Interventions to reduce medication errors in neonatal care: a systematic review

Background: Medication errors represent a significant but often preventable cause of morbidity and mortality in neonates. The objective of this systematic review was to determine the effectiveness of interventions to reduce neonatal medication errors. Methods: A systematic review was undertaken of all comparative and noncomparative studies published in any language, identified from searches of PubMed and EMBASE and reference-list checking. Eligible studies were those investigating the impact of any medication safety interventions aimed at reducing medication errors in neonates in the hospital setting. Results: A total of 102 studies were identified that met the inclusion criteria, including 86 comparative and 16 noncomparative studies. Medication safety interventions were classified into six themes: technology ( n = 38; e.g. electronic prescribing), organizational ( n = 16; e.g. guidelines, policies, and procedures), personnel ( n = 13; e.g. staff education), pharmacy ( n = 9; e.g. clinical pharmacy service), hazard and risk analysis ( n = 8; e.g. error detection tools), and multifactorial ( n = 18; e.g. any combination of previous interventions). Significant variability was evident across all included studies, with differences in intervention strategies, trial methods, types of medication errors evaluated, and how medication errors were identified and evaluated. Most studies demonstrated an appreciable risk of bias. The vast majority of studies (>90%) demonstrated a reduction in medication errors. A similar median reduction of 50–70% in medication errors was evident across studies included within each of the identified themes, but findings varied considerably from a 16% increase in medication errors to a 100% reduction in medication errors. Conclusion: While neonatal medication errors can be reduced through multiple interventions aimed at improving the medication use process, no single intervention appeared clearly superior. Further research is required to evaluate the relative cost-effectiveness of the various medication safety interventions to facilitate decisions regarding uptake and implementation into clinical practice.

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THE IMPACT OF BARCODE MEDICATION ADMINISTRATION ON PATIENT SAFETY: A SYSTEMATIC REVIEW

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i6.1951 ◽

2021 ◽

Vol 5 (6) ◽

Author(s):

Seham Sahal Aloufi

Keyword(s):

Systematic Review ◽

Patient Safety ◽

Medication Error ◽

Medication Errors ◽

Improve Patient Safety ◽

Hospital Setting ◽

Medication Administration ◽

Bar Code ◽

The Impact ◽

Improve Patient

Patient safety is considered as an essential feature of healthcare system. Many trials have been conducted in order to find ways to improve patient safety, and many reports indicate that medication errors pose a threat to patient safety. Thus, some studies have investigated the impact of bar code medication administration (BCMA) system on medication error reduction during the medication administration procedure. This systematic review (SR) reports the impact of BCMA system on reducing medication errors to improve patient safety; it also compares traditional medication administration with the BCMA system. The review concentrates on the effectiveness of BCMA technology on medication administration errors, and on the accuracy of medication administration. This review also focused on different designs of quantitative studies, as they are more effective at investigating the impact of the intervention than qualitative studies. The findings from this systematic review show various results depending on the nature of the hospital setting. Most of the studies agree that the BCMA system enhances compliance with the 'five rights’' requirement (right drug, right patient, right dose, right time and right route) of medication administration. In addition, BCMA technology identified medication error types that could not be identified with the traditional approach which is applying the 'five rights' of medication administration. The findings of this systematic review also confirm the impact of BCMA system in reducing medication error, preventing adverse events and increasing the accuracy of the medication administration rate. However, BCMA technology did not consistently reduce the overall errors of medication administration. Keyword: Patient Safety, Impact, BCMA, eMAR

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Contributing factors that influence medication errors in the prehospital paramedic environment: a mixed-method systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2019-034094 ◽

2019 ◽

Vol 9 (12) ◽

pp. e034094

Author(s):

Dennis Walker ◽

Clint Moloney ◽

Brendan SueSee ◽

Renee Sharples

Keyword(s):

Systematic Review ◽

Medication Errors ◽

Medication Safety ◽

Data Extraction ◽

Prehospital Care ◽

Integrated Approach ◽

Care Providers ◽

Contributing Factors ◽

Multiple Sources ◽

Qualitative Synthesis

IntroductionThere is limited reliable research available on medication errors in relation to paramedic practice, with most evidence-based medication safety guidelines based on research in nursing, operating theatre and pharmacy settings. While similarities exist, evidence suggests that the prehospital environment is distinctly different in many aspects. The prevention of errors requires attention to factors from the organisational and regulatory level down to specific tasks and patient characteristics. The evidence available suggests errors may occur in up to 12.76% of medication administrations in some prehospital settings. With multiple sources stating that the errors are under-reported, this represents significant potential for patient harm. This review will seek to identify the factors influencing the occurrence of medication errors by paramedics in the prehospital environment.Methods and analysisThe review will include qualitative and quantitative studies involving interventions or phenomena regarding medication errors or medication safety relating to paramedics (including emergency medical technicians and other prehospital care providers) within the prehospital environment. A search will be conducted using MEDLINE (Ovid), EBSCOhost Megafile Search, the International Committee of Medical Journal Editors trial registry, Google Scholar and the OpenGrey database to identify studies meeting this inclusion criteria, with initial searches commencing 30 September 2019. Studies selected will undergo assessment of methodological quality, with data to be extracted from all studies irrespective of quality. Each stage of study selection, appraisal and data extraction will be conducted by two reviewers, with a third reviewer deciding any unresolved conflicts. The review will follow a convergent integrated approach, conducting a single qualitative synthesis of qualitative and ‘qualitised’ quantitative data.Ethics and disseminationNo ethical approval was required for this review. Findings from this systematic review will be disseminated via publications, reports and conference presentations.

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The impact of SARS‐CoV‐2 on the mental health of healthcare workers in a hospital setting—A Systematic Review

Journal of Occupational Health ◽

10.1002/1348-9585.12175 ◽

2020 ◽

Vol 62 (1) ◽

Cited By ~ 1

Author(s):

Jaspinder Sanghera ◽

Nikhil Pattani ◽

Yousuf Hashmi ◽

Kate F. Varley ◽

Manikandar Srinivas Cheruvu ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Healthcare Workers ◽

Hospital Setting ◽

The Impact

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2 The impact of health information technology on medication errors in a paediatric intensive care unit

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-314585.2 ◽

2018 ◽

Vol 103 (2) ◽

pp. e2.12-e2

Author(s):

Moninne Howlett

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Medication Error ◽

Medication Errors ◽

Error Rate ◽

Paediatric Intensive Care Unit ◽

Electronic Prescribing ◽

Novel Technology ◽

The Impact ◽

Smart Pump

AimsHealth information technology (HIT) is increasingly being promoted as a medication error reduction strategy. Electronic prescribing and smart-pump technology are examples of HIT widely advocated in the hospital setting. In critical care, the risks associated with paediatric infusions have been specifically addressed with calls for the use of standard concentration infusions (SCIs) in conjunction with smart-pump technology. Evidence on the benefits of HIT in the paediatric setting remains limited. This study aims to assess the impact of both electronic prescribing and a smart-pump drug library of SCIs on medication errors in paediatric critical care.MethodsA retrospective, observational study based on an interrupted time series design was conducted in the 23-bed paediatric intensive care unit (PICU) of a tertiary children’s hospital. 3400 randomly selected medication orders were reviewed over 4 epochs: pre-implementation of either technology (Epoch 1); post-implementation of SCIs (Epoch 2); immediate post-implementation of electronic prescribing (Epoch 3); and 1 year post-implementation of both (Epoch 4). Orders prescribed during the study period were included provided they had undergone clinical pharmacy review. Intravenous fluids, epidural/regional blocks, total parental nutrition, chemotherapy and patient/nurse controlled analgesia were excluded. Medication error rates were calculated applying pre-specified definitions and inclusion criteria.1 Novel technology-generated errors were identified and defined using a modified Delphi process. Errors were graded for severity using a combination of two validated grading tools.2,3ResultsOverall medication error rate based on all orders were similar in Epoch 1 and 4 (10.2% vs 9.7%; p=0.66). Altered error distribution was however evident. Incomplete and wrong unit errors were eradicated, but duplicate orders increased. Dosing errors remained the most common. 77% of pre-implementation errors were considered likely to be removed by the new technology. 24% of post-implementation errors were considered to be novel technology-generated errors. Examples included incorrect formulation selection and errors on altered electronic orders. In Epoch 2, the implementation of SCIs prior to electronic prescribing significantly reduced infusion-related prescribing errors (31.4% to 12.6%; p<0.01). An infusion error rate of 7.9% was reported post-implementation of electronically-generated standard infusion orders in Epoch 4.ConclusionThe overall medication error rate in PICU was largely unchanged by the introduction of electronic prescribing. Some errors disappeared but new errors directly attributable to the implemented technologies emerged. In the complex PICU environment, dosing errors remain common. A significant reduction in infusion-related errors was found as a consequence of the introduction of SCIs and smart-pump technology. The introduction of electronically-generated standard infusion orders brought further benefits. The results of this study show that the benefits of HIT in the paediatric setting cannot be assumed and highlight the need for further studies with increasing use of HIT in paediatric settings.ReferencesGhaleb MA, Barber N, Dean Franklin B, et al. What constitutes a prescribing error in paediatrics?BMJ Qual Saf2005;14(5):352–7.Dean BS, Barber ND. A validated, reliable method of scoring the severity of medication errors. Am J Health Syst Pharm1999;56(1):57–62.National Coordinating Council for Medication Error Reporting and Prevention. Taxonomy of medication errors1998. http://www.nccmerp.org/about-medication-errors

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Repeat prescribing reducing errors

Journal of Primary Health Care ◽

10.1071/hc11153 ◽

2011 ◽

Vol 3 (2) ◽

pp. 153 ◽

Cited By ~ 3

Author(s):

Steven Lillis ◽

Hayley Lord

Keyword(s):

Error Detection ◽

Significant Proportion ◽

Error Rates ◽

Electronic Prescribing ◽

Contributing Factors ◽

Repeat Prescribing ◽

Cause Of Error ◽

General Practices ◽

Practice Assessment ◽

The Impact

BACKGROUND AND CONTEXT: Prescribing errors account for a significant proportion of overall error in general practice. Repeat prescribing occurs commonly in New Zealand and is a likely cause of error in practice. ASSESSMENT OF PROBLEM: This paper reports on two related aspects of repeat prescribing; an audit of adherence to a repeat prescribing protocol and self-reported repeat prescribing incidents in a network of 97 general practices. RESULTS: The audit of adherence to the repeat prescribing protocol revealed that some issues persist. In particular, prescribing medication outside an approved list and exceeding specified time limits or maximal scripts before clinical review were problematic. Repeat prescribing encompassed a range of departures of process from minor (such as prescription not available on time) to major (wrong medication). Corrective measures highlighted the importance of both the pharmacist and the patient in error detection. STRATEGIES FOR IMPROVEMENT: Repeat prescribing needs to be recognised as a process potentially fraught with error. Effective practice systems, patient involvement and enhanced pharmacy communication are important contributing factors in reducing error. LESSONS: There is need for robust data regarding error rates in prescribing and the impact of changing prescribing protocols on error rates. KEYWORDS: Medication errors; electronic prescribing

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Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta-analysis

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocw145 ◽

2016 ◽

Vol 24 (2) ◽

pp. 413-422 ◽

Cited By ~ 28

Author(s):

Mirela Prgomet ◽

Ling Li ◽

Zahra Niazkhani ◽

Andrew Georgiou ◽

Johanna I Westbrook

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Medication Errors ◽

Meta Analysis ◽

Clinical Decision Support Systems ◽

Clinical Decision ◽

Order Entry ◽

Icu Mortality ◽

Computerized Provider Order Entry ◽

The Impact

Objective: To conduct a systematic review and meta-analysis of the impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay (LOS), and mortality in intensive care units (ICUs). Methods: We searched for English-language literature published between January 2000 and January 2016 using Medline, Embase, and CINAHL. Titles and abstracts of 586 unique citations were screened. Studies were included if they: (1) reported results for an ICU population; (2) evaluated the impact of CPOE or the addition of CDSSs to an existing CPOE system; (3) reported quantitative data on medication errors, ICU LOS, hospital LOS, ICU mortality, and/or hospital mortality; and (4) used a randomized controlled trial or quasi-experimental study design. Results: Twenty studies met our inclusion criteria. The transition from paper-based ordering to commercial CPOE systems in ICUs was associated with an 85% reduction in medication prescribing error rates and a 12% reduction in ICU mortality rates. Overall meta-analyses of LOS and hospital mortality did not demonstrate a significant change. Discussion and Conclusion: Critical care settings, both adult and pediatric, involve unique complexities, making them vulnerable to medication errors and adverse patient outcomes. The currently limited evidence base requires research that has sufficient statistical power to identify the true effect of CPOE implementation. There is also a critical need to understand the nature of errors arising post-CPOE and how the addition of CDSSs can be used to provide greater benefit to delivering safe and effective patient care.

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Characteristics and Recovery Methods of Studies Falsely Excluded During Literature Screening –A Systematic Review

10.21203/rs.3.rs-745015/v1 ◽

2021 ◽

Author(s):

Lisa Affengruber ◽

Andreea Dobrescu ◽

Emma Persad ◽

Irma Klerings ◽

Gernot Wagner ◽

...

Keyword(s):

Systematic Review ◽

Information Science ◽

Citation Index ◽

Grey Literature ◽

Case Series ◽

Rapid Review ◽

Reference List ◽

Search Methods ◽

Increased Risk ◽

The Impact

Abstract Background: Due to the growing need to provide evidence syntheses under time constraints, researchers have begun focusing on the exploration of rapid review methods, which often employ single-reviewer literature screening. However, single-reviewer screening misses, on average, 13% of relevant studies, compared to 3% with dual-reviewer screening. Little guidance exists regarding methods to recover studies falsely excluded during literature screening. Likewise, it is unclear whether specific study characteristics can predict an increased risk of false exclusion. This systematic review aimed to identify supplementary search methods that can be used to recover studies falsely excluded during literature screening. Moreover, it strove to identify study-level predictors that indicate an elevated risk of false exclusions of studies during literature screening. Methods: We performed literature searches for eligible studies in Medline, Science Citation Index Expanded, Social Sciences Citation Index, Current Contents Connect, Embase, Epistemonikos.org, and Information Science & Technology Abstracts from 1999 to June 23, 2020. We searched for grey literature, checked reference lists, and conducted hand searches in two relevant journals and similar articles searches current to January 28, 2021. Two investigators independently screened the literature; one investigator performed the data extraction, a second investigator checked for correctness and completeness. Two reviewers assessed the risk of bias of eligible studies. We synthesized the results narratively. Results: Three methods studies, two with a case study design and one with a case series design, met the inclusion criteria. One study reported that all falsely excluded publications (8%) could be recovered through reference list checking compared to other supplementary search methods. No included methods study analyzed the impact of recovered studies on conclusions or meta-analyses. Two studies reported that up to 8% of studies were falsely excluded due to uninformative titles and abstracts, and one study showed that 11% of non-English studies were falsely excluded. Conclusions: Due to the limited evidence based on two case studies and one case series, we can draw no firm conclusion about the most reliable and most valid method to recover studies falsely excluded during literature screening or about the characteristics that might predict a higher risk of false exclusion. Systematic review registration: https://osf.io/v2pjr/

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