Sustaining and spreading penicillin allergy de-labelling: a narrative review of the challenges for service delivery and patient safety

Many patients report allergies to penicillin, although in over 90% of these the label of penicillin allergy is shown to be incorrect following comprehensive testing. Inappropriate and inaccurate penicillin allergy labelling is a barrier to antimicrobial stewardship and can lead to patient harm. This review assesses an emergent evidence base and trend favouring delabelling using direct oral penicillin challenges following a stratified risk assessment of the likelihood and existence of true penicillin allergy, to identify and make recommendations for key components for implementation in standard practice. Research to date has focussed on the feasibility and clinical and financial outcomes of these direct delabelling strategies. There is a paucity of studies exploring the views and engagement of patients and healthcare professionals, and a gap in the evidence for prerequisites to safely deliver, sustain and spread the implementation of such services across health systems

The Informing Science Framework: An Assessment and Implications for the Discipline of Information Systems

The discipline of Information systems has established itself as an independent discipline now. However there are criticisms of it being fragmented and there being a lack of pluralistic approaches of inquiry. The Informing Science framework conceptualizes Information Systems as a part of the growing discipline of Informing Science and proposes to draw upon the other disciplines that share the common goal of informing the client. This paper assesses the strengths and weaknesses of this framework. While cautioning against indiscriminate borrowing of concepts from other disciplines, the paper suggests that the principles of General Systems Theory may be quite useful in conceptualizing and enriching Information Systems. It suggests that pluralism should not be considered a sign of disorder. Homogeneity may be desired but it may also be a sign of a closed system whereas heterogeneity is a characteristic of any open, growing system

A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems.

Accurate and complete prescriptions of insulin are crucial to prevent medication errors from occurring. Two core components for safe insulin prescriptions are the word 'units' being written in full for the dose, and clear documentation of the insulin device alongside the name. A retrospective review of annual audit data was conducted for insulin prescriptions to assess the impact of changes to the prescribing system within a secondary care setting, at five time points over a period of 7 years (2014 to 2020). The review points were based on when changes were made, from standardized paper charts with a dedicated section for insulin prescribing, to a standalone hospital wide electronic prescribing and medicines administration (ePMA) system, and finally an integrated electronic health record system (EHRS). The measured outcomes were compliance with recommended standards for documentation of 'units' in full, and inclusion of the insulin device as part of the prescription. Overall, an improvement was seen in both outcomes of interest. Device documentation improved incrementally with each system change-34% for paper charts, 23%-56% for standalone ePMA, and 100% for ePMA integrated within EHRS. Findings highlight that differences in ePMA systems may have varying impact on safe prescribing practices

Scoping review exploring the impact of digital systems on processes and outcomes in the care management of acute kidney injury and progress towards establishing learning healthcare systems

Objectives: Digital systems have long been used to improve the quality and safety of care when managing acute kidney injury (AKI). The availability of digitised clinical data can also turn organisations and their networks into learning healthcare systems (LHSs) if used across all levels of health and care. This review explores the impact of digital systems i.e. on patients with AKI care, to gauge progress towards establishing LHSs and to identify existing gaps in the research. / Methods: Embase, PubMed, MEDLINE, Cochrane, Scopus and Web of Science databases were searched. Studies of real-time or near real-time digital AKI management systems which reported process and outcome measures were included. / Results: Thematic analysis of 43 studies showed that most interventions used real-time serum creatinine levels to trigger responses to enable risk prediction, early recognition of AKI or harm prevention by individual clinicians (micro level) or specialist teams (meso level). Interventions at system (macro level) were rare. There was limited evidence of change in outcomes. / Discussion: While the benefits of real-time digital clinical data at micro level for AKI management have been evident for some time, their application at meso and macro levels is emergent therefore limiting progress towards establishing LHSs. Lack of progress is due to digital maturity, system design, human factors and policy levers. / Conclusion: Future approaches need to harness the potential of interoperability, data analytical advances and include multiple stakeholder perspectives to develop effective digital LHSs in order to gain benefits across the system

Evaluating the effectiveness of digital communication within the National Medication Safety Network for England

Objectives: The medication safety officer (MSO) role was created following a patient safety alert, with an action for MSOs to be active participants in a national network in England, which included regular online webinar meetings and an online forum. The aim of the study was to assess the effectiveness of digital platforms in facilitating interaction and communication by the MSO network. The objectives were to establish the proportion of MSOs who interact through monthly webinars and the online forum. A secondary objective was to identify barriers and facilitators for engaging digitally within the MSO network. Methods: An online survey was used alongside semistructured interviews. The online survey was disseminated to all 400 MSOs registered with the UK Department of Health Central Alerting System from December 2018 to February 2019. Interviewees were identified purposively through snowball sampling and voluntarily through the survey. Results: 84 MSOs responded to the survey (21% response rate) and 10 participated in the semistructured interviews. The majority of the respondents were pharmacists (79/84, 94%) from NHS large healthcare providers (44/84, 52%). MSO respondents (61/84, 73%) joined the monthly webinar and 47/84 (56%) believed the webinar was useful for networking. Ten (12%) did not attend the webinars due to technical difficulties or lack of time. The online forum was used less frequently, with a third (27/84, 32%) that had never used it. Conclusions: Digital communications through webinars and online forums were perceived by respondents as a way to facilitate networking but require a robust information technology infrastructure that can be accessed without difficulty. User-friendly platforms can help the MSO network achieve critical mass and greater interaction, allowing timely access to information

Learning from medicine related safety incidents

This is the first in a series of eight articles that will discuss the recommendations pertaining to medication safety, and provide insights into their application and implications for practice

Interdisciplinary systematic review: does alignment between system and design shape adoption and use of barcode medication administration technology?

BACKGROUND: In order to reduce safety risks associated with medication administrations, technologies such as barcode medication administration (BCMA) are increasingly used. Examining how human factors influence adoption and usability of this technology can potentially highlight areas for improvement in design and implementation. OBJECTIVE: To describe how human factors related determinants for BCMA have been researched and reported by healthcare and human-computer interaction disciplines. DATA SOURCES: The Cumulative Index of Nursing, and Allied Health Literature, PubMed, OVID MEDLINE and Google Scholar. STUDY ELIGIBILITY CRITERIA: Primary research published from April 2000 to April 2020, search terms developed to identity different disciplinary research perspectives that examined BCMA use, used a human factors lens and were published in English. SYNTHESIS METHODS: Computerised systematic searches were conducted in four databases. Eligible papers were systematically analysed for themes. Themes were discussed with a second reviewer and supervisors to ensure they were representative of content. RESULTS: Of 3707 papers screened, 11 were included. Studies did not fit neatly into a clinical or human-computer interaction perspective but instead uncovered a range of overlapping narratives, demonstrating consensus on the key themes despite differing research approaches. Prevalent themes were misaligned design and workflow, adaptation and workarounds, mediating factors, safety, users' perceptions and design and usability. Inadequate design frequently led to workarounds, which jeopardised safety. Reported mediating factors included clarity of user needs, pre/post implementation evaluations, analysis of existing workarounds and appropriate technology, infrastructure and staffing. LIMITATIONS: Most studies were relatively small and qualitative, making it difficult to generalise findings. CONCLUSION: Evaluating interdisciplinary perspectives including human factors approaches identified similar and complementary enablers and barriers to successful technology use. Often, mediating factors were developed to compensate for unsuitable design; a collaborative approach between system designer and end users is necessary for BCMA to achieve its true safety potential

Pengaruh Latihan Front Split Terhadap Ekstensi Tungkai Pada Klub Beladiri Kempo Dojo Rumbai Pesisir Pekanbaru

The problem raised in this research is the effect of the training Front Split for Leg Extension self defence kempo club dojo rumbai pesisir pekanbaru . The research aims to determine the effect of Front Split training for Leg Extension self defence kempo club dojo rumbai pesisir pekanbaru.These research is pra experimental, the one group pretest – posttest design. The research was conducted in club dojo rumbai pesisir pekanbaru. The sample of this study of 15 people. Research data collected through the initial pretest and posttest with the Leg Extension test. The data were analyzed descriptive, then further research is done to test the hypothesis that has been asked in the problem, namely : there are Front Split training effect on Leg Extension self defence kempo club dojo rumbai pesisir pekanbaru.Based on t test analysis produces large thitung 16,97 and as much as 1,761 ttabel . Means thitung > ttabel. It can be concluded that Ho denied and H1 accepted. It can be concluded that there is significant effect of the training Front Split (X) and Leg Extension (Y) self defence kempo club dojo rumbai pesisir pekanbaru

The role of organizational and professional cultures in medication safety: a scoping review of the literature

Purpose: This scoping review explores what is known about the role of organizational and professional cultures in medication safety. The aim is to increase our understanding of ‘cultures’ within medication safety and provide an evidence base to shape governance arrangements. / Data sources: Databases searched are ASSIA, CINAHL, EMBASE, HMIC, IPA, MEDLINE, PsycINFO and SCOPUS. / Study selection: Inclusion criteria were original research and grey literature articles written in English and reporting the role of culture in medication safety on either organizational or professional levels, with a focus on nursing, medical and pharmacy professions. Articles were excluded if they did not conceptualize what was meant by ‘culture’ or its impact was not discussed. / Data extraction: Data were extracted for the following characteristics: author(s), title, location, methods, medication safety focus, professional group and role of culture in medication safety. / Results of data synthesis: A total of 1272 citations were reviewed, of which, 42 full-text articles were included in the synthesis. Four key themes were identified which influenced medication safety: professional identity, fear of litigation and punishment, hierarchy and pressure to conform to established culture. At times, the term ‘culture’ was used in a non-specific and arbitrary way, for example, as a metaphor for improving medication safety, but with little focus on what this meant in practice. / Conclusions: Organizational and professional cultures influence aspects of medication safety. Understanding the role these cultures play can help shape both local governance arrangements and the development of interventions which take into account the impact of these aspects of culture