The Impact of Pharmacist Interventions on Reducing Medication Errors in Pediatric Patients: A Systematic Review and Meta-analysis

How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa230 ◽

2020 ◽

Author(s):

Peter J Gates ◽

Rae-Anne Hardie ◽

Magdalena Z Raban ◽

Ling Li ◽

Johanna I Westbrook

Keyword(s):

Systematic Review ◽

Medication Error ◽

Medication Errors ◽

Meta Analysis ◽

Error Rates ◽

Prescribing Error ◽

Before And After ◽

Actual Harm ◽

Computer Based ◽

Wide Scale

Abstract Objective To conduct a systematic review and meta-analysis to assess: 1) changes in medication error rates and associated patient harm following electronic medication system (EMS) implementation; and 2) evidence of system-related medication errors facilitated by the use of an EMS. Materials and Methods We searched Medline, Scopus, Embase, and CINAHL for studies published between January 2005 and March 2019, comparing medication errors rates with or without assessments of related harm (actual or potential) before and after EMS implementation. EMS was defined as a computer-based system enabling the prescribing, supply, and/or administration of medicines. Study quality was assessed. Results There was substantial heterogeneity in outcomes of the 18 included studies. Only 2 were strong quality. Meta-analysis of 5 studies reporting change in actual harm post-EMS showed no reduced risk (RR: 1.22, 95% CI: 0.18–8.38, P = .8) and meta-analysis of 3 studies reporting change in administration errors found a significant reduction in error rates (RR: 0.77, 95% CI: 0.72–0.83, P = .004). Of 10 studies of prescribing error rates, 9 reported a reduction but variable denominators precluded meta-analysis. Twelve studies provided specific examples of system-related medication errors; 5 quantified their occurrence. Discussion and Conclusion Despite the wide-scale adoption of EMS in hospitals around the world, the quality of evidence about their effectiveness in medication error and associated harm reduction is variable. Some confidence can be placed in the ability of systems to reduce prescribing error rates. However, much is still unknown about mechanisms which may be most effective in improving medication safety and design features which facilitate new error risks.

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Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0253588 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253588

Author(s):

Myriam Jaam ◽

Lina Mohammad Naseralallah ◽

Tarteel Ali Hussain ◽

Shane Ashley Pawluk

Keyword(s):

Systematic Review ◽

Medication Error ◽

Medication Errors ◽

Meta Analysis ◽

Healthcare Providers ◽

Educational Interventions ◽

Educational Programs ◽

Error Rates ◽

Audit And Feedback ◽

Cochrane Library

Introduction Medication errors are avoidable events that can occur at any stage of the medication use process. They are widespread in healthcare systems and are linked to an increased risk of morbidity and mortality. Several strategies have been studied to reduce their occurrence including different types of pharmacy-based interventions. One of the main pharmacist-led interventions is educational programs, which seem to have promising benefits. Objective To describe and compare various pharmacist-led educational interventions delivered to healthcare providers and to evaluate their impact qualitatively and quantitatively on medication error rates. Methods A systematic review and meta-analysis was conducted through searching Cochrane Library, EBSCO, EMBASE, Medline and Google Scholar from inception to June 2020. Only interventional studies that reported medication error rate change after the intervention were included. Two independent authors worked through the data extraction and quality assessment using Crowe Critical Appraisal Tool (CCAT). Summary odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model for rates of medication errors. Research protocol is available in The International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42019116465. Results Twelve studies involving 115058 participants were included. The two main recipients of the educational interventions were nurses and resident physicians. Educational programs involved lectures, posters, practical teaching sessions, audit and feedback method and flash cards of high-risk abbreviations. All studies included educational sessions as part of their program, either alone or in combination with other approaches, and most studies used errors encountered before implementing the intervention to inform the content of these sessions. Educational programs led by a pharmacist were associated with significant reductions in the overall rate of medication errors occurrence (OR, 0.38; 95% CI, 0.22 to 0.65). Conclusion Pharmacist-led educational interventions directed to healthcare providers are effective at reducing medication error rates. This review supports the implementation of pharmacist-led educational intervention aimed at reducing medication errors.

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Impact of pharmacist interventions on medication errors in hospitalized pediatric patients: a systematic review and meta-analysis

International Journal of Clinical Pharmacy ◽

10.1007/s11096-020-01034-z ◽

2020 ◽

Vol 42 (4) ◽

pp. 979-994 ◽

Cited By ~ 1

Author(s):

Lina Mohammad Naseralallah ◽

Tarteel Ali Hussain ◽

Myriam Jaam ◽

Shane Ashley Pawluk

Keyword(s):

Systematic Review ◽

Medication Errors ◽

Pediatric Patients ◽

Meta Analysis ◽

Pharmacist Interventions

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Misuse of medication in adult substance misuse services: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-047283 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047283

Author(s):

Rosalind Gittins ◽

Louise Missen ◽

Ian Maidment

Keyword(s):

Systematic Review ◽

Substance Misuse ◽

Data Extraction ◽

Meta Analysis ◽

Grey Literature ◽

Opioid Analgesics ◽

Physical And Mental Health ◽

Qualitative Synthesis ◽

Treatment Services ◽

The Impact

IntroductionThere is a growing concern about the misuse of over the counter (OTC) and prescription only medication (POM) because of the impact on physical and mental health, drug interactions, overdoses and drug-related deaths. These medicines include opioid analgesics, anxiolytics such as pregabalin and diazepam and antidepressants. This protocol outlines how a systematic review will be undertaken (during June 2021), which aims to examine the literature on the pattern of OTC and POM misuse among adults who are accessing substance misuse treatment services. It will include the types of medication being taken, prevalence and demographic characteristics of people who access treatment services.Methods and analysisAn electronic search will be conducted on the Cochrane, OVID Medline, Pubmed, Scopus and Web of Science databases as well as grey literature. Two independent reviewers will conduct the initial title and abstract screenings, using predetermined criteria for inclusion and exclusion. If selected for inclusion, full-text data extraction will be conducted using a pilot-tested data extraction form. A third reviewer will resolve disagreements if consensus cannot be reached. Quality and risk of bias assessment will be conducted for all included studies. A qualitative synthesis and summary of the data will be provided. If possible, a meta-analysis with heterogeneity calculation will be conducted; otherwise, Synthesis Without Meta-analysis will be undertaken for quantitative data. The reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationEthical approval is not required. Findings will be peer reviewed, published and shared verbally, electronically and in print, with interested clinicians and policymakers.PROSPERO registration numberCRD42020135216.

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The impact of the clinical pharmacist-led interventions in China: A systematic review and Meta-Analysis

International Journal of Clinical Pharmacy ◽

10.1007/s11096-020-00972-y ◽

2020 ◽

Vol 42 (2) ◽

pp. 366-377 ◽

Cited By ~ 2

Author(s):

Si-bei Qin ◽

Xin-yi Zhang ◽

Yu Fu ◽

Xiao-yan Nie ◽

Jian Liu ◽

...

Keyword(s):

Systematic Review ◽

Clinical Pharmacist ◽

Meta Analysis ◽

The Impact

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The Effect of Lingual Resistance Training Interventions on Adult Swallow Function: A Systematic Review

Dysphagia ◽

10.1007/s00455-019-10066-1 ◽

2019 ◽

Vol 35 (5) ◽

pp. 745-761 ◽

Cited By ~ 4

Author(s):

Sana Smaoui ◽

Amy Langridge ◽

Catriona M. Steele

Keyword(s):

Systematic Review ◽

Resistance Training ◽

Data Extraction ◽

Meta Analysis ◽

Quality Data ◽

Tongue Pressure ◽

Swallowing Function ◽

Temporal Measures ◽

The Impact ◽

Training Protocols

Abstract Lingual resistance training has been proposed as an intervention to improve decreased tongue pressure strength and endurance in patients with dysphagia. However, little is known about the impact of lingual resistance training on swallow physiology. This systematic review scrutinizes the available evidence regarding the effects of lingual resistance training on swallowing function in studies using Videofluoroscopic Swallowing Studies (VFSS) with adults. Seven articles met the inclusion criteria and underwent detailed review for study quality, data extraction, and planned meta-analysis. Included studies applied this intervention to a stroke and brain injury patient populations or to healthy participants, applied different training protocols, and used a number of outcome measures, making it difficult to generalize results. Lingual resistance training protocols included anterior and posterior tongue strengthening, accuracy training, and effortful press against hard palate with varying treatment durations. VFSS protocols typically included a thin barium stimulus along with one other consistency to evaluate the effects of the intervention. Swallowing measures included swallow safety, efficiency, and temporal measures. Temporal measures significantly improved in one study, while safety improvements showed mixed results across studies. Reported improvements in swallowing efficiency were limited to reductions in thin liquid barium residue in two studies. Overall, the evidence regarding the impact of lingual resistance training for dysphagia is mixed. Meta-analysis was not possible due to differences in methods and outcome measurements across studies. Reporting all aspects of training and details regarding VFSS protocols is crucial for the reproducibility of these interventions. Future investigations should focus on completing robust analyses of swallowing kinematics and function following tongue pressure training to determine efficacy for swallowing function.

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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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Efficacy of Modern Diabetes Treatments- Dpp-4i, Sglt-2i, Glp-1ra- in White and Asian Patients With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

10.2337/figshare.12003276.v1 ◽

2020 ◽

Author(s):

Sushrima Gan1 ◽

Adem Y Dawed ◽

Louise A Donnelly ◽

ATN Nair ◽

Colin NA Palmer ◽

...

Keyword(s):

Systematic Review ◽

Randomized Clinical Trials ◽

Data Extraction ◽

Meta Analysis ◽

Controlled Trials ◽

Glucose Lowering ◽

Asian Ethnicity ◽

Mesh Terms ◽

Oral Agents ◽

The Impact

Background and Purpose:The pathophysiology of Type 2 diabetes differs markedly by ethnicity. A systematic review and meta-analysis was conducted to assess the impact of ethnicity on the glucose lowering efficacy of the newer oral agents, SGLT-2is, GLP-1RAs and DPP-4is, using evidence from randomized clinical trials (RCTs). Data Sources:A literature search was conducted in PubMed of all randomized, placebo-controlled trials of DPP-4 inhibitors, SGLT-2 inhibitors and GLP-1RA. The search strategy was developed based on medical subject sub-headings (MeSH) terms and keywords. Study selection : 64 studies qualified for meta-analysis after full-text review based on pre-defined inclusion and exclusion criteria. RCTs with at least 50 patients in each arm; >70% of population from Asian or White group; duration>=24 weeks; published up to March 2019 were selected for systematic review and meta-analysis. Data extraction:Data extraction was done for aggregated study-level data , by two independent researchers. Absolute changes in HbA1c (%) from baseline to 24 weeks between the drug and placebo was considered as the primary endpoint of the study. Data synthesis: Change in HbA1c was evaluated by computing mean differences (MDs) and 95% confidence intervals (CI) between treatment and placebo arms. Limitations: Study is based on summarized data and could not be separated based on East Asians and South Asians. Conclusion : The glucose lowering efficacy of SGLT-2i, and to a lesser extent DPP-4i, was greater in studies of predominantly Asian ethnicity compared to studies of predominantly white ethnicity. There was no difference seen by ethnicity for GLP-1RA.

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Prenatal maternal stress and risk of neurodevelopmental disorders in the offspring: A systematic review and meta-analysis protocol

HRB Open Research ◽

10.12688/hrbopenres.12827.1 ◽

2018 ◽

Vol 1 ◽

pp. 15

Author(s):

Nicla Manzari ◽

Karen Matvienko-Sikar ◽

Franco Baldoni ◽

Gerard W. O'Keeffe ◽

Ali S. Khashan

Keyword(s):

Systematic Review ◽

Maternal Stress ◽

Data Extraction ◽

Meta Analysis ◽

Autism Spectrum ◽

Prenatal Maternal Stress ◽

Cross Sectional ◽

Increased Risk ◽

Meta Analyses ◽

The Impact

Background: Prenatal maternal stress (PNMS) is defined as the experience of significant levels of prenatal stress, depression or anxiety during pregnancy. PNMS has been associated with increased risk of autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) in exposed offspring. However, these findings are inconsistent and other studies found no association, meaning a clear consensus on the impact of PNMS on ASD and ADHD risk is required. The purpose of this systematic review and meta-analysis is to summarize and critically review the existing literature on the effects of PNMS on ASD and ADHD risk. Methods: Electronic databases (PubMed, PsycINFO, Web of Science, Scopus and EMBASE) will be searched for articles following a detailed search strategy. We will include cohort, case-control and cross-sectional studies that assessed maternal exposure to psychological and/or environmental stress and had ASD or ADHD as an outcome. Two reviewers will independently screen the titles, abstracts and full articles to identify eligible studies. We will use a standardised data extraction form for extracting data and a bias classification tool for assessing study quality. This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The generic inverse variance method will be used if possible to perform meta-analyses. Ethics and dissemination: Ethical approval is not required for this study because it will not involve the conduct or inclusion of any experimental or personal data that would require informed consent. The systematic review will be disseminated in peer-reviewed journals. PROSPERO registration number: CRD42018084222.

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Efficacy of Modern Diabetes Treatments- Dpp-4i, Sglt-2i, Glp-1ra- in White and Asian Patients With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

10.2337/figshare.12003276 ◽

2020 ◽

Author(s):

Sushrima Gan1 ◽

Adem Y Dawed ◽

Louise A Donnelly ◽

ATN Nair ◽

Colin NA Palmer ◽

...

Keyword(s):

Systematic Review ◽

Randomized Clinical Trials ◽

Data Extraction ◽

Meta Analysis ◽

Controlled Trials ◽

Glucose Lowering ◽

Asian Ethnicity ◽

Mesh Terms ◽

Oral Agents ◽

The Impact

Background and Purpose:The pathophysiology of Type 2 diabetes differs markedly by ethnicity. A systematic review and meta-analysis was conducted to assess the impact of ethnicity on the glucose lowering efficacy of the newer oral agents, SGLT-2is, GLP-1RAs and DPP-4is, using evidence from randomized clinical trials (RCTs). Data Sources:A literature search was conducted in PubMed of all randomized, placebo-controlled trials of DPP-4 inhibitors, SGLT-2 inhibitors and GLP-1RA. The search strategy was developed based on medical subject sub-headings (MeSH) terms and keywords. Study selection : 64 studies qualified for meta-analysis after full-text review based on pre-defined inclusion and exclusion criteria. RCTs with at least 50 patients in each arm; >70% of population from Asian or White group; duration>=24 weeks; published up to March 2019 were selected for systematic review and meta-analysis. Data extraction:Data extraction was done for aggregated study-level data , by two independent researchers. Absolute changes in HbA1c (%) from baseline to 24 weeks between the drug and placebo was considered as the primary endpoint of the study. Data synthesis: Change in HbA1c was evaluated by computing mean differences (MDs) and 95% confidence intervals (CI) between treatment and placebo arms. Limitations: Study is based on summarized data and could not be separated based on East Asians and South Asians. Conclusion : The glucose lowering efficacy of SGLT-2i, and to a lesser extent DPP-4i, was greater in studies of predominantly Asian ethnicity compared to studies of predominantly white ethnicity. There was no difference seen by ethnicity for GLP-1RA.

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