Safe Medication Practices Research Articles

Developing an immersive virtual reality medication administration scenario using the nominal group technique

AimThis paper aims to describe how the Nominal Group Technique was applied to obtain focused content to develop medication administration error scenarios for future use to educate practicing RNs with immersive virtual reality simulation. BackgroundIn the United States, medication errors account for up to $46 million in daily loss to hospital operational budgets. Each phase of prescribing, dispensing, administration, monitoring, and reconciliation is crucial in reducing potentially life-threatening outcomes associated with medication errors. Registered Nurses are responsible for safely administering diverse classifications of medications to patients in various healthcare settings. However, human and system factors can contribute to the exposure of hospitalized patients to a medication error. Virtual reality simulation-based education can be a methodology to educate practicing Registered Nurses on safe medication practices. DesignA Nominal Group Technique process was used to generate consensus from participating Registered Nurses on human and system factors that can contribute to medication administration errors. MethodsThe process consisted of (a) preparation, (b) running the group with an introduction of the subject, (c) generation of ideas, (d) listing of ideas, (e) discussion of ideas, (f) ranking of top ideas, (g) voting on top ideas, (h) discussion of the vote outcome, and (i) re-ranking and rating the top items. Human and system factor idea items encompassed medication errors during ordering, prescribing, or administering medications. Both novice and experienced Registered Nurses rank-ordered these factors as those most likely to encounter or which would most likely occur during one working shift. ResultsDescriptive statistics of frequencies and percentages were used to analyze the findings when grouped by human and system factor categories. Non-parametric testing with a Kruskal-Wallis test was conducted to compare the human and system factors by categories and years of Registered Nurse experience. Findings revealed that the factors of Time Management: getting behind, hurried, urgent (KW-H 11.2, df 4, p = .025) and Right Medication: medications have similar look and sound-alike names (KW-H 11.1, df 4, p = .025) impacted safe medication administration for both the novice and experienced nurse. ConclusionThe NGT process identified human and system factors contributing to errors and impacting safe medication administration practices. Findings will support the creation of medication administration scenarios for use with immersive virtual reality simulation.

Clinical Reasoning, Judgment, and Safe Medication Administration Practices in Senior Nursing Students.

Medication errors occur at alarming rates. Safe medication administration practices require more than observing patient safety rights and psychomotor skills. The purpose of this study was to explore the relationships between clinical judgment skills and reasoning processes and safe medication practices in senior nursing students. Using a cross-sectional design, 29 students from 3 schools of nursing watched a video simulation of a nurse administering medications in a clinical setting. At predetermined times, reflections on the medication administration practices were journaled. Journals were scored for clinical reasoning processes and clinical judgment using the Clinical Judgment Rubric-Reflective Journal (CJR-RJ) and for medication administration best practices. Students scored low on the CJR-RJ (mean [SD], 5.2 [1.7]). We found a positive relationship between clinical judgment skills and safe medication practices (r = 0.39, t27 = 2.94, P = .018). The clinical reasoning process of Interpreting was a significant indicator of best practices (b = 1.4, t28 = 2.81, P = .010). Our findings suggest that students struggle to connect theory to practice, emphasizing the need to plan experiential learning opportunities for students to develop clinical reasoning, particularly in Interpreting, and judgment skills to prevent medication errors upon entry to practice.

Extension of Intravenous Tubing and Pumps Outside Rooms for Safety and Efficiency.

Extension of Intravenous Tubing and Pumps Outside Rooms for Safety and Efficiency.

Medication Errors.

PRESIDENT OF THE INSTITUTE FOR SAFE MEDICATION PRACTICES The reports described in Medication Errors were received through the ISMP Medication Errors Reporting Program. Report errors, close calls, or hazardous conditions to the Institute for Safe Medication Practices (ISMP) at www.ismp.org, 1-800-FAIL Safe, or [email protected]. Michael R. Cohen is a member of the Nursing2021 editorial board.

A solution for global hygienic challenges regarding the application of heater-cooler systems in cardiac surgery.

71.759 surgical procedures were performed in 2019 with the aid of cardiopulmonary bypass in Germany. To adjust the patient's body temperature on extracorporeal circulation, the application of a heater-cooler unit (HCU) is mandatory. However, in case of insufficient sanitisation of HCU, life-threatening infections can be transmitted by the device to the patients, including Legionella bacteria, Mycobacterium chimaera, Pseudomonas aeruginosa. To avoid disease transmission, as a requirement for safe medical practice established by regulatory authorities, HCUs must be regularly disinfected by hazardous chemicals posing a danger for both handling humans and the environment. Therefore, to comply with regulations, HCU manufacturers have introduced both timely and financially extensive sanitisation procedures. Our paper describes a novel, effective and easy to handle disinfection method for the above problematics without utilising hazardous chemicals. The method's technical principle is electrolysis, resulting in drinking water quality regarding the analysed germs in the worldwide most commonly utilised heater-cooler device. The main aim of the study was to prove the efficacy and reliability of the device cleansing process. Furthermore, the economic impact of the novel method was evaluated. Therefore, we have undertaken 60 microbiological sampling series between December 2019 and November 2020 from a conventional HCU (3T LivaNova, Germany). During the total investigational period, no contamination with Pseudomonas aeruginosa or Legionellae could have been demonstrated in the HCU. The extreme slow-growing nontuberculous M. chimaera was detected only in one sample obtained from diamond electrode cleansed HCU water, and source of contamination was promptly eliminated by a simple technical modification of the device test-site. Additionally, the diamond electrode application is beneficial for eliminating potentially hazardous cleansing material from the process, which may affect otherwise both patients operated on cardiopulmonary bypass and the perfusionists.

Phone a pharmacist: Telepharmacy services at freestanding emergency departments

AbstractIntroductionEmergency medicine (EM) pharmacy practice has experienced significant growth in the past decade, but the scope of services provided for freestanding emergency departments (FSEDs) has not been previously described.ObjectivesThe primary objective was to describe EM pharmacist interventions provided through telepharmacy services for three FSEDs.MethodsThis was a retrospective chart review conducted in three FSEDs that are part of a large health system. EM pharmacists provide remote clinical coverage for the FSEDs. Pharmacist interventions for FSED patients between 1 January 2017 and 31 December 2018 were eligible for inclusion. Documentation related to non‐direct patient care activities was excluded. Drug therapy recommendations were categorized by therapeutic drug class and the proportion associated with Institute for Safe Medication Practices (ISMP) high‐alert medications was analyzed. The clinical significance of a random sample of drug therapy recommendations was rated using a validated scale. Data was analyzed descriptively and a weighted Kappa statistic was calculated to assess inter‐rater reliability.ResultsA total of 4313 interventions met inclusion criteria with drug therapy recommendations accounting for 38.4% of all interventions. Of 1664 drug therapy recommendations, there were 1424 linked to a medication with the most frequently implicated therapeutic classes being antimicrobial agents (n = 732; 51.4%), vaccines (n = 168; 11.8%), and cardiovascular agents (n = 90; 6.3%). ISMP high‐alert medications accounted for 11% (n = 157) of these recommendations with antithrombotic agents (n = 51; 32.5%), insulin (n = 34; 21.7%), and opioids (n = 20; 12.7%) most frequently implicated. In a random sample of drug therapy recommendations, 19.2% were rated as significant errors by both reviewers with moderate inter‐rater reliability (κ = 0.55; SE 0.09). When assessing the value of service, 59% of interventions were rated as significant by both reviewers with fair inter‐rater reliability (κ = 0.22; SE 0.05).ConclusionEM pharmacists provided clinically significant drug therapy recommendations through telepharmacy services which may represent a novel approach to optimize patient care in FSEDs.

KNOWLEDGE AND ATTITUDE OF MEDICATION ERROR AMONG NURSES IN FEDERAL NEURO-PSYCHIATRIC HOSPITAL, CALABAR

This study was conducted to assess knowledge and attitude of medication among Nurses in Federal Neuropsychiatric Hospital, Calabar. Three (3) research questions were raised and one hypothesis formulated to direct the study. The descriptive cross-sectional survey design was used to study a total of one hundred and two (102) nurses selected from the study area using the stratified random sampling technique. A well developed and structured questionnaire was used for data collection. The questionnaire was duly validated and its reliability ensured. Data collected were analyzed using descriptive statistics of frequency count, simple percentage, mean, weighted mean, and standard deviation. The study hypothesis was tested using Pearson Product Moment Correlation Coefficient analysis with its significance level set at 0.05. Findings of the study revealed that majority (73.6%) of the nurses used for the study had adequate knowledge of medication error, and majority (72.6%) had positive attitude towards prevention of medication error in the Hospital. Factors that affect safe medication practices among the nurses include: individual negligence, excessive workload, inadequate staff strength, poor working environment, lack of staff development and training, lack of equipment and supplies, non-regular review of patient’s drugs by doctors, and prescription of under dosage drug by doctors. There is a statistically significant and positive relationship between knowledge and attitude of nurses towards prevention of medication error. Based on these findings, it was recommended that government should employ more qualified nurses to increase the strength of nurses in the Hospital and improve the nurse-patient ratio to avoid excessive workload which is a strong and significant contributing factor to medication error among nurses in the Hospital.

Graduate nurse views on patient safety: Navigating challenging workplace interactions with senior clinical nurses.

To explore and understand the negative experiences of graduate nurses' interaction with senior nurses and the implications for safe patient care. Patient safety is dependent on the nursing care they receive. Working in environments where there is reduced collegial support and increased emotional distress, increases the likelihood of nurses making errors that may negatively impact on patient outcomes. Insights drawn from graduate nurses' negative interactions with senior nurses may provide an understanding of the impact of nurse-to-nurse interactions on patient safety outcomes. A qualitative exploratory descriptive design was used. A purposive sample of 18 graduate registered nurses participated in this study. Semi-structured interviews were conducted, audio-recorded and transcribed verbatim. Data were thematically analysed. The COREQ checklist was followed. The overarching theme, 'Navigating workplace challenges' was identified with two sub-themes: Processing unsupportive nurse behaviour and responding to nurse deviations from best practice. Common deviations in practice included erosion of safe medication practice, wound care and non-compliance with universal precautions. Graduate nurses also observed unsafe workplace practice, however, were hesitant to speak up due to fear of retribution. Unsupportive behaviours impacted on their critical thinking ability, follow-up interactions with other nurses and subsequent delivery of patient care. Quality and safety strategies should not ignore and/or overlook the impact of interpersonal relationships on patient safety and risk. Strategies for delivering evidence-based, safe and quality care to patients go beyond the establishment of standards and technically focussed management strategies. It is vital to examine the quality of working relationships between all levels of healthcare professionals including graduate nurses and their supervisors to ensure supportive behaviours prevail in advancing delivery of quality care within the practice environment. The study alludes to the fact that disruptive workplace behaviours are more hierarchical than horizontal (i.e., graduate nurse-to-graduate nurse).

Development and Validation of the Safe Parenteral Medication Administration Self-Efficacy Scale.

This study aimed to develop a valid and reliable measurement instrument for determining the self-efficacy perceptions of nurses concerning safe medication practices. The study was conducted at the hospital of a state university in Istanbul, Turkey, between August and December 2016. The sample consisted of 278 nurses. The exploratory factor analysis indicated the scale had a single-factor structure that explained 47.92% of the total variance. The remaining 76 items had factor loads ranging from .50 to .87. The item-total correlations varied between .49 and .86, and Cronbach's alpha coefficient for the scale was .98. The results of the analysis show the items constituting the scale have validity and reliability criteria that can measure the self-efficacy of nurses related to parenteral medication administration. [J Contin Educ Nurs. 2021;52(6):267-273.].

Challenges in the Management of an Echis coloratus Adult Snakebite Victim at a Tertiary Care Hospital: A Case Report

Patient: Male, 18-year-oldFinal Diagnosis: Snakebite envenomationSymptoms: CoagulopathyMedication:—Clinical Procedure: Anti snake venomSpecialty: General and Internal Medicine • Toxicology • Tropical MedicineObjective:Unusual clinical courseBackground:The World Health Organization has set clear guidelines for the management of snakebite envenomation. However, challenges have been reported in the clinical application of guidelines, such as identification of the biting snake, hypersensitivity reactions to the antivenom, and influence of repeated antivenom administration during hospital stay. This report aims to discuss how these challenges can affect patient management and to highlight improvement opportunities.Case Report:An 18-year-old man presented to the Emergency Department without remarkable signs of envenomation following a snakebite. An initial dose of antivenom was given despite the misidentification of snake species. An allergic reaction developed and was successfully managed. Following admission, the coagulation profile and local tissue reaction worsened. Upon consulting the Drug and Poison Information Center, it was discovered that a subtherapeutic dose of antivenom was administered. The patient was rechallenged after the administration of premedication. Coagulation profile could not be maintained; therefore, 2 extra doses of antivenom were administered, resulting in sustained improvement in local tissue reaction and coagulation profile.Conclusions:First, victims presenting without signs and symptoms of envenomation may benefit from close monitoring for late presentation of envenomation signs. Second, dosing guidelines are suggested to consider Institute of Safe Medication Practices recommendations for order sets to reduce the possibility of medication errors. Third, premedication may be an effective alternative in patients who develop allergic reaction to the locally produced equine antivenom in the setting of absent goat-derived antivenom. Lastly, antivenom administration should be titrated to patient response even if it occurs over several days.

Medication math dosage assessment anxiety in undergraduate nursing students: A systematic review.

Medication calculation assessment is commonplace in undergraduate nursing programs. A test is routinely used to assist in the determination of safe medication administration practice in a clinical setting. Multiple factors negatively impact student performance. The aim of this article is to analyze current literature related to medication calculation assessment and undergraduate nursing student anxiety. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Articles included were peer-reviewed publications focused on undergraduate nursing student anxiety related to medication dosage calculation. Anxiety related to medication calculation assessments can stem from students' personal lives and previous math experiences. Interventions related to increasing self-efficacy can impact student performance on assessments. A variety of interventions to assist undergraduate nursing students increase performance on assessments were indicated in the literature. Advances in educational technologies allow for more assessment options to facilitate safe medication practices.

Why is Anatomy Difficult to Learn? The Implications for Undergraduate Medical Curricula.

The impact of the medical curricular reform on anatomy education has been inconclusive. A pervasive perception is that graduates do not possess a sufficient level of anatomical knowledge for safe medical practice; however, the reason is less well-studied. This qualitative study investigated the perceived challenges in learning anatomy, possible explanations, and ways to overcome these challenges. Unlike previous work, it explored the perceptions of multiple stakeholders in anatomy learning. Semi-structured interviews were conducted and the transcripts were analyzed by a grounded theory approach. Three main themes emerged from the data: (1) visualization of structures, (2) body of information, and (3) issues with curriculum design. The decreasing time spent in anatomy laboratories forced students to rely on alternative resources to learn anatomy but they lacked the opportunities to apply to human specimens, which impeded the "near" transfer of learning. The lack of clinical integration failed to facilitate the "far" transfer of learning. Learners also struggled to cope with the large amount of surface knowledge, which was pre-requisite to successful deep and transfer of learning. It was theorized that the perceived decline in anatomical knowledge was derived from this combination of insufficient surface knowledge and impeded "near" transfer resulting in impeded deep and "far" transfer of learning. Moving forward, anatomy learning should still be cadaveric-based coupled with complementary technological innovations that demonstrate "hidden" structures. A constant review of anatomical disciplinary knowledge with incremental integration of clinical contexts should also be adopted in medical curricula which could promote deep and far transfer of learning.

Medication Errors.

PRESIDENT OF THE INSTITUTE FOR SAFE MEDICATION PRACTICES The reports described in Medication Errors were received through the ISMP Medication Errors Reporting Program. Report errors, close calls, or hazardous conditions to the Institute for Safe Medication Practices (ISMP) at www.ismp.org, 1-800-FAIL Safe, or [email protected]. Michael R. Cohen is a member of the Nursing2021 editorial board.

Both new and persistent medication errors among ISMP’s 2020 top 10 list

The Institute for Safe Medication Practice’s (ISMP) annual Top 10 Medication Errors and Hazards list may or may not include the most frequently reported errors or the errors that cause the most serious harm to patients. Instead, ISMP’s list focuses primarily on the most stubborn errors—the ones that occur year after year, even though certain practice or system changes are known to mitigate or avoid them. But new and emerging threats also earned spots in the 2020 edition, and their origin is unsurprising.

Characterizing perceptions of an abbreviated ISMP Medication Safety Self Assessment for community pharmacies

ObjectivesThis study sought to characterize users’ perceptions of, and identify the average time needed to complete a newly abbreviated version of the Institute for Safe Medication Practices Medication Safety Self Assessment for Community and Ambulatory Pharmacy (MSSA-CAP). MethodsThis study took place within a large, national, nonprofit, faith-based health system. An abbreviated version of ISMP’s MSSA-CAP was developed through an iterative process by researchers and the health system’s medication safety officers (MSOs, i.e., the assessment tool's 'users'). Retained items included those with nonoverlapping (1) bolded or keywords; (2) “quick asks,” answerable without external information; or (3) were relevant to community pharmacy practice (i.e., nonambulatory care–specific). During site visits, MSOs assessed the organization’s community pharmacies with the abbreviated tool. Users completed pre- and post-visit surveys asking their perceptions of and time spent using the full and abbreviated versions of the MSSA-CAP. Results were analyzed using descriptive statistics. ResultsSixty of the original MSSA-CAP’s 216 items were retained. Between August to December 2019, six MSO users assessed 59 community pharmacies across 10 states with the abbreviated assessment tool. On the average, users reported needing 86.1 ± 35.4 minutes to complete the abbreviated assessment. Sixty-seven percent of users agreed or strongly agreed that the abbreviated assessment was of a good length, compared with only 17% for the original full assessment. Collectively, assessed community pharmacies scored highest on MSSA-CAP items related to Physical Environment and Prescription Labels, and lowest on Hard Stops and Proactive Risk Assessments. ConclusionStreamlining items in medication safety assessment tools may be useful in overcoming time barriers to implementation in community pharmacies.

Medication Errors.

PRESIDENT OF THE INSTITUTE FOR SAFE MEDICATION PRACTICES The reports described in Medication Errors were received through the ISMP Medication Errors Reporting Program. Report errors, close calls, or hazardous conditions to the Institute for Safe Medication Practices (ISMP) at www.ismp.org, 1-800-FAIL Safe, or [email protected]. Michael R. Cohen is a member of the Nursing2021 editorial board.

Correlation between Medication Administration–Related Errors in Patients with Parkinson Disease and Timing of Pharmacy-Led Best Possible Medication Histories

Poor prescribing and incomplete medication administration have been linked to increased lengths of hospitalization for patients with Parkinson disease. The Institute for Safe Medication Practices (ISMP) has recommended that patients with Parkinson disease receive a pharmacy consultation within 2 h of admission to hospital. To examine whether the time for a pharmacy team member to obtain a best possible medication history (BPMH) was associated with administration-related medication errors. The primary outcome was the proportion of doses with a medication error during a patient's admission in relation to the time to completion of the initial BPMH by a registered pharmacist (RPh) or registered pharmacy technician (RPhT). The secondary objective was to compare the proportion of doses with a medication error in relation to whether the BPMH was completed by an RPh or an RPhT. This retrospective chart review involved patients with Parkinson disease who were admitted to the medicine services at London Health Sciences Centre from September 30, 2014, to September 30, 2018. Patients were included if they had Parkinson disease and a medication regimen that included levodopa-carbidopa. For all patients, an RPhT or RPh conducted the initial BPMH or updated the BPMH. Pearson correlation analysis was used to determine whether a correlation existed between administration-related errors and completion of the BPMH by a pharmacy staff member. A total of 84 patients with 104 admissions were included. There was no significant correlation between the time to completion of the initial BPMH by a pharmacy team member and the proportion of doses with medication errors (p = 0.32). Although RPhTs completed the BPMHs more quickly than RPhs (p < 0.001), there was no significant difference between pharmacy team members in terms of the proportion of doses with medication errors (p = 0.86). Completing a BPMH within 2 h of a patient's admission, as per the ISMP recommendation, is unlikely to affect administration-related medication errors, given that no correlation was identified. Expediting BPMH without addressing other factors is insufficient, and initiatives are required to improve the medication administration process.

To crush or not to crush: A brief review of novel tablets and capsules prepared from nanocrystal and amorphous solid dispersion technologies.

To educate healthcare professionals regarding the risks of manipulating drug products formulated via nanocrystal or amorphous solid dispersion technologies. Recent pharmaceutics innovations such as nanocrystals and amorphous solid dispersions have been used successfully to improve oral bioavailability of drugs. Over 30 drug products based on these technologies have been approved by the Food and Drug Administration, and more are in the development pipeline. While these products are similar in appearance to traditional tablets or capsules, they should not be crushed or suspended in liquid vehicles. Such manipulations can compromise the integrity of the formulation and subsequently alter the oral bioavailability. It is alarming that the majority of these products are not included in the Institute for Safe Medication Practices (ISMP) "Do Not Crush" list. A summary drug table is presented in this article to provide accurate information for pharmacists and other healthcare providers. Novel formulations of tablets and capsules are being used to increase the oral bioavailability of certain drugs. Crushing these products can significantly alter product performance and clinical outcomes. We encourage ISMP to add these drug products to the Do Not Crush list due to wide use of this list throughout healthcare. In the meantime, pharmacists should be mindful of the new formulation technologies and advocate for the proper use of these drug products.

Polypharmacy in the Older Adult: Medication Review in the Community

Polypharmacy remains a significant healthcare issue in the United States, resulting in drug interactions, adverse drug reactions, and potentially dangerous complications. Polypharmacy, often defined as the simultaneous use of five or more medications, may lead to adherence problems and an increased risk of hospitalizations and death, particularly in the older population. Medication management was incorporated into undergraduate nursing clinical experience in an affordable housing urban community as part of the New Jersey Geriatric Workforce Enhancement Program (NJGWEP), a 5-year grant supported by DHHS-HRSA. This paper will describe the first phase of this project, which involved the determination of the prevalence of polypharmacy and high-risk medications in this setting. The charts of sixty residents were reviewed and along with demographic information, the following data was collected: total number of medications (prescription, non-prescription and herbal supplements), high-risk medications using Beers criteria and identification of common themes or issues. The average age of the residents was 72 years, with cardiovascular diseases and diabetes mellitus being the most common comorbidities. Fifty-two of the sixty residents (86%) received five or more medications daily, meeting the definition of polypharmacy. The average number of medications taken on a daily basis was 8.9. Among the residents, centrally-active agents such as gabapentin, tramadol and lorazepam were the most commonly prescribed medications. The second phase of this project will include implementation of a medication reconciliation process to identify potential issues using the Beers criteria and implement appropriate interventions to ensure safe medication practices in this high-risk population.

Medication Errors

PRESIDENT OF THE INSTITUTE FOR SAFE MEDICATION PRACTICES The reports described in Medication Errors were received through the ISMP Medication Errors Reporting Program. Report errors, close calls, or hazardous conditions to the Institute for Safe Medication Practices (ISMP) at www.ismp.org, 1-800-FAIL Safe, or [email protected]. Michael R. Cohen is a member of the Nursing2020 editorial board.