Thesis (M.H.A.)--University of Michigan, 1968.

Thesis (M.H.A.)--University of Michigan, 1968.

This paper presents the results of a survey of 30 adults aged 55 and older, who had taken multiple prescription medications in the past two years. The purpose of the study was to determine how older adults manage their medication information currently, what information they save and share, and how they wish to manage medication information in an electronic environment, such as a personal health record. Adults in the survey shared information most frequently with their doctors, and with friends and family. They usually shared basic information about a medication, including its name, dose, and the frequency with which it is taken. Nearly half used an artifact, such as a list, to keep track of and share their information. Nearly a third of participants desired to keep an electronic record, suggesting that a percentage of the older adult population would be open to using electronic records to manage medication information.

Este estudo identificou, analisou e comparou os erros de medicação ocorridos nos processos de preparo e administração de medicamentos, em uma unidade de internação clínica de um hospital público de ensino, pertencente à Rede de Hospitais-Sentinela da Agência Nacional de Vigilância Sanitária (ANVISA) e localizado na cidade de Rio Branco-AC. Trata-se de um estudo observacional e transversal, realizado no período de julho a setembro de 2005. A amostra foi constituída de 1.129 doses de medicamentos. Esta investigação foi desenvolvida em duas fases: na primeira, os dados foram obtidos a partir da observação direta dos processos que compõem o sistema de medicação e de entrevistas com três profissionais: o responsável pelo setor de farmácia, o chefe do serviço médico e a supervisora do serviço de enfermagem. Na segunda fase, foram observados o preparo e a administração de 1.129 doses, e os erros de medicação foram identificados. Os resultados permitiram identificar 404 (35,8%) erros de medicação e um sistema de medicação com 56 ações. Verificou-se que 866 (76,7%) prescrições estavam manuscritas; 126 (11,2%) não continham o nome legível do medicamento; em 267 (23,6%) faltavam as doses; em 107 (9,5%) não constava a via; em 712 (63,1%) não havia a forma de apresentação; em 20 (1,8%) faltava a freqüência; e em 338 (29,9%) não constavam o tipo e volume do diluente para o preparo. No preparo de medicamentos, foi identificado que 976 (86,4%) doses estavam rotuladas incorretamente e 49 (4,3%) doses não possuíam rótulo. Em relação à administração, observou-se que apenas 31 (2,7%) doses foram administradas após conferência direta da prescrição; em 691 (61,2%) doses não ocorreu identificação do paciente e em 904 (80,1%) doses não houve orientação a respeito do medicamento. Constatouse que 179 (78,2%) doses infundidas não foram controladas, e 214 (18,9%) doses foram registradas imediatamente após a administração. Nas observações em que se desconhecia previamente a prescrição do medicamento, ocorreram os seguintes erros: 47 (4,2%) erros de dose, 2 (0,2%) erros de via, 130 (11,5%) erros de horário, 2 (0,2%) erros de pacientes, 11(1%) erros de medicamentos não autorizados e 71 (6,3%) erros de omissão. Nas observações em que se conhecia previamente a prescrição, identificaram-se 17 (1,5%) erros de dose, 85 (7,5%) erros de horário, 4 (0,4%) erros de medicamentos não autorizados e 35 (3,1%) erros de omissão. Nessa etapa, não ocorreram erros de via e de paciente. Propõe-se como medidas para a redução dos erros nessa instituição: formar um grupo multiprofissional com a finalidade de discutir e estabelecer estratégias que possam promover a segurança do paciente; elaborar protocolos de preparo e administração de medicamentos e promover a educação continuada e permanente para os profissionais. Sugere-se, ainda, que a instituição padronize a prescrição médica, normatizando os itens da prescrição dos medicamentos; desenvolvendo um sistema de distribuição de dose unitária e implementando a prescrição médica eletrônica. / This study identified, analyzed and compared the medication errors that occurred in the medication preparation and administration processes at a clinical hospitalization unit of a public teaching hospital, which is part of the Sentinel Hospital Network of the Brazilian National Health Surveillance Agency (ANVISA) and located in Rio Branco-AC, Brazil. We carried out an observational and cross-sectional study between July and September 2005. The sample consisted of 1,129 medication doses. This study was developed in two phases: in the first, data were obtained through direct observation of the medication system processes and interviews with three professionals: the pharmacy sector responsible, the medical service head and the nursing service supervisor. In the second phase, we observed the preparation and administration of 1,129 doses and identified medication errors. The results revealed 404 (35.8%) medication errors and a medication system that consisted of 56 actions. We found 866 (76.7%) handwritten prescriptions; 126 (11.2%) did not contain the readable name of the drug; doses were missing in 267 (23.6%); route in 107 (9.5%); form in 712 (63.1%); frequency in 20 (1.8%); and the diluent type and volume for preparation in 338 (29.9%). In medication preparation, we identified that 976 (86.4%) doses were labeled incorrectly and that 49 (4.3%) doses did not have a label. With respect to administration, only 31 (2.7%) doses were administered after direct verification of the prescription; in 691 (61.2%) doses, the patient was not identified and, in 904 doses (80.1%), no orientation was provided about the drug. We found that 179 (78.2%) infused doses were not controlled, and that 214 (18.9%) were registered immediately after their administration. In those observations when the medication prescription was previously unknown, the following errors occurred: 47 (4.2%) dose errors, 2 (0.2%) route errors, 130 (11.5%) time errors, 2 (0.2%) patient errors, 11(1%) unauthorized medication errors and 71 (6.3%) omission errors. In those cases when the medication prescription was previously known, we identified 17 (1.5%) dose errors, 85 (7.5%) time errors, 4 (0.4%) unauthorized medication errors and 35 (3.1%) omission errors. In this phase, no route and patient errors occurred. To reduce errors at this institution, we propose the following measures: constitute a multiprofessional group to discuss and establish strategies with a view to promoting patient safety; elaborate medication preparation and administration protocols and promote continuing and permanent professional education. We also suggest that the institution should standardize medication prescriptions by normalizing medication prescription items; developing a unit dose distribution system and implementing electronic medical prescriptions.

A administração de medicamentos se constitui num processo multidisciplinar e um multissistema e seus riscos podem ser reduzidos de forma significativa por meio da implantação de processos reconhecidos para melhoria da segurança. Medicamentos Potencialmente Perigosos (MPP) são medicamentos que possuem maior risco de provocar danos significativos aos pacientes. O gerenciamento de risco em saúde é um processo complexo que associa várias áreas do conhecimento e que tem como objetivo prevenir erros e eventos adversos advindos dos procedimentos e produtos utilizados na assistência, em relação aos MPP, é imprescindível implantar barreiras específicas para gerenciar os riscos envolvidos. O objetivo do estudo foi investigar o gerenciamento de risco de MPP em instituições hospitalares. Estudo transversal, quantitativo, não experimental, realizado em quatro unidades de Terapia Intensiva de hospitais gerais, sendo um público, dois privados com fins lucrativos e um privado beneficente. Foi utilizado um instrumento do tipo questionário, com questões fechadas, elaborado pelo pesquisador, validado para face e conteúdo por cinco juízes e quanto a aplicabilidade por meio de um piloto aplicado em uma unidade de terapia intensiva pediátrica. Os participantes foram todos os membros da equipe de enfermagem das unidades de terapia intensiva pesquisadas e todos os farmacêuticos das instituições pesquisadas. Os resultados apontaram que a participação total foi de 76% da população proposta para o estudo. Todos os medicamentos que compunham o instrumento eram considerados como MPP, entretanto, nenhum foi apontado por 100 % dos participantes como MPP, 17 deles foram apontados como utilizados por 95% ou mais dos entrevistados. Desses, o cloreto de potássio, foi o medicamento mais reconhecido como MPP (99%) e o tramadol o menos reconhecido como perigoso (46%). O medicamento apontado como menos utilizado nas unidades pesquisadas foi o hidrato de cloral (14%), reconhecido como MPP por 78%. O medicamento apontado como menos perigoso foi a água estéril em soluções superiores a 100 ml, reconhecida como MPP por 27% dos entrevistados e utilizada por 90%. Itens considerados rotineiros não foram considerados MPP, dentre eles a solução parenteral prolongada, lidocaína, glicose hipertônica de 25 ou 50%, cloreto de sódio e a enoxaparina, considerados como MPP por 61, 61, 69, 72 e 74% dos entrevistados, respectivamente. Os enfermeiros foram os que mais reconheceram a existência de barreiras de prevenção (96%), já os farmacêuticos os que menos reconheceram (78%). Em média, 84% dos profissionais reconheceram a existência de medidas de prevenção na administração de MPP. A barreira mais reconhecida pelos profissionais foi a de acesso restrito aos MPP (79%). Outra barreira foi a verificação dos certos da terapia medicamentosa, que mesmo sendo uma prática recomendada na administração de todos os medicamentos, foi reconhecida somente por 56% dos entrevistados. O reconhecimento dos MPP, assim como as medidas de prevenção de danos relacionados à esta classe de medicamentos ainda é frágil nas instituições de saúde. A adoção de medidas isoladas ou agrupadas de prevenção de riscos não constituem um sistema de gerenciamento de risco institucional, tampouco em relação aos MPP. A constituição dos comitês de segurança do paciente, além de ser uma obrigação legal pode ser um caminho importante para a efetivação do gerenciamento de risco nas instituições. Diante deste contexto, cabe às instituições de ensino melhorar a qualidade da formação profissional em relação à farmacologia, abordando o tema dos MPP, e aos serviços de saúde implementar programas de educação permanente robustos nos ambientes de trabalho, aplicar barreiras de prevenção baseadas em evidencia de forma sistemática e, finalmente, instituir uma política de incentivo à cultura de segurança do paciente por meio de estratégias educativas, estimulando ações não punitivas ao lidar com os erros / The administration of drugs constitutes a multidisciplinary and multi-system process and its risks can be reduced significantly by implementing recognized processes to improve security. High-Alert Medications (HAM) are drugs that bear a heightened risk of causing harm to the patients. The risk management in healthcare is a complex process that associates several areas of knowledge and aims to prevent errors and events that may come from procedures and products used in assistances. Regarding HAM, it is essential to implement specific barriers in order to manage the risks involved. The objective of this study was to investigate the risk management for HAM in hospital institutions. This study is transversal, quantitative, non-experimental and it was performed in four Intensive Care Units from general hospitals, one of them being public, two of them private for-profit, and one of them a charitable hospital. A questionnaire type instrument containing closed questions made by the researcher was used. Its face and content validation were performed by five judges and its applicability validated by a pilot applied in a pediatric intensive care unit. The participants were the entire nursing staff of the researched intensive care units and the entire pharmacists staff of the researched institutions. The results show that the participants were 76% of the proposed populations for the study. All drugs that formed part of the instrument were HAM, however, none of them were pointed out as HAM by 100% of participants and 17 of them were pointed out as being used by at least 95% of the interviewed. Of these, the potassium chloride was the drug that was most recognized as HAM (99%) and the tramadol was the least recognized as being hazardous (46%). The least used drug in the researched units was the chloral hydrate (14%), it was recognized as HAM by 78% of the participants. The drug pointed out as being the least hazardous was the sterile water in solutions superior to 100mL, recognized as HAM by 27% of the interviewed and used by 90% of them. Routine items were not considered HAM; among them, long-term parenteral, lidocaine, hypertonic glucose 25% or 50%, sodium chloride and enoxaparin were considered HAM by 61, 61, 69, 72 and 74% of the interviewed respectively. The nurses were the ones that most recognized the existence of prevention barriers (96%), whereas the pharmacists were the ones that least recognized them (78%). On average, 84% of the professionals recognized the existence of prevention measures in the administration of HAM. The barrier most recognized by the professionals was the restrict access to HAM. Checking the rights of medication administration was another barrier, recognized only by 56% of the interviewed despite the fact that it is recommended when administering all types of drugs. Recognizing HAM as well as the harm prevention measures regarding this type of medicine is still feeble in healthcare institutions. The adoptions of risk prevention measures, isolated or in group, do not constitute an institutional risk management system, let alone regarding HAM. The constitution of patient security committees, besides being a legal obligation, can be an important path to implement risk management in institutions. In face of this, educational institutions need to improve professional training quality in relation to pharmacology, addressing the HAM theme, and, in relation to healthcare services, they need to implement solid permanent educational programs, apply prevention barriers based on systematic evidence and, finally, institute a patient security culture incentive policy through educational strategies, stimulating non-punitive actions when dealing with errors

A administração de medicamentos se constitui num processo multidisciplinar e um multissistema e seus riscos podem ser reduzidos de forma significativa por meio da implantação de processos reconhecidos para melhoria da segurança. Medicamentos Potencialmente Perigosos (MPP) são medicamentos que possuem maior risco de provocar danos significativos aos pacientes. O gerenciamento de risco em saúde é um processo complexo que associa várias áreas do conhecimento e que tem como objetivo prevenir erros e eventos adversos advindos dos procedimentos e produtos utilizados na assistência, em relação aos MPP, é imprescindível implantar barreiras específicas para gerenciar os riscos envolvidos. O objetivo do estudo foi investigar o gerenciamento de risco de MPP em instituições hospitalares. Estudo transversal, quantitativo, não experimental, realizado em quatro unidades de Terapia Intensiva de hospitais gerais, sendo um público, dois privados com fins lucrativos e um privado beneficente. Foi utilizado um instrumento do tipo questionário, com questões fechadas, elaborado pelo pesquisador, validado para face e conteúdo por cinco juízes e quanto a aplicabilidade por meio de um piloto aplicado em uma unidade de terapia intensiva pediátrica. Os participantes foram todos os membros da equipe de enfermagem das unidades de terapia intensiva pesquisadas e todos os farmacêuticos das instituições pesquisadas. Os resultados apontaram que a participação total foi de 76% da população proposta para o estudo. Todos os medicamentos que compunham o instrumento eram considerados como MPP, entretanto, nenhum foi apontado por 100 % dos participantes como MPP, 17 deles foram apontados como utilizados por 95% ou mais dos entrevistados. Desses, o cloreto de potássio, foi o medicamento mais reconhecido como MPP (99%) e o tramadol o menos reconhecido como perigoso (46%). O medicamento apontado como menos utilizado nas unidades pesquisadas foi o hidrato de cloral (14%), reconhecido como MPP por 78%. O medicamento apontado como menos perigoso foi a água estéril em soluções superiores a 100 ml, reconhecida como MPP por 27% dos entrevistados e utilizada por 90%. Itens considerados rotineiros não foram considerados MPP, dentre eles a solução parenteral prolongada, lidocaína, glicose hipertônica de 25 ou 50%, cloreto de sódio e a enoxaparina, considerados como MPP por 61, 61, 69, 72 e 74% dos entrevistados, respectivamente. Os enfermeiros foram os que mais reconheceram a existência de barreiras de prevenção (96%), já os farmacêuticos os que menos reconheceram (78%). Em média, 84% dos profissionais reconheceram a existência de medidas de prevenção na administração de MPP. A barreira mais reconhecida pelos profissionais foi a de acesso restrito aos MPP (79%). Outra barreira foi a verificação dos certos da terapia medicamentosa, que mesmo sendo uma prática recomendada na administração de todos os medicamentos, foi reconhecida somente por 56% dos entrevistados. O reconhecimento dos MPP, assim como as medidas de prevenção de danos relacionados à esta classe de medicamentos ainda é frágil nas instituições de saúde. A adoção de medidas isoladas ou agrupadas de prevenção de riscos não constituem um sistema de gerenciamento de risco institucional, tampouco em relação aos MPP. A constituição dos comitês de segurança do paciente, além de ser uma obrigação legal pode ser um caminho importante para a efetivação do gerenciamento de risco nas instituições. Diante deste contexto, cabe às instituições de ensino melhorar a qualidade da formação profissional em relação à farmacologia, abordando o tema dos MPP, e aos serviços de saúde implementar programas de educação permanente robustos nos ambientes de trabalho, aplicar barreiras de prevenção baseadas em evidencia de forma sistemática e, finalmente, instituir uma política de incentivo à cultura de segurança do paciente por meio de estratégias educativas, estimulando ações não punitivas ao lidar com os erros / The administration of drugs constitutes a multidisciplinary and multi-system process and its risks can be reduced significantly by implementing recognized processes to improve security. High-Alert Medications (HAM) are drugs that bear a heightened risk of causing harm to the patients. The risk management in healthcare is a complex process that associates several areas of knowledge and aims to prevent errors and events that may come from procedures and products used in assistances. Regarding HAM, it is essential to implement specific barriers in order to manage the risks involved. The objective of this study was to investigate the risk management for HAM in hospital institutions. This study is transversal, quantitative, non-experimental and it was performed in four Intensive Care Units from general hospitals, one of them being public, two of them private for-profit, and one of them a charitable hospital. A questionnaire type instrument containing closed questions made by the researcher was used. Its face and content validation were performed by five judges and its applicability validated by a pilot applied in a pediatric intensive care unit. The participants were the entire nursing staff of the researched intensive care units and the entire pharmacists staff of the researched institutions. The results show that the participants were 76% of the proposed populations for the study. All drugs that formed part of the instrument were HAM, however, none of them were pointed out as HAM by 100% of participants and 17 of them were pointed out as being used by at least 95% of the interviewed. Of these, the potassium chloride was the drug that was most recognized as HAM (99%) and the tramadol was the least recognized as being hazardous (46%). The least used drug in the researched units was the chloral hydrate (14%), it was recognized as HAM by 78% of the participants. The drug pointed out as being the least hazardous was the sterile water in solutions superior to 100mL, recognized as HAM by 27% of the interviewed and used by 90% of them. Routine items were not considered HAM; among them, long-term parenteral, lidocaine, hypertonic glucose 25% or 50%, sodium chloride and enoxaparin were considered HAM by 61, 61, 69, 72 and 74% of the interviewed respectively. The nurses were the ones that most recognized the existence of prevention barriers (96%), whereas the pharmacists were the ones that least recognized them (78%). On average, 84% of the professionals recognized the existence of prevention measures in the administration of HAM. The barrier most recognized by the professionals was the restrict access to HAM. Checking the rights of medication administration was another barrier, recognized only by 56% of the interviewed despite the fact that it is recommended when administering all types of drugs. Recognizing HAM as well as the harm prevention measures regarding this type of medicine is still feeble in healthcare institutions. The adoptions of risk prevention measures, isolated or in group, do not constitute an institutional risk management system, let alone regarding HAM. The constitution of patient security committees, besides being a legal obligation, can be an important path to implement risk management in institutions. In face of this, educational institutions need to improve professional training quality in relation to pharmacology, addressing the HAM theme, and, in relation to healthcare services, they need to implement solid permanent educational programs, apply prevention barriers based on systematic evidence and, finally, institute a patient security culture incentive policy through educational strategies, stimulating non-punitive actions when dealing with errors

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

Thesis (M.H.A.)--University of Michigan, 1967.

Thesis (M.H.A.)--University of Michigan, 1976.

Thesis (M.H.A.)--University of Michigan, 1975.