Medication error reporting: a survey of nursing staff.

The objective of this article is to describe findings from a medication error (ME) survey, to estimate the extent of ME underreporting by comparison of survey results with written incident reports (IRs), and to determine factors associated with IR reporting of MEs. Participants were registered nurses from the 38-bed infant unit of a pediatric hospital. Most recent ME in each of four stages of the medication process was classified as to: timing, nature, whether the error was prevented from the patient, patient injury, and completed IR. Surveys were administered to nurses during mandatory skills session and were compared with IRs for MEs for the previous 6 months. The survey response rate was 93.5 percent; 72 nurses described 177 errors, 40.3 percent observed an ME in the previous week, 62.1 percent were prevented from reaching the patient and the likelihood of prevention was reduced in the later stages of the medication process. About 30 percent of MEs resulted in IRs. Administration errors were more likely to result in IRs compared with ordering errors, especially when the error was not prevented from the patient. There were 51 IRs for MEs. A multivariate logistic regression with completed IRs as the dependent variable showed a decreased likelihood of IRs for ordering than administration errors. IRs were more likely for wrong medication or dose errors and IRs were less likely for errors prevented from reaching the patient. The study found that by augmenting IR reporting of MEs and classifying errors by stage, anonymous ME surveys can be used for monitoring and guiding improvements to hospital medication systems.

Reducing medication errors in hospitals: a peer review organization collaboration.

BACKGROUND: Motivated by published reports of the incidence, costs, causes, and nature of adverse drug events (ADEs) in hospitalized patients, in 1997 the Medicare peer review organization for Nevada and Utah initiated a voluntary project of medication error reduction for Utah hospitals. METHODS: Through project activities, hospital teams were encouraged to make changes to their medication processes based on direct evaluation of medication systems characteristics, informed by ergonomic principles and published studies of medication errors. Assessment of project effects included an evaluation of the changes implemented and results from an anonymous medication errors survey of clinical staff from participating organizations. RESULTS: Thirteen of the 39 acute care hospitals in Utah participated in 1997-1998 in the collaborative project. Participants reported substantive medication system changes that were expected to result in improved patient safety. Baseline and follow-up survey data were available for 8 of the participating hospitals. Analysis of 560 responses showed a 26.9% decrease in overall error frequency, a 12.5% increase in error detection and prevention, and a 24.1% increase in formal written reporting of errors that reached the patient. CONCLUSIONS: This project demonstrated community interest in a proactive and collaborative approach to improving patient safety. The improvement efforts were substantive and sustainable. Survey results suggest that the changes implemented in participating organizations may have reduced medication errors and improved capacity for error detection and prevention.

Sepsis evaluations in hospitalized infants with bronchiolitis.

OBJECTIVES: To define variation in the decision to perform a sepsis evaluation in hospitalized infants with bronchiolitis, to define predictors of the decision and to measure the clinical and cost outcomes. METHODS: Retrospective chart review of all nonintensive care unit infants < or = 60 days with any discharge diagnosis of bronchiolitis (n = 282 from 1993 to 1995 in a 232-bed pediatric hospital. Process variables included temperature at sepsis work-up or Tmax if no sepsis workup. Outcome variables were charges, length of stay, sepsis workup and serious bacterial infection. RESULTS: There was no difference in mean temperature between groups with or without sepsis evaluation (38.1 degrees C, P = 0.75). Of 282 infants 140 had a sepsis workup; 5 (1.8%) had serious bacterial infection. Infants with sepsis workup had an average total charge of $4507 and length of stay of 3.4 days compared with $2998 and 2.8 days for those without (P = 0.0001 and P = 0.002, respectively). A multivariate logistic regression model was constructed with sepsis workup as the dichotomous dependent variable. Significant (P < or = 0.05) predictor variables with a positive coefficient were: higher bronchiolitis score and normal chest roentgenogram. Significant variables with a negative coefficient were: admission diagnosis of bronchiolitis, chest roentgenogram typical for bronchiolitis and age > 28 days. CONCLUSIONS: Temperature was not a predictor of sepsis evaluation. Infants with respiratory distress and normal chest roentgenogram were more likely to receive sepsis evaluations; those with recognized typical bronchiolitis and those > 28 days of age were less likely. Risk of serious bacterial infection is low; the costs of a sepsis evaluation outweigh the benefits in infants with obvious bronchiolitis.

Cytoskeletal structures and oligodendroglial differentiation in C-6 glial cells.

The relationship of the cytoskeleton to a biochemical expression of oligodendroglial differentiation was studied in cultured C-6 glial cells. Specifically, we investigated the effect of the cytoskeletal perturbants, colchicine and cytochalasin D, on the induction of the oligodendroglial marker enzyme, 2',3'-cyclic nucleotide 3'-phosphohydrolase (CNP), caused by removal of serum from the culture medium. Each drug inhibited CNP induction in a concentration-dependent manner, and essentially complete inhibition of induction was observed with 0.25 microM colchicine or 2.0 microM cytochalasin D. Detailed study of the effect of colchicine was carried out. This antimicrotubular agent not only totally prevented induction if added at the onset of serum removal, but also prevented further induction when added at various times after serum removal. That the effect of colchicine related to the drug's effect on microtubules was supported by the demonstration that lumicolchicine, a colchicine isomer which has no effect on microtubules, had no effect on the CNP induction. Moreover, colchicine, but not lumicolchicine, prevented the morphological signs of differentiation provoked by serum removal. The effect of colchicine was reversible and relatively specific. Thus, no concomitant effect of colchicine on the activity of another plasma membrane enzyme of C-6 cells, i.e., (Na+ + K+)-activated ATPase, or on the rate of incorporation of [3H]leucine into total protein of intact cells could be discerned. The possibility that the site of the effect of colchicine is on intracellular events was suggested by the observation that the drug inhibited the induction of CNP by dibutyryl cyclic AMP. The data suggest that the cytoskeleton is involved in oligodendroglial differentiation.