Reduce Medication Errors Research Articles

Medication Errors in Intensive Care Units: An Umbrella Review of Control Measures.

Medication errors are defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.” Such errors account for 30 to 50 percent of all errors in health care. The literature is replete with systematic reviews of medication errors, with a considerable number of studies focusing on systems and strategies to prevent errors in intensive care units, where these errors occur more frequently; however, to date, there appears to be no study that encapsulates and analyzes the various strategies. The aim of this study is to identify the main strategies and interventions for preventing medication errors in intensive care units through an umbrella review. The search was conducted on the following databases: PubMed, CINAHL, PsycInfo, Embase, and Scopus; it was completed in November 2020. Seven systematic reviews were included in this review, with a total of 47 studies selected. All reviews aimed to evaluate the effectiveness of a single intervention or a combination of interventions and strategies to prevent and reduce medication errors. Analysis of the results that emerged identified two macro-areas for the prevention of medication errors: systems and processes. In addition, the findings highlight the importance of adopting an integrated system of interventions in order to protect the system from harm and contain the negative consequences of errors.

HSD126 Pilot Testing a Web-Based Mobile App Designed to Increase Communication and Care Coordination Among Patients, Physicians and Pharmacists

The fragmented healthcare system in the United States results in failures of care coordination estimated to cost the healthcare system between $27.2 billion to $78.2 billion. Improving communication between providers, pharmacists, and patients is an area with potential to reduce medication errors. Current fax and phone-based communication between pharmacists and physicians is insufficient to address patient concerns. The objective of this pilot project was to test the feasibility and categorize the desired features of a web-based health platform.

In adults admitted to hospital, does medication reconciliation help reduce medication errors?

In adults admitted to hospital, does medication reconciliation help reduce medication errors?

How does a computerized physician order entry (CPOE)/clinical decision support systems (CDSS) compare with control/paper-based system to reduce medication errors?

How does a computerized physician order entry (CPOE)/clinical decision support systems (CDSS) compare with control/paper-based system to reduce medication errors?

Improving Clinical Efficiency and Reducing Medical Errors through NLP-enabled Diagnosis of Health Conditions from Transcription Reports

Misdiagnosis rates are one of the leading causes of medical errors in hospitals, affecting over 12 million adults across the US. To address the high rate of misdiagnosis, this study utilizes 4 NLP-based algorithms to determine the appropriate health condition based on an unstructured transcription report. From the Logistic Regression, Random Forest, LSTM, and CNN-LSTM models, the CNN-LSTM model performed the best with an accuracy of 97.89%. We packaged this model into a authenticated web platform for accessible assistance to clinicians. Overall, by standardizing health care diagnosis and structuring transcription reports, our NLP platform drastically improves the clinical efficiency and accuracy of hospitals worldwide.

Designing an electronic medical record alert to identify hospitalised patients with HIV: successes and challenges

ObjectivesElectronic medical record (EMR) tools can identify specific populations among hospitalised patients, allowing targeted interventions to improve care quality and safety. We created an EMR alert using readily available data...

Tall man lettering application in medication information systems as a quality and safety strategy in hospital organization.

The technique of highlighted capital letters, Tall Man lettering, is a tool that allows differentiating the names of similar drugs in a way that contributes to reduce medication errors related to the drug identification. The objective was to implement and monitor the application protocol of the Tall Man lettering tool in drug information systems in the healthcare environment to improve the quality of care and patient safety in the pharmacy service and the medical institution. Scope: Tertiary general hospital with 1000 beds in which a Tall Man lettering application protocol was approved in the pharmacy service information systems. Retrospective observational study. 2019-2021. Information systems and databases used in the pharmacy service. Working group: Made up of people in charge of information areas and systems. Five phases were defined: organization of the working group, selection of drug names and information systems, establishment of actions, their execution, and results monitoring. Number of pharmaceutical specialties, names of active ingredient and brands incorporated in the information systems. The application of Tall Man lettering was authorized in 13/13 information systems, six have been fully implemented and seven are in the database update phase. Of the implanted systems, a total of 210 drug names have been modified (168/210 active ingredient and 42/210 brand names), corresponding to 659 pharmaceutical specialties. The application of Tall Man lettering in hospital information systems is a tool for improving the quality of the pharmacy service and guarantees the safety of medicines in the hospital.

Assessment of the implementation of safe medication practices in Intensive Medicine Units

ObjectiveTo assess the level of implementation of medication safety practices in Intensive Care Units (ICUs) and to identify opportunities for improvement. DesignA descriptive multicenter study was carried out. SettingIntensive Care Units. Participants/ProcedureA total of 40 ICUs voluntarily completed the “Medication use-system safety self-assessment for Intensive Care Units” between March and September 2020. The survey comprised 147 items for evaluation grouped into 10 key elements. Main variablesCalculation was made of the mean scores and mean percentages based on the maximum possible values for the overall survey, referred to the key elements and to each individual item for evaluation. ResultsThe mean score of the overall questionnaire among the participating ICUs was 436.8 (49.2% of the maximum possible score). No differences were found according to functional dependence, size of the hospital or type of ICU. The key elements referred to the incorporation of clinical pharmacists in these Units, as well as the competence and training of the professionals in safety practices yielded the lowest values (31.2% and 33.2%, respectively). Three other key elements related to accessibility to information about patients and medicines; to the standardization, storage and distribution of medicines; and to the quality and risk management programs, yielded percentages <50%. ConclusionsNumerous effective safety medication practices have been identified with a low level of implementation in ICUs. This situation must be addressed in order to reduce medication errors in critically ill patients.

Nurses’ experience of medication errors in residential aged care facilities: An exploratory descriptive study

<h2>ABSTRACT</h2><h3>Background</h3> The incidence of medication errors is of great concern in residential aged care facilities. However, registered nurses' perceptions on medication errors and the strategies to reduce medication errors have not been previously explored. <h3>Aim</h3> The aim of this study was to explore nurses' experiences of medication errors and their suggestions to reduce these in residential aged care facilities. <h3>Methods</h3> An exploratory descriptive design was employed; 12 registered nurses working in residential aged care facilities across Victoria participated in the study. Semi-structured interviews were used for data collection, and the data were thematically analysed. <h3>Findings</h3> Four themes emerged from the interviews: (i) work environment, with sub themes of inadequate staffing and unmanageable workload; (ii) external constraints, with sub themes of involvement of a multi-disciplinary team and work interruptions; (iii) psychological impact; and (iv) medication error prevention strategies. <h3>Discussion</h3> This study identified that medication errors occur because of inadequate staffing, work interruptions, and varying factors of multi-disciplinary team involvement. Medication errors negatively impact staff, residents, and family members causing additional stress and frustration surrounding follow-up and management. However, practical suggestions provided by registered nurses could be implemented in future to reduce the occurrence of such medication errors. <h3>Conclusion</h3> This study described the contributing factors to medication errors; their impact on the staff, residents, and family members; and practical strategies to reduce medication errors, based on the experience of registered nurses in residential aged care facilities. This study makes a novel contribution to knowledge and practice in medication management process in RACF.

Pictograms for safer medication handling by health care workers: a validation study in nursing students in Poland

Background and objectiveMedication use often causes errors that are dangerous to the health of patients. Previous studies indicate that the use of pharmaceutical pictograms can effectively reduce medication errors. The purpose of this study was to determine the comprehensibility, representativeness, and recall rate of nine medication safety pictograms in a sample of nursing students in Poland in order to validate these images.MethodsA pictogram validation study was conducted in two phases among nursing students at the Hipolit Cegielski State University of Applied Sciences, Gniezno, Poland.All experimental protocols were approved by the Children's Hospital of Eastern Ontario Research Ethics Board (REB Protocol No: 19/122X). All methods were carried out in accordance with relevant guidelines and regulations.In phase 1, the participants' first exposure to the pictograms, the students were asked to guess the meaning of the pictograms without any additional information in order to assess the pictograms' comprehensibility. To be considered valid, according to ISO standards, the pictograms had to be correctly understood by at least 66.7% of participants. After testing all pictograms, students were given explanations and meanings of the pictograms and asked to rate the representativeness of pictograms. To do so, participants were asked to select a number on a seven-point Likert-style scale to indicate the perceived strength of the relationship between the pictogram and its intended meaning for each pictogram. To be considered valid, a pictogram had to be rated at least five on this scale by at least 66.7% of participants. Phase 2 took place four weeks later, during which recall of the intended meaning and representativeness were assessed following the same procedure.ResultsA total of 66 third-year nursing students participated in both phases. In phase 1, of the nine pictograms, six met ISO requirements for comprehensibility and seven met ISO requirements for representativeness. In phase 2, all nine pictograms were correctly understood and rated at least 5 by at least 66.7% of participants. Therefore, all nine pictograms are considered valid.ConclusionsThe nine medication safety pictograms can be deployed, but must be combined with training and a written hazard statement to improve comprehension.

Formulary management guiding principles for automated systems.

Structural and financial changes in US healthcare are the driving forces reshaping care delivery and the technologies that clinicians use in their practice. Structural-level changes in healthcare organizations bringing facilities varying in size, systems, and complexity under the new integrated care delivery networks create unprecedented challenges. This paper develops guiding principles for formulary management in automated systems that facilitate medication management and alignment of medication information technology (IT) solutions in healthcare organizations ranging in size from a single facility to very large enterprise/multifacility networks. This paper describes formulary management best practices for healthcare organizations as they follow crucial medication management processes: formulary item builds, urgent and nonformulary medication requests, and formulary item build testing and maintenance. As medication management practices are embedded in automated technologies that are similar yet nuanced, we pay special attention to practices and change control processes that maximize coordination among systems while preserving medication data integrity and reducing medication errors. For increasingly complex healthcare systems with multiple medication management system demands, formulary drug database builds and maintenance are challenging and time-consuming. Formulary item build, testing, and maintenance processes involve multifunctional teams collaborating to ensure the integrity of data, prevent unexpected system incompatibilities, and improve patient safety by reducing medication errors. Ideally, formulary item build, testing, and maintenance processes produce consistent final drug records in IT systems meeting user needs.

An initiative to reduce medication errors in neonatal care unit of a tertiary care hospital, Kolkata, West Bengal: a quality improvement report

BackgroundMedication errors are an emerging problem in various hospital settings, especially in neonates. A study conducted in the neonatal care unit of a tertiary institute in Kolkata as baseline over...

Impact of Computerized Provider Order Entry on Chemotherapy Medication Errors: A Systematic Review

Context: Chemotherapy errors are considered the second most common cause of fatal medication errors (ME). Currently, computerized provider order entry (CPOE) is increasingly used to prevent or decrease ME and improve the safety of the medication process. Objectives: This study was conducted to systematically review the impacts of CPOE on the incidence of chemotherapy ME, the severity of errors, and adverse drug events (ADEs) in cancer care units. Data Sources: The literature search was conducted, using 5 databases of PubMed, EMBASE, Scopus, Web of Science, and ScienceDirect between 2000 and 2020. Search terms included keywords and MESH terms related to CPOE, ME, chemotherapy, and cancer care unit. Study Selection: Articles were included in this research if they investigated the CPOE system, reported ME, and were carried out in the oncology department. Non-English papers, duplications, review studies, and conference papers were excluded. Data Extraction: The selected papers were checked carefully and related data were extracted. All eligible articles were qualitatively evaluated with a tool provided by Downs. The extracted information included the author’s name, year of publication, study location, type of study, study objectives, and main findings. Results: A total of 829 studies were retrieved. Fourteen articles met the inclusion criteria. Ten studies (71%) reported the impact of CPOE on chemotherapy ME in comparison with the paper-based ordering method. In 4 studies (29%), researchers developed a CPOE for the oncology department, and the system was then assessed concerning user experience, safety challenges as well as the effects of CPOE on ME. Nine articles (64%) reported the impact of the CPOE system on ME only in the prescribing phase, and 5 studies (36%) examined ME in all phases of the chemotherapy process. Five studies (36%) reported the impact of the CPOE system on ADEs and the severity of errors. Conclusions: Implementing CPOE is associated with a significant reduction in ME in all phases of the chemotherapy process. However, the CPOE does not prevent all MEs and may cause new difficulties. The rigorous analysis of the chemotherapy process and considering the designing principles could help developing well-designed CPOEs and minimizing ME.

Assessing the potentiality of algorithms and artificial intelligence adoption to disrupt patient primary care with a safer and faster medication management: a systematic review protocol

IntroductionIn primary care, almost 75% of outpatient visits by family doctors and general practitioners involve continuation or initiation of drug therapy. Due to the enormous amount of drugs used by...

Integrating a simulated electronic medical record system and barcode medication administration into a pre-licensure nursing program.

Many healthcare facilities implement technology to reduce medication errors. Nursing schools are exploring implementing similar technology to promote best practice. Our institution developed a quality improvement project to evaluate the integration of similar technology into pre-licensure curriculum. Our quality improvement project examined using a simulated electronic medical record (EMR) and a barcode medication administration (BCMA) system in pre-licensure nursing curriculum. In our initial project, 96second-semester BSN students participated in a skill check off using the system. Student perception was positive, 96% of respondents stated the system increased realism, and 94% indicated improved clinical preparedness. Implementing this system was a positive experience which enriched our pre-licensure curriculum.

Clinical Pharmacist Led Medication Reconciliation Program in an Emergency Department Observation Unit.

Objectives: Medication reconciliation is the process of comparing a patient's hospital medication orders to all of the medications that the patient has been taking prior to admission. The primary aim of this study was to evaluate the effectiveness of pharmacist-led medication reconciliation in reducing ED visit rates. The secondary aim of this study was to evaluate if a clinical pharmacist reduces medication errors in an ED observation unit (OBS). Methods: This was a retrospective, IRB approved, chart review conducted at New York University Langone Health-Tisch Hospital. The study defines the year before a clinical pharmacist was present on the unit (July 5, 2016 through July 4, 2017) as the control group and the first year a clinical pharmacist was present on the unit (July 5, 2017 through July 4, 2018) as the intervention group. The primary endpoint was 30-day ED re-visits. The secondary endpoints were 60-and 90-day ED re-visits, number, type and severity of medication history and reconciliation discrepancies. Results: The primary endpoint of 30-day ED visits occurred in 153 patients in the no pharmacist group and 88 patients in the OBS clinical pharmacist group (19.1% vs 9.9%, P < .00001). The secondary endpoint of 60- day ED visits occurred in 53 patients in the no pharmacist group and 39 patients in the OBS clinical pharmacist group (8.2% vs 4.9%, P = .01). The secondary endpoint of 90- day ED visits occurred in 31 patients in the no pharmacist group and 26 patients in the OBS clinical pharmacist group (5.2% vs 3.4%, P = .01). Conclusion: The benefits of having a clinical pharmacist perform medication reconciliation are highlighted by the reduction in ED visits, cost savings, and the prolific amount of errors corrected.

Microfluidic Thermal Flowmeters for Drug Injection Monitoring

This paper presents a microfluidic thermal flowmeter for monitoring injection pumps, which is essential to ensure proper patient treatment and reduce medication errors that can lead to severe injury or death. The standard gravimetric method for flow-rate monitoring requires a great deal of preparation and laboratory equipment and is impractical in clinics. Therefore, an alternative to the standard method suitable for remote, small-scale, and frequent infusion-pump monitoring is in great demand. Here, we propose a miniaturized thermal flowmeter consisting of a silicon substrate, a platinum heater layer on a silicon dioxide thin-membrane, and a polymer microchannel to provide accurate flow-rate measurement. The present thermal flowmeter is fabricated by the micromachining and micromolding process and exhibits sensitivity, linearity, and uncertainty of 0.722 mW/(g/h), 98.7%, and (2.36 ± 0.80)%, respectively, in the flow-rate range of 0.5–2.5 g/h when the flowmeter is operated in the constant temperature mode with the channel width of 0.5 mm. The measurement range of flow rate can be easily adjusted by changing the cross-sectional microchannel dimension. The present miniaturized thermal flowmeter shows a high potential for infusion-pump calibration in clinical settings.

The Impact of Medication Reconciliation on Continuityof Drug Therapy during Perioperative Period

Background. Medication errors and resultant adverse drug events (ADEs) often occur during transitions of care. Up to 67% of in-patients prescriptions have at least one unintentional medication discrepancy with previously prescribed therapy. The proportion of clinically significant medication discrepancies is 1159%. Studies from the developed countries demonstrated the effectiveness of medication reconciliation in reducing medication errors, ADEs and healthcare resource utilization. There is a necessity to conduct medication reconciliation studies within Russian current clinical practice to develop effective medical care quality and patients safety programs. Aims to evaluate the impact of pharmacologist-led medication reconciliation on the frequency and structure of unintentional medication discrepancies and potential ADEs at hospital admission and discharge. Methods. Standard care was compared to medication reconciliation led by a clinical pharmacologist in a prospective randomized trial of 410 elective surgical patients. Medication discrepancies at hospital admission and discharge were identified and reconciled. Clinical outcomes were evaluated by reviewing electronic health records. Results. In the intervention group the frequency of unintentional discrepancies at hospital admission decreased from 32.68 to 16.86%, the proportion of patients with at least one unintentional discrepancy decreased from 64.9 to 44.9%, the number of discrepancies per patient decreased from 1.5 to 0.66. The incidence of discrepancies at hospital discharge decreased from 82.90 to 43.29%, the proportion of patients with discrepancies decreased from 95.61 to 52.68%, the average number of discrepancies per patient decreased from 2.79 to 1.67. Medication reconciliation led by clinical pharmacologist decreased the frequency of unscheduled out-patient visits after discharge from 7.32 to 2.93%. The determined risk factors for unintentional discrepancies at hospital admission were: prescribing of cardiovascular, endocrine drugs and those affecting the central nervous system. Both at admission and discharge medication reconciliation was the significant factor reducing the risk of unintentional discrepancies. Conclusions. Medication reconciliation at hospital admission and discharge reduces the frequency of unintentional discrepancies in drug prescriptions by 16 and 40%, respectively. The implementation of medication reconciliation into clinical practice reduces unscheduled out-patient visits after hospital discharge.

Interdisciplinary and Innovative: A Nursing and Computer Science Collaboration to Create a Barcode Medication Administration System.

Preventing medication errors remains a priority in nursing education. The implementation of Barcode Medication Administration (BCMA) systems is one strategy that has been used to reduce medication errors. Practice using BCMA in simulated settings may enhance the transfer of these skills to the clinical practice setting. However, the purchase of BCMA educational products available for nursing students can be cost prohibitive for many nursing programs. To overcome the barrier of cost, an interdisciplinary and innovative collaborative approach was used to create a fully functional low-cost BCMA system.

Understanding Engagement and the Potential Impact of an Electronic Drug Repository: Multi-Methods Study.

BackgroundCentralized drug repositories can reduce adverse events and inappropriate prescriptions by enabling access to dispensed medication data at the point of care; however, how they achieve this goal is largely unknown.ObjectiveThis study aims to understand the perceived clinical value; the barriers to and enablers of adoption; and the clinician groups for which a provincial, centralized drug repository may provide the most benefit.MethodsA mixed methods approach, including a web-based survey and semistructured interviews, was used. Participants were clinicians (eg, nurses, physicians, and pharmacists) in Ontario who were eligible to use the digital health drug repository (DHDR), irrespective of actual use. Survey data were ranked on a 7-point adjectival scale and analyzed using descriptive statistics, and interviews were analyzed using qualitative descriptions.ResultsOf the 161 survey respondents, only 40 (24.8%) actively used the DHDR. Perceptions of the utility of the DHDR were neutral (mean scores ranged from 4.11 to 4.76). Of the 75.2% (121/161) who did not use the DHDR, 97.5% (118/121) rated access to medication information (eg, dose, strength, and frequency) as important. Reasons for not using the DHDR included the cumbersome access process and the perception that available data were incomplete or inaccurate. Of the 33 interviews completed, 26 (79%) were active DHDR users. The DHDR was a satisfactory source of secondary information; however, the absence of medication instructions and prescribed medications (which were not dispensed) limited its ability to provide a comprehensive profile to meaningfully support clinical decision-making.ConclusionsDigital drug repositories must be adjusted to align with the clinician’s needs to provide value. Ensuring integration with point-of-care systems, comprehensive clinical data, and streamlined onboarding processes would optimize clinically meaningful use. The electronic provision of accessible drug information to providers across health care settings has the potential to improve efficiency and reduce medication errors.