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

Shaw, Kathy N.; Lillis, Kathleen; Ruddy, Richard M.; Mahajan, Prashant; Lichenstein, Richard; Olsen, Cody S.; Chamberlain, James M.

doi:10.1136/emermed-2012-201642

Cited by 57 publications

(59 citation statements)

References 26 publications

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“…In Shaw et al's study [19] investigating reporting of 597 medication errors in pediatric emergency rooms, the rate of near miss errors was the lowest (30%). In Sears, Pallas, Stevens, and Murphy's study, [20] of the 372 reported errors, 127 were potential errors in other words near miss errors.…”

Section: Discussionmentioning

confidence: 99%

Reporting of medication errors by pediatric nurses

Gök

Sarı²

2017

JNEP

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Background and objective: Children have a higher risk of being exposed to medication errors and are more prone to harm due to reasons such as differences in their growth and development, and their physiological and psychological characteristics which are different from those of adults. The purpose of this study is to determine pediatric nurses' attitudes towards reporting of medication errors and causes of not reporting of medication errors and to determine their views on the incidence of medication errors. Methods: The study was conducted in a Children's Hospital in the province of Izmir, with the participation of 179 pediatric nurses. To collect the data, two forms were used in the study, socio-demographic questionnaire and Questionnaire for Medication Errors. Results: While 34.6% (n = 62) of the nurses thought that medication errors never happened in the clinics over the past year. While 94.4% (n = 169) of the participating nurses did not report any medication errors within the past year, 5.6% reported 1-2 times. The highest proportion (75.4%) (n = 135) of the nurses, the reason for not reporting medication errors was the fear of receiving legal punishment. Conclusions: Reporting medication errors is low level. In conclusion, the main reason for not reporting medication errors was the perception of receiving punishment. Implications for nursing and/or health policy: Education to nurses should be given at regular intervals and in small groups by using case samples. If the managers are to promote reporting, they should eliminate the perception of receiving punishment, and make necessary arrangements to develop non-accusatory culture aiming to learn from the results of reported errors.

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Section: Discussionmentioning

confidence: 99%

Reporting of medication errors by pediatric nurses

Gök

Sarı²

2017

JNEP

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Section: Web Of Science 2016 Canadá Journal Of Evaluation In Clinicalunclassified

“…A maioria das pesquisas sobre o tema proposto foi realizada no exterior, com destaque para Estados Unidos da América (11)(12)(13)(14)(15)17,(22)(23)25,(27)(28)(29)(30)(31)33) . Com relação ao ano de publicação, há predomínio a partir do ano de 2011 (9,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(31)(32)(33)(34)(35) . Unidades pediátricas gerais aparecem como maior foco dos estudos (66,6%), entre elas, unidades de internação clínica e unidades cirúrgicas (9,(11)(12)(13)(17)(18)(19)(20)(21)(22)(23)25,(27)(28)(29)(31)…”

Section: Web Of Science 2016 Canadá Journal Of Evaluation In Clinicalunclassified

“…O sistema de notificação espontânea de eventos adversos de medicação revela-se como uma estratégia de prevenção nos estudos analisados (9,(11)(12)15,28) . Pesquisa realizada nos EUA, durante cinco anos, concluiu que analisar relatórios de erros de medicação é uma forma de encorajar que outros possam aprender com os erros, evitando a repetição desses no futuro (12) .…”

Section: Discussão Estratégias Para Prevenção De Erros De Medicaçãounclassified

“…Reported medication events in a pediatric emergency research network: sharing to improve patient safety (15) (18) Sears K, O`Brien-Pallas L, Stevens B, Murphy GT.…”

Section: Etapas Do Processo: Não Informadomentioning

confidence: 99%

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Erros De Medicação Em Pediatria E Estratégias De Prevenção: Revisão Integrativa

et al. 2017

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RESUMO: Trata-se de revisão integrativa com o objetivo de analisar as estratégias, os incidentes de segurança e a etapa do processo medicamentoso para prevenção de eventos adversos na pediatria. Realizou-se a coleta entre novembro/2015 e fevereiro/2017, nas bases: Literatura Latino-Americana em Ciências de Saúde, Cumulative Index of Nursing and Allied Health Literature, U.S. National Library of Medicine e Web of Science. Utilizaram-se os descritores: erros de medicação, segurança do paciente e criança. Foram selecionados 27 artigos, publicados entre 2004 e 2016. A etapa do processo medicamentoso mais pesquisada foi a prescrição médica. As taxas de incidentes de segurança variaram entre 0,91% e 54%, não sendo identificada padronização metodológica nos estudos. As estratégias de prevenção relatadas foram: uso da prescrição médica eletrônica, simulação clínica, protocolo de doses, e notificações de incidentes. É importante que a identificação de riscos e o planejamento das estratégias de prevenção subsidiem a análise global do processo medicamentoso. DESCRITORES: Segurança do paciente; Erros de medicação; Criança; Enfermagem. ERROS DE MEDICAÇÃO EM PEDIATRIA E ESTRATÉGIAS DE PREVENÇÃO ERRORES DE MEDICACIÓN EN PEDIATRÍA Y ESTRATEGIAS DE PREVENCIÓN: REVISIÓN INTEGRATIVARESUMEN: Esta es un revisión integrativa cuya finalidad fue analizar las estrategias, los incidentes de seguridad y la etapa del proceso medicamentoso para prevención de eventos adversos en la pediatría. Los datos fueron obtenidos entre noviembre/2015 y febrero/2017, en las bases: Literatura Latinoamericana en Ciencias de Salud, Cumulative Index of Nursingand Allied Health Literature, U.S. National Library of Medicine y Web of Science. Fueron utilizados los descriptores: errores de medicación, seguridad del paciente y niño. Se eligieron 27 artículos publicados entre 2004 y 2016. La etapa del proceso medicamentoso más investigada fue la prescripción médica. Las tajas de incidentes de seguridad variaron entre 0,91% y 54%, no siendo identificada estandarización metodológica en los estudios. Las estrategias de prevención relatadas fueron: uso de la prescripción médica electrónica, simulación clínica, protocolo de dosis, y notificaciones de incidentes. Es importante que la identificación de riesgos y el planeamiento de las estrategias de prevención subsidien el análisis global del proceso medicamentoso. DESCRIPTORES: Seguridad del paciente; Errores de medicación; Niño; Enfermería.

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Ethics of Research in Pediatric Emergency Medicine

et al. 2014

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Clinical research in the pediatric emergency department (ED) has been rapidly growing in the past decade, and has resulted in some of the most important milestone studies in the pediatric medical literature. However, it presents a unique ethical goal and requires that additional challenges, such as the acute medical condition, fear and anxiety, unfamiliar physician(s), fatigue, and lack of time be addressed in addition to the standard ethical requirements. These may impair several fundamental elements of research, including the patient enrollment process, informed consent/assent, randomization, and others. Every possible attempt must be made to reduce or minimize the risks to which the children are exposed, and one must be cognizant of the special needs of children and their families in the ED. Nevertheless, we are also obliged to find ethical ways to include them in appropriate research endeavors that aim to improve treatments for conditions unique to the ED. This paper explores and overviews the most recent literature in order to characterize the nature of ethical challenges complicating clinical research in pediatric emergency medicine, and then suggests some ethically sound solutions such as deferred/waived consent, designated research staff, and alternative study designs. Finally, a few examples of prospective, blinded randomized trials involving drugs in pediatric emergency medicine are provided, with special emphasis on how the investigators are overcoming the obvious ethical challenges.

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

Abstract: ME reporting by the system revealed valuable data across sites on medication categories and potential human factors. Harm was infrequently reported. Our analyses identify trends and latent systems issues, suggesting areas for future interventions to reduce paediatric ED medication errors.

Cited by 57 publications

References 26 publications

Reporting of medication errors by pediatric nurses

Reporting of medication errors by pediatric nurses

Erros De Medicação Em Pediatria E Estratégias De Prevenção: Revisão Integrativa

Ethics of Research in Pediatric Emergency Medicine

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