Impact of Live Training on Medication Errors in a Community-Based Pharmacy Setting

Objective: To compare community-based pharmacy medication errors before and after a one-hour live interactive training session for both pharmacists and technicians. Methods: A one group pre-post intervention design study was conducted in 20 community-based pharmacies in a district of a large national community pharmacy chain. A one-hour live, interactive session was developed based on incident reports and medication error trends including medication error definition, ways in which medication errors occur, strategies for mitigating errors, information about human error, and methods and habits to improve patient safety. At least 50% of full-time staff for each of the 20 pharmacies were required to attend a training session between December 1, 2017-January 15, 2018. Participants completed a demographics survey documenting gender, age, credentials, number of years of experience, and years of service with the company. Pharmacies were categorized as low, medium or high volume based on prescription count. Medication errors were compared six months pre- and post-live education session. Data were analyzed using SAS version 9.4. Results: One hundred and thirty- five errors and 111 errors were reported pre-and post-live training (mean 6.85 and 5.55, p < 0.301), respectively. Nine pharmacies were low, eight medium, and three high volume with the mean number of medication errors reported pre- and post-live training; low 4.33 vs 4.11 p<0.478, medium 9.37 vs 6.87 p<0.443, and high 7.66 vs 6.33 p<0.593, respectively. Sixty pharmacy staff (34 pharmacists, 26 technicians) attended one of the live training sessions; 73% female; most frequently reported age range 35-50 years; 23 Doctor of Pharmacy, 11 Bachelor of Science in Pharmacy, and 26 Certified Technician; and average number of years’ experience was 13.6 and average service with the company was 8.6 years. Conclusions: A live training session for both pharmacists and technicians did not significantly decrease medication errors, but could be incorporated as an element of a medication safety program. It should be considered for implementation in other districts of this large national pharmacy chain as a part of an improved patient safety effort. Article Type: Original Research

SISTEM JAMINAN KESELAMATAN KERJA KARYAWAN BENGKEL LAS

The employee safety is the responsibility of a company often ignored. The company is not optimal in doing safety effort for employees become one of its trigger. Welding garages in the sub-district of Tanah Jambo Aye is the company engaged in welding which has high level of potential hazard. In addition, the workers have to obtain the word safety that was listed in the law No. 13 year 2003 about employment. The problems will be discussed in this thesis are: (1) How is the employee safety guarantees system of welding garage in Tanah Jambo Aye sub-district? (2) How is the Islamic law perspective and the law No.13 year 2003 on the employee safety guarantees system of welding garage in Tanah Jambo Aye sub-district? . The first purpose of this research to know how is the employee safety guarantees system of welding garage in Tanah Jambo Aye. The last is to know how is the Islamic law perspective and the law No.13 year 2003 on the employee guarantees system of welding garage in Tanah Jambo Aye sub-district. The research methodology that is used in this research is descriptive analysis of Qualitative method. The result show the welding garage in Tanah Jambo Aye sub-district is less effective and not go well yet, because the welding garage company in that district do not provide perfect tool for personal protection in safety working, such as: hand protectors, masker, shoes, hat protections, and face protections. The risk happened in working or work accident can cause the employees disabled or injury, the all cases is not in full responsibility by the welding garage in Tanah Jambo Aye sub-district. This case less corresponding with Islamic concept, as intended in Maqashid Syari’ah by maintaining Al-umur al-dharuruyah that are maintaining the soul, religion, mind, descent, and treasure. Therefore, it can safety guarantee of the world and hereafter. Abstrak:Keselamatan pekerja Merupakan Tanggung jawab perusahaan yang sering diabaikan oleh perusahaan, salah satu penyebabnya adalah kurang optimalnya perusahaan dalam menyelenggarakan upaya keselamatan bagi karyawannya. Bengkel Las Kecamatan Tanah Jambo Aye merupakan perusahaan yang bergerak dibidang pengelasan yang memiliki tingkat potensi bahaya tinggi. Selain itu Keselamatan Kerja juga merupakan hak yang harus diperoleh pekerja yang sudah tercantum dalam Undang-undang No. 13 Tahun 2003 Tentang Ketenagakerjaan. Adapun Permasalahan yang di bahas dalam skripsi ini adalah: (1) Bagaimana Sistem Jaminan Keselamatan kerja Karyawan Bengkel Las Kecamatan Tanah Jambo Aye? (2) Bagaimana tinjauan Hukum Islam dan Undang-undang No.13 Tahun 2003 terhadap Sistem Jaminan Keselamatan kerja Karyawan Bengkel Las Kecamatan Tanah Aye? Tujuan Penelitian ini adalah Untuk mengetahui Bagaimana Sistem Jaminan keselamatan kerja Karyawan Bengkel Las Kecamatan Tanah Jambo Aye. Dan untuk mengetahui bagaimana tinjauan Hukum Islam dan Undang-undang No.13 Tahun 2003 terhadap Sistem Jaminan keselamatan Karyawan Bengkel Las Kecamatan Tanah Aye?. Metode yang digunakan dalam penelitian ini adalah metode Kualitatif yang berbentuk deskriptif analisis. Hasil Penelitian Menunjukkan bahwa Bengkel Las Kecamatan Tanah Jambo Aye dalam Melaksanakan Jaminan Keselamatan Kerja kurang Maksimal dan belum berjalan dengan baik karena Bengkel Las Kecamatan Tanah Jambo Aye belum sempurna dalam menyediakan alat-alat pelindung diri untuk keselamatan kerja Seperti: alat pelindung tangan, masker, sepatu, topi pelindung, alat pelindung wajah. Dan Bentuk Risiko yang terjadi dalam melakukan pekerjaan atau kecelakaan kerja yang dapat mengakibatkan para pekerja cacat ataau luka-luka, semua itu tidak di tanggung penuh oleh Bengkel Las Kecamatan Tanah Jambo Aye. Hal ini kurang sesuai dengan konsep Islam, sebagaimana yang dimaksud dalam Maqashid Syari’ah dengan memelihara Al-umur al-dharuriyah yaitu memelihara jiwa, agama, akal, keturunan dan harta sehingga dapat terjamin keselamatan dunia dan akhirat. Kata Kunci: Bengkel Las, Keselamatan Kerja, Hukum Islam, Hukum Ketenagakerjaan.

2038. Antimicrobial Stewardship (AS) Recognition, Confidence, and Organizational Factors: Multi-center Survey of Bedside Nurses

Background There is no literature on practices nurses associated with AS processes and how patient safety culture influences nursing AS understanding and confidence. Methods This cross-sectional study used an investigator-developed survey with optional comments to describe how bedside nurses recognize and perceive their confidence performing nursing activities that support AS processes and the potential role of organization culture as an AS engagement factor. 9 hospitals ranging in size from 42 to 562 beds participated. Composite scores for practice, confidence, and safety were calculated and correlated. ANOVA with Tukey HSD post-hoc tests and non-parametric (Kruskal–Wallis) tests with Bonferroni adjusted P-values for multiple comparisons were used to evaluate differences by clinical unit and years of clinical experience. Results A total of 558 inpatient nurses participated (response rate 13%). A significant positive association was identified between nurses’ beliefs about nursing practices that contribute to the antibiotic stewardship process and their perceived confidence to perform rs = 0.454, P < 0.001. Nurses ≤5 years of experience were significantly less confident than those with >15 years of experience in: (a) assessing for a history of an adverse drug reaction (P = 0.049, P = 0.023), (b) reviewing preliminary microbiology results and comparing susceptibilities (P = 0.011, P < 0.001), and (c) notifying a provider of a wrong antibiotic dose (P = 0.011, P = 0.017). Medical/surgical nurses (P = 0.003 recognized that taking an allergy history contributes to the stewardship process significantly more than ICU respondents and were more confident, in assuring that cultures are obtained prior to antibiotic administration (P = 0.038). Free text comments indicated: organizational factors (n = 50), knowledge gap (n = 35) and poor communication (n = 11) impeded AS engagement. Conclusion This is the largest multi-site study on nursing stewardship practice that includes organizational culture as a factor influencing behavior to steward. The results identify interprofessional collaboration is needed to improve organizational factors so nurses can serve as powerful AS collaborators in this important patient safety effort. Disclosures All authors: No reported disclosures.

Drilling Like There’s No Tomorrow: Bankruptcy, Insurance, and Environmental Risk

This paper measures the effects of bankruptcy protection on industry structure and environmental outcomes in oil and gas extraction. Using administrative data from Texas, I exploit variation in an insurance requirement that reduced firms’ ability to avoid liability through bankruptcy. Among small firms, the policy substantially improved environmental outcomes and reduced production. Most production was reallocated to larger firms with better environmental records, but high-cost production where social cost may have exceeded social benefit decreased. These results suggest that incomplete internalization of environmental costs due to bankruptcy is an important determinant of industry structure and safety effort in hazardous industries. (JEL G22, G33, L25, L71, Q35, Q52)

Implementing process safety critical roles to reduce risk

In late 2014, Woodside commenced the implementation of the Energy Institute Process Safety Management (PSM) Framework to transform how process safety is managed in the organisation. The framework consists of four focus areas and 20 elements which formed a structure around which a cultural change to a ‘line led, risk based’ approach was made. The transformation focused on four key improvement opportunities: (i) consistent multi-disciplined risk assessments, (ii) efficient management of safety critical devices, (iii) better recognition of excursions beyond integrity limits and (iv) lift and formalise the capability of people to lead and deliver superior process safety performance. The first three focused on tools and methodologies – the PSM ‘system’. The capability workstream considered the people aspect of process safety, so that people understand and are able to execute their role in the overall process safety effort. This paper discusses the capability workstream in Woodside’s PSM Initiative, the ‘how’ of establishing process safety critical roles and implementing cultural change. It then discusses the demonstrable improvements and reduction in risk that were realised and measured, using lagging indicators (Tier 1 and 2 events) and a suite of leading indicators.