Incidence and types of preventable adverse events in elderly patients: population based review of medical records.
(9/850)
OBJECTIVE: To determine the incidence and types of preventable adverse events in elderly patients. DESIGN: Review of random sample of medical records in two stage process by nurses and physicians to detect adverse events. Two study investigators then judged preventability. SETTING: Hospitals in US states of Utah and Colorado, excluding psychiatric and Veterans Administration hospitals. SUBJECTS: 15 000 hospitalised patients discharged in 1992. MAIN OUTCOME MEASURES: Incidence of preventable adverse events (number of preventable events per 100 discharges) in elderly patients (>/=65 years old) and non-elderly patients (16-64 years). RESULTS: When results were extrapolated to represent all discharges in 1992 in both states, non-elderly patients had 8901 adverse events (incidence 2.80% (SE 0.18%)) compared with 7419 (5.29% (0.37%)) among elderly patients (P=0.001). Non-elderly patients had 5038 preventable adverse events (incidence 1.58% (0.14%)) compared with 4134 (2.95% (0.28%)) in elderly patients (P=0.001). Elderly patients had a higher incidence of preventable events related to medical procedures (such as thoracentesis, cardiac catheterisation) (0.69% (0.14%) v 0.13% (0.04%)), preventable adverse drug events (0.63% (0.14%) v 0.17% (0.05%)), and preventable falls (0.10% (0.06%) v 0.01% (0.02%)). In multivariate analyses, adjusted for comorbid illnesses and case mix, age was not an independent predictor of preventable adverse events. CONCLUSIONS: Preventable adverse events were more common among elderly patients, probably because of the clinical complexity of their care rather than age based discrimination. Preventable adverse drug events, events related to medical procedures, and falls were especially common in elderly patients and should be targets for efforts to prevent errors. (+info)
Implementation of rules based computerised bedside prescribing and administration: intervention study.
(10/850)
OBJECTIVES: To implement and assess a rules based computerised prescribing system with the aim of improving the safety of prescriptions and the administration of drugs. DESIGN: Analysis of performance of computerised system plus questionnaire survey of users. SETTING: 64 bed renal unit in a teaching hospital. INTERVENTION: : Introduction of the system into routine clinical use. MAIN OUTCOME MEASURES: Number of attempted prescriptions cancelled by the system; proportion of warning messages overridden; users' comparisons of the system with conventional procedures. RESULTS: Between October 1998 and August 1999 the system cancelled 58 (0.07%) out of 87 789 prescriptions on the grounds of clinical safety. In addition, 427 (57%) attempted prescriptions generating high level warnings and 1257 (8%) generating low level warnings were not completed. In a user survey 82% (31/38) of doctors and nurses considered the system to be an improvement on conventional procedures. CONCLUSIONS: The system has contributed to safety and patient care. All prescriptions are complete and legible, and transcription errors have been eliminated. The system assists clinicians when they are writing a prescription by making available information on patients. The system supports clinical decision making and has been well received by doctors, nurses, and pharmacists. (+info)
Identifying drug safety issues: from research to practice.
(11/850)
PURPOSE: Adverse drug events (ADEs), or injuries due to drugs, are common and often preventable. However, identifying ADEs, potential ADEs, and medication errors can be a major challenge. In this review, we describe methodologies that have been used to identify these events and give strategies for identification in non-study settings. RESULTS: Methods such as voluntary reporting, chart review, and computerized monitoring for events have been most commonly used in studies of ADEs in inpatients. However, voluntary reporting, the method most hospitals currently use, has a very low yield of events. Chart review is much more sensitive but the costs are prohibitive. Computerized monitoring for ADEs (using rules or triggers) is a high yield and relatively inexpensive strategy that should be adopted by organizations. A limitation of this strategy, however, is that it identifies few medication errors and potential ADEs, which are also important. These can be captured through pharmacy logs, chart review, and direct observation. Once events have been identified, they can be classified by type of event, severity, and preventability. In non-study settings, the most practical method for identifying ADEs is computerized monitoring, and for identifying prescribing errors it is pharmacy logs of interventions. Once problems are found, a structure (either individual or committee) must be in place to classify them, identify opportunities for improvement, and carry out the necessary changes. CONCLUSIONS: Health care organizations have the technology to significantly improve their detection of ADEs, medication errors, and potential ADEs. Identification and subsequent classification of events is crucial for quality efforts to improve patient safety. (+info)
Medication review and documentation in physician office practice.
(12/850)
CONTEXT: Adverse drug reactions and drug-drug interactions are common. Medication-induced morbidity might be prevented through the documentation of medicines in the medical record and review of the medical record before new medications are prescribed. PRACTICE PATTERN EXAMINED: Documentation and review by primary care physicians of patient use of prescription drugs, over-the-counter drugs (OTCs), nutritional supplements, and herbal and other alternative treatments. DATA SOURCE: A stratified random sample of 1802 internists and family practitioners from the American Medical Association Physician Masterfile was surveyed; 655 physicians responded (response rate, 36%). RESULTS: 99.8% of physicians reported documenting prescription drugs in the medical record. Fewer reported documenting OTCs (68%) or nutritional supplements (63%); only 47% documented herbal and other alternative treatments. Almost all respondents reported reviewing prescription medications before prescribing a new therapy (99.8%), but only 86% reported reviewing OTCs at the same time. Fewer than half of physicians reported reviewing nutritional supplements or herbal and other alternative treatments before prescribing a new therapy. CONCLUSIONS: This study draws on self-reported data, and the response rate was low. Thus, the results probably overestimate actual rates of documentation and review. Review and documentation of nonprescription substances are uncommon in primary care practice. (+info)
RADARx: Recognizing, Assessing, and Documenting Adverse Rx events.
(13/850)
BACKGROUND: Adverse events are a leading cause of morbidity and mortality. Adverse Drug Events (ADEs) are frequent, under-reported, costly, and largely preventable. Computerized tools expose effectively ADEs and can reduce their impact. METHODS: RADARx is a Veterans Administration (VA) VistA-compatible M software program that integrates computerized ADE screening, probability assessment, documentation, and reporting capabilities. Data dictionary mapping tools have enabled RADARx implementation at 3 sites. All RADARx alerts generated at VA Medical Center (VAMC) Nashville from 7/1/99 to 9/30/99 were evaluated. RESULTS: Total ADEs documented using RADARx numbered 57. RADARx discovered 34 ADEs and 48 'potential' ADEs; 23 ADEs were found using traditional means. Overall, 11% of RADARx alerts were true positives. Pharmacist review of the 8-20 alerts generated daily costs between 10 and 30 minutes. (+info)
Error analysis using organizational simulation.
(14/850)
Organizational simulations have been used by project organizations in civil and aerospace industries to identify work processes and organizational structures that are likely to fail under certain conditions. Using a simulation system based on Galbraith's information-processing theory and Simon's notion of bounded-rationality, we retrospectively modeled a chemotherapy administration error that occurred in a hospital setting. Our simulation suggested that when there is a high rate of unexpected events, the oncology fellow was differentially backlogged with work when compared with other organizational members. Alternative scenarios suggested that providing more knowledge resources to the oncology fellow improved her performance more effectively than adding additional staff to the organization. Although it is not possible to know whether this might have prevented the error, organizational simulation may be an effective tool to prospectively evaluate organizational "weak links", and explore alternative scenarios to correct potential organizational problems before they generate errors. (+info)
Use of a clinical event monitor to prevent and detect medication errors.
(15/850)
Errors in health care facilities are common and often unrecognized. We have used our clinical event monitor to prevent and detect medication errors by scrutinizing electronic messages sent to it when any medication order is written in our facility. A growing collection of medication safety rules covering dose limit errors, laboratory monitoring, and other topics may be applied to each medication order message to provide an additional layer of protection beyond existing order checks, reminders, and alerts available within our computer-based record system. During a typical day the event monitor receives 4802 messages, of which 4719 pertain to medication orders. We have found the clinical event monitor to be a valuable tool for clinicians and quality management groups charged with improving medication safety. (+info)
Medication errors in a paediatric teaching hospital in the UK: five years operational experience.
(16/850)
BACKGROUND: In the past 10 years, medication errors have come to be recognised as an important cause of iatrogenic disease in hospital patients. AIMS: To determine the incidence and type of medication errors in a large UK paediatric hospital over a five year period, and to ascertain whether any error prevention programmes had influenced error occurrence. METHODS: Retrospective review of medication errors documented in standard reporting forms completed prospectively from April 1994 to August 1999. Main outcome measure was incidence of error reporting, including pre- and post-interventions. RESULTS: Medication errors occurred in 0.15% of admissions (195 errors; one per 662 admissions). While the highest rate occurred in neonatal intensive care (0.98%), most errors occurred in medical wards. Nurses were responsible for most reported errors (59%). Errors involving the intravenous route were commonest (56%), with antibiotics being the most frequent drug involved (44%). Fifteen (8%) involved a tenfold medication error. Although 18 (9.2%) required active patient intervention, 96% of errors were classified as minor at the time of reporting. Forty eight per cent of parents were not told an error had occurred. The introduction of a policy of double checking all drugs dispensed by pharmacy staff led to a reduction in errors from 9.8 to 6 per year. Changing the error reporting form to make it less punitive increased the error reporting rate from 32.7 to 38 per year. CONCLUSION: The overall medication error rate was low. Despite this there are clear opportunities to make system changes to reduce error rates further. (+info)