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1

Idris, Muhammad Usamah Bin Mohamed, Nursa'adah Binte Jamil, Xu Yi, Lim Su-Fee, Ang Shin Yuh, Fazila Aloweni, and Rachel Marie Towle. "Keeping patients safe through medication review and management in the community." British Journal of Community Nursing 29, no. 6 (June 2, 2024): 288–93. http://dx.doi.org/10.12968/bjcn.2024.29.6.288.

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Background: There are numerous publications on inpatient medication errors. However, little focus is given to medication errors that occur at home. Aims: To describe and analyse the types of medication errors among community-dwelling patients following their discharge from an acute care hospital in Singapore. Method: This is a retrospective review of a ‘good catch’ reporting system from December 2018 to March 2022. Medication-related errors were extracted and analysed. Findings: A total of 73 reported medication-related error incidents were reviewed. The mean age of the patients was 78 years old (SD=9). Most patients managed their medications independently at home (45.2%, n=33). The majority of medications involved were cardiovascular medications (51.5%, n=50). Incorrect dosing (41.1%, n=39) was the most common medication error reported. Poor understanding of medication usage (35.6%, n=26) and lack of awareness of medication changes after discharge (24.7%, n=18) were the primary causes of the errors. Conclusion: This study's findings provide valuable insights into reducing medication errors at home. More attention must be given to post-discharge care, especially to preventable medication errors. Medication administration and management education can be emphasised using teach-back methods.
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Clark, Henry, Delesha Carpenter, Kathleen Walsh, Scott A. Davis, Nacire Garcia, and Betsy Sleath. "Medication Errors in Adolescents Using Asthma Controller Medications." Global Pediatric Health 7 (January 2020): 2333794X2098134. http://dx.doi.org/10.1177/2333794x20981341.

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The purpose of this study was to describe the number and types of errors that adolescents and caregivers report making when using asthma controller medications. A total of 319 adolescents ages 11 to 17 with persistent asthma and their caregivers participated in this cross-sectional study. Adolescent and caregiver reports of asthma medication use were compared to the prescribed directions in the medical record. An error was defined as discrepancies between reported use and the prescribed directions. About 38% of adolescents reported 1 error in using asthma controller medications, 16% reported 2 errors, and 5% reported 3 or more errors. About 42% of caregivers reported 1 error in adolescents using asthma controller medications, 14% reported 2 errors, while 6% reported 3 or more errors. The type of error most frequently reported by both was not taking the medication at all. Providers should ask open-ended questions of adolescents with asthma during visits so they can detect and educate families on how to overcome errors in taking controller medication use.
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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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Alboudi, Ayman, and Anna Bank. "Medication Reconciliation Errors on Discharge for Epilepsy Monitoring Unit Patients." Journal of Epilepsy Research 14, no. 1 (June 30, 2024): 17–20. http://dx.doi.org/10.14581/jer.24003.

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Background and Purpose: Medication errors are common in the inpatient setting. Epilepsy patients who miss doses of their antiseizure medications are at risk for breakthrough seizures and subsequent complications. The purpose of this study was to quantify and characterize anti-seizure medications reconciliation errors on discharge from the epilepsy monitoring unit (EMU).Methods: Consecutive admissions to an academic medical center EMU were retrospectively reviewed. Medication reconciliation errors on discharge, including drug errors, dosing errors, and dose timing errors, were recorded. Associations between medication errors and clinical and demographic variables were analyzed using binary logistic regression for continuous variables and Fisher exact tests for categorical variables.Results: One hundred and eleven admissions between January 1, 2021 and December 31, 2021 were identified. Fourteen anti-seizure medication reconciliation errors were recorded during 11 unique admissions (9.9% of admissions). The most common error type was dosing error (10/14 errors; 71.4%). Number of antiseizure medications on admission (<i>p</i>=0.004), total number of medications on admission (<i>p</i>=0.013), number of medication changes during admission (<i>p</i>=0.0007), and length of stay (<i>p</i>=0.0001) were associated with increased likelihood of errors.Conclusions: Medication reconciliation errors upon discharge from the EMU occur during approximately 10% of admissions. A higher number of preadmission antiseizure medications, higher total number of preadmission medications, higher number of medication changes during admission, and longer length of stay are associated with increased risk of discharge medication reconciliation errors. Careful attention should be paid to patients with these risk factors.
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Apsay, Khandy Lorraine Guerrero, Gianille Geselle Alvarado, Marlon Charles Paguntalan, and Sittie Hannah Tumog. "CONTRIBUTING FACTORS TO MEDICATION ERRORS AS PERCEIVED BY NURSING STUDENTS IN ILIGAN CITY, PHILIPPINES." Belitung Nursing Journal 4, no. 6 (November 7, 2018): 537–44. http://dx.doi.org/10.33546/bnj.566.

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Background: Nursing students are allowed to give medication with clinical supervision to give medications with clinical supervision to enhance skills in medication administration. However, studies suggest that some students commit medication errors due to knowledge, personal, administrative and environmental factors.Objective: This study will identify factors that cause student nurses to commit medication errors and correlate it to the number of perceived medication errors committed.Methods: A correlational design was used to correlate the factors contributing to medication administration and the number of medication errors committed by the students. 388 randomly selected nursing students were asked to answer a Modified Medication Error Questionnaire which measures the knowledge, administrative, personal and environmental factors which may contribute to medication administration errors. Medication administration errors are measured according to the number of times a student commits as perceived by them.Results: Lack of knowledge of the drug and equipment to be used for administration, decrease in confidence, poor clinical assessment of patients; conditions, and poor follow ups from clinical instructor are identified concerns under knowledge factor. Poor positive feedback, inadequate supervision and belittling ways of clinical instructors are identified under the administrative factor. Fear of administering an injection or giving medications is a common problem under personal factor. Inappropriate labelling of medications, unfavorable room temperature, lack of space, inadequate lighting, disorganized medication administration schedule and noise are problems found under environmental factor. A minority of 17.3% claimed that they have encountered a medication error in any of their clinical duties.Conclusion: Knowledge, administrative, personal and environmental factors have no effect towards medication errors. However, the relationship between age and the number of perceived medications errors is established. More in-depth investigation is recommended to determine the type of medication errors committed and its detrimental effects towards patient safety.
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Walsh, Kathleen E., Katherine S. Dodd, Kala Seetharaman, Douglas W. Roblin, Lisa J. Herrinton, Ann Von Worley, G. Naheed Usmani, David Baer, and Jerry H. Gurwitz. "Medication Errors Among Adults and Children With Cancer in the Outpatient Setting." Journal of Clinical Oncology 27, no. 6 (February 20, 2009): 891–96. http://dx.doi.org/10.1200/jco.2008.18.6072.

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Purpose Outpatients with cancer receive complicated medication regimens in the clinic and home. Medication errors in this setting are not well described. We aimed to determine rates and types of medication errors and systems factors associated with error in outpatients with cancer. Methods We retrospectively reviewed records from visits to three adult and one pediatric oncology clinic in the Southeast, Southwest, Northeast, and Northwest for medication errors using established methods. Two physicians independently judged whether an error occurred (κ = 0.65), identified its severity (κ = 0.76), and listed possible interventions. Results Of 1,262 adult patient visits involving 10,995 medications, 7.1% (n = 90; 95% CI, 5.7% to 8.6%) were associated with a medication error. Of 117 pediatric visits involving 913 medications, 18.8% (n = 22; 95% CI, 12.5% to 26.9%) were associated with a medication error. Among all visits, 64 of the 112 errors had the potential to cause harm, and 15 errors resulted in injury. There was a range in the rates of chemotherapy errors (0.3 to 5.8 per 100 visits) and home medication errors (0 to 14.5 per 100 visits in children) at different sites. Errors most commonly occurred in administration (56%). Administration errors were often due to confusion over two sets of orders, one written at diagnosis and another adjusted dose on the day of administration. Physician reviewers selected improved communication most often to prevent error. Conclusion Medication error rates are high among adult and pediatric outpatients with cancer. Our findings suggest some practical targets for intervention, including improved communication about medication administration in the clinic and home.
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Allison, Geneve M., Bernard Weigel, and Christina Holcroft. "Does electronic medication reconciliation at hospital discharge decrease prescription medication errors?" International Journal of Health Care Quality Assurance 28, no. 6 (July 13, 2015): 564–73. http://dx.doi.org/10.1108/ijhcqa-12-2014-0113.

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Purpose – Medication errors are an important patient safety issue. Electronic medication reconciliation is a system designed to correct medication discrepancies at transitions in healthcare. The purpose of this paper is to measure types and prevalence of intravenous antibiotic errors at hospital discharge before and after the addition of an electronic discharge medication reconciliation tool (EDMRT). Design/methodology/approach – A retrospective study was conducted at a tertiary hospital where house officers order discharge medications. In total, 100 pre-EDMRT and 100 post-EDMRT subjects were randomly recruited from the study center’s clinical Outpatient Parenteral Antimicrobial Therapy (OPAT) program. Using infectious disease consultant recommendations as gold standard, each antibiotic listed in these consultant notes was compared to the hospital discharge orders to ascertain the primary outcome: presence of an intravenous antibiotic error in the discharge orders. The primary covariate of interest was pre- vs post-EDMRT group. After generating the crude prevalence of antibiotic errors, logistic regression accounted for potential confounding: discharge day (weekend vs weekday), average years of practice by prescribing physician, inpatient service (medicine vs surgery) and number of discharge mediations per patient. Findings – Prevalence of medication errors decreased from 30 percent (30/100) among pre-EDMRT subjects to 15 percent (15/100) errors among post-EDMRT subjects. Dosage errors were the most common type of medication error. The adjusted odds ratio of discharge with intravenous antibiotic error in the post-EDMRT era was 0.39 (0.18, 0.87) compared to the pre-EDMRT era. In the adjusted model, the total number of discharge medications was associated with increased OR of discharge error. Originality/value – To the authors’ knowledge, no other study has examined the impact of reconciliation on types and prevalence of medication errors at hospital discharge. The focus on intravenous antibiotics as a class of high-stakes medications with serious risks to patient safety during error events highlights the clinical importance of the findings. Electronic medication reconciliation may be an important tool in efforts to improve patient safety.
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Henry Basil, Josephine, Nurul Ain Mohd Tahir, Chandini Menon Premakumar, Adliah Mhd Ali, Zamtira Seman, Shareena Ishak, Kwee Ching See, et al. "Clinical and economic impact of medication administration errors among neonates in neonatal intensive care units." PLOS ONE 19, no. 7 (July 11, 2024): e0305538. http://dx.doi.org/10.1371/journal.pone.0305538.

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Despite efforts in improving medication safety, medication administration errors are still common, resulting in significant clinical and economic impact. Studies conducted using a valid and reliable tool to assess clinical impact are lacking, and to the best of our knowledge, studies evaluating the economic impact of medication administration errors among neonates are not yet available. Therefore, this study aimed to determine the potential clinical and economic impact of medication administration errors in neonatal intensive care units and identify the factors associated with these errors. A national level, multi centre, prospective direct observational study was conducted in the neonatal intensive care units of five Malaysian public hospitals. The nurses preparing and administering the medications were directly observed. After the data were collected, two clinical pharmacists conducted independent assessments to identify errors. An expert panel of healthcare professionals assessed each medication administration error for its potential clinical and economic outcome. A validated visual analogue scale was used to ascertain the potential clinical outcome. The mean severity index for each error was subsequently calculated. The potential economic impact of each error was determined by averaging each expert’s input. Multinomial logistic regression and multiple linear regression were used to identify factors associated with the severity and cost of the errors, respectively. A total of 1,018 out of 1,288 (79.0%) errors were found to be potentially moderate in severity, while only 30 (2.3%) were found to be potentially severe. The potential economic impact was estimated at USD 27,452.10. Factors significantly associated with severe medication administration errors were the medications administered intravenously, the presence of high-alert medications, unavailability of a protocol, and younger neonates. Moreover, factors significantly associated with moderately severe errors were intravenous medication administration, younger neonates, and an increased number of medications administered. In the multiple linear regression analysis, the independent variables found to be significantly associated with cost were the intravenous route of administration and the use of high-alert medications. In conclusion, medication administration errors were judged to be mainly moderate in severity costing USD 14.04 (2.22–22.53) per error. This study revealed important insights and highlights the need to implement effective error reducing strategies to improve patient safety among neonates in the neonatal intensive care unit.
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Cochran, Gary L., Ryan S. Barrett, and Susan D. Horn. "Comparison of medication safety systems in critical access hospitals: Combined analysis of two studies." American Journal of Health-System Pharmacy 73, no. 15 (August 1, 2016): 1167–73. http://dx.doi.org/10.2146/ajhp150760.

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Abstract Purpose The role of pharmacist transcription, onsite pharmacist dispensing, use of automated dispensing cabinets (ADCs), nurse–nurse double checks, or barcode-assisted medication administration (BCMA) in reducing medication error rates in critical access hospitals (CAHs) was evaluated. Methods Investigators used the practice-based evidence methodology to identify predictors of medication errors in 12 Nebraska CAHs. Detailed information about each medication administered was recorded through direct observation. Errors were identified by comparing the observed medication administered with the physician’s order. Chi-square analysis and Fisher’s exact test were used to measure differences between groups of medication-dispensing procedures. Results Nurses observed 6497 medications being administered to 1374 patients. The overall error rate was 1.2%. The transcription error rates for orders transcribed by an onsite pharmacist were slightly lower than for orders transcribed by a telepharmacy service (0.10% and 0.33%, respectively). Fewer dispensing errors occurred when medications were dispensed by an onsite pharmacist versus any other method of medication acquisition (0.10% versus 0.44%, p = 0.0085). The rates of dispensing errors for medications that were retrieved from a single-cell ADC (0.19%), a multicell ADC (0.45%), or a drug closet or general supply (0.77%) did not differ significantly. BCMA was associated with a higher proportion of dispensing and administration errors intercepted before reaching the patient (66.7%) compared with either manual double checks (10%) or no BCMA or double check (30.4%) of the medication before administration (p = 0.0167). Conclusion Onsite pharmacist dispensing and BCMA were associated with fewer medication errors and are important components of a medication safety strategy in CAHs.
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Huq, Nishat, Eimeira Padilla-Tolentino, and Brandy McGinnis. "Identifying Potential High-Risk Medication Errors Using Telepharmacy and a Web-Based Survey Tool." INNOVATIONS in pharmacy 12, no. 1 (February 12, 2021): 9. http://dx.doi.org/10.24926/iip.v12i1.3377.

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Background and Introduction: Obtaining patient medication histories during emergency department (ED) admissions is an important step towards identifying potential errors that could otherwise remain in the patient’s active medication list. This is a descriptive report of a standardized, electronic data collection tool created to document potential medication errors in patients receiving high-risk medications during ED admissions. Materials and Methods: Trained pharmacy technicians completed a survey following medication history collection using a secure web platform called REDCap®. Data collected included patient-specific information, the number and type of high-risk medications, and potential medication errors identified in the collection process. Results: During a pilot period of April 2019 to October 2020, 191 patient records were completed using the survey tool. Out of a total of 1088 medications recorded, 41% were considered high-risk medications. 42% of potential medication errors were classified as high-risk medication errors. Results from this survey tool demonstrated that 58% of high-risk medication orders could potentially result in a medication error that can be carried through patient admission and discharge. Discussion: Accurate medication history and transitions of care can significantly impact patient quality of life. The cost of addressing a medication related-adverse event is also substantial. Based on published reports, annual gross savings to a hospital is estimated to be $4532 per harmful error in 2020, after adjusting for inflation. This equated to approximately $1,182,852 in estimated savings for Ascension Texas in 18 months. Nationwide, preventing potential medication errors in an outpatient setting can save on average $3.5 billion per year. Conclusion: This web-based survey tool has improved the quality and efficiency of potential error identification during medication history collection by pharmacy technicians. This information can be easily retrieved and aid in discussions regarding medication reconciliation at the leadership level and impact patient treatment outcomes by developing virtual processes that may result in fewer medication related events.
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Stockton, K. R., M. E. Wickham, S. Lai, K. Badke, D. Villanyi, V. Ho, K. Dahri, and C. M. Hohl. "LO51: Incidence of clinically relevant medication errors after implementation of an electronic medication reconciliation process." CJEM 19, S1 (May 2017): S45. http://dx.doi.org/10.1017/cem.2017.113.

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Introduction: Medication discrepancies are unintended differences between a patient’s outpatient and inpatient medication regimens, and occur in up to 60% of hospital admissions. Canadian emergency departments (EDs) have implemented medication reconciliation forms that are pre-populated with outpatient medication dispensing data in order to reduce medication discrepancies and resultant adverse drug events. However, these forms may introduce errors of commission by prompting prescribers to reorder discontinued or potentially harmful medications. Our objective was to evaluate the incidence of medication discrepancies and errors of commission after the implementation of pre-populated medication reconciliation forms. Methods: This chart review included admitted patients who were enrolled in a parent study in which a research pharmacist prospectively collected best-possible medication histories (BPMHs) in the ED using all available information sources. Following discharge, research assistants uninvolved with the parent study compared medication orders documented within 48 h of admission with the BPMH to identify medication discrepancies and errors of commission. Errors of commission were defined as inappropriate continuations of medications and reordering discontinued medications. An independent panel adjudicated the clinical significance of the errors. We used regression methods to identify factors associated with errors. The sample size was limited by enrolment into the parent study. Results: Of 151 patients, 71 (47%; 95%CI 39.2-54.9) were exposed to 112 medication errors. Of these errors, 75.9% (85/112; 95%CI 67.1-82.9) were discrepancies, of which 18.8% (16/85; 95%CI 12.0-28.4) were clinically significant. Errors of commission made up 24.1% (27/112; 95%CI 17.3-32.8) of all errors, of which 37.0% (10/27; 95%CI 18.8-55.2) were clinically significant. Taking 8 or more medications was associated with a 5-fold greater odds of experiencing a medication error after controlling for confounders (OR 5.00; 95%CI 2.45-10.17; p&lt;0.001). Conclusion: Clinically significant medication discrepancies and errors of commission remain common despite the implementation of electronically pre-populated medication reconciliation forms. Prospective studies are needed to evaluate whether using pre-populated medication reconciliation forms increases the risk of introducing errors of commission.
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Eluri, Madhulika, Henry A. Spiller, Marcel J. Casavant, Thitphalak Chounthirath, Kristen A. Conner, and Gary A. Smith. "Analgesic-Related Medication Errors Reported to US Poison Control Centers." Pain Medicine 19, no. 12 (November 23, 2017): 2357–70. http://dx.doi.org/10.1093/pm/pnx272.

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Abstract Objective This study investigates the characteristics and trends of medication errors involving analgesic medications. Design and Methods A retrospective analysis was conducted of analgesic-related medication errors reported to the National Poison Data System (NPDS) from 2000 through 2012. Results From 2000 through 2012, the NPDS received 533,763 reports of analgesic-related medication errors, averaging 41,059 medication errors annually. Overall, the rate of analgesic-related medication errors reported to the NPDS increased significantly by 82.6% from 2000 to 2009, followed by a 5.7% nonsignificant decrease from 2009 to 2012. Among the analgesic categories, rates of both acetaminophen-related and opioid-related medication errors reported to the NPDS increased during 2000–2009, but the opioid error rate leveled off during 2009–2012, while the acetaminophen error rate decreased by 17.9%. Analgesic-related medication errors involved nonsteroidal anti-inflammatory drugs (37.0%), acetaminophen (35.5%), and opioids (23.2%). Children five years or younger accounted for 38.8% of analgesics-related medication errors. Most (90.2%) analgesic-related medication errors were managed on-site, rather than at a health care facility; 1.6% were admitted to a hospital, and 1.5% experienced serious medical outcomes, including 145 deaths. The most common type of medication error was inadvertently taking/given the medication twice (26.6%). Conclusion Analgesic-related medication errors are common, and although most do not result in clinical consequences, they can have serious adverse outcomes. Initiatives associated with the decrease in acetaminophen-related medication errors among young children merit additional research and potential replication as a model combining government policy and multisectoral collaboration.
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DWIVEDI, MADHAW, AMIT SHARMA, and SANDEEP ARORA. "A Review on Medication Errors." JOURNAL OF PHARMACEUTICAL TECHNOLOGY, RESEARCH AND MANAGEMENT 3, no. 2 (November 2, 2015): 89–96. http://dx.doi.org/10.15415/jptrm.2015.32007.

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Al-Jumaili, Ali Azeez, and Melad Mohammed Ali. "Appraising the Role of Pharmacists in Medication Reconciliation at Hospital Discharge: A Field-Based Study." Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) 5, no. 1S (November 2, 2023): S57–63. http://dx.doi.org/10.54133/ajms.v5i1s.319.

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Objective: To measure the effect of the pharmacist-led medication reconciliation service before hospital discharge on preventing potential medication errors. Methods: This behavioral interventional study took place in a public teaching hospital in Iraq between December 2022 and January 2023. It included inpatients who were taking four or more medications upon discharge from the internal medicine ward and the cardiac care unit. The researcher provided the patients with a medication reconciliation form and reconciliation form (including medication regimen and pharmacist instructions) before discharging them home. Any discrepancies between the patients’ understanding and the actual medication recommendations prescribed by the physician were identified and solved. Results: Fifty inpatients received a pharmacist-led medication reconciliation review before hospital discharge. Out of 50 patients, 44% had a clear understanding of their medications before the intervention. In contrast, 56% of the patients had at least one potential medication error before the reconciliation, which was addressed by the pharmacist's intervention. Approximately two-thirds (89.4%) of the potential medication errors were clinically significant, and 5.3% of these errors were serious. The most frequent potential error that prevented this was duplication (31.5%) (the patient was about to duplicate the same medication from different manufacturers or different medications from the same pharmacological class). Conclusion: Lack of medication reconciliation can cause significant medication errors, which might be serious and cause harm to patients. This study has the potential to shape policies and practices that prioritize medication safety and optimize patient outcomes during transitions of care.
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Goulas, Clara, Laura Lohan, Marion Laureau, Damien Perier, Véronique Pinzani, Marie Faucanie, Valérie Macioce, et al. "Involvement of Pharmacists in the Emergency Department to Correct Errors in the Medication History and the Impact on Adverse Drug Event Detection." Journal of Clinical Medicine 12, no. 1 (January 3, 2023): 376. http://dx.doi.org/10.3390/jcm12010376.

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(1) Incomplete or wrong medication histories can lead to missed diagnoses of Adverse Drug Effects (ADEs). We aimed to evaluate pharmacist-identified ED errors in the medication histories obtained by physicians, and their consequences for ADE detection. (2) This prospective monocentric study was carried out in an ED of a university hospital. We included adult patients presenting with an ADE detected in the ED. The best possible medication histories collected by pharmacists were used to identify errors in the medication histories obtained by physicians. We described these errors, and identified those related to medications involved in ADEs. We also identified the ADEs that could not have been detected without the pharmacists’ interventions. (3) Of 735 patients presenting with an ADE, 93.1% had at least one error on the medication list obtained by physicians. Of the 1047 medications involved in ADEs, 51.3% were associated with an error in the medication history. In total, 23.1% of the medications involved in ADEs were missing in the physicians’ medication histories and were corrected by the pharmacists. (4) Medication histories obtained by ED physicians were often incomplete, and half the medications involved in ADEs were not identified, or were incorrectly characterized in the physicians’ medication histories.
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Dalmolin, Gabriella Rejane dos Santos, Eloni Terezinha Rotta, and José Roberto Goldim. "Medication errors: classification of seriousness, type, and of medications involved in the reports from a university teaching hospital." Brazilian Journal of Pharmaceutical Sciences 49, no. 4 (December 2013): 793–802. http://dx.doi.org/10.1590/s1984-82502013000400019.

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Medication errors can be frequent in hospitals; these errors are multidisciplinary and occur at various stages of the drug therapy. The present study evaluated the seriousness, the type and the drugs involved in medication errors reported at the Hospital de Clínicas de Porto Alegre. We analyzed written error reports for 2010-2011. The sample consisted of 165 reports. The errors identified were classified according to seriousness, type and pharmacological class. 114 reports were categorized as actual errors (medication errors) and 51 reports were categorized as potential errors. There were more medication error reports in 2011 compared to 2010, but there was no significant change in the seriousness of the reports. The most common type of error was prescribing error (48.25%). Errors that occurred during the process of drug therapy sometimes generated additional medication errors. In 114 reports of medication errors identified, 122 drugs were cited. The reflection on medication errors, the possibility of harm resulting from these errors, and the methods for error identification and evaluation should include a broad perspective of the aspects involved in the occurrence of errors. Patient safety depends on the process of communication involving errors, on the proper recording of information, and on the monitoring itself.
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Triantafyllou, Christos, Maria Gamvrouli, and Pavlos Myrianthefs. "Frequency of nursing student medication errors: A systematic review." Health & Research Journal 9, no. 4 (October 4, 2023): 237–42. http://dx.doi.org/10.12681/healthresj.33669.

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Background: Health promotion and patient safety are the main targets of the healthcare provision by the National Health Systems. As for the nursing profession, nursing students make medication errors during clinical interventions, which could be a potential danger to patient safety. The investigation of the frequency of nursing student medication errors, as well as the frequency of each type of nursing student medication errors. Method and Material: A systematic review of the literature was conducted on the electronic database "PubMed" with the keywords: "medication error", "prescribing error", "drug error", "drug use error", "drug mistake", "wrong drug", "wrong dose", "administration error", "dispensing error", "incorrect drug", "incorrect dose", "inappropriate prescribing", "inappropriate medication", "transcription error", "nursing student", "nursing trainee" and on the Greek electronic database IATROTEK-online with the keywords: "medication errors" and "nursing students", without time limit for the publication of scientific papers. On PubMed, the keywords were searched in the title and abstract of the studies. Studies were excluded if they were not published in English and Greek language, were conducted on animals, and were case studies, editorials, and letters to the editor. Results: Of the 47 scientific papers retrieved, 6 were included in the systematic review. A total of 1,904 nursing student medication errors were recorded by nursing students. The majority of errors were: 1) wrong dose form (330,17%), 2) omission error (313, 16.4%), and 3) wrong time (259, 13.6%). Conclusions: The frequency of nursing student medication errors is high. The safe administration of medications is an important skill that nursing students should learn. medication administration.
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El-Fattah Mohamed Aly, Nagah Abd, Safaa M. El-Shanawany, Maha Ghanem, Maysa Abdalla Elbiaa, Hana Abass Ahmed Mohamed, and Wael M. Lotfy. "Medication safety climate: managing high-alert medication administration and errors among nurses in intensive and critical care units." Egyptian Nursing Journal 20, no. 2 (May 2023): 228–36. http://dx.doi.org/10.4103/enj.enj_16_23.

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Background High-alert medications are drugs that may lead to serious harm when they are wrongly administered to patients. Safe medication administration is the crucial role of nursing staff. Aim This study aims to investigate relationships of medication safety climate and nurses’ knowledge about high-alert medications with managing their administration and errors. Design A cross-sectional correlational study. Sample A convenience sample of 300 nurses. Setting Surgical intensive and critical care units. Tools Self-report questionnaires about medication safety climate, nurses’ knowledge and administration competency of high-alert medications and high-alert medication error experience as well as high-alert medication practice observational tool. Results The nurses’ knowledge, practice, and competencies about administering high-alert medications were below sufficient standards. They described medication safety climate at undesirable levels and reported encountering high-alert medication administration errors of about 25.3%. The medication safety climate and nurses’ knowledge of high-alert medication were associated with and affected nurses’ practice (r =.43; r =.31, respectively) and competencies (r=.32; r=.23, respectively), during administration of high-alert medications. Insufficient levels of medication safety climate and nurses’ knowledge and administration practice of high-medications were the predictive factors of incidence of high-alert medication administration errors among nurses (r =-.18; r =-.32; r = -.21, respectively). Conclusion Sufficient nurses’ knowledge and medication safety climate were deemed to be one of the most important measures to improve managing high-alert medication administration and reduce the occurrence of high-alert medication administration errors. Recommendation The hospital management should implement medication safety in its clinical standards and plan for promoting the safe administration of high-alert medications.
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Gray, Jennifer, Rodney W. Hicks, and Cristi Hutchings. "Antiretroviral Medication Errors in a National Medication Error Database." AIDS Patient Care and STDs 19, no. 12 (December 2005): 803–12. http://dx.doi.org/10.1089/apc.2005.19.803.

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Cohen, Michael R. "Medication Errors." Nursing 51, no. 2 (February 2021): 72. http://dx.doi.org/10.1097/01.nurse.0000731872.34230.bf.

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Cohen, Michael R. "Medication Errors." Nursing 51, no. 6 (June 2021): 72. http://dx.doi.org/10.1097/01.nurse.0000751356.39086.49.

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Cohen, Michael R. "Medication Errors." Nursing 51, no. 4 (April 2021): 72. http://dx.doi.org/10.1097/01.nurse.0000736940.26887.b4.

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Cohen, Michael R. "Medication Errors." Nursing 51, no. 3 (March 2021): 72. http://dx.doi.org/10.1097/01.nurse.0000733944.06027.e0.

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Scott, Lisa. "Medication errors." Nursing Standard 30, no. 35 (April 27, 2016): 61–62. http://dx.doi.org/10.7748/ns.30.35.61.s49.

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Cohen, Michael R. "Medication Errors." Nursing 51, no. 5 (May 2021): 72. http://dx.doi.org/10.1097/01.nurse.0000743088.23154.7f.

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Cohen, Michael R. "Medication Errors." Nursing 52, no. 7 (July 2022): 64. http://dx.doi.org/10.1097/01.nurse.0000832336.11193.73.

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Cohen, Michael R. "Medication Errors." Nursing 52, no. 8 (August 2022): 64. http://dx.doi.org/10.1097/01.nurse.0000839848.64411.90.

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Cohen, Michael R. "Medication Errors." Nursing 52, no. 9 (September 2022): 64. http://dx.doi.org/10.1097/01.nurse.0000853964.25569.76.

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Howarth, Patricia Lesley. "Medication errors." Nursing Standard 29, no. 47 (July 22, 2015): 61. http://dx.doi.org/10.7748/ns.29.47.61.s46.

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Cohen, Michael R. "Medication Errors." Nursing 52, no. 5 (May 2022): 64. http://dx.doi.org/10.1097/01.nurse.0000827220.13708.d1.

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Cohen, Michael R. "Medication Errors." Nursing 52, no. 4 (April 2022): 64. http://dx.doi.org/10.1097/01.nurse.0000823248.19181.ec.

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Guchelaar, Henk-Jan, Hadewig B. B. Colen, Mathijs D. Kalmeijer, Patrick T. W. Hudson, and Irene M. Teepe-Twiss. "Medication Errors." Drugs 65, no. 13 (2005): 1735–46. http://dx.doi.org/10.2165/00003495-200565130-00001.

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Cohen, Michael R. "Medication Errors." Nursing 51, no. 12 (December 2021): 64. http://dx.doi.org/10.1097/01.nurse.0000800136.45333.4f.

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Cohen, Michael R. "Medication Errors." Nursing 51, no. 11 (November 2021): 72. http://dx.doi.org/10.1097/01.nurse.0000795336.26236.04.

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Cohen, Michael R. "Medication Errors." Nursing 51, no. 8 (August 2021): 72. http://dx.doi.org/10.1097/01.nurse.0000757184.80085.c4.

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Cohen, Michael R. "Medication Errors." Nursing 51, no. 7 (July 2021): 72. http://dx.doi.org/10.1097/01.nurse.0000754072.81008.d6.

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Cohen, Michael R. "Medication Errors." Nursing 52, no. 2 (February 2022): 64. http://dx.doi.org/10.1097/01.nurse.0000806196.81185.12.

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Cohen, Michael R. "Medication Errors." Nursing 52, no. 3 (March 2022): 64. http://dx.doi.org/10.1097/01.nurse.0000820040.44479.92.

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Cohen, Michael R. "Medication Errors." Nursing 51, no. 9 (September 2021): 72. http://dx.doi.org/10.1097/01.nurse.0000769880.82566.49.

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Cohen, Michael R. "Medication Errors." Nursing 52, no. 1 (January 2022): 64. http://dx.doi.org/10.1097/01.nurse.0000803520.57945.1d.

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&NA;. "Medication Errors." Drug Safety 10, no. 4 (April 1994): 328–29. http://dx.doi.org/10.2165/00002018-199410040-00007.

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Bates, David W. "Medication Errors." Drug Safety 15, no. 5 (November 1996): 303–10. http://dx.doi.org/10.2165/00002018-199615050-00001.

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Cohen, Michael R. "Medication Errors." Nursing 52, no. 10 (October 2022): 64. http://dx.doi.org/10.1097/01.nurse.0000872440.52020.c1.

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Cohen, Michael R. "Medication Errors." Nursing 52, no. 11 (November 2022): 64. http://dx.doi.org/10.1097/01.nurse.0000897060.86152.f8.

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COHEN, MICHAEL R. "MEDICATION ERRORS." Nursing 15, no. 1 (January 1985): 20–22. http://dx.doi.org/10.1097/00152193-198501000-00005.

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COHEN, MICHAEL R. "MEDICATION ERRORS." Nursing 15, no. 2 (February 1985): 67. http://dx.doi.org/10.1097/00152193-198502000-00027.

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COHEN, MICHAEL R. "MEDICATION ERRORS." Nursing 15, no. 4 (April 1985): 14–18. http://dx.doi.org/10.1097/00152193-198504000-00003.

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Cohen, Michael R. "MEDICATION ERRORS." Nursing 15, no. 5 (May 1985): 84–86. http://dx.doi.org/10.1097/00152193-198505000-00016.

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COHEN, MICHAEL R. "MEDICATION ERRORS." Nursing 15, no. 8 (August 1985): 57. http://dx.doi.org/10.1097/00152193-198508000-00022.

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COHEN, MICHAEL R. "MEDICATION ERRORS." Nursing 15, no. 11 (November 1985): 22–25. http://dx.doi.org/10.1097/00152193-198511000-00008.

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