Evaluating patient safety indicators in orthopedic surgery between Italy and the USA.

OBJECTIVE: To compare patient safety in major orthopedic procedures between an orthopedic hospital in Italy, and 26 US hospitals of similar size. DESIGN: Retrospective analysis of administrative data from hospital discharge records in Italy and Florida, USA, 2011-13. Patient Safety Indicators (PSIs) developed by the Agency for Healthcare Quality and Research were used to identify inpatient adverse events (AEs). We examined the factors associated with the development of each different PSI, taking into account known confounders, using logistic regression. SETTING: One Italian orthopedic hospital and 26 hospitals in Florida with ≥ 1000 major orthopedic procedures per year. PARTICIPANTS: Patients ≥ 18 years who underwent 1 of the 17 major orthopedic procedures, and with a length of stay (LOS) > 1 day. INTERVENTION: Patient Safety management between Italy and the USA. MAIN OUTCOME MEASURE: Patient Safety Indicators. RESULTS: A total of 14 393 patients in Italy (mean age = 59.8 years) and 131 371 in the USA (mean age = 65.4 years) were included. US patients had lower adjusted odds of developing a PSI compared to Italy for pressure ulcers (odds ratio [OR]: 0.21; 95% confidence interval [CI]: 0.10-0.45), hemorrhage or hematoma (OR: 0.42; CI 0.23-0.78), physiologic and metabolic derangement (OR: 0.08; CI 0.02-0.37). Italian patients had lower odds of pulmonary embolism/deep vein thrombosis (OR: 3.17; CI 2.16-4.67) compared to US patients. CONCLUSIONS: Important differences in patient safety events were identified across countries using US developed PSIs. Though caution about potential coding differences is wise when comparing PSIs internationally, other differences may explain AEs, and offer opportunities for cross-country learning about safe practices.

[Does the electronic prescription reduce drugs errors? Comparison between electronic and manual prescription]. / La gestione informatizzata delle prescrizioni terapeutiche riduce gli errori di terapia? Confronto tra un sistema informatizzato e il sistema tradizionale.

BACKGROUND: Medication errors are the major responsible for adverse events in hospitals. Although computerized prescription systems are widely considered the best option to decrease the medication errors, this belief is not evidence based since only few studies assessed their effectiveness. AIM: The aim of this study is to compare the effectiveness on reducing medication errors of the manual prescription system (drugs transcribed in the clinical records) with a computerized system. METHOD: Drugs prescriptions (manual and electronic) were retrospectively analyzed to identify medication errors. A medication error is the lack of clarity and completedness of the prescription. RESULTS: 1587 prescriptions were analyzed with the manual prescription system (phase 1), 1500 with the provisional electronic system (phase 2) and 1034 with the final one (phase 3). Between phase 1 and 2 an increase of incomplete prescriptions for dose (+17%) and lack of completedness of prescription (+49%) was observed. After some modifications a decrease of "errors" was observed, respectively -39% and -23.5% (p<0.001). CONCLUSIONS: The study shows that the informatization of the drug prescriptions reduces medication errors but requires a close planning, monitoring and tailoring of the system according to local problems and needs.

[An integrated project to prevent and minimize medication errors. The Istituti Ortopedici Rizzoli of Bologna's experience]. / Progetto integrato per la prevenzione e la riduzione degli errori di terapia. L'esperienza degli Istituti Ortopedici Rizzoli di Bologna.

Medication errors are a well-known problem in healthcare organizations. Several studies have shown that medication errors and adverse drug events (ADEs) are the biggest causes of adverse events in hospitals. This work will present the Istituti Ortopedici Rizzoli of Bologna's project, which has an systemic and integrated approach to prevent and minimize medication errors. The project performed this activities: a cognitive survey to learn the nurse staff's knowledge and perception of risks level; educational activities to sensitize nurse staff; a detailed retrospective study, based on the analysis of clinical records, to determine the rate of medication errors in the prescription and transcription phases; the introduction of a unified tool for medication, which eliminates the transcription phase, enable the medication prescription and the administered drug to be recorded.

[A retrospective study to evaluate the incidence of medication errors occurring in the prescription and transcription steps of the medication use process]. / Incidenza degli errori di terapia nelle fasi di prescrizione e trascrizione: un'indagine retrospettiva.

Medication errors occur frequently in many clinical settings. Various studies have highlighted that, together with adverse drug events, they represent one of the major causes of adverse events occurring in hospitals. The aim of this study was to perform a detailed retrospective medical record review in order to investigate the incidence of medication errors occurring in the prescription and transcription phases of the medication use process. Overall, 56 medical records were reviewed to determine the incidence of incomplete or incorrect prescriptions and incorrect transcription by nurses of the original medication order. The findings highlight the need to improve medication safety, in particular at the time of prescription and transcription of orders. The study also confirms that the retrospective review of medical records is an effective method for identifying certain types of medication errors that occur during the prescription and transcription phases. However, this type of review is complex and too costly to be used routinely, for continuous monitoring, in clinical practice.