Effectiveness of Nursing Guidelines on Nurses’ Performance Regarding High Alert Medications at Neonatal Intensive Care Units

Context: A high alert medication (HAM) is a medication that causes serious harm if it is used in error. Neonatal nurses are responsible for administering HAMs; incorrect administration can significantly affect clinical outcomes.Aim: The study aimed to evaluate the effectiveness of nursing guidelines on nurses' performance regarding HAMs at neonatal intensive care units (NICUs). Methods: A quasi-experimental design (pre/post-test) was utilized. The study was conducted at NICUs in Children's Hospital and Maternity and Gynecological Hospital affiliated to Ain Shams University. A convenience sample of 80 nurses caring for high-risk neonates was included in the current study from the previous setting for six months. Two tools were used to collect data. They are a structured interview questionnaire and nurses’ performance observational checklist. Results: The nurses' mean age was 27.79±6.83. 35% of them were worked part-time jobs. A highly statistically significant improvement was shown post-test compared to the pre-test regarding the nurses' knowledge and practices about HAMs at 0.001. Conclusion: The present study concludes that applying nursing guidelines interventions improved the neonatal nurses' knowledge and practice related to HAMs. The study recommended emphasizing the importance of using nursing guidelines for HAMs interventions for improving neonatal nurses' knowledge and practices at NICUs

Prescribing errors among adult patients in a large tertiary care system in Saudi Arabia

Background: Multiple studies have investigated medication errors in hospitals in Saudi Arabia; however, prevalence data on prescribing errors and associated factors remains uncertain.Objective: Assess the prevalence, type, severity, and factors associated with prescribing errors.Design: Retrospective database review.Setting: Large tertiary care setting in Riyadh.Patients and methods: We described and analyzed data related to prescribing errors in adults (>14 years of age) from the Medication Error Electronic Report Forms database for the two-year period from January 2017 to December 2018.Main outcome measure: The prevalence of prescribing errors and associated factors among adult patients.Sample size: 315 166 prescriptions screened.Results: Of the total number of inpatient and outpatient prescriptions screened, 4934 prescribing errors were identified for a prevalence of 1.56%. The most prevalent types of prescribing errors were improper dose (n=1516; 30.7%) and frequency (n=987; 20.0%). Two-thirds of prescribing errors did not cause any harm to patients. Most prescribing errors were made by medical residents (n=2577; 52%) followed by specialists (n=1629; 33%). Prescribing errors were associated with a lack of documenting clinical information (adjusted odds ratio: 14.1; 95% CI 7.7-16.8, PPConclusion: Inadequate documentation in electronic health records and prescribing of anti-infective medications were the most common factors for predicting prescribing errors. Future studies should focus on testing innovative measures to control these factors and their impact on minimizing prescribing errors

Prevalence and factor associating medication error among registered nurses at Public Hospital Ipoh

Medication administration is an important task performed daily by nurses and is one of the key aspects of safe patient care. Research indicates that when medication errors occur the concern is usually for the patients involved in the incident. However, making a medication administration error has a lasting effect on the nurse as well as the patient (Schelbred & Nord, 2007; Treiber & Jones, 2010). The objective of the study is to evaluate the prevalence and factor associate medication error among registered nurse at public hospital Ipoh. Method of the study is quantitative study in carry out the research from the questionnaires. This study has conducted two types of statistics namely descriptive and inferential. Data collected from N = 80 respondents from two clinical areas; medical and surgical ward. The data collected through this questionnaire was analysed with the help of statistical program for social science (SPSS) version 24.0. The data were statistically treated using mean, standard deviation and one-way ANOVA test. Based on the key findings of the study, it found out the element related to 'preparing and administering' (mean=4.88) was the highest prevalence compared to other elements. This study also found that management factor (mean = 3.55; SD = 4.914) was the main factor contributing to the incident of medication error at the study location followed by environmental factor (mean = 3.53; SD = 4.231) and human characteristic factor with mean score = 3.51 (SD = 4.237). While one-way ANOVA test showed that the difference in marital status of the respondents was significant with the causative factor of medication error with the value is (p=0.027). In conclusion, this review paper summarizes the preventive measures of medication errors made by nurses. As it is obvious, there is a plenty of factors that need to be applied in the hospital to succeed low medication error rate. To improve nurses‘ knowledge of how individual factors, contribute to errors and help them develop effective strategies to prevent errors occurring, it is important that institutions reward and encourage leaders who demonstrate characteristics of mindfulness on all levels. (Abstract by author

Exploring medication error causality and reporting in the Middle East.

The "Medication Without Harm, WHO Global Patient Safety Challenge", published by the World Health Organization in 2017, calls for action to reduce patient harm as a result of unsafe medication practices and medication errors. Medication error-related research conducted within the Middle East has been noted to be of poor quality. The aim of this thesis was to investigate issues relating to medication error causality and suboptimal reporting of medication errors, with the intention of contributing to the development of theory-informed interventions. The first phase was a PROSPERO-registered systematic review, which aimed to critically appraise, synthesise and present the available evidence around the incidence/prevalence, nature and causes of medication errors among hospitalised patients in Middle Eastern countries. Findings indicated the lack of robust and rigorous research, both generally and also specifically in Qatar. There was a clear need for theory-informed primary research. The second phase collated data recorded in medication error reports submitted within Hamad Medical Corporation (HMC), Qatar. The estimated incidence of medication errors in HMC (as derived from medication error reports) was 0.44 per 1,000 medication orders, which is lower than previous studies published in the region and elsewhere. According to Reason's Accident Causality Model, the vast majority were considered as active failures (i.e. slips, lapses, mistakes and violations). One further key finding was that the reports featured a lack of details, hence limiting any synthesis and conclusions. Notably, behaviour change theories could not be applied and so specific targeted research was warranted. The third phase comprised qualitative focus groups with samples of health professionals in HMC, to explore the perspectives of health professionals on issues of medication error causes, contributory factors and error reporting. The thesis suggests that the following Theoretical Domains Framework (TDF) determinants are potentially associated with these errors: social/professional role and identity; emotions; and environmental context and resources. There was a lack of recognition of nurses' roles and frequent policy non-adherence. Stress was perceived to be a major contributor to errors, as was excessive workload and lack of staff at key times. Discussions on issues of medication error reporting identified a number of facilitators and barriers. The TDF domain of emotions featured heavily, with several key themes emerging as barriers to reporting: fear and worry; concern about an investigation that would likely follow reporting; and concern about the impact on evaluation and appraisal processes. This doctoral research has generated original findings that can be used as part of intervention development, aiming to improve medication safety and optimise medication error reporting systems. Future work should now focus on the feasibility/piloting phase of the Medical Research Council guidelines on complex interventions

Medication errors in the outpatient and ambulatory settings: an evidence synthesis approach

Background: Medication errors are preventable incidents that may occur at any stage of the medication use process. Despite their potential to cause severe harm, they are common in healthcare settings. Outpatient and ambulatory settings are known to enhance patient access to healthcare and promote continuity of care. Medication therapy remain key interventions offered in these settings. Currently, there is a dearth of literature on the prevalence and contributory factors to medication errors in the outpatient setting. The program of work presented in this thesis firstly, through the use of an umbrella review, aims to systematically evaluate the contributory factors to medication errors in healthcare settings in terms of the nature of these factors; methodologies and theories used to classify them; and terminologies and definitions used to describe them. The second phase of the thesis aims to synthesize the literature on the prevalence, nature, contributory factors, and interventions to minimize medication errors in outpatient and ambulatory settings using a systematic review of research literature. Methods: In the first phase, an umbrella review was conducted. Systematic reviews were searched using Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, and Google Scholar from inception to March 2022. The data extraction form was informed by the Joanna Briggs Institute (JBI) manual and critical appraisal was conducted using the JBI quality assessment tool. A narrative approach to data synthesis was adopted. In the second phase, a systematic review was conducted. Literature was searched using Medline, Embase, CINAHL, and Google Scholar from 2011 to November 2021. Quality assessment was conducted using the quality assessment checklist for prevalence studies tool. Data related to contributory factors were synthesized according to Reason’s Accident Causation Model. Results: Twenty-seven systematic reviews were included, most of which focused on a specific healthcare setting or clinical area. Decision-making mistakes such as non-consideration for patient risk factors most commonly led to error, followed by organizational and environmental factors (e.g. understaffing and distractions). Only ten studies used a prespecified methodology to classify contributory factors, among which the use of theory, specifically Reason’s theory was most common. None of the reviews evaluated the effectiveness of interventions in preventing errors. Twenty-four articles were included in the systematic review. Medication errors were common in outpatient and ambulatory settings. A wide range of prevalence of prescribing errors and dosing errors was reported with errors ranging from 0-91% and 0-41% respectively of all medications prescribed. Latent conditions largely due to inadequate knowledge were common contributory factors followed by active failures. The seven studies that described the use of interventions were of poor quality. Conclusion: The findings of this program of work provides a comprehensive list of contributory factors to medication errors in healthcare settings. It also emphasizes on the need for consistent use of terminology and methodology in researching contributory factors. The systematic review reports the prevalence and contributory factors to errors in outpatient setting. This thesis overall, emphasizes the need for multifactorial theory-based interventions that incorporate system-level strategies, pharmacists, technology, and education to minimize medication errors in all healthcare settings