SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Clinical nurse specialists use a variety of preexisting instruments to measure and describe health-related concepts. It is important for clinical nurse specialists to know how to evaluate the content validity of potentially useful instruments. This study assessed the content validity of the Institute for Safe Medication Practice's Medication Error Worksheet. The worksheet is used as a questioning framework to guide data collection processes when beginning analysis of a medication error. Although the worksheet has been valuable to the Institute for Safe Medication Practice staff, its content validity has not been determined. Content validity methods included expert validation and a review of the related literature. Results support the validity of the Medication Error Worksheet and suggest that this worksheet is a comprehensive tool that may be helpful when exploring the circumstances of medication errors and when analyzing medication use systems. Results were shared with the Institute for Safe Medication Practice staff to improve the accuracy of the worksheet.
OBJECTIVES: o prevent medical errors, improve user performance, and enhance the quality, safety, and connectivity (bidirectional communication) of point-of-care testing. PARTICIPANTS: Group A included 37 multidisciplinary experts in point-of-care testing programs in critical care and other hospital disciplines. Group B included 175 professional point-of-care managers, specialists, clinicians, and researchers. The total number of participants equaled 212. EVIDENCE: This study followed a systems approach. Expert specifications for prevention of medical errors were incorporated into the designs of security, validation, performance, and emergency systems. Additional safeguards need to be implemented through instrument software options and point-of-care coordinators. Connectivity will be facilitated by standards that eliminate deficiencies in instrument communication and device compatibility. Assessment of control features on handheld, portable, and transportable point-of-care instruments shows that current error reduction features lag behind needs. CONCENSUS PROCESS: Step 1: United States national survey and collation of group A expert requirements for security, validation, and performance. Step 2: Design of parallel systems for these functions. Step 3: Written critique and improvement of the error-prevention systems during 4 successive presentations to group B participants over 9 months until system designs stabilized into final consensus form. CONCLUSIONS: The consensus process produced 6 conclusions for preventing medical errors in point-of-care testing: (1) adopt operator certification and validation in point-of-care testing programs; (2) implement security, validation, performance, and emergency systems on existing and new devices; (3) require flexible, user-defined error-prevention system options on instruments as a prerequisite to federal licensing of new diagnostic tests and devices; (4) integrate connectivity standards for bidirectional information exchange; (5) preserve fast therapeutic turnaround time of point-of-care test results; and (6) monitor invalid use, operator competence, quality compliance, and other performance improvement indices to reduce errors, thereby focusing on patient outcomes.(Arch Pathol Lab Med. 2001;1307-1315)
In a 4-year prospective quality assurance study, 315 iatrogenic medication errors were reported among the 2147 neonatal and paediatric intensive-care admissions, an error rate of 1 per 6.8 admissions (14.7%). The frequency of iatrogenic injury of any sort due to a medication error was 66/2147 (3.1%)--1 injury for each 33 intensive-care admissions. 33 (10.5%) errors were potentially serious, 32 (10.2%) caused mild patient injuries, and 1 patient had acute aminophylline poisoning after receiving five intravenous doses of the drug at a dosage ten times higher than prescribed, owing to a calculation error during dilution. A longitudinal monitoring system helps to identify iatrogenic complications due to medication errors and may help in implementing preventive measures.
A number of barriers to the enhancement of patient safety through a reduction of medication errors have been identified These include a blame culture; lack of leadership;lack of peer-review protection; and the absence of a collaborative voluntary national reporting system. The latter would provide oversight and help healthcare providers avoid recurrence of these adverse drug events stemming from human error.A voluntary practitioners reporting system similar to that promoted by the Institute for Safe Medication Practices Canada (ISMP Canada) has been shown to be successful in the United States in achieving the goal of enhancing patient safety. ISMP Canada needs collaboration with other reporting systems to gain more insight and knowledge of the causal factors underlying medication errors. This collaborative mode fits into the conceptual model of the medication incident reporting and prevention program currently being developed by a coalition of key stakeholders including Health Canada, ISMP Canada and the other health care professional organizations. The model for a successful patient safety enhancement strategy as proposed by Baker and Norton in their lead paper is a valid one. In the meantime, there is enough knowledge and information about medication errors to permit our putting prevention strategies into practice.
22 papers on clinical decision support (CDS) for computer physician order entry (CPOE) and the ability to reduce medication errors were reviewed. Among the 22 original clinical trials, 21 demonstrated a reduced number of medication errors after the implementation of CDS. The effect was strongest for 2nd and 3rd generation of the CDS-systems. CPOE with CDS is time consuming and may generate new medication errors in itself. All the trials had poor designs. A Danish data source for CDS has not yet been established.
Different medical errors were committed in 147 of 1029 patients (14.28%) operated for acute cholecystitis. Diagnostic errors were noted in 66 patients (44.90%). Diagnostic errors in patients older than 60 were committed much more often than in patients younger than 60. In men such errors were committed 2 times as often as in women. Tactical errors were revealed in 35 patients (23.81%). Some or other defects of the operation technique were noted in 46 patients (31.29%).
CONTEXT: Low service volume, insufficient information technology, and limited human resources are barriers to learning about and correcting system failures in small rural hospitals. PURPOSE: This paper describes the implementation of and initial findings from a voluntary medication error reporting program developed by the Nebraska Center for Rural Health Research (NCRHR) to overcome these barriers in 6 Nebraska critical access hospitals (CAHs). METHODS: Participating Nebraska CAHs mailed copies of medication error reports to the NCRHR monthly for entry into a database. Quarterly summaries enabled each CAH to compare its reports by severity, type, phase of the medication use process, contributing factors, and causes to those of its peers and MEDMARX, a national medication error reporting program. Workshops emphasized learning from the reported errors by identifying system sources of variation in medication use and initiating change to achieve best practices. FINDINGS: Similar to MEDMARX, 99% of medication errors reported by 6 Nebraska CAHs were not harmful, reported errors most often originated in the administration phase, and the most common error type was omission. The CAHs reported significantly smaller proportions of "near miss" errors and errors originating in the prescribing phase than in MEDMARX. CONCLUSIONS: By collaborating with CAHs, an academic medical center, and a national reporting program, the NCRHR is translating the Institute of Medicine's recommendation for voluntary error reporting into practices that allow CAHs to learn about and improve their medication use systems. However, limited presence of pharmacists in CAHs is a barrier to implementing double checks and learning from system failures in the medication use system.
Medication errors in hospital settings are considered both widespread and costly to the American healthcare system; yet, it is tractable to available solutions. This article offers a novel prescription for the problem that could be implemented by 2010. It consists of a systems approach--failure mode effects analysis (FMEA)--in combination with emerging technologies, such as a decision support system (DDS) with integrated real-time medical informatics, electronic medical records (EMR), computer physician order entry (CPOE), bar coding, automated dispensing machines (ADM), and robotics. Cost and benefit analysis reveals that this proposed integrated solution will radically reduce medication errors in hospitals and save the lives of thousands of Americans who frequent such facilities on an annual basis, as well as reduce healthcare costs.
Increased patient loads, time pressures, and heightened public awareness of medical errors are forcing many physicians and clinical administrators to consider acquiring computerized physician order entry (CPOE) systems and clinical information systems. The recent revelation that CPOE systems can facilitate medical errors, however, is a call to physicians to remain vigilant despite the new technologies. By attending to specific data-capture and data-access errors associated with clinical information systems, physicians can minimize errors associated with clinical information systems and maximize the potential benefits to their patients.