scholarly journals How Safe is Intravenous N-Acetylcysteine for the Treatment of Paracetamol Poisoning?

2007 ◽  
Vol 14 (4) ◽  
pp. 198-203 ◽  
Author(s):  
W Merl ◽  
Z Koutsogiannis ◽  
D Kerr ◽  
AM Kelly
Keyword(s):  
Adverse Drug Reactions ◽  
Univariate Analysis ◽  
Primary Outcome Measure ◽  
Paracetamol Poisoning ◽  
Drug Reactions ◽  
Chi Square ◽  
Exact Test ◽  
Clinically Significant ◽  
Paracetamol Toxicity ◽  
Chi Square Analysis

Objective Paracetamol poisoning remains one of the most common and potentially lethal ingestions. N-acetylcysteine (NAC) has been proven to be a highly effective antidote. The aim of this study was to determine the rate of adverse drug reactions (ADR) to intravenous (IV) NAC. Our hypothesis was that IV NAC for the treatment of paracetamol toxicity has a low rate of adverse events. Methods This was an observational cohort study undertaken by explicit retrospective medical record review. It included patients who presented to the emergency department with paracetamol overdose over the ten-year period from July 1995 to June 2004. The primary outcome measure was the occurrence of an ADR during NAC administration. Adverse drug reactions were classified as minor (including flushing, urticaria, pruritus, bronchospasm, tachycardia, and non-ischaemic chest pain) and major (including hypotension, angio-oedema and death). Data analysis was by descriptive statistics and chi-square analysis using univariate analysis, Fisher's exact test and Mann-Whitney U-test. Inter-rater agreement was checked for 9% of the sample. Results There were 470 cases of paracetamol poisoning. Of these, 320 received IV NAC. Thirty-six (11%, 95% CI 8–15%) of these patients developed ADRs. There were two major ADRs, one hypotension and one angio-oedema (0.6%, 95% CI 0.02–2%). Two patients died during hospitalisation, but neither had an ADR to NAC. The most common ADRs were urticaria (20), flushing (15), bronchospasm (12), and pruritus (3). None of the variables analysed was a clinically significant predictor of increased ADR risk. Conclusion Adverse drug reactions after IV NAC infusion occur commonly, but most are minor. Treatment of paracetamol poisoning with IV NAC appears to be safe, however a large prospective study would be required to confirm this.

Incidence of adverse drug reactions induced by N-acetylcysteine in patients with acetaminophen overdose

2010 ◽  
Vol 29 (3) ◽  
pp. 153-160 ◽  
Author(s):  
Sa'ed H Zyoud ◽  
Rahmat Awang ◽  
Syed Azhar Syed Sulaiman ◽  
Waleed M Sweileh ◽  
Samah W Al-jabi
Keyword(s):  
Adverse Drug Reactions ◽  
Univariate Analysis ◽  
Drug Reactions ◽  
Chi Square ◽  
Exact Test ◽  
Acetaminophen Overdose ◽  
Significant Difference ◽  
Chi Square Test ◽  
Comparative Results ◽  
Student’S T

Background: Intravenous N-acetylcysteine (IV-NAC) is widely recognized as the antidote of choice for acetaminophen overdose. However, its use is not without adverse drug reactions (ADR) that might affect therapeutic outcome or lead to treatment delay. Objective: the aim of this study was to investigate the type and incidence of ADR induced by IV-NAC in patients treated for acetaminophen overdose. Methods: This is a retrospective study of patients admitted to the hospital for acute acetaminophen overdose over a period of 4 years (1 January 2005 to 31 December 2008). The primary outcome of interest in this study was the occurrence of ADR during NAC administration. Pearson chi-square test or Fisher’s exact test, student’s t test, and Mann-Whitney U test were used in univariate analysis. SPSS 15 was used for data analysis. Results: Two hundred and fifty five patients were studied. Different types of ADR were observed in 119 (46.7%) cases. Of those patients, 83 (69.7%) had been treated with IV-NAC versus 36 (30.3%) who had not (p < .001). The following ADR were significantly associated with IV-NAC administration: vomiting (p = .001), flushing (p < .001), rash (p < .001), pruritus (p < .001), chest pain (p = .001), bronchospasm (p = .03), coughing (p = .01), headache (p = .001), dizziness (p < .001), convulsion (p = .03), and hypotension (p = .001). ADR were mild in 54 (43.2%), moderate in 17 (13.6%), and severe in 12 (9.6%) patients. There were no ADR in 42 (33.6%) patients. Comparative results of the characteristics of patients who reacted to IV-NAC and nonreactors showed that patients with ADR had no significant difference in age, gender, ethnicity, amount ingested, latency time, and acetaminophen level than nonreactors. Conclusion: ADR to IV-NAC were common among patients with acetaminophen overdose, but mostly minor and all reported adverse reactions were easily managed.

scholarly journals 2145. Carbapenem-Resistant Enterobacteriaceae infections at the Maharaj Nakorn Chiang Mai Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S727-S727
Author(s):  
Romanee Chaiwarith ◽  
Wisarut Supparatpinyo
Keyword(s):  
Univariate Analysis ◽  
Tertiary Care ◽  
Control Measures ◽  
Fisher Exact Test ◽  
Care Hospital ◽  
Chiang Mai ◽  
Chi Square ◽  
Exact Test ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Nowadays, carbapenem-resistant enterobacteriaceae (CRE) infection has been spreading worldwide in a tertiary care hospital and causing globally health damage. In Thailand, the studies of the epidemiology of CRE are scarce. This study aimed to describe epidemiology, clinical characteristics and treatment outcome of CRE infection. Methods A retrospective cohort study was conducted among patients admitted to the Maharaj Nakorn Chiang Mai Hospital between January 2014 and December 2016 who had clinical diagnosis of CRE infection. Characteristics between groups were compared using Chi-square, Fisher exact test or Student t-test, Mann–Whitney U test. Factors associated with mortality in univariate analysis were analyzed in the logistic regression model. Results Among 241 patients who had clinical specimens grew CRE, 51 had infection. Twenty-five patients (49%) were previously hospitalized within 90 days and 42 patients (82.4%) had exposed to antibiotics before documented CRE infection. The most common sites of clinical isolates were urine (33.3%), sputum (29.4%), and blood (21.6%). The mortality rate was 47.1%, which 17 (33.3%) patients’ death was attributable to CRE infection. Factor associated with mortality was higher body temperature (OR 4.8, P = 0.005) and thrombocytopenia. Conclusion CRE infections cause high mortality. Strategies to prevent emergence through prudent uses of antibiotics and transmission through infection control measures should be implemented in order to reduce mortality. Disclosures All authors: No reported disclosures.

Analysis of Contingency Tables with Sparse Values

1979 ◽  
Vol 16 (3) ◽  
pp. 382-386 ◽  
Author(s):  
William S. Shields ◽  
Roger M. Heeler
Keyword(s):  
Contingency Tables ◽  
Fisher Exact Test ◽  
Financial Cost ◽  
Chi Square ◽  
Exact Test ◽  
Loss Of Information ◽  
Cell Counts ◽  
Chi Square Analysis ◽  
The Cost

In the chi square analysis of cross-tabulated variables, the problem of low cell counts is usually solved by combining categories, at the cost of a loss of information, or by using larger samples, at added financial cost. Use of a chi square statistic based on an extension of the Fisher Exact Test can provide a third, less costly, alternative.

Prognostic Value of High Thymidine Kinase Activity in Previously Untreated Diffuse Large B-Cell Lymphoma Treated by R-CHOP

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1541-1541
Author(s):  
Kazuhito Suzuki ◽  
Yasuhito Terui ◽  
Noriko Nishimura ◽  
Yuko Mishima ◽  
Sakura Sakajiri ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
B Cell Lymphoma ◽  
Chi Square ◽  
Exact Test ◽  
Large B Cell Lymphoma ◽  
Chi Square Test ◽  
Activity Groups ◽  
Large B Cell

Abstract Abstract 1541 Introduction Thymidine kinase (TK) activity has been investigated as a prognostic factor in hematological malignancies, and several studies have demonstrated that a high TK activity correlates with the disease stage and provides prognostic information on overall survival (OS) and progression free survival (PFS). However, the prognostic significance of TK activity for patients with diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP has not been investigated yet. The purpose of this retrospective study was to investigate the prognostic value of high TK activity compared with other laboratory findings in evaluating OS in patients undergoing R-CHOP for previously untreated DLBCL. Methods We retrospectively analyzed patients treated with R-CHOP for previously untreated DLBCL from September 2003 to October 2008 in our institute. We evaluated serum TK activity, C-reactive protein (CRP), lactate dehydrogenase (LDH), and hemoglobin (Hb) before R-CHOP. The cut-off for TK activity was defined as 14 IU/L. The cut-offs for CRP and LDH were defined as the upper normal limits, and the cut-off for Hb was defined as the lower normal limit. The primary endpoint was OS. The OS and PFS were analyzed by the Kaplan-Meier method, and biological prognostic factors for OS were evaluated by Cox regression analysis. Second, complete response (CR) rate was assessed by the chi square test and Fisher's exact test, comparing patients with and without the prognostic factors. All p-values reported were two-sided, and statistical significance was defined as p < 0.05. Results The clinical records of 242 patients with previously untreated DLBCL were analyzed in this study. The median age of the patients was 65.2 years old (range, 23.2 – 88.1). The median levels of TK activity, CRP, LDH, and Hb were 14.0 IU/L (range, 3.0 – 1100), 0.3 IU/L (range, 0.1 – 21.2), 254.5 IU/L (range, 111.0 – 44432), and 13.1 g/dL (range, 7.7 – 17.0), respectively. Median follow-up time for all patients was 53.0 months. Median OS was 82.3 months (95% CI, 78.6 – 86.0). The OS was significantly worse in patients with high TK activity (p =.001) and anemia (p =.006) by univariate analysis. Median OS in the high and low TK activity groups was 71.7 months (95% CI 63.9 – 79.4) and 85.9 months (95% CI 81.8 – 89.9). In multivariate analysis, the OS was significantly worse in patients with high TK activity (HR 2.640, 95% CI 1.018 – 6.881; p =.046) and anemia (HR 2.228, 95% CI 1.000 – 4.967; p =.050). Median PFS was 73.9 months (95% CI, 69.4 – 78.4). The PFS was significantly worse in patients with high TK activity (p =.000), anemia (p =.005), and high LDH level (p =.010) by univariate analysis. Median PFS in the high and low TK activity groups was 57.3 months (95% CI 48.7 – 66.0) and 80.9 months (95% CI 75.5 – 86.2). In multivariate analysis, PFS was significantly worse in patients with high TK activity (HR 2.809, 95% CI 1.375 – 5.737; p =.005) and anemia (HR 1.902, 95% CI 1.033 – 3.504; p =.039). The CR and overall response rates were 81.4% and 93.0%, respectively. The OS was significantly better in patients who achieved CR than those with partial response or less. Median OS in the CR and non-CR groups was 86.1 months (95% CI 82.7 – 89.5) and 66.0 months (95% CI 53.6 – 78.3), respectively (p <.001). According to the chi square test and Fisher's exact test, the CR rates of patients with high TK activity (p <.001), high CRP (p =.004), and high LDH (p =.019) were significantly worse. The CR rates in the high and low TK activity groups were 68.9% and 92.5%, respectively. The OS for patients with high TK activity who did not achieve CR was even significantly worse than that of both low TK activity patients who did not achieve CR and high TK activity patients who achieved CR (p =.047 and <.001). However, the OS was similar in high and low TK activity group patients who achieved CR (p =.171, Figure 1). Conclusion High TK activity significantly worsened OS and PFS among patients with previously untreated DLBCL who had undergone R-CHOP. While we commonly perform R-CHOP for DLBCL as an initial treatment, our findings show that the OS becomes significantly worse in patients who do not achieve CR by R-CHOP. The OS in patients with high TK activity who did not achieve CR was significantly worse than that with both low TK activity patients who did not achieve CR and high TK activity patients who achieved CR. Our findings suggest that novel treatment strategies for previously untreated DLBCL patients with high TK activity are certainly necessary. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Correlation Between The Use of Personal Protective Equipment (PPE) and Soil-Transmitted Helminths Infection in the Workers of Kaliputih Plantation Jember Regency

2019 ◽  
Vol 5 (2) ◽  
pp. 8
Author(s):  
Ivan Iqbal Baidowi ◽  
Yunita Armiyanti ◽  
Zahrah Febianti ◽  
Yudha Nurdian ◽  
Bagus Hermansyah
Keyword(s):  
Personal Protective Equipment ◽  
Sampling Technique ◽  
Protective Equipment ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
Soil Transmitted Helminths ◽  
Faecal Samples ◽  
The Status ◽  
Chi Square Analysis

This study aimed to investigate the correlation between the use of Personal Protective Equipment (PPE) and the status of Soil-Transmitted Helminths infection in the workers of Kaliputih plantation in Jember Regency. The research method applied was Analytic observational with a Cross-sectional approach. The population, as well as the sample, were all workers of Kaliputih Plantation, Sumber Bulus Village, Ledokombo District, Jember Regency, by the total of 63 people. The sampling technique was the Total sampling. Laboratory analysis on faecal samples of respondents were conducted at the Parasitology Laboratory, Faculty of Medicine, University of Jember. Furthermore, the research data were analyzed using Chi-Square analysis or Fisher’s Exact Test. The results demonstrated that the prevalence of STH infection in Kaliputih Plantation workers was 25%. This figure was supported by the good awareness of the use of Personal Protective Equipment (PPE) of workers (91.67%). In addition, the Soil-Transmitted Helminths species that infested the plantation workers were Ascaris lumbricoides, found in 6 people (16.67%), and Hookworm, found in 3 people (8.33%). Finally, the result of Chi-square analysis showed a significance value of <0.05. Therefore, it can be concluded that the use of PPE in Kaliputih plantation workers had a significant correlation with the STH infection status. Keywords: Correlation, PPE, Soil-Transmitted Helminths Infection

scholarly journals SEROPREVALENCE OF Trypanosoma vivax, Anaplasma marginale, and Babesia bovis IN DAIRY CATTLE

2016 ◽  
Vol 17 (4) ◽  
pp. 564-573 ◽  
Author(s):  
Jonata de Melo Barbieri ◽  
Yuly Andrea Caicedo Blanco ◽  
Fábio Raphael Pascoti Bruhn ◽  
Antônio Marcos Guimarães
Keyword(s):  
Dairy Cattle ◽  
Univariate Analysis ◽  
Anaplasma Marginale ◽  
Minas Gerais ◽  
Immunofluorescence Assay ◽  
Babesia Bovis ◽  
Multiple Model ◽  
Trypanosoma Vivax ◽  
Chi Square ◽  
Exact Test

Abstract In order to determine the prevalence of IgG against Trypanosoma vivax, Anaplasma marginale, and Babesia bovis in dairy cattle in southern Minas Gerais, four hundred cows from 40 dairy farms were randomly selected and distributed in 14 municipalities. Seroprevalence was determined by indirect immunofluorescence assay (IFA). Interviews were conducted to characterize producers and dairy production. Univariate analysis was carried out using chi-square (x2) or Fisher's exact test. The multiple model was constructed with variables associated with p ≤ 0.25 by x2 test using generalized estimating equations (GEE). True prevalence at herd level was 49.6% (31.7-67.5), 100% (92.1-100), and 100% (86.5-100) for T. vivax, A. marginale, and B. bovis, respectively. At individual level, true seroprevalence was 9.9% (6.7-13.1), 96.2% (92.1-99.6), and 93.7% (89.4-97.2), respectively, for T. vivax, A. marginale, and B. bovis. Among the factors adjusted by logistic regression GEE model, "total farm area" (p= 0.021, OR= 0.308, Ic95%= 0.114-0.836) and "fly season" (p= 0.016, OR= 2.133, Ic95%= 1.153-3.948) remained associated with seropositivity for T. vivax. As the State of Minas Gerais is considered non-endemic for T. vivax, producers and veterinarians should be informed about the risk of occurrence of bovine trypanosomiasis.

Prediction of factors affecting clinical trial accrual at Cancer Therapy and Research Center, San Antonio.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18207-e18207
Author(s):  
Praveena Iruku
Keyword(s):  
Clinical Trial ◽  
Univariate Analysis ◽  
New Drugs ◽  
Disease Category ◽  
Chi Square ◽  
Significance Level ◽  
Factors Affecting ◽  
Exact Test ◽  
Investigational Drugs ◽  
Clinical Trial Accrual

e18207 Background: Oncology is a very rapidly emerging science with need for more investigational drugs. It is highly essential to accrue patients into clinical trials to develop new drugs. According to the available data, about 38 % of the CTEP/NCI supporting oncology trials close due to inadequate accrual. We here by present a retrospective analysis of factors which affect clinical trial accrual in our institution. Methods: Eligible studies included treatment and supportive care intervention studies either open or closed to accrual between 09/1999 and 012/2015 at our center. Data abstracted includes coordinating group, sponsor type, presence of competing trials, trial phase, disease category, single institutional study, author, primary purpose of the study, interventional modality, targeted therapy, advanced disease, randomization, presence of placebo, rare cancer category and new investigational agents. Successful clinical trial accrual was defined as accruing 4 or more patients. Statistical analysis was performed in the statistic software R (R Foundation for Statistical Computing, Vienna, Austria). We used Chi-square test and Fisher’s exact test. The significance level was set to alpha = 0.05. Results: Retrospective univariate analysis at our institution showed that the variables significantly associated with clinical accrual are Authored by principal investigator, type of sponsor, phase of the trial and number of interventions in the study. Using a random forest model with the above mentioned predictors, we computed an AUC of 64.1 % . We have also developed a histogram of predictions which has identified atleast 5 studies with an 80% failure probability to accrue. Conclusions: Clinical trial accrual is absolutely necessary for development of investigational drugs and progress of research in Hematology/Oncology especially with the rise in incidence of many malignancies. We have identified a few factors that may impact accrual in our institution, and we propose to prospectively validate it in our future endeavor. The major limitations of our study are its retrospective nature and being a single site analysis.

IIB or not IIB, part 1: retrospective evaluation of Kenney–Doig categorization of equine endometrial biopsies at a veterinary diagnostic laboratory and comparison with published reports

2021 ◽  
pp. 104063872110622
Author(s):  
Jane Westendorf ◽  
Bruce Wobeser ◽  
Tasha Epp
Keyword(s):  
Observer Variation ◽  
Fisher Exact Test ◽  
Observer Variability ◽  
Retrospective Evaluation ◽  
Review Of The Literature ◽  
Rater Agreement ◽  
Chi Square ◽  
Diagnostic Laboratory ◽  
Exact Test ◽  
Chi Square Analysis

The Kenney–Doig scale is a histopathology categorization (grading) system often used as the standard for assessing endometrial disease and communicating prognostic fertility information for equine breeding prospects. We investigated how Kenney–Doig categories compared within the same institution and across different institutions to determine if observer variability may contribute to category frequencies. We conducted a retrospective analysis of all equine endometrial submission records between 1998 and 2018 at the Western College of Veterinary Medicine (WCVM) and Prairie Diagnostic Services (PDS). Of 726 biopsies, we found the following category distribution: 46 of 726 (6.3%) I, 307 of 726 (42.3%) IIA, 326 of 726 (44.9%) IIB, and 47 of 726 (6.5%) III. We also conducted a review of the literature and included 6 studies reporting Kenney–Doig category distributions. Chi-square analysis showed significant differences between the category distribution found at WCVM and PDS and the category distribution reported in the 6 studies. To account for differences in mare populations, individual category distributions were generated for 5 pathologists at the WCVM and PDS. The Fisher exact test among these 5 Kenney–Doig categories revealed significant differences in category tendencies, suggesting that observer variation affects the use of the scale. Our results suggest that there is a need for prospective inter-rater and intra-rater agreement studies of the repeatability of the Kenney–Doig scale.

Bleeding Score as a Preoperative Predictor of Postoperative Bleeding in Type 1 Von Willebrand Disease.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1019-1019 ◽  
Author(s):  
Laura R. Goldberg ◽  
Margaret V. Ragni
Keyword(s):  
Family History ◽  
Postoperative Bleeding ◽  
Von Willebrand Disease ◽  
Chi Square ◽  
Exact Test ◽  
Bleeding Score ◽  
Chi Square Analysis ◽  
Bleeding History ◽  
Von Willebrand

Abstract Type 1 Von Willebrand Disease (VWD) is the most common congenital bleeding disorder, affecting 1% of the population, and caused by a quantitative deficiency of Von Willebrand Factor (VWF). In addition to mucosal bleeding, VWD patients often suffer postoperative bleeding, leading to significant morbidity. Thus, a preoperative diagnosis could potentially reduce postoperative bleeding. Because symptoms correlate poorly with VWD assays, subject to extragenic effects and lab variability, diagnosis is difficult. The bleeding score (BS) is a simple quantitative tool recently developed to rate bleeding symptom severity, with 99% specificity for VWD. To determine the potential utility of BS in predicting postoperative bleeding in VWD, we evaluated preoperative BS by retrospective review of type 1 VWD patients who suffered postoperative bleeding prior to diagnosis. Preoperative clinical bleeding symptoms and VWD assays, including VWF:RCo, VWF:Ag, and FVIII:C, were obtained. The severity of clinical bleeding symptoms present prior to surgery was rated by the 4-point BS scale: 0 = no/trivial; 1 = present; 2 = intervention required; 3 = replacement therapy. Statistical analysis was by chi square analysis and Fisher’s exact test for categorical data, and by student t test for continuous data. Of 260 registered type 1 VWD patients, 71 (27.3 %) experienced surgical bleeding prior to a diagnosis of VWD. Of these 56 (78.9%) were female, 48 (67.6%) were adults (≥ 18 yr), and 61 (85.9%) had a family bleeding history. The surgeries included general, gynecologic, genitourinary, and otolaryngologic procedures. The median preop BS, 3 in females and 4 in adults, was significantly higher than in males and children, each median 1, p&lt;0.01, respectively. A BS ≥ 3 would have identified only 59.1% patients before surgery, but as many as 90.1%, if combined with one abnormal VWD test; 94.4%, with family bleeding history; or 97.2% with both family history and one abnormal VWD test. The proportion of children identified by BS was significantly lower than in adults, 26.1% vs 75.0 % with BS &gt; 3, p = 0.001. Yet this significantly improved by combining BS with family history, 91.3% vs 95.8%, not different from adults, p = 0.591. We conclude that obtaining a preoperative BS and family bleeding history may reduce postoperative bleeding and promote timely diagnosis among individuals with type 1 VWD patients, particularly children. Preoperative Bleeding Score in Type 1 VWD Patients with Postoperative Bleeding Male Female Age &lt; 18 Age ≥ 18 All N = 15 N = 56 N = 23 N = 48 N = 71 τp = .001, as compared with under 18 yr; σp = .007, as compared with males; ζ p &gt; 0.5 as compared with age under 18 or males, respectively. BS≥1 10/15 (66.7%) 54/56 (96.4%) 18/23 (78.3%) 46/48 (95.8%) 64/71 (90.1%) BS≥3 4/15 (26.7%) 38/56 (67.8%)σ 6/23 (26.1%) 36/48 (75.0%)τ 42/71 (59.1%) BS≥5 2/15 (13.3%) 17/56 (30.3%) 2/23 (8.7%) 17/48 (35.4%) 19/71 (26.7%) Abnl VWF:RCo 8/15 (53.3%) 19/56 (33.9%) 6/23 (26.1%) 19/48 (39.6%) 27/71 (38.0%) Abnl VWD Test 11/15 (73.3%) 41/56 (73.2%) 16/23 (69.6%) 36/48 (75.0%) 52/71 (73.2%) Fam Bld History 15/15 (100%) 47/56 (83.9%) 21/23 (91.3%) 40/48 (83.3%) 61/71 (85.9%) BS≥3 ± Abnl VWD Test 13/15 (86.7%) 51/56 (91.1%) 18/23 (78.3%) 46/48 (95.8%) 64/71 (90.1%) BS≥3 ± Fam Hx 15/15 (100.0%) 52/56 (92.8%)ζ 21/23 (91.3%) 46/48 (95.8%)ζ 67/71 (94.4%) BS≥3 ± Fam Hx ± Abnl VWD Test 15/15 (100.0%) 54/56 (96.4%) 22/23 (95.6%) 47/48 (97.9%) 69/71 (97.2%)

Comparison of medication safety systems in critical access hospitals: Combined analysis of two studies

2016 ◽  
Vol 73 (15) ◽  
pp. 1167-1173 ◽  
Author(s):  
Gary L. Cochran ◽  
Ryan S. Barrett ◽  
Susan D. Horn
Keyword(s):  
Medication Errors ◽  
Medication Safety ◽  
Medication Administration ◽  
Error Rates ◽  
Critical Access Hospitals ◽  
Chi Square ◽  
Exact Test ◽  
Transcription Error ◽  
Chi Square Analysis ◽  
Dispensing Errors

Abstract Purpose The role of pharmacist transcription, onsite pharmacist dispensing, use of automated dispensing cabinets (ADCs), nurse–nurse double checks, or barcode-assisted medication administration (BCMA) in reducing medication error rates in critical access hospitals (CAHs) was evaluated. Methods Investigators used the practice-based evidence methodology to identify predictors of medication errors in 12 Nebraska CAHs. Detailed information about each medication administered was recorded through direct observation. Errors were identified by comparing the observed medication administered with the physician’s order. Chi-square analysis and Fisher’s exact test were used to measure differences between groups of medication-dispensing procedures. Results Nurses observed 6497 medications being administered to 1374 patients. The overall error rate was 1.2%. The transcription error rates for orders transcribed by an onsite pharmacist were slightly lower than for orders transcribed by a telepharmacy service (0.10% and 0.33%, respectively). Fewer dispensing errors occurred when medications were dispensed by an onsite pharmacist versus any other method of medication acquisition (0.10% versus 0.44%, p = 0.0085). The rates of dispensing errors for medications that were retrieved from a single-cell ADC (0.19%), a multicell ADC (0.45%), or a drug closet or general supply (0.77%) did not differ significantly. BCMA was associated with a higher proportion of dispensing and administration errors intercepted before reaching the patient (66.7%) compared with either manual double checks (10%) or no BCMA or double check (30.4%) of the medication before administration (p = 0.0167). Conclusion Onsite pharmacist dispensing and BCMA were associated with fewer medication errors and are important components of a medication safety strategy in CAHs.

Sign in / Sign up

Export Citation Format

Share Document