Medication errors during simulated paediatric resuscitations: a prospective, observational human reliability analysis

Introduction: Medication errors during paediatric resuscitation are thought to be common. However, there is little evidence about the individual process steps that contribute to such medication errors in this context. Objectives: To describe the incidence, nature and severity of medication errors in simulated paediatric resuscitations, and to employ human reliability analysis to understand the contribution of discrepancies in individual process steps to the occurrence of these errors. Methods: We conducted a prospective observational study of simulated resuscitations subjected to video micro-analysis, identification of medication errors, severity assessment and human reliability analysis in a large English teaching hospital. Fifteen resuscitation teams of two doctors and two nurses each conducted one of two simulated paediatric resuscitation scenarios. Results: At least one medication error was observed in every simulated case, and a large magnitude (>25% discrepant) or clinically significant error in 11 of 15 cases. Medication errors were observed in 29% of 180 simulated medication administrations, 40% of which considered to be moderate or severe. These errors were the result of 884 observed discrepancies at a number of steps in the drug ordering, preparation and administration stages of medication use, 8% of which made a major contribution to a resultant medication error. Most errors were introduced by discrepancies during drug preparation and administration. Conclusions: Medication errors were common with a considerable proportion likely to result in patient harm. There is an urgent need to optimise existing systems and to commission research into new approaches to increase the reliability of human interactions during administration of medication in the paediatric emergency setting

Use of Pediatric Injectable Medicines Guidelines and Associated Medication Administration Errors: A Human Reliability Analysis

BACKGROUND: In a recent human reliability analysis (HRA) of simulated pediatric resuscitations, ineffective retrieval of preparation and administration instructions from online injectable medicines guidelines was a key factor contributing to medication administration errors (MAEs). OBJECTIVE: The aim of the present study was to use a specific HRA to understand where intravenous medicines guidelines are vulnerable to misinterpretation, focusing on deviations from expected practice (discrepancies) that contributed to large-magnitude and/or clinically significant MAEs. METHODS: Video recordings from the original study were reanalyzed to identify discrepancies in the steps required to find and extract information from the NHS Injectable Medicines Guide (IMG) website. These data were combined with MAE data from the same original study. RESULTS: In total, 44 discrepancies during use of the IMG were observed across 180 medication administrations. Of these discrepancies, 21 (48%) were associated with an MAE, 16 of which (36% of 44 discrepancies) made a major contribution to that error. There were more discrepancies (31 in total, 70%) during the steps required to access the correct drug webpage than there were in the steps required to read this information (13 in total, 30%). Discrepancies when using injectable medicines guidelines made a major contribution to 6 (27%) of 22 clinically significant and 4 (15%) of 27 large-magnitude MAEs. CONCLUSION AND RELEVANCE: Discrepancies during the use of an online injectable medicines guideline were often associated with subsequent MAEs, including those with potentially significant consequences. This highlights the need to test the usability of guidelines before clinical use

Medication errors during simulated paediatric resuscitations: a prospective, observational human reliability analysis

Introduction: Medication errors during paediatric resuscitation are thought to be common. However, there is little evidence about the individual process steps that contribute to such medication errors in this context. / Objectives: To describe the incidence, nature and severity of medication errors in simulated paediatric resuscitations, and to employ human reliability analysis to understand the contributory role of individual process step discrepancies to these errors. / Methods: We conducted a prospective observational study of simulated resuscitations subject to video micro-analysis, identification of medication errors, severity assessment and human reliability analysis in a large English teaching hospital. Fifteen resuscitation teams of two doctors and two nurses each conducted one of two simulated paediatric resuscitation scenarios. / Results: At least one medication error was observed in every simulated case, and a large magnitude or clinically significant error in 11 of 15 cases. Medication errors were observed in 29% of 180 simulated medication administrations, 40% of which considered to be moderate or severe. These errors were the result of 884 observed discrepancies at a number of steps in the drug ordering, preparation and administration stages of medication use, 8% of which made a major contribution to a resultant medication error. Most errors were introduced by discrepancies during drug preparation and administration. / Conclusions: Medication errors were common with a considerable proportion likely to result in patient harm. There is an urgent need to optimise existing systems and to commission research into new approaches to increase the reliability of human interactions during administration of medication in the paediatric emergency setting

Organisational culture of further education colleges delivering higher education business programmes: developing a culture of ‘HEness’ – what next?

This paper draws on the views of lecturers working in and delivering college-based higher education (CBHE) in the UK. There have been numerous works on the culture of higher education in further education (HE in FE). However, as noted by some literati, the culture of further education (FE) is not easy to define, and does not readily lend itself to the incorporation of a higher education (HE) culture. This could be due to the large number of changes FE has had to adopt owing to various government policies. The study comprises 26 in-depth individual interviews conducted at various further education colleges throughout the Yorkshire and Humber region of the UK. Via the use of an interpretivist approach, common themes and word use were extracted from the narratives for analysis. The organisational culture of these further education colleges was relatively easy to define, the word ‘blame’ being one of the common themes. However, when identifying if the individual colleges had a HE culture; this proved more difficult

Trait self-control and beliefs about the utility of emotions for initiatory and inhibitory self-control

How do people with high trait self-control achieve their success? This research aimed to provide evidence for beliefs about emotion utility as a potential mechanism. Specifically, because beliefs about the utility of emotions predict emotion regulation and successful performance, we investigate the hypothesis that trait self-control influences beliefs about the utility of emotions for self-control. Two preregistered studies examined whether beliefs about the utility of emotions in everyday self-control situations varied depending on the person (trait self-control) and the situation (initiatory or inhibitory self-control). Our key finding was that people considered positive emotions more useful for self-control than negative emotions. This effect was also moderated by situational and individual factors, such that positive emotions were considered especially useful by participants with high trait self-control and in situations requiring initiatory self-control (with the opposite effect for negative emotions). This research suggests a potential role for instrumental emotion regulation in self-control success

Potential mainland Chinese cruise travelers’ expectations, motivations, and intentions

The global cruise industry is the fastest growing sector in the entire leisure market. Due to the limited development of the Chinese cruise sector and government controls on outbound travel, the cruise, especially the outbound cruise, is a new concept in China. Few studies have addressed Chinese consumers’ perceptions of cruises. This study aimed to explore the preferences of potential Chinese cruisers and their expectations, motivations, and intentions in relation to taking an outbound cruise. This study also proposed and tested a conceptual framework: the Expectation, Motivation, and Intention (EMI) Model. Data were collected in Beijing and Shanghai; 242 valid responses were received. The results partially supported the proposed model. The theoretical and practical contributions of the study are discussed

Science lives: School choices and ‘natural tendencies’

An analysis of 12 semi-structured interviews with university-based scientists and non-scientists illustrates their life journeys towards, or away from, science and the strengths and impact of life occurrences leading them to choose science or non-science professions. We have adopted narrative approaches and used Mezirow's transformative learning theory framework. The areas of discussion from the result have stressed on three main categories that include ‘smooth transition’, ‘incremental wavering transition' and ‘transformative transition’. The article concludes by discussing the key influences that shaped initial attitudes and direction in these people through natural inclination, environmental inspirations and perceptions of science

A Wellspring for New Pedagogical Approaches: The Importance of Foundation Years for Universities

In the context of increasing hostility towards the value of foundation years in universities, this article seeks to emphasise their value in helping develop new pedagogical approaches which can be replicated at all levels of undergraduate study. Owing to the diverse nature of foundation years, practitioners who work on these courses develop a range of innovations to promote engagement, attendance, attainment and retention. The impact of the Covid-19 pandemic on the educational experience of many young people, combined with the implementation of stringent performance indicators by the Office for Students makes these strategies more important than ever in supporting students at all levels of undergraduate study

Search based software engineering: Trends, techniques and applications

© ACM, 2012. This is the author's version of the work. It is posted here by permission of ACM for your personal use. Not for redistribution. The definitive version is available from the link below.In the past five years there has been a dramatic increase in work on Search-Based Software Engineering (SBSE), an approach to Software Engineering (SE) in which Search-Based Optimization (SBO) algorithms are used to address problems in SE. SBSE has been applied to problems throughout the SE lifecycle, from requirements and project planning to maintenance and reengineering. The approach is attractive because it offers a suite of adaptive automated and semiautomated solutions in situations typified by large complex problem spaces with multiple competing and conflicting objectives. This article provides a review and classification of literature on SBSE. The work identifies research trends and relationships between the techniques applied and the applications to which they have been applied and highlights gaps in the literature and avenues for further research.EPSRC and E

Development of a rapid in vitro pre-screen for distinguishing effective liposome-adjuvant delivery systems

Abstract: Liposomes are a strong supporting tool in vaccine technology, as they are a versatile system that not only act as antigen delivery systems but also adjuvants that can be highly effective at stimulating both innate and adaptive immune responses. Their ability to induce cell-mediated immunity makes their use in vaccines a useful tool in the development of novel, more effective vaccines against intracellular infections (e.g. HIV, malaria and tuberculosis). Currently, screening of novel liposome formulations uses murine in vivo models which generate data that often correlates poorly with human data. In addition, these models are both high cost and low throughput, making them prohibitive for large scale screening of formulation libraries. This study uses the cationic liposome formulation DDA:TDB (known as cationic adjuvant formulation 01 (CAF01)), as a lead formulation, along with other liposome formulations of known in vivo efficacy to develop an in vitro screening tool for liposome formulation development. THP-1-derived macrophages were the model antigen presenting cell used to assess the ability of the liposome formulations to attract, associate with and activate antigen presenting cells in vitro, crucial steps necessary for an effective immune response to antigen. By using a combination of in vitro functions, the study highlights the potential use of an in vitro screening tool, to predict the in vivo efficacy of novel liposome formulations. CAF01 was predicted as the most effective liposome formulation when assessing all in vitro functions and a measure of in vitro activation was able to predict 80% of the liposome correctly for their ability to induce an in vivo IFN-ү response