Medication error trends and effects of person-related, environment-related and communication-related factors on medication errors in a paediatric hospital.

AIM: This study aimed to examine reported medication error trends in an Australian paediatric hospital over a 5-year period and to determine the effects of person-related, environment-related and communication-related factors on the severity of medication outcomes. In particular, the focus was on the influence of changes to a hospital site and structure on the severity of medication errors. METHODS: A retrospective clinical audit was undertaken over a 5-year period of paediatric medication errors submitted to an online voluntary reporting system of an Australian, tertiary, public teaching paediatric hospital. All medication errors submitted to the online system between 1 July 2010 and 30 June 2015 were included. RESULTS: A total of 3340 medication errors was reported, which corresponded to 0.56% medication errors per combined admissions and presentations or 5.73 medication errors per 1000 bed days. The most common patient outcomes related to errors requiring monitoring or an intervention to ensure no harm occurred (n = 1631, 48.8%). A new hospital site and structure had 0.354 reduced odds of producing medication errors causing possible or probable harm (95% confidence interval 0.298-0.421, P < 0.0001). Patient and family involvement had 1.270 increased odds of identifying medication errors associated with possible or probable harm compared with those causing no harm (95% confidence interval 1.028-1.568, P = 0.027). Interrupted time series analyses showed that moving to a new hospital site and structure was associated with a reduction in reported medication errors. CONCLUSION: Encouraging child and family involvement, facilitating hospital redesign and improving communication could help to reduce the harm associated with medication errors.

A qualitative examination of the relationship between rumination, distress, and dysregulated behaviours in vulnerable young people.

OBJECTIVES: Young people accessing mental health treatment in Australia frequently engage in dysregulated behaviours, such as substance misuse, deliberate self-harm (DSH), and binge eating and purging. Rumination has been identified as a correlate of behavioural dysregulation; however, a qualitative examination of the functional relationship between ruminative processes and distress and subsequent engagement in dysregulated behaviours has not yet been conducted. This study aimed to explore the characteristics of rumination in young people and examine how this process relates to engagement in DSH, binge eating and purging, and substance misuse in a sample of treatment-seeking young people. DESIGN: A qualitative research methodology was used gain an in-depth understanding of participants' experience of rumination as it relates to their engagement in dysregulated behaviours. METHODS: Twelve treatment-seeking young people were interviewed about their experience of rumination in the context of a recently recalled situation where they engaged in a dysregulated behaviour. Interview data were analysed using thematic analysis. RESULTS: Themes included the following: (1) triggers to behavioural dysregulation; (2) characteristics and content of rumination; (3) key precipitants to dysregulated behaviours (rumination, distress, and prior ineffective were at managing rumination); and (4) distraction from rumination and regulation of distress as short term, positively reinforcing consequences of dysregulated behaviours, while ongoing cycles of rumination and psychological distress were identified as long-term consequences. CONCLUSIONS: DSH, binge/purge behaviours, and substance misuse represent maladaptive ways to distract from intense and pervasive rumination in this cohort of young people. Theoretical and treatment implications pertaining to these findings are discussed. PRACTITIONER POINTS: Rumination is a common experience in young people who engage in dysregulated behaviours including deliberate self-harm, binging and purging, and substance misuse Engagement in behavioural dysregulation functions to distract from rumination, which negatively reinforces further engagement in dysregulated behaviours. Interventions in this population should focus on the development of adaptive skills that provide the same level of distraction provided by the physical sensations associated with engaging in a dysregulated behaviour.

An investigation of Australian midwifery curricula for obesity management and health behaviour change training.

INTRODUCTION: Fifty percent of Australian women enter pregnancy overweight or obese. Unfortunately, few women receive weight management advice from health professionals during pregnancy. The aim of this study was to investigate current midwifery curricula from Australian universities to identify strengths and deficits in the teaching of preconception and antenatal weight management. METHODS: Midwifery courses from 20 universities were identified. Of the 568 units taught at these universities, 252 course outlines were obtained. Data were coded using the qualitative analysis technique of Framework Analysis for the following main themes: 1) the effect of weight, diet and physical activity on health outcomes for women who are pregnant or planning a pregnancy; 2) weight management advice in any population; and 3) health behaviour change techniques in any context. RESULTS: Analysis revealed a variety of teaching methods and skills training that emphasised the importance of clinical judgement and autonomous clinical practice, in conjunction with critical enquiry and sourcing reputable evidence. There was little evidence, however, that weight management advice was taught explicitly to midwifery students in the curricula. DISCUSSION: A greater emphasis on skilling midwifery students to address weight gain during pregnancy, and behavioural techniques to achieve this, is required.

Interdisciplinary medication decision making by pharmacists in pediatric hospital settings: An ethnographic study.

OBJECTIVE: Children are particularly vulnerable to experiencing medication incidents in hospitals. Making sound medication decisions is therefore of paramount importance. Prior research has principally described pharmacists' role in reducing medication errors. There is a dearth of information about pharmacists' interactions with pediatric hospital staff across disciplines in resolving medication issues. The aim of this study was to examine interdisciplinary medication decision making by pharmacists in pediatric hospital settings. DESIGN: An ethnographic design was undertaken comprising observations, semi-structured interviews and focus groups. Audio-recorded data were analyzed thematically. SETTING: The study was conducted in three wards of an Australian pediatric tertiary teaching hospital, comprising general surgical, gastroenterology, endocrinology, neurology, adolescent and rehabilitation settings. PARTICIPANTS: Pharmacists, registered nurses and doctors were recruited from diverse clinical wards following information sessions. RESULTS: Pharmacists were central to complex pediatric medication decision making, intervening about dosage, administration, drug interactions and authorities. Pharmacists proactively contacted doctors and nurses about prescribing issues; conversely, staff routinely approached pharmacists for medication advice. Pharmacists were perceived as medication experts, their extensive knowledge valued in resolving complex issues: when off-label medications were prescribed, when protocols were absent or ambiguous, where tension existed between protocol adherence and patient safety, and where patients on multiple medications were at risk of medication error. Pharmacists had strong relationships with doctors and nurses, which had a bearing on pharmacists' input in interventions. Furthermore, pharmacists identified prescribing errors through strategies, such as case note review and medication reconciliation, although the lack of emergency department pharmacists and limited after-hours staffing posed challenges to both strategies. CONCLUSIONS: Pharmacists made a substantial and highly valued contribution to pediatric inter-professional medication decision making. These results provide new knowledge that informs theoretical developments of pharmacists' role in decision making.

Difficulties with assessment and management of an infant's distress in the postoperative period: Optimising opportunities for interdisciplinary information-sharing.

OBJECTIVES: The importance of accurate paediatric patient assessment is well established but under-utilised in managing postoperative medication regimens. METHODS: Data for this case report were collected through observations of clinical practice, conduct of interviews, and retrieval of information from the medical record. This case report involving a hospitalised 1-year-old boy demonstrates the difficulties associated with assessing and managing postoperative distress, including pain and other clinical conditions related to the surgical procedure. RESULTS: Postoperatively, there were difficulties in managing pain and an episode of over-sedation, occasioning opiate reversal with naloxone. In addition, he had decreasing oxygen saturation and increased work of breathing. X-ray showed changes consistent with either atelectasis or aspiration, and he was commenced on antibiotics. The patient experienced respiratory distress and required intervention from the medical emergency team. CONCLUSION: This case demonstrated the importance of comprehensive assessment and careful consideration of alternative causes of an infant's distress using the results of assessment tools to aid decision-making. Communication moderates effective patient care, and more favourable outcomes could be achieved by optimising interdisciplinary information-sharing.