Interception of potential adverse drug events in long-term psychiatric care units.

The interception of medication errors is required for patient safety. The aim of the present study was to clarify factors associated with the interception of potential adverse drug events in long-term psychiatric care units. A survey was conducted of medication-related errors in 132 Japanese long-term psychiatric care units for 2 months using an incident reporting system. The relationship was analyzed between the reported potential adverse drug events and the characteristics of the units and the staff, as well as those of the patients involved. A multivariate logistic regression analysis was performed with environmental, organizational, and human factors as independent variables to predict the interception of potential adverse drug events. Of the 221 reported incidents, 55 (24.9%) were intercepted before reaching patients. The following patient groups were significantly associated with the failure to intercept potential adverse drug events: patients receiving a relatively large number of tablets, patients with relatively frequent admissions, and patients exposed to a relatively high patient-staff ratio in the evening. In contrast, patients with a diagnosis of schizophrenia were significantly associated with an increased possibility of interception. To intercept more potential adverse drug events, simpler prescriptions are crucial. To improve the current situation, organizational efforts, such as increasing staff in the evening, and educating the staff about medications, will be required, as well as improvements in the medications themselves.

[Preliminary reports on psychiatric practice in correctional facilities].

In October 2001, Nanashakon, a council composed of seven psychiatry-related organizations in Japan, decided to launch an investigation into forensic psychiatry in Japan, and established a working team (WT) for this purpose. From its establishment to March 2004, the WT performed surveys and analyses of the current situation of preliminary reports by psychiatric experts (preliminary reports) and of psychiatric practice in correctional facilities. Based on the results, the WT has presented proposals including guidelines for preliminary reports. In January 2002, the WT conducted an awareness survey on the status quo of testimony by psychiatric experts and forensic psychiatry, targeting the members of the Japanese Society of Psychiatry and Neurology, and obtained 666 replies. The survey revealed various critical opinions such as skepticism over the current punishment imposed on criminal patients with mental disorders. In February 2002, the WT obtained data on preliminary reports (2,042 cases) compiled prior to prosecution in FY2000 from the Japanese Ministry of Justice. Reviewing the details and differences between the evaluation by psychiatrists and the decision by public prosecutors, the WT pointed out the ambiguity of criteria used for the evaluation of competency of weak-minded persons and the criteria for criminal punishment. Around the same time, the WT was also asked by a news agency to analyze the preliminary reports of 50 district public prosecutor offices. The results revealed marked regional differences in the operation of the preliminary evaluation system for competency. In January 2003, the WT collected 146 preliminary reports from around the country for comparison and review, and again found conspicuous individual and regional discrepancies in the format and content. Based on these results, the WT conducted a hearing of 41 expert opinions on preliminary reports, and in January 2004, proposed guidelines outlining a format model of preliminary reports, and a training and authorizing system for forensic psychiatrists, to standardize preliminary reports and enhance their reliability. In February 2004, the WT conducted a questionnaire survey on the current situation of psychiatry in correctional facilities, targeting doctors with experience working under these circumstances. Fifty-one replies were obtained. Most of the respondents approved of the current system. However, to incite arguments in this area, attempts were made to draw critical responses and discussion by presenting data on the current situation of psychiatric practice in correctional facilities.

Common types of medication errors on long-term psychiatric care units.

OBJECTIVE: This multi-center study identified the most frequent types of medication errors in long-term psychiatric care hospitals. SETTING: Japan. DESIGN AND STUDY PARTICIPANTS: We asked 132 units in 44 Japanese psychiatric hospitals to introduce an in-patient incident reporting system on potential adverse drug events (PADEs) for the period 1 October to 30 November 2000. We analyzed types of PADE, outcomes, and characteristics of patients, staff, and units. RESULTS: We received 221 PADE incident reports from 85 units of 44 hospitals. One-quarter (24.9%) of the incidents were intercepted before reaching patients. The frequency of monitoring of the patients by clinical staff in response to medication errors increased by 8.1%. Wrong drug administration, i.e. giving a drug to a patient that was not the drug prescribed for that patient, was the most common type of incident (35.7%). Logistic regression analysis revealed that wrong drug administration occurred more frequently on units with either fewer registered nurses, or two or more patients with the same (or similar) name staying on the same unit. Incident reporters evaluated wrong drug administration as being potentially more serious than the other types of medication error. Wrong drug administration was seen more frequently in units with no patient name printed on medication drug pouches. CONCLUSIONS: Wrong drug administration was the most common type of PADE, and may result in more serious consequences than others. Even a simple organizational quality improvement effort, in which printed patients' names are placed on the drug pouch (not only with each prescription but with each drug administration), could reduce risk to patients from adverse outcomes due to medication errors.