Reduce Medication Errors Research Articles

Evaluation of Medication Errors by Prescription Audit at a Tertiary Care Teaching Hospital

Objectives The prescription errors and prescribing fault analysis was assessed, the rationality of the prescriptions was checked, and the medication error was categorized according to the NCC MERP Index. Materials and Methods A cross-sectional, observational study was designed as per STROBE guidelines and conducted for 2 months in the pharmacy stores after approval of the Institutional Review Board. Patients’ written informed consent was taken before getting their prescriptions, and each of the prescriptions procured in this way was photographed for record. The completeness of 320 prescriptions of outpatients of all age groups regarding the details about the doctor and the patient and clinical diagnosis/indication was analyzed. The rationality of prescription was based on WHO core drug use indicators. Descriptive analysis was done by using Microsoft Excel. Results A total of 320 prescriptions were analyzed from eight departments. Information about patients and prescribers was mentioned in 100% of prescriptions. The diagnosis (40%), an indication was written in 195 prescriptions. Instructions for dispensing drugs (89%), instructions to patients (90%), duration of treatment (100%), follow-up visits (19%), and non-pharmacological instructions (13%) were mentioned. In total, 82% of prescriptions were legible. In a total of 1004 drugs, 92% of drugs were prescribed with a generic name, 100% from the essential drug list. The route and frequency of drug administration were mentioned for all drugs. According to NCCMERP, the category of medication errors falls under category B. Conclusion To reduce medication errors, we can implement an electronic system, involve clinical pharmacologists, utilize prescription charts, and organize nationwide workshops on rational prescription writing. We should encourage regular prescription audits and reporting to improve the healthcare system in the country.

Original Research: Exploring Medication Safety Practices from the Nurse's Perspective.

Medication preparation and administration are complex tasks that nurses must perform daily within today's complicated health care environment. Despite more than two decades of efforts to reduce medication errors, it's well known that such errors remain prevalent. Obtaining insight from direct care nurses may clarify where opportunities for improvement exist and guide future efforts to do so. The study purpose was to explore direct care nurses' perspectives on and experiences with medication safety practices and errors. A qualitative descriptive study was conducted among direct care nurses employed across a large health care system. Data were collected using semistructured interview questions with participants in focus groups and one-on-one meetings and were analyzed using qualitative direct content analysis. A total of 21 direct care nurses participated. Four major themes emerged that impact the medication safety practices of and errors by nurses: the care environment, nurse competency, system influences, and the error paradigm. These themes were often interrelated. Most participants depicted chaotic environments, heavy nursing workloads, and distractions and interruptions as increasing the risk of medication errors. Many seemed unsure about what an error was or could be. The complexity of medication safety practices makes it difficult to implement improvement strategies. Understanding the perspectives and experiences of direct care nurses is imperative to implementing such strategies effectively. Based on the study findings, potential solutions should include actively addressing environmental barriers to safe medication practices, ensuring more robust medication management education and training (including guidance regarding the definition of medication errors and the importance of reporting), and revising policies and procedures with input from direct care nurses.

A cross sectional survey of nurses’ reasons for medication errors at private multispecialty hospitals in Madurai, India

Abstract Introduction Healthcare services should eliminate errors, but any human-involved tasks are prone to error and healthcare is no exception.1 Medication errors are possible in hospitals though they should be eliminated with utmost care. Such medication errors would lead to an increased fatality rate, the emergence of new diseases, increased mediation costs and extended hospital stays.2,3 Aim This cross-sectional study aimed to classify and to identify the reasons for medication error as reported by the nurses and the impact of the collaborative work of Nurses, Pharmacists and Doctors in reducing medication errors and improving patient safety. Methods An exploratory (cross-sectional) study was conducted to classify and to identify the reasons for medication error among 474 nurses working in private multispecialty hospitals in Madurai between January to May 2023. The data for the study was collected using a questionnaire which included demographic variables and questions on medication errors. The questionnaire was filled through a one-to-one interview method and the data collected were analysed using SPSS 21.0. Results The results of analyses done using SPSS revealed that 58.2% of nurses reported having made medication errors and 88.4% of them said they had reported these immediately on the occurrence of such errors to their nursing superintendents. The most common type of medication errors reported were wrong infusion rates and wrong medicines, especially for medicines with similar sounding names (sound-alike drugs). Lack of awareness of the causes of medication errors was found to be the major reason for the occurrence of such errors in hospitals. The analyses showed that there was a significant relationship between age, years of experience and medication errors. One-way ANOVA analysis revealed that the greater the age and experience, the lesser the occurrence of medication errors. However, there was no significant relationship between working shifts and medication errors. The findings also highlighted that the greater the number of patients in the ward, the higher the error in oral administration of drugs. The finding reveals that teamwork between nurses, pharmacists and doctors was reported to help to drastically reduce the number of errors. Discussion/Conclusion Whilst a small-scale study only and reliant on accurate self-reporting, the findings suggest that not all nurses report medication errors, which could result in adverse outcomes for patients. Hence the nursing managers or nursing superintendents should encourage nurses to report medication errors to ensure patient safety. The findings also suggest that collaborative work between nurses, pharmacists, and doctors can reduce medication errors, hence collaborative work and appointing clinical Pharmacists is important to reducing medication errors.

Medication reconciliation on admission in paediatric chronic patients: A multicentre study

IntroductionMedication reconciliation (MC) is one of the main strategies to reduce medication errors in care transitions. In Spain, several guidelines have been published with recommendations for the implementation and development of MC aimed at the adult population, although paediatric patients are not included. In 2018, a study was carried out that led to the subsequent publication of a document with criteria for selecting paediatric patients in whom CM should be prioritised. ObjectivesTo describe the characteristics of paediatric patients most likely to suffer from errors of reconciliation (EC), to confirm whether the results of a previous study can be extrapolated. MethodologyProspective, multicentre study of paediatric inpatients. We analysed the CE detected during the performance of the CM on admission. The best possible pharmacotherapeutic history of the patient was obtained using different sources of information and confirmed by an interview with the patient/caregiver. Results1043 discrepancies were detected, 544 were identified as CD, affecting 317 patients (43%). Omission of a drug was the most common error (51%). The majority of CD were associated with drugs in groups A (31%), N (23%) and R (11%) of the ATC classification. Polymedication and onco-haematological based disease were the risk factors associated with the presence of CD with statistical significance. ConclusionsThe findings of this study allow prioritisation of CM in a specific group of paediatric patients, favouring the efficiency of the process. Onco-haematological patients and polymedication are confirmed as the main risk factors for the appearance of CD in the paediatric population.

The workload and satisfaction of pharmacists and pharmacy assistants after installation of an automated tablet dispensing and packaging system in a tertiary university hospital in Malaysia.

The aim of this study was to examine the impact of pharmacy automation on the workload and satisfaction of pharmacists and pharmacy assistants in an inpatient setting. This was an observational, cross-sectional survey using a convenience sampling method conducted at the University Malaya Medical Centre (UMMC) In-Patient Pharmacy. A validated online questionnaire assessed user satisfaction and task duration. A total of 21 pharmacists and 18 pharmacy assistants participated in the survey. Most pharmacists (n = 17/21) were confident in the system, and both pharmacists and pharmacy assistants perceived it to be beneficial for patients (n = 33/39) and for reducing medication errors (n = 32/39). Pharmacy assistants spent approximately 5.34 hours on traditional work including filling medication orders (1.44 hours) after automated tablet dispensing and packaging system (ATDPS) implementation. Pharmacists spent 1.19 hours filling medication orders and 1.71 hours checking/verifying them, in contrast. Pharmacists focused mainly on clinical duties with healthcare colleagues, while pharmacy assistants handled various medication orders. Nevertheless, ATDPS reduced pharmacy staff workload in medication handling, achieving user satisfaction.

Assessing the Clinical, Economic, and Health Resource Utilization Impacts of Prefilled Syringes Versus Conventional Medication Administration Methods: Results From a Systematic Literature Review.

The objective of this systematic review was to assess the clinical, economic, and health resource utilization outcomes associated with the use of prefilled syringes in medication administration compared with traditional preparation methods. We conducted a systematic literature review to evaluate outcomes such as medication errors, wastage, time savings, and contamination in prefilled syringes. Our search encompassed multiple databases, including PubMed and Embase, for studies published between January 1, 2017, and November 1, 2022. Peer-reviewed publications meeting our inclusion criteria underwent rigorous screening, including title, abstract, and full-text article assessments, performed by two reviewers. Among reviewed articles, 24 met our eligibility criteria. Selected studies were primarily observational (46%) and conducted in Europe (46%). Our findings indicated that prefilled syringes consistently reduced medication errors (by 10%-73%), adverse events (from 1.1 to 0.275 per 100 administrations), wastage (by up to 80% of drug), and preparation time (from 4.0 to 338.0 seconds) (ranges varied by drug type, setting, and dosage). However, there was limited data on contamination. Economically, prefilled syringes reduced waste and error rates, which may translate into overall savings. This review highlights the value of prefilled syringes, which can streamline medication delivery, save nursing time, and reduce preventable medication errors. Moreover, prefilled syringes have the potential to minimize medication wastage, optimizing resource utilization and efficiency in health care settings. Our findings provide new insights into clinical and economic benefits of prefilled syringe adoption. These benefits include improved medication delivery and safety, which can lead to time and cost reductions for health care departments, hospitals, and health systems. However, further real-world research on clinical and economic outcomes, especially in contamination, is needed to better understand the benefits of prefilled syringes.

1565. Antiretroviral Stewardship: Protocol Development and Implementation at an Academic Medical Center.

Abstract Background 1.2 million people are living with HIV (PLWH) in the USA. As this population grows older (47% of PLWH were over age 50 in 2018) and more medically complex, the risk of medication errors increases. This population has not been prioritized for stewardship efforts, but experts have called for ARV stewardship programs to be developed. We developed a protocol to systematically review patients on ARVs during inpatient admissions to reduce and prevent medication errors, improve patient safety, and improve equity of care for PLWH. Methods We implemented a pharmacist-driven intervention over a 3-month period and compared it to usual practice in the 3 months prior to launch. Patients with active ARV prescriptions were identified using a novel automated patient report generated within the EMR. Then, a pharmacist reviewed the ARV regimen and opportunistic infection prophylaxis for accuracy, completeness, potential DDIs or administration issues. A standardized consult note was developed to communicate pharmacist recommendations to the care team. We evaluated qualitative features of the ARV-related interventions and calculated the proportion of hospital days with and without medication errors. Results The baseline period included 52 patients with an average age of 52 years and LOS of 6.6 days. The intervention period included 60 patients with an average age of 53 years and LOS of 5.4 days. During the intervention, automated pharmacy review led to medication intervention on 49% of patients, compared with 36% of patients in the baseline period. Similarly, the average time to pharmacy intervention decreased from 3 days after admission in the baseline period to 2.5 days in the intervention period. The most common interventions were resuming an ARV regimen and management of DDIs. The most common clinical rationales for interventions were DDIs, acute changes in renal function, and non-formulary medication restrictions. Automated patient identification and pharmacist review reduced the prevalence of medication errors related to ART from 17% of inpatient days to 2% of inpatient days. Conclusion There is a need for ARV stewardship. Expanding, automating, and standardizing these capabilities improved patient safety by reducing medication errors and improving continuity of care in the inpatient setting. Disclosures All Authors: No reported disclosures

Perception of nudge interventions to mitigate medication errors risk in healthcare service delivery

BackgroundConventional cognitive interventions to reduce medication errors have been found to be less effective as behavioural change does not always follow intention change. Nudge interventions, which subtly steer one’s choices, have recently been introduced.MethodsConducted from February to May 2023, this study aimed to determine the relationships between perceived effectiveness and perceived ease of implementation of six nudge interventions to reduce medication errors, i.e., provider champion, provider’s commitment, peer comparison, provider education, patient education and departmental feedback, and the moderating effects of seniority of job positions and clinical experience on nudge acceptability. Partial Least Square Structural Equation Modelling was used for data analysis.Results and discussionAll six nudge strategies had significant positive relationships between perceived effectiveness and acceptability. In three out of six interventions, perceived ease of implementation was shown to have positive relationships with perceived acceptability. Only seniority of job position had a significant moderating effect on perceived ease of implementation in peer comparison intervention. Interventions that personally involve senior doctors appeared to have higher predictive accuracy than those that do not, indicating that high power-distance culture influence intervention acceptability.ConclusionFor successful nudge implementations, both intrinsic properties of the interventions and the broader sociocultural context is necessary.

Quality Control in Primary Healthcare in Saudi Arabia: A Systematic Review

Introduction: The quality of primary healthcare is crucial for ensuring efficient and effective patient care, particularly in rapidly evolving healthcare systems like that of Saudi Arabia. With ongoing reforms aimed at improving healthcare delivery, there is a pressing need to assess the state of quality control within primary healthcare settings. This systematic review aimed to evaluate the effectiveness of various quality control interventions implemented in primary healthcare centers in Saudi Arabia, focusing on their impact on patient care and system efficiency. Methods: The review strictly included interventional studies and clinical trials published in the last years up to 2022, employing a comprehensive search across multiple databases including PubMed, Scopus, Web of Science, and the Cochrane Library. Inclusion criteria were set to consider only studies that directly addressed quality control measures within primary healthcare settings in Saudi Arabia, with clear intervention and outcome measures. The analysis synthesized data on the types of interventions, sample sizes, and effectiveness, including risk ratios and percentage improvements with their confidence intervals. Results: Seven studies were included, revealing a range of interventions from EHR implementations to provider training programs and patient feedback systems. Key findings include a 55% reduction in medication errors following EHR system implementation, a 35% increase in compliance with national quality standards post-provider training, a 20% increase in patient satisfaction with the introduction of patient feedback systems, and a 30% improvement in patient outcomes from clinical guideline updates for chronic disease management. Conclusions: The review demonstrates that targeted interventions can significantly enhance quality control in primary healthcare settings in Saudi Arabia, with notable improvements in medication accuracy, compliance with quality standards, patient satisfaction, and clinical outcomes. These findings highlight the potential of comprehensive, integrated quality control measures to advance patient care and healthcare system efficiency.

Clinical Decision Support Implementation in Health Information Systems Across Radiology Departments

Introduction: Understanding the economic landscape is pivotal for gauging the feasibility and sustainability of Clinical Decision Support (CDS) integration across radiology, nursing, and laboratory departments. This review will delve into the economic considerations associated with CDS implementation, shedding light on clinical impact and cost-effectiveness. Methods: The systematic review employed a robust methodology, combining controlled vocabulary and free-text keywords in a comprehensive search across multiple databases. The inclusion criteria encompassed original research articles, systematic reviews, and meta-analyses in English, focusing on Clinical Decision Support (CDS) implementation in radiology, nursing, and laboratory departments within Health Information Systems. The two-step screening process, detailed data extraction, and methodological quality assessment were conducted with rigor by two reviewers, resolving discrepancies through discussion or consultation with a third reviewer. Results: The systematic review incorporated seven intervention studies spanning radiology, nursing, and laboratory departments within Health Information Systems (HIS). Findings revealed a broad range of sample sizes, from 152 to 805 participants, showcasing the diversity of healthcare professionals involved. Across these studies, CDS interventions demonstrated substantial positive impacts, particularly in radiology with a risk ratio of 1.75 (95% CI: 1.42-2.10) for improved diagnostic accuracy, in nursing with a 58% risk reduction in medication errors (95% CI: 0.30-0.58), and in laboratory services with a 65% lower risk of unnecessary tests (95% CI: 0.24-0.51). These consistent themes highlight the effectiveness of CDS interventions but underscore the need for ongoing customization to meet department-specific needs. Conclusions: The systematic review underscores the significant positive impact of Clinical Decision Support (CDS) implementation across radiology, nursing, and laboratory departments within Health Information Systems, as evidenced by improved diagnostic precision, medication management, and laboratory efficiency, while emphasizing the importance of continuous customization to address department-specific nuances.

Medication error and associated factors among adults admitted to emergency ward at the university of Gondar comprehensive specialized hospital, North-West Ethiopia: a cross-sectional study, 2022

BackgroundMedication errors are the most common cause of preventable adverse drug events at the emergency ward.ObjectivesThis study assessed medication errors and associated factors among adult patients admitted to the emergency ward at the University of Gondar Comprehensive Specialized Hospital, North-West Ethiopia.MethodsA cross-sectional study was conducted from June 1, 2022, to August 30, 2022. Data were entered into EpiData Manager 4.6.0.0 for clearing and exported to SPSS version 24 for analysis. Descriptive statistics such as frequencies, medians with an interquartile range and inferential statistics like binary logistic regression were used for data analysis. The level of significance was declared at a p value less than 0.05 with a 95% confidence interval.ResultsFrom 422 study participants, medication errors were found in three-fourths (74.4%) of study participants. The most frequent type of medication error was omitted dose (26.27%). From a total of 491 medication errors, 97.75% were not prevented before reaching patients. More than one-third (38.9%) of medication errors had potentially moderate harmful outcomes. More than half (55.15%) of possible causes of medication errors committed by staff are due to behavioral factors. Physicians accepted 99.16% and nurses accepted 98.71% of clinical pharmacist intervention. Hospital stay ≥ 6 days (AOR: 3.00 95% CI 1.65–5.45, p < 0.001), polypharmacy (AOR: 5.47, 95% CI 2.77–10.81 p < 0.001), and Charlson comorbidity index ≥ 3 (AOR: 1.94, 95% CI (1.02–3.68), p < 0.04) significantly associated with medication error.ConclusionsAbout three-fourths of adult patients admitted to the emergency ward experienced medication errors. A considerable amount of medication errors were potentially moderately harmful. Most medication errors were due to behavioral factors. Most clinical pharmacists’ interventions were accepted by physicians and nurses. Patients who stayed longer at the emergency ward, had a Charlson comorbidity index value of ≥ 3, and were on polypharmacy were at high risk of medication error. The hospital should strive to reduce medication errors at the emergency ward.

Unmet technological demands in orodispersible films for age-appropriate paediatric drug delivery.

Age-appropriateness of a formulation is the ability to deliver variable but accurate doses to the paediatric population in a safe and acceptable manner to improve medical adherence and reduce medication errors. Paediatric drug delivery is a challenging area of formulation research due to the existing gap in knowledge. This includes the unknown safety of excipients in the paediatric population, the need for an age-appropriate formulation, the lack of an effective taste-masking method and the lack of paediatric pharmacokinetic data and patient acceptability. It is equally important to establish methods for predicting the biopharmaceutical performance of a paediatric formulation as a function of age. Overcoming the challenges of existing technologies and providing custom-made solutions for the development of age-appropriate formulation is, therefore, a daunting task. Orodispersible films (ODF) are promising as age-appropriate formulations, an unmet need in paediatric drug delivery. New technological improvements in taste masking, improving solubility and rate of dissolution of insoluble drugs, the flexibility of dosing and extemporaneous preparation of these films in a hospital good manufacturing practises (GMP) setup using 3D printing can increase its acceptance among clinicians, patients and caregivers. The current review discusses the problems and possibilities in ODF technology to address the outstanding issues of age-appropriateness, which is the hallmark of patient acceptance and medical adherence in paediatrics.

Reducing medication errors in adult intensive care: Current insights for nursing practice

Reducing medication errors in adult intensive care: Current insights for nursing practice

Conciliación de la medicación al ingreso en paciente crónico pediátrico: estudio multicéntrico

IntroductionMedication reconciliation (MR) is one of the main strategies used to reduce medication errors in care transitions. In Spain, several guidelines have been published with recommendations for the implementation and development of MR processes aimed at the adult population, and not applicable to paediatric patients. In 2018, a study was carried out that allowed the subsequent publication of a document establishing criteria for the selection of paediatric patients in whom CM should be prioritised. ObjectivesTo describe the characteristics of the paediatric patients most likely to be subject to reconciliation errors (REs) to confirm whether the results of a previous study could be extrapolated. MethodologyProspective, multicentre study in paediatric inpatients. We analysed the REs detected in the MR at the time of admission. We obtained the best possible medication history of the patient using different sources of information, subsequently confirmed through an interview with the patient/caregiver. Results1043 discrepancies were detected, of which 544 were categorised as REs, affecting 317 patients (43%). Omission of a drug was the most common error (51%). Most REs involved drugs in groups A (31%), N (23%) and R (11%) of the ATC classification. Polypharmacy and oncological/haematological disease were the risk factors that exhibited a statistically significant association with the occurrence of REs. ConclusionsThe findings of this study allow the prioritisation of MR in a specific group of paediatric patients, contributing to improve the efficiency of the process. Oncological/haematological disease and polypharmacy were confirmed as the main risk factors for the occurrence of REs in the paediatric population.

Improving Efficiency and Accuracy: Implementing Automation in King Hamad Hospital Outpatient Pharmacy

Pharmacy automation is an important tool for improving the safety, accuracy, and efficiency of medication delivery in healthcare settings. King Hamad University Hospital (KHUH) has implemented a comprehensive pharmacy automation system to improve the quality of care provided to its patients. The implementation of pharmacy automation at KHUH has resulted in improved patient safety and satisfaction. Automated dispensing cabinets have reduced medication errors by providing secure storage and access to medications. Automated medication packaging systems have improved accuracy by reducing the risk of errors associated with manual packaging. The CPOE system has improved communication between physicians and pharmacists by allowing physicians to electronically enter orders for medications directly into the EMR. Additionally, the implementation of pharmacy automation has improved patient satisfaction by reducing wait times for medications and increasing convenience for patients who need to pick up their prescriptions from the hospital pharmacy. Overall, pharmacy automation at KHUH has been successful in improving patient safety, accuracy, efficiency, and satisfaction. The implementation of this technology has allowed KHUH to provide better quality care for its patients while also reducing costs associated with manual processes.

A89Paramedic placements: Let’s not forget the non-technical skills

Simulated placements for paramedics are increasing, with some organizations approaching these placements innovatively, focussing on combining undergraduate paramedic facilitation skills with peer reviewing skills [1]. Other HEIs focus on clinical skills with manikin scenario-simulations and on virtual reality driven learning. Effective communication skills are crucial for paramedics and simulated placements provide an opportunity to practice these skills. There is a heavy focus on communication skills in the HCPC Standards of Proficiency for Paramedics [2]; this, combined with our responsibilities to patients and their relatives means that rehearsal of these skills, are not overlooked in preference to technical skill acquisition. A simulation-based education provider and an HEI, co-created a two-day simulated placement for 60 paramedic undergraduates. The scenario content was developed to reflect the broad client base paramedics interact with: patients, relatives, by-standers, other healthcare, and emergency service professionals, all from across the life span and from different cultural and social backgrounds. The scenario focus was: care, kindness and compassion, confidentiality and candour, supporting colleagues, de-escalation, safeguarding, inclusivity, and transgender and gender diversity. Scenario development was undertaken by a range of healthcare professionals, and co-produced with lay developers, people who had experienced paramedic intervention. Actors were coached in role depiction and escalation, briefed regarding the learning outcomes, and had the pre-requisite experience in debriefing and feedback skills. Each learning outcome was scored by the students, for confidence and ability, in a pre-post evaluation. Overall students evaluated the placement as a meaningful learning opportunity. They felt able to consider their existing knowledge, then practice their skills and reflect on their attitudes. They described feeling better prepared for ‘real’ situations. Students reported the usefulness of being able to stop, discuss and restart/resume the simulation. Feedback from actors, peers and facilitators was described as an enhancement, and crucially, the co-production of the scenarios with lay developers, translating their ‘real’ experiences resonated with the students creating genuine, authentic learning opportunities. Communicating is a vital paramedic skill; evidence demonstrates that these vital skills, done well, lead to improved patient outcomes and satisfaction, and a reduction of medical errors [3]. Simulated placements are an essential ingredient in developing these skills and the involvement of actors and experienced facilitators provides a safe environment for students to practice. This initiative provides valuable insights into the co-production of scenarios (with users) and partnerships between HEIs and external simulation-based education providers. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Reducing medical errors for older veterans through communication, mediation and quality assurance

This study aims to evaluate the effectiveness of integrated strategies—communication protocols, mediation techniques, and quality assurance (QA) measures—in reducing medical errors among older veterans within the Veterans Health Administration (VHA). The research seeks to identify key factors contributing to errors and assess the impact of targeted interventions on enhancing patient safety. A mixed-methods research design was employed, combining qualitative interviews with healthcare providers, veterans, and caregivers, alongside quantitative analysis of medical records, incident reports, and patient safety surveys. The study utilized stratified sampling to ensure diversity across different VHA facilities and applied statistical techniques, including chi-square tests, logistic regression, and bootstrapping, to evaluate the effectiveness of interventions. The findings indicate a significant reduction in medical errors through the implementation of standardized communication protocols, particularly during patient handoffs. Mediation effectively resolved conflicts arising from errors, fostering a culture of transparency and continuous improvement. Facilities with robust QA programs demonstrated higher success rates in identifying and mitigating potential risks. The integration of these strategies led to a 45% reduction in overall error rates, with communication errors showing the most substantial decline. The study highlights the critical role of communication, mediation, and QA in enhancing patient safety within veterans' healthcare. While the results demonstrate the effectiveness of these strategies, challenges such as resource variability and the need for ongoing training persist. The research underscores the importance of adopting a multi-faceted approach to error reduction and suggests further exploration of advanced technologies and longitudinal studies to assess the sustainability of these interventions.

Service Enhancement Strategies for Pharmacy, Laboratory, and Nursing Departments: A Systematic Review

This systematic review explores service enhancement strategies in three critical supporting health departments: pharmacy, laboratory, and nursing. These departments play a crucial role in ensuring high-quality healthcare delivery, yet they often face challenges that can impede efficiency and patient outcomes. The review identifies and analyzes various strategies, such as process automation, technology integration, workflow optimization, and staff empowerment, that have been implemented to improve service quality in these departments. Key findings reveal that enhanced pharmacy services can reduce medication errors and improve inventory management, while laboratory improvements can lead to faster diagnostics and more accurate results. In the nursing department, better staff ratios, decision-making tools, and health informatics have shown promise in increasing patient care quality. This review highlights the positive impact of service enhancements on patient safety, satisfaction, and operational efficiency while discussing challenges in implementation and the need for future research to address these gaps.

Dose 4 You: Dose Division Calculator-A Tool to Reduce Calculation Errors.

Background: Medication dosing calculation errors can cause significant harm to patients, especially in the pediatric population. Crushing tablets for dose division purposes may increase the risk of calculation errors, which can lead to incorrect dosing and compromised patient safety. This study aimed to develop a calculator to eliminate calculation errors associated with dose division. Methods: Using the Wix platform, a group of pharmacists created a user-friendly webpage "Dose 4 You." To enable accurate dose division calculations, the advanced language model Chat GPT and Visual Studio were used. The tool assists healthcare professionals through a step-by-step process, allowing them to enter the necessary dose and medication requirements. The Dose 4 You web page's reliability and feasibility were assessed using retrospective data and validated questionnaires, including the System Usability Scale (SUS), respectively and a Likert scale-based acceptance questionnaire. Results: The Dose 4 You website calculated the required amount of powdered tablet to achieve the desired dose with 100% accuracy. The obtained SUS score was 88.38, indicating excellent usability. The average score of all questions for acceptance was found to be 4.7 ± 0.15 indicating a strong agreement on the tool's usefulness and effectiveness. Conclusion: Dose 4 You is a reliable tool that improves patient safety by streamlining dose calculations and lowering calculation errors. The tool's ease of use, practicality in daily clinical practice, and potential to reduce medication errors are highlighted by the positive perception among healthcare professionals. Dose 4 You's successful implementation demonstrates the power of technology and collaboration in transforming medication administration and improving patient outcomes. Similar innovative solutions to optimize healthcare practices can be explored in future health informatics endeavors.

Scaling the optimizing care model in community pharmacy using implementation mapping and COM-B theoretical frameworks

BackgroundThere has been increasing evidence that “task shifting,” when a provider entrusting specific responsibilities to another member of their team, can increase care access and may lead to better patient care outcomes. This has been particularly underscored in underserved communities throughout the world where task shifting has led to increased health care access in areas of provider shortages. Within the profession of pharmacy, pharmacy technicians are the primary pharmacist assistants and recipients of pharmacist-delegated tasks. Recently, such task delegation has placed the pharmacist in more direct patient care responsibilities beyond medication dispensing—and one such model with a growing evidence base is the optimizing care model. The optimizing care model is an novel approach to community pharmacy practice centered on expanded clinical service delivery by means of task delegation. Through task shifting, the optimizing care model has been shown to reduce medication errors and increase the quantity of patient care services offered by the pharmacist. However, means to spread and scale the model have yet to be reported in the literature. MethodsThis article describes the development of a package of implementation strategies designed to facilitate implementation of the optimizing care model in a single division of nationwide supermarket pharmacy chain. The implementation mapping approach was used to systematically develop strategies. In this approach, a protocol is prospectively developed to guide the implementation of a novel evidence-based interventions into a given setting, including the development of implementation strategies. ResultsThe application of the 5 steps of implementation mapping is described in detail. Implementation objectives, models, and strategies are outlined, as well as the final implementation protocol. There was an overall increase in weeks meeting the 10% optimizing care model threshold—33% at baseline to 83% after the intervention. ConclusionsThe implementation mapping process led to development of multifaceted implementation strategy for implementing the optimizing care model into community pharmacy practice. The strategy improved optimizing care model implementation. Further research is needed to understand which strategies were most impactful.