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PubMedDate not supplied

Medication errors. Research in practice: how drug mistakes affect self-esteem.

In this study a critical topic is introduced: Medication errors have worried almost every nurse and so how they are experienced, how they are dealt with and what their occurrence means at individual, institutional and professional levels, are discussed in this article. The tool of discourse analysis is outlined as the interpretive instrument of analysis. Of the analytic results from the study, five themes are introduced and shown in terms of their relevance to everyday nursing practice.

Humans↗
PubMed2003

Medical errors, incidents, accidents and violations.

Atul Gawande: 'The real problem isn't how to stop bad doctors from harming, even killing their patients. It's how to prevent good doctors from doing so.' A. Gawande: When doctors make mistakes. The New Yorker, 1st February 1999; 40-55.Errors are an integral part of human behaviour and performance, and in this respect, medical/ surgical practice is no exception. Undoubtedly medical errors account for substantial patient morbidity and mortality. The subject is complicated due to complex and at times confusing taxonomy and the lack of agreed definitions and classification of medical/ surgical errors. It is not possible to eliminate errors from clinical practice but we can improve the quality of medical care by adopting error-tolerant operating medical systems (E-TOMS) based on progress in cognitive psychology, human factors, and human reliability assessment made during the past 30 years. E-TOMS should enable detection, reporting and targeted reduction of errors, and together with effective team dynamics, good clinical governance incorporating root-cause analysis of adverse events during the delivery of health care should improve the quality of care that we can provide for our patients.

Journal Article↗
PubMed2000

Use of a clinical event monitor to prevent and detect medication errors.

Errors in health care facilities are common and often unrecognized. We have used our clinical event monitor to prevent and detect medication errors by scrutinizing electronic messages sent to it when any medication order is written in our facility. A growing collection of medication safety rules covering dose limit errors, laboratory monitoring, and other topics may be applied to each medication order message to provide an additional layer of protection beyond existing order checks, reminders, and alerts available within our computer-based record system. During a typical day the event monitor receives 4802 messages, of which 4719 pertain to medication orders. We have found the clinical event monitor to be a valuable tool for clinicians and quality management groups charged with improving medication safety.

Decision Support Systems, Clinical↗
PubMed1976

A method for decreasing patients' medication errors.

Eighty anxious and eighty depressed patients were assigned randomly to receiving one of three versions of an information leaflet about their medication, or to receiving no leaflet at all. Mean medication errors were reduced from 15 to 4% by provision of suitably constructed leaflets. The results show the practical importance of informing patients about their medication and of paying attention to the difficulty level of any leaflets issued.

Antidepressive Agents↗
PubMed2005

The Perruche case and the issue of compensation for the consequences of medical error.

The case of Nicolas Perruche gave rise to a national debate in France over compensation for serious consequences of medical error. Ultimately, legislation was enacted banning the cause of action known in Anglo-American law as wrongful life, and an agency was established to adjudicate subsequent claims. As other developed nations continue to wrestle with rapid increases in the cost of professional liability coverage and health care in general, a review of the Perruche case and its influence on French health policy may advance the discussion beyond the current stalemate of hardened advocacy positions.

Compensation and Redress↗
PubMed2005

Chronology of medication errors by nurses: accumulation of stresses and PTSD symptoms.

The aim of this research was to examine the influence of medication errors on the mental state of the erring caregiver. In-depth interviews were conducted with 20 erring nurses. The data were analyzed using content analysis. The following categories were identified: "stress, pressure, and inattention," "responsibility," "the double fear," "I might get fired," "he who works, errs," waiting for the inquiry--"every day is like eternity," "absurdly, it got worse with time," and "following the event I learned my lessons." The emotional distress of several subjects was, across time, reminiscent of PTSD symptoms.

Adult↗
PubMed2005

It's one step toward quality. Many hurdles remain to establishing new patient-safety groups, which will use confidential provider data on medical errors.

The new Patient Safety and Quality Improvement Act, passed late last month, would provide incentives for healthcare providers to report medical errors. While the idea behind the new bill is universally popular--to reduce errors and increase quality of care--some members of the industry, such as physician Steve McDermott, left, say that implementing a national reporting system will be harder than it sounds.

Database Management Systems↗
PubMed2005

Medical errors: five years after the IOM report.

Five years after publication of the Institute for Medicine's landmark 1999 report,To Err Is Human, notable advances have been made. They include the development of performance standards, an increase in error reporting, integration of information technology, and improved safety systems. But the IOM notes that efforts are still needed to improve safety and reduce errors, including development of data standards for patient safety information, establishment of a national health information infrastructure, and comprehensive patient safety programs in health care organizations.

Humans↗
PubMedDate not supplied

Medication error reporting by community pharmacists in Vermont.

OBJECTIVE: To document community pharmacists' awareness and use of the United States Pharmacopeia Medication Errors Reporting (USP MER) program. DESIGN: Telephone survey. SETTING: Community pharmacies in Vermont. PARTICIPANTS: One self-identified community pharmacist from each community pharmacy. INTERVENTION: Each operating community pharmacy in Vermont was contacted by telephone between June 2002 and February 2003. The first individual to self-identify himself or herself as a pharmacist was asked to participate. The telephone surveys were conducted using a standard script. MAIN OUTCOME MEASURE: Survey responses to questions about awareness and use of USP MER. RESULTS: A pharmacist was contacted in 98% (122/124) of all operating community pharmacies in Vermont. Nine (7%) pharmacists refused to participate, leaving 113 pharmacists who responded to the survey. Although more than one half of all respondents (70/113; 62%) had heard of USP MER, less than one quarter (24/113; 21%) had ever submitted a report. Significantly more pharmacists employed by independent pharmacies had submitted a report, compared with pharmacists from other pharmacy types (chain, supermarket, mass merchandiser; P = .03). Submitting reports through a corporate hierarchy or to a corporate program was the reason most frequently cited by pharmacists for not submitting reports directly to USP MER (37%). Whether corporate reports were forwarded to USP MER is unknown. CONCLUSION: The majority of Vermont community pharmacists were aware of USP MER. However, use was low. Barriers to reporting to a common system such as USP MER may differ depending on pharmacy type. Further research to document the barriers to submitting reports is warranted.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

Medication errors in hospitals: computerized unit dose drug dispensing system versus ward stock distribution system.

AIM: The aim of this study was to evaluate the rates and types of drug prescription and administration errors in one pediatric nephrology ward, comparing two dispensing schemes: the first one defined as handwritten prescription plus ward stock distribution system (WSDS), and the second one as computerized prescription plus unit dose drug dispensing system (UDDDS). METHOD: Data were collected over an 8-week period, from 1 February to 31 March 1999. Two fifth-year pharmacy students photocopied prescription and administration documents on the ward each day, under the supervision of a senior pharmacist. The medical record analysis was used to compare the prescription with the administration report. Prescribing and administration medication errors were classified according to the American Society of Health-System Pharmacists. RESULTS: Prescribing errors: overall, for both dispensing schemes, a total of 511 prescriptions, resulting in 4532 prescribed drugs (an average of 9 drugs per prescription) were prescribed. The total prescription error rate was 20.7% (937 of 4532), resulting in 1.9 errors per patient per day. The computerized prescription error rate was 10.6% (419 of 3943), the handwritten prescription error rate was 87.9% (518 of 589). This difference was very significant (P < 0.0001). ADMINISTRATION ERRORS: The total opportunity of administration errors was 4589 (sum of administered and omitted drugs). The total administration error rate was 23.5% (1077 of 4589) including wrong administration time, and 11.7% (538 of 4589) excluding administration time. The administration error rate, including administration associated with time errors, was only 22.5% (888 of 3943) for computerized prescription + UDDDS, compared with 29.3% (189 of 646) for handwritten prescriptions plus WSDS (P < 0.001). Excluding administration associated with time errors, the administration error rates were 9.7% and 24.3%, respectively (P < 0.0001). CONCLUSION: The drug prescription and administration error rates were significantly decreased using computerized prescription plus UDDDS as compared with handwritten prescription plus WSDS in a pediatric unit (even with potential biases taken into account).

Child↗
PubMed2003

Teaching baccalaureate nursing students to prevent medication errors using a problem-based learning approach.

An objective of the baccalaureate nursing curriculum at Thomas Jefferson University, Jefferson College of Health Professions is to facilitate nursing students' transfer of medication error knowledge into preventive action in the clinical unit. Using a problem-based learning approach, first-semester students are exposed to situations that reflect the real-world scope and complexity of medication administration and errors. Using the frameworks of Failure Mode Analysis and Human Error Mode and Effects Analysis, student groups identify hypotheses, devise solutions, and develop continuous quality improvement processes to prevent errors and facilitate error reporting. Problem-based learning is used in subsequent clinical experiences throughout the curriculum. This reinforcement, combined with a focus on increasingly complex pharmacological agents and medication calculations, enables students to employ critical thinking skills and develop the confidence necessary for safe, professional practice.

Attitude of Health Personnel↗
PubMed2006

Systematic review of medication errors in pediatric patients.

OBJECTIVE: To systematically locate and review studies that have investigated the incidence of medication errors (MEs) in pediatric inpatients and identify common errors. METHODS: A systematic search of studies related to MEs in children was performed using the following databases: MEDLINE (1951-April 2006), EMBASE (1966-April 2006), Pharm-line (1978-April 2006), International Pharmaceutical Abstracts (1970-April 2006), Cumulative Index to Nursing and Allied Health Literature (1982-April 2006), and British Nursing Index (1994-April 2006). Studies of the incidence and nature of MEs in pediatrics were included. The title, abstract, or full article was reviewed for relevance; any study not related to MEs in children was excluded. RESULTS: Three methods were used to detect MEs in the studies reviewed: spontaneous reporting (n = 10), medication order or chart review (n = 14), or observation (n = 8). There was great variation in the definitions of ME used and the error rates reported. The most common type of ME was dosing error, often involving 10 times the actual dose required. Antibiotics and sedatives were the most common classes of drugs associated with MEs; these are probably among the most common drugs prescribed. CONCLUSIONS: Interpretation of the literature was hindered by variation in definitions employed by different researchers, varying research methods and setting, and a lack of theory-based research. Overall, it would appear that our initial concern about MEs in pediatrics has been validated; however, we do not know the actual size of the problem. Further work to determine the incidence and causes of MEs in pediatrics is urgently needed, as well as evaluation of the best interventions to reduce them.

Child↗