The use of a contextual, modal and psychological classification of medication errors in the emergency department: a retrospective descriptive study

Cabilan, C.J.; Hughes, James Alexander; Shannon, Carl

doi:10.1111/jocn.13760

Cited by 30 publications

(49 citation statements)

References 52 publications

(84 reference statements)

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“…Working conditions that include interruptions and distractions have been identified as factors contributing to HAM errors (Engles & Ciarkowski, ) and medication errors in general (Blignaut, Coetzee, Klopper, & Ellis, ; Brady, Malone, & Fleming, ; Cabilan et al, ; Johnson et al, ; Keers et al, ; Kosits & Jones, ; Raban & Westbrook, ; Thomas et al, ; Trbovich, Prakash, Stewart, Trip, & Savage, 2). As in our study, others have described the potential of bar‐code scanning to reduce HAM errors but identified frequent nurse workarounds (failure to scan the armband or drug), demonstrating a need to continuously assess and improve processes to support effective use of these technologies (Hawkins et al, ; Miller et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Nurse competence in terms of overall medication knowledge and dosage calculation is robustly represented in the literature. (Brady et al, ; Cabilan et al, ; Johnson et al, ; Keers et al, ; Wimpenny & Kirkpatrick, ). Clinical judgement in any medication administration warrants further research (Rohde & Domm, ).…”

Section: Discussionmentioning

confidence: 99%

“…Although harm can occur even when a HAM is used correctly, the risks increase when associated with a medication error (Institute for Safe Medication Practices, ). HAMs appear in 14–50% of medication error incidents in acute care settings, 11–29% of which occur during the administration process (Cabilan, Hughes, & Shannon, ; Engles & Ciarkowski, ; Manias et al, ). In the US, the National Action Plan for Adverse Drug Event Prevention (ADE Action Plan) was developed to stem adverse HAM drug events causing patient harm (U.S. Department of Health and Human Services & Office of Disease Prevention and Health Promotion, , p. 1).…”

Section: Introductionmentioning

confidence: 99%

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Nurses’ perceptions of high‐alert medication administration safety: A qualitative descriptive study

Sessions

Nemeth

Catchpole

et al. 2019

Journal of Advanced Nursing

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Aims The aim of this study was to determine nurses’ perceptions of supports and barriers to high‐alert medication (HAM) administration safety. Design A qualitative descriptive design was used. Methods Eighteen acute care nurses were interviewed about HAM administration practices. Registered nurses (RNs) working with acutely ill adults in two hospitals participated in one‐on‐one interviews from July–September, 2017. Content analysis was conducted for data analysis. Results Three themes contributed to HAM administration safety: Organizational Culture of Safety, Collaboration, and RN Competence and Engagement. Error factors included distractions, workload and acuity. Work arounds bypassing bar code scanning and independent double check procedures were common. Findings highlighted the importance of intra‐ and interprofessional collaboration, nurse engagement and incorporating the patient in HAM safety. Conclusions Current HAM safety strategies are not consistently used. An organizational culture that supports collaboration, education on safe HAM practices, pragmatic HAM policies and enhanced technology are recommended to prevent HAM errors. Impact Hospitals incorporating these findings could reduce HAM errors. Research on nurse engagement, intra‐ and interprofessional collaboration and inclusion of patients in HAM safety strategies is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nurses’ perceptions of high‐alert medication administration safety: A qualitative descriptive study

Sessions

Nemeth

Catchpole

et al. 2019

Journal of Advanced Nursing

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“…Shams [22] mentions that human factors, such as de cits of knowledge, skills, attitudes, protocol adherence and audits, are some of the most common reasons for medication administration errors. [4,23,24] Managers thus highlighted education and training as a crucial intervention to address medication safety issues. [25] This training should include high-quality pharmacological training, and in the clinical setting should preferably be conducted by clinical accompanists, so that there is no further increase in nurses' workload.…”

Section: Discussionmentioning

confidence: 99%

Nurses’ Perceptions of Medication Administration Safety in Public Hospitals in the Gauteng Province: A Mixed Method Study

Aj¹,

Sk²,

Sm³

et al. 2020

Preprint

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Background: This study was carried out to determine factors perceived to impact on medication administration errors and possible solutions to such errors in medical and surgical units of public hospitals in Gauteng Province, South Africa. More data on this challenge to patient health are needed from low- and middle-income countries like South Africa.Methods: A mixed-methods research design with a sequential approach was used. Data were gathered among 683 (n=280) medication administrators using self-report surveys, and 16 (n=15) nursing unit managers using semi-structured individual interviews.Results: Causes of medication error related to communication, human, environmental and medication factors were considered to have a moderate risk. Workload (M=3.39; SD 0.91), stock problems (M=3.18; SD 0.96) and illegible prescriptions (M=3.05; SD 1.09) pose the greatest threats to medication administration safety. Most participants (n=184; 71.1%) agreed that medication errors never or rarely occurred in their units. The majority of respondents graded overall patient safety as excellent or very good (n=161; 61.5%). With regard to safety culture, nurses felt that they are actively attempting to improve medication safety (n=239; 90.5%), that people support one another in the unit (n=216; 80%), and that their procedures and systems are good at preventing errors (n=210; 80.2%). Participants felt that medication administration errors were rarely reported, and the most apparent reason for not reporting medication administration errors was fear and administrative response. Safety culture items were correlated with medication error incidence, grade of overall patient safety and reasons for non-reporting. Qualitative findings supported the quantitative data, adding knowledge, skill and attitude of staff as further threats to medication administration safety. Adherence to protocols, auditing, education and training, collaboration and support, communication, awareness of changes, resource management and time management were identified as possible solutions to medication administration errors.Conclusions: Solutions aimed at mitigating medication errors should be based on causes identified within a specific context. In the Gauteng Province of South Africa, multidisciplinary collaboration and communication; support of nurses by the hospital administration; hospital systems, procedures and initiatives; better resource management and improved pharmacological training could be seen as the foundation for improved medication administration safety.

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“…The Emergency Department (ED) is a hospital setting that poses many patient safety challenges, including highly unpredictable conditions and frequent use of high-risk medications (1). These conditions increase the risk of medication errors (2). Medication management has been evidenced as a strategy to address patient safety challenges related to the medication errors (3).…”

mentioning

confidence: 99%

The Role of Participatory Action Research on Clinicians’ Attitudes toward Medication Management

Bakhshi

Mitchell

Nasrabadi

et al. 2020

Preprint

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Background: Medication management is a cyclic and multidisciplinary approach to enhance safe medication therapy. This paper explores clinician attitude toward medication management which is both open to influence and strongly linked to successful changes in mediation behavior.Purpose: To investigate effects of engaging in participatory action research to improve emergency medicine clinicians’ attitudes toward implementing effective medication management.Methodology: Data are drawn from two-cycle participatory action research. Within the study, a total of 85 clinicians including nurses and physicians from emergency department of one university affiliated hospital participated as participants. Eight managers and clinicians participated as representatives. Initially, a situation analysis on the current medication management and clinician views regarding medication management was conducted using three focus groups. Evaluation and reflection data were obtained through qualitative interviews. All qualitative data were analyzed using content analysis. Results: Clinicians initially expressed negative attitudes toward existing and new plans for medication management, in that they were critical of current medication-related policy and procedures, as well as wary of the potential relevance and utility of potential changes to medication management. Through the action research, improvement actions were implemented including interprofessional courses, pharmacist-led interventions, and the development of new guidelines regarding medication management. Participants and their representatives were engaged in all participatory action research stages. Extracted results from evaluation and reflection stages revealed that by engaging in the action research and practice new interventions, clinicians’ attitude toward medication management was improved. Conclusion: The results support the impact of participatory action research on enhanced clinicians’ positive attitudes through involvement in planning and implementing medication management actions.

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The use of a contextual, modal and psychological classification of medication errors in the emergency department: a retrospective descriptive study

Abstract: Technology can be implemented to help minimise errors in the ED, but this must be coupled with efforts to enhance the culture of safety.

Cited by 30 publications

References 52 publications

Nurses’ perceptions of high‐alert medication administration safety: A qualitative descriptive study

Nurses’ perceptions of high‐alert medication administration safety: A qualitative descriptive study

Nurses’ Perceptions of Medication Administration Safety in Public Hospitals in the Gauteng Province: A Mixed Method Study

The Role of Participatory Action Research on Clinicians’ Attitudes toward Medication Management

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