Barriers to Emergency Departments’ Adherence to Four Medication Safety–Related Joint Commission National Patient Safety Goals

Juarez, Altair; Gacki-Smith, Jessica; Bauer, Mary Rose; Jepsen, Dennis L.; Paparella, Susan; VonGoerres, Beverly; MacLean, Susan

doi:10.1016/s1553-7250(09)35008-4

Cited by 16 publications

(14 citation statements)

References 10 publications

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“…Similarly, the most common contributing factor to ME reports across our network was the failure of ED staff to comply with established procedures. Duplicate dosing, another major cause of wrong dose errors in our study, are predominantly due to communication problems in the ED environment 31 32. EDs are particularly prone to medication error from human factors, as the environment is highly complex and hectic 5 7 33.…”

Section: Discussionmentioning

confidence: 81%

Reported medication events in a paediatric emergency research network: sharing to improve patient safety

et al. 2012

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Section: Discussionmentioning

confidence: 81%

Reported medication events in a paediatric emergency research network: sharing to improve patient safety

et al. 2012

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“…An important part of patient safety is the issue of medication administration (MA) within the acute-care setting that has long been the focus of scrutiny and research because it contributes directly to patient morbidity and mortality (1,2) . Medication errors are a serious public health threat, causing patient injury, death and sharply increasing health care costs (3) . The medication administration process is an everyday part of nursing practice (2) , and is so much more than a simple psychomotor task (4) .…”

Section: Introductionmentioning

confidence: 99%

“…In reality, it reflects a complex interaction of a large number of specific decision and actions (8) . While medication administration errors (MAEs) are frequently associated with nursing actions, it is important to recognize that actual administration of a drug is the last step in a long and complicated process involving a number of different physicians, pharmacists, nurses, clerical and technical staff (3,9) . Preventing MAE represents a central focus of hospital's quality improvement and risk management initiatives.…”

Section: Introductionmentioning

confidence: 99%

“…Interception of medication errors occurs more commonly in the early stages of medication processing (prescription and preparation); whereas errors originating in later stages of the process (administration) have fewer system checks and are at a greater risk for remaining undetected. Because nurses administer most medications to patients in hospitals, medication errors can be directly affected by nursing care (14,16) .…”

Section: Introductionmentioning

confidence: 99%

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Nurses' Experiences toward Perception of Medication Administration Errors Reporting

Iosr¹,

Ibrahim²,

Youssif³

2013

IOSR-JNHS

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Wakefield et al. (1996) and was modified by the researchers. It contained 65 questions; 29 items regarding reasons why medication errors occur, 16 items regarding reasons why medication errors not reporting and 20 items regarding what percentage of each type of medication error actually reported on units which divided into 9 items for non intravenous and 11 items for intravenous medication administration errors. Results: This study suggested five categories for reasons of why MAEs occur and three categories for reasons of why MAEs not reporting. Nurses perceive low percentages of MAEs reporting. Emergency room was more likely to report medication administration errors than other units. Conclusion

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“…Suboptimal adherence has also been shown in other critical care fields, such as the intensive care unit [53,54] and the recovery room [55,56], but also on more general topics as hand hygiene [57] and medication safety [58]. It is possible that the wide variation in adherence is due to often poor evidence-based prehospital guidelines [59], to differences in guideline quality or due to justified deviations as guidelines have to be tailored to unique patients.…”

Section: Discussionmentioning

confidence: 99%

Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review

Ebben

Vloet

Verhofstad

et al. 2013

Scand J Trauma Resusc Emerg Med

106

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A gap between guidelines or protocols and clinical practice often exists, which may result in patients not receiving appropriate care. Therefore, the objectives of this systematic review were (1) to give an overview of professionals’ adherence to (inter)national guidelines and protocols in the emergency medical dispatch, prehospital and emergency department (ED) settings, and (2) to explore which factors influencing adherence were described in studies reporting on adherence. PubMed (including MEDLINE), CINAHL, EMBASE and the Cochrane database for systematic reviews were systematically searched. Reference lists of included studies were also searched for eligible studies. Identified articles were screened on title, abstract and year of publication (≥1990) and were included when reporting on adherence in the eligible settings. Following the initial selection, articles were screened full text and included if they concerned adherence to a (inter)national guideline or protocol, and if the time interval between data collection and publication date was <10 years. Finally, articles were assessed on reporting quality. Each step was undertaken by two independent researchers. Thirty-five articles met the criteria, none of these addressed the emergency medical dispatch setting or protocols. Median adherence ranged from 7.8-95% in the prehospital setting, and from 0-98% in the ED setting. In the prehospital setting, recommendations on monitoring came with higher median adherence percentages than treatment recommendations. For both settings, cardiology treatment recommendations came with relatively low median adherence percentages. Eight studies identified patient and organisational factors influencing adherence. The results showed that professionals’ adherence to (inter)national prehospital and emergency department guidelines shows a wide variation, while adherence in the emergency medical dispatch setting is not reported. As insight in influencing factors for adherence in the emergency care settings is minimal, future research should identify such factors to allow the development of strategies to improve adherence and thus improve quality of care.

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Barriers to Emergency Departments’ Adherence to Four Medication Safety–Related Joint Commission National Patient Safety Goals

Cited by 16 publications

References 10 publications

Reported medication events in a paediatric emergency research network: sharing to improve patient safety

Reported medication events in a paediatric emergency research network: sharing to improve patient safety

Nurses' Experiences toward Perception of Medication Administration Errors Reporting

Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review

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