Medication errors: following a game plan for continued improvement.
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Biomedical subjects
Publications and source records attributed to H G Cohen.
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During October and November of 1983, three subsamples were selected from three schools in Mesa, Arizona: 34 students in 6th grade, 34 students in 8th grade, and 34 students in 10th grade. A battery of Piagetian-type tasks were individually and randomly administered to each subject. Seven tasks examined projective spatial conceptual abilities, and three tasks examined Euclidean abilities. The same battery of tasks was again administered to the same subjects during November and December of 1984 when all the subjects were in the next grade, that is, 7th, 9th, and 11th. Because of attrition, the number of students tested during the second year were 33, 30, and 28, respectively. To test for significant differences between grade levels, a chi-square one-sample procedure was used. Out of a possible 50 tasks, significant differences were detected in 36 (72%). Those findings, along with an examination of the percentage of students passing each task, support the notion of sequential development of spatial conceptual abilities.
Two patients with angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) were studied. Both patients had marked increases in all three major immunoglobulin classes, and both lacked suppressor cell activity in vitro. These findings are consistent with the theory that AILD is a defectively regulated immune response to an unidentified antigen(s) and could provide clues to the pathogenesis of other lymphoproliferative disorders as well.
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Chloroquine and metronidazole were compared in a randomized trial for the treatment of amoebic liver abscess in 36 patients. An additional 30 patients were treated without randomization. Chloroquine was given according to the standard protocol at Los tangeles County-University of Southern California Medical Center, which is 500 mg daily for 10 weeks, whereas metronidazole was given in a dose of 750 mg three times daily for 10 days. Criteria for the diagnosis of amoebic abscess included (a) a suitable clinical picture, (b) filling defect on hepatic scan, (c) high titer of antibody to Entamoeba histolytica by indirect hemagglutination, and (d) eventual complete recovery with treatment or appropriate findings on autopsy examination. Treatment failure, defined as illness that persisted beyond 10 days or recurred after that time, occurred in 1 of 28 patients treated with chloroquine and in 2 of 36 treated with metronidazole. In 2 patients who died it was difficult to assess the result of drug therapy. We conclude that both drugs are highly effective. Metronidazole has the advantage of effectiveness against intestinal amoebiasis and the probability of cure with a shorter course of treatment. Speed of response was slightly greater with metronidazole and was somewhat related to abscess size.
With medication errors, a more productive approach is to look at what, rather than who, caused the error. Unclear orders, both written and verbal, need to be clarified: Never make assumptions about the drug, dose, route, or frequency. Nurses must be assertive and join forces with pharmacists, physicians, risk managers, and quality improvement professionals to make a difference in error prevention and medication safety.