Nursing homework help

https://doi.org/10.1177/2042098620968309 https://doi.org/10.1177/2042098620968309

Ther Adv Drug Saf

2020, Vol. 11: 1–29

DOI: 10.1177/ 2042098620968309

© The Author(s), 2020. Article reuse guidelines: sagepub.com/journals- permissions

Therapeutic Advances in Drug Safety

journals.sagepub.com/home/taw 1

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Lay summary

Activities to reduce medication errors in adult medical and surgical hospital areas

Introduction: Medication errors or mistakes may happen at any time in hospital, and they are a major reason for death and harm around the world.

Interventions to reduce medication errors in adult medical and surgical settings: a systematic review Elizabeth Manias , Snezana Kusljic and Angela Wu

Abstract Background and Aims: Medication errors occur at any point of the medication management process, and are a major cause of death and harm globally. The objective of this review was to compare the effectiveness of different interventions in reducing prescribing, dispensing and administration medication errors in acute medical and surgical settings. Methods: The protocol for this systematic review was registered in PROSPERO (CRD42019124587). The library databases, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched from inception to February 2019. Studies were included if they involved testing of an intervention aimed at reducing medication errors in adult, acute medical or surgical settings. Meta-analyses were performed to examine the effectiveness of intervention types. Results: A total of 34 articles were included with 12 intervention types identified. Meta-analysis showed that prescribing errors were reduced by pharmacist-led medication reconciliation, computerised medication reconciliation, pharmacist partnership, prescriber education, medication reconciliation by trained mentors and computerised physician order entry (CPOE) as single interventions. Medication administration errors were reduced by CPOE and the use of an automated drug distribution system as single interventions. Combined interventions were also found to be effective in reducing prescribing or administration medication errors. No interventions were found to reduce dispensing error rates. Most studies were conducted at single-site hospitals, with chart review being the most common method for collecting medication error data. Clinical significance of interventions was examined in 21 studies. Since many studies were conducted in a pre–post format, future studies should include a concurrent control group. Conclusion: The systematic review identified a number of single and combined intervention types that were effective in reducing medication errors, which clinicians and policymakers could consider for implementation in medical and surgical settings. New directions for future research should examine interdisciplinary collaborative approaches comprising physicians, pharmacists and nurses.

Keywords: hospitals, medication errors, medical order entry systems, medication reconciliation, medication therapy management, nurses, patient safety, pharmacists, physicians, systematic review

Received: 27 May 2020; revised manuscript accepted: 23 September 2020.

Correspondence to: Elizabeth Manias School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia

Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia

Department of Medicine, Royal Melbourne Hospital emanias@deakin.edu.au; emanias@unimelb.edu.au

Snezana Kusljic Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia

The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia

Angela Wu Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia

968309TAW0010.1177/2042098620968309Therapeutic Advances in Drug SafetyE Manias, S Kusljic research-article20202020

Systematic Review

 

 

2 journals.sagepub.com/home/taw

Therapeutic Advances in Drug Safety 11

Objective: To compare the effectiveness of different activities in reducing medication errors occurring with prescribing, giving and supplying medications in adult medical and surgical settings in hospital. Methods: Six library databases were examined from the time they were developed to February 2019. Studies were included if they involved testing of an activity aimed at reducing medication errors in adult medical and surgical settings in hospital. Statistical analysis was used to look at the success of different types of activities. Results: A total of 34 studies were included with 12 activity types identified. Statistical analysis showed that prescribing errors were reduced by pharmacists matching medications, computers matching medications, partnerships with pharmacists, prescriber education, medication matching by trained physicians, and computerised physician order entry (CPOE). Medication-giving errors were reduced by the use of CPOE and an automated medication distribution system. The combination of different activity types were also shown to be successful in reducing prescribing or medication-giving errors. No activities were found to be successful in reducing errors relating to supplying medications. Most studies were conducted at one hospital with reviewing patient charts being the most common way for collecting information about medication errors. In 21 out of 34 articles, researchers examined the effect of activity types on patient harm caused by medication errors. Many studies did not involve the use of a control group that does not receive the activity. Conclusion: A number of activity types were shown to be successful in reducing prescribing and medication-giving errors. New directions for future research should examine activities comprising health professionals working together.

Introduction Medication errors occur at any point of the medi- cation management process involving prescrib- ing, transcribing, dispensing, administering and monitoring,1,2 have been reported to account for approximately one-quarter of all healthcare errors.3 Medication errors are a major cause of death and harm globally.4 According to the World Health Organisation (WHO), medication errors cost an estimated US$42 billion annually world- wide, which is 0.7% of the total global health expenditure.5

Systematic reviews examining interventions aimed at reducing medication errors have largely focused on specialty settings, such as patients sit- uated in adult and paediatric intensive care units, emergency departments, and neonatal intensive care and paediatric units.6–10 Previous relevant systematic reviews relating to testing interven- tions for reducing medication errors in general hospital settings have focused on administration errors only,11,12 have involved adult and paediat- ric settings or have tested interventions in spe- cialty and general hospital settings with no differentiation in results.11–13 This systematic review aims to compare the effectiveness of differ- ent interventions in reducing prescribing, dis- pensing and administration medication errors in

acute medical and surgical settings. Information obtained from this review can inform clinicians and policymakers about the types of interventions that have been shown to be effective, which can guide the development of comprehensive guide- lines for clinical practice and policy directives.

Methods In conducting this systematic review, the authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.14 The review protocol was registered with PROSPERO (CRD42019124587).

Search strategy A search was conducted of the following library databases, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials, from inception to February 2019.

A search strategy was devised following consulta- tion with a university research librarian to yield relevant studies. Keywords used in the search comprised five categories: the setting, with key- words ‘hospital’, ‘acute’, ‘medical’, ‘surgical’;

 

 

E Manias, S Kusljic et al.

journals.sagepub.com/home/taw 3

perspective, with keywords ‘medication manage- ment’, ‘medication process’, ‘medicines manage- ment’, ‘prescribing’, ‘dispensing’, ‘administration’, ‘monitoring’; population, with keyword ‘adult’; activity, with keywords ‘pro- gram’ and ‘intervention’; and phenomenon of interest, with keywords ‘medication errors’, ‘pre- ventive adverse drug events’, and ‘medicine errors’. Keywords in each category were searched using the operator OR, and then combined between categories using the operator AND. Search histories for all databases are listed in Supplemental file S1. Key article cross-checking was performed using citation-linking databases, Scopus and Web of Science in an attempt to iden- tify further articles. Reference lists of relevant articles were checked to identify additional papers. Previous systematic reviews on a similar topic were also examined to determine possible papers for inclusion.11–13

Eligibility criteria Studies were included if they involved testing an intervention aimed at reducing medication errors in adult acute medical or surgical settings. Adults were defined as patients aged 18 years or over. If patients received the intervention during hospitali- sation and the effect on medication errors was measured in the hospital setting, these studies were included. Medication errors comprised any pre- ventable events that may cause or lead to inappro- priate medication use or patient harm during prescribing, dispensing or administration.15 The prevalence of medication errors must have been identified as a primary or secondary outcome to be included. Papers were considered for inclusion if they were published before 2000, as this was the year when the landmark publication, To Err is Human: Building a Safer Health System was released by the Institute of Medicine.16 This publication drew attention of the need for health services to develop tools and systems to address problems in patient safety, such as medication errors.

Near misses were not included as medication errors. Only papers published in English were included. Case studies, commentaries, editorials, reviews, epidemiological studies and conference abstracts were excluded. If studies examined medication-related problems as an outcome, which often comprised a combination of medica- tion errors, as well as problems with medication knowledge, medication adherence and other

aspects of medication management, these studies were not included. If the effect of the intervention was measured outside the hospital setting, these studies were excluded. Specialty wards such as intensive care, emergency care, perioperative care, neurological and cancer care were excluded. Outpatient settings and subacute settings, such as rehabilitation wards and geriatric evaluation and management units were excluded.

Study selection Rayyan (Qatar Computing Research Institute), an online platform, was used for independent screening of articles at the title and abstract level, and subsequently at the full text level.17 Two authors reviewed titles and abstracts indepen- dently. The third author assessed discrepancies at the title and abstract level. Any uncertainty or disagreement about articles meeting the inclusion criteria was resolved after discussion among all authors. Full texts of papers were then examined independently by two authors to determine if studies were eligible for inclusion in the review. Any discrepancies identified at the full-text level were examined by the third author. Previous sys- tematic reviews on similar topics were also exam- ined to determine possible papers for inclusion.

Quality assessment Quality assessment was undertaken using the Equator reporting guidelines whereby ran- domised controlled trials were assessed using the CONSORT guidelines,18 non-randomised stud- ies were assessed using the TREND guide- lines,19 and quality improvement studies were assessed using the SQUIRE guidelines.20 No study was excluded on the basis of the score obtained for quality assessment. Risk of bias assessment was also undertaken using Review Manager, version 5.3 (RevMan) (Cochrane Collaboration) software.

Data extraction Data were extracted from each paper to a stand- ard form for study design, country and setting, number of patients, intervention type, type of medication error analysed and effect of the inter- vention (Table 1). If the studies provided infor- mation about the severity of medication errors using their approach for measuring severity, these data were also included in data extraction.

 

 

4 journals.sagepub.com/home/taw

Therapeutic Advances in Drug Safety 11

Ta b

le 1

. O

ve rv

ie w

o f

st u

d ie

s in

cl u

d ed

in t

h e

sy st

em at

ic r

ev ie

w (

n =

34 ).

R ef

er en

ce

(c ou

n tr

y) S

tu d

y d

es ig

n S

et ti

n g

N u

m b

er o

f p

at ie

n ts

In te

rv en

ti on

t yp

e Ty

p e

of m

ed ic

at io

n e

rr or

a n

al ys

ed (

m et

h od

o f

d at

a co

ll ec

ti on

f or

m ed

ic at

io n

e rr

or s)

, ef

fe ct

o f

in te

rv en

ti on

o n

m ed

ic at

io n

e rr

or r

at e

P L

-M R

A l-

H as

h ar

e t

al .2

1 (O

m an

) P

ro sp

ec ti

ve

ra n

d om

is ed

co

n tr

ol le

d s

tu d

y

M ed

ic al

w ar

d s

of a

t er

ti ar

y ca

re

ac ad

em ic

h os

p it

al

w it

h a

b ed

c ap

ac it

y of