Integration of Medication Safety Training and Development of a Culture of Safety in Pharmacy Education

Medication safety events with the potential for patient harm do occur in health care settings. Pharmacists are regularly tasked with utilizing their medication knowledge to optimize the medication use process and reduce the likelihood of error. To prepare for these responsibilities in professional practice, it is important to introduce patient safety principles during educational experiences. The Accreditation Council for Pharmacy Education (ACPE) and the American Society of Health-System Pharmacists (ASHP) have set forth accreditation standards focused on the management of medication use processes to ensure these competencies during pharmacy didactic learning and postgraduate training. The experience described here provides perspective on educational and experiential opportunities across the continuum of pharmacy education, with a focus on a relationship between a college of pharmacy and healthcare system. Various activities, including discussions, medication event reviews, audits, and continuous quality improvement efforts, have provided the experiences to achieve standards for these pharmacy learners. These activities support a culture of safety from early training.

Development and Validation of a Knowledge, Attitude, and Practice Scale for Medication Safety in Patients with Chronic Kidney Disease: A Cross-Sectional Study

Purpose To develop a knowledge, attitude, and practice (KAP) scale for medication safety in patients with chronic kidney disease (CKD), test its reliability and validity, and provide a reliable assessment instrument for the self-medication of patients with CKD. Methods The initial scale was formulated based on the KAP theory together with a literature review, research group discussion and semi-structured interviews of patients with CKD. An expert panel consultation and pre-investigation were conducted to improve the scale. Next, 209 patients with CKD were enrolled to undertake the questionnaire linked to the primary scale. The item analysis, exploratory factor analysis (EFA), Cronbach’s alpha coefficient and split-half reliability were used to evaluate the validity and reliability of the scale. Results The primary scale consisted of 32 items with three dimensions. Three items were deleted after the item analysis. Then, the principal component analysis with Varimax rotation was employed to analyze the construct and factor structure. Finally, item 20 was deteled and the formal scale was formed with 28 items and four dimensions. The cumulative variance contribution rate was 65.132%. The alpha coefficient was 0.944 and the split-half reliability coefficient was 0.834 for the scale. Conclusion The KAP scale has good reliability and validity. It may be valuable for evaluating the levels of medication adherence and managing the self-medication of patients with CKD in China. In the future, further translation and validation in different regions with expansion of sample size are required, so that this scale can be further applied worldwide.

Strategies for Implementing Pediatric Dose Standardization: Considerations From the Vizient University Health System Consortium Pharmacy Network Pediatric Pharmacy Committee

Pediatric patients are at a heightened risk for medication errors due to variability in medication ordering and administration. Dose rounding and standardization have been 2 practices historically used to reduce variability and improve medication safety. This article will describe strategies for implementing pediatric dose standardization. Local practice often dictates the operational decisions made at an institutional level, leading to a lack of a standard methodology. Vizient survey results demonstrate there is wide variation in dose standardization and ready-to-use (RTU) practices although most responding institutions have attempted to limit bedside manipulation to reduce medication error. There are many barriers to consider before pursuing dose standardization at an institution. These include selecting medications to standardize, calculating appropriate standardized doses, preparing RTU products, and supplying the products to the patient. Strategies to overcome implementation issues are described as well as identification of knowledge gaps related to the preparation and use of RTU products in the pediatric population. There is opportunity to enhance an institution's ability to provide RTU medications. Although there are several barriers, those that have had successful implementation have leveraged their information technology systems, garnered multidisciplinary support, and customized their practice to meet their operational demands.

The Secondary Use of Data to Support Medication Safety in the Hospital Setting: A Systematic Review and Narrative Synthesis

Objectives: To conduct a systematic review and narrative synthesis of interventions based on secondary use of data (SUD) from electronic prescribing (EP) and electronic hospital pharmacy (EHP) systems and their effectiveness in secondary care, and to identify factors influencing SUD. Method: The search strategy had four facets: 1. Electronic databases, 2. Medication safety, 3. Hospitals and quality/safety, and 4. SUD. Searches were conducted within EMBASE, Medline, CINAHL, and International Pharmaceutical Abstracts. Empirical SUD intervention studies that aimed to improve medication safety and/or quality, and any studies providing insight into factors affecting SUD were included. Results: We identified nine quantitative studies of SUD interventions and five qualitative studies. SUD interventions were complex and fell into four categories, with ‘provision of feedback’ the most common. While heterogeneous, the majority of quantitative studies reported positive findings in improving medication safety but little detail was provided on the interventions implemented. The five qualitative studies collectively provide an overview of the SUD process, which typically comprised nine steps from data identification to analysis. Factors influencing the SUD process were electronic systems implementation and level of functionality, knowledge and skills of SUD users, organisational context, and policies around data reuse and security. Discussion and Conclusion: The majority of the SUD interventions were successful in improving medication safety, however, what contributes to this success needs further exploration. From synthesis of research evidence in this review, an integrative framework was developed to describe the processes, mechanisms, and barriers for effective SUD.

FPGA Implementation of Mutual Authentication Protocol for Medication Security System

Medication safety administration is a complicated process involving the information of patients, drugs, and data storage. The sensitive data transmitted through wireless sensor networks (WSNs) from Internet of things (IoT) over an insecure channel is vulnerable to several threats and needs proper attention to be secured from adversaries. Taking medication safety into consideration, this paper presents a secure authentication protocol for wireless medical sensor networks. The XOR scheme-based algorithm is applied to achieve the purposes of data confidentiality. The proposed architecture is realized as hardware in a field-programmable gate array (FPGA) device which acts as a secure edge computing device. The performance of the proposed protocol is evaluated and simulated via Verilog hardware description language. The functionality of the proposed protocol is verified using the Altera Quartus II software tool and implemented in the Altera Cyclone II DE2-70 FPGA development module. Furthermore, the output signals from the FPGA are measured in the 16702A logic analyzer system to demonstrate real-time functional verification.

Analysis of medication errors during anaesthesia in the first 4000 incidents reported to webAIRS

Medication error is a well-recognised cause of harm to patients undergoing anaesthesia. From the first 4000 reports in the webAIRS anaesthetic incident reporting system, we identified 462 reports of medication errors. These reports were reviewed iteratively by several reviewers paying particular attention to their narratives. The commonest error category was incorrect dose (29.4%), followed by substitution (28.1%), incorrect route (7.6%), omission (6.5%), inappropriate choice (5.8%), repetition (5.4%), insertion (4.1%), wrong timing (3.5%), wrong patient (1.5%), wrong side (1.5%) and others (6.5%). Most (58.9%) of the errors resulted in at least some harm (20.8% mild, 31.0% moderate and 7.1% severe). Contributing factors to the medication errors included the presence of look-alike medications, storage of medications in the incorrect compartment, inadequate labelling of medications, pressure of time, anaesthetist fatigue, unfamiliarity with the medication, distraction, involvement of multiple people and poor communication. These data add to current evidence suggesting a persistent and concerning failure effectively to address medication safety in anaesthesia. The wide variation in the nature of the errors and contributing factors underline the need for increased systematic and multifaceted efforts underpinned by a strengthening of the current focus on safety culture to improve medication safety in anaesthesia. This will require the concerted and committed engagement of all concerned, from practitioners at the clinical workface, to those who fund and manage healthcare.