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Tran, Tim, Simone E. Taylor, Andrew Hardidge, Elise Mitri, Parnaz Aminian, Johnson George, and Rohan A. Elliott. "The Prevalence and Nature of Medication Errors and Adverse Events Related to Preadmission Medications When Patients Are Admitted to an Orthopedic Inpatient Unit: An Observational Study." Annals of Pharmacotherapy 53, no. 3 (September 20, 2018): 252–60. http://dx.doi.org/10.1177/1060028018802472.
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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.
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Bakker, Michael, Michaela E. Johnson, Lauren Corre, Deanna N. Mill, Xingzhuo Li, Richard J. Woodman, and Jacinta L. Johnson. "Identifying rates and risk factors for medication errors during hospitalization in the Australian Parkinson’s disease population: A 3-year, multi-center study." PLOS ONE 17, no. 5 (May 4, 2022): e0267969. http://dx.doi.org/10.1371/journal.pone.0267969.
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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.
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Runciman, W. B. "Adverse drug events and medication errors in Australia." International Journal for Quality in Health Care 15, no. 90001 (December 1, 2003): 49i—59. http://dx.doi.org/10.1093/intqhc/mzg085.
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Mutair, Abbas Al, Saad Alhumaid, Abbas Shamsan, Abdul Rehman Zia Zaidi, Mohammed Al Mohaini, Alya Al Mutairi, Ali A. Rabaan, Mansour Awad, and Awad Al-Omari. "The Effective Strategies to Avoid Medication Errors and Improving Reporting Systems." Medicines 8, no. 9 (August 27, 2021): 46. http://dx.doi.org/10.3390/medicines8090046.
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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.
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Vaghasiya, Milan R., Simon K. Poon, Naren Gunja, and Jonathan Penm. "The Impact of Electronic Medication Management Systems on Medication Deviations on Admission and Discharge from Hospital." International Journal of Environmental Research and Public Health 20, no. 3 (January 19, 2023): 1879. http://dx.doi.org/10.3390/ijerph20031879.
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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.
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Rajanayagam, J., J. R. Bishop, P. J. Lewindon, and Helen M. Evans. "Paracetamol-associated acute liver failure in Australian and New Zealand children: high rate of medication errors." Archives of Disease in Childhood 100, no. 1 (September 16, 2014): 77–80. http://dx.doi.org/10.1136/archdischild-2013-304902.
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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.
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Latimer, Sharon, Jayne Hewitt, Trudy Teasdale, Carl de Wet, and Brigid M. Gillespie. "The accuracy, completeness and timeliness of discharge medication information and implementing medication reconciliation: A cross-sectional survey of general practitioners." Australian Journal of General Practice 49, no. 12 (December 1, 2020): 854–58. http://dx.doi.org/10.31128/ajgp-04-20-5375.
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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.
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Karande, Indrajit S., Zoy Goff, Jacqueline Kewley, Shailender Mehta, and Thomas Snelling. "Dose-Banding of Intravenous Piperacillin-Tazobactam in Pediatric Surgical Inpatients." Journal of Pediatric Pharmacology and Therapeutics 22, no. 5 (September 1, 2017): 364–68. http://dx.doi.org/10.5863/1551-6776-22.5.364.
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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.
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Roughead, Elizabeth E., Susan J. Semple, and Ellie Rosenfeld. "The extent of medication errors and adverse drug reactions throughout the patient journey in acute care in Australia." International Journal of Evidence-Based Healthcare 14 (September 2016): 113–22. http://dx.doi.org/10.1097/xeb.0000000000000075.
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Weir, Kristie Rebecca, Vasi Naganathan, Carissa Bonner, Kirsten McCaffery, Debbie Rigby, Andrew J. McLachlan, and Jesse Jansen. "Pharmacists’ and older adults’ perspectives on the benefits and barriers of Home Medicines Reviews – a qualitative study." Journal of Health Services Research & Policy 25, no. 2 (September 10, 2019): 77–85. http://dx.doi.org/10.1177/1355819619858632.
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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.
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Karki, Surendra, Karin Leder, and Allen C. Cheng. "Patients under Contact Precautions Have an Increased Risk of Injuries and Medication Errors A Retrospective Cohort Study." Infection Control & Hospital Epidemiology 34, no. 10 (October 2013): 1118–20. http://dx.doi.org/10.1086/673153.
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Contact precautions (CPs) may lead to adverse psychological effects, delays in access to services, and compromises in the quality of care and patient safety. These need to be balanced with the benefits in preventing transmission of resistant microorganisms. In this study, we aimed to quantify the effect of CPs on reported patient safety incidents.The Alfred hospital is a tertiary referral hospital in Melbourne, Australia. Previous studies have shown that colonization with vancomycin-resistant enterococcus (VRE) is endemic in our hospital. Patients found to be colonized with VRE are placed in CPs immediately and during each subsequent admission. At our facility, modified CPs practiced during the study period include isolation in single rooms with a dedicated toilet, use of gloves when entering the room, and gloves and gown if contact with body fluids is anticipated. The hospital has a computerized risk management system where relevant patient safety incidents are reported to facilitate institutional review and response. We conducted a retrospective cohort study using these routinely collected data, comparing the incidence rate of documented adverse events in patients prior and subsequent to initiation of CPs among patients colonized or infected with VRE. Patients with incident VRE detection between January 2009 and October 2010 were included.
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Westbrook, J. I., J. C. Wyatt, and E. Coiera. "Section 1: Health and Clinical Mangement: The Safety and Quality of Decision Support Systems." Yearbook of Medical Informatics 15, no. 01 (August 2006): 20–25. http://dx.doi.org/10.1055/s-0038-1638469.
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SummaryThe use of clinical decision support systems (CDSS) can improve the overall safety and quality of health care delivery, but may also introduce machine-related errors. Recent concerns about the potential for CDSS to harm patients have generated much debate, but there is little research available to identify the nature of such errors, or quantify their frequency or clinical impact.A review of recent literature into electronic prescribing systems, as well as related literature in decision support.There seems to be some evidence for variation in the outcomes of using CDSS, most likely reflecting variations in clinical setting, culture, training and organizational process, independent of technical variables. There is also preliminary evidence that poorly implemented CDSS can lead to increased mortality in some settings. Studies in the US, UK and Australia have found commercial prescribing systems often fail to uniformly detect significant drug interactions, probably because of errors in their knowledge base. Electronic medication management systems may generate new types of error because of user-interface design, but al so because of events in the workplace such as distraction affecting the actions of system users. Another potential source of CDSS influenced errors are automation biases, including errors of omission where individuals miss important data because the system does not prompt them to notice them, and errors of commission where individuals do what the decision aid tells to do, even when this contradicts their training and other available data. Errors of dismissal occur when relevant alerts are ignored. On-line decision support systems may also result in errors where clinicians come to an incorrect assessment of the evidence, possibly shaped in part by cognitive decision biases.The effectiveness of decision support systems, like all other health IT, cannot be assessed purely by evaluating the usability and performance of the software, but is the outcome of a complex set of cognitive and socio-technical interactions. A deeper understanding of these issues can result in the design of systems which are not just intrinsically ‘safe’ but which also result in safe outcomes in the hands of busy or poorly resourced clinicians.
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Nath, Noleen S., Ellen H. Jones, Peter Stride, Manuja Premaratne, Darshit Thaker, and Ivan Lim. "The nuts and bolts of pills and potions: the functions of a drug safety working group." Australian Health Review 35, no. 4 (2011): 395. http://dx.doi.org/10.1071/ah09863.
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Hospitalised patients commonly experience adverse drug events (ADEs) and medication errors. Runciman reported that ADEs in hospitals account for 20% of reported adverse events and contribute to 27% of deaths where death followed an adverse event. Hughes recommends multidisciplinary hospital drug committees to assess performance and raise standards. The new Code of Conduct of the Medical Board of Australia recommends participation in systems for surveillance and monitoring of adverse events, and to improve patient safety. We describe the functions and role of a Drug Safety Working Group (DSWG) in a suburban hospital, which aims to audit and promote a culture of prescribing and medication administration that is prudent and cautious to minimise the risk of harm to patients. We believe that regular prescription monitoring and feedback to Resident Medical Officers (RMOs) improves medication management in our hospital. What is known about the topic? Adverse drug events are common, leading to increased patient dissatisfaction, increased hospital morbidity and mortality, and increased costs. There is extensive medical literature on the problems of individual drugs, and global information of ADEs in healthcare, but little information for local solutions. What does this paper add? This paper details our experience and methods of running a drug safety working group (DSWG) in a suburban hospital. We strongly believe in a multidisciplinary committee, with feedback to RMOs given by their peer group. This ‘how we do it’ approach is largely absent from medical journals. What are the implications for practitioners? We strive for safer prescribing in our environment and hope to develop for inter-hospital benchmarking with other hospital DSWGs of clearly similar data, with an aim to raise state or nationwide standards.
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Matti, Nadine, Minh-Nha R. Nguyen, Cassandra Mosel, and Luke E. Grzeskowiak. "Utilization of neonatal medication error prevention strategies: a clinical practice survey of Australian and New Zealand neonatal units." Therapeutic Advances in Drug Safety 9, no. 11 (September 12, 2018): 609–17. http://dx.doi.org/10.1177/2042098618796952.
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Background: Medication errors are common in neonatal care and can lead to significant harm. We sought to explore utilization of various medication error prevention strategies across Australian and New Zealand neonatal units (NNUs) through a clinical practice survey. Methods: An electronic survey was distributed in October 2016 to relevant staff at each of the 29 level III NNUs identified as members of the Australian and New Zealand Neonatal Network (ANZNN). The survey contained questions relating to a range of medication error prevention strategies identified from a previous systematic review on the topic. The evaluated interventions targeted different aspects of the medication-use process including prescribing, evaluation/checking of orders by clinical pharmacists, transmission, preparation and dispensing of orders, storage of medications, and medication administration. Results: From the 20 respondents, the evidence-based strategies most commonly utilized were use of smart pumps ( n = 18; 90%), and ward-based clinical pharmacists ( n = 17; 85%). Interventions least commonly utilized included barcode scanning with medication administration ( n = 0; 0%), electronic prescribing and clinical decision support ( n = 1; 5%), and dedicated medication administration nurse ( n = 2; 10%). The total number of evidence-based medication error prevention strategies utilized in each NNU ranged from 2 to 10 (median = 7), 10 of 16 strategies were utilized by less than 50% of NNUs. Conclusion: While evidence supports utilization of a number of medication error prevention strategies, these appear inconsistently utilized across current practice settings.
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Gillespie, Brigid M., Wendy Chaboyer, Rhonda J. Boorman, Ishtar Sladdin, Teresa Withers, and Carl de Wet. "Characterising the nature of clinical incidents reported across a tertiary health service: a retrospective audit." Australian Health Review 45, no. 4 (2021): 447. http://dx.doi.org/10.1071/ah20271.
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ObjectiveReducing the number of adverse patient safety incidents (PSIs) requires careful monitoring and active management processes. However, there is limited information about the association between hospital settings and the type of PSI. The aims of this study were to describe the severity, nature and characteristics of PSIs from an analysis of their incidence and to assess the relationships between the type of PSI and its setting. MethodsA retrospective audit of a clinical incident management system database was conducted for a tertiary health service in Australia with 620000 residents. Records of PSIs reported for patients between 1 July 2017 and 30 June 2018 with Safety Assessment Codes (SAC) of PSIs were extracted from the clinical incident management system and analysed using descriptive and inferential statistics. PSIs involving paediatrics, mental health and primary care were excluded. ResultsIn all, 4385 eligible PSIs were analysed: 24 SAC1, 107 SAC2 and 4254 SAC3 incidents. Across reported PSIs, the most common incidents related to skin injury (28.6%), medication (23.2%), falls (19.9%) and clinical process (8.5%). Falls were reported significantly more often in the medical division (χ2=43.85, P<0.001), whereas skin injury incidents were reported significantly more often in the surgical division (χ2=22.56, P<0.001). ConclusionsA better understanding of the nature of PSIs and where they occur may lead to more targeted quality improvement strategies. What is known about this topic?Improving patient safety requires effective safety learning systems, which include incident reporting and management processes. Although incident reporting systems typically underestimate the incidence of iatrogenic harm, they do provide valuable opportunities to improve the future safety of health care. What does this paper add?This study reports the extent and severity of different types of PSIs that typically occur in a large tertiary hospital in Australia. The most common types of incidents are skin injury, falls, medication errors and clinical process. There are empirical associations between the type of PSI and clinical division (medical, surgical). What are the implications for practitioners?A greater understanding of the types of PSI and the settings in which they occur may inform the development of more targeted quality improvement strategies that potentially reduce their incidence.
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Fossum, Mariann, Lee Hughes, Elizabeth Manias, Paul Bennett, Trisha Dunning, Alison Hutchinson, Julie Considine, Mari Botti, Maxine M. Duke, and Tracey Bucknall. "Comparison of medication policies to guide nursing practice across seven Victorian health services." Australian Health Review 40, no. 5 (2016): 526. http://dx.doi.org/10.1071/ah15202.
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Objectives The objective of this paper is to review and compare the content of medication management policies across seven Australian health services located in the state of Victoria. Methods The medication management policies for health professionals involved in administering medications were obtained from seven health services under one jurisdiction. Analysis focused on policy content, including the health service requirements and regulations governing practice. Results and Conclusions The policies of the seven health services contained standard information about staff authorisation, controlled medications and poisons, labelling injections and infusions, patient self-administration, documentation and managing medication errors. However, policy related to individual health professional responsibilities, single- and double-checking medications, telephone orders and expected staff competencies varied across the seven health services. Some inconsistencies in health professionals’ responsibilities among medication management policies were identified. What is known about the topic? Medication errors are recognised as the single most preventable cause of patient harm in hospitals and occur most frequently during administration. Medication management is a complex process involving several management and treatment decisions. Policies are developed to assist health professionals to safely manage medications and standardise practice; however, co-occurring activities and interruptions increase the risk of medication errors. What does this paper add? In the present policy analysis, we identified some variation in the content of medication management policies across seven Victorian health services. Policies varied in relation to medications that require single- and double-checking, as well as by whom, nurse-initiated medications, administration rights, telephone orders and competencies required to check medications. What are the implications for practitioners? Variation in medication management policies across organisations is highlighted and raises concerns regarding consistency in governance and practice related to medication management. Lack of practice standardisation has previously been implicated in medication errors. Lack of intrajurisdictional concordance should be addressed to increase consistency. Inconsistency in expectations between healthcare services may lead to confusion about expectations among health professionals moving from one healthcare service to another, and possibly lead to increased risk of medication errors.
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Davies, Sarah, Cathryn Keenan, and Bernice Redley. "Health Assistant in Nursing: a Victorian health service pilot." Asia Pacific Journal of Health Management 12, no. 2 (July 18, 2017): 17–24. http://dx.doi.org/10.24083/apjhm.v12i2.73.
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Objective: Develop and evaluate pilot of a new role to support nursing care delivery in hospital settings.
Design: A naturalistic, three-stage pre-post, multimethod pilot design used data collected from hospital administrative datasets, and surveys and focus groups with staff participants.
Setting: Three wards at three hospital sites of a large tertiary health service in Victoria, Australia.
Subjects: Staff performing the new role and registered nurses working on participating wards.
Intervention: Pilot of a new Health Assistant in Nursing (HAN) role.
Main outcome measures: Staff outcomes were work satisfaction and workload of registered nurses; quality outcomes included reported patient falls and medication errors; organisational outcomes included service costs and sick leave.
Results: Work satisfaction and workload of registered nurses remained stable after introducing the new role. The frequency of reported patient falls reduced in two of the three wards. Costing outcomes suggested potential for cost benefits attributed to reduced falls in acute wards.
Conclusions: This pilot identified the new HAN role has capacity to contribute to improved patient quality and safety outcomes without compromising nurse job satisfaction and workload. Potential cost benefits of thenew role warrant further consideration in the acute care sector.
Abbreviations: CPO – Constant Patient Observer; CSN – Clinical Support Nurse; HAN – Health Assistant in Nursing. NWSQ – Nursing Workplace Satisfaction
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Tran, Tim, Simone E. Taylor, Andrew Hardidge, Elise Mitri, Parnaz Aminian, Johnson George, and Rohan A. Elliott. "Pharmacist-assisted electronic prescribing at the time of admission to an inpatient orthopaedic unit and its impact on medication errors: a pre- and postintervention study." Therapeutic Advances in Drug Safety 10 (January 2019): 204209861986398. http://dx.doi.org/10.1177/2042098619863985.
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Background: Prescribing and administration errors related to pre-admission medications are common amongst orthopaedic inpatients. Postprescribing medication reconciliation by clinical pharmacists after hospital admission prevents some but not all errors from reaching the patient. Involving pharmacists at the prescribing stage may more effectively prevent errors. The aim of the study was to evaluate the effect of pharmacist-assisted electronic prescribing at the time of hospital admission on medication errors in orthopaedic inpatients. Methods: A pre- and postintervention study was conducted in the orthopaedic unit of a major metropolitan Australian hospital. During the 10-week intervention phase, a project pharmacist used electronic prescribing to assist with prescribing admission medications and postoperative venous thromboembolism (VTE) prophylaxis, in consultation with orthopaedic medical officers. The primary endpoint was the number of medication errors per patient within 72 h of admission. Secondary endpoints included the number and consequence of adverse events (AEs) associated with admission medication errors and the time delay in administering VTE prophylaxis after elective surgery (number of hours after recommended postoperative dose-time). Results: A total of 198 and 210 patients, pre- and postintervention, were evaluated, respectively. The median number of admission medication errors per patient declined from six pre-intervention to one postintervention ( p < 0.01). A total of 17 AEs were related to admission medication errors during the pre-intervention period compared with 1 postintervention. There were 54 and 63 elective surgery patients pre- and postintervention, respectively. The median delay in administering VTE prophylaxis for these patients declined from 9 h pre-intervention to 2 h postintervention ( p < 0.01). Conclusions: Pharmacist-assisted electronic prescribing reduced the number of admission medication errors and associated AEs.
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Nichols, Pamela, Tandy‐Sue Copeland, Ian A. Craib, Paul Hopkins, and David G. Bruce. "Learning from error: identifying contributory causes of medication errors in an Australian hospital." Medical Journal of Australia 188, no. 5 (March 2008): 276–79. http://dx.doi.org/10.5694/j.1326-5377.2008.tb01619.x.
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Van de Vreede, Melita, Anne McGrath, and Jan de Clifford. "Review of medication errors that are new or likely to occur more frequently with electronic medication management systems." Australian Health Review 43, no. 3 (2019): 276. http://dx.doi.org/10.1071/ah17119.
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Objective The aim of the present study was to identify and quantify medication errors reportedly related to electronic medication management systems (eMMS) and those considered likely to occur more frequently with eMMS. This included developing a new classification system relevant to eMMS errors. Methods Eight Victorian hospitals with eMMS participated in a retrospective audit of reported medication incidents from their incident reporting databases between May and July 2014. Site-appointed project officers submitted deidentified incidents they deemed new or likely to occur more frequently due to eMMS, together with the Incident Severity Rating (ISR). The authors reviewed and classified incidents. Results There were 5826 medication-related incidents reported. In total, 93 (47 prescribing errors, 46 administration errors) were identified as new or potentially related to eMMS. Only one ISR2 (moderate) and no ISR1 (severe or death) errors were reported, so harm to patients in this 3-month period was minimal. The most commonly reported error types were ‘human factors’ and ‘unfamiliarity or training’ (70%) and ‘cross-encounter or hybrid system errors’ (22%). Conclusions Although the results suggest that the errors reported were of low severity, organisations must remain vigilant to the risk of new errors and avoid the assumption that eMMS is the panacea to all medication error issues. What is known about the topic? eMMS have been shown to reduce some types of medication errors, but it has been reported that some new medication errors have been identified and some are likely to occur more frequently with eMMS. There are few published Australian studies that have reported on medication error types that are likely to occur more frequently with eMMS in more than one organisation and that include administration and prescribing errors. What does this paper add? This paper includes a new simple classification system for eMMS that is useful and outlines the most commonly reported incident types and can inform organisations and vendors on possible eMMS improvements. The paper suggests a new classification system for eMMS medication errors. What are the implications for practitioners? The results of the present study will highlight to organisations the need for ongoing review of system design, refinement of workflow issues, staff education and training and reporting and monitoring of errors.
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Hinchcliff, R., J. Westbrook, D. Greenfield, M. Baysari, M. Moldovan, and J. Braithwaite. "Analysis of Australian newspaper coverage of medication errors." International Journal for Quality in Health Care 24, no. 1 (November 24, 2011): 1–8. http://dx.doi.org/10.1093/intqhc/mzr067.
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Teoh, L., MJ McCullough, and G. Moses. "Preventing medication errors in dental practice: An australian perspective." Journal of Dentistry 119 (April 2022): 104086. http://dx.doi.org/10.1016/j.jdent.2022.104086.
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Carter, M., N. Abutheraa, N. Ivers, J. Grimshaw, S. Chapman, P. Rogers, M. Simeoni, and M. Watson. "A systematic review of pharmacist-led audit and feedback interventions to influence prescribing behaviour in general practice settings." International Journal of Pharmacy Practice 29, Supplement_1 (March 26, 2021): i34—i35. http://dx.doi.org/10.1093/ijpp/riab015.041.
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Abstract Introduction Audit and Feedback (A&F) involves measuring data about practice, comparing it with clinical guidelines, professional standards or peer performance, and then feeding back the data to individuals/groups of health professionals to encourage change in practice (if required). A 2012 Cochrane review (1) found A&F was effective in changing health professionals’ behaviour and suggested that the person who delivers the A&F intervention influences its effect. Increasingly, pharmacists work in general practice and often have responsibility for medication review and repeat prescriptions. The effectiveness of pharmacist-led A&F in influencing prescribing behaviour is uncertain. Aim This secondary analysis from an ongoing update of the original Cochrane review aims to identify and describe pharmacist-led A&F interventions and evaluate their impact on prescribing behaviour in general practice compared with no intervention. Methods This sub-review is registered with PROSPERO: CRD42020194355 and complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (2). For the updated Cochrane review, the Cochrane Effective Practice and Organization of Care Group searched MEDLINE (1946 to present), EMBASE, CINAHL and Cochrane Library (March 2019) to identify randomised trials featuring A&F interventions. For this sub-review, authors screened titles and abstracts (May 2020) to identify trials involving pharmacist-led A&F interventions in primary care, extracted data, and assessed risk of bias (RoB) in eligible studies. Review results are summarised descriptively. Heterogeneity will be assessed and a random-effects meta-analysis is planned. Publication bias for selected outcomes and the certainty of the body of evidence will be evaluated and presented. Sub-group analyses will be conducted. Results Titles and abstracts of 295 studies identified for inclusion in the Cochrane A&F review update were screened. Eleven studies (all cluster-randomised trials) conducted in 9 countries (Denmark, Italy, Netherlands, Norway, Republic of Ireland, UK, Australia, Malaysia, USA) were identified for inclusion (Figure 1). Six studies had low RoB, two had high risk due to dissimilarities between trial arms at baseline and/or insufficient detail about randomisation, and three studies had unclear RoB. Studies examined the effect of A&F on prescribing for specific conditions (e.g. hypertension), medications (e.g. antibiotics), populations (e.g. patients >70), and prescribing errors (e.g. inappropriate dose). The pharmacist delivering A&F was a colleague of intervention participants in five studies. Pharmacists’ levels of skill and experience varied; seven studies reported details of pharmacist training undertaken for trial purposes. A&F interventions in nine studies demonstrated changes in prescribing, including reductions in errors or inappropriate prescribing according to the study aims and smaller increases in unwanted prescribing compared with the control group. Data analyses are ongoing (results will be available for the conference). Conclusion The preliminary results demonstrate the effectiveness of pharmacist-led A&F interventions in different countries and health systems with influencing prescribing practice to align more closely with guidance. Studies measured different prescribing behaviours; meta-analysis is unlikely to include all 11 studies. Further detailed analysis including feedback format/content/frequency and pharmacist skill level/experience, work-base (external/internal to recipients), will examine the impact of specific features on intervention effectiveness. References 1. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012(6):CD000259. 2. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
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Ling, Rod, Andrew Searles, Jacqueline Hewitt, Robyn Considine, Catherine Turner, Susan Thomas, Kelly Thomas, et al. "Cost analysis of an integrated aged care program for residential aged care facilities." Australian Health Review 43, no. 3 (2019): 261. http://dx.doi.org/10.1071/ah16297.
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Objective To compare annual costs of an intervention for acutely unwell older residents in residential age care facilities (RACFs) with usual care. The intervention, the Aged Care Emergency (ACE) program, includes telephone clinical support aimed to reduce avoidable emergency department (ED) presentations by RACF residents. Methods This costing of the ACE intervention examines the perspective of service providers: RACFs, Hunter Medicare Local, the Ambulance Service of New South Wales, and EDs in the Hunter New England Local Health District. ACE was implemented in 69 RACFs in the Hunter region of NSW, Australia. Analysis used 14 weeks of ACE and ED service data (June–September 2014). The main outcome measure was the net cost and saving from ACE compared with usual care. It is based on the opportunity cost of implementing ACE and the opportunity savings of ED presentations avoided. Results Our analysis estimated that 981 avoided ED presentations could be attributed to ACE annually. Compared with usual care, ACE saved an estimated A$921214. Conclusions The ACE service supported a reduction in avoidable ED presentations and ambulance transfers among RACF residents. It generated a cost saving to health service providers, allowing reallocation of healthcare resources. What is known about the topic? Residents from RACFs are at risk of further deterioration when admitted to hospital, with high rates of delirium, falls, and medication errors. For this cohort, some conditions can be managed in the RACF without hospital transfer. By addressing avoidable presentations to EDs there is an opportunity to improve ED efficiency as well as providing care that is consistent with the resident’s goals of care. RACFs generate some avoidable ED presentations for residents who may be more appropriately treated in situ. What does this paper add? Telephone triaging with nursing support and training is a means by which ED presentations from RACFs can be reduced. One of the consequences of this intervention is ‘cost avoided’, largely through savings on ambulance costs. What are the implications for practitioners? Unnecessary transfer from RACFs to ED can be avoided through a multicomponent program that includes telephone support with cost-saving implications for EDs and ambulance services.
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Khalil, Viviane. "Evaluating the impact of various medication safety risk reduction strategies on medication errors in an Australian Health Service." International Journal of Clinical Pharmacy 42, no. 6 (September 20, 2020): 1515–20. http://dx.doi.org/10.1007/s11096-020-01142-w.
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Pang, Rebecca KY, David CM Kong, Jan-Marie de Clifford, Skip S. Lam, and Benjamin K. Leung. "Smart Infusion Pumps Reduce Intravenous Medication Administration Errors at an Australian Teaching Hospital." Journal of Pharmacy Practice and Research 41, no. 3 (September 2011): 192–95. http://dx.doi.org/10.1002/j.2055-2335.2011.tb00860.x.
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Elliott, Rohan A., Cik Yin Lee, and Safeera Y. Hussainy. "Evaluation of a hybrid paper–electronic medication management system at a residential aged care facility." Australian Health Review 40, no. 3 (2016): 244. http://dx.doi.org/10.1071/ah14206.
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Objectives The aims of the study were to investigate discrepancies between general practitioners’ paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper–electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5–12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18 min to 98 h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper–electronic medication management systems, in which prescribers’ orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care facilities. The accuracy and safety of these systems has not been studied. What does this paper add? The present study identified discrepancies between general practitioners’ orders and pharmacy-prepared electronic medication administration charts, back-up paper medication charts and dose-administration aids, as well as delays between ordering, charting and administering medicines. Discrepancies and delays sometimes led to medication administration errors. What are the implications for practitioners? Facilities that use hybrid systems need to implement robust systems for communicating medication changes to their pharmacy and reconciling prescribers’ orders against pharmacy-generated medication charts and dose-administration aids. Fully integrated, paperless medication management systems, in which prescribers’ electronic medication orders directly populate an electronic medication administration chart and are automatically communicated to the facility’s pharmacy, could improve patient safety.
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Evans, Jennifer. "Prevalence, risk factors, consequences and strategies for reducing medication errors in Australian hospitals: A literature review." Contemporary Nurse 31, no. 2 (February 2009): 176–89. http://dx.doi.org/10.5172/conu.673.31.2.176.
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MCNALLY, KAREN M., and V. BRUCE SUNDERLAND. "No-Blame Medication Administration Error Reporting by Nursing Staff at a Teaching Hospital in Australia." International Journal of Pharmacy Practice 6, no. 2 (June 1998): 67–71. http://dx.doi.org/10.1111/j.2042-7174.1998.tb00918.x.
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Bomba, David, and Tim Land. "The feasibility of implementing an electronic prescribing decision support system: a case study of an Australian public hospital." Australian Health Review 30, no. 3 (2006): 380. http://dx.doi.org/10.1071/ah060380.
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Medication errors are common in public hospitals, with the majority at the prescribing stage of the medication pathway. Electronic prescribing decision support (EPDS) is a rules-based computer system that can be used by clinicians to warn against such errors to improve patient safety and support staff workflows. Despite its apparent advantages, this technology has not been widely adopted in Australian public hospitals for inpatient prescribing. A case study using Sauer?s (1993) Triangle of Dependencies Model was conducted in 2003 into the feasibility of implementing an EPDS system at an Australian public hospital in New South Wales. It was found not feasible to implement an EPDS at the hospital studied due to the legacy patient administration system, low availability of information technology on the wards, differing stakeholder views, legislation, and the Independent Pricing and Regulatory Tribunal of NSW report recommendations. A statewide standard was preferred, with an agreed specification framework identifying basic core data items and functions that an EPDS must meet which can then be used by area health services to: (i) choose a solution which best meets their contextual needs; and (ii) engage vendors to tender for building an open source (non-proprietary) system based on the specification framework.
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Hanson, Julie, Arif Manji, Steven Coverdale, Bernadette Morris-Smith, and Marianne Wallis. "Medication Error and Interprofessional Communication-Related Factors Contributing to Hospitalisation in Community-Dwelling Older Adults in Australia." Open Journal of Nursing 11, no. 10 (2021): 896–907. http://dx.doi.org/10.4236/ojn.2021.1110073.
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Heneka, Nicole, Tim Shaw, Debra Rowett, Samuel Lapkin, and Jane L. Phillips. "Exploring Factors Contributing to Medication Errors with Opioids in Australian Specialist Palliative Care Inpatient Services: A Multi-Incident Analysis." Journal of Palliative Medicine 21, no. 6 (June 2018): 825–35. http://dx.doi.org/10.1089/jpm.2017.0578.
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Bismark, Marie M., Simon J. Walter, and David M. Studdert. "The role of boards in clinical governance: activities and attitudes among members of public health service boards in Victoria." Australian Health Review 37, no. 5 (2013): 682. http://dx.doi.org/10.1071/ah13125.
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Objectives To determine the nature and extent of governance activities by health service boards in relation to quality and safety of care and to gauge the expertise and perspectives of board members in this area. Methods This study used an online and postal survey of the Board Chair, Quality Committee Chair and two randomly selected members from the boards of all 85 health services in Victoria. Seventy percent (233/332) of members surveyed responded and 96% (82/85) of boards had at least one member respond. Results Most boards had quality performance as a standing item on meeting agendas (79%) and reviewed data on medication errors and hospital-acquired infections at least quarterly (77%). Fewer boards benchmarked their service’s quality performance against external comparators (50%) or offered board members formal training on quality (53%). Eighty-two percent of board members identified quality as a top priority for board oversight, yet members generally considered their boards to be a relatively minor force in shaping the quality of care. There was a positive correlation between the size of health services (total budget, inpatient separations) and their board’s level of engagement in quality-related activities. Ninety percent of board members indicated that additional training in quality and safety would be ‘moderately useful’ or ‘very useful’. Almost every respondent believed the overall quality of care their service delivered was as good as, or better than, the typical Victorian health service. Conclusions Collectively, health service boards are engaged in an impressive range of clinical governance activities. However, the extent of engagement is uneven across boards, certain knowledge deficits are evident and there was wide agreement among board members that further training in quality-related issues would be useful. What is known about the topic? There is an emerging international consensus that effective board leadership is a vital element of high-quality healthcare. In Australia, new National Health Standards require all public health service boards to have a ‘system of governance that actively manages patient safety and quality risks’. What does this paper add? Our survey of all public health service Boards in Victoria found that, overall, boards are engaged in an impressive range of clinical governance activities. However, tensions are evident. First, whereas some boards are strongly engaged in clinical governance, others report relatively little activity. Second, despite 8 in 10 members rating quality as a top board priority, few members regarded boards as influential players in determining it. Third, although members regarded their boards as having strong expertise in quality, there were signs of knowledge limitations, including: near consensus that (additional) training would be useful; unfamiliarity with key national quality documents; and overly optimistic beliefs about quality performance. What are the implications for practitioners? There is scope to improve board expertise in clinical governance through tailored training programs. Better board reporting would help to address the concern of some board members that they are drowning in data yet thirsty for meaningful information. Finally, standardised frameworks for benchmarking internal quality data against external measures would help boards to assess the performance of their own health service and identify opportunities for improvement.
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Anwar, Muhammad Idrees. "The hidden sharks of clinical practice." Health Professions Educator Journal 2, no. 2 (June 30, 2019): 7–8. http://dx.doi.org/10.53708/hpej.v2i2.236.
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‘The doctors of tomorrow will be applying knowledge and deploying skills which are at present unforeseen’. This was written by General Medical Council , UK in “Tomorrow’s Doctor” 1993,(General Medical Council, 1993), but this still holds true. We as health care providers strive to provide the best of care to our patients and perhaps doing a good job. You may object to this “perhaps “as obviously at a glance the health care appears optimal. But we do not know that underneath this poise and calm sea are deadly sharks that gulp and bite our results. Statistically speaking, there is one in eleven million risks of being bitten by a shark. In comparison, the risk of patient death occurring due to a preventable medical accident, while receiving health care, is estimated to be one in three hundred. It is obvious that you are safer in diving in the ocean than receiving treatment at a health care facility. Yet it is preventable. This preventable medical accident is the hidden shark of our clinical practice that bites our results without us even knowing about it. Hippocrates defined patient safety as primum no nocere, or “First, do no harm.” Yet we discovered it quite recently. A television program by the name of ” Deep Sleep “ aired in April 1983 first shocked the public that six thousand patients die due to anesthesia-related deaths. In 1983, the Harvard Medical School and the British Royal Society of Medicine jointly sponsored a symposium on anesthesia, deaths, and injuries. They also agreed to share statistics and to conduct studies for all anesthesia accidents. In 1984, the American Society of Anesthesiologists (ASA) had established the Anesthesia Patient Safety Foundation (APSF). The foundation marked the first use of the term “patient safety” in the name of a professional reviewing organization. The Australian Patient Safety Foundation was founded in 1989 for anesthesia error monitoring. Both organizations were soon expanded, as the magnitude of the medical error crisis became known. The studies expanded to all specialties, areas, and actual impact was measured. It is now estimated that that healthcare errors impact one in every ten patients around the world, the World Health Organization calls patient safety an endemic concern. Alarming, isn’t it? Yes, it is quite an alarming situation and it is the time that we all must blow the whistle to this global as well as regional problem. We are at a very initial stage where most of us are not even aware of its serious concerns. The waters are infested with sharks, and we must know and learn how to tackle them. The errors typically include surgical, diagnostic, medication, devices and equipment, and systems failures, infections, falls, and healthcare technology. Wrong or missed diagnosis and side effects of drugs are more common. No area of health care delivery is exempt, but they occur more so in an emergency room and outpatient clinic. (Bari, Khan, & Rathore, 2016) Errors are classified as two types: 1. Errors of omission occur because of actions not taken. Examples are not putting a strap to a patient. 2. Errors of the commission occur because of the wrong action taken. Examples include administering a medication to which a patient has a known allergy. You must be wondering why I chose this in a medical education journal. First and foremost, it is one of the serious international health concerns in the current era. Globally, almost a million patients die each year along with the cost associated with medication errors of about $42 billion USD annually. Secondly, the key to the solution lies with medical educationists. By now, you must be wondering how medical educationists could solve the predicament. Well! The solution lies in developing skills like communication, organization, teamwork, leadership, and decision-making. Not just the skills but also patient safety attitudes have to be adapted along with developing a “safety culture” at the workplace (Ayub & Khan, 2018). Our doctors of future and health care centers will only be safe if the safety is taught and assessed, at every level of learning and teaching. The culture of patient safety is created by identifying errors, developing systems based on newer technologies to recognize and correct errors. A broad range of safety culture properties can be organized into multiple subcultures like leadership, teamwork, evidence-based patient care, communication, learning from errors, identifying systems errors, and providing patient-centered care. Currently, the issue is remotely addressed in learning and teaching at both graduate and postgraduate levels. It is imperative that medical educationist should play their role by not only learning but also teaching all the necessary skills required to develop a safe environment for patients. The waters are full of sharks, and we must take protective measures.
Stay safe
References
Ayub, A., & Khan, R. A. 2018. Learning to cure with care:
Awareness of faculty and medical students about students’ roles
related to patient safety. J. Pak. Med. Assoc., 68(9).
Bari, A., Khan, R. A., & Rathore, A. W. 2016. Medical errors;
causes, consequences, emotional response and resulting
behavioral change. Pakistan J. Med. Sci., 32(3) doi:10.12669/
pjms.323.9701.
General Medical Council, U.K. (1993). Tomorrow’s doctors:
Recommendations on undergraduate medical education.
London.
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Durie, M., U. Beckmann, I. Baldwin, I. Morrison, and L. Shaw. "An analysis of medication errors identified in the first 3800 incident reports submitted to the Australian Incident Monitoring Study in Intensive Care (AIMS-ICU)." Australian Critical Care 12, no. 1 (March 1999): 37. http://dx.doi.org/10.1016/s1036-7314(99)70528-x.
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Lim, Hok, Lena Sanci, Susan Webster, Alyce N. Wilson, and Phyllis Lau. "‘No-Frills Prils’: GPs’ views on drug costs and therapeutic interchange of angiotensin-converting enzyme inhibitors: a qualitative study." Australian Journal of Primary Health 27, no. 2 (2021): 152. http://dx.doi.org/10.1071/py20208.
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Medications form a significant portion of spending in primary health care. Angiotensin-converting enzyme inhibitors (ACE-Is) are among the most prescribed blood pressure medications in general practice. Medications within this class are considered therapeutically equivalent, but the cost of each ACE-I varies. Our aim was to explore cost and other factors that influence general practitioners (GPs) to prescribe a specific ACE-I and understand their views on therapeutic interchange within this drug class. We conducted a qualitative study of Australian GPs using thematic analysis. We found that GPs were aware of therapeutic equivalency within the ACE-I class, but unaware of the cost differences. Although GPs tended to adopt a prescribing preference, they were open to fewer prescribing options if there was a decreased cost to patients and the PBS, or potential to minimise prescribing error. Our findings have immediate relevance for national prescribing policies and the Pharmaceutical Benefits Scheme (PBS). The wide selection of ACE-Is that are available results in diverse prescribing patterns and may not be cost-effective for patients or the PBS. Restricting the number of drug options within the ACE-I class in primary care appears to be an acceptable drug cost-containment strategy according to our sample of GPs.
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Goulart, Juliana Das Chagas, Paulo Fernandes Marcusso, Oduvaldo Camara Marques Pereira Júnior, and Juliano Bortolo De Conti. "Forma heterozigota da anomalia de Pelger-Huët em cão." Acta Scientiae Veterinariae 46 (July 18, 2018): 5. http://dx.doi.org/10.22456/1679-9216.86536.
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Background: The Pelger-Huët anomaly is a congenital alteration in segmented neutrophil, eosinophil and basophil morphology consisting of nuclear hypo-segmentation. It presents in two ways: the homozygote (very rare) presenting granulocytes with rounded nuclei and dense chromatin, where nuclei with more than two lobes are not found; and in the heterozygote form which presents leukocytes with bi-lobulated nuclei, yet leukocytes that seem immature can also be found. Diagnosis is important for preventing WBC interpretation errors. The objective of this study is to report a case of the heterozygote form of Perger-Huët anomaly in an Australian Shepherd bit.Case: A 6-year-old Australian Shepherd bitch, weighing 28 kg, was received to perform tartar cleaning at the Veterinary Hospital (HV) of the Universidade Estadual de Maringá (UEM), in Umuarama in Paraná State. In the anamnesis, the owner reported that the animal was healthy, vaccinated, and had not made use of medications recently. Upon physical examination, the animal was overweight, with adequate hydration, alert consciousness level, no exo-parasites present, rectal temperature of 39.3°C (37.5 to 39.2), heart rate of 96 beats per min (60 to 120 beats per min), breathing (18 to 36 movements per min), a two second capillary perfusion time, strong and regular pulse, hyperemic oral mucosa, and otherwise, a normal-colored and popliteal reactive left lymph. Semiological evaluation presented no alteration. Due to the tartar cleaning procedure, a hemogram was requested. Blood smear analysis from the first blood workup showed a large increase in the number of hypo-segmented leukocytes, with a pattern of mature chromatin, in the form of bands and meta-myelocytes, characterizing a deviation to the left, all of which did not correspond to the patient’s clinical presentation. In addition, other cells in the granulocytic lineage, such as eosinophils, also presented hypo-segmentation. Since the dog was healthy, the Pelger-Huët anomaly was suspected. To confirm, the hemogram was repeated at 12 days and a bone marrow collection was performed; the same pattern of morphological alterations in leukocytes was observed both in the peripheral blood and the bone marrow, compatible with the Pelger-Huët anomaly.Discussion: In order to arrive at an APH diagnosis, hypo-segmentation of granulocytes in the blood smear must be found and compared with the clinical results that the animal presents; associating any use of medication, serious infections, myeloid leukemia, and metastatic tumors in the bone marrow that might result in acquired hypo-segmentation; also known as pseudo Pelger-Huët anomaly. It is also necessary to evaluate family members for confirmation. Diagnosis is based on persistent nuclear hypo-segmentation of granulocytes, a clinically healthy animal, absence of medication use, and analysis of the bone marrow. It was not possible to determine a hereditary origin; for not having access to the animal’s family, but earlier studies have shown that the incidence of this anomaly is high in the Australian Shepherd race. Generally, the Perger-Huët anomaly is a hematological finding that must be differentiated from other forms of hypo-segmentation. Because of its hereditary origin, it is appropriate that the owner limits the animal’s reproductive interactions to avoid the risk of offspring inheriting the homozygote, which leads to death. The clinical pathologist should be aware of the patient’s history to diagnose and differentiate true from pseudo Pelger-Huët anomaly. Direct blood smear microscopy is essential, because automated hematological analysis alone will not detect such changes.
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Nainani, Abhir Krishan, Jun Yang, Sanne Peters, and Grant Russell. "‘I can’t understand why others don’t screen more’: a qualitative study exploring why Australian general practitioners screen for primary aldosteronism." BMJ Open 12, no. 6 (June 2022): e061671. http://dx.doi.org/10.1136/bmjopen-2022-061671.
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ObjectiveWe sought to understand the factors that influence a general practitioner’s (GP’s) experience of screening for primary aldosteronism (PA) in hypertensive patients.DesignA qualitative study, framed by phenomenology, using semistructured interviews that were audiorecorded, transcribed verbatim, entered into NVivo V.12.0 for coding and analysed for emerging themes.SettingMelbourne, Australia.ParticipantsEligible GPs had received education on PA as part of a previous study. We recruited a purposive sample of 16 GPs (6 females, 10 males) who varied in practice location, clinical experience and the number of patients screened for PA.ResultsAlthough GPs had been educated about PA, they found it challenging to explain the condition to patients and were uncertain about how to screen patients who were already taking antihypertensive medications. Most viewed the screening process to be practical, inexpensive and, by and large, acceptable to their patients. However, they found it inconvenient to alter antihypertensive medications before screening to allow for easier interpretation of the aldosterone-renin ratio. They were also less enthused about screening patients whom they thought fitted a clinical picture of essential hypertension. Knowledge of the screening process, cost and convenience of performing the aldosterone–renin ratio, conceptualisation of risk related to PA, and a desire to improve clinical care were influencing factors that modified the GPs’ screening experience.ConclusionOur findings suggest that knowledge gaps, practical limitations of the aldosterone–renin ratio, and errors in diagnostic reasoning were challenges of routine PA screening. Most of these practical barriers could be addressed by relatively simple educational and practice modifications to increase PA screening rates and optimise detection for the most common cause of secondary hypertension in primary care.
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McCaffrey, Nikki, Thomas Flint, Billingsley Kaambwa, Belinda Fazekas, Debra Rowett, David C. Currow, Janet Hardy, Meera R. Agar, Steve Quinn, and Simon Eckermann. "Economic evaluation of the randomised, double-blind, placebo-controlled study of subcutaneous ketamine in the management of chronic cancer pain." Palliative Medicine 33, no. 1 (October 1, 2018): 74–81. http://dx.doi.org/10.1177/0269216318801754.
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Background: Treating chronic, uncontrolled, cancer pain with subcutaneous ketamine in patients unresponsive to opioids and co-analgesics remains controversial, especially in light of recent evidence demonstrating ketamine does not have net clinical benefit in this setting. Aim: To evaluate the cost-effectiveness of subcutaneous ketamine versus placebo in this patient population. Design and setting: A within-trial cost-effectiveness analysis of the Australian Palliative Care Clinical Studies Collaborative’s randomised, double-blind, placebo-controlled trial of ketamine was conducted from a healthcare provider perspective. Mean costs and outcomes were estimated from participant-level data over 5 days including positive response, health-related quality of life (HrQOL) measured with the Functional Assessment of Chronic Illness Therapy–Palliative Care (FACIT-Pal), ketamine costs, medication usage and in-patient stays. Results: There was no statistically significant difference in responder rates, but higher toxicity and worse HrQOL for ketamine participants (mean change −3.10 (standard error (SE) 1.76), ketamine n = 93; 4.53 (SE 1.38), placebo n = 92). Estimated total mean costs were AU$706 higher per ketamine participant (AU$6608) compared with placebo (AU$5902), attributable to the cost of higher in-patient costs as well as costs of ketamine administration. The results were robust to sensitivity analyses accounting for different medication use costing methods and removal of cost outliers. Conclusion: The findings suggest subcutaneous ketamine in conjunction with opioids and standard adjuvant therapy is neither an effective nor cost-effective treatment for refractory pain in advanced cancer patients.
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Westbrook, J. I., L. Li, E. C. Lehnbom, M. T. Baysari, J. Braithwaite, R. Burke, C. Conn, and R. O. Day. "What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system." International Journal for Quality in Health Care 27, no. 1 (January 12, 2015): 1–9. http://dx.doi.org/10.1093/intqhc/mzu098.
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Kosari, Sam, Kwang Choon Yee, Stephanie Mulhall, Jackson Thomas, Shane L. Jackson, Gregory M. Peterson, Ayla Rudgley, Iain Walker, and Mark Naunton. "Pharmacists’ Perspectives on the Use of My Health Record." Pharmacy 8, no. 4 (October 14, 2020): 190. http://dx.doi.org/10.3390/pharmacy8040190.
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(1) Background: My Health Record (MHR) is a relatively new nationwide Australian digital health record system accessible by patients and a range of healthcare professionals. Pharmacists will be key contributors and users of the MHR system, yet little is known about the perceived barriers and benefits of use. (2) Objective: To explore pharmacists’ perspectives related to potential benefits and barriers associated with use of MHR. (3) Methods: An online survey was developed and face-validated. The survey was advertised to Australian pharmacists on pharmacy professional bodies’ websites. This was a cross-sectional study using an anonymous questionnaire. Descriptive statistics were used to describe the distribution of the data. Chi-square, Kendall’s tau coefficient (tau-c) and Kruskal–Wallis tests were used to examine the relationships where appropriate. (4) Results: A total of 63 pharmacists completed the survey. The majority of respondents worked in a metropolitan area (74%), and the most common workplace setting was community pharmacy (65%). Perceived benefits identified by responders include that the use of MHR would help with continuity of care (90%), and that it would improve the safety (71%) and quality (75%) of care they provided. Importantly, more than half of pharmacists surveyed agreed that MHR could reduce medication errors during dispensing (57%) and could improve professional relationships with patients (57%) and general practitioners (59%). Potential barriers identified by pharmacists included patients’ concerns about privacy (81%), pharmacists’ own concern about privacy (46%), lack of training, access to and confidence in using the system. Sixty six percent of respondents had concerns about the accuracy of information contained within MHR, particularly among hospital and general practice pharmacists (p = 0.016) and almost half (44%) had concerns about the security of information in the system, mainly pharmacists working at general practice and providing medication review services (p = 0.007). Overall satisfaction with MHR varied, with 48% satisfied, 33% neither satisfied nor dissatisfied, and 19% dissatisfied, with a higher satisfaction rate among younger pharmacists (p = 0.032). (5) Conclusions: Pharmacists considered that the MHR offered key potential benefits, notably improving the safety and quality of care provided. To optimize the use of MHR, there is a need to improve privacy and data security measures, and to ensure adequate provision of user support and education surrounding the ability to integrate use of MHR with existing workflows and software.
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Basetty, Praveena, Charlie G. Buffie, Jennifer Lagman, Cara C. Tigue, Neal Dandade, and Charles L. Bennett. "Inadvertent Intrathecal Administration of Vincristine." Blood 108, no. 11 (November 16, 2006): 3327. http://dx.doi.org/10.1182/blood.v108.11.3327.3327.
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Abstract Background: Vincristine is a vesicant drug which is normally given intravenously. Intrathecal administration of vincristine is a therapeutic misadventure, causing chemical leptomeningitis and focal ventriculitis. While 55 cases of intrathecal vincristine administration have been reported worldwide, only 32 cases have been documented in the literature, 13 have been reported to the FDA Med Watch, and many more cases are believed to be unreported. Of the documented cases, 84.3% resulted in death and 15.6% of those who survived had serious neurological consequences such as quadriplegia and paraplegia. Methods: The Research on Adverse Events and Reports (RADAR) project conducted a review of literature published between 1968 and June 2006. Sources included Med Watch reports, published abstracts and journal articles, online newsletters, and letters from pharmacists. Findings: The reports reviewed showed that intrathecal administration of vincristine occurred most often because of inadequate communication between pharmacy and medical staff (22 of 32 cases; 68.7%). In these cases, the pharmacy mistakenly delivered vincristine syringes together with syringes containing intrathecal medications and physicians or nurses wrongly administered vincristine intrathecally. Pharmacy error alone, such as the mislabeling of syringes, accounted for 6 of 32 cases of intrathecal administration of vincristine (18.7%) while physician/nurse error alone (failure to read syringe labeling or check physician’s orders) accounted for 4 of 32 cases (12.5%). Conclusions: Since vincristine is lethal when given intrathecally, its administration should be executed with the precautionary measures employed with other potentially lethal substances, such as blood products. Carefully reviewing physician orders before drug administration and dispensing vincristine in syringes incompatible with spinal needles can also curb fatal error. Other preventive measures include properly labeling vincristine syringes for intravenous use only and diluting vincristine in intravenous mini-infusion bags. Literature review of case reports since 1968 < 1985 1986–1990 1991–1995 1996–2000 2001–2005 Total USA/Canada 7 1 2 4 2 16 Europe 0 0 2 2 1 5 Australia 0 1 1 0 1 3 Asia 1 0 1 3 0 5 Total Cases 8 2 6 8 8 32 Deaths 8 1 4 6 8 27 (84.3%) Pharmacy/medical staff error 5 1 3 5 5 22 (68.7%) Pharmacy error 2 0 2 2 3 6 (18.7%) Physician/Nurse error 1 1 1 1 0 4 (12.5%)
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Downey, G. B., J. McDonald, and R. G. Downey. "Welfare of Anaesthesia Trainees Survey." Anaesthesia and Intensive Care 45, no. 1 (January 2017): 73–78. http://dx.doi.org/10.1177/0310057x1704500111.
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This study was designed to investigate levels of stress, anxiety or depression and to identify factors compounding or relieving stress in anaesthesia trainees within the Australian and New Zealand College of Anaesthetists (ANZCA) training scheme. An electronic survey was sent to 999 randomly selected trainees and 428 responses were received. In addition to demographics, psychological wellbeing was assessed using the Kessler Psychological Distress Scale (K10) and questions were asked about depression and anxiety, exacerbating factors, personal healthcare and strategies used to manage stress. The majority of respondents (73%) reported being satisfied or very satisfied with their job and training. However, 28% of respondents had K10 scores indicating high or very high distress levels. Eleven percent reported being currently on treatment for anxiety and/ or depression. Twenty-two percent reported having experienced bullying and 14% sexism. Twenty-eight percent reported that they did not have a regular general practitioner (GP), and 41% reported having not visited their GP in the previous year. Forty-seven percent of trainees reported that they self-prescribe medications. Major stressors reported were exams, critical clinical events and fear of making errors. Two stressors previously not identified in similar studies were concern about job prospects in 71% of respondents and workplace-based assessments in 51%. This survey demonstrates significant psychological impairment and poor personal healthcare amongst many trainees. Education, careful continuing assessment of trainees' welfare and a review of current support and remedial measures may be required.
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ISAACS, Anton N., Kenneth CH’NG, Naaz DELHIWALE, Kieran TAYLOR, Bethany KENT, and Anita RAYMOND. "Hospital medication errors: a cross-sectional study." International Journal for Quality in Health Care, October 16, 2020. http://dx.doi.org/10.1093/intqhc/mzaa136.
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Abstract Background Medication errors (MEs) are among the most common types of incidents reported in Australian and international hospitals. There is no uniform method of reporting and reducing these errors. This study aims to identify the incidence, time trends, types and factors associated with MEs in a large regional hospital in Australia. Methods A 5-year cross-sectional study. Results The incidence of MEs was 1.05 per 100 admitted patients. The highest frequency of errors was observed during the colder months of May–August. When distributed by day of the week, Mondays and Tuesdays had the highest frequency of errors. When distributed by hour of the day, time intervals from 7 am to 8 am and from 7 pm to 8 pm showed a sharp increase in the frequency of errors. One thousand and eighty-eight (57.8%) MEs belonged to incidence severity rating (ISR) level 4 and 787 (41.8%) belonged to ISR level 3. There were six incidents of ISR level 2 and only one incident of ISR level 1 reported during the five-year period 2014-2018. Administration-only errors were the most common accounting for 1070 (56.8%) followed by prescribing-only errors (433, 23%). High-risk medications were associated with half the number of errors, the most common of which were narcotics (17.9%) and antimicrobials (13.2%). Conclusions MEs continue to be a problem faced by international hospitals. Inexperience of health professionals and nurse–patient ratios might be the fundamental challenges to overcome. Specific training of junior staff in prescribing and administering medication and nurse workload management could be possible solutions to reducing MEs in hospitals.
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Kruse, Clemens Scott, Michael Mileski, Rohan Syal, Lauren MacNeil, Edward Chabarria, and Cody Basch. "Evaluating the relationship between health information technology and safer-prescribing in the long-term care setting: A systematic review." Technology and Health Care, August 28, 2020, 1–14. http://dx.doi.org/10.3233/thc-202196.
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BACKGROUND: The prevalence of health information technology (HIT) as an adjunct to increase safety and quality in healthcare applications is well known. There is a relationship between the use of HIT and safer-prescribing practices in long-term care. OBJECTIVE: The objective of this systematic review is to determine an association between the use of HIT and the improvement of prescription administration in long-term care facilities. METHODS: A systematic review was conducted using the MEDLINE and CINAHL databases. With the use of certain key terms, 66 articles were obtained. Each article was then reviewed by two researchers to determine if the study was germane to the research objective. If both reviewers agreed with using the article, it became a source for our review. The review was conducted and structured based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: The researchers identified 14 articles to include in a group for analysis from North America, Europe, and Australia. Electronic health records and electronic medication administration records were the two most common forms of technological interventions (6 of 14, 43%). Reduced risk, decreased error, decreased missed dosage, improved documentation, improved clinical process, and stronger clinical focus comprised 92% of the observations. CONCLUSIONS: HIT has shown beneficial effects for many healthcare organizations. Long-term care facilities that implemented health information technologies, have shown reductions in adverse drug events caused by medication errors overall reduced risk to the organization. The implementation of new technologies did not increase the time nurses spent on medication rounds.
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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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Allan, Julaine, Emma Webster, Brett Chambers, and Shannon Nott. "“This is streets ahead of what we used to do”: staff perceptions of virtual clinical pharmacy services in rural and remote Australian hospitals." BMC Health Services Research 21, no. 1 (December 2021). http://dx.doi.org/10.1186/s12913-021-07328-w.
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Abstract Background The use of medications is the most common intervention in healthcare. However, unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in healthcare systems across the world. A Virtual Clinical Pharmacy Service (VCPS) was introduced in rural and remote New South Wales public hospitals to support safe and effective use of medications. In this model clinical pharmacy services are delivered via a telehealth cart at the patient’s bedside and through electronic medical and pharmaceutical record systems. The aim of this research was to understand healthcare staff perspectives of the VCPS and identify areas for improvement. Methods A qualitative approach informed by Appreciative Inquiry was used to investigate healthcare staff perceptions of the VCPS. Focus group discussions (n = 15) with hospital staff and medical officers were conducted via videoconference at each study site. Focus groups explored issues, benefits and barriers 3 months after service implementation. Transcribed data were analysed using thematic analysis and team discussion to synthesise themes. Results Focus group participants identified the value of the VCPS to patients, to the health service and to themselves. They also identified enhancements to increase value for each of these groups. Perceived benefits to patients included access to specialist medication advice and improved medication knowledge. Staff valued access to an additional, trusted workforce who provided back-up and guidance. Staff also reported confidence in improved patient safety and identification of medication errors. Enhanced compliance with antimicrobial stewardship and hospital accreditation standards were beneficial to the health service. Suggested improvements included extending virtual service hours and widening patient eligibility to include aged care patients. Conclusions The VCPS brought a positive, collegiate culture regarding medications. Healthcare staff perceived the VCPS was effective and an efficient way for the health service to supply pharmacy services to smaller hospitals. The ease of use, model of delivery, availability, local knowledge and responsiveness of highly skilled pharmacists was the key to user satisfaction. Trial registration ANZCTR ACTRN12619001757101, 11/12/2019.
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Beks, Hannah, Kevin Mc Namara, Elizabeth Manias, Andrew Dalton, Erica Tong, and Michael Dooley. "Hospital pharmacists’ experiences of participating in a partnered pharmacist medication charting credentialing program: a qualitative study." BMC Health Services Research 21, no. 1 (March 19, 2021). http://dx.doi.org/10.1186/s12913-021-06267-w.
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Abstract Background Medication-related errors are one of the most frequently reported incidents in hospitals. With the aim of reducing the medication error rate, a Partnered Pharmacist Medication Charting (PPMC) model was trialled in seven Australian hospitals from 2016 to 2017. Participating pharmacists completed a credentialing program to equip them with skills to participate in the trial as a medication-charting pharmacist. Skills included obtaining a comprehensive medication history to chart pre-admission medications in collaboration with an admitting medical officer. The program involved both theoretical and practical components to assess the competency of pharmacists. Methods A qualitative evaluation of the multi-site PPMC implementation trial was undertaken. Pharmacists and key informants involved in the trial participated in an interview or focus group session to share their experiences and attitudes regarding the PPMC credentialing program. An interview schedule was used to guide sessions. Transcripts were analysed using a pragmatic inductive-deductive thematic approach. Results A total of 125 participants were involved in interviews or focus groups during early and late implementation data collection periods. Three themes pertaining to the PPMC credentialing program were identified: (1) credentialing as an upskilling opportunity, (2) identifying the essential components of credentialing, and (3) implementing and sustaining the PPMC credentialing program. Conclusions The PPMC credentialing program provided pharmacists with an opportunity to expand their scope of practice and consolidate clinical knowledge. Local adaptations to the PPMC credentialing program enabled pharmacists to meet the varying needs and capacities of hospitals, including the policies and procedures of different clinical settings. These findings highlight key issues to consider when implementation a credentialing program for pharmacists in the hospital setting.
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Piya, Milan K., Therese Fletcher, Kyaw P. Myint, Reetu Zarora, Dahai Yu, and David Simmons. "The impact of nursing staff education on diabetes inpatient glucose management: a pilot cluster randomised controlled trial." BMC Endocrine Disorders 22, no. 1 (March 10, 2022). http://dx.doi.org/10.1186/s12902-022-00975-y.
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Abstract Background An increasing number of patients in hospital have diabetes, with most of them cared for by non-specialist staff. The effect of diabetes education for staff on patient outcomes, as well as the most effective method of staff education is unclear. Therefore, the aim of this study was to compare diabetes outcomes in medical wards where nursing staff were offered one face-to-face (F2F) session followed by access to online education (online), F2F education only, or standard care (control). Methods We conducted a pilot cluster randomised controlled trial involving 16-weeks baseline/rollout followed by a 28-week post-intervention period across three medical wards (clusters) in a Sydney Teaching Hospital. The online ward provided an online competency-based diabetes education program and 1-h F2F teaching from a diabetes nurse educator (DNE), the F2F ward provided four separate 1-h teaching sessions by a DNE, with no additional sessions in the control ward. The primary outcome was length of stay (LOS); secondary outcomes included good diabetes days (GDD), hypoglycaemia and medication errors. Poisson and binary logistic regression were used to compare clusters. Results Staff attendance/completion of ≥ 2 topics was greater with online than F2F education [39/48 (81%) vs 10/33 (30%); p < 0.001]. Among the 827/881 patients, there was no difference in LOS change between online [Median(IQR) 5(2–8) to 4(2–7) days], F2F [7(4–14) to 5(3–13) days] or control wards [5(3–9) to 5(3–7) days]. GDD improved only in the online ward 4.7(2.7–7.0) to 6.0(2.3–7.0) days; p = 0.038. Total patients with hypoglycaemia and appropriately treated hypoglycaemia increased in the online ward. Conclusions The inclusion of online education increased diabetes training uptake among nursing staff. GDD and appropriate hypoglycaemia management increased in the online education wards. Trial registration Prospectively registered on the Australia New Zealand Clinical Trials Registry (ANZCTR) on 24/05/2017: ACTRN12617000762358.
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Khalil, Viviane, and Antoinette Bates. "Assessing the impact of a mixed intervention model on the reduction of medication administration errors in an Australian hospital." Irish Journal of Medical Science (1971 -), December 2, 2021. http://dx.doi.org/10.1007/s11845-021-02872-0.
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