Knowledge,attitude,and practices related to medication errors among nursing professionals:a questionnaire-based study in a tertiary care hospital

Objective:To evaluate the level of understanding(knowledge),beliefs(attitude),and behavior(practice)of staff nurses toward medication errors(MEs).Methods:Self-administered questionnaires were distributed to nursing professionals who had at least 1 year of work experience.Each questionnaire contained 19 items assessing“knowledge,”“attitude,”and“practice”attributes toward MEs.Results:Responses from 47 nursing respondents were included for the final analysis.The mean knowledge score was 3.8±1.1(out of 6);66%and 79%of the respondents had awareness of medication repor ting systems and interventions in preventing MEs,respectively.Lack of adequate knowledge in recognizing MEs(P=0.003),or presuming MEs are not as important enough to be reported(P=0.002),was considered as the major reason for under-repor ting of MEs.Nurses with higher knowledge score were against administration of medication through a different route than that prescribed by the physician(P=0.023),and tried to rectify an ME(P=0.020)and stayed with the patient until an oral medication had been swallowed(P=0.037).Conclusions:The nursing professionals were aware of the ME repor ting system and methods to prevent the occurrence of MEs.They also exhibited a positive attitude and followed optimal practices in controlling MEs.

Nurses' families' experiences of involvement in nursing errors: A qualitative study

Background: The most important and irreversible consequence of medical errors is the human impact caused by unintended actions.In a few studies,the significant impact of this error on the private life of healthcare staff have been mentioned,but the problems of the involved nurses' families had been ignored,as of now.Aims: This study aimed to explain the nurses' families' experiences of involvement in nursing errors.Methods: This is a qualitative study using conventional content analysis with 20 semi-structured interviews conducted with nurses and family members of nurses involved in medical errors,done through purposeful sampling and willingness to participate in the study.Results: The results of the data analysis consisted of five main categories including disruption in family functioning,the crisis of fear,oppression,damage,and neglect,along with 15 subcategories.Conclusion: Considering the effects of nursing errors on the families of nurses involved in the error,such as disruption of family functioning,the family of nurses involved in the error should also be considered and paid attention to.These families are abandoned and the need to promote the culture of supporting the family is tangible.

Error reporting in the emergency department:do we do what we say we do?

BACKGROUND:The Joint Commission accreditation manual contains standards in improving organization performance related to report and review of patient care issues causing unexpected harm.In spite of regulations mandating reporting,it remains inconsistent,varying by provider type and hospital.Our purpose was to determine current attitudes,knowledge,and practice of error reporting among emergency department(ED) providers.METHODS:We administered a survey assessing ED staff practice regarding error reporting.Questions involved reporting of errors in which the practitioner was directly involved,errors the practitioner observed,and general awareness of reporting mandates.We also questioned individuals regarding fear of repercussions for reporting.RESULTS:Fifty-two surveys were returned.For most errors,providers were more likely to tell their supervisor about the issue than to tell the patient.Seventeen percent of respondents did not think that referring errors for review was their job.Only 31%of respondents were aware of standardized institution-wide pathways to report errors.Any respondent who was aware of the institution-wide pathway also felt responsibility for error reporting.Thirty-three percent of the respondents were concerned about negative repercussions from reporting errors.In querying the hospital reporting system,263 cases were referred for quality issues over the previous year,51%of them were referred by nurses,27%by medical technicians(MTs),2%by mid-level providers(MLPs),1%by physicians,and 19%by other personnel.CONCLUSION:Although most of the ED staff are responsible for patient safety,most are not aware of systems available to assist in reporting,and even many do not utilize those systems.

The Impact of Medical Profession Type, Gender, and Years of Experience on Thinking Styles: What Are the Implications for Patient Safety?

Background: Healthcare providers were faced daily with many decision-making that impacted patients’ safety. According to dual process theory, there were two types of thinking: Experiential style (ES) and Rational Style (RS). Both thinking styles had an impact on individuals’ decisions making. Therefore, the aim of this study was to find out nurses’ and physicians’ styles of thinking and how this impacted patients’ safety. Design: A cross-sectional study. Methods: Nurses and physicians sample of adults (n = 308), 190 (61.7%) of the sample were nurses and 118 (38.3%) of the sample were physicians. Participants completed a self-report online survey, which included demographic information followed by questionnaires to measure thinking style and a cognitive puzzle to see if the medical error was associated with certain styles of thinking. Results: The main findings were that nurses (M = 2.41, SD = 0.37) had significantly higher scores compared to physicians (M = 2.29, SD = 0.39) in their ES, t(305) = 2.73, p = 0.007;with medium effect size, d = 0.37692. Conclusion: Nurses differed from physicians in ES where nurses had a significantly higher score than physicians which could be positive for patients’ safety as higher ES would report errors compared to lower ES.

German critical incident reporting system database of prehospital emergency medicine: Analysis of reported communication and medication errors between 2005–2015

BACKGROUND: Communication failure in prehospital emergency medicine can affect patient safety as it does in other areas of medicine as well. We analyzed the database of the critical incident reporting system for prehospital emergency medicine in Germany retrospectively regarding communication errors.METHODS: Experts of prehospital emergency medicine and risk management screened the database for verbal communication failure, non-verbal communication failure and missing communication at all.RESULTS: Between 2005 and 2015, 845 reports were analyzed, of which 247 reports were considered to be related to communication failure. An arbitrary classifi cation resulted in six different kinds: 1) no acknowledgement of a suggestion; 2) medication error; 3) miscommunication with dispatcher; 4) utterance heard/understood improperly; 5) missing information transfer between two persons; and 6) other communication failure.CONCLUSION: Communication defi cits can lead to critical incidents in prehospital emergency medicine and are a very important aspect in patient safety.

Effect of Medication Safety Education Program on Intensive Care Nurses’ Knowledge regarding Medication Errors

Background: Medication errors are the iceberg of patient safety in hospitals and leading cause of morbidity and mortality among patients. Objectives: The study aim was to evaluate the effect of an educational program of medication safety on the knowledge of critical care nurses regarding intravenous medication errors. Methods Design: There are one group pretest and posttest designs. Subject: A convenient sample of all registered nurses (52) works in Palestine Medical Complex. Data collection tools: A self-administered knowledge determination questionnaire consists of both qualitative and quantitative statements to measure level of knowledge, used as data collection tool in pre and post educational sessions, with educational booklet as intervention tool. Statistical analysis: Data were analyzed with Statistical Package for the Social Sciences Software Version 18. The results are presented as frequency & percentage as appropriate at alpha level of P < 0.05;inferential statistics were generated. Paired t-test was used to perform the comparisons. Results: There was statistically significant difference in the knowledge level for the intensive care unit’s nurses regarding the intravenous medication administration during pre and post education program. Statistical analysis showed that there was a statistically significant between age, educational degree, critical units/wards, years of nursing experience and previous medication administration education program of the nurses and their knowledge during different phases of program intervention. Conclusion: Educational program on medication safety improves the knowledge of critical care nurses regarding intravenous medication errors. This study recommends that medication errors should be periodically assessed by improving clinical guidelines of medication administration.

A continuous quality improvement project to reduce medication error in the emergency department

BACKGROUND:Medication errors are a common source of adverse healthcare incidents particularly in the emergency department(ED) that has a number of factors that make it prone to medication errors.This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED.METHODS:In 2009,a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems.RESULTS:Responsible officers were assigned to look after seven error-prone areas.Strategies were proposed,discussed,endorsed and promulgated to eliminate the problems identified.A reduction of medication incidents(Ml) from 16 to 6 was achieved before and after the improvement work.CONCLUSION:This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.

Establishment and application of medication error classification standards in nursing care based on the International Classification of Patient Safety

Objective:To standardize the classification,reporting and analysis of medication errors in nursing in order to improve patient safety management by achieving real-time monitoring and systemic analysis.Methods:A system of classifying nurse-related adverse drug effects into four category grades was developed based on the framework provided by the International Classification of Patient Safety.Three investigators used the system to classify 1343 nursing-related drug adverse events reported between January 2006 and December 2010 at 15 tertiary medical institutions in Shanghai.Results:The classification standard incorporated all relevant information provided in the reporting system and revealed that the greatest frequency of drug adverse events resulted from staff-related factors.In particular,the largest number of events resulted from routine violations,followed by technology type errors of negligence and fault.Conclusion:Application of this classification system will help nursing administrators to accurately detect system-and process-related defects leading to medication errors,and enable the factors to be targeted to improve the level of patient safety management.

Medication Error and Interprofessional Communication-Related Factors Contributing to Hospitalisation in Community-Dwelling Older Adults in Australia

Background: Population ageing is a worldwide phenomenon. It is common for older adults to develop multiple age-related illnesses and the prevalence of multimorbidity increases substantially with age. Multimorbid adults are frequently treated with several concurrent medications and the regimen may be complex requiring multiple steps in the preparation of a medication prior to its administration. Polypharmacy is a concerning trend and older adults have a 100% risk of experiencing adverse drug events when taking ten or more medications concurrently. Discharge summaries communicating the number of medications, changes made to medication regimens during hospitalisations and the requirement for ongoing monitoring in the community are often incomplete. The aim of this study was to investigate contributing factors to medication-related hospitalisation, length of stay or readmission in older community-dwelling persons and examine the quality of discharge summaries. Methods: Descriptive and correlational analyses of demographic, clinical, admission, readmission, length of stay and medication variables were examined in Australia in 2016-2018. Discharge summaries were analysed for completeness, timeliness and interprofessional communication. Results: There were 295 participants, mean age 80 years, 55% were female, taking an average of 11 prescribed medications and with a mean Medication Regimen Complexity Index score of 34. Medication errors that were unrecognised at the time of hospitalisation were present in 19% of the sample. Factors associated with medication error were older age and a longer median length of stay. Fewer than 52% of these older patients had detailed discharge summaries. Conclusion: The prevalence of polypharmacy and medication regimen complexity at admission was high. A high proportion of older adults on medical units may have unrecognised medication errors impacting their admission. Medical discharge summaries are inadequately addressing this issue for patients returning to the care of their family physician.

Personality Traits, Thinking Styles, and Emotional Intelligence in Nursing, towards Healthcare Providers’ Characterization and Safer Patient Care

Background: This study explored nursing personality traits (Big Five Inventory BFI), emotional intelligence (EI), and thinking styles (Rational, RS, and Experiential, ES) together with demographic data to see how they could relate and the implication of this on nurses and patient safety. Design: A cross-sectional study. Methods: Nursing sample (n = 435). Participants completed a self-report online survey, which included demographic information, followed by questionnaires to measure personality traits, thinking styles, and emotional intelligence. Results: Spearman’s rank correlation was computed to assess the relationship between EI and Extraversion;there was a moderate positive correlation between the two variables, r = 0.487, p r = 0.731, p r = 0.723, p r = -0.666, p r = 0.467, p Conclusion: Different studies consolidated each other, and all converge and channel into the concept of characterization of healthcare providers for better support to them and safer patient care. EI correlated with all BFI components, and both positively impacted all desirable behaviors. Therefore, it would be valuable if organizations invested in increasing EI in their providers as it might highlight areas for improvement and equip providers with appropriate and advantageous coping strategies.

Promoting Clinician Well-Being and Patient Safety Using Human Factors Science: Reducing Unnecessary Occupational Stress

Our healthcare delivery system has accumulated complexity of payment, regulation systems, expectations and requirements. Often these are not designed to align with clinical thinking process flow of patient care. As a result, clinicians are utilizing enormous mental (cognitive) resource to comply with these complexities, over and above the baseline mental effort required to give good care to the patient. Recent studies suggest a significant number of physicians, advanced practice providers and nurses no longer want to stay in healthcare due to difficult work expectations and conditions that have become unreasonable. Technology has benefitted healthcare delivery, but also is a conduit of many expectations that have been grafted upon clinician workloads, exceeding the resources provided to accomplish them. Cognitive load is a measure of mental effort and is divided into Intrinsic, Germane and Extraneous Cognitive Load. Extraneous Cognitive Load (ECL) is what is not necessary and can be removed by better design. High cognitive load is associated with increased risk of both medical error and clinician burnout. Chronic high level occupational stress occurs from dealing with this job/resource imbalance and is showing serious personal health impact upon clinicians and the quality of the work they can provide for patients. Since organizational systems have become more complex, leadership methods, clinician wellbeing and patient safety efforts need to adjust to adapt and succeed. Safety efforts have tended to predominantly follow methods of a few decades ago with predominant focus upon how things go wrong (Safety I) but are now being encouraged to include more of the study of how things go right (Safety II). Human Factors/Ergonomics (HFE) science has been used in many industries to preserve worker wellbeing and improve system performance. Patient safety is a product of good system performance. HFE science helps inform mechanisms behind Safety I and II approach. HFE concepts augment existing burnout and safety interventions by providing a conceptual roadmap to follow that can inform how to improve the multiple human/technology, human/system, and human/work environment interfaces that comprise healthcare delivery. Healthcare leaders, by their influence over culture, resource allocation, and implementation of requirements and workflows are uniquely poised to be effective mitigators of the conditions leading to clinician burnout and latent medical error. Basic knowledge of HFE science is a strategic advantage to leaders and individuals tasked with achieving quality of care, controlling costs, and improving the experiences of receiving and providing care.

Traditional Medicine Diagnostic Codes in ICD-11 and Alternative Diagnostic Classifications in the Mainstream Healthcare

In 2018,the 11^(th) Edition of the International Classification of Diseases(ICD-11)defined a diagnostic code list for standard traditional medicine(TM)conditions.The codes improve patient safety by providing more comprehensive and accurate medical records for hospitals in the Western Pacific Region.In these facilities,TM is often a standard of care for those populations.In several mainstream media sources,writers are circumventing evidence-based peer-reviewed medical literature by unduly influencing public opinion and,in this case,against the new ICD-11 codes.The dangers imposed by the transgression of popular writing onto the discipline of peer-reviewed works are present since best practices in medical record-keeping will fail without the inclusion of TM in the ICD-11 codes.Such failures directly affect the health of the patients and policymakers in regions where TM and conventional medicine are combined.This article investigates the boundaries between substantial evidence and popular opinion.In this era where media is used to manipulate evidence,the reader’s use of sound judgment and critical thought are thwarted.This article also challenges three controversial themes in pop literature,including the threat to endangered species,increased patient risk,and contaminants in the TM.These themes are made without evidence and are,in fact,of flawed logic.There is no reason to assume that improved medical record-keeping and knowledge of patient cases increase risks.

Knowledge Representation in Patient Safety Reporting: An Ontological Approach

Purpose： The current development of patient safety reporting systems is criticized for loss of information and low data quality due to the lack of a uniformed domain knowledge base and text processing functionality. To improve patient safety reporting, the present paper suggests an ontological representation of patient safety knowledge. Design/methodology/approach： We propose a framework for constructing an ontological knowledge base of patient safety. The present paper describes our design, implementation,and evaluation of the ontology at its initial stage. Findings： We describe the design and initial outcomes of the ontology implementation. The evaluation results demonstrate the clinical validity of the ontology by a self-developed survey measurement. Research limitations： The proposed ontology was developed and evaluated using a small number of information sources. Presently, US data are used, but they are not essential for the ultimate structure of the ontology.Practical implications： The goal of improving patient safety can be aided through investigating patient safety reports and providing actionable knowledge to clinical practitioners.As such, constructing a domain specific ontology for patient safety reports serves as a cornerstone in information collection and text mining methods.Originality/value： The use of ontologies provides abstracted representation of semantic information and enables a wealth of applications in a reporting system. Therefore, constructing such a knowledge base is recognized as a high priority in health care.

Development and application of a closed-loop medication administration system in University of Hongkong-Shenzhen Hospital

Objective： This study aimed to develop and apply a closed-loop medication administration system in a hospital in order to reduce medication administration errors （MAEs）.Methods： The study was implemented in four pilot general wards. We used a before-and-after design to collect oral medication administration times before and after the implementation of the closed-loop medication administration system, evaluated MAE alert logs after the intervention, and conducted a survey of the nurses1 satisfaction with the system in the pilot wards.Results： （a） Nursing time of oral medication administration： before the adoption of the closed-loop medication administration system, the average nursing time was 31.56 ± 10.88 minutes （n = 78）; after the adoption of the system, the time was 18.74 ± 5.60 minutes （n = 54）. Independent sample Mests showed a significant difference between two groups（t= 8.85, P 〈0.00）. （b） Degree of nurses’ satisfaction with the closed-loop medication administration system： 60.00% （n = 42） of nurses considered the system to be helpful for their work and nearly half of the nurses （47.14%, n = 33） believed that the system could facilitate clinical work and reduce workload; 51.43% {n = 36） believed that the system could reduce checking time and enhance work efficiency; 82.86% （n = 58） believed that the system was helpful in improving checking accuracy to reduce MAEs and ensure patient safety. More than 60% of the nurses considered the system to be a method that could help to track MAEs to improve nursing quality, （c） The MAE alert logs during observation period： it revealed only 27 alerts from the repeated scans of 3,428 instances of medication administration.Conclusions： The nurses were satisfied with the closed-loop medication administration system because it improved their work efficiency and reduced their workload. The current investigation was limited by time; therefore, further research is needed to more closely examine the relationship between the system and MAEs.

Undergraduate paramedic students cannot do drug calculations

BACKGROUND:Previous investigation of drug calculation skills of qualified paramedics has highlighted poor mathematical ability with no published studies having been undertaken on undergraduate paramedics.There are three major error classifications.Conceptual errors involve an inability to formulate an equation from information given,arithmetical errors involve an inability to operate a given equation,and finally computation errors are simple errors of addition,subtraction,division and multiplication.The objective of this study was to determine if undergraduate paramedics at a large Australia university could accurately perform common drug calculations and basic mathematical equations normally required in the workplace.METHODS:A cross-sectional study methodology using a paper-based questionnaire was administered to undergraduate paramedic students to collect demographical data,student attitudes regarding their drug calculation performance,and answers to a series of basic mathematical and drug calculation questions.Ethics approval was granted.RESULTS:The mean score of correct answers was 39.5%with one student scoring 100%,3.3%of students(n=3) scoring greater than 90%,and 63%(n=58) scoring 50%or less,despite 62%(n=57) of the students stating they 'did not have any drug calculations issues'.On average those who completed a minimum of year 12 Specialist Maths achieved scores over 50%.Conceptual errors made up 48.5%,arithmetical 31.1%and computational 17.4%.CONCLUSIONS:This study suggests undergraduate paramedics have deficiencies in performing accurate calculations,with conceptual errors indicating a fundamental lack of mathematical understanding.The results suggest an unacceptable level of mathematical competence to practice safely in the unpredictable prehospital environment.

Drug calculation ability of qualified paramedics:A pilot study

BACKGROUND: The inability of paramedics to perform accurate calculations may result in a compromise of patient safety which may result from under or over dosing of drugs, incorrect joules for defibrillation, or a major adverse event such as death. The objective of this study was to identify the drug calculation and mathematical ability of qualified operational paramedics.METHODS: The study used a cross-sectional design with a paper-based calculation questionnaire. Twenty paramedics enrolled in an intensive care paramedic course were eligible to participate in the study. The questionnaire consisted of demographic, drug calculation(seven questions), and mathematical(five) questions. Students were given no notice of the impending study and use of a calculator was not permitted.RESULTS: All eligible students participated in the study. The average time employed as a paramedic was 7.25 years, SD 2.5 years, range four years to twelve years. Four(20%) students got all 12 questions correct, and five(41.6%) got 50% or less. The average score was 8.6(71.7%) correct, SD 2.8 correct, range 3 to 12 correct questions. There were eight(40%) conceptual errors, 12(60%) arithmetical errors, and five(25%) computational errors.CONCLUSION: The results from this study supports similar international studies where paramedic's ability to undertake mathematical and drug calculations without a calculator varies, with some results highlighting the paramedics mathematical skills as a potential risk to patient safety. These results highlight the need for regular continuing mathematical and drug calculation practice and education to ensure a lower error rate.

The Records of Anatomy in Ancient China

Through long-term observations and repeated practices of human body structure,anatomical knowledge in ancient China has gradually developed from the sprouting period when ancient Chinese hunted animals for survival,to anatomical exploration,which breaks the shackles of fear and religious rites.For example,Hua Tuo(华佗),a famous doctor in the period of The Three Kingdoms,did exquisite abdominal surgery;Yan Luozi(烟萝子),a Taoist priest in the period of The Five Dynasties,drew a map of human anatomy;Wang Weiyi(王唯一),a medical official in Northern Song dynasty,was responsible for casting acupuncture bronze figures,an anatomical mold for practicing acupuncture;Song Ci(宋慈),a forensic expert in Southern Song Dynasty,wrote Xi Yuan Ji Lu(《洗冤集录》Collected Cases of Injustice Rectified);Wang Qingren(王清任),a physician in Qing Dynasty wrote Yi Lin Gai Cuo(《医林改错》Correction on Errors in Medical Works).Ancient Chinese anatomy is far ahead of Western anatomy in understanding and describing human body structures.It has made great contributions to the emergence of Huang Di Nei Jing(《黄帝内经》Huangdi's Internal Classic)and laid a solid foundation for the establishment of visceral manifestation theory and meridian and collateral theory.Even now,it has served the basic theory of traditional Chinese medicine and clinical practices.Anatomical knowledges,such as relevant operation records,books,Atlas,models in ancient China,especially the names of Zangorgan and Fu-organ,bones and five sense organs,are still used in modern anatomy and modern medicine,making indelible contributions to the development of modern anatomy in China.

New technologies as a strategy to decrease medication errors: how do they affect adults and children differently?

Background:Medication error can occur throughout the drug treatment process,with special relevance in children given the risk of adverse effects resulting from a medication error is more prevalent than in adults.The significance of medication error in children is also greater because small error that would be tolerated in adults can cause significant damage in children.Moreover,the likelihood of injury is higher than in adults.Data sources:Based on the data published,most medication errors take place in prescribing and administration stages in both populations.Taking in account that child's risk factors are different from those of adults,with some specific causes to pediatrics,we have reviewed available data about new technologies as a strategy to reduce pediatric medication errors.Results:Even though there is a lack of standardized definitions and terminology that makes studies difficult to compare,we checked that new technologies have proven to be effectives in reducing medication errors,mainly computerized physician order entry(CPOE)and platforms to aid decision-making.However,we also observed that the use of these informatic tools can also generate new errors.Conclusions:Implementation of CPOE programs for pediatrics,communication improvement between healthcare professionals taking care of admitted children and the knowledge of these programs should be the mayor priorities for the safety of hospitalized children.

Quality management in anatomic pathology:The past,present,and future

One of the challenges in anatomic pathology laboratories is to meet the increasing need for pathological diagnosis,using quality management(QM)activities and systems to ensure that patients receive their accurate and timely pathology report.The aim of this paper is to review anatomic pa-thology QM from both management and technical perspectives,including the past,present,and future opportunities.First,the evolution of the QM concept and scope will be discussed.Next,current QM system imple-mentation and laboratory accreditations will be discussed from the man-agement perspective,and common medical errors in anatomic pathology in different testing cycles will be analyzed.Finally,selected future management systems to improve the level of total QM worldwide for patient safety and the potential of informatics to be used as an auxiliary tool in anatomic pathology will be discussed.