Frequency, Timing, and Types of Medication Ordering Errors Made by Residents in the Electronic Medical Records Era

Garber, Ari; Nowacki, Amy S.; Chaitoff, Alexander; Brateanu, Andrei; Colbert, Colleen Y.; Bauer, Seth; Arora, Zubin; Mehdi, Ali; Lam, Simon W.; Spencer, Abby L.; Rothberg, Michael B.

doi:10.14423/smj.0000000000000923

Cited by 13 publications

(18 citation statements)

References 46 publications

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“…Thus, our first practical recommendation is to implement more dialogical and reflective approaches in residency training instead of relying solely on observation and feedback. Previous research has shown that less than optima practices take place while residents are training; [27][28][29] our study complements prior knowledge in this area and adds to understanding what kinds of omissions residents make. In our study, residents were criticized because they did not adequately perform some of the basic tasks of the visit, such as not eliciting sufficient information from a suicidal patient, not diagnosing the reason for a patient's fracture not healing, or at times not giving the right advice.…”

Section: )supporting

confidence: 56%

Explicating Practice Norms and Tensions Between Values in Resident Training in Family Medicine

Achkar¹

2019

Preprint

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Purpose Residency programs have the intricate and complex role of training health care providers. But little is known about what residents and attendings consider norms of practice or the tensions among different values residents are expected to uphold. Thus, dialogical and reflective frameworks are being explored for resident learning. Methods This study examined the use of facilitated conversations with groups of residents and attending physicians while reviewing video-recorded resident–patient interactions. The conversations were recorded, transcribed, and qualitatively analyzed.Results A total of 24 residents and 10 attendings participated in conversations while separately and in parallel groups reviewing 15 resident sessions. Residents explicated the norms of practice and evaluated their performance, which often agreed with those of attending physicians in calling out important learning opportunities. When disagreement occurred, residents’ explications of their reasoning were often relevant and, via reflection and dialogue, helped clarify intentions that were not apparent in the videos. Residents and attendings both often judged actions on more than one domain of value. For instance, if a resident addressed problems, built relationships in a timely manner, and acted autonomously without jeopardizing the quality of care, she satisfactorily performed her duty. Conclusions Practice norms and value struggles were addressed by participants during reviews, which provided a promising framework for learning and assessment. Also, the non-hierarchical structure opened space to acknowledge a diversity of positions and for tensions among values to be explicated.

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Section: )supporting

confidence: 56%

Explicating Practice Norms and Tensions Between Values in Resident Training in Family Medicine

Achkar¹

2019

Preprint

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“…28,29 Previous research has shown that less than errors occur while residents are training. [30][31][32] My study contributes to the understanding of the kinds of omissions residents make. Residents were criticized because they did not adequately perform some of the basic tasks of the visit, such as eliciting su cient information from a suicidal patient, diagnosing the reason for a patient's fracture not healing, or at times not giving the right advice.…”

Section: Discussionmentioning

confidence: 97%

Explicating Practice Norms and Tensions Between Values in Resident Training in Family Medicine

Achkar

2020

Preprint

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Background. Residency programs have the intricate and complex role of training health care providers. But little is known about what residents and attendings consider norms of practice or the tensions among different values residents are expected to uphold. Thus, dialogical and reflective frameworks are being explored for resident learning.Methods. This study examined the use of facilitated conversations with groups of residents and attending physicians while reviewing video-recorded resident–patient interactions. The conversations were recorded, transcribed, and qualitatively analyzed.Results. A total of 24 residents and 10 attendings participated in conversations while separately and in parallel groups reviewing 15 resident sessions. Residents explicated the norms of practice and evaluated their performance, which often agreed with those of attending physicians in calling out important learning opportunities. When disagreement occurred, residents’ explications of their reasoning were often relevant and, via reflection and dialogue, helped clarify intentions that were not apparent in the videos. Residents and attendings often judged actions on more than one domain of value. For instance, if a resident addressed problems, built relationships in a timely manner, and acted autonomously without jeopardizing the quality of care, she satisfactorily performed her duty.Conclusions. Practice norms and value struggles were addressed by participants during reviews, which provided a promising framework for learning and assessment. Also, the non-hierarchical structure opened space to acknowledge a diversity of positions and for tensions among values to be explicated.

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“…Another study showed that renal dose adjustments were appropriately implemented in about (43%) of the prescribed medications that need renal dose adjustments according to Cockcroft‐Gault equation, and (60%) according to MDRD formula 6,26 . Moreover, a study was conducted at a Case Western Reserve University, College of Medicine, reorted that 1 772 462 orders of medications placed by 335 residents, and showed renal dose adjustments/monitoring was the most common error (40%) 27 …”

Section: Discussionmentioning

confidence: 99%

Antibiotic dosing adjustments in patients with declined kidney function at a tertiary hospital in Jordan

Jarab

Mukattash

et al. 2020

Int. J. Clin. Pract.

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Background Estimating kidney function is essential to consider in drug dosing for renally eliminated drugs. It has been estimated that more than half of medications’ adverse effects are caused by the inappropriate dosing. Limited data are available on drug dosing adjustment, particularly the antibiotics, among Jordanian patients with declined kidney function. Aim The aim of this study was to evaluate the extent of antibiotics’ dose adjustment according to the recent guidelines of drugs’ renal dose adjustment. Method The present study utilised data from a previous retrospective study, which recruited inpatients who were clinically stable and received IV antibiotics for more than 24 hours at King Abdullah University Hospital. Sociodemographic and clinical data were collected by referring to information technology departments at KAUH. The percentage of antibiotics which were inappropriately adjusted based on creatinine clearance was evaluated using Lexicomp‐Clinical Drug information website. Results A total of 110 antibiotics were dispensed for 80 patients. Results showed that (36.25%) of patients were given antibiotics without renal dose adjustments based on their creatinine clearance. Urinary tract infections followed by respiratory tract infections were the most common among the study participants. The most commonly prescribed antibiotic was Imipenem/cilastatin (41.25%). Among antibiotics prescribed without renal dose adjustment, Imipenem/cilastatin was the most common and represented 62% of the cases while vancomycin was the least and represented only 3.45% of the non‐renally adjusted doses. Conclusions The current study clearly demonstrates the lack of adherence to recent guidelines of renal dose adjustment for renally excreted antibiotics. Such findings shed the light on the necessity of considering antibiotics dose adjustment in patients with declined kidney function with the aim of ensuring medication safety and improve health outcomes.

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Frequency, Timing, and Types of Medication Ordering Errors Made by Residents in the Electronic Medical Records Era

Cited by 13 publications

References 46 publications

Explicating Practice Norms and Tensions Between Values in Resident Training in Family Medicine

Explicating Practice Norms and Tensions Between Values in Resident Training in Family Medicine

Explicating Practice Norms and Tensions Between Values in Resident Training in Family Medicine

Antibiotic dosing adjustments in patients with declined kidney function at a tertiary hospital in Jordan

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