Letters

2006 ◽  
Vol 25 (3) ◽  
pp. 187-187
Author(s):  
Lorraine Harbold ◽  
Julie Appel ◽  
David Copelan
Keyword(s):  
Enteral Nutrition ◽  
Safety Concern ◽  
Medication Administration ◽  
Contributing Factors ◽  
Administration System ◽  
Feeding Tubes ◽  
Oral Medications ◽  
Unit Dose

I read with interest, the January/February, 2006 (Vol. 25, No. 1) article, “Implementation of an Enteral Nutrition and Medication Administration System Utilizing Oral Syringes in the NICU.” The inadvertent administration of an enteral product intravenously is certainly a safety concern for all NICUs. Our institution began addressing this more than a decade ago by first converting all oral medications to a unit dose system dispensed only in oral syringes. I was surprised by the incompatibility between oral syringes and orogastric, nasogastric, or nasojejunal tubes, cited by the authors, as one of the contributing factors in preventing them from making this conversion. Over the years we have used several brands of NG/OG tubes that easily accommodate the intermittent use of oral syringes. They do not have luer-lok hubs that preclude the use of an oral syringe. The feeding tubes that we generally use for transpyloric placement (duodenal/jejunal), often have a medication port that easily accommodates an oral syringe.

Implementation of an Enteral Nutrition and Medication Administration System Utilizing Oral Syringes in the NICU

2006 ◽  
Vol 25 (1) ◽  
pp. 21-24 ◽  
Author(s):  
David Copelan ◽  
Julie Appel
Keyword(s):  
Medication Administration ◽  
Patient Specific ◽  
Syringe Pump ◽  
Process Change ◽  
Administration System ◽  
Oral Medications ◽  
Change In Practice ◽  
Check System ◽  
Unit Dose ◽  
Enteral Formulas

NICU patients are at particularly high risk of harm and even death from medical error. In one NICU, a process change was undertaken to minimize the risk of errors resulting in the intravenous (IV) administration of enteral formulas and oral medications. In addition, a double-check system for medication doses was introduced to reduce the likelihood of medication errors. The previous practice was to deliver enteral formulas via syringe pump using IV syringes and tubing and to dispense medications in bulk bottles, drawing up patient-specific doses at the bedside. Converting to oral syringe delivery of medications and enteral formulas utilizing enteral-only tubing eliminated the necessity for Luer-Lok IV tubing and syringes, thereby reducing the potential for wrong-route error. Converting from dispensing medications in bulk to a unit-dose system permitted establishment of a double- check system in which doses are first checked by a pharmacist and then checked by the nurse before they are administered. This article describes the planning, implementation, and postimplementation process required to make this change in practice a success.

scholarly journals Medication Administration through Enteral Feeding Tubes in Mechanically Ventilated Critically Ill Patients: Evaluation of the Potential Medication Errors

2020 ◽  
Author(s):  
Mandana Izadpanah ◽  
Negin Amraie ◽  
Farhad Soltani ◽  
Leila Kouti ◽  
Sepideh Sayyadi ◽  
...  
Keyword(s):  
Critically Ill ◽  
Medication Errors ◽  
Enteral Feeding ◽  
Critically Ill Patients ◽  
Medication Administration ◽  
Oral Medication ◽  
Drug Preparation ◽  
Mechanically Ventilated ◽  
Feeding Tubes ◽  
Oral Medications

Background: Oral medication administration through enteral feeding tubes is a challenging issue in critically ill patients, which can lead to medication error. Patients admitted to the intensive care unit may not have the ability to swallow oral medications for various reasons such as lack of consciousness, or the need for mechanical ventilation. Improving the quality of drug administration through enteral feeding tubes is essential. The present study aimed at evaluation of the prevalence of medication errors that occur during the administration of oral medications through enteral feeding tubes in mechanically ventilated critically ill patients. Methods: This study was a cross-sectional observational study conducted in Golestan Educational Hospital, Ahvaz, Iran. Oral medication administration was evaluated in 50 patients within three months; demographic information, medical records and medicine prescribing information about each patient was examined. The errors were measured according to the Handbook of Drugs Administration via enteral feeding tubes. Results: Errors occurred in percentage of total prescriptions as follows: Drug-drug interaction 26%, wrong preparation 22.3%, incorrect dosage form 12.1%, wrong time error 11.6%, drug-food interaction 6.7%, improper dose error 5.5%, wrong route 3.8%, extra dose 0.9%, omission 0.2%, deteriorated drug 0.2%, and unordered drug 0.0%. In our study, it was found that most of the drugs were administered in solid dosage forms, and almost 33% of them could be substituted for injection or oral liquid formulations. Conclusion: Our study indicated the high frequency of drug preparation errors in mechanically ventilated critically ill patients. Close teamwork between pharmacists or pharmacotherapists, physicians, and nurses can result in the appropriate administration of medications by an enteral feeding tube. J Pharm Care 2019; 7(3): 52-56

scholarly journals Feedback of patient survey on medication improves the management of polypharmacy: a pilot trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yuta Hirose ◽  
Kiyoshi Shikino ◽  
Yoshiyuki Ohira ◽  
Sumihide Matsuoka ◽  
Chihiro Mikami ◽  
...  
Keyword(s):  
Health Professionals ◽  
Questionnaire Survey ◽  
Pilot Trial ◽  
Patient Survey ◽  
Contributing Factors ◽  
Chi Square ◽  
Oral Medications ◽  
Medical Institutions ◽  
Chi Square Test ◽  
Survey Results

Abstract Background Patient awareness surveys on polypharmacy have been reported previously, but no previous study has examined the effects of sending feedback to health professionals on reducing medication use. Our study aimed to conduct a patient survey to examine factors contributing to polypharmacy, feedback the results to health professionals, and analyze the resulting changes in the number of polypharmacy patients and prescribed medications. Methods After conducting a questionnaire survey of patients in Study 1, we provided its results to the healthcare professionals, and then surveyed the number of polypharmacy patients and oral medications using a before-after comparative study design in Study 2. In Study 1, we examined polypharmacy and its contributing factors by performing logistic regression analysis. In Study 2, we performed a t-test and a chi-square test. Results In the questionnaire survey, significant differences were found in the following 3 items: age (odds ratio (OR) = 3.14; 95% confidence interval (CI) = 2.01–4.91), number of medical institutions (OR = 2.34; 95%CI = 1.50–3.64), and patients’ difficulty with asking their doctors to deprescribe their medications (OR = 2.21; 95%CI = 1.25–3.90). After the feedback, the number of polypharmacy patients decreased from 175 to 159 individuals and the mean number of prescribed medications per patient decreased from 8.2 to 7.7 (p < 0.001, respectively). Conclusions Providing feedback to health professionals on polypharmacy survey results may lead to a decrease in the number of polypharmacy patients. Factors contributing to polypharmacy included age (75 years or older), the number of medical institutions (2 or more institutions), and patients’ difficulty with asking their physicians to deprescribe their medications. Feedback to health professionals reduced the percentage of polypharmacy patients and the number of prescribed medications. Trial registration UMIN. Registered 21 June 2020 - Retrospectively registered, https://www.umin.ac.jp/ctr/index-j.htm

scholarly journals Unsafe medication administration experience in nursing practice at Public Hospitals of Harari region, eastern Ethiopia: Phenomenological Study.

2020 ◽  
Author(s):  
Gelana Fekadu ◽  
Amanuel Oljira ◽  
Biftu Geda ◽  
Gudina Egata
Keyword(s):  
Nursing Practice ◽  
Phenomenological Study ◽  
Organizational Factors ◽  
Medication Administration ◽  
Public Hospitals ◽  
Limited Information ◽  
Contributing Factors ◽  
Eastern Ethiopia ◽  
Major Factors

Abstract Background: The unsafe medication administration is one of the most medication related problems which causes harm and death to the patients and threatens the healthcare system. Given medication administration is predominantly the role of nurses. This study was aimed to explore the nurse’s experience of unsafe medication administration at public hospitals in Harari region, eastern Ethiopia. Methods: A phenomenological study design was conducted and the data were collected from 11 nurses from March 1 to March 31, 2019. The tape recorder and note taking was used to collect the data by in-depth interviews and key informant interviews. Open code software version 3.4 was used to write memos, coding and categorizing under their inductive thematic areas. Thematic analysis method were used.Result: The study had explored nurse’s experience and contributing factors for unsafe medication administration. Nurses have reported that they have ever experienced unsafe medication administration like, wrong time, medication, patient and self-stick injury during their practice. i) Organizational factors: inadequate resource, lack of clear policy and job description, lack of supervision and poor collaboration among staffs. The identified themes were, ii) Precondition challenges: expensive medication, frequently changed and too much prescription for a single patient, new medications with limited information. iii) Individual nurses factor: work absenteeism, lack of training and knowledge gap.Conclusion: The organizational culture, precondition challenges and individual nurse’s factors was found to be a major factors linked to unsafe medication administration practice. So tailored intervention is needed to reduce the unsafe medication administration in nursing practice.

Solid oral medications' suitability for use in enteral feeding tubes

2021 ◽  
Author(s):  
Kersti Teder ◽  
Liisa Jõhvik ◽  
Andres Meos ◽  
Marika Saar ◽  
Alesya Visbek ◽  
...  
Keyword(s):  
Enteral Feeding ◽  
Feeding Tubes ◽  
Oral Medications

Evaluation of Delivery of Enteral Nutrition in Critically Ill Patients Receiving Mechanical Ventilation

2008 ◽  
Vol 17 (1) ◽  
pp. 53-61 ◽  
Author(s):  
Debra O’Meara ◽  
Eduardo Mireles-Cabodevila ◽  
Fran Frame ◽  
A. Christine Hummell ◽  
Jeffrey Hammel ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Feeding Tube ◽  
Feeding Tubes ◽  
Academic Center ◽  
Specific Step ◽  
Feeding Process ◽  
Medical Intensive Care

Background Published reports consistently describe incomplete delivery of prescribed enteral nutrition. Which specific step in the process delays or interferes with the administration of a full dose of nutrients is unclear. Objectives To assess factors associated with interruptions in enteral nutrition in critically ill patients receiving mechanical ventilation. Methods An observational prospective study of 59 consecutive patients who required mechanical ventilation and were receiving enteral nutrition was done in an 18-bed medical intensive care unit of an academic center. Data were collected prospectively on standardized forms. Steps involved in the feeding process from admission to discharge were recorded, each step was timed, and delivery of nutrition was quantified. Results Patients received approximately 50% (mean, 1106.3; SD, 885.9 Cal) of the prescribed caloric needs. Enteral nutrition was interrupted 27.3% of the available time. A mean of 1.13 interruptions occurred per patient per day; enteral nutrition was interrupted a mean of 6 (SD, 0.9) hours per patient each day. Prolonged interruptions were mainly associated with problems related to small-bore feeding tubes (25.5%), increased residual volumes (13.3%), weaning (11.7%), and other reasons (22.8%). Placement and confirmation of placement of the small-bore feeding tube were significant causes of incomplete delivery of nutrients on the day of admission. Conclusions Delivery of enteral nutrition in critically ill patients receiving mechanical ventilation is interrupted by practices embedded in the care of these patients. Evaluation of the process reveals areas to improve the delivery of enteral nutrition.

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