Wrong Instructions Research Articles

Exploring near miss errors associated with split-pack robotic dispensing

Abstract Introduction Pharmacy automation using dispensing robots for the supply of medicines is not new. Improved dispensing efficiencies, maximised storage capacity and reduced dispensing errors are cited as key benefits.1 Published articles describe the impact of automation on dispensing error rates and types for original-pack dispensing2 with a paucity of literature on split-packs. Split-pack dispensing cannot be entirely eradicated: the ability to barcode and return to the robot facilitates the storage of medicines locally where dispensary footprint is limited; a manual process and one that is subject to human error. With anecdotal reports of split-pack robotic dispensing errors, there is an opportunity to explore near-miss errors as part of routine monitoring undertaken. Aim To establish the incidence and type of near-miss dispensing errors associated with split-pack robotic dispensing. Methods Approval was obtained from the Trust Pharmacy Research Committee. The need for ethical submission was waived. Near-miss dispensing errors were recorded in real-time via direct observations using a standardised data collection tool adapted from the Royal Pharmaceutical Society Near Miss Error Log3; with additional data collected on whether prescription requests were for original or split-pack quantities and storage location. All drugs dispensed/ checked in the dispensary between 09:00-17:00 were included (4 days in January 2023). All prescription types for individual patient medication orders were included. Stock drugs and outpatient prescriptions were excluded. A manual count of all items dispensed/ checked was undertaken each day to provide the denominator. Data was entered into Microsoft excel and analysed. Results Overall near-miss dispensing error incidence of 3.5% (72 near-misses/ 2035 items dispensed). Fourteen of fifty-eight (24.1%) erroneously dispensed items had two near-misses identified. Near-miss incidence associated with original-pack dispensing of 3.1% (50 near-misses/ 1590 items dispensed) compared with split-pack dispensing of 4.9% (22 near-misses/ 445 items dispensed). Chi square (with Yate’s correction) did not identify a statistical significant difference between the overall near-miss error rate between the two (p> 0.06). Most common original-pack dispensing error types were ‘wrong instructions on label’ (n=29/50), ‘wrong quantity on label and dispensed’ (n= 6/50), and ‘missing label’ on item (n=5/50). For split-pack dispensing, ‘wrong instructions on label’ (n=9/22), ‘wrong quantity dispensed’ (n=8/22), and ‘wrong quantity labelled’ (n=5/22) were most common. Discussion/Conclusion Local prevalence of near-misses is higher than in reported published literature1. Whilst direct comparisons are difficult to make due to differences in research methods, definitions, and operating systems; the incidence of near-miss errors associated with split-packs was notably higher than original-pack dispensing despite no statistical difference. Similar near-miss error types were identified for original/ split-pack dispensing with ‘wrong instructions on the label’ being the most common. This is consistent with published literature1 on errors with pharmacy automation. With split-pack robotic dispensing, it was noted that the quantity were not always as identified on the barcode label due to the manual returns process. Direct observations have indicated that missing patient information leaflets are a common problem for split-pack dispensing, although not recorded in this study. Further work should focus on causes/ contributory factors to split-pack robotic dispensing errors.

Plain language summary of the GENEr8-1 clinical trial of valoctocogene roxaparvovec gene therapy for hemophilia A

What is this summary about? In healthy people, a protein called factor VIII (FVIII) helps blood to clot and prevents excessive bleeding. People with hemophilia A lack FVIII because a faulty F8 gene is giving the wrong instructions to the liver cells that make it. Valoctocogene roxaparvovec (ROCTAVIAN™) is a gene therapy designed to transfer working copies of the F8 gene into liver cells. This summary describes the GENEr8-1 study, which looked at how well valoctocogene roxaparvovec works for treating people with severe hemophilia A compared with their usual FVIII replacement therapy, and its safety. 134 men received valoctocogene roxaparvovec; results from the first 2 years are reported. What were the results? Valoctocogene roxaparvovec significantly improved bleed control in men with severe hemophilia A. A single infusion reduced average treated bleeding episodes per year from almost 5 while on FVIII prophylaxis to less than one after gene therapy. Eight out of every 10 participants had no bleeds needing treatment and 9 out of every 10 had no joint bleeds needing treatment; FVIII levels improved to normal or mild hemophilia ranges. All except 6 participants remained off regular FVIII prophylaxis for at least 2 years. All participants had at least one side effect and 22 (16%) reported serious adverse events. Nine out of every 10 participants (89%) showed increased blood levels of liver enzymes, indicating an expected immune response to the product's viral shell; this was manageable with steroids. Other common side effects included headache (41%), joint pain (40%), feeling sick (38%), and side effects to steroids (60%). What do the results mean? After a one-time dose of valoctocogene roxaparvovec, people with severe hemophilia A start producing their own FVIII and require fewer or no FVIII injections to protect them from bleeds. Results showing bleed control for at least 2 years have led to approvals of valoctocogene roxaparvovec in Europe and the USA for use in adults with severe hemophilia A who do not have antibodies against FVIII or AAV type 5. How well valoctocogene roxaparvovec works and the side effects over a longer period are still being studied.

A cycle-level recovery method for embedded processor against HT tamper

As the core of Internet of Things (IoT), embedded processors are being used more and more extensive. However, embedded processors face various hardware security issues such as hardware trojans (HT) and code tamper attacks. In this paper, a cycle-level recovery method for embedded processor against HT tamper is proposed, which builds two hardware-implementation units, a General-Purpose Register (GPRs) backup unit and a PC rollback unit. Once a HT tamper is detected, the two units will carry out fast recovery through rolling back to the exact PC address corresponding to the wrong instruction and resuming the instruction execution. An open RISC-V core of PULPino is adopted for recovery mechanism verification, the experimental results and hardware costs show that the proposed method could guarantee the processor restore from abnormal state in real time with a reasonable hardware overhead.

Transparent Interaction Based Learning for Human-Robot Collaboration

The number of collaborative robots that perform different tasks in close proximity to humans is increasing. Previous studies showed that enabling non-expert users to program a cobot reduces the cost of robot maintenance and reprogramming. Since this approach is based on an interaction between the cobot and human partners, in this study, we investigate whether making this interaction more transparent can improve the interaction and lead to better performance for non-expert users. To evaluate the proposed methodology, an experiment with 67 participants is conducted. The obtained results show that providing explanation leads to higher performance, in terms of efficiency and efficacy, i.e., the number of times the task is completed without teaching a wrong instruction to the cobot is two times higher when explanations are provided. In addition, providing explanation also increases users’ satisfaction and trust in working with the cobot.

Online detection of class-imbalanced error-related potentials evoked by motor imagery

Objective. Error-related potentials (ErrPs) are spontaneous electroencephalogram signals related to the awareness of erroneous responses within brain domain. ErrPs-based correction mechanisms can be applied to motor imagery-brain–computer interface (MI-BCI) to prevent incorrect actions and ultimately improve the performance of the hybrid BCI. Many studies on ErrPs detection are mostly conducted under offline conditions with poor classification accuracy and the error rates of ErrPs are preset in advance, which is too ideal to apply in realistic applications. In order to solve these problems, a novel method based on adaptive autoregressive (AAR) model and common spatial pattern (CSP) is proposed for ErrPs feature extraction. In addition, an adaptive threshold classification method based spectral regression discriminant analysis (SRDA) is suggested for class-unbalanced ErrPs data to reduce the false positives and false negatives. Approach. As for ErrPs feature extraction, the AAR coefficients in the temporal domain and CSP in the spatial domain are fused. Given that the performance of different subjects’ MI tasks is different but stable, and the samples of ErrPs are class-imbalanced, an adaptive threshold based SRDA is suggested for classification. Two datasets are used in this paper. The open public clinical neuroprosthetics and brain interaction (CNBI) dataset is used to validate the performance of the proposed feature extraction algorithm and the real-time data recorded in our self-designed system is used to validate the performance of the proposed classification algorithm under class-imbalanced situations. Different from the pseudo-random paradigm, the ErrPs signals collected in our experiments are all elicited by four-class of online MI-BCI tasks, and the sample distribution is more natural and suitable for practical tests. Main results. The experimental results on the CNBI dataset show that the average accuracy and false positive rate for ErrPs detection are 94.1% and 8.1%, which outperforms methods using features extracted from a single domain. What’s more, although the ErrPs induction rate is affected by the performance of subjects’ MI-BCI tasks, experimental results on data recorded in the self-designed system prove that the ErrPs classification algorithm based on an adaptive threshold is robust under different ErrPs data distributions. Compared with two other methods, the proposed algorithm has advantages in all three measures which are accuracy, F1-score and false positive rate. Finally, ErrPs detection results were used to prevent wrong actions in a MI-BCI experiment, and it leads to a reduction of the hybrid BCI error rate from 48.9% to 24.3% in online tests. Significance. Both the AAR-CSP fused feature extraction and the adaptive threshold based SRDA classification methods suggested in our work are efficient in improving the ErrPs detection accuracy and reducing the false positives. In addition, by introducing ErrPs to multi-class MI-BCIs, the MI decoding results can be corrected after ErrPs are detected to avoid executing wrong instructions, thereby improving the BCI accuracy and lays the foundation for using MI-BCIs in practical applications.

Dispensing Errors in Hospital Pharmacies in Yemen: An Exploratory Study

Aims. This study aimed to describe the dispensing errors that occurred during the dispensing process in selected hospital pharmacies in Sana'a, Yemen, and to describe their types and causes. Methodology. A prospective study was carried out in selected hospital pharmacies in Yemen over 40 days using a validated tool. Results. A total of 9000 dispensed prescriptions were evaluated for the dispensing errors, and 2.13% dispensing errors were identified. Wrong dosage form (134/192), incorrect strength (24/192), wrong drug (18/192), incorrect quantity, wrong instructions written and drug available in the pharmacy but not given (6/192) and dispensing expired drugs (3/192) were the dispensing errors reported in this study. Poor handwriting, similar drug names, similar drug packaging, fatigue, heavy work, workforce issues, and poor communication were the most commonly reported causes of dispensing errors. Conclusion. There is a wide variation in the rates of prevalence of medication errors observed during this prospective study. Dispensing errors were the most common. This variation may be attributed to the nature and heterogeneity of the prescription’s sources. Study results indicate that medication errors imposed an extraordinary challenge to the healthcare system in Yemen and post significant potential harm to the patient in light of the current economic, social and security conditions. Well-designed nationwide future studies aimed at investigating the causes of medication errors to guide the design of interventions aimed at reducing their burden on the national healthcare system is highly recommended.

Research on Security Technology of Network Communication Information Based on Double Encryption

Data is transmitted from the server to the terminal or the terminal to the server during the transmission process, the data information is easily monitored or tampered with, which will cause information leakage or data display false data. If the wrong instruction information may be received in the industrial control field, it will bring a lot to industrial production. Hazards and losses, so in order to ensure the reliability and data security of the network communication between the terminal and the server, industrial equipment and management system, it is very necessary to use secure communication connections and reliable data encryption algorithms to ensure communication and data security.This paper proposes an improved AES and MD5 hybrid encryption scheme, which uses SSL to encrypt the transmission channel during the communication process, uses the improved symmetric encryption algorithm AES to encrypt the data in network transmission, and encrypts the data at the sending end Then use the improved MD5 to generate a digital fingerprint for the encrypted data. At the receiving end, use MD5 to generate the same fingerprint for the encrypted data sent, and use the digest fingerprint verification to determine whether the data has been tampered with or lost during transmission. is possible to greatly improve the security and reliability of system communication and data.

Detection Scheme Against Cyber-Physical Attacks on Load Frequency Control Based on Dynamic Characteristics Analysis

The safety and security of load frequency control (LFC) system are menaced by cyber attacks and physical attacks. Sophisticated attackers can launch cyber-physical attacks (CPAs), in which cyber attacks are used to increase the impacts of physical attacks by sending wrong instructions to the LFC controller. Considering that parameters of cyber attacks in CPAs may be either fixed or variable, a novel detection scheme is designed against two potential CPAs on an LFC system, namely fixed cyber-physical attacks (FCPAs) and variable cyber-physical attacks (VCPAs), respectively. As for FCPAs, dynamic characteristics of Area Control Error (ACE) are utilized to detect the compromised data. Compared with FCPAs, VCPAs are more deceptive. A relation-based (RB) feature extraction method is introduced to distinguish the signals compromised by VCPAs from the normal ones. A detection model that does not require compromised samples is developed with the aid of support vector domain description. In the end, a comprehensive detection scheme is designed to detect both FCPAs and VCPAs on the LFC system.

Evaluation of out-patient prescriptions in rural part of central Gujarat.

Background:The prescription error is a failure in the prescription writing process leading to wrong instructions about the identity of the recipient, the identity of the drug, the formulation, dose, route, timing, frequency, and duration of administration. This study is an effort directed to find errors in prescription writing and interventions to improve on such error-prone practices of prescription writing.Methods:This was a cross-sectional, observational study conducted to analyze the prescription writing errors in the outpatient department in the rural area of Anand district of Central Gujarat. Prescriptions were collected from two nearby rural areas of Anand city-Petlad and Anklav. The prescription copies so-obtained were analyzed as per the WHO guidelines for “Prescription Writing Errors.”Results:Overall, 191 prescriptions were collected from both rural areas in the study. The highest number of prescriptions was collected from general practitioners, followed by surgeons and gynecologists. Name, qualification, and address of prescribers were mentioned in all the prescriptions while registration number was mentioned only in 14.10% of prescriptions. The esoteric symbol was mentioned in 63% of prescriptions. Prescribers signed their prescription only in 48% of prescriptions. A total of 420 drugs were prescribed to the patients in the study. All but one drug were prescribed by brand name. Dosage form and route of administration of drugs were mentioned in >60% of drugs.Conclusion:Most medical schools provide some training in prescribing to medical undergraduates; however, this training is perceived to be suboptimal by medical students and junior doctors. Such training programs are the need of the hour.

Enhancing Instruction TLB Resilience to Soft Errors

A translation lookaside buffer (TLB) is a type of cache used to speed up the virtual to physical memory translation process. Instruction TLBs store virtual page numbers and their related physical page numbers for the last accessed pages of instruction memory. TLBs like other memories suffer soft errors that can corrupt their contents. A false positive due to an error produced in the virtual page number stored in the TLB may lead to a wrong translation and, consequently, the execution of a wrong instruction that can lead to a program hard fault or to data corruption. Parity or error correction codes have been proposed to provide protection for the TLB, but they require additional storage space. This paper presents some schemes to increase the instruction TLB resilience to this type of errors without requiring any extra storage space, by taking advantage of the spatial locality principle that takes place when executing a program.

In directions to patients,be clear and explicit

Recently, a 67-year-old man, who appeared well educated and knowledgeableabout his health care, arrived at the emergency department(ED) with hypotension, tachycardia, gray vision, and lightheadedness.The patient's EKG showed an abnormal sinus rhythm resembling atrialfibrillation. The patient's cardiologist recommended starting him ondigoxin and increasing his current metoprolol dose.

Double Dutch: The ‘think-aloud’ Brief IPQ study uses a Dutch translation with confusing wording and the wrong instructions

This commentary describes the methodological shortcomings and the misleading presentation of the 'think-aloud' Brief Illness Perception Questionnaire (IPQ) paper by van Oort, Schröder, & French (2011). We highlight that this paper uses a confusing Dutch translation of the scale, fabricates incorrect instructions, and employs a sample in which the majority of patients do not have established illness diagnoses. We believe these problematic methodological issues are the likely cause of the results presented in the paper. We argue that the conclusions of the paper are inaccurate, unsupported, and overstated given the limitations of the study. Furthermore, the think-aloud method cannot be a substitute for the established psychometric methods for assessing reliability and validity.

Incidence of near accidental drowsing in locomotive driving during a period of rotation.

The incidence of drowsings as a cause of near traffic accidents was studied on the basis of daily recordings or near accidental events by 288 locomotive drivers during a rotation period of 2-3 weeks. Of 198 near accidents reported during 2,290 trips, 34 cases, or 1,5 cases per 100 trips, were operation missess involving drowsing or strong drowsiness. Improper operation due to drowsing occurred at a certain rate for any group of drivers, irrespective of the type of train, running sections, weather, and other operative conditions such as train delays, whereas 117 cases of danger caused by unforeseen obstacles on the track were related to site characteristics, and 47 cases of other disorders were frequent in unusual operative conditions such as arrival-departure, poor signal display, wrong instructions, or equipment failure. Thus continued driving under ordinary track conditions at a more or less constant speed was likely to induce drowsiness under the dominant influences of fatigue and time of the day; 79% of such cases occurred between midnight and 6 a.m. Most drowsings on the second night appeared during the first 2-4 hr of duty. Effects of monotony and insufficient rest were discussed in relation to recurrent fluctuation in vigilance.

Medication errors: EMERGing solutions

C’est pire qu’un crime, c’est une fauteCharles Maurice de Talleyrand-Perigord (attributed)The error that Talleyrand is said to have considered worsethan a crime was Napoleon’s order to execute the Ducd’Enghien in 1794.The saying has also been attributed toJoseph Fouche, Bonaparte’s Minister of Police (later to bethe Duc d’Otrante) and to Antoine Boulay de la Meurthe (adeputy in the corps legislative). But whoever said it, itbetokens an attitude that the end justifies the means.And while one would not recommend breaking the law inorder to avoid medication errors, one should certainlystrive to avoid them as assiduously as one would refrainfrom committing a crime.A Pubmed search for the terms ‘medication errors’ or‘prescribing errors’yields nearly 8000 hits. [In contrast‘sur-gical errors’ yields about 100 hits – do surgeons not makeerrors?] And there is evidence that deaths from medicationerrors have been on the rise [1].This issue of the

Medication errors: definitions and classification

1. To understand medication errors and to identify preventive strategies, we need to classify them and define the terms that describe them. 2. The four main approaches to defining technical terms consider etymology, usage, previous definitions, and the Ramsey-Lewis method (based on an understanding of theory and practice). 3. A medication error is 'a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient'. 4. Prescribing faults, a subset of medication errors, should be distinguished from prescription errors. A prescribing fault is 'a failure in the prescribing [decision-making] process that leads to, or has the potential to lead to, harm to the patient'. The converse of this, 'balanced prescribing' is 'the use of a medicine that is appropriate to the patient's condition and, within the limits created by the uncertainty that attends therapeutic decisions, in a dosage regimen that optimizes the balance of benefit to harm'. This excludes all forms of prescribing faults, such as irrational, inappropriate, and ineffective prescribing, underprescribing and overprescribing. 5. A prescription error is 'a failure in the prescription writing process that results in a wrong instruction about one or more of the normal features of a prescription'. The 'normal features' include the identity of the recipient, the identity of the drug, the formulation, dose, route, timing, frequency, and duration of administration. 6. Medication errors can be classified, invoking psychological theory, as knowledge-based mistakes, rule-based mistakes, action-based slips, and memory-based lapses. This classification informs preventive strategies.

A 3-year study of medication incidents in an acute general hospital

Inappropriate medication use may harm patients. We analysed medication incident reports (MIRs) as part of the feedback loop for quality assurance. From all MIRs in a university-affiliated acute general hospital in Hong Kong in the period January 2004-December 2006, we analysed the time, nature, source and severity of medication errors. There were 1278 MIRs with 36 (range 15-107) MIRs per month on average. The number of MIRs fell from 649 in 2004, to 353 in 2005, and to 276 in 2006. The most common type was wrong strength/dosage (36.5%), followed by wrong drug (16.7%), wrong frequency (7.7%), wrong formulation (7.0%), wrong patient (6.9%) and wrong instruction (3.1%). 60.9%, 53.7% and 84.0% of MIRs arose from handwritten prescription (HP) rather than the computerized medication order entry in 2004, 2005 and 2006 respectively. In 43.1% of MIRs, preregistration house officers were involved. Most errors (80.2%) were detected before any drug was wrongly administered. The medications were administered in 212 cases (19.7%), which resulted in an untoward effect in nine cases (0.8%). The most common errors were wrong dosage and wrong drug. Many incidents involved preregistration house officers and HPs. Our computerized systems appeared to reduce medication incidents.

Choice-egalitarianism and the paradox of the baseline: a reply to Manor

In 'Choice-egalitarianism and the paradox of the baseline' (2003) I proposed a paradox pertaining to choice-egalitarianism (CE), the dominant philosophical view of egalitarianism. In his ingenious response, Tal Manor (2005) uses my reductio argument against my own argument. I made two claims against CE. First, that under careful analysis, CE compels us to bring about states of affairs so unacceptable that the position becomes absurd. By virtue of its very conceptual structure, CE gives us manifestly wrong instructions. Second, that CE's hope of reconciling a strong egalitarianism with robust personal choice and something like the prevailing market economy is a chimera. Manor's paper does not dispute my second claim. Indeed, his own claim, that in fact CE leads to something close to strict equality, supports my pessimism about CE's reconciliation project. My reply to Manor therefore focuses on his denial of my first claim, that choice-egalitarianism leads to absurdity. According to CE, the moral baseline is equality, and the only way of justifying inequality is if it results from one's free choice: people may not

Knowledge of diarrhea management among rural practitioners.

To determine diarrhea management in rural practitioners. This study was conducted among the RMP's of 4 blocks of Aligarh. Pre-coded questionnaire was completed and educational programme followed. 91% were prescribing ORS in various combinations, but only 9.8% were advising ORS and feeding as standard management of diarrhea. Only 12.8% could name a WHO ORS brand and 50% were giving wrong instructions for preparation. 95% were advising inadequate amounts of ORS. Only 43.5% were advising feeding during diarrhea but 86.6% were advising to continue breastfeeding. On an average every 3rd to 4th patient was administered IVF's. 52% felt that drugs should be prescribed. 90% and 55.3% of RMPs could identify diarrhea and key signs of dehydration. There is a need for hands on training for the practitioners and education of the masses regarding proper management of diarrhea.

Self-repair in dialogues of schizophrenics: Effects of hallucinations and negative symptoms

This paper concerns the discourse features of verbal hallucinations and negative symptoms of schizophrenia. A total of 46 schizophrenics, varying in verbal hallucination and in negative symptoms status, and 22 controls were tested on the Reporter Test. The frequency with which they issued inadequate instructions, attempted to repair the inadequacies, and the success of repairs were compared. We observed that schizophrenics, on the whole, issued more wrong and incomplete instructions. This was in part related to their worse working memory, but it was not affected by verbal hallucinations or negative symptoms. We observed, further, that schizophrenics had no particular problems monitoring messages for inadequacies. We did find, however, that schizophrenics with verbal hallucinations had a specific problem with self-repairing wrong instructions. We interpret these results in the framework of Hoffman's (1986b) plan disruption-based model of verbal hallucinations; the Frith (1987) and Frith and Done (1988) internal monitoring model of positive and negative symptoms; and finally Frith and Frith's (1990) model of negative and positive schizophrenia and we use the results to specify the models.

Incidence of near accidental drowsing in locomotive driving during a period of rotation : Kogi, K. and Ohta, T.Journal of Human Ergology, Sep 1975, 4.1, 65–76

The incidence of drowsings as a cause of near traffic accidents was studied on the basis of daily recordings or near accidental events by 288 locomotive drivers during a rotation period of 2-3 weeks. Of 198 near accidents reported during 2,290 trips, 34 cases, or 1,5 cases per 100 trips, were operation missess involving drowsing or strong drowsiness. Improper operation due to drowsing occurred at a certain rate for any group of drivers, irrespective of the type of train, running sections, weather, and other operative conditions such as train delays, whereas 117 cases of danger caused by unforeseen obstacles on the track were related to site characteristics, and 47 cases of other disorders were frequent in unusual operative conditions such as arrival-departure, poor signal display, wrong instructions, or equipment failure. Thus continued driving under ordinary track conditions at a more or less constant speed was likely to induce drowsiness under the dominant influences of fatigue and time of the day; 79% of such cases occurred between midnight and 6 a.m. Most drowsings on the second night appeared during the first 2-4 hr of duty. Effects of monotony and insufficient rest were discussed in relation to recurrent fluctuation in vigilance.