scholarly journals Medication Errors among Healthcare Workers in a Major HIV Treatment Centre in Nigeria

2019 ◽  
pp. 1-9
Author(s):  
S. O. Ekama ◽  
A. N. David ◽  
A. Z. Musa ◽  
I. I. Olojo ◽  
E. C. Herbertson ◽  
...  
Keyword(s):  
Medication Errors ◽  
Health Workers ◽  
Well Being ◽  
Error Rates ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Continuous Training ◽  
Error Type ◽  
Care Experience ◽  
Medication Error Reporting

Background: Medication errors are major challenging clinical incidents in health care settings that could jeopardize a patient’s life and well being. These errors could occur at any step of the medication use process from prescribing, prescription verification, dispensing, drug administration to monitoring. This study aims to assess and classify medication errors among doctors and pharmacists. Methods: A prospective observational study from July to September 2018. Randomly selected prescriptions were screened for errors before and after dispensing of drugs. Errors were assessed and classified according to the National Coordination Council for Medication Error Reporting and Prevention (NCCMERP) index to determine the level of harm it posed to the patient. Results: Out of 1529 prescriptions analyzed, 182(11.9%) medication errors were observed; 104(57.1%) and 78 (42.9%) among doctors and pharmacists respectively. Majority of the errors were for female patients, those on first line antiretroviral drug regimen, in the age group 41-50 years and according to the NCCMERP index of the error type D. The most common medication errors among the doctors were omission errors (36.5%) and errors in patient data (21.1%) while unsigned prescriptions (33.3%) and omitting prescribed drugs from dispensed drugs (28.2%) ranked highest among pharmacists’ errors. Doctors and pharmacists (53.3% and 75% respectively) with < 5years HIV care experience had higher error rates. Conclusion: Medication errors associated with cotrimoxazole therapy were most common for both categories of health workers and this has a potential for poor treatment outcome. There is need for continuous training of health workers in HIV management.

scholarly journals “Our Tradition Our Enemy”: A Qualitative Study of Barriers to Women’s HIV Care in Jimma, Southwest Ethiopia

2020 ◽  
Vol 17 (3) ◽  
pp. 833
Author(s):  
Hailay Gesesew ◽  
Pamela Lyon ◽  
Paul Ward ◽  
Kifle Woldemichael ◽  
Lillian Mwanri
Keyword(s):  
Treatment Outcomes ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Health Workers ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Negative Consequences ◽  
Framework Analysis ◽  
Southwest Ethiopia

Evidence exists that suggests that women are vulnerable to negative HIV treatment outcomes worldwide. This study explored barriers to treatment outcomes of women in Jimma, Southwest Ethiopia. We interviewed 11 HIV patients, 9 health workers, 10 community advocates and 5 HIV program managers from 10 institutions using an in-depth interview guide designed to probe barriers to HIV care at individual, community, healthcare provider, and government policy levels. To systematically analyze the data, we applied a thematic framework analysis using NVivo. In total, 35 participants were involved in the study and provided the following interrelated barriers: (i) Availability— most women living in rural areas who accessed HIV cared less often than men; (ii) free antiretroviral therapy (ART) is expensive—most women who have low income and who live in urban areas sold ART drugs illegally to cover ART associated costs; (iii) fear of being seen by others—negative consequences of HIV related stigma was higher in women than men; (iv) the role of tradition—the dominance of patriarchy was found to be the primary barrier to women’s HIV care and treatment outcomes. In conclusion, barriers related to culture or tradition constrain women’s access to HIV care. Therefore, policies and strategies should focus on these contextual constrains.

scholarly journals P25 Incidents involving paediatric parenteral nutrition

2020 ◽  
Vol 105 (9) ◽  
pp. e19.1-e19
Author(s):  
Kouzhu Zhu ◽  
Andrea Gill
Keyword(s):  
Parenteral Nutrition ◽  
Medication Error ◽  
Total Parenteral Nutrition ◽  
Medication Errors ◽  
Error Reporting ◽  
List Type ◽  
Error Type ◽  
Safe Medication ◽  
Medication Error Reporting ◽  
Coordinating Council

AimParenteral nutrition (PN) is one of the medications most frequently reported to be involved in medication errors in hospital.1 PN is a class of high alert medications listed by The Institute for Safe Medication Practices.2 Medication errors involving PN may have potentially serious consequences especially in infants.3 The purpose of this study was to determine the type of incidents reported, who reported it, severity of incidents and the part of the process involved in the error with the aim of ensuring quality and safety in PN processes.MethodThe incidents involving PN reported on the Ulysses system in a specialist children’s hospital were surveyed between April 2018 and March 2019. Incidents were assigned to different error-type categories. We focused on the whole process of prescribing, transcription, preparation, and administration of PN. Severity classification was based on the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index.4ResultsThere were 34 incidents involving PN ranging from 1 to 8 per month. Job titles who reported these incidents were nurses (16 incidents), pharmacists (14 incidents), dieticians (2 incidents) and unknown (2 incidents). The most common types of incidents were omitted medicine/dose (7 incidents), labelling error (6 incidents), wrong quantity supplied (4 incidents) and wrong/unclear dose (4 incidents). The processes during which the incident had occurred were administration/supply of a medicine (14 incidents), preparation of medicines/dispensing in a pharmacy (13 incidents) and prescribing (7 incidents). The majority of incidents (82.4%, 28/34) were assigned category C (no harmful consequences), while 14.7% (5/34) and 2.9% (1/34) were assigned to category B (an error occurred but the error did not reach the patient) and category D (an error occurred that reached the patient and required monitoring to confirm that it resulted in no harm to the patient and/or required intervention to preclude harm) respectively. The following actions have been taken to try to prevent error with PN: training, providing information, introduction of new labels, changes to the profiles on infusion pumps, reinforcing independent checking and the increased use of standard PN solutions.ConclusionNurses and pharmacists are the main reporters of incidents of PN. Omitted medicine/dose is the most common incident reported. The majority of errors involved administration of PN. The majority of all incidents did not cause harm to patients.ReferencesRinke ML, Bundy DG, Velasquez CA, et al. Interventions to reduce pediatric medication errors: a systematic review[J]. Pediatrics, 2014, 134(2):338–60.Institute for Safe Medication Practices. ISMP List of High-Alert Medications in Acute Care Settings. Horsham, PA. Available from: http://www.ismp.org/Tools/institutionalhighAlert.asp (accessed January 15, 2017)NHS/PSA/W/2017/005,Risk of severe harm and death from infusing total parenteral nutrition too rapidly in babies. Available from: https://improvement.nhs.uk/news-alerts/infusing-total-parenteral-nutrition-too-rapidly-in-babies/National Coordinating Council for Medication Error Reporting and Prevention. NCC MERP Index for Categorizing Medication Errors. Available from http://www.nccmerp.org/sites/default/files/indexColor2001-06-12.pdf (accessed March 10, 2017)

scholarly journals Medication errors involving intravenous patient-controlled analgesia: results from the 2005–2015 MEDMARX database

2018 ◽  
Vol 9 (8) ◽  
pp. 389-404 ◽  
Author(s):  
Maitreyee Mohanty ◽  
Oluwadolapo D. Lawal ◽  
Margie Skeer ◽  
Ryan Lanier ◽  
Nathalie Erpelding ◽  
...  
Keyword(s):  
Medication Errors ◽  
Human Error ◽  
Human Performance ◽  
Descriptive Analysis ◽  
Clinical Intervention ◽  
Patient Controlled Analgesia ◽  
Error Type ◽  
Medication Error Reporting ◽  
Improper Use ◽  
Cause Of Error

Background: The aim of this study was to determine the current magnitude and characteristics of intravenous patient-controlled analgesia (IV-PCA) errors, and to identify opportunities for improving the PCA modality. Methods: We conducted a descriptive analysis of IV-PCA medication errors submitted to the MEDMARX database. Events were restricted to those occurring in inpatient hospital settings between 1 January 2005 and 31 December 2015. IV-PCA errors were classified by error category, cause of error, error type, level of care rendered, and actions taken. Results: A total of 1948 IV-PCA errors were identified as potential errors (3.9%), nonharmful errors (89.5%), or harmful errors (6.7%) based on the National Coordinating Council for Medication Error Reporting and Prevention taxonomy for categorizing medication errors. Of these, 19.1% required a clinical intervention to address the deleterious effects of the error, indicating an underestimation of the risks associated with IV-PCA errors. The most frequent types of errors were improper dose/quantity (43.2%) and omission errors (19.9%). While human performance deficit was the leading cause of error (50.2%), other common causes included failure to follow procedure and protocol (42.2%) and improper use of the pump (22.7%). Although remedial actions were often taken to prevent error recurrence, actions were taken to rectify the systemic deficits that led to errors in only a minority of cases (11.8%). Conclusion: Preventable errors continue to pose unnecessary risks to patients receiving IV-PCA. Multimodal analgesic regimens and novel PCA systems that reduce human error are needed to prevent errors while preserving the advantages of PCA for the management of acute pain.

scholarly journals Resilience-Focused HIV Care to Promote Psychological Well-Being During COVID-19 and Other Catastrophes

2021 ◽  
Vol 9 ◽  
Author(s):  
L. Lauren Brown ◽  
Erika G. Martin ◽  
Hannah K. Knudsen ◽  
Heather J. Gotham ◽  
Bryan R. Garner
Keyword(s):  
Systems Of Care ◽  
Well Being ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Psychological Wellness ◽  
Multi Level ◽  
Definition Of ◽  
Hiv Continuum Of Care ◽  
Hiv Treatment Outcomes

The COVID-19 pandemic has adversely affected people with HIV due to disruptions in prevention and care services, economic impacts, and social isolation. These stressors have contributed to worse physical health, HIV treatment outcomes, and psychological wellness. Psychological sequelae associated with COVID-19 threaten the overall well-being of people with HIV and efforts to end the HIV epidemic. Resilience is a known mediator of health disparities and can improve psychological wellness and behavioral health outcomes along the HIV Continuum of Care. Though resilience is often organically developed in individuals as a result of overcoming adversity, it may be fostered through multi-level internal and external resourcing (at psychological, interpersonal, spiritual, and community/neighborhood levels). In this Perspective, resilience-focused HIV care is defined as a model of care in which providers promote optimum health for people with HIV by facilitating multi-level resourcing to buffer the effects of adversity and foster well-being. Adoption of resilience-focused HIV care may help providers better promote well-being among people living with HIV during this time of increased psychological stress and help prepare systems of care for future catastrophes. Informed by the literature, we constructed a set of core principles and considerations for successful adoption and sustainability of resilience-focused HIV care. Our definition of resilience-focused HIV care marks a novel contribution to the knowledge base and responds to the call for a multidimensional definition of resilience as part of HIV research.

scholarly journals The Effect of Motivational System on the Reporting Rate of Medication Errors in  Iranian Pediatric Wards

2020 ◽  
Author(s):  
laleh massah ◽  
Rouhangiz mohammadi ◽  
Namnabati Mahboobeh
Keyword(s):  
Medication Error ◽  
Medication Errors ◽  
Positive Reinforcement ◽  
Reporting Rate ◽  
Continuous Training ◽  
Motivational System ◽  
Medication Error Reporting ◽  
Before And After ◽  
Quasi Experimental

Abstract Backgrand: The rate of reporting medication errors among nurses is lower than the actual rate. The role of education, encouragement, and promotion of reporting culture can contribute to the increase of errors reporting. This study was to investigate the effect of motivational system on reporting of medication errors in pediatric wards Methods: A quasi-experimental study was done through 60 nurses working in pediatric wards of the selected hospital were selected using census sampling method. Data were collected using a questionnaire based on eight medication principles completed by the nurses before and after the intervention. The intervention in this study was a motivational program with two parts of training and positive reinforcement that was conducted in 2018 for four months. For data analysis, SPSS16 was used. Results: After the intervention, the most prevalent medication error (60%) was in the principle of right medication (related to similar name. Furthermore, the mean score of nurses' medication error reporting increased significantly in all the principles after the intervention (P <0.05). Conclusions: Motivational system increased reporting of medication errors in nurses. Therefore, the managers can improve medication care and the children safety through continuous training and encouragement in the hospitals.

“He Can’t Say a Man’s Stuff to a Woman…”: Perspectives on the Preferences of Men Living with HIV for Gender-Concordant Care Workers in Cape Town, South Africa

2017 ◽  
Vol 22 (5) ◽  
pp. 751-777 ◽  
Author(s):  
Lesley Gittings
Keyword(s):  
South Africa ◽  
Health Workers ◽  
Cape Town ◽  
Well Being ◽  
Hiv Care ◽  
Power Dynamics ◽  
Gender Preferences ◽  
Male Clients ◽  
Adherence Support ◽  
Living With Hiv

Community health workers (CHWs) play a central role in the provision of HIV care in South Africa, and people receiving such community-based adherence support have considerably better health outcomes. As with other forms of care work, the majority of CHWs are women. HIV vulnerability is also gendered, with women being more likely to contract HIV, while men living with HIV are more likely to die of AIDS-related illness. This article explores the relational gender dynamics of eight Cape Town–based CHWs and their male clients. Derived from multiple semistructured interviews, it engages the perspectives of CHWs, men living with HIV, and HIV and masculinities activists to explore HIV-positive men’s gender preferences for CHWs, and how these pairings may support their health and well-being. Reasons cited for gender-concordant preferences include gendered power dynamics, comfort in sharing intimate health information of someone of the same gender, and, in some cases, negative associations of women as untrustworthy gossips.

SP3 The effect of electronic prescribing and medicines administration systems (epmass) on paediatric medication errors

2018 ◽  
Vol 103 (2) ◽  
pp. e1.23-e1
Author(s):  
Aragon Octavio ◽  
Fayyaz Goher ◽  
Gill Andrea ◽  
Morecroft Charles
Keyword(s):  
Medication Errors ◽  
Error Rate ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Error Type ◽  
Common Error ◽  
Period 2 ◽  
The Difference ◽  
Paediatric Prescribing

BackgroundThe complex nature of paediatric prescribing makes this population more vulnerable to medication errors.1Electronic Prescribing and Medicines Administration Systems (EPMASs) have been suggested to improve paediatric medication safety by reducing prescribing errors.AimTo identify and compare the number and nature of paediatric medication errors pre and post introduction of an EPMAS at a tertiary paediatric hospital.MethodologyPharmacists collected data monthly on the number of new items prescribed and the number of errors (if any) detected in these prescriptions following methodology from the EQUIP study.2 The EPMAS Meditechv6 was introduced in June 2015. Data analysed included forms from 1st-January-2015 to 30th-June-2015 (period 1: pre-EPMAS) and 1st-January-2016 to 30th-June-2016 (period 2: post-EPMAS). The analysis aimed to investigate the rate, type and severity of errors as well as the prescriber grade, prescribing stage and drug class associated with each. Descriptive statistical methods were used to analyse the frequency and nature of errors pre and post implementation of Meditech. Statistical significance was tested using a contingency Chi-squared (χ2) test for the difference in error rates across both periods and a Mann-Whitney test for the difference between the severities of errors across both periodsResultsAn increase of 6.4% in error rate was detected post-Meditech introduction with 67 errors in 1706 items (3.9%) during period 1 and 151 errors in 1459 items (10.3%) during period 2 (p<0.001, χ2 test). FY2 doctors and ‘admission stage’ were associated with the highest error rates across both periods. Minor severity errors were the most common in both periods, with 55.2% in period 1% and 66.2% in period 2. No statistical difference was detected (p=0.403) in the severity of errors reported although the proportion of significant and serious errors decreased from 38.8% to 27.8% and 6.0% to 0.7% respectively. No errors were classed to be potentially lethal in period 1, however there was one such incident in period 2. Underdosing was the most common error type in period 1 (22.4%), falling to 4.0% in period 2. Omission on admission was the most common error type in period 2, with an error rate of 37.7% vs 20.9% in period 1. Antibacterials and analgesics were the most common classes of drugs involved in errors in both periods, although a wider range of drug classes were involved in errors post Meditech introductionConclusionA significant increase of 6.4% in error rate was found post implementation of Meditech highlighting the concept of EPMAS-facilitated errors. The positive effect of EPMASs is also apparent as the incidence of significant and serious errors decreased in period 2, although this difference was not statistically significant. Reaching definitive conclusions is difficult due to the lack of available research into the effects of EPMASs on paediatric prescribing and due to methodological limitations. However, it can be suggested that introducing functions such as comprehensive decision support and dose calculators may overcome the shortcomings of the current system3 and allow for the true benefits of EPMASs in improving paediatric medication safety to be demonstrated.ReferencesNational Patient Safety Agency. Review of patient safety for children and young people 2009. England: National Reporting and Learning Services. http://www.nrls.npsa.nhs.uk/resources/?entryid45=5986 [Accessed: 29th October 2016].Dornan T, et al. An in-depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education: EQUIP study. Final Report to the General Medical Council 2009. http://www.gmcuk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf [Accessed: 9th November 2016].Johnson KB, Lehmann CU. Electronic prescribing in paediatrics: Toward safer and more effective medication management. Paediatrics 2013;131(4):e1350–e1356. doi:10.1542/peds.2013-0193

Perceptual Characteristics of Consonant Production in Apraxia of Speech and Aphasia

2019 ◽  
Vol 28 (4) ◽  
pp. 1411-1431 ◽  
Author(s):  
Lauren Bislick ◽  
William D. Hula
Keyword(s):  
Error Rate ◽  
Error Rates ◽  
Group Differences ◽  
Diagnostic Process ◽  
Apraxia Of Speech ◽  
Contextual Variables ◽  
Error Type ◽  
Type Distribution ◽  
Phonetic Features ◽  
Syllable Position

Purpose This retrospective analysis examined group differences in error rate across 4 contextual variables (clusters vs. singletons, syllable position, number of syllables, and articulatory phonetic features) in adults with apraxia of speech (AOS) and adults with aphasia only. Group differences in the distribution of error type across contextual variables were also examined. Method Ten individuals with acquired AOS and aphasia and 11 individuals with aphasia participated in this study. In the context of a 2-group experimental design, the influence of 4 contextual variables on error rate and error type distribution was examined via repetition of 29 multisyllabic words. Error rates were analyzed using Bayesian methods, whereas distribution of error type was examined via descriptive statistics. Results There were 4 findings of robust differences between the 2 groups. These differences were found for syllable position, number of syllables, manner of articulation, and voicing. Group differences were less robust for clusters versus singletons and place of articulation. Results of error type distribution show a high proportion of distortion and substitution errors in speakers with AOS and a high proportion of substitution and omission errors in speakers with aphasia. Conclusion Findings add to the continued effort to improve the understanding and assessment of AOS and aphasia. Several contextual variables more consistently influenced breakdown in participants with AOS compared to participants with aphasia and should be considered during the diagnostic process. Supplemental Material https://doi.org/10.23641/asha.9701690

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

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.

scholarly journals Policy implementation analysis on access to healthcare among undocumented immigrants in seven autonomous communities of Spain, 2012–2018

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e045626
Author(s):  
Megi Gogishvili ◽  
Sergio A Costa ◽  
Karen Flórez ◽  
Terry T Huang
Keyword(s):  
Policy Implementation ◽  
Undocumented Immigrants ◽  
Healthcare Services ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Undocumented Migrants ◽  
Royal Decree ◽  
La Mancha ◽  
Free Healthcare ◽  
Implementation Analysis

BackgroundIn 2012, the Government of Spain enacted Royal Decree-Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012 excluding undocumented immigrants from publicly funded healthcare services. We conducted a policy implementation analysis to describe and evaluate the legal and regulatory actions taken at the autonomous community (AC) level after enactment of 2012 RDL and RD and their impact on access to general healthcare and HIV services among undocumented immigrants.MethodsWe reviewed documents published by the governments of seven ACs (Andalucía, Aragón, Euskadi (Basque Country), Castilla-La Mancha, Galicia, Madrid, Valencia) from April 2012 to July 2018, describing circumstances under which undocumented immigrants would be able to access free healthcare services. We developed indicators according to the main systemic barriers presented in official documents to analyse access to free healthcare across the participating ACs. ACs were grouped under five access categories: high, medium-high, medium, medium-low and low.ResultsAndalucía provided the highest access to free healthcare for undocumented immigrants in both general care and HIV treatment. Medium-high access was provided by Euskadi and medium access by Aragón, Madrid and Valencia. Castilla-La Mancha provided medium-low access. Galicia had low access. Only Madrid and Galicia provided different and higher level of access to undocumented migrants in HIV care compared with general healthcare.ConclusionsImplementation of 2012 RDL and RD across the ACs varied significantly, in part due to the decentralisation of the Spanish healthcare system. The challenge of healthcare access among undocumented immigrants included persistent systemic restrictions, frequent and unclear rule changes, and the need to navigate differences across ACs of Spain.

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