Evaluation of electronic medication management systems on inpatient omitted dose rates at 2 acute metropolitan hospitals

Rationale, aim and objectives: Medication error is common and the most common form of administration error is omission. Implementation of Electronic Medication Management systems (eMMS) has been hypothesized to decrease the rate of omitted doses due to the creation of a number of forcing functions and decision support tools however there is limited evidence currently available in the literature to support this assumption. This study therefore aims to ascertain if implementation of eMMS at 2 acute metropolitan hospitals reduces the rate of omitted doses Method: A retrospective cohort study was undertaken pre and post implementation of eMMS. Patients meeting eligibility criteria had all medication charts from their admission reviewed and an omitted dose rate calculated. For each omitted dose identified; medication name, imprest availability, dispensing history, administration time and frequency were recorded. Results: 386 patients met eligibility criteria for this study (11,796 opportunities for omission). The implementation of eMMS was associated with a significant reduction in omitted doses (3.6% vs 1.8% p<0.01). Benefit was not consistent among subgroups. eMMS implementation at the hospital with the higher baseline omitted dose rate was associated with a significant reduction in omitted doses (5.8% vs 0.9% p<0.01) but not at the hospital with a lower baseline rate (2.7% vs 2.4% p=0.3). The most common times for an omitted dose to occur were 0800 (33%) and 2000 (18%). The most common frequencies for an omitted dose were daily (35%) and twice daily (32%). Conclusion: The introduction of eMMS was associated with a decrease rate of omitted doses. Greatest benefit is likely to occur in areas with a high baseline rate of omission.

Investigating the Role of Labelling and Packaging on Medication Error

<p>Medication administration error contributes to deaths and injury in hospitals, especially in the area of anaesthesia. Labelling and packaging contribute to medication error. The current study examined the role of labelling and packaging in medication error and compared medically trained and medically naive participants. Using eye-tracking equipment, Study 1A investigated the distribution of fixations across 32 pre-existing medication labels and packages. Both groups of participants fixated less on the dose and top of medications than on the name and ‘other’ features. Both medical experience and packaging type influenced on which label areas participants fixated. Medical participants fixated on dose more than control participants; there were no other differences between groups. In Study 1B participants viewed a target medication, they were then asked whether it was present in an array. The target was present in 50% of arrays. Distractors varied in similarity to the target. Signal detection theory analysis of discriminability through d’ revealed that medical participants were significantly better than control participants at discriminating whether or not the target was in the array. Bias analyses through C revealed that there was no difference between the biases of the two groups. Both groups of participants adopted a liberal criterion which increased the occurrence of false alarms. Across all trials, participants were most likely to select a distractor that differed only in the dose of the medication. Divided attention can increase medication error rates, therefore Study 1C utilised the same procedure as Study 1B and added a divided attention task. During the divided attention task participants saw a string of either five or seven letters and were later asked to recall one of the letters. Both groups of participants recalled fewer letters in the seven-letter compared to five-letter condition. There was no difference in the overall performance of the two groups on the divided attention task. Both groups showed a significant reduction in discriminability under the seven- compared to five-letter divided attention condition. Medical participants had significantly higher discriminability indices than control participants. Both groups of participants adopted a liberal criterion, however control participants were more biased than medical professionals. Control participants displayed an increase in bias in the seven-letter, compared to five-letter condition; the bias of medical participants was not influenced by the divided attention task. As in Study 1B, participants were most likely to select a distractor that differed only in the dose of the medication.</p>

Investigating the Role of Labelling and Packaging on Medication Error

<p>Medication administration error contributes to deaths and injury in hospitals, especially in the area of anaesthesia. Labelling and packaging contribute to medication error. The current study examined the role of labelling and packaging in medication error and compared medically trained and medically naive participants. Using eye-tracking equipment, Study 1A investigated the distribution of fixations across 32 pre-existing medication labels and packages. Both groups of participants fixated less on the dose and top of medications than on the name and ‘other’ features. Both medical experience and packaging type influenced on which label areas participants fixated. Medical participants fixated on dose more than control participants; there were no other differences between groups. In Study 1B participants viewed a target medication, they were then asked whether it was present in an array. The target was present in 50% of arrays. Distractors varied in similarity to the target. Signal detection theory analysis of discriminability through d’ revealed that medical participants were significantly better than control participants at discriminating whether or not the target was in the array. Bias analyses through C revealed that there was no difference between the biases of the two groups. Both groups of participants adopted a liberal criterion which increased the occurrence of false alarms. Across all trials, participants were most likely to select a distractor that differed only in the dose of the medication. Divided attention can increase medication error rates, therefore Study 1C utilised the same procedure as Study 1B and added a divided attention task. During the divided attention task participants saw a string of either five or seven letters and were later asked to recall one of the letters. Both groups of participants recalled fewer letters in the seven-letter compared to five-letter condition. There was no difference in the overall performance of the two groups on the divided attention task. Both groups showed a significant reduction in discriminability under the seven- compared to five-letter divided attention condition. Medical participants had significantly higher discriminability indices than control participants. Both groups of participants adopted a liberal criterion, however control participants were more biased than medical professionals. Control participants displayed an increase in bias in the seven-letter, compared to five-letter condition; the bias of medical participants was not influenced by the divided attention task. As in Study 1B, participants were most likely to select a distractor that differed only in the dose of the medication.</p>

Improving patient safety through identifying barriers to reporting medication administration errors among nurses: an integrative review

Background The aim of the third WHO challenge released in 2017 was to attain a global commitment to lessen the severity and to prevent medication-related harm by 50% within the next five years. To achieve this goal, comprehensive identification of barriers to reporting medication errors is imperative. Objective This review systematically identified and examined the barriers hindering nurses from reporting medication administration errors in the hospital setting. Design An integrative review. Review methods PubMed, Web of Science, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) including Google scholar were searched to identify published studies on barriers to medication administration error reporting from January 2016 to December 2020. Two reviewers (AA, and KDK) independently assessed the quality of all the included studies using the Mixed Methods Appraisal Tool (MMAT) version 2018. Results Of the 10, 929 articles retrieved, 14 studies were included in this study. The main themes and subthemes identified as barriers to reporting medication administration errors after the integration of results from qualitative and quantitative studies were: organisational barriers (inadequate reporting systems, management behaviour, and unclear definition of medication error), and professional and individual barriers (fear of management/colleagues/lawsuit, individual reasons, and inadequate knowledge of errors). Conclusion Providing an enabling environment void of punitive measures and blame culture is imperious for nurses to report medication administration errors. Policymakers, managers, and nurses should agree on a uniform definition of what constitutes medication error to enhance nurses’ ability to report medication administration errors.

Effectiveness of a ‘do not interrupt’ vest intervention to reduce medication errors during medication administration: a multicenter cluster randomized controlled trial

Background The use of a ‘do not interrupt’ vest during medication administration rounds is recommended but there have been no controlled randomized studies to evaluate its impact on reducing administration errors. We aimed to evaluate the impact of wearing such a vest on reducing such errors. The secondary objectives were to evaluate the types and potential clinical impact of errors, the association between errors and several risk factors (such as interruptions), and nurses’ experiences. Methods This was a multicenter, cluster, controlled, randomized study (March–July 2017) in 29 adult units (4 hospitals). Data were collected by direct observation by trained observers. All nurses from selected units were informed. A ‘Do not interrupt’ vest was implemented in all units of the experimental group. A poster was placed at the entrance of these units to inform patients and relatives. The main outcome was the administration error rate (number of Opportunities for Error (OE), calculated as one or more errors divided by the Total Opportunities for Error (TOE) and multiplied by 100). Results We enrolled 178 nurses and 1346 patients during 383 medication rounds in 14 units in the experimental group and 15 units in the control group. During the intervention period, the administration error rates were 7.09% (188 OE with at least one error/2653 TOE) for the experimental group and 6.23% (210 OE with at least one error/3373 TOE) for the control group (p = 0.192). Identified risk factors (patient age, nurses’ experience, nurses’ workload, unit exposition, and interruption) were not associated with the error rate. The main error type observed for both groups was wrong dosage-form. Most errors had no clinical impact for the patient and the interruption rates were 15.04% for the experimental group and 20.75% for the control group. Conclusions The intervention vest had no impact on medication administration error or interruption rates. Further studies need to be performed taking into consideration the limitations of our study and other risk factors associated with other interventions, such as nurse’s training and/or a barcode system. Trial registration The PERMIS study protocol (V2–1, 11/04/2017) was approved by institutional review boards and ethics committees (CPP Ile de France number 2016-A00211–50, CNIL 21/03/2017, CCTIRS 11/04/2016). It is registered at ClinicalTrials.gov (registration number: NCT03062852, date of first registration: 23/02/2017).

Root Cause Analysis of Medication Administration Error by Nursing Staff at a Number of Medical Institutes in Riyadh

Background: Medication errors genuinely influence patient safety, staying cost in hospital and integrity of nursing job, because the nurses play a specific part in managing the medication for the patients. The present study was done with the aim to investigate factors associated with nurses’ medication errors in a number of medical institutes (Ministry of Health) and the role of clinical pharmacist in these errors. Methodology: The present study was a cross-sectional study based on standardized questionnaire which was designed and distributed to the target nurses in a number of medical institutes (Ministry of Health). The target number was (171) which was achieved depending on the calculation of sample size after the questionnaires was gathered; data was subjected to descriptive and inferential statistics. Results: The highest mean score of error was obtained in the factor related to medication packaging reason, which includes that different medications look alike, and the names of at least 60 medications were similar by 82.7%. The second group of reasons was system associated, which included: abbreviations were used instead of writing the orders out completely, overall 60.5% of the times nurses were pulled between teams. Third reason, overall 45.3% of the times the errors were associated with pharmacy when they did not prepare\label the medication correctly, and clinical pharmacist did not give education workshops to the nurses. Documentation issues were the fourth reason, 39.5% of the times nurses were interrupted while administering medication to perform other duties and nurses on the same unit did not adhere to the approved medication administration procedure. Conclusion: The data of the current study suggested the ranking of five reasons or root causes of why medication errors happened. These are medication package, system related, pharmacy related, documentation-transcription reason and physician-nurse related respectively. Furthermore, clinical pharmacists must thrive to improve the nurses' knowledge of how these factors will lead to critical errors and help them discover strategies to prevent these errors from happening.

Characteristics of Medication Administration Error Alerts in Application of Mobile Medication System

Purpose: To assess characteristics the application of mobile medication system and medication administration error (MAE) alerts in a general hospital.Methods: The subject hospital adopted a mobile medication system in 2016. All medication administrations in the general wards and ICUs were automatically recorded in real-time using identification barcodes, drug barcodes, and hand-held point-of-care devices. MAE alert logs were recorded from April 1st 2017 to March 31st 2018. For this study analysis was done using Pearson’s chi-squared test for potentially related factors of MAE alerts included administration time, order type, medication route, and length of nurse’s employment.Results: The total number of medications during the period of this study was 3,227,990. Among them, 2,698,317 medication doses were recorded, resulting in the system application rate of 83.6%. The system application rate was significantly correlated with all factors related to potential MAE alters. In this study 23,314 MAE alerts(0.9% of the total medication doses) were identified. The MAE alerts were related to new (OR=2.26, p<.001) and emergency (OR=2.25, p<.001) orders, and administration at a non-standard time (OR=2.032, p<.001). Medication route (p<.001), and nurse’s employment duration(p<.001) were also related.Conclusion: A mobile medication system contributes to improving patient safety by preventing potential MAEs. The MAE alerts were related to administration time, order type, medication route, and duration of nurse’s employment. In order to prevent medication administration errors, it is necessary to standardize the process of medication and create an environment in which medication administration can be performed in a planned situation.

Reducing the waitlist of referred patients in a medical specialist outpatient clinic: an observational study

PurposeLong waitlists in outpatient clinics are a widely recognised problem. The purpose of this paper is to describe and report the impact of a waitlist reduction strategy for an epilepsy clinic.Design/methodology/approachThis observational study described the local impact of a methodical approach to tackling a long waiting list, using targeted strategies supported by a modest additional budget. The interventions were described using the template for intervention description and replication (TIDieR).FindingsOver an eight-month period, the waitlist for the epilepsy clinic was reduced from 599 to 24 patients without increasing the number of days until the next available appointment. Most referrals were removed from the waitlist without an appointment. Auditing revealed a high proportion of patients no longer required the service or referrals remained on the waitlist due to administration error. A short-term increase in clinic capacity of 51 extra appointments met the needs of the remaining waiting patients. The additional project funding invested in this process was AUD $10,500 and a time-limited amount of extra work was absorbed by using existing clinic resources.Practical implicationsThis waitlist reduction strategy resulted in a very small waitlist for the epilepsy clinic, which is now well placed to trial further interventions with the aim of sustaining the service with minimal waiting times. Not every referral on the waitlist, particularly the very long waiters, required an appointment. Other outpatient clinics may be able to apply this process to reduce their waitlists using a modest budget.Originality/valueAlthough there are reports of successful waitlist reduction, few report the intervention in detail. Use of the TIDieR in reporting enables the intervention to be appraised or adapted to other settings where long waitlists are problematic. Considerations related to implementation of policy are discussed and in this case, a locally led and executed change management strategy was a key to achieving the result.