ABSTRACT
PURPOSE: To aid nurses in dosing sufentanil sublingual tablet (SST) 30 mcg administered via a single-dose applicator, dosing requirements and efficacy of SST 30 mcg were analyzed across age, sex, race, and body mass index subgroups. DESIGN: Patient characteristics were pooled from three postoperative studies (two placebo-controlled and one open-label) and one open-label emergency department study. Drug dosing and efficacy data were pooled from the postoperative studies. METHODS: Efficacy was assessed through summed pain intensity difference to baseline during 12 hours across subgroups. FINDINGS: Mean (standard deviation) drug doses administered from 0 to 12 hours was 3.9 (2.0) for SST 30 mcg and was less frequent for older (≥65 years) versus younger patients. The summed pain intensity difference to baseline during 12 hours was superior with SST 30 mcg versus placebo across all subgroups. CONCLUSIONS: SST 30 mcg is a sublingual opioid analgesic with efficacy across demographic subgroups.
Subject(s)
Acute Pain/drug therapy , Medication Systems, Hospital/standards , Sufentanil/administration & dosage , Administration, Sublingual , Adult , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/therapeutic use , Female , Humans , Male , Medication Systems, Hospital/statistics & numerical data , Middle Aged , Pain Management/methods , Pain Management/standards , Pain Management/statistics & numerical data , Pain Measurement/methods , Sufentanil/therapeutic useABSTRACT
BACKGROUND: We implemented a previously described barcode-based drug safety system in all of our anesthetizing locations. Providers were instructed to scan the barcode on syringes using our Anesthesia Information Management System before drug administration, but the rate of provider adherence was low. We studied an implementation intervention intended to increase the rate of scanning. METHODS: Using our Anesthesia Information Management System and Smart Anesthesia Manager software, we quantified syringe drug administrations by anesthesia providers with and without barcode scanning. We use an anesthesia team model in which an attending anesthesiologist is paired with a certified registered nurse anesthetist (CRNA) or a resident. Our system identified the pair of providers associated with a particular drug administration, but did not distinguish which providers actually administered the drug. Therefore, the rate of barcode scanning for a particular case was assigned to both providers equally. A baseline rate of scanning was established over a period of 17 months. An audit and feedback intervention was then performed that consisted of monthly performance reports sent by email to individual providers along with coffee gift card awards for top performers. The coffee gift cards were awarded in only the first 2 months of the intervention, while the email performance reports continued on a monthly basis. The coffee card awards were made public. The monthly emails reported the individual provider's rank order of performance relative to other providers, but was otherwise anonymous. The baseline rate of scanning was compared to the rate of scanning after the intervention for a period of 7 months. RESULTS: From November 2014 to March 2017, we accumulated 60,197 cases performed by 88 attending anesthesiologists, 65 CRNAs, and 148 residents. The total number of syringe drug administrations was 653,355. Average scanning performance improved from 8.7% of syringe barcodes scanned during the baseline period from November 2014 to February 2016 to 64.4% scanned during the period September 2016 to March 2017 (P < .001). Variation in performance among individuals was marked, ranging from 0% to 100% of syringes scanned. The performance of some individuals showed marked oscillation over time. There was greater variation in performance attributable to residents than in performance attributable to CRNAs. CONCLUSIONS: Feedback of individual provider performance data from the anesthesia information system to providers can be used in conjunction with other measures to improve performance. Despite improved average performance, there was marked variation in performance between individuals, and some individuals had marked oscillation of their performance over time.
Subject(s)
Anesthesiologists/standards , Anesthetics/administration & dosage , Drug Labeling/standards , Formative Feedback , Guideline Adherence/standards , Medication Systems, Hospital/standards , Nurse Anesthetists/standards , Practice Patterns, Nurses'/standards , Practice Patterns, Physicians'/standards , Reward , Anesthesia Department, Hospital/standards , Anesthesiologists/education , Anesthesiologists/psychology , Anesthetics/adverse effects , Attitude of Health Personnel , Health Knowledge, Attitudes, Practice , Humans , Internship and Residency , Medical Audit , Nurse Anesthetists/psychology , Prospective Studies , Quality Improvement/standards , Quality Indicators, Health Care/standardsABSTRACT
OBJECTIVES: To evaluate the return on investment (ROI) and quality improvement after implementation of a centralized automated-dispensing system after 8 years of use. DESIGN: Prospective evaluation of ROI; before and after study to evaluate dispensing errors; user satisfaction questionnaire after 8 years of use. SETTING: The study was conducted at a French teaching hospital in the pharmacy department, which is equipped with decentralized automated medication cabinets in the wards. PARTICIPANTS: Pharmacy staff (technicians and residents). INTERVENTION(S): Implementation of a centralized automated-dispensing robot. MAIN OUTCOME MEASURE(S): The true ROI was prospectively and annually compared to estimated returns calculated after implementation and upgrade of the robot; dispensing errors determined by observation of global deliveries and the satisfaction of users based on a validated questionnaire were evaluated. RESULTS: Following the upgrade, we found little difference for the ROI (+1.86%). The payback period increased by almost 3 years. There was a significant reduction of dispensing errors, from 2.9% to 1.7% (P < 0.001). User satisfaction of the robot by the pharmacy staff was reported (score of 5.52 ± 1.20 out of 7). CONCLUSIONS: These systems are worthwhile investments and largely contribute to improving the quality and safety of the medication process.
Subject(s)
Medication Errors/statistics & numerical data , Medication Systems, Hospital/economics , Medication Systems, Hospital/standards , Robotics/economics , France , Hospitals, Teaching , Humans , Pharmacy Service, Hospital/economics , Pharmacy Service, Hospital/standards , Prospective Studies , Quality Improvement/economics , Robotics/standardsABSTRACT
Medication administration is a critical task of nurses that, if not done appropriately, can lead to fatal errors. New technologies, including barcode medication administration, are intended to decrease medication errors and enhance verification of medication-administration rights. Therefore, in this study, we examined the effect of introducing barcode medication administration on nurses' satisfaction and identified correlates of nurses' satisfaction with barcode medication administration. A descriptive, cross-sectional design using self-reported questionnaires was utilized to recruit 207 nurses from three public hospitals. Participants reported being moderately satisfied with barcode medication administration, especially with its efficacy and safety aspects. Their satisfaction had a significant negative correlation with their age, nursing experience, and experience using barcode medication administration, and a significant positive correlation with barcode medication-administration training satisfaction, computer competence, comfort with using barcode medication administration, and perceived job productivity using barcode medication administration. This study provides important information about Jordanian nurses' satisfaction with barcode medication-administration technology and provides greater understanding of different clinical correlates to barcode medication-administration satisfaction. It is recommended that effective barcode medication-administration training and computer skills training be provided prior to establishing barcode medication administration in hospitals and that the safety features of barcode medication administration be integrated in clinical education and training.
Subject(s)
Medication Systems, Hospital/standards , Nurses/psychology , Personal Satisfaction , Adult , Analysis of Variance , Attitude of Health Personnel , Cross-Sectional Studies , Female , Humans , Male , Medication Errors/prevention & control , Medication Systems, Hospital/statistics & numerical data , Middle Aged , Nurses/statistics & numerical data , Surveys and QuestionnairesABSTRACT
OBJECTIVE: This study describes the development and implementation of a medication safety program for Aboriginal Health Practitioners practising in rural Australia. DESIGN: A two-stage process was used to develop and implement the medication safety program. Initially, a total of eight semi-structured interviews was undertaken with Aboriginal Health Practitioners to identify the main challenges faced while implementing medication safety in the organisation. This was followed by the development of a culturally appropriate medication safety program. SETTING: Aboriginal Community Controlled Health Service. PARTICIPANTS: Aboriginal Health Practitioners. MAIN OUTCOME MEASURE: The participants' knowledge, confidence, behaviour, and utilisation of medication safety developed resources. RESULTS: The development and implementation of the medication safety program in the Aboriginal Community Controlled Health Service consisted of addressing the barriers to medication safety cited by the Aboriginal Health Practitioner from the interviews, providing face-to-face educational sessions and developing a culturally appropriate educational resource to address the identified gaps. The program developed was evaluated by 17 Aboriginal Health Practitioners who took part in the study. The evaluation of Aboriginal Health Practitioners' knowledge, confidence, behaviour, utilisation of the medication safety program and resources was undertaken using an anonymous survey. A total of 31 participants completed the survey: 17 before the training and 14 at 6 months post-training. The data analysis, using t test, revealed a statistically significant change in the Aboriginal Health Practitioners' knowledge, confidence, behaviour and utilisation. CONCLUSION: The success of the implementation of a collaborative medication safety program within the Aboriginal Community Controlled Health Service is dependent on understanding the barriers to medication safety in the workplace associated within the organisation and emphasising a wide culture of patient safety.
Subject(s)
Drug Administration Schedule , Health Services, Indigenous/standards , Medication Systems, Hospital/standards , Patient Safety/standards , Practice Guidelines as Topic , Australia , Humans , Native Hawaiian or Other Pacific Islander , Rural Population , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To provide ICU clinicians with evidence-based guidance on safe medication use practices for the critically ill. DATA SOURCES: PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and ISI Web of Science for relevant material to December 2015. STUDY SELECTION: Based on three key components: 1) environment and patients, 2) the medication use process, and 3) the patient safety surveillance system. The committee collectively developed Population, Intervention, Comparator, Outcome questions and quality of evidence statements pertaining to medication errors and adverse drug events addressing the key components. A total of 34 Population, Intervention, Comparator, Outcome questions, five quality of evidence statements, and one commentary on disclosure was developed. DATA EXTRACTION: Subcommittee members were assigned selected Population, Intervention, Comparator, Outcome questions or quality of evidence statements. Subcommittee members completed their Grading of Recommendations Assessment, Development, and Evaluation of the question with his/her quality of evidence assessment and proposed strength of recommendation, then the draft was reviewed by the relevant subcommittee. The subcommittee collectively reviewed the evidence profiles for each question they developed. After the draft was discussed and approved by the entire committee, then the document was circulated among all members for voting on the quality of evidence and strength of recommendation. DATA SYNTHESIS: The committee followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation system to determine quality of evidence and strength of recommendations. CONCLUSIONS: This guideline evaluates the ICU environment as a risk for medication-related events and the environmental changes that are possible to improve safe medication use. Prevention strategies for medication-related events are reviewed by medication use process node (prescribing, distribution, administration, monitoring). Detailed considerations to an active surveillance system that includes reporting, identification, and evaluation are discussed. Also, highlighted is the need for future research for safe medication practices that is specific to critically ill patients.
Subject(s)
Drug-Related Side Effects and Adverse Reactions/prevention & control , Intensive Care Units/organization & administration , Medication Errors/prevention & control , Medication Systems, Hospital/organization & administration , Body Weights and Measures , Checklist/standards , Clinical Protocols/standards , Decision Support Systems, Clinical/organization & administration , Disclosure , Documentation/standards , Dose-Response Relationship, Drug , Drug Labeling/methods , Electronic Data Processing , Environment , Evidence-Based Practice , Humans , Infusion Pumps , Inservice Training , Intensive Care Units/standards , Intensive Care Units, Pediatric/organization & administration , Medical Order Entry Systems/organization & administration , Medication Reconciliation/organization & administration , Medication Systems, Hospital/standards , Organizational Culture , Patient Care Bundles/standards , Patient Handoff/standards , Patient Participation , Risk Factors , Software DesignABSTRACT
AIM: To explore interruptions during medication preparation and administration and their consequences. BACKGROUND: Although not all interruptions in nursing have a negative impact, interruptions during medication rounds have been associated with medication errors. METHOD: A non-participant observational study was undertaken of nurses conducting medication rounds. RESULTS: Fifty-six medication events (including 101 interruptions) were observed. Most medication events (99%) were interrupted, resulting in nurses stopping medication preparation or administration to address the interruption (mean 2.5 minutes). The mean number of interruptions was 1.79 (SD 1.04). Thirty-four percent of medication events had at least one procedural failure, while 3.6% resulted in a clinical error. CONCLUSIONS: Our study confirmed that interruptions occur frequently during medication preparation and administration, and these interruptions were associated with procedural failures and clinical errors. Nurses were the primary source of interruptions with interruptions often being unrelated to patient care. IMPLICATIONS FOR NURSING MANAGEMENT: This study has confirmed that interruptions are frequent and result in clinical errors and procedural failures, compromising patient safety. These interruptions contribute a substantial additional workload to medication tasks. Various interventions should be implemented to reduce non-patient-related interruptions. Medication systems and procedures are advocated, that reduce the need for joint double-checking of medications, indirectly avoiding interruptions.
Subject(s)
Attention , Medication Errors/nursing , Nurses/psychology , Nurses/standards , Hospitals/standards , Humans , Medication Systems, Hospital/standards , Prospective Studies , Safety Management/methods , Workforce , Workload/standardsABSTRACT
AIM: The aim was to evaluate the impact of staff training and wearing safety vests as a combined intervention on interruptions during medication preparation and double-checking. BACKGROUND: Interruptions and errors during the medication process are common and an important issue for patient safety in the hospital setting. METHODS: We performed a pre- and post-intervention pilot-study using direct structured observation of 26 nurses preparing and double-checking 431 medication doses (225 pre-intervention and 206 post-intervention) for 36 patients (21 pre-intervention and 15 post-intervention). RESULTS: With staff training and the introduction of safety vests, the interruption rate during medication preparation was reduced from 36.8 to 28.3 interruptions per hour and during double-checking from 27.5 to 15 interruptions per hour. CONCLUSION: This pilot-study showed that the frequency of interruptions decreased during the critical tasks of medication preparation and double-checking after the introduction of staff training and wearing safety vests as part of a quality improvement process. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management should acknowledge interruptions as an important factor potentially influencing medication safety. Unnecessary interruptions can be successfully reduced by considering human and system factors and increasing both staff and nursing managers' awareness of 'interruptive communication practices' and implementing physical barriers. This is the first pilot-study specifically evaluating the impact of staff training and wearing safety vests on the reduction of interruptions during medication preparation and double-checking.
Subject(s)
Attention , Drug Compounding/methods , Medication Errors/prevention & control , Nurses/psychology , Workload/standards , Clothing/psychology , Humans , Medication Systems, Hospital/standards , Nurses/trends , Pilot Projects , Quality Improvement , Safety Management/methods , Safety Management/standards , Workload/psychologyABSTRACT
CONTEXT: Alzheimer's disease is a common disease in nursing homes. Evolution is constantly negative and specific treatments, which are only symptomatic, are subject to controversy. In a context of media exposure, the Transparency Committee of the Haute Autorité de santé (HAS) downgraded their medical service in October 2011, seeing it as weak. AIM: Assess the evolution of the consumption of specific treatments for Alzheimer's disease; assess changes in the quality of monitoring in specific consultation. METHODS: This is a retrospective and descriptive study, cross-sectional in three times (T0 January 2011, T1 October 2011 and T2 June 2012), in 6 nursing homes of Lille and its surroundings. RESULTS: In total, 262 residents with dementia and present at least once during the three times of the study were included. Their mean age was 85.8 years. Among them, 40 % had Alzheimer's disease clearly identified. At T0, 76.7 % of patients present who were supposed to receive a specific treatment of Alzheimer's disease were actually receiving such treatment, 73.6 % at T1 and 71.6 % at T2. After 17 months of observation, the discontinuation rate of anticholinesterase was 34 %, 24 % for anti-glutamate. The monitoring in specific consultations decreased slightly between the three stages. CONCLUSION: Our work did not show major impact of the media campaign against specific drugs for Alzheimer's disease. There is however a trend towards a decrease of their consumption in people with dementia living in nursing homes with no obvious link between monitoring in specific consultation and specific prescription. This trend would ask to be confirmed by a study on a larger scale.
Subject(s)
Alzheimer Disease/drug therapy , Drug Prescriptions , Drug-Related Side Effects and Adverse Reactions/prevention & control , Health Promotion , Medication Systems, Hospital/standards , Nursing Homes , Aged , Aged, 80 and over , Alzheimer Disease/epidemiology , Cholinesterase Inhibitors/therapeutic use , Communications Media , Cross-Sectional Studies , Drug Prescriptions/standards , Drug Prescriptions/statistics & numerical data , Drug-Related Side Effects and Adverse Reactions/epidemiology , Excitatory Amino Acid Antagonists/therapeutic use , Female , France/epidemiology , Health Promotion/methods , Homes for the Aged/organization & administration , Homes for the Aged/standards , Humans , Male , Medication Systems, Hospital/organization & administration , Medication Systems, Hospital/statistics & numerical data , Nursing Homes/organization & administration , Nursing Homes/standards , Retrospective StudiesABSTRACT
This article highlights the significance of medication errors, identifying potential issues and support systems required. Medication errors involve different health professionals and present at various stages of the medication cycle. Focusing on a collaborative approach and the role of the nurse is necessary. Special groups, particularly older adults, are considered where multiple conditions and multiple medications increase the risk of adverse drug reactions. Nurses' accountability and their knowledge of medications are taken into account along with the role of nurse educators. Reporting errors is crucial; the culture of the organisation significantly contributes to whether errors are reported. Learning arises from near misses and errors, enabling preventive measures to be put in place. There is a need for a culture of safety within organisations where medication governance promotes patient safety and the provision of high-quality care.
Subject(s)
Drug-Related Side Effects and Adverse Reactions/prevention & control , Medication Errors/prevention & control , Medication Systems, Hospital/standards , Nurse's Role , Patient Safety/standards , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Practice Guidelines as Topic , Risk Management , United KingdomABSTRACT
OBJECTIVE: To assess the impact of investigational drug labels on the risk of medication error in drug dispensing. DESIGN: A simulation-based learning program focusing on investigational drug dispensing was conducted. SETTING: The study was undertaken in an Investigational Drugs Dispensing Unit of a University Hospital of Lyon, France. PARTICIPANTS: Sixty-three pharmacy workers (pharmacists, residents, technicians or students) were enrolled. INTERVENTION: Ten risk factors were selected concerning label information or the risk of confusion with another clinical trial. Each risk factor was scored independently out of 5: the higher the score, the greater the risk of error. From 400 labels analyzed, two groups were selected for the dispensing simulation: 27 labels with high risk (score ≥3) and 27 with low risk (score ≤2). Each question in the learning program was displayed as a simulated clinical trial prescription. MAIN OUTCOME MEASURE: Medication error was defined as at least one erroneous answer (i.e. error in drug dispensing). For each question, response times were collected. RESULTS: High-risk investigational drug labels correlated with medication error and slower response time. Error rates were significantly 5.5-fold higher for high-risk series. Error frequency was not significantly affected by occupational category or experience in clinical trials. CONCLUSIONS: SIMME-CT is the first simulation-based learning tool to focus on investigational drug labels as a risk factor for medication error. SIMME-CT was also used as a training tool for staff involved in clinical research, to develop medication error risk awareness and to validate competence in continuing medical education.
Subject(s)
Drug Labeling/statistics & numerical data , Drugs, Investigational/administration & dosage , Medication Errors/statistics & numerical data , Medication Systems, Hospital/organization & administration , Medication Systems, Hospital/statistics & numerical data , Computer Simulation , France , Hospitals, University , Humans , Medication Systems, Hospital/standards , Pharmacists/statistics & numerical data , Pharmacy Residencies/statistics & numerical data , Pharmacy Technicians/statistics & numerical data , Risk Factors , Students, Pharmacy/statistics & numerical data , Time FactorsABSTRACT
Bar-code medication administration (BCMA) effectiveness is contingent upon compliance with best-practice protocols. We developed a 4-phased BCMA evaluation program to evaluate the degree of integration of current evidence into BCMA policies, procedures, and practices; identify barriers to best-practice BCMA use; and modify BCMA practice in concert with changes to the practice environment. This program provides an infrastructure for frontline nurses to partner with hospital leaders to continually evaluate and improve BCMA using a systematic process.
Subject(s)
Electronic Data Processing/standards , Evidence-Based Practice/standards , Guideline Adherence/standards , Medication Errors/prevention & control , Medication Systems, Hospital/standards , Humans , Organizational Culture , United StatesABSTRACT
The aim of the study is to assess the feasibility of Drugs Rational Usage Guideline System (DRUGS)-supported clinical pathway (CP) for breast carcinoma, cataract, inguinal hernia and 2-diabetes mellitus whether the application of such a system could improve work efficiency, medical safety, and decrease hospital cost. Four kinds of diseases which included 1773 cases (where 901 cases using paper-based clinical pathways and 872 cases using DRUGS-supported clinical pathways) were selected and their demographic and clinical data were collected. The evaluation criteria were length of stay, preoperative length of stay, hospital cost, antibiotics prescribed during hospitalization, unscheduled surgery, complications and prognosis. The median total LOS was 1 to 3 days shorter in the DRUGS-supported CP group as compared to the Paper-based CP group for all types (p < 0.05). Totel hospital cost decreased significantly in the DRUGS-supported CP group than that in Paper-based CP group. About antibiotics prescribed during hospitalization, there were no statistically differences in the time of initial dose of antibiotic and the duration of administration except the choice of antibiotic categories. The proportion of DRUGS-supported clinical pathway conditions where a broad-spectrum antibiotic was prescribed decreased from 63.6 to 34.5 % (p < 0.01) in the Paper-based group. While after the intervention, the differences were statistically not significant in unscheduled surgery, complications and prognosis. In this study, DRUGS-supported clinical pathway for breast carcinoma, cataract, inguinal hernia, 2-diabetes mellitus was smoothly shifted from a paper-based to an electronic system, and confer benefits at the hospital level.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Critical Pathways/organization & administration , Drug Utilization/statistics & numerical data , Efficiency, Organizational , Medication Systems, Hospital/organization & administration , Adult , Aged , Breast Neoplasms/drug therapy , Cataract Extraction/methods , Critical Pathways/standards , Diabetes Mellitus, Type 2/drug therapy , Female , Herniorrhaphy/methods , Hospital Costs/statistics & numerical data , Humans , Length of Stay/statistics & numerical data , Male , Medication Systems, Hospital/standards , Middle Aged , Patient Safety , Practice Guidelines as Topic , Quality Improvement/organization & administration , Software Design , Time FactorsABSTRACT
Purpose - The purpose of this paper is to investigate violations against work standards associated with using a new health information technology (HIT) system. Relevant recommendations for implementing HIT in rural hospitals are provided and discussed to achieve meaningful use. Design/methodology/approach - An observational study is conducted to map medication administration process while using a HIT system in a rural hospital. Follow-up focus groups are held to determine and verify potential adverse factors related to using the HIT system while passing drugs to patients. Findings - A detailed task analysis demonstrated several violations, such as only relying on the barcode scanning system to match up with patient and drugs could potentially result in the medical staff forgetting to provide drug information verbally before administering drugs. There was also a lack of regulated and clear work procedure in using the new HIT system. In addition, the computer system controls and displays could not be adjusted so as to satisfy the users' expectations. Nurses prepared medications and documentation in an environment that was prone to interruptions. Originality/value - Recommendations for implementing a HIT system in rural healthcare facilities can be categorized into five areas: people, tasks, tools, environment, and organization. Detailed remedial measures are provided for achieving continuous process improvements at resource-limited healthcare facilities in rural areas.
Subject(s)
Hospitals, Rural/organization & administration , Medical Informatics Applications , Medication Systems, Hospital/organization & administration , User-Computer Interface , Clinical Protocols , Electronic Data Processing , Environment , Focus Groups , Hospitals, Rural/standards , Humans , Medication Errors/prevention & control , Medication Systems, Hospital/standards , Task Performance and AnalysisABSTRACT
A cold chain is a temperature-controlled supply chain. An unbroken cold chain is an uninterrupted series of storage and distribution activities which maintains a given temperature chain. It can be managed by the Quality Management System. It analyses, measuires, controls, documents the supply of vaccines to the reaching point. As a cold chain handler ANMs play an important role in improving the immunisation coverage. In a study, Samant Y, et al (2007) revealed weaknesses in the cold chain mechanism. Cold chain for the oral polio vaccine (OPV) was not adequately managed at primary and sub-health centres in rural areas. In India, at grass root level ANMs are the key persons, who handle the vaccine and equipment. So it was necessary to assess their knowledge and practices about management of cold chain system. Sufficient cold chain space is available at the district and block level. Some PHCs do not have electrical cold chain equipments. Although the breakdown rate is very low for existing cold chain equipments, yet cold chain management is not followed as per prescribed guidelines. Thus, necessary action can be taken for effective management of cold chain to ensure that the children get potent vaccines and are protected from the vaccine-preventable diseases. The management ofcold chain system is the most important component ofimmunisation on which success ofthe programme depends.
Subject(s)
Drug Storage/standards , Medication Systems, Hospital/standards , Nurse's Role , Poliovirus Vaccine, Oral/chemistry , Practice Guidelines as Topic , Refrigeration/standards , Rural Health Services/standards , Adult , Female , Health Knowledge, Attitudes, Practice , Humans , India , Male , Middle AgedABSTRACT
At Valenciennes general hospital, for some patients, the medicine use pathway is made secure through the use of computer systems which ensure named-patient daily dispensing. Secure cupboards are a complement to this main pathway.
Subject(s)
Medication Systems, Hospital/organization & administration , Medicine Chests , Security Measures/organization & administration , Equipment Design/standards , Humans , Medication Errors/prevention & control , Medication Systems, Hospital/standards , Medicine Chests/standards , Patient Safety/standards , Pharmaceutical PreparationsABSTRACT
BACKGROUND: Many anesthetic drug errors result from vial or syringe swaps. Scanning the barcodes on vials before drug preparation, creating syringe labels that include barcodes, and scanning the syringe label barcodes before drug administration may help to prevent errors. In contrast, making syringe labels by hand that comply with the recommendations of regulatory agencies and standards-setting bodies is tedious and time consuming. A computerized system that uses vial barcodes and generates barcoded syringe labels could address both safety issues and labeling recommendations. METHODS: We measured compliance of syringe labels in multiple operating rooms (ORs) with the recommendations of regulatory agencies and standards-setting bodies before and after the introduction of the Codonics Safe Label System (SLS). The Codonics SLS was then combined with Smart Anesthesia Manager software to create an anesthesia barcode drug administration system, which allowed us to measure the rate of scanning syringe label barcodes at the time of drug administration in 2 cardiothoracic ORs before and after introducing a coffee card incentive. Twelve attending cardiothoracic anesthesiologists and the OR satellite pharmacy participated. RESULTS: The use of the Codonics SLS drug labeling system resulted in >75% compliant syringe labels (95% confidence interval, 75%-98%). All syringe labels made using the Codonics SLS system were compliant. The average rate of scanning barcodes on syringe labels using Smart Anesthesia Manager was 25% (730 of 2976) over 13 weeks but increased to 58% (956 of 1645) over 8 weeks after introduction of a simple (coffee card) incentive (P < 0.001). CONCLUSIONS: An anesthesia barcode drug administration system resulted in a moderate rate of scanning syringe label barcodes at the time of drug administration. Further, adaptation of the system will be required to achieve a higher utilization rate.
Subject(s)
Anesthesia Department, Hospital , Anesthesia , Anesthetics/administration & dosage , Drug Labeling/instrumentation , Medication Errors/prevention & control , Medication Systems, Hospital , Pharmacy Service, Hospital , Anesthesia/adverse effects , Anesthesia/methods , Anesthesia/standards , Anesthesia Department, Hospital/methods , Anesthesia Department, Hospital/standards , Anesthetics/adverse effects , Anesthetics/standards , Drug Labeling/methods , Drug Labeling/standards , Equipment Design , Equipment Failure , Guideline Adherence , Humans , Materials Testing , Medication Systems, Hospital/standards , Pharmacy Service, Hospital/methods , Pharmacy Service, Hospital/standards , Practice Guidelines as Topic , Software Design , Treatment OutcomeABSTRACT
BACKGROUND: Random safety audits (RSA) are a safety tool enabling prevention of adverse events, but they have not been widely used in hospitals. The aim of this study was to use RSAs to assess and compare the frequency of appropriate use of infusion pump safety systems in a Neonatal Intensive Care Unit (NICU) before and after quality improvement interventions and to analyse the intravenous medication programming data. METHODS: Prospective, observational study comparing the frequency of appropriate use of Alaris® CC smart pumps through RSAs over two periods, from 1 January to 31 December 2012 and from 1 November 2014 to 31 January 2015. Appropriate use was defined as all evaluated variables being correctly programmed into the same device. Between the two periods they were established interventions to improve the use of pumps. The information recorded at the pumps with the new security system, also extracted for one year. RESULTS: Fifty-two measurements were collected during the first period and 160 measurements during the second period. The frequency of appropriate use was 73.13 % (117/160) in the second period versus 0 % (0/52) in the first period (p < 0.0001). Information was recorded on 44,924 infusions; in 46.03 % (20,680/44,924) of cases the drug name was recorded. In 2.5 % (532/20,680) of cases there was an attempt to exceed the absolute limit. CONCLUSIONS: Random Safety Audits were a very useful tool for detecting inappropriate use of pumps in the NICU. The improvement strategies were effective for improving appropriate use and programming of the intravenous medication infusion pumps in our NICU.
Subject(s)
Infusion Pumps , Intensive Care Units, Neonatal/standards , Medical Audit , Patient Safety/standards , Humans , Infant, Newborn , Medication Systems, Hospital/standards , Prospective Studies , Quality Improvement , Safety ManagementABSTRACT
QUALITY ISSUE: Omitting time-critical medications leads to delays in treatment and may result in patient harm. INITIAL ASSESSMENT: Published studies show that omission of prescribed medication doses is common. Although most are inconsequential, up to 86% of omitted medications place patients at some risk of harm. SOLUTION: Funding was obtained to develop a medication safety package to facilitate decreasing omitted dose incidents by audit, education and feedback. IMPLEMENTATION: A panel of nursing and pharmacy hospital staff in Victoria, Australia, reviewed existing audit tools and published studies to develop a critical medication list and audit tool. The tool, definitions and instructions were tested in 11 rural, urban and teaching hospitals. Qualitative feedback was sought to refine the tool using a Plan-Do-Study-Act model. An educational presentation was developed using reported incidents. EVALUATION: Staff in 11 hospitals tested the audit tool in 321 patients receiving 17 361 doses of medication. Feedback indicated audit data were useful for informing improvements in practice and for accreditation. The educational material consists of the User Guide, plus a presentation for nursing staff illustrated by six cases with questions, with instructions on how to decrease harm from omitted doses by ensuring correct documentation and prioritising time-critical medications. LESSONS LEARNED: A medication safety package using standard definitions and a critical medication list was successfully tested. It is now used by nursing and pharmacy staff across the state. Several interstate hospitals are using the tools as part of their hospital medication safety programmes.
Subject(s)
Drug Packaging/methods , Medication Errors/prevention & control , Medication Systems, Hospital/organization & administration , Patient Harm/prevention & control , Risk Management/organization & administration , Hospital Administration , Humans , Inpatients , Medication Systems, Hospital/standards , Quality Improvement , Residence Characteristics , Time Factors , VictoriaABSTRACT
Oxytocin infusion used in labour can sometimes be left hung on the stand for many hours. There has been no study to determine if oxytocin is equally distributed throughout the infusion bag and if the distribution stays the same with time. We postulated that there may be settling of the molecules such that oxytocin concentrates at the bottom of the infusion bag. Eight infusion bags were prepared by mixing 10 IU of oxytocin in 1 litre of normal saline. The infusion bags were hung on infusion stands for 8 hours after which 10 samples of 100 mls of the solution from each bag were taken in different containers and the concentration of oxytocin calculated using oxytocin specific Enzyme Immunoassay (EIA) in the different samples. No statistically significant correlation between the oxytocin concentration and the sample number was observed (p-value = 0.738). There was no obvious relationship between oxytocin concentration and the sample number in each bag. There was no evidence to suggest that a linear oxytocin concentration gradient develops in a bag of normal saline over an 8-hour period. In fact the distribution appears to be random and unequal.