A call to action for optimizing the electronic health record in the parenteral nutrition workflow

Vanek, Vincent W.; Ayers, Phil; Kraft, Michael D.; Bouche, Jean M.; Do, Van; Durham, Charles W.; Guenter, Peggi; Hoggle, Lindsey; Kent, Sue; Lin, Emily T.; Molinar, L. Steven; Plogsted, Steven; Poehls, Jessica M.; Turner, Peggy; Way, Charles Van

doi:10.2146/ajhp180276

Cited by 9 publications

(1 citation statement)

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“…This corresponded to the high needs (92.0%) for decision support about HAMs in our results. In 2018, the American Society for Parenteral and Enteral Nutrition recommended providing clinical decision support to healthcare professionals at the time of parenteral nutrition prescription, order verification, compounding, and administration to avoid possible adverse consequences ( Vanek et al, 2018 ). In a qualitative study about HAM administration, Sessions et al (2019) found that current HAM safety strategies were not consistently used and recommended that education on safe HAM practices, technology enhancement, and organizational culture updates should be carried out to prevent HAM errors.…”

Section: Discussionmentioning

confidence: 99%

Call for Decision Support for High-Alert Medication Administration Among Pediatric Nurses: Findings From a Large, Multicenter, Cross-Sectional Survey in China

Huang²,

Lü³

et al. 2022

Front. Pharmacol.

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Background: Children have a higher risk of medication errors (MEs) than adults. The Institute for Safe Medication Practice (ISMP) defined high-alert medications (HAMs) as a group of medications that could cause significant patient harm or even death when they are used in error. Nurses are actively involved in and responsible for patient care, especially in medication administration. This study aimed to estimate the knowledge, decision-making basis and confidence and decision support needs related to HAMs among pediatric nurses in China.Methods: A web-based, cross-sectional survey was conducted among pediatric nurses who were recruited from 14 member hospitals of the Pediatric Nursing Alliance of National Children’s Medical Center in China using a convenient sampling technique. Data were collected using a self-administered instrument composed of four parts: the demographic characteristics of participants, participants’ knowledge about HAMs, participants’ self-evaluation of the basis of and confidence in decision-making, and decision support needs regarding HAMs. Among the participants, the maximum score for HAM knowledge was 100. All data were entered and analyzed using SPSS 20.0.Results: A total of 966 nurses participated in this study. Nurses were found to have insufficient knowledge about HAMs, with a median (IQR) of 75.0 (70.0, 80.0), out of a maximum score of 100. Knowledge about HAM administration was significantly higher than that about HAM regulation, with a p value < 0.001. The three lowest-scoring items concerned HAM regulation, and the “Treat fentanyl skin patches as a regulated narcotic” item obtained the lowest score, with only 1/5 of respondents answering it correctly. Most participants reported that their basis for decision-making about HAMs was drug instructions (90.0%) or drug handbooks (81.9%) and evaluated their confidence in decision-making about HAMs as high or relatively high (84.6%). The decision-making difficulties when encountering HAMs focused on most stages of HAM administration, especially the appropriateness of prescriptions, checks, preparation and administration. The vast majority of participants assessed decision support as necessary or very necessary (92.0%), and the most popular options for decision support were computerized clinical decision support systems (46.4%) and real-time online communication with pharmacists (23.9%).Conclusion: Our study demonstrated the inadequacies in HAM knowledge, the basis and difficulty of decision-making, and decision support needs regarding HAMs in Chinese pediatric nurses. Nurses need greater support in HAM administration, including not only training but also adequate technology, mutually beneficial interprofessional collaboration, and a positive institutional culture.

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Section: Discussionmentioning

confidence: 99%

Call for Decision Support for High-Alert Medication Administration Among Pediatric Nurses: Findings From a Large, Multicenter, Cross-Sectional Survey in China

Huang²,

Lü³

et al. 2022

Front. Pharmacol.

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The Drug Shortage Era: A Scoping Review of the Literature 2001–2019

Tucker

Cao

Fox

et al. 2020

Clin Pharma and Therapeutics

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Drug shortages continue at crisis levels in the United States, with no end in sight. Extensive research in disparate areas has been conducted to explore the impact that shortages have on patients and the healthcare system. We conducted a scoping review to categorize existing work in order to identify opportunities for further research. We considered peer‐reviewed and non‐peer‐reviewed articles involving non‐vaccine, human drug shortages in the United States published in English between January 2001 and May 2019. In total, 430 papers were charted according to the following categories: causes, impacts on care, health outcomes, costs, management, prevention, and federal government response. Of these, 112 papers considered causes; 199 discussed effects, 158 considered management strategies, and 140 discussed prevention. We provide a resource to navigate the vast literature on drug shortages in the United States, identifying areas in need of further research. This review highlights the widespread negative effects that drug shortages have on patients, providers, and health system costs in the United States. Evidence of their ramifications should be sufficient to justify policy change. Future work should move from characterizing the problem to working toward solutions to reduce the impact, occurrence, and effects of shortages.

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