scholarly journals What is the impact of introducing inpatient electronic prescribing on prescribing errors? A naturalistic stepped wedge study in an English teaching hospital

2019 ◽  
Vol 26 (4) ◽  
pp. 3152-3162 ◽  
Author(s):  
Bryony Dean Franklin ◽  
Seetal Puaar
Keyword(s):  
Logistic Regression ◽  
Study Design ◽  
Teaching Hospital ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Stepped Wedge ◽  
Future Studies ◽  
Before And After ◽  
Study Designs ◽  
The Impact

Most studies evaluating the impact of electronic prescribing on prescribing safety have used comparatively weak study designs such as uncontrolled before-and-after studies. This study aimed to apply a more robust naturalistic stepped wedge study design to compare the prevalence and types of prescribing errors for electronic prescribing and paper prescribing. Data were collected weekly during a phased electronic prescribing implementation across 20 wards in a large English hospital. We identified 511 (7.8%) erroneous orders in 6523 paper medication orders, and 312 (6.0%) in 5237 electronic prescribing orders. Logistic regression suggested no statistically significant effect of electronic prescribing use or of study week; patient and ward had significant effects. Errors involving incorrect doses and illegible or incomplete orders were less common with electronic prescribing; those involving duplication, omission, incorrect drug and incorrect formulation were more common. Actions are needed to mitigate these error types; future studies should give more consideration to the effects of patient and ward.

scholarly journals Impact of Electronic Prescription on Prescribing Errors

2021 ◽  
pp. 212-220
Author(s):  
Ameen M. Almohammadi ◽  
Huda M. Al-Dhahri ◽  
Shroug H. Al-Harbi
Keyword(s):  
Study Design ◽  
Intervention Study ◽  
Dosage Forms ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Post Intervention ◽  
Electronic Prescription ◽  
Prescription Errors ◽  
Trade Names ◽  
The Impact

Aims: There are series of medical errors that can be prevented by taking precautions.             Therefore, the study evaluates the impact of the electronic prescribing system on prescription errors. Study Design:  A pre-post study design was conducted. Place and Duration of Study: The study was conducted at outpatient pharmacy services of a teaching hospital in Jeddah city. Methodology: Prescriptions were evaluated for the presence of the essential prescription elements such as patient information, drug name, dose, frequency, strength, and other prescription completeness parameters. Results: In the pre-intervention study, 1182 handwritten prescriptions were evaluated, and 6627 errors were detected from these prescriptions. The length of the pre-and post-intervention period was two weeks each. The most prevalent prescribing errors were that of medications written without defined dosage forms were recorded 1653 (55.90%) time followed by prescriptions written by trade names 1493 (22.5%), without route of administration 1266 (19.1%), and without specified duration 1009 (15.2%). However, 1512 prescriptions were evaluated in the post-intervention study, among which 339 errors were detected. The errors included prescriptions written without diagnosis (5.09%), or without doctor’s name or stamp (1.52%), written by trade names (4.49%), without defined dosage forms (4.29%), and without specified duration (2.84%). Conclusion: The study concluded that E-prescribing eliminated prescription errors that resulted from handwritten prescriptions.

scholarly journals P047 Evaluating the impact of pre-prepared neonatal intubation premedication kits on a level 3 neonatal unit (Project NIK)

2019 ◽  
Vol 104 (7) ◽  
pp. e2.52-e2
Author(s):  
Suzannah Hibberd ◽  
Alok Sharma ◽  
Marhamat Chavoshzadeh
Keyword(s):  
Nursing Staff ◽  
Response Rate ◽  
Electronic Prescribing ◽  
Drug Preparation ◽  
Prescribing Errors ◽  
Before And After ◽  
Level 3 ◽  
Perceived Impact ◽  
Set Up ◽  
The Impact

BackgroundIn January 2018, neonatal intubation premedication kits containing atropine, suxamethonium and fentanyl were introduced alongside the implementation of dose- banding for these medicines according to patient’s weight and regardless of the patient’s gestation. A prescribing bundle on the electronic prescribing system was also created to automatically populate the doses based on the patient’s weight. Seven kits are produced each week by the Pharmacy Technical Services Unit.AimTo assess the staff perceived impact of pre-prepared intubation drug kits with associated dose-banding of the medication.MethodsThree months after the kits were implemented, a survey was sent to all nursing and medical staff to establish their thoughts on the intubation process before and after the introduction of pre-made intubation drug kits.Results78 staff responded, 45.5% were doctors and 54.5% were nursing staff. The response rate was 53.8%. 78% of respondents reported being part of a difficult intubation over the last 5 years. The main problems identified, prior to the implementation of the neonatal intubation drug kits, included the intubation process (51.5%), preparation and communication prior to intubation, (13.6%), time drawing up intubation drugs (10.6%) and the patient having a difficult airway (9%). 87.2% found the premade intubation kits very useful, none of the respondents thought the kits were not useful. Four themes were found irrespective of whether the respondent was a doctor or member of nursing staff. The themes were: they made the process easier; quicker; reduced risk of error and helped provide better patient care. When asked if any complications had arisen, 4% reported that they had run out of kits and 2.7% said there was confusion when signing the kits out of the controlled drug (CD) register.Three weeks out of 25 saw all the kits being used, average usage is 4 intubation kits per week. 97.4% reported the doses used were effective in sedating and paralysing the baby prior to intubation, 2.6% commented that they were somewhat effective but that in one occasion the paralysis had not been optimal, however they questioned whether the cannula had been functioning properly.ConclusionThe implementation of ready to use intubation drug kits has made the process of preparing for an intubation easier and quicker for all involved in the process. Having the dose banding set up on the electronic prescribing system has reduced the chance of prescribing errors and the pre- filled kits have reduced the chances of calculation errors during drug preparation. When the kits run out there are instructions in the guideline detailing how to make the required concentrations. As a result of this study standardised teaching videos were introduced from the beginning of July 18. Further simulations have been completed to ensure that all staff follow a standardised process. Next steps are to ensure that the documentation in the CD register includes all necessary information without any need for amendments. To overcome this, a stamp is being designed to use in the book each time a patient requires a kit, thereby providing a prompt for the nurses.

scholarly journals The Impact of Technology on Prescribing Errors in Pediatric Intensive Care: A Before and After Study

2020 ◽  
Vol 11 (02) ◽  
pp. 323-335 ◽  
Author(s):  
Moninne M. Howlett ◽  
Eileen Butler ◽  
Karen M. Lavelle ◽  
Brian J. Cleary ◽  
Cormac V. Breatnach
Keyword(s):  
Intensive Care ◽  
New Technology ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Before And After ◽  
The Impact ◽  
Before And After Study

Abstract Background Increased use of health information technology (HIT) has been advocated as a medication error reduction strategy. Evidence of its benefits in the pediatric setting remains limited. In 2012, electronic prescribing (ICCA, Philips, United Kingdom) and standard concentration infusions (SCIs)—facilitated by smart-pump technology—were introduced into the pediatric intensive care unit (PICU) of an Irish tertiary-care pediatric hospital. Objective The aim of this study is to assess the impact of the new technology on the rate and severity of PICU prescribing errors and identify technology-generated errors. Methods A retrospective, before and after study design, was employed. Medication orders were reviewed over 24 weeks distributed across four time periods: preimplementation (Epoch 1); postimplementation of SCIs (Epoch 2); immediate postimplementation of electronic prescribing (Epoch 3); and 1 year postimplementation (Epoch 4). Only orders reviewed by a clinical pharmacist were included. Prespecified definitions, multidisciplinary consensus and validated grading methods were utilized. Results A total of 3,356 medication orders for 288 patients were included. Overall error rates were similar in Epoch 1 and 4 (10.2 vs. 9.8%; p = 0.8), but error types differed (p < 0.001). Incomplete and wrong unit errors were eradicated; duplicate orders increased. Dosing errors remained most common. A total of 27% of postimplementation errors were technology-generated. Implementation of SCIs alone was associated with significant reductions in infusion-related prescribing errors (29.0% [Epoch 1] to 14.6% [Epoch 2]; p < 0.001). Further reductions (8.4% [Epoch 4]) were identified after implementation of electronically generated infusion orders. Non-infusion error severity was unchanged (p = 0.13); fewer infusion errors reached the patient (p < 0.01). No errors causing harm were identified. Conclusion The limitations of electronic prescribing in reducing overall prescribing errors in PICU have been demonstrated. The replacement of weight-based infusions with SCIs was associated with significant reductions in infusion prescribing errors. Technology-generated errors were common, highlighting the need for on-going research on HIT implementation in pediatric settings.

scholarly journals Conceptualising natural and quasi experiments in public health

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Frank de Vocht ◽  
Srinivasa Vittal Katikireddi ◽  
Cheryl McQuire ◽  
Kate Tilling ◽  
Matthew Hickman ◽  
...  
Keyword(s):  
Public Health ◽  
Study Design ◽  
Grey Literature ◽  
Public Health Research ◽  
Natural Experiments ◽  
Target Trial ◽  
Design Elements ◽  
Randomized Controlled ◽  
Study Designs ◽  
The Impact

Abstract Background Natural or quasi experiments are appealing for public health research because they enable the evaluation of events or interventions that are difficult or impossible to manipulate experimentally, such as many policy and health system reforms. However, there remains ambiguity in the literature about their definition and how they differ from randomized controlled experiments and from other observational designs. We conceptualise natural experiments in the context of public health evaluations and align the study design to the Target Trial Framework. Methods A literature search was conducted, and key methodological papers were used to develop this work. Peer-reviewed papers were supplemented by grey literature. Results Natural experiment studies (NES) combine features of experiments and non-experiments. They differ from planned experiments, such as randomized controlled trials, in that exposure allocation is not controlled by researchers. They differ from other observational designs in that they evaluate the impact of events or process that leads to differences in exposure. As a result they are, in theory, less susceptible to bias than other observational study designs. Importantly, causal inference relies heavily on the assumption that exposure allocation can be considered ‘as-if randomized’. The target trial framework provides a systematic basis for evaluating this assumption and the other design elements that underpin the causal claims that can be made from NES. Conclusions NES should be considered a type of study design rather than a set of tools for analyses of non-randomized interventions. Alignment of NES to the Target Trial framework will clarify the strength of evidence underpinning claims about the effectiveness of public health interventions.

scholarly journals Pneumococcal Conjugate Vaccine impact assessment in Bangladesh

2018 ◽  
Vol 2 ◽  
pp. 21 ◽  
Author(s):  
Abdullah H. Baqui ◽  
Eric D. McCollum ◽  
Samir K. Saha ◽  
Arun K. Roy ◽  
Nabidul H. Chowdhury ◽  
...  
Keyword(s):  
Conjugate Vaccine ◽  
Study Design ◽  
Pneumococcal Conjugate Vaccine ◽  
Case Control Study ◽  
Case Control ◽  
Incident Case ◽  
Vaccine Type ◽  
Before And After ◽  
The Impact ◽  
Control Study

The study examines the impact of the introduction of 10-valent Pneumococcal Conjugate Vaccine (PCV10) into Bangladesh’s national vaccine program. PCV10 is administered to children under 1 year-old; the scheduled ages of administration are at 6, 10, and 18 weeks. The study is conducted in ~770,000 population containing ~90,000 <5 children in Sylhet, Bangladesh and has five objectives: 1) To collect data on community-based pre-PCV incidence rates of invasive pneumococcal diseases (IPD) in 0-59 month-old children in Sylhet, Bangladesh; 2) To evaluate the effectiveness of PCV10 introduction on Vaccine Type (VT) IPD in 3-59 month-old children using an incident case-control study design. Secondary aims include measuring the effects of PCV10 introduction on all IPD in 3-59 month-old children using case-control study design, and quantifying the emergence of Non Vaccine Type IPD; 3) To evaluate the effectiveness of PCV10 introduction on chest radiograph-confirmed pneumonia in children 3-35 months old using incident case-control study design. We will estimate the incidence trend of clinical and radiologically-confirmed pneumonia in 3-35 month-old children in the study area before and after introduction of PCV10; 4) To determine the feasibility and utility of lung ultrasound for the diagnosis of pediatric pneumonia in a large sample of children in a resource-limited setting. We will also evaluate the effectiveness of PCV10 introduction on ultrasound-confirmed pneumonia in 3-35 month-old children using an incident case-control design and to examine the incidence trend of ultrasound-confirmed pneumonia in 3-35 month-old children in the study area before and after PCV10 introduction; and 5) To determine the direct and indirect effects of vaccination status on nasopharyngeal colonization on VT pneumococci among children with pneumonia.  This paper presents the methodology. The study will allow us to conduct a comprehensive and robust assessment of the impact of national introduction of PCV10 on pneumococcal disease in Bangladesh.

A Novel Study Design to Systematically Explore the Impact of Trial Methodology on Psychopharmacological Treatment Outcome in Patients with Depression

2018 ◽  
Vol 52 (04) ◽  
pp. 170-174
Author(s):  
Emanuel Severus ◽  
Cathrin Sauer ◽  
Michael Bauer ◽  
Michael Ostacher ◽  
Ion-George Anghelescu
Keyword(s):  
Study Design ◽  
Depressive Episode ◽  
External Validity ◽  
Major Depressive Episode ◽  
Major Depressive ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Psychopharmacological Treatment ◽  
Study Designs ◽  
The Impact

Abstract Introduction Randomized, double-blind, placebo-controlled trials were developed to draw rather unbiased conclusions regarding the efficacy of antidepressants in the treatment of a major depressive episode (internal validity), mostly with the purpose of formal approval of new compounds in this indication. However, at the same time, data suggest that the very process of randomization and blinded administrations of placebo will have a significant impact on the efficacy of the antidepressant tested and therefore may limit the external validity of results obtained from this type of studies. Therefore, there is an urgent need to systematically study the impact of randomization/placebo control/blinding on patient population, efficacy, tolerability, and external validity in the psychopharmacological treatment of patients with a major depressive episode. Methods To develop a study design that allows the systematic exploration of the impact of trial design on characteristics of included patient population and outcome. Results We propose a study design including sample size calculation and statistical analysis in which patients with a major depressive episode are randomized to 3 distinct study designs that differ with regard to control, randomization, and blindness. Discussion The results of the proposed study design may have substantial consequences when it comes to how to best interpret the results of traditional randomized, double-blind, placebo-controlled trials in the acute treatment of major depressive disorder. Furthermore, they may lead to the implementation of new study designs that may be more suitable for assessing the effectiveness of new antidepressant compounds in everyday clinical practice.

scholarly journals Differences in reimbursement listing of anticancer therapies in China: an observational study

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e031203 ◽  
Author(s):  
Xiaodong Guan ◽  
Yichen Zhang ◽  
Haishaerjiang Wushouer ◽  
Luwen Shi ◽  
Dennis Ross-Degnan ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Observational Study ◽  
Study Design ◽  
Primary Outcome ◽  
Insurance Coverage ◽  
Essential Medicines ◽  
Appropriate Use ◽  
Economic Level ◽  
Drug List ◽  
Before And After

ObjectiveAccess to highly priced anticancer medications usually requires insurance coverage. A first step towards coverage of such medications is their inclusion in reimbursement lists. We assessed listing for reimbursement in China between 2009 and 2018 of anticancer medications on the WHO’s Essential Medicines List.Setting and study designUsing publicly available data, we assessed which anticancer medications listed in the 20th WHO Model List of Essential Medicines (EML) were included in China’s National Reimbursement Drug List (NRDL). For five targeted anticancer medications on the WHO EML, we also assessed inclusion in the 31 Chinese Provincial Reimbursement Drug Lists (PRDLs). Logistic regression was used to test whether inclusion of targeted anticancer medications was associated with provincial economic levels.Primary outcome measuresInclusion of five targeted anticancer medications in the NRDL and PRDLs before and after 2017.ResultsThe 2017 NRDL included all anticancer medications on the WHO EML (except for one not approved in China at the time), and by 2018, all 31 PRDLs listed the targeted anticancer medications except for nilotinib; four provinces had covered all five targeted medications before the 2017 NRDL coverage mandate. Provincial economic level and regional incidence of specific cancers seemed unrelated to the inclusion of five targeted anticancer medications in PRDLs.ConclusionOur findings suggest that by including medications in the national and provincial reimbursement lists, China has taken an important first step in promoting access to targeted anticancer medications. Further research is needed to determine whether inclusion in PRDLs improved the availability, appropriate use and affordability of highly priced targeted anticancer medications in China.

scholarly journals Strength of functional signature correlates with effect size in autism

2016 ◽  
Author(s):  
Sara Ballouz ◽  
Jesse Gillis
Keyword(s):  
Study Design ◽  
Effect Size ◽  
Statistical Power ◽  
Fragile X ◽  
Meta Analysis ◽  
Autism Spectrum ◽  
Protein Interaction Data ◽  
Functional Convergence ◽  
Study Designs ◽  
The Impact

AbstractBackgroundDisagreements over genetic signatures associated with disease have been particularly prominent in the field of psychiatric genetics, creating a sharp divide between disease burdens attributed to common and rare variation, with study designs independently targeting each. Meta-analysis within each of these study designs is routine, whether using raw data or summary statistics, but combining results across study designs is atypical. However, tests of functional convergence are used across all study designs, where candidate gene sets are assessed for overlaps with previously known properties. This suggests one possible avenue for combining not study data, but the functional conclusions that they reach.MethodIn this work, we test for functional convergence in autism spectrum disorder (ASD) across different study types, and specifically whether the degree to which a gene is implicated in autism is correlated with the degree to which it drives functional convergence. Because different study designs are distinguishable by their differences in effect size, this also provides a unified means of incorporating the impact of study design into the analysis of convergence.ResultsWe detected remarkably significant positive trends in aggregate (p < 2.2e-16) with 14 individually significant properties (FDR<0.01), many in areas researchers have targeted based on different reasoning, such as the fragile X mental retardation protein (FMRP) interactor enrichment (FDR 0.003). We are also able to detect novel technical effects and we see that network enrichment from protein-protein interaction data is heavily confounded with study design, arising readily in control data.ConclusionsWe see a convergent functional signal for a subset of known and novel functions in ASD from all sources of genetic variation. Meta-analytic approaches explicitly accounting for different study designs can be adapted to other diseases to discover novel functional associations and increase statistical power.

scholarly journals The Impact of Scratch-Assisted Instruction on Computational Thinking (CT) Skills of Pre-Service Teachers

2021 ◽  
Vol 7 (2) ◽  
pp. 426-444
Author(s):  
Ulaş İlic
Keyword(s):  
Computational Thinking ◽  
Thinking Skills ◽  
Study Data ◽  
Instructional Technologies ◽  
Future Studies ◽  
Face To Face ◽  
Survey Form ◽  
Before And After ◽  
Assisted Instruction ◽  
The Impact

The present study aimed to determine the effect of Scratch-assisted expressions and applications on the Computational Thinking skills of pre-service teachers. For this purpose, the research was designed with an exploratory sequential design, a mixed research method. Thirty-three pre-service teachers participated in the study. Data were collected with Computational Thinking Scale before and after the applications conducted in the Instructional Technologies course, and with a survey form developed by the author and face-to-face interviews conducted with the participants at the end of the course. Based on the data obtained, it was determined that the applications conducted in the course improved the Computational Thinking skills of the participants. Although the improvement did not differ based on gender, it was determined that the differences were significant based on creativity, algorithmic thinking, and critical thinking sub-dimensions. Furthermore, it was observed that there was a positive and significant correlation between Computational Thinking and academic achievement. Also, pre-service teachers stated that Scratch applications contributed to the acquisition of Computational Thinking skills. It was suggested that the present study findings would contribute to future studies on Computational Thinking acquisition in similar courses.

Sign in / Sign up

Export Citation Format

Share Document