Academic literature on the topic 'Medication errors Australia'

Background: Medication errors commonly occur when patients move from the community into hospital. Whereas medication reconciliation by pharmacists can detect errors, delays in undertaking this can increase the risk that patients receive incorrect admission medication regimens. Orthopedic patients are an at-risk group because they are often elderly and use multiple medications. Objective: To evaluate the prevalence and nature of medication errors when patients are admitted to an orthopedic unit where pharmacists routinely undertake postprescribing medication reconciliation. Methods: A 10-week retrospective observational study was conducted at a major metropolitan hospital in Australia. Medication records of orthopedic inpatients were evaluated to determine the number of prescribing and administration errors associated with patients’ preadmission medications and the number of related adverse events that occurred within 72 hours of admission. Results: Preadmission, 198 patients were taking at least 1 regular medication, of whom 176 (88.9%) experienced at least 1 medication error. The median number of errors per patient was 6 (interquartile range 3-10). Unintended omission of a preadmission medication was the most common prescribing error (87.4%). There were 17 adverse events involving 24 medications in 16 (8.1%) patients that were potentially related to medication errors; 6 events were deemed moderate consequence (moderate injury or harm, increased length of stay, or cancelled/delayed treatment), and the remainder were minor. Conclusion and Relevance: Medication errors were common when orthopedic patients were admitted to hospital, despite postprescribing pharmacist medication reconciliation. Some of these errors led to patient harm. Interventions that ensure that medications are prescribed correctly at admission are required.

Background Admission to hospital introduces risks for people with Parkinson’s disease in maintaining continuity of their highly individualized medication regimens, which increases their risk of medication errors. This is of particular concern as omitted medications and irregular dosing can cause an immediate increase in an individual’s symptoms as well as other adverse outcomes such as swallowing difficulties, aspiration pneumonia, frozen gait and even potentially fatal neuroleptic malignant type syndrome. Objective To determine the occurrence and identify factors that contribute to Parkinson’s medication errors in Australian hospitals. Methods A retrospective discharge diagnosis code search identified all admissions for people with Parkinson’s disease to three tertiary metropolitan hospitals in South Australia, Australia over a 3-year period. Of the 405 case notes reviewed 351 admissions met our inclusion criteria. Results Medication prescribing (30.5%) and administration (85%) errors during admission were extremely common, with the most frequent errors related to administration of levodopa preparations (83%). A higher levodopa equivalent dosage, patients with a modified swallowing status or nil by mouth order during admission, and patients who did not have a pharmacist led medication history within 24 hours of admission had significantly higher rates of medication errors. Conclusions This study identified 3 major independent factors that increased the risk of errors during medication management for people with Parkinson’s disease during hospitalization. Thus, targeting these areas for preventative interventions have the greatest chance of producing a clinically meaningful impact on the number of hospital medication errors occurring in the Parkinson’s population.

Background: Population-based studies from several countries have constantly shown excessively high rates of medication errors and avoidable deaths. An efficient medication error reporting system is the backbone of reliable practice and a measure of progress towards achieving safety. Improvement efforts and system changes of medication error reporting systems should be targeted towards reductions in the likelihood of injury to future patients. However, the aim of this review is to provide a summary of medication errors reporting culture, incidence reporting systems, creating effective reporting methods, analysis of medication error reports, and recommendations to improve medication errors reporting systems. Methods: Electronic databases (PubMed, Ovid, EBSCOhost, EMBASE, and ProQuest) were examined from 1 January 1998 to 30 June 2020. 180 articles were found and 60 papers were ultimately included in the review. Data were mined by two reviewers and verified by two other reviewers. The search yielded 684 articles, which were then reduced to 60 after the deletion of duplicates via vetting of titles, abstracts, and full-text papers. Results: Studies were principally from the United States of America and the United Kingdom. Limited studies were from Canada, Australia, New Zealand, Korea, Japan, Greece, France, Saudi Arabia, and Egypt. Detection, measurement, and analysis of medication errors require an active rather than a passive approach. Efforts are needed to encourage medication error reporting, including involving staff in opportunities for improvement and the determination of root cause(s). The National Coordinating Council for Medication Error Reporting and Prevention taxonomy is a classification system to describe and analyze the details around individual medication error events. Conclusion: A successful medication error reporting program should be safe for the reporter, result in constructive and useful recommendations and effective changes while being inclusive of everyone and supported with required resources. Health organizations need to adopt an effectual reporting environment for the medication use process in order to advance into a sounder practice.

Medication errors at transition of care remain a concerning issue. In recent times, the use of integrated electronic medication management systems (EMMS) has caused a reduction in medication errors, but its effectiveness in reducing medication deviations at transition of care has not been studied in hospital-wide settings in Australia. The aim of this study is to assess medication deviations, such as omissions and mismatches, pre-EMMS and post-EMMS implementation at transition of care across a hospital. In this study, patient records were reviewed retrospectively to identify medication deviations (medication omissions and medication mismatches) at admission and discharge from hospital. A total of 400 patient records were reviewed (200 patients in the pre-EMMS and 200 patients in the post-EMMS group). Out of 400 patients, 112 in the pre-EMMS group and 134 patients in post-EMMS group met the inclusion criteria and were included in the analysis. A total of 105 out of 246 patients (42.7%) had any medication deviations on their medications. In the pre-EMMS group, 59 out of 112 (52.7%) patients had any deviations on their medications compared to 46 out of 134 patients (34.3%) from the post-EMMS group (p = 0.004). The proportion of patients with medication omitted from inpatient orders was 36.6% in the pre-EMMS cohort vs. 22.4% in the post-EMMS cohort (p = 0.014). Additionally, the proportion of patients with mismatches in medications on the inpatient charts compared to their medication history was 4.5% in the pre-EMMS group compared to 0% in the post-EMMS group (p = 0.019). Similarly, the proportion of patients with medications omitted from their discharge summary was 23.2% in the pre-EMMS group vs. 12.7% in the post-EMMS group (p = 0.03). Our study demonstrates a reduction in medication deviations after the implementation of the EMMS in hospital settings.

BackgroundIn children, paracetamol overdose due to deliberate self-poisoning, accidental exposure or medication errors can lead to paediatric acute liver failure and death. In Australia and New Zealand, the nature of ingestion and outcomes of paracetamol-associated paediatric acute liver failure have not been described.ObjectiveTo describe the nature and outcomes of paracetamol-associated paediatric acute liver failure.DesignRetrospective analysis of paracetamol-associated paediatric acute liver failure cases presenting 2002–2012.SettingNew Zealand and Queensland Paediatric Liver Transplant Services.Results14 of 54 cases of paediatric acute liver failure were attributed to paracetamol, the majority were secondary to medication errors. 12 of the 14 children were under the age of 5 years. Seven children received doses in excess of 120 mg/kg/day. Many of the other children received either a double dose, too frequent administration, coadministration of other medicines containing paracetamol or regular paracetamol for up to 24 days. Three children underwent transplant. One of these and one other child died.ConclusionsIn Australia and New Zealand, paracetamol overdose secondary to medication errors is the leading cause of paediatric acute liver failure. A review of regional safety practices surrounding paracetamol use in children is indicated.

Background and objectives General practitioners (GPs) require accurate medication information to care for recently discharged hospital patients. Pre-discharge medication reconciliation improves the accuracy of patient medication lists that GPs receive. This study aimed to explore GPs’ perceptions of the accuracy, completeness and timeliness of hospital discharge medication information, and how they undertake medication reconciliation. Methods Using a cross-sectional online survey, quantitative and qualitative data were collected from a convenience sample of GPs practising across the Gold Coast, Australia. Data were analysed using descriptive statistics and content analysis. Results Twelve GPs were recruited. Patient hospital discharge medication information was mostly accurate and complete, but delays in receiving this information affected the ability of GPs to undertake medication reconciliation. Discussion Receiving accurate and timely patient discharge medication information can reduce errors. Optimising the communication of medication information to GPs may improve patient safety.

BACKGROUND Antimicrobial doses in children are often prescribed by using an individually calculated dose per weight (e.g., mg/kg) or based on body surface area. Dosing errors are the most commonly reported medication errors in children. A “dose-banding” strategy is frequently used for some over-the-counter drugs to prevent dosing errors. It could also lead to efficiencies by enabling batch preparation of intravenous (IV) medications in hospitals. OBJECTIVES To evaluate whether use of dose-banding for IV piperacillin-tazobactam results in acceptable dose variation from standard practice of individualized prescription of 100 mg/kg in children. METHODS We conducted a historically controlled intervention study comparing prescriptions of IV piperacillin-tazobactam before vs. after introduction of dose-banding prescribing guidance for surgical inpatients weighing >5 kg and <16 years of age at the tertiary referral pediatric hospital in Western Australia. RESULTS Dose-banding of IV piperacillin-tazobactam (with a maximum of 15% departure from the recommended milligram-per-weight dose of 100 mg/kg) resulted in similar overall variation of prescribed dose in comparison to individualized milligram-per-weight (non–dose-banded) prescribing. There was a trend toward fewer prescriptions with large variance (>30% variation from the 100-mg/kg dose) in the dose-banded compared to the non–dose-banded group (1/140 vs. 5/105; p = 0.09). CONCLUSIONS Our study showed dose-banding of IV piperacillin-tazobactam resulted in acceptable variation when compared to individualized milligram-per-weight dosing in children. Prospectively designed controlled trials are warranted to determine whether dose-banding could reduce medication errors and optimize use of hospital resources. Implications for future practice could include faster batch preparation, shorter checking and dispensing time, and reduction in drug wastage.

Objectives Conducting a medication review is one way to optimize medications and support older people to reduce the burden of polypharmacy. In Australia, a service called a Home Medicines Review (HMR) is conducted by pharmacists as part of a nationally funded program. HMRs aim to identify and resolve problems associated with polypharmacy and improve collaboration between patient, pharmacist and general practitioner. The aim of this study was to explore the benefits of and barriers to HMRs from the perspective of older patients and pharmacists. Methods This qualitative study involved observations of HMRs ( n = 12) and telephone interviews with 32 participants including 11 accredited pharmacists, 17 older adults aged 65 years and above, with 4 of their companions, in Australia. The researcher observing took notes during the HMR and added more detail and reflections afterwards. Transcribed audio-recordings and observational notes were thematically coded using framework analysis. Results Older patients and their companions found the HMR useful and they appreciated the opportunity to learn more about their medicines. However, many did not understand the purpose of the HMR, had limited understanding about their medicines and some did not want to know more. Pharmacists found HMRs useful for identifying medication errors and improving adherence. They also reported barriers to effective HMRs relating to patients (resistance to the evaluation of their medicines, misunderstanding about the aim of the HMR) and GPs (limited information upon referral, and limited follow-up afterwards). Conclusions Older patients and pharmacists reported a range of benefits for HMRs in terms of optimizing medicines use. Barriers to effective HMR use need to be addressed, including gaps in inter-professional communication and factors related to patient involvement, such as limited medicines understanding and health literacy.

Background: According to the Australian Bureau of Statistics (2013) falls and medication errors in hospitals are among the first twenty leading causes of death. Research on the relationship between nurse staffing, patient falls, and medication errors are limited. Even scarcer are studies that examine this relationship on a nursing shift by shift and ward by ward basis, and no research exists on shift overlap periods and adverse patient outcomes. Objective: This study examined whether there was a relationship between hospital inpatient falls and medication errors and nurse staffing on a shift by shift and ward by ward basis, including an analysis of patient characteristics and the severity of incidents. Research Design: Multinomial logistic regression models were used. Data were collected using a secondary analysis of two existing databases: Advanced Incident Management System (AIMS) database and the nursing staff roster database (RoSTAR) over two years (January 2011 to December 2012). The Kane framework of nurse staffing was used to guide the current study. Setting: The study was conducted in three adult tertiary teaching hospitals in Perth, Western Australia. Participants: Reports of 7,558 incidents that occurred during the study period from 76 nursing wards and wards (4,677 medical, 2,209 surgical, and 672 critical care wards incidents), and 320,009 nursing shift records in three hospitals, were examined. Measures: The occurrence and severity of shift-level inpatient falls and medication errors were measured as dependent variables. Independent variables included nursing staff skill-mix, staff experience, and actual nursing hours. Control variables were shift, ward type, and hospital. Results: This study supports the importance of RN staffing levels in improving patient outcomes. However, it also shows that the relationship between nurse staffing and patient outcomes can be affected by different factors such as patient characteristics, nurse characteristics, and ward type. The number of total clinical incident reports decreased by 7.4% from 2011 to 2012. Falls declined by 4.6% and medication errors declined by 10.8%. The average age of patients who fell or had medication errors was 56.3 years (range of 15 to 100 years) but was more common in patients over 65 years old (57.3%). The number of incidents was highest during the morning shift, less during the evening and lowest during the night shift (28.4%, 27.2%, and 21.8% respectively). Notably, 22.6% of total incidents were reported during the overlap period (13:00 pm to 15:29 pm) which is only two and a half hours. Medical wards had the highest incident records followed by surgical wards; fewer incidents occurred in critical care wards (61.9%, 29.2%, and 8.9% respectively). More registered nurses and more experienced staff on the shift were both associated with fewer falls and medication error incidents, as well as less severe injuries. An increase in the actual nursing hours was associated with fewer medication errors but not fewer fall incidents. However, an increase in in the actual nursing hours was associated with less severe falls but not less severe medication errors. Conclusion: Overall, the fall and medication error incidents in three Perth hospitals decreased over the study period. However, the large variation in the incidents at both the shift and the ward level indicated room for improvement related to fall and medication error prevention. A relationship was identified between both more RNs and more experienced nurses in attendance and fewer incidents and less severe injuries. Further studies are necessary to identify prevention strategies for hospital falls and medication errors in the overlap period. Immediate consideration of the number of incidents that occurred during the overlap period is required. It is necessary to improve communication and teamwork among staff. Actions should be taken to review, implement and evaluate policies and procedures.

The high prevalence of Adverse Events (AEs) in Australian hospitals and their effects on patient outcomes is a major concern among healthcare service organizations and authorities. The contributing factors which exacerbate this situation, such as the effect of intensified hospital workload on AEs have not been adequately examined in the previous literature. The few studies that have concentrated on the association of hospital workload with AEs have methodological drawbacks due to insufficient numbers of Hospital Workload Indicators (HWIs) employed and the limitation of dimensions that include different types of HWIs. This thesis aims to examine the association of HWIs with AEs using indicators drawn from a hospital episode dataset.