scholarly journals Investigating the Role of Labelling and Packaging on Medication Error

2021 ◽  
Author(s):  
◽  
Carrie Bailey
Keyword(s):  
Medication Error ◽  
Divided Attention ◽  
Medication Administration ◽  
Error Rates ◽  
False Alarms ◽  
Attention Task ◽  
Administration Error ◽  
Divided Attention Task ◽  
Letter Condition

<p>Medication administration error contributes to deaths and injury in hospitals, especially in the area of anaesthesia. Labelling and packaging contribute to medication error. The current study examined the role of labelling and packaging in medication error and compared medically trained and medically naive participants.  Using eye-tracking equipment, Study 1A investigated the distribution of fixations across 32 pre-existing medication labels and packages. Both groups of participants fixated less on the dose and top of medications than on the name and ‘other’ features. Both medical experience and packaging type influenced on which label areas participants fixated. Medical participants fixated on dose more than control participants; there were no other differences between groups.  In Study 1B participants viewed a target medication, they were then asked whether it was present in an array. The target was present in 50% of arrays. Distractors varied in similarity to the target. Signal detection theory analysis of discriminability through d’ revealed that medical participants were significantly better than control participants at discriminating whether or not the target was in the array. Bias analyses through C revealed that there was no difference between the biases of the two groups. Both groups of participants adopted a liberal criterion which increased the occurrence of false alarms. Across all trials, participants were most likely to select a distractor that differed only in the dose of the medication.  Divided attention can increase medication error rates, therefore Study 1C utilised the same procedure as Study 1B and added a divided attention task. During the divided attention task participants saw a string of either five or seven letters and were later asked to recall one of the letters. Both groups of participants recalled fewer letters in the seven-letter compared to five-letter condition. There was no difference in the overall performance of the two groups on the divided attention task. Both groups showed a significant reduction in discriminability under the seven- compared to five-letter divided attention condition. Medical participants had significantly higher discriminability indices than control participants. Both groups of participants adopted a liberal criterion, however control participants were more biased than medical professionals. Control participants displayed an increase in bias in the seven-letter, compared to five-letter condition; the bias of medical participants was not influenced by the divided attention task. As in Study 1B, participants were most likely to select a distractor that differed only in the dose of the medication.</p>

scholarly journals Investigating the Role of Labelling and Packaging on Medication Error

2021 ◽  
Author(s):  
◽  
Carrie Bailey
Keyword(s):  
Medication Error ◽  
Divided Attention ◽  
Medication Administration ◽  
Error Rates ◽  
False Alarms ◽  
Attention Task ◽  
Administration Error ◽  
Divided Attention Task ◽  
Letter Condition

<p>Medication administration error contributes to deaths and injury in hospitals, especially in the area of anaesthesia. Labelling and packaging contribute to medication error. The current study examined the role of labelling and packaging in medication error and compared medically trained and medically naive participants.  Using eye-tracking equipment, Study 1A investigated the distribution of fixations across 32 pre-existing medication labels and packages. Both groups of participants fixated less on the dose and top of medications than on the name and ‘other’ features. Both medical experience and packaging type influenced on which label areas participants fixated. Medical participants fixated on dose more than control participants; there were no other differences between groups.  In Study 1B participants viewed a target medication, they were then asked whether it was present in an array. The target was present in 50% of arrays. Distractors varied in similarity to the target. Signal detection theory analysis of discriminability through d’ revealed that medical participants were significantly better than control participants at discriminating whether or not the target was in the array. Bias analyses through C revealed that there was no difference between the biases of the two groups. Both groups of participants adopted a liberal criterion which increased the occurrence of false alarms. Across all trials, participants were most likely to select a distractor that differed only in the dose of the medication.  Divided attention can increase medication error rates, therefore Study 1C utilised the same procedure as Study 1B and added a divided attention task. During the divided attention task participants saw a string of either five or seven letters and were later asked to recall one of the letters. Both groups of participants recalled fewer letters in the seven-letter compared to five-letter condition. There was no difference in the overall performance of the two groups on the divided attention task. Both groups showed a significant reduction in discriminability under the seven- compared to five-letter divided attention condition. Medical participants had significantly higher discriminability indices than control participants. Both groups of participants adopted a liberal criterion, however control participants were more biased than medical professionals. Control participants displayed an increase in bias in the seven-letter, compared to five-letter condition; the bias of medical participants was not influenced by the divided attention task. As in Study 1B, participants were most likely to select a distractor that differed only in the dose of the medication.</p>

Bright light and night work: effects on selective and divided attention in elderly persons

2011 ◽  
Vol 43 (4) ◽  
pp. 473-486 ◽  
Author(s):  
V Kretschmer ◽  
B Griefahn ◽  
K-H Schmidt
Keyword(s):  
Divided Attention ◽  
Cognitive Abilities ◽  
Bright Light ◽  
Error Rates ◽  
Night Work ◽  
Elderly Persons ◽  
Statistical Control ◽  
Light At Night ◽  
Attention Task ◽  
Divided Attention Task

Night work is associated with reduced levels of performance. Due to demographic change, the ability of over 50-year-olds to work at night is important for the employment market. Ageing is associated with decrements in both cognitive abilities and the capabilities of the visual system. This study focuses on the effects of exposure to bright light at night on selective and divided attention in elderly persons during three consecutive night shifts. After statistical control for neuroticism and intelligence as covariates, the results demonstrate that exposure to bright light at night reduced error rates for a divided attention task but performance on a selective attention task was unaffected.

Pain Influences Several Levels of Attention

2005 ◽  
Vol 16 (4) ◽  
pp. 235-242 ◽  
Author(s):  
Astrid von Bueren Jarchow ◽  
Bogdan P. Radanov ◽  
Lutz Jäncke
Keyword(s):  
Chronic Pain ◽  
Divided Attention ◽  
Covert Attention ◽  
Attention Task ◽  
Attentional Deficits ◽  
Control Subjects ◽  
Chronic Pain Patients ◽  
Divided Attention Task ◽  
Pain Stimuli ◽  
Pain Patients

Abstract: The aim of the present study was to examine to what extent chronic pain has an impact on various attentional processes. To measure these attention processes a set of experimental standard tests of the “Testbatterie zur Aufmerksamkeitsprüfung” (TAP), a neuropsychological battery testing different levels of attention, were used: alertness, divided attention, covert attention, vigilance, visual search, and Go-NoGo tasks. 24 chronic outpatients and 24 well-matched healthy control subjects were tested. The control subjects were matched for age, gender, and education. The group of chronic pain patients exhibited marked deficiencies in all attentional functions except for the divided attention task. Thus, the data supports the notion that chronic pain negatively influences attention because pain patients` attention is strongly captivated by the internal pain stimuli. Only the more demanding divided attention task has the capability to distract the focus of attention to the pain stimuli. Therefore, the pain patients are capable of performing within normal limits. Based on these findings chronic pain patients' attentional deficits should be appropriately evaluated and considered for insurance and work related matters. The effect of a successful distraction away from the pain in the divided attention task can also open new therapeutic aspects.

Specific Computerized Attention Training in Stroke and Traumatic Brain-Injured Patients

2003 ◽  
Vol 14 (4) ◽  
pp. 283-292 ◽  
Author(s):  
W. Sturm ◽  
B. Fimm ◽  
A. Cantagallo ◽  
N. Cremel ◽  
P. North ◽  
...  
Keyword(s):  
Divided Attention ◽  
Single Case ◽  
Baseline Period ◽  
Specific Training ◽  
Attention Task ◽  
Baseline Phase ◽  
Computerized Training ◽  
Brain Injured ◽  
Divided Attention Task ◽  
Injured Patients

Abstract: In a multicenter European approach, the efficacy of the AIXTENT computerized training programs for intensity aspects (alertness and vigilance) and selectivity aspects (selective and divided attention) of attention was studied in 33 patients with brain damage of vascular and traumatic etiology. Each patient received training in one of two most impaired of the four attention domains. Control tests were performed by means of a standardized computerized attention test battery (TAP) comprising tests for the four attention functions. Assessment was carried out at the beginning and at the end of a four week baseline period and after the training period of 14 one-hour sessions. At the end of the baseline phase, there was only slight but significant improvement for the most complex attention function, divided attention (number of omissions). After the training, there were significant specific training effects for both intensity aspects (alertness and vigilance) and also for the number of omissions in the divided attention task. The application of inferential single case procedures revealed a high number of significant improvements in individual cases after specific training of alertness and vigilance problems. On the other hand, a non specific training addressing selectivity aspects of attention lead either to improvement or deterioration of alertness and vigilance performance. The results corroborate the findings of former studies with the same training instrument but in patients with different lesion etiologies.

Analisis Faktor Perawat Dalam Pelaksanakan Keselamatan Pasien Terhadap Kejadian Medication Administration Error di Rumah Sakit

2020 ◽  
Author(s):  
Bintang Marsondang Rambe
Keyword(s):  
Patient Safety ◽  
Literature Review ◽  
Medication Error ◽  
Medication Errors ◽  
Medication Administration ◽  
Prescribing Error ◽  
Medication Administration Error ◽  
Administration Error

Latar Belakang Keselamatan pasien (patient safety) rumah sakit adalah suatu sistem dimana rumah sakit membuat asuhan pasien lebih aman yang meliputi assessment risiko, identifikasi dan pengelolaan hal yang berhubungan dengan risiko pasien, pelaporan dan analisis insiden, kemampuan belajar dari insiden dan tindak lanjutnya serta implementasi solusi untuk meminimalkan timbulnya risiko dan mencegah terjadinya cedera yang disebabkan oleh kesalahan akibat melaksanakan suatu tindakan atau tidak mengambil tindakan yang seharusnya diambil yang dilakukan oleh perawat (Kemenkes, 2011).Salah satu kesalahan yang dapat merugikan pasien adalah medication error. Menurut WHO (2016) medication error adalah setiap kejadian yang dapat dicegah yang menyebabkan penggunaan obat yang tidak tepat yang menyebabkan bahaya kepasien, dimana obat berada dalam kendali profesional perawatan kesehatan. proses terjadi medication error dimulai dari tahap prescribing, transcribing, dispensing,dan administration. Kesalahan peresepan (prescribing error), kesalahan penerjemahan resep (transcribing erorr), kesalahan menyiapkan dan meracik obat (dispensing erorr), dan kesalahan penyerahan obat kepada pasien (administration error). Medication error yang paling sering terjadi adalah pada fase administration / pemberian obat yang dilakukan oleh perawat.Administration error terjadi ketika pemberian obat kepada pasien tidak sesuai dengan prinsip enam benar yaitu benar obat, benar pasien, benar dosis, benar rute pemberian, benar waktu pemberian dan benar pendokumentasian. Secara global, kesalahan pemberian obat (medication errors) sampai saat ini masih menjadi isu keselamatan pasien dan kualitas pelayanan di beberapa rumah sakit (Depkes RI, 2015; AHRQ, 2015). Perawat sebagai bagian terbesar dari tenaga kesehatan di rumah sakit, mempunyai peranan dalam kejadian medication error. Perawat berkontribusi karena perawat banyak berperan dalam proses pemberian obat. Pemberian obat/ Medication Administration adalah salah satu intervensi keperawatan yang paling banyak dilakukan, dengan sekitar 5- 20% waktu perawat dialokasikan untuk kegiatan ini (Härkänen et al.,, 2019). Pemberian obat juga mencakup tugas-tugas lain, seperti menyiapkan dan memeriksa obat obatan, memantau efek obat-obatan, mengedukasi pasien tentang pengobatan, dan memperdalam pengetahuan perawat tentang obat – obatan sendiri (DrachZahavy et al., 2014 dalam Yulianti et al., 2019)Berdasarkan isu tersebut, penulis tertarik untuk melakukan literature review terkait faktor perawat dalam pelaksanakan keselamatan pasien terhadap kejadian medication administration error di Rumah Sakit.

Functional Mobility in a Divided Attention Task in Older Adults With Cognitive Impairment

2015 ◽  
Vol 47 (5) ◽  
pp. 378-385 ◽  
Author(s):  
Sheila de Melo Borges ◽  
Márcia Radanovic ◽  
Orestes Vicente Forlenza
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Divided Attention ◽  
Functional Mobility ◽  
Attention Task ◽  
Divided Attention Task

Greater Impairment of Ability in the Divided Attention Task Is Seen in Alzheimer’s Disease Patients with Depression than in Those without Depression

2007 ◽  
Vol 23 (4) ◽  
pp. 231-240 ◽  
Author(s):  
Shutaro Nakaaki ◽  
Yoshie Murata ◽  
Junko Sato ◽  
Yoshihiro Shinagawa ◽  
Hiroshi Tatsumi ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Divided Attention ◽  
Attention Task ◽  
Divided Attention Task

scholarly journals Changes in medication administration error rates associated with the introduction of electronic medication systems in hospitals: a multisite controlled before and after study

2020 ◽  
Vol 27 (3) ◽  
pp. e100170
Author(s):  
Johanna I Westbrook ◽  
Neroli S Sunderland ◽  
Amanda Woods ◽  
Magda Z Raban ◽  
Peter Gates ◽  
...  
Keyword(s):  
Medication Administration ◽  
Error Rates ◽  
Teaching Hospitals ◽  
Medication Administration Error ◽  
Medication Systems ◽  
Before And After ◽  
Wrong Dose ◽  
Administration Error ◽  
Trained Observers ◽  
Before And After Study

BackgroundElectronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication administration errors (MAEs).ObjectiveTo assess changes in MAE rates and types associated with EMS implementation.MethodsThis was a controlled before and after study (three intervention and three control wards) at two adult teaching hospitals. Intervention wards used an EMS with no bar-coding. Independent, trained observers shadowed nurses and recorded medications administered and compliance with 10 safety procedures. Observational data were compared against medication charts to identify errors (eg, wrong dose). Potential error severity was classified on a 5-point scale, with those scoring ≥3 identified as serious. Changes in MAE rates preintervention and postintervention by study group, accounting for differences at baseline, were calculated.Results7451 administrations were observed (4176 pre-EMS and 3275 post-EMS). At baseline, 30.2% of administrations contained ≥1 MAE, with wrong intravenous rate, timing, volume and dose the most frequent. Post-EMS, MAEs decreased on intervention wards relative to control wards by 4.2 errors per 100 administrations (95% CI 0.2 to 8.3; p=0.04). Wrong timing errors alone decreased by 3.4 per 100 administrations (95% CI 0.01 to 6.7; p<0.05). EMS use was associated with an absolute decline in potentially serious MAEs by 2.4% (95% CI 0.8 to 3.9; p=0.003), a 56% reduction in the proportion of potentially serious MAEs. At baseline, 74.1% of administrations were non-compliant with ≥1 of 10 procedures and this rate did not significantly improve post-EMS.ConclusionsImplementation of EMS was associated with a modest, but significant, reduction in overall MAE rate, but halved the proportion of MAEs rated as potentially serious.

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