scholarly journals Communication failure: analysis of prescribers’ use of an internal free-text field on electronic prescriptions

2018 ◽  
Vol 25 (6) ◽  
pp. 709-714 ◽  
Author(s):  
Angela Ai ◽  
Adrian Wong ◽  
Mary Amato ◽  
Adam Wright
Keyword(s):  
Safety Concern ◽  
Medical Center ◽  
Academic Medical Center ◽  
Electronic Prescribing ◽  
Free Text ◽  
Potential Harm ◽  
Administrative Personnel ◽  
Academic Medical ◽  
Record Data ◽  
Electronic Prescriptions

Abstract Importance Electronic prescribing promises to improve the safety and clarity of prescriptions. However, it also can introduce miscommunication between prescribers and pharmacists. There are situations where information that is meant to be sent to pharmacists is not sent to them, which has the potential for dangerous errors. Objective To examine how frequently prescribers or administrative personnel put information intended for pharmacists in a field not sent to pharmacists, classify the type of information included, and assess the potential harm associated with these missed messages. Design, Setting, Participants Medication record data from our legacy electronic health record were requested for ambulatory care patients seen at an academic medical center from January 1, 2000, to May 31, 2015 (20 123 881 records). From this database, 6 060 272 medication orders met our inclusion criteria. We analyzed a random sample of 10 000 medication orders with internal comments. Main Outcomes and Measures Reviewers classified internal comments for intent. Comments intended for pharmacists were also sorted into descriptive categories and analyzed for the potential for patient harm. Results We found that 11.7% of the prescriptions in our sample contained comments that were intended to be sent to pharmacists. Many comments contained information about the dose, route, or duration of the prescription (38.0%). Approximately a third of the comments intended for pharmacists contained information that had the potential for significant or severe harm if not communicated. Conclusion We found undelivered comments that were clearly intended for pharmacists and contained important information for either pharmacists or patients. This poses a legitimate safety concern, as a portion of comments contained information that could have prevented severe or significant harm.

ICU Admission Source as a Predictor of Mortality for Patients With Sepsis

2017 ◽  
Vol 33 (9) ◽  
pp. 510-516 ◽  
Author(s):  
Christine A. Motzkus ◽  
Stavroula A. Chrysanthopoulou ◽  
Roger Luckmann ◽  
Teresa A. Rincon ◽  
Kate L. Lapane ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Severity Of Illness ◽  
Hospital Ward ◽  
Icu Admission ◽  
Admission Source ◽  
Academic Medical ◽  
Record Data ◽  
Hospital Wards ◽  
Selection Of

Purpose: Sepsis is the leading noncardiac cause of intensive care unit (ICU) death. Pre-ICU admission site may be associated with mortality of ICU patients with sepsis. This study quantifies mortality differences among patients with sepsis admitted to an ICU from a hospital ward, emergency department (ED), or an operating room (OR). Methods: We conducted a retrospective cohort study of 1762 adults with sepsis using ICU record data obtained from a clinical database of an academic medical center. Survival analysis provided crude and adjusted hazard rate ratio (HRR) estimates comparing hospital mortality among patients from hospital wards, EDs, and ORs, adjusted for age, sex, and severity of illness. Results: Mortality of patients with sepsis differed based on the pre-ICU admission site. Compared to patients admitted from an ED, patients admitted from hospital wards had higher mortality (HRR: 1.35; 95% confidence interval [CI]: 1.09-1.68) and those admitted from an OR had lower mortality (HRR: 0.37; 95% CI: 0.23-0.58). Conclusion: Patients with sepsis admitted to an ICU from a hospital ward experienced greater mortality than patients with sepsis admitted to an ICU from an ED. These findings indicate that there may be systematic differences in the selection of patient care locations, recognition, and management of patients with sepsis that warrant further investigation.

Abstract WP324: Stroke Recognition Among Inpatient Staff at an Academic Medical Center

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Eric E Adelman ◽  
William J Meurer ◽  
Dorinda K Nance ◽  
Mary Jo Kocan ◽  
Kate E Maddox ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Signs And Symptoms ◽  
Rapid Identification ◽  
Warning Signs ◽  
Free Text ◽  
Staff Members ◽  
Academic Medical ◽  
Stroke Knowledge

Background About 10% of all strokes occur in hospitalized patients. The goal of this work was to evaluate the knowledge of stroke signs and to determine predictors of that knowledge among inpatient staff at an academic medical center. Methods Stroke education was the topic of a mandatory in-service for all adult inpatient medical, surgical, and ICU nursing unit clinical staff; including nurses, techs, and aides. The staff members anonymously completed an optional web-survey which included free text responses for stroke signs and symptoms, along with additional multiple choice questions regarding experience and training. The primary outcome was stroke knowledge which was defined as correct naming of 2 or more stroke warning signs or symptoms. Logistic regression was used to determine predictors of the primary outcome. Results The survey was offered to 1,593 staff members and 875 (55%) completed the survey. Eighty-seven percent of inpatient staff members correctly identified 2 or more stroke warning signs or symptoms while 31% identified 3 stroke warning signs or symptoms. Individual level predictors of stroke knowledge are shown in the Table. Greater self-reported confidence in identifying stroke symptoms and higher ratings for the importance of rapid identification of stroke symptoms were associated with stroke knowledge. Clinical experience, educational experience, work location, and personal knowledge of a stroke patient were not associated with stroke knowledge. Conclusion More than 80% of adult clinical inpatient staff members have knowledge of two or more stroke signs and symptoms. Future nursing education should emphasize the importance of rapid identification of stroke signs and symptoms and increasing confidence in knowledge of stroke symptoms.

scholarly journals Implementation of an Extended-Infusion Piperacillin-Tazobactam Dosing Protocol: Unexpected Findings when Monitoring Safety and Compliance with Smart Pump Technology

Pharmacy ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 169
Author(s):  
Nathaniel J. Rhodes ◽  
Jenna Lopez ◽  
Cecilia K. Pham ◽  
Helga Brake ◽  
Michael Fotis ◽  
...  
Keyword(s):  
Medical Center ◽  
Infusion Pump ◽  
Academic Medical Center ◽  
Potential Harm ◽  
Academic Medical ◽  
Before And After ◽  
Protocol Compliance ◽  
Unexpected Findings ◽  
Smart Pump ◽  
Extended Infusion

Compliance with recommended infusion rates was evaluated before, during, and after the implementation of extended-infusion (EI) piperacillin-tazobactam at an academic medical center. Software-controlled infusion-pump alert data were studied for piperacillin-tazobactam administrations before and after implementation of a four-hour EI protocol. Compliance was analyzed 16 weeks before (pre-EI), two weeks after (peri-EI), and an additional 16 weeks after (post-EI) protocol implementation. We defined potential harm as a programmed infusion rate exceeding the recommended rate, possible harm as a programmed infusion aborted by the user, and compliance as reversion to recommended rates. Potential and possible harm were standardized to 1000 patient days. Overall, 3110 alerts were identified during the period. Potential harm per 1000 patient days for pre-, peri-, and post-EI were 0, 6.12, and 1.05 (p < 0.001). Possible harm per 1000 patient days for the pre-, peri-, and post-EI were 0.33, 21.9, and 5.02 (p < 0.001). Compliance after an initial potential harm alert occurred more often post-EI (0.4 per 1000 patient days vs. 0 per 1000 patient days for pre- and peri-EI; p < 0.001), while alerts remaining in non-compliance were more prevalent if they initially occurred during the peri- and post-EI vs. pre-EI (6.1 and 0.6 per 1000 patient days vs. 0 per 1000 patient days; p < 0.001) period. Piperacillin-tazobactam infusions were administered faster than recommended during implementation (i.e., peri-EI) despite standardized orders.

Implementation of a Direct Oral Anticoagulation Screening Service at a Large Academic Medical Center Provided by a Pharmacist-managed Antithrombosis Clinic as a Method to Expand Antithrombotic Stewardship Efforts

2018 ◽  
Vol 33 (3) ◽  
pp. 271-275 ◽  
Author(s):  
Ellen M. Uppuluri ◽  
Meghan N. McComb ◽  
Nancy L. Shapiro
Keyword(s):  
Medical Center ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Academic Medical Center ◽  
Electronic Prescribing ◽  
First Year ◽  
Screening Service ◽  
Medication Access ◽  
Academic Medical

Background: How and when to monitor direct oral anticoagulants (DOACs) for safety and efficacy is a question many anticoagulation clinics are trying to answer. A pharmacist-led antithrombosis clinic (ATC) initiated a clinical service to provide oversight for all prescribed DOACs. Objective: Describe the implementation and outcomes of a DOAC screening service. Methods: The service was initiated utilizing a daily electronic prescribing report of DOAC prescriptions. Prescriptions were reviewed by clinical pharmacists to assess patient insurance, eligibility, and accuracy of prescribed doses. Results: In the first year since service implementation in April 2016, 317 new prescriptions and 595 refill prescriptions were reviewed. A DOAC service pharmacist was able to reach 125 (39.4%) of 317 patients about their new prescription and 59 (9.9%) of 595 refill patients to provide education and follow-up on management as needed. Interventions were performed for 79 (28%) of 317 new prescriptions and 86 (14.5%) of 595 refill prescriptions. Common interventions with new prescriptions include contacting the prescriber for a medication or dose change (25.4%), assistance with medication access (21.5%), and coordinating appropriate lab and provider follow up (21.5%). Common interventions with refill prescriptions include recommending appropriate follow-up (50%) and contacting the prescriber for medication or dosage change (24.4%). Conclusion: Implementation of a DOAC screening service identified and resolved dosing errors, improved medication access, provided patient education, and improved follow-up.

Gender differences in career progress and satisfaction in an academic medical center

2002 ◽  
Vol 2 (3) ◽  
pp. 95-104 ◽  
Author(s):  
JoAnn Manson ◽  
Beverly Rockhill ◽  
Margery Resnick ◽  
Eleanor Shore ◽  
Carol Nadelson ◽  
...  
Keyword(s):  
Gender Differences ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Career Progress
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