Effectiveness of the automated drug dispensing system: systematic review and meta-analysis.

OBJECTIVES: to compare the effectiveness of the decentralized automated drug dispensing system with pockets. METHODS: an effectiveness study based on a systematic review guided by the question: for patients admitted to hospital units, is the use of automated drug dispensing effective for reducing medication errors when compared to manual unit dose dispensing? The evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses instrument, used in the report. RESULTS: the sample was composed of 15 studies and none of them directly compared both technologies; however, the meta-analysis showed that there is no difference in effectiveness between them [OR 1.03 95%CI (0,12 - 8,99)]. CONCLUSIONS: the conclusion is that the recommendation in favor of the automated dispensing system is weak.

Análise dos registros das prescrições medicamentosas em um hospital universitário / Analysis of the records of drug prescriptions in a university hospital / Análisis de los archivos de las recetas de medicamentos de un hospital universitario

OBJETIVO: analisar as prescrições medicamentosas em três unidades de internação de um hospital universitário no estado de Sergipe. MÉTODO: estudo descritivo, transversal e documental. Os dados foram coletados nas unidades de internação pelo período de 10 dias durante o mês de março de 2012. A amostra compreendeu 286 prescrições com 2.605 itens referentes a medicamentos. A pesquisa foi aprovada pelo Comitê de Ética e Pesquisa da Universidade Federal de Sergipe, sob o nº CAAE 0263.0.107.000-11. RESULTADOS: do total das prescrições analisadas, 48% estavam digitadas, em 98% não constava o número do registro do paciente e 100,0% continham abreviaturas e siglas. Das 4.522 doses medicamentosas prescritas, foi observada prevalência de ausência da forma farmacêutica, nome do fármaco e outros dados relativos à medicação. CONCLUSÃO: a existência de inadequações nos registros das prescrições medicamentosas comprovou que a administração de medicamentos na instituição pode apresentar riscos à segurança do paciente, indicando a necessidade de implementar ações corretivas.

OBJECTIVE: to analyze drug prescriptions in three inpatient units of a university hospital in the State of Sergipe. METHOD: this was a descriptive, transversal, and documental study. Data were collected in inpatient units during ten days in March of 2012. The sample consisted of 286 prescriptions with 2,605 items related to drugs. The study was approved by the Ethics and Research Committee of the Federal University of Sergipe, under number CAAE 0263.0.107.000-11. RESULTS: out of the total prescriptions analyzed, 48% were typed, 98% did not show the patients record number, and 100.0% contained abbreviations and acronyms. Out of the 4,522 prescribed drugs, a prevalence in the absence of dosage form, drug name, and other data on the medication was observed. CONCLUSION: the existence of inadequacies in the records of drug prescriptions has shown that the administration of drugs in the studied institution can pose risks to patient safety, indicating the need for the implementation of corrective actions.

El objetivo del presente estudio fue analizar las recetas de los medicamentos de tres unidades de internación de un hospital universitario del Estado de Sergipe. Se trata de un estudio transversal, descriptivo y documental. Los datosfueron recogidos en las unidades de internación durante 10 días del mes de marzo de 2012. La muestra consistió en 286 recetas con 2.605 insumos relacionados con los medicamentos. Este estudio fue aprobado por el Comité de Ética de la Universidad Federal de Sergipe, bajo el nº CAAE 0263.0.107.000-11. El 48% del total de las recetas analizadas estaban digitadas, en 98% no figuraba el número de protocolo del paciente y 100,0% tenían abreviaturas y siglas. De las 4.522 dosis recetadas, se observó que prevalece la falta de la forma farmacêutica, nombre del medicamento y otros datos referentes a la medicación. La falta de adecuaciones en los archivos de las recetas de los medicamentos mostró que en este hospital la administración de medicamentos puede presentar riesgos para la seguridad del paciente, lo cual sehala la necesidad de tomar medidas correctivas.

Evaluation of the medication process in pediatric patients: a meta-analysis / Avaliação do processo de medicação em pacientes pediátricos: meta-análise

OBJECTIVE: to meta-analyze studies that have assessed the medication errors rate in pediatric patients during prescribing, dispensing, and drug administration. SOURCES: searches were performed in the PubMed, Cochrane Library, and Trip databases, selecting articles published in English from 2001 to 2010. SUMMARY OF THE FINDINGS: a total of 25 original studies that met inclusion criteria were selected, which referred to pediatric inpatients or pediatric patients in emergency departments aged 0-16 years, and assessed the frequency of medication errors in the stages of prescribing, dispensing, and drug administration. CONCLUSIONS: the combined medication error rate for prescribing errors to medication orders was 0.175 (95% Confidence Interval: [CI] 0.108-0.270), the rate of prescribing errors to total medication errors was 0.342 (95% CI: 0.146-0.611), that of dispensing errors to total medication errors was 0.065 (95% CI: 0.026-0.154), and that ofadministration errors to total medication errors was 0.316 (95% CI: 0.148-0.550). Furthermore, the combined medication error rate for administration errors to drug administrations was 0.209 (95% CI: 0.152-0.281). Medication errors constitute a reality in healthcare services. The medication process is significantly prone to errors, especially during prescription and drug administration. Implementation of medication error reduction strategies is required in order to increase the safety and quality of pediatric healthcare. .

OBJETIVO: analisar estudos de meta-análise que avaliaram o índice de erros de medicação em pacientes pediátricos na prescrição, liberação e administração de medicamentos. FONTES DOS DADOS: foram feitas buscas nas bases de dados Pubmed, Biblioteca Cochrane e Trip, selecionando artigos publicados em inglês de 2001 a 2010. SÍNTESE DOS DADOS: um total de 25 estudos originais que atenderam aos critérios de inclusão foi selecionado e está relacionado a pacientes pediátricos internados ou pacientes pediátricos nos Serviços de Emergência, com idades entre 0-16 anos. Esses estudos avaliaram a frequência de erros de medicação nas etapas de prescrição, liberação e administração de medicamentos. CONCLUSÕES: o índice combinado de erros de medicação para erros na prescrição/solicitação de medicação foi igual a 0,175 (com intervalos de confiança (IC) de 95%: 0,108-0,270); para erros na prescrição/total de erros de medicação foi 0,342, com IC de 95%: 0,146-0,611; para erros na liberação/total de erros de medicação foi 0,065, com IC de 95%: 0,026-0,154; e para erros na administração/total de erros de medicação foi 0,316, com IC de 95%: 0,148-0,550. Adicionalmente, o índice combinado de erros de medicação para erros na administração/administração de medicamentos foi igual a 0,209, com IC de 95%: 0,152-0,281. Erros de medicação constituem uma realidade nos serviço de saúde. O processo de medicação é significativamente propenso a erros, principalmente na prescrição e administração de medicamentos. Precisa haver a implementação de estratégias de redução dos erros de medicação ...

Evaluation of the medication process in pediatric patients: a meta-analysis.

OBJECTIVE: to meta-analyze studies that have assessed the medication errors rate in pediatric patients during prescribing, dispensing, and drug administration. SOURCES: searches were performed in the PubMed, Cochrane Library, and Trip databases, selecting articles published in English from 2001 to 2010. SUMMARY OF THE FINDINGS: a total of 25 original studies that met inclusion criteria were selected, which referred to pediatric inpatients or pediatric patients in emergency departments aged 0-16 years, and assessed the frequency of medication errors in the stages of prescribing, dispensing, and drug administration. CONCLUSIONS: the combined medication error rate for prescribing errors to medication orders was 0.175 (95% Confidence Interval: [CI] 0.108-0.270), the rate of prescribing errors to total medication errors was 0.342 (95% CI: 0.146-0.611), that of dispensing errors to total medication errors was 0.065 (95% CI: 0.026-0.154), and that ofadministration errors to total medication errors was 0.316 (95% CI: 0.148-0.550). Furthermore, the combined medication error rate for administration errors to drug administrations was 0.209 (95% CI: 0.152-0.281). Medication errors constitute a reality in healthcare services. The medication process is significantly prone to errors, especially during prescription and drug administration. Implementation of medication error reduction strategies is required in order to increase the safety and quality of pediatric healthcare.

Medication errors in an intensive care unit.

AIM: This paper is a report of a study to investigating the incidence types and causes of medication errors (MEs) and the consequences for patients. Background. Medication errors are a common problem in hospitals around the world, including those in Brazil. METHOD: An exploratory, quantitative survey design was used and 44 adult inpatients were studied over a 30-day period in 2006. Three different methods were employed: anonymous self-reports, staff interviews and review of patient prescriptions. FINDINGS: A total of 305 MEs was observed. The mean (sd) number was 6.9 (6.8) per patient. The numbers of MEs per day differed statistically significantly between the two groups with length of stay in the intensive care unit of <1 week and more than 1 week, respectively, with mean (sd) of 0.4 (0.38) vs. 0.73 (0.39) The most frequent types were: omission (71.1%), wrong time of administration (11.5%), and prescribing errors (4.6%). The main causes were: medication not available in the hospital (41%); pharmacy stocking and delivery problems (16.3%); transcription errors (11%). No death was directly related to any ME. CONCLUSION: There is a need to develop a culture of safety and quality in patient care. An understanding of the profile of ME types and frequencies in an institution is fundamental to raise awareness and implement measures to avoid them. Structural and procedural changes in hospital organization, with a focus on the efficacy, efficiency, and effectiveness of the medication system are needed to reduce MEs.

Frequency, types, and potential clinical significance of medication-dispensing errors.

INTRODUCTION AND OBJECTIVES: Many dispensing errors occur in the hospital, and these can endanger patients. The purpose of this study was to assess the rate of dispensing errors by a unit dose drug dispensing system, to categorize the most frequent types of errors, and to evaluate their potential clinical significance. METHODS: A prospective study using a direct observation method to detect medication-dispensing errors was used. From March 2007 to April 2007, 'errors detected by pharmacists' and 'errors detected by nurses' were recorded under six categories: unauthorized drug, incorrect form of drug, improper dose, omission, incorrect time, and deteriorated drug errors. The potential clinical significance of the 'errors detected by nurses' was evaluated. RESULTS: Among the 734 filled medication cassettes, 179 errors were detected corresponding to a total of 7249 correctly fulfilled and omitted unit doses. An overall error rate of 2.5% was found. Errors detected by pharmacists and nurses represented 155 (86.6%) and 24 (13.4%) of the 179 errors, respectively. The most frequent types of errors were improper dose (n = 57, 31.8%) and omission (n = 54, 30.2%). Nearly 45% of the 24 errors detected by nurses had the potential to cause a significant (n = 7, 29.2%) or serious (n = 4, 16.6%) adverse drug event. CONCLUSIONS: Even if none of the errors reached the patients in this study, a 2.5% error rate indicates the need for improving the unit dose drug-dispensing system. Furthermore, it is almost certain that this study failed to detect some medication errors, further arguing for strategies to prevent their recurrence.

Frequency, types, and potential clinical significance of medication-dispensing errors

INTRODUCTION AND OBJECTIVES: Many dispensing errors occur in the hospital, and these can endanger patients. The purpose of this study was to assess the rate of dispensing errors by a unit dose drug dispensing system, to categorize the most frequent types of errors, and to evaluate their potential clinical significance. METHODS: A prospective study using a direct observation method to detect medication-dispensing errors was used. From March 2007 to April 2007, "errors detected by pharmacists" and "errors detected by nurses" were recorded under six categories: unauthorized drug, incorrect form of drug, improper dose, omission, incorrect time, and deteriorated drug errors. The potential clinical significance of the "errors detected by nurses" was evaluated. RESULTS: Among the 734 filled medication cassettes, 179 errors were detected corresponding to a total of 7249 correctly fulfilled and omitted unit doses. An overall error rate of 2.5 percent was found. Errors detected by pharmacists and nurses represented 155 (86.6 percent) and 24 (13.4 percent) of the 179 errors, respectively. The most frequent types of errors were improper dose (n = 57, 31.8 percent) and omission (n = 54, 30.2 percent). Nearly 45 percent of the 24 errors detected by nurses had the potential to cause a significant (n = 7, 29.2 percent) or serious (n = 4, 16.6 percent) adverse drug event. CONCLUSIONS: Even if none of the errors reached the patients in this study, a 2.5 percent error rate indicates the need for improving the unit dose drug-dispensing system. Furthermore, it is almost certain that this study failed to detect some medication errors, further arguing for strategies to prevent their recurrence.

[Medication systems in hospitals and their evaluation by professional groups]. / O sistema de medicação nos hospitais e sua avaliação por um grupo de profissionais.

This study was aimed at analyzing the medication systems in hospitals based on the opinions of 107 professionals. With regard to medical prescriptions in the institutions, 74.8 percent were handwritten and 50.4 percent of the medication distribution systems were in individualized doses. Concerning the causes of medication errors, 91 percent were associated with the professionals. For 61.7 percent, the system was adequate, but had shortcomings. Few professionals suggested changes that would favor their work. The conclusion is that the culture of attributing responsibility to the professional for the error, as well as the practice of punishment without a substantial change of the cause that led to it, persists.

Medication errors and drug-dispensing systems in a hospital pharmacy.

Pharmacies permeate and interconnect various actions developed in different sectors within the complex process of the use of drugs in a hospital. Dispensing failures mean that a breach has occurred in one of the last safety links in the use of drugs. Although most failures do not harm patients, their existence suggests fragility in the process and indicates an increased risk of severe accidents. Present concepts on drug-related incidents may be classified as side effects, adverse effects, and medication errors. Among these are dispensing errors, usually associated with poor safety and inefficient dispensing systems. Factors associated with dispensing errors may be communication failures, problems related to package labels, work overload, the physical structure of the working environment, distraction and interruption, the use of incorrect and outdated information sources and the lack of patient knowledge and education about the drugs they use. So called banal dispensing errors reach significant epidemiological levels. The purpose of this paper, which is part of a study on the occurrence of dispensing errors in the pharmacy of a large hospital, is to review the main concepts that guide studies on adverse effects and to provide an update on dispensing errors.

Medication errors and drug-dispensing systems in a hospital pharmacy

A farmácia hospitalar permeia e interliga várias ações desenvolvidas em diferentes setores no complexo processo de utilização do medicamento dentro do hospital. Falhas na dispensação significam o rompimento de um dos últimos elos na segurança do uso dos medicamentos. Ainda que grande parte dessas falhas não cause danos aos pacientes, sua existência denuncia fragilidade no processo e indica, em uma relação direta, riscos maiores de ocorrência de acidentes graves. Os conceitos atuais dos incidentes relacionados a medicamentos podem ser categorizados em grupos e incluem as reações adversas, os eventos adversos e os erros de medicação. Dentre estes se inclui os erros de dispensação, cujas causas mais comuns se associam ao caráter inseguro e ineficiente dos próprios sistemas de dispensação. Os fatores associados a estes erros se resumem nas falhas de comunicação, nos problemas relacionados à rotulagem e embalagem dos medicamentos, na sobrecarga de trabalho e na estrutura da área de trabalho, nas distrações e interrupções, no uso de fontes de informação incorretas e desatualizadas e na falta de conhecimento e educação do paciente sobre os medicamentos que utiliza. O erro de dispensação, ainda que em muitos casos possa ser classificado como banal, assume níveis epidemiológicos importantes. Este artigo, parte de um estudo sobre a ocorrência de erros de dispensação na farmácia de um hospital geral de grande porte, visa divulgar uma revisão sobre os principais conceitos que hoje norteiam os estudos sobre eventos adversos, bem como o estágio atual do conhecimento sobre os erros de dispensação.

La Cooperativa de Hospitales de Antioquia y la política farmacéutica nacional / The Cooperative of Hospitals of Antioquia and the pharmaceutical national policy

Se presenta una síntesis de las principales acciones desarrolladas durante los últimos años por la Cooperativa de Hospitales de Antioquia —Centro colaborador de la Organización Mundial de la Salud y la Organización Panamericana de la salud—, concordantescon la política farmacéutica de Colombia. Igualmente, se analiza la forma como estas acciones han contribuido a su desarrollo e implementación en el país

Estructuración y adecuación de un sistema centralizado de distribución de medicamentos por dosis unitaria, proyecto del hospital San Vicente de Paúl, de Caldas, Antioquia / Structuring and adjusting a centralized system for medicament distribution by unitary dose, a project of the hospital San Vicente de Paúl, in Caldas, Antioquia

Se acepta que el sistema centralizado de distribución de medicamentos por dosis unitaria (SCDMDU) contribuye a garantizar la efectividad terapéutica y administrativa y a disminuir los riesgos asociados con la utilización de estos insumos. Sin embargo, losanálisis de las inversiones económicas que se deben realizar para su estructuración limitan su presencia en nuestro medio. Buscando evidenciar las bondades del SCDMDU y sobre la base de que inicialmente no se requiere de una inversión económicaimportante, se diseñó un estudio longitudinal prospectivo de antes–después que posibilitara evaluar su impacto sobre los costos directos e indirectos en el servicio de pensionados de la ESE Hospital San Vicente de Paúl, de Caldas, Antioquia. El estudiose desarrolló durante 136 días (50 días en los que se midieron las variables de estudio en el sistema anterior, 36 días de capacitación y estructuración del SCDMDU y 50 días en los que se repitieron las mediciones iniciales). La información se procesó mediante EPI–INFO 6.03 y se analizó estadísticamente con el test de la t por parejas. Se obtuvo disminución en los costos por medicamentos de $1.306.221 (13,80 por cien ); en el valor de las solicitudes para reposición del inventario, de $500.940 (67,63 por cien ) y en las devoluciones, de $583.354 (39,46 por cien ). También se ve que este sistema facilita la detección y corrección oportuna de errores en los procesos asociados. Los resultados obtenidos evidencian que un SCDMDU contribuye a mejorar la calidad de la atención y a la optimización de los recursos, aspectos que son demandados por las condiciones creadas por la Ley 100/93 en Colombia

Preparación y administración de mezclas intravenosas en un servicio de internación pediátrico del Centro Hospitalario Pereira Rossell / Preparation and administration of intravenous mixtures at a pediatric hospitalization service of Centro Hospitalario Pereira Rossell

Introducción: en el Centro Hospitalario Pereira Rossell los fármacos de uso intravenoso representan un porcentaje importante del gasto en medicamentos. Es frecuente observar diversas formas de uso inapropiado en la práctica clínica. Objetivo: evaluar el cumplimiento de las recomendaciones para la preparación y administración de mezclas intravenosas, en un servicio de internación pediátrico. Metodología: durante el mes de junio de 2000, en la Clínica Pediátrica "A" se observaron los hábitos de 16 auxiliares de enfermería con relación a la preparación y administración de mezclas intravenosas. Resultados: ningún enfermero verificó el vencimiento e integridad de la medicación antes de su administración. Sólo la mitad del personal realizó un adecuado lavado de manos al iniciar la preparación. La utilización de una única aguja para reconstituir diferentes medicamentos fue una práctica habitual. Conclusiones: en la Clínica Pediátrica "A" se comprobó un escaso cumplimiento de las recomendaciones establecidas para estos procedimientos. Es necesario evaluar el cumplimiento de estas recomendaciones en otros servicios de internación del hospital y desarrollar estrategias de educación continua del personal. Es posible que la implementación de una Unidad de Reconstitución y Fraccionamiento de inyectables por dosis unitarias contribuya a mejorar alguno de estos problemas

Preparación y administración de mezclas intravenosas en un servicio de internación pediátrico del Centro Hospitalario Pereira Rossell / Preparation and administration of intravenous mixtures at a pediatric hospitalization service of Centro Hospitalario Pereira Rossell

Introducción: en el Centro Hospitalario Pereira Rossell los fármacos de uso intravenoso representan un porcentaje importante del gasto en medicamentos. Es frecuente observar diversas formas de uso inapropiado en la práctica clínica. Objetivo: evaluar el cumplimiento de las recomendaciones para la preparación y administración de mezclas intravenosas, en un servicio de internación pediátrico. Metodología: durante el mes de junio de 2000, en la Clínica Pediátrica A se observaron los hábitos de 16 auxiliares de enfermería con relación a la preparación y administración de mezclas intravenosas. Resultados: ningún enfermero verificó el vencimiento e integridad de la medicación antes de su administración. Sólo la mitad del personal realizó un adecuado lavado de manos al iniciar la preparación. La utilización de una única aguja para reconstituir diferentes medicamentos fue una práctica habitual. Conclusiones: en la Clínica Pediátrica A se comprobó un escaso cumplimiento de las recomendaciones establecidas para estos procedimientos. Es necesario evaluar el cumplimiento de estas recomendaciones en otros servicios de internación del hospital y desarrollar estrategias de educación continua del personal. Es posible que la implementación de una Unidad de Reconstitución y Fraccionamiento de inyectables por dosis unitarias contribuya a mejorar alguno de estos problemas (AU)

Medication cart-filling time, accuracy, and cost with an automated dispensing system.

Medication cart filling with an automated dispensing system was compared with manual cart filling with respect to personnel time, costs, and accuracy. At a 650-bed tertiary-care medical center, technician cart filling and pharmacist cart checking were timed for the existing manual system and for the Baxter ATC-212 automated dispensing system. Subsequently, carts filled with each system were checked for accuracy of dispensing. On the basis of drugs used in the automated system over three months, drug acquisition and dispensing costs were calculated for automated and manual cart filling; the costs of personnel time were also compared. Daily cart filling time for technicians was significantly less with the automated system. The savings of pharmacist time was not significant; pharmacists had to cut the strip-packaged drugs into individual doses as they checked patients' medications. For both systems, errors were found in fewer than 1% of the doses (0.84% for the manual system and 0.65% for the automated system). Drug costs were higher with the automated system; acquisition prices for the bulk drugs purchased for use in the dispensing machine were higher than the prices of the same products in unit dose packaging. Personnel time saved amounted to less than 0.5 full-time equivalent. With the automated system, overall time savings was not great enough to substantially affect pharmacy operations, and drug costs were higher.

A systems approach to the problem of missing medications.

Overall, the systems approach employed in this study has significantly decreased the frequency of missing medication requests on one pharmacy satellite by 38 percent. The most dramatic impact came from the systems-change phase of the study. While the pharmacy personnel-change phase did not contribute to the overall reduction in missing medications, there was a large decrease in missing medications due to discrepancies between the nursing MAR and the pharmacy profile. This study has prompted further investigation into the p.r.n. drug-distribution subsystem.