Medication error awareness among health care providers in Palestine: A questionnaire-based cross-sectional observational study

BackgroundIncreased awareness among healthcare professionals regarding medication errors and the establishment of a medication error reporting system can significantly reduce the prevalence of medication errors. Unfortunately, Palestine lacks a regulatory system for the control, reporting, and education of medication errors.ObjectivesThis study aimed to assess the awareness of medication errors and reporting of medication errors in the Palestinian medical community.MethodsA cross-sectional observational study was conducted using a self-administered survey involving doctors, nurses, and pharmacists in Palestine. The survey consisted of 20 questions to assess healthcare providers' awareness and course of actions related to medication errors. Data were collected from February 2020 to April 2020. Statistical Package for the Social Sciences (SPSS) was used for data analysis. This study was approved by the ethical committee of Birzeit University.ResultsA total of 394 participants were included, including 202 nurses, 114 doctors, and 78 pharmacists. 203 (51.5%) had a good awareness level of medication errors, whereas 126 (32%) and 65 (16.5%) had average awareness and poor awareness levels, respectively. In addition, 66.0% of providers did not inform the patients after recognizing the error. Fear of legal or social consequences and being too busy are significant barriers to reporting medication errors. Moreover, 35 % of all providers were not aware of the reporting system in their institutions or the reporting methodology, and only 26% of all participants confirmed that their institutions provided continuous education on medication errors.ConclusionThis study revealed differences in healthcare professionals' awareness of medication errors. The study's findings emphasize the urgent need to adopt appropriate measures to raise awareness about medication errors among healthcare providers in Palestine. Furthermore, establishing a regulatory policy and a national medication error reporting system to improve medication safety.     

An observational study of intravenous medication errors in the United Kingdom and in Germany

Objectives: To investigate the incidence and the severity of intravenous (i.v.) drug preparation and administration errors in two countries and three pharmacy services. Method: A disguised observational method was used to record details of the preparation and administration of prescribed i.v. drugs on two wards in each of three teaching hospitals: one with a traditional British ward pharmacy service (TBP) and two hospitals in Germany, one with a traditional ward stock supply (TGP) and one with a satellite pharmacy service (GSP) with unit dose system. Main outcome measures: Errors in i.v. drug preparation and administration and their potential significance. Results: The number of observed preparations/administrations were: TBP 77/63, TGP 126/109 and GSP 134/106. The preparation error rates were: TBP 22% (95% confidence interval: 1331%), TGP 23% (1630%) and GSP 31% (2339%). The administration error rates were TBP 27% (1638%), TGP 49% (3958%) and GSP 22% (1430%). The percentage of administration errors on the wards with TGP was statistically significantly higher than in the other two services. Common errors at the study sites with TBP and GSP were omissions. Wrong rate of administration occurred most frequently on the wards with TGP. The majority of errors were likely to be of 'moderate' to 'severe' outcome. Careful drug chart reading could possibly reduce omission errors on the wards with TBP. A change of the German nursing law ('Krankenpflegegesetz') to legally entitle nurses to administer i.v. drugs could probably result in better training, national guidelines and standards. Conclusion: This study found a high rate of i.v. medication errors of moderate to severe significance. Changes in practice should be considered to make i.v. therapy safer for patients.     

Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation

AIMS

Movement into or out of hospital is a vulnerable period for medication safety. Reconciling the medication a patient is using before admission with the medication prescribed on discharge, and documenting any changes (medication reconciliation) is recommended to improve safety. The aims of the study were to investigate the factors contributing to medication reconciliation on discharge, and identify the prevalence of non-reconciliation.

METHODS

The study was a cross-sectional, observational survey using consecutive discharges from purposively selected services in two acute public hospitals in Ireland. Medication reconciliation, potential for harm and unplanned re-admission were investigated.

RESULTS

Medication non-reconciliation was identified in 50% of 1245 inpatient episodes, involving 16% of 9569 medications. The majority of non-reconciled episodes had potential to result in moderate (63%) or severe (2%) harm. Handwritten rather than computerized discharges (adjusted odds ratio (adjusted OR) 1.60, 95% CI 1.11, 2.99), increasing number of medications (adjusted OR 1.26, 95% CI 1.21, 1.31) or chronic illness (adjusted OR 2.08, 95% CI 1.33, 3.24) were associated with non-reconciliation. Omission of endocrine, central nervous system and nutrition and blood drugs was more likely on discharge, whilst omission on admission and throughout inpatient care, without documentation, was more likely for obstetric, gynaecology and urinary tract (OGU) or respiratory drugs. Documentation in the discharge communication that medication was intentionally stopped during inpatient care was less likely for cardiovascular, musculoskeletal and OGU drugs. Errors involving the dose were most likely for respiratory drugs.

CONCLUSIONS

The findings inform strategies to facilitate medication reconciliation on discharge from acute hospital care.     

The effectiveness of medication reconciliation to prevent medication error: A systematic review and meta-analysis

BackgroundThe impact of medication reconciliation (MR) in low-middle-income countries, including Thailand, may differ from other developed countries.ObjectiveTo evaluate the effect of medication reconciliation (MR) on the reduction of medication error in Thailand.MethodsA systematic search was conducted in the following databases: PubMed, CENTRAL, CINAHL, Scopus, Thai Journals Online, Thai index Medicus, Thai Medical Index, and Health Science Journal in Thailand from inception to January 2018. Studies that evaluated the effect of MR compared to usual care within hospitals in Thailand and reported the occurrence of medication error were included. Meta-analyses were performed using random-effects model.ResultsOf the 107 articles retrieved, 7 articles involving 1581 patients were included in quantitative synthesis. Three of the included studies were randomized controlled trials (RCT). Overall, the risk of medication error in patients who received MR in all transitions of care was 75% lower than those receiving usual care (RR 0.25; 95%CI 0.15–0.43). The effect on the reduction of medication error appeared higher when MR was provided to ambulatory patients (RR 0.17 [95%CI 0.04–0.80] compared with hospitalized patients during admission (RR 0.37 [95%CI 0.20–0.65]) and discharge (RR 0.27 [95%CI 0.17–0.43]). Effects on reducing medication error was greater when MR was provided in secondary care hospitals compared with primary care hospitals both during admission (RR 0.49 [95%CI, 0.34–0.69] vs RR 0.25 [95%CI, 0.05–1.26]), and discharge transition (RR 0.19 [95%CI, 0.09–0.39] vs RR 0.30 [95%CI, 0.12–0.79]).ConclusionOverall, current evidence indicates that the provision of MR in Thailand is effective in reducing medication errors in all transitions of care. However, to promote patient safety, appropriate strategies should be developed to support MR in specific transition of care and hospital setting so patients can benefit most from this service.     

The medication discrepancy taxonomy (MedTax): The development and validation of a classification system for medication discrepancies identified through medication reconciliation

BackgroundMedication discrepancies directly impact patient safety and can adversely impact quality of care and resource utilization at transitions of care.ObjectivesTo develop a common nomenclature and taxonomy for classifying and reporting medication discrepancies and to assess the content validity and reliability of the taxonomy.MethodsThe taxonomy was developed following a multi-stage process. The content of the taxonomy was then assessed using expert opinion through a two-round modified Delphi process. The expert panel comprised 10 experts who were selected based on pre-defined selection criteria. Six experienced pharmacists were then invited to classify medication discrepancies from a number of fictitious cases (adapted from authentic cases) using the taxonomy.ResultsThe medication discrepancy taxonomy (MedTax) comprises 12 main types and 28 sub-types of discrepancies. A set of operational instructions and definitions to aid the use of the taxonomy was formulated. The overall Average content validity index (Ave-CVI) was 0.93 and interrater reliability was 0.67 (multirater κfree), indicating substantial agreement. An excellent internal consistency of the taxonomy was established (Kuder–Richardson Formula 20 (KR-20) = 0.92).ConclusionsA content valid and reliable taxonomy for classifying medication discrepancies was developed. The MedTax may be used to classify medication discrepancies identified following medication reconciliation services. The clear and consistent reporting of medication discrepancies arising from medication reconciliation services may be of value to policy makers, healthcare professionals and researchers, when evaluating such services. The MedTax was designed to fill an essential void in global endeavors to reinforce standardization of medication reconciliation practices and to improve medication safety across transitions of care.     

Defining and identifying concepts of medication literacy: An international perspective

Background

Multiple concepts to define health literacy in the context of medication use exist, such as medication literacy, pharmacotherapy literacy, pharmacy health literacy; however, no studies have looked at consensus among experts internationally.

Defining and identifying concepts of medication reconciliation: An international pharmacy perspective

BackgroundMedication discrepancies occur in up to 80% of hospitalized patients during transitions of care, either at admission or discharge. However, numerous organization have different definitions of medication reconciliation which may result in variations of services being implemented.ObjectiveTo develop a consensus definition of medication reconciliation and define the essential components of medication reconciliation based on international consensus using a modified Delphi process.MethodsStatements and definitions about medication reconciliation found in the literature were used to build a Delphi Questionnaire and sent to experts around the world. Experts were identified based on their leadership in publication, education, professional interest and participation in the area of medication management. Delphi rounds continued until an 80% agreement was achieved.ResultsIn total, 24 experts were included in the Delphi panel. Three Delphi rounds were required to reach consensus on the key concepts included in a medication reconciliation. These concepts included 65 statements classified under (1) tasks involved, (2) who can conduct them, (3) when they should be conducted, (4) who should receive them, (5) how should it be measured and (6) clarifying the difference between medication reconciliation and medication review. This led to a proposed definition for medication reconciliation tasks as “the process of creating the most accurate list possible of all medications a patient is taking and comparing that list against the prescriber's orders. In addition, the patient's allergies, history of side effects from medications and medication aids are listed with the goal of providing correct medication to the patient at all transition points within the health care system.”ConclusionAn international expert panel was able to receive consensus on the definition of tasks involved in medication reconciliation and its essential concepts after four Delphi rounds. This definition is broader in scope than previous definitions.     

A text mining analysis of medication quality related event reports from community pharmacies

BackgroundMedication errors are estimated to cost $42 billion in annual global treatment costs. Pharmacy-based Patient Safety Organizations (PSO) are tasked with collecting and analyzing incidents, near misses, and unsafe condition reports as one way of engaging pharmacies in quality improvement efforts. Collectively, these reports are referred to as quality related events (QREs). Large-scale analysis of typed narratives from QRE reports across organizations has been a missing component of quality improvement programs.ObjectiveTo identify topics within the components of a proposed medication safety event framework contained in the free-text narrative of QRE reports.MethodsA retrospective, observational analysis of data from a PSOs voluntary reporting system, from January 1, 2011 to December 31, 2014. The dataset contained structured and unstructured data elements. A structural topic model extracted themes from the free-text narrative component of the report. These topics were assigned a human label and mapped onto constructs of the medication safety event framework.ResultsA total of 531,555 QREs were analyzed from 1660 pharmacies. 90.6% were near miss and unsafe condition reports. There were 40 topics generated. There were 29 topics identified as QRE types, 3 were identified as contributing factors, and 5 were related to signals/alerts that an incident or near miss had occurred. One topic each was identified as a recovery step and a quality improvement strategy. One topic was not assigned a human label. Examples of topics labeled included incorrect tapering directions, needing to double-check work, and attention-related contributing factor.ConclusionsThe free-text narrative provided novel information compared to the structured fields of the reports. Topics were mapped onto a proposed medication safety event framework to advance knowledge of medication QREs and identify ways to improve medication safety in community pharmacy. Future work may focus on communicating these topics to the pharmacies to improve medication safety efforts.     

Assessment of knowledge and awareness of safe disposal of unused or expired medication in Saudi Arabia: A cross-sectional study

BackgroundPoor waste management of unused or expired medications jeopardizes healthcare staff, employees who oversee medical waste, patients and their families, the neighboring population, and environmental contamination. In addition, the inappropriate treatment or disposal of that waste leads to. In addition, medical waste disposal exerts an intolerable burden on the economy of health care facilities. Currently, there is a lack of data in community settings regarding adequate methods of medication disposal in Saudi Arabia.Aim of the StudyThe current study aimed to evaluate current knowledge and awareness of the safe disposal of unused or expired medicines in the Saudi Arabia.MethodA survey study was conducted in Saudi Arabia within 5 months from October 2021–February 2022. The survey was distributed to participants via social media channels. The questionnaire was constituted of 16 items divided into three sections: demographic information, quantification, and characterization of unused and expired medication at home, and practice and attitude regarding the disposal of unused or expired medication.ResultsThe survey was taken by 1105 participants and 1100 (99.54%) participants completed the survey. The study found that (49.1%) of participants stored medicines at home and these medicines were mainly stored in the refrigerator (64.4%). Household trash was the most frequent method of disposal (79.5%). Non-prescribed medicines (67%) were mainly stored as unused or expiry medicines at home followed by prescribed medicines (51.9%). The main reason for the storage of unused/expired medicines at home was stopped medication after recovery (68.5%). Only 8.4% of participants had received appropriate education or training related to the correct disposal of medication. The best-practiced method to increase community awareness regarding the disposal of unused or expiry medicine was awareness through social networking (70.3%). In conclusion, patients’ education regarding safe medication disposal and availability of medication disposal program is necessary to improve appropriate medication waste methods and decrease possible environmental harm.     

Narratives about illness and medication: a neglected theme/new methodology within pharmacy practice research. Part II: medication narratives in practice

AIM: Part 2 of this paper aims to provide a methodological framework for the study of medication narratives, including a semi-structured interview guide and suggested method of analysis, in an attempt to aid the development of narrative scholarship within pharmacy practice research. Examples of medication narratives are provided to illustrate their diversity and usefulness. METHODS: The framework is derived from the work of other researchers and adapted for our specific purpose. It comes from social psychology, narrative psychology, narrative anthropology, sociology and critical theory and fits within the social constructionist paradigm. The suggested methods of analysis could broadly be described as narrative analysis and discourse analysis. Examples of medication narratives are chosen from a variety of sources and brief interpretations are presented by way of illustration. CONCLUSION: Narrative analysis, a neglected area of research in pharmacy practice, has the potential to provide new understanding about how people relate to their medicines, how pharmacists are engaged in producing narratives and the importance of narrative in the education of students. IMPACT OF THE ARTICLE: This article aims to have the following impact on pharmacy practice research: Innovative approach to researching and conceptualising the use of medicines. Introduction of a new theoretical perspective and methodology. Incorporation of social science research methods into pharmacy practice research. Development of narrative scholarship within pharmacy.     

A system approach to dispensing errors: a national study on perceptions of the Finnish community pharmacists

Objective To examine pharmacists’ perceptions and opinions on the potential causes of dispensing errors and the ways to prevent them in community pharmacies, and to assess whether pharmacists’ perceptions reflect the system approach. Method A survey instrument was mailed to privately owned Finnish community pharmacies (n = 599) in March 2005. The survey included two open-ended questions to assess the pharmacists’ perceptions on potential causes and prevention of dispensing errors. Furthermore, the questionnaire contained 20 structured, Likert-type, statements of dispensing errors and their management. The survey was addressed to the owner or operational manager of the pharmacy. The emphasis in the analysis of the study was on the open-ended questions which were analysed using the content analysis method. All quantitative data was analysed using the SPSS for Windows. Main outcome measure: The community pharmacists’ perceptions and opinions on the potential causes and preventive factors of dispensing errors. Results A total of 340 responses were entered in the study (response rate 57%). The content analysis revealed that factors related to organization and those related to individual professionals were the most frequently mentioned as the potential causes of dispensing errors (37% and 30% of all potential causes given, respectively; number of respondents n = 326; total number of given items n = 967). The organizational factors (46% of all the preventive factors given), and factors related to individual professionals (41%) were also the most frequently considered as preventive (number of respondents n = 323; total number of given items n = 916). The analysis of the structured statements revealed that discussion about the dispensing errors with pharmacy staff and changes in working routines based on the dispensing error incidents were considered to be the most important factors in error prevention. A heavy workload and the similarity of drug packages were considered as the most important potential causes of the dispensing errors in the structured statements. Conclusion Finnish community pharmacists still, to some extent, have the person-centred approach to medication safety although signs of the system approach were also evident. Attitudinal changes still have to take place, as well as changes to the practice environment, in order to get the system approach fully implemented in the Finnish community pharmacies.     

Interdisciplinary medication decision making by pharmacists in pediatric hospital settings: An ethnographic study

Objective

Children are particularly vulnerable to experiencing medication incidents in hospitals. Making sound medication decisions is therefore of paramount importance. Prior research has principally described pharmacists' role in reducing medication errors. There is a dearth of information about pharmacists' interactions with pediatric hospital staff across disciplines in resolving medication issues. The aim of this study was to examine interdisciplinary medication decision making by pharmacists in pediatric hospital settings.

Effects of interdisciplinary collaboration in hospitals on medication errors: an integrative review

Introduction: Medication errors are commonly affected by breakdowns in communication. Interdisciplinary collaboration is an important means of facilitating communication between health professionals in clinical practice. To date, there has been little systematic examination of past research in this area.

Areas covered: The aims of this integrative review are to examine how interdisciplinary collaboration influences medication errors in hospitals, the araes of interdisciplinary collaboration that have been researched in previous work, and recommendations for future research and practice. An integrative review was undertaken of research papers (N = 30) published from inception to August 2017 using MEDLINE, the Cochrane Library, CINAHL, PsycINFO, and Embase.

Expert opinion: Five different areas of interdisciplinary collaboration were identified in research involving medication errors. These areas were: communication through tools including guidelines, protocols, and communication logs; participation of pharmacists in interdisciplinary teams; collaborative medication review on admission and at discharge; collaborative workshops and conferences; and complexity of role differentiation and environment. Despite encouraging results demonstrated in past research, medication errors continued to occur. Increased focus is needed on developing tailored, individualized strategies that can be applied in particular contexts to create further reductions in medication errors. Greater understandings are also needed about the changing roles of various disciplines.     

某医院新员工用药安全认知情况调查分析

目的 了解某医院新员工对用药安全的认知情况,为开展用药安全入职教育提供参考。方法 自行设计调查问卷,就合理用药、药品不良反应、合理输液、特殊人群用药、中药合理应用、用药错误及临床药师制方面对100名新员工进行认知情况调查分析。结果 回收有效问卷100份,有效回收率100.0%。新员工对涉及合理用药、药品不良反应、合理输液、特殊人群用药概念的问题掌握较好,正确率均超过80.0%,对于涉及这些知识点的用药安全实践题正确率58.0%～99.0%;对于中药合理应用认知程度较好,选题正确率超过90.0%;对于用药错误、临床药师工作职责的认知程度低,选题正确率均未超过50.0%。新员工用药安全认知程度与学历水平有关。结论 医院新员工在用药安全认知上存在短板,入职教育应向新员工,特别是低学历水平的新员工,传播非惩罚性用药安全文化、宣传临床药师制内涵、强化用药安全知识临床实践培训。     

The Institute for Safe Medication Practices and Poison Control Centers: Collaborating to Prevent Medication Errors and Unintentional Poisonings

This article provides an overview on the Institute for Safe Medication Practices (ISMP), the only independent nonprofit organization in the USA devoted to the prevention of medication errors. ISMP developed the national Medication Errors Reporting Program (MERP) and investigates and analyzes errors in order to formulate recommendations to prevent further occurrences. ISMP works closely with the US Food and Drug Administration (FDA), drug manufacturers, professional organizations, and others to promote changes in package design, practice standards, and healthcare practitioner and consumer education. By collaborating with ISMP to share and disseminate information, Poison Control centers, emergency departments, and toxicologists can help decrease unintentional and accidental poisonings.