Research LettersIncrease in US medication-error deaths between 1983 and 1993
References (4)
- American Hospital Association. Hospital statistics: the AHA profile of United States hospitals. Chicago, IL: American...
- EJ Emanuel et al.
Managed competition and the patient-physician relationship.
N Engl J Med
(1993)
Cited by (312)
Role of pharmacist during COVID-19 pandemic: A retrospective study focused on critically ill COVID-19 patients
2021, Saudi Pharmaceutical JournalCitation Excerpt :Medication errors (MEs) represent a major concern globally. Early studies have estimated that MEs account for 7000 deaths annually in the United States (Phillips et al., 1998, 2001). Whereas recent reports have shown that the number is underestimated as MEs may account for up to 251,000 deaths a year in the U.S. (Makary and Daniel, 2016; Anderson and Abrahamson, 2017).
During the Coronavirus 2019 (COVID-19) crisis, there has been a huge demand for medications and unprecedented utilization of intensive care unit (ICU) services that subsequently and profoundly impacted the quality of medical care provided to COVID-19 patients. This study aimed to shed light on the role of pharmacists on the health care provided to critically ill COVID-19 patients.
A retrospective study, was conducted in Diriyah hospital in Riyadh, Saudi Arabia on all COVID-19 patients admitted to the ICU between June 27th and August 15th, 2020 until patients were transferred to the medical ward, discharged, or deceased. All medication related interventions performed by pharmacists have been documented electronically, collected and subsequently categorized and analyzed.
The mean age of patients was 58.8 years (±12.98 SD), with age of >64 years in approximately 37%. Four hundred and seventy interventions (470) were made by pharmacists of which 32%, 11.7%, 4%, 2.6%, 2.1% were due to error in dosing regimens, drug duplication, missing drug information, drugs requiring prior authorization, and missing critical information, respectively; while 40.6% were due to medication shortage of which 40.3% were substituted with alternative medications. Based on the analysis of drugs involved in interventions, medication groups that were mainly associated with interventions included antibiotics (16.8%), electrolytes/minerals (11.7%) and vitamins (9.4%).
During health crises such as COVID-19 pandemic, the role of pharmacists in the ICU services becomes extremely crucial for providing better patients’ outcomes. Further studies should be conducted to follow up these findings in the context of COVID-19 pandemic.
Communicating Patient Quality and Safety in Your Hospital
2021, Veterinary Clinics of North America - Small Animal PracticeQuality assessment of drug therapy
2021, Atkinson's Principles of Clinical PharmacologyAuthor reviews key elements of the medication use process, areas of risk for medication errors, and opportunities to improve medication safety. Medication use evaluation is a quality improvement process that attempts to connect specific elements of the medication use process, to improved outcome opportunities. The author discusses medication safety and quality improvement in the context of the Shewhart chart quality improvement model.
Evaluation of a medication error monitoring system to reduce the incidence of medication errors in a clinical setting
2019, Research in Social and Administrative PharmacyMedication errors have significant health and economic consequences. Monitoring medication errors by implementing monitoring systems proved in the USA and European countries since 1990s to be an effective method for error detection, leading to improved safety at all levels of health care. Currently, China does not have a universal medication error monitoring system.
To evaluate the effectiveness of the Medication Error Monitoring System for the reduction of medication errors in Xiamen Maternity and Child Care Hospital.
Between January–June 2014, the Medication Error Monitoring System developed by Xiamen Maternity and Child Care Hospital was employed to monitor medication errors through error reporting by physicians and pharmacists. The errors collected by this system were then thoroughly assessed and addressed by specific improvements including more frequent training, introducing computerised prescribing systems and a bar-coding medicine dispensing system. Data collected from January–June 2015, was then compared with the data collected in 2014 to determine whether medication errors had been reduced.
Between 2014 and 2015, the total medication errors in prescribing and dispensing were reduced by approximately 27%. Compared with 2014, there was a marked reduction in the number of errors due to misdiagnoses and inappropriate usage/dosage in 2015, while the number of data entry errors increased and became the most common cause of medication error. The success rate of pharmacy interventions increased from 95.25% to 96.88%, albeit modest. However, across all medication errors in the stage of prescribing and dispensing, non-human-related errors significantly decreased from 44.25% in 2014 to 37.94% in 2015 with a p value of 0.021.
The Medication Error Monitoring System is effective at monitoring medication error data, leading to a reduction in reported medication errors. Better training for hospital staff including doctors and pharmacists will be critical to reduce human-related medication errors in the hospital.
Medication reconciliation: Predictors of risk of unintentional medication discrepancies in the cardiology department
2019, Archives of Cardiovascular DiseasesMedication reconciliation is a powerful formal process to decrease medication errors, but it has proved to be complex and time consuming.
To describe the frequency and types of medication discrepancies (between previous treatment and medication order at admission), and to identify predictors of unintentional medication discrepancies (UMDs).
This interventional study was carried out in the cardiology department of a French teaching hospital. Medication reconciliation was conducted at admission to the cardiology department over 1 month in 2016 by trained pharmacists for: (1) determination of best possible medication history using multiple sources; (2) comparison with the patient's admission medication order and identification of discrepancies; and (3) classification of discrepancies (intentional/unintentional) with the physician. Associations between UMDs and various factors were examined.
Overall, 100 patients were included (mean age 67.6 ± 16.7 years; 56 men). The reconciliation process identified 544 drug discrepancies, 77 of which were UMDs; these occurred in 42 patients. The most common UMD type was omission (70.1%). Inability to speak French (P = 0.007), low educational level (P = 0.004), admission to a non-intensive care unit (P = 0.019), two or more co-morbidities (P = 0.001) and eight or more drugs on the admission order (P = 0.004) were significantly associated with UMDs. Educational level remained significantly and independently associated with UMDs in a multivariable analysis after adjustment for factors that were statistically significant in the univariate analysis.
This study highlights the high risk of medication discrepancies and the factors associated with UMDs. Our results allowed us to identify patients who should receive priority medication reconciliation in a cardiology department.
La conciliation des traitements médicamenteux permet de diminuer les erreurs médicamenteuses, mais ce processus formel s’avère complexe et chronophage.
Décrire la fréquence et le type de divergences (entre le traitement avant l’hospitalisation et la prescription à l’admission), identifier les facteurs de risque de divergence non intentionnelle.
La conciliation a été réalisée à l’admission des patients dans le service de cardiologie d’un centre hospitalo-universitaire français, pendant un mois en mars 2016 par des pharmaciens formés : (1) réalisation du bilan médicamenteux optimisé ; (2) comparaison avec la prescription médicamenteuse à l’admission et identification des divergences ; (3) caractérisation des divergences (intentionnelles/non intentionnelles) avec le clinicien. Les associations entre divergences non intentionnelles et les caractéristiques des patients ont été analysées.
Chez les 100 patients inclus (âge moyen 67,6 ± 16,7 ans; sexe-ratio (H/F) 1,3). La conciliation a identifié 544 divergences, dont 77 non intentionnelles chez 42 (42 %) patients. La plus fréquente était l’omission (70 %). Les facteurs associés à la présence de divergences non intentionnelles sont: ne pas parler français (P = 0,007), faible niveau d’éducation (P = 0,004), admission en hospitalisation conventionnelle (VS soins intensifs) (P = 0,019), ≥ 2 comorbidités (P = 0,001) et ≥ 8 médicaments (P = 0,004). Le niveau d’étude demeure significativement associé après ajustement sur les facteurs statistiquement significatifs de l’analyse univariée.
Notre étude nous a permis de mettre en évidence l’importance des divergences et les facteurs associés. Nous pouvons désormais sélectionner les patients chez qui la conciliation médicamenteuse est à réaliser en priorité en cardiologie.
SBA 2020: Regional anesthesia safety recommendations update
2020, Brazilian Journal of AnesthesiologyO propósito desta atualização das Recomendações da Sociedade Brasileira de Anestesiologia (SBA) para Segurança em Anestesia Regional foi apresentar novas diretrizes com base na relevância e atualidade clínica nos aspectos de segurança relacionados a analgesia e anestesia regional. Este artigo visa prover uma visão ampla sobre o conhecimento atual no tocante a assepsia e antissepsia pré‐procedimento, fatores de risco, diagnóstico e tratamento das complicações infecciosas decorrentes das técnicas anestésicas. Também visa esclarecer sobre o uso de materiais reprocessados na prática da anestesia regional, estabelecer as implicações no manejo asséptico de frascos e ampolas e elucidar sobre a relação custo‐efetividade no preparo de soluções a serem administradas continuamente em bloqueios regionais. As bases de dados eletrônicas foram pesquisadas entre Janeiro de 2011 (final da pesquisa de literatura das diretrizes anteriores da SBA sobre segurança em anestesia regional) e Setembro de 2019. Um total de 712 artigos foram encontrados, dos quais 201 foram incluídos para análise posterior e 82 novos estudos foram acrescentados nesta revisão. O sistema de Avaliação, Desenvolvimento e Avaliação da Classificação das Recomendações (GRADE) foi utilizado para avaliar a qualidade do estudo individual e classificar a força da evidência. Esta revisão foi elaborada por membros da Comissão de Normas Técnicas da SBA.
The purpose of the Brazilian Society of Anesthesiology's (SBA) Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre‐procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost‐effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.