National Study on the Frequency, Types, Causes, and Consequences of Voluntarily Reported Emergency Department Medication Errors

Pham, Julius Cuong; Story, J.; Hicks, Rodney W.; Shore, Andrew D.; Morlock, Laura L.; Cheung, Dickson; Kelen, Gabor D.; Pronovost, Peter J.

doi:10.1016/j.jemermed.2008.02.059

Cited by 142 publications

(150 citation statements)

References 27 publications

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Section: Discussionsupporting

confidence: 86%

“…2,5,13 Errors in dosing were the most common type, consistent with previous studies involving children in other acute care settings. [3][4][5][6]8,11,13 These studies attributed dosing errors in children to the chaotic environment in EDs and the lack of sufficient provider training and knowledge in calculating medication doses for children. [3][4][5][6]8,11,13 Our finding of lower physician-related ED medication errors among patients who received telemedicine consultations could be attributed to the specialized training and higher level of experience among the consulting physicians in treating children, which is consistent with other studies evaluating the impact of physician training and experience on patient outcomes.…”

Section: Discussionsupporting

confidence: 86%

“…[3][4][5][6]8,11,13 These studies attributed dosing errors in children to the chaotic environment in EDs and the lack of sufficient provider training and knowledge in calculating medication doses for children. [3][4][5][6]8,11,13 Our finding of lower physician-related ED medication errors among patients who received telemedicine consultations could be attributed to the specialized training and higher level of experience among the consulting physicians in treating children, which is consistent with other studies evaluating the impact of physician training and experience on patient outcomes. 8,15,[30][31][32][33] Kozer et al, 8 who examined medication errors experienced by children in an ED, found that trainees who do not have sufficient experience in treating children are more likely to commit prescribing errors than attending physicians.…”

Section: Discussionmentioning

confidence: 99%

“…1 Patients receiving treatment in emergency departments (EDs) are at particularly high risk for experiencing medication errors due to the acute nature of the presenting illness, the importance of timely administration of therapies, [2][3][4][5][6] the chaotic environment, and the lack of oversight to verify medication orders and administration. 7,8 Particularly among children, the risk of medication errors is magnified because of weight-based drug dosing and limited experience among many health care professionals in pediatric prescribing and pharmacotherapy.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

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Telemedicine Consultations and Medication Errors in Rural Emergency Departments

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Medication errors occur frequently among pediatric patients, particularly those treated in rural emergency departments (EDs). Although telemedicine has been proposed as a potential solution, there are few data supporting its clinical effectiveness and its effect on medication errors. WHAT THIS STUDY ADDS:The use of telemedicine to provide pediatric critical care consultations to rural EDs is associated with less frequent physician-related ED medication errors among seriously ill and injured children. Therefore, this model of care may improve patient safety in rural hospital EDs. abstract OBJECTIVE: To compare the frequency of physician-related medication errors among seriously ill and injured children receiving telemedicine consultations, similar children receiving telephone consultations, and similar children receiving no consultations in rural emergency departments (EDs). METHODS:We conducted retrospective chart reviews on seriously ill and injured children presenting to 8 rural EDs with access to pediatric critical care physicians from an academic children' s hospital. Physician-related ED medication errors were independently identified by 2 pediatric pharmacists by using a previously published instrument. The unit of analysis was medication administered. The association of telemedicine consultations with ED medication errors was modeled by using hierarchical logistic regression adjusting for covariates (age, risk of admission, year of consultation, and hospital) and clustering at the patient level. RESULTS:Among the 234 patients in the study, 73 received telemedicine consultations, 85 received telephone consultations, and 76 received no specialist consultations. Medications for patients who received telemedicine consultations had significantly fewer physician-related errors than medications for patients who received telephone consultations or no consultations (3.4% vs 10.8% and 12.5%, respectively; P , .05). In hierarchical logistic regression analysis, medications for patients who received telemedicine consultations had a lower odds of physician-related errors than medications for patients who received telephone consultations (odds ratio: 0.19, P , .05) or no consultations (odds ratio: 0.13, P , .05).CONCLUSIONS: Pediatric critical care telemedicine consultations were associated with a significantly reduced risk of physician-related ED medication errors among seriously ill and injured children in rural EDs.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: (Continued On Last Page)mentioning

confidence: 99%

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Telemedicine Consultations and Medication Errors in Rural Emergency Departments

et al. 2013

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“…[5] Also according to the performed estimations, 3% of all hospital errors are related World J Emerg Med, Vol 7, No 2, 2016 Taleghani et al to the emergency ward. [6] As well as traumatic events in about 10% of patients with surgery that is more common in the emergency section. [7] The results from the New Zealand study indicated that 3.4% of deaths were related to medical mistakes which are preventable.…”

Section: Introductionmentioning

confidence: 99%

Risk assessment of the emergency processes: Healthcare failure mode and effect analysis

Taleghani¹,

Rezaei²,

Sheikhbardsiri

2016

World Journal of Emergency Medicine

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BACKGROUND: Ensuring about the patient's safety is the fi rst vital step in improving the quality of care and the emergency ward is known as a high-risk area in treatment health care. The present study was conducted to evaluate the selected risk processes of emergency surgery department of a treatment-educational Qaem center in Mashhad by using analysis method of the conditions and failure effects in health care. METHODS:In this study, in combination (qualitative action research and quantitative crosssectional), failure modes and effects of 5 high-risk procedures of the emergency surgery department were identified and analyzed according to Healthcare Failure Mode and Effects Analysis (HFMEA). To classify the failure modes from the "nursing errors in clinical management model (NECM)", the classification of the effective causes of error from "Eindhoven model" and determination of the strategies to improve from the "theory of solving problem by an inventive method" were used. To analyze the quantitative data of descriptive statistics (total points) and to analyze the qualitative data, content analysis and agreement of comments of the members were used. RESULTS:In 5 selected processes by "voting method using rating", 23 steps, 61 sub-processes and 217 potential failure modes were identifi ed by HFMEA. 25 (11.5%) failure modes as the high risk errors were detected and transferred to the decision tree. The most and the least failure modes were placed in the categories of care errors (54.7%) and knowledge and skill (9.5%), respectively. Also, 29.4% of preventive measures were in the category of human resource management strategy.CONCLUSION: "Revision and re-engineering of processes", "continuous monitoring of the works", "preparation and revision of operating procedures and policies", "developing the criteria for evaluating the performance of the personnel", "designing a suitable educational content for needs of employee", "training patients", "reducing the workload and power shortage", "improving team communication" and "preventive management of equipment's" were on the agenda as the guidelines.

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Effect of Systematic Physician Cross-checking on Reducing Adverse Events in the Emergency Department

et al. 2018

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IMPORTANCE Emergency departments (ED) are environments that are at high risk for medical errors. Previous studies suggested that the proportion of medical errors may decrease when more than 1 physician is involved.OBJECTIVE To reduce the proportion of medical errors by implementing systematic cross-checking between emergency physicians. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized crossover trial includes a random sample of 14 adult patients (age Ն18 years) per day during two 10-day period in 6 EDs (n = 1680 patients) in France.INTERVENTIONS Systematic cross-checking between emergency physicians, 3 times a day, which included a brief presentation of one physician's case to another, followed by the second physician's feedback to the first. MAIN OUTCOMES AND MEASURESMedical error in the ED, defined as an adverse event (either a near miss or a serious adverse event). The primary end point was identified using a 2-level error detection surveillance system, blinded to the strategy allocation. RESULTS Among the 1680 included patients (mean [SD] age, 57.5 [21.7] years), 144 (8.6%) had an adverse event. There were 54 adverse events among 840 patients (6.4%) in the cross-check group compared with 90 adverse events among 840 patients (10.7%) in the standard care group (relative risk reduction [RRR], 40% [95% CI, 12% to 59%]; absolute risk reduction [ARR], 4.3%; number needed to treat [NNT], 24). There was also a significant reduction rate of near misses (RRR, 47% [95% CI, 15% to 67%]; ARR, 2.7%; NNT, 37) but not of the rate of preventable serious adverse events (RRR, 29% [95% CI, −18% to 57%]; ARR, 1.2%; NNT, 83). CONCLUSIONS AND RELEVANCEThe implementation of systematic cross-checking between emergency physicians was associated with a significant reduction in adverse events, mainly driven by a reduction in near misses.

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National Study on the Frequency, Types, Causes, and Consequences of Voluntarily Reported Emergency Department Medication Errors

Cited by 142 publications

References 27 publications

Telemedicine Consultations and Medication Errors in Rural Emergency Departments

Telemedicine Consultations and Medication Errors in Rural Emergency Departments

Risk assessment of the emergency processes: Healthcare failure mode and effect analysis

Effect of Systematic Physician Cross-checking on Reducing Adverse Events in the Emergency Department

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