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Vercler, Christian J., Steven R. Buchman, and Kevin C. Chung. "Discussing Harm-Causing Errors With Patients." Annals of Plastic Surgery 74, no. 2 (February 2015): 140–44. http://dx.doi.org/10.1097/sap.0000000000000217.
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Bhat, Priya N., John M. Costello, Ranjit Aiyagari, Paul J. Sharek, Claudia A. Algaze, Mjaye L. Mazwi, Stephen J. Roth, and Andrew Y. Shin. "Diagnostic errors in paediatric cardiac intensive care." Cardiology in the Young 28, no. 5 (February 7, 2018): 675–82. http://dx.doi.org/10.1017/s1047951117002906.
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AbstractIntroductionDiagnostic errors cause significant patient harm and increase costs. Data characterising such errors in the paediatric cardiac intensive care population are limited. We sought to understand the perceived frequency and types of diagnostic errors in the paediatric cardiac ICU.MethodsPaediatric cardiac ICU practitioners including attending and trainee physicians, nurse practitioners, physician assistants, and registered nurses at three North American tertiary cardiac centres were surveyed between October 2014 and January 2015.ResultsThe response rate was 46% (N=200). Most respondents (81%) perceived that diagnostic errors harm patients more than five times per year. More than half (65%) reported that errors permanently harm patients, and up to 18% perceived that diagnostic errors contributed to death or severe permanent harm more than five times per year. Medication side effects and psychiatric conditions were thought to be most commonly misdiagnosed. Physician groups also ranked pulmonary overcirculation and viral illness to be commonly misdiagnosed as bacterial illness. Inadequate care coordination, data assessment, and high clinician workload were cited as contributory factors. Delayed diagnostic studies and interventions related to the severity of the patient’s condition were thought to be the most commonly reported process breakdowns. All surveyed groups ranked improving teamwork and feedback pathways as strategies to explore for preventing future diagnostic errors.ConclusionsPaediatric cardiac intensive care practitioners perceive that diagnostic errors causing permanent harm are common and associated more with systematic and process breakdowns than with cognitive limitations.
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Mondal, Montosh Kumar, Beauty Rani Roy, Shibani Banik, and Debabrata Banik. "Medication Error in Anaesthesia A Review." Journal of the Bangladesh Society of Anaesthesiologists 27, no. 1 (July 30, 2016): 31–35. http://dx.doi.org/10.3329/jbsa.v27i1.28999.
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Medication error is a major cause of morbidity and mortality in medical profession . There is an increasing recognition that medication errors are causing a substantial global public health problem, as many result in harm to patients and increased costs to health providers.Anaesthesia is now safe and routine, yet anaesthetists are not immune from making medication errors and the consequences of their mistakes may be more serious than those of doctors in other specialties. Steps are being taken to determine the extent of the problem of medication error in anaesthesia. In this review, incidence, types, risk factors and preventive measures of the medication errors are discussed in detail.Journal of Bangladesh Society of Anaesthesiologists 2014; 27(1): 31-35
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A, Jimenez, Tran TM, Le B, and Le J. "Comparative Cross-Sectional Pharmacovigilance Study of Medication Errors in Children and Adults in Community-Based Hospitals." Asploro Journal of Pediatrics and Child Health 2, no. 1 (January 29, 2020): 1–12. http://dx.doi.org/10.36502/2020/asjpch.6150.
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Objective: To compare medication errors that reached pediatric and adult patients during hospitalization. Methods: Observational, non-experimental, cross-sectional study from January 2011 to March 2015 at two community-based, teaching hospitals. Results: Over a 4-year period, there were 4.2 and 13.3 million doses dispensed in pediatrics and adults, respectively. Less than 0.25% of doses dispensed contributed to medication errors, with 9.6% of these medication errors reaching patients and 0.04% causing harm. There was no statistical difference in medication error rates based on doses dispensed, patient-days, admission rate, and severity. However, significantly more errors in the documentation and prescribing processes occurred in adults (21.9% vs 6.5% and 37.4% vs 29.8% respectively, p<.001) versus administration in pediatrics (42.5 vs 29.8% in adults, p <0.001). Errors in drug administration that occurred in pediatrics consisted of infusion devices, incorrect dose, the omission of medication, and time of administration. Pediatrics had higher medication errors related to electrolytes and total parenteral nutrition. Independent of age, there were more medication errors that caused harm in patients residing in the intensive care unit (5.5% of 769 vs 3.5% of 2800 patients, respectively, p =0.006). Conclusion: While the prevalence of medication errors that reached patients and caused harm were similar between adults and pediatrics, the types of errors within the medication use process, class of drugs, and severity of the mediation errors varied between the groups. Given these differences, it is quintessential to develop population-specific medication safety programs aimed at addressing the needs of pediatric patients to enhance safe medication use.
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Harrington, Aoife, Sukeshi Makhecha, Sian Bentley, Anja Kollman, Sarah Osborne, and Eva Zizkova. "P2 Interventions to improve safety of parenteral nutrition use on a paediatric intensive care unit." Archives of Disease in Childhood 103, no. 2 (January 19, 2018): e2.3-e2. http://dx.doi.org/10.1136/archdischild-2017-314585.11.
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AimParenteral nutrition is a high risk treatment, and under- or over-infusion can have serious consequences for patients. Following several errors where parenteral nutrition (PN) was administered at incorrect rates, including incidents of vamin and lipid rates being switched, we aimed to reduce errors causing harm related to PN prescribing and administration.MethodThe local incident reporting system was used to identify errors and trends involving PN. The most common errors involved incorrect rates being either prescribed or administered. A series of interventions were developed between March 2014 and December 2015 aimed at reducing errors.Unit staff were surveyed and PN bag changeover was moved from day to night shifts.The nursing PN administration guideline was updated and relaunched to reinforce the correct procedure.Usual practice on the unit is for nurses to titrate PN to maximum rates according to fluid allowance. Prescription rates were audited, multidisciplinary team (MDT) staff surveyed and daily prescribing of administration rate ranges was implemented with MDT support.PN education sessions were targeted at all staff via a short ‘bootcamp’ format repeated over three weeks and a session at weekly medical teaching. The sessions covered general information, risks and examples of both common and serious errors.ResultsPlanned changes were accepted and supported by the unit staff. The initial prescription audit found 100% of patients had inaccurate rates prescribed and 43% of patients had rates running above those prescribed. Re-audit of prescriptions following the change showed that the correct rate ranges were being updated daily and PN was administered at or below maximum rates. Through the bootcamp sessions we identified some areas of confusion and variations in practice; the administration guideline was further updated as a result. Error monitoring showed an initial increase in reported errors for 2015. These were mainly near miss reports (no harm) but also included two incidents where lipid and vamin rates were switched. This was followed by a reduction in errors in 2016 with no further incidence of lipid and vamin rates switched.ConclusionThe interventions implemented did reduce the incidence of PN errors causing harm. We believe the decrease in errors was due to the cumulative effect of changes and increased awareness. The initial increase in reported errors in 2015 may have been due to increased awareness and reporting. We considered the possibility of interventions increasing errors but discussion with staff involved suggested this was not a factor. MDT involvement is crucial, as is good communication with all staff throughout the change process. We will continue to encourage near miss reporting and monitor on an ongoing basis to ensure the change is sustained, and target new staff to maintain these improvements.
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Phua, Dong Haur, and Nigel CK Tan. "Cognitive Aspect of Diagnostic Errors." Annals of the Academy of Medicine, Singapore 42, no. 1 (January 15, 2013): 33–41. http://dx.doi.org/10.47102/annals-acadmedsg.v42n1p33.
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Diagnostic errors can result in tangible harm to patients. Despite our advances in medicine, the mental processes required to make a diagnosis exhibits shortcomings, causing diagnostic errors. Cognitive factors are found to be an important cause of diagnostic errors. With new understanding from psychology and social sciences, clinical medicine is now beginning to appreciate that our clinical reasoning can take the form of analytical reasoning or heuristics. Different factors like cognitive biases and affective influences can also impel unwary clinicians to make diagnostic errors. Various strategies have been proposed to reduce the effect of cognitive biases and affective influences when clinicians make diagnoses; however evidence for the efficacy of these methods is still sparse. This paper aims to introduce the reader to the cognitive aspect of diagnostic errors, in the hope that clinicians can use this knowledge to improve diagnostic accuracy and patient outcomes. Keywords: Affective influence, Analytical, Diagnostic errors, Heuristics, Reflective practice
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Rinke, Michael L., Hardeep Singh, Sarah Ruberman, Jason Adelman, Steven J. Choi, Heather O’Donnell, Ruth E. K. Stein, et al. "Primary care pediatricians’ interest in diagnostic error reduction." Diagnosis 3, no. 2 (June 1, 2016): 65–69. http://dx.doi.org/10.1515/dx-2015-0033.
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Abstract: Diagnostic errors causing harm in children are understudied, resulting in a knowledge gap regarding pediatricians’ interest in reducing their incidence.: Electronic survey of general pediatricians focusing on diagnostic error incidence, errors they were interested in trying to improve, and errors reduced by their electronic health record (EHR).: Of 300 contacted pediatricians, 77 (26%) responded, 58 (19%) served ambulatory patients, and 48 (16%) completed the entire questionnaire. Of these 48, 17 (35%) reported making a diagnostic error at least monthly, and 16 (33%) reported making a diagnostic error resulting in an adverse event at least annually. Pediatricians were “most” interested in “trying to improve” missed diagnosis of hypertension (17%), delayed diagnosis due to missed subspecialty referral (15%), and errors associated with delayed follow-up of abnormal laboratory values (13%). Among the 44 pediatricians with an EHR, 16 (36%) said it reduced the likelihood of missing obesity and 14 (32%) said it reduced the likelihood of missing hypertension. Also, 15 (34%) said it helped avoid delays in follow-up of abnormal laboratory values. A third (36%) reported no help in diagnostic error reduction from their EHR.: Pediatricians self-report an appreciable number of diagnostic errors and were most interested in preventing high frequency, non-life-threatening errors. There exists a need to leverage EHRs to support error reduction efforts.
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Rahman, Zaida, and Rukhsana Parvin. "Medication Errors Associated with Look-alike/Sound-alike Drugs: A Brief Review." Journal of Enam Medical College 5, no. 2 (June 29, 2015): 110–17. http://dx.doi.org/10.3329/jemc.v5i2.23385.
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The existence of confusing drug names is one of the most common causes of medication errors. There are many types of medication errors: wrong drug, wrong dose, wrong route of administration, wrong patient etc. Misreading medication names that look similar is a common mistake. These look-alike medication names may also sound alike and can lead to errors associated with verbal prescriptions. Similar sounding drugs may produce confusion and may lead to unintended interchange of drugs causing harm to patients or even patient death. The main aim of the study was to evaluate medication errors related to look alikesound alike drug names and to find out the strategies to prevent these medication errors.J Enam Med Col 2015; 5(2): 110-117
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Turcu, Diana Veronica, Adina Magdalena Turcanu, Cristina Grigorescu, Alexandru Patrascu, Irina Chiselita, and Traian Mihaescu. "Value of Autopsies in the Study of Diagnostic Errors in Respiratory Medicine." Revista de Chimie 70, no. 3 (April 15, 2019): 1037–39. http://dx.doi.org/10.37358/rc.19.3.7058.
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Diagnostic errors are real and are causing harm to patients on a global scale. However, the methods for measuring diagnostic errors are underdeveloped. One very important tool in this regard is the use of autopsies, in order to point out the cases where the actual affliction was missed and to quantify the incidence of such mistakes. We have carried out a study to compare the clinical diagnostic with the post mortem autopsy report in 119 patients who have died at the Pulmonology Hospital in Iasi, Romania, between January 2nd 2016 and January 2nd 2017. The purpose of this research is to determine the incidence of diagnostic errors and to identify the most missed or overlooked respiratory diseases.
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Heneka, Nicole, Priyanka Bhattarai, Tim Shaw, Debra Rowett, Samuel Lapkin, and Jane L. Phillips. "Clinicians’ perceptions of opioid error–contributing factors in inpatient palliative care services: A qualitative study." Palliative Medicine 33, no. 4 (March 1, 2019): 430–44. http://dx.doi.org/10.1177/0269216319832799.
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Background: Opioid errors are a leading cause of patient harm and adversely impact palliative care inpatients’ pain and symptom management. Yet, the factors contributing to opioid errors in palliative care are poorly understood. Identifying and better understanding the individual and system factors contributing to these errors is required to inform targeted strategies. Objectives: To explore palliative care clinicians’ perceptions of the factors contributing to opioid errors in Australian inpatient palliative care services. Design: A qualitative study using focus groups or semi-structured interviews. Settings: Three specialist palliative care inpatient services in New South Wales, Australia. Participants: Inpatient palliative care clinicians who are involved with, and/or have oversight of, the services’ opioid delivery or quality and safety processes. Methods: Deductive thematic content analysis of the qualitative data. The Yorkshire Contributory Factors Framework was applied to identify error-contributing factors. Findings: A total of 58 clinicians participated in eight focus groups and 20 semi-structured interviews. Nine key error contributory factor domains were identified, including: active failures; task characteristics of opioid preparation; clinician inexperience; sub-optimal skill mix; gaps in support from central functions; the drug preparation environment; and sub-optimal clinical communication. Conclusion: This study identified multiple system-level factors contributing to opioid errors in inpatient palliative care services. Any quality and safety initiatives targeting safe opioid delivery in specialist palliative care services needs to consider the full range of contributing factors, from individual to systems/latent factors, which promote error-causing conditions.
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Howlett, Moninne M., Eileen Butler, Karen M. Lavelle, Brian J. Cleary, and Cormac V. Breatnach. "The Impact of Technology on Prescribing Errors in Pediatric Intensive Care: A Before and After Study." Applied Clinical Informatics 11, no. 02 (March 2020): 323–35. http://dx.doi.org/10.1055/s-0040-1709508.
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Abstract Background Increased use of health information technology (HIT) has been advocated as a medication error reduction strategy. Evidence of its benefits in the pediatric setting remains limited. In 2012, electronic prescribing (ICCA, Philips, United Kingdom) and standard concentration infusions (SCIs)—facilitated by smart-pump technology—were introduced into the pediatric intensive care unit (PICU) of an Irish tertiary-care pediatric hospital. Objective The aim of this study is to assess the impact of the new technology on the rate and severity of PICU prescribing errors and identify technology-generated errors. Methods A retrospective, before and after study design, was employed. Medication orders were reviewed over 24 weeks distributed across four time periods: preimplementation (Epoch 1); postimplementation of SCIs (Epoch 2); immediate postimplementation of electronic prescribing (Epoch 3); and 1 year postimplementation (Epoch 4). Only orders reviewed by a clinical pharmacist were included. Prespecified definitions, multidisciplinary consensus and validated grading methods were utilized. Results A total of 3,356 medication orders for 288 patients were included. Overall error rates were similar in Epoch 1 and 4 (10.2 vs. 9.8%; p = 0.8), but error types differed (p < 0.001). Incomplete and wrong unit errors were eradicated; duplicate orders increased. Dosing errors remained most common. A total of 27% of postimplementation errors were technology-generated. Implementation of SCIs alone was associated with significant reductions in infusion-related prescribing errors (29.0% [Epoch 1] to 14.6% [Epoch 2]; p < 0.001). Further reductions (8.4% [Epoch 4]) were identified after implementation of electronically generated infusion orders. Non-infusion error severity was unchanged (p = 0.13); fewer infusion errors reached the patient (p < 0.01). No errors causing harm were identified. Conclusion The limitations of electronic prescribing in reducing overall prescribing errors in PICU have been demonstrated. The replacement of weight-based infusions with SCIs was associated with significant reductions in infusion prescribing errors. Technology-generated errors were common, highlighting the need for on-going research on HIT implementation in pediatric settings.
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Mohiuddin, AK. "Patient Safety: A Deep Concern to Caregivers." INNOVATIONS in pharmacy 10, no. 1 (February 7, 2019): 7. http://dx.doi.org/10.24926/iip.v10i1.1639.
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Patient safety is a global concern and is the most important domains of health-care quality. Medical error is a major patient safety concern, causing increase in health-care cost due to mortality, morbidity, or prolonged hospital stay. A definition for patient safety has emerged from the health care quality movement that is equally abstract, with various approaches to the more concrete essential components. Patient safety was defined by the IOM as “the prevention of harm to patients.” Emphasis is placed on the system of care delivery that prevents errors; learns from the errors that do occur; and is built on a culture of safety that involves health care professionals, organizations, and patients. Patient safety culture is a complex phenomenon. Patient safety culture assessments, required by international accreditation organizations, allow healthcare organizations to obtain a clear view of the patient safety aspects requiring urgent attention, identify the strengths and weaknesses of their safety culture, help care giving units identify their existing patient safety problems, and benchmark their scores with other hospitals.
Article Type: Commentary
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Ognerubov, Nikolai. "On the issue of criminal liability for iatrogenic harm amid the COVID-19 pandemic." Current Issues of the State and Law, no. 16 (2020): 485–94. http://dx.doi.org/10.20310/2587-9340-2020-4-16-485-494.
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Iatrogenic crimes have been underinvestigated in domestic science, however, a significant number of foreign studies are devoted to the issue of criminal liability of medical workers for iatrogenic harm. We analyze the work of many scientists, including those from Australia, India and Italy. Foreign theory is increasingly adhering to the idea of mitigating the criminal liability of medical workers for medical errors. We conclude that the general basis for bringing a doctor to criminal responsibility in foreign countries is a gross violation of generally accepted medical care standards. At the same time, the COVID-19 pandemic plays an important role in rethinking the domestic approach to understanding the responsibility for iatrogenesis and the need for its differentiation. In an environment where doctors every day receive new instructions on appropriate therapy, and the search for ways to treat a new coronavirus infection is still associated with many errors, the qualification of an iatrogenic crime must take into account the special cir-cumstances that reduce the social danger of the crime. In conclusion, we talk about the prospect of using foreign practice to mitigate criminal liability for iatrogenesis as a guideline for the formation of new privileged features of the offenses associated with causing iatrogenic harm in domestic criminal law.
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Aubin, Diane Louise, Allison Soprovich, Fabiola Diaz Carvallo, Deborah Prowse, and Dean Eurich. "Support for healthcare workers and patients after medical error through mutual healing: another step towards patient safety." BMJ Open Quality 11, no. 4 (December 2022): e002004. http://dx.doi.org/10.1136/bmjoq-2022-002004.
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BackgroundMedical errors, especially those resulting in patient harm, have a negative psychological impact on patients and healthcare workers (HCWs). Healing may be promoted if both parties are able to work together and explore the effect and outcome of the event from each of their perspectives. There is little existing research in this area, even though this has the potential to improve patient safety and wellness for both HCWs and patients.MethodsUsing a patient-oriented research approach with constructive grounded theory methodology, we examined the potential for patients and HCWs to heal together after harm from a medical error. Individual interviews were conducted and transcribed verbatim. We conducted concurrent data collection and analysis according to grounded theory principles. With our findings, we created a framework and visual breakdown of the communication process between patients and HCWs.ResultsOur findings suggest that, after a medical error causing harm, both patients and HCWs have feelings of empathy and respect towards each other that often goes unrecognised. Barriers to communication for patients were related to their perception that HCWs did not care about them, showed no remorse or did not admit to the error. For HCWs, communication barriers were related to feelings of blame or shame, and fear of professional and legal consequences. Patients reported needing open and transparent communications to help them heal, and HCWs required leadership and peer support, including training and space to talk about the event(s).DiscussionOur resulting framework suggests that if there was an opportunity for an open and purposeful conversation early or before increased emotional suffering, there might be an opportunity to bridge the barriers, and help patients and HCWs heal together. This, in turn, contributes to improved health quality and patient safety.
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Hooley, Joseph, Diana Karius, Christina Colvin, Patti Akins, Carolyn Best, and Allyson Brinker. "Utilizing a two nurse timeout process to eliminate errors during chemotherapy administration." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 237. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.237.
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237 Background: Chemotherapeutic agents are listed as high risk medications at Cleveland Clinic, and have long been included on the Institute for Safe Medication Practices (ISMP) List of High Alert Medications due to the heightened risk of causing significant patient harm if they are used in error. Following a series of significant adverse events involving chemotherapy administration in 2012 at Cleveland Clinic, a two nurse timeout process (modeled after surgical and procedural timeout practices) was established to eliminate interruptions and decrease the risk of error. Methods: A written protocol was established to formalize a two nurse timeout process which must be completed prior to administration of chemotherapy. In order to eliminate unnecessary distractions during order review and medication administration, nurses hand off their phone and/or pager and coverage is provided for the nurses who are checking in the chemotherapy. A designated distraction-free area is utilized chemotherapy verification and order review. Following comparison of the chemotherapy agents to the orders, the nurses proceed to the patient’s room with the chemotherapy and the order pulled up on a computer. A procedure stop sign is placed on the door and the door is closed to eliminate interruptions. During the in-room timeout process, each step in the chemotherapy documentation flow sheet is reviewed by both nurses. After proper patient identification, one nurse will read the chemotherapeutic agent label and the other nurse will program the infusion pump. The two nurses will then switch roles with re-verification of the label and the infusion pump. The tubing set-up is then verified and the infusion is initiated. Results: Since the two nurse timeout process was established in 2013, there have been zero serious chemotherapy errors resulting in patient harm. Conclusions: Results have shown that implementation of the chemotherapy timeout process has increased the safety of administration of chemotherapeutic agents. It has now been more than five years since the last significant adverse event involving chemotherapy has occurred at Cleveland Clinic.
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Voskanyan, Yu E. "Epidemiology of Medical Errors and Incidents in Emergency Medicine." Russian Sklifosovsky Journal "Emergency Medical Care" 11, no. 2 (September 8, 2022): 301–16. http://dx.doi.org/10.23934/2223-9022-2022-11-2-301-316.
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Relevance the issues of patient care and quality management have acquired particular relevance in modern healthcare. Improvement in the clinical performance of medical technologies has led to a significant reduction in deaths and complications associated with the disease and side effects of interventions. As a result, the share of additional harm related to the process of providing medical services has become more noticeable. Accurate data regarding the type, frequency and severity of active threats and incidents they cause are needed to reduce the likelihood and severity of additional harm. In this respect, emergency medical care is the subject of special attention and is characterized by the greatest difficulty in terms of obtaining valid and relevant information about deviations associated with health worker performance, equipment operation and patient behavior.The aim of the study was to explore the main epidemiological characteristics of medical errors and incidents associated with the provision of emergency medical care.Material and methods We present a literature review followed by an analytical study of the epidemiology of incidents and active threats (including medical errors) that precede those incidents in various areas of emergency medical care. By an incident, the authors understood an event with a patient that was more related to the process of providing medical care than to the course of the disease or comorbid conditions which led or could lead to causing additional harm. Active threats included events that subsequently became the direct cause of the incident (medical errors and malpractice, mistakes and deviations in patient behavior, emergency situations in the physical environment). By the “mortality from adverse events”, the authors understood the proportion of deaths from adverse events among all hospitalized patients. By the concept of “lethality associated with adverse events”, the authors denoted the proportion of deaths from adverse events among all the patients affected by adverse events. The search for information was carried out for the period of 1995–2021 using the following medical databases: medline; cochrane collaboration; embase; scopus; isi web of science. For analysis, we used prospective and retrospective observational studies of high methodological quality, meta-analyses and systematic reviews. For the statistical evaluation of frequency characteristics, indicators of incidence, prevalence, and incidence density were used. The calculation of generalized frequency indicators for large samples was carried out with a 95% confidence interval.Results The epidemiology of medical errors and incidents depends on the area in which emergency care is provided. For prehospital emergency medical care, there are 12.45 medical errors and 4.50 incidents with consequences for every 100 visits. In emergency departments, one in fourteen patients suffers additional harm which in 10.14% of cases has severe consequences, and in 3.18% of cases leads to unexpected death. In intensive care units, incidents related to the provision of medical care are recorded in every third patient in the amount of 1.55 per 1 patient. Of these, 58.67% of incidents are accompanied by harm, but the fatality associated with the incidents is only 0.77%. The prevalence of patients affected by incidents during the provision of anesthesia for children is almost 2 times higher than for adults (4.79% vs. 2.03%). At the same time, mortality due to anesthesia-related incidents in children is 11 times lower than in adults (0.27% versus 3.09%). The author draws attention to a number of factors contributing to the development of incidents during the provision of emergency medical care. These include environmental complexity, suboptimal configuration of the workspace, technological interface complexity, the effects of acute stress on performers, and organizational vulnerabilities. A special role was assigned to environmental complexity which was studied in detail both in terms of the complexity of the tasks being solved, and in connection with obstacles to solving problems. It was shown that the intensity of the influence of various components of environmental complexity is not the same in different departments providing emergency care. Particular attention was paid to the fact that organizational vulnerabilities reduce the effectiveness of protective mechanisms during the interaction of the human factor with a complex environment.Conclusion The study showed that the provision of emergency medical care is associated with moderately high risks of incidents, including severe and critical consequences for patients. The main factor contributing to the development of incidents is environmental complexity which becomes much harder to counter under the influence of organizational vulnerabilities. Identification and registration of errors and incidents in units providing medical care is difficult due to the short time of contact with patients, the high speed of situation update, and the constant impact of chronic and acute stressors on staff. In this connection, the optimization and improvement of the efficiency of the system for recording errors and incidents in departments providing emergency medical care remains an area for improvement.
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Younis, Ishrat, Nabeela Shaheen, and Sumaira Bano. "KNOWLEDGE & PRACTICE ABOUT ADMINISTRATION OF HIGH ALERT MEDICATION IN THE TERTIARY CARE HOSPITAL IN LAHORE." International Journal of Health, Medicine and Nursing Practice 3, no. 4 (August 16, 2021): 1–16. http://dx.doi.org/10.47941/ijhmnp.644.
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Purpose: High alert medications are enlightened as those medicines that bear the maximum threat of causing major patient harm when administered incorrectly. Nurses are accountable for the administration of high alert medication; inappropriate administration can show a substantial clinical result and at times can be deadly for the patients. High Alert Medication is commonly used in the emergency room, intensive care unit, pediatric ward and medical ward. Because high alert medication is used in emergency situations, they bear a heightened risk of causing patient harm when used incorrectly. Some high alert medication has a narrow therapeutic index e.g., warfarin, when used improperly, rapidly causes the undesirable side effect of bleeding. Further, well-known chemotherapeutic agents, such as vincristine, require special handling, and should be administered according to the manufacturer’s recommendation. Current investigation targeted to evaluate the level of knowledge of high alert medication among nurses in tertiary care hospital. Methodology: A quantitative, descriptive cross-sectional study design was used to explore the level of knowledge and regulations of high alert medication and obstacles faced by nurses during the administration of high alert medication in tertiary care hospital. The instrument used for the data collection was adopted questioner and convenient sampling technique was used.
Results: Outcome of current study deliver confirmation that nurses have deficient knowledge of high alert medication and its administration and regulation. Deficiency of knowledge was the significant obstacles that nurses faced during administration of high alert medication. Participants reported that conflicting views between nurses and doctors, were the most commonly encountered obstacles during administration of high alert medication these contribute to the possibility of Medicine Errors.
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Mohana, Mohamed, Abdelaziz Salah Saidi, Salem Alelyani, Mohammed J. Alshayeb, Suhail Basha, and Ali Eisa Anqi. "Small-Scale Solar Photovoltaic Power Prediction for Residential Load in Saudi Arabia Using Machine Learning." Energies 14, no. 20 (October 17, 2021): 6759. http://dx.doi.org/10.3390/en14206759.
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Photovoltaic (PV) systems have become one of the most promising alternative energy sources, as they transform the sun’s energy into electricity. This can frequently be achieved without causing any potential harm to the environment. Although their usage in residential places and building sectors has notably increased, PV systems are regarded as unpredictable, changeable, and irregular power sources. This is because, in line with the system’s geographic region, the power output depends to a certain extent on the atmospheric environment, which can vary drastically. Therefore, artificial intelligence (AI)-based approaches are extensively employed to examine the effects of climate change on solar power. Then, the most optimal AI algorithm is used to predict the generated power. In this study, we used machine learning (ML)-based algorithms to predict the generated power of a PV system for residential buildings. Using a PV system, Pyranometers, and weather station data amassed from a station at King Khalid University, Abha (Saudi Arabia) with a residential setting, we conducted several experiments to evaluate the predictability of various well-known ML algorithms from the generated power. A backward feature-elimination technique was applied to find the most relevant set of features. Among all the ML prediction models used in the work, the deep-learning-based model provided the minimum errors with the minimum set of features (approximately seven features). When the feature set is greater than ten features, the polynomial regression model shows the best prediction, with minimal errors. Comparing all the prediction models, the highest errors were associated with the linear regression model. In general, it was observed that with a small number of features, the prediction models could minimize the generated power prediction’s mean squared error value to approximately 0.15.
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Rakha, Emad A., David Clark, Brinder Singh Chohan, Maysa El-Sayed, Soumadri Sen, Liz Bakowski, and Simon O'Connor. "Efficacy of an incident-reporting system in cellular pathology: a practical experience." Journal of Clinical Pathology 65, no. 7 (March 24, 2012): 643–48. http://dx.doi.org/10.1136/jclinpath-2011-200453.
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Background and aimsIncident reporting (IR) refers to systematic documentation of adverse incidents to facilitate their appropriate investigation and institution of corrective or remedial actions, and provide data to identify risk trends for recurrent problems. Minimisation of errors and reduction in process variation is recognised as an important goal of quality management and is an essential part of continuous quality improvement. Published data on the role IR plays in cellular pathology remains scanty.MethodsIn this study, the authors collected and analysed all incidents and adverse events reported in their department over a 2-year period.Results584 incidents were reported (0.5% of all cases processed). The majority (59%) occurred in the pre-analytical phase of the laboratory process with 23% in the analytical and 18% in the post-analytical phases. Booking-in and specimen labelling-related incidents were the largest single group (56% of all incidents), prompting further root cause analysis, but no other obvious patterns or trends were identified, and most incidents were followed by corrective actions on an individual basis. Most incidents (79%) posed potential harm, as opposed to causing actual harm to the service or patients. Only 78 cases (14%) posed a major risk to patients, such as specimen loss or mix-up, whereas 27% were associated with moderate risk and 59% with minor or insignificant risk.ConclusionMajor risk incidents are relatively rare in the cellular pathology laboratory. IR should be included as an important component of a risk management strategy and clinical governance framework.
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Araripe, Marcos Cordeiro, Glauco Martins Silva, Marcos Venicius Malveira de Lima, Ítalla Maria Pinheiro Bezerra, Walédya Araújo Lopes de Melo, and Gabriel Zorello Laporta. "Perception of Patient Safety Culture in the Framework of the Psychosocial Care Network in Western Amazon: A Cross-Sectional Study." Healthcare 8, no. 3 (August 23, 2020): 289. http://dx.doi.org/10.3390/healthcare8030289.
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The culture of patient safety should be considered a guiding principle for different areas of health. This research presents the results of an analysis on Patient Safety Culture (PSC), according to the perception of health professionals who work in the Psychosocial Care Network, through a descriptive observational cross-sectional study, using the Hospital Survey on Patient Safety Culture in a municipality in the Western Amazon of Brazil. Sixty-nine (69) professionals expressed that the best dimensions evaluated were: “expectations and actions to promote the safety of supervisors and managers” (75%) and “support from hospital management to patient safety” (64%). The worst evaluations were: “non-punitive responses to errors” (27%) and “general perceptions about patient safety” (35%), demonstrating that there still is a culture of fear of causing harm and the need for educational actions on patient safety. In general, all professionals have close contact with patients, regardless of the length on duty; however, the weekly workload and turnover in this sector is leading to a greater chance of errors. The analysis of the internal reliability of the dimensions ranged from 0.12 to 0.89. Only one-third of the respondents scored PSC as “Good” in the studied institutions and 63 out 69 professionals did not report any adverse events in the last 12 months. There are weaknesses in the observed perception of PSC and the obtained results show opportunities and challenges for improvements in the study system.
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Hu, Daiming, Bülent Tezkan, Mingxin Yue, Xiaodong Yang, Xiaoping Wu, and Guanqun Zhou. "Prediction of Conductive Anomalies Ahead of the Tunnel by the 3D-Resitivity Forward Modeling in the Whole Space." Geofluids 2021 (December 21, 2021): 1–12. http://dx.doi.org/10.1155/2021/7301311.
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Water inrush in tunneling poses serious harm to safe construction, causing economic losses and casualties. The prediction of water hazards before tunnel excavations becomes an urgent task for governments or enterprises to ensure security. The three-dimensional (3D) direct current (DC) resistivity method is widely used in the forward-probing of tunnels because of its low cost and highly sensitive response to water-bearing structures. However, the different sizes of the tunnel will distort the distribution of the potential field, which causes an inaccurate prediction of water-bearing structures in front of the tunnels. Some studies have pointed out that the tunnel effect must be considered in the quantitative interpretation of the data. However, there is rarely a predicted model considering the tunnel effect to be reported in geophysical literature. We developed a predicted model algorithm by considering the tunnel effect for forward-probing in tunnels. The algorithm is proven to be feasible using a slab analytic model. By simulating a large number of models with different tunnel sizes, we propose an equation, which considers the tunnel effect and can predict the water-bearing structures ahead of the tunnel face. The Monte Carlo method is used to evaluate the quality of the predicted model by simulating and comparing 10,000 random models. The results show that the proposed method is accurate to forecast the water-rich structures with small errors.
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Aksu Dönmez, Özlem, Şule Dinç-Zor, Bürge Aşçı, and Abdürrezzak E. Bozdoğan. "Quantitative Analysis of Food Additives in a Beverage using High Performance Liquid Chromatography and Diode Array Detection Coupled with Chemometrics." Journal of AOAC INTERNATIONAL 103, no. 3 (April 25, 2020): 779–83. http://dx.doi.org/10.1093/jaocint/qsz009.
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Abstract Background In many countries, the levels of synthetic food additives causing harm to humans have been determined and their use has been controlled by legal regulations. Sensitive, accurate and low-cost analysis methods are required for food additive determination. Objective In this study, a fast high performance liquid chromatography-diode array detection (HPLC-DAD) analytical methodology for quantification of sodium benzoate, potassium sorbate, ponceau 4R, and carmoisine in a beverage was proposed. Methods Partial least squares (PLS) and principal component regression (PCR) multivariate calibration methods applied to chromatograms with overlapped peaks were used to establish a green and smart method with short isocratic elution. A series of synthetic solutions including different concentrations of analytes were used to test the prediction ability of the developed methods. Conclusions The average recoveries for all target analytes were in the range of 98.27–101.37% with average relative prediction errors of less than 3%. The proposed chemometrics-assisted HPLC-DAD methods were implemented to a beverage successfully. Analysis results from sodium benzoate, potassium sorbate, ponceau 4R, and carmoisine in a beverage by PLS-2 and PCR were statistically compared with conventional HPLC. Highlights The HPLC methods coupled with the PLS-2 and PCR algorithm could provide a simple, quick and accurate strategy for simultaneous determination of sodium benzoate, potassium sorbate, ponceau 4R, and carmoisine in a beverage sample.
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Al Maamari, Amira, and Firdouse Khan. "Evaluating the Causes and Impact of Change Orders on Construction Projects Performance in Oman." International Journal of Research in Entrepreneurship & Business Studies 2, no. 1 (January 11, 2021): 41–50. http://dx.doi.org/10.47259/ijrebs.215.
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Purpose of the study: The purpose of the study was to investigate the factors causing the change orders in construction projects and to assess their impact on the project's performance in Oman. Design/Methodology/Approach: The study was conducted using a random sampling technique. The questionnaire was used to collect data from215contractingcompanies located in Muscat Governorate, Oman. Statistical analyses such as the chi-square test, Kolmogorov-Smirnov, and linear regression tests were used. Findings: The result of the study showed that the variations have more impacts on the project and the change orders harm the project most. It was also revealed that 'change in specifications’, ‘Alterations in design and drawing' and Time lag in the project implementation were considered to be the primary causes of change orders, and ‘Change of scope’, ‘Errors and omissions in design' and 'Insufficient Logistics’ were the primary causes of variations affecting the construction projects in Oman. Research Implications: It was suggested to plan for a strategy to avoid the time lag and to take up adequate financial pre-planning to maximize the profit. Social Implications: The findings of the study help the companies to take proactive measures to eliminate or reduce unnecessary variations and change orders to accomplish the prime objectives of such projects. Originality/value: This is the first study of its kind in bringing out the issues related to change orders and variations in the construction projects of Muscat Governorate, Oman. Keywords: Change Orders, Variations, Causes and Impacts on the Construction Projects, Construction Projects in Oman, Clients, Contractors, and Consultants.
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Kim, Jong Goo. "The Right to Cross-Examination and the Admissibility of Video Statements of the Child Victims of Sexual Violence." National Public Law Review 18, no. 3 (August 31, 2022): 157–88. http://dx.doi.org/10.46751/nplak.2022.18.3.157.
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The Constitutional Court of Korea decided that the provision of the Sexual Violence Punishment Act that allows the use of video statements of victims of child sexual violence as evidence without cross-examination is unconstitutional in the 2021 decision. The Constitutional Court held that the right to cross-examination was the core of the right to a fair trial. According to the judgment of the Constitutional Court, it was determined that the provisions the Sexual Violence Punishment Act did not guarantee the defendant's right to cross-examination, and consequently violated the defendant's right to a fair trial. The provision stipulated an exception to the hearsay rule to prevent secondary harm to victims of child sexual violence, and the Constitutional Court judged that the provision that recognized this exception was unconstitutional.
Unlike the US Constitution, there is no right to confrontation clause in the Korean Constitution. It has not been empirically confirmed whether the right to cross-examination against child victims of sexual violence contributes to the discovery of the substantive truth. Therefore, although the Constitutional Court regards the right to cross-examination as equivalent to the fundamental right under the Constitution, it is questionable whether this judgment is correct. Rather, the decision of the Constitutional Court seems to be more in line with the American legal system, which has the right to confrontation clause in the Constitution, regarding the right to cross-examination as the most effective device for finding the truth.
On the other hand, the hearsay rule and the right to cross-examination are clearly stipulated in the Criminal Procedure Act of Korea. The Criminal Procedure Act of Korea is oriented toward trial-centered system and adversarial trial system. Therefore, the right to cross-examination is an important device for correcting errors and discovering the substantive truth in the Korean legal system. Therefore, it is meaningful that the Constitutional Court recognized the right to cross-examination as a constitutional right and strictly interpreted the exception to the hearsay rule in the Sexual Violence Punishment Act. In the future, it will be urgent to come up with a plan to ensure the right of cross-examination of the accused without causing secondary harm to the victim by reconciling the two interests of guaranteeing the defendant's right to cross-examination and the protection of child victims of sexual violence.
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Sung, Su-Kyung, Eun-Seok Lee, and Byeong-Seok Shin. "Prevention of Mountain Disasters and Maintenance of Residential Area through Real-Time Terrain Rendering." Sustainability 13, no. 5 (March 9, 2021): 2950. http://dx.doi.org/10.3390/su13052950.
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Climate change increases the frequency of localized heavy rains and typhoons. As a result, mountain disasters, such as landslides and earthworks, continue to occur, causing damage to roads and residential areas downstream. Moreover, large-scale civil engineering works, including dam construction, cause rapid changes in the terrain, which harm the stability of residential areas. Disasters, such as landslides and earthenware, occur extensively, and there are limitations in the field of investigation; thus, there are many studies being conducted to model terrain geometrically and to observe changes in terrain according to external factors. However, conventional topography methods are expressed in a way that can only be interpreted by people with specialized knowledge. Therefore, there is a lack of consideration for three-dimensional visualization that helps non-experts understand. We need a way to express changes in terrain in real time and to make it intuitive for non-experts to understand. In conventional height-based terrain modeling and simulation, there is a problem in which some of the sampled data are irregularly distorted and do not show the exact terrain shape. The proposed method utilizes a hierarchical vertex cohesion map to correct inaccurately modeled terrain caused by uniform height sampling, and to compensate for geometric errors using Hausdorff distances, while not considering only the elevation difference of the terrain. The mesh reconstruction, which triangulates the three-vertex placed at each location and makes it the smallest unit of 3D model data, can be done at high speed on graphics processing units (GPUs). Our experiments confirm that it is possible to express changes in terrain accurately and quickly compared with existing methods. These functions can improve the sustainability of residential spaces by predicting the damage caused by mountainous disasters or civil engineering works around the city and make it easy for non-experts to understand.
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Schutijser, Bernadette, Joanna Ewa Klopotowska, Irene Jongerden, Peter Spreeuwenberg, Cordula Wagner, and Martine de Bruijne. "Nurse compliance with a protocol for safe injectable medication administration: comparison of two multicentre observational studies." BMJ Open 8, no. 1 (January 2018): e019648. http://dx.doi.org/10.1136/bmjopen-2017-019648.
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ObjectivesMedication administration errors with injectable medication have a high risk of causing patient harm. To reduce this risk, all Dutch hospitals implemented a protocol for safe injectable medication administration. Nurse compliance with this protocol was evaluated as low as 19% in 2012. The aim of this second evaluation study was to determine whether nurse compliance had changed over a 4-year period, what factors were associated over time with protocol compliance and which strategies have been implemented by hospitals to increase protocol compliance.MethodsIn this prospective observational study, conducted between November 2015 and September 2016, nurses from 16 Dutch hospitals were directly observed during intravenous medication administration. Protocol compliance was complete if nine protocol proceedings were conducted correctly. Protocol compliance was compared with results from the first evaluation. Multilevel logistic regression analyses were used to assess the associations over time between explanatory variables and complete protocol compliance. Implemented strategies were classified according to the five components of the Systems Engineering Initiative for Patient Safety (SEIPS) model.ResultsA total of 372 intravenous medication administrations were observed. In comparison with 2012, more proceedings per administration were conducted (mean 7.6, 95% CI 7.5 to 7.7 vs mean 7.3, 95% CI 7.3 to 7.4). No significant change was seen in complete protocol compliance (22% in 2016); compliance with the proceedings ‘hand hygiene’ and ‘check by a second nurse’ remained low. In contrast to 2012, the majority of the variance was caused by differences between wards rather than between hospitals. Most implemented improvement strategies targeted the organisation component of the SEIPS model.ConclusionsCompliance with ‘hand hygiene’ and ‘check by a second nurse’ needs to be further improved in order to increase complete protocol compliance. To do so, interventions focused on nurses and individually tailored to each ward are needed.
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Hin, Chu Man, and Chong Chung Hong. "Oncology Pharmacist’s Role and Impact on the Multidisciplinary Patient-Centre Practice of Oncology Clinic in Public Hospitals." Asia Pacific Journal of Health Management 14, no. 1 (April 15, 2019): 16. http://dx.doi.org/10.24083/apjhm.v14i1.203.
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Oncology pharmacy service was developed and integrated into the multidisciplinary team of oncology clinic in 2013 at the United Christian Hospital aiming to enhance the holistic patient-centre practice of the clinic through the optimization of the safety and efficacy of anti-cancer treatment. This review aims to describe the role and impact of oncology pharmacists (OPs) in clinical setting to optimize anti-cancer treatment for cancer patients in a multidisciplinary care approach. From selection, prescribing, procurement to monitoring and patient education, OPs significantly contribute to the safety and effective use of anti-neoplastics in any circumstances. OPs provide professional advices to oncologists in choosing the appropriate anti-cancer agents for specific cancer and designing personalized anti-cancer treatment according to patients’ fitness and appropriateness for chemotherapy. Parenteral and oral chemotherapeutic agents carry heightened risk of causing significant patient harm when they are used in errors. Thus, OPs also develop standardized chemotherapy orders and ensure the final dose is appropriate in terms of both hematological and non-hematological responses and tolerability. Moreover, OPs play an important role in procuring anti-cancer drugs and sourcing alternative drug choices that will deliver similar clinical outcomes. In addition, OPs also assure the clinical integrity of anti-cancer drugs for full anti-neoplastic activity and safe administration of these drugs by nursing staff to minimize potential occupational risk. Most importantly, OPs play a vital role in providing direct patient care functions such as drug therapy monitoring and management (e.g. ensure that patients receive sufficient pre-medications for administration of anti-cancer drugs), and medication counseling for patients and their carers to better understand their anti-cancer treatment. The positive impact of integrating OPs into the multidisciplinary patient-center practice of oncology clinic includes (1) reduction in potentially life-threatening medication incidents and cancer drug administration errors in public hospitals; (2) collaboration with oncologists to select the most suitable cancer drug regimens for patients; (3) prevention of potential occupational risk to the healthcare professionals who handle cancer drugs; and (4) provision of optimal therapy treatment, monitoring and counseling to patients to reduce side effects and hospital readmission. The professional drug knowledge of OPs adds value to the multidisciplinary team in oncology clinics and the growth of OPs into effective direct patient care in oncology clinics should be encouraged to optimize medication-related outcomes.
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Banja, John D. "CEU: Ethically speaking: The case manager's response to harm-causing error." Case Manager 16, no. 3 (May 2005): 60–64. http://dx.doi.org/10.1016/j.casemgr.2005.04.002.
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Tjia, Jennifer, Maija Reblin, Celeste Lemay, Margaret Clayton, and Lee Ellington. "Organization, teamwork, and advocacy: Important skills needed by hospice family caregivers who manage medications." Journal of Clinical Oncology 32, no. 31_suppl (November 1, 2014): 121. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.121.
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121 Background: In the home hospice setting, family caregivers (CGs) often assume medication administration responsibilities traditionally performed by licensed nurses. Little is known about how to assess and support CG medication management skills. As part of an ongoing study of nurse-caregiver interactions in home hospice, we gathered data on CG medication management needs. Methods: A longitudinal, multicenter study of home hospice nurse visits captured audiorecorded communication between nurses and CGs. Participants included patients with cancer and their self-identified CGs who were recruited upon home hospice enrollment. The current sub-study included participants aged ≥65 and their family CGs from 7 hospice agencies. Two investigators independently coded transcriptions of the first audio recorded nurse home visit using a directive content analytic approach to map conversations to a previously published, interview-derived, framework for hospice medication management by CGs. Results: A total of 18 patients (mean age 76.5 [SD 10.7], 56% female) and their CGs (mean age 59.6 [SD13.4], 78% female) were included. Content analysis revealed that CG skills needed for medication management are not limited to drug knowledge. Complicated organizational skills are needed to track medication acquisition and dosing, record the use of short- and long-acting drugs with similar modes of action, and coordinate medication administration by multiple CGs. Teamwork skills are needed to help coordinate medication prescribing between specialist, primary, and hospice physicians. CGs also need symptom management skills regarding the proper selection of medications, as well as skills to manage side effects, inadvertent errors, and possible medication related-emergencies. CGs play a vital role in patient advocacy, alerting providers to the burden and quality of life issues related to medication use, including whether medications have intended or unintended effects, or are potentially unnecessary or causing harm. Conclusions: CGs must have multiple skills to effectively manage medications in home hospice. A systematic approach and intervention is needed to support CGs’ medication management skills.
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Sigurgeirsdóttir, Sigurbjörg, Anna María Þórðardóttir, and Elísabet Benedikz. "Professional versus public attitudes towards criminal charges in healthcare – registered nurses and a random national panel compared: Dark clouds on the horizon?" Læknablaðið 107, no. 01 (January 4, 2021): 17–23. http://dx.doi.org/10.17992/lbl.2021.01.616.
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INTRODUCTION: The aim of this study is to encourage a discussion on patient safety and public responses to serious incidents in healthcare. Triggered by the first of its kind in Iceland, it addresses the question what characterizes attitudes towards criminal charges for a serious incident in healthcare. MATERIAL AND METHODS: In this comparative study we examined whether attitudes towards culpability of healthcare professionals differed between cohorts from a random national panel and registered Icelandic nurses. Both groups were asked whether a healthcare professional should face criminal charges if causing serious harm or death due to human error, accident, neglect or intent. Answers were given on a Likert scale. RESULTS: When asked if a healthcare professional causing serious harm or death due to human error or by accident should face criminal charges, nurses were significantly more likely to somewhat or strongly disagree, while the panel was significantly more likely to somewhat or strongly agree. The difference was inversely proportional to educational levels among the panel members. When asked whether a healthcare professional should be charged for causing serious harm or death due to neglect or intent, there was no significant difference between the groups. CONCLUSION: The results indicate that healthcare professionals, as represented by Icelandic nurses, do not seek to avoid accountability in serious patient incidents, but implicate the importance of distinguishing between the different nature of incidents. The results show that a more informed public debate on serious healthcare incidents is needed in which appropriate measures protecting patient safety as well as professional safety are ensured.
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Meng, Long, Can Qu, Xia Qin, Huali Huang, Yongsheng Hu, Feng Qiu, and Shusen Sun. "Drug-Related Problems among Hospitalized Surgical Elderly Patients in China." BioMed Research International 2021 (February 15, 2021): 1–6. http://dx.doi.org/10.1155/2021/8830606.
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There is a lack of data on drug-related problems (DRPs) among elderly patients from surgical departments. The current study is aimed at identifying and categorizing types of DRPs and assessing the severities of the DRPs. Medication orders for hospitalized patients aged ≥65 years from six surgery departments were reviewed to determine DRPs over 6 months in a tertiary teaching hospital of Chongqing, China. DRPs were classified based on the Pharmaceutical Care Network Europe classification V8.02. The severity ratings of the DRPs were assessed using the National Coordinating Council for Medication Error Reporting and Prevention classification. A total of 53,231 medication orders from 1,707 elderly patients were reviewed, and 1,061 DRPs were identified. Treatment safety (44.9%) was the most common DRP type. Drug selection (43.1%) and dose selection (43.1%) were the major causes of DRPs. A total of 75.1% of the DRPs were classified into severity categories B to D (causing no or potential harm), and 24.9% were classified as categories E to H (causing actual harm). DRPs are common in hospitalized elderly surgical patients. Pharmacists should provide medication order reviews in this vulnerable patient population.
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Shah, Peer Tehseen, and Sumbal Afridi. "COMPUTER-BASED MEDICAL AND DENTAL COLLEGE ADMISSION TEST (MDCAT) IN PAKISTAN: A REFORM OR COMMOTION?" KHYBER MEDICAL UNIVERSITY JOURNAL 14, no. 4 (December 31, 2021): 257–8. http://dx.doi.org/10.35845/kmuj.2021.22264.
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In Pakistan, there used to be a separate system of examinations in each province to get admission in Bachelor of Medicine, Bachelor of Surgery (MBBS) and Bachelor of Dental Surgery (BDS).It was a very efficient, transparent, reliable and authentic system unless it was decided to hand-over the task of conducting the exam to a private company called TEPS. In 2019, upon the dissolution of Pakistan medical and dental council (PMDC) and replacing it with Pakistan medical commission (PMC), it was unanimously decided to conduct a centralized examination across the country to provide a level-playing field by hiring a private company “TEPS”. Well, it made sense that this decision was in the best interest of students according to PMC and a way forward to standardization. However, assigning such a major task to the private company not only put the reliability of PMC at risk but also raised queries against its integrity. TEPS was not an authentic body to be given such a crucial task. Later on, in 2021, not only the examination was centralized but also it was taken on tablets computers with so many faulty techniques and errors, which raised many concerns amongst the students. This action put the student’s future at stake and turned out to be a disaster causing more harm than good.
Initially, this decision was unacceptable to pre-medical students because they weren’t aware of this new pattern and weren’t prepared for it. Also, COVID-19 hit hard in 2020 and since then it resulted in the loss of precious time and studies of students. The students were not satisfied with the whole process, but somehow exam was conducted. According to the president of PMC, a total of 194,133 students appeared in the Medical and Dental College Admission Test (MDCAT) from 30th August to 2nd October 2021. Out of all, 68,680 students succeeded in the exam, making an outcome of 35.4 per cent pass percentage.1 The president reiterated and kept vouching for the authenticity and transparency of the exam.
On the other hand, PMC was assailed by the pre-medical students after the exam. According to students, the examination was conducted on multiple days, with few being the most challenging than others in respect to the difficulty level. Ironically, during the exam, they weren’t provided with a good internet facility; thus, in most cases, students were unable to answer skipped questions and even some of them weren’t able to finish the exam in time.2 Questions were also raised regarding critical technical issues in construction of multiple choice questions (MCQs) without any item analysis or difficulty/discriminatory index by the experts. The credibility of MDCAT results was further jeopardize by declaration of results by PMC which were full of errors and blunders.3,4
Apart from this, PMC launched a question bank for preparation prior to the exam, which was not readily available to everyone since it was costly and not many were aware of it. Students complained about hacking of TEPS website as they were not getting access to the practice test on the website for few days. Questions were also raised about the contract of PMC with TEPS for conducting MDCAT examinations, which was later on declared as a violation of the rules of Public Procurement Regulatory Authority.5
Moreover, the evaluation of exam through a third party and revision of results further raised eyebrows. It gave an impression that the firm that was assigned this task to conduct exam was not prepared and the quality of MCQS and their reliability was questionable. However, PMC’s officials denied all the grievances and kept reassuring that the exam was conducted on a local network, irrespective of the need for internet connectivity. Similarly, it was reported that few questions were out of course and students faced a lot more difficulty in answering them. Furthermore, they added that the course syllabus was already shared on their website and all questions were reviewed by the subjects’ specialists.6
Students have their own excuses and PMC responds with their own arguments, but there is an obvious gap and lack communication between them. It’s a call for urgent attention of the president of Pakistan and other concerned officials to take notice of this newly imposed system by PMC and revisit it for better improvements. It’s completely unfair to be oblivious to such an issue. Nevertheless, it has caused more damage to the students and in many cases, they are in a terrible dilemma and reluctant to pursue a medical career in future.
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Smirnov, Alexander М. "Foreign experience in legal regulation of extrajudicial forms of protection of an individual’s rights and freedoms, excluding the criminality of the act." Vestnik of Saint Petersburg University. Law 12, no. 1 (2021): 144–54. http://dx.doi.org/10.21638/spbu14.2021.110.
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The article describes the provisions of the sources of criminal law of some foreign countries regarding the regulation of extrajudicial forms of protection of an individual’s rights and freedoms, excluding the criminality of the act. The author refers to these forms as a necessary defense, causing harm to the person who committed the crime, and extreme necessity. The article discusses the possibility of implementing the provisions of these sources in Russian criminal law to improve the state response to the implementation of these forms. The author comes to the conclusion that the most positive and constructive features of legal regulation in foreign countries, extrajudicial forms of protection of an individual’s rights and freedoms while excluding the criminality of the act, deserve scientific attention and consideration of their implementation in domestic criminal law and legal practice. The main features consist of the following: the conditions for the onset of the right to necessary defense, extreme need and infliction of harm during the detention of a person who has committed a crime, and the grounds for exceeding it; taking into account the situation when determining the legitimacy of the given circumstances; allocation of privileged conditions under which a person is either exempted from criminal liability or not exempted from it, but can count on mitigation of punishment; criminal prosecution for actions if absolutely necessary only if they have resulted in more harm than the harm prevented; regulation of legal and factual error with the necessary defense and extreme necessity; legal regulation of the conditions for the use of weapons in the implementation of these forms; holding accountable those who provoked the necessary defense; the emergence of the right to necessary defense of the person whose rights are being encroached upon.
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Mitchell, E. A. D., B. Mulhauser, M. Mulot, A. Mutabazi, G. Glauser, and A. Aebi. "A worldwide survey of neonicotinoids in honey." Science 358, no. 6359 (October 5, 2017): 109–11. http://dx.doi.org/10.1126/science.aan3684.
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Growing evidence for global pollinator decline is causing concern for biodiversity conservation and ecosystem services maintenance. Neonicotinoid pesticides have been identified or suspected as a key factor responsible for this decline. We assessed the global exposure of pollinators to neonicotinoids by analyzing 198 honey samples from across the world. We found at least one of five tested compounds (acetamiprid, clothianidin, imidacloprid, thiacloprid, and thiamethoxam) in 75% of all samples, 45% of samples contained two or more of these compounds, and 10% contained four or five. Our results confirm the exposure of bees to neonicotinoids in their food throughout the world. The coexistence of neonicotinoids and other pesticides may increase harm to pollinators. However, the concentrations detected are below the maximum residue level authorized for human consumption (average ± standard error for positive samples: 1.8 ± 0.56 nanograms per gram).
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Zhang, Haifei, Jian Xu, Lanmei Qian, and Jianlin Qiu. "Prediction of the COVID-19 Spread in China Based on Long Short-Term Memory Network." Journal of Physics: Conference Series 2138, no. 1 (December 1, 2021): 012015. http://dx.doi.org/10.1088/1742-6596/2138/1/012015.
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Abstract The sudden outbreak of COVID-19 has caused great losses to the economy and the life of the masses. Long short-term memory (LSTM) network is a time recursive neural network, which is suitable for processing and predicting important events with relatively long interval and delay in time series. Using LSTM network to predict and analyze the development trend of epidemic situation, it is imperative to prevent epidemic situation from causing secondary harm to China’s development. In this paper, we first obtained the COVID-19 data published by China Health Net using crawler technology, which is the accurate value of infection trend after the outbreak of COVID-19 in China. Then, based on these data, the LSTM model is used to predict the development trend of the epidemic in one year, and the mean square error is used to calculate the error between the prediction and the real data. The experimental model is used to predict and analyze the development trend of COVID-19. The results show that the error between predicted data and real data is small and the effect is very good, which provides a reasonable basis and forecast for scientific prevention and control of epidemic situation.
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Kumar, P. Vinay, M. C. Ajay Kumar, B. Anil Kumar, and P. Venkateswara Rao. "Prediction of PM2.5 Over Hyderabad Using Deep Learning Technique." Nature Environment and Pollution Technology 21, no. 2 (June 1, 2022): 691–96. http://dx.doi.org/10.46488/nept.2022.v21i02.029.
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Urbanization and Industrialization during the last few decades have increased air pollution causing harm to human health. Air pollution in metro cities turns out to be a serious environmental problem, especially in developing countries like India. The major environmental challenge is, to predict accurate air quality from pollutants. Envisaging air quality from pollutants like PM2.5, using the latest deep learning technique (LSTM timer series) has turned out to be a significant research area. The primary goal of this research paper is to forecast near-time pollution using the LSTM time series multivariate regression technique. The air quality data from Central Pollution Control Board over Hyderabad station has been used for the present study. All the processing is done in real-time and the system is found to be functionally very stable and works under all conditions. The Root Mean Square Error (RMSE) and R2 have been used as evaluation criteria for this regression technique. Further, the time series regression has been used to find the best fit model in terms of processing time to get the lowest error rate. The statistical model based on machine learning established a relevant prediction of PM2.5 concentrations from meteorological data.
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Hoverman, J. R., K. M. Shuey, D. Richardson, K. Hansen, and P. C. Dugger. "Assessment of medication safety in the outpatient setting." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 6631. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.6631.
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6631 Background: US Oncology provides the pharmacy and drug infusion support for over 700 medical oncologists and hematologists. As such medication safety is a principle concern for the delivery of quality care. As described earlier, a survey of affiliated practices indicated three areas of concern: 1) no uniform reporting mechanism, 2) no standard double check mechanism, and 3) variable inclusion of medication safety procedures and reporting into practice operations. This report describes the first three years experience and proposals for continuing improvement. Methods: An online reporting tool was made available to all practices. 337 practice sites and 35 practice groups were monitored. The first hour of chemotherapy (1HC) was used as the denominator for all occurrence calculations. All reporting was voluntary. Occurrences were rated as to severity, from 1 (error detected before any steps towards completion) to 7 (error resulting in death of the patient). The occurrences were categorized according to process, either in prescribing, calculation of doses, lab or allergy issues, or matching the mixed dose to the order or in administering a mixed dose. In each circumstance a near miss or failure to double check was determined. The total experience for the network was determined for 2004 and 2005 with projected data for 2006. Results: The 1HC numbers used as denominators are: 2004–534,542: 2005–534,606: 2006 –542,000. Occurrences with error rates were: 2004 –1,723 (0.32%), 2005 –2,467 (0.46%), 2006 –2,653 (0.49%). The percent practices participating were 70%, 83% and 75% for 2004, 2005 and 2006 respectively. When considering only reporting practices the occurrence rates were: 2004 –0.45%, 2005–0.55%, 2006–0.65%. The percent occurrences with temporary or permanent harm to the patient dropped from 19% in 2004 to 16% in 2006. A failure to double check was a contributing factor in 57% in 2004, 42% in 2006. Conclusions: An anonymous reporting mechanism resulted in an increase in occurrence reporting. An education program led to fewer failures to double check and a decrease in events causing harm to patients. Next steps include enhanced feedback to practices and the use of an EHR to improve processes. The malpractice environment in some areas inhibits reporting. No significant financial relationships to disclose.
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Barreveld, Antje M., Robert J. McCarthy, Nabil Elkassabany, Edward R. Mariano, Brian Sites, Roshni Ghosh, and Asokumar Buvanendran. "Opioid Stewardship Program and Postoperative Adverse Events." Anesthesiology 132, no. 6 (June 1, 2020): 1558–68. http://dx.doi.org/10.1097/aln.0000000000003238.
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Abstract Background A 6-month opioid use educational program consisting of webinars on pain assessment, postoperative and multimodal pain opioid management, safer opioid use, and preventing addiction coupled with on-site coaching and monthly assessments reports was implemented in 31 hospitals. The authors hypothesized the intervention would measurably reduce and/or prevent opioid-related harm among adult hospitalized patients compared to 33 nonintervention hospitals. Methods Outcomes were extracted from medical records for 12 months before and after the intervention start date. Opioid adverse events, evaluated by opioid overdose, wrong substance given or taken in error, naloxone administration, and acute postoperative respiratory failure causing prolonged ventilation were the primary outcomes. Opioid use in adult patients undergoing elective hip or knee arthroplasty or colorectal procedures was also assessed. Differences-in-differences were compared between intervention and nonintervention hospitals. Results Before the intervention, the incidence ± SD of opioid overdose, wrong substance given, or substance taken in error was 1 ± 0.5 per 10,000 discharges, and naloxone use was 117 ± 13 per 10,000 patients receiving opioids. The incidence of respiratory failure was 42 ± 10 per 10,000 surgical discharges. A difference-in-differences of –0.2 (99% CI, –1.1 to 0.6, P = 0.499) per 10,000 in opioid overdose, wrong substance given, or substance taken in error and –13.6 (99% CI, –29.0 to 0.0, P = 0.028) per 10,000 in respiratory failure was observed postintervention in the intervention hospitals; however, naloxone administration increased by 15.2 (99% CI, 3.8 to 30.0, P = 0.011) per 10,000. Average total daily opioid use, as well as the fraction of patients receiving daily opioid greater than 90 mg morphine equivalents was not different between the intervention and nonintervention hospitals. Conclusions A 6-month opioid educational intervention did not reduce opioid adverse events or alter opioid use in hospitalized patients. The authors’ findings suggest that despite opioid and multimodal analgesia awareness, limited-duration educational interventions do not substantially change the hospital use of opioid analgesics. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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Sharapov, Roman, and Evgeniy Smakhtin. "New Grounds of Criminal Liability for Inducement to Suicide and Other Life-Threatening Behavior." Russian Journal of Criminology 12, no. 3 (June 18, 2018): 349–57. http://dx.doi.org/10.17150/2500-4255.2018.12(3).349-357.
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The paper analyzes the criminal policy and legal evaluation of inducement to suicide and other life-threatening behavior in view of the changes in criminal legislation in June 2017. The authors show that the key social condition for introducing new grounds for criminal liability for inducement to suicide and other life-threatening behavior is the wide-spread cases of inducement of children and teenagers to suicidal and other life-threatening behavior via the Internet. The authors also present criminal legal characteristics of the differentiation between homicide by taking your own life and inducement to (counseling, aiding) suicide, and the definition of crimes in cases of factual error. They recommend classifying the actions under Art. 110-110.2 of the Criminal Code if the intent of the offender includes the fact that a person will deliberately and understandingly take his/her life. In contrast, the involvement of a person into auto-aggressive behavior connected with causing their own death by counseling such an act or any other inducement to it when the offender is aware that, due to age or psychological disorder, the victims do not understand the character and meaning of the actions carried out with them should be classified as a murder. The concept of the victims helplessness in the crimes of inducement to suicide should be interpreted in a restrictive way; such victims should be understood as being physically but not psychologically helpless. Criminal liability for the propaganda of auto-aggressive behavior (excepting suicidal behavior), connected with self-harm should be regulated under Part 3, Art. 239 of the Criminal Code.
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Motter, Fabiane Raquel, Nathalia Margarida Cantuaria, and Luciane Cruz Lopes. "Healthcare professionals’ knowledge, attitudes and practices toward deprescribing: a protocol of cross-sectional study (Desmedica Study—Brazil)." BMJ Open 11, no. 8 (August 2021): e044312. http://dx.doi.org/10.1136/bmjopen-2020-044312.
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BackgroundDeprescribing is the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit. It is an activity that should be a normal part of care/the prescribing cycle. Although now broadly recognised, there are still challenges in its effective implementation.ObjectivesTo develop and validate an instrument to measure Brazilian healthcare professionals’ knowledge, attitudes and practices towards deprescribing.MethodsThis study will include the following steps: (1) development of the preliminary instrument; (2) content validation; (3) pilot study; (4) evaluation of psychometric characteristics. After the elaboration of items of the instrument through the literature review, we will use a hybrid Delphi method to develop and establish the content validity of the instrument. Further, a pilot survey will be performed with 30 healthcare professionals. Finally, for the evaluation of psychometric characteristics, a cross-sectional study will be accomplished with a representative sample of different healthcare professionals from different Brazilian states using respondent-driven sampling. Exploratory factor analysis and confirmatory factor analysis will be performed. For assessing the model fit, we will use the ratio of χ2 and df (χ2/df), comparative fit index, the goodness of fit index and root mean square error of approximation. In addition, the reliability of the instrument will be estimated by test–retest reproducibility and Cronbach’s alpha coefficient (α).Ethics and disseminationThe Ethics Committee for Research at the University of Sorocaba (ethics approval number: 3.848.916) approved the study. Study findings will be circulated to healthcare professionals and scientists in the field through publication in peer-reviewed journals and conference presentations.
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Hosni Mahmoud, Hanan A. "Diabetic Retinopathy Progression Prediction Using a Deep Learning Model." Axioms 11, no. 11 (November 4, 2022): 614. http://dx.doi.org/10.3390/axioms11110614.
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Diabetes is an illness that happens with a high level of glucose in the body, and can harm the retina, causing permanent loss vision or diabetic retinopathy. The fundus oculi method comprises detecting the eyes to perform a pathology test. In this research, we implement a method to predict the progress of diabetic retinopathy. There is a research gap that exists for the detection of diabetic retinopathy progression employing deep learning models. Therefore, in this research, we introduce a recurrent CNN (R-CNN) model to detect upcoming visual field inspections to predict diabetic retinopathy progression. A benchmark dataset of 7000 eyes from healthy and diabetic retinopathy progress cases over the years are utilized in this research. Approximately 80% of ocular cases from the dataset is utilized for the training stage, 10% of cases are used for validation, and 10% are used for testing. Six successive visual field tests are used as input and the seventh test is compared with the output of the R-CNN. The precision of the R-CNN is compared with the regression model and the Hidden Markov (HMM) method. The average prediction precision of the R-CNN is considerably greater than both regression and HMM. In the pointwise classification, R-CNN depicts the least classification mean square error among the compared models in most of the tests. Also, R-CNN is found to be the minimum model affected by the deterioration of reliability and diabetic retinopathy severity. Correctly predicting a progressive visual field test with the R-CNN model can aid physicians in making decisions concerning diabetic retinopathy.
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CHERIAN, SHERIMON PULIPRATHU, ALAA ISMAEEL, MANNA ANN MARIYAM, SIAN GIJO, WINNY ANNA VARKEY, SHERIN JOHN, and NISHA JOSEPH. "AN INTELLIGENT DECISION SUPPORT SYSTEM FOR WASTEWATER TREATMENT PLANTS IN THE SULTANATE OF OMAN." Pollution Research 41, no. 04 (2022): 1178–83. http://dx.doi.org/10.53550/pr.2022.v41i04.005.
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All living things need access to clean water to survive. However, drinkable water is scarce, and as a result of human activity, these supplies are becoming severely contaminated. In order to replenish these depleting water supplies while also reducing contamination-causing activities, several steps must be made. Wastewater treatment plants (WWTPs) are essential for removing toxins from various sectors so that clean water may be released into the environment with the least amount of environmental harm. It involves a combination of complex processes used to treat and remove pollutants from water. All the decisions in WWTPs are conventionally taken by skilled and qualified plant operators with the necessary training and education in order to get the job done right. There can be a considerable amount of error that can occur when critical decisions are taken by these operators. In order to tackle this and to improve efficiency and accuracy, a Decision Support System (DSS) can be used as traditional methods of decision making by human operators are considerably less efficient. Water quality parameters such as pH, hardness, solids, chloramines, sulphate, conductivity, organic carbon, trihalomethanes, turbidity are used to determine the purity status of water being considered. The proposed study focuses on a Machine Learning based DSS built on Decision Tree (DT) algorithm that will predict the purity of water using historical data, which will aid the plant operators in making daily operational decisions at the WTTPs. The experimental result analysis shows that the model built using DT algorithm gives good performance.
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TKACHOVA, Viktoriia, and Pavlo LAVRYK. "Law of Ukraine “On administrative procedure”. First critical comments." Economics. Finances. Law 6/1, no. - (June 29, 2022): 28–32. http://dx.doi.org/10.37634/efp.2022.6(1).6.
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The paper examines in detail the way to develop the Law of Ukraine "On Administrative Procedure", which began in 1998. It is noted that the adoption of this Law was hampered by the Soviet past of Ukraine and the lack of awareness of the importance of adopting this legal act. The adoption of the law on administrative procedure in the post-Soviet space at the beginning of the XXI century, the experience and concept of this law in some European countries are analyzed. It is noted that Ukraine has repeatedly noted the priority and need to develop the provision of administrative services and the adoption of a law on administrative procedure in accordance with European standards. It was emphasized that Ukraine has come a long way before the adoption of the Law of Ukraine "On Administrative Procedure", which was signed on June 13, 2022. The repeated presidential veto has become such an obstacle to the adoption of this Law. The paper explains why this version of the Law was approved by international commissions. There are always objections to any law and this case is no exception, so we analyzed three main shortcomings of this law, namely: giving administrative bodies "quasi-judicial functions", the possibility of causing harm to a person by confiscating property due to administrative error and the court's ability to decide , which body is competent to decide the case. However, it should be noted that these shortcomings did not prevent the adoption of this law on June 13, 2022. In conclusion, it was emphasized that the adoption of the Law of Ukraine "On Administrative Procedure" is one of the outstanding achievements of our country, and despite the presence of certain serious shortcomings, it will be very useful for Ukrainian society.This Law will help bureaucratize public administration in general and its individual components (bodies) and bring Ukrainian legislation closer to the standards of the European Union.
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Allen, Michael, Charlotte James, Julia Frost, Kristin Liabo, Kerry Pearn, Thomas Monks, Zhivko Zhelev, et al. "Using simulation and machine learning to maximise the benefit of intravenous thrombolysis in acute stroke in England and Wales: the SAMueL modelling and qualitative study." Health and Social Care Delivery Research 10, no. 31 (October 2022): 1–148. http://dx.doi.org/10.3310/gvzl5699.
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Background Stroke is a common cause of adult disability. Expert opinion is that about 20% of patients should receive thrombolysis to break up a clot causing the stroke. Currently, 11–12% of patients in England and Wales receive this treatment, ranging between 2% and 24% between hospitals. Objectives We sought to enhance the national stroke audit by providing further analysis of the key sources of inter-hospital variation to determine how a target of 20% of stroke patients receiving thrombolysis may be reached. Design We modelled three aspects of the thrombolysis pathway, using machine learning and clinical pathway simulation. In addition, the project had a qualitative research arm, with the objective of understanding clinicians’ attitudes to use of modelling and machine learning applied to the national stroke audit. Participants and data source Anonymised data were collected for 246,676 emergency stroke admissions to acute stroke teams in England and Wales between 2016 and 2018, obtained from the Sentinel Stroke National Audit Programme. Results Use of thrombolysis could be predicted with 85% accuracy for those patients with a chance of receiving thrombolysis (i.e. those arriving within 4 hours of stroke onset). Machine learning models allowed prediction of likely treatment choice for each patient at all hospitals. A clinical pathway simulation predicted hospital thrombolysis use with an average absolute error of 0.5 percentage points. We found that about half of the inter-hospital variation in thrombolysis use came from differences in local patient populations, and half from in-hospital processes and decision-making. Three changes were applied to all hospitals in the model: (1) arrival to treatment in 30 minutes, (2) proportion of patients with determined stroke onset times set to at least the national upper quartile and (3) thrombolysis decisions made based on majority vote of a benchmark set of 30 hospitals. Any single change alone was predicted to increase national thrombolysis use from 11.6% to between 12.3% and 14.5% (with clinical decision-making having the most effect). Combined, these changes would be expected to increase thrombolysis to 18.3% (and to double the clinical benefit of thrombolysis, as speed increases also improve clinical benefit independently of the proportion of patients receiving thrombolysis); however, there would still be significant variation between hospitals depending on local patient population. For each hospital, the effect of each change could be predicted alone or in combination. Qualitative research with 19 clinicians showed that engagement with, and trust in, the model was greatest in physicians from units with higher thrombolysis rates. Physicians also wanted to see a machine learning model predicting outcome with probability of adverse effect of thrombolysis to counter a fear that driving thrombolysis use up may cause more harm than good. Limitations Models may be built using data available in the Sentinel Stroke National Audit Programme only. Not all factors affecting use of thrombolysis are contained in Sentinel Stroke National Audit Programme data and the model, therefore, provides information on patterns of thrombolysis use in hospitals, but is not suitable for, or intended as, a decision aid to thrombolysis. Conclusions Machine learning and clinical pathway simulation may be applied at scale to national audit data, allowing extended use and analysis of audit data. Stroke thrombolysis rates of at least 18% look achievable in England and Wales, but each hospital should have its own target. Future work Future studies should extend machine learning modelling to predict the patient-level outcome and probability of adverse effects of thrombolysis, and apply co-production techniques, with clinicians and other stakeholders, to communicate model outputs. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 31. See the NIHR Journals Library website for further project information.
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Elliott, Rachel Ann, Elizabeth Camacho, Dina Jankovic, Mark J. Sculpher, and Rita Faria. "Economic analysis of the prevalence and clinical and economic burden of medication error in England." BMJ Quality & Safety, June 11, 2020, bmjqs—2019–010206. http://dx.doi.org/10.1136/bmjqs-2019-010206.
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ObjectivesTo provide national estimates of the number and clinical and economic burden of medication errors in the National Health Service (NHS) in England.MethodsWe used UK-based prevalence of medication errors (in prescribing, dispensing, administration and monitoring) in primary care, secondary care and care home settings, and associated healthcare resource use, to estimate annual number and burden of errors to the NHS. Burden (healthcare resource use and deaths) was estimated from harm associated with avoidable adverse drug events (ADEs).ResultsWe estimated that 237 million medication errors occur at some point in the medication process in England annually, 38.4% occurring in primary care; 72% have little/no potential for harm and 66 million are potentially clinically significant. Prescribing in primary care accounts for 34% of all potentially clinically significant errors. Definitely avoidable ADEs are estimated to cost the NHS £98 462 582 per year, consuming 181 626 bed-days, and causing/contributing to 1708 deaths. This comprises primary care ADEs leading to hospital admission (£83.7 million; causing 627 deaths), and secondary care ADEs leading to longer hospital stay (£14.8 million; causing or contributing to 1081 deaths).ConclusionsUbiquitous medicines use in health care leads unsurprisingly to high numbers of medication errors, although most are not clinically important. There is significant uncertainty around estimates due to the assumption that avoidable ADEs correspond to medication errors, data quality, and lack of data around longer-term impacts of errors. Data linkage between errors and patient outcomes is essential to progress understanding in this area.
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"Challenge: Tertiary Care Hospitals to Management of High Alert Medicine for Reduce the Medication Error." Journal of Nursing & Healthcare 2, no. 4 (October 6, 2017). http://dx.doi.org/10.33140/jnh/02/04/00001.
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Medication errors are one of the most common causes of avoidable harm to patients in health care organizations. Medications that have the highest risk of causing injury when used wrongly are known as high-alert medications in JCI accredited hospitals. Safe practices can reduce the potential for harm. Because of the significant nature of the potential adverse effects such as bleeding or hypoglycemia. Many of these medications are also more likely to be associated with dosing errors, due to issues such as the need to frequently calculate dosing based on weight. A separate list for community and ambulatory healthcare settings is also available from ISMP. In case of LASA medication regular updating of regular LASA medication list on the basis of current incidence need to be under observation of Pharmacy and Therapeutics Committee. Prescription review by clinical pharmacist in relation with patient report, indication and instruction for the dilution was to be done before administration. This may lead to convert medication error into near miss error. All High alert medication has to be audited for every step in MMU (Medication Management and Use) like prescription, indenting, dispensing and administration. Double checking is compulsory follow in every step.
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Dossari, Dalal Salem Al, Mohammed Ibrahim Alnami, and Naseem Akhtar Qureshi. "Analysis of Reported E-prescribing Medication Administration Errors at King Saud Medical City, Riyadh: A Cross-Sectional, Retrospective Study." Journal of Pharmaceutical Research International, June 27, 2020, 34–45. http://dx.doi.org/10.9734/jpri/2020/v32i1030491.
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Background: Drug prescription error is a medication error that most frequently happens in healthcare organizations and adversely affects the healthcare consumers. Most medication errors (MEs) but not all are captured and corrected before reaching the patient by designed system controls. Medication administration errors (MAEs) mostly are made by nurses but frequently reported by clinical pharmacists in hospitals in Saudi Arabia.
Objective: This study aimed to analyze exclusively the voluntarily reported drug administration errors in a tertiary care hospital in Riyadh city.
Methods: This cross-sectional, retrospective study evaluated consecutively collected medication administration report forms over a period of one year from January 1, 2015 to December 31, 2015.
Results: The number of MAEs occurring during stage of drug administration constituted 7.1% (n=971) of total medication errors (n=13677). The maximum number of MEs (n=6838, 50%) and MAEs (n=455, 46.9%) occurred during the 4th quarter of the year 2015. The most common MAE happened to be category C (n=888, 91.5%) which means error occurred, reached the patient but without causing any harm. Concerning MAE types, the most common error included wrong frequency (40%) followed by wrong drug (17%), wrong time of administration (16%) and wrong rate of infusion (10%). Nurses made the most of the errors (92.2%) while the clinical pharmacists reported the most MAEs (75.5%). High alert medications (HAM) errors constituted 32.3% (n=314) of MAEs (n=971) and most common HAM errors included the wrong route of administration of Lanus Insulin (15%) followed by Insulin Aspart (15%), Enoxaparin (13%) and Insulin Protamine-Nvomix (12%). Look-alike and sound-alike (LASA) errors constituted 55.2% of MAEs (971/536) and most common LASA drugs identified were Gentamycin (13%), Insulin Mixtard (11%), NPH Insulin (8%) Intralipid vial (8%) and Insulin regular (6%).
Conclusion: This retrospective study provides some important tentative pharmacovigilance insights into MAEs, which are partially comparable with current international trends in drug administration errors. Further studies on MAEs are warranted not only in the Kingdom of Saudi Arabia but also other Gulf countries.
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Abraham, Joanna, William L. Galanter, Daniel Touchette, Yinglin Xia, Katherine J. Holzer, Vania Leung, and Thomas Kannampallil. "Risk factors associated with medication ordering errors." Journal of the American Medical Informatics Association, November 22, 2020. http://dx.doi.org/10.1093/jamia/ocaa264.
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Abstract Objective We utilized a computerized order entry system–integrated function referred to as “void” to identify erroneous orders (ie, a “void” order). Using voided orders, we aimed to (1) identify the nature and characteristics of medication ordering errors, (2) investigate the risk factors associated with medication ordering errors, and (3) explore potential strategies to mitigate these risk factors. Materials and Methods We collected data on voided orders using clinician interviews and surveys within 24 hours of the voided order and using chart reviews. Interviews were informed by the human factors–based SEIPS (Systems Engineering Initiative for Patient Safety) model to characterize the work systems–based risk factors contributing to ordering errors; chart reviews were used to establish whether a voided order was a true medication ordering error and ascertain its impact on patient safety. Results During the 16-month study period (August 25, 2017, to December 31, 2018), 1074 medication orders were voided; 842 voided orders were true medication errors (positive predictive value = 78.3 ± 1.2%). A total of 22% (n = 190) of the medication ordering errors reached the patient, with at least a single administration, without causing patient harm. Interviews were conducted on 355 voided orders (33% response). Errors were not uniquely associated with a single risk factor, but the causal contributors of medication ordering errors were multifactorial, arising from a combination of technological-, cognitive-, environmental-, social-, and organizational-level factors. Conclusions The void function offers a practical, standardized method to create a rich database of medication ordering errors. We highlight implications for utilizing the void function for future research, practice and learning opportunities.
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Manias, Elizabeth, Maryann Street, Grainne Lowe, Jac Kee Low, Kathleen Gray, and Mari Botti. "Associations of person-related, environment-related and communication-related factors on medication errors in public and private hospitals: a retrospective clinical audit." BMC Health Services Research 21, no. 1 (September 28, 2021). http://dx.doi.org/10.1186/s12913-021-07033-8.
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Abstract Background Efforts to ensure safe and optimal medication management are crucial in reducing the prevalence of medication errors. The aim of this study was to determine the associations of person-related, environment-related and communication-related factors on the severity of medication errors occurring in two health services. Methods A retrospective clinical audit of medication errors was undertaken over an 18-month period at two Australian health services comprising 16 hospitals. Descriptive statistical analysis, and univariate and multivariable regression analysis were undertaken. Results There were 11,540 medication errors reported to the online facility of both health services. Medication errors caused by doctors (Odds Ratio (OR) 0.690, 95% CI 0.618–0.771), or by pharmacists (OR 0.327, 95% CI 0.267–0.401), or by patients or families (OR 0.641, 95% CI 0.472–0.870) compared to those caused by nurses or midwives were significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of double-checking of medication orders compared to single-checking (OR 0.905, 95% CI 0.826–0.991) was significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of electronic systems for prescribing (OR 0.580, 95% CI 0.480–0.705) and dispensing (OR 0.350, 95% CI 0.199–0.618) were significantly associated with reduced odds of possibly or probably harmful medication errors compared to the absence of these systems. Conversely, insufficient counselling of patients (OR 3.511, 95% CI 2.512–4.908), movement across transitions of care (OR 1.461, 95% CI 1.190–1.793), presence of interruptions (OR 1.432, 95% CI 1.012–2.027), presence of covering personnel (OR 1.490, 95% 1.113–1.995), misread or unread orders (OR 2.411, 95% CI 2.162–2.690), informal bedside conversations (OR 1.221, 95% CI 1.085–1.373), and problems with clinical handovers (OR 1.559, 95% CI 1.136–2.139) were associated with increased odds of medication errors causing possible or probable harm. Patients or families were involved in the detection of 1100 (9.5%) medication errors. Conclusions Patients and families need to be engaged in discussions about medications, and health professionals need to provide teachable opportunities during bedside conversations, admission and discharge consultations, and medication administration activities. Patient counselling needs to be more targeted in effort to reduce medication errors associated with possible or probable harm.
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Joy, Brian F., Sheilah Harrison, Douglas W. Teske, and Janet Simsic. "Abstract 163: Decreasing Adverse Drug Events Through a "Simple Intervention"." Circulation: Cardiovascular Quality and Outcomes 6, suppl_1 (May 2013). http://dx.doi.org/10.1161/circoutcomes.6.suppl_1.a163.
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BACKGROUND: Patients in the cardiac intensive care unit (CICU) are at risk for adverse drug events (ADE). CICU ADEs may result in life-threatening consequences and have been shown to be associated with polypharmacy, severity of illness, and intensity of treatment. The purpose of this review was to highlight the significance of a multidisciplinary huddle following each ADE in reducing future events. METHODS: All patients admitted to the CICU at Nationwide Children’s Hospital from 2010 to 2012 were retrospectively reviewed. ADE reporting is voluntary via an electronic Event Reporting System. ADEs are placed on a 9 point clinical severity scale based on the seriousness of the error. Huddles, defined as an in depth multidisciplinary discussions revolving around causative factors and potential interventions, were instituted following harm-causing ADEs (clinical severity 4-9) and select high risk non-harming ADEs (clinical severity 1-3). ADEs were tracked, and the resultant huddles were reviewed. Huddle contributors included physicians, nurses, nurse practitioners, and pharmacists. Huddle process included chart review of events leading to the ADE, caregiver input about contributing clinical or situational factors, root cause identification, and prevention strategies. RESULTS: There were 238 ADEs (clinical severity 1-9); 60 huddles were conducted on ADEs of all severities. Causative factors identified were errors in drug administration (N=40), nursing stressors (N=21), nursing double check (N=17), human factors (N=16), handoffs (N=13), staffing (N=9), equipment (N=5), verbal orders (N=3), pharmacy (N=2), and medication reconciliation (N=1). Action plans initiated included extending the “distraction free zone”, improving nursing handoffs, implementing a hands-free communication system, improving the electronic medical record, educating and reinforcing unit policies, and eliminating verbal orders. Harm-causing ADEs were reduced from 0.43 to 0.06 per 1000 doses administered (p<0.0001). CONCLUSION: Multidisciplinary huddles are one effective tool utilized to spearhead a quality improvement initiative to reduce ADEs in a CICU. Huddles are analogous to a small-scale root cause analysis with the goal to determine causative factors and develop interventions to prevent future events.