Enhancing Safe Medication Use for Pediatric Patients in the Emergency Department

Greenall, Julie; Santora, Pauline; Koczmara, Christine; Hyland, Sylvia

doi:10.4212/cjhp.v62i2.445

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…35 Unsupervised inventory checks when replenishing unit inventory can open the door to intentional miscounts. 37,43 Reduced pharmacy oversight of dispensing with introduction of technology Implementation of ADCs 44 and computerized physician order entry can reduce awareness of drug use (eg, hydromorphone previously available only from pharmacy may become available in the emergency department's ADC 45 ).…”

Section: Forgerymentioning

confidence: 99%

Diversion of Controlled Drugs in Hospitals: A Scoping Review of Contributors and Safeguards

Fan

Tscheng²,

Hamilton³

et al. 2019

J Hosp Med

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T he United States (US) and Canada are the two highest per-capita consumers of opioids in the world; 1 both are struggling with unprecedented opioid-related mortality. 2,3 The nonmedical use of opioids is facilitated by diversion and defined as the transfer of drugs from lawful to unlawful channels of use 4,5 (eg, sharing legitimate prescriptions with family and friends 6). Opioids and other controlled drugs are also diverted from healthcare facilities; 4,5,7,8 Canadian data suggest these incidents may be increasing (controlled-drug loss reports have doubled each year since 2015 9). The diversion of controlled drugs from hospitals affects patients, healthcare workers (HCWs), hospitals, and the public. Patients suffer insufficient analgesia or anesthesia, experience substandard care from impaired HCWs, and are at risk of infections from compromised syringes. 4,10,11 HCWs that divert are at risk of overdose and death; they also face regulatory censure, criminal prosecution, and civil malpractice suits. 12,13 Hospitals bear the cost of diverted drugs, 14,15 internal investigations, 4 and follow-up care for affected patients, 4,13 and can be fined in

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Section: Forgerymentioning

confidence: 99%

Diversion of Controlled Drugs in Hospitals: A Scoping Review of Contributors and Safeguards

Fan

Tscheng²,

Hamilton³

et al. 2019

J Hosp Med

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show abstract

“…There is a lack of primary research describing how medications are lost or stolen from hospitals. Diversion literature largely consists of expert commentary and institutional experience,34–37 case reports,38–40 commentary on past incidents21 41 and audit reports 42–45. These methods are retrospective and limited in their ability to identify or adequately characterise the system vulnerabilities that enable diversion.…”

Section: Introductionmentioning

confidence: 99%

Clinical observations and a Healthcare Failure Mode and Effect Analysis to identify vulnerabilities in the security and accounting of medications in Ontario hospitals: a study protocol

Vries

Fan

Tscheng³

et al. 2019

BMJ Open

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IntroductionAn increasing number of opioids and other controlled substances are being stolen from healthcare facilities, diverting medications from their intended medical use to be used or sold illicitly. Many incidents of medication loss from Canadian hospitals are reported as unexplained losses. Together, this suggests not only that vulnerabilities for diversion exist within current medication-use processes (MUPs), but that hospitals lack robust mechanisms to accurately track and account for discrepancies and loss in inventory. There is a paucity of primary research investigating vulnerabilities in the security and accounting of medications across hospital processes. The purpose of this study is to map hospital MUPs, systematically identify risks for diversion or unintentional loss and proactively assess opportunities for improvements to medication accounting and security.Methods and analysisWe will conduct human factors-informed clinical observations and a Healthcare Failure Mode and Effect Analysis (HFMEA). We will observe hospital personnel in the intensive care unit, emergency department and inpatient pharmacy in two hospitals in Ontario, Canada. Observations will capture how participants complete tasks, as well as gather contextual information about the environment, technologies and processes. A multidisciplinary team will complete an HFMEA to map process flow diagrams for the MUPs in the observed clinical units, identify and prioritise potential methods of medication loss (failure modes) and describe mechanisms or actions to prevent, detect and trace medication loss.Ethics and disseminationWe received province-wide research ethics approval via Clinical Trials Ontario Streamlined Research Review System, and site-specific approvals from each participating hospital. The results from this study will be presented at conferences and meetings, as well as published in peer-reviewed journals. The findings will be shared with hospitals; professional, regulatory and accreditation organisations; patient safety and healthcare quality organisations and equipment and drug manufacturers.

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“…The adhesion is crucial for ensuring patient safety, treatment e cacy, and product quality. Poor adhesion can compromise drug delivery, increase patient costs, and pose safety hazards 4,33,34 . It is well known that intrinsic factors, including coat weight, viscosity of PSAs, excipients, backing membrane, size, shape, and adhesive type affect the adhesion properties of TDS products.…”

Section: Discussionmentioning

confidence: 99%

Development of Novel Skin Mimetic Substrate to Assess the Adhesion Properties of Transdermal Patches

Bagde,

Mosley-Kellum,

Salau

et al. 2024

Preprint

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The objective of the present study was to develop novel skin mimetic substrates using 3D Fused Deposition Modeling (FDM) printing using materials with similar surface energy as skin and evaluate the adhesion property of pressure-sensitive adhesives (PSAs). Additionally, the objective was to study the effect of various intrinsic factors, including coat weight, elastic properties of backing membranes, and viscosity of PSAs on adhesion properties of PSAs. Our novel 3D-printed polypropylene (PP) probe was successfully printed and postprocessed using FDM printing coupled with an automated robotic arm setup for adhesion testing. Probe tack test results showed no significant difference in peak adhesive force in case of skin and PP probes. However, PP probes showed about a 10.26-fold decrease (p < 0.0001) in the adhesive force compared to the SS probe. Probe tack and peel adhesion tests of the marketed Salonpas patch also showed a significant decrease (p < 0.0001) in the adhesive force in case of PP as compared to the SS probe/plate. Effect of coat weight using PP probe results revealed that both amine (PSA-4302) and non-amine (PSA-4501) compatible silicone PSAs showed significant (p < 0.05) increase in their adhesion prosperities at 10 mg/cm2 as compared to 5 mg/cm2 coating. Further, the choice of backing membrane and viscosity of silicone PSAs also showed a significant (p < 0.0001) effect on the PSA’s adhesion property. In conclusion, PP probes/plates could be a promising approach for in vitro adhesion testing of TDS products. Further, intrinsic properties, including coat weight and viscosity of silicone PSAs, significantly affected their adhesion properties.

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Enhancing Safe Medication Use for Pediatric Patients in the Emergency Department

Cited by 4 publications

References 9 publications

Diversion of Controlled Drugs in Hospitals: A Scoping Review of Contributors and Safeguards

Diversion of Controlled Drugs in Hospitals: A Scoping Review of Contributors and Safeguards

Clinical observations and a Healthcare Failure Mode and Effect Analysis to identify vulnerabilities in the security and accounting of medications in Ontario hospitals: a study protocol

Development of Novel Skin Mimetic Substrate to Assess the Adhesion Properties of Transdermal Patches

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