Linguistic Analysis of Generic-Generic Drug Name Pairs Prone to Wrong-Drug Errors for which Tall-Man Lettering is Recommended.

OBJECTIVE: The Institute for Safe Medication Practices (ISMP) and the United States Food and Drug Administration (FDA) disseminated widely used lists of drug name pairs involved in wrong-drug errors, for which they recommended tall-man lettering (TML). Linguistic similarity is believed responsible for confusion of these drugs. This study aims to quantify linguistic similarity and other linguistic properties of these generic-generic name pairs. METHODS: The FDA's Phonetic and Orthographic Computer Analysis (POCA) software was used to generate numerical similarity scores for the generic-generic name pairs on these lists and to identify conflicts between these names and the names of other marketed products. Within each pair, differences in name length and the number of identical prefix (initial) letters and suffix (final) letters were determined. RESULTS: The selected pairs shared a mean of 2.5 (± 1.8) identical prefix letters and 3.2 (± 2.9) identical suffix letters. The mean POCA score 69.5 (± 9.7), indicated moderate-to-high similarity. POCA scores for individual pairs ranged from 90 (most similar) to 46 (least similar). Individual names averaged 11.2 (± 9.1) high-similarity conflicts with names of other marketed drugs. CONCLUSIONS: POCA analysis could be a valuable tool in determining whether linguistic similarity contributes to specific wrong-drug errors. The finding of 11.2 (± 9.1) high-similarity conflicts with names of other marketed drugs is more than for candidate names USAN accepts and suggests the names on the FDA and ISMP lists are linguistically problematic.

Cardiovascular Drug Administration Errors During Neuraxial Anesthesia or Analgesia-A Narrative Review.

The prevalence and harm associated with inadvertent neuraxial cardiovascular (CV) medication administration errors are unknown. This review aims to analyze neuraxial CV drug administration errors and associated clinical consequences. The secondary objective is to identify the causes and contributory factors in order to prevent future incidents. The author reviewed reports of accidental administration of CV medications via neuraxial routes during spinal or epidural anesthesia or analgesia published in the last 5 decades (1972-2022). Twenty-seven publications reported neuraxial administration of 10 different CV drugs among patients aged 1 to 81. Seventeen of the 33 errors occurred via the epidural route. Digoxin (9 patients), ephedrine (6), metaraminol (4), labetalol (4), and dopamine (3) were frequently involved in the incidents. Intrathecal digoxin (8 patients) was associated with paraplegia and encephalopathy, of whom 4 pregnant women scheduled for elective cesarean delivery sustained permanent lower limb neurologic deficits. Reversible systemic hemodynamic changes were predominant following the administration of epidural inotropes (dobutamine, dopamine, and epinephrine) and vasopressors (ephedrine and metaraminol). Most administrations (30 out of 32) were only bolus injections. All were preventable skill-based errors. The human factor analysis classification system (HFACS) identified poor organizational climate, inadequate supervision of junior doctors, deficiencies in neuraxial task processes, and incorrect visual perception of objects. The HFACS suggests CV medication safety strategies should include better education and training of junior doctors, modifications in neuraxial anesthesia practices, and careful handling of the CV drug ampoules and syringes.

Medicines management for nurses: explaining legal governance.

There are multiple acts of law and case law that govern UK prescribing practice. This article examines three important topics for nurses: the classification and prescribing of controlled drugs, including the meaning of medicine classes and schedules; the prescribing of unlicensed medicines, including the difference between unlicensed and off-license medicines; and negligence in prescribing practice. The article outlines the acts of law that are relevant to each topic and provides examples of significant case law or other legal rulings to demonstrate how the law is relevant to nurses' clinical practice.

Assessment of Medication Errors Among Anesthesia Clinicians in Saudi Arabia: A Cross-Sectional Survey Study.

Introduction: Anesthetic drugs are prepared and administrated without referral to the pharmacy or other medical departments. We aimed to assess the occurrence of anesthetic drug errors in Saudi Arabia. We also determined the contributing factors, reporting strategies, and clinicians' opinions of the preventive measures. Methods: We conducted a cross-sectional web-based survey study using a validated tool. A total of 300 anesthesia clinicians completed the survey (146 anesthesiologists and 154 anesthesia technology specialists). We measured descriptive statistics to describe the demographic characteristics and performed inferential statistics to examine associations and differences. Results: Sixty-nine percent of respondents had experienced an anesthetic drug error at least once in their career. The two primary factors that caused drug errors were haste (60.3%) and heavy workload (60.3%). On syringe labeling, 56.3% withdrew the drug then labeled the syringe, and 43.7% labeled the syringe then withdrew the drug. The chi-square test revealed that clinicians who labeled the syringe first then withdrew the drug made errors more frequently (p = 0.036). The test also showed that clinicians with less experience had committed more errors (p = 0.015). On reporting drug errors, 77.7% of respondents identified the fear of medicolegal issues as the most common barrier to reporting errors. Respondents believed that double-checking the medication and color-coded syringe labels were the most effective strategies to reduce errors (82% and 64%, respectively). The Mann-Whiney U test revealed significant differences between the two specialties about their opinions of the preventive measures. Conclusions: There was a high occurrence rate of anesthetic drug errors in Saudi Arabia. Policymakers need to unify the syringe-labeling practice, and future research needs to focus on what makes a nonpunitive culture to encourage reporting errors.

Medication error trends in Middle Eastern countries: A systematic review on healthcare services.

Medication errors (MEs) are a critical worldwide concern and can cause genuine clinical ramifications for patients. Studies concerning such errors have not been undertaken as much in the Middle Eastern region. The aim of this study was to systematically review and identify studies done in the Middle Eastern nations to recognize the principle contributory factors included and to estimate the prevalence in the region. A review of the retrospective, prospective, cohort, and case-control studies based on MEs in the Middle Eastern nations was directed in January 2020 utilizing the accompanying databases: Embase, Medline, PubMed, Ebsco, Cochrane, Scopus, and Prospero. The search methodology incorporated all ages and in English only dating back to 2010. The search methodology included articles about MEs in the Middle East with errors in people of all ages, articles in English, and articles dating back to 2010. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses appraisal instrument was used to assess the quality of the included articles. Individual data extraction, pooled analysis, and the accompanying databases were used for data analysis of the MEs in eligible studies. Fifteen of the 18 articles reviewed from four Middle Eastern countries had low risk of bias, while three out of 18 had medium risk of bias. A total of 58,221 reported people were studied, with a total of 34,730.9 reported MEs. The pooled analysis showed that numbers of errors were mainly prescribing errors (n = 22,715.25), general prescription errors (n = 8097.16), and commission errors (n = 158.2). Iran had the highest rate amid the reported administration errors, at 25.07% (599.11/2388.9). Measuring a patient's clinical laboratory values was another less common type of prescription ME. Lebanon reported to have the highest monitoring errors, with a rate of 13.13% (277.91/2117). A negative trend was shown in the amount of MEs in the vast majority of the nations under the examination. The under-reporting or uncertain information recommended that significan changes are needed in the healthcare sector. There is solid need of literature on healthcare services in the region to completely understand and address the MEs and issues.

Pediatric Medication Errors and Reduction Strategies in the Perioperative Period.

Anesthesia providers are regularly responsible for assessing, diagnosing, and determining pharmacologic treatment of a problem. This critical workflow often includes medication preparation. Decision making in anesthesia frequently requires rapid intervention, and caring for the pediatric population poses additional challenges, such as needing to quickly calculate the weight-based dosing of medications. The objective of this review article was to identify and describe themes related to pediatric medication errors associated with anesthesia. Additional goals of the review consisted of identifying and comparing various error reduction strategies with a primary goal of communicating the most effective methods to reduce medication errors in the pediatric population. Screening criteria were set, and 17 published scholarly articles meeting inclusion criteria were evaluated using a systematic process. Common themes found leading to medication errors were incorrect dosing, incorrect medication, syringe swap, wrong patient, and wrong dosing interval. The most valuable and sustainable error reduction strategies found were standardized labeling, prefilled syringes, and 2-person medication checks. It is believed that this review will expound on the factors that can be controlled or minimized to decrease the incidence of anesthesia-related pediatric medication errors and facilitate implementation of risk mitigation strategies immediately into clinical practice.

Examining the effect of an education intervention on nurses' medicines management knowledge.

BACKGROUND: Suboptimal medicines management due to inadequate knowledge can cause risks to patient safety and affect the quality of care and patient outcomes. AIM: To examine the effect of an educational programme on nurses' knowledge of medicines management. METHOD: A pre and post-design was used to evaluate the effectiveness of an educational medicines management programme. Data were collected from nurses before and after programme participation from September 2016 to June 2018. A total of 99 nurses received a multiple-choice questionnaire before and after the programme to assess for changes in their knowledge. Any changes in test performance following the medicines management programme were quantified and tested using McNemar's test and the generalised estimating equation for binary outcomes. The Chi-square test was used to analyse group differences. RESULTS: The nurses' scores were significantly improved after the medicines management programme on questions regarding documentation, observation, aseptic technique and pharmacology half-life. There was a significant improvement on one of the five questions relating to medicine calculation when converting doses from milligrams to grams. CONCLUSION: A mandatory hospital medicines management programme had some effect on increasing nurses' knowledge. However, it also was also found that the programme content could have been improved, particularly regarding nurses' responsibilities for medicines management at patient discharge and documentation when undertaking generic substitution.

Minimising prescription errors-a quality improvement project in the ophthalmology department in a tertiary referral hospital.

PURPOSE: The aim of this quality improvement project was to look into the hospital prescriptions and to identify and record the type and number of errors, to implement measures to reduce the risk of these errors and then to reaudit to assess the impact of changes implemented. METHODS: The initial audit was conducted prospectively over a eleven-week period. Prescriptions written by doctors of all grades and members of the staff, such as optometrists and nurses, were analysed. A glaucoma prescription guide along with more training at prescribing for doctors was introduced with a view to reducing these errors. A reaudit later demonstrated a significant reduction in these errors. RESULTS: After the introduction of a glaucoma prescription guide and more training for all grades of staff members, prescription errors reduced to 73/2342 (3.1%). Reaudit showed a reduction in both prescription writing errors 50/73(68.4%) and drug-related errors 23/73(31.6%). CONCLUSION: Prescription errors are avoidable. This audit demonstrated that providing an accessible, easy to read and understand glaucoma prescription guide in the outpatient department along with targeted training for medical staff in prescribing can help in minimising these errors and can lead to safer practice.

Using change management to implement barcode medicines administration technology.

Confirming the patient's identity is one of the most important elements in medicines administration, with research showing that medication errors are one of the most common sources of harm caused to patients. This article discusses the implementation of a barcode medicines administration system using two change management models. A complex project such as the implementation of barcode medicines administration technology, requires staff engagement at all levels. The adoption rates of the new workflow patterns in this project showed the benefits of using various change management models during different phases of a project. The project also demonstrated how nurse leaders must use a range of resources to effectively implement a new project.

Patient safety incidents and medication errors during a clinical trial: experience from a pre-hospital randomized controlled trial of emergency medication administration.

AIM: To assess and evaluate patient safety incidents and in particular, medication errors, during a large multi-center pre-hospital trial of emergency therapy (PARAMEDIC2), in order to inform and improve future pre-hospital medicines trials. METHODS: The PARAMEDIC2 trial was undertaken across five NHS Ambulance Services in England and Wales with randomisation between December 2014 and October 2017. Patients with an out -of-hospital cardiac arrest unresponsive to initial resuscitation were randomly assigned to 1 mg intravenous adrenaline or matching placebo. Records were reviewed to identify trial medication errors involving documentation and/or clinical protocol errors occurring in trial participants. Causes of medication errors, including root cause analysis where available, were reviewed to identify patterns and themes contributing to these errors. RESULTS: Eight thousand sixteen patients were enrolled, of whom 4902 received trial medication. A total of 331 patient safety incidents was reported, involving 295 patients, representing an overall rate of 3.6% of these, 166 (50.2%) were documentation errors while 165 (49.8%) were clinical protocol/medication errors. An overall rate of 0-4.5% was reported across all five ambulance services, with a mean of 2.0%. These errors had no impact on patient care or the trial and were all resolved CONCLUSION: The overall medication error rate of 1.8% primarily consisted of administration of open-label adrenaline and confusion with trial medication packs. A similar number of patients had documentation errors. This study is the first to provide data on patient safety incidents relating to medication errors encountered during a pre-hospital trial of emergency medication administration and will provide supporting data for planning future trials in this area.

Out of sight: a lesson in drug errors.

A 76-year-old man developed recurrent encephalopathy, visual disturbance, myoclonus, generalised seizures and atonic drop attacks on a background of a gastrectomy for adenocarcinoma and stable chronic lymphocytic leukaemia. He presented to three different hospitals and was admitted twice, with normal investigations. His symptoms transiently improved during each admission (and with starting levetiracetam) but recurred each time on hospital discharge. Subsequent careful inspection of his medication box identified that his community pharmacy had in error been dispensing baclofen 80 mg per day instead of his prescribed Buscopan 80 mg per day. This case highlights the importance of physically inspecting a patient's medications and emphasises the spectrum of baclofen-related toxicity; it also highlights potential deficiencies in the pharmacy dispensary process and the need for multiple checks by patients and professionals.

Deprescribing in older people.

Polypharmacy and multimorbidity are both currently rising. The number of medicines taken is the single biggest predictor of adverse drug events. Deprescribing is an approach to managing polypharmacy and reducing adverse outcomes. Multiple international evidence-based guidelines are emerging to promote discontinuation of high-risk medications, and use of alternative medical and non-pharmacological management. This review outlines the evidence base behind deprescribing, and suggests some pragmatic approaches to decision making around medication review.

A process for supporting children's nurses after medication errors.

Preventable medication-related incidents are a reality during an inpatient stay. While most incidents are intercepted, some reach the patient and can result in varying degrees of harm. This article reports on a quality improvement project aimed at improving the process of supporting nurses after medication-related incidents have occurred on a paediatric intensive care unit. The process provides a robust system for all involved and recognises the importance of patient safety. It has been well received by the managers using it and the nurses who were supported through the process. It is now embedded in practice and is perceived by staff to be fair and proportionate.

How to undertake intravenous infusion calculations.

RATIONALE AND KEY POINTS: This article provides a step-wise, practical approach to undertaking intravenous (IV) infusion calculations. It also explores the evidence base behind medication errors in relation to calculations. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of.

Exploring the common prescribing errors that occur in the emergency department.

BACKGROUND: Prescribing errors are a subset of medication errors that occur on the forms used to prescribe medicines for patients. On their discharge from the emergency department (ED), many patients are given a prescription form to obtain medicines from their local community pharmacist. On the identification of a prescribing error, the patient is sent back to the ED because the medicine cannot be dispensed. AIM: To identify the most common prescribing errors on prescriptions returned to one large inner-city ED in South Wales from community pharmacies. METHOD: Prescriptions that were returned to the ED over a six-week period from September and October 2016 were analysed to determine the types of prescribing errors that occurred and their frequency. RESULTS: A total of 10,218 patients attended the ED over the six-week period, of which 7,731 patients were seen by a clinician and discharged home. Of these, 322 patients were discharged with a prescription, and 20 (6%) of these patients returned to the ED with a prescribing error that prevented the pharmacist from dispensing the medicines. The most common prescribing error was incorrect or missing prescriber information. CONCLUSION: This study identified that there was a low rate of prescribing errors in the ED, and this was comparable with the rate of prescribing errors identified in the literature. Common prescribing errors could be mitigated through the introduction of electronic prescribing in the ED.

How to undertake oral medicines calculations.

RATIONALE AND KEY POINTS: This article provides a step-wise, practical approach to undertaking oral medicines calculations for tablets, capsules and liquid preparations. It also explores the evidence base behind medication errors in relation to calculations. • Medication errors have been identified as one of the most frequent types of patient safety incident that occur, and they are the most common, single preventable cause of adverse events.• Undertaking a medicines calculation can reduce the risk of an incorrect medicines dose being administered to the patient, which would result in a suboptimal therapeutic benefit or possible harm to the patient.• Nurses must ensure that they practise undertaking medicines calculations, while healthcare organisations have an important role in ensuring this skill is developed and maintained among their staff. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might improve your practice when undertaking oral medicines calculations.2. How you could use this information to educate nursing students or your colleagues on the appropriate methods for undertaking oral medicines calculations.

Reducing interruptions during medication preparation and administration.

PURPOSE: According to literature, interruptions during drug administration lead to a significant proportion of medication errors. Evidence on the effectiveness of interventions to reduce interruption is still limited. The purpose of this paper is to explore main reasons for interruptions during drug administration rounds in a geriatric ward of an Italian secondary hospital and test the effectiveness of a combined intervention. DESIGN/METHODOLOGY/APPROACH: This is a pre and post-intervention observational study based on direct observation. All nurse staff (24) participated to the study that lead to observe a total of 44 drug dispensing rounds with 945 drugs administered to 491 patients in T0 and 994 drugs to 506 patients in T1. FINDINGS: A significant reduction of raw number of interruptions (mean per round from 17.31 in T0 to 9.09 in T1, p<0.01), interruptions/patient rate (from 0.78 in T0 to 0.40 in T1, p<0.01) and interruptions/drugs rate (from 0.44 in T0 to 0.22 in T1, p<0.01) were observed. Needs for further improvements were elicited (e.g. a greater involvement of support staff). PRACTICAL IMPLICATIONS: Nurse staff should be adequately trained on the risks related to interruptions during drug administration since routine activity is at high risk of distractions due to its repetitive and skill-based nature. ORIGINALITY/VALUE: A strong involvement of both MB and leadership, together with the frontline staff, helped to raise staff motivation and guide a bottom-up approach, able to identify tailored interventions and serve concurrently as training instrument tool.

Validation of a mobile app for reducing errors of administration of medications in an emergency.

Medication errors occur frequently and are a risk to patient safety. To reduce mistakes in the medication process in emergencies, a mobile app has been developed supporting the calculation of doses and administration of drugs. A simulation study was performed to validate the app as a tool to reduce medication errors. This was a randomised crossover study conducted in the Academic Hospital. The participants included were residents and attendings in anaesthesiology. 74 Participants performed four simulation scenarios in which they had to calculate and administer drugs for emergencies. Two scenarios were performed with the app ("app scenarios") and the other two scenarios were performed without the use of the app ("control scenarios"). The order of drugs, simulation patients and usage of aid were randomized. The accuracy of administered drug doses were measured. Medications were categorised as either "accurate" ([Formula: see text]% of target dosage) or "wrong" (less than 50% or more than 200% of target dosage). The dosage calculated and the dosage administered were documented separately to differentiate between calculation and handling errors. During app scenarios, there were no "wrong" dosages, whereas 6.8 (95% CI 2.7-10.8%) of dosages in control scenarios were evaluated as "wrong". The probability of giving an "accurate" dosage was increased from 77.7 (70.9-84.5%) in control scenarios to 93.9 (90-97.8%) in app scenarios. Calculation errors were the main cause for wrong dosing. The app is an appropriate and feasible tool to reduce calculation and handling errors and may increase patient safety.

An evaluation of the role of mixing techniques in the observed variation in acetylcysteine infusion concentrations.

Intravenous acetylcysteine is commonly prescribed as a course of three infusions for the management of paracetamol poisoning. Previous studies have demonstrated large variation in administered doses of intravenous acetylcysteine, which has been attributed to numerous factors, including inadequate mixing of infusion bags. The aim of this study was to determine whether the amount of mixing of infusion bags contributes significantly to this variation. Using acetylcysteine doses for a 60-69 kg patient, we added the appropriate volume of acetylcysteine to 5% glucose and subsequently inverted the infusion bags 0-5 times to mix the solutions. Infusion bags were then run through using an infusion pump and acetylcysteine concentrations measured at the beginning and end of the infusions. We found no significant difference between the beginning and end concentrations of acetylcysteine regardless of whether bags were mixed or not; infusion 1 (150 mg kg-1 ) showed beginning and end concentrations of 44.61 and 42.48 mg ml-1 respectively after 0 mixes, whilst beginning and end concentrations were 44.45 and 44.58 mg ml-1 respectively after five mixes. The same trend was observed for infusions 2 and 3. This confirmed that mixing does not play a substantial role in variation of drug concentrations; these are likely to be caused by an accumulation of small errors in infusion preparation.