Elimination of Emergency Department Medication Errors Due To Estimated Weights

Greenwalt, Mary; Griffen, David; Wilkerson, Jim

doi:10.1136/bmjquality.u214416.w5476

Cited by 7 publications

(12 citation statements)

References 1 publication

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“…These factors, in turn, make it challenging to identify patients who may meet the criteria for malnutrition based upon weight loss. This project supports findings from previous studies indicating that collection of patient weights is a frequently omitted task or weight is collected and documented using subjective methods that may be prone to significant error 7,8. Instances where weight may not be documented include perceived barriers such as the standing scale not being readily accessible or implicit rationing of nursing care due to staff being too busy and deeming collection and documentation of weight as “not as important” as other tasks 9.…”

Section: Discussionsupporting

confidence: 80%

“…To eliminate use of estimated or stated weights, this center used multiple strategies to improve compliance. Implemented efforts included encouraging ED leadership to set an expectation for using actual weights, making scales more readily available to health care personnel, and, finally, eliminating the option of documenting an estimated weight in the EMR 7. These findings support results from the present project that clinician-estimated and patient-stated weights are frequently and inappropriately used and documented in the EMR.…”

Section: Discussionmentioning

confidence: 99%

“…Data showed patients were significantly better estimators of their own weight than both doctors and nurses. Weight was estimated within 10% of actual weight by 90.6% of the patients, 50.4% of the physicians, and 49.6% of nurses 7. The present project found that stated and clinician estimated weights were most likely to be documented in the surgical unit and the ICU.…”

Section: Discussionmentioning

confidence: 99%

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Documentation of Patient Weights by Clinical Care Staff in a Rural, Regional Medical Center

Ballew

Maroulakis

Moore

2023

Topics in Clinical Nutrition

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Weight loss over a specific time period is an important indicator for recognizing malnutrition in hospitalized patients. Documenting accurate weights in the electronic medical record is crucial to identify and treat malnutrition. The purpose of this project was to evaluate clinical care staff compliance with documenting patient weight. A medical record review was performed on 7 randomly selected days (n = 122) over a 5-week period. Documented weight and method of obtaining weight were recorded. Weight information was documented 91.2% of the time. Objective methods of obtaining patient weight were used 77.9% of the time, while subjective methods were used 13.9% of the time. Results support the need to educate the clinical care staff on the importance of documenting patient weights as an indicator of nutritional status in order to improve outcomes in malnourished and at-risk patients.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Documentation of Patient Weights by Clinical Care Staff in a Rural, Regional Medical Center

Ballew

Maroulakis

Moore

2023

Topics in Clinical Nutrition

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“…To date and to the best of the author’s knowledge, no studies have been directly carried out in this area. However due to the importance of body mass in giving the correct dosage of medication to patients in the medical environment (34), and the fact that in some cases, such as when a patient is in intensive care or unconscious in an emergency department, it is not possible to directly measure the body mass of the patient, it must be estimated by eye by medical practitioners (35). Studies have been carried out in the medical arena, and this allows us to have some estimation of how good individuals are at estimating body mass.…”

Section: Accuracy Of Body Mass (M)mentioning

confidence: 99%

The Contribution of Body Mass and Volume of Distribution to the Estimated Uncertainty Associated with the Widmark Equation

Maskell

Cooper

2020

Journal of Forensic Sciences

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The Widmark equation is used forensically for the determination of the amount of ethanol (alcohol) that may have been consumed and also to determine the blood alcohol concentration (BAC) of an individual at a specific time. It is important to be able to estimate the uncertainty associated with Widmark equations. To date, there has been no detailed determination of contribution to the final uncertainty of Widmark calculations of the volume of distribution of ethanol (Vd), using anthropometric equations, or the contribution of an individual’s body mass. Using published data, published literature, and freedom of information data, we determined that the variability (%CV) associated with Vd was ~10% (Watson et al. and Forrest anthropometric equations) and that the %CV associated with estimated body mass was ~15% compared to ~3% when body mass was directly measured. These data allow an estimation of the overall uncertainty of Widmark calculations using general error propagation. The estimated total uncertainty for BAC calculations increased from ~11% (volume consumed) and ~22% (BAC) to ~19% (volume consumed) and ~37% (BAC) when using measured body mass compared to estimated body mass. These results demonstrate that forensic practitioners should be mindful of the increase in estimated uncertainty in calculated Widmark equation results when estimated body mass is used rather than measured body mass. These data further improve the knowledge around the uncertainty of results calculated with the Widmark equation.

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“…Greenwalt et al [8] published a successful multi-modal strategy used to reduce the number of avoidable, weightbased dosing medication errors which occurred due to World J Emerg Med, Vol 9, No 3, 2018 inaccurate, documented, estimated patient weights in the ED. Interventions were aimed at increasing actual weights obtained at triage, implementing processes for effective service and preventive maintenance schedules for stretcher scales, increasing communication to staff about the impact of inaccurate estimated weights, and removing the estimated weight field from the ED electronic forms.…”

Section: Introductionmentioning

confidence: 99%

Enoxaparin dosing errors in the emergency department

Jellinek-Cohen

Husk

2018

World Journal of Emergency Medicine

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BACKGROUND:The study aimed to determine the frequency of enoxaparin dosing errors for patients who had a measured emergency department (ED) weight compared to those who did not have a measured ED weight, and to determine if demographic variables (e.g., weight, height, age, Englishspeaking, race) impact the likelihood of receiving an inappropriate dose.METHODS: This is a retrospective, electronic chart review of patients who received a dose of enoxaparin in the ED between January 1, 2008 and July 1, 2013. We identifi ed all patients >18 years who received a dose of enoxaparin while in the ED, were admitted, and had at least one inpatient weight within the fi rst four days of hospitalization. Patients were excluded if they received enoxaparin for prophylaxis or a dose of more than 1.25 mg/kg. RESULTS:A total of 1,944 patients were included. Patients were more likely to experience an error if they did not have a measured ED weight. Over-doses of >10 mg were more likely to occur in patients without a measured ED weight. Patients with no documented ED weight or with a staffestimated ED weight were more likely to experience a dosing error than those with a patient-stated weight. Patients were more likely to experience an error if their fi rst inpatient weight was more than 96 kg, they were more than 175-cm tall, or were English speaking.CONCLUSION: Dosing errors are more likely to occur when patients are not weighed in the ED. Modifications to current workflows to incorporate weighing those patients who receive weightdosed medications may be warranted.

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Elimination of Emergency Department Medication Errors Due To Estimated Weights

Cited by 7 publications

References 1 publication

Documentation of Patient Weights by Clinical Care Staff in a Rural, Regional Medical Center

Documentation of Patient Weights by Clinical Care Staff in a Rural, Regional Medical Center

The Contribution of Body Mass and Volume of Distribution to the Estimated Uncertainty Associated with the Widmark Equation

Enoxaparin dosing errors in the emergency department

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