp;RC (1.73 and 3.5). The highest rate of MEs was observed in admitted wards (14.69 / 1,000 patients). Most commonly, MEs occurred at the prescribing stage (81.1%), were caused by a physician (83.3%), and were discovered by the pharmacist (85.5%). Improper medication dosage (34.0%), frequency (14.2%), and duration (10.4%) were the three most common forms of MEs. Paediatric inpatient treatment has a significant frequency of MEs, accounting for 24% of hospitalisations. The ME may not get to the patient if independent double-check prescriptions, accurate medication reconciliation of new prescriptions against the previously prescribed, and improved medicine labelling and packaging techniques are used.

Optimizing the Use of Dose Error Reduction Software on Intravenous Infusion Pumps.

Intravenous infusions have the potential to cause significant harm in patients and are associated with a high rate of adverse drug events and medication errors. Infusion pumps with dose error reduction software (DERS) can be used to reduce errors by establishing safe infusion parameters. In 2019, a quality improvement project was initiated with the aim to increase DERS compliance from 46% to 75% at our specialty institution by October 1, 2022. An interdisciplinary group was tasked with improving compliance with DERS by identifying key drivers, including informed staff, engaged staff, and an accurate smart pump library. We used the Model for Improvement framework to guide this improvement project, and Plan-Do-Study-Act (PDSA) cycles were used to plan for interventions. PDSA cycles included drug library updates, education, and unit-level compliance reporting. Weekly average DERS compliance was monitored as the outcome measure, and weekly pump alerts per 100 infusions were monitored as a balancing measure; statistical process control charts were used to monitor measures from 2018 to 2022. Over the course of 25 months, 8 PDSA cycles resulted in 5 centerline improvements from a baseline mean of 46% to a final mean of 78%. Pump alerts per 100 infusions decreased from 15.9 to 6.4 with the first PDSA cycle and then continued to decrease to 3.9 with subsequent interventions. Although features like DERS can help ensure safe medication administration, continuous improvement efforts to increase DERS compliance without increasing alert burden are needed to ensure that benefits of this technology are optimized.

The effect of an extended-hours ED clinical pharmacy service on admission medication prescribing errors.

The aim of this study was to determine the effect of a 7-day extended-hours clinical pharmacy service in the ED on medication prescribing errors upon hospital admission and time to medication reconciliation. In this retrospective observational study, high-needs patients reviewed by ED pharmacists were compared against those not reviewed, to determine if the service was associated with reduction in admission medication errors. The primary outcome was the rate of medication errors. Errors were independently rated by two senior clinicians using a risk-probability matrix. Secondary outcomes included service's impact on time to best possible medication history (BPMH) and medication reconciliation. There were 242 patients who met the inclusion criteria: 105 intervention vs 137 control. In the intervention arm, 74 patients had at least 1 medication error compared with 113 in the control arm (total errors 206 vs 407). The error rate per 10 medications (interquartile range) was 1.4 (0, 2.9) in the intervention arm compared with 2.7 (1.2, 4.3) in the control arm (risk ratio 0.66 [95% confidence interval: 0.56-0.78]; P < 0.001). There were 33 moderate-risk and no high-risk errors (intervention), compared with 84 moderate-risk and 3 high-risk errors (control). Percent agreement was 98.98% (weighted kappa: 0.62). Time to BPMH and medication reconciliation were reduced from 40.5 and 45.0 h to 7.8 and 40.0 h, respectively. The 7-day extended-hours ED clinical pharmacy service was associated with a reduction in medication prescribing errors in high-needs patients and improved time to BPMH and medication reconciliation.

Enhancing Patient Safety Through Effective Interprofessional Communication: A Focus on Medication Error Prevention.

Medication errors significantly impact patient safety and healthcare costs. This study investigates the influence of interprofessional communication on medication error rates, with a focus on identifying actionable strategies to improve communication efficacy among healthcare professionals. Utilizing a quantitative approach, this research distributed a detailed online questionnaire to a broad cohort of healthcare workers in various settings within Saudi Arabia. The survey encompassed sections on demographics, the frequency and quality of interprofessional communication, perceived barriers and facilitators to effective communication, and personal experiences with medication errors. Statistical analysis was performed using SPSS to derive descriptive and inferential statistics, alongside thematic analysis for qualitative responses. The survey attracted 1165 respondents, predominantly aged 20-30 (68.58%) and female (65.49%). Pharmacists constituted the largest professional group (40.34%). We identified a notable positive correlation (r = 0.16) between high-quality interprofessional communication and employment in hospital environments or having 5-20 years of experience. In contrast, negative correlations were observed with employment in non-traditional healthcare settings (r = -0.19) and professionals with less than five years of experience (r = -0.13), indicating communication challenges. The analysis also highlighted a concerning frequency of prescription and dispensing errors, with 52.70% of participants reporting prescription errors as the most common issue encountered. Effective interprofessional communication is pivotal in mitigating medication errors within healthcare settings. The study illuminates specific areas for improvement, including the need for targeted communication training, particularly for less experienced professionals and those in non-traditional settings. Enhancing communication channels and fostering an environment conducive to open, interdisciplinary dialogue are essential steps towards advancing patient safety and reducing medication errors.

Telemedicine vs Telephone Consultations and Medication Prescribing Errors Among Referring Physicians

Critically ill children presenting to emergency departments (EDs) in non-children's hospitals are at high risk for experiencing medical errors, including medication errors. Video telemedicine consultations with pediatric specialists have the potential to reduce the risk of medication errors beyond the current standard of care, telephone consultations. To compare the rates of ED physician-related medication errors among critically ill children randomized to receive either video telemedicine or telephone consultations. This cluster randomized, unbalanced crossover trial was conducted at 15 community EDs in northern California between September 2014 and March 2018. Analyses were conducted from May 2022 to January 2023. Participants included acutely ill children younger than 15 years presenting to a participating ED. Participating EDs were randomized to use video telemedicine or telephone for consultations with pediatric critical care physicians according to 1 of 4 unbalanced (3 telemedicine to 1 telephone) crossover treatment assignment sequences. Pharmacists reviewed medical records to document physician-related medication errors using a previously validated instrument. Multilevel logistic regression analyses were performed to create models with the medication order as the unit of analysis and adjusting for age, the log-transformed Revised Pediatric Emergency Assessment Tool score, and hospital study period. A total of 696 patient encounters were included in the trial (mean [SD] age, 4.2 [4.6] years; median [IQR] age, 2.1 [0.5-2.1] years; 304 female [43.7%]), with 537 patient encounters (77.2%) assigned to video telemedicine and 159 patient encounters (22.8%) assigned to telephone. At least 1 physician-related medication error occurred for 87 patients (12.5%), including 20 of 159 patients (12.6%) in the telephone cohort and 67 of 537 patients (12.5%) in the telemedicine cohort. Of the 2414 medication orders, errors occurred in 124 cases (5.1%), including 26 of 513 orders (5.1%) in the telephone cohort and 98 of 1901 orders (5.2%) in the telemedicine cohort. In the multivariable analysis, the adjusted odds ratio of experiencing a medication error among those assigned to telemedicine was 0.86 (95% CI, 0.49-1.52; P = .61). This cluster randomized crossover trial found no statistically significant differences in physician-related medication errors between critically ill children assigned to receive telephone consultations vs video telemedicine consultations. ClinicalTrials.gov Identifier: NCT02877810.

A comprehensive study of prescribing, administering and drug handling medication errors in ten wards of a university hospital after implementation of electronic prescribing, clinical pharmacists or medication reconciliation.

Background and aim: Medication errors lead to preventable risks. Preventing strategies such as e-prescribing, clinical pharmacists and medication reconciliation have been implemented in recent years. However, information on long-term medication error rates in routine procedures is missing. Investigations: We aimed to identify predefined medication errors in ten wards of a university hospital where e-prescribing, clinical pharmacists and medication reconciliation have been partially implemented. Patient files were reviewed and routine processes were monitored for drug prescription errors (missing, unclear, outdated information), administration errors (wrong dispensed drugs) and drug handling errors (no light-, moisture-protection, wrong splitting, no separation of drugs, which ought to be taken by an empty stomach). Results: We analyzed 959 prescriptions with 933 solid peroral drugs for 182 patients (98 female, median age 66.5 years [Q25-Q75: 56-78 years]; the median number of drugs was 5 [Q25-Q75: 3-7]). The most frequent prescription error was a not specified drug form (91.1%). The most common administration error was a not adequately provided release dose formulation (72.7%). The lack of light protection for observed photosensitive drugs was the most frequent drug handling error (100%). We found a significantly higher amount of complete drug prescriptions with one of the implemented measurements e-prescribing, medication reconciliation and clinical pharmacists (Fisher's exact test two tailed, each p<0.001; CI 95%). Drug administration errors and drug handling errors were not significantly improved. Among the most frequently involved drug were drugs for acid-related disorders, immunosuppressant, and antineoplastic drugs. Conclusions: In the nearly 1,000 prescriptions and drugs analyzed, medication errors were still common. Various preventive strategies had been implemented in recent years, positively influencing the predefined errors rates.

Practices Used to Improve Patient Safety Culture Among Healthcare Professionals in a Tertiary Care Hospital.

A patient safety culture primarily refers to the values, beliefs, attitudes, and behaviors within a healthcare setup in a community that assists in prioritizing patient safety and encouraging the reporting of errors and near-misses in that facility. There is a direct impact of patient safety culture on how well patient safety and quality improvement programs work. The aim of this cross-sectional descriptive study was to investigate the practices to improve patient safety culture and adverse event reporting practices among healthcare professionals in a tertiary care hospital located in Mirpur Azad Jammu and Kashmir. In the non-probability convenience sampling of this cross-sectional study, Divisional Headquarters Teaching Hospital in Mirpur, Azad Kashmir used the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture Hospital Survey to collect data about the perceptions of healthcare professionals regarding patient safety culture within their hospital to assess the trends of patient safety culture by obtaining longitudinal data. A pre-validated questionnaire that has undergone a rigorous trial of testing to maximize the reliability and accuracy of the outcomes was distributed among clinical staff (healthcare professionals who interact with patients on a daily basis, such as nurses, doctors, pharmacists, and laboratory technicians) and administrative staff (medical superintendent, deputy medical superintendent, assistant medical superintendent, heads of departments). A total of 312 questionnaires were returned (response rate, 76%). The study found that the dimension "supervisor/manager expectation and action promoting safety" had the highest positive response rate (65.16%), and "nonpunitive response" had the lowest (27.4%). Higher scores in "nonpunitive response to error" were associated with lower rates of medication errors, pressure ulcers, and surgical site infections, and higher scores in "frequency of event reporting" were associated with lower rates of medication errors, pressure ulcers, falls, hospital-acquired infections, and urinary tract infections. We suggest that in order for hospital staff to continue providing excellent, clinically safe treatment, a well-structured hospital culture promoting patient safety is necessary. Moreover, further study is needed to determine strategies to improve patient safety expertise and awareness, and lower the frequency of adverse occurrences.

Effect of a closed-loop medication order executive system on safe medication administration at a tertiary hospital: a quasi-experimental study.

Closed-loop electronic medication management systems are effective measures for preventing medication errors (MEs). However, there is limited evidence supporting this, and few studies have evaluated the long-term effects of these systems on safe medication. To evaluate the long-term effects of implementing a closed-loop medication order executive system on the safe clinical use of medications. A quasi-experimental design. Data from 2017 to 2023 were extracted and retrospectively analyzed. The primary outcome indicator was the ME rate. Secondary outcome indicators were the accuracy of order verification and patient identification and the implementation rate of fresh medicine dispensing. The autoregressive integrated moving average (ARIMA) model in time-series analysis was used to evaluate the level and trend changes in ME rates using SPSS 25.0 before and after system implementation. Root cause analysis and descriptive statistics were used to assess changes in types, stages, and causes of ME rates. The independent samples t-test was used to analyze secondary outcomes. Overall, 295 MEs were reported with a mean of 0.26 ± 0.26 ME rates per month during 2017-2023. The ARIMA model showed a decrease in the average level of ME rates after system implementation, with no statistically significant decrease in the long term, and a significant drop in the ME rate in the short and medium term (p < 0.01). Nurses' administration accounted for more than 60% of errors post-implementation, and lack of communication was a prominent factor. The accuracy of order verification and patient identification and the implementation rate of fresh medicine dispensing all increased after implementation. Adopting a closed-loop executive system is beneficial for ensuring patient medication safety, but a single integrated system does not completely eliminate MEs. Optimizing system functionalities and applying structured handoff tools are recommended to meet clinical needs and enhance system usability.

Cost-effectiveness analysis of pharmaceutical care in adult critically ill patients: based on a prospective cohort study.

The medication regimen for critically ill patients is complex and dynamic, leading to a high incidence of drug-related problems. This study aimed to assess the effectiveness and economic efficiency of pharmaceutical care for these patients. In this prospective cohort study conducted in a tertiary hospital, adult patients were assigned either to a clinical pharmaceutical care group or a control group based on existing clinical grouping rules. Health outcomes and economic indicators were collected, followed by a cost-effectiveness analysis. The acceptance rate for clinical pharmacist interventions was 89.31%. The pharmaceutical care group exhibited significant reductions in the rate of medication errors (40.65% vs. 61.69%, P < 0.001) and adverse drug events (44.52% vs. 56.45%, P = 0.020). The usage rates for special-grade antibiotics (85.16% vs. 91.13%, P = 0.009) and proton pump inhibitors (77.42% vs. 88.71%, P = 0.002) were also lower in the pharmaceutical care group. Secondary outcomes did not show significant differences in total hospital stay (21days vs. 22days, P = 0.092). However, ICU stay was significantly shorter (9days vs. 11days, P = 0.003) in the pharmaceutical care group. Cost-effectiveness analysis demonstrated that each 1% reduction in adverse drug events associated with ICU pharmaceutical care saved $226.75 in ICU hospitalization costs and $203.42 in total ICU drug costs. A 1% reduction in the medication error rate saved $128.57 in ICU hospitalization costs and $115.34 in total ICU drug costs. Pharmaceutical care significantly reduces adverse drug events and medication errors, promotes rational use of medications, decreases the length of ICU stay, and lowers treatment costs in critically ill patients, establishing a definitive advantage in terms of cost-effectiveness.

Effect of in-hospital training on medical errors made by teams during neonatal resuscitation.

Neonatal resuscitation is one of the most critical and risky events that requires a high level of individual skill and team performance. To evaluate the effect of training of resuscitation teams on the frequency and type of medical errors (ME) that result from neonatal resuscitation. A prospective observational study was performed using a checklist to detect ME related to neonatal resuscitation. The rate of ME was 24.82%. There was a significant reduction in the percentage of errors from 17.28% in pre- pre-training phase to 7.54% in post post-training phase. Near miss MEs (98.77%) were significantly higher than adverse events. The active errors were significantly higher than latent errors, P <0.001, and decreased from 39.19% during pre-training to 19.64% in the post-training phase. The commission ME s were significantly higher than the omission, P <0.001. The latent errors percentage was 41.17% of the total errors and were not significantly reduced after training. Training sessions reduced ME that occurred during resuscitation, however careful distinguishing and recognizing the type of MEs is important to plan for further reduction of errors. Special attention to latent errors is imperative as it needs a specific approach rather than just training.