scholarly journals How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis

2020 ◽  
Author(s):  
Peter J Gates ◽  
Rae-Anne Hardie ◽  
Magdalena Z Raban ◽  
Ling Li ◽  
Johanna I Westbrook
Keyword(s):  
Systematic Review ◽  
Medication Error ◽  
Medication Errors ◽  
Meta Analysis ◽  
Error Rates ◽  
Prescribing Error ◽  
Before And After ◽  
Actual Harm ◽  
Computer Based ◽  
Wide Scale

Abstract Objective To conduct a systematic review and meta-analysis to assess: 1) changes in medication error rates and associated patient harm following electronic medication system (EMS) implementation; and 2) evidence of system-related medication errors facilitated by the use of an EMS. Materials and Methods We searched Medline, Scopus, Embase, and CINAHL for studies published between January 2005 and March 2019, comparing medication errors rates with or without assessments of related harm (actual or potential) before and after EMS implementation. EMS was defined as a computer-based system enabling the prescribing, supply, and/or administration of medicines. Study quality was assessed. Results There was substantial heterogeneity in outcomes of the 18 included studies. Only 2 were strong quality. Meta-analysis of 5 studies reporting change in actual harm post-EMS showed no reduced risk (RR: 1.22, 95% CI: 0.18–8.38, P = .8) and meta-analysis of 3 studies reporting change in administration errors found a significant reduction in error rates (RR: 0.77, 95% CI: 0.72–0.83, P = .004). Of 10 studies of prescribing error rates, 9 reported a reduction but variable denominators precluded meta-analysis. Twelve studies provided specific examples of system-related medication errors; 5 quantified their occurrence. Discussion and Conclusion Despite the wide-scale adoption of EMS in hospitals around the world, the quality of evidence about their effectiveness in medication error and associated harm reduction is variable. Some confidence can be placed in the ability of systems to reduce prescribing error rates. However, much is still unknown about mechanisms which may be most effective in improving medication safety and design features which facilitate new error risks.

scholarly journals Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253588
Author(s):  
Myriam Jaam ◽  
Lina Mohammad Naseralallah ◽  
Tarteel Ali Hussain ◽  
Shane Ashley Pawluk
Keyword(s):  
Systematic Review ◽  
Medication Error ◽  
Medication Errors ◽  
Meta Analysis ◽  
Healthcare Providers ◽  
Educational Interventions ◽  
Educational Programs ◽  
Error Rates ◽  
Audit And Feedback ◽  
Cochrane Library

Introduction Medication errors are avoidable events that can occur at any stage of the medication use process. They are widespread in healthcare systems and are linked to an increased risk of morbidity and mortality. Several strategies have been studied to reduce their occurrence including different types of pharmacy-based interventions. One of the main pharmacist-led interventions is educational programs, which seem to have promising benefits. Objective To describe and compare various pharmacist-led educational interventions delivered to healthcare providers and to evaluate their impact qualitatively and quantitatively on medication error rates. Methods A systematic review and meta-analysis was conducted through searching Cochrane Library, EBSCO, EMBASE, Medline and Google Scholar from inception to June 2020. Only interventional studies that reported medication error rate change after the intervention were included. Two independent authors worked through the data extraction and quality assessment using Crowe Critical Appraisal Tool (CCAT). Summary odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model for rates of medication errors. Research protocol is available in The International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42019116465. Results Twelve studies involving 115058 participants were included. The two main recipients of the educational interventions were nurses and resident physicians. Educational programs involved lectures, posters, practical teaching sessions, audit and feedback method and flash cards of high-risk abbreviations. All studies included educational sessions as part of their program, either alone or in combination with other approaches, and most studies used errors encountered before implementing the intervention to inform the content of these sessions. Educational programs led by a pharmacist were associated with significant reductions in the overall rate of medication errors occurrence (OR, 0.38; 95% CI, 0.22 to 0.65). Conclusion Pharmacist-led educational interventions directed to healthcare providers are effective at reducing medication error rates. This review supports the implementation of pharmacist-led educational intervention aimed at reducing medication errors.

scholarly journals The Impact of Pharmacist Interventions on Reducing Medication Errors in Pediatric Patients: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Lina Mohammad Naseralallah ◽  
Tarteel Ali Hussain ◽  
Shane Pawluk ◽  
Myriam Eljaam
Keyword(s):  
Systematic Review ◽  
Medication Error ◽  
Medication Errors ◽  
Clinical Pharmacist ◽  
Pediatric Patients ◽  
Data Extraction ◽  
Meta Analysis ◽  
Error Rates ◽  
Pharmacist Interventions ◽  
The Impact

Background: Medication errors are avoidable events that could occur at any stage of the medication use process. They are widespread in the healthcare system and are associated with increased risk of morbidity and mortality. Implementing a clinical pharmacist is one strategy that is believed to reduce medication errors in the general population including pediatric patients who are more vulnerable to medication errors due to several contributing factors including the challenges of weight-based dosing. Aim: The aim of this study is to qualitatively and quantitatively evaluate the impact of clinical pharmacist interventions on medication error rates for hospitalized pediatric patients. Methodology: PubMed, Embase, Cochrane and Google Scholar search engines were searched from database inception to February 2019. Study selection, data extraction and quality assessment was conducted by two independent reviewers. Observational and interventional studies were included. Data extraction was done manually and the Crowe Critical Appraisal Tool (CCAT) was used to critically appraise eligible articles. Summary odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model for rates of medication errors. Results: A total of 19 studies were systematically reviewed and 6 studies (29 291 patients) were included in the meta-analysis. Pharmacist interventions involved delivering educational sessions, reviewing prescriptions, attending rounds and implementing a unit-based clinical pharmacist. The systematic review showed that the most common trigger for pharmacist interventions was inappropriate dosing. Pharmacist involvement was associated with significant reductions in the overall rate of medication errors occurrence (OR, 0.27; 95% CI, 0.15 to 0.49). Conclusion: The most common cause for pharmacist interventions in pediatric patients at hospital settings was inappropriate dosing. Overall, pharmacist interventions are effective at reducing medication error rates.

scholarly journals Medication Errors in Ethiopia: Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Aklilu Endalamaw ◽  
Getnet Dessie ◽  
Henok Biresaw ◽  
Amare Belachew ◽  
Desalegn Amare ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medication Error ◽  
Medication Errors ◽  
Meta Analysis ◽  
Medication Administration ◽  
Medication Prescription ◽  
Technical Errors ◽  
Statistical Heterogeneity ◽  
Wrong Dose ◽  
National Prevalence

Abstract Background: The caution of medication prescription and administration are the main physician and nursing services though there was no study to show medication error at the nation level in Ethiopia. Therefore, we estimated the national prevalence of medication errors. Methods: A systematic review of studies searched in PubMed, Scopus, African Journal of Online, and Google Scholar was done. Newcastle-Ottawa quality assessment scale was used to assess the quality status of the included studies. We employed Galbraith plot and Egger’s regression test to assess publication bias. The national prevalence of medication errors was estimated using a random-effects model meta-analysis. Moreover, subgroup analysis and meta-regression analyses were done to explore the reason of statistical heterogeneity.Results: A total of 14 studies with 5,552 administered medications and 5,661 prescription sheets were included. The overall prevalence of medication error in Ethiopia was 57.6% (95% CI: 46.2, 69.0). The pooled burden of medication administration and prescription error was 58.4% (95% CI: 51.4, 65.5) and 55.8% (95% CI: 27.0, 84.6), respectively. Omission error (38%), wrong dose (38.5%), and the wrong combination of drugs (28.7%) were highly reported types of prescription errors, whereas missed doses (57.0%), technical errors (47.0%), wrong time (35.0%), and wrong dose (30.0%) were frequently observed medication administration errors.Conclusions: Medication errors were very common in Ethiopian hospitals whereby at least one out of two medications were wrongly prescribed and administered. Our review provided a shred of up-to-date evidence for clinicians, regional, and national healthcare policymakers to appraise and improve the quality of hospitals’ inpatient care.Trail registration: The protocol is registered in the Prospero database with a registration number of CRD42019138125.

scholarly journals Prevalence, contributory factors and severity of medication errors associated with direct-acting oral anticoagulants in adult patients: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Abdulrhman Al Rowily ◽  
Zahraa Jalal ◽  
Malcolm J. Price ◽  
Mohammed H. Abutaleb ◽  
Hind Almodiaemgh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medication Errors ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Contributing Factors ◽  
Prescribing Error ◽  
Random Effects Models ◽  
Contributory Factors ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

Abstract Purpose This study aimed to estimate the prevalence, contributory factors, and severity of medication errors associated with direct acting oral anticoagulants (DOACs). Methods A systematic review and meta-analysis were undertaken by searching 11 databases including Medline, Embase, and CINHAL between January 2008 and September 2020. The pooled prevalence of errors and predictive intervals were estimated using random-effects models using Stata software. Data related to error causation were synthesised according to Reason’s accident causation model. Results From the 5205 titles screened, 32 studies were included which were mostly based in hospitals and included DOAC treatment for thromboembolism and atrial fibrillation. The proportion of study population who experienced either prescription, administration, or dispensing error ranged from 5.3 to 37.3%. The pooled percentage of patients experiencing prescribing error was 20% (95% CI 15–25%; I2 = 96%; 95% PrI 4–43%). Prescribing error constituted the majority of all error types with a pooled estimate of 78% (95%CI 73–82%; I2 = 0) of all errors. The common reported causes were active failures including wrong drug, and dose for the indication. Mistakes such as non-consideration of renal function, and error-provoking conditions such as lack of knowledge were common contributing factors. Adverse events such as potentially fatal intracranial haemorrhage or patient deaths were linked to the errors but causality assessments were often missing. Conclusions Despite their favourable safety profile, DOAC medication errors are common. There is a need to promote multidisciplinary working, guideline-adherence, training, and education of healthcare professionals, and the use of theory-based and technology-facilitated interventions to minimise errors and maximise the benefits of DOACs usage in all settings. Protocol A protocol developed as per PRISMA-P guideline is registered under PROSPERO ID = CRD42019122996

Analisis Faktor Perawat Dalam Pelaksanakan Keselamatan Pasien Terhadap Kejadian Medication Administration Error di Rumah Sakit

2020 ◽  
Author(s):  
Bintang Marsondang Rambe
Keyword(s):  
Patient Safety ◽  
Literature Review ◽  
Medication Error ◽  
Medication Errors ◽  
Medication Administration ◽  
Prescribing Error ◽  
Medication Administration Error ◽  
Administration Error

Latar Belakang Keselamatan pasien (patient safety) rumah sakit adalah suatu sistem dimana rumah sakit membuat asuhan pasien lebih aman yang meliputi assessment risiko, identifikasi dan pengelolaan hal yang berhubungan dengan risiko pasien, pelaporan dan analisis insiden, kemampuan belajar dari insiden dan tindak lanjutnya serta implementasi solusi untuk meminimalkan timbulnya risiko dan mencegah terjadinya cedera yang disebabkan oleh kesalahan akibat melaksanakan suatu tindakan atau tidak mengambil tindakan yang seharusnya diambil yang dilakukan oleh perawat (Kemenkes, 2011).Salah satu kesalahan yang dapat merugikan pasien adalah medication error. Menurut WHO (2016) medication error adalah setiap kejadian yang dapat dicegah yang menyebabkan penggunaan obat yang tidak tepat yang menyebabkan bahaya kepasien, dimana obat berada dalam kendali profesional perawatan kesehatan. proses terjadi medication error dimulai dari tahap prescribing, transcribing, dispensing,dan administration. Kesalahan peresepan (prescribing error), kesalahan penerjemahan resep (transcribing erorr), kesalahan menyiapkan dan meracik obat (dispensing erorr), dan kesalahan penyerahan obat kepada pasien (administration error). Medication error yang paling sering terjadi adalah pada fase administration / pemberian obat yang dilakukan oleh perawat.Administration error terjadi ketika pemberian obat kepada pasien tidak sesuai dengan prinsip enam benar yaitu benar obat, benar pasien, benar dosis, benar rute pemberian, benar waktu pemberian dan benar pendokumentasian. Secara global, kesalahan pemberian obat (medication errors) sampai saat ini masih menjadi isu keselamatan pasien dan kualitas pelayanan di beberapa rumah sakit (Depkes RI, 2015; AHRQ, 2015). Perawat sebagai bagian terbesar dari tenaga kesehatan di rumah sakit, mempunyai peranan dalam kejadian medication error. Perawat berkontribusi karena perawat banyak berperan dalam proses pemberian obat. Pemberian obat/ Medication Administration adalah salah satu intervensi keperawatan yang paling banyak dilakukan, dengan sekitar 5- 20% waktu perawat dialokasikan untuk kegiatan ini (Härkänen et al.,, 2019). Pemberian obat juga mencakup tugas-tugas lain, seperti menyiapkan dan memeriksa obat obatan, memantau efek obat-obatan, mengedukasi pasien tentang pengobatan, dan memperdalam pengetahuan perawat tentang obat – obatan sendiri (DrachZahavy et al., 2014 dalam Yulianti et al., 2019)Berdasarkan isu tersebut, penulis tertarik untuk melakukan literature review terkait faktor perawat dalam pelaksanakan keselamatan pasien terhadap kejadian medication administration error di Rumah Sakit.

scholarly journals Movement Patterns and Muscular Function Before and After Onset of Sports-Related Groin Pain: A Systematic Review with Meta-analysis

2016 ◽  
Vol 46 (12) ◽  
pp. 1847-1867 ◽  
Author(s):  
Paulina Kloskowska ◽  
Dylan Morrissey ◽  
Claire Small ◽  
Peter Malliaras ◽  
Christian Barton
Keyword(s):  
Systematic Review ◽  
Groin Pain ◽  
Meta Analysis ◽  
Movement Patterns ◽  
Before And After ◽  
Muscular Function

scholarly journals Effect of electroconvulsive therapy on hippocampal and amygdala volumes: systematic review and meta-analysis

2018 ◽  
Vol 212 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Akihiro Takamiya ◽  
Jun Ku Chung ◽  
Kuo-ching Liang ◽  
Ariel Graff-Guerrero ◽  
Masaru Mimura ◽  
...  
Keyword(s):  
Systematic Review ◽  
Electroconvulsive Therapy ◽  
Animal Studies ◽  
Brain Volume ◽  
Meta Analysis ◽  
Brain Structures ◽  
Volume Increase ◽  
Left Hippocampus ◽  
Before And After ◽  
Underlying Mechanisms

BackgroundElectroconvulsive therapy (ECT) is one of the most effective treatments for depression, although the underlying mechanisms remain unclear. Animal studies have shown that electroconvulsive shock induced neuroplastic changes in the hippocampus.AimsTo summarise volumetric magnetic resonance imaging studies investigating the effects of ECT on limbic brain structures.MethodA systematic review and meta-analysis was conducted to assess volumetric changes of each side of the hippocampus and amygdala before and after ECT. Standardised mean difference (SMD) was calculated.ResultsA total of 8 studies (n = 193) were selected for our analyses. Both right and left hippocampal and amygdala volumes increased after ECT. Meta-regression analyses revealed that age, percentage of those responding and percentage of those in remission were negatively associated with volume increases in the left hippocampus.ConclusionsECT increased brain volume in the limbic structures. The clinical relevance of volume increase needs further investigation.Declaration of interestNone.

scholarly journals The protective association between statins use and adverse outcomes among COVID-19 patients: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Ronald Chow ◽  
James Im ◽  
Nicholas Chiu ◽  
Leonard Chiu ◽  
Rahul Aggarwal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Odds Ratio ◽  
Lower Risk ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Risk Of Mortality ◽  
Before And After ◽  
Statin Usage ◽  
Similar Risk ◽  
Ventilation Studies

ABSTRACTIntroductionStatins may reduce a cytokine storm, which has been hypothesized as a possible mechanism of severe COVID-19 pneumonia. The aim of this study was to conduct a systematic review and meta-analysis to report on adverse outcomes among COVID-19 patients by statin usage.MethodsLiteratures were searched from January 2019 to December 2020 to identify studies that reported the association between statin usage and adverse outcomes, including mortality, ICU admissions, and mechanical ventilation. Studies were meta-analyzed for mortality by the subgroups of ICU status and statin usage before and after COVID-19 hospitalization. Studies reporting an odds ratio (OR) and hazard ratio (HR) were analyzed separately.ResultsThirteen cohorts, reporting on 110,078 patients, were included in this meta-analysis. Individuals who used statins before their COVID-19 hospitalization showed a similar risk of mortality, compared to those who did not use statins (HR 0.80, 95% CI: 0.50, 1.28; OR 0.62, 95% CI: 0.38, 1.03). Patients who were administered statins after their COVID-19 diagnosis were at a lower risk of mortality (HR 0.53, 95% CI: 0.46, 0.61; OR 0.57, 95% CI: 0.43, 0.75). The use of statins did not reduce the mortality of COVID-19 patients admitted to the ICU (OR 0.65; 95% CI: 0.26, 1.64). Among non-ICU patients, statin users were at a lower risk of mortality relative to non-statin users (HR 0.53, 95% CI: 0.46, 0.62; OR 0.64, 95% CI: 0.46, 0.88).ConclusionPatients administered statins after COVID-19 diagnosis or non-ICU admitted patients were at lower risk of mortality relative to non-statin users.

Accuracy of Antiretroviral Prescribing in a Community Teaching Hospital: A Medication Use Evaluation

2019 ◽  
pp. 089719001985784
Author(s):  
Jacob Lines ◽  
Paul Lewis
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Medication Error ◽  
Medication Errors ◽  
Retrospective Chart Review ◽  
The United States ◽  
Error Rates ◽  
Transitions Of Care ◽  
Hiv Diagnosis ◽  
Increased Risk

Background: Medication errors account for nearly 250 000 deaths in the United States annually, with approximately 60% of errors occurring during transitions of care. Previous studies demonstrated that almost 80% of participants with human immunodeficiency virus (HIV) have experienced a medication error related to their antiretroviral therapy (ART). Objective: This retrospective chart review examines propensity and type of ART-related errors and further seeks to identify risk factors associated with higher error rates. Methods: Participants were identified as hospitalized adults ≥18 years old with preexisting HIV diagnosis receiving home ART from July 2015 to June 2017. Medication error categories included delays in therapy, dosing errors, scheduling conflicts, and miscellaneous errors. Logistic regression was used to examine risk factors for medication errors. Results: Mean age was 49 years, 76.5% were men, and 72.1% used hospital-supplied medication. For the primary outcome, 60.3% (41/68) of participants had at least 1 error, with 31.3% attributed to delays in therapy. Logistic regression demonstrated multiple tablet regimens (odds ratio [OR]: 3.40, 95% confidence interval [CI]: 1.22-9.48, P = .019) and serum creatinine (SCr) ≥1.5 mg/dL (OR: 8.87, 95% CI: 1.07-73.45, P = .043) were predictive for risk of medication errors. Regimens with significant drug–drug interactions (eg, cobicistat-containing regimens) were not significantly associated with increased risk of medication errors. Conclusions and Relevance: ART-related medication error rates remain prevalent and exceeded 60%. Independent risk factors for medication errors include use of multiple tablet regimens and SCr ≥1.5 mg/dL.

scholarly journals The effect of methadone on depression among addicts: a systematic review and meta-analysis

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Masoud Mohammadi ◽  
Mohsen Kazeminia ◽  
Nasrin Abdoli ◽  
Behnam Khaledipaveh ◽  
Shamarina Shohaimi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Web Of Science ◽  
Treatment Plan ◽  
Meta Analysis ◽  
Intervention Group ◽  
Depression Score ◽  
Inclusion Criteria ◽  
The World ◽  
Before And After ◽  
The Mean

Abstract Background Opioids addiction and misuse are among the major problems in the world today. There have been several preliminary studies examining the effect of methadone on depression among addicts, however, these studies have reported inconsistent and even contradictory results. Therefore, the aim of the present study was to determine the effect of methadone on depression in addicts in Iran and around the world, using a meta-analysis approach. Methods This study was a systematic review and meta-analysis including articles published in the SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, ScienceDirect, Scopus, PubMed and Web of Science databases were searched systematically to find articles published from 2006 to March 2019. Heterogeneity index was determined using the Cochran's test (Qc) and I2. Considering heterogeneity of studies, the random effects model was used to estimate the standardized difference of mean score for depression. Subsequently, the level of depression reduction in Iran and worldwide in the intervention group before and after the testwas measured. Results A total of 19 articles met the inclusion criteria, and were therefore selected for this systematic review and meta-analysis. The sample size of the intervention group in the selected studies was 1948. According to the meta-analysis results, the mean depression score in the intervention group was 26.4 ± 5.6 and 18.4 ± 2.6 before and after intervention respectively, indicating the reducing effect of methadone on depression, and this difference was statistically significant (P < 0.01). Conclusion The results of the present study show that methadone significantly reduces depression in addicts. Therefore, regular methadone use can be part of a drug treatment plan.

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