Reduce Drug Errors Research Articles

Claims of Medical Malpractice in the Age of Information Technology

"Introduction. Medical practice is almost constantly bending to new technologies, and in recent years, the health care system has been increasingly dominated by advances in information technology. Its use offers many advantages, but it also has its own risks. Material and method. The authors conducted a literature review to see to what extent the accessibility and effective use of information technology, i.e. electronic health records (EHR) influence risk of malpractice. Results. The literature refers both to how EHR use can prevent malpractice claims, and how it can increase their number. Thus, EHR can prevent medical errors and associated complaints by: instant access to complete patient information (including laboratory and imaging results); improving communication between medical team members; reducing drug errors (e.g. drug interactions, allergic reactions); prompt request for further investigations. However, the misuse of EHR can create new problems: inadequate training with errors from implementation and accommodation; automatic or unexpected deletion of the recommended medication; the temptation to use the information obtained previously and the circumvention of the stage of obtaining a new medical history or the temptation to copy and paste the information from the previous consultations to the current consultation - which will lead to the perpetuation of errors and omissions from the previous consultations; increased risk of privacy and confidentiality breach. Likewise, certain facilities that these systems allow may be ambivalent, and may both reduce or increase the risk of complaints, depending on how they are used: communication between doctor and patient through messages, including updating prescriptions and reporting symptoms that require prompt evaluation but at the same time, delay in response may dissatisfy the patient. Conclusions. The implementation of EHR brings many advantages, both for the patient and for the medical staff in terms of accessing information, facilitating communication and carrying out treatment plans, but the medical staff must be constantly aware of the risks involved, especially related to their proper use. "

P0528 / #493: REDUCING DRUG ERRORS IN THE PAEDIATRIC CRITICAL CARE UNIT: A QUALITY IMPROVEMENT PROJECT

Aims & Objectives: Drug errors cause considerable harm to patients. A recent spot-check on our Paediatric Critical Care Unit (PCCU) revealed a culture of under-reporting errors. By increasing the reporting of errors and implementing change following analysis of the type of errors that occurred, we aimed to reduce drug errors in the PCCU by 30% by February 2020. Methods: Using Quality Improvement (QI) methodology we created a driver diagram and process map using members of the multidisciplinary team to better understand the main areas where drug errors could occur. “Plan, Do, Study, Act” (PDSA) cycles were used to develop and improve the reporting tool, frequency and timing of use. Data collected on a weekly basis included: number of errors per active drug prescription; staffing acuity and monthly Datixes. Change ideas included: reintroduction of a prescribing zone and “Dual Prescribing” followed by PDSA cycles to evaluate them. Results: An increase in errors was initially noted, with an average of 1.1 errors per active prescription. By December 2019 this had decreased to an average of 0.28 errors per prescription. Feedback revealed that “Dual Prescribing” of all new prescriptions by the nurse in charge was too time consuming, but was tolerated by the bedside nurse for their individual patient. In times of busyness it was felt that this would be difficult. Conclusions: Reducing drug errors through the use of QI methodology is possible. Further testing and refining of the current change ideas should result in an improved system of prescribing within the PCCU.

Reducing drug errors by engaging student nurses in medication management simulation

The occurrence of drug errors in the NHS has been much discussed in the media. Nurses are in a position to prevent drug errors, as they are often involved in administering medication or advising patients. To enable nurses to do this they need to be able to begin safe medication practice early in their education. This can be achieved through performing safe medication management simulations in undergraduate nursing courses. By setting up a number of patient scenarios in a skills laboratory, student nurses can practise medication management skills that are realistic in an environment where it is safe to make mistakes in order to ensure patient safety at all times.

Medication management: Reducing drug errors, striving for safer practice

The issue of drug errors in the NHS has been highlighted recently in the mainstream press, and has shown that mistakes can, and occasionally do, happen. Yet nurses are in a unique position to prevent drug errors, as they are at the forefront of medication management. To do this, nurses need to understand the issues related to the administration of a drug, e.g. the five or six rights. Nuses should also be aware of drug errors that can occur before and after administration, i.e. considering the full medication journey, as a drug error can occur from naming, labelling, prescribing, transcribing, dispensing, preparing, failing to undertake a medication review and failing to monitor outcomes. This article considers drug errors and their causes, and draws on current literature to discuss some of the strategies nurses can use to prevent such errors from occurring. These strategies are not without their own problems and issues; nevertheless, a lot of information has been accrued about drug errors and it is time to start putting these together and take action by applying them to everyday medication management practice in order to ensure patient safety at all times.

Addressing Medication Errors Involving HIV-Positive Inpatients: Development of a Clinician’s Guide to Assessing Antiretroviral Therapy

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The 10 ‘R's of safe multidisciplinary drug administration

Nurses are responsible for medication administration, and, as with many other nursing interventions, some risk is involved. If an error occurs, a patient may suffer harm or injury, which may lead to a permanent disability or a fatality. To ensure safe drug administration, nurses are encouraged to follow the five rights (‘R's; patient, drug, route, time and dose) of medication administration to prevent errors in administration. The five ‘R's do not consider all causes of drug errors; instead, they focus on medication administration at the bedside so they relate only to this stage of a drug prescription. A drug's journey is more than what happens at the bedside; therefore, the reduction of errors requires more than just the five ‘R's. This article proposes a multi-professional, evidence-based approach to medicines management, which all clinicians can work towards, together. Clinicians can achieve this approach by considering the National Patients Safety Agency's definition of a medication error and the values set out by the National Prescribing Centre. The approach utilizes 10 ‘R's, which provide a benchmark for good practice. The 10 ‘Rs’ advocate the need for the knowledge of the causes of drug errors, how to implement strategies to reduce drug errors, how to ensure safe practice throughout the medication journey, from chemical preparation, to monitoring outcomes, to response.

Human Factors Approach in the Design of an Electronic Medication Management System for Preventing Inpatient Medication Errors

Background: In order to ensure quality and safety of prescriptions, electronic medication management system needs to comply with medication safety requirements and human factors principles. The design of such a system can make the difference on physician acceptance and consequently on medication safety. The aim of the study is to evaluate to what extent the changes in the design of the electronic medication management system may affect the rate of medication errors. Materials and method: In light of the growing development of computerized systems in health services it has become necessary to design electronic medication management system for drug prescription and administration compliant with the requirements of medication safety practices. Prescription data relative to 100 patients admitted to the Cardiothoracic Department of the Gabriele Monasterio Foundation Heart Hospital (FTGM) were extracted from the computerized medical notes from March 2013 until May 2013. The prescriptions examined had been written using the electronic documentation prompt without structured entry fields. All prescriptions were evaluated using the medication safety requirements of the medication safety practice developed by the Centre for Patient Safety of the Regional Department of Health in Tuscany, Italy. The same prescriptions were then simulated using the novel electronic medication management module and reassessed according to the safety requirements. Results: Of the 4112 prescriptions pertaining to the 100 study patients analyzed, 88.5% were found to be erroneous or incomplete. In particular 46.8% did not include the route of administration, 29.4% the pharmaceutical form, 10.6% the number of administrations per day and/or the time of administration, in 8.2% the dose was not defined and 4.9% did not include the active pharmaceutical agent or trade name. 14.9% were considered with high potential for harm. The same prescriptions simulated through the novel electronic module were 99.1% correct and complete. Conclusions: The ergonomic design of the module for electronic prescription meets the medication safety requirements and has a role in reducing drug errors and enhancing the safety of the workflow. The module introduced structured fields pertaining the type of drug being prescribed which were positively embodied in the routine and produced a significant reduction of prescription errors.

IMPLEMENTATION OF A SMALL, PORTABLE, OPIATE CONVERSION GUIDE FOR STAFF IN AN INDEPENDENT HOSPICE

BackgroundEffective and safe titration of medication has a major impact on patient comfort. Confusion surrounding the differing ranges and potencies of opiates and benzodiazepines can result in under- or overdosing...

Could pharmaceutical companies help reduce drug errors?

Could pharmaceutical companies help reduce drug errors?

Two-round Delphi technique for the consensual design of a paediatric pharmaceutical care model

The main goal of clinical pharmacists is to improve patient care quality by providing individualised care. This is achieved by validating prescriptions and performing pharmacotherapeutic follow-up, leading to effective, safe and efficient drug therapy. However, there is no specific model for medication order validation in paediatrics addressing the distinct issues of paediatric drug use or the greater susceptibility of medication errors occurring in this patient group. For this reason we intended to design and reach consensus on a paediatric pharmaceutical care model by applying a two-round Delphi technique. In order to define the levels of complexity in reaching consensus for the model, three variables were taken into account: level of access to patient medical and drug records (partial vs. total), access to medical and nursing staff attending the patient (on-site vs. off-site) and the pharmacist available time (limited vs. adequate). In order to describe the minimum items to be included in the validation process at each of the three levels of complexity, we analysed the safety profile in the medication order prescription previously defined in an epidemiological study in eight hospitals with a total capacity of 1565 paediatric beds. A panel of experts was recruited (50 experts from 20 different hospitals) and the questionnaire was completed. Consensus was established at 70% of agreement by experts for an item. Following debate on the items that did not obtain consensus, a second round was performed, after which the final consensus model was defined. After two rounds of consultation, consensus was obtained for 39 out of the 41 items that were surveyed. Of these, 17 were then used for the basic validation model (e.g. weight/age check, dose/weight check), 13 were implemented in the intermediate level (e.g. identification of adverse effects from excipients) and 9 were incorporated at advanced level (e.g. reconciliation at discharge for patients at risk). By applying the model, based on homogenous criteria for action, the clinical pharmacist's role will improve, and in turn, this will doubtlessly reduce drug errors through medication order validation.

A survey of standardised drug syringe label use in European anaesthesiology departments

Standardised drug syringe labelling may reduce drug errors, but data on drug syringe labelling use in European anaesthesiology departments are lacking. Survey investigating if standardised drug syringe labelling is used, and if there are geographical, demographic and professional differences in hospitals with and without use of drug syringe labelling. Structured, web-based anonymised questionnaire. European anaesthesia departments. Members of the European Society of Anaesthesiology. Online survey from 2 February to 12 April 2011. Standardised drug syringe labelling use and, if yes, drug syringe labelling for insulin and norepinephrine. Descriptive and comparative analyses of users and nonusers of standardised drug syringe labelling. One thousand and sixty-four of 4163 members (25.6%) from 72 countries participated, among whom 660 (62.0%) used standardised drug syringe labelling; in Northern and Western Europe, there were 428 users of drug syringe labelling and 112 nonusers, and in Southern and Eastern Europe, there were 184 users and 255 nonusers (P < 0.001). Three hundred and ninety-four (37%) respondents used standardised drug syringe labelling hospital-wide; 202 (30.1%) used International Organisation of Standardisation-based standardised drug syringe labelling, 101 (15.1%) used similar systems, 278 (41.5%) used other systems and 89 (13.3%) used labels supplied by drug manufacturers. The label colour for insulin was reported as white or 'none' in 519 (76.7%) answers and another colour in 158 (23.3%). The label colour for norepinephrine was reported as violet in 206 (30.4%) answers, white or 'none' in 226 (33.3%), red in 114 (16.8%) and another colour in 132 (19.5%). A standardised drug syringe labelling system supplied by the pharmaceutical industry was supported by 819 (76.9%) respondents, and not supported by 227 (21.3%). A majority of European anaesthesiology departments used standardised drug syringe labelling, with regional differences and mostly without following an international standard. Thus, there are options for quality improvement in drug syringe labelling.

Reducing Drug Errors in Neonatal Unit by Implementation of a Standardised Care Pathway Program

Background and aims: Drug errors cause significant morbidity, mortality and are associated with increased health care costs. Incorrect dosing is the most frequent prescribing error in the paediatric population. Introduction of Care Pathways standardises patient care and regular education updates may reduce errors. The incidence of drug-related errors in our neonatal unit (NICU) was higher. The aim of this observational study was to reduce drug-related errors by designing and implementing a Standardised Care Pathway. Methods: Standardised Care Pathway was implemented during 2007 and 2008 in our NICU. This included dedicated pharmacy teaching at induction for all new staff followed by monthly updates for all staff, developing a unit specific Neonatal Formulary and web-based drug dose calculator. Drug error data were collected from clinical incident reports (CIR) for 14 months before Care Pathway implementation (2005 to 2006) and for 24 months after implementation (2009 to 2010). Differences between the groups were analysed using parametric tests. Results: Before care pathway implementation there were 35 drug errors from 106 CIR compared to 20 drug errors from 176 CIR after care pathway implementation (c2 test p < 0.001, Fisher's exact test p < 0.001); Odds Ratio 0.34 (95% CI 0.19 to 0.63, p =0.0005). Incidence of drug errors was 4.36 per 1,000 cot days before care pathway implementation compared to 1.86 per 1,000 cot days after care pathway implementation; IRR (Incidence rate ratio) 0.43 (95% CI 0.23 to 0.76). Conclusions: Implementation of a standardised care pathway can significantly reduce drug errors on a NICU.

Effective administration of medicines

Following best practice in the management of medicines in residential care homes is vital to improve care and reduce drug errors. This article explains how this can be achieved.

Smart infusion technology: a minimum safety standard for intensive care?

There is overwhelming evidence that medication errors present a risk to patients. This risk is highest in the intensive care unit (ICU) setting and even greater when medications are administered via an infusion pump. Standard pumps will not alert for, or prevent, drug calculation, drug unit, button push, or multiple of ten errors when medication delivery data is inputted. However, the literature suggests that smart pumps programmed with hard (unchangeable) limits can significantly reduce drug errors at the point of administration. Staff at St George's Hospital paediatric ICU wanted to implement an infusion pump system that would be immediately effective in reducing medication errors at the point of administration. This article presents an overview of the relevant literature together with clinical examples from the authors' ICU, which demonstrates their experiences with smart pumps. It is the authors' firm belief that smart infusion technology sets a new minimum safety standard for intensive care.

Policy, Practice and Education 2004: Reducing drug errors: the role of nurses and pharmacists

Guy J et al. Drug errors: what role do nurses and pharmacists have in minimizing the risk? Journal of Child Health Care 2003; 7(4): 277–290.

Drug errors in obstetric anaesthesia: a national survey

We conducted a postal survey of lead obstetric anaesthetists in all consultant-led maternity units in the UK about drug errors and the measures taken to reduce or prevent them. Of the 179 out of 240 (75%) who responded, 70 (39%) knew of at least one drug error in their unit during the last year, with 28 of them (40%) experiencing more than one. Of the most recent errors, giving the wrong drug (most commonly thiopental instead of antibiotics or vice versa [14 cases], or suxamethonium instead of Syntocinon ® [8 cases] or other drugs [4 cases]) was the most common error, occurring in 27 units (15%). Errors involving epidural/spinal analgesia/anaesthesia (including drugs intended for these routes but given via other routes) occurred in 20 cases. Only 36 respondents (20%) described protocols for checking anaesthetic drugs. Methods described for reducing drug errors were use of coloured labels (20%) or pre-filled labelled syringes (6%), limiting the range of drugs available (6%) and keeping drugs in separate trays once drawn up (6%).

Medication errors: causes, prevention and reduction.

Medication errors: causes, prevention and reduction.

Clinical or industrial pharmacy? Case studies of hospital pharmacy automation in Canada and France.

Automated medication dispensing systems for hospital pharmacies, heralded as an important means of reducing drug errors and improving labor productivity, have also been seen as a means of furthering the transformation of the pharmacy profession from its role in dispensing prescriptions to a clinical profession concerned with treatments and patient outcomes. Automation aids this transformation by transferring the responsibility for routine dispensing to technicians performing rationalized and computer-mediated tasks. Not all pharmacists agree with these trends. Some fear a loss of professional status and employment as their knowledge is expropriated and incorporated into machinery operated by those with lesser qualifications. They fear an industrial rather than a clinical future. Their concerns are compounded by health care cutbacks. These issues were studied at two hospitals in Canada and one in France, all mid-sized public hospitals with automated unit dose drug delivery systems installed in the late 1980s and early 1990s. Preliminary results indicated national differences in approaches to hospital pharmacy automation. In Canada, pharmacists have resisted major changes in their control of the dispensing process and in their traditional roles vis à vis doctors and pharmacy technicians. In France, where hospital pharmacy as a profession is less developed than in North America, automation has brought about a far more radical substitution for pharmacists' labor.