THESIS (D.N.P. (Doctor of Nursing Practice))--School of Nursing, University of San Francisco, 2009. / Bibliography: leaves 22-26.

nÃo hà / A seguranÃa relacionada ao sistema de medicaÃÃo tem sido objeto de pesquisas recentes, principalmente, em relaÃÃo aos antibacterianos que possuem alta especificidade farmacolÃgica e podem ter sua aÃÃo prejudicada em detrimento de erros associados Ãs fases de preparo e administraÃÃo. Assim, o estudo teve como objetivo geral: Analisar os fatores comportamentais e ambientais envolvidos na ocorrÃncia de erros durante as etapas de preparo de administraÃÃo de antibacterianos. Trata-se de um estudo observacional, exploratÃrio e transversal, de natureza quantitativa, realizado entre agosto a dezembro de 2014 em Hospital da Rede Sentinela em Fortaleza. A amostra compreendeu 44% das doses de antibiÃticos das clÃnicas mÃdicas A e B, 108 e 157, respectivamente. A coleta de dados se deu em duas fases: a primeira para caracterizar o perfil sÃcio ocupacional dos profissionais de enfermagem; e a segunda para identificar as adequaÃÃes e inadequaÃÃes comportamentais e ambientais nas fases de preparo e administraÃÃo. Os dados foram organizados em tabelas e analisados por meio da estatÃstica descritiva e analÃtica. Todos os princÃpios bioÃticos foram respeitados, conforme aprovaÃÃo da pesquisa pelo Comità de Ãtica da Universidade Federal do CearÃ, protocolo nÃmero 660.897. Os resultados permitiram realizar as seguintes inferÃncias: a concretizaÃÃo do preparo e administraÃÃo dos antibacterianos foi realizada por tÃcnicos de enfermagem (100%), predominantemente do sexo feminino, na faixa etÃria de 31 a 40 anos, que concluÃram a formaÃÃo entre os Ãltimos dez a 20 anos e atuam na Ãrea por um perÃodo semelhante, no entanto, hà menos de dez anos na instituiÃÃo onde a pesquisa foi realizada. Sobre a influÃncia de fatores ambientais verificou-se que durante o preparo houve inadequaÃÃo em 136 observaÃÃes na variÃvel limpeza e em 187 na organizaÃÃo. A dimensÃo para o preparo foi inadequada na ClÃnica MÃdica A (3,8m2), e os itens iluminaÃÃo, temperatura e ruÃdo foram extremamente oscilantes nos trÃs turnos e nas duas clÃnicas, com mÃdias geralmente acima do recomendado. Quanto Ãs variÃveis comportamentais observou-se: fontes produtoras de interrupÃÃes em 145 doses durante o preparo, e, no entanto, nÃo foram estatisticamente significativas para aumentar o tempo de preparo dos antibiÃticos (p=0,776). Houve maior frequÃncia de nÃo-conformidades respectivamente nas clÃnicas A e B quanto ao itens: comportamento de utilizaÃÃo da prescriÃÃo 86 (79,6%) e 157 (100%); confirmaÃÃo do nome do paciente 68 (62,9%) e 142 (90,4%); e, monitoramento 84 (77,7%) e 82 (52,2%). Jà a ClÃnica MÃdica B apresentou maiores Ãndices de conformidade no controle do tempo de infusÃo 84 (53,5%) e checagem imediata 93 (59,2%). Fator que contribuiu para aumentar as chances de interaÃÃo medicamentosa foi a ausÃncia de diretrizes com informaÃÃes sobre o medicamento (p=0,003). A principal categoria de erro encontrada foi o erro de dose (157). Jà o antibiÃtico mais comumente utilizado foi a Piperaciclina + Tazobactan com 51 doses. Conclui-se que o ambiente de trabalho e o comportamento adotado pelos profissionais de enfermagem sÃo condiÃÃes que podem favorecer a ocorrÃncia de erros com antibiÃticos.

Class of 2017 Abstract / Objectives: To evaluate the perceptions of the pharmacy staff on prescription errors, efficiency, and difficulty of use before and after implementation of a new pharmacy computer system. Subjects: Employees of El Rio Community Health Center outpatient pharmacies located at the Congress, Northwest, and El Pueblo Clinics. Methods: This study was of a retrospective pre-post design. A 5-question survey on error rates and workflow efficiency was distributed to pharmacists and technicians 6 months after a new computer system had been implemented. Participants of the study included employees of El Rio Community Health Center outpatient pharmacies who were employed with El Rio during the time of transition between the old and new computer systems. Results: Questionnaire responses were completed by 10 (41.7%) technicians and 6 (66.7%) pharmacists at three El Rio Clinics. There was an increase in perceived efficiency between the new (Liberty) (n=17, 94.4%) and old (QS1) (n=11, 61.1%) computer systems (p<0.05). There were no significant differences in perceived difficulty of use, most common types of errors, error rates, and time to fix detected errors. Conclusions: While there were no significant differences between Liberty and QS1 in perceived difficulty of use, most common types of errors, error rates, and time to correct detected errors, there was a significant difference in the perceived efficiency, which may have beneficial implications.

Caregivers of elderly people may make errors in administering medicine. This study aims to determine a more effective method of presenting prescription instructions to caregivers and to determine if the multiple resource hypothesis holds in the context of prescription instructions by evaluating the effect a voice prescription label (that gives audio instructions) has on comprehension and memory of a drug regimen under varying training level, task complexity, and instruction format. In performing a multivariate analyses of variance on data collected among formal and informal caregivers, training level, task complexity, sound condition, and instruction format were found to significantly affect caregivers' memory and comprehension. There is evidence that audio instructions and the matrix format reduce errors. These results could lead to the development of a Medication Scheduling Management System that would organize medicines according to administration time and incorporate decision rules to determine what to do if a dose is missed.

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Kan, Ka Lai Carrie. / "May 2008." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 118-125). / Abstracts in English and Chinese, some text in appendix also in Chinese. / Chapter CHAPTER 1: --- INTRODUCTION --- p.1 / Chapter CHAPTER 2: --- LITERATURE REVIEW / Introduction --- p.3 / Medication error --- p.4 / Definition of medication error --- p.4 / Incidents of medication error --- p.6 / The issues of defining medication error --- p.7 / The issue of medication error reporting --- p.8 / Near miss --- p.9 / Factors associated with medication error --- p.10 / System factors --- p.10 / Environmental factors --- p.12 / Human factors --- p.13 / Slips and lapses and medication error --- p.14 / "Distraction, slips and lapses and medication error" --- p.15 / Distraction --- p.15 / Definition of distraction --- p.15 / Consequences of distraction --- p.16 / Factors associated with distraction --- p.16 / Cognitive factors --- p.17 / Personality factors --- p.18 / Environmental factors --- p.18 / Studies on distraction during medication administration --- p.19 / Distraction and medication error --- p.21 / Strategies to reduce distraction --- p.22 / Visual Sign --- p.23 / Definition of visual sign --- p.23 / Nature of visual sign --- p.24 / Studies on visual sign to reduce distraction --- p.25 / Summary of literature review --- p.25 / Chapter CHAPTER 3: --- METHODOLOGY / Introduction --- p.27 / Aims and objectives --- p.27 / Operational definitions --- p.28 / Research design --- p.28 / Setting --- p.31 / Stage one --- p.32 / Setting --- p.32 / Sampling --- p.33 / Instrument --- p.35 / Data collection method --- p.36 / Data analysis --- p.37 / Stage two --- p.38 / Stage three --- p.40 / Pilot study --- p.40 / Validity and reliability of methodology --- p.41 / Interview --- p.41 / Observation --- p.42 / Ethical considerations --- p.43 / Chapter CHAPTER 4: --- FINDINGS / Introduction --- p.44 / Stage one --- p.44 / Baseline interview --- p.44 / Informants' characteristics --- p.44 / Categories and sub-categories --- p.45 / Feelings of medication error --- p.46 / Causes of medication error --- p.47 / Causes of distraction --- p.49 / Perception of distraction --- p.50 / Feelings about distraction --- p.52 / Strategies to reduce distraction --- p.53 / Strategies to reduce medication error --- p.54 / Baseline observation --- p.56 / Findings of stage one --- p.59 / Stage two --- p.60 / One week after implementation observation --- p.60 / Findings of stage two --- p.63 / Stage three / Three months after implementation observation --- p.63 / Follow-up interview --- p.66 / Informants' characteristics --- p.66 / Categories and sub-categories --- p.67 / Conflicting feelings --- p.68 / Different effects on nursing service --- p.69 / Feelings about wearing the red vest --- p.70 / Enhanced a non-distractive culture --- p.72 / Improved cognitive process --- p.73 / Improved performance --- p.75 / Findings of stage three --- p.76 / Comparison of the three stages of quantitative observational data --- p.77 / "Lapse time, items given, and number of patients" --- p.77 / Comparison of lapse time and total distraction --- p.78 / Comparison of the ten items on distraction --- p.78 / Comparison of total distraction --- p.79 / Comparison of near misses --- p.80 / Overall Summary of the findings --- p.80 / Chapter CHAPTER 5: --- DISCUSSION / Introduction --- p.82 / Characteristics of informants and observational data --- p.82 / Nurseśة perception of distraction as a cause of medication administration error --- p.83 / Causes of distraction during medication administration --- p.87 / Evaluation outcome --- p.91 / Evaluation process --- p.98 / Chapter CHAPTER 6: --- "LIMITATIONS, IMPLICATIONS AND RECOMMEDATIONS" / Limitations --- p.111 / Setting --- p.111 / Population and sampling --- p.111 / Observer's influence --- p.112 / Interviewer's influence --- p.112 / Implications for nursing practice --- p.113 / Recommendations for future studies --- p.114 / Conclusion --- p.116 / REFERENCES --- p.118 / APPENDICES / Chapter 1: --- Literature search --- p.126 / Chapter 2: --- Medication Administration Distraction Observation Sheet (MADOS) --- p.127 / Chapter 3: --- Adapted MADOS --- p.128 / Chapter 4: --- Baseline interview guide --- p.129 / Chapter 5: --- Interview consent form --- p.130 / Chapter 6: --- Observation consent form --- p.136 / Chapter 7: --- Informal letter to nursing staff --- p.142 / Chapter 8: --- Follow-up interview guide --- p.144 / Chapter 9: --- Rationale for pilot study --- p.145 / Chapter 10: --- Ethical approval (CUHK) --- p.147 / Chapter 11: --- Ethical approval ( Hospital Administrative Council) --- p.148 / Chapter 12: --- Baseline interview (1) --- p.149 / Chapter 13: --- Baseline observation (MAC 4) --- p.154 / Chapter 14: --- One week after observation (MAC 01) --- p.155 / Chapter 15: --- Three months after observation (MAC 005) --- p.156 / Chapter 16: --- Follow-up interview (08) --- p.157 / TABLES / Chapter 1: --- Different units and the approximate numbers of nurses --- p.30 / Chapter 2: --- Proposed sample size for baseline interview --- p.33 / Chapter 3. --- Medication administration at different scheduled time --- p.35 / Chapter 4. --- Informantśة characteristics at baseline interview --- p.45 / Chapter 5: --- Categories and subcategories: baseline interview --- p.46 / Chapter 6: --- "Elapse time, items given, number of patients, distractions and near misses at baseline observation" --- p.57 / Chapter 7: --- Frequency of the ten items of distraction at baseline observation --- p.57 / Chapter 8: --- Ranking of the ten items on distraction at baseline observation --- p.58

Class of 2009 Abstract / OBJECTIVES: To assess the ability of pharmacy, medicine, and nursing students to identify prescribing errors METHODS: Pharmacy, medicine, and nursing students from the University of Arizona were asked to participate in this prospective, descriptive study. Pharmacy and medical students in the last didactic year of their program and traditional bachelor of nursing students in the fourth semester of their program were eligible to participate. Subjects were asked to assess a questionnaire containing three sample prescriptions, evaluate if each was correct and indicate the type of error found, if any. The primary outcome measure was the number of correctly identified prescribing errors. The secondary outcome measure was the number of correct types of error found. Error identification rates for each group were calculated. Comparisons in these rates were made between pharmacy, medicine and nursing students. Chi square tests were used to analyze the nominal data gathered from various groups. RESULTS: Pharmacy students were significantly better able to identify errors than medical and nursing students (p<0.001). Pharmacy students were significantly better able to determine the type of error (p<0.001). CONCLUSIONS: Overall, pharmacy students had higher prescribing error identification rates than medical and nursing students. More studies need to be done to determine the most appropriate way to increase prescribing error identification rates.

According to the National Patient Safety Foundation, more than 1.5 million Americans are affected by medication errors because of varied factors including miscommunication, bad handwriting, name confusion, poor packaging, and metric or other dosing unit errors. This project addressed medication errors and adverse drug events by developing policy and practice guidelines to support and aid the utilization of health information technology (HIT) systems in addressing medication errors and adverse drug events at a local nursing home in Cincinnati, Ohio. The National Quality Strategy Framework was used by a team of interdisciplinary stakeholders as a guide for the development of policies and practice guidelines. An interdisciplinary project team of institutional stakeholders was led by the DNP student through a review of literature to assess the effectiveness of current policies and guidelines and explore areas for improvement. New policy, practice guidelines, and educational materials were developed, along with plans for implementing and evaluating the policies in the institution. Policy and practice guidelines were shared with 4 scholars possessing expertise in health information technology to validate content of the products. Feedback was used to inform revision and preparation of final policy, practice guidelines, educational materials, and plans for implementation and evaluation. The implementation plan advocates a process that includes multiple stakeholders and institutional preparatory stages. The evaluation plan addresses multiple outcomes related to efficiency and patient safety, and proposes both intermediate and long-term evaluation based on comparisons of pre-post metrics routinely collected by the institution. Following implementation and evaluation, dissemination of results of the project may stimulate positive social change by reducing medication errors in similar health care institutions that adopt related measures.

Background. Medication-related patient injuries (adverse drug events, ADEs) are an important problem in all hospitalised populations; however, the potential for injury is reported to be greater in children than adults. Many ADEs are due to error and therefore could be prevented. Data regarding the risk factors (or predictors) for these events in paediatric inpatients is limited. It was hypothesised that "identification of risk factors for ADEs and medication errors in the paediatric inpatient setting will inform likely prevention strategies". Aims. To determine the frequency, nature and risk factors for ADEs and potential ADEs occurring in a paediatric inpatient population; to assess the vulnerable processes in the neonatal intensive care unit (NICU) medication use process; and to provide recommendations for the targeting of likely prevention strategies. Setting. A general paediatric ward (PW), postnatal ward (PNW) and NICU of a University- affiliated urban general hospital. Design. There were two study components: the medEVENT study which involved identification of actual ADEs and potential ADEs over a twelve week period, through prospective review of medical records, medication charts and administration records along with voluntary and solicited staff report and parent interview; and the FMEA study which used a proactive risk assessment technique, Failure Mode and Effect Analysis (FMEA), to rank all potential failures in the NICU medication use process according to risk. Results. In the MedEVENT study 3160 prescription episodes were reviewed (which represented 520 admissions, 3037 patient-days) and revealed a total of 67 ADEs and 77 potential ADEs. The greatest number of events occurred in NICU with very few events in the PNW. However, paediatric surgical admissions experienced the highest rate of ADEs per 1000 patient-days (80) as compared to medical (65) then NICU admissions (19). Over half of the ADEs were deemed preventable, 38 (57%), with the �more serious� ADEs more likely to be preventable than �not serious� ADEs. The impact on hospital resources was considerable with the cost attributed to extra bed days due to ADEs to be $NZD 50,000. Dosing errors were the most common type of error, particularly when prescribing and administering medications. Antibacterial and narcotic analgesics were commonly implicated, as was the intravenous route of administration. Few events were related to unlicensed use of medications. For ADEs, the major risk factors when analysed by admission, were greater medication exposure and increasing age; by prescription, were increasing age, oral route and narcotics and antibacterial agents; for paediatric ward admission, were increasing age and increased length of stay; and for NICU admission, no major risk factors emerged. For potential ADEs, the major risk factors when analysed by admission were greater medication exposure; by prescription, were junior prescriber, intravenous route, narcotics and antibacterials; for paediatric ward admission, were junior prescriber and narcotics; and for NICU admission were antibacterials, electrolytes and umbilical venous catheter administration. Neither ADEs nor potential ADEs were associated with unlicensed use of medicines or high alert status drugs. The FMEA study identified 72 potential failures in the NICU medication use process with 193 associated causes and effects. Multiple failures were possible in the process of �prescribing medication� and in the process of �preparation of medication for administration�. The highest ranking issues were found to occur at the administration stage. Common potential failures related to errors in the dose, timing of administration, infusion pump settings and route of administration. Conclusions. Analysis of the risk factors of ADEs and potential ADEs found that the most vulnerable processes were when prescribing and when preparing a medicine for administration; especially when involving narcotic and antibacterial agents and for children with greater medication exposure Strategies that selectively target these high risk areas are therefore likely to have the greatest impact on preventing drug-related injuries in hospitalised children.