Displaying publications 1 - 20 of 52 in total

  1. Mortell M
    Br J Nurs, 2019 Nov 14;28(20):1292-1298.
    PMID: 31714835 DOI: 10.12968/bjon.2019.28.20.1292
    This article employs a paediatric case study, involving a 3-year-old child who had an anaphylactic reaction that occurred as a result of the multidisciplinary team's failure to identify and acknowledge the patient's documented 'known allergy' status. It examines and reconsiders the ongoing healthcare dilemma of medication errors and recommends that known allergy status should be considered the second medication administration 'right' before the prescribing, transcribing, dispensing and administration of any drug. Identifying and documenting drug allergy status is particularly important when caring for paediatric patients, because they cannot speak for themselves and must rely on their parents, guardians or health professionals as patient advocates. The literature states that medication errors can be prevented by employing a 'rights of medication administration' format, whether that be the familiar '5 rights' or a more detailed list. However, none of these formats specify known allergy status as a distinct 'right'. The medication safety literature is also found wanting in respect of the known allergy status of the patient. When health professionals employ a medication administration rights format prior to prescribing, transcribing, dispensing or administering a medication, the 'known allergy status' of the patient should be a transparent inclusion.
    Matched MeSH terms: Medication Errors/adverse effects; Medication Errors/prevention & control*
  2. Ong WM, Subasyini S
    Med J Malaysia, 2013;68(1):52-7.
    PMID: 23466768 MyJurnal
    Medications given via the intravenous (IV) route provide rapid drug delivery to the body. IV therapy is a complex process requiring proper drug preparation before administration to the patients. Therefore, errors occurring at any stage can cause harmful clinical outcomes to the patients, which may lead to morbidity and mortality. This was a prospective observational study with the objectives to determine whether medication errors occur in IV drug preparation and administration in Selayang Hospital, determining the associated factors and identifying the strategies in reducing these medication errors. 341 (97.7%) errors were identified during observation of total 349 IV drug preparations and administrations. The most common errors include the vial tap not swabbed during prepreparation and injecting bolus doses faster than the recommended administration rate. There was one incident of wrong drug attempted. Errors were significantly more likely to occur during administration time at 8.00am and when bolus drugs were given. Errors could be reduced by having proper guidelines on IV procedures, more common use of IV infusion control devices and by giving full concentration during the process. Awareness among the staff nurses and training needs should be addressed to reduce the rate of medication errors. Standard IV procedures should be abided and this needs the cooperation and active roles from all healthcare professionals as well as the staff nurses.
    Study site: Hospital Selayang, Kuala Lumpur
    Matched MeSH terms: Medication Errors*
  3. Chua SS, Chua HM, Omar A
    Eur J Pediatr, 2010 May;169(5):603-11.
    PMID: 19823870 DOI: 10.1007/s00431-009-1084-z
    Paediatric patients are more vulnerable to drug administration errors due to a lack of appropriate drug dosages and strengths for use in this group of patients. Therefore, the aim of the present study was to determine the extent and types of drug administration errors in two paediatric wards and to identify measures to reduce such errors. A researcher was stationed in two paediatric wards of a teaching hospital to observe all drugs administered to paediatric inpatients in each of the ward, for 1 day in a week over ten consecutive weeks. All data were recorded in a data collection form and then compared with the actual drugs and dosages prescribed for the patients. Of the 857 drug administrations observed, 100 doses had errors, and this gave an error rate of 11.7% [95% confidence interval (CI) 9.5-13.9%]. If wrong time administration errors were excluded, the error rate reduced to 7.8% (95% CI 6.0-9.6%). The most common types of drug administration errors were incorrect time of administration (28.8%), followed by incorrect drug preparation (26%), omission errors (16.3%) and incorrect dose (11.5%). None of the errors observed were considered as potentially life threatening, although 40.4% could possibly cause patient harm. Drug administration errors are as common in paediatric wards in Malaysia as in other countries. Double-checking should be conducted, as this could reduce drug administration errors by about 20%, but collaborative efforts between all healthcare professionals are essential.
    Matched MeSH terms: Medication Errors/statistics & numerical data*
  4. Taib IA, McIntosh AS
    Ther Adv Drug Saf, 2010 Dec;1(2):53-63.
    PMID: 25083195 DOI: 10.1177/2042098610389850
    A reliable database on the causes and contributing factors of medication errors can inform strategies for their prevention. To form a single database from multiple databases requires a process of integration that both maximizes the utility of the new data and minimizes the loss of information. Unfortunately, the terminologies used by different studies and databases may limit integration; therefore, terminologies must be standardized prior to integration.
    Matched MeSH terms: Medication Errors
  5. Sellappans R, Chua SS, Tajuddin NA, Lai PSM
    Australas Med J, 2013;6(1):60-3.
    PMID: 23423150 DOI: 10.4066/AMJ.2013.1643
    Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.
    Matched MeSH terms: Medication Errors
  6. Palasuberniam, Praneetha, Chin, Suliong, Thangiah, Viknesvaran, D’Souza, Urban John Arnold
    Medication errors (MEs) are preventable mistakes that occur when there is a failure in the treatment process of any disease that can cause potential harm to patients. Having an effect on patients, health outcomes and costs incurred, it does burden our economically-developing country. Database systems have been created worldwide for the reporting of MEs, but varying countries practise different classifications of MEs hence it poses a challenge to categorize them. This makes it next to impossible to fully curb this continual problem. There are a number of classifications of MEs, based on mistakes and errors based on skills, based on the mistakes itself, based on symptoms and based on the stages of drug delivery system. This review summarizes the pre-existing classifications of MEs.
    Matched MeSH terms: Medication Errors
  7. Salmasi S, Wimmer BC, Khan TM, Zaidi STR, Ming LC
    Res Social Adm Pharm, 2018 Feb;14(2):207-209.
    PMID: 28330781 DOI: 10.1016/j.sapharm.2017.02.015
    Matched MeSH terms: Medication Errors/prevention & control*
  8. Samsiah A, Othman N, Jamshed S, Hassali MA, Wan-Mohaina WM
    Eur J Clin Pharmacol, 2016 Dec;72(12):1515-1524.
    PMID: 27637912
    PURPOSE: Reporting and analysing the data on medication errors (MEs) is important and contributes to a better understanding of the error-prone environment. This study aims to examine the characteristics of errors submitted to the National Medication Error Reporting System (MERS) in Malaysia.

    METHODS: A retrospective review of reports received from 1 January 2009 to 31 December 2012 was undertaken. Descriptive statistics method was applied.

    RESULTS: A total of 17,357 MEs reported were reviewed. The majority of errors were from public-funded hospitals. Near misses were classified in 86.3 % of the errors. The majority of errors (98.1 %) had no harmful effects on the patients. Prescribing contributed to more than three-quarters of the overall errors (76.1 %). Pharmacists detected and reported the majority of errors (92.1 %). Cases of erroneous dosage or strength of medicine (30.75 %) were the leading type of error, whilst cardiovascular (25.4 %) was the most common category of drug found.

    CONCLUSIONS: MERS provides rich information on the characteristics of reported MEs. Low contribution to reporting from healthcare facilities other than government hospitals and non-pharmacists requires further investigation. Thus, a feasible approach to promote MERS among healthcare providers in both public and private sectors needs to be formulated and strengthened. Preventive measures to minimise MEs should be directed to improve prescribing competency among the fallible prescribers identified.

    Matched MeSH terms: Medication Errors/statistics & numerical data*
  9. Salmasi S, Khan TM, Hong YH, Ming LC, Wong TW
    PLoS One, 2015;10(9):e0136545.
    PMID: 26340679 DOI: 10.1371/journal.pone.0136545
    BACKGROUND: Medication error (ME) is a worldwide issue, but most studies on ME have been undertaken in developed countries and very little is known about ME in Southeast Asian countries. This study aimed systematically to identify and review research done on ME in Southeast Asian countries in order to identify common types of ME and estimate its prevalence in this region.

    METHODS: The literature relating to MEs in Southeast Asian countries was systematically reviewed in December 2014 by using; Embase, Medline, Pubmed, ProQuest Central and the CINAHL. Inclusion criteria were studies (in any languages) that investigated the incidence and the contributing factors of ME in patients of all ages.

    RESULTS: The 17 included studies reported data from six of the eleven Southeast Asian countries: five studies in Singapore, four in Malaysia, three in Thailand, three in Vietnam, one in the Philippines and one in Indonesia. There was no data on MEs in Brunei, Laos, Cambodia, Myanmar and Timor. Of the seventeen included studies, eleven measured administration errors, four focused on prescribing errors, three were done on preparation errors, three on dispensing errors and two on transcribing errors. There was only one study of reconciliation error. Three studies were interventional.

    DISCUSSION: The most frequently reported types of administration error were incorrect time, omission error and incorrect dose. Staff shortages, and hence heavy workload for nurses, doctor/nurse distraction, and misinterpretation of the prescription/medication chart, were identified as contributing factors of ME. There is a serious lack of studies on this topic in this region which needs to be addressed if the issue of ME is to be fully understood and addressed.

    Matched MeSH terms: Medication Errors/statistics & numerical data*; Medication Errors/ethics
  10. Lee FY, Chan HK, Wong HS
    Pharmacoepidemiol Drug Saf, 2019 05;28(5):760-761.
    PMID: 30919516 DOI: 10.1002/pds.4780
    Matched MeSH terms: Medication Errors/prevention & control*; Medication Errors/statistics & numerical data
  11. Chua SS, Tea MH, Rahman MH
    J Clin Pharm Ther, 2009 Apr;34(2):215-23.
    PMID: 19250142 DOI: 10.1111/j.1365-2710.2008.00997.x
    Drug administration errors were the second most frequent type of medication errors, after prescribing errors but the latter were often intercepted hence, administration errors were more probably to reach the patients. Therefore, this study was conducted to determine the frequency and types of drug administration errors in a Malaysian hospital ward.
    Matched MeSH terms: Medication Errors/classification; Medication Errors/statistics & numerical data*
  12. Che Romli R, Chan SG
    This quantitative-oriented research was conducted to identify factors that contributed to errors in dispensing medication among nurses and to understand why nurses did not report their errors in dispensing. In this study a total of 284 U29 nurses participated in focusing on factors contributing to medication errors and failure to report the errors. In this study, analysis of the data collected was made in two sections; dispensing errors and failure to report the errors in giving medication. According to Evans et al. (2006) although nurses may not admit directly to such errors, they expressed their perceptions towards situations described in the questionnaire items as contributing to medication errors among nurses. Almost all in the sample of 284 chose not to report medication errors because they could not identify the cause of dispensing errors; other nurses perceived that the individual involved is not competent in performing the task. Other reasons include fear that the action will be exposed by the management, to avoid publicity from the media, and there is no difference in reporting or not reporting the medication errors. This study was done not only for exploring factors of medication errors; it also aspires to identify problems that arise in hospital services and in order to maintain the quality of health care. The management should consider the impact of medication errors and failure to report medication errors on the nursing profession and quality image of the hospital.
    Matched MeSH terms: Medication Errors
  13. Fatimah Sham, Siti Munirah Abdul Wahab, Hapesah Mohamed Sihat, Haznizan Abdullah Nazri, Aida Juliana Mohamad Amyah, Harnake Kaur
    Medication errors could bring serious consequences to patients. Reporting medication error is a strategy to
    mitigate such incidence from happening. Unfortunately, some nurses do no report the errors due to certain
    factors. Determining the factors influencing unreported medication errors will ensure imperative actions
    that are to be taken to curb this issue. The aim of this study is to determine the prevalence and perceived
    causes of unreported medication errors among nurses in a public hospital in Selangor. A descriptive and
    cross-sectional study was carried out in 26 wards from various disciplines and the sample involved 234
    nurses. The data were gathered through self-reported questionnaires consisting of three sections. The first
    section covered demographic characteristics, the second section aimed to obtain information on the
    frequency of medication error incidents and the last section aimed to obtain information on nurses'
    perceptions of barriers in reporting medication errors. The findings of this study indicated that there was a
    significant relationship between level of education and the nurses' perceptions of barriers in reporting
    medication errors. The study recommended that providing enough education, initiating a non-punitive
    culture may help increase voluntary reporting of medication errors among nurses to strengthen the
    reporting system and to avert medication errors in the future.
    Matched MeSH terms: Medication Errors
  14. George D, Supramaniam ND, Hamid SQA, Hassali MA, Lim WY, Hss AS
    Pharm Pract (Granada), 2019 08 21;17(3):1501.
    PMID: 31592290 DOI: 10.18549/PharmPract.2019.3.1501
    Background: Patients requiring medications during discharge are at risk of discharge medication errors that potentially cause readmission due to medication-related events.

    Objective: The objective of this study was to develop interventions to reduce percentage of patients with one or more medication errors during discharge.

    Methods: A pharmacist-led quality improvement (QI) program over 6 months was conducted in medical wards at a tertiary public hospital. Percentage of patients discharge with one or more medication errors was reviewed in the pre-intervention and four main improvements were developed: increase the ratio of pharmacist to patient, prioritize discharge prescription order within office hours, complete discharge medication reconciliation by ward pharmacist, set up a Centralized Discharge Medication Pre-packing Unit. Percentage of patients with one or more medication errors in both pre- and post-intervention phase were monitored using process control chart.

    Results: With the implementation of the QI program, the percentage of patients with one or more medication errors during discharge that were corrected by pharmacists significantly increased from 77.6% to 95.9% (p<0.001). Percentage of patients with one or more clinically significant error was similar in both pre and post-QI with an average of 24.8%.

    Conclusions: Increasing ratio of pharmacist to patient to complete discharge medication reconciliation during discharge significantly recorded a reduction in the percentage of patients with one or more medication errors.

    Matched MeSH terms: Medication Errors
  15. Mohd Yusof M, Takeda T, Mihara N, Matsumura Y
    Stud Health Technol Inform, 2020 Jun 16;270:1036-1040.
    PMID: 32570539 DOI: 10.3233/SHTI200319
    Health information systems (HIS) and clinical workflows generate medication errors that affect the quality of patient care. The rigorous evaluation of the medication process's error risk, control, and impact on clinical practice enable the understanding of latent and active factors that contribute to HIS-induced errors. This paper reports the preliminary findings of an evaluation case study of a 1000-bed Japanese secondary care teaching hospital using observation, interview, and document analysis methods. Findings were analysed from a process perspective by adopting a recently introduced framework known as Human, Organisation, Process, and Technology-fit. Process factors influencing risk in medication errors include template- and calendar-based systems, intuitive design, barcode check, ease of use, alert, policy, systematic task organisation, and safety culture Approaches for managing medication errors also exert an important role on error reduction and clinical workflow.
    Matched MeSH terms: Medication Errors
  16. Olakotan O, Mohd Yusof M, Ezat Wan Puteh S
    Stud Health Technol Inform, 2020 Jun 16;270:906-910.
    PMID: 32570513 DOI: 10.3233/SHTI200293
    Clinical decision support systems (CDSSs) provides vital information for managing patients by advising clinicians through an alert or reminders about adverse events and medication errors. Clinicians receive a high number of alerts, resulting in alert override and workflow disruptions. A systematic review was carried out to identify factors affecting CDSS alert appropriateness in supporting clinical workflows using a recently introduced framework. The review findings identified several influencing factors of CDSS alert appropriateness including: technology (usability, alert presentation, workload and data entry), human (training, knowledge and skills, attitude and behavior), organization (rules and regulation, privacy and security) and process (waste, delay, tuning and optimization). The findings can be used to guide the design of CDSS alert and minimise potential safety hazards associated with CDSS use.
    Matched MeSH terms: Medication Errors
  17. Rasool MF, Rehman AU, Imran I, Abbas S, Shah S, Abbas G, et al.
    Front Public Health, 2020;8:531038.
    PMID: 33330300 DOI: 10.3389/fpubh.2020.531038
    Introduction: Medication error is unintentional and can be reduced by reducing the risk factors. Patients suffering from chronic diseases are at an increased risk of medication errors. Objective: This work aims to assess the risk factors associated with medication errors among patients suffering from chronic disorders in hospitals of South Punjab, Pakistan. Methodology: Multiple logistic regression analysis was used to assess the impact of different risk factors on the prevalence of medication errors in patients suffering from chronic diseases. Results: A greater risk for the occurrence of medication errors was associated with age ≥60 years (odds ratio, OR = 1.9; 95% CI = 1.3-3.1; p = 0.001), overburdened healthcare system (OR = 2.2; 95% CI = 1.64-3.56; p < 0.000), number of prescribed drugs ≥5 (OR = 1.74; 95% CI = 1.02-2.64; p < 0.000), comorbidities (OR = 2.6; 95% CI = 1.72-3.6; p = 0.003), Charlson comorbidity index (OR = 1.31; 95% CI = 0.49-1.84; p = 0.004), and multiple prescribers to one patient (OR = 1.12; 95% CI = 0.64-1.76; p = 0.001). Conclusion: Older age, overburdened healthcare system, number of prescribed drugs, comorbidities, Charlson comorbidity index, and multiple prescribers to one patient are significant risk factors for the occurrence of medication errors.
    Matched MeSH terms: Medication Errors
  18. Shafie AA, Hassali MA, Azhar S, See OG
    Res Social Adm Pharm, 2012 May-Jun;8(3):258-62.
    PMID: 21824823 DOI: 10.1016/j.sapharm.2011.06.002
    The role of pharmacists has transformed significantly because of changes in pharmacists' training and population health demands. Within this context, community pharmacists are recognized as important health personnel for the provision of extended health services. Similarly, in Malaysia, the need to transform community pharmacy practice has been discussed by all interested parties; however, the transition has been slow due in part to the nonexistence of a dispensing separation policy between pharmacists and medical doctors in private community practices. For decades, medical doctors in private community practices have had the right to prescribe and dispense, thus diluting the role of community pharmacists because of overlapping roles. This article explores dispensing separation in Malaysia and, by taking into account the needs of health professionals and health care consumers, suggests a mechanism for how dispensing separation practice can be implemented.
    Matched MeSH terms: Medication Errors/prevention & control
  19. Raja Lope RJ, Boo NY, Rohana J, Cheah FC
    Singapore Med J, 2009 Jan;50(1):68-72.
    PMID: 19224087
    This study aimed to determine the rates of non-adherence to standard steps of medication administration and medication administration errors committed by registered nurses in a neonatal intensive care unit before and after intervention.
    Matched MeSH terms: Medication Errors/prevention & control*
  20. Tang KL, Wimmer BC, Akkawi ME, Ming LC, Ibrahim B
    Res Social Adm Pharm, 2018 Mar;14(3):317-319.
    PMID: 28365153 DOI: 10.1016/j.sapharm.2017.03.053
    Matched MeSH terms: Medication Errors/statistics & numerical data*
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