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  1. Oh AL, Tan AGHK, Chieng IYY
    J Pharm Pract, 2021 Jan 12.
    PMID: 33433248 DOI: 10.1177/0897190020987127
    INTRODUCTION: Medication history assessment during hospital admissions is an important element in the medication reconciliation process. It ensures continuity of care and reduces medication errors.

    OBJECTIVES: This study aimed to determine the incidence of unintentional discrepancies (medication errors), types of medication errors with its potential severity of patient harm and acceptance rate of pharmaceutical care interventions.

    METHODS: A four-month cross-sectional study was conducted in the general medical wards of a tertiary hospital. All newly admitted patients with at least one prescription medication were recruited via purposive sampling. Medication history assessments were done by clinical pharmacists within 24 hours or as soon as possible after admission. Pharmacist-acquired medication histories were then compared with in-patient medication charts to detect discrepancies. Verification of the discrepancies, interventions, and assessment of the potential severity of patient harm resulting from medication errors were collaboratively carried out with the treating doctors.

    RESULTS: There were 990 medication discrepancies detected among 390 patients recruited in this study. One hundred and thirty-five (13.6%) medication errors were detected in 93 (23.8%) patients (1.45 errors per patient). These were mostly contributed by medication omissions (79.3%), followed by dosing errors (9.6%). Among these errors, 88.2% were considered "significant" or "serious" but none were "life-threatening." Most (83%) of the pharmaceutical interventions were accepted by the doctors.

    CONCLUSION: Medication history assessment by pharmacists proved vital in detecting medication errors, mostly medication omissions. Majority of the errors intervened by pharmacists were accepted by the doctors which prevented potential significant or serious patient harm.

    Matched MeSH terms: Patient Harm
  2. Olakotan OO, Yusof MM
    J Biomed Inform, 2020 06;106:103453.
    PMID: 32417444 DOI: 10.1016/j.jbi.2020.103453
    The overwhelming number of medication alerts generated by clinical decision support systems (CDSS) has led to inappropriate alert overrides, which may lead to unintended patient harm. This review highlights the factors affecting the alert appropriateness of CDSS and barriers to the fit of CDSS alert with clinical workflow. A literature review was conducted to identify features and functions pertinent to CDSS alert appropriateness using the five rights of CDSS. Moreover, a process improvement method, namely, Lean, was used as a tool to optimise clinical workflows, and the appropriate design for CDSS alert using a human automation interaction (HAI) model was recommended. Evaluating the appropriateness of CDSS alert and its impact on workflow provided insights into how alerts can be designed and triggered effectively to support clinical workflow. The application of Lean methods and tools to analyse alert efficiencies in supporting workflow in this study provides an in-depth understanding of alert-workflow fit problems and their root cause, which is required for improving CDSS design. The application of the HAI model is recommended in the design of CDSS alerts to support various levels and stages of alert automations, namely, information acquisition and analysis, decision action and action implementation.
    Matched MeSH terms: Patient Harm
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