Dispensing errors from look-alike drug trade names.

OBJECTIVES: To improve patient safety, we investigated near-miss dispensing errors in our hospital and evaluated the effectiveness of specific preventive strategies. METHODS: The incidence and type of near-miss dispensing errors in a single hospital in Taiwan were identified in 2013. The causes of dispensing errors were analysed by consensus of an expert panel comprising a senior pharmacist on duty, a group leader in the pharmacy and an author. Because alphabetical trade names were routinely used in our pharmacy, they were used for similarity analysis. Trigram-2b and normalised edit distance (NED) were used to calculate orthographic similarity and distance measure, respectively. The correlation between drug-name confusion and dispensing errors was then studied. Preventive strategies, including the introduction of tall man letters, were completed at the end of 2013, and error data were then recollected in 2014. Differences between before and after the interventions were examined by t-test. RESULTS: Before the intervention, look-alike alphabetical names were the main cause of dispensing wrong medicine (134/202, 66.3%). The frequency of near-miss dispensing errors correlated significantly with drug-name similarity (p<0.01). After implementation of preventive strategies, dispensing errors due to drug-name confusion were reduced significantly (77/140, 55.0%, p=0.004). CONCLUSIONS: The frequency of near-miss drug dispensing errors correlated with greater similarity or lower NED scores, and dispensing errors related to drug-name confusion were significantly reduced by our interventions. However, other dispensing errors might need to be investigated in order to prevent them.

Comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after hip fracture repair.

OBJECTIVE: To examine differences in rehabilitation outcomes across 3 post-acute care (PAC) rehabilitation settings for patients after hip fracture repair. DESIGN: Prospective, observational cohort study. SETTING: Six skilled nursing facilities (SNFs), 4 inpatient rehabilitation facilities (IRFs), and 8 home health agencies (HHAs) in 10 states. PARTICIPANTS: Patients (N=181) receiving PAC rehabilitation following hip fracture with internal fixation (n=116) or total hip replacement (n=64), or no surgical intervention (n=1). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Self-care and mobility status at PAC discharge measured by the Inpatient Rehabilitation Facility Patient Assessment Instrument. RESULTS: IRF and HHA patients had lower self-care function at discharge relative to SNF patients controlling for patient characteristics, severity, comorbidities, and services. Adding length of stay (LOS) resulted in nonsignificant differences between IRFs and SNFs. In contrast, there was no setting-specific advantage in discharge mobility for patients with or without the addition of LOS. The average LOS of HHA patients was 2 weeks longer than that of SNF patients, whose average LOS was 9 days longer than that of IRF patients (average, 15d). IRF and SNF patients received about the same total minutes of therapy over their PAC stays (∼2100min on average), whereas HHA patients received only approximately 25% as many minutes. CONCLUSIONS: Setting-specific effects varied depending on whether self-care or mobility was the outcome of focus. It remains unclear to what extent rehabilitation intensity or natural recovery effects changes in functional status for patients with hip fracture. This study points to important directions for PAC setting comparative effectiveness studies in the future, including uniform measurement, limited consensus on factors affecting recovery, accounting for selection bias, and using end-point data collection that is at the same follow-up time periods for all settings.

A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery.

OBJECTIVE: To examine differences in outcomes of patients after lower-extremity joint replacement across 3 post-acute care (PAC) rehabilitation settings. DESIGN: Prospective observational cohort study. SETTING: Skilled nursing facilities (SNFs; n=5), inpatient rehabilitation facilities (IRFs; n=4), and home health agencies (HHAs; n=6) from 11 states. PARTICIPANTS: Patients with total knee (n=146) or total hip replacement (n=84) not related to traumatic injury. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Self-care and mobility status at PAC discharge measured by using the Inpatient Rehabilitation Facility Patient Assessment Instrument. RESULTS: Based on our study sample, HHA patients were significantly less dependent than SNF and IRF patients at admission and discharge in self-care and mobility. IRF and SNF patients had similar mobility levels at admission and discharge and similar self-care at admission, but SNF patients were more independent in self-care at discharge. After controlling for differences in patient severity and length of stay in multivariate analyses, HHA setting was not a significant predictor of self-care discharge status, suggesting that HHA patients were less medically complex than SNF and IRF patients. IRF patients were more dependent in discharge self-care even after controlling for severity. For the full discharge mobility regression model, urinary incontinence was the only significant covariate. CONCLUSIONS: For the patients in our U.S.-based study, direct discharge to home with home care was the optimal strategy for patients after total joint replacement surgery who were healthy and had social support. For sicker patients, availability of 24-hour medical and nursing care may be needed, but intensive therapy services did not seem to provide additional improvement in functional recovery in these patients.

Functional reorganization of upper-body movement after spinal cord injury.

Survivors of spinal cord injury need to reorganize their residual body movements for interacting with assistive devices and performing activities that used to be easy and natural. To investigate movement reorganization, we asked subjects with high-level spinal cord injury (SCI) and unimpaired subjects to control a cursor on a screen by performing upper-body motions. While this task would be normally accomplished by operating a computer mouse, here shoulder motions were mapped into the cursor position. Both the control and the SCI subjects were rapidly able to reorganize their movements and to successfully control the cursor. The majority of the subjects in both groups were successful in reducing the movements that were not effective at producing cursor motions. This is inconsistent with the hypothesis that the control system is merely concerned with the accurate acquisition of the targets and is unconcerned with motions that are not relevant to this goal. In contrast, our findings suggest that subjects can learn to reorganize coordination so as to increase the correspondence between the subspace of their upper-body motions with the plane in which the controlled cursor moves. This is effectively equivalent to constructing an inverse internal model of the map from body motions to cursor motions, established by the experiment. These results are relevant to the development of interfaces for assistive devices that optimize the use of residual voluntary control and enhance the learning process in disabled users, searching for an easily learnable map between their body motor space and control space of the device.

Functional reorganization of upper-body movements for wheelchair control.

In general, survivors of neuromotor disorders and injuries need to reorganize their body movements in order to achieve goals that used to be easy and natural. Often, disabled people are offered the option to control assistive devices that will facilitate the recovery of independence and capability in their daily lives. The knowledge acquired during the last few years in the motor control field can be used to study and enhance this learning process. Furthermore, this knowledge may aid in finding methods for optimizing the use of residual voluntary muscular control in disabled users and searching for an easily learnable map between body motor space and devices control space. To investigate movement reorganization we asked healthy subjects to control a cursor performing a reaching task using shoulders and upper arm movements. These movements were mapped to a lower dimensional space by principal components analysis and were used to control the cursor. We found that all subjects were able to learn to control the cursor with ease and precision while reducing the proportion of ineffective body movement components in favor of the components that mapped directly into the control space. Moreover, with practice the movements of the controlled device - the cursor - became faster, smother, more precise and with a nearly symmetric speed profile.