Automated Dispensing Cabinet Functionality Expansion to Reduce Controlled Substance Inventory Discrepancies

2021 ◽  
pp. 001857872110613
Author(s):  
James A. M. Rhodes ◽  
Bryan C. McCarthy ◽  
Anthony C. Scott
Keyword(s):  
Medication Use ◽  
Error Rates ◽  
Before And After ◽  
Quasi Experimental ◽  
Unit Dose ◽  
Controlled Substance ◽  
The University ◽  
The Impact ◽  
Dispensing Error ◽  
Dispensing Errors

Background: Automated dispensing cabinets have the potential to create technology-induced errors that can arise during controlled substance medication dispensing. Despite enhancements made to the medication use process, the impact of ADC functionality on technology-induced controlled substance discrepancies have yet to be described. Objective: To evaluate the impact of ADC functionality expansion on technology-induced errors such as controlled substance discrepancies created during “blind inventory counts” and cassette dispensing errors. Methods: This quasi-experimental study was conducted over 18 months that evaluated the expanded use of dispensing cassettes within 8 ADCs at the University of Chicago Medicine. Unit-dose controlled substances with high usage were directed for inventory reassignment to cassettes. Controlled substance dispenses, blind inventory counts discrepancies and cassette dispensing errors were evaluated before and after cassette expansion. ADC discrepancy and Cassette Dispensing Error rates were calculated using 1-week segments across the study period. Results: Of the 64 040 dispenses during the study period, the proportion of cassette dispenses increased from 16% to 72% after cassette expansion. Controlled substance discrepancies decreased from 11 to 7 discrepancies for every 1000 dispenses ( P < .0001). After cassette expansion, cassette dispensing errors increased to roughly 28 errors for every 1000 dispenses ( P < .0001). Conclusion: Expansion of ADC functionality created opportunities for reduced technology-induced controlled substance discrepancy rates at the expense of increased cassette dispensing errors.

The Effect of Using Flipped Classroom Model to Improve Iraqi EFL Learners’ Pronunciation in English at University Level

2020 ◽  
Vol 1 (40) ◽  
pp. 631-654
Author(s):  
Khaldoon Waleed Husam Al-Mofti
Keyword(s):  
Language Learning ◽  
Flipped Classroom ◽  
Efl Learners ◽  
English Pronunciation ◽  
Before And After ◽  
Quasi Experimental ◽  
University Level ◽  
The University ◽  
And Control ◽  
Experimental Group

For Iraqi EFL learners who are studying English pronunciation in a traditional instruction method often requires more effort and hard work. Thus, using new methods of teaching such as the flipped classroom model (FCM) is necessary to facilitate learning and improve performance. Hence, this study reports on explanatory research that investigates the effect of using the FCM in the teaching of English pronunciation for Iraqi EFL learners at the university level. The study implemented mixed research methods for data collection in a quasi-experimental analysis. Therefore, two tests were conducted on the assigned groups to measure the effect of the FCM before and after the intervention. Besides, a questionnaire and interviews were used on the experiment group students to collect data about their perceptions of the FCM. The study length (lasted)  was 15 weeks and is comprised of 60 students from the department of English, College of Arts at the University of Anbar. The students were divided into two groups, experimental, and control with 30 students in each group. The findings revealed that there was a significant statistical difference between the two groups in favour of the experimental group with better performance, indicating that the FCM has considerably assisted the Iraqi EFL learners to improve their English pronunciation. Moreover, the students expressed their positive feedback and satisfaction on the use of the FCM in their responses to the questionnaire and the interviews. As such, the current study recommends further research to study the effect of applying the FCM in areas and disciplines other than language learning.

scholarly journals The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

2019 ◽  
Vol 3 (4) ◽  
pp. 545-552
Author(s):  
Nathalia De Oro ◽  
Maria E Gauthreaux ◽  
Julie Lamoureux ◽  
Joseph Scott
Keyword(s):  
Lactic Acid ◽  
Length Of Stay ◽  
Community Hospital ◽  
Unit Length ◽  
Hospital Setting ◽  
Control Group ◽  
Before And After ◽  
Quasi Experimental ◽  
Current Cutoff ◽  
The Impact

Abstract Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

scholarly journals SP10.1.7 The Important Role of In-Situ Simulation in Preparing Surgeons for the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Pierre Montauban ◽  
Charannya Balakumar ◽  
Jaideep Rait ◽  
Prizzi Zarsadias ◽  
Sara Iqbal ◽  
...  
Keyword(s):  
High Risk ◽  
In Situ Simulation ◽  
Level Of Confidence ◽  
Effective Training ◽  
Before And After ◽  
Quasi Experimental ◽  
Surgical Teams ◽  
Imminent Threat ◽  
The Impact

Abstract Background Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19. Methods This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients. Results 27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy. Conclusion In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.

scholarly journals Efficacy of standard- vs reduced-dose insulin for treatment of hyperkalemia: A quasi-experiment

2021 ◽  
Author(s):  
Sara Catherine Pearson ◽  
Kristin O’Connor ◽  
Kimberly Keller ◽  
T J Hodge ◽  
Ross Nesbit
Keyword(s):  
Glucose Level ◽  
Standard Dose ◽  
Additional Treatment ◽  
Treatment Pathway ◽  
Reduced Dose ◽  
Significant Difference ◽  
Before And After ◽  
Quasi Experimental ◽  
Stage Renal Disease ◽  
The Impact

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Hyperkalemia more commonly affects patients with a glomerular filtration rate of less than 60 mL/min. Using intravenous (IV) insulin to shift potassium intracellularly may cause hypoglycemia, requiring additional treatment or longer hospitalization. Literature on insulin dosing in this context is limited, with one previous study indicating that 5 units of IV insulin might be as effective and result in less hypoglycemia than the standard dose of 10 units of IV insulin. The hyperkalemia treatment pathway at our institution was revised in May 2018 to include a reduced-dose option (5 units of insulin) for patients with end-stage renal disease. This study aimed to compare the prevalence of hypoglycemia between patients who received standard-dose vs reduced-dose IV insulin. Methods This single-center, retrospective, quasi-experimental study evaluated the impact of revision of the hyperkalemia treatment pathway by assessing rates of hypoglycemia during the 6 months before and after implementation of the revised pathway. The primary endpoint was prevalence of hypoglycemia, defined as a blood glucose level of less than or equal to 70 mg/dL. Results There was no statistically significant difference in the occurrence of hypoglycemia when comparing the pre- and postimplementation groups (36 [17.7%] patients vs 34 [18.7%] patients; P = 0.7924). The postimplementation group had a statistically significant lower reduction in potassium levels after treatment than the preimplementation group (mean [interquartile range], –0.9 [–1.3, –0.5] mEq/L vs –0.6 [–1.2, –0.2] mEq/L; P = 0.0095). Baseline potassium levels were similar between the groups. Conclusion Administration of reduced-dose IV insulin for treatment of hyperkalemia was significantly less effective in lowering serum potassium levels and did not decrease prevalence of hypoglycemia. When accounting for potential confounders, the only variable that was associated with hypoglycemia was pretreatment glucose level.

scholarly journals 1039. Forty-eight-hour Antibiotic Time-out: Impact on Antibiotic Duration and Clinical Outcomes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S365-S366
Author(s):  
Natasha N Pettit ◽  
Palak Bhagat ◽  
Cynthia T Nguyen ◽  
Victoria J L Konold ◽  
Madan Kumar ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Medical Center ◽  
Inpatient Setting ◽  
Core Element ◽  
Time Out ◽  
Before And After ◽  
Control And Prevention ◽  
Quasi Experimental ◽  
Tract Infections ◽  
The Impact

Abstract Background A core element of the Centers for Disease Control and Prevention Antimicrobial Stewardship standard for the inpatient setting includes a 48-hour antibiotic time-out (ATO) process to reassess antibiotic indication. We implemented an automated alert in the electronic health record (EHR) that identifies patients that have received >=48hours of antibiotic therapy. The alert requires the clinician (physician or pharmacist) to note an indication for continuation or plan for discontinuation. Within the alert, a dashboard was developed to include relevant patient information (e.g., temperature, white blood cell count, microbiology, etc). We sought to evaluate the impact of the ATO alert on the duration of therapy (DOT) of cefepime (CFP), ceftazidime (CTZ) and vancomycin (VAN), for the treatment of pneumonia (PNA) and urinary tract infections (UTI) for adult and pediatric patients. Methods This quasi-experimental, retrospective analysis included adult and pediatric patients that received ≥48 hours of CFP, CTZ, or VAN for UTI or PNA between April 1, 2017 and July 31, 2017 (pre-48H ATO) and October 1, 2018–December 31, 2018 (post-48H ATO). Fields at order-entry to specify an antibiotic indication were not available prior to our EHR interventions. A randomized subset from the Pre-48Hr ATO group was selected for detailed analysis. The primary endpoint was to evaluate the average DOT of CFP/CTZ combined, VAN alone, and the combination of CFP/CTZ/VAN. We also evaluated length of stay (LOS), all-cause inpatient mortality, and 30-day readmissions. Results A total of 157 antibiotic orders (n = 94 patients) were evaluated in the pre-48h ATO group, and 2093 antibiotic orders (n = 521 patients) post-48H ATO group. Pre-48H ATO, 85 patients received CFP/CTZ and 72 VAN. Post-48H ATO, 322 patients received CFP/CTZ and 198 VAN. PNA was the most common indication pre- and post-48H ATO. DOT significantly decreased pre- vs. post-48H ATO (Figure 1). LOS was 2 days shorter (P = 0.01) in the post-48H ATO group, mortality and 30-day readmissions was similar between groups (Table 1). Conclusion Average antibiotic DOT for CFP/CTZ, and VAN significantly decreased following the implementation of the 48H ATO at our medical center. LOS was reduced by 2 days, while mortality and 30-day readmissions were similar before and after. Disclosures All authors: No reported disclosures.

scholarly journals Systematic review and meta-analysis of community pharmacy error rates in the USA: 1993–2015

2018 ◽  
Vol 7 (4) ◽  
pp. e000193 ◽  
Author(s):  
Patrick J Campbell ◽  
Mira Patel ◽  
Jennifer R Martin ◽  
Ana L Hincapie ◽  
David Rhys Axon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Community Pharmacy ◽  
Error Rate ◽  
Meta Analysis ◽  
Grey Literature ◽  
Error Rates ◽  
Significant Heterogeneity ◽  
The Usa ◽  
Dispensing Error ◽  
Dispensing Errors

ImportanceWhile much is known about hospital pharmacy error rates in the USA, comparatively little is known about community pharmacy dispensing error rates.ObjectiveThe aim of this study was to determine the rate of community pharmacy dispensing errors in the USA.MethodsEnglish language, peer-reviewed observational and interventional studies that reported community pharmacy dispensing error rates in the USA from January 1993 to December 2015 were identified in 10 bibliographic databases and topic-relevant grey literature. Studies with a denominator reflecting the total number of prescriptions in the sample were necessary for inclusion in the meta-analysis. A random effects meta-analysis was conducted to estimate an aggregate community pharmacy dispensing error rate. Heterogeneity was assessed using the I2 statistic prior to analysis.ResultsThe search yielded a total of 8490 records, of which 11 articles were included in the systematic review. Two articles did not have adequate data components to be included in the meta-analysis. Dispensing error rates ranged from 0.00003% (43/1 420 091) to 55% (55/100). The meta-analysis included 1 461 128 prescriptions. The overall community pharmacy dispensing error rate was estimated to be 0.015 (95% CI 0.014 to 0.018); however, significant heterogeneity was observed across studies (I2=99.6). Stratification by study error identification methodology was found to have a significant impact on dispensing error rate (p<0.001).Conclusion and relevanceThere are few published articles that describe community pharmacy dispensing error rates in the USA. Thus, there is limited information about the current rate of community pharmacy dispensing errors. A robust investigation is needed to assess dispensing error rates in the USA to assess the nature and magnitude of the problem and establish prevention strategies.

The impact of a TV report in schizophrenia stigma reduction: A quasi-experimental study

2017 ◽  
Vol 63 (3) ◽  
pp. 275-277 ◽  
Author(s):  
Nathaly de Oliveira Bosoni ◽  
Geraldo Busatto Filho ◽  
Daniel Martins de Barros
Keyword(s):  
Brief Intervention ◽  
Social Distance ◽  
Mass Communication ◽  
Long Term Effects ◽  
Stigma Reduction ◽  
The Social ◽  
Before And After ◽  
Quasi Experimental ◽  
The Impact

Background: Stigma is a major problem in schizophrenia, and the most effective way to reduce it is to provide information. But literature lacks studies evaluating long-term efficacy of mass communication. Aims: This is a pilot study to assess if a brief intervention (TV report) may have long-term effects. Method: Assessing stigma scores from subjects before and after seeing a vignette. Results: We found that the social distance and restriction to patients not only fell after a brief intervention but also kept lower after 1 and 3 months. Conclusion: We conclude that even brief intervention may create persistent impact in reducing discrimination.

scholarly journals Developing checklists to prevent diagnostic error in Emergency Room settings

Diagnosis ◽  
2014 ◽  
Vol 1 (3) ◽  
pp. 223-231 ◽  
Author(s):  
Mark L. Graber ◽  
Asta V. Sorensen ◽  
Jon Biswas ◽  
Varsha Modi ◽  
Andrew Wackett ◽  
...  
Keyword(s):  
Emergency Room ◽  
Diagnostic Errors ◽  
Evaluation Process ◽  
Diagnostic Error ◽  
Error Rates ◽  
Diagnostic Uncertainty ◽  
Maximum Benefit ◽  
Before And After ◽  
The Impact ◽  
Test Ordering

AbstractChecklists have been shown to improve performance of complex, error-prone processes. To develop a checklist with potential to reduce the likelihood of diagnostic error for patients presenting to the Emergency Room (ER) with undiagnosed conditions.Participants included 15 staff ER physicians working in two large academic centers. A rapid cycle design and evaluation process was used to develop a general checklist for high-risk situations vulnerable to diagnostic error. Physicians used the general checklists and a set of symptom-specific checklists for a period of 2 months. We conducted a mixed methods evaluation that included interviews regarding user perceptions and quantitative assessment of resource utilization before and after checklist use.A general checklist was developed iteratively by obtaining feedback from users and subject matter experts, and was trialed along with a set of specific checklists in the ER. Both the general and the symptom-specific checklists were judged to be helpful, with a slight preference for using symptom-specific lists. Checklist use commonly prompted consideration of additional diagnostic possibilities, changed the working diagnosis in approximately 10% of cases, and anecdotally was thought to be helpful in avoiding diagnostic errors. Checklist use was prompted by a variety of different factors, not just diagnostic uncertainty. None of the physicians used the checklists in collaboration with the patient, despite being encouraged to do so. Checklist use did not prompt large changes in test ordering or consultation.In the ER setting, checklists for diagnosis are helpful in considering additional diagnostic possibilities, thus having potential to prevent diagnostic errors. Inconsistent usage and using the checklists privately, instead of with the patient, are factors that may detract from obtaining maximum benefit. Further research is needed to optimize checklists for use in the ER, determine how to increase usage, to evaluate the impact of checklist utilization on error rates and patient outcomes, to determine how checklist usage affects test ordering and consultation, and to compare checklists generally with other approaches to reduce diagnostic error.

scholarly journals Transit-oriented economic development: The impact of light rail on new business starts in the Phoenix, AZ Region, USA

Urban Studies ◽  
2017 ◽  
Vol 55 (13) ◽  
pp. 2838-2862 ◽  
Author(s):  
Kevin Credit
Keyword(s):  
Service Sector ◽  
Interrupted Time Series ◽  
Light Rail ◽  
Initial Increase ◽  
New Business Formation ◽  
Before And After ◽  
New Business ◽  
Quasi Experimental ◽  
And Control ◽  
The Impact

This article examines the impact of Phoenix’s light rail system, which opened in 2008, on new firm formation in specific industries. Individual business data from 1990–2014 are used in a quasi-experimental adjusted-interrupted time series (AITS) regression to compare the impact of the transit system’s construction on new business starts in ‘treatment’ and ‘control’ areas before and after the opening of the line. Findings show that the transit adjacency is worth an 88% increase in knowledge sector new starts, a 40% increase in service sector new starts and a 28% increase in retail new starts at the time the system opened, when compared with automobile-accessible control areas. However, the light rail also appears to suffer from a ‘novelty factor’– after the initial increase in new establishment activity in adjacent block groups, the effect diminishes at the rate of 8%, 6% and 7% per year, respectively. The results also provide insight into the spatial extent of light rail impacts to new business formation, with areas 1 mile from stations observing 21% fewer retail new business starts and 12% fewer knowledge sector new starts than areas within a quarter of a mile of stations.

scholarly journals The Influences of Audio Visual Media And Vocabulary Mastery towards English Learning Achievement of EFL Students

2020 ◽  
Vol 7 (1) ◽  
pp. 57-65
Author(s):  
Tubagus Zam Zam Al Arif
Keyword(s):  
Visual Media ◽  
Achievement Test ◽  
P Value ◽  
Colleges Of Education ◽  
Learning Achievement ◽  
Before And After ◽  
Quasi Experimental ◽  
Efl Students ◽  
The Impact ◽  
Test Result

This study was an attempt to determine the impact of interaction between teaching media and vocabulary mastery towards students’ learning achievement in colleges of education at Jambi University. This is a quasi-experimental study with nonequivalent control and experimental group design. Based on the test for normality, homogeneity, and analysis of variance to the data students’ achievement score of experiment class can be concluded that, there are significant differences of learners’ achievement between before and after treatment in experimental class using audio-visual media. Then, there are significant differences between the learners’ vocabulary mastery on their learning achievement. The result of this study showed; 1. There is a significant effect between teaching media toward learners’ achievement. Test result obtained that p-value 0,015 (<0,05) 2. Vocabulary mastery gave the significant effect to the learners’ achievement. Test result obtained that p-value for vocabulary mastery is 0,000 (<0,05). 3. There is no interaction influence between the teaching media and vocabulary mastery towards learners’ achievement. Test result retrieved that p-value is 0,948 (>0,05).

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