PubMed · 10260294
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W O Umiker. 1983. Pathologists must delegate--not abdicate.. https://pubmed.ncbi.nlm.nih.gov/10260294/
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OBJECTIVE: The purpose of this study was to record prospectively the frequency of medication order errors in a general hospital in Israel with the objective of assessing the impact of pharmacist intervention in preventing potential harm. METHODS: The study was conducted during a 6-month period. A total of 160 medication order errors were detected at the hospital of which 60.6% were prescription errors and 39.4% were therapy ones. Principal types of errors detected were incorrect dosage (27.5%), interactions between drugs (20%), incorrect drug (12.5%), route (11.2%) and frequency (11.2%). Medication error rate by degree of severity was calculated per 100 patient days. The highest rate was found in Hemato-Oncology (2.48), followed by Intensive Care (0.82), Surgery (0.48) and Internal Medicine (0.26). Anti-infective drugs were the most prevalent class of drugs in which errors occurred (38.7%) followed by total parenteral nutrition preparations (21.8%), antineoplastics (15.6%) and anticoagulants (11.3%). Changes in medication orders due to pharmacists' intervention only occurred in 73.8% of error cases, most referring to dosage or route change (37.5%). CONCLUSIONS: This study underestimates the actual number of medication errors. However, it identified problem areas and trends so that better measures to improve drug use could be implemented.
OBJECTIVE: To assess the inter-rater reliability between nurses and the convergent validity of the Appropriateness Evaluation Protocol (AEP) in the Turkish context. METHODS: Two nurses applied the original AEP concurrently to a random subsample of 335 patient-days in internal medicine, general surgery, and gynaecology departments at a university hospital and a government teaching hospital, as a part of a larger study. Inter-rater reliability was tested by calculating overall agreement and specific agreements between nurse reviewers' AEP assessments. Validity was tested by comparing the assessments of the nurses based on the AEP with the implicit judgements of five expert physicians on a random subsample of 818 patient-days. Sensitivity, specificity, positive and negative predictive values of the AEP were calculated. Reliability and validity were also evaluated by the K statistic. RESULTS: In the reliability test, there was a high level of agreement between the two independent raters applying the AEP in the three departments studied: overall agreement = 90.7-97.6%; specific inappropriate agreement = 69.1-92.3%; specific appropriate agreement = 88.3-96.6%. In validity testing, the AEP had a sensitivity of 0.83-0.97, specificity of 0.62-0.80, and positive and negative predictive values of 0.84-0.88 and 0.73-0.95 respectively. Kappa coefficients in internal medicine and gynaecology indicated almost perfect agreement in reliability testing and moderate agreement in validity testing. In general surgery, the K coefficients showed substantial agreement in both tests. CONCLUSION: These results indicate that the AEP is a reliable and valid instrument to assess appropriateness of patient-days in Turkey.