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Sample records for preventable medical errors

  1. 20 Tips to Help Prevent Medical Errors

    MedlinePlus

    ... Prevent Medical Errors 20 Tips to Help Prevent Medical Errors: Patient Fact Sheet This information is for ... current information. Select to Download PDF (295 KB). Medical errors can occur anywhere in the health care ...

  2. Medical Errors: Tips to Help Prevent Them

    MedlinePlus

    ... to Web version Medical Errors: Tips to Help Prevent Them Medical Errors: Tips to Help Prevent Them Medical errors are one of the nation's ... single most important way you can help to prevent errors is to be an active member of ...

  3. Prevention of medication errors: detection and audit.

    PubMed

    Montesi, Germana; Lechi, Alessandro

    2009-06-01

    1. Medication errors have important implications for patient safety, and their identification is a main target in improving clinical practice errors, in order to prevent adverse events. 2. Error detection is the first crucial step. Approaches to this are likely to be different in research and routine care, and the most suitable must be chosen according to the setting. 3. The major methods for detecting medication errors and associated adverse drug-related events are chart review, computerized monitoring, administrative databases, and claims data, using direct observation, incident reporting, and patient monitoring. All of these methods have both advantages and limitations. 4. Reporting discloses medication errors, can trigger warnings, and encourages the diffusion of a culture of safe practice. Combining and comparing data from various and encourages the diffusion of a culture of safe practice sources increases the reliability of the system. 5. Error prevention can be planned by means of retroactive and proactive tools, such as audit and Failure Mode, Effect, and Criticality Analysis (FMECA). Audit is also an educational activity, which promotes high-quality care; it should be carried out regularly. In an audit cycle we can compare what is actually done against reference standards and put in place corrective actions to improve the performances of individuals and systems. 6. Patient safety must be the first aim in every setting, in order to build safer systems, learning from errors and reducing the human and fiscal costs. PMID:19594533

  4. Preventing medication errors in cancer chemotherapy.

    PubMed

    Cohen, M R; Anderson, R W; Attilio, R M; Green, L; Muller, R J; Pruemer, J M

    1996-04-01

    Recommendations for preventing medication errors in cancer chemotherapy are made. Before a health care provider is granted privileges to prescribe, dispense, or administer antineoplastic agents, he or she should undergo a tailored educational program and possibly testing or certification. Appropriate reference materials should be developed. Each institution should develop a dose-verification process with as many independent checks as possible. A detailed checklist covering prescribing, transcribing, dispensing, and administration should be used. Oral orders are not acceptable. All doses should be calculated independently by the physician, the pharmacist, and the nurse. Dosage limits should be established and a review process set up for doses that exceed the limits. These limits should be entered into pharmacy computer systems, listed on preprinted order forms, stated on the product packaging, placed in strategic locations in the institution, and communicated to employees. The prescribing vocabulary must be standardized. Acronyms, abbreviations, and brand names must be avoided and steps taken to avoid other sources of confusion in the written orders, such as trailing zeros. Preprinted antineoplastic drug order forms containing checklists can help avoid errors. Manufacturers should be encouraged to avoid or eliminate ambiguities in drug names and dosing information. Patients must be educated about all aspects of their cancer chemotherapy, as patients represent a last line of defense against errors. An interdisciplinary team at each practice site should review every medication error reported. Pharmacists should be involved at all sites where antineoplastic agents are dispensed. Although it may not be possible to eliminate all medication errors in cancer chemotherapy, the risk can be minimized through specific steps. Because of their training and experience, pharmacists should take the lead in this effort. PMID:8697025

  5. Medication error prevention: profiling one of pharmacy's foremost advocacy efforts for advice on error prevention.

    PubMed

    Proulx, S; Wilfinger, R; Cohen, M R

    1997-04-01

    Medication errors have become a growing concern with the increase in the number of critically ill patients, in the complexity of drug therapy and in the use of more potent, dangerous drugs. The Institute for Safe Medication Practices (ISMP), a nonprofit organization founded three years ago, is in the forefront of medication error prevention efforts. Working with practitioners, regulatory agencies, healthcare institutions, professional organizations and the pharmaceutical industry, both nationally and internationally, ISMP provides timely and accurate medication safety information through its educational programs, site-reviews, and ongoing publications. This article reviews the work of ISMP and offers recommendations for managers to begin error prevention strategies. PMID:10166239

  6. The pharmacist's role in preventing medication errors in older adults.

    PubMed

    Kasbekar, Rupal; Maples, Meghan; Bernacchi, Ann; Duong, Linh; Oramasionwu, Christine U

    2014-12-01

    Approximately 1.5 million medication errors occur each year in the United States. Older adults may be at increased risk for these errors as a result of a variety of contributing factors such as inappropriate medication use, polymorbidity, and complexities in managing dosage adjustments for geriatric patients. Pharmacists, as trained medication experts, are uniquely poised to lead efforts to prevent, detect, and resolve medications errors. As the American population continues to age, future pharmacists are likely to play an even greater role in promoting safe and effective medication use in older adults. In this paper, we highlight common settings for medication errors in older individuals, explore tools and solutions for error prevention, and outline the unique role that pharmacists have in preventing medication errors in older adults. PMID:25521659

  7. Emergency department crowding and risk of preventable medical errors.

    PubMed

    Epstein, Stephen K; Huckins, David S; Liu, Shan W; Pallin, Daniel J; Sullivan, Ashley F; Lipton, Robert I; Camargo, Carlos A

    2012-04-01

    The objective of the study is to determine the association between emergency department (ED) crowding and preventable medical errors (PME). This was a retrospective cohort study of 533 ED patients enrolled in the National ED Safety Study (NEDSS) in four Massachusetts EDs. Individual patients' average exposure to ED crowding during their ED visit was compared with the occurrence of a PME (yes/no) for the three diagnostic categories in NEDSS: acute myocardial infarction, asthma exacerbation, and dislocation requiring procedural sedation. To accommodate site-to-site differences in available administrative data, ED crowding was measured using one of three previously validated crowding metrics (ED Work Index, ED Workscore, and ED Occupancy). At each site, the continuous measure was placed into site-specific quartiles, and these quartiles then were combined across sites. We found that 46 (8.6%; 95% confidence interval, 6.4-11.3%) of the 533 patients experienced a PME. For those seen during higher levels of ED crowding (quartile 4 vs. quartile 1), the occurrence of PMEs was more than twofold higher, both on unadjusted analysis and adjusting for two potential confounders (diagnosis, site). The association appeared non-linear, with most PMEs occurring at the highest crowding level. We identified a direct association between high levels of ED crowding and risk of preventable medical errors. Further study is needed to determine the generalizability of these results. Should such research confirm our findings, we would suggest that mitigating ED crowding may reduce the occurrence of preventable medical errors. PMID:22009553

  8. An intravenous medication safety system: preventing high-risk medication errors at the point of care.

    PubMed

    Hatcher, Irene; Sullivan, Mark; Hutchinson, James; Thurman, Susan; Gaffney, F Andrew

    2004-10-01

    Improving medication safety at the point of care--particularly for high-risk drugs--is a major concern of nursing administrators. The medication errors most likely to cause harm are administration errors related to infusion of high-risk medications. An intravenous medication safety system is designed to prevent high-risk infusion medication errors and to capture continuous quality improvement data for best practice improvement. Initial testing with 50 systems in 2 units at Vanderbilt University Medical Center revealed that, even in the presence of a fully mature computerized prescriber order-entry system, the new safety system averted 99 potential infusion errors in 8 months. PMID:15577664

  9. Medication Errors: New EU Good Practice Guide on Risk Minimisation and Error Prevention.

    PubMed

    Goedecke, Thomas; Ord, Kathryn; Newbould, Victoria; Brosch, Sabine; Arlett, Peter

    2016-06-01

    A medication error is an unintended failure in the drug treatment process that leads to, or has the potential to lead to, harm to the patient. Reducing the risk of medication errors is a shared responsibility between patients, healthcare professionals, regulators and the pharmaceutical industry at all levels of healthcare delivery. In 2015, the EU regulatory network released a two-part good practice guide on medication errors to support both the pharmaceutical industry and regulators in the implementation of the changes introduced with the EU pharmacovigilance legislation. These changes included a modification of the 'adverse reaction' definition to include events associated with medication errors, and the requirement for national competent authorities responsible for pharmacovigilance in EU Member States to collaborate and exchange information on medication errors resulting in harm with national patient safety organisations. To facilitate reporting and learning from medication errors, a clear distinction has been made in the guidance between medication errors resulting in adverse reactions, medication errors without harm, intercepted medication errors and potential errors. This distinction is supported by an enhanced MedDRA(®) terminology that allows for coding all stages of the medication use process where the error occurred in addition to any clinical consequences. To better understand the causes and contributing factors, individual case safety reports involving an error should be followed-up with the primary reporter to gather information relevant for the conduct of root cause analysis where this may be appropriate. Such reports should also be summarised in periodic safety update reports and addressed in risk management plans. Any risk minimisation and prevention strategy for medication errors should consider all stages of a medicinal product's life-cycle, particularly the main sources and types of medication errors during product development. This article

  10. Preventing medication errors in neonatology: Is it a dream?

    PubMed

    Antonucci, Roberto; Porcella, Annalisa

    2014-08-01

    Since 1999, the problem of patient safety has drawn particular attention, becoming a priority in health care. A "medication error" (ME) is any preventable event occurring at any phase of the pharmacotherapy process (ordering, transcribing, dispensing, administering, and monitoring) that leads to, or can lead to, harm to the patient. Hence, MEs can involve every professional of the clinical team. MEs range from those with severe consequences to those with little or no impact on the patient. Although a high ME rate has been found in neonatal wards, newborn safety issues have not been adequately studied until now. Healthcare professionals working in neonatal wards are particularly susceptible to committing MEs due to the peculiarities of newborn patients and of the neonatal intensive care unit (NICU) environment. Current neonatal prevention strategies for MEs have been borrowed from adult wards, but many factors such as high costs and organizational barriers have hindered their diffusion. In general, two types of strategies have been proposed: the first strategy consists of identifying human factors that result in errors and redesigning the work in the NICU in order to minimize them; the second one suggests to design and implement effective systems for preventing errors or intercepting them before reaching the patient. In the future, prevention strategies for MEs need to be improved and tailored to the special neonatal population and the NICU environment and, at the same time, every effort will have to be made to support their clinical application. PMID:25254183

  11. Checklists in Neurosurgery to Decrease Preventable Medical Errors: A Review.

    PubMed

    Enchev, Yavor

    2015-10-01

    Neurosurgery represents a zero tolerance environment for medical errors, especially preventable ones like all types of wrong site surgery, complications due to the incorrect positioning of patients for neurosurgical interventions and complications due to failure of the devices required for the specific procedure. Following the excellent and encouraging results of the safety checklists in intensive care medicine and in other surgical areas, the checklist was naturally introduced in neurosurgery. To date, the reported world experience with neurosurgical checklists is limited to 15 series with fewer than 20,000 cases in various neurosurgical areas. The purpose of this review was to study the reported neurosurgical checklists according to the following parameters: year of publication; country of origin; area of neurosurgery; type of neurosurgical procedure-elective or emergency; person in charge of the checklist completion; participants involved in completion; whether they prevented incorrect site surgery; whether they prevented complications due to incorrect positioning of the patients for neurosurgical interventions; whether they prevented complications due to failure of the devices required for the specific procedure; their specific aims; educational preparation and training; the time needed for checklist completion; study duration and phases; number of cases included; barriers to implementation; efforts to implementation; team appreciation; and safety outcomes. Based on this analysis, it could be concluded that neurosurgical checklists represent an efficient, reliable, cost-effective and time-saving tool for increasing patient safety and elevating the neurosurgeons' self-confidence. Every neurosurgical department must develop its own neurosurgical checklist or adopt and modify an existing one according to its specific features and needs in an attempt to establish or develop its safety culture. The world, continental, regional and national neurosurgical societies

  12. Checklists in Neurosurgery to Decrease Preventable Medical Errors: A Review

    PubMed Central

    Enchev, Yavor

    2015-01-01

    Neurosurgery represents a zero tolerance environment for medical errors, especially preventable ones like all types of wrong site surgery, complications due to the incorrect positioning of patients for neurosurgical interventions and complications due to failure of the devices required for the specific procedure. Following the excellent and encouraging results of the safety checklists in intensive care medicine and in other surgical areas, the checklist was naturally introduced in neurosurgery. To date, the reported world experience with neurosurgical checklists is limited to 15 series with fewer than 20,000 cases in various neurosurgical areas. The purpose of this review was to study the reported neurosurgical checklists according to the following parameters: year of publication; country of origin; area of neurosurgery; type of neurosurgical procedure-elective or emergency; person in charge of the checklist completion; participants involved in completion; whether they prevented incorrect site surgery; whether they prevented complications due to incorrect positioning of the patients for neurosurgical interventions; whether they prevented complications due to failure of the devices required for the specific procedure; their specific aims; educational preparation and training; the time needed for checklist completion; study duration and phases; number of cases included; barriers to implementation; efforts to implementation; team appreciation; and safety outcomes. Based on this analysis, it could be concluded that neurosurgical checklists represent an efficient, reliable, cost-effective and time-saving tool for increasing patient safety and elevating the neurosurgeons’ self-confidence. Every neurosurgical department must develop its own neurosurgical checklist or adopt and modify an existing one according to its specific features and needs in an attempt to establish or develop its safety culture. The world, continental, regional and national neurosurgical societies

  13. Medication Errors

    MedlinePlus

    ... to reduce the risk of medication errors to industry and others at FDA. Additionally, DMEPA prospectively reviews ... List of Abbreviations Regulations and Guidances Guidance for Industry: Safety Considerations for Product Design to Minimize Medication ...

  14. Medication Errors

    MedlinePlus

    Medicines cure infectious diseases, prevent problems from chronic diseases, and ease pain. But medicines can also cause harmful reactions if not used ... You can help prevent errors by Knowing your medicines. Keep a list of the names of your ...

  15. Use of a clinical event monitor to prevent and detect medication errors.

    PubMed Central

    Payne, T. H.; Savarino, J.; Marshall, R.; Hoey, C. T.

    2000-01-01

    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. PMID:11079962

  16. A method for the prevention of high-risk medication errors

    NASA Astrophysics Data System (ADS)

    Allgeyer, Dean

    2007-02-01

    A device and process for preventing medical errors due to the improper administration of an intravenously delivered medication includes the spectroscopic analysis of intravenous fluid components. An emission source and detector are placed adjacent to the intravenous tubing of an administration set to generate signals for spectroscopic analysis. The signals are processed to identify the medication and, in certain embodiments of the invention, can determine the medication's concentration. In a preferred embodiment, the emission source, detector, and hardware and software for the spectroscopic analysis are placed in an infusion pump.

  17. Medical error and disclosure.

    PubMed

    White, Andrew A; Gallagher, Thomas H

    2013-01-01

    Errors occur commonly in healthcare and can cause significant harm to patients. Most errors arise from a combination of individual, system, and communication failures. Neurologists may be involved in harmful errors in any practice setting and should familiarize themselves with tools to prevent, report, and examine errors. Although physicians, patients, and ethicists endorse candid disclosure of harmful medical errors to patients, many physicians express uncertainty about how to approach these conversations. A growing body of research indicates physicians often fail to meet patient expectations for timely and open disclosure. Patients desire information about the error, an apology, and a plan for preventing recurrence of the error. To meet these expectations, physicians should participate in event investigations and plan thoroughly for each disclosure conversation, preferably with a disclosure coach. Physicians should also anticipate and attend to the ongoing medical and emotional needs of the patient. A cultural change towards greater transparency following medical errors is in motion. Substantial progress is still required, but neurologists can further this movement by promoting policies and environments conducive to open reporting, respectful disclosure to patients, and support for the healthcare workers involved. PMID:24182370

  18. Evaluating a medical error taxonomy.

    PubMed Central

    Brixey, Juliana; Johnson, Todd R.; Zhang, Jiajie

    2002-01-01

    Healthcare has been slow in using human factors principles to reduce medical errors. The Center for Devices and Radiological Health (CDRH) recognizes that a lack of attention to human factors during product development may lead to errors that have the potential for patient injury, or even death. In response to the need for reducing medication errors, the National Coordinating Council for Medication Errors Reporting and Prevention (NCC MERP) released the NCC MERP taxonomy that provides a standard language for reporting medication errors. This project maps the NCC MERP taxonomy of medication error to MedWatch medical errors involving infusion pumps. Of particular interest are human factors associated with medical device errors. The NCC MERP taxonomy of medication errors is limited in mapping information from MEDWATCH because of the focus on the medical device and the format of reporting. PMID:12463789

  19. Insulin use: preventable errors.

    PubMed

    2014-01-01

    Insulin is vital for patients with type 1 diabetes and useful for certain patients with type 2 diabetes. The serious consequences of insulin-related medication errors are overdose, resulting in severe hypoglycaemia, causing seizures, coma and even death; or underdose, resulting in hyperglycaemia and sometimes ketoacidosis. Errors associated with the preparation and administration of insulin are often reported, both outside and inside the hospital setting. These errors are preventable. By analysing reports from organisations devoted to medication error prevention and from poison control centres, as well as a few studies and detailed case reports of medication errors, various types of error associated with insulin use have been identified, especially in the hospital setting. Generally, patients know more about the practicalities of their insulin treatment than healthcare professionals with intermittent involvement. Medication errors involving insulin can occur at each step of the medication-use process: prescribing, data entry, preparation, dispensing and administration. When prescribing insulin, wrong-dose errors have been caused by the use of abbreviations, especially "U" instead of the word "units" (often resulting in a 10-fold overdose because the "U" is read as a zero), or by failing to write the drug's name correctly or in full. In electronic prescribing, the sheer number of insulin products is a source of confusion and, ultimately, wrong-dose errors, and often overdose. Prescribing, dispensing or administration software is rarely compatible with insulin prescriptions in which the dose is adjusted on the basis of the patient's subsequent capillary blood glucose readings, and can therefore generate errors. When preparing and dispensing insulin, a tuberculin syringe is sometimes used instead of an insulin syringe, leading to overdose. Other errors arise from confusion created by similar packaging, between different insulin products or between insulin and other

  20. Predictors of Chemotherapy Patients' Intentions to Engage in Medical Error Prevention

    PubMed Central

    Wernli, Martin

    2010-01-01

    Background. Patients can make contributions to the safety of chemotherapy administration but little is known about their motivations to participate in safety-enhancing strategies. The theory of planned behavior was applied to analyze attitudes, norms, behavioral control, and chemotherapy patients' intentions to participate in medical error prevention. Methods. A quantitative, cross-sectional survey study among chemotherapy patients treated at the oncology/hematology department of a large regional hospital was conducted. Confirmatory factor analysis and structural equation modeling were used to investigate the relationship between patients' responses to measures of attitudes, norms, and behavioral control and their intentions. Results. Four hundred seventy-nine patients completed the survey (52% response rate). Attitudes, perceived behavioral control, and subjective norms explained 62% of the variance in intentions to engage in error monitoring and reporting. Perceived behavioral control (β = 0.476), norms relating to patients' relatives (β = 0.343), and instrumental attitudes (β = 0.281) were the strongest (direct) predictors of patients' intentions. Experiential attitudes had the smallest effect on intentions (β = 0.178). Subjective norms relating to expectations attributed to oncology staff had strong direct and indirect effects on patients' intentions (total effect, 0.382). Conclusions. Patients acknowledge the benefit of error monitoring and reporting and anticipate positive outcomes of involvement, but their valuations of the process of engaging in error prevention are less positive. Behavioral control and perceptions of staff approval are central for patients. Involvement of cancer patients in safety requires oncologists to address their patients' normative and control beliefs through education and proactive approval of patient engagement. PMID:20682607

  1. Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE)

    PubMed Central

    Galanter, William; Falck, Suzanne; Burns, Matthew; Laragh, Marci; Lambert, Bruce L

    2013-01-01

    Objective To determine whether indication-based computer order entry alerts intercept wrong-patient medication errors. Materials and methods At an academic medical center serving inpatients and outpatients, we developed and implemented a clinical decision support system to prompt clinicians for indications when certain medications were ordered without an appropriately coded indication on the problem list. Among all the alerts that fired, we identified every instance when a medication order was started but not completed and, within a fixed time interval, the same prescriber placed an order for the same medication for a different patient. We closely reviewed each of these instances to determine whether they were likely to have been intercepted errors. Results Over a 6-year period 127 320 alerts fired, which resulted in 32 intercepted wrong-patient errors, an interception rate of 0.25 per 1000 alerts. Neither the location of the prescriber nor the type of prescriber affected the interception rate. No intercepted errors were for patients with the same last name, but in 59% of the intercepted errors the prescriber had both patients’ charts open when the first order was initiated. Discussion Indication alerts linked to the problem list have previously been shown to improve problem list completion. This analysis demonstrates another benefit, the interception of wrong-patient medication errors. Conclusions Indication-based alerts yielded a wrong-patient medication error interception rate of 0.25 per 1000 alerts. These alerts could be implemented independently or in combination with other strategies to decrease wrong-patient medication errors. PMID:23396543

  2. A Review of Medication Errors in Iran: Sources, Underreporting Reasons and Preventive Measures

    PubMed Central

    Mansouri, Ava; Ahmadvand, Alireza; Hadjibabaie, Molouk; Javadi, Mohammadreza; Khoee, Seyed Hamid; Dastan, Farzaneh; Gholami, Kheirollah

    2014-01-01

    Medication error (ME) is the most common preventable cause of adverse drug events which negatively affects patient safety. Inadequate, low-quality studies plus wide estimation variations in ME from developing countries including Iran, decreases the reliability of ME evaluations. To clarify sources, underreporting reasons and preventive measures of MEs, we reviewed Iran current available literature. We searched Scopus, WOS, PubMed, CINAHL, EBSCOHOST and Persian databases (IranMedex, and SID) up to October 2012. Two authors independently selected and one reviewed and extracted data. Results reported by more than 30% of studies considered as the most important topics. Finally 25 articles were included. All study designs were cross-sectional (except for two interventional studies) and in hospital settings. Nursing staff and students were the most observed populations. Individual factor, with “inadequate knowledge of medication” as its most frequent reason, were the mostly reported source of MEs. Fear and reporting process were two most important reporting barriers. The sense of being reprimanded and ignoring to report respectively were their most frequent factors. Anti-infectives were the most frequent drugs involved in MEs. Preventive measures were varied and reporting of their effectiveness was inconsistent. There are still many research gaps which need to be explored by further studies. Based on our findings, further researches may be focused on design, implementation, and evaluation of a ME reporting system as groundwork, assessing systems-related factors to ME alongside individual factors and evaluating the effectiveness of preventive measures for MEs in trials. PMID:24734052

  3. Investigating the Causes of Medication Errors and Strategies to Prevention of Them from Nurses and Nursing Student Viewpoint

    PubMed Central

    Gorgich, Enam Alhagh Charkhat; Barfroshan, Sanam; Ghoreishi, Gholamreza; Yaghoobi, Maryam

    2016-01-01

    Introduction and Aim: Medication errors as a serious problem in world and one of the most common medical errors that threaten patient safety and may lead to even death of them. The purpose of this study was to investigate the causes of medication errors and strategies to prevention of them from nurses and nursing student viewpoint. Materials & Methods: This cross-sectional descriptive study was conducted on 327 nursing staff of khatam-al-anbia hospital and 62 intern nursing students in nursing and midwifery school of Zahedan, Iran, enrolled through the availability sampling in 2015. The data were collected by the valid and reliable questionnaire. To analyze the data, descriptive statistics, T-test and ANOVA were applied by use of SPSS16 software. Findings: The results showed that the most common causes of medications errors in nursing were tiredness due increased workload (97.8%), and in nursing students were drug calculation, (77.4%). The most important way for prevention in nurses and nursing student opinion, was reducing the work pressure by increasing the personnel, proportional to the number and condition of patients and also creating a unit as medication calculation. Also there was a significant relationship between the type of ward and the mean of medication errors in two groups. Conclusion: Based on the results it is recommended that nurse-managers resolve the human resources problem, provide workshops and in-service education about preparing medications, side-effects of drugs and pharmacological knowledge. Using electronic medications cards is a measure which reduces medications errors. PMID:27045413

  4. Preventing medication errors in hospitals through a systems approach and technological innovation: a prescription for 2010.

    PubMed

    Crane, Jacquelyn; Crane, Frederick G

    2006-01-01

    Medication errors in hospital settings are considered both widespread and costly to the American healthcare system; yet, it is tractable to available solutions. This article offers a novel prescription for the problem that could be implemented by 2010. It consists of a systems approach--failure mode effects analysis (FMEA)--in combination with emerging technologies, such as a decision support system (DDS) with integrated real-time medical informatics, electronic medical records (EMR), computer physician order entry (CPOE), bar coding, automated dispensing machines (ADM), and robotics. Cost and benefit analysis reveals that this proposed integrated solution will radically reduce medication errors in hospitals and save the lives of thousands of Americans who frequent such facilities on an annual basis, as well as reduce healthcare costs. PMID:17131715

  5. Clinical review: Medication errors in critical care

    PubMed Central

    Moyen, Eric; Camiré, Eric; Stelfox, Henry Thomas

    2008-01-01

    Medication errors in critical care are frequent, serious, and predictable. Critically ill patients are prescribed twice as many medications as patients outside of the intensive care unit (ICU) and nearly all will suffer a potentially life-threatening error at some point during their stay. The aim of this article is to provide a basic review of medication errors in the ICU, identify risk factors for medication errors, and suggest strategies to prevent errors and manage their consequences. PMID:18373883

  6. Medical device error.

    PubMed

    Goodman, Gerald R

    2002-12-01

    This article discusses principal concepts for the analysis, classification, and reporting of problems involving medical device technology. We define a medical device in regulatory terminology and define and discuss concepts and terminology used to distinguish the causes and sources of medical device problems. Database classification systems for medical device failure tracking are presented, as are sources of information on medical device failures. The importance of near-accident reporting is discussed to alert users that reported medical device errors are typically limited to those that have caused an injury or death. This can represent only a fraction of the true number of device problems. This article concludes with a summary of the most frequently reported medical device failures by technology type, clinical application, and clinical setting. PMID:12400632

  7. Help prevent hospital errors

    MedlinePlus

    ... A.D.A.M. Editorial team. Related MedlinePlus Health Topics Medication Errors Patient Safety Browse the Encyclopedia A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission ... for online health information and services. Learn more about A.D. ...

  8. Medical Error and Moral Luck.

    PubMed

    Hubbeling, Dieneke

    2016-09-01

    This paper addresses the concept of moral luck. Moral luck is discussed in the context of medical error, especially an error of omission that occurs frequently, but only rarely has adverse consequences. As an example, a failure to compare the label on a syringe with the drug chart results in the wrong medication being administered and the patient dies. However, this error may have previously occurred many times with no tragic consequences. Discussions on moral luck can highlight conflicting intuitions. Should perpetrators receive a harsher punishment because of an adverse outcome, or should they be dealt with in the same way as colleagues who have acted similarly, but with no adverse effects? An additional element to the discussion, specifically with medical errors, is that according to the evidence currently available, punishing individual practitioners does not seem to be effective in preventing future errors. The following discussion, using relevant philosophical and empirical evidence, posits a possible solution for the moral luck conundrum in the context of medical error: namely, making a distinction between the duty to make amends and assigning blame. Blame should be assigned on the basis of actual behavior, while the duty to make amends is dependent on the outcome. PMID:26662613

  9. Medication errors: an overview for clinicians.

    PubMed

    Wittich, Christopher M; Burkle, Christopher M; Lanier, William L

    2014-08-01

    Medication error is an important cause of patient morbidity and mortality, yet it can be a confusing and underappreciated concept. This article provides a review for practicing physicians that focuses on medication error (1) terminology and definitions, (2) incidence, (3) risk factors, (4) avoidance strategies, and (5) disclosure and legal consequences. A medication error is any error that occurs at any point in the medication use process. It has been estimated by the Institute of Medicine that medication errors cause 1 of 131 outpatient and 1 of 854 inpatient deaths. Medication factors (eg, similar sounding names, low therapeutic index), patient factors (eg, poor renal or hepatic function, impaired cognition, polypharmacy), and health care professional factors (eg, use of abbreviations in prescriptions and other communications, cognitive biases) can precipitate medication errors. Consequences faced by physicians after medication errors can include loss of patient trust, civil actions, criminal charges, and medical board discipline. Methods to prevent medication errors from occurring (eg, use of information technology, better drug labeling, and medication reconciliation) have been used with varying success. When an error is discovered, patients expect disclosure that is timely, given in person, and accompanied with an apology and communication of efforts to prevent future errors. Learning more about medication errors may enhance health care professionals' ability to provide safe care to their patients. PMID:24981217

  10. [Medication errors with concentrated potassium intravenous solutions: Data of the literature, context and prevention].

    PubMed

    Charpiat, B; Magdinier, C; Leboucher, G; Aubrun, F

    2016-01-01

    Accidental direct intravenous injection of a concentrated solution of potassium often leads to patient death. In France, recommendations of healthcare agencies to prevent such accidents cover only preparation and intravenous infusion conditions. Accidents continue to occur in French hospitals. These facts demonstrate that these recommendations are insufficient and ineffective to prevent such deaths, especially those occurring during a catheter flushing. This article reviews the measures able to reduce the number of accidents. Countries which removed concentrated ampoules from ward stocks observed a decrease of the number of accidental deaths. This withdrawal, recommended by the World Health Organization, is now part of standards in studies aimed at determining the safety of care in hospitals. However, removal alone is insufficient to eliminate the risk. The combination with other measures should be considered. These measures are the provision of a combination of diluted intravenous ready to use solutions, the promotion of the oral route with tablets and oral solutions for potassium replenishment and to make available products with safeguards to prevent single shot intravenous injection. Studies aimed at determining the consequences on preventing concentrated potassium accidents of a widespread distribution of isotonic sodium chloride pre-filled ready-to-use syringes for catheter flushing should be performed. PMID:26298848

  11. Medication Errors in Outpatient Pediatrics.

    PubMed

    Berrier, Kyla

    2016-01-01

    Medication errors may occur during parental administration of prescription and over-the-counter medications in the outpatient pediatric setting. Misinterpretation of medication labels and dosing errors are two types of errors in medication administration. Health literacy may play an important role in parents' ability to safely manage their child's medication regimen. There are several proposed strategies for decreasing these medication administration errors, including using standardized dosing instruments, using strictly metric units for medication dosing, and providing parents and caregivers with picture-based dosing instructions. Pediatric healthcare providers should be aware of these strategies and seek to implement many of them into their practices. PMID:27537086

  12. Identifying and preventing medical errors in patients with limited English proficiency: key findings and tools for the field.

    PubMed

    Wasserman, Melanie; Renfrew, Megan R; Green, Alexander R; Lopez, Lenny; Tan-McGrory, Aswita; Brach, Cindy; Betancourt, Joseph R

    2014-01-01

    Since the 1999 Institute of Medicine (IOM) report To Err is Human, progress has been made in patient safety, but few efforts have focused on safety in patients with limited English proficiency (LEP). This article describes the development, content, and testing of two new evidence-based Agency for Healthcare Research and Quality (AHRQ) tools for LEP patient safety. In the content development phase, a comprehensive mixed-methods approach was used to identify common causes of errors for LEP patients, high-risk scenarios, and evidence-based strategies to address them. Based on our findings, Improving Patient Safety Systems for Limited English Proficient Patients: A Guide for Hospitals contains recommendations to improve detection and prevention of medical errors across diverse populations, and TeamSTEPPS Enhancing Safety for Patients with Limited English Proficiency Module trains staff to improve safety through team communication and incorporating interpreters in the care process. The Hospital Guide was validated with leaders in quality and safety at diverse hospitals, and the TeamSTEPPS LEP module was field-tested in varied settings within three hospitals. Both tools were found to be implementable, acceptable to their audiences, and conducive to learning. Further research on the impact of the combined use of the guide and module would shed light on their value as a multifaceted intervention. PMID:24629098

  13. Medication Errors Involving the Intravenous Administration Route: Characteristics of Voluntarily Reported Medication Errors.

    PubMed

    Wolf, Zane Robinson

    2016-01-01

    Characteristics of medication errors involving the intravenous (IV) route of administration were analyzed in reports from 1995 to 2013. This was accomplished through a voluntary medication error reporting program. A retrospective case study design analyzed reports by practitioners or consumers on IV-associated medication errors (N = 975) affecting patients. Patterns in error accounts reflected cultural changes in health care organizations. Equipment, labeling, incorrect route of administration, types of errors, patient outcomes, and causal agents represented major codes. Results point to health care provider and consumer knowledge, the need for ongoing education of nursing staff, and interdisciplinary strategies for preventing IV-associated medication errors. PMID:27379682

  14. Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events?

    PubMed

    Charles, Krista; Cannon, Margaret; Hall, Robert; Coustasse, Alberto

    2014-01-01

    Computerized provider order entry (CPOE) systems allow physicians to prescribe patient services electronically. In hospitals, CPOE essentially eliminates the need for handwritten paper orders and achieves cost savings through increased efficiency. The purpose of this research study was to examine the benefits of and barriers to CPOE adoption in hospitals to determine the effects on medical errors and adverse drug events (ADEs) and examine cost and savings associated with the implementation of this newly mandated technology. This study followed a methodology using the basic principles of a systematic review and referenced 50 sources. CPOE systems in hospitals were found to be capable of reducing medical errors and ADEs, especially when CPOE systems are bundled with clinical decision support systems designed to alert physicians and other healthcare providers of pending lab or medical errors. However, CPOE systems face major barriers associated with adoption in a hospital system, mainly high implementation costs and physicians' resistance to change. PMID:25593568

  15. Predictors of medication errors among elderly hospitalized patients.

    PubMed

    Picone, Debra Matsen; Titler, Marita G; Dochterman, Joanne; Shever, Leah; Kim, Taikyoung; Abramowitz, Paul; Kanak, Mary; Qin, Rui

    2008-01-01

    Medication errors are a serious safety concern and most errors are preventable. A retrospective study design was employed to describe medication errors experienced during 10187 hospitalizations of elderly patients admitted to a Midwest teaching hospital between July 1, 1998 and December 31, 2001 and to determine the factors predictive of medication errors. The model considered patient characteristics, clinical conditions, interventions, and nursing unit characteristics. The dependent variable, medication error, was measured using a voluntary incident reporting system. There were 861 medication errors; 96% may have been preventable. Most errors were omissions errors (48.8%) and the source was administration (54%) or transcription errors (38%). Variables associated with a medication error included unique number of medications (polypharmacy), patient gender and race, RN staffing changes, medical and nursing interventions, and specific pharmacological agents. Further validation of this explanatory model and focused interventions may help decrease the incidence of medication errors. PMID:18305099

  16. Barriers to Medical Error Reporting

    PubMed Central

    Poorolajal, Jalal; Rezaie, Shirin; Aghighi, Negar

    2015-01-01

    Background: This study was conducted to explore the prevalence of medical error underreporting and associated barriers. Methods: This cross-sectional study was performed from September to December 2012. Five hospitals, affiliated with Hamadan University of Medical Sciences, in Hamedan, Iran were investigated. A self-administered questionnaire was used for data collection. Participants consisted of physicians, nurses, midwives, residents, interns, and staffs of radiology and laboratory departments. Results: Overall, 50.26% of subjects had committed but not reported medical errors. The main reasons mentioned for underreporting were lack of effective medical error reporting system (60.0%), lack of proper reporting form (51.8%), lack of peer supporting a person who has committed an error (56.0%), and lack of personal attention to the importance of medical errors (62.9%). The rate of committing medical errors was higher in men (71.4%), age of 50–40 years (67.6%), less-experienced personnel (58.7%), educational level of MSc (87.5%), and staff of radiology department (88.9%). Conclusions: This study outlined the main barriers to reporting medical errors and associated factors that may be helpful for healthcare organizations in improving medical error reporting as an essential component for patient safety enhancement. PMID:26605018

  17. Error Prevention Aid

    NASA Technical Reports Server (NTRS)

    1987-01-01

    In a complex computer environment there is ample opportunity for error, a mistake by a programmer, or a software-induced undesirable side effect. In insurance, errors can cost a company heavily, so protection against inadvertent change is a must for the efficient firm. The data processing center at Transport Life Insurance Company has taken a step to guard against accidental changes by adopting a software package called EQNINT (Equations Interpreter Program). EQNINT cross checks the basic formulas in a program against the formulas that make up the major production system. EQNINT assures that formulas are coded correctly and helps catch errors before they affect the customer service or its profitability.

  18. Case report of a medication error

    PubMed Central

    Naunton, Mark; Nor, Kowsar; Bartholomaeus, Andrew; Thomas, Jackson; Kosari, Sam

    2016-01-01

    Abstract Introduction: The World Health Organisation recognizes confusing drug names as one of the most common causes of medication errors. Other factors include spelling, phonetic, or packaging similarities. Case presentation: We presented a case report of an inadvertent administration of a non-ocular pharmaceutical product (Novasone® lotion) into the eye of an octogenarian individual, and briefly reviewed the relevant literature. Discussion: We discussed prevention strategies to avoid similar ophthalmic medication errors. PMID:27428216

  19. The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis

    PubMed Central

    2014-01-01

    Background The Health Information Technology for Economic and Clinical Health (HITECH) Act subsidizes implementation by hospitals of electronic health records with computerized provider order entry (CPOE), which may reduce patient injuries caused by medication errors (preventable adverse drug events, pADEs). Effects on pADEs have not been rigorously quantified, and effects on medication errors have been variable. The objectives of this analysis were to assess the effectiveness of CPOE at reducing pADEs in hospital-related settings, and examine reasons for heterogeneous effects on medication errors. Methods Articles were identified using MEDLINE, Cochrane Library, Econlit, web-based databases, and bibliographies of previous systematic reviews (September 2013). Eligible studies compared CPOE with paper-order entry in acute care hospitals, and examined diverse pADEs or medication errors. Studies on children or with limited event-detection methods were excluded. Two investigators extracted data on events and factors potentially associated with effectiveness. We used random effects models to pool data. Results Sixteen studies addressing medication errors met pooling criteria; six also addressed pADEs. Thirteen studies used pre-post designs. Compared with paper-order entry, CPOE was associated with half as many pADEs (pooled risk ratio (RR) = 0.47, 95% CI 0.31 to 0.71) and medication errors (RR = 0.46, 95% CI 0.35 to 0.60). Regarding reasons for heterogeneous effects on medication errors, five intervention factors and two contextual factors were sufficiently reported to support subgroup analyses or meta-regression. Differences between commercial versus homegrown systems, presence and sophistication of clinical decision support, hospital-wide versus limited implementation, and US versus non-US studies were not significant, nor was timing of publication. Higher baseline rates of medication errors predicted greater reductions (P < 0.001). Other context and

  20. Addressing medical errors in hand surgery.

    PubMed

    Johnson, Shepard P; Adkinson, Joshua M; Chung, Kevin C

    2014-09-01

    Influential think tanks such as the Institute of Medicine have raised awareness about the implications of medical errors. In response, organizations, medical societies, and hospitals have initiated programs to decrease the incidence and prevent adverse effects of these errors. Surgeons deal with the direct implications of adverse events involving patients. In addition to managing the physical consequences, they are confronted with ethical and social issues when caring for a harmed patient. Although there is considerable effort to implement system-wide changes, there is little guidance for hand surgeons on how to address medical errors. Admitting an error by a physician is difficult, but a transparent environment where patients are notified of errors and offered consolation and compensation is essential to maintain physician-patient trust. Furthermore, equipping hand surgeons with a guide for addressing medical errors will help identify system failures, provide learning points for safety improvement, decrease litigation against physicians, and demonstrate a commitment to ethical and compassionate medical care. PMID:25154576

  1. Analysis of Medication Error Reports

    SciTech Connect

    Whitney, Paul D.; Young, Jonathan; Santell, John; Hicks, Rodney; Posse, Christian; Fecht, Barbara A.

    2004-11-15

    In medicine, as in many areas of research, technological innovation and the shift from paper based information to electronic records has created a climate of ever increasing availability of raw data. There has been, however, a corresponding lag in our abilities to analyze this overwhelming mass of data, and classic forms of statistical analysis may not allow researchers to interact with data in the most productive way. This is true in the emerging area of patient safety improvement. Traditionally, a majority of the analysis of error and incident reports has been carried out based on an approach of data comparison, and starts with a specific question which needs to be answered. Newer data analysis tools have been developed which allow the researcher to not only ask specific questions but also to “mine” data: approach an area of interest without preconceived questions, and explore the information dynamically, allowing questions to be formulated based on patterns brought up by the data itself. Since 1991, United States Pharmacopeia (USP) has been collecting data on medication errors through voluntary reporting programs. USP’s MEDMARXsm reporting program is the largest national medication error database and currently contains well over 600,000 records. Traditionally, USP has conducted an annual quantitative analysis of data derived from “pick-lists” (i.e., items selected from a list of items) without an in-depth analysis of free-text fields. In this paper, the application of text analysis and data analysis tools used by Battelle to analyze the medication error reports already analyzed in the traditional way by USP is described. New insights and findings were revealed including the value of language normalization and the distribution of error incidents by day of the week. The motivation for this effort is to gain additional insight into the nature of medication errors to support improvements in medication safety.

  2. Medication Errors - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Are Here: Home → Multiple Languages → All Health Topics → Medication Errors URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Medication Errors - Multiple Languages To use the sharing features on ...

  3. The pathophysiology of medication errors: how and where they arise

    PubMed Central

    McDowell, Sarah E; Ferner, Harriet S; Ferner, Robin E

    2009-01-01

    Errors arise when an action is intended but not performed; errors that arise from poor planning or inadequate knowledge are characterized as mistakes; those that arise from imperfect execution of well-formulated plans are called slips when an erroneous act is committed and lapses when a correct act is omitted. Some tasks are intrinsically prone to error. Examples are tasks that are unfamiliar to the operator or performed under pressure. Tasks that require the calculation of a dosage or dilution are especially susceptible to error. The tasks of prescribing, preparation, and administration of medicines are complex, and are carried out within a complex system; errors can occur at each of many steps and the error rate for the overall process is therefore high. The error rate increases when health-care professionals are inexperienced, inattentive, rushed, distracted, fatigued, or depressed; orthopaedic surgeons and nurses may be more likely than other health-care professionals to make medication errors. Medication error rates in hospital are higher in paediatric departments and intensive care units than elsewhere. Rates of medication errors may be higher in very young or very old patients. Intravenous antibiotics are the drugs most commonly involved in medication errors in hospital; antiplatelet agents, diuretics, and non-steroidal anti-inflammatory drugs are most likely to account for ‘preventable admissions’. Computers effectively reduce the rates of easily counted errors. It is not clear whether they can save lives lost through rare but dangerous errors in the medication process. PMID:19594527

  4. Medical error and related factors during internship and residency.

    PubMed

    Ahmadipour, Habibeh; Nahid, Mortazavi

    2015-01-01

    It is difficult to determine the real incidence of medical errors due to the lack of a precise definition of errors, as well as the failure to report them under certain circumstances. We carried out a cross- sectional study in Kerman University of Medical Sciences, Iran in 2013. The participants were selected through the census method. The data were collected using a self-administered questionnaire, which consisted of questions on the participants' demographic data and questions on the medical errors committed. The data were analysed by SPSS 19. It was found that 270 participants had committed medical errors. There was no significant difference in the frequency of errors committed by interns and residents. In the case of residents, the most common error was misdiagnosis and in that of interns, errors related to history-taking and physical examination. Considering that medical errors are common in the clinical setting, the education system should train interns and residents to prevent the occurrence of errors. In addition, the system should develop a positive attitude among them so that they can deal better with medical errors. PMID:26592783

  5. Toward a cognitive taxonomy of medical errors.

    PubMed Central

    Zhang, Jiajie; Patel, Vimla L.; Johnson, Todd R.; Shortliffe, Edward H.

    2002-01-01

    One critical step in addressing and resolving the problems associated with human errors is the development of a cognitive taxonomy of such errors. In the case of errors, such a taxonomy may be developed (1) to categorize all types of errors along cognitive dimensions, (2) to associate each type of error with a specific underlying cognitive mechanism, (3) to explain why, and even predict when and where, a specific error will occur, and (4) to generate intervention strategies for each type of error. Based on Reason's (1992) definition of human errors and Norman's (1986) cognitive theory of human action, we have developed a preliminary action-based cognitive taxonomy of errors that largely satisfies these four criteria in the domain of medicine. We discuss initial steps for applying this taxonomy to develop an online medical error reporting system that not only categorizes errors but also identifies problems and generates solutions. PMID:12463962

  6. Reducing the Risk of Harm From Medication Errors in Children

    PubMed Central

    Neuspiel, Daniel R.; Taylor, Melissa M.

    2013-01-01

    Medication errors affect the pediatric age group in all settings: outpatient, inpatient, emergency department, and at home. Children may be at special risk due to size and physiologic variability, limited communication ability, and treatment by nonpediatric health care providers. Those with chronic illnesses and on multiple medications may be at higher risk of experiencing adverse drug events. Some strategies that have been employed to reduce harm from pediatric medication errors include e-prescribing and computerized provider order entry with decision support, medication reconciliation, barcode systems, clinical pharmacists in medical settings, medical staff training, package changes to reduce look-alike/sound-alike confusion, standardization of labeling and measurement devices for home administration, and quality improvement interventions to promote nonpunitive reporting of medication errors coupled with changes in systems and cultures. Future research is needed to measure the effectiveness of these preventive strategies. PMID:25114560

  7. FMEA: a model for reducing medical errors.

    PubMed

    Chiozza, Maria Laura; Ponzetti, Clemente

    2009-06-01

    Patient safety is a management issue, in view of the fact that clinical risk management has become an important part of hospital management. Failure Mode and Effect Analysis (FMEA) is a proactive technique for error detection and reduction, firstly introduced within the aerospace industry in the 1960s. Early applications in the health care industry dating back to the 1990s included critical systems in the development and manufacture of drugs and in the prevention of medication errors in hospitals. In 2008, the Technical Committee of the International Organization for Standardization (ISO), licensed a technical specification for medical laboratories suggesting FMEA as a method for prospective risk analysis of high-risk processes. Here we describe the main steps of the FMEA process and review data available on the application of this technique to laboratory medicine. A significant reduction of the risk priority number (RPN) was obtained when applying FMEA to blood cross-matching, to clinical chemistry analytes, as well as to point-of-care testing (POCT). PMID:19298799

  8. Medical Errors: a Hidden Killer

    MedlinePlus

    ... who called for changes to that criteria. "The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being ... studies that analyzed medical death rate data from 2000 to 2008, including ...

  9. Medical errors: getting the incentives right.

    PubMed

    Grepperud, Sverre

    2005-12-01

    This work examines the role of penalties as providers of incentives to prevent medical errors and ensure that such incidents, once they occur, become common knowledge. It is shown that a scheme with two penalties (accountability and non-report) induces the first-best solution. However, this scheme does not necessarily imply a punitive environment, but may, under given circumstances, yield insignificant and even negative penalties. Alternative sanction systems, such as voluntary reporting and immunity, are found to have less desirable properties. An exception is confidentiality (anonymity) which turns out to be an optimal scheme. Finally, the examination of various penalty restrictions (scope and scale) shows that such barriers may promote both tougher and softer sanction schemes. PMID:16378237

  10. Propylene Glycol Toxicity with Stoss Therapy; State Drug Tracking Database Helps Prevent an Error; Where Did That Medication Come From?; Expiration Date Difficult to Read.

    PubMed

    Cohen, Michael R; Smetzer, Judy L

    2015-04-01

    These medication errors have occurred in health care facilities at least once. They will happen again-perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site (www.ismp.org), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications. PMID:26448654

  11. Medical Errors: a Hidden Killer

    MedlinePlus

    ... The medical coding system was designed to maximize billing for physician services, not to collect national health ... the views of MedlinePlus, the National Library of Medicine, the National Institutes of Health, the U.S. Department ...

  12. Strategies for reducing medication errors in the emergency department

    PubMed Central

    Weant, Kyle A; Bailey, Abby M; Baker, Stephanie N

    2014-01-01

    Medication errors are an all-too-common occurrence in emergency departments across the nation. This is largely secondary to a multitude of factors that create an almost ideal environment for medication errors to thrive. To limit and mitigate these errors, it is necessary to have a thorough knowledge of the medication-use process in the emergency department and develop strategies targeted at each individual step. Some of these strategies include medication-error analysis, computerized provider-order entry systems, automated dispensing cabinets, bar-coding systems, medication reconciliation, standardizing medication-use processes, education, and emergency-medicine clinical pharmacists. Special consideration also needs to be given to the development of strategies for the pediatric population, as they can be at an elevated risk of harm. Regardless of the strategies implemented, the prevention of medication errors begins and ends with the development of a culture that promotes the reporting of medication errors, and a systematic, nonpunitive approach to their elimination. PMID:27147879

  13. Preventing and responding to medical identity theft.

    PubMed

    Amori, Geraldine

    2008-01-01

    Medical identity theft is a crime with two victims: patients and providers. It is easy to commit and lucrative because healthcare record keeping and business interactions are complex and mainly electronic. Patients whose identity has been stolen are vulnerable to both medical error and financial loss. Providers may suffer both reputation loss and financial loss. There are steps to help prevent and to respond appropriately to medical identity theft. PMID:20200908

  14. Patient-Controlled Analgesia Basal Infusion Overdose; Life-threatening Errors with Flecainide Suspension in Children; Medical Product Error-Prevention Efforts Need to Be Shared and Harmonized Internationally.

    PubMed

    Cohen, Michael R; Smetzer, Judy L

    2015-09-01

    These medication errors have occurred in health care facilities at least once. They will happen again-perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site (www.ismp.org), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications. PMID:26715797

  15. Patient-Controlled Analgesia Basal Infusion Overdose; Life-threatening Errors with Flecainide Suspension in Children; Medical Product Error-Prevention Efforts Need to Be Shared and Harmonized Internationally

    PubMed Central

    Cohen, Michael R.; Smetzer, Judy L.

    2015-01-01

    These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site (www.ismp.org), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications. PMID:26715797

  16. Analyzing temozolomide medication errors: potentially fatal.

    PubMed

    Letarte, Nathalie; Gabay, Michael P; Bressler, Linda R; Long, Katie E; Stachnik, Joan M; Villano, J Lee

    2014-10-01

    The EORTC-NCIC regimen for glioblastoma requires different dosing of temozolomide (TMZ) during radiation and maintenance therapy. This complexity is exacerbated by the availability of multiple TMZ capsule strengths. TMZ is an alkylating agent and the major toxicity of this class is dose-related myelosuppression. Inadvertent overdose can be fatal. The websites of the Institute for Safe Medication Practices (ISMP), and the Food and Drug Administration (FDA) MedWatch database were reviewed. We searched the MedWatch database for adverse events associated with TMZ and obtained all reports including hematologic toxicity submitted from 1st November 1997 to 30th May 2012. The ISMP describes errors with TMZ resulting from the positioning of information on the label of the commercial product. The strength and quantity of capsules on the label were in close proximity to each other, and this has been changed by the manufacturer. MedWatch identified 45 medication errors. Patient errors were the most common, accounting for 21 or 47% of errors, followed by dispensing errors, which accounted for 13 or 29%. Seven reports or 16% were errors in the prescribing of TMZ. Reported outcomes ranged from reversible hematological adverse events (13%), to hospitalization for other adverse events (13%) or death (18%). Four error reports lacked detail and could not be categorized. Although the FDA issued a warning in 2003 regarding fatal medication errors and the product label warns of overdosing, errors in TMZ dosing occur for various reasons and involve both healthcare professionals and patients. Overdosing errors can be fatal. PMID:25026995

  17. Nursing student medication errors: a retrospective review.

    PubMed

    Harding, Lorill; Petrick, Teresa

    2008-01-01

    This article presents the findings of a retrospective review of medication errors made and reported by nursing students in a 4-year baccalaureate program. Data were examined in relation to the semester of the program, kind of error according to the rights of medication administration, and contributing factors. Three categories of contributing factors were identified: rights violations, system factors, and knowledge and understanding. It became apparent that system factors, or the context in which medication administration takes place, are not fully considered when students are taught about medication administration. Teaching strategies need to account for the dynamic complexity of this process and incorporate experiential knowledge. This review raised several important questions about how this information guides our practice as educators in the clinical and classroom settings and how we can work collaboratively with practice partners to influence change and increase patient safety. PMID:18232615

  18. Medication errors during hospital drug rounds.

    PubMed Central

    Ridge, K W; Jenkins, D B; Noyce, P R; Barber, N D

    1995-01-01

    Objective--To determine the nature and rate of drug administration errors in one National Health Service hospital. Design--Covert observational survey be tween January and April 1993 of drug rounds with intervention to stop drug administration errors reaching the patient. Setting--Two medical, two surgical, and two medicine for the elderly wards in a former district general hospital, now a NHS trust hospital. Subjects--37 Nurses performing routine single nurse drug rounds. Main measures--Drug administration errors recorded by trained observers. Results--Seventy four drug rounds were observed in which 115 errors occurred during 3312 drug administrations. The overall error rate was 3.5% (95% confidence interval 2.9% to 4.1%). Errors owing to omissions, because the drug had not been supplied or located or the prescription had not been seen, accounted for most (68%, 78) of the errors. Wrong doses accounted for 15% (17) errors, four of which were greater than the prescribed dose. The dose was given within two hours of the time indicated by the prescriber in 98.2% of cases. Conclusion--The observed rate of drug administration errors is too high. It might be reduced by a multidisciplinary review of practices in prescribing, supply, and administration of drugs. PMID:10156392

  19. Nature and frequency of medication errors in a geriatric ward: an Indonesian experience

    PubMed Central

    Ernawati, Desak Ketut; Lee, Ya Ping; Hughes, Jeffery David

    2014-01-01

    Purpose To determine the nature and frequency of medication errors during medication delivery processes in a public teaching hospital geriatric ward in Bali, Indonesia. Methods A 20-week prospective study on medication errors occurring during the medication delivery process was conducted in a geriatric ward in a public teaching hospital in Bali, Indonesia. Participants selected were inpatients aged more than 60 years. Patients were excluded if they had a malignancy, were undergoing surgery, or receiving chemotherapy treatment. The occurrence of medication errors in prescribing, transcribing, dispensing, and administration were detected by the investigator providing in-hospital clinical pharmacy services. Results Seven hundred and seventy drug orders and 7,662 drug doses were reviewed as part of the study. There were 1,563 medication errors detected among the 7,662 drug doses reviewed, representing an error rate of 20.4%. Administration errors were the most frequent medication errors identified (59%), followed by transcription errors (15%), dispensing errors (14%), and prescribing errors (7%). Errors in documentation were the most common form of administration errors. Of these errors, 2.4% were classified as potentially serious and 10.3% as potentially significant. Conclusion Medication errors occurred in every stage of the medication delivery process, with administration errors being the most frequent. The majority of errors identified in the administration stage were related to documentation. Provision of in-hospital clinical pharmacy services could potentially play a significant role in detecting and preventing medication errors. PMID:24940067

  20. Medication error in anaesthesia and critical care: A cause for concern

    PubMed Central

    Kothari, Dilip; Gupta, Suman; Sharma, Chetan; Kothari, Saroj

    2010-01-01

    Medication error is a major cause of morbidity and mortality in medical profession, and anaesthesia and critical care are no exception to it. Man, medicine, machine and modus operandi are the main contributory factors to it. In this review, incidence, types, risk factors and preventive measures of the medication errors are discussed in detail. PMID:20885862

  1. Preventing Communication Errors in Telephone Medicine

    PubMed Central

    Reisman, Anna B; Brown, Karen E

    2005-01-01

    Errors in telephone communication can result in outcomes ranging from inconvenience and anxiety to serious compromises in patient safety. Although 25% of interactions between physicians and patients take place on the telephone, little has been written about telephone communication and medical mishaps. Similarly, training in telephone medicine skills is limited; only 6% of residency programs teach any aspect of telephone medicine. Increasing familiarity with common telephone challenges with patients may help physicians decrease the likelihood of negative outcomes. We use case vignettes to highlight communication errors in common telephone scenarios. These scenarios include giving sensitive test results, requests for narcotics, managing ill patients who are not sick enough for the emergency room, dealing with late-night calls, communicating with unintelligible patients, and handling calls from family members. We provide management strategies to minimize the occurrence of these errors. PMID:16191150

  2. Factors effective on medication errors: A nursing view

    PubMed Central

    Shahrokhi, Akram; Ebrahimpour, Fatemeh; Ghodousi, Arash

    2013-01-01

    Objective: Medication errors are the most common medical errors, which may result in some complications for patients. This study was carried out to investigate what influence medication errors by nurses from their viewpoint. Methods: In this descriptive study, 150 nurses who were working in Qazvin Medical University teaching hospitals were selected by proportional random sampling, and data were collected by means of a researcher-made questionnaire including demographic attributes (age, gender, working experience,…), and contributing factors in medication errors (in three categories including nurse-related, management-related, and environment-related factors). Findings: The mean age of the participant nurses was 30.7 ± 6.5 years. Most of them (87.1%) were female with a Bachelor of Sciences degree (86.7%) in nursing. The mean of their overtime working was 64.8 ± 38 h/month. The results showed that the nurse-related factors are the most effective factors (55.44 ± 9.14) while the factors related to the management system (52.84 ± 11.24) and the ward environment (44.0 ± 10.89) are respectively less effective. The difference between these three groups was significant (P = 0.000). In each aforementioned category, the most effective factor on medication error (ranked from the most effective to the least effective) were as follow: The nurse's inadequate attention (98.7%), the errors occurring in the transfer of medication orders from the patient's file to kardex (96.6%) and the ward's heavy workload (86.7%). Conclusion: In this study nurse-related factors were the most effective factors on medication errors, but nurses are one of the members of health-care providing team, so their performance must be considered in the context of the health-care system like work force condition, rules and regulations, drug manufacturing that might impact nurses performance, so it could not be possible to prevent medication errors without paying attention to our health-care system in a

  3. Reducing medical errors through barcoding at the point of care.

    PubMed

    Nichols, James H; Bartholomew, Cathy; Brunton, Mary; Cintron, Carlos; Elliott, Sheila; McGirr, Joan; Morsi, Deborah; Scott, Sue; Seipel, Joseph; Sinha, Daisy

    2004-01-01

    Medical errors are a major concern in health care today. Errors in point-of-care testing (POCT) are particularly problematic because the test is conducted by clinical operators at the site of patient care and immediate medical action is taken on the results prior to review by the laboratory. The Performance Improvement Program at Baystate Health System, Springfield, Massachusetts, noted a number of identification errors occurring with glucose and blood gas POCT devices. Incorrect patient account numbers that were attached to POCT results prevented the results from being transmitted to the patient's medical record and appropriately billed. In the worst case, they could lead to results being transferred to the wrong patient's chart and inappropriate medical treatment. Our first action was to lock-out operators who repeatedly made identification errors (3-Strike Rule), requiring operators to be counseled and retrained after their third error. The 3-Strike Rule significantly decreased our glucose meter errors (p = 0.014) but did not have an impact on the rate of our blood gas errors (p = 0.378). Neither device approached our ultimate goal of zero tolerance. A Failure Mode and Effects Analysis (FMEA) was conducted to determine the various processes that could lead to an identification error. A primary source of system failure was the manual entry of 14 digits for each test, five numbers for operator and nine numbers for patient account identification. Patient barcoding was implemented to automate the data entry process, and after an initial familiarization period, resulted in significant improvements in error rates for both the glucose (p = 0.0007) and blood gas devices (p = 0.048). Despite the improvements, error rates with barcoding still did not achieve zero errors. Operators continued to utilize manual data entry when the barcode scan was unsuccessful or unavailable, and some patients were found to have incorrect patient account numbers due to hospital transfer

  4. To Your Health: NLM update transcript - Impact of Medical errors

    MedlinePlus

    ... To Your Health: NLM update Transcript Impact of Medical errors : 06/27/2016 To use the sharing ... topics. While recent research published in BMJ finds medical errors may be higher than previously reported in ...

  5. Speak Up: Help Prevent Errors in Your Care: Laboratory Services

    MedlinePlus

    ... TM Help Prevent Errors in Your Care Laboratory Services To prevent health care errors, patients are urged ... are supported by the Centers for Medicare & Medicaid Services. This program gives simple advice on how you ...

  6. Opioids, iatrogenic harm and disclosure of medical error.

    PubMed

    Blinderman, Craig D

    2010-02-01

    The safety of patients in U.S. hospitals is a serious problem, with adverse events because of medical error affecting a significant proportion of hospitalized patients. Patients at the end of life are particularly vulnerable and are at risk of potential adverse events. This article presents a case in which opioids were rapidly titrated to neurotoxic doses in a patient who was terminally extubated. The patient was profoundly sedated and was noted to have Cheyne-Stokes breathing. The possibility of opioid-related iatrogenic harm is raised, and a discussion of what counts as medical error in these circumstances is explored. Palliative care specialists have a unique responsibility to provide guidance and establish a standard of care that clinicians should adhere to. Prevention of harm in dying patients should be a priority in the hospital setting. PMID:20152593

  7. Speak Up: Prevent Errors in Your Child's Care

    MedlinePlus

    SpeakUP TM Prevent Errors in Your Child’s Care Prevent Errors in Your Child’s Care Your child’s health and safety are important ... brochure has tips and answers to questions to prevent errors in your child’s care. The Joint Commission ...

  8. Medical errors in primary care clinics – a cross sectional study

    PubMed Central

    2012-01-01

    Background Patient safety is vital in patient care. There is a lack of studies on medical errors in primary care settings. The aim of the study is to determine the extent of diagnostic inaccuracies and management errors in public funded primary care clinics. Methods This was a cross-sectional study conducted in twelve public funded primary care clinics in Malaysia. A total of 1753 medical records were randomly selected in 12 primary care clinics in 2007 and were reviewed by trained family physicians for diagnostic, management and documentation errors, potential errors causing serious harm and likelihood of preventability of such errors. Results The majority of patient encounters (81%) were with medical assistants. Diagnostic errors were present in 3.6% (95% CI: 2.2, 5.0) of medical records and management errors in 53.2% (95% CI: 46.3, 60.2). For management errors, medication errors were present in 41.1% (95% CI: 35.8, 46.4) of records, investigation errors in 21.7% (95% CI: 16.5, 26.8) and decision making errors in 14.5% (95% CI: 10.8, 18.2). A total of 39.9% (95% CI: 33.1, 46.7) of these errors had the potential to cause serious harm. Problems of documentation including illegible handwriting were found in 98.0% (95% CI: 97.0, 99.1) of records. Nearly all errors (93.5%) detected were considered preventable. Conclusions The occurrence of medical errors was high in primary care clinics particularly with documentation and medication errors. Nearly all were preventable. Remedial intervention addressing completeness of documentation and prescriptions are likely to yield reduction of errors. PMID:23267547

  9. The Importance of Medication Errors Reporting in Improving the Quality of Clinical Care Services

    PubMed Central

    Elden, Nesreen Mohamed Kamal; Ismail, Amira

    2016-01-01

    Introduction: Medication errors have significant implications on patient safety. Error detection through an active management and effective reporting system discloses medication errors and encourages safe practices. Objectives: To improve patient safety through determining and reducing the major causes of medication errors (MEs), after applying tailored preventive strategies. Methodology: A pre-test, post-test study was conducted on all inpatients at a 177 bed hospital where all medication procedures in each ward were monitored by a clinical pharmacist. The patient files were reviewed, as well. Error reports were submitted to a hospital multidisciplinary committee to identify major causes of errors. Accordingly, corrective interventions that consisted of targeted training programs for nurses and physicians were conducted. Results: Medication errors were higher during ordering/prescription stage (38.1%), followed by administration phase (20.9%). About 45% of errors reached the patients: 43.5% were harmless and 1.4% harmful. 7.7% were potential errors and more than 47% could be prevented. After the intervention, error rates decreased from (6.7%) to (3.6%) (P≤0.001). Conclusion: The role of a ward based clinical pharmacist with a hospital multidisciplinary committee was effective in recognizing, designing and implementing tailored interventions for reduction of medication errors. A systematic approach is urgently needed to decrease organizational susceptibility to errors, through providing required resources to monitor, analyze and implement effective interventions. PMID:27045415

  10. The spectrum of medical errors: when patients sue

    PubMed Central

    Kels, Barry D; Grant-Kels, Jane M

    2012-01-01

    Inarguably medical errors constitute a serious, dangerous, and expensive problem for the twenty-first-century US health care system. This review examines the incidence, nature, and complexity of alleged medical negligence and medical malpractice. The authors hope this will constitute a road map to medical providers so that they can better understand the present climate and hopefully avoid the “Scylla and Charybdis” of medical errors and medical malpractice. Despite some documented success in reducing medical errors, adverse events and medical errors continue to represent an indelible stain upon the practice, reputation, and success of the US health care industry. In that regard, what may be required to successfully attack the unacceptably high severity and volume of medical errors is a locally directed and organized initiative sponsored by individual health care organizations that is coordinated, supported, and guided by state and federal governmental and nongovernmental agencies. PMID:22924008

  11. Classifying and Predicting Errors of Inpatient Medication Reconciliation

    PubMed Central

    Pippins, Jennifer R.; Gandhi, Tejal K.; Hamann, Claus; Ndumele, Chima D.; Labonville, Stephanie A.; Diedrichsen, Ellen K.; Carty, Marcy G.; Karson, Andrew S.; Bhan, Ishir; Coley, Christopher M.; Liang, Catherine L.; Turchin, Alexander; McCarthy, Patricia C.

    2008-01-01

    Background Failure to reconcile medications across transitions in care is an important source of potential harm to patients. Little is known about the predictors of unintentional medication discrepancies and how, when, and where they occur. Objective To determine the reasons, timing, and predictors of potentially harmful medication discrepancies. Design Prospective observational study. Patients Admitted general medical patients. Measurements Study pharmacists took gold-standard medication histories and compared them with medical teams’ medication histories, admission and discharge orders. Blinded teams of physicians adjudicated all unexplained discrepancies using a modification of an existing typology. The main outcome was the number of potentially harmful unintentional medication discrepancies per patient (potential adverse drug events or PADEs). Results Among 180 patients, 2066 medication discrepancies were identified, and 257 (12%) were unintentional and had potential for harm (1.4 per patient). Of these, 186 (72%) were due to errors taking the preadmission medication history, while 68 (26%) were due to errors reconciling the medication history with discharge orders. Most PADEs occurred at discharge (75%). In multivariable analyses, low patient understanding of preadmission medications, number of medication changes from preadmission to discharge, and medication history taken by an intern were associated with PADEs. Conclusions Unintentional medication discrepancies are common and more often due to errors taking an accurate medication history than errors reconciling this history with patient orders. Focusing on accurate medication histories, on potential medication errors at discharge, and on identifying high-risk patients for more intensive interventions may improve medication safety during and after hospitalization. PMID:18563493

  12. Avoiding Medication Errors: Reducing Harm in Residents Using Oral Anticoagulants.

    PubMed

    Grissinger, Matthew; Gaunt, Michael J; Rich, Darryl S

    2016-01-01

    Medication errors involving oral anticoagulants have led to serious adverse events, including hemorrhage, treatment failures leading to thromboembolic events, and death. This article will highlight medication errors that may arise during the use of oral anticoagulants and provide risk-reduction strategies to address the potential for error and patient harm. PMID:27250070

  13. Diagnostic Errors in Ambulatory Care: Dimensions and Preventive Strategies

    ERIC Educational Resources Information Center

    Singh, Hardeep; Weingart, Saul N.

    2009-01-01

    Despite an increasing focus on patient safety in ambulatory care, progress in understanding and reducing diagnostic errors in this setting lag behind many other safety concerns such as medication errors. To explore the extent and nature of diagnostic errors in ambulatory care, we identified five dimensions of ambulatory care from which errors may…

  14. Workload and environmental factors in hospital medication errors.

    PubMed

    Roseman, C; Booker, J M

    1995-01-01

    Nine hospital workload factors and seasonal changes in daylight and darkness were examined over a 5-year period in relation to nurse medication errors at a medical center in Anchorage, Alaska. Three workload factors, along with darkness, were found to be significant predictors of the risk of medication error. Errors increased with the number of patient days per month (OR/250 patient days = 1.61) and the number of shifts worked by temporary nursing staff (OR/10 shifts = 1.15); errors decreased with more overtime worked by permanent nursing staff members (OR/10 shifts = .85). Medication errors were 95% more likely in midwinter than in the fall, but the effect of increasing darkness was strongest; a 2-month delay was found between the level of darkness and the rate of errors. More than half of all medication errors occurred during the first 3 months of the year. PMID:7624233

  15. Reducing medication errors in critical care: a multimodal approach

    PubMed Central

    Kruer, Rachel M; Jarrell, Andrew S; Latif, Asad

    2014-01-01

    The Institute of Medicine has reported that medication errors are the single most common type of error in health care, representing 19% of all adverse events, while accounting for over 7,000 deaths annually. The frequency of medication errors in adult intensive care units can be as high as 947 per 1,000 patient-days, with a median of 105.9 per 1,000 patient-days. The formulation of drugs is a potential contributor to medication errors. Challenges related to drug formulation are specific to the various routes of medication administration, though errors associated with medication appearance and labeling occur among all drug formulations and routes of administration. Addressing these multifaceted challenges requires a multimodal approach. Changes in technology, training, systems, and safety culture are all strategies to potentially reduce medication errors related to drug formulation in the intensive care unit. PMID:25210478

  16. Knowledge of healthcare professionals about medication errors in hospitals

    PubMed Central

    Abdel-Latif, Mohamed M. M.

    2016-01-01

    Context: Medication errors are the most common types of medical errors in hospitals and leading cause of morbidity and mortality among patients. Aims: The aim of the present study was to assess the knowledge of healthcare professionals about medication errors in hospitals. Settings and Design: A self-administered questionnaire was distributed to randomly selected healthcare professionals in eight hospitals in Madinah, Saudi Arabia. Subjects and Methods: An 18-item survey was designed and comprised questions on demographic data, knowledge of medication errors, availability of reporting systems in hospitals, attitudes toward error reporting, causes of medication errors. Statistical Analysis Used: Data were analyzed with Statistical Package for the Social Sciences software Version 17. Results: A total of 323 of healthcare professionals completed the questionnaire with 64.6% response rate of 138 (42.72%) physicians, 34 (10.53%) pharmacists, and 151 (46.75%) nurses. A majority of the participants had a good knowledge about medication errors concept and their dangers on patients. Only 68.7% of them were aware of reporting systems in hospitals. Healthcare professionals revealed that there was no clear mechanism available for reporting of errors in most hospitals. Prescribing (46.5%) and administration (29%) errors were the main causes of errors. The most frequently encountered medication errors were anti-hypertensives, antidiabetics, antibiotics, digoxin, and insulin. Conclusions: This study revealed differences in the awareness among healthcare professionals toward medication errors in hospitals. The poor knowledge about medication errors emphasized the urgent necessity to adopt appropriate measures to raise awareness about medication errors in Saudi hospitals. PMID:27330261

  17. A systems approach to error prevention in medicine.

    PubMed

    Wieman, Thomas Jeffery; Wieman, Eric Andrew

    2004-12-01

    Minimization of medical errors is at the core of all clinical medical practices. The first tenet of care is to do no harm. The enormous complexity of modern medical care has made error detection and management extremely difficult. Traditional deterministic methods of solving the "error issue" cannot cope with the huge number of potential errors that are possible. Systems thinking and approach to error reduction provides a different avenue for tackling this challenging dilemma. The intent of this article is to introduce a systems view of medical errors and to explain how it can provide new insights about dealing with massively complex organizations such as the healthcare system. Important features include an understanding of system relationships, sources of error, human components, optimization versus perfection in systems and the interrelationships between human and system processes. PMID:15562464

  18. Medication Errors in the Home: A Multisite Study of Children With Cancer

    PubMed Central

    Roblin, Douglas W.; Weingart, Saul N.; Houlahan, Kathleen E.; Degar, Barbara; Billett, Amy; Keuker, Christopher; Biggins, Colleen; Li, Justin; Wasilewski, Karen; Mazor, Kathleen M.

    2013-01-01

    OBJECTIVE: As home medication use increases, medications previously managed by nurses are now managed by patients and their families. Our objective was to describe the types of errors occurring in the home medication management of children with cancer. METHODS: In a prospective observational study at 3 pediatric oncology clinics in the northeastern and southeastern United States, patients undergoing chemotherapy and their parents were recruited from November 2007 through April 2011. We reviewed medical records and checked prescription doses. A trained nurse visited the home, reviewed medication bottles, and observed administration. Two physicians independently made judgments regarding whether an error occurred and its severity. Overall rates of errors were weighted to account for clustering within sites. RESULTS: We reviewed 963 medications and observed 242 medication administrations in the homes of 92 patients. We found 72 medication errors. Four errors led to significant patient injury. An additional 40 errors had potential for injury: 2 were life-threatening, 13 were serious, and 25 were significant. Error rates varied between study sites (40–121 errors per 100 patients); the weighted overall rate was 70.2 errors per 100 patients (95% confidence interval [CI]: 58.9–81.6). The weighted rate of errors with injury was 3.6 (95% CI: 1.7–5.5) per 100 patients and with potential to injure the patient was 36.3 (95% CI: 29.3–43.3) per 100 patients. Nonchemotherapy medications were more often involved in an error than chemotherapy. CONCLUSIONS: Medication errors were common in this multisite study of outpatient pediatric cancer care. Rates of preventable medication-related injuries in this outpatient population were comparable or higher than those found in studies of hospitalized patients. PMID:23629608

  19. Development of an ontology to model medical errors, information needs, and the clinical communication space.

    PubMed Central

    Stetson, P. D.; McKnight, L. K.; Bakken, S.; Curran, C.; Kubose, T. T.; Cimino, J. J.

    2001-01-01

    Medical errors are common, costly and often preventable. Work in understanding the proximal causes of medical errors demonstrates that systems failures predispose to adverse clinical events. Most of these systems failures are due to lack of appropriate information at the appropriate time during the course of clinical care. Problems with clinical communication are common proximal causes of medical errors. We have begun a project designed to measure the impact of wireless computing on medical errors. We report here on our efforts to develop an ontology representing the intersection of medical errors, information needs and the communication space. We will use this ontology to support the collection, storage and interpretation of project data. The ontology's formal representation of the concepts in this novel domain will help guide the rational deployment of our informatics interventions. A real-life scenario is evaluated using the ontology in order to demonstrate its utility. PMID:11825270

  20. Medical Prevention of Breast Cancer

    PubMed Central

    Stubert, Johannes; Dieterich, Max; Gerber, Bernd

    2014-01-01

    Summary Breast cancer is the most common cancer of women in Western Europe and North America. Effective strategies of medical prevention could reduce the burden of breast cancer mortality. The best evidence for a risk reduction exists for hormonal agents such as tamoxifen and raloxifene (22–72%) or aromatase inhibitors (50–65%). However, the severity of side effects and the lack of evidence for an improved survival compromise the risk/benefit balance. In this review the results of chemoprevention studies, including new treatment approaches, are summarized with critical discussion of their use in clinical practice. PMID:25759621

  1. NURSE STAFFING AND MEDICATION ERRORS: CROSS SECTIONAL OR LONGITUDINAL RELATIONSHIPS?

    PubMed Central

    Mark, Barbara A.; Belyea, Michael

    2008-01-01

    We used autoregressive latent trajectory (ALT) modeling to examine the relationship between change in nurse staffing and change in medication errors over 6 months in 284 general medical-surgical nursing units. We also investigated the impact of select hospital and nursing unit characteristics on the baseline level and rate of change in medication errors. We found essentially no support for a nurse staffing – medication error relationship either cross-sectionally or longitudinally. Few hospital or nursing unit characteristics had significant relationships to either the baseline level or rate of change in medication errors. However, ALT modeling is a promising technique that can promote a deeper understanding of the theoretically complex relationships that may underlie the nurse staffing – medication error relationship. PMID:18825733

  2. Medication errors: problems and recommendations from a consensus meeting

    PubMed Central

    Agrawal, Abha; Aronson, Jeffrey K; Britten, Nicky; Ferner, Robin E; de Smet, Peter A; Fialová, Daniela; Fitzgerald, Richard J; Likić, Robert; Maxwell, Simon R; Meyboom, Ronald H; Minuz, Pietro; Onder, Graziano; Schachter, Michael; Velo, Giampaolo

    2009-01-01

    Here we discuss 15 recommendations for reducing the risks of medication errors: Provision of sufficient undergraduate learning opportunities to make medical students safe prescribers. Provision of opportunities for students to practise skills that help to reduce errors. Education of students about common types of medication errors and how to avoid them. Education of prescribers in taking accurate drug histories. Assessment in medical schools of prescribing knowledge and skills and demonstration that newly qualified doctors are safe prescribers. European harmonization of prescribing and safety recommendations and regulatory measures, with regular feedback about rational drug use. Comprehensive assessment of elderly patients for declining function. Exploration of low-dose regimens for elderly patients and preparation of special formulations as required. Training for all health-care professionals in drug use, adverse effects, and medication errors in elderly people. More involvement of pharmacists in clinical practice. Introduction of integrated prescription forms and national implementation in individual countries. Development of better monitoring systems for detecting medication errors, based on classification and analysis of spontaneous reports of previous reactions, and for investigating the possible role of medication errors when patients die. Use of IT systems, when available, to provide methods of avoiding medication errors; standardization, proper evaluation, and certification of clinical information systems. Nonjudgmental communication with patients about their concerns and elicitation of symptoms that they perceive to be adverse drug reactions. Avoidance of defensive reactions if patients mention symptoms resulting from medication errors. PMID:19594525

  3. The Environmental Context of Patient Safety and Medical Errors

    ERIC Educational Resources Information Center

    Wholey, Douglas; Moscovice, Ira; Hietpas, Terry; Holtzman, Jeremy

    2004-01-01

    The environmental context of patient safety and medical errors was explored with specific interest in rural settings. Special attention was paid to unique features of rural health care organizations and their environment that relate to the patient safety issue and medical errors (including the distribution of patients, types of adverse events…

  4. [Occurrence and prevention of errors in intensive care units].

    PubMed

    Valentin, A

    2012-05-01

    Recognition and analysis of error constitutes an essential tool for quality improvement in intensive care units (ICUs). The potential for the occurrence of error is considerably high in ICUs. Although errors will never be completely preventable, it is necessary to reduce frequency and consequences of error. A system approach needs to consider human limitations and to design working conditions, workplace, and processes in ICUs in a way that promotes reduction of error. The development of a preventive safety culture must be seen as an essential task for ICUs. PMID:22476763

  5. The effectiveness of risk management program on pediatric nurses’ medication error

    PubMed Central

    Dehghan-Nayeri, Nahid; Bayat, Fariba; Salehi, Tahmineh; Faghihzadeh, Soghrat

    2013-01-01

    Background: Medication therapy is one of the most complex and high-risk clinical processes that nurses deal with. Medication error is the most common type of error that brings about damage and death to patients, especially pediatric ones. However, these errors are preventable. Identifying and preventing undesirable events leading to medication errors are the main risk management activities. The aim of this study was to investigate the effectiveness of a risk management program on the pediatric nurses’ medication error rate. Materials and Methods: This study is a quasi-experimental one with a comparison group. In this study, 200 nurses were recruited from two main pediatric hospitals in Tehran. In the experimental hospital, we applied the risk management program for a period of 6 months. Nurses of the control hospital did the hospital routine schedule. A pre- and post-test was performed to measure the frequency of the medication error events. SPSS software, t-test, and regression analysis were used for data analysis. Results: After the intervention, the medication error rate of nurses at the experimental hospital was significantly lower (P < 0.001) and the error-reporting rate was higher (P < 0.007) compared to before the intervention and also in comparison to the nurses of the control hospital. Conclusions: Based on the results of this study and taking into account the high-risk nature of the medical environment, applying the quality-control programs such as risk management can effectively prevent the occurrence of the hospital undesirable events. Nursing mangers can reduce the medication error rate by applying risk management programs. However, this program cannot succeed without nurses’ cooperation. PMID:24403939

  6. Medical errors; causes, consequences, emotional response and resulting behavioral change

    PubMed Central

    Bari, Attia; Khan, Rehan Ahmed; Rathore, Ahsan Waheed

    2016-01-01

    Objective: To determine the causes of medical errors, the emotional and behavioral response of pediatric medicine residents to their medical errors and to determine their behavior change affecting their future training. Methods: One hundred thirty postgraduate residents were included in the study. Residents were asked to complete questionnaire about their errors and responses to their errors in three domains: emotional response, learning behavior and disclosure of the error. The names of the participants were kept confidential. Data was analyzed using SPSS version 20. Results: A total of 130 residents were included. Majority 128(98.5%) of these described some form of error. Serious errors that occurred were 24(19%), 63(48%) minor, 24(19%) near misses,2(2%) never encountered an error and 17(12%) did not mention type of error but mentioned causes and consequences. Only 73(57%) residents disclosed medical errors to their senior physician but disclosure to patient’s family was negligible 15(11%). Fatigue due to long duty hours 85(65%), inadequate experience 66(52%), inadequate supervision 58(48%) and complex case 58(45%) were common causes of medical errors. Negative emotions were common and were significantly associated with lack of knowledge (p=0.001), missing warning signs (p=<0.001), not seeking advice (p=0.003) and procedural complications (p=0.001). Medical errors had significant impact on resident’s behavior; 119(93%) residents became more careful, increased advice seeking from seniors 109(86%) and 109(86%) started paying more attention to details. Intrinsic causes of errors were significantly associated with increased information seeking behavior and vigilance (p=0.003) and (p=0.01) respectively. Conclusion: Medical errors committed by residents have inadequate disclosure to senior physicians and result in negative emotions but there was positive change in their behavior, which resulted in improvement in their future training and patient care. PMID:27375682

  7. Turning the tide on medical errors in intensive care units: a human factors approach.

    PubMed

    Rogerson, William T; Tremethick, Mary Jane

    2004-01-01

    Errors occur in all nursing settings. The current healthcare climate tends to focus on individuals as the cause of errors rather than addressing issues that may be inherently wrong with the healthcare system that predisposes the individual to make errors. Human factors engineering (HFE), which is focused on removing human factors as much as possible from errors, has the potential to greatly impact medical errors in intensive care units. Applied in other high-risk industries, HFE has been critical in understanding and preventing errors at a systems level. Knowledge concerning the role systems play in errors and improvements to medical systems using HFE is intended to empower nurses to be advocates for systems change, resulting in a safer work environment and a safer healthcare delivery system. PMID:15273483

  8. Coping with medical mistakes and errors in judgment.

    PubMed

    Goldberg, Richard M; Kuhn, Gloria; Andrew, Louise B; Thomas, Harold A

    2002-03-01

    Attention has recently been focused on medical errors as a cause of morbidity and mortality in clinical practice. Although much has been written regarding the cognitive aspects of decision making and the importance of systems management as an approach to medical error reduction, little consideration has been given to the emotional impact of errors on the practitioner. Evidence exists that errors are common in clinical practice and that physicians often deal with them in dysfunctional ways. However, there is no general acknowledgment within the profession of the inevitability of medical errors or of the need for practitioners to be trained in their management. This article focuses on the affective aspects of physician errors and presents a strategy for coping with them. PMID:11867981

  9. Medication error detection in two major teaching hospitals: What are the types of errors?

    PubMed Central

    Saghafi, Fatemeh; Zargarzadeh, Amir H

    2014-01-01

    Background: Increasing number of reports on medication errors and relevant subsequent damages, especially in medical centers has become a growing concern for patient safety in recent decades. Patient safety and in particular, medication safety is a major concern and challenge for health care professionals around the world. Our prospective study was designed to detect prescribing, transcribing, dispensing, and administering medication errors in two major university hospitals. Materials and Methods: After choosing 20 similar hospital wards in two large teaching hospitals in the city of Isfahan, Iran, the sequence was randomly selected. Diagrams for drug distribution were drawn by the help of pharmacy directors. Direct observation technique was chosen as the method for detecting the errors. A total of 50 doses were studied in each ward to detect prescribing, transcribing and administering errors in each ward. The dispensing error was studied on 1000 doses dispensed in each hospital pharmacy. Results: A total of 8162 number of doses of medications were studied during the four stages, of which 8000 were complete data to be analyzed. 73% of prescribing orders were incomplete and did not have all six parameters (name, dosage form, dose and measuring unit, administration route, and intervals of administration). We found 15% transcribing errors. One-third of administration of medications on average was erroneous in both hospitals. Dispensing errors ranged between 1.4% and 2.2%. Conclusion: Although prescribing and administrating compromise most of the medication errors, improvements are needed in all four stages with regard to medication errors. Clear guidelines must be written and executed in both hospitals to reduce the incidence of medication errors. PMID:25364360

  10. Medication administration errors for older people in long-term residential care

    PubMed Central

    2011-01-01

    /41 staff administering drugs reported they were aware of potential administration errors in their care home. Conclusions The incidence of medication administration errors is high in long-term residential care. A barcode medication administration system can capture medication administration errors and prevent these from occurring. PMID:22151472

  11. The Effect of Individual Factors on the Medication Error.

    PubMed

    Zyoud, Amr H; Abdullah, Nor Azimah Chew

    2016-01-01

    Medication error is a major issue in healthcare industry and significant efforts have been taken in recent years to comprehend factors that influence errors in medication. Therefore, the present study aims to examine individual factors that contribute to medication errors as perceived by nurses. 255 registered nurses working in different Jordanian public hospitals have been chosen as samples to collect the study data from. They were asked to complete a questionnaire to assess the perceived individual factors, specifically, on nursing mathematical calculation skills and training as well as knowledge on medication treatment as factors contributing to medication errors. The current study found that the nurses' mathematical calculation skills, training and their knowledge on medication treatment have significant relationship with medication error. This was proven as the study framework is able to explain 45.6% of the total variance. Consequently, it is recommended that healthcare authorities and hospitals in Jordan should focus on nursing knowledge in medication treatment and the nurses' ability to perform drug calculation in order to improve the medication system in Jordan. PMID:27357892

  12. Frequency, Types, and Potential Clinical Significance of Medication-Dispensing Errors

    PubMed Central

    Bohand, Xavier; Simon, Laurent; Perrier, Eric; Mullot, Hélène; Lefeuvre, Leslie; Plotton, Christian

    2009-01-01

    INTRODUCTION AND OBJECTIVES: Many dispensing errors occur in the hospital, and these can endanger patients. The purpose of this study was to assess the rate of dispensing errors by a unit dose drug dispensing system, to categorize the most frequent types of errors, and to evaluate their potential clinical significance. METHODS: A prospective study using a direct observation method to detect medication-dispensing errors was used. From March 2007 to April 2007, “errors detected by pharmacists” and “errors detected by nurses” were recorded under six categories: unauthorized drug, incorrect form of drug, improper dose, omission, incorrect time, and deteriorated drug errors. The potential clinical significance of the “errors detected by nurses” was evaluated. RESULTS: Among the 734 filled medication cassettes, 179 errors were detected corresponding to a total of 7249 correctly fulfilled and omitted unit doses. An overall error rate of 2.5% was found. Errors detected by pharmacists and nurses represented 155 (86.6%) and 24 (13.4%) of the 179 errors, respectively. The most frequent types of errors were improper dose (n = 57, 31.8%) and omission (n = 54, 30.2%). Nearly 45% of the 24 errors detected by nurses had the potential to cause a significant (n = 7, 29.2%) or serious (n = 4, 16.6%) adverse drug event. CONCLUSIONS: Even if none of the errors reached the patients in this study, a 2.5% error rate indicates the need for improving the unit dose drug-dispensing system. Furthermore, it is almost certain that this study failed to detect some medication errors, further arguing for strategies to prevent their recurrence. PMID:19142545

  13. Human factors and medication errors: a case study.

    PubMed

    Gluyas, Heather; Morrison, Paul

    2014-12-15

    Human beings are error prone. A significant component of human error is flaws inherent in human cognitive processes, which are exacerbated by situations in which the individual making the error is distracted, stressed or overloaded, or does not have sufficient knowledge to undertake an action correctly. The scientific discipline of human factors deals with environmental, organisational and job factors, as well as human and individual characteristics, which influence behaviour at work in a way that potentially gives rise to human error. This article discusses how cognitive processing is related to medication errors. The case of a coronial inquest into the death of a nursing home resident is used to highlight the way people think and process information, and how such thinking and processing may lead to medication errors. PMID:25492790

  14. Medication prescribing errors and associated factors at the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia

    PubMed Central

    2014-01-01

    Background Medication error is common and preventable cause of medical errors and occurs as a result of either human error or a system flaw. The consequences of such errors are more harmful and frequent among pediatric patients. Objective To assess medication prescribing errors and associated factors in the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia. Methods A cross-sectional study was carried out in the pediatric wards of Dessie Referral Hospital from February 17 to March 17, 2012. Data on the prescribed drugs were collected from patient charts and prescription papers among all patients who were admitted during the study period. Descriptive statistics was used to determine frequency, prevalence, means, and standard deviations. The relationship between dependent and independent variables were computed using logistic regression (with significance declared at p-value of 0.05 and 95% confidence interval). Results Out of the 384 Medication order s identified during the study, a total of 223 prescribing errors were identified. This corresponds to an overall medication prescribing error rate of 58.07%. Incomplete prescriptions and dosing errors were the two most common types of prescribing errors. Antibiotics (54.26%) were the most common classes of drugs subjected to prescribing error. Day of the week and route of administration were factors significantly associated with increased prescribing error. Conclusions Medication prescribing errors are common in the pediatric wards of Dessie Referral Hospital. Improving quick access to up to date reference materials, providing regular refresher trainings and possibly including a clinical pharmacist in the healthcare team are recommended. PMID:24826198

  15. Estimated Cost Savings from Reducing Errors in the Preparation of Sterile Doses of Medications

    PubMed Central

    Schneider, Philip J.

    2014-01-01

    Abstract Background: Preventing intravenous (IV) preparation errors will improve patient safety and reduce costs by an unknown amount. Objective: To estimate the financial benefit of robotic preparation of sterile medication doses compared to traditional manual preparation techniques. Methods: A probability pathway model based on published rates of errors in the preparation of sterile doses of medications was developed. Literature reports of adverse events were used to project the array of medical outcomes that might result from these errors. These parameters were used as inputs to a customized simulation model that generated a distribution of possible outcomes, their probability, and associated costs. Results: By varying the important parameters across ranges found in published studies, the simulation model produced a range of outcomes for all likely possibilities. Thus it provided a reliable projection of the errors avoided and the cost savings of an automated sterile preparation technology. The average of 1,000 simulations resulted in the prevention of 5,420 medication errors and associated savings of $288,350 per year. The simulation results can be narrowed to specific scenarios by fixing model parameters that are known and allowing the unknown parameters to range across values found in previously published studies. Conclusions: The use of a robotic device can reduce health care costs by preventing errors that can cause adverse drug events. PMID:25477598

  16. MEADERS: Medication Errors and Adverse Drug Event Reporting system.

    PubMed

    Zafar, Atif

    2007-01-01

    The Agency for Healthcare Research and Quality (AHRQ) recently funded the PBRN Resource Center to develop a system for reporting ambulatory medication errors. Our goal was to develop a usable system that practices could use internally to track errors. We initially performed a comprehensive literature review of what is currently available. Then, using a combination of expert panel meetings and iterative development we designed an instrument for ambulatory medication error reporting and createad a reporting system based both in MS Access 2003 and on the web using MS ASP.NET 2.0 technologies. PMID:18694263

  17. [The analysis of the medication error, in practice].

    PubMed

    Didelot, Nicolas; Cistio, Céline

    2016-01-01

    By performing a systemic analysis of medication errors which occur in practice, the multidisciplinary teams can avoid a reoccurrence with the aid of an improvement action plan. The methods must take into account all the factors which might have contributed to or favoured the occurrence of a medication incident or accident. PMID:27177485

  18. Incidence of medication errors in a Moroccan medical intensive care unit

    PubMed Central

    2011-01-01

    Background Medication errors (ME) are an important problem in all hospitalized populations, especially in intensive care unit (ICU). The aim of the study was to determine incidence, type and consequences of ME. Materials and methods Prospective observational cohort study during six weeks in a Moroccan ICU. Were included all patients admitted for > 24 hours. ME were collected by two reviewers following three methods: voluntary and verbally report by medical and paramedical staff, chart review and studying prescriptions and transcriptions. Seriousness of events was classified from Category A: circumstances or events that have the capacity to cause error, to Category I: patient's death. Results 63 patients were eligible with a total of 509 patient-days, and 4942 prescription. We found 492 ME, which incidence was 10 per 100 orders and 967 per 1000 patient-days. There were 113 potential Adverse Drug Events (ADEs) [2.28 per 100 orders and 222 per 1000 patient-days] and 8 ADEs [0.16 per 100 orders and 15.7 per 1000 patient-days]. MEs occurred in transcribing stage in 60%cases. Antibiotics were the drug category in 33%. Two ADEs conducted to death. Conclusion MEs are common in Moroccan medical ICU. These results suggest future targets of prevention strategies to reduce the rate of ME. PMID:21970430

  19. Do calculation errors by nurses cause medication errors in clinical practice? A literature review.

    PubMed

    Wright, Kerri

    2010-01-01

    This review aims to examine the literature available to ascertain whether medication errors in clinical practice are the result of nurses' miscalculating drug dosages. The research studies highlighting poor calculation skills of nurses and student nurses have been tested using written drug calculation tests in formal classroom settings [Kapborg, I., 1994. Calculation and administration of drug dosage by Swedish nurses, student nurses and physicians. International Journal for Quality in Health Care 6(4): 389 -395; Hutton, M., 1998. Nursing Mathematics: the importance of application Nursing Standard 13(11): 35-38; Weeks, K., Lynne, P., Torrance, C., 2000. Written drug dosage errors made by students: the threat to clinical effectiveness and the need for a new approach. Clinical Effectiveness in Nursing 4, 20-29]; Wright, K., 2004. Investigation to find strategies to improve student nurses' maths skills. British Journal Nursing 13(21) 1280-1287; Wright, K., 2005. An exploration into the most effective way to teach drug calculation skills to nursing students. Nurse Education Today 25, 430-436], but there have been no reviews of the literature on medication errors in practice that specifically look to see whether the medication errors are caused by nurses' poor calculation skills. The databases Medline, CINAHL, British Nursing Index (BNI), Journal of American Medical Association (JAMA) and Archives and Cochrane reviews were searched for research studies or systematic reviews which reported on the incidence or causes of drug errors in clinical practice. In total 33 articles met the criteria for this review. There were no studies that examined nurses' drug calculation errors in practice. As a result studies and systematic reviews that investigated the types and causes of drug errors were examined to establish whether miscalculations by nurses were the causes of errors. The review found insufficient evidence to suggest that medication errors are caused by nurses' poor

  20. Medication Error Management around the Globe: An Overview.

    PubMed

    Patel, Isha; Balkrishnan, R

    2010-09-01

    Medical mistakes that include medication errors have raised concerns about medication safety. Due to high consumption of medicines and self-treatment by all, especially the aging population, the issue of proper medication use and safety is at the forefront of public health concerns globally. Each country has a different approach towards medication event monitoring that is compliant with its own health care system. This paper focuses on the efforts and endeavors of some of the countries around the world to create an efficient error reporting systems to ensure public safety. Our analysis indicates that there are established and effective medication vigilance systems in many developed countries. The different countries undertake activities which range from collecting information about prescriptions, surveying physicians about adverse drug events, and conducting sophisticated post-marketing surveillance studies. There is still need for such sophisticated system in India; however recent promising developments are occurring towards building a medication vigilance system. Development of these systems may eventually contribute to a global medication vigilance system, which could reduce concern with medication errors and safety. PMID:21694983

  1. Medication Error Management around the Globe: An Overview

    PubMed Central

    Patel, Isha; Balkrishnan, R.

    2010-01-01

    Medical mistakes that include medication errors have raised concerns about medication safety. Due to high consumption of medicines and self-treatment by all, especially the aging population, the issue of proper medication use and safety is at the forefront of public health concerns globally. Each country has a different approach towards medication event monitoring that is compliant with its own health care system. This paper focuses on the efforts and endeavors of some of the countries around the world to create an efficient error reporting systems to ensure public safety. Our analysis indicates that there are established and effective medication vigilance systems in many developed countries. The different countries undertake activities which range from collecting information about prescriptions, surveying physicians about adverse drug events, and conducting sophisticated post-marketing surveillance studies. There is still need for such sophisticated system in India; however recent promising developments are occurring towards building a medication vigilance system. Development of these systems may eventually contribute to a global medication vigilance system, which could reduce concern with medication errors and safety. PMID:21694983

  2. Detecting medication errors: analysis based on a hospital's incident reports.

    PubMed

    Härkänen, Marja; Turunen, Hannele; Saano, Susanna; Vehviläinen-Julkunen, Katri

    2015-04-01

    The aim of this paper is to analyse how medication incidents are detected in different phases of the medication process. The study design is a retrospective register study. The material was collected from one university hospital's web-based incident reporting database in Finland. In 2010, 1617 incident reports were made, 671 of those were medication incidents and analysed in this study. Statistical methods were used to analyse the material. Results were reported using frequencies and percentages. Twenty-one percent of all medication incidents were detected during documenting or reading the documents. One-sixth of medication incidents were detected during medicating the patients, and approximately one-tenth were detected during verifying of the medicines. It is important to learn how to break the chain of medication errors as early as possible. Findings showed that for nurses, the ability to concentrate on documenting and medicating the patient is essential. PMID:24256158

  3. Poor communication on patients’ medication across health care levels leads to potentially harmful medication errors

    PubMed Central

    Frydenberg, Karin; Brekke, Mette

    2012-01-01

    Objective General practitioners have a key role in updating their patients’ medication. Poor communication regarding patients’ drug use may easily occur when patients cross health care levels. We wanted to explore whether such inadequate communication leads to errors in patients’ medication on admission, during hospital stay, and after discharge, and whether these errors were potentially harmful. Design Exploratory case study of 30 patients. Setting General practices in central Norway and medical ward of Innlandet Hospital Trust Gjøvik, Norway. Subjects 30 patients urgently admitted to the medical ward, and using three or more drugs on admission. Main outcome measures Discrepancies between the patients’ actual drugs taken and what was recorded on admission to hospital, during hospitalization, at discharge, and five weeks after hospital stay. The discrepancies were grouped according to the NCC Merp Index for Categorizing Medication Errors to assess their potential harm. Results The 30 patients used a total of 250 drugs, and 50 medication errors were found, affecting 18 of the patients; 27 errors were potentially harmful, according to NCC Merp Index: 23 in category E, four in category F. Half of the errors originated from an incomplete medication list in the referral letter. Conclusion The majority of the medication errors were made when the patients were admitted to hospital, and a substantial proportion were potentially harmful. The medication list should be reviewed together with the patient on admission, and each patient should carry an updated medication list provided by his or her general practitioner. PMID:23050954

  4. Disclosing harmful medical errors to patients: tackling three tough cases.

    PubMed

    Gallagher, Thomas H; Bell, Sigall K; Smith, Kelly M; Mello, Michelle M; McDonald, Timothy B

    2009-09-01

    A gap exists between recommendations to disclose errors to patients and current practice. This gap may reflect important, yet unanswered questions about implementing disclosure principles. We explore some of these unanswered questions by presenting three real cases that pose challenging disclosure dilemmas. The first case involves a pancreas transplant that failed due to the pancreas graft being discarded, an error that was not disclosed partly because the family did not ask clarifying questions. Relying on patient or family questions to determine the content of disclosure is problematic. We propose a standard of materiality that can help clinicians to decide what information to disclose. The second case involves a fatal diagnostic error that the patient's widower was unaware had happened. The error was not disclosed out of concern that disclosure would cause the widower more harm than good. This case highlights how institutions can overlook patients' and families' needs following errors and emphasizes that benevolent deception has little role in disclosure. Institutions should consider whether involving neutral third parties could make disclosures more patient centered. The third case presents an intraoperative cardiac arrest due to a large air embolism where uncertainty around the clinical event was high and complicated the disclosure. Uncertainty is common to many medical errors but should not deter open conversations with patients and families about what is and is not known about the event. Continued discussion within the medical profession about applying disclosure principles to real-world cases can help to better meet patients' and families' needs following medical errors. PMID:19736193

  5. Medical error and systems of signaling: conceptual and linguistic definition.

    PubMed

    Smorti, Andrea; Cappelli, Francesco; Zarantonello, Roberta; Tani, Franca; Gensini, Gian Franco

    2014-09-01

    In recent years the issue of patient safety has been the subject of detailed investigations, particularly as a result of the increasing attention from the patients and the public on the problem of medical error. The purpose of this work is firstly to define the classification of medical errors, which are distinguished between two perspectives: those that are personal, and those that are caused by the system. Furthermore we will briefly review some of the main methods used by healthcare organizations to identify and analyze errors. During this discussion it has been determined that, in order to constitute a practical, coordinated and shared action to counteract the error, it is necessary to promote an analysis that considers all elements (human, technological and organizational) that contribute to the occurrence of a critical event. Therefore, it is essential to create a culture of constructive confrontation that encourages an open and non-punitive debate about the causes that led to error. In conclusion we have thus underlined that in health it is essential to affirm a system discussion that considers the error as a learning source, and as a result of the interaction between the individual and the organization. In this way, one should encourage a non-guilt bearing discussion on evident errors and on those which are not immediately identifiable, in order to create the conditions that recognize and corrects the error even before it produces negative consequences. PMID:25034521

  6. The Impact of Bar Code Medication Administration Technology on Reported Medication Errors

    ERIC Educational Resources Information Center

    Holecek, Andrea

    2011-01-01

    The use of bar-code medication administration technology is on the rise in acute care facilities in the United States. The technology is purported to decrease medication errors that occur at the point of administration. How significantly this technology affects actual rate and severity of error is unknown. This descriptive, longitudinal research…

  7. Evaluation of Intravenous Medication Errors with Smart Infusion Pumps in an Academic Medical Center

    PubMed Central

    Ohashi, Kumiko; Dykes, Patricia; McIntosh, Kathleen; Buckley, Elizabeth; Wien, Matt; Bates, David W.

    2013-01-01

    While some published research indicates a fairly high frequency of Intravenous (IV) medication errors associated with the use of smart infusion pumps, the generalizability of these results are uncertain. Additionally, the lack of a standardized methodology for measuring these errors is an issue. In this study we iteratively developed a web-based data collection tool to capture IV medication errors using a participatory design approach with interdisciplinary experts. Using the developed tool, a prevalence study was then conducted in an academic medical center. The results showed that the tool was easy to use and effectively captured all IV medication errors. Through the prevalence study, violation errors of hospital policy were found that could potentially place patients at risk, but no critical errors known to contribute to patient harm were noted. PMID:24551395

  8. A classification of errors in lay comprehension of medical documents

    PubMed Central

    Keselman, Alla; Smith, Catherine Arnott

    2012-01-01

    Emphasis on participatory medicine requires that patients and consumers participate in tasks traditionally reserved for healthcare providers. This includes reading and comprehending medical documents, often but not necessarily in the context of interacting with Personal Health Records (PHRs). Research suggests that while giving patients access to medical documents has many benefits (e.g., improved patient-provider communication), lay people often have difficulty understanding medical information. Informatics can address the problem by developing tools that support comprehension; this requires in-depth understanding of the nature and causes of errors that lay people make when comprehending clinical documents. The objective of this study was to develop a classification scheme of comprehension errors, based on lay individuals’ retellings of two documents containing clinical text: a description of a clinical trial and a typical office visit note. While not comprehensive, the scheme can serve as a foundation of further development of a taxonomy of patients’ comprehension errors. Eighty participants, all healthy volunteers, read and retold two medical documents. A data-driven content analysis procedure was used to extract and classify retelling errors. The resulting hierarchical classification scheme contains nine categories and twenty-three subcategories. The most common error made by the participants involved incorrectly recalling brand names of medications. Other common errors included misunderstanding clinical concepts, misreporting the objective of a clinical research study and physician’s findings during a patient’s visit, and confusing and misspelling clinical terms. A combination of informatics support and health education is likely to improve the accuracy of lay comprehension of medical documents. PMID:22925723

  9. Indication Alerts Intercept Drug Name Confusion Errors during Computerized Entry of Medication Orders

    PubMed Central

    Galanter, William L.; Bryson, Michelle L.; Falck, Suzanne; Rosenfield, Rachel; Laragh, Marci; Shrestha, Neeha; Schiff, Gordon D.; Lambert, Bruce L.

    2014-01-01

    Background Confusion between similar drug names is a common cause of potentially harmful medication errors. Interventions to prevent these errors at the point of prescribing have had limited success. The purpose of this study is to measure whether indication alerts at the time of computerized physician order entry (CPOE) can intercept drug name confusion errors. Methods and Findings A retrospective observational study of alerts provided to prescribers in a public, tertiary hospital and ambulatory practice with medication orders placed using CPOE. Consecutive patients seen from April 2006 through February 2012 were eligible if a clinician received an indication alert during ordering. A total of 54,499 unique patients were included. The computerized decision support system prompted prescribers to enter indications when certain medications were ordered without a coded indication in the electronic problem list. Alerts required prescribers either to ignore them by clicking OK, to place a problem in the problem list, or to cancel the order. Main outcome was the proportion of indication alerts resulting in the interception of drug name confusion errors. Error interception was determined using an algorithm to identify instances in which an alert triggered, the initial medication order was not completed, and the same prescriber ordered a similar-sounding medication on the same patient within 5 minutes. Similarity was defined using standard text similarity measures. Two clinicians performed chart review of all cases to determine whether the first, non-completed medication order had a documented or non-documented, plausible indication for use. If either reviewer found a plausible indication, the case was not considered an error. We analyzed 127,458 alerts and identified 176 intercepted drug name confusion errors, an interception rate of 0.14±.01%. Conclusions Indication alerts intercepted 1.4 drug name confusion errors per 1000 alerts. Institutions with CPOE should consider

  10. Medication safety in neonatal care: a review of medication errors among neonates

    PubMed Central

    Krzyzaniak, Natalia; Bajorek, Beata

    2016-01-01

    Objective: The objective of this study was to describe the medication errors in hospitalized patients, comparing those in neonates with medication errors across the age spectrum. Method: In tier 1, PubMed, Embase and Google Scholar were searched, using selected MeSH terms relating to hospitalized paediatric, adult and elderly populations. Tier 2 involved a search of the same electronic databases for literature relating to hospitalized neonatal patients. Results: A total of 58 articles were reviewed. Medication errors were well documented in each patient group. Overall, prescribing and administration errors were most commonly identified across each population, and mostly related to errors in dosing. Errors due to patient misidentification and overdosing were particularly prevalent in neonates, with 47% of administration errors involving at least tenfold overdoses. Unique errors were identified in elderly patients, comprising duplication of therapy and unnecessary prescribing of medicines. Overall, the medicines most frequently identified with error across each patient group included: heparin, antibiotics, insulin, morphine and parenteral nutrition. While neonatal patients experience the same types of medication errors as other hospitalized patients, the medication-use process within this group is more complex and has greater consequences resulting from error. Suggested strategies to help overcome medication error most commonly involved the integration of a clinical pharmacist into the treating team. Conclusion: This review highlights that each step of the medication-use process is prone to error across the age spectrum. Further research is required to develop targeted strategies relevant to specific patient groups that integrate key pharmacy services into wards. PMID:27298721

  11. Characteristics associated with post-discharge medication errors

    PubMed Central

    Mixon, Amanda S.; Myers, Amy P.; Leak, Cardella L.; Mary Lou Jacobsen, J.; Cawthon, Courtney; Goggins, Kathryn M.; Nwosu, Samuel; Schildcrout, Jonathan S.; Schnelle, John F.; Speroff, Theodore; Kripalani, Sunil

    2014-01-01

    Objective To examine the association of patient- and medication-related factors with post-discharge medication errors. Patients and Methods The Vanderbilt Inpatient Cohort Study (VICS) includes adults hospitalized with acute coronary syndromes (ACS) and/or acute decompensated heart failure (ADHF). We measured health literacy, subjective numeracy, marital status, cognition, social support, education, income, depression, global health status, and medication adherence in patients enrolled between October 2011 and August 2012. We used binomial logistic regression to determine predictors of discordance between the discharge medication list and patient-reported list during post-discharge medication review. Results Among 471 patients, mean age was 59 years; mean total number of medications reported was 12; and 17% had inadequate or marginal health literacy. Half (51%) of patients had ≥1 one discordant medication (i.e., appeared either on the discharge or patient-reported list but not both); 27% failed to report a medication on their discharge list; and 36% reported a medication not on their discharge list. Additionally, 59% had a misunderstanding in indication, dose, or frequency in a cardiac medication. In multivariable analyses, higher subjective numeracy (Odds Ratio (OR)=0.81, 95% Confidence Interval (CI) 0.67-0.98) was associated with lower odds of having discordant medications. For cardiac medications, participants with higher health literacy (OR=0.84, CI 0.74-0.95), higher subjective numeracy (OR=0.77, CI 0.63-0.95), and who were female (OR=0.60, CI 0.46-0.78) had lower odds of misunderstandings in indication, dose, or frequency. Conclusion Medication errors are present in approximately half of patients following hospital discharge and are more common among patients with lower numeracy or health literacy. PMID:24998906

  12. Error prevention and error management in medicine--adopting strategies from other professions.

    PubMed

    Thomeczek, C

    2003-12-01

    The report of the Institute of Medicine (IOM) 'To Err Is Human' received public interest. The simple term 'medical error' as it has been used in public so far does not describe the complex setting in medicine. The development of error management in industry (e.g. aviation) with an emphasis on human factors, communication, and systematic error is demonstrated in order to design similar approaches for medicine. Recommendations are based on the principles for designing safety systems in health care organisations published in the IOM report. PMID:14709928

  13. [Ethics and prevention of medicalization].

    PubMed

    Tovar-Bobo, M; Cerecedo-Pérez, M J; Rozadilla-Arias, A

    2013-10-01

    Society has shifted issues of subjective and social reality of the population into the medical field, with the obsession with perfect health becoming a predominant pathogenic factor in the increase in the number of diseases and patients, while the level of health in the population is improving. The power of medicine has made the idea of «medicalising» various aspects of life that can be perceived as medical problems as attractive even when it is not the case. Living entails times of unhappiness and anguish but, should we treat these episodes? We are in the health culture of «everything, here and now». In this article, the ethical implications of unnecessary interventions are analysed, along with the different alternatives that the professionals involved may perform to redirect this situation. It is reflected if we want a world where we all risk wearing labels for this or that disease. PMID:23768567

  14. Medication Errors of Nurses and Factors in Refusal to Report Medication Errors Among Nurses in a Teaching Medical Center of Iran in 2012

    PubMed Central

    Mostafaei, Davoud; Barati Marnani, Ahmad; Mosavi Esfahani, Haleh; Estebsari, Fatemeh; Shahzaidi, Shiva; Jamshidi, Ensiyeh; Aghamiri, Seyed Samad

    2014-01-01

    Background: About one third of unwanted reported medication consequences are due to medication errors, resulting in one-fifth of hospital injuries. Objectives: The aim of this study was determined formal and informal medication errors of nurses and the level of importance of factors in refusal to report medication errors among nurses. Patients and Methods: The cross-sectional study was done on the nursing staff of Shohada Tajrish Hospital, Tehran, Iran in 2012. The data was gathered through a questionnaire, made by the researchers. The questionnaires' face and content validity was confirmed by experts and for measuring its reliability test-retest was used. The data was analyzed by descriptive statistics. We used SPSS for related statistical analyses. Results: The most important factors in refusal to report medication errors respectively were: lack of medication error recording and reporting system in the hospital (3.3%), non-significant error reporting to hospital authorities and lack of appropriate feedback (3.1%), and lack of a clear definition for a medication error (3%). There were both formal and informal reporting of medication errors in this study. Conclusions: Factors pertaining to management in hospitals as well as the fear of the consequences of reporting are two broad fields among the factors that make nurses not report their medication errors. In this regard, providing enough education to nurses, boosting the job security for nurses, management support and revising related processes and definitions are some factors that can help decreasing medication errors and increasing their report in case of occurrence. PMID:25763202

  15. Effect of an automated bedside dispensing machine on medication errors.

    PubMed

    Barker, K N; Pearson, R E; Hepler, C D; Smith, W E; Pappas, C A

    1984-07-01

    The effect of an automated bedside dispensing machine on medication errors was studied on a 32-bed surgical unit of an 848-bed hospital. The experimental system (McLaughlin Dispensing System) included at each patient's bedside a locked medication cabinet that was electronically programmed to allow the nurse access to doses due at a particular time. The control system was a decentralized unit dose system. A crossover study design with random assignment of subjects and treatments was used. In the 14-day study period, nurses were observed by a pharmacist for 28 five-hour periods as they administered medications on the day and evening shifts. The mean error rates were significantly different--10.6% for the experimental system and 15.9% for the control system. Wrong time errors were the most common type. No significant differences were found between day and evening shifts or workloads of individual nurses. There was no treatment order effect. The error rate was significantly lower for the automated dispensing system than for the system using unit doses dispensed from a satellite pharmacy. Automated dispensing systems may be useful in reducing errors in administration time and dose omissions. PMID:6465150

  16. Medication Errors in the Southeast Asian Countries: A Systematic Review

    PubMed Central

    Salmasi, Shahrzad; Khan, Tahir Mehmood; Hong, Yet Hoi; Ming, Long Chiau; Wong, Tin Wui

    2015-01-01

    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. PMID:26340679

  17. Reducing medication errors and increasing patient safety: case studies in clinical pharmacology.

    PubMed

    Benjamin, David M

    2003-07-01

    Today, reducing medication errors and improving patient safety have become common topics of discussion for the president of the United States, federal and state legislators, the insurance industry, pharmaceutical companies, health care professionals, and patients. But this is not news to clinical pharmacologists. Improving the judicious use of medications and minimizing adverse drug reactions have always been key areas of research and study for those working in clinical pharmacology. However, added to the older terms of adverse drug reactions and rational therapeutics, the now politically correct expression of medication error has emerged. Focusing on the word error has drawn attention to "prevention" and what can be done to minimize mistakes and improve patient safety. Webster's New Collegiate Dictionary has several definitions of error, but the one that seems to be most appropriate in the context of medication errors is "an act that through ingnorance, deficiency, or accident departs from or fails to achieve what should be done." What should be done is generally known as "the five rights": the right drug, right dose, right route, right time, and right patient. One can make an error of omission (failure to act correctly) or an error of commission (acted incorrectly). This article now summarizes what is currently known about medication errors and translates the information into case studies illustrating common scenarios leading to medication errors. Each case is analyzed to provide insight into how the medication error could have been prevented. "System errors" are described, and the application of failure mode effect analysis (FMEA) is presented to determine the part of the "safety net" that failed. Examples of reengineering the system to make it more "error proof" are presented. An error can be prevented. However, the practice of medicine, pharmacy, and nursing in the hospital setting is very complicated, and so many steps occur from "pen to patient" that there

  18. Initiatives to identify and mitigate medication errors in England.

    PubMed

    Cousins, David; Gerrett, David; Richards, Natalie; Jadeja, Mitulsinh M

    2015-04-01

    In response to the EU Directive on Pharmacovigilance, the National Health Service (NHS) in England and the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK have formed a partnership to work together to simplify and increase medication error reporting, improve data report quality, maximise learning and guide practice to minimise harm from medication errors by sharing incident data. This initiative will facilitate implementation of new requirements for medication error reporting and reduce the need for duplicate data entry by frontline staff. The initiative is also intended to provide new types of feedback from the National Reporting and Learning System run by the NHS England and from the Yellow Card Scheme run by the MHRA and to improve learning at the local level by clarifying medication safety roles and identifying key safety contacts to allow better communication between local and national levels. Finally, the partnership has established a new National Medication Safety Network to provide a forum for discussing potential and recognised safety issues, and for identifying trends and actions to improve the safe use of medicines. This article describes the initiative, the structure of which may act as a template for other countries. PMID:25735854

  19. Medication error report: Intrathecal administration of labetalol during obstetric anesthesia

    PubMed Central

    Laha, Baisakhi; Hazra, Avijit

    2015-01-01

    Labetalol, a combined alfa and beta-adrenergic receptor antagonist, is used as an antihypertensive drug. We report a case of an acute rise in blood pressure and lower limb pain due to the inadvertent intrathecal administration of labetalol, mistaking it for bupivacaine, during obstetric anesthesia. The situation was rescued by converting to general anesthesia. The cesarean delivery was uneventful, and mother as well as newborn child showed no ill-effect. This particular medication error was attributable to a failure on the part of the doctors administering the injection to read and cross-check medication labels and the practice of keeping multiple injections together. In the absence of an organized medication error reporting system and action on that basis, such events may recur in future. PMID:26288484

  20. Automated Communication Tools and Computer-Based Medication Reconciliation to Decrease Hospital Discharge Medication Errors.

    PubMed

    Smith, Kenneth J; Handler, Steven M; Kapoor, Wishwa N; Martich, G Daniel; Reddy, Vivek K; Clark, Sunday

    2016-07-01

    This study sought to determine the effects of automated primary care physician (PCP) communication and patient safety tools, including computerized discharge medication reconciliation, on discharge medication errors and posthospitalization patient outcomes, using a pre-post quasi-experimental study design, in hospitalized medical patients with ≥2 comorbidities and ≥5 chronic medications, at a single center. The primary outcome was discharge medication errors, compared before and after rollout of these tools. Secondary outcomes were 30-day rehospitalization, emergency department visit, and PCP follow-up visit rates. This study found that discharge medication errors were lower post intervention (odds ratio = 0.57; 95% confidence interval = 0.44-0.74; P < .001). Clinically important errors, with the potential for serious or life-threatening harm, and 30-day patient outcomes were not significantly different between study periods. Thus, automated health system-based communication and patient safety tools, including computerized discharge medication reconciliation, decreased hospital discharge medication errors in medically complex patients. PMID:25753453

  1. Prevalence of medication administration errors in two medical units with automated prescription and dispensing

    PubMed Central

    Herranz-Alonso, Ana; Martin-Barbero, Maria Luisa; Duran-Garcia, Esther; Durango-Limarquez, Maria Isabel; Hernández-Sampelayo, Paloma; Sanjurjo-Saez, Maria

    2011-01-01

    Objective To identify the frequency of medication administration errors and their potential risk factors in units using a computerized prescription order entry program and profiled automated dispensing cabinets. Design Prospective observational study conducted within two clinical units of the Gastroenterology Department in a 1537-bed tertiary teaching hospital in Madrid (Spain). Measurements Medication errors were measured using the disguised observation technique. Types of medication errors and their potential severity were described. The correlation between potential risk factors and medication errors was studied to identify potential causes. Results In total, 2314 medication administrations to 73 patients were observed: 509 errors were recorded (22.0%)—68 (13.4%) in preparation and 441 (86.6%) in administration. The most frequent errors were use of wrong administration techniques (especially concerning food intake (13.9%)), wrong reconstitution/dilution (1.7%), omission (1.4%), and wrong infusion speed (1.2%). Errors were classified as no damage (95.7%), no damage but monitoring required (2.3%), and temporary damage (0.4%). Potential clinical severity could not be assessed in 1.6% of cases. The potential risk factors morning shift, evening shift, Anatomical Therapeutic Chemical medication class antacids, prokinetics, antibiotics and immunosuppressants, oral administration, and intravenous administration were associated with a higher risk of administration errors. No association was found with variables related to understaffing or nurse's experience. Conclusions Medication administration errors persist in units with automated prescription and dispensing. We identified a need to improve nurses' working procedures and to implement a Clinical Decision Support tool that generates recommendations about scheduling according to dietary restrictions, preparation of medication before parenteral administration, and adequate infusion rates. PMID:21890872

  2. Sensitivity analysis of geometric errors in additive manufacturing medical models.

    PubMed

    Pinto, Jose Miguel; Arrieta, Cristobal; Andia, Marcelo E; Uribe, Sergio; Ramos-Grez, Jorge; Vargas, Alex; Irarrazaval, Pablo; Tejos, Cristian

    2015-03-01

    Additive manufacturing (AM) models are used in medical applications for surgical planning, prosthesis design and teaching. For these applications, the accuracy of the AM models is essential. Unfortunately, this accuracy is compromised due to errors introduced by each of the building steps: image acquisition, segmentation, triangulation, printing and infiltration. However, the contribution of each step to the final error remains unclear. We performed a sensitivity analysis comparing errors obtained from a reference with those obtained modifying parameters of each building step. Our analysis considered global indexes to evaluate the overall error, and local indexes to show how this error is distributed along the surface of the AM models. Our results show that the standard building process tends to overestimate the AM models, i.e. models are larger than the original structures. They also show that the triangulation resolution and the segmentation threshold are critical factors, and that the errors are concentrated at regions with high curvatures. Errors could be reduced choosing better triangulation and printing resolutions, but there is an important need for modifying some of the standard building processes, particularly the segmentation algorithms. PMID:25649961

  3. [Medical reviews of claims for damages and errors in urology].

    PubMed

    Lent, V; Smentkowski, U; Weber, B; Brummeisl, W

    2013-09-01

    In liability law, a medical review is considered to be an expert opinion that is provided at the request of those involved (patient or physician) of a course of treatment. It must be carried out according to defined criteria with the aim of providing a plausible basis for arbitration. This is achieved by means of an objective determination of the facts, a reasonable assessment of the error(s) and (where appropriate) a realistic description of the injury involved. The following fields should be covered in a concise review: conditions and procedures applied to the review, criteria to be used in the review, types of error that are possible during the treatment, assessment of the treatment errors committed, possible treatment errors that can occur in urology, conclusions to be drawn from the review. In summary, a medical assessment carried out in the course of claims for damages should provide a balanced assessment that takes into account the confidential relationship between the physician and patient. This means that the review procedure must be performed under the best possible conditions for professional standards and care. PMID:24043538

  4. What have we learned about interventions to reduce medical errors?

    PubMed

    Woodward, Helen I; Mytton, Oliver T; Lemer, Claire; Yardley, Iain E; Ellis, Benjamin M; Rutter, Paul D; Greaves, Felix E C; Noble, Douglas J; Kelley, Edward; Wu, Albert W

    2010-01-01

    Medical errors and adverse events are now recognized as major threats to both individual and public health worldwide. This review provides a broad perspective on major effective, established, or promising strategies to reduce medical errors and harm. Initiatives to improve safety can be conceptualized as a "safety onion" with layers of protection, depending on their degree of remove from the patient. Interventions discussed include those applied at the levels of the patient (patient engagement and disclosure), the caregiver (education, teamwork, and checklists), the local workplace (culture and workplace changes), and the system (information technology and incident reporting systems). Promising interventions include forcing functions, computerized prescriber order entry with decision support, checklists, standardized handoffs and simulation training. Many of the interventions described still lack strong evidence of benefit, but this should not hold back implementation. Rather, it should spur innovation accompanied by evaluation and publication to share the results. PMID:20070203

  5. Developing control charts to review and monitor medication errors.

    PubMed

    Ciminera, J L; Lease, M P

    1992-03-01

    There is a need to monitor reported medication errors in a hospital setting. Because the quantity of errors vary due to external reporting, quantifying the data is extremely difficult. Typically, these errors are reviewed using classification systems that often have wide variations in the numbers per class per month. The authors recommend the use of control charts to review historical data and to monitor future data. The procedure they have adopted is a modification of schemes using absolute (i.e., positive) values of successive differences to estimate the standard deviation when only single incidence values are available in time rather than sample averages, and when many successive differences may be zero. PMID:10116719

  6. Patient safety: helping medical students understand error in healthcare

    PubMed Central

    Patey, Rona; Flin, Rhona; Cuthbertson, Brian H; MacDonald, Louise; Mearns, Kathryn; Cleland, Jennifer; Williams, David

    2007-01-01

    Objective To change the culture of healthcare organisations and improve patient safety, new professionals need to be taught about adverse events and how to trap and mitigate against errors. A literature review did not reveal any patient safety courses in the core undergraduate medical curriculum. Therefore a new module was designed and piloted. Design A 5‐h evidence‐based module on understanding error in healthcare was designed with a preliminary evaluation using self‐report questionnaires. Setting A UK medical school. Participants 110 final year students. Measurements and main results Participants completed two questionnaires: the first questionnaire was designed to measure students' self‐ratings of knowledge, attitudes and behaviour in relation to patient safety and medical error, and was administered before and approximately 1 year after the module; the second formative questionnaire on the teaching process and how it could be improved was administered after completion of the module. Conclusions Before attending the module, the students reported they had little understanding of patient safety matters. One year later, only knowledge and the perceived personal control over safety had improved. The students rated the teaching process highly and found the module valuable. Longitudinal follow‐up is required to provide more information on the lasting impact of the module. PMID:17693671

  7. Medication error reduction and the use of PDA technology.

    PubMed

    Greenfield, Sue

    2007-03-01

    The purpose of this study was to determine whether nursing medication errors could be reduced and nursing care provided more efficiently using personal digital assistant (PDA) technology. The sample for this study consisted of junior and senior undergraduate baccalaureate nursing students. By self-selection of owning a PDA or not, students were placed in the PDA (experimental) group or the textbook (control) group, provided with a case study to read, and asked to answer six questions (i.e., three medication administration calculations and three clinical decisions based on medication administration). The analysis of collected data, calculated using a t test, revealed that the PDA group answered the six questions with greater accuracy and speed than did the textbook group. PMID:17396552

  8. Medication errors in an internal intensive care unit of a large teaching hospital: a direct observation study.

    PubMed

    Vazin, Afsaneh; Delfani, Saadat

    2012-01-01

    Medication errors account for about 78% of serious medical errors in intensive care unit (ICU). So far no study has been performed in Iran to evaluate all type of possible medication errors in ICU. Therefore the objective of this study was to reveal the frequency, type and consequences of all type of errors in an ICU of a large teaching hospital. The prospective observational study was conducted in an 11 bed internal ICU of a university hospital in Shiraz. In each shift all processes that were performed on one selected patient was observed and recorded by a trained pharmacist. Observer would intervene only if medication error would cause substantial harm. The data was evaluated and then were entered in a form that was designed for this purpose. The study continued for 38 shifts. During this period, a total of 442 errors per 5785 opportunities for errors (7.6%) occurred. Of those, there were 9.8% administration errors, 6.8% prescribing errors, 3.3% transcription errors and, 2.3% dispensing errors. Totally 45 interventions were made, 40% of interventions result in the correction of errors. The most common causes of errors were observed to be: rule violations, slip and memory lapses and lack of drug knowledge. According to our results, the rate of errors is alarming and requires implementation of a serious solution. Since our system lacks a well-organize detection and reporting mechanism, there is no means for preventing errors in the first place. Hence, as the first step we must implement a system where errors are routinely detected and reported. PMID:22837122

  9. Corpus-based error detection in a multilingual medical thesaurus.

    PubMed

    Andrade, Roosewelt L; Pacheco, Edson; Cancian, Pindaro S; Nohama, Percy; Schulz, Stefan

    2007-01-01

    Cross-language document retrieval systems require support by some kind of multilingual thesaurus for semantically indexing documents in different languages. The peculiarities of the medical sublanguage, together with the subjectivism of lexicographers' choices, complicates the thesaurus construction process. It furthermore requires a high degree of communication and interaction between the lexicographers involved. In order to detect errors, a systematic procedure is therefore necessary. We here describe a method which supports the maintenance of the multilingual medical subword repository of the MorphoSaurus system which assigns language-independent semantic identifiers to medical texts. Based on the assumption that the distribution of these semantic identifiers should be similar whenever comparing closely related texts in different languages, our approach identifies those semantic identifiers that vary most in distribution comparing language pairs. The revision of these identifiers and the lexical items related to them revealed multiple errors which were subsequently classified and fixed by the lexicographers. The overall quality improvement of the thesaurus was finally measured using the OHSUMED IR benchmark, resulting in a significant improvement of the retrieval quality for one of the languages tested. PMID:17911773

  10. Medication errors: an analysis comparing PHICO's closed claims data and PHICO's Event Reporting Trending System (PERTS).

    PubMed

    Benjamin, David M; Pendrak, Robert F

    2003-07-01

    Clinical pharmacologists are all dedicated to improving the use of medications and decreasing medication errors and adverse drug reactions. However, quality improvement requires that some significant parameters of quality be categorized, measured, and tracked to provide benchmarks to which future data (performance) can be compared. One of the best ways to accumulate data on medication errors and adverse drug reactions is to look at medical malpractice data compiled by the insurance industry. Using data from PHICO insurance company, PHICO's Closed Claims Data, and PHICO's Event Reporting Trending System (PERTS), this article examines the significance and trends of the claims and events reported between 1996 and 1998. Those who misread history are doomed to repeat the mistakes of the past. From a quality improvement perspective, the categorization of the claims and events is useful for reengineering integrated medication delivery, particularly in a hospital setting, and for redesigning drug administration protocols on low therapeutic index medications and "high-risk" drugs. Demonstrable evidence of quality improvement is being required by state laws and by accreditation agencies. The state of Florida requires that quality improvement data be posted quarterly on the Web sites of the health care facilities. Other states have followed suit. The insurance industry is concerned with costs, and medication errors cost money. Even excluding costs of litigation, an adverse drug reaction may cost up to $2500 in hospital resources, and a preventable medication error may cost almost $4700. To monitor costs and assess risk, insurance companies want to know what errors are made and where the system has broken down, permitting the error to occur. Recording and evaluating reliable data on adverse drug events is the first step in improving the quality of pharmacotherapy and increasing patient safety. Cost savings and quality improvement evolve on parallel paths. The PHICO data

  11. Medication review and transitions of care: a case report of a decade-old medication error.

    PubMed

    Comer, Rachel; Lizer, Mitsi

    2015-03-01

    A 69-year-old Caucasian male with a 25-year history of paranoid schizophrenia was brought to the emergency department because of violence toward the staff in his nursing facility. He was diagnosed with a urinary tract infection and was admitted to the behavioral health unit for medication stabilization. History included a five-year state psychiatric hospital admission and nursing facility placement. Because of poor cognitive function, the patient was unable to corroborate medication history, so the pharmacy student on rotation performed an in-depth chart review. The review revealed a transcription error in 2003 deleting amantadine 100 mg twice daily and adding amiodarone 100 mg twice daily. Subsequent hospitalization resulted in another transcription error increasing the amiodarone to 200 mg twice daily. All electrocardiograms conducted were negative for atrial fibrillation. Once detected, the consulted cardiologist discontinued the amiodarone, and the primary care provider was notified via letter and discharge papers. An admission four months later revealed that the nursing facility restarted the amiodarone. Amiodarone was discontinued and the facility was again notified. This case reviews how a 10-year-old medication error went undetected in the electronic medical records through numerous medication reconciliations, but was uncovered when a single comprehensive medication review was conducted. PMID:25760662

  12. Impact of pharmacy-led medication reconciliation on medication errors during transition in the hospital setting

    PubMed Central

    Smith, Lillian; Mosley, Juan; Lott, Sonia; Cyr, Ernie; Amin, Raid; Everton, Emily; Islami, Abdullah; Phan, Linh; Komolafe, Opeyemi

    2015-01-01

    Objective: To assess if the pharmacy department should be more involved in the medication reconciliation process to assist in the reduction of medication errors that occur during transition of care points in the hospital setting. Methods: This was an observational prospective cohort study at a 531-bed hospital in Pensacola, FL from June 1, 2014 to August 31, 2014. Patients were included in the study if they had health insurance and were taking five or more medications. Patients with congestive heart failure were excluded from the study. Student pharmacists collected and evaluated medication histories obtained from patients’ community pharmacies, and directed patient interviews. Primary care providers were only contacted on an as needed basis. The information collected was presented to the clinical pharmacist, where interventions were made utilizing clinical judgment. Results: During the three month study, 1045 home medications were reviewed by student pharmacist. Of these, 290 discrepancies were discovered (27.8%; p=0.02). The most common medication discrepancy found was dose optimization (45.5%). The remaining discrepancies included: added therapy (27.6%), other (15.2%), and discontinued therapy (11.7%). Pharmacists made 143 interventions based on clinical judgment (49.3%; p=0.04). Conclusion: Involvement of pharmacy personnel during the medication reconciliation process can be an essential component in reducing medical errors. With the addition of the pharmacy department during the admission process, accuracy, cost savings, and patient safety across all phases and transition points of care were achieved. PMID:26759617

  13. Voluntary Electronic Reporting of Medical Errors and Adverse Events

    PubMed Central

    Milch, Catherine E; Salem, Deeb N; Pauker, Stephen G; Lundquist, Thomas G; Kumar, Sanjaya; Chen, Jack

    2006-01-01

    OBJECTIVE To describe the rate and types of events reported in acute care hospitals using an electronic error reporting system (e-ERS). DESIGN Descriptive study of reported events using the same e-ERS between January 1, 2001 and September 30, 2003. SETTING Twenty-six acute care nonfederal hospitals throughout the U.S. that voluntarily implemented a web-based e-ERS for at least 3 months. PARTICIPANTS Hospital employees and staff. INTERVENTION A secure, standardized, commercially available web-based reporting system. RESULTS Median duration of e-ERS use was 21 months (range 3 to 33 months). A total of 92,547 reports were obtained during 2,547,154 patient-days. Reporting rates varied widely across hospitals (9 to 95 reports per 1,000 inpatient-days; median=35). Registered nurses provided nearly half of the reports; physicians contributed less than 2%. Thirty-four percent of reports were classified as nonmedication-related clinical events, 33% as medication/infusion related, 13% were falls, 13% as administrative, and 6% other. Among 80% of reports that identified level of impact, 53% were events that reached a patient (“patient events”), 13% were near misses that did not reach the patient, and 14% were hospital environment problems. Among 49,341 patient events, 67% caused no harm, 32% temporary harm, 0.8% life threatening or permanent harm, and 0.4% contributed to patient deaths. CONCLUSIONS An e-ERS provides an accessible venue for reporting medical errors, adverse events, and near misses. The wide variation in reporting rates among hospitals, and very low reporting rates by physicians, requires investigation. PMID:16390502

  14. [In the aftermath of medical error: caring for patients, family, and the healthcare workers involved].

    PubMed

    Schwappach, David L B

    2015-01-01

    Medical errors, in particular those resulting in harm, pose a serious situation for patients ("first victims") and the healthcare workers involved ("second victims") and can have long-lasting and distressing consequences. To prevent a second traumatization, appropriate and empathic interaction with all persons involved is essential besides error analysis. Patients share a nearly universal, broad preference for a complete disclosure of incidents, regardless of age, gender, or education. This includes the personal, timely and unambiguous disclosure of the adverse event, information relating to the event, its causes and consequences, and an apology and sincere expression of regret. While the majority of healthcare professionals generally support and honest and open disclosure of adverse events, they also face various barriers which impede the disclosure (e.g., fear of legal consequences). Despite its essential importance, disclosure of adverse events in practice occurs in ways that are rarely acceptable to patients and their families. The staff involved often experiences acute distress and an intense emotional response to the event, which may become chronic and increase the risk of depression, burnout and post-traumatic stress disorders. Communication with peers is vital for people to be able to cope constructively and protectively with harmful errors. Survey studies among healthcare workers show, however, that they often do not receive sufficient individual and institutional support. Healthcare organizations should prepare for medical errors and harmful events and implement a communication plan and a support system that covers the requirements and different needs of patients and the staff involved. PMID:25410745

  15. Teaching older adults to self-manage medications: preventing adverse drug reactions.

    PubMed

    Curry, Linda Cox; Walker, Charles; Hogstel, Mildred O; Burns, Paulette

    2005-04-01

    Older adults use more prescription and OTC medications than any other age group. Because their medication regimens often are complicated by many medications and different doses, times, and administration methods, older adults are at high risk for medication mismanagement. The most common errors associated with medication mismanagement include mixing OTC and prescription medications, discontinuing prescriptions, taking wrong dosages, using incorrect techniques, and consuming inappropriate foods with specific medications. Both human and environmental factors contribute to medication mismanagement among older adults. Human factors include faulty communication between the health care provider and the patient; the patient's lack of knowledge; ADRs; alcohol-drug interactions; use of OTC medications and herbal products; cognitive, sensory, and motor impairments; and polypharmacy. Environmental factors include high cost of prescribed medications, improper medication storage, and absence of clearly marked expiration dates. Nurses need to take advantage of both formal and informal teaching opportunities in all settings to prepare a patient for medication self-management. Teaching should be individualized and based on a thorough assessment of the patient's abilities to administer medication safely and the specific medication regimen. By involving older adults as active partners in their health care, many errors and medication-related health problems can be prevented. New technologies and devices have the potential for improving the patient's self-management of medications. The role of nurses in educating older adults and their families about proper medication management is vital. PMID:15839523

  16. Improving end of life care: an information systems approach to reducing medical errors.

    PubMed

    Tamang, S; Kopec, D; Shagas, G; Levy, K

    2005-01-01

    Chronic and terminally ill patients are disproportionately affected by medical errors. In addition, the elderly suffer more preventable adverse events than younger patients. Targeting system wide "error-reducing" reforms to vulnerable populations can significantly reduce the incidence and prevalence of human error in medical practice. Recent developments in health informatics, particularly the application of artificial intelligence (AI) techniques such as data mining, neural networks, and case-based reasoning (CBR), presents tremendous opportunities for mitigating error in disease diagnosis and patient management. Additionally, the ubiquity of the Internet creates the possibility of an almost ideal network for the dissemination of medical information. We explore the capacity and limitations of web-based palliative information systems (IS) to transform the delivery of care, streamline processes and improve the efficiency and appropriateness of medical treatment. As a result, medical error(s) that occur with patients dealing with severe, chronic illness and the frail elderly can be reduced.The palliative model grew out of the need for pain relief and comfort measures for patients diagnosed with cancer. Applied definitions of palliative care extend this convention, but there is no widely accepted definition. This research will discuss the development life cycle of two palliative information systems: the CONFER QOLP management information system (MIS), currently used by a community-based palliative care program in Brooklyn, New York, and the CAREN case-based reasoning prototype. CONFER is a web platform based on the idea of "eCare". CONFER uses XML (extensible mark-up language), a W3C-endorced standard mark up to define systems data. The second system, CAREN, is a CBR prototype designed for palliative care patients in the cancer trajectory. CBR is a technique, which tries to exploit the similarities of two situations and match decision-making to the best

  17. [Longer working hours of pharmacists in the ward resulted in lower medication-related errors--survey of national university hospitals in Japan].

    PubMed

    Matsubara, Kazuo; Toyama, Akira; Satoh, Hiroshi; Suzuki, Hiroshi; Awaya, Toshio; Tasaki, Yoshikazu; Yasuoka, Toshiaki; Horiuchi, Ryuya

    2011-04-01

    It is obvious that pharmacists play a critical role as risk managers in the healthcare system, especially in medication treatment. Hitherto, there is not a single multicenter-survey report describing the effectiveness of clinical pharmacists in preventing medical errors from occurring in the wards in Japan. Thus, we conducted a 1-month survey to elucidate the relationship between the number of errors and working hours of pharmacists in the ward, and verified whether the assignment of clinical pharmacists to the ward would prevent medical errors between October 1-31, 2009. Questionnaire items for the pharmacists at 42 national university hospitals and a medical institute included the total and the respective numbers of medication-related errors, beds and working hours of pharmacist in 2 internal medicine and 2 surgical departments in each hospital. Regardless of severity, errors were consecutively reported to the Medical Security and Safety Management Section in each hospital. The analysis of errors revealed that longer working hours of pharmacists in the ward resulted in less medication-related errors; this was especially significant in the internal medicine ward (where a variety of drugs were used) compared with the surgical ward. However, the nurse assignment mode (nurse/inpatients ratio: 1 : 7-10) did not influence the error frequency. The results of this survey strongly indicate that assignment of clinical pharmacists to the ward is critically essential in promoting medication safety and efficacy. PMID:21467804

  18. Searching for the Final Answer: Factors Contributing to Medication Administration Errors.

    ERIC Educational Resources Information Center

    Pape, Tess M.

    2001-01-01

    Causal factors contributing to errors in medication administration should be thoroughly investigated, focusing on systems rather than individual nurses. Unless systemic causes are addressed, many errors will go unreported for fear of reprisal. (Contains 42 references.) (SK)

  19. Being a Victim of Medical Error in Brazil: An (Un)Real Dilemma

    PubMed Central

    Mendonça, Vitor Silva; Custódio, Eda Marconi

    2016-01-01

    Medical error stems from inadequate professional conduct that is capable of producing harm to life or exacerbating the health of another, whether through act or omission. This situation has become increasingly common in Brazil and worldwide. In this study, the aim was to understand what being the victim of medical error is like and to investigate the circumstances imposed on this condition of victims in Brazil. A semi-structured interview was conducted with twelve people who had gone through situations of medical error in their lives, creating a space for narratives of their experiences and deep reflection on the phenomenon. The concept of medical error has a negative connotation, often being associated with the incompetence of a medical professional. Medical error in Brazil is demonstrated by low-quality professional performance and represents the current reality of the country because of the common lack of respect and consideration for patients. Victims often remark on their loss of identity, as their social functions have been interrupted and they do not expect to regain such. It was found, however, little assumption of error in the involved doctors’ discourses and attitudes, which felt a need to judge the medical conduct in an attempt to assert their rights. Medical error in Brazil presents a punitive character and is little discussed in medical and scientific circles. The stigma of medical error is closely connected to the value and cultural judgments of the country, making it difficult to accept, both by victims and professionals. PMID:27403461

  20. Being a Victim of Medical Error in Brazil: An (Un)Real Dilemma.

    PubMed

    Mendonça, Vitor Silva; Custódio, Eda Marconi

    2016-06-23

    Medical error stems from inadequate professional conduct that is capable of producing harm to life or exacerbating the health of another, whether through act or omission. This situation has become increasingly common in Brazil and worldwide. In this study, the aim was to understand what being the victim of medical error is like and to investigate the circumstances imposed on this condition of victims in Brazil. A semi-structured interview was conducted with twelve people who had gone through situations of medical error in their lives, creating a space for narratives of their experiences and deep reflection on the phenomenon. The concept of medical error has a negative connotation, often being associated with the incompetence of a medical professional. Medical error in Brazil is demonstrated by low-quality professional performance and represents the current reality of the country because of the common lack of respect and consideration for patients. Victims often remark on their loss of identity, as their social functions have been interrupted and they do not expect to regain such. It was found, however, little assumption of error in the involved doctors' discourses and attitudes, which felt a need to judge the medical conduct in an attempt to assert their rights. Medical error in Brazil presents a punitive character and is little discussed in medical and scientific circles. The stigma of medical error is closely connected to the value and cultural judgments of the country, making it difficult to accept, both by victims and professionals. PMID:27403461

  1. Unintentional Pharmaceutical-Related Medication Errors Caused by Laypersons Reported to the Toxicological Information Centre in the Czech Republic.

    PubMed

    Urban, Michal; Leššo, Roman; Pelclová, Daniela

    2016-07-01

    The purpose of the article was to study unintentional pharmaceutical-related poisonings committed by laypersons that were reported to the Toxicological Information Centre in the Czech Republic. Identifying frequency, sources, reasons and consequences of the medication errors in laypersons could help to reduce the overall rate of medication errors. Records of medication error enquiries from 2013 to 2014 were extracted from the electronic database, and the following variables were reviewed: drug class, dosage form, dose, age of the subject, cause of the error, time interval from ingestion to the call, symptoms, prognosis at the time of the call and first aid recommended. Of the calls, 1354 met the inclusion criteria. Among them, central nervous system-affecting drugs (23.6%), respiratory drugs (18.5%) and alimentary drugs (16.2%) were the most common drug classes involved in the medication errors. The highest proportion of the patients was in the youngest age subgroup 0-5 year-old (46%). The reasons for the medication errors involved the leaflet misinterpretation and mistaken dose (53.6%), mixing up medications (19.2%), attempting to reduce pain with repeated doses (6.4%), erroneous routes of administration (2.2%), psychiatric/elderly patients (2.7%), others (9.0%) or unknown (6.9%). A high proportion of children among the patients may be due to the fact that children's dosages for many drugs vary by their weight, and more medications come in a variety of concentrations. Most overdoses could be prevented by safer labelling, proper cap closure systems for liquid products and medication reconciliation by both physicians and pharmacists. PMID:26990237

  2. Noncompliance pattern due to medication errors at a Teaching Hospital in Srikot, India

    PubMed Central

    Thakur, Heenopama; Thawani, Vijay; Raina, Rangeel Singh; Kothiyal, Gitanjali; Chakarabarty, Mrinmoy

    2013-01-01

    Objective: To study the medication errors leading to noncompliance in a tertiary care teaching hospital. Materials and Methods: This study was conducted in a tertiary care hospital of a teaching institution from Srikot, Garhwal, Uttarakhand to analyze the medication errors in 500 indoor prescriptions from medicine, surgery, obstetrics and gynecology, pediatrics and ENT departments over five months and 100 outdoor patients of medicine department. Results: Medication error rate for indoor patients was found to be 22.4 % and 11.4% for outdoor patients as against the standard acceptable error rate 3%. Maximum errors were observed in the indoor prescriptions of the surgery department accounting for 44 errors followed by medicine 32 and gynecology 25 in the 500 cases studied leading to faulty administration of medicines. Conclusion: Many medication errors were noted which go against the practice of rational therapeutics. Such studies can be directed to usher in the rational use of medicines for increasing compliance and therapeutic benefits. PMID:23833376

  3. Toward a theoretical approach to medical error reporting system research and design.

    PubMed

    Karsh, Ben-Tzion; Escoto, Kamisha Hamilton; Beasley, John W; Holden, Richard J

    2006-05-01

    The release of the Institute of Medicine (Kohn et al., 2000) report "To Err is Human", brought attention to the problem of medical errors, which led to a concerted effort to study and design medical error reporting systems for the purpose of capturing and analyzing error data so that safety interventions could be designed. However, to make real gains in the efficacy of medical error or event reporting systems, it is necessary to begin developing a theory of reporting systems adoption and use and to understand how existing theories may play a role in explaining adoption and use. This paper presents the results of a 9-month study exploring the barriers and facilitators for the design of a statewide medical error reporting system and discusses how several existing theories of technology acceptance, adoption and implementation fit with many of the results. In addition we present an integrated theoretical model of medical error reporting system design and implementation. PMID:16182233

  4. Toward a theoretical approach to medical error reporting system research and design

    PubMed Central

    Karsh, Ben-Tzion; Escoto, Kamisha Hamilton; Beasley, John W.; Holden, Richard J.

    2014-01-01

    The release of the Institute of Medicine (Kohn et al., 2000) report “To Err is Human”, brought attention to the problem of medical errors, which led to a concerted effort to study and design medical error reporting systems for the purpose of capturing and analyzing error data so that safety interventions could be designed. However, to make real gains in the efficacy of medical error or event reporting systems, it is necessary to begin developing a theory of reporting systems adoption and use and to understand how existing theories may play a role in explaining adoption and use. This paper presents the results of a 9-month study exploring the barriers and facilitators for the design of a statewide medical error reporting system and discusses how several existing theories of technology acceptance, adoption and implementation fit with many of the results. In addition we present an integrated theoretical model of medical error reporting system design and implementation. PMID:16182233

  5. [Medical error--professional liability for malpractice in Bosnia and Herzegovina].

    PubMed

    Pranjić, Nurka

    2009-01-01

    Medical care is frequently compared to aviation, as many of the factors which lead to errors in both fields are similar. In this article we review the literature on such events and discuss the ethical, legal and practical aspects of civil liability in the case of medical error. Ethics, professional policy and the law, as well as the relevant empirical literature, suggest that timely and candid disclosure should be standard practice. In harmonization to ethical codex, the physician is obliged to inform the patient about the origin of medical error. Civil liability is one of the most important parts of law that regulates health care service. Medical chambers could be having a very important role in alternative methods of medical error disciplinary screening proceedings. Guidelines for disclosure of medical error to patients, and their families if necessary, are proposed. PMID:19769287

  6. Sleep Loss in Resident Physicians: The Cause of Medical Errors?

    PubMed Central

    Kramer, Milton

    2010-01-01

    This review begins with the history of the events starting with the death of Libby Zion that lead to the Bell Commission, that the studied her death and made recommendations for improvement that were codified into law in New York state as the 405 law that the ACGME essentially adopted in putting a cap on work hours and establishing the level of staff supervision that must be available to residents in clinical situations particularly the emergency room and acute care units. A summary is then provided of the findings of the laboratory effects of total sleep deprivation including acute total sleep loss and the consequent widespread physiologic alterations, and of the effects of selective and chronic sleep loss. Generally the sequence of responses to increasing sleep loss goes from mood changes to cognitive effects to performance deficits. In the laboratory situation, deficits resulting from sleep deprivation are clearly and definitively demonstrable. Sleep loss in the clinical situation is usually sleep deprivation superimposed on chronic sleep loss. An examination of questionnaire studies, the literature on reports of sleep loss, studies of the reduction of work hours on performance as well as observational and a few interventional studies have yielded contradictory and often equivocal results. The residents generally find they feel better working fewer hours but improvements in patient care are often not reported or do not occur. A change in the attitude of the resident toward his role and his patient has not been salutary. Decreasing sleep loss should have had a positive effect on patient care in reducing medical error, but this remains to be unequivocally demonstrated. PMID:21188260

  7. Medical error reduction and tort reform through private, contractually-based quality medicine societies.

    PubMed

    MacCourt, Duncan; Bernstein, Joseph

    2009-01-01

    physicians cede their implicit "right to remain silent", even if some injured patients will receive less than they do today. Likewise, physicians will be happier with a system that avoids blame-even if this system placed strict requirements for high quality care and disclosure of error. We therefore conceive of de facto trade between patients and physicians, a Pareto improvement, taking form via the establishment of "Societies of Quality Medicine." Physicians working within these societies would consent to onerous processes for disclosing, rectifying and preventing medical error. Patients would in turn contractually agree to assert their claims in arbitration and with limits on recovery. The role of plaintiffs' lawyers would be unchanged, but due to increased disclosure, discovery costs would diminish and the likelihood of prevailing will more than triple. This article examines the legal and policy issues surrounding the establishment of Societies of Quality Medicine, particularly the issues of contracting over liability, and outlines a means of overcoming the theoretical and practical difficulties with enterprise liability, alternative dispute resolution and the imposition of limits on recovery for non-pecuniary damages. We aim to build a welfare enhancing system that rebuffs the culture of silence and promotes error reduction, a system that is at the same time legally sound, fiscally prudent and politically possible. PMID:20196282

  8. Frequency of medication errors in an emergency department of a large teaching hospital in southern Iran.

    PubMed

    Vazin, Afsaneh; Zamani, Zahra; Hatam, Nahid

    2014-01-01

    This study was conducted with the purpose of determining the frequency of medication errors (MEs) occurring in tertiary care emergency department (ED) of a large academic hospital in Iran. The incidence of MEs was determined through the disguised direct observation method conducted by a trained observer. A total of 1,031 medication doses administered to 202 patients admitted to the tertiary care ED were observed over a course of 54 6-hour shifts. Following collection of the data and analysis of the errors with the assistance of a clinical pharmacist, frequency of errors in the different stages was reported and analyzed in SPSS-21 software. For the 202 patients and the 1,031 medication doses evaluated in the present study, 707 (68.5%) MEs were recorded in total. In other words, 3.5 errors per patient and almost 0.69 errors per medication are reported to have occurred, with the highest frequency of errors pertaining to cardiovascular (27.2%) and antimicrobial (23.6%) medications. The highest rate of errors occurred during the administration phase of the medication use process with a share of 37.6%, followed by errors of prescription and transcription with a share of 21.1% and 10% of errors, respectively. Omission (7.6%) and wrong time error (4.4%) were the most frequent administration errors. The less-experienced nurses (P=0.04), higher patient-to-nurse ratio (P=0.017), and the morning shifts (P=0.035) were positively related to administration errors. Administration errors marked the highest share of MEs occurring in the different medication use processes. Increasing the number of nurses and employing the more experienced of them in EDs can help reduce nursing errors. Addressing the shortcomings with further research should result in reduction of MEs in EDs. PMID:25525391

  9. Frequency of medication errors in an emergency department of a large teaching hospital in southern Iran

    PubMed Central

    Vazin, Afsaneh; Zamani, Zahra; Hatam, Nahid

    2014-01-01

    This study was conducted with the purpose of determining the frequency of medication errors (MEs) occurring in tertiary care emergency department (ED) of a large academic hospital in Iran. The incidence of MEs was determined through the disguised direct observation method conducted by a trained observer. A total of 1,031 medication doses administered to 202 patients admitted to the tertiary care ED were observed over a course of 54 6-hour shifts. Following collection of the data and analysis of the errors with the assistance of a clinical pharmacist, frequency of errors in the different stages was reported and analyzed in SPSS-21 software. For the 202 patients and the 1,031 medication doses evaluated in the present study, 707 (68.5%) MEs were recorded in total. In other words, 3.5 errors per patient and almost 0.69 errors per medication are reported to have occurred, with the highest frequency of errors pertaining to cardiovascular (27.2%) and antimicrobial (23.6%) medications. The highest rate of errors occurred during the administration phase of the medication use process with a share of 37.6%, followed by errors of prescription and transcription with a share of 21.1% and 10% of errors, respectively. Omission (7.6%) and wrong time error (4.4%) were the most frequent administration errors. The less-experienced nurses (P=0.04), higher patient-to-nurse ratio (P=0.017), and the morning shifts (P=0.035) were positively related to administration errors. Administration errors marked the highest share of MEs occurring in the different medication use processes. Increasing the number of nurses and employing the more experienced of them in EDs can help reduce nursing errors. Addressing the shortcomings with further research should result in reduction of MEs in EDs. PMID:25525391

  10. Characteristics of medication errors made by students during the administration phase: a descriptive study.

    PubMed

    Wolf, Zane Robinson; Hicks, Rodney; Serembus, Joanne Farley

    2006-01-01

    Faculty concentrate on teaching nursing students about safe medication administration practices and on challenging them to develop skills for calculating drug dose and intravenous flow rate problems. In spite of these efforts, students make medication errors and little is known about the attributes of these errors. Therefore, this descriptive, retrospective, secondary analysis study examined the characteristics of medication errors made by nursing students during the administration phase of the medication use process as reported to the MEDMARX, a database operated by the United States Pharmacopeia through the Patient Safety Program. Fewer than 3% of 1,305 student-made medication errors occurring in the administration process resulted in patient harm. Most were omission errors, followed by errors of giving the wrong dose (amount) of a drug. The most prevalent cause of the errors was students' performance deficits, whereas inexperience and distractions were leading contributing factors. The antimicrobial therapeutic class of drugs and the 10 subcategories within this class were the most commonly reported medications involved. Insulin was the highest-frequency single medication reported. Overall, this study shows that students' administration errors may be more frequent than suspected. Faculty might consider curriculum revisions that incorporate medication use safety throughout each course in nursing major courses. PMID:16459288

  11. Voluntary Medical Incident Reporting Tool to Improve Physician Reporting of Medical Errors in an Emergency Department

    PubMed Central

    Okafor, Nnaemeka G.; Doshi, Pratik B.; Miller, Sara K.; McCarthy, James J.; Hoot, Nathan R.; Darger, Bryan F.; Benitez, Roberto C.; Chathampally, Yashwant G.

    2015-01-01

    Introduction Medical errors are frequently under-reported, yet their appropriate analysis, coupled with remediation, is essential for continuous quality improvement. The emergency department (ED) is recognized as a complex and chaotic environment prone to errors. In this paper, we describe the design and implementation of a web-based ED-specific incident reporting system using an iterative process. Methods A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. Results The utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012. This is an increase in rate of reported events from 0.07% of all ED visits to 0.44% of all ED visits. In 2012, faculty reported 60% of all incidents, while residents and midlevel providers reported 24% and 16% respectively. The most commonly reported incidents were delays in care and management concerns. Conclusion Error reporting frequency can be dramatically improved by using a web-based, user-friendly, voluntary, and non-punitive reporting system. PMID:26759657

  12. The approach of Bayesian model indicates media awareness of medical errors

    NASA Astrophysics Data System (ADS)

    Ravichandran, K.; Arulchelvan, S.

    2016-06-01

    This research study brings out the factors behind the increase in medical malpractices in the Indian subcontinent in the present day environment and impacts of television media awareness towards it. Increased media reporting of medical malpractices and errors lead to hospitals taking corrective action and improve the quality of medical services that they provide. The model of Cultivation Theory can be used to measure the influence of media in creating awareness of medical errors. The patient's perceptions of various errors rendered by the medical industry from different parts of India were taken up for this study. Bayesian method was used for data analysis and it gives absolute values to indicate satisfaction of the recommended values. To find out the impact of maintaining medical records of a family online by the family doctor in reducing medical malpractices which creates the importance of service quality in medical industry through the ICT.

  13. Speak Up: Help Prevent Errors in Your Care: Behavioral Health Care

    MedlinePlus

    ... TM Help Prevent Errors in Your Care Behavioral Health Care To prevent health care errors, patients are urged to... SpeakUP TM Service ... individuals should be involved in their own behavioral health care. These efforts to increase consumer awareness and involvement ...

  14. Obligation towards medical errors disclosure at a tertiary care hospital in Dubai, UAE

    PubMed Central

    Zaghloul, Ashraf Ahmad; Rahman, Syed Azizur; Abou El-Enein, Nagwa Younes

    2016-01-01

    OBJECTIVE: The study aimed to identify healthcare providers’ obligation towards medical errors disclosure as well as to study the association between the severity of the medical error and the intention to disclose the error to the patients and their families. DESIGN: A cross-sectional study design was followed to identify the magnitude of disclosure among healthcare providers in different departments at a randomly selected tertiary care hospital in Dubai. SETTING AND PARTICIPANTS: The total sample size accounted for 106 respondents. Data were collected using a questionnaire composed of two sections namely; demographic variables of the respondents and a section which included variables relevant to medical error disclosure. RESULTS: Statistical analysis yielded significant association between the obligation to disclose medical errors with male healthcare providers (X2 = 5.1), and being a physician (X2 = 19.3). Obligation towards medical errors disclosure was significantly associated with those healthcare providers who had not committed any medical errors during the past year (X2 = 9.8), and any type of medical error regardless the cause, extent of harm (X2 = 8.7). Variables included in the binary logistic regression model were; status (Exp β (Physician) = 0.39, 95% CI 0.16–0.97), gender (Exp β (Male) = 4.81, 95% CI 1.84–12.54), and medical errors during the last year (Exp β (None) = 2.11, 95% CI 0.6–2.3). CONCLUSION: Education and training of physicians about disclosure conversations needs to start as early as medical school. Like the training in other competencies required of physicians, education in communicating about medical errors could help reduce physicians’ apprehension and make them more comfortable with disclosure conversations. PMID:27567766

  15. Reduced error signalling in medication-naive children with ADHD: associations with behavioural variability and post-error adaptations

    PubMed Central

    Plessen, Kerstin J.; Allen, Elena A.; Eichele, Heike; van Wageningen, Heidi; Høvik, Marie Farstad; Sørensen, Lin; Worren, Marius Kalsås; Hugdahl, Kenneth; Eichele, Tom

    2016-01-01

    Background We examined the blood-oxygen level–dependent (BOLD) activation in brain regions that signal errors and their association with intraindividual behavioural variability and adaptation to errors in children with attention-deficit/hyperactivity disorder (ADHD). Methods We acquired functional MRI data during a Flanker task in medication-naive children with ADHD and healthy controls aged 8–12 years and analyzed the data using independent component analysis. For components corresponding to performance monitoring networks, we compared activations across groups and conditions and correlated them with reaction times (RT). Additionally, we analyzed post-error adaptations in behaviour and motor component activations. Results We included 25 children with ADHD and 29 controls in our analysis. Children with ADHD displayed reduced activation to errors in cingulo-opercular regions and higher RT variability, but no differences of interference control. Larger BOLD amplitude to error trials significantly predicted reduced RT variability across all participants. Neither group showed evidence of post-error response slowing; however, post-error adaptation in motor networks was significantly reduced in children with ADHD. This adaptation was inversely related to activation of the right-lateralized ventral attention network (VAN) on error trials and to task-driven connectivity between the cingulo-opercular system and the VAN. Limitations Our study was limited by the modest sample size and imperfect matching across groups. Conclusion Our findings show a deficit in cingulo-opercular activation in children with ADHD that could relate to reduced signalling for errors. Moreover, the reduced orienting of the VAN signal may mediate deficient post-error motor adaptions. Pinpointing general performance monitoring problems to specific brain regions and operations in error processing may help to guide the targets of future treatments for ADHD. PMID:26441332

  16. Types and severity of medication errors in Iran; a review of the current literature

    PubMed Central

    2013-01-01

    Medication error (ME) is the most common single preventable cause of adverse drug events which negatively affects patient safety. ME prevalence is a valuable safety indicator in healthcare system. Inadequate studies on ME, shortage of high-quality studies and wide variations in estimations from developing countries including Iran, decreases the reliability of ME evaluations. In order to clarify the status of MEs, we aimed to review current available literature on this subject from Iran. We searched Scopus, Web of Science, PubMed, CINAHL, EBSCOHOST and also Persian databases (IranMedex, and SID) up to October 2012 to find studies on adults and children about prescription, transcription, dispensing, and administration errors. Two authors independently selected and one of them reviewed and extracted data for types, definitions and severity of MEs. The results were classified based on different stages of drug delivery process. Eighteen articles (11 Persian and 7 English) were included in our review. All study designs were cross-sectional and conducted in hospital settings. Nursing staff and students were the most frequent populations under observation (12 studies; 66.7%). Most of studies did not report the overall frequency of MEs aside from ME types. Most of studies (15; 83.3%) reported prevalence of administration errors between 14.3%-70.0%. Prescribing error prevalence ranged from 29.8%-47.8%. The prevalence of dispensing and transcribing errors were from 11.3%-33.6% and 10.0%-51.8% respectively. We did not find any follow up or repeated studies. Only three studies reported findings on severity of MEs. The most reported types of and the highest percentages for any type of ME in Iran were administration errors. Studying ME in Iran is a new area considering the duration and number of publications. Wide ranges of estimations for MEs in different stages may be because of the poor quality of studies with diversity in definitions, methods, and populations. For gaining

  17. [Medication errors: importance of notification in the management of patient safety].

    PubMed

    Bohomol, Elena; Ramos, Laís Helena

    2007-01-01

    Notifying medication errors is an important instrument in managing assistance quality and safety for the patient. The objective of this study was to verify with the nursing team their understanding that a medication error had been committed, and to observe how they notified responsible physicians of the event. To achieve this, researchers used a descriptive/exploratory survey with 89 professionals. The results demonstrate a lack of uniformity in understanding that medication errors had been committed, when these errors must be communicated to a physician, and when an event report must be filled out. The research shows the necessity to develop educational programs that shed light on exactly what constitutes a medication error, clarifying causes of the problem and providing solutions to solve it. PMID:17477164

  18. Database Design to Ensure Anonymous Study of Medical Errors: A Report from the ASIPS collaborative

    PubMed Central

    Pace, Wilson D.; Staton, Elizabeth W.; Higgins, Gregory S.; Main, Deborah S.; West, David R.; Harris, Daniel M.

    2003-01-01

    Medical error reporting systems are important information sources for designing strategies to improve the safety of health care. Applied Strategies for Improving Patient Safety (ASIPS) is a multi-institutional, practice-based research project that collects and analyzes data on primary care medical errors and develops interventions to reduce error. The voluntary ASIPS Patient Safety Reporting System captures anonymous and confidential reports of medical errors. Confidential reports, which are quickly de-identified, provide better detail than do anonymous reports; however, concerns exist about the confidentiality of those reports should the database be subject to legal discovery or other security breaches. Standard database elements, for example, serial ID numbers, date/time stamps, and backups, could enable an outsider to link an ASIPS report to a specific medical error. The authors present the design and implementation of a database and administrative system that reduce this risk, facilitate research, and maintain near anonymity of the events, practices, and clinicians. PMID:12925548

  19. Use of Electronic Medication Administration Records to Reduce Perceived Stress and Risk of Medication Errors in Nursing Homes.

    PubMed

    Alenius, Malin; Graf, Peter

    2016-07-01

    Concerns have been raised about the effects of current medication administration processes on the safety of many of the aspects of medication administration. Keeping electronic medication administration records could decrease many of these problems. Unfortunately, there has not been much research on this topic, especially in nursing homes. A prospective case-control survey was consequently performed at two nursing homes; the electronic record system was introduced in one, whereas the other continued to use paper records. The personnel were asked to fill in a questionnaire of their perceptions of stress and risk of medication errors at baseline (n = 66) and 20 weeks after the intervention group had started recording medication administration electronically (n = 59). There were statistically significant decreases in the perceived risk of omitting a medication, of medication errors occurring because of communication problems, and of medication errors occurring because of inaccurate medication administration records in the intervention group (all P < .01 vs the control group). The perceived overall daily stress levels were also reduced in the intervention group (P < .05). These results indicate that the utilization of electronic medication administration records will reduce many of the concerns regarding the medication administration process. PMID:27270628

  20. Eleven-year descriptive analysis of closed court verdicts on medical errors in Spain and Massachusetts

    PubMed Central

    Giraldo, Priscila; Sato, Luke; Martínez-Sánchez, Jose M; Comas, Mercè; Dwyer, Kathy; Sala, Maria; Castells, Xavier

    2016-01-01

    Objectives To evaluate and compare the characteristics of court verdicts on medical errors allegedly harming patients in Spain and Massachusetts from 2002 to 2012. Design, setting and participants We reviewed 1041 closed court verdicts obtained from data on litigation in the Thomson Reuters Aranzadi Westlaw databases in Spain (Europe), and 370 closed court verdicts obtained from the Controlled Risk and Risk Management Foundation of Harvard Medical Institutions (CRICO/RMF) in Massachusetts (USA). We included closed court verdicts on medical errors. The definition of medical errors was based on that of the Institute of Medicine (USA). We excluded any agreements between parties before a judgement. Results Medical errors were involved in 25.9% of court verdicts in Spain and in 74% of those in Massachusetts. The most frequent cause of medical errors was a diagnosis-related problem (25.1%; 95% CI 20.7% to 31.1% in Spain; 35%; 95% CI 29.4% to 40.7% in Massachusetts). The proportion of medical errors classified as high severity was 34% higher in Spain than in Massachusetts (p=0.001). The most frequent factors contributing to medical errors in Spain were surgical and medical treatment (p=0.001). In Spain, 98.5% of medical errors resulted in compensation awards compared with only 6.9% in Massachusetts. Conclusions This study reveals wide differences in litigation rates and the award of indemnity payments in Spain and Massachusetts; however, common features of both locations are the high rates of diagnosis-related problems and the long time interval until resolution. PMID:27577585

  1. INTRAVENOUS MEDICATION ADMINISTRATION ERRORS AND THEIR CAUSES IN CARDIAC CRITICAL CARE UNITS IN IRAN

    PubMed Central

    Bagheri-Nesami, Masoumeh; Esmaeili, Ravanbakhsh; Tajari, Mojdeh

    2015-01-01

    Background and Objectives: The dangerous events caused by medication errors are one of the main challenges faced in critical care units. The present study was conducted to determine the frequency of intravenous medication administration errors and their causes in cardiac critical care units in Iran. Materials and Methods: The present descriptive study was conducted in the critical care units (CCUs and cardiac surgery intensive care units) of 12 teaching hospitals. Of the total of 240 nurses working in these departments, 190 participated in the present study. The data collection tools used in this study included the “nurses’ demographic data questionnaire”, the “patients’ medical and demographic data questionnaire” and the “nurses’ self-reporting questionnaire about the frequency of intravenous medication administration errors and their causes”. The data obtained were analyzed in SPSS-20 using descriptive statistics such as the absolute and relative frequency. Findings: During the 2 months in which this study was being conducted, 2542 patients were admitted to these departments and 20240 doses of intravenous medications were administered to these patients. The nurses reported 262 intravenous medication administration errors. The most common intravenous medication error pertained to administering the wrong medication (n=71 and 27.1%). As for the causes of intravenous medication administration errors, 51.5% of the errors were associated with work conditions, 24% with packaging, 13.4% with communication, 9.9% with transcription and 1.2% with pharmacies. Discussion and Conclusion: According to the results, strategies are recommended to be adopted for reducing or limiting medication errors, such as building a stronger pharmacology knowledge base in nurses and nursing students, improving work conditions and improving communication between the nurses and physicians. PMID:26889108

  2. Justifying a pediatric critical-care satellite pharmacy by medication-error reporting.

    PubMed

    Tisdale, J E

    1986-02-01

    As a part of an evaluation of the need for a satellite pharmacy to serve two pediatric critical-care units, an observational study was conducted to determine the incidence of medication errors in the units. A pharmacist observed nurses preparing and administering medications in 18 12-hour shifts. Of the nine shifts observed in each unit, five were day shifts and four were night shifts. Five nurses were observed per shift in the intensive-care nursery (ICN) and three nurses per shift in the pediatric intensive-care unit (PICU). The classification of errors was based on the definitions established by the American Society of Hospital Pharmacists. The total error rate was 17.4% in the ICN and 38.0% in the PICU. When the error rates were calculated excluding wrong-time errors, they were 7.1% in the ICN and 11.7% in the PICU. Of 147 errors, 124 (84.4%) occurred with medications with a high potential for serious consequences. The error rates were similar on the day and night shifts in the PICU (42.1% and 31.3%, respectively), but they were significantly higher on the day shifts than the night shifts in the ICN (24.5% and 8.4%, respectively). The number of medication errors in the two units was substantial, and steps were taken to implement a 24-hour pediatric critical-care satellite pharmacy with unit dose drug distribution to reduce the incidence of errors. PMID:3953597

  3. Perspective of midwives working at hospitals affiliated to the Isfahan University of Medical Sciences regarding medical errors

    PubMed Central

    Valiani, Mahboubeh; Majidi, Jamileh; Beigi, Marjan

    2015-01-01

    Background: Committing an error is part of the human nature. No health care provider, despite the mastery of their skills, is immune from committing it. Medical error in the labor and obstetrics wards as well as other health units is inevitable and reduces the quality of health care, leading to accident. Sometimes these events, like the death of mother, fetus, and newborn, would be beyond repair. The purpose of this study was to investigate the perspective of gynecological ward providers about medical errors. Materials and Methods: This was a descriptive–analytical study. Sample size was 94 participants selected using census sampling. The study population included all midwives of four hospitals (Al-Zahra, Beheshti, Isa Ben Maryam, and Amin). Data were collected by a self-administered questionnaire and analyzed using SPSS software. Results: This study shows that three factors (human, structural, and managerial) have affected medical errors in the labor and obstetrics wards. From the midwifery perspective, human factors were the most important factors with an average score of 73.26% and the lowest score was related to structural factors with an average score of 65.36%. Intervention strategies to reduce errors, service training program tailored to the needs of the service provider, distribution of the tasks at different levels, and attempts to reform the system instead of punishing the wrongdoer were set in priority list. Conclusions: Based on the results of this study on the perspectives of participants, among the three factors of medical errors (human factors, structural factors, and management factors), human factors are the biggest threat in committing medical errors. Modification in the pattern of teaching by the midwifery professors and their presence in the hospitals, creating a no-blame culture, and sharing of alerts in medical errors are among appropriate actions in the dimensions of human, structural, and managerial factors. PMID:26457089

  4. [Plagiarism in medical schools, and its prevention].

    PubMed

    Annane, Djillali; Annane, Frédérique

    2012-09-01

    The plagiarism has become very common in universities and medical school. Undoubtedly, the easy access to a huge amount of electronic documents is one explanation for the increasing prevalence of plagiarism among students. While most of universities and medical school have clear statements and rules about plagiarism, available tools for the detection of plagiarism remain inefficient and dedicate training program for students and teachers too scarce. As lack of time is one reason for students to choose plagiarism, it should be one main target for educational programs. PMID:22739066

  5. Comprehensive framework for preventive maintenance priority of medical equipment.

    PubMed

    Saleh, Neven; Balestra, Gabriella

    2015-08-01

    Throughout the medical equipment life cycle, preventive maintenance is considered one of the most important stages that should be managed properly. However, the need for better management and control by giving a reasonable prioritization for preventive maintenance becomes essential. The purpose of this study is to develop a comprehensive framework for preventive maintenance priority of medical equipment using Quality Function Deployment (QFD) and Fuzzy Logic (FL). The quality function deployment is proposed in order to identify the most important criteria that could impact preventive maintenance priority decision; meanwhile the role of the fuzzy logic is to generate a priority index of the list of equipment considering those criteria. The model validation was carried out on 140 pieces of medical equipment belonging to two hospitals. In application, we propose to classify the priority index into five classes. The results indicate that the strong correlation existence between risk-based criteria and preventive maintenance priority decision. PMID:26736488

  6. Description of medication errors detected at a drug information centre in Southern Brazil

    PubMed Central

    Dos Santos, Luciana; Winkler, Natália; Dos Santos, Marlise A.; Martinbiancho, Jacqueline K.

    2014-01-01

    Objective: To identify and describe actual or potential medication errors related to drug information inquiries made by staff members of a teaching hospital to a Drug Information Centre from January 2012 to December 2013. Methods: Data were collected from the records of inquiries made by health care professionals to the Drug Information Centre throughout this period. Results: During the study period, the Drug Information Centre received 3,500 inquiries. Of these, 114 inquiries had medication errors. Most errors were related to prescribing, preparation, and administration and were classified according to severity as category B (57%) (potential errors) and categories C (26.3%) and D (15.8%) (actual errors that did not result in harm to the patient). Error causes included overdose (13.2%), wrong route of administration (11.4%), inadequate drug storage (11.4%), and wrong dosage form (8.8%). The drugs most frequently involved in errors were vitamin K (4.4%), vancomycin (3.5%), and meropenem (3.5%). Conclusion: In this study, it was not possible to measure the reduction in error rate involving medication use because of the lack of previous data on this process in the institution. However, our findings indicate that the Drug Information Centre may be used as a strategy to seek improvements in processes involving medication use. PMID:25883691

  7. Medication errors in the intensive care unit: literature review using the SEIPS model.

    PubMed

    Frith, Karen H

    2013-01-01

    Medication errors in intensive care units put patients at risk for injury or death every day. Safety requires an organized and systematic approach to improving the tasks, technology, environment, and organizational culture associated with medication systems. The Systems Engineering Initiative for Patient Safety model can help leaders and health care providers understand the complicated and high-risk work associated with critical care. Using this model, the author combines a human factors approach with the well-known structure-process-outcome model of quality improvement to examine research literature. The literature review reveals that human factors, including stress, high workloads, knowledge deficits, and performance deficits, are associated with medication errors. Factors contributing to medication errors are frequent interruptions, communication problems, and poor fit of health information technology to the workflow of providers. Multifaceted medication safety interventions are needed so that human factors and system problems can be addressed simultaneously. PMID:24153217

  8. Medical Amnesty: Professional Enabling or Indicated Prevention?

    ERIC Educational Resources Information Center

    Chapman, Robert J.

    2009-01-01

    The intent of this brochure is to review the pros and cons of employing what has come to be known as a Good Samaritan Policy or what some refer to as Medical Amnesty. Such policies are designed to address dangerous student drinking off campus. These policies differ in their details but have a common focus in an attempt to protect the inebriate…

  9. Injury prevention education in medical schools: an international survey of medical students

    PubMed Central

    Villaveces, A; Kammeyer, J; Bencevic, H

    2005-01-01

    Background: Injuries account for an estimated 9% of global mortality. Health professionals worldwide receive little formal injury prevention training, especially in developing countries. Objective: To identify injury prevention training topics taught in a sample of medical schools throughout the world. Design and setting: Cross sectional survey of 82 medical schools from 31 countries. Based on a convenience sample, respondents recalled the injury prevention concepts they were taught, estimated the time dedicated to these topics, specified the courses and rotations where these concepts were taught, and noted whether they were compulsory or elective sessions. Participants: Medical students in their last year of medical training. Main exposure measures: Student recall of classes and rotations where topics of injury prevention and control were discussed. Results: Basic injury prevention concepts including risk factors for injuries and injury classification systems were not covered in 60% of medical schools. Concepts related to child abuse and neglect and emergency care were more commonly taught than others such as traffic injury prevention and youth violence prevention. In general, injury prevention and control concepts were less frequently taught in Middle Eastern and African universities compared with other regions and some topics such as violence prevention were more frequently taught in medical schools in the Americas. Injury prevention concepts were taught most frequently in preventive medicine, forensic medicine, emergency medicine, surgery and pediatrics courses, and rotations. Conclusions: Injury prevention and control education is infrequent and fragmented in medical schools around the world. Inclusion or further development of curricula on this subject could benefit prevention and control efforts. PMID:16326768

  10. Secondary preventive medication persistence and adherence 1 year after stroke

    PubMed Central

    Olson, D.M.; Zhao, X.; Pan, W.; Zimmer, L.O.; Goldstein, L.B.; Alberts, M.J.; Fagan, S.C.; Fonarow, G.C.; Johnston, S.C.; Kidwell, C.; LaBresh, K.A.; Ovbiagele, B.; Schwamm, L.; Peterson, E.D.

    2011-01-01

    Objective: Data on long-term use of secondary prevention medications following stroke are limited. The Adherence eValuation After Ischemic stroke–Longitudinal (AVAIL) Registry assessed patient, provider, and system-level factors influencing continuation of prevention medications for 1 year following stroke hospitalization discharge. Methods: Patients with ischemic stroke or TIA discharged from 106 hospitals participating in the American Heart Association Get With The Guidelines–Stroke program were surveyed to determine their use of warfarin, antiplatelet, antihypertensive, lipid-lowering, and diabetes medications from discharge to 12 months. Reasons for stopping medications were ascertained. Persistence was defined as continuation of all secondary preventive medications prescribed at hospital discharge, and adherence as continuation of prescribed medications except those stopped according to health care provider instructions. Results: Of the 2,880 patients enrolled in AVAIL, 88.4% (2,457 patients) completed 1-year interviews. Of these, 65.9% were regimen persistent and 86.6% were regimen adherent. Independent predictors of 1-year medication persistence included fewer medications prescribed at discharge, having an adequate income, having an appointment with a primary care provider, and greater understanding of why medications were prescribed and their side effects. Independent predictors of adherence were similar to those for persistence. Conclusions: Although up to one-third of stroke patients discontinued one or more secondary prevention medications within 1 year of hospital discharge, self-discontinuation of these medications is uncommon. Several potentially modifiable patient, provider, and system-level factors associated with persistence and adherence may be targets for future interventions. PMID:21900638

  11. Detecting and preventing error propagation via competitive learning.

    PubMed

    Silva, Thiago Christiano; Zhao, Liang

    2013-05-01

    Semisupervised learning is a machine learning approach which is able to employ both labeled and unlabeled samples in the training process. It is an important mechanism for autonomous systems due to the ability of exploiting the already acquired information and for exploring the new knowledge in the learning space at the same time. In these cases, the reliability of the labels is a crucial factor, because mislabeled samples may propagate wrong labels to a portion of or even the entire data set. This paper has the objective of addressing the error propagation problem originated by these mislabeled samples by presenting a mechanism embedded in a network-based (graph-based) semisupervised learning method. Such a procedure is based on a combined random-preferential walk of particles in a network constructed from the input data set. The particles of the same class cooperate among them, while the particles of different classes compete with each other to propagate class labels to the whole network. Computer simulations conducted on synthetic and real-world data sets reveal the effectiveness of the model. PMID:23200192

  12. The effect of a safe zone on nurse interruptions, distractions, and medication administration errors.

    PubMed

    Yoder, Mindy; Schadewald, Diane; Dietrich, Kim

    2015-01-01

    Patient safety is a health care priority. Yet medical errors are ranked the eighth leading cause of death. Medication administration errors (MAEs) often result from multiple environmental and individual factors. This quality improvement initiative adapted a protocol based on airline industry safety measures to decrease nurse distractions and interruptions during medication administration, with the goal of decreasing MAEs. Sources of distractions, interruptions, and MAEs were measured pre and post intervention. Patient satisfaction scores were measured concurrently. Results of this initiative differ from previous studies in which similar interventions reduced both distractions and MAEs. An unexpected finding was dramatically increased patient satisfaction. PMID:25723837

  13. Errors of oral medication administration in a patient with enteral feeding tube.

    PubMed

    Emami, Shahram; Hamishehkar, Hadi; Mahmoodpoor, Ata; Mashayekhi, Simin; Asgharian, Parina

    2012-07-01

    Enteral feeding tube is employed for feeding of critically ill patients who are unable to eat. In the cases of oral medication administration to enterally fed patients, some potential errors could happen. We report a 53-year-old man who was admitted to intensive care unit (ICU) of a teaching hospital due to the post-CPR hypoxemic encephalopathy. The patient was intubated and underwent mechanical ventilation. A nasogastric (NG) tube was used as the enteral route for nutrition and administration of oral medications. Oral medications were crushed then dissolved in tap water and were given to the patient through NG tube. In present article we report several medication errors occurred during enterally drug administration, including errors in dosage form selection, methods of oral medication administration and drug interactions and incompatibility with nutrition formula. These errors could reduce the effects of drugs and lead to unsuccessful treatment of patient and also could increase the risk of potential adverse drug reactions. Potential leading causes of these errors include lack of drug knowledge among physicians, inadequate training of nurses and lack of pharmacists participation in medical settings. PMID:24991587

  14. Antithrombotic Medication for Cardioembolic Stroke Prevention

    PubMed Central

    Font, M. Àngels; Krupinski, Jerzy; Arboix, Adrià

    2011-01-01

    Embolism of cardiac origin accounts for about 20% of ischemic strokes. Nonvalvular atrial fibrillation is the most frequent cause of cardioembolic stroke. Approximately 1% of population is affected by atrial fibrillation, and its prevalence is growing with ageing in the modern world. Strokes due to cardioembolism are in general severe and prone to early recurrence and have a higher long-term risk of recurrence and mortality. Despite its enormous preventive potential, continuous oral anticoagulation is prescribed for less than half of patients with atrial fibrillation who have risk factors for cardioembolism and no contraindications for anticoagulation. Available evidence does not support routine immediate anticoagulation of acute cardioembolic stroke. Anticoagulation therapy's associated risk of hemorrhage and monitoring requirements have encouraged the investigation of alternative therapies for individuals with atrial fibrillation. New anticoagulants being tested for prevention of stroke are low-molecular-weight heparins (LMWH), unfractionated heparin, factor Xa inhibitors, or direct thrombin inhibitors like dabigatran etexilate and rivaroxaban. The later exhibit stable pharmacokinetics obviating the need for coagulation monitoring or dose titration, and they lack clinically significant food or drug interaction. Moreover, they offer another potential that includes fixed dosing, oral administration, and rapid onset of action. There are several concerns regarding potential harm, including an increased risk for hepatotoxicity, clinically significant bleeding, and acute coronary events. Therefore, additional trials and postmarketing surveillance will be needed. PMID:21822469

  15. How the brain prevents a second error in a perceptual decision-making task

    PubMed Central

    Perri, Rinaldo Livio; Berchicci, Marika; Lucci, Giuliana; Spinelli, Donatella; Di Russo, Francesco

    2016-01-01

    In cognitive tasks, error commission is usually followed by a performance characterized by post-error slowing (PES) and post-error improvement of accuracy (PIA). Three theoretical accounts were hypothesized to support these post-error adjustments: the cognitive, the inhibitory, and the orienting account. The aim of the present ERP study was to investigate the neural processes associated with the second error prevention. To this aim, we focused on the preparatory brain activities in a large sample of subjects performing a Go/No-go task. The main results were the enhancement of the prefrontal negativity (pN) component -especially on the right hemisphere- and the reduction of the Bereitschaftspotential (BP) -especially on the left hemisphere- in the post-error trials. The ERP data suggested an increased top-down and inhibitory control, such as the reduced excitability of the premotor areas in the preparation of the trials following error commission. The results were discussed in light of the three theoretical accounts of the post-error adjustments. Additional control analyses supported the view that the adjustments-oriented components (the post-error pN and BP) are separated by the error-related potentials (Ne and Pe), even if all these activities represent a cascade of processes triggered by error-commission. PMID:27534593

  16. How the brain prevents a second error in a perceptual decision-making task.

    PubMed

    Perri, Rinaldo Livio; Berchicci, Marika; Lucci, Giuliana; Spinelli, Donatella; Di Russo, Francesco

    2016-01-01

    In cognitive tasks, error commission is usually followed by a performance characterized by post-error slowing (PES) and post-error improvement of accuracy (PIA). Three theoretical accounts were hypothesized to support these post-error adjustments: the cognitive, the inhibitory, and the orienting account. The aim of the present ERP study was to investigate the neural processes associated with the second error prevention. To this aim, we focused on the preparatory brain activities in a large sample of subjects performing a Go/No-go task. The main results were the enhancement of the prefrontal negativity (pN) component -especially on the right hemisphere- and the reduction of the Bereitschaftspotential (BP) -especially on the left hemisphere- in the post-error trials. The ERP data suggested an increased top-down and inhibitory control, such as the reduced excitability of the premotor areas in the preparation of the trials following error commission. The results were discussed in light of the three theoretical accounts of the post-error adjustments. Additional control analyses supported the view that the adjustments-oriented components (the post-error pN and BP) are separated by the error-related potentials (Ne and Pe), even if all these activities represent a cascade of processes triggered by error-commission. PMID:27534593

  17. Designing an Algorithm to Preserve Privacy for Medical Record Linkage With Error-Prone Data

    PubMed Central

    Pal, Doyel; Chen, Tingting; Khethavath, Praveen

    2014-01-01

    Background Linking medical records across different medical service providers is important to the enhancement of health care quality and public health surveillance. In records linkage, protecting the patients’ privacy is a primary requirement. In real-world health care databases, records may well contain errors due to various reasons such as typos. Linking the error-prone data and preserving data privacy at the same time are very difficult. Existing privacy preserving solutions for this problem are only restricted to textual data. Objective To enable different medical service providers to link their error-prone data in a private way, our aim was to provide a holistic solution by designing and developing a medical record linkage system for medical service providers. Methods To initiate a record linkage, one provider selects one of its collaborators in the Connection Management Module, chooses some attributes of the database to be matched, and establishes the connection with the collaborator after the negotiation. In the Data Matching Module, for error-free data, our solution offered two different choices for cryptographic schemes. For error-prone numerical data, we proposed a newly designed privacy preserving linking algorithm named the Error-Tolerant Linking Algorithm, that allows the error-prone data to be correctly matched if the distance between the two records is below a threshold. Results We designed and developed a comprehensive and user-friendly software system that provides privacy preserving record linkage functions for medical service providers, which meets the regulation of Health Insurance Portability and Accountability Act. It does not require a third party and it is secure in that neither entity can learn the records in the other’s database. Moreover, our novel Error-Tolerant Linking Algorithm implemented in this software can work well with error-prone numerical data. We theoretically proved the correctness and security of our Error

  18. The use of failure mode effect and criticality analysis in a medication error subcommittee.

    PubMed

    Williams, E; Talley, R

    1994-04-01

    Failure Mode Effect and Criticality Analysis (FMECA) is the systematic assessment of a process or product that enables one to determine the location and mechanism of potential failures. It has been used by engineers, particularly in the aerospace industry, to identify and prioritize potential failures during product development when there is a lack of data but an abundance of expertise. The Institute for Safe Medication Practices has recommended its use in analyzing the medication administration process in hospitals and in drug product development in the pharamceutical industry. A medication error subcommittee adopted and modified FMECA to identify and prioritize significant failure modes in its specific medication administration process. Based on this analysis, the subcommittee implemented solutions to four of the five highest ranked failure modes. FMECA provided a method for a multidisciplinary group to address the most important medication error concerns based upon the expertise of the group members. It also facilitated consensus building in a group with varied perceptions. PMID:10133462

  19. Female residents experiencing medical errors in general internal medicine: a qualitative study

    PubMed Central

    2014-01-01

    Background Doctors, especially doctors-in-training such as residents, make errors. They have to face the consequences even though today’s approach to errors emphasizes systemic factors. Doctors’ individual characteristics play a role in how medical errors are experienced and dealt with. The role of gender has previously been examined in a few quantitative studies that have yielded conflicting results. In the present study, we sought to qualitatively explore the experience of female residents with respect to medical errors. In particular, we explored the coping mechanisms displayed after an error. This study took place in the internal medicine department of a Swiss university hospital. Methods Within a phenomenological framework, semi-structured interviews were conducted with eight female residents in general internal medicine. All interviews were audiotaped, fully transcribed, and thereafter analyzed. Results Seven main themes emerged from the interviews: (1) A perception that there is an insufficient culture of safety and error; (2) The perceived main causes of errors, which included fatigue, work overload, inadequate level of competences in relation to assigned tasks, and dysfunctional communication; (3) Negative feelings in response to errors, which included different forms of psychological distress; (4) Variable attitudes of the hierarchy toward residents involved in an error; (5) Talking about the error, as the core coping mechanism; (6) Defensive and constructive attitudes toward one’s own errors; and (7) Gender-specific experiences in relation to errors. Such experiences consisted in (a) perceptions that male residents were more confident and therefore less affected by errors than their female counterparts and (b) perceptions that sexist attitudes among male supervisors can occur and worsen an already painful experience. Conclusions This study offers an in-depth account of how female residents specifically experience and cope with medical errors. Our

  20. Simple prescribing errors and allergy documentation in medical hospital admissions in Australia and New Zealand.

    PubMed

    Barton, Lorna; Futtermenger, Judith; Gaddi, Yash; Kang, Angela; Rivers, Jon; Spriggs, David; Jenkins, Paul F; Thompson, Campbell H; Thomas, Josephine S

    2012-04-01

    This study aimed to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient's hospital admission. Four public or private acute care hospitals across Australia and New Zealand each audited 200 patients' drug charts. Patient demographics, pharmacist review and pre-defined prescribing errors were recorded. At least one simple error was present on the medication charts of 672/715 patients, with a linear relationship between the number of medications prescribed and the number of errors (r = 0.571, p < 0.001). The four sites differed significantly in the prevalence of different types of simple prescribing errors. Pharmacists were more likely to review patients aged > or = 75 years (39.9% vs 26.0%; p < 0.001) and those with more than 10 drug prescriptions (39.4% vs 25.7%; p < 0.001). Patients reviewed by a pharmacist were less likely to have inadequate documentation of allergies (13.5% vs 29.4%, p < 0.001). Simple prescribing errors are common, although their nature differs from site to site. Clinical pharmacists target patients with the most complex health situations, and their involvement leads to improved documentation. PMID:22586784

  1. Medication errors in family practice, in hospitals and after discharge from the hospital: an ethical analysis.

    PubMed

    Clark, Peter A

    2004-01-01

    Thousands of medical errors are occurring daily in physician's offices, in hospitals, and even upon discharge from the hospital, leading to unnecessary injury and death and costing billions of dollars. We have a systems approach that has been proven to be tried and true in aviation, nuclear energy and many other industrial settings. Being honest when medical mistakes occur, reporting them to national clearing house, objectively searching for root causes, avoiding the fixing of arbitrary blame, and then, where possible, implementing safeguards to minimize the occurrence of future mistakes, is the best way to enhance patient safety. But until the medical establishment takes medical errors and patient safety more seriously, and until the general public rises up in protest, it is up to the state and federal governments to take the lead in protecting the lives of innocent Americans by creating a public policy. PMID:15301199

  2. Microbial colonization of medical devices and novel preventive strategies.

    PubMed

    Shunmugaperumal, Tamilvanan

    2010-06-01

    Upon implantation or insertion into patient's body for exerting the intended purpose like salvage of normal functions of vital organs, the medical devices are unfortunately becoming the sites of competition between host cell integration and microbial adhesion. Moreover, since there is an increased use of implanted medical devices, the incidence of biofilm-and medical devices-related nosocomial infections is also increasing progressively. To control microbial colonization and subsequent biofilm formation of the medical devices, different approaches either to enhance the efficiency of certain antimicrobial agents or to disrupt the basic physiology of the pathogenic microorganisms including novel small molecules and antipathogenic drugs are being explored. In addition, the various lipid-and polymer-based drug delivery carriers are also investigated for applying antibiofilm coating of the medical devices especially over catheters. The main intention of this review is therefore to summarize the major and/breakthrough inventions disclosed in patent literature as well as in research papers related to microbial colonization of medical devices and novel preventive strategies. This review starts with an overview of the preventive strategies followed by a short description about the potential of different lipidic-and polymeric-drug delivery carriers in eradicating the biofilm-associated infections from the medical devices. PMID:20236065

  3. Translating Research Into Practice: Voluntary Reporting of Medication Errors in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Jones, Katherine J.; Cochran, Gary; Hicks, Rodney W.; Mueller, Keith J.

    2004-01-01

    Context:Low service volume, insufficient information technology, and limited human resources are barriers to learning about and correcting system failures in small rural hospitals. This paper describes the implementation of and initial findings from a voluntary medication error reporting program developed by the Nebraska Center for Rural Health…

  4. Effects of Crew Resource Management Training on Medical Errors in a Simulated Prehospital Setting

    ERIC Educational Resources Information Center

    Carhart, Elliot D.

    2012-01-01

    This applied dissertation investigated the effect of crew resource management (CRM) training on medical errors in a simulated prehospital setting. Specific areas addressed by this program included situational awareness, decision making, task management, teamwork, and communication. This study is believed to be the first investigation of CRM…

  5. Designing a national combined reporting form for adverse drug reactions and medication errors.

    PubMed

    Tanti, A; Serracino-Inglott, A; Borg, J J

    2015-04-01

    The Maltese Medicines Authority was tasked with developing a reporting form that captures high-quality case information on adverse drug reactions (ADRs) and medication errors in order to fulfil its public-health obligations set by the European Union (EU) legislation on pharmacovigilance. This paper describes the process of introducing the first combined ADR/medication error reporting form in the EU for health-care professionals, the analysis of reports generated by it and the promotion of the system. A review of existing ADR forms was carried out and recommendations from the European Medicines Agency and World Health Organization audits integrated. A new, combined ADR/medication error reporting form was developed and pilot tested based on case studies. The Authority's quality system (ISO 9001 certified) was redesigned and a promotion strategy was deployed. The process used in Malta can be useful for countries that need to develop systems relative to ADR/medication error reporting and to improve the quality of data capture within their systems. PMID:26077519

  6. Quality and Safety in Health Care, Part X: Other Technology to Reduce Medication Errors.

    PubMed

    Harolds, Jay A; Harolds, Laura B

    2016-05-01

    There are many devices, as well as computer programs, that have the potential to reduce medication errors. In the prior article, computer provider order entry linked to electronic clinical decision support was discussed. The current article discusses bar coding, automated dispensing cabinets, and smart intravenous infusion pumps. PMID:26914567

  7. 75 FR 18514 - Developing Guidance on Naming, Labeling, and Packaging Practices to Reduce Medication Errors...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-12

    ...The Food and Drug Administration (FDA) is announcing a public workshop entitled ``Developing Guidance on Naming, Labeling, and Packaging Practices to Reduce Medication Errors.'' The purpose of the public workshop is to initiate constructive dialogue and information sharing among regulators, researchers, the pharmaceutical industry, health care organizations, health care professionals, and......

  8. Defining excellence: next steps for practicing clinicians seeking to prevent diagnostic error.

    PubMed

    Foster, Paul N; Klein, Julie R

    2016-01-01

    The Institute of Medicine (IOM) released its report on diagnostic errors in September, 2015. The report highlights the urgency of reducing errors and calls for system-level intervention and changes in our basic clinical interactions. Using the report's controversial definition of diagnostic error as a starting point, we introduce the issues and the potential impact on practicing physicians. We report a case used to illustrate this in an academic conference. Finally, we turn to the challenge of integrating these ideas into the traditional peer-review process. We argue that the medical community must evolve from understanding diagnostic failures to redesigning the diagnostic process. We should see errors as steps toward diagnostic excellence and reliable processes that minimize the risk of mislabeling and harm. PMID:27609723

  9. Recent Literature on Medication Errors and Adverse Drug Events in Older Adults.

    PubMed

    Naples, Jennifer G; Hanlon, Joseph T; Schmader, Kenneth E; Semla, Todd P

    2016-02-01

    Medication errors and adverse drug events are common in older adults, but locating literature addressing these issues is often challenging. The objective of this article is to summarize recent studies addressing medication errors and adverse drug events in a single location to improve accessibility for individuals working with older adults. A comprehensive literature search for studies published in 2014 was conducted, and 51 potential articles were identified. After critical review, 17 studies were selected for inclusion based on innovation; rigorous observational or experimental study designs; and use of reliable, valid measures. Four articles characterizing potentially inappropriate prescribing and interventions to optimize medication regimens were annotated and critiqued in detail. The authors hope that health policy-makers and clinicians find this information helpful in improving the quality of care for older adults. PMID:26804210

  10. Recent Literature on Medication Errors and Adverse Drug Events in Older Adults

    PubMed Central

    Naples, Jennifer G.; Hanlon, Joseph T.; Schmader, Kenneth E.; Semla, Todd P.

    2015-01-01

    Medication errors and adverse drug events are common in older adults, but locating literature addressing these issues is often challenging. The objective of this article was to summarize recent studies addressing medication errors and adverse drug events in a single location to improve accessibility for individuals working with older adults. The authors conducted a comprehensive literature search for studies published in 2014 and identified 51 potential articles. After critical review, 17 studies were selected for inclusion based on innovation, rigorous observational or experimental study designs, and use of reliable, valid measures. Four articles characterizing potentially inappropriate prescribing and interventions to optimize medication regimens were annotated and critiqued in detail. We hope that health policy makers and clinicians find this information helpful in improving the quality of care for older adults. PMID:26804210

  11. Modern Palliative Radiation Treatment: Do Complexity and Workload Contribute to Medical Errors?

    SciTech Connect

    D'Souza, Neil; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario ; Holden, Lori; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario ; Robson, Sheila; Mah, Kathy; Di Prospero, Lisa; Wong, C. Shun; Chow, Edward; Spayne, Jacqueline; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario

    2012-09-01

    Purpose: To examine whether treatment workload and complexity associated with palliative radiation therapy contribute to medical errors. Methods and Materials: In the setting of a large academic health sciences center, patient scheduling and record and verification systems were used to identify patients starting radiation therapy. All records of radiation treatment courses delivered during a 3-month period were retrieved and divided into radical and palliative intent. 'Same day consultation, planning and treatment' was used as a proxy for workload and 'previous treatment' and 'multiple sites' as surrogates for complexity. In addition, all planning and treatment discrepancies (errors and 'near-misses') recorded during the same time frame were reviewed and analyzed. Results: There were 365 new patients treated with 485 courses of palliative radiation therapy. Of those patients, 128 (35%) were same-day consultation, simulation, and treatment patients; 166 (45%) patients had previous treatment; and 94 (26%) patients had treatment to multiple sites. Four near-misses and 4 errors occurred during the audit period, giving an error per course rate of 0.82%. In comparison, there were 10 near-misses and 5 errors associated with 1100 courses of radical treatment during the audit period. This translated into an error rate of 0.45% per course. An association was found between workload and complexity and increased palliative therapy error rates. Conclusions: Increased complexity and workload may have an impact on palliative radiation treatment discrepancies. This information may help guide the necessary recommendations for process improvement for patients who require palliative radiation therapy.

  12. Selected Medication Safety Risks to Manage in 2016-Part II; Methylergonovine Errors in Obstetrics.

    PubMed

    Cohen, Michael R; Smetzer, Judy L

    2016-06-01

    These medication errors have occurred in health care facilities at least once. They will happen again-perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site (www.ismp.org), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications. PMID:27354742

  13. Medical and dietary therapy for kidney stone prevention.

    PubMed

    Gul, Zeynep; Monga, Manoj

    2014-12-01

    The prevalence of kidney stone disease is increasing, and newer research is finding that stones are associated with several serious morbidities. These facts suggest that emphasis needs to be placed not only on stone treatment but also stone prevention. However, there is a relative dearth of information on dietary and medical therapies to treat and avoid nephrolithiasis. In addition, studies have shown that there are many misconceptions among both the general community and physicians about how stones should be managed. This article is meant to serve as a review of the current literature on dietary and drug therapies for stone prevention. PMID:25512810

  14. Medical and Dietary Therapy for Kidney Stone Prevention

    PubMed Central

    Gul, Zeynep

    2014-01-01

    The prevalence of kidney stone disease is increasing, and newer research is finding that stones are associated with several serious morbidities. These facts suggest that emphasis needs to be placed not only on stone treatment but also stone prevention. However, there is a relative dearth of information on dietary and medical therapies to treat and avoid nephrolithiasis. In addition, studies have shown that there are many misconceptions among both the general community and physicians about how stones should be managed. This article is meant to serve as a review of the current literature on dietary and drug therapies for stone prevention. PMID:25512810

  15. A suicide prevention advisory group at an academic medical center.

    PubMed

    Hough, D; Lewis, P

    2000-02-01

    During a 15-month period, there were seven suicides among patients who were in active treatment or who had been seen recently by providers in the Department of Psychiatry of Tripler Army Medical Center, Honolulu, Hawaii. As a result, a Suicide Prevention Advisory Group was formed to identify possible causes and make recommendations aimed at improving the identification and treatment of suicidal patients. The group made 11 specific recommendations. No known suicides occurred during the 22 months after the implementation of the Suicide Prevention Advisory Group's recommendations. PMID:10709368

  16. A suicide prevention advisory group at an academic medical center.

    PubMed

    Hough, David; Lewis, Philip

    2010-05-01

    During a 15-month period, there were seven suicides among patients who were in active treatment or who had been seen recently by providers in the Department of Psychiatry of Tripler Army Medical Center, Honolulu, Hawaii. As a result, a Suicide Prevention Advisory Group (SPAG) was formed to identify possible causes and make recommendations aimed at improving the identification and treatment of suicidal patients. The group made 11 specific recommendations. No known suicides occurred during the 22 months after the implementation of the Suicide Prevention Advisory Group's recommendations. PMID:20486507

  17. [Medico-legal opinionating in cases of medical errors in declaration of death].

    PubMed

    Jurek, Tomasz; Swiatek, Barbara; Drozd, Radosław

    2007-01-01

    Declaration of death is a diagnosis and it has legal consequences. While declaring death, there is a possibility of committing a medical error. The majority of irregularities in declaring an individual dead occur in emergency situations. When a physician declares death, he is released from the professional obligation of saving the individual's life. The studies were based on the results of medico-legal evaluations in criminal cases in medical errors. In case death is erroneously declared, we may face a situation of squandering the chance of saving the life of a human being. Exposure to loss of life or to severe detriment to health are possible charges here, along with failure to offer medical assistance, although a deliberate character of the offence according to article 162 of the Polish penal code renders such a legal qualification dubious in case of medical errors. In both cases verification is needed whether an interest protected by law was still in existence, i.e. whether the individual was still alive when the physician incorrectly declared him dead. PMID:18432142

  18. Medical prevention of recurrent acute otitis media: an updated overview.

    PubMed

    Marchisio, Paola; Nazzari, Erica; Torretta, Sara; Esposito, Susanna; Principi, Nicola

    2014-05-01

    Acute otitis media (AOM) is one of the most common pediatric diseases; almost all children experience at least one episode, and a third have two or more episodes in the first three years of life. The disease burden of AOM has important medical, social and economic effects. AOM requires considerable financial assistance due to needing at least one doctor visit and a prescription for antipyretics and/or antibiotics. AOM is also associated with high indirect costs, which are mostly related to lost days of work for one parent. Moreover, due to its acute symptoms and frequent recurrences, AOM considerably impacts both the child and family's quality of life. AOM prevention, particularly recurrent AOM (rAOM), is a primary goal of pediatric practice. In this paper, we review current evidence regarding the efficacy of medical treatments and vaccines for preventing rAOM and suggest the best approaches for AOM-prone children. PMID:24678887

  19. Failure mode and effect analysis: a technique to prevent chemotherapy errors.

    PubMed

    Sheridan-Leos, Norma; Schulmeister, Lisa; Hartranft, Steve

    2006-06-01

    Complex, multidrug chemotherapy protocols commonly are administered to patients with cancer. At every step of the chemotherapy administration process, from the point that chemotherapy is ordered to the point that it is infused and beyond, potential for error exists. FMEA, a proactive process that promotes systematic thinking about the safety of patient care, is a risk analysis technique that can be used to evaluate the process of chemotherapy administration. Error prevention is an ongoing quality improvement process that requires institutional commitment and support, and nurses play a vital role in the process. PMID:16789584

  20. Quality and liability issues with the Papanicolaou smear: lessons from the science of error prevention.

    PubMed

    Derman, H

    1997-03-01

    The pathologists and cytologists who study Papanicolaou smears perform a highly successful cancer screening test in a low-prevalence population. This leads to a mathematically inevitable false-negative error rate even in the most competent professional hands. The US judicial system supports a public expectation of perfect performance by civil and, recently, criminal punishment of error. Lessons are sought from a considerable industrial experience with accident prevention for possible insights into process improvement that might mitigate the risk of false-negative errors. The elements that, by system analysis, contribute to accidents are reviewed, and the conditions that enhance the accident potential are outlined. The cognitive functions and aberrations that are involved in the operator component of error analysis are described. As a result of pathologists' activities in the systematic measurement of laboratory performance for the last half century, the College of American Pathologists' accreditation program and its derivative Clinical Laboratory Improvement Act requirements have already laid out the avenues of error minimalization. There are no lessons from the science of error prevention that can affect the public expectation of zero error in a screening test and the consequent punishment of cytology professionals. A thesis is offered that the problem is society's if its goal is eradication of cervical cancer mortality. A call is made for leadership by a prestigious, nonpathologist, national organization to make the public understand that the current cytology liability issue is primarily a threat to women and the public health. To initiate public dialogue, a mechanism is suggested to protect simultaneously a patient's right of access to the judicial system and the general availability of the Papanicolaou smear to reduce cervical cancer mortality and morbidity. PMID:9111120

  1. Prevention of Medical Events During Air Travel: A Narrative Review.

    PubMed

    Naouri, Diane; Lapostolle, Frederic; Rondet, Claire; Ganansia, Olivier; Pateron, Dominique; Yordanov, Youri

    2016-09-01

    Prior to traveling, and when seeking medical pretravel advice, patients consult their personal physicians. Inflight medical issues are estimated to occur up to 350 times per day worldwide (1/14,000-40,000 passengers). Specific characteristics of the air cabin environment are associated with hypoxia and the expansion of trapped gases into body cavities, which can lead to harm. The most frequent medical events during air travel include abdominal pain; ear, nose, and throat pathologies; psychiatric disorders; and life-threatening events such as acute respiratory failure or cardiac arrest. Physicians need to be aware of the management of these conditions in this unusual setting. Chronic respiratory and cardiovascular diseases are common and are at increased risk of acute exacerbation. Physicians must be trained in these conditions and inform their patients about their prevention. PMID:27267286

  2. Medication overuse headache: history, features, prevention and management strategies.

    PubMed

    Saper, Joel R; Da Silva, Arnaldo Neves

    2013-11-01

    Medication overuse headache (MOH) is a daily, or almost daily, headache form that arises from overuse of one or more classes of migraine-abortive or analgesic medication. The main classes of drugs that cause MOH are opioids, butalbital-containing mixed analgesics, triptans, ergotamine tartrate derivatives, simple analgesics (except for plain aspirin), and perhaps non-steroidal anti-inflammatory drugs. MOH can be debilitating and results from biochemical and functional brain changes induced by certain medications taken too frequently. At this time, migraine and other primary headache disorders in which migraine or migraine-like elements occur seem exclusively vulnerable to the development of MOH. Other primary headache disorders are not currently believed to be vulnerable. The treatment of MOH consists of discontinuation of the offending drug(s), acute treatment of the withdrawal symptoms and escalating pain, establishing a preventive treatment when necessary, and the implementation of educational and behavioral programs to prevent recidivism. In most patients, MOH can be treated in the outpatient setting but, for the most difficult cases, including those with opioid or butalbital overuse, or in patients with serious medical or behavioral disturbances, effective treatment requires a multidisciplinary, comprehensive headache program, either day-hospital with infusion or an inpatient hospital setting. PMID:23925669

  3. An Empirically Derived Taxonomy of Factors Affecting Physicians' Willingness to Disclose Medical Errors

    PubMed Central

    Kaldjian, Lauris C; Jones, Elizabeth W; Rosenthal, Gary E; Tripp-Reimer, Toni; Hillis, Stephen L

    2006-01-01

    BACKGROUND Physician disclosure of medical errors to institutions, patients, and colleagues is important for patient safety, patient care, and professional education. However, the variables that may facilitate or impede disclosure are diverse and lack conceptual organization. OBJECTIVE To develop an empirically derived, comprehensive taxonomy of factors that affects voluntary disclosure of errors by physicians. DESIGN A mixed-methods study using qualitative data collection (structured literature search and exploratory focus groups), quantitative data transformation (sorting and hierarchical cluster analysis), and validation procedures (confirmatory focus groups and expert review). RESULTS Full-text review of 316 articles identified 91 impeding or facilitating factors affecting physicians' willingness to disclose errors. Exploratory focus groups identified an additional 27 factors. Sorting and hierarchical cluster analysis organized factors into 8 domains. Confirmatory focus groups and expert review relocated 6 factors, removed 2 factors, and modified 4 domain names. The final taxonomy contained 4 domains of facilitating factors (responsibility to patient, responsibility to self, responsibility to profession, responsibility to community), and 4 domains of impeding factors (attitudinal barriers, uncertainties, helplessness, fears and anxieties). CONCLUSIONS A taxonomy of facilitating and impeding factors provides a conceptual framework for a complex field of variables that affects physicians' willingness to disclose errors to institutions, patients, and colleagues. This taxonomy can be used to guide the design of studies to measure the impact of different factors on disclosure, to assist in the design of error-reporting systems, and to inform educational interventions to promote the disclosure of errors to patients. PMID:16918739

  4. Using Simulation to Improve First-Year Pharmacy Students’ Ability to Identify Medication Errors Involving the Top 100 Prescription Medications

    PubMed Central

    Awdishu, Linda; Namba, Jennifer

    2016-01-01

    Objective. To evaluate first-year pharmacy students’ ability to identify medication errors involving the top 100 prescription medications. Design. In the first quarter of a 3-quarter pharmacy self-care course, a didactic lecture on the most common prescribing and dispensing prescription errors was presented to first-year pharmacy students (P1) in preparation for a prescription review simulation done individually and as a group. In the following quarter, they were given a formal prescription review workshop before a second simulation involving individual and group review of a different set of prescriptions. Students were evaluated based on the number of correctly checked prescriptions and a self-assessment of their confidence in reviewing prescriptions. Assessment. All 63 P1 students completed the prescription review simulations. The individual scores did not significantly change, but group scores improved from 79 (16.2%) in the fall quarter to 98.6 (4.7%) in the winter quarter. Students perceived improvement of their prescription checking skills, specifically in their ability to fill a prescription on their own, identify prescribing and dispensing errors, and perform pharmaceutical calculations. Conclusion. A prescription review module consisting of a didactic lecture, workshop and simulation-based methods to teach prescription analysis was successful at improving first year pharmacy students’ knowledge, confidence, and application of these skills. PMID:27402989

  5. Using Simulation to Improve First-Year Pharmacy Students' Ability to Identify Medication Errors Involving the Top 100 Prescription Medications.

    PubMed

    Atayee, Rabia S; Awdishu, Linda; Namba, Jennifer

    2016-06-25

    Objective. To evaluate first-year pharmacy students' ability to identify medication errors involving the top 100 prescription medications. Design. In the first quarter of a 3-quarter pharmacy self-care course, a didactic lecture on the most common prescribing and dispensing prescription errors was presented to first-year pharmacy students (P1) in preparation for a prescription review simulation done individually and as a group. In the following quarter, they were given a formal prescription review workshop before a second simulation involving individual and group review of a different set of prescriptions. Students were evaluated based on the number of correctly checked prescriptions and a self-assessment of their confidence in reviewing prescriptions. Assessment. All 63 P1 students completed the prescription review simulations. The individual scores did not significantly change, but group scores improved from 79 (16.2%) in the fall quarter to 98.6 (4.7%) in the winter quarter. Students perceived improvement of their prescription checking skills, specifically in their ability to fill a prescription on their own, identify prescribing and dispensing errors, and perform pharmaceutical calculations. Conclusion. A prescription review module consisting of a didactic lecture, workshop and simulation-based methods to teach prescription analysis was successful at improving first year pharmacy students' knowledge, confidence, and application of these skills. PMID:27402989

  6. Risk factors for medication errors in the electronic and manual prescription 1

    PubMed Central

    Volpe, Cris Renata Grou; de Melo, Eveline Maria Magalhães; de Aguiar, Lucas Barbosa; Pinho, Diana Lúcia Moura; Stival, Marina Morato

    2016-01-01

    ABSTRACT Objective: to compare electronic and manual prescriptions of a public hospital of Brasilia, identifying risk factors for the occurrence of medication errors. Method: descriptive-exploratory, comparative and retrospective study. Data collection occurred from July 2012 to January 2013, using an instrument for the review of the information contained in medical records related to the medication process. A total of 190 manual and 199 electronic records composed the sample, with 2027 prescriptions each. Results: compared to the manual prescription, a significant reduction was observed in the risk factors after implantation of the electronic prescription, in items such as "lack of the form of dilution" (71.1% to 22.3%) and "prescription with brand name" (99.5% to 31.5%). Conversely, the risk factors "no check" and "lack of CRM of the prescriber" increased. The lack of the allergy registration and the occurrences related to medication were the same for both groups. Conclusion: generally, the use of the electronic prescription system was associated with a significant reduction in risk factors for medication errors, concerning the following aspects: illegibility, prescription with brand name and presence of essential items that provide a safe and effective prescription. PMID:27508913

  7. [Legal and medico-legal assessment of medical errors in obstetrics].

    PubMed

    Jurek, Tomasz; Swiatek, Barbara; Rorat, Marta; Drozd, Radosław

    2011-01-01

    The authors review the doctrine of criminal law and the jurisdiction of the Supreme Court in search of a starting point for the legal protection of human life and health. In cases of medical errors in obstetrics concerning a fetus, an act of a perpetrator can be classified as manslaughter or exposure to direct danger of loss of life or great bodily injury depending on whether the fetus is recognized as "a human being". The authors criticize the doctrinal criteria of the beginning of legal protection: spatial, physiological, obstetric, and developmental, pointing to the possibilities of decriminalization of medical errors of omission. A solution to this situation is the presented evolution of the jurisdiction of the Supreme Court. It moves towards establishing the beginning of legal and criminal protection of life and health at the "moment of emergence of objective grounds to necessitate delivery". PMID:22715678

  8. The disclosure of unanticipated outcomes of care and medical errors: what does this mean for anesthesiologists?

    PubMed

    Souter, Karen J; Gallagher, Thomas H

    2012-03-01

    The disclosure of unanticipated outcomes to patients, including medical errors, has received considerable attention of late. The discipline of anesthesiology is a leader in patient safety, and as the doctrine of full disclosure gains momentum, anesthesiologists must become acquainted with these philosophies and practices. Effective disclosure can improve doctor-patient relations, facilitate better understanding of systems, and potentially decrease medical malpractice costs. However, many physicians remain wary of discussing errors with patients due to concern about litigation, the communication challenges of disclosure, and loss of self-esteem. As a result, harmful errors are often not disclosed to patients. Disclosure poses special challenges for anesthesiologists. There is often very limited time before the anesthetic in which to build the patient-physician relationship, and anesthesiologists usually function within complex health care teams. Other team members such as the surgeon may have different perspectives on what the patient should be told about operating room errors. The anesthesiologist may still be physically caring for the patient while the surgeon has the initial discussion with the family about the event. As a result the anesthesiologist may be excluded from the planning or conduct of the important initial disclosure conversations. New disclosure strategies are needed to engage anesthesiologists as active participants in the disclosure of unanticipated outcomes. Anesthesiologists should be aware of the emerging best practices surrounding disclosure, as well as the training opportunities and disclosure support resources that are increasingly available. Innovative models should be developed that promote collaboration between all perioperative team members in the disclosure process. There are important opportunities for anesthesiologists to play a leading role in defining specialty-specific disclosure practices and to more effectively meet patients

  9. How to minimize perceptual error and maximize expertise in medical imaging

    NASA Astrophysics Data System (ADS)

    Kundel, Harold L.

    2007-03-01

    Visual perception is such an intimate part of human experience that we assume that it is entirely accurate. Yet, perception accounts for about half of the errors made by radiologists using adequate imaging technology. The true incidence of errors that directly affect patient well being is not known but it is probably at the lower end of the reported values of 3 to 25%. Errors in screening for lung and breast cancer are somewhat better characterized than errors in routine diagnosis. About 25% of cancers actually recorded on the images are missed and cancer is falsely reported in about 5% of normal people. Radiologists must strive to decrease error not only because of the potential impact on patient care but also because substantial variation among observers undermines confidence in the reliability of imaging diagnosis. Observer variation also has a major impact on technology evaluation because the variation between observers is frequently greater than the difference in the technologies being evaluated. This has become particularly important in the evaluation of computer aided diagnosis (CAD). Understanding the basic principles that govern the perception of medical images can provide a rational basis for making recommendations for minimizing perceptual error. It is convenient to organize thinking about perceptual error into five steps. 1) The initial acquisition of the image by the eye-brain (contrast and detail perception). 2) The organization of the retinal image into logical components to produce a literal perception (bottom-up, global, holistic). 3) Conversion of the literal perception into a preferred perception by resolving ambiguities in the literal perception (top-down, simulation, synthesis). 4) Selective visual scanning to acquire details that update the preferred perception. 5) Apply decision criteria to the preferred perception. The five steps are illustrated with examples from radiology with suggestions for minimizing error. The role of perceptual

  10. Identifying the Latent Failures Underpinning Medication Administration Errors: An Exploratory Study

    PubMed Central

    Lawton, Rebecca; Carruthers, Sam; Gardner, Peter; Wright, John; McEachan, Rosie R C

    2012-01-01

    Objectives The primary aim of this article was to identify the latent failures that are perceived to underpin medication errors. Study Setting The study was conducted within three medical wards in a hospital in the United Kingdom. Study Design The study employed a cross-sectional qualitative design. Data Collection Methods Interviews were conducted with 12 nurses and eight managers. Interviews were transcribed and subject to thematic content analysis. A two-step inter-rater comparison tested the reliability of the themes. Principal Findings Ten latent failures were identified based on the analysis of the interviews. These were ward climate, local working environment, workload, human resources, team communication, routine procedures, bed management, written policies and procedures, supervision and leadership, and training. The discussion focuses on ward climate, the most prevalent theme, which is conceptualized here as interacting with failures in the nine other organizational structures and processes. Conclusions This study is the first of its kind to identify the latent failures perceived to underpin medication errors in a systematic way. The findings can be used as a platform for researchers to test the impact of organization-level patient safety interventions and to design proactive error management tools and incident reporting systems in hospitals. PMID:22375850

  11. The Relationship Between Nursing Experience and Education and the Occurrence of Reported Pediatric Medication Administration Errors.

    PubMed

    Sears, Kim; O'Brien-Pallas, Linda; Stevens, Bonnie; Murphy, Gail Tomblin

    2016-01-01

    Medication errors are one of the most common incidents in the hospitals. They can be harmful, and they are even more detrimental for pediatric patients. This study explored the relationship between nursing experience, education, the frequency and severity of reported pediatric medication administration errors (PMAEs). The data for this study were collected from a larger pan Canadian study. A survey tool was developed to collect self-reported data from nurses. In addition to descriptive statistics, a Poisson regression or a multiple linear regression was completed to address the research questions, and a Boneferrai correction was conducted to adjust for the small sample size. Results demonstrated that on units with more nurses with a higher level of current experience, more PMAEs were reported (p=.001), however; the PMAEs reported by these nurses were not as severe (p=.003). Implications to advance both safe medication delivery in the pediatric setting and safe culture of reporting for both actual and potential errors are identified. PMID:26872514

  12. [Second victims of medical errors: a systematic review of the literature].

    PubMed

    Panella, Massimiliano; Rinaldi, Carmela; Vanhaecht, Kris; Donnarumma, Chiara; Tozzi, Quinto; Di Stanislao, Francesco

    2014-01-01

    "Second victims" are health care providers who remain traumatized and suffer at the psycho-physical level after being involved in a patient adverse event. A systematic review of the literature was conducted to: a) estimate the prevalence of second victims among healthcare workers, b) describe personal and work outcomes of second victims, c) identify coping strategies used by second victims to face their problems, and d) describe current support strategies. Findings reveal that the prevalence of "second victims" of medical errors is high, ranging in four studies from 10.4% to 43.3%. Medical errors have a negative impact on healthcare providers involved, leading to physical, cognitive and behavioural symptoms including the practice of defensive medicine. Managers of health organizations need to be aware of the "second victim" phenomenon and ensure adequate support is given to healthcare providers involved. The best strategy seems to be the creation of networks of support at both the individual and organizational levels. More research is needed to evaluate the efficacy of support structures for second victims and to quantify the extent of the practice of defensive medicine following medical error. PMID:24770362

  13. Potential error in the use of an automated external defibrillator during an in-flight medical emergency.

    PubMed

    Katis, Peter G; Dias, Solange M

    2004-01-01

    In-flight medical emergencies are uncommon, generally non-lethal events. In fatal cases, the most common cause of death is a sudden cardiac event. This fact, and the awareness that early defibrillation is the most important determinant of successful cardiac resuscitation, have led to the increasing availability of automated external defibrillators (AEDs) aboard commercial airplanes. AEDs are sophisticated and extremely reliable devices that are designed to be used by trained laypersons in the hope of minimizing the crucial time to defibrillation. Although designed to be foolproof, both machine- and operator-dependent usage errors have been recognized. In this case study we report a unique operator-dependent error involving the misreading of an AED instruction window, briefly review the history of AED use in the airline industry, and underscore the need for a sound knowledge of basic life support skills when working with these devices. We conclude by making recommendations to prevent similar errors from occurring in the future. PMID:17433145

  14. Adherence to Preventive Medications: Predictors and outcomes in the Diabetes Prevention Program

    PubMed Central

    Walker, Elizabeth A.; Molitch, Mark; Kramer, M. Kaye; Kahn, Steven; Ma, Yong; Edelstein, Sharon; Smith, Kellie; Johnson, Mariana Kiefer; Kitabchi, Abbas; Crandall, Jill

    2006-01-01

    OBJECTIVE To evaluate barriers to and strategies for medication adherence and predictors of adherence and the primary outcome in the Diabetes Prevention Program (DPP). RESEARCH DESIGN AND METHODS Within a randomized, controlled primary prevention study for type 2 diabetes, we collected data on study medication adherence, its predictors, and health outcomes in 27 clinical centers across mainland U.S. and Hawaii. Medication arm participants included 2,155 adults with impaired glucose tolerance randomly assigned to either metformin or matched placebo treatment arms. Structured interviews were used to promote medication adherence and to collect data regarding adherence. Adherence was measured by pill count. The primary DPP outcome of type 2 diabetes was assessed by fasting plasma glucose and oral glucose tolerance test. RESULTS Older age-groups were more adherent than the youngest group (P = 0.01) in the metformin group. The most frequently reported barrier to adherence was “forgetting” (22%). Women reported more adverse effects of metformin (15 vs. 10%, P = 0.002) in the metformin group. Odds of nonadherence increased as participants reported more than one barrier (odds ratio 19.1, P < 0.001). Odds of adherence increased as participants reported multiple strategies to take medication (2.69, P < 0.0001). There was a 38.2% risk reduction for developing diabetes for those adherent to metformin compared with those adherent to placebo (P < 0.0003). CONCLUSIONS DPP medication adherence results are unique in primary prevention for a chronic disease in a large multiethnic sample. Our finding that adherence was associated with risk reduction for diabetes supports the development of brief interventions in clinical settings where medication adherence is a challenge. PMID:16936143

  15. Pharmacotherapy for Alcohol Dependence: Anticraving Medications for Relapse Prevention

    PubMed Central

    Jung, Young-Chul

    2006-01-01

    Alcohol dependence is a chronic disorder that results from a variety of genetic, psychosocial, and environmental factors. Relapse prevention for alcohol dependence has traditionally involved psychosocial and psychotherapeutic interventions. Pharmacotherapy, however, in conjunction with behavioral therapy, is generating interest as another modality to prevent relapse and enhance abstinence. Naltrexone and acamprosate are at the forefront of the currently available pharmacological options. Naltrexone is an opioid receptor antagonist and is thought to reduce the rewarding effect of alcohol. Acamprosate normalizes the dysregulation of N-methyl-D-aspartate (NMDA)-mediated glutamatergic excitation that occurs in alcohol withdrawal and early abstinence. These different mechanisms of action and different target neurotransmitter systems may endow the two drugs with efficacy for different aspects of alcohol use behavior. Since not all patients seem to benefit from naltrexone and acamprosate, there are ongoing efforts to improve the treatment outcomes by examining the advantages of combined pharmacotherapy and exploring the variables that might predict the response of the medications. In addition, novel medications are being investigated to assess their efficacy in preventing relapse and increasing abstinence. PMID:16642544

  16. Medical errors--is total quality management for the battlefield desirable?

    PubMed

    Cohen, David J; Lisagor, Philip

    2005-11-01

    There has recently been a great deal of discussion in both the lay press as well as the medical press regarding the incidence of errors that occur during medical practice. There have been many discussions of how quality control measures from industry can be applied to the health care system. Indeed both civilian and "brick and mortar" military medical treatment facilities are adapting these techniques. It is important that we understand the principles behind Total Quality Management (TQM) as well as its techniques and limitations. TQM is based on limiting deviation from an accepted standard of practice. These principles may be as applicable to our military health care facilities in a field environment as they are to our fixed facilities, although the standards used for measurement may have to be modified to adapt to different constraints of environment and resources. TQM techniques can nonetheless be applied in virtually any facility to ensure the best possible care and outcomes for our soldiers. PMID:16450816

  17. [Prevention of medico-legal conflicts in medical practice].

    PubMed

    Minossi, José Guilherme

    2009-02-01

    Generally, medico-legal conflicts which occur in surgical and medical practice are a source of worry for both the medical profession and the society as a whole, because on one hand, they could cause high emotional stress for doctors, and on the other hand, patients could be rejected. Once consolidated, defensive medicine increases treatment costs and the doctor-patient relationship could transform into a tragedy. There are many causes for this, including non-treatment factors, such as an unsupported and disorganized health system, lack of participation from society and the doctor in improving this system, the training machine which launches a large number of young unprepared doctors to practice in this noble profession, along with a lack of continuing training, as there are few public or private institutions providing preparation, or further medical training. The related treatment factors are generally, a deficient doctor-patient relationship, poor work condition, power abuse by the doctor, a lack of clear agreement, and poor medical record keeping. These conflicts cannot be solved by simple creating legislation, or by denying the existence of medical error, which occurs at higher frequency than the actual conflicts. It is very important to improve the doctor-patient relationship because an effective fraternal relationship reduces the chance of a judicial demand. The doctor still needs to fully understand his/her conduct obligations and mainly to avoid power abuse. Doctors must also professionally link themselves with politicians who fight for the individual's rights against the system. Society must also understand that health is not just an issue exclusive for doctors, and people must fight to improve living conditions. Society must seriously show its frustration with the increasing disparity between scientific possibilities and actual wellbeing. The training machine needs immediate profound changes to produce professionals with the highest qualifications equipped

  18. Medical error disclosure: from the therapeutic alliance to risk management: the vision of the new Italian code of medical ethics

    PubMed Central

    2014-01-01

    Background The Italian code of medical deontology recently approved stipulates that physicians have the duty to inform the patient of each unwanted event and its causes, and to identify, report and evaluate adverse events and errors. Thus the obligation to supply information continues to widen, in some way extending beyond the doctor-patient relationship to become an essential tool for improving the quality of professional services. Discussion The new deontological precepts intersect two areas in which the figure of the physician is paramount. On the one hand is the need for maximum integrity towards the patient, in the name of the doctor’s own, and the other’s (the patient’s) dignity and liberty; on the other is the physician’s developing role in the strategies of the health system to achieve efficacy, quality, reliability and efficiency, to reduce errors and adverse events and to manage clinical risk. Summary In Italy, due to guidelines issued by the Ministry of Health and to the new code of medical deontology, the role of physicians becomes a part of a complex strategy of risk management based on a system focused approach in which increasing transparency regarding adverse outcomes and full disclosure of health- related negative events represent a key factor. PMID:25023339

  19. Errors and pitfalls: Briefing and accusation of medical malpractice - the second victim.

    PubMed

    Wienke, Albrecht

    2013-01-01

    In June 2012, the German Medical Association (Bundesärztekammer) published the statistics of medical malpractice for 2011 (published at http://www.bundesaerztekammer.de). Still ENT-specific accusations of medical malpractice are by far the fewest in the field of hospitals and actually even in the outpatient context. Clearly most of the unforeseen incidents still occur in the disciplines of trauma surgery and orthopedics. In total, however, an increasing number of errors in treatment can be noticed on the multidisciplinary level: in 25.5% of the registered cases, an error in treatment was found to be the origin of damage to health justifying a claim for compensation of the patient. In the year before, it was only 24.7%. The reasons may be manifold, but the medical system itself certainly plays a major role in this context: the recent developments related to health policy lead to a continuous economisation of medical care. Rationing and limited remuneration more and more result in the fact that therapeutic decision are not exclusively made for the benefit of the patient but that they are oriented at economic or bureaucratic aspects. Thus, in the long term, practising medicine undergoes a change. According to the §§ 1, 3 of the professional code of conduct for doctors (Musterberufsordnung für Ärzte; MBO-Ä) medical practice as liberal profession is principally incompatible with the pursuit of profit, however, even doctors have to earn money which more and more makes him play the role of a businessman. Lack of personnel and staff savings lead to excessive workloads of physicians, caregivers, and nurses, which also favour errors. The quality and even the confidential relationship between doctor and patient, which is important for the treatment success, are necessarily affected by the cost pressure. The victims in this context are not only the patients but also the physicians find themselves in the continuous conflict between ethical requirements of their profession

  20. Errors and pitfalls: Briefing and accusation of medical malpractice – the second victim

    PubMed Central

    Wienke, Albrecht

    2013-01-01

    In June 2012, the German Medical Association (Bundesärztekammer) published the statistics of medical malpractice for 2011 (published at http://www.bundesaerztekammer.de). Still ENT-specific accusations of medical malpractice are by far the fewest in the field of hospitals and actually even in the outpatient context. Clearly most of the unforeseen incidents still occur in the disciplines of trauma surgery and orthopedics. In total, however, an increasing number of errors in treatment can be noticed on the multidisciplinary level: in 25.5% of the registered cases, an error in treatment was found to be the origin of damage to health justifying a claim for compensation of the patient. In the year before, it was only 24.7%. The reasons may be manifold, but the medical system itself certainly plays a major role in this context: the recent developments related to health policy lead to a continuous economisation of medical care. Rationing and limited remuneration more and more result in the fact that therapeutic decision are not exclusively made for the benefit of the patient but that they are oriented at economic or bureaucratic aspects. Thus, in the long term, practising medicine undergoes a change. According to the §§ 1, 3 of the professional code of conduct for doctors (Musterberufsordnung für Ärzte; MBO-Ä) medical practice as liberal profession is principally incompatible with the pursuit of profit, however, even doctors have to earn money which more and more makes him play the role of a businessman. Lack of personnel and staff savings lead to excessive workloads of physicians, caregivers, and nurses, which also favour errors. The quality and even the confidential relationship between doctor and patient, which is important for the treatment success, are necessarily affected by the cost pressure. The victims in this context are not only the patients but also the physicians find themselves in the continuous conflict between ethical requirements of their profession

  1. Safety subcultures in health-care organizations and managing medical error.

    PubMed

    Sirriyeh, Reema; Lawton, Rebecca; Armitage, Gerry; Gardner, Peter; Ferguson, Sally

    2012-02-01

    Leadership has been proposed as a key latent factor influencing the safety culture of an organization, the likelihood of errors occurring and the way in which these are managed. Therefore, when an error occurs, managers have an integral role to ensure that the most desirable outcomes are achieved for patients, health-care staff and their organization. Semistructured interviews were conducted in a large UK teaching hospital to explore the perspectives of staff who are tasked in some way with managing patient safety. Data from 26 transcripts were analysed using an adapted version of Spencer's (2003) qualitative framework, which revealed five primary themes. This paper reports findings from two overarching primary themes, described as being management and safety subcultures. These themes describe experiences of managing medical errors and the subgroup variations between professions, ranks and specialties in attitudes and behaviours towards error, and its management in a large National Health Service Trust. We discuss implications for health-care managers and health professionals in developing a stronger and more unified safety culture in their organizations, along with considerations for academic researchers when undertaking health services research. PMID:22323667

  2. Preventing and managing unprofessionalism in medical school faculties.

    PubMed

    Binder, Renee; Friedli, Amy; Fuentes-Afflick, Elena

    2015-04-01

    Professionalism is a required competency for medical students, residents, practicing physicians, and academic faculty. Faculty members must adhere to codes of conduct or risk discipline. The authors describe issues of unprofessionalism that culminate in allegations of faculty misconduct or filing of grievances in academic medicine and outline strategies for early intervention and prevention. The authors, vice and associate deans and executive director of the office of faculty affairs at a large U.S. medical school, have handled many allegations of unprofessional conduct over the past decade. They present case examples based on behaviors such as lack of respect, inappropriate language and behavior, failure to cooperate with members of the health care team, and sexual harassment/discrimination. They discuss factors complicating evaluation of these behaviors, including variable definitions of respect, different cultural norms, and false allegations. The authors make recommendations for prevention and intervention, including early identification, performance management, education about sexual harassment, and referrals to professional coaches, anger management classes, and faculty-staff assistance programs. PMID:25470311

  3. [Witch trials in the Salem as a medical error. Witch hunts in the XVII century and the medical art].

    PubMed

    Werner, Wiktor

    2005-01-01

    That article concerns with the influences of medical practitioners in witch hunts in the Salem (1692). Witch trials in England and English colonies in the XVII century were mainly criminal trials. Witchcraft had been there considered principally as a crime-tool rather then the crime itself. Witches were usually accused of crimes such as the murder and the disease sending. Physicians normally played in that situations the role of court experts. They decided if analyzed disease had normal or abnormal, artificial origin. In the Salem an medical practitioner judged that an illness which touched some children had come from the acts of sorcery. That was the beginning of a long and bloody witch hunt. Death sentences in the Salem trial were also justified with applying medical and physical categories to show the objectivity of a witchcraft. Salem judges were sure that by using "objective" categories they had been able to proof the existence of material relations between the witch and bewitched persons without the possibility of error. PMID:17144196

  4. Systems mapping workshops and their role in understanding medication errors in healthcare.

    PubMed

    Buckle, P; Clarkson, P J; Coleman, R; Bound, J; Ward, J; Brown, J

    2010-09-01

    Systems mapping workshops have been applied to the problem of medication errors in healthcare. The workshops were designed using experiential group work principles. They involved a range of stakeholders from within the health service as well as those who supply the health sector, including designers who may be able to enhance the safety of products and systems used in healthcare. Research has shown that the method encourages stakeholder participation, provides robust results within a limited time and enhances understanding across specialist interest groups. Additional, creative design workshops that considered the same topic showed significant promise in developing concepts from which potential solutions could be developed further. PMID:20129599

  5. Task and error analysis balancing benefits over business of electronic medical records.

    PubMed

    Carstens, Deborah Sater; Rodriguez, Walter; Wood, Michael B

    2014-01-01

    Task and error analysis research was performed to identify: a) the process for healthcare organisations in managing healthcare for patients with mental illness or substance abuse; b) how the process can be enhanced and; c) if electronic medical records (EMRs) have a role in this process from a business and safety perspective. The research question is if EMRs have a role in enhancing the healthcare for patients with mental illness or substance abuse. A discussion on the business of EMRs is addressed to understand the balancing act between the safety and business aspects of an EMR. PMID:25161108

  6. Using Simulation to Address Hierarchy-Related Errors in Medical Practice

    PubMed Central

    Calhoun, Aaron William; Boone, Megan C; Porter, Melissa B; Miller, Karen H

    2014-01-01

    Objective: Hierarchy, the unavoidable authority gradients that exist within and between clinical disciplines, can lead to significant patient harm in high-risk situations if not mitigated. High-fidelity simulation is a powerful means of addressing this issue in a reproducible manner, but participant psychological safety must be assured. Our institution experienced a hierarchy-related medication error that we subsequently addressed using simulation. The purpose of this article is to discuss the implementation and outcome of these simulations. Methods: Script and simulation flowcharts were developed to replicate the case. Each session included the use of faculty misdirection to precipitate the error. Care was taken to assure psychological safety via carefully conducted briefing and debriefing periods. Case outcomes were assessed using the validated Team Performance During Simulated Crises Instrument. Gap analysis was used to quantify team self-insight. Session content was analyzed via video review. Results: Five sessions were conducted (3 in the pediatric intensive care unit and 2 in the Pediatric Emergency Department). The team was unsuccessful at addressing the error in 4 (80%) of 5 cases. Trends toward lower communication scores (3.4/5 vs 2.3/5), as well as poor team self-assessment of communicative ability, were noted in unsuccessful sessions. Learners had a positive impression of the case. Conclusions: Simulation is a useful means to replicate hierarchy error in an educational environment. This methodology was viewed positively by learner teams, suggesting that psychological safety was maintained. Teams that did not address the error successfully may have impaired self-assessment ability in the communication skill domain. PMID:24867545

  7. Effect of automated drug distribution systems on medication error rates in a short-stay geriatric unit

    PubMed Central

    Cousein, Etienne; Mareville, Julie; Lerooy, Alexandre; Caillau, Antoine; Labreuche, Julien; Dambre, Delphine; Odou, Pascal; Bonte, Jean-Paul; Puisieux, François; Decaudin, Bertrand; Coupé, Patrick

    2014-01-01

    Rationale, aims and objectives To assess the impact of an automated drug distribution system on medication errors (MEs). Methods Before-after observational study in a 40-bed short stay geriatric unit within a 1800 bed general hospital in Valenciennes, France. Researchers attended nurse medication administration rounds and compared administered to prescribed drugs, before and after the drug distribution system changed from a ward stock system (WSS) to a unit dose dispensing system (UDDS), integrating a unit dose dispensing robot and automated medication dispensing cabinet (AMDC). Results A total of 615 opportunities of errors (OEs) were observed among 148 patients treated during the WSS period, and 783 OEs were observed among 166 patients treated during the UDDS period. ME [medication administration error (MAE)] rates were calculated and compared between the two periods. Secondary measures included type of errors, seriousness of errors and risk reduction for the patients. The implementation of an automated drug dispensing system resulted in a 53% reduction in MAEs. All error types were reduced in the UDDS period compared with the WSS period (P < 0.001). Wrong dose and wrong drug errors were reduced by 79.1% (2.4% versus 0.5%, P = 0.005) and 93.7% (1.9% versus 0.01%, P = 0.009), respectively. Conclusion An automated UDDS combining a unit dose dispensing robot and AMDCs could reduce discrepancies between ordered and administered drugs, thus improving medication safety among the elderly. PMID:24917185

  8. Medication errors related to transdermal opioid patches: lessons from a regional incident reporting system

    PubMed Central

    2014-01-01

    Objective A few cases of adverse reactions linked to erroneous use of transdermal opioid patches have been reported in the literature. The aim of this study was to describe and characterize medication errors (MEs) associated with use of transdermal fentanyl and buprenorphine. Methods All events concerning transdermal opioid patches reported between 2004 and 2011 to a regional incident reporting system and assessed as MEs were scrutinized and characterized. MEs were defined as “a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient”. Results In the study 151 MEs were identified. The three most common error types were wrong administration time 67 (44%), wrong dose 34 (23%), and omission of dose 20 (13%). Of all MEs, 118 (78%) occurred in the administration stage of the medication process. Harm was reported in 26 (17%) of the included cases, of which 2 (1%) were regarded as serious harm (nausea/vomiting and respiratory depression). Pain was the most common adverse reaction reported. Conclusions Of the reported MEs related to transdermal fentanyl and buprenorphine, most occurred during administration. Improved routines to ascertain correct and timely administration and educational interventions to reduce MEs for these drugs are warranted. PMID:24912424

  9. MERIS (Medical Error Reporting Information System) as an innovative patient safety intervention: a health policy perspective.

    PubMed

    Riga, Marina; Vozikis, Athanassios; Pollalis, Yannis; Souliotis, Kyriakos

    2015-04-01

    The economic crisis in Greece poses the necessity to resolve problems concerning both the spiralling cost and the quality assurance in the health system. The detection and the analysis of patient adverse events and medical errors are considered crucial elements of this course. The implementation of MERIS embodies a mandatory module, which adopts the trigger tool methodology for measuring adverse events and medical errors an intensive care unit [ICU] environment, and a voluntary one with web-based public reporting methodology. A pilot implementation of MERIS running in a public hospital identified 35 adverse events, with approx. 12 additional hospital days and an extra healthcare cost of €12,000 per adverse event or of about €312,000 per annum for ICU costs only. At the same time, the voluntary module unveiled 510 reports on adverse events submitted by citizens or patients. MERIS has been evaluated as a comprehensive and effective system; it succeeded in detecting the main factors that cause adverse events and discloses severe omissions of the Greek health system. MERIS may be incorporated and run efficiently nationally, adapted to the needs and peculiarities of each hospital or clinic. PMID:25554702

  10. Social network approaches to recruitment, HIV prevention, medical care, and medication adherence

    PubMed Central

    Latkin, Carl A.; Davey-Rothwell, Melissa A.; Knowlton, Amy R.; Alexander, Kamila A.; Williams, Chyvette T.; Boodram, Basmattee

    2013-01-01

    This article reviews current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates and treatment access and outcomes. Social network analysis is a value tool to link social structural factors to individual behaviors. Social networks provide an avenue for low cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, and optimizing HIV medical care and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics. PMID:23673888

  11. Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

    PubMed Central

    Adams, Diane L.; Norman, Helen; Burroughs, Valentine J.

    2002-01-01

    Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction

  12. Using Medications Safely

    MedlinePlus

    ... health systems play an important role in preventing medication errors. To make sure you use medicines safely and effectively, ASHP recommends that you: Keep a list of all medications that you take (prescribed drugs, nonprescription medicines, herbal ...

  13. Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital: a trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era

    PubMed Central

    Wang, Hua-fen; Jin, Jing-fen; Feng, Xiu-qin; Huang, Xin; Zhu, Ling-ling; Zhao, Xiao-ying; Zhou, Quan

    2015-01-01

    Background Medication errors may occur during prescribing, transcribing, prescription auditing, preparing, dispensing, administration, and monitoring. Medication administration errors (MAEs) are those that actually reach patients and remain a threat to patient safety. The Joint Commission International (JCI) advocates medication error prevention, but experience in reducing MAEs during the period of before and after JCI accreditation has not been reported. Methods An intervention study, aimed at reducing MAEs in hospitalized patients, was performed in the Second Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China, during the journey to JCI accreditation and in the post-JCI accreditation era (first half-year of 2011 to first half-year of 2014). Comprehensive interventions included organizational, information technology, educational, and process optimization-based measures. Data mining was performed on MAEs derived from a compulsory electronic reporting system. Results The number of MAEs continuously decreased from 143 (first half-year of 2012) to 64 (first half-year of 2014), with a decrease in occurrence rate by 60.9% (0.338% versus 0.132%, P<0.05). The number of MAEs related to high-alert medications decreased from 32 (the second half-year of 2011) to 16 (the first half-year of 2014), with a decrease in occurrence rate by 57.9% (0.0787% versus 0.0331%, P<0.05). Omission was the top type of MAE during the first half-year of 2011 to the first half-year of 2014, with a decrease by 50% (40 cases versus 20 cases). Intravenous administration error was the top type of error regarding administration route, but it continuously decreased from 64 (first half-year of 2012) to 27 (first half-year of 2014). More experienced registered nurses made fewer medication errors. The number of MAEs in surgical wards was twice that in medicinal wards. Compared with non-intensive care units, the intensive care units exhibited higher occurrence rates of MAEs

  14. [Medical errors and iatrogenic injury--results of 173 Schlichtungsstellen proceedings in general practice].

    PubMed

    Scheppokat, K D

    2004-09-01

    The Schlichtungsstelle (expert panel for alternative dispute resolution) of Northern Germany receives and decides on large numbers of malpractice claims. We report on 173 panel decisions on claims involving general practitioners: Medical negligence was found in 40%, and patient-injuries due to negligence in 28% of these cases. Treatment-caused injuries of the patient were also found in several of the cases decided against the claimant. In proceedings on the grounds of injections, 26 of 30 claimants concerned had suffered iatrogenic injuries. Treatment-caused injuries were severe in 40 of the 173 patients, fatal in 7. Injury rated and margins of error are much lower in industry than in medicine. Reviews of hospital records identified adverse events in 3-4% of hospitalized patients. Autopsy studies revealed that in 10-50% of cases the diagnosis verified postmortem had been missed clinically. Effective risk-management should be based on a trustful relationship among the persons working together: so that errors and adverse events might be discussed openly and the roles of persons, organization or system can be laid open. PMID:15527195

  15. Understanding the causes of intravenous medication administration errors in hospitals: a qualitative critical incident study

    PubMed Central

    Keers, Richard N; Williams, Steven D; Cooke, Jonathan; Ashcroft, Darren M

    2015-01-01

    Objectives To investigate the underlying causes of intravenous medication administration errors (MAEs) in National Health Service (NHS) hospitals. Setting Two NHS teaching hospitals in the North West of England. Participants Twenty nurses working in a range of inpatient clinical environments were identified and recruited using purposive sampling at each study site. Primary outcome measures Semistructured interviews were conducted with nurse participants using the critical incident technique, where they were asked to discuss perceived causes of intravenous MAEs that they had been directly involved with. Transcribed interviews were analysed using the Framework approach and emerging themes were categorised according to Reason's model of accident causation. Results In total, 21 intravenous MAEs were discussed containing 23 individual active failures which included slips and lapses (n=11), mistakes (n=8) and deliberate violations of policy (n=4). Each active failure was associated with a range of error and violation provoking conditions. The working environment was implicated when nurses lacked healthcare team support and/or were exposed to a perceived increased workload during ward rounds, shift changes or emergencies. Nurses frequently reported that the quality of intravenous dose-checking activities was compromised due to high perceived workload and working relationships. Nurses described using approaches such as subconscious functioning and prioritising to manage their duties, which at times contributed to errors. Conclusions Complex interactions between active and latent failures can lead to intravenous MAEs in hospitals. Future interventions may need to be multimodal in design in order to mitigate these risks and reduce the burden of intravenous MAEs. PMID:25770226

  16. Voluntary medical male circumcision: an HIV prevention priority for PEPFAR.

    PubMed

    Reed, Jason Bailey; Njeuhmeli, Emmanuel; Thomas, Anne Goldzier; Bacon, Melanie C; Bailey, Robert; Cherutich, Peter; Curran, Kelly; Dickson, Kim; Farley, Tim; Hankins, Catherine; Hatzold, Karin; Justman, Jessica; Mwandi, Zebedee; Nkinsi, Luke; Ridzon, Renee; Ryan, Caroline; Bock, Naomi

    2012-08-15

    As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President's Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen populations may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya's Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success. Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods-such as medical devices that remove the foreskin without injected anesthesia and/or sutures-are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all. PMID:22797745

  17. Voluntary Medical Male Circumcision: An HIV Prevention Priority for PEPFAR

    PubMed Central

    Reed, Jason Bailey; Njeuhmeli, Emmanuel; Thomas, Anne Goldzier; Bacon, Melanie C.; Bailey, Robert; Cherutich, Peter; Curran, Kelly; Dickson, Kim; Farley, Tim; Hankins, Catherine; Hatzold, Karin; Justman, Jessica; Mwandi, Zebedee; Nkinsi, Luke; Ridzon, Renee; Ryan, Caroline; Bock, Naomi

    2013-01-01

    As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President’s Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen populations may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya’s Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success. Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods—such as medical devices that remove the foreskin without injected anesthesia and/or sutures—are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all. PMID:22797745

  18. Color-Coded Prefilled Medication Syringes Decrease Time to Delivery and Dosing Error in Simulated Emergency Department Pediatric Resuscitations

    PubMed Central

    Moreira, Maria E.; Hernandez, Caleb; Stevens, Allen D.; Jones, Seth; Sande, Margaret; Blumen, Jason R.; Hopkins, Emily; Bakes, Katherine; Haukoos, Jason S.

    2016-01-01

    Study objective The Institute of Medicine has called on the US health care system to identify and reduce medical errors. Unfortunately, medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients when dosing requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national health care priorities. Our goal was to evaluate novel, prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape, compared with conventional medication administration, in simulated pediatric emergency department (ED) resuscitation scenarios. Methods We performed a prospective, block-randomized, crossover study in which 10 emergency physician and nurse teams managed 2 simulated pediatric arrest scenarios in situ, using either prefilled, color-coded syringes (intervention) or conventional drug administration methods (control). The ED resuscitation room and the intravenous medication port were video recorded during the simulations. Data were extracted from video review by blinded, independent reviewers. Results Median time to delivery of all doses for the conventional and color-coded delivery groups was 47 seconds (95% confidence interval [CI] 40 to 53 seconds) and 19 seconds (95% CI 18 to 20 seconds), respectively (difference=27 seconds; 95% CI 21 to 33 seconds). With the conventional method, 118 doses were administered, with 20 critical dosing errors (17%); with the color-coded method, 123 doses were administered, with 0 critical dosing errors (difference=17%; 95% CI 4% to 30%). Conclusion A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by emergency physician and nurse teams during simulated pediatric ED resuscitations. PMID:25701295

  19. Investigating the epidemiology of medication errors and error-related adverse drug events (ADEs) in primary care, ambulatory care and home settings: a systematic review protocol

    PubMed Central

    Assiri, Ghadah Asaad; Grant, Liz; Aljadhey, Hisham; Sheikh, Aziz

    2016-01-01

    Introduction There is a need to better understand the epidemiology of medication errors and error-related adverse events in community care contexts. Methods and analysis We will systematically search the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Eastern Mediterranean Regional Office of the WHO (EMRO), MEDLINE, PsycINFO and Web of Science. In addition, we will search Google Scholar and contact an international panel of experts to search for unpublished and in progress work. The searches will cover the time period January 1990–December 2015 and will yield data on the incidence or prevalence of and risk factors for medication errors and error-related adverse drug events in adults living in community settings (ie, primary care, ambulatory and home). Study quality will be assessed using the Critical Appraisal Skills Program quality assessment tool for cohort and case–control studies, and cross-sectional studies will be assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Descriptive Studies. Meta-analyses will be undertaken using random-effects modelling using STATA (V.14) statistical software. Ethics and dissemination This protocol will be registered with PROSPERO, an international prospective register of systematic reviews, and the systematic review will be reported in the peer-reviewed literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PMID:27580826

  20. [Main types of activity of specialists of medical and preventive profile in military hospitals].

    PubMed

    Akimkin, V G; Azarov, I I; Volynkov, I O; Bobylev, V A

    2015-09-01

    Infection prevention in medical organizations is an essential task to ensure quality of medical care and create a safe environment for patients and medical staff. The main task of a specialist of medical and preventive profile in the hospital is to maintain sanitary and epidemiological safety and control fulfillment of a complex of preventive measures. To achieve these goals specialists monitor epidemiological and microbiological fulfilment of the implementation and effectiveness of preventive measures, which allow to except infection entry to the hospital and possible carrying out beyond the hospital, occurrence and spread of disease. An obligatory activity of the specialist of medical and preventive profile in the hospital is a scientific and methodical work. The authors propose adoption of preventive structural subdivisions to the state largest diversified military hospitals. PMID:26827514

  1. Caffeine for the prevention of injuries and errors in shift workers

    PubMed Central

    Ker, Katharine; Edwards, Philip James; Felix, Lambert M; Blackhall, Karen; Roberts, Ian

    2014-01-01

    Background Sleepiness leads to a deterioration in performance and attention, and is associated with an increased risk of injury. Jet lag and shift work disorder are circadian rhythm sleep disorders which result in sleepiness and can elevate injury risk. They create a need for individuals to operate at times which are different to those dictated by their circadian rhythms. Consequently there is also a need for interventions to help ensure that these persons can do so safely. Caffeine has a potential role in promoting alertness during times of desired wakefulness in persons with jet lag or shift work disorder, however its effects on injury and error are unclear. Objectives To assess the effects of caffeine for preventing injuries caused by impaired alertness in persons with jet lag or shift work disorder. Search methods We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, CINAHL, TRANSPORT (to July 2008); and PubMed databases (to April 2010). We also searched the Internet and checked reference lists of relevant papers. Selection criteria Randomised controlled trials investigating the effects of caffeine on injury, error or cognitive performance in people with jet lag or shift work disorder. Data collection and analysis Two authors independently screened search results and assessed full texts for inclusion. Data were extracted and risk of bias was assessed. Estimates of treatment effect (odds ratio and standardised mean difference (SMD)) and 95% confidence intervals (CI) were calculated and pooled using the fixed-effect model. Main results Thirteen trials were included. None measured an injury outcome. Two trials measured error, and the remaining trials used neuropsychological tests to assess cognitive performance. The trials assessing the impact on errors found that caffeine significantly reduced the number of errors compared to placebo. The pooled effect estimates on performance by cognitive domain

  2. What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system

    PubMed Central

    Westbrook, Johanna I.; Li, Ling; Lehnbom, Elin C.; Baysari, Melissa T.; Braithwaite, Jeffrey; Burke, Rosemary; Conn, Chris; Day, Richard O.

    2015-01-01

    Objectives To (i) compare medication errors identified at audit and observation with medication incident reports; (ii) identify differences between two hospitals in incident report frequency and medication error rates; (iii) identify prescribing error detection rates by staff. Design Audit of 3291patient records at two hospitals to identify prescribing errors and evidence of their detection by staff. Medication administration errors were identified from a direct observational study of 180 nurses administering 7451 medications. Severity of errors was classified. Those likely to lead to patient harm were categorized as ‘clinically important’. Setting Two major academic teaching hospitals in Sydney, Australia. Main Outcome Measures Rates of medication errors identified from audit and from direct observation were compared with reported medication incident reports. Results A total of 12 567 prescribing errors were identified at audit. Of these 1.2/1000 errors (95% CI: 0.6–1.8) had incident reports. Clinically important prescribing errors (n = 539) were detected by staff at a rate of 218.9/1000 (95% CI: 184.0–253.8), but only 13.0/1000 (95% CI: 3.4–22.5) were reported. 78.1% (n = 421) of clinically important prescribing errors were not detected. A total of 2043 drug administrations (27.4%; 95% CI: 26.4–28.4%) contained ≥1 errors; none had an incident report. Hospital A had a higher frequency of incident reports than Hospital B, but a lower rate of errors at audit. Conclusions Prescribing errors with the potential to cause harm frequently go undetected. Reported incidents do not reflect the profile of medication errors which occur in hospitals or the underlying rates. This demonstrates the inaccuracy of using incident frequency to compare patient risk or quality performance within or across hospitals. New approaches including data mining of electronic clinical information systems are required to support more effective medication error detection and

  3. Preventing (impulsive) errors: Electrophysiological evidence for online inhibitory control over incorrect responses

    PubMed Central

    van den Wildenberg, Wery P. M.; Spieser, Laure; Ridderinkhof, K. Richard

    2016-01-01

    Abstract In a rich environment, with multiple action affordances, selective action inhibition is critical in preventing the execution of inappropriate responses. Here, we studied the origin and the dynamics of incorrect response inhibition and how it can be modulated by task demands. We used EEG in a conflict task where the probability of compatible and incompatible trials was varied. This allowed us to modulate the strength of the prepotent response, and hence to increase the risk of errors, while keeping the probability of the two responses equal. The correct response activation and execution was not affected by compatibility or by probability. In contrast, incorrect response inhibition in the primary motor cortex ipsilateral to the correct response was more pronounced on incompatible trials, especially in the condition where most of the trials were compatible, indicating a modulation of inhibitory strength within the course of the action. Two prefrontal activities, one medial and one lateral, were also observed before the response, and their potential links with the observed inhibitory pattern observed are discussed. PMID:27005956

  4. Are Medical Students Ready To Provide HIV-Prevention Counseling?

    ERIC Educational Resources Information Center

    Cook, Robert L.; Steiner, Beat D.; Smith, Allen C., III; Evans, Arthur T.; Willis, Stephen E.; Petrusa, Emil R.; Harward, Donna H.; Richards, Boyd F.

    1998-01-01

    A study investigated the ability of 415 medical students at four North Carolina medical schools to ask risk-behavior questions and provide risk-reduction advice when interviewing a standardized patient concerned about human immunovirus (HIV) infection. A majority did not assess several important risk factors, and many would have provided incorrect…

  5. Setting up a national system of compounding pharmacies: preventing error, assuring quality, building trust.

    PubMed

    de Souza, Hugo Guedes; Favaro, Alvaro; Andrade, Alba Livia; Gomes, Lenir Yago; Aguiar, Simone de Souza; Garcez, Mario do Carmo

    2009-01-01

    Influencing the drawing of future legislation, gaining the confidence of consumers, prescribers, and government; and enhancing the communication with the medical profession are among the major upcoming challenges for compounding pharmacists worldwide. In our systematic effort to prevent eror and improve quality, we have learned that guidance is our main ally. When the Brazilian National Health Agency issued legislation that had a major impact on operating costs for compounding businesses, the Brazilian National Health Agency issued legislation that had major impact on operating costs for compounding businesses, the Brazilian National Association of Compounding Pharmacies, a nongovernmental organization, set out to tackle the many deadlocks resulting from the legislation. With the support of compounding pharmacists, the association has been able to develop and implement a National System for the Monitoring and Improvement of Compounding Practices, a process-focused system. Custom-made, individualized drugs are necessary for providing the best treatment, and compounding pharmacies must be viewed and act as partners for health. PMID:23965327

  6. Mortality as an indicator of patient safety in orthopaedics: lessons from qualitative analysis of a database of medical errors

    PubMed Central

    2012-01-01

    Background Orthopaedic surgery is a high-risk specialty in which errors will undoubtedly occur. Patient safety incidents can yield valuable information to generate solutions and prevent future cases of avoidable harm. The aim of this study was to understand the causative factors leading to all unnecessary deaths in orthopaedics and trauma surgery reported to the National Patient Safety Agency (NPSA) over a four-year period (2005–2009), using a qualitative approach. Methods Reports made to the NPSA are categorised and stored in the database as free-text data. A search was undertaken to identify the cases of all-cause mortality in orthopaedic and trauma surgery, and the free-text elements were used for thematic analysis. Descriptive statistics were calculated based on the incidents reported. This included presenting the number of times categories of incidents had the same or similar response. Superordinate and subordinate categories were created. Results A total of 257 incident reports were analysed. Four main thematic categories emerged. These were: (1) stages of the surgical journey – 118/191 (62%) of deaths occurred in the post-operative phase; (2) causes of patient deaths – 32% were related to severe infections; (3) reported quality of medical interventions – 65% of patients experienced minimal or delayed treatment; (4) skills of healthcare professionals – 44% of deaths had a failure in non-technical skills. Conclusions Most complications in orthopaedic surgery can be dealt with adequately, provided they are anticipated and that risk-reduction strategies are instituted. Surgeons take pride in the precision of operative techniques; perhaps it is time to enshrine the multimodal tools available to ensure safer patient care. PMID:22682470

  7. Recruitment into diabetes prevention programs: what is the impact of errors in self-reported measures of obesity?

    PubMed Central

    2012-01-01

    Background Error in self-reported measures of obesity has been frequently described, but the effect of self-reported error on recruitment into diabetes prevention programs is not well established. The aim of this study was to examine the effect of using self-reported obesity data from the Finnish diabetes risk score (FINDRISC) on recruitment into the Greater Green Triangle Diabetes Prevention Project (GGT DPP). Methods The GGT DPP was a structured group-based lifestyle modification program delivered in primary health care settings in South-Eastern Australia. Between 2004–05, 850 FINDRISC forms were collected during recruitment for the GGT DPP. Eligible individuals, at moderate to high risk of developing diabetes, were invited to undertake baseline tests, including anthropometric measurements performed by specially trained nurses. In addition to errors in calculating total risk scores, accuracy of self-reported data (height, weight, waist circumference (WC) and Body Mass Index (BMI)) from FINDRISCs was compared with baseline data, with impact on participation eligibility presented. Results Overall, calculation errors impacted on eligibility in 18 cases (2.1%). Of n = 279 GGT DPP participants with measured data, errors (total score calculation, BMI or WC) in self-report were found in n = 90 (32.3%). These errors were equally likely to result in under- or over-reported risk. Under-reporting was more common in those reporting lower risk scores (Spearman-rho = −0.226, p-value < 0.001). However, underestimation resulted in only 6% of individuals at high risk of diabetes being incorrectly categorised as moderate or low risk of diabetes. Conclusions Overall FINDRISC was found to be an effective tool to screen and recruit participants at moderate to high risk of diabetes, accurately categorising levels of overweight and obesity using self-report data. The results could be generalisable to other diabetes prevention programs using screening tools which

  8. Hospitals and plastics. Dioxin prevention and medical waste incinerators.

    PubMed

    Thornton, J; McCally, M; Orris, P; Weinberg, J

    1996-01-01

    CHLORINATED DIOXINS and related compounds are extremely potent toxic substances, producing effects in humans and animals at extremely low doses. Because these compounds are persistent in the environment and accumulate in the food chain, they are now distributed globally, and every member of the human population is exposed to them, primarily through the food supply and mothers' milk. An emerging body of information suggests that dioxin contamination has reached a level that may pose a large-scale, long-term public health risk. Of particular concern are dioxin's effects on reproduction, development, immune system function, and carcinogenesis. Medical waste incineration is a major source of dioxins. Polyvinyl chloride (PVC) plastic, as the dominant source of organically bound chlorine in the medical waste stream, is the primary cause of "iatrogenic" dioxin produced by the incineration of medical wastes. Health professionals have a responsibility to work to reduce dioxin exposure from medical sources. Health care institutions should implement policies to reduce the use of PVC plastics, thus achieving major reductions in medically related dioxin formation. PMID:8711095

  9. Hospitals and plastics. Dioxin prevention and medical waste incinerators.

    PubMed Central

    Thornton, J; McCally, M; Orris, P; Weinberg, J

    1996-01-01

    CHLORINATED DIOXINS and related compounds are extremely potent toxic substances, producing effects in humans and animals at extremely low doses. Because these compounds are persistent in the environment and accumulate in the food chain, they are now distributed globally, and every member of the human population is exposed to them, primarily through the food supply and mothers' milk. An emerging body of information suggests that dioxin contamination has reached a level that may pose a large-scale, long-term public health risk. Of particular concern are dioxin's effects on reproduction, development, immune system function, and carcinogenesis. Medical waste incineration is a major source of dioxins. Polyvinyl chloride (PVC) plastic, as the dominant source of organically bound chlorine in the medical waste stream, is the primary cause of "iatrogenic" dioxin produced by the incineration of medical wastes. Health professionals have a responsibility to work to reduce dioxin exposure from medical sources. Health care institutions should implement policies to reduce the use of PVC plastics, thus achieving major reductions in medically related dioxin formation. Images p298-a p299-a p300-a p301-a p305-a p307-a p310-a PMID:8711095

  10. [Error prevention through management of complications in urology: standard operating procedures from commercial aviation as a model].

    PubMed

    Kranz, J; Sommer, K-J; Steffens, J

    2014-05-01

    Patient safety and risk/complication management rank among the current megatrends in modern medicine, which has undoubtedly become more complex. In time-critical, error-prone and difficult situations, which often occur repeatedly in everyday clinical practice, guidelines are inappropriate for acting rapidly and intelligently. With the establishment and consistent use of standard operating procedures like in commercial aviation, a possible strategic approach is available. These medical aids to decision-making - quick reference cards - are short, optimized instructions that enable a standardized procedure in case of medical claims. PMID:24744109

  11. Family Perceptions of Medication Administration at School: Errors, Risk Factors, and Consequences

    ERIC Educational Resources Information Center

    Clay, Daniel; Farris, Karen; McCarthy, Ann Marie; Kelly, Michael W.; Howarth, Robyn

    2008-01-01

    Medications are administered every day in schools across the country. Researchers and clinicians have studied school nurses' and educators' experiences with medication administration, but not the experiences of children or their parents. This study examined medication administration from the child and parent perspectives to (a) determine problems…

  12. Hepatitis C: Part II. Prevention counseling and medical evaluation.

    PubMed

    Moyer, L A; Mast, E E; Alter, M J

    1999-01-15

    An estimated 3.9 million Americans are infected with hepatitis C virus (HCV), and most do not know that they are infected. This group includes persons who are at risk for HCV-associated chronic liver disease and who also serve as reservoirs for transmission of HCV to others. Because there is no vaccine to prevent HCV infection and immune globulin is not effective for postexposure prophylaxis, prevention of HCV infection is paramount. Patients who are at risk of exposure to HCV should be advised on steps they might take to minimize their risk of infection. Patients who are infected with HCV should be counseled on ways to prevent transmission of HCV to others and to avoid hepatotoxins. They should also be examined for liver disease and referred for treatment, if indicated. PMID:9930128

  13. Do US Medical Students Report More Training on Evidence-Based Prevention Topics?

    ERIC Educational Resources Information Center

    Frank, Erica; Schlair, Sheira; Elon, Lisa; Saraiya, Mona

    2013-01-01

    Little is known about the extent to which evidence-based prevention topics are taught in medical school. All class of 2003 medical students (n = 2316) at 16 US schools were eligible to complete three questionnaires: at the beginning of first and third years and in their senior year, with 80.3% responding. We queried these students about 21…

  14. The Rehabilitation of Adolescents in a Medical and Preventive Treatment Facility

    ERIC Educational Resources Information Center

    Cherkasova, I.

    2008-01-01

    The author discusses the weaknesses of medical and preventive treatment facilities (MPTFs) that provide specialized medical assistance to an increasing number of youth with complex psychophysical impairments. Maintaining that substantial improvement of the effectiveness of rehabilitation measures for adolescents in an MPTF is possible by creating…

  15. Getting ready for identity theft rules: creating a prevention program for your medical practice.

    PubMed

    Cascardo, Debra

    2009-01-01

    Identity theft worries have found their way into medical practices. By August 1, 2009, all "creditors" must have a written program to prevent, detect, and minimize damage from identity theft. Any medical practice that bills patients is considered a creditor. Like HIPAA, these new Red Flag guidelines will serve to protect your practice from lawsuits as well as protect your patients from identity theft of their financial, personal, and medical information. PMID:19911551

  16. Reducing Aversion to Side Effects in Preventive Medical Treatment Decisions

    ERIC Educational Resources Information Center

    Waters, Erika A.; Weinstein, Neil D.; Colditz, Graham A.; Emmons, Karen M.

    2007-01-01

    Laypeople tend to be overly sensitive to side effects of treatments that prevent illness, possibly leading them to refuse beneficial therapies. This Internet-based study attempted to reduce such side effect aversion by adding graphic displays to the numerical risk probabilities. It also explored whether graphics reduce side effect aversion by…

  17. 3W approach to the investigation, analysis, and prevention of human-error aircraft accidents.

    PubMed

    Ricketson, D S; Brown, W R; Graham, K N

    1980-09-01

    Human error is the largest cause of U.S. Army aircraft accidents. An approach to this problem is presented which is based on a model of the human-error accident. This 3W approach identifies what task error (TE) caused or contributed to the accident, what inadequacy (I) in the aviation system caused or allowed the TE to occur, and what remedial measure (R) is required to correct the I. There were 82 human-error accidents analyzed to identify TEIR information. Statistically important is were identified which could be remedied based on accident costs. Then, potentially cost-effective remedial actions were ranked on a cost-benefit totem pole. The totem pole was given to the aviation system manager as a management tool to assist in determining priorities for corrective actions. PMID:7417175

  18. Impact of a Preventive Cardiology Curriculum on Knowledge and Attitudes of First-Year Medical Students.

    ERIC Educational Resources Information Center

    Veitia, Marie C.; And Others

    1993-01-01

    A study of 54 first-year Marshall University (West Virginia) medical students found that a preventive cardiology curriculum improved both knowledge of and attitudes about preventive cardiology in general and on all 4 subscales (epidemiological evidence, risk factor characteristics, pathophysiology, primary interventions). (Author/MSE)

  19. Retreat from Nuremberg: can we prevent unethical medical research?

    PubMed

    Horner, J S

    1999-09-01

    The prosecution of doctors guilty of appalling human rights abuses at Nuremberg was achieved on the mistaken premise that the research community already had a code of conduct which, if applied, would have made such abuses impossible. In fact, not only was there no such code but when the 'Nuremberg Code' was published after the trial it continued to be ignored by many doctors for some thirty years afterwards. Indeed its central principle of informed consent has itself been eroded by subsequent international agreements on the ethics of medical research. This review shows that the mechanisms for approval of medical research which have now been promulgated in England and Wales, in practice, are applied on a very variable basis. Research in vulnerable groups unable to give fully informed consent such as children, prisoners and the incompetent elderly require the application of more rigorous standards of ethical control than those currently in operation. The use of vulnerable populations in the developing world and the application of international standards to them is also considered. A number of suggestions for improvements in current procedures in all these areas are put forward. The proposals for the United Kingdom would meet the requirements of the European Convention on bioethical research and the recent government consultation paper on medical treatment and research in incompetent adults. PMID:10557112

  20. Infection prevention and the medical director: uncharted territory.

    PubMed

    Kapoian, Toros; Meyer, Klemens B; Johnson, Douglas S

    2015-05-01

    Infections continue to be a major cause of disease and contributor to death in patients on dialysis. Despite our knowledge and acceptance that hemodialysis catheters should be avoided and eliminated, most patients who begin dialysis initiate treatment through a central vein hemodialysis catheter. Dialysis Medical Directors must be the instrument through which our industry changes. We must lead the charge to educate our dialysis staff and our dialysis patients. We must also educate ourselves so that we not only know that our facility policies are consistent with the best evidence available, but we must also know where local and federal regulations differ. When these differences impact on patient care, we must speak out and have these regulations changed. But it is not enough to know the rules and write them. We must lead by example and show our patients, our nephrology colleagues and our dialysis staff that we always follow these same policies. We need to practice what we preach and be willing and available to redirect those individuals who have difficulty following the rules. In order to effectively change process meaningful data must be collected, analyzed and acted upon. Dialysis Medical Directors must direct and lead the quality improvement process. We hope this review provides Dialysis Medical Directors with the necessary tools to effectively drive this process and improve care. PMID:25710803

  1. Infection Prevention and the Medical Director: Uncharted Territory

    PubMed Central

    Kapoian, Toros; Meyer, Klemens B.

    2015-01-01

    Infections continue to be a major cause of disease and contributor to death in patients on dialysis. Despite our knowledge and acceptance that hemodialysis catheters should be avoided and eliminated, most patients who begin dialysis initiate treatment through a central vein hemodialysis catheter. Dialysis Medical Directors must be the instrument through which our industry changes. We must lead the charge to educate our dialysis staff and our dialysis patients. We must also educate ourselves so that we not only know that our facility policies are consistent with the best evidence available, but we must also know where local and federal regulations differ. When these differences impact on patient care, we must speak out and have these regulations changed. But it is not enough to know the rules and write them. We must lead by example and show our patients, our nephrology colleagues and our dialysis staff that we always follow these same policies. We need to practice what we preach and be willing and available to redirect those individuals who have difficulty following the rules. In order to effectively change process meaningful data must be collected, analyzed and acted upon. Dialysis Medical Directors must direct and lead the quality improvement process. We hope this review provides Dialysis Medical Directors with the necessary tools to effectively drive this process and improve care. PMID:25710803

  2. [Occupational risk factors and medical prevention in corrections officers].

    PubMed

    Mennoial, Nunzio Valerio; Napoli, Paola; Battaglia, Andrea; Candura, Stefano M

    2014-01-01

    In Italy, the Law n. 395/1990 defines the tasks and attributions of prison officers. According to the article 25 of the Legislative Decree n. 81/2008, the occupational physician should participate to risk assessment, and carry out the sanitary surveillance. This report analyzes the various tasks of prison staff, identifies the risk factors, and discusses the preventive strategies, including workers formation and education. Biological agents and work-related stress are the main risk factors, as a consequence of prison overcrowding, personnel shortage and work organization complexity. In his preventive action, and particularly in formulating the judgment on work fitness, the occupational physician often clashes with inadequate ministerial funding. PMID:25558744

  3. Pediatric primary urolithiasis: Symptoms, medical management and prevention strategies

    PubMed Central

    Penido, Maria Goretti Moreira Guimarães; Tavares, Marcelo de Sousa

    2015-01-01

    In the past few decades pediatric urolithiasis has become more frequent. The reason for this increase is not completely clear but has been attributed to changes in climate, nutritional habits and possibly other environmental factors. Although less frequent than adult stone disease, urolithiasis in the pediatric age group is also related to significant morbidity, particularly since stones tend to recur, and, thus, should not be underestimated. Most children with idiopathic stone disease have an underlying metabolic abnormality substantiating the importance of metabolic evaluation already following initial diagnosis of urolithiasis. Identification of the metabolic abnormality allows for more specific prescription of non pharmacological and pharmacological interventions aimed at preventing recurrent stone formation. A better understanding of the causes of kidney stone disease will provide better strategies for stone prevention in children. PMID:26380196

  4. Drug Administration Errors in an Institution for Individuals with Intellectual Disability: An Observational Study

    ERIC Educational Resources Information Center

    van den Bemt, P. M. L. A.; Robertz, R.; de Jong, A. L.; van Roon, E. N.; Leufkens, H. G. M.

    2007-01-01

    Background: Medication errors can result in harm, unless barriers to prevent them are present. Drug administration errors are less likely to be prevented, because they occur in the last stage of the drug distribution process. This is especially the case in non-alert patients, as patients often form the final barrier to prevention of errors.…

  5. Pattern and Predictors of Medication Dosing Errors in Chronic Kidney Disease Patients in Pakistan: A Single Center Retrospective Analysis

    PubMed Central

    Saleem, Ahsan; Masood, Imran

    2016-01-01

    Background Chronic kidney disease (CKD) alters the pharmacokinetic and pharmacodynamic response of various drugs and increases the risk of toxicity. The data regarding the pattern and predictors of medication dosing errors is scare from the developing countries. Therefore, the present study was conducted to assess the pattern and predictors of medication dosing errors in CKD patients in a tertiary care setting in Pakistan. Methods A retrospective study design was employed and medical charts of all those CKD patients who had an eGFR ≤60ml/min/1.73m2, hospitalization ≥24 hours, and admitted in the nephrology unit during January 2013 to December 2014 were assessed. Descriptive statistics and the logistic regression analysis were done using IBM SPSS version 20. Results In total, 205 medical charts were assessed. The mean age of patients was 38.64 (±16.82) years. Overall, 1534 drugs were prescribed to CKD patients, of which, nearly 34.0% drugs required dose adjustment. Among those drugs, only 41.8% were properly adjusted, and the remaining 58.2% were unadjusted. The logistic regression analysis revealed that the medication dosing errors were significantly associated with the CKD stages, i.e. stage 4 (OR 0.054; 95% CI [0.017–0.177]; p <0.001) and stage 5 (OR 0.098; 95% CI [0.040–0.241]; p <0.001), the number of prescribed medicines ≥ 5 (OR 0.306; 95% CI [0.133–0.704]; p 0.005), and the presence of a comorbidity (OR 0.455; 95% CI [0.226–0.916]; p 0.027) such as the hypertension (OR 0.453; 95% CI [0.231–0.887]; p 0.021). Conclusions It is concluded that more than half drugs prescribed to CKD patients requiring dose adjustment were unadjusted. The predictors of medication dosing errors were the severe-to-end stages of chronic kidney disease, the presence of a comorbidity such as hypertension, and a higher number of prescribed medicines. Therefore, attention should be paid to these risk factors. PMID:27367594

  6. Preventing infection from reusable medical equipment: a systematic review

    PubMed Central

    Sopwith, Will; Hart, Tony; Garner, Paul

    2002-01-01

    Background In 2000, the World Health Organization (WHO) had eight sets of conflicting recommendations for decontaminating medical equipment. We conducted a systematic review of observational studies to assist WHO in reconciling the various guidelines. This paper summarises the methods developed and illustrates the results for three procedures – alcohol, bleach and povidone iodine. Methods We developed a Medline search strategy and applied inclusion criteria specifying the decontamination procedures of interest and an outcome of microbial destruction for a set of marker organisms. We developed protocols to assess the quality of studies and categorised them according to the reliability of the methods used. Through an iterative process we identified best practice for the decontamination methods and key additional factors required to ensure their effectiveness. We identified 88 published papers for inclusion, describing 135 separate studies of decontamination. Results For disinfection with alcohol, best practice was identified from 23 studies as an exposure to 70–80% ethanol or isopropanol for at least 5 minutes. Bleach was effective for sterilization at a concentration of 5000 ppm for 5 minutes and for disinfection at 1000 ppm for 10 minutes (33 studies). Povidone iodine was only partially effective for disinfection at a concentration of 1% for 15 minutes (15 studies). Conclusions Our findings provide an evidence base for WHO guidelines on decontaminating medical equipment. The results support the recommended use of bleach and show that alcohol could be used more widely than current guidelines suggest, provided best practice is followed. The effectiveness of povidone iodine is uncertain. PMID:11916458

  7. Role of medication therapy management in preexposure prophylaxis therapy for HIV prevention.

    PubMed

    Ferrell, Kelli W; Woodard, Laresa M; Woodard, Todd J

    2015-02-01

    Patient medication adherence is a long-standing problem and is one that raises serious issues for patient health, public health, and health care quality. Medication nonadherence costs the US economy an estimated US$290 billion in avoidable medical spending every year. One of the most costly health conditions is HIV disease, which continues to be a serious health issue for parts of the world. About 34 million people are living with HIV around the world. With the emerging preventative treatment against HIV, known as preexposure prophylaxis (PrEP), come concerns surrounding the potential impact of nonadherence to this newly approved medication therapy. Nonadherence to antiretroviral treatments are commonly the root cause for patients not reaching their treatment goals, putting them at risk of progression and worsening of their disease and complications, such as increased risk of opportunistic infections. Therefore, it is essential to improve antiretroviral medication adherence. By identifying members who are nonadherent to their prescribed antiretroviral medications and working collaboratively with patients, physicians, and pharmacists, Medication Therapy Management (MTM) can potentially increase medication adherence by helping patients identify, resolve, and prevent issues that may affect their decision not to take a medication as intended. PMID:25500557

  8. Comparison of provider claims data versus medical records review for assessing provision of adult preventive services.

    PubMed

    Naessens, James M; Ruud, Kari L; Tulledge-Scheitel, Sidna M; Stroebel, Robert J; Cabanela, Rosa L

    2008-01-01

    Administrative claims data are often used to assess the delivery of preventive services, yet there are important limitations. This study assessed the use of claims data to measure quality for pay-for-performance and as a preventive services screening tool compared with medical records review. Accuracy and bias in relying on claims data from a provider perspective were investigated, including a comparison of practice types. Claims data consistently underestimated the rate of preventive services, but the type of practice influenced accuracy. Claims data should be used cautiously, if at all, for pay for performance or to trigger reminders for preventive services completion. PMID:18360179

  9. Benzodiazepine administration prevents the use of error-correction mechanisms during fear extinction.

    PubMed

    Hart, Genevra; Holmes, Nathan M; Harris, Justin A; Westbrook, R Frederick

    2014-12-01

    Three experiments examined the effect of systemic administration of the benzodiazepine midazolam on extinction and re-extinction of conditioned fear. Experiment 1 demonstrated that midazolam administration prior to extinction of a conditioned stimulus (CS) impaired that extinction when rats were subsequently tested drug free; however, extinction was spared if rats were extinguished, reconditioned, and re-extinguished under midazolam. Experiment 2 provided a replication of this effect within-subjects; rats were conditioned to two CSs (A and B), extinguished to one (A-), reconditioned to both, and then extinguished/re-extinguished to both stimuli in compound (AB-), under either vehicle or midazolam. On the drug-free test, rats given midazolam froze more to the CS that had been extinguished (B) than the one that been re-extinguished (A). The final experiment examined whether extinction under midazolam was regulated by prediction error. Rats were trained with three CSs (A, B, C) and extinguished to two (A-, C-). These stimuli then underwent additional extinction under midazolam or vehicle, with one CS now presented in compound with the non-extinguished CS (AB-, C-). Rats were then tested for fear of A relative to C. Rats given vehicle showed a deepening of extinction to A relative to C, as is predicted from error-correction models; however, rats given midazolam failed to show any such discrepancy in responding. The results are interpreted to indicate that the drug reduced prediction error during extinction by reducing fear, and rats were able to re-extinguish fear via a retrieval mechanism that is independent of prediction error. PMID:25318899

  10. Effectiveness of preventive medicine education and its determinants among medical students in Malaysia.

    PubMed

    Anil, Shirin; Zawahir, Mohamed Shukry; Al-Naggar, Redhwan Ahmed

    2016-03-01

    Preventive medicine has been incorporated in the medical school curriculum, but its effectiveness and the factors that affect it are yet to be widely looked into in the context of Malaysia. We aimed to measure the familiarity with, perception about the importance to learn, and the ability to practice preventive medicine as well as its determinants among the medical students in Malaysia. Thus, a cross sectional study was conducted through an anonymous online survey among 387 randomly selected final year medical students of four large public medical schools in Malaysia from March to September 2014. Of the total sample, 340 (response rate 87.8%) gave a written informed consent and took part in the survey. The familiarity of the sample with preventive medicine was measured in 19 preventive medicine areas, and their perception about the importance of preventive medicine and their ability to practice it were gauged on a Likert scale (low score indicates disagreement and high indicates agreement). Descriptive statistical analysis was performed, followed by logistic regression. The mean age of the respondents was 23.7 (SD 0.77) years, and 61.2% (n = 208) of them were females. Results showed that 22.9% of the sample (n = 78) had a low familiarity with preventive medicine, whereas 76.8% (n = 261) had a high familiarity. The study sample specified that among all the preventive medicine subjects, screening and control as well as smoking cessation and immunization are "extremely important to learn." In univariable analysis, being a female, medical school, family size, and perception about the importance to learn preventive medicine were associated with the ability to practice it. In multivariable analysis, the perception towards the importance to learn preventive medicine was the only significant determinant: aOR (adjusted odds ratio) for those who "agreed" 17.28 (95% CI aOR 4.44-67.26, P < 0.001) and for "strongly agreed" 35.87 (95% CI aOR 8.04-159.87, P < 0.001). Considering

  11. Implementing a medication safety and poison prevention program at a senior center.

    PubMed

    Gershman, Jennifer A

    2013-10-01

    The Institute for Safe Medication Practices encourages pharmacists to assist in preventing medication misuse. The purpose of this article is to discuss a medication-safety education session conducted by a pharmacy professor, the faculty advisor to the American Society of Consultant Pharmacists university student chapter and students in a pharmacovigilance rotation, which was conducted at a local senior center. The author attended a train-the-trainer Webinar and then educated the pharmacy students. Participants at the senior center were taught about poison prevention, drug interactions, and appropriate drug disposal through an interactive format. We plan to continue the medication safety program at the senior center as a longitudinal project to promote patient safety. Pharmacists should be encouraged to play an active role in community outreach programs. PMID:24129222

  12. Kids get care: integrating preventive dental and medical care using a public health case management model.

    PubMed

    Wysen, Kirsten H; Hennessy, Patricia M; Lieberman, Martin I; Garland, Tracy E; Johnson, Susan M

    2004-05-01

    Kids Get Care is a public health-based program in the Seattle area designed to ensure that low-income children, regardless of insurance status, receive early integrated preventive medical, dental, and developmental health services through attachment to medical and dental homes (the usual sources of medical or dental care). The oral health component of the program focuses on cross-training medical and dental providers, providing partner medical clinics with a case manager, and educating staff in nearby community-based organizations about how to identify incipient dental disease and possible early childhood developmental delays. The program identifies a local, well-respected dentist to champion the delivery of oral health screening within a medical clinic and to provide oral health training to medical clinic staff. The program works with community agencies to educate families on the importance of healthy baby teeth, routine dental care beginning at age one, and general prevention. In its first year, the program trained 355 community staff and 184 primary care providers on how to conduct an oral health assessment. These staff and providers screened more than 5,500 children for oral health problems. One medical clinic more than doubled the number of fluoride varnishes it provided, increasing from 80 to 167 during a nine-month pilot phase. Other outcome studies are in progress. PMID:15186069

  13. Adherence to preventive medications in asthmatic children at a tertiary care teaching hospital in Malaysia

    PubMed Central

    Md Redzuan, Adyani; Lee, Meng Soon; Mohamed Shah, Noraida

    2014-01-01

    Purpose Asthma affects an estimated 300 million people worldwide. Poor adherence to prescribed preventive medications, especially among children with asthma, leads to increased mortality and morbidity. The purpose of this study was to assess the adherence and persistence levels of asthmatic children at the Universiti Kebangsaan Malaysia Medical Center (UKMMC), a tertiary care teaching hospital, and to determine the factors that influence adherence to prescribed preventive medications. Patients and methods Participants were asthmatic patients aged 18 years and younger with at least one prescription for a preventive medication refilled between January and December 2011. Refill records from the pharmacy dispensing database were used to determine the medication possession ratio (MPR) and continuous measure of gaps (CMG), measures of adherence and persistence levels, respectively. Results The sample consisted of 218 children with asthma from the General and Respiratory pediatric clinics at UKMMC. The overall adherence level was 38% (n=83; MPR ≥80%), and the persistence level was 27.5% (n=60; CMG ≤20%). We found a significant association between the adherence and persistence levels (r=0.483, P<0.01). The presence of comorbidities significantly predicted the adherence (odds ratio [OR] =16.21, 95% confidence interval [CI]: 7.76–33.84, P<0.01) and persistence level (OR =2.63, 95% CI: 0.13–52.79, P<0.01). Other factors, including age, sex, ethnicity, duration of asthma diagnosis, and number of prescribed preventive medications did not significantly affect adherence or persistence (P>0.05). Conclusion In conclusion, the adherence level among children with asthma at UKMMC was low. The presence of comorbidities was found to influence adherence towards preventive medications in asthmatic children. PMID:24600208

  14. [Carbon monoxide poisoning caused by medical error. Fatalities in connection with medical measures in Leipzig and Hannover].

    PubMed

    Hunger, H; Tröger, H D; Urban, R

    1990-01-01

    There are significant differences in the frequency of CO intoxication and its relation to other not natural causes of death between the autopsy cases of Leipzig (DDR) and Hannover (BRD). While the percentage of all autopsies in Leipzig runs up to 7.6%, in Hannover it runs up to only 1.5%. Beside the well-known cases of not recognized CO intoxication at the autopsy with or without following intoxication of other persons, two concrete cases of not recognized CO intoxication with the survival of the victims discussed. The not noticed CO intoxication followed by the death of the victim is usually considered in medicolegal opinious as "medical malpractice". In cases of survived not noticed CO intoxications this opinion ist only supposed in special cases with longer anamnesis and a typical seasonal rythmic of symptoms. PMID:2241778

  15. Preventive maintenance prioritization index of medical equipment using quality function deployment.

    PubMed

    Saleh, Neven; Sharawi, Amr A; Elwahed, Manal Abd; Petti, Alberto; Puppato, Daniele; Balestra, Gabriella

    2015-05-01

    Preventive maintenance is a core function of clinical engineering, and it is essential to guarantee the correct functioning of the equipment. The management and control of maintenance activities are equally important to perform maintenance. As the variety of medical equipment increases, accordingly the size of maintenance activities increases, the need for better management and control become essential. This paper aims to develop a new model for preventive maintenance priority of medical equipment using quality function deployment as a new concept in maintenance of medical equipment. We developed a three-domain framework model consisting of requirement, function, and concept. The requirement domain is the house of quality matrix. The second domain is the design matrix. Finally, the concept domain generates a prioritization index for preventive maintenance considering the weights of critical criteria. According to the final scores of those criteria, the prioritization action of medical equipment is carried out. Our model proposes five levels of priority for preventive maintenance. The model was tested on 200 pieces of medical equipment belonging to 17 different departments of two hospitals in Piedmont province, Italy. The dataset includes 70 different types of equipment. The results show a high correlation between risk-based criteria and the prioritization list. PMID:25029522

  16. Development of a patient positioning error compensation tool for Korea Heavy-Ion Medical Accelerator Treatment Center

    NASA Astrophysics Data System (ADS)

    Kim, Min-Joo; Suh, Tae-Suk; Cho, Woong; Jung, Won-Gyun

    2015-07-01

    In this study, a potential validation tool for compensating for the patient positioning error was developed by using 2D/3D and 3D/3D image registration. For 2D/3D registration, digitallyreconstructed radiography (DRR) and three-dimensional computed tomography (3D-CT) images were applied. The ray-casting algorithm is the most straightforward method for generating DRR, so we adopted the traditional ray-casting method, which finds the intersections of a ray with all objects, voxels of the 3D-CT volume in the scene. The similarity between the extracted DRR and the orthogonal image was measured by using a normalized mutual information method. Two orthogonal images were acquired from a Cyber-knife system from the anterior-posterior (AP) and right lateral (RL) views. The 3D-CT and the two orthogonal images of an anthropomorphic phantom and of the head and neck of a cancer patient were used in this study. For 3D/3D registration, planning CT and in-room CT images were applied. After registration, the translation and the rotation factors were calculated to position a couch to be movable in six dimensions. Registration accuracies and average errors of 2.12 mm ± 0.50 mm for transformations and 1.23 ° ± 0.40 ° for rotations were acquired by using 2D/3D registration with the anthropomorphic Alderson-Rando phantom. In addition, registration accuracies and average errors of 0.90 mm ± 0.30 mm for transformations and 1.00 ° ± 0.2 ° for rotations were acquired by using CT image sets. We demonstrated that this validation tool could compensate for patient positioning errors. In addition, this research could be a fundamental step in compensating for patient positioning errors at the Korea Heavy-ion Medical Accelerator Treatment Center.

  17. [MEDICAL AND PREVENTIVE TECHNOLOGIES OF THE MANAGEMENT OF THE RISK OF HEALTH DISORDERS ASSOCIATED WITH EXPOSURE TO ADVERSE ENVIRONMENTAL FACTORS].

    PubMed

    Zaĭtseva, N V; Ustinova, O Iu; Zemlianova, M A

    2015-01-01

    It the article there are reported methodological approaches to the development of medical and preventive technologies for rendering specialized medical, diagnostic and preventive care to the population residing in polluted areas. There is proposed the classification of medical and preventive technologies of specialized care to the population with risk- associated pathologies based on principles of assessing the character and level of risk, etiopathogenetic regularities of the development of risk-associated pathological process and the extent of its clinical and laboratory manifestation. There were distinguished four groups of medical and preventive technologies having specific goals and tasks, there was determined the group targeting of the medical and preventive actions, the area of there application and forms of their implementation. There were presented the main directions of medical and preventive actions taken within the technologies applied to various groups. PMID:26155660

  18. Estimation of immunization providers' activities cost, medication cost, and immunization dose errors cost in Iraq.

    PubMed

    Al-lela, Omer Qutaiba B; Bahari, Mohd Baidi; Al-abbassi, Mustafa G; Salih, Muhannad R M; Basher, Amena Y

    2012-06-01

    The immunization status of children is improved by interventions that increase community demand for compulsory and non-compulsory vaccines, one of the most important interventions related to immunization providers. The aim of this study is to evaluate the activities of immunization providers in terms of activities time and cost, to calculate the immunization doses cost, and to determine the immunization dose errors cost. Time-motion and cost analysis study design was used. Five public health clinics in Mosul-Iraq participated in the study. Fifty (50) vaccine doses were required to estimate activities time and cost. Micro-costing method was used; time and cost data were collected for each immunization-related activity performed by the clinic staff. A stopwatch was used to measure the duration of activity interactions between the parents and clinic staff. The immunization service cost was calculated by multiplying the average salary/min by activity time per minute. 528 immunization cards of Iraqi children were scanned to determine the number and the cost of immunization doses errors (extraimmunization doses and invalid doses). The average time for child registration was 6.7 min per each immunization dose, and the physician spent more than 10 min per dose. Nurses needed more than 5 min to complete child vaccination. The total cost of immunization activities was 1.67 US$ per each immunization dose. Measles vaccine (fifth dose) has a lower price (0.42 US$) than all other immunization doses. The cost of a total of 288 invalid doses was 744.55 US$ and the cost of a total of 195 extra immunization doses was 503.85 US$. The time spent on physicians' activities was longer than that spent on registrars' and nurses' activities. Physician total cost was higher than registrar cost and nurse cost. The total immunization cost will increase by about 13.3% owing to dose errors. PMID:22521848

  19. The role of medical schools in the prevention of alcohol-related problems.

    PubMed Central

    Negrete, J C

    1990-01-01

    There is agreement that physicians can play a major role in the prevention of alcohol problems among their patients and that medical schools should prepare physicians for this role by teaching three major subject areas: knowledge, attitudes and clinical skills. Despite this agreement and the acknowledged high prevalence of alcohol problems in clinical populations, medical school coverage of these problems is not proportional to their importance. Barriers to adequate coverage of alcohol problems are traditional attitudes, confusion as to whether such problems are "medical" and lack of adequate faculty role models. These problems could be remedied by encouragement and training of interested faculty members, establishment of substance abuse centres in university medical schools, integration of alcohol-related material with relevant topics in all departments and inclusion of alcohol-related questions on medical qualifying exams. PMID:2224672

  20. Connection error in the delivery of medical gases to a surgical unit.

    PubMed

    Dangoisse, M J; Lalot, M; Lechat, J P

    2010-01-01

    Whilst anesthetic incidents due to problems with the delivery of medical gases to a surgical unit are exceptional, their consequences are potentially drastic. With the growing of modern hospitals, every anesthetist may one day find himself confronted with such events, which are new to him, partly because they are infrequent, but mainly because they are due to causes outside his immediate environment. A simple mistake in the labelling and identification of medical gas lines resulted in a cross-connection of the oxygen and air, causing perioperative hypoxemia following the administration of a mixture poor in oxygen. The questions of training, responsibility and procedures in regard to these types of incidents are discussed below. PMID:20593642

  1. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update.

    PubMed

    Davis, Chris; Engeln, Anna; Johnson, Eric L; McIntosh, Scott E; Zafren, Ken; Islas, Arthur A; McStay, Christopher; Smith, William R; Cushing, Tracy

    2014-12-01

    To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded on the basis of the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for Prevention and Treatment of Lightning Injuries published in Wilderness & Environmental Medicine 2012;23(3):260-269. PMID:25498265

  2. The Lifetime Medical Cost Savings from Preventing HIV in the United States

    PubMed Central

    Schackman, Bruce R.; Fleishman, John A.; Su, Amanda E.; Berkowitz, Bethany K.; Moore, Richard D.; Walensky, Rochelle P.; Becker, Jessica E.; Voss, Cindy; Paltiel, A. David; Weinstein, Milton C.; Freedberg, Kenneth A.; Gebo, Kelly A.; Losina, Elena

    2015-01-01

    Objective Enhanced HIV prevention interventions, such as pre-exposure prophylaxis for high-risk individuals, require substantial investments. We sought to estimate the medical cost saved by averting one HIV infection in the United States. Methods We estimated lifetime medical costs in persons with and without HIV to determine the cost saved by preventing one HIV infection. We used a computer simulation model of HIV disease and treatment (CEPAC) to project CD4 cell count, antiretroviral treatment status, and mortality after HIV infection. Annual medical cost estimates for HIV-infected persons, adjusted for age, sex, race/ethnicity, and transmission risk group, were from the HIV Research Network (range $1,854–$4,545/month) and for HIV-uninfected persons were from the Medical Expenditure Panel Survey (range $73–$628/month). Results are reported as lifetime medical costs from the US health system perspective discounted at 3% (2012 US dollars). Results The estimated discounted lifetime cost for persons who become HIV infected at age 35 is $326,500 (60% for antiretroviral medications, 15% for other medications, 25% non-drug costs). For individuals who remain uninfected but at high risk for infection, the discounted lifetime cost estimate is $96,700. The medical cost saved by avoiding one HIV infection is $229,800. The cost saved would reach $338,400 if all HIV-infected individuals presented early and remained in care. Cost savings are higher taking into account secondary infections avoided and lower if HIV infections are temporarily delayed rather than permanently avoided. Conclusions The economic value of HIV prevention in the US is substantial given the high cost of HIV disease treatment. PMID:25710311

  3. Guidelines for Curriculum Development for Undergraduate Medical Education in the Prevention of Pulmonary Diseases.

    ERIC Educational Resources Information Center

    National Heart, Lung, and Blood Inst. (DHHS/NIH), Bethesda, MD. Div. of Lung Diseases.

    These guidelines for developing an undergraduate medical education curriculum in pulmonary disease prevention emphasize not only the most current scientific practice but also the active application of cognitive and behavioral skills related to patient education. Chapter 1 introduces the guidelines and the issues and trends in preventative…

  4. The Right to Prevention, Early Detection and Medical Rehabilitation under National and International Aspects.

    ERIC Educational Resources Information Center

    Greza, Gerhard

    1987-01-01

    Important aspects of legislation establishing the right of individuals to health protection and health promotion are highlighted. Examples from the Federal Republic of Germany are used to illustrate efforts to implement systematic measures for the prevention, early detection, early treatment, and medical rehabilitation of disabilities. (Author/JDD)

  5. The Rate of Physicochemical Incompatibilities, Administration Errors. Factors Correlating with Nurses' Errors.

    PubMed

    Fahimi, Fanak; Sefidani Forough, Aida; Taghikhani, Sepideh; Saliminejad, Leila

    2015-01-01

    Medication errors are commonly encountered in hospital setting. Intravenous medications pose particular risks because of their greater complexity and the multiple steps required in their preparation, administration and monitoring. We aimed to determine the rate of errors during the preparation and administration phase of intravenous medications and the correlation of these errors with the demographics of nurses involved in the process. One hundred patients who were receiving IV medications were monitored by a trained pharmacist. The researcher accompanied the nurses during the preparation and administration process of IV medications. Collected data were compared with the acceptable guidelines. A checklist was filled for each IV medication. Demographic data of the nurses were collected as well. A total of 454 IV medications were recorded. Inappropriate administration rate constituted a large proportion of errors in our study (35.3%). No significant or life threatening drug interaction was recorded during the study. Evaluating the impact of the nurses' demographic characteristics on the incidence of medication errors showed that there is a direct correlation between nurses' employment status and the rate of medication errors, while other characteristics did not show a significant impact on the rate of administration errors. Administration errors were significantly higher in temporary 1-year contract group than other groups (p-value < 0.0001). Study results show that there should be more vigilance on administration rate of IV medications to prevent negative consequences especially by pharmacists. Optimizing the working conditions of nurses may play a crucial role. PMID:26185509

  6. The Rate of Physicochemical Incompatibilities, Administration Errors. Factors Correlating with Nurses' Errors

    PubMed Central

    Fahimi, Fanak; Sefidani Forough, Aida; Taghikhani, Sepideh; Saliminejad, Leila

    2015-01-01

    Medication errors are commonly encountered in hospital setting. Intravenous medications pose particular risks because of their greater complexity and the multiple steps required in their preparation, administration and monitoring. We aimed to determine the rate of errors during the preparation and administration phase of intravenous medications and the correlation of these errors with the demographics of nurses involved in the process. One hundred patients who were receiving IV medications were monitored by a trained pharmacist. The researcher accompanied the nurses during the preparation and administration process of IV medications. Collected data were compared with the acceptable guidelines. A checklist was filled for each IV medication. Demographic data of the nurses were collected as well. A total of 454 IV medications were recorded. Inappropriate administration rate constituted a large proportion of errors in our study (35.3%). No significant or life threatening drug interaction was recorded during the study. Evaluating the impact of the nurses’ demographic characteristics on the incidence of medication errors showed that there is a direct correlation between nurses’ employment status and the rate of medication errors, while other characteristics did not show a significant impact on the rate of administration errors. Administration errors were significantly higher in temporary 1-year contract group than other groups (p-value < 0.0001). Study results show that there should be more vigilance on administration rate of IV medications to prevent negative consequences especially by pharmacists. Optimizing the working conditions of nurses may play a crucial role. PMID:26185509

  7. Attitude toward preventive counseling and healthy practices among medical students at a Colombian university.

    PubMed

    Alba, Luz Helena; Badoui, Nora; Gil, Fabián

    2015-06-01

    Unhealthy behaviors of medical students influence their attitudes toward preventive counseling. The burden of chronic diseases is continually growing in developing countries, emphasizing the need for the increased role of general practitioners in preventive counseling. The objective of this study was to describe the effect of medical training on the risk profiles and attitudes of medical students toward preventive counseling in a Colombian university. Students in their first and fifth years of training were surveyed using the "Healthy Doctor = Healthy Patient" questionnaire to assess counseling attitudes; personal practices, such as risky drinking, smoking, inadequate nutrition, and non-compliance with physical activity recommendations; and the university environment. The association among these components was estimated, as well as the effect of the university environment. Risky drinking and smoking decreased from first to fifth year (59.3% vs. 37.1%, P = 0.021 and 31.5% vs. 25.9%, P = 0.51, respectively), whereas inadequate nutrition and non-compliance with physical activity recommendations increased. Physical activity (PA) was associated with positive counseling attitude (ORs: nutrition 7.6; alcohol 5.2; PA 10.6). Areas governed by institutional policies that are emphasized in the curriculum positively affected student practices. PA promoted preventive counseling and healthy lifestyles most effectively. Universities should therefore strengthen their preventive medicine curricula and modify social determinants. PMID:25917929

  8. The Effect of an Intervention Aimed at Reducing Errors when Administering Medication through Enteral Feeding Tubes in an Institution for Individuals with Intellectual Disability

    ERIC Educational Resources Information Center

    Idzinga, J. C.; de Jong, A. L.; van den Bemt, P. M. L. A.

    2009-01-01

    Background: Previous studies, both in hospitals and in institutions for clients with an intellectual disability (ID), have shown that medication errors at the administration stage are frequent, especially when medication has to be administered through an enteral feeding tube. In hospitals a specially designed intervention programme has proven to…

  9. Towards more reliable automated multi-dose dispensing: retrospective follow-up study on medication dose errors and product defects.

    PubMed

    Palttala, Iida; Heinämäki, Jyrki; Honkanen, Outi; Suominen, Risto; Antikainen, Osmo; Hirvonen, Jouni; Yliruusi, Jouko

    2013-03-01

    To date, little is known on applicability of different types of pharmaceutical dosage forms in an automated high-speed multi-dose dispensing process. The purpose of the present study was to identify and further investigate various process-induced and/or product-related limitations associated with multi-dose dispensing process. The rates of product defects and dose dispensing errors in automated multi-dose dispensing were retrospectively investigated during a 6-months follow-up period. The study was based on the analysis of process data of totally nine automated high-speed multi-dose dispensing systems. Special attention was paid to the dependence of multi-dose dispensing errors/product defects and pharmaceutical tablet properties (such as shape, dimensions, weight, scored lines, coatings, etc.) to profile the most suitable forms of tablets for automated dose dispensing systems. The relationship between the risk of errors in dose dispensing and tablet characteristics were visualized by creating a principal component analysis (PCA) model for the outcome of dispensed tablets. The two most common process-induced failures identified in the multi-dose dispensing are predisposal of tablet defects and unexpected product transitions in the medication cassette (dose dispensing error). The tablet defects are product-dependent failures, while the tablet transitions are dependent on automated multi-dose dispensing systems used. The occurrence of tablet defects is approximately twice as common as tablet transitions. Optimal tablet preparation for the high-speed multi-dose dispensing would be a round-shaped, relatively small/middle-sized, film-coated tablet without any scored line. Commercial tablet products can be profiled and classified based on their suitability to a high-speed multi-dose dispensing process. PMID:22458299

  10. [Implementation and evaluation of error prevention measures in surgical clinics: Results of a current online survey].

    PubMed

    Rothmund, Matthias; Kohlmann, Thomas; Heidecke, Claus-Dieter; Siebert, Hartmut; Ansorg, Jörg

    2015-01-01

    In the autumn of 2014, more than 3,000 surgeons completed an online questionnaire asking for the prevalence and efficiency of instruments to prevent adverse events within surgical departments in Germany. About 90 % of the respondents stated that perioperative checklists, preoperative marking of the surgical site and the documentation of hospital infections had been implemented in their institution; and 75 % of the institutions had introduced critical incident reporting systems (CIRS), morbidity and mortality conferences and identification bracelets for patients. The surgeons were asked to rank the different instruments for the prevention of adverse events. According to the respondents, preoperative marking of the surgical site and the use of checklists were at the top of the efficacy ranking, followed by an introductory course for surgeons starting work in a hospital or when new devices became available. Only 50 % of the responding surgeons perceived CIRS as being efficient. Overall, the answers showed that instruments to increase patient safety were commonly available in surgical departments. On the other hand, there is still room for improvement in daily practice. PMID:26354140

  11. A Review of the Literature on Computational Errors With Whole Numbers. Mathematics Education Diagnostic and Instructional Centre (MEDIC).

    ERIC Educational Resources Information Center

    Burrows, J. K.

    Research on error patterns associated with whole number computation is reviewed. Details of the results of some of the individual studies cited are given in the appendices. In Appendix A, 33 addition errors, 27 subtraction errors, 41 multiplication errors, and 41 division errors are identified, and the frequency of these errors made by 352…

  12. Does the implementation of an electronic prescribing system create unintended medication errors? A study of the sociotechnical context through the analysis of reported medication incidents

    PubMed Central

    2011-01-01

    Background Even though electronic prescribing systems are widely advocated as one of the most effective means of improving patient safety, they may also introduce new risks that are not immediately obvious. Through the study of specific incidents related to the processes involved in the administration of medication, we sought to find out if the prescribing system had unintended consequences in creating new errors. The focus of this study was a large acute hospital in the Midlands in the United Kingdom, which implemented a Prescribing, Information and Communication System (PICS). Methods This exploratory study was based on a survey of routinely collected medication incidents over five months. Data were independently reviewed by two of the investigators with a clinical pharmacology and nursing background respectively, and grouped into broad types: sociotechnical incidents (related to human interactions with the system) and non-sociotechnical incidents. Sociotechnical incidents were distinguished from the others because they occurred at the point where the system and the professional intersected and would not have occurred in the absence of the system. The day of the week and time of day that an incident occurred were tested using univariable and multivariable analyses. We acknowledge the limitations of conducting analyses of data extracted from incident reports as it is widely recognised that most medication errors are not reported and may contain inaccurate data. Interpretation of results must therefore be tentative. Results Out of a total of 485 incidents, a modest 15% (n = 73) were distinguished as sociotechnical issues and thus may be unique to hospitals that have such systems in place. These incidents were further analysed and subdivided into categories in order to identify aspects of the context which gave rise to adverse situations and possible risks to patient safety. The analysis of sociotechnical incidents by time of day and day of week indicated a trend

  13. Retrieval enhances route knowledge acquisition, but only when movement errors are prevented.

    PubMed

    Kelly, Jonathan W; Carpenter, Shana K; Sjolund, Lori A

    2015-09-01

    Studies of the testing effect have shown that retrieval significantly improves learning. However, most of these studies have been restricted to simple types of declarative verbal knowledge. Five experiments were designed to explore whether testing improves acquisition of route knowledge, which has a procedural component consisting of actions to be performed at decision points (Golledge, 1991). Participants learned a route through a series of connected rooms in a virtual building. Each room contained multiple doors, only one of which led to the next room. During encoding, participants were shown the correct sequence of doors in a manner similar to global positioning system (GPS) navigation guidance. During subsequent exposures to the route, participants were either shown the correct sequence again or had to recall the sequence from memory. Participants later completed a final test in which they traversed the route without guidance or feedback. Testing improved route memory compared to studying, but only when participants were given feedback about the correct door prior to moving through the room. When feedback occurred after moving to an incorrect door, testing resulted in worse performance compared to studying. These findings parallel work on errorless learning, in which procedural skills are acquired more quickly when errors are minimized during learning. PMID:25581223

  14. The effect of Computerized Physician Order Entry and decision support system on medication errors in the neonatal ward: experiences from an Iranian teaching hospital.

    PubMed

    Kazemi, Alireza; Ellenius, Johan; Pourasghar, Faramarz; Tofighi, Shahram; Salehi, Aref; Amanati, Ali; Fors, Uno G H

    2011-02-01

    Medication dosing errors are frequent in neonatal wards. In an Iranian neonatal ward, a 7.5 months study was designed in three periods to compare the effect of Computerized Physician Order Entry (CPOE) without and with decision support functionalities in reducing non-intercepted medication dosing errors in antibiotics and anticonvulsants. Before intervention (Period 1), error rate was 53%, which did not significantly change after the implementation of CPOE without decision support (Period 2). However, errors were significantly reduced to 34% after that the decision support was added to the CPOE (Period 3; P < 0.001). Dose errors were more often intercepted than frequency errors. Over-dose was the most frequent type of medication errors and curtailed-interval was the least. Transcription errors did not reduce after the CPOE implementation. Physicians ignored alerts when they could not understand why they appeared. A suggestion is to add explanations about these reasons to increase physicians' compliance with the system's recommendations. PMID:20703588

  15. Scar prevention and remodeling: a review of the medical, surgical, topical and light treatment approaches.

    PubMed

    Kerwin, Leonard Y; El Tal, Abdel Kader; Stiff, Mark A; Fakhouri, Tarek M

    2014-08-01

    Cosmetic, functional, and structural sequelae of scarring are innumerable, and measures exist to optimize and ultimately minimize these sequelae. To evaluate the innumerable methods available to decrease the cosmetic, functional, and structural repercussions of scarring, pubMed search of the English literature with key words scar, scar revision, scar prevention, scar treatment, scar remodeling, cicatrix, cicatrix treatment, and cicatrix remodeling was done. Original articles and reviews were examined and included. Seventy-nine manuscripts were reviewed. Techniques, comparisons, and results were reviewed and tabulated. Overall, though topical modalities are easier to use and are usually more attractive to the patient, the surgical approaches still prove to be superior and more reliable. However, advances in topical medications for scar modification are on the rise and a change towards medical treatment of scars may emerge as the next best approach. Comparison studies of the innumerable specific modalities for scar revision and prevention are impossible. Standardization of techniques is lacking. Scarring, the body's natural response to a wound, can create many adverse effects. At this point, the practice of sound, surgical fundamentals still trump the most advanced preventative methods and revision techniques. Advances in medical approaches are available, however, to assist the scarring process, which even the most advanced surgical fundamentals will ultimately lead to. Whether through newer topical therapies, light treatment, or classical surgical intervention, our treatment armamentarium of scars has expanded and will allow us to maximize scar prevention and to minimize scar morbidity. PMID:24697346

  16. Determinants of the Demand for Using Preventive Medical Care Among Adults in Penang, Malaysia

    PubMed Central

    Cheah, Yong Kang

    2013-01-01

    Background: In light of the fact that chronic diseases were becoming more prevalent recently, the primary objective of the study was to examine the socio-demographic, health, and lifestyle determinants of the use of preventive medical care in Penang, Malaysia. Methods: The study used the primary survey data in Penang which had a total of 398 respondents. Respondents were chosen based on convenient sampling, and the survey was carried out in various locations in Penang. During the survey, the designed questionnaires were distributed for self-administration by the respondents between August and October, 2010. The binary logistic regression model was employed for statistical analysis. Results: Socio-demographic and health factors like income, marital status, education, history of serious family illnesses and self-perceived health status were statistically significant in affecting the likelihood of using preventive medical care. Specifically, being married (OR: 1.94; 95% CI: 1.13, 3.32), the presence of a history of serious family illnesses (OR: 2.14; 95% CI: 1.37, 3.36), having high income (OR: 8.71; 95% CI: 1.03, 73.59) and self-perceived poor health status (OR: 4.78; 95% CI: 1.09, 21.00) were positively related with using preventive medical care. However, having low educational background (OR: 0.23; 95% CI: 0.06, 0.95) were inversely related to the probability of using such medical care. Conclusion: In view of the findings, the individuals’ socio-demographic and health profiles were suggested to be given attention by the public health authorities if the goals of increasing the use of preventive medical care in the community were to be achieved. PMID:23613658

  17. Prevention of venous thromboembolism in medically ill patients: a clinical update

    PubMed Central

    Turpie, Alexander G G; Leizorovicz, Alain

    2006-01-01

    The risk of venous thromboembolism (VTE) in hospitalised medically ill patients is often underestimated, despite the fact that it remains a major cause of preventable morbidity and mortality in this group. It is not well recognised that the risk of VTE in many hospitalised medically ill patients is at least as high as in populations after surgery. This may partly be attributed to the clinically silent nature of VTE in many patients, and the difficulty in predicting which patients might develop symptoms or fatal pulmonary embolism. Two large studies, Prospective Evaluation of Dalteparin Efficacy for Prevention of VTE in Immobilized Patients Trial and prophylaxis in MEDical patients with ENOXaparin, have shown that low‐molecular‐weight heparins provide effective thromboprophylaxis in medically ill patients, without increasing bleeding risk. Recent guidelines from the American College of Chest Physicians recommend that acutely medically ill patients admitted with congestive heart failure or severe respiratory disease, or those who are confined to bed and have at least one additional risk factor for VTE, should receive thromboprophylaxis. PMID:17148703

  18. Safety in numbers 2: Competency modelling and diagnostic error assessment in medication dosage calculation problem-solving.

    PubMed

    Weeks, Keith W; Hutton, B Meriel; Young, Simon; Coben, Diana; Clochesy, John M; Pontin, David

    2013-03-01

    Accurately defining and modelling competence in medication dosage calculation problem-solving (MDC-PS) is a fundamental pre-requisite to measuring competence, diagnosing errors and determining the necessary design and content of professional education programmes. In this paper we advance an MDC-PS competence model that illustrates the relationship between conceptual competence (dosage problem-understanding), calculation competence (dosage-computation) and technical measurement competence (dosage-measurement). To facilitate bridging of the theory-practice gap it is critical that such models are operationalised within a wider education framework that supports the learning, assessment and synthesis of cognitive competence (the knowing that and knowing why of MDC-PS) and functional competence (the know-how and skills associated with the professional practice of MDC-PS in clinical settings). Within the context of supporting the learning and diagnostic assessment of MDC-PS we explore PhD fieldwork that challenges the value of pedagogical approaches that focus solely on abstract information, that isolate the process of knowledge construction from its application in practice settings and contribute to the generation of conceptual errors. We consider misconceptions theory and the concept of mathematical 'dropped stitches' and offer an assessment model and program designed to diagnose flawed arithmetical operation and computation constructs. PMID:23276625

  19. [The forensic medical assessment of injury prevention characteristics of limited-lethality weapons].

    PubMed

    Makarov, I Iu; Kovalev, A V; Kutsenko, K I; Evteeva, I A

    2012-01-01

    The results of analysis of the data presented in the special literature and normative legal documentation indicate that the forensic medical aspects of the injuries inflicted by gunshots of limited-lethality weapons either need to be clarified or remain virtually unexplored. There is the long overdue necessity to consolidate efforts of forensic medical experts and specialists from other agencies and institutions for the comprehensive solution of the problems related to the injury prevention characteristics of limited-lethality weapons and participation in the interdepartmental activities for the improvement of the legislation regulating weapon trafficking. PMID:23272558

  20. The annual wellness visit shared medical appointment: innovative delivery of preventive care to the elderly.

    PubMed

    Kainkaryam, Vasanth

    2013-01-01

    The Hartford HealthCare Medical Group instituted 3 types of shared medical appointments (SMAs) in 2013, one being for the Medicare Annual Wellness Visit (AWV). While traditionally there have been 2 types of SMAs-either a chronic disease follow-up model or an annual physical examination model, the SMA AWV offers a preventive care focus in a dedicated visit for the elderly population, without co-pays and without logistics of conducting a physical examination. This article reviews the benefits and challenges of SMAs, including those specific to conducting the AWV, as well as the overall patient experience with the AWV SMA. PMID:24402075

  1. [On systemic training of preventive medical specialists under the present conditions].

    PubMed

    Makarova, V G; Tkachev, P G; Kiriushin, V A

    2002-01-01

    The results of a systemic approach to training the students of the Faculty of Preventive Medicine, I. P. Pavlov Ryazan State Medical University during the reorganization of higher medical education in the country, which covered pre-higher higher, and post-higher education are presented. Prehigher education on the basis of school and the university assumes that students will obtain extended theoretical and practical skills in chemistry, anatomy, and biology. Higher education at the stage of propedeutic hygiene forms in students ideas of the significance of environmental factors for human health, the threshold of their action, and sanitary standardization. PMID:12198902

  2. State-Level Unemployment and the Utilization of Preventive Medical Services

    PubMed Central

    Tefft, Nathan; Kageleiry, Andrew

    2014-01-01

    ObjectiveTo study the association between macroeconomic conditions and preventive medical service utilization. Data Sources/Study SettingSecondary data collection of a survey of the civilian, non-institutionalized population of adults (age 18 and older) in the United States between 1987 and 2010. Study DesignRegression analyses that adjust for individual-level demographic and socioeconomic determinants, state and time-fixed effects, and state-specific time trends. Data Collection/Extraction MethodsState health departments, with technological and methodological assistance from the Centers for Disease Control and Prevention, conducted a cross-sectional yearly telephone survey using a standardized questionnaire. Principal FindingsThe use of preventive medical services is procyclical: a 1 percentage point increase in the state-level unemployment rate is associated with a 1.58 percent decrease in the quantity of distinct preventive care services utilized. Women and economically disadvantaged populations are shown to be especially sensitive to macroeconomic fluctuations. ConclusionsPolicy makers should be aware of cyclical changes in preventive care use, particularly among disadvantaged populations, when making challenging budgetary decisions during economic downturns. As physician recommendations can have a strong impact on patients’ use, health care providers could increase efforts to persuade patients to seek screening exams and necessary vaccinations during periods of high unemployment. PMID:23855636

  3. Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite: 2014 update.

    PubMed

    McIntosh, Scott E; Opacic, Matthew; Freer, Luanne; Grissom, Colin K; Auerbach, Paul S; Rodway, George W; Cochran, Amalia; Giesbrecht, Gordon G; McDevitt, Marion; Imray, Christopher H; Johnson, Eric L; Dow, Jennifer; Hackett, Peter H

    2014-12-01

    The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the original guidelines published in Wilderness & Environmental Medicine 2011;22(2):156-166. PMID:25498262

  4. Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial☆, ☆

    PubMed Central

    Stevens, Allen D.; Hernandez, Caleb; Jones, Seth; Moreira, Maria E.; Blumen, Jason R.; Hopkins, Emily; Sande, Margaret; Bakes, Katherine; Haukoos, Jason S.

    2016-01-01

    Background Medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients where dosing often requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national healthcare priorities. Our goal was to evaluate novel, prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape, compared to conventional medication administration, in simulated prehospital pediatric resuscitation scenarios. Methods We performed a prospective, block-randomized, cross-over study, where 10 full-time paramedics each managed two simulated pediatric arrests in situ using either prefilled, color-coded-syringes (intervention) or their own medication kits stocked with conventional ampoules (control). Each paramedic was paired with two emergency medical technicians to provide ventilations and compressions as directed. The ambulance patient compartment and the intravenous medication port were video recorded. Data were extracted from video review by blinded, independent reviewers. Results Median time to delivery of all doses for the intervention and control groups was 34 (95% CI: 28–39) seconds and 42 (95% CI: 36–51) seconds, respectively (difference = 9 [95% CI: 4–14] seconds). Using the conventional method, 62 doses were administered with 24 (39%) critical dosing errors; using the prefilled, color-coded syringe method, 59 doses were administered with 0 (0%) critical dosing errors (difference = 39%, 95% CI: 13–61%). Conclusions A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by paramedics during simulated prehospital pediatric resuscitations. PMID:26247145

  5. Mandatory physical exercise for the prevention of mental illness in medical students.

    PubMed

    Bitonte, Robert A; DeSanto, Donald Joseph

    2014-09-01

    Medical students experience higher rates of mental illness than the general population. With competition rising for success in medical school, and residency, increasing incidence of distress are leading this population to experience higher rates of thoughts of dropping out of school, and even suicide. Since many stigmas deter medical students from receiving mental health counseling, such as the perceived inability to handle the stresses of medical school, and the potential lack of competitiveness for residencies if reported, prevention of mental illness may be a better course to take in reducing prevalence in this population. Regular exercise has demonstrated a positive effect on not only promoting physical health, but also mental health. Exercise encourages a healthy mood, positive self esteem, and better cognition, while decreasing the chances of depression, anxiety, and burnout. Implementing exercise time into medical school curriculums, just like the basic sciences, albeit for less time in the day, could provide a feasible way to ensure that all students are taking time to partake in this important activity for their well being. Though medical schools are rigid with attempts to make changes in their curriculum, thirty minutes a day, three to five times a week of exercise of the students' choice not only is more cost effective than counseling, but it also reduces the chances that they will experience burnout, which if left untreated could transcend into a compromised training experience. PMID:25553235

  6. The Precise Observation System for the Safe Use of Medicines (POSSUM): An Approach for Studying Medication Administration Errors in the Field.

    PubMed

    Westbrook, Johanna I; Raban, Magdalena Z; Lehnbom, Elin C; Li, Ling

    2016-01-01

    Medication administration errors (MAEs) in hospital are frequent and significantly more likely to result in serious harm to patients than other medication error types. Many interventions have been proposed in order reduce MAEs and the amount of harm associated with these errors. A major limitation in assessing the effectiveness of these interventions has been the lack of robust measures for assessing changes in MAEs and associated harms. Drawing upon extensive foundational research we have developed a robust approach and data collection software to be applied in direct observational studies of nurses to allow measurement of changes in MAE rates. We report how this approach is being applied in a large stepped-wedge cluster randomised controlled trial to assess the effectiveness of an electronic medication management system to reduce MAEs in a paediatric hospital. PMID:27577460

  7. An Observational Study of the Impact of a Computerized Physician Order Entry System on the Rate of Medication Errors in an Orthopaedic Surgery Unit

    PubMed Central

    Hernandez, Fabien; Majoul, Elyes; Montes-Palacios, Carlota; Antignac, Marie; Cherrier, Bertrand; Doursounian, Levon; Feron, Jean-Marc; Robert, Cyrille; Hejblum, Gilles; Fernandez, Christine; Hindlet, Patrick

    2015-01-01

    Aim To assess the impact of the implementation of a Computerized Physician Order Entry (CPOE) associated with a pharmaceutical checking of medication orders on medication errors in the 3 stages of drug management (i.e. prescription, dispensing and administration) in an orthopaedic surgery unit. Methods A before-after observational study was conducted in the 66-bed orthopaedic surgery unit of a teaching hospital (700 beds) in Paris France. Direct disguised observation was used to detect errors in prescription, dispensing and administration of drugs, before and after the introduction of computerized prescriptions. Compliance between dispensing and administration on the one hand and the medical prescription on the other hand was studied. The frequencies and types of errors in prescribing, dispensing and administration were investigated. Results During the pre and post-CPOE period (two days for each period) 111 and 86 patients were observed, respectively, with corresponding 1,593 and 1,388 prescribed drugs. The use of electronic prescribing led to a significant 92% decrease in prescribing errors (479/1593 prescribed drugs (30.1%) vs 33/1388 (2.4%), p < 0.0001) and to a 17.5% significant decrease in administration errors (209/1222 opportunities (17.1%) vs 200/1413 (14.2%), p < 0.05). No significant difference was found in regards to dispensing errors (430/1219 opportunities (35.3%) vs 449/1407 (31.9%), p = 0.07). Conclusion The use of CPOE and a pharmacist checking medication orders in an orthopaedic surgery unit reduced the incidence of medication errors in the prescribing and administration stages. The study results suggest that CPOE is a convenient system for improving the quality and safety of drug management. PMID:26207363

  8. Design of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial

    PubMed Central

    Chimowitz, Marc I.; Lynn, Michael J.; Turan, Tanya N.; Fiorella, David; Lane, Bethany F.; Janis, Scott; Derdeyn, Colin P.

    2011-01-01

    Background Patients with recent transient ischemic attack or stroke caused by 70–99% stenosis of a major intracranial artery are at high risk of recurrent stroke on usual medical management, suggesting the need for alternative therapies for this disease. Methods The Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis trial is an ongoing, randomized, multicenter, two-arm trial that will determine whether intracranial angioplasty and stenting adds benefit to aggressive medical management alone for preventing the primary endpoint (any stroke or death within 30 days after enrollment or after any revascularization procedure of the qualifying lesion during follow-up, or stroke in the territory of the symptomatic intracranial artery beyond 30 days) during a mean follow-up of 2 years in patients with recent TIA or stroke caused by 70–99% stenosis of a major intracranial artery. Aggressive medical management in both arms consists of aspirin 325 mg per day, clopidogrel 75mg per day for 90 days after enrollment, intensive risk factor management primarily targeting systolic blood pressure < 140 mm Hg (< 130 mm Hg in diabetics) and low density cholesterol < 70 mg / dl, and a lifetsyle modification program. The sample size required todetect a 35% reduction in the rate of the primary endpoint from angioplasty and stenting based on the log-rank test with an alpha of 0.05, 80% power, and adjusting for a 2% loss to follow-up and 5% crossover from the medical to the stenting arm is 382 patients per group. Conclusion This is the first randomized trial to compare intracranial angioplasty and stenting with medical therapy and to incorporate intensive management of multiple risk factors and a lifestyle modification program in the study design. Hopefully, the results of the trial will lead to more effective therapy for this high-risk disease. PMID:21729789

  9. Home medication injection among Latina women in Los Angeles: implications for health education and prevention.

    PubMed

    Flaskerud, J H; Nyamathi, A M

    1996-02-01

    Reuse of needles and syringes after home injection of medications and vitamins may be a risk for transmission of HIV. An exploratory study was done to determine (1) how commonly injectable medications were used in the home; (2) whether needles and syringes were reused; and (3) common practices for cleaning needles and syringes. A survey was conducted of low income Latina women (n = 216) who were attending a Public Health Foundation nutrition programme for women, infants and children (WIC) in Los Angeles. To clarify and expand on the survey findings, focus group interviews were done with an additional 55 women attending WIC. Quantitative data were analysed using descriptive and comparative statistics. Qualitative data were subjected to content analysis. The use of injectable medications purchased in Mexico was fairly common (43.5%); reuse of disposable needles and syringes (48%) and sharing (36%) among injectors were also common. Methods of cleaning needles and syringes were inadequate to CDC recommended guidelines. Injectors and non-injectors differed significantly in ethnicity, religion, and marital status. The only significant predictor of medication injection was educational level. Analysis of qualitative data revealed the reasons that Latina subjects were injecting medication; how they were transporting medicines from Mexico; and how they were cleaning their equipment. The practical implications for health education and prevention programmes should include an awareness that home use and reuse of needles for injection of medications may be common in some social groups and that knowledge of the potential dangers in reuse and sharing of needles may not extend to home medication injection. PMID:8664373

  10. Learning without Borders: A Review of the Implementation of Medical Error Reporting in Médecins Sans Frontières

    PubMed Central

    Shanks, Leslie; Bil, Karla; Fernhout, Jena

    2015-01-01

    Objective To analyse the results from the first 3 years of implementation of a medical error reporting system in Médecins Sans Frontières-Operational Centre Amsterdam (MSF) programs. Methodology A medical error reporting policy was developed with input from frontline workers and introduced to the organisation in June 2010. The definition of medical error used was “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.” All confirmed error reports were entered into a database without the use of personal identifiers. Results 179 errors were reported from 38 projects in 18 countries over the period of June 2010 to May 2013. The rate of reporting was 31, 42, and 106 incidents/year for reporting year 1, 2 and 3 respectively. The majority of errors were categorized as dispensing errors (62 cases or 34.6%), errors or delays in diagnosis (24 cases or 13.4%) and inappropriate treatment (19 cases or 10.6%). The impact of the error was categorized as no harm (58, 32.4%), harm (70, 39.1%), death (42, 23.5%) and unknown in 9 (5.0%) reports. Disclosure to the patient took place in 34 cases (19.0%), did not take place in 46 (25.7%), was not applicable for 5 (2.8%) cases and not reported for 94 (52.5%). Remedial actions introduced at headquarters level included guideline revisions and changes to medical supply procedures. At field level improvements included increased training and supervision, adjustments in staffing levels, and adaptations to the organization of the pharmacy. Conclusion It was feasible to implement a voluntary reporting system for medical errors despite the complex contexts in which MSF intervenes. The reporting policy led to system changes that improved patient safety and accountability to patients. Challenges remain in achieving widespread acceptance of the policy as evidenced by the low reporting and disclosure rates. PMID:26381622

  11. Role of Bacillus subtilis Error Prevention Oxidized Guanine System in Counteracting Hexavalent Chromium-Promoted Oxidative DNA Damage

    PubMed Central

    Santos-Escobar, Fernando; Gutiérrez-Corona, J. Félix

    2014-01-01

    Chromium pollution is potentially detrimental to bacterial soil communities, compromising carbon and nitrogen cycles that are essential for life on earth. It has been proposed that intracellular reduction of hexavalent chromium [Cr(VI)] to trivalent chromium [Cr(III)] may cause bacterial death by a mechanism that involves reactive oxygen species (ROS)-induced DNA damage; the molecular basis of the phenomenon was investigated in this work. Here, we report that Bacillus subtilis cells lacking a functional error prevention oxidized guanine (GO) system were significantly more sensitive to Cr(VI) treatment than cells of the wild-type (WT) strain, suggesting that oxidative damage to DNA is involved in the deleterious effects of the oxyanion. In agreement with this suggestion, Cr(VI) dramatically increased the ROS concentration and induced mutagenesis in a GO-deficient B. subtilis strain. Alkaline gel electrophoresis (AGE) analysis of chromosomal DNA of WT and ΔGO mutant strains subjected to Cr(VI) treatment revealed that the DNA of the ΔGO strain was more susceptible to DNA glycosylase Fpg attack, suggesting that chromium genotoxicity is associated with 7,8-dihydro-8-oxodeoxyguanosine (8-oxo-G) lesions. In support of this notion, specific monoclonal antibodies detected the accumulation of 8-oxo-G lesions in the chromosomes of B. subtilis cells subjected to Cr(VI) treatment. We conclude that Cr(VI) promotes mutagenesis and cell death in B. subtilis by a mechanism that involves radical oxygen attack of DNA, generating 8-oxo-G, and that such effects are counteracted by the prevention and repair GO system. PMID:24973075

  12. Role of Bacillus subtilis error prevention oxidized guanine system in counteracting hexavalent chromium-promoted oxidative DNA damage.

    PubMed

    Santos-Escobar, Fernando; Gutiérrez-Corona, J Félix; Pedraza-Reyes, Mario

    2014-09-01

    Chromium pollution is potentially detrimental to bacterial soil communities, compromising carbon and nitrogen cycles that are essential for life on earth. It has been proposed that intracellular reduction of hexavalent chromium [Cr(VI)] to trivalent chromium [Cr(III)] may cause bacterial death by a mechanism that involves reactive oxygen species (ROS)-induced DNA damage; the molecular basis of the phenomenon was investigated in this work. Here, we report that Bacillus subtilis cells lacking a functional error prevention oxidized guanine (GO) system were significantly more sensitive to Cr(VI) treatment than cells of the wild-type (WT) strain, suggesting that oxidative damage to DNA is involved in the deleterious effects of the oxyanion. In agreement with this suggestion, Cr(VI) dramatically increased the ROS concentration and induced mutagenesis in a GO-deficient B. subtilis strain. Alkaline gel electrophoresis (AGE) analysis of chromosomal DNA of WT and ΔGO mutant strains subjected to Cr(VI) treatment revealed that the DNA of the ΔGO strain was more susceptible to DNA glycosylase Fpg attack, suggesting that chromium genotoxicity is associated with 7,8-dihydro-8-oxodeoxyguanosine (8-oxo-G) lesions. In support of this notion, specific monoclonal antibodies detected the accumulation of 8-oxo-G lesions in the chromosomes of B. subtilis cells subjected to Cr(VI) treatment. We conclude that Cr(VI) promotes mutagenesis and cell death in B. subtilis by a mechanism that involves radical oxygen attack of DNA, generating 8-oxo-G, and that such effects are counteracted by the prevention and repair GO system. PMID:24973075

  13. [Treatment errors involving diagnosis using prostate specific antigen. Decisions of the commission of experts for medical mistakes of treatment of the state medical board of North Rhine].

    PubMed

    Lent, V; Baumbusch, F; Weber, G

    2005-12-01

    Advances in prostate specific antigen (PSA) diagnosis are accompanied by deficits in realization. The justification of claims by affected patients against their doctors are reviewed by commissions of experts and mediation by medical councils out of court, impartial and free of charge. The objectivity of the review is ensured by the independence of the commission and its members as well as the determination of facts and their assessment. Criteria are professional standards and required care. Since 1995, 21 requests by affected patients have been reviewed. In 15 cases (71.4%), treatment errors were ascertained. This involved either a delayed or an insufficient diagnosis (prostatic biopsy). In ten of the patients, a mostly early prostate cancer would have be diagnosed and treated at the time of the first finding of PSA values between 3.3 and 10.4 ng/ml. In ten of 13 patients, the tumor was diagnosed late, having PSA values between 6.8 and 1251 ng/ml with no chance of curative therapy. As in other life threatening diseases, time of recognition is most important for the diagnosis and treatment of patients with prostate cancer. Particularly for early recognition, PSA is much more sensitive then digital rectal examination, and in cases without a digital finding is the only parameter for early diagnoses. In men with suspicious PSA values (>4.0 ng/ml) suitable a diagnostic test (prostate biopsy) is required early, until cancer is detected or excluded. PMID:16142454

  14. Barriers to medication adherence for the secondary prevention of stroke: a qualitative interview study in primary care

    PubMed Central

    Jamison, James; Graffy, Jonathan; Mullis, Ricky; Mant, Jonathan; Sutton, Stephen

    2016-01-01

    Background Medications are highly effective at reducing risk of recurrent stroke, but success is influenced by adherence to treatment. Among survivors of stroke and transient ischaemic attack (TIA), adherence to medication is known to be suboptimal. Aim To identify and report barriers to medication adherence for the secondary prevention of stroke/TIA. Design and setting A qualitative interview study was conducted within general practice surgeries in the East of England, UK. Method Patients were approached by letter and invited to take part in a qualitative research study. Semi-structured interviews were undertaken with survivors of stroke, caregivers, and GPs to explore their perspectives and views around secondary prevention and perceived barriers to medication adherence. Key themes were identified using a grounded theory approach. Verbatim quotes describing the themes are presented here. Results In total, 28 survivors of stroke, including 14 accompanying caregivers and five GPs, were interviewed. Two key themes were identified. Patient level barriers included ability to self-care, the importance people attach to a stroke event, and knowledge of stroke and medication. Medication level barriers included beliefs about medication and beliefs about how pills work, medication routines, changing medications, and regimen complexity and burden of treatment. Conclusion Patients who have had a stroke are faced with multiple barriers to taking secondary prevention medications in UK general practice. This research suggests that a collaborative approach between caregivers, survivors, and healthcare professionals is needed to address these barriers and facilitate medication-taking behaviour. PMID:27215572

  15. Physician Order Entry Or Nurse Order Entry? Comparison of Two Implementation Strategies for a Computerized Order Entry System Aimed at Reducing Dosing Medication Errors

    PubMed Central

    Fors, Uno GH; Tofighi, Shahram; Tessma, Mesfin; Ellenius, Johan

    2010-01-01

    Background Despite the significant effect of computerized physician order entry (CPOE) in reducing nonintercepted medication errors among neonatal inpatients, only a minority of hospitals have successfully implemented such systems. Physicians' resistance and users' frustration seem to be two of the most important barriers. One solution might be to involve nurses in the order entry process to reduce physicians’ data entry workload and resistance. However, the effect of this collaborative order entry method in reducing medication errors should be compared with a strictly physician order entry method. Objective To investigate whether a collaborative order entry method consisting of nurse order entry (NOE) followed by physician verification and countersignature is as effective as a strictly physician order entry (POE) method in reducing nonintercepted dose and frequency medication errors in the neonatal ward of an Iranian teaching hospital. Methods A four-month prospective study was designed with two equal periods. During the first period POE was used and during the second period NOE was used. In both methods, a warning appeared when the dose or frequency of the prescribed medication was incorrect that suggested the appropriate dosage to the physicians. Physicians’ responses to the warnings were recorded in a database and subsequently analyzed. Relevant paper-based and electronic medical records were reviewed to increase credibility. Results Medication prescribing for 158 neonates was studied. The rate of nonintercepted medication errors during the NOE period was 40% lower than during the POE period (rate ratio 0.60; 95% confidence interval [CI] .50, .71;P < .001). During the POE period, 80% of nonintercepted errors occurred at the prescription stage, while during the NOE period, 60% of nonintercepted errors occurred in that stage. Prescription errors decreased from 10.3% during the POE period to 4.6% during the NOE period (P < .001), and the number of warnings

  16. Negligence, genuine error, and litigation.

    PubMed

    Sohn, David H

    2013-01-01

    Not all medical injuries are the result of negligence. In fact, most medical injuries are the result either of the inherent risk in the practice of medicine, or due to system errors, which cannot be prevented simply through fear of disciplinary action. This paper will discuss the differences between adverse events, negligence, and system errors; the current medical malpractice tort system in the United States; and review current and future solutions, including medical malpractice reform, alternative dispute resolution, health courts, and no-fault compensation systems. The current political environment favors investigation of non-cap tort reform remedies; investment into more rational oversight systems, such as health courts or no-fault systems may reap both quantitative and qualitative benefits for a less costly and safer health system. PMID:23426783

  17. Persistence of Hemorrhage and Hypertensive Disorders of Pregnancy (HDP) as the Main Causes of Maternal Mortality: Emergence of Medical Errors in Iranian Healthcare System

    PubMed Central

    FARROKH-ESLAMLOU, Hamidreza; AGHLMAND, Siamak; OSHNOUEI, Sima

    2014-01-01

    Abstract Background This study aimed to assess factors affecting substandard care and probable medical errors associated with obstetric hemorrhage and HDP at a Northwestern Iranian health care system. Methods In a community-based descriptive cross-sectional study, data on all maternal deaths occurred at West Azerbaijan Province, Iran during a period of 10 years from March 21, 2002 to March 20, 2011 was analyzed. The principal cause of death, main contributory factors, nature of care, main responsible staff for sub-standard care and medical error were determined. The data on maternal deaths was obtained from the national Maternal Mortality Surveillance System (MMSS) which were covered all maternal deaths. The “Three delays model” was used to recognize contributing factors of maternal deaths due to obstetric hemorrhage and HDP. Results There were 183 maternal deaths, therefore the Mean Maternal Mortality Ratio (MMR) in the province was 32.8 per 100 000 live births (95% CI, 32.64—32.88). The most common causes of maternal deaths were obstetric hemorrhage in 36.6% of cases and HDP in 25.7%. The factors that most contributed to the deaths were all types of medical errors and substandard care with different proportions in management of obstetric hemorrhage and HDP. Conclusion A substandard care and medical error was the major contributing factor in both obstetric hemorrhage and HDP leading to maternal mortality, therefore, it is necessary to improve the quality of health care at all levels especially hospitals. PMID:26060702

  18. The Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education – A Position Statement of the Committee for Patient Safety and Error Management of the German Association for Medical Education

    PubMed Central

    Kiesewetter, Jan; Gutmann, Johanna; Drossard, Sabine; Gurrea Salas, David; Prodinger, Wolfgang; Mc Dermott, Fiona; Urban, Bert; Staender, Sven; Baschnegger, Heiko; Hoffmann, Gordon; Hübsch, Grit; Scholz, Christoph; Meier, Anke; Wegscheider, Mirko; Hoffmann, Nicolas; Ohlenbusch-Harke, Theda; Keil, Stephanie; Schirlo, Christian; Kühne-Eversmann, Lisa; Heitzmann, Nicole; Busemann, Alexandra; Koechel, Ansgar; Manser, Tanja; Welbergen, Lena; Kiesewetter, Isabel

    2016-01-01

    Background: Since the report “To err is human” was published by the Institute of Medicine in the year 2000, topics regarding patient safety and error management are in the focal point of interest of science and politics. Despite international attention, a structured and comprehensive medical education regarding these topics remains to be missing. Goals: The Learning Objective Catalogue for Patient Safety described below the Committee for Patient Safety and Error Management of the German Association for Medical Education (GMA) has aimed to establish a common foundation for the structured implementation of patient safety curricula at the medical faculties in German-speaking countries. Methods: The development the Learning Objective Catalogue resulted via the participation of 13 faculties in two committee meetings, two multi-day workshops, and additional judgments of external specialists. Results: The Committee of Patient Safety and Error Management of GMA developed the present Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education, structured in three chapters: Basics, Recognize Causes as Foundation for Proactive Behavior, and Approaches for Solutions. The learning objectives within the chapters are organized on three levels with a hierarchical organization of the topics. Overall, the Learning Objective Catalogue consists of 38 learning objectives. All learning objectives are referenced with the National Competency-based Catalogue of Learning Objectives for Undergraduate Medical Education. Discussion: The Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education is a product that was developed through collaboration of members from 13 medical faculties. In the German-speaking countries, the Learning Objective Catalogue should advance discussion regarding the topics of patient safety and error management and help develop subsequent educational structures. The Learning Objective Catalogue for Patient Safety can

  19. Do Medical Homes Reduce Disparities in Receipt of Preventive Services Between Children Living in Immigrant and Non-immigrant Families?

    PubMed Central

    Degboe, A. N.; Miranda, P. Y.; Francis, L. A.

    2014-01-01

    The patient-centered medical home model has the potential to reduce healthcare disparities among immigrant children. The purpose of this study is to examine the relationship between medical home (MH) participation and receipt of preventive services among immigrant children age 0–17. The study employed extant data from the National Survey of Children’s Health, 2007 (NSCH). Logistic regression analyses were employed to assess the relationship between receipt of preventive services and MH status among immigrant and non-immigrant children. Due to primarily the lack of family-centered care, only 40% of immigrant children met the medical home criteria versus approximately 62% of non-immigrant children. Immigrant children have decreased odds of receiving preventive care despite MH status. Improving the family-centered care aspect of the MH is necessary to increasing medical home access to immigrant children and the receipt of preventive services for immigrant children who meet the MH criteria. PMID:22052082

  20. Thetford plastics fire, October 1991: the role of a preventive medical team in chemical incidents.

    PubMed Central

    Baxter, P J; Heap, B J; Rowland, M G; Murray, V S

    1995-01-01

    OBJECTIVES--To review the role of a medical team in the emergency management of a major polyvinyl chloride (PVC) fire in an urban area. METHODS--The district health authority's consultant in communicable disease control (CCDC) was requested to advise on the health impacts of a fire that consumed some 1000 tonnes of plastic, mainly PVC, over 72 hours and which emitted a large smoke plume that threatened the health of local residents and emergency workers alike, constituting one of the largest incidents the local emergency services had dealt with in recent years. A medical team was formed comprising the CCDC, a regional epidemiologist, an occupational physician, and a medical toxicologist. This paper is an account of this team's experience of advising on the medical management of the emergency without having any formally established role or previous training for the task. RESULTS--The main issues requiring the input of the medical team included: the possible products of combustion and their effects on health; the clinical management of those exposed; the alerting of local hospitals to the type of casualties to expect; the special health risks posed to emergency workers, especially the firemen; the need for evacuation of local residents; the risks of contamination of soil, water, and crops; the potential health impact of the plume; and the provision of expert and authoritative advice on the short and long term health implications to the public. Active surveillance systems, which included the local general practitioners and hospitals, were established and air monitoring instigated. The 46 casualties were restricted to emergency personnel who had inadvertently received exposure to the fire smoke: all recovered within 48 hours. Local residents were unharmed. CONCLUSION--The incident showed the need for preventive medical teams trained to fill a formal advisory and investigative role for chemical releases and fires, and which can play an integral part in emergency

  1. An update on prevention of venous thromboembolism in hospitalized acutely ill medical patients

    PubMed Central

    Samama, Meyer Michel; Kleber, Franz-Xaver

    2006-01-01

    Both the recently updated consensus guidelines published by the American College of Chest Physicians, and the International Union of Angiology recommend thromboprophylaxis with either low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) in medical patients at risk of VTE. However, no guidance is given regarding the appropriate dosing regimens that should be used for thromboprophylaxis in this patient group. LMWH (enoxaparin and dalteparin) and UFH have been shown to be effective for thromboprophylaxis in at-risk hospitalized medical patients. Although LMWH once daily (o.d.) has been shown to be as effective as UFH three times daily (t.i.d.) for thromboprophylaxis in at-risk medical patients, there are no data to show that UFH twice daily (b.i.d) is as effective as either LMWH o.d. or UFH t.i.d. On the basis of currently available evidence, the LMWHs enoxaparin and dalteparin are more attractive alternatives to UFH for the prevention of VTE in hospitalized medical patients because of their convenient once-daily administration and better safety profile, demonstrated in terms of reduced bleeding, HIT, and other adverse events. PMID:16817957

  2. Do medical patients need to receive pharmacologic prophylaxis for the prevention of venous thromboembolism?

    PubMed

    Ageno, Walter

    2012-10-01

    Acutely ill medical patients with reduced mobility are at increased risk of venous thromboembolism, which can occur during hospitalization or after discharge. A number of clinical trials and meta-analyses have shown that pharmacologic prophylaxis with anticoagulant drugs in these patients significantly reduces the risk of fatal pulmonary embolism as compared to placebo or no treatment, without significant increase in the risk of major bleeding. Thus, the use of anticoagulant prophylaxis is recommended for all high risk medical patients during hospitalization. To identify these high risk patients, clinicians may use the inclusion criteria applied in the trials, with a selection that is mostly qualitative, or risk assessment models, with a selection that is both qualitative and quantitative. With both approaches, about 40 % of medical patients would be at increased risk of venous thrombosis. Because in the real world medical patients tend to be much older and with more comorbidities than in clinical trials, patient selection needs to also take into account risk factors for bleeding. Among others, estimation of creatinine clearance appears to be particularly important to prevent excessive exposure to anticoagulant drugs. Finally, although the risk of venous thrombosis may persist in some patients after hospital discharge, clinical trials assessing extended prophylaxis in this setting have failed to show a convincing clinical benefit with this approach. PMID:23073856

  3. Use of wound dressings to enhance prevention of pressure ulcers caused by medical devices.

    PubMed

    Black, Joyce; Alves, Paulo; Brindle, Christopher Tod; Dealey, Carol; Santamaria, Nick; Call, Evan; Clark, Michael

    2015-06-01

    Medical device related pressure ulcers (MDR PUs) are defined as pressure injuries associated with the use of devices applied for diagnostic or therapeutic purposes wherein the PU that develops has the same configuration as the device. Many institutions have reduced the incidence of traditional PUs (sacral, buttock and heel) and therefore the significance of MDR PU has become more apparent. The highest risk of MDR PU has been reported to be patients with impaired sensory perception, such as neuropathy, and an impaired ability for the patient to communicate discomfort, for example, oral intubation, language barriers, unconsciousness or non-verbal state. Patients in critical care units typify the high-risk patient and they often require more devices for monitoring and therapeutic purposes. An expert panel met to review the evidence on the prevention of MDR PUs and arrived at these conclusions: (i) consider applying dressings that demonstrate pressure redistribution and absorb moisture from body areas in contact with medical devices, tubing and fixators, (ii) in addition to dressings applied beneath medical devices, continue to lift and/or move the medical device to examine the skin beneath it and reposition for pressure relief and (iii) when simple repositioning does not relieve pressure, it is important not to create more pressure by placing dressings beneath tight devices. PMID:23809279

  4. The current status of the use of oral medication to prevent HIV transmission

    PubMed Central

    Ramjee, Gita

    2016-01-01

    Purpose of review This review was designed to evaluate the progress in studies of the use of oral and topical antiretroviral medication for primary HIV prevention. Recent findings Non-human primate data has suggested that the administration of antiretroviral medication before or after retroviral exposure can protect against the establishment of chronic infection. Over the past two decades, observational studies have demonstrated the safety of antiretroviral agents for post-exposure prophylaxis (PEP) and more recent efficacy studies have demonstrated that tenofovir with or without emtricitabine can protect against HIV when used as pre-exposure prophylaxis (PrEP). Efficacy studies have been conducted in diverse populations, including men and transgender women who have sex with men, young African heterosexuals, and injection drug users. Three studies in African women evaluating oral and topical tenfovir-based regimens did not demonstrate efficacy, in large part because of suboptimal medication adherence. Further research is underway to determine the optimal ways to provide chemoprophylaxis, the optimal medications, and dosing regimens. Summary PrEP can be effective in decreasing HIV transmission to at risk uninfected persons, but further research is needed to determine the optimal modes of delivery. PMID:26049946

  5. Preventing ragging: outcome of an integrated programme in a medical faculty in Sri Lanka.

    PubMed

    Lekamwasam, Sarath; Rodrigo, Mahinda; Wickramathilake, Madhu; Wijesinghe, Champa; Wijerathne, Gaya; Silva, Aruna De; Napagoda, Mayuri; Attanayake, Anoja; Perera, Clifford

    2015-01-01

    Ragging is prevalent in higher educational institutes in Sri Lanka and the deaths of some new entrants in the past have been directly linked to physical and emotional torture caused by cruel acts of ragging. Although there are general anti-ragging rules in place, the effectiveness of these measures is unknown. We developed an action plan to prevent ragging by integrating the views of the major stakeholders, implemented the plan and assessed its success. This article highlights the action plan and its success in a medical faculty in southern Sri Lanka. PMID:26322639

  6. Knowledge and acceptability of alternative HIV prevention bio-medical products among MSM who bareback.

    PubMed

    Nodin, N; Carballo-Diéguez, A; Ventuneac, A M; Balan, I C; Remien, R

    2008-01-01

    Condom use is the best available strategy to prevent HIV infection during sexual intercourse. However, since many people choose not to use condoms in circumstances in which HIV risk exists, alternatives to condom use for HIV prevention are needed. Currently there are several alternative bio-medical HIV-prevention products in different stages of development: microbicides, vaccines, post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP). Seventy-two men who have sex with men (MSM) who took part in a study on Internet use and intentional condomless anal intercourse were asked about these four products during a semi-structured interview. The questions explored knowledge and acceptability of all the products and willingness to participate in microbicide and vaccine trials. Qualitative analysis of the data suggests that these men had virtually no knowledge of PrEP, very limited knowledge of microbicides, some information about PEP and considerably more knowledge about vaccines. Reactions towards the products were generally positive except for PrEP, for which reactions were polarized as either enthusiastic or negative. With the exception of PrEP, many men expressed willingness to use the products in the future. Most men would be willing to participate in trials for microbicides and vaccines if given basic reassurances. Concerns over negative side effects and preoccupation with possible infection were some of the motives given for non-willingness to participate in a vaccine trial. These results should inform the development of future trials of biomedical prevention products. PMID:18278621

  7. The use of secondary medical prevention after primary vascular reconstruction: studies on usage and effectiveness.

    PubMed

    Høgh, Annette L

    2012-09-01

    Peripheral arterial disease (PAD) is a common manifestation of symptomatic atherosclerosis that leads to a significantly elevated risk of cardiovascular events, including major limb loss, myocardial infarction, stroke and death. The prevalence proportions of PAD increase dramatically with age and appear to progress more aggressively in women than in men. Several studies have indicated that the use of secondary medical prevention is generally insufficient among PAD patients. However, current national and international guidelines recommend lipid-lowering and anti-platelet therapy, supplemented with aggressive blood pressure lowering treatment. We aimed to determine whether there were age-, gender-, geography or time related differences in the use of secondary medical prevention, following primary vascular reconstruction. We also sought to describe the prognoses for the same population, according to the association between the use of ACE/ATII inhibitors (angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists) or beta blockers and clinical outcomes (all cause mortality, myocardial infarction, stroke, major amputation and/or recurrent vascular surgery) in a population-based, long-term follow-up study. We established a data base by linking four population based administrative and health-care registries. All Danish patients undergoing primary vascular surgical reconstruction due to atherosclerotic disease between 1997 and 2007 were included and identified in the Danish Vascular Registry; a total of 20,761 patients were followed during a median of 582 days (range of 30 to 4,379 days). Data regarding all prescriptions filled by the study population were obtained from the Medical Registry of the Danish Medicines Agency. Study I: Age- and gender-related differences. We found moderate to low use of secondary medical prevention. However, this use has increased in recent years and the age- and gender-related differences in use have been reduced or

  8. 75 FR 42103 - Advancing the Development of Medical Products Used In the Prevention, Diagnosis, and Treatment of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-20

    ... Prevention, Diagnosis, and Treatment of Neglected Tropical Diseases; Public Hearing AGENCY: Food and Drug..., and medical devices) used in the prevention, diagnosis, and treatment of neglected tropical diseases..., diagnosis, and treatment of neglected tropical diseases. To help solicit such views and information, FDA...

  9. [Shamanism as medical prevention? A case study from Ladakh, Northwest-India].

    PubMed

    Kressing, Frank

    2011-01-01

    Relating to a research project in the trans-Himalayan region of Ladakh, Northwest-India, the paper examines indications that the shamanic vocation and practice grew significantly in this region. The author tries to link this increase to severe psychological pressures imposed by the heavy presence of the Indian Army, political and administrative ties to the Indian state of Jammu and Kashmir (with a predominantly Muslim population), and the region's status as a popular tourist destination. The paper argues that shamanic rituals performed by so-called oracles that embody deities of the Buddhist pantheon in trance (lhamo, lhapa) not only provide important services of healing and divination, they contribute significantly to medical prevention in times of growing competition and the deterioration of value systems. Turning from a local (Ladakh, the Tibetan Plateau) to a global perspective, it is further argued that the preventive function of shamanism has often been overlooked in previous ethnographic research and might be neglected by increasing efforts (also fostered by indigenous ritualists themselves) to establish and legitimize traditional ritual practices as part of modern health care systems which might eventually lead to the medicalization of traditional ceremonies--in short: "shamans do a lot more than just heal people". PMID:22701957

  10. Preventing sexual abusers of children from reoffending: systematic review of medical and psychological interventions

    PubMed Central

    Enebrink, Pia; Laurén, Eva-Marie; Lindblom, Jonas; Werkö, Sophie; Hanson, R Karl

    2013-01-01

    Objective To evaluate the effectiveness of current medical and psychological interventions for individuals at risk of sexually abusing children, both in known abusers and those at risk of abusing. Design Systematic review of interventions designed to prevent reoffending among known abusers and prevention for individuals at risk of sexually abusing children. Randomised controlled trials and prospective observational studies were eligible. Primary outcomes were arrests, convictions, breaches of conditions, and self reported sexual abuse of children after one year or more. Results After review of 1447 abstracts, we retrieved 167 full text studies, and finally included eight studies with low to moderate risk of bias. We found weak evidence for interventions aimed at reducing reoffending in identified sexual abusers of children. For adults, evidence from five trials was insufficient regarding both benefits and risks with psychological treatment and pharmacotherapy. For adolescents, limited evidence from one trial suggested that multisystemic therapy prevented reoffence (relative risk 0.18, 95% confidence interval 0.04 to 0.73); lack of adequate research prevented conclusions about effects of other treatments. Evidence was also inadequate regarding effectiveness of treatment for children with sexual behavioural problems in the one trial identified. Finally, we found no eligible research on preventive methods for adults and adolescents who had not sexually abused children but were at higher risk of doing so (such as those with paedophilic sexual preference). Conclusion There are major weaknesses in the scientific evidence, particularly regarding adult men, the main category of sexual abusers of children. Better coordinated and funded high quality studies including several countries are urgently needed. Until conclusive evidence is available, realistic clinical strategies might involve reduction of specific risk factors for sex crimes, such as sexual preoccupation, in

  11. Seroprevalence and immunization history of selected vaccine preventable diseases in medical students.

    PubMed

    Baer, Gurli; Bonhoeffer, Jan; Schaad, Urs B; Heininger, Ulrich

    2005-03-14

    To evaluate protection against vaccine-preventable diseases in medical students, we obtained data on immunization status and history of diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, varicella and hepatitis B from students with elective periods in our institution. Further, serum antibodies against measles, mumps, rubella and varicella-zoster virus (VZV) and hepatitis B surface (HBs) antigen were determined on a voluntary basis. For students with incomplete immunization status or lack of protective antibodies, vaccination was offered for free. Success of catch-up immunizations was serologically confirmed 4 weeks later. From May 1999 to April 2003, 170 students were enrolled; their mean age was 26 years with a median of 25 years (range 22-48 years). Immunization records were complete in 148 (87%), incomplete in 11 (6.5%) and missing in 11 (6.5%) students. Only 26% of the cohort had a complete and up-to-date immunization status. Seroprevalence of IgG antibodies against measles, mumps, rubella, VZV and HBs (> or = 10 IU/l) in 149 students were 85, 85, 92, 97 and 90%, respectively. Indications for > or = 1 catch-up immunization were found in 125 (74%) students and were accepted by 97 of them (78%). Sixty two (99%) of 63 immunized students available for follow-up demonstrated an adequate serological response. In conclusion, the great majority of medical students had immunization gaps. Systematic immunization programmes for medical students should be implemented. PMID:15734076

  12. Sustained prevention of biofilm formation on a novel silicone matrix suitable for medical devices.

    PubMed

    Steffensen, Søren Langer; Vestergaard, Merete Hedemark; Groenning, Minna; Alm, Martin; Franzyk, Henrik; Nielsen, Hanne Mørck

    2015-08-01

    Bacterial colonization and biofilm formation on medical devices constitute major challenges in clinical long-term use of e.g. catheters due to the risk of (re)infection of patients, which would result in additional use of antibiotics risking bacterial resistance development. The aim of the present project was to introduce a novel antibacterial approach involving an advanced composite material applicable for medical devices. The polymeric composites investigated consisted of a hydrogel network of cross-linked poly(2-hydroxyethyl methacrylate) (PHEMA) embedded in a poly(dimethylsiloxane) (PDMS) silicone elastomer produced using supercritical carbon dioxide (scCO2). In these materials, the hydrogel may contain an active pharmaceutical ingredient while the silicone elastomer provides the sufficient mechanical stability of the material. In these conceptual studies, the antimicrobial agent ciprofloxacin was loaded into the polymer matrix by a post-polymerization loading procedure. Sustained release of ciprofloxacin was demonstrated, and the release could be controlled by varying the hydrogel content in the range 13-38% (w/w) and by changing the concentration of ciprofloxacin during loading in the range of 1-20mg/mL. Devices containing 25% (w/w) hydrogel and loaded with ciprofloxacin displayed a strong antibacterial effect against Staphylococcus aureus bacterial colonization and subsequent biofilm formation on the device material was inhibited for 29days. In conclusion, the hydrogel/silicone composite represents a promising candidate material for medical devices that prevent bacterial colonization during long-term use. PMID:26028273

  13. A practical procedure to prevent electromagnetic interference with electronic medical equipment.

    PubMed

    Hanada, Eisuke; Takano, Kyoko; Antoku, Yasuaki; Matsumura, Kouji; Watanabe, Yoshiaki; Nose, Yoshiaki

    2002-02-01

    Problems involving electromagnetic interference (EMI) with electronic medical equipment are well-documented. However, no systematic investigation of EMI has been done. We have systematically investigated the causes of EMI. The factors involved in EMI were determined as follows: 1) Electric-field intensity induced by invasive radio waves from outside a hospital. 2) Residual magnetic-flux density at welding points in a building. 3) Electric-field intensity induced by conveyance systems with a linear motor. 4) The shielding capacity of hospital walls. 5) The shielding capacity of commercial shields against a wide range frequency radio waves. 6) The immunity of electronic medical equipment. 7) EMI by cellular telephone and personal handy-phone system handsets. From the results of our investigation, we developed a following practical procedure to prevent EMI. 1) Measurement of electric-field intensity induced by invasive radio waves from outside the hospital and industrial systems in the hospital. 2) Measurement of residual magnetic-flux density at electric welding points of hospital buildings with steel frame structures. 3) Control of the electromagnetic environment by utilizing the shielding capacity of walls. 4) Measurement of the immunity of electronic medical equipment. And 5) Installation of electronic gate equipment at the building entrance to screen for handsets. PMID:11777312

  14. Achieving the HIV prevention impact of voluntary medical male circumcision: lessons and challenges for managing programs.

    PubMed

    Sgaier, Sema K; Reed, Jason B; Thomas, Anne; Njeuhmeli, Emmanuel

    2014-05-01

    Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009-2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection "Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up." The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform. PMID:24800840

  15. Achieving the HIV Prevention Impact of Voluntary Medical Male Circumcision: Lessons and Challenges for Managing Programs

    PubMed Central

    Sgaier, Sema K.; Reed, Jason B.; Thomas, Anne; Njeuhmeli, Emmanuel

    2014-01-01

    Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009–2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection “Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up.” The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform. PMID:24800840

  16. Compliance and Cognitive Function: A Methodological Approach to Measuring Unintentional Errors in Medication Compliance in the Elderly.

    ERIC Educational Resources Information Center

    Isaac, Lisa M.; And Others

    1993-01-01

    Assessed multiple aspects of cognitive performance, medication planning ability, and medication compliance in 20 elderly outpatients. Findings suggest that aspects of attention/concentration, visual and verbal memory, and motor function which are untapped by simple mental status assessment are related to medication access, planning, and compliance…

  17. Preventing a perfect storm in your medical practice: understanding communication, collaboration, and conflict.

    PubMed

    Strakal, Dan

    2007-01-01

    Practice management can be both challenging and frustrating. In today's world of high turnover, decreased numbers of skilled workers, and increased regulatory requirements, it is more important than ever that practice managers understand the dynamics of creating a climate of motivation. There are three events that, when they hit all at once, can wreak havoc on the effective management of a medical practice. These are: (1) communica-tion breakdown; (2) lack of collaboration between employees and managers; and (3) the inability to prevent, manage, and/or resolve conflict. This article will present strategies to streamline communication, explore ideas on how to collaborate more effectively, and provide insight into the five styles of conflict management. PMID:17974089

  18. Creating an organizational culture for medication safety.

    PubMed

    Dennison, Robin Donohoe

    2005-03-01

    Medication errors are costly from human, economic, and societal perspectives. All patients are vulnerable to the detrimental effects of these errors. Recommendations regarding the problem of medication errors include: Prevention of error by learning from the nonpunitive reporting of errors and near misses; Evaluation of the system for potential causes of error through failure mode and effects analysis and encouragement of a questioning attitude; Elimination of system problems that increase the risk of error; Recognition that humans are fallible and that error will occur even in a perfect system; Minimization of the consequences of errors when they do occur. An important goal for healthcare organizations should be to create a culture that accepts the imperfection of human performance and solicits the assistance of team members in the development of safeguards for error prevention. Proposed interventions to prevent medication errors can be described by the PATIENT SAFE taxonomy, which includes: Patient participation; Adherence to established policy and procedures; Technology use; Information accessibility; Education regarding medication safety; Nonpunitive approach to reporting of errors and near misses; Teamwork, communication, and collaboration; Staffing: adequate number and staffing mix; Administration support for the clinical goal of patient safety; Failure mode and effects analysis with team member involvement; Environment and equipment to support patient safety PMID:15733943

  19. Advanced medical countermeasures for radiological accidents and nuclear disasters: prevention, prophylaxis, treatment and pre- and post-exposure management.

    NASA Astrophysics Data System (ADS)

    Popov, Dmitri; Maliev, Slava; Jones, Jeffrey

    Countermeasures against nuclear terrorism to prevent or limit the number of irradiated human population or radiation intoxications include early identification of the nuclear terrorism event and all persons which exposed by radiation, decontamination program and procedures, radiation control, and medical countermeasures which include medical diagnosis,differential diagnosis of Acute Radiation Syndromes by Immune Enzyme Assay , pre-exposure vaccination with Human Antiradiation Vaccine, post-exposure specific treatment - de-intoxication with Radiation Antidote IgG (blocking Antiradiation Antibodies). Our Advanced Medical Technology elaborated as a part of effective countermeasure include Plan of Action.Countermeasures against nuclear terrorism to prevent or limit the number of high level of lethality and severe forms of radiation illness or intoxications include A.early identification of the nuclear terrorism event and persons exposed,b. appropriate decontamination, c. radiation control, and d.medical countermeasures and medical management of ARS. Medical countermeasures, which include medical interventions such as active immuneprophylaxis with Human Antiradiation Vaccine , passive immune-prophylaxis with Antiradiation Antitoxins immune-globulins IgG , and chemoprophylaxis - post-exposure antioxidants prophylaxis and antibioticprophylaxis. Medical countermeasures with Antiradiation Vaccine should be initiated before an exposure (if individuals are identified as being at high risk for exposure)but after a confirmed exposure event Antiradiation Vaccine not effective and Antiradiation Antidot IgG must be applyed for treatment of Acute Radiation Syndromes.

  20. Impact of a Drug Shortage on Medication Errors and Clinical Outcomes in the Pediatric Intensive Care Unit

    PubMed Central

    Goswami, Elizabeth S.; Morris, Jennifer L.

    2015-01-01

    OBJECTIVES: The purpose of this study was to assess the rate of prescribing errors, resulting adverse events, and patient outcomes associated with sedation and analgesia in the pediatric intensive care unit (PICU) before and during a national shortage of fentanyl and injectable benzodiazepines. METHODS: A retrospective chart review was performed of patients admitted to the PICU with at least 1 prescribed order for a sedative or analgesic agent during the time periods of January to February of 2011 and 2012. Initial orders for sedative and analgesic agents were identified and investigated for appropriateness of dose and were assessed for error-associated adverse events. Orders were stratified by timing in regard to clinical pharmacist on-site availability. Demographic and outcome information, including unintended extubations, ventilator days, and PICU length of stay, were gathered. RESULTS: One hundred sixty-nine orders representing 72 patients and 179 orders representing 75 patients in 2011 and 2012, respectively, were included in analysis. No differences were found in the rate of prescribing errors in 2011 and 2012 (33 errors in 169 orders vs. 39 errors in 179 orders, respectively, p=0.603). No differences were found in rates of prescribing errors in regard to clinical pharmacist on-site availability. A significant increase was seen in unintended extubations per 100 ventilator days, with 0.15 in 2011 vs. 1.13 in 2012, respectively (p<0.001). A significant decrease was seen in ventilator days per patient (p<0.001) and PICU length of stay per patient (p=0.019). CONCLUSIONS: There were no differences in rates of prescribing errors before versus during the fentanyl and benzodiazepine shortage. PMID:26766934

  1. A practical guide to the implementation of an effective incident reporting scheme to reduce medication error on the hospital ward.

    PubMed

    Webster, Craig S; Anderson, David J

    2002-08-01

    This paper discusses an anonymous incident reporting scheme to reduce drug administration error on the hospital ward, as part of an effective, non-punitive, systems-focused approach to safety. Drug error is costly in terms of increased hospital stay, resources consumed, patient harm, lives lost and careers ruined. Safety initiatives that focus, not on blaming individuals, but on improving the wider system in which personnel work have been adopted in a number of branches of health care. However, in nursing, blame remains the predominant approach for dealing with error, and the ward has seen little application of the systems approach to safety. Safety interventions founded on an effective incident scheme typically pay for themselves in terms of dollar savings arising from averted harm. Recent calls for greater health-care safety require finding new ways to make drug administration safer throughout the hospital, and the scope for such safety gains on the hospital ward remains considerable. PMID:12100674

  2. Knowledge, Attitudes and Preventive Efforts of Malaysian Medical Students Regarding Exposure to Environmental Tobacco and Cigarette Smoking.

    ERIC Educational Resources Information Center

    Frisch, Ann Stirling; Kurtz, Margot; Shamsuddin, Khadijah

    1999-01-01

    Study examines changes in knowledge, attitudes, and preventive efforts of Malaysian students concerning cigarette smoking and environmental exposure to tobacco smoke from their first pre-clinical year in medical school until their final clinical year. Although there were significant improvements in knowledge about smoking and environmental…

  3. German critical incident reporting system database of prehospital emergency medicine: Analysis of reported communication and medication errors between 2005–2015

    PubMed Central

    Hohenstein, Christian; Fleischmann, Thomas; Rupp, Peter; Hempel, Dorothea; Wilk, Sophia; Winning, Johannes

    2016-01-01

    BACKGROUND: Communication failure in prehospital emergency medicine can affect patient safety as it does in other areas of medicine as well. We analyzed the database of the critical incident reporting system for prehospital emergency medicine in Germany retrospectively regarding communication errors. METHODS: Experts of prehospital emergency medicine and risk management screened the database for verbal communication failure, non-verbal communication failure and missing communication at all. RESULTS: Between 2005 and 2015, 845 reports were analyzed, of which 247 reports were considered to be related to communication failure. An arbitrary classification resulted in six different kinds: 1) no acknowledgement of a suggestion; 2) medication error; 3) miscommunication with dispatcher; 4) utterance heard/understood improperly; 5) missing information transfer between two persons; and 6) other communication failure. CONCLUSION: Communication deficits can lead to critical incidents in prehospital emergency medicine and are a very important aspect in patient safety. PMID:27313802

  4. Molecular hydrogen as a preventive and therapeutic medical gas: initiation, development and potential of hydrogen medicine.

    PubMed

    Ohta, Shigeo

    2014-10-01

    Molecular hydrogen (H2) has been accepted to be an inert and nonfunctional molecule in our body. We have turned this concept by demonstrating that H2 reacts with strong oxidants such as hydroxyl radical in cells, and proposed its potential for preventive and therapeutic applications. H2 has a number of advantages exhibiting extensive effects: H2 rapidly diffuses into tissues and cells, and it is mild enough neither to disturb metabolic redox reactions nor to affect signaling reactive oxygen species; therefore, there should be no or little adverse effects of H2. There are several methods to ingest or consume H2; inhaling H2 gas, drinking H2-dissolved water (H2-water), injecting H2-dissolved saline (H2-saline), taking an H2 bath, or dropping H2-saline into the eyes. The numerous publications on its biological and medical benefits revealed that H2 reduces oxidative stress not only by direct reactions with strong oxidants, but also indirectly by regulating various gene expressions. Moreover, by regulating the gene expressions, H2 functions as an anti-inflammatory and anti-apoptotic, and stimulates energy metabolism. In addition to growing evidence obtained by model animal experiments, extensive clinical examinations were performed or are under investigation. Since most drugs specifically act to their targets, H2 seems to differ from conventional pharmaceutical drugs. Owing to its great efficacy and lack of adverse effects, H2 has promising potential for clinical use against many diseases. PMID:24769081

  5. Knowledge, awareness, and attitude regarding infection prevention and control among medical students: a call for educational intervention

    PubMed Central

    Ibrahim, Awab Ali; Elshafie, Sittana Shamseldin

    2016-01-01

    Background Medical students can be exposed to serious health care-associated infections, if they are not following infection prevention and control (IPC) measures. There is limited information regarding the knowledge, awareness, and practices of medical students regarding IPC and the educational approaches used to teach them these practices. Aim To evaluate the knowledge, awareness, and attitude of medical students toward IPC guidelines, and the learning approaches to help improve their knowledge. Methods A cross-sectional, interview-based survey included 73 medical students from Weill Cornell Medical College, Qatar. Students completed a questionnaire concerning awareness, knowledge, and attitude regarding IPC practices. Students’ knowledge was assessed by their correct answers to the survey questions. Findings A total of 48.44% of the respondents were aware of standard isolation precautions, 61.90% were satisfied with their training in IPC, 66.13% were exposed to hand hygiene training, while 85.48% had sufficient knowledge about hand hygiene and practiced it on a routine basis, but only 33.87% knew the duration of the hand hygiene procedure. Conclusion Knowledge, attitude, and awareness of IPC measures among Weill Cornell Medical Students in Qatar were found to be inadequate. Multifaceted training programs may have to target newly graduated medical practitioners or the training has to be included in the graduate medical curriculum to enable them to adopt and adhere to IPC guidelines. PMID:27579002

  6. Self Care. Preventing Misuse of Medication and Alcohol in an Aging Society. Pharmacists and Prevention Specialists Working Together.

    ERIC Educational Resources Information Center

    Illinois State Dept. on Aging, Springfield.

    This manual, which was originally developed to supplement a corresponding continuing education program offered by the Illinois Pharmacy Foundation and Illinois Pharmacists Association, is intended as a resource for pharmacists and other health care professionals who work to prevent alcohol and drug misuse/abuse in older patients. Discussed in…

  7. Intricacies and strategies for the implementation of new technologies in radiotherapy: Reflections on the meaning and prevention of the error

    NASA Astrophysics Data System (ADS)

    Espejo-Villalobos, J. D.; Franco-Cabrera, M. C.; Estrada-Hernandez, C.; Quintero-Castelan, M. S.

    2012-10-01

    When facing the challenge of implementing new technologies in Radiotherapy, a reflection on philosophical and ethical principles is in order for the Medical Physicist to assume a reality of increased risks of harm to the patient. A series of ideas from philosophers and clinical professionals are reviewed to encourage an increased awareness of our ethical responsibility towards patients that entrust us with their hopes for alleviating their disease.

  8. Intricacies and strategies for the implementation of new technologies in radiotherapy: Reflections on the meaning and prevention of the error

    SciTech Connect

    Espejo-Villalobos, J. D.; Franco-Cabrera, M. C.; Estrada-Hernandez, C.; Quintero-Castelan, M. S.

    2012-10-23

    When facing the challenge of implementing new technologies in Radiotherapy, a reflection on philosophical and ethical principles is in order for the Medical Physicist to assume a reality of increased risks of harm to the patient. A series of ideas from philosophers and clinical professionals are reviewed to encourage an increased awareness of our ethical responsibility towards patients that entrust us with their hopes for alleviating their disease.

  9. Pathophysiology of chronic migraine and mode of action of preventive medications.

    PubMed

    Mathew, Ninan T

    2011-01-01

    anterior cingulate and insula using magnetic resonance spectroscopy. Medications affecting central glutamatergic neurotransmission may have a potential therapeutic role in CM. Frequent use of opioids and analgesics in EM leads to CM. Opioid-induced hyperalgesia, recognized in recent years, can lead to intractability of migraine. Better understanding of the pathophysiology of CM should lead to better ways to treat these patients. The various effective preventive agents used in migraine prophylaxis, such as topiramate, valproate, β-blockers, and tricyclic antidepressants, appear to have a common effect of suppressing cortical excitability (cortical spreading depression). Suppression of cortical spreading depression by these agents is correlated with the dosages and the duration of treatment. The beneficial effect of botulinum toxin in CM may be due to its antinociceptive effect. Changes in the glutamate and calcitonin gene-related peptide at the peripheral nerve endings reduce peripheral sensitization, which eventually leads to reduced central sensitization. PMID:21770930

  10. An Examination of the Concept of Social Integration as Related to Preventive Medical Care in Poverty Families in Rural and Urban Areas.

    ERIC Educational Resources Information Center

    Slesinger, Doris P.

    Based on an in-depth study of 125 mothers of young infants in both urban and rural areas of Wisconsin, this study analyzed the utilization of preventive medical services for the infant. The hypothesis that "mothers who are more socially integrated will be more likely to use preventive medical services than those who are less integrated,…

  11. A Conceptual Model of Medical Student Well-Being: Promoting Resilience and Preventing Burnout

    ERIC Educational Resources Information Center

    Dunn, Laura B.; Iglewicz, Alana; Moutier, Christine

    2008-01-01

    Objective: This article proposes and illustrates a conceptual model of medical student well-being. Method: The authors reviewed the literature on medical student stress, coping, and well-being and developed a model of medical student coping termed the "coping reservoir." Results: The reservoir can be replenished or drained by various aspects of…

  12. Prevention

    MedlinePlus

    ... our e-newsletter! Aging & Health A to Z Prevention Basic Facts & Information Some factors that affect your ... control of the things that you can change. Preventive Recommendations for Adults Aged 65 and Older The ...

  13. Antibacterial Peptide-Based Gel for Prevention of Medical Implanted-Device Infection

    PubMed Central

    Mateescu, Mihaela; Baixe, Sébastien; Garnier, Tony; Jierry, Loic; Ball, Vincent; Haikel, Youssef; Metz-Boutigue, Marie Hélène; Nardin, Michel; Schaaf, Pierre; Etienne, Olivier; Lavalle, Philippe

    2015-01-01

    Implanted medical devices are prone to infection. Designing new strategies to reduce infection and implant rejection are an important challenge for modern medicine. To this end, in the last few years many hydrogels have been designed as matrices for antimicrobial molecules destined to fight frequent infection found in moist environments like the oral cavity. In this study, two types of original hydrogels containing the antimicrobial peptide Cateslytin have been designed. The first hydrogel is based on alginate modified with catechol moieties (AC gel). The choice of these catechol functional groups which derive from mussel’s catechol originates from their strong adhesion properties on various surfaces. The second type of gel we tested is a mixture of alginate catechol and thiol-terminated Pluronic (AC/PlubisSH), a polymer derived from Pluronic, a well-known biocompatible polymer. This PlubisSH polymer has been chosen for its capacity to enhance the cohesion of the composition. These two gels offer new clinical uses, as they can be injected and jellify in a few minutes. Moreover, we show these gels strongly adhere to implant surfaces and gingiva. Once gelled, they demonstrate a high level of rheological properties and stability. In particular, the dissipative energy of the (AC/PlubisSH) gel detachment reaches a high value on gingiva (10 J.m-2) and on titanium alloys (4 J.m-2), conferring a strong mechanical barrier. Moreover, the Cateslytin peptide in hydrogels exhibited potent antimicrobial activities against P. gingivalis, where a strong inhibition of bacterial metabolic activity and viability was observed, indicating reduced virulence. Gel biocompatibility tests indicate no signs of toxicity. In conclusion, these new hydrogels could be ideal candidates in the prevention and/or management of periimplant diseases. PMID:26659616

  14. Antibacterial Peptide-Based Gel for Prevention of Medical Implanted-Device Infection.

    PubMed

    Mateescu, Mihaela; Baixe, Sébastien; Garnier, Tony; Jierry, Loic; Ball, Vincent; Haikel, Youssef; Metz-Boutigue, Marie Hélène; Nardin, Michel; Schaaf, Pierre; Etienne, Olivier; Lavalle, Philippe

    2015-01-01

    Implanted medical devices are prone to infection. Designing new strategies to reduce infection and implant rejection are an important challenge for modern medicine. To this end, in the last few years many hydrogels have been designed as matrices for antimicrobial molecules destined to fight frequent infection found in moist environments like the oral cavity. In this study, two types of original hydrogels containing the antimicrobial peptide Cateslytin have been designed. The first hydrogel is based on alginate modified with catechol moieties (AC gel). The choice of these catechol functional groups which derive from mussel's catechol originates from their strong adhesion properties on various surfaces. The second type of gel we tested is a mixture of alginate catechol and thiol-terminated Pluronic (AC/PlubisSH), a polymer derived from Pluronic, a well-known biocompatible polymer. This PlubisSH polymer has been chosen for its capacity to enhance the cohesion of the composition. These two gels offer new clinical uses, as they can be injected and jellify in a few minutes. Moreover, we show these gels strongly adhere to implant surfaces and gingiva. Once gelled, they demonstrate a high level of rheological properties and stability. In particular, the dissipative energy of the (AC/PlubisSH) gel detachment reaches a high value on gingiva (10 J.m-2) and on titanium alloys (4 J.m-2), conferring a strong mechanical barrier. Moreover, the Cateslytin peptide in hydrogels exhibited potent antimicrobial activities against P. gingivalis, where a strong inhibition of bacterial metabolic activity and viability was observed, indicating reduced virulence. Gel biocompatibility tests indicate no signs of toxicity. In conclusion, these new hydrogels could be ideal candidates in the prevention and/or management of periimplant diseases. PMID:26659616

  15. Prevention

    MedlinePlus

    Skip to main content Error processing SSI file Connect with us: Enter Search Term(s): Skip to main content Toggle navigation Home Tools & Protocols Undiagnosed Hypertension Self-Measured Blood Pressure ...

  16. Patient and general practitioner attitudes to taking medication to prevent cardiovascular disease after receiving detailed information on risks and benefits of treatment: a qualitative study

    PubMed Central

    2011-01-01

    Background There are now effective drugs to prevent cardiovascular disease and guidelines recommend their use. Patients do not always choose to accept preventive medication at levels of risk reduction recommended in guidelines. The purpose of the study was to identify and explore the attitudes of patients and general practitioners towards preventative medication for cardiovascular disease (CVD) after they have received information about it; to identify implications for practice and prescribing. Methods Qualitative interviews with GPs and patients following presentation of in depth information about CVD risks and the absolute effects of medication. Setting: GP practices in Birmingham, United Kingdom. Results In both populations: wide variation on attitudes to preventative medication; concerns about unnecessary drug taking & side effects; preferring to consider lifestyle changes first. In patient population: whatever their attitudes to medication were, the vast majority explained that they would ultimately do what their GP recommended; there was some misunderstanding of the distinction between curative and preventative medication. A common theme was the degree of trust in their doctors' judgement and recommendations, which contrasted with scepticism of the role of pharmaceutical companies and academics. Scepticism in guidelines was also common among doctors although many nevertheless recommended treatment for their patients Conclusions A guideline approach to prescribing preventative medication could be against the interests and preferences of the patient. GPs must take extra care to explain what preventative medication is and why it is recommended, attempt to discern preferences and make recommendations balancing these potentially conflicting concerns. PMID:21703010

  17. Errors inducing radiation overdoses.

    PubMed

    Grammaticos, Philip C

    2013-01-01

    There is no doubt that equipments exposing radiation and used for therapeutic purposes should be often checked for possibly administering radiation overdoses to the patients. Technologists, radiation safety officers, radiologists, medical physicists, healthcare providers and administration should take proper care on this issue. "We must be beneficial and not harmful to the patients", according to the Hippocratic doctrine. Cases of radiation overdose are often reported. A series of cases of radiation overdoses have recently been reported. Doctors who were responsible, received heavy punishments. It is much better to prevent than to treat an error or a disease. A Personal Smart Card or Score Card has been suggested for every patient undergoing therapeutic and/or diagnostic procedures by the use of radiation. Taxonomy may also help. PMID:24251304

  18. High-resolution, low-delay, and error-resilient medical ultrasound video communication using H.264/AVC over mobile WiMAX networks.

    PubMed

    Panayides, Andreas; Antoniou, Zinonas C; Mylonas, Yiannos; Pattichis, Marios S; Pitsillides, Andreas; Pattichis, Constantinos S

    2013-05-01

    In this study, we describe an effective video communication framework for the wireless transmission of H.264/AVC medical ultrasound video over mobile WiMAX networks. Medical ultrasound video is encoded using diagnostically-driven, error resilient encoding, where quantization levels are varied as a function of the diagnostic significance of each image region. We demonstrate how our proposed system allows for the transmission of high-resolution clinical video that is encoded at the clinical acquisition resolution and can then be decoded with low-delay. To validate performance, we perform OPNET simulations of mobile WiMAX Medium Access Control (MAC) and Physical (PHY) layers characteristics that include service prioritization classes, different modulation and coding schemes, fading channels conditions, and mobility. We encode the medical ultrasound videos at the 4CIF (704 × 576) resolution that can accommodate clinical acquisition that is typically performed at lower resolutions. Video quality assessment is based on both clinical (subjective) and objective evaluations. PMID:23232416

  19. Nutritional treatment for inborn errors of metabolism: indications, regulations, and availability of medical foods and dietary supplements using phenylketonuria as an example.

    PubMed

    Camp, Kathryn M; Lloyd-Puryear, Michele A; Huntington, Kathleen L

    2012-09-01

    Medical foods and dietary supplements are used to treat rare inborn errors of metabolism (IEM) identified through state-based universal newborn screening. These products are regulated under Food and Drug Administration (FDA) food and dietary supplement statutes. The lack of harmony in terminology used to refer to medical foods and dietary supplements and the misuse of words that imply that FDA regulates these products as drugs have led to confusion. These products are expensive and, although they are used for medical treatment of IEM, third-party payer coverage of these products is inconsistent across the United States. Clinicians and families report termination of coverage in late adolescence, failure to cover treatment during pregnancy, coverage for select conditions only, or no coverage. We describe the indications for specific nutritional treatment products for IEM and their regulation, availability, and categorization. We conclude with a discussion of the problems that have contributed to the paradox of identifying individuals with IEM through newborn screening but not guaranteeing that they receive optimal treatment. Throughout the paper, we use the nutritional treatment of phenylketonuria as an example of IEM treatment. PMID:22854513

  20. Voluntary Medical Male Circumcision for HIV Prevention in Swaziland: Modeling the Impact of Age Targeting

    PubMed Central

    Kripke, Katharine; Okello, Velephi; Maziya, Vusi; Benzerga, Wendy; Mirira, Munamato; Gold, Elizabeth; Schnure, Melissa; Sgaier, Sema; Castor, Delivette; Reed, Jason

    2016-01-01

    Background Voluntary medical male circumcision (VMMC) for HIV prevention has been a priority for Swaziland since 2009. Initially focusing on men ages 15–49, the Ministry of Health reduced the minimum age for VMMC from 15 to 10 years in 2012, given the existing demand among 10- to 15-year-olds. To understand the implications of focusing VMMC service delivery on specific age groups, the MOH undertook a modeling exercise to inform policy and implementation in 2013–2014. Methods and Findings The impact and cost of circumcising specific age groups were assessed using the Decision Makers’ Program Planning Tool, Version 2.0 (DMPPT 2.0), a simple compartmental model. We used age-specific HIV incidence from the Swaziland HIV Incidence Measurement Survey (SHIMS). Population, mortality, births, and HIV prevalence were imported from a national Spectrum/Goals model recently updated in consultation with country stakeholders. Baseline male circumcision prevalence was derived from the most recent Swaziland Demographic and Health Survey. The lowest numbers of VMMCs per HIV infection averted are achieved when males ages 15–19, 20–24, 25–29, and 30–34 are circumcised, although the uncertainty bounds for the estimates overlap. Circumcising males ages 25–29 and 20–24 provides the most immediate reduction in HIV incidence. Circumcising males ages 15–19, 20–24, and 25–29 provides the greatest magnitude incidence reduction within 15 years. The lowest cost per HIV infection averted is achieved by circumcising males ages 15–34: $870 U.S. dollars (USD). Conclusions The potential impact, cost, and cost-effectiveness of VMMC scale-up in Swaziland are not uniform. They vary by the age group of males circumcised. Based on the results of this modeling exercise, the Ministry of Health’s Swaziland Male Circumcision Strategic and Operational Plan 2014–2018 adopted an implementation strategy that calls for circumcision to be scaled up to 50% coverage for neonates, 80

  1. Prevention of blindness from glaucoma using the King's College Hospital computerized problem orientated medical record.

    PubMed Central

    Crick, R. P.

    1975-01-01

    (1) Chronic glaucoma accounts for a high proportion of blindness which is preventable and calls for energetic action because existing knowledge is not applied as it should be because of the indifference of the Department of Health and Social Security to the glaucoma problem. (2) The condition is frequently insidious and advanced before being identified, and requires life-long supervision. (3) When diagnosed, the management of glaucoma is frequently inadequate and intermittent for a variety of reasons. (4) AtKing's College Hospital, a Glaucoma Centre has been initiated to supervise accurately and regularly a large number of glaucoma patients, assisted by numerical recording and computer analysis. While we are fortunate in having a computer in the hospital, it is important to emphasize that the system can be operated without this facility, either by employing manual methods, or by batch processing. It would be both possible and desirable to organize recording a nd analysis on a regional basis in collaboration with hospitals wishing to participiate. (5) Attempts are being made to improve the early diagnosis ofglaucoma by better communication between the hospital ophthalmologists, and other members of the medical, optical, and ancillary professions by lectures, demonstrations, and publications. (6) Research is always hampered by the absence of factual knowledge. It is planned to use fully the opportunity for research into glaucoma made possible by this basic organization. At present however, we consider it more important to carry out investigations into the problems of organizing the investigation, treatment, and follow-up of glaucoma patients than t o embark on a few individual projects of research. We are serously hampered in our work by shortage of funds for staff and facilities, but we look forward confidently to the time when, with the essential support of the Department of Health, these methods will give us access to the facts of glaucoma, which besides enabling

  2. Reducing Medication Costs to Prevent Cardiovascular Disease: A Community Guide Systematic Review

    PubMed Central

    Finnie, Ramona K.C.; Acharya, Sushama D.; Jacob, Verughese; Proia, Krista K.; Hopkins, David P.; Pronk, Nicolaas P.; Goetzel, Ron Z.; Kottke, Thomas E.; Rask, Kimberly J.; Lackland, Daniel T.; Braun, Lynne T.

    2015-01-01

    Introduction Hypertension and hyperlipidemia are major cardiovascular disease risk factors. To modify them, patients often need to adopt healthier lifestyles and adhere to prescribed medications. However, patients’ adherence to recommended treatments has been suboptimal. Reducing out-of-pocket costs (ROPC) to patients may improve medication adherence and consequently improve health outcomes. This Community Guide systematic review examined the effectiveness of ROPC for medications prescribed for patients with hypertension and hyperlipidemia. Methods We assessed effectiveness and economics of ROPC for medications to treat hypertension, hyperlipidemia, or both. Per Community Guide review methods, reviewers identified, evaluated, and summarized available evidence published from January 1980 through July 2015. Results Eighteen studies were included in the analysis. ROPC interventions resulted in increased medication adherence for patients taking blood pressure and cholesterol medications by a median of 3.0 percentage points; proportion achieving 80% adherence to medication increased by 5.1 percentage points. Blood pressure and cholesterol outcomes also improved. Nine studies were included in the economic review, with a median intervention cost of $172 per person per year and a median change in health care cost of −$127 per person per year. Conclusion ROPC for medications to treat hypertension and hyperlipidemia is effective in increasing medication adherence, and, thus, improving blood pressure and cholesterol outcomes. Most ROPC interventions are implemented in combination with evidence-based health care interventions such as team-based care with medication counseling. An overall conclusion about the economics of the intervention could not be reached with the small body of inconsistent cost-benefit evidence. PMID:26605708

  3. The Rtt109 histone acetyltransferase facilitates error-free replication to prevent CAG/CTG repeat contractions

    PubMed Central

    Yang, Jiahui H.; Freudenreich, Catherine H.

    2010-01-01

    Lysine 56 is acetylated on newly synthesized histone H3 in yeast, Drosophila and mammalian cells. All of the proteins involved in histone H3 lysine 56 (H3K56) acetylation are important for maintaining genome integrity. These include Rtt109, a histone acetyltransferase, responsible for acetylating H3K56, Asf1, a histone H3/H4 chaperone, and Hst3 and Hst4, histone deacetylases which remove the acetyl group from H3K56. Here we demonstrate a new role for Rtt109 and H3K56 acetylation in maintaining repetitive DNA sequences in Saccharomyces cerevisiae. We found that cells lacking RTT109 had a high level of CAG/CTG repeat contractions and a two-fold increase in breakage at CAG/CTG repeats. In addition, repeat contractions were significantly increased in cells lacking ASF1 and in an hst3Δhst4Δ double mutant. Because the Rtt107/Rtt101 complex was previously shown to be recruited to stalled replication forks in an Rtt109-dependent manner, we tested whether this complex was involved. However, contractions in rtt109Δ cells were not due to an inability to recruit the Rtt107/Rtt101 complex to repeats, as absence of these proteins had no effect on repeat stability. On the other hand, Dnl4 and Rad51-dependent pathways did play a role in creating some of the repeat contractions in rtt109Δ cells. Our results show that H3K56 acetylation by Rtt109 is important for stabilizing DNA repeats, likely by facilitating proper nucleosome assembly at the replication fork to prevent DNA structure formation and subsequent slippage events or fork breakage. PMID:20083442

  4. Prevention

    MedlinePlus

    ... Prevention Treatment 2003 U.S. Outbreak African Rodent Importation Ban For Clinicians Clinical Recognition Specimen Collection Treatment Smallpox ... Examining Animals with Suspected Monkeypox African Rodent Importation Ban Resources Related Links Poxvirus Molluscum Contagiosum Orf Virus ( ...

  5. Prevalence, nature and potential preventability of adverse drug events – a population-based medical record study of 4970 adults

    PubMed Central

    Hakkarainen, Katja M; Gyllensten, Hanna; Jönsson, Anna K; Andersson Sundell, Karolina; Petzold, Max; Hägg, Staffan

    2014-01-01

    Aims To estimate the 3 month prevalence of adverse drug events (ADEs), categories of ADEs and preventable ADEs, and the preventability of ADEs among adults in Sweden. Further, to identify drug classes and organ systems associated with ADEs and estimate their seriousness. Methods A random sample of 5025 adults in a Swedish county council in 2008 was drawn from the Total Population Register. All their medical records in 29 inpatient care departments in three hospitals, 110 specialized outpatient clinics and 51 primary care units were reviewed retrospectively in a stepwise manner, and complemented with register data on dispensed drugs. ADEs, including adverse drug reactions (ADRs), sub-therapeutic effects of drug therapy (STEs), drug dependence and abuse, drug intoxications from overdose, and morbidities due to drug-related untreated indication, were detected during a 3 month study period, and assessed for preventability. Results Among 4970 included individuals, the prevalence of ADEs was 12.0% (95% confidence interval (CI) 11.1, 12.9%), and preventable ADEs 5.6% (95% CI 5.0, 6.2%). ADRs (6.9%; 95% CI 6.2, 7.6%) and STEs (6.4%; 95% CI 5.8, 7.1%) were more prevalent than the other ADEs. Of the ADEs, 38.8% (95% CI 35.8–41.9%) was preventable, varying by ADE category and seriousness. ADEs were frequently associated with nervous system and cardiovascular drugs, but the associated drugs and affected organs varied by ADE category. Conclusions The considerable burden of ADEs and preventable ADEs from commonly used drugs across care settings warrants large-scale efforts to redesign safer, higher quality healthcare systems. The heterogeneous nature of the ADE categories should be considered in research and clinical practice for preventing, detecting and mitigating ADEs. PMID:24372506

  6. Sustainable medical research by effective and comprehensive medical skills: overcoming the frontiers by predictive, preventive and personalized medicine

    PubMed Central

    2014-01-01

    Background Clinical research and practice require affordable objectives, sustainable tools, rewarding training strategies and meaningful collaboration. Method Our unit delivers courses on project design and management promoting ideas, useful skills, teaching and exploring implementation of networks and existing collaborations. We investigated the effectiveness of a sustainable approach of comprehensive diagnosis and care and its usefulness within concrete models of research project teaching methodology. Results The model of predictive, preventive and personalized medicine (PPPM) of adolescent hypertension, developed since 1976 and still active, was displayed. This is a paradigm of comprehensive PPPM aimed at the management of a recognized, but actually neglected, societal and clinical problem. The second model was addressed to the analysis of performance of an outpatient diagnostic and therapy unit and its relationship with the emergency department. Part of the patients, 4,057 cancer patients presenting at the emergency care, were addressed to the outpatient diagnostic and therapy unit for further assessment, treatment and follow-up. The stay in DH was 6.3 ± 2.1 non-consecutive days, with shortage of costs, vs. in-hospital stays. Research planning courses, based on these models, ensued in an increase of competitive project submission and successful funding. Discussion Active promotion of interdisciplinary knowledge and skills is warranted. Misleading messages and information are detrimental not only to healthy and sick people but, equally, to all health professionals: efforts for basing on evidence by research any statement are needed. The actual pre-requisite of personalized medicine is the coherent and articulated promotion of the professional quality of staff. Health professionals should and can be skilled in sustainable non-invasive diagnostic procedures, in non-pharmacological intervention, in translational research (from epidemiology to personalized

  7. Preventing Medical Noncompliance in the Outpatient Treatment of Bipolar Affective Disorders.

    ERIC Educational Resources Information Center

    Cochran, Susan D.

    1984-01-01

    Evaluated the efficacy of a preventive compliance intervention based on cognitive therapy principles with newly admitted lithium outpatients (N=28). Results indicated that the intervention significantly enhanced compliance at both postintervention and 6-month follow-up assessment. (LLL)

  8. Normal vitamin D levels and bone mineral density among children with inborn errors of metabolism consuming medical food-based diets.

    PubMed

    Geiger, Katie E; Koeller, David M; Harding, Cary O; Huntington, Kathleen L; Gillingham, Melanie B

    2016-01-01

    A higher incidence of osteopenia is observed among children with inherited metabolic disorders (inborn errors of metabolism, or IEMs) who consume medical food-based diets that restrict natural vitamin D-containing food sources. We evaluated the vitamin D status of children with IEMs who live in the Pacific Northwest with limited sun exposure and determined whether bone mineral density (BMD) in children with phenylketonuria (PKU), the most common IEM, correlated with diet or biochemical markers of bone metabolism. We hypothesized that children with IEMs would have lower serum vitamin D concentrations than controls and that some children with PKU would have reduced bone mineralization. A retrospective record review of 88 patients with IEMs, and 445 children on unrestricted diets (controls) found the 25-hydroxyvitamin D concentrations were normal and not significantly different between groups (IEM patients, 27.1 ± 10.9; controls, 27.6 ± 11.2). Normal BMD at the hip or spine (-2 medical food-based diets supports normal 25-hydroxyvitamin D levels and BMD in children with IEMs, including PKU. The risk of vitamin D deficiency among patients consuming a medical food-based diet is similar to the general population. PMID:26773786

  9. Medications

    MedlinePlus

    ... involve the use of estrogen alone or estrogen plus progestin. For women with heart disease, estrogen alone will not prevent heart attacks, and estrogen plus progestin increases the risk for heart attack during ...

  10. Review article: Medical decision models of Helicobacter pylori therapy to prevent gastric cancer.

    PubMed

    Sonnenberg, A; Inadomi, J M

    1998-02-01

    The aim of the present article is to study the utility of Helicobacter pylori eradication programmes in decreasing the incidence of gastric cancer. Three types of decision models are employed to pursue this aim, i.e. decision tree, present value, and declining exponential approximation of life expectancy (DEALE). 1) A decision tree allows one to model the interaction of multiple variables in great detail and to calculate the marginal cost, as well as the marginal cost-benefit ratio, of a preventive strategy. The cost of gastric cancer, the efficacy of H. pylori therapy in preventing cancer, and the cumulative probability of developing gastric cancer exert the largest influence on the marginal cost of cancer prevention. The high cost of future gastric cancer and a high efficacy of therapy make screening for H. pylori and its eradication the preferred strategy. 2) The present value is an economic method to adjust future costs or benefits to their current value using a discount rate and the length of time between now and a given time point in the future. It accounts for the depreciation of money and all material values over time. During childhood, the present value of future gastric cancer is very low. Vaccination of children to prevent gastric cancer would need to be very inexpensive to be practicable. Cancer prevention becomes a feasible option, only if the time period between the preventive measures and the occurrence of gastric cancer can be made relatively short. 3) The DEALE provides a means to calculate the increase in life expectancy that would occur, if death from a particular disease became preventable. Life expectancy of the general population is hardly affected by gastric cancer. For life expectancy to increase appreciably by vaccination or antibiotic therapy directed against H. pylori infection, these interventions would need to be focused towards a sub-population with an a priori high risk for gastric cancer. PMID:9701008

  11. [Compatibility of intravenous medications needs attention. Catheter occlusion, treatment failure and embolisms can be prevented].

    PubMed

    Colldén, Hannah; Teimori, Kaveh; Asadian, Reza

    2015-01-01

    When dealing with more drugs than available lumens, intravenous medications need to be co-administered in the same catheter. This type of scenario may induce therapeutic risks, such as catheter occlusion, changes in drug effect or embolization of precipitated particles. Various sources are available to provide information on compatibilities of intravenous medications. When using these sources, the applicability of the information must be assessed, comparing concentrations, diluents used and other pharmaceutical aspects. For the last three years, a group of pharmacists at Sahlgrenska University Hospital has worked on a project collecting and validating compatibility data for intravenous medications. In the future, this data will be available to more hospitals in Sweden. PMID:26556450

  12. Traditional, complementary and alternative medical systems and their contribution to personalisation, prediction and prevention in medicine—person-centred medicine

    PubMed Central

    2012-01-01

    Traditional, complementary and alternative medical (TCAM) systems contribute to the foundation of person-centred medicine (PCM), an epistemological orientation for medical science which places the person as a physical, psychological and spiritual entity at the centre of health care and of the therapeutic process. PCM wishes to broaden the bio-molecular reductionistic approach of medical science towards an integration that allows people, doctors, nurses, health-care professionals and patients to become the real protagonists of the health-care scene. The doctor or caregiver needs to act out of empathy to meet the unique value of each human being, which unfolds over the course of a lifetime from conception to natural death. Knowledge of the human being should not be instrumental to economic or political interests, ideology, theories or religious dogma. Research needs to be broadened with methodological tools to investigate person-centred medical interventions. Salutogenesis is a fundamental principle of PCM, promoting health and preventing illness by strengthening the individual's self-healing abilities. TCAM systems also give tools to predict the insurgence of illness and treat it before the appearance of overt organic disease. A task of PCM is to educate people to take better care of their physical, psychological and spiritual health. Health-care education needs to be broadened to give doctors and health-care workers of the future the tools to act in innovative and highly differentiated ways, always guided by deep respect for individual autonomy, personal culture, religion and beliefs. PMID:23126628

  13. Traditional, complementary and alternative medical systems and their contribution to personalisation, prediction and prevention in medicine-person-centred medicine.

    PubMed

    Roberti di Sarsina, Paolo; Alivia, Mauro; Guadagni, Paola

    2012-01-01

    Traditional, complementary and alternative medical (TCAM) systems contribute to the foundation of person-centred medicine (PCM), an epistemological orientation for medical science which places the person as a physical, psychological and spiritual entity at the centre of health care and of the therapeutic process. PCM wishes to broaden the bio-molecular reductionistic approach of medical science towards an integration that allows people, doctors, nurses, health-care professionals and patients to become the real protagonists of the health-care scene. The doctor or caregiver needs to act out of empathy to meet the unique value of each human being, which unfolds over the course of a lifetime from conception to natural death. Knowledge of the human being should not be instrumental to economic or political interests, ideology, theories or religious dogma. Research needs to be broadened with methodological tools to investigate person-centred medical interventions. Salutogenesis is a fundamental principle of PCM, promoting health and preventing illness by strengthening the individual's self-healing abilities. TCAM systems also give tools to predict the insurgence of illness and treat it before the appearance of overt organic disease. A task of PCM is to educate people to take better care of their physical, psychological and spiritual health. Health-care education needs to be broadened to give doctors and health-care workers of the future the tools to act in innovative and highly differentiated ways, always guided by deep respect for individual autonomy, personal culture, religion and beliefs. PMID:23126628

  14. Multifaceted Intervention to Prevent Venous Thromboembolism in Patients Hospitalized for Acute Medical Illness: A Multicenter Cluster-Randomized Trial

    PubMed Central

    Roy, Pierre-Marie; Rachas, Antoine; Meyer, Guy; Le Gal, Grégoire; Durieux, Pierre; El Kouri, Dominique; Honnart, Didier; Schmidt, Jeannot; Legall, Catherine; Hausfater, Pierre; Chrétien, Jean-Marie; Mottier, Dominique

    2016-01-01

    Background Misuse of thromboprophylaxis may increase preventable complications for hospitalized medical patients. Objectives To assess the net clinical benefit of a multifaceted intervention in emergency wards (educational lectures, posters, pocket cards, computerized clinical decision support systems and, where feasible, electronic reminders) for the prevention of venous thromboembolism. Patients/Methods Prospective cluster-randomized trial in 27 hospitals. After a pre-intervention period, centers were randomized as either intervention (n = 13) or control (n = 14). All patients over 40 years old, admitted to the emergency room, and hospitalized in a medical ward were included, totaling 1,402 (712 intervention and 690 control) and 15,351 (8,359 intervention and 6,992 control) in the pre-intervention and intervention periods, respectively. Results Symptomatic venous thromboembolism or major bleeding (primary outcome) occurred at 3 months in 3.1% and 3.2% of patients in the intervention and control groups, respectively (adjusted odds ratio: 1.02 [95% confidence interval: 0.78–1.34]). The rates of thromboembolism (1.9% vs. 1.9%), major bleedings (1.2% vs. 1.3%), and mortality (11.3% vs. 11.1%) did not differ between the groups. Between the pre-intervention and intervention periods, the proportion of patients who received prophylactic anticoagulant treatment more steeply increased in the intervention group (from 35.0% to 48.2%: +13.2%) than the control (40.7% to 44.1%: +3.4%), while the rate of adequate thromboprophylaxis remained stable in both groups (52.4% to 50.9%: -1.5%; 49.1% to 48.8%: -0.3%). Conclusions Our intervention neither improved adequate prophylaxis nor reduced the rates of clinical events. New strategies are required to improve thromboembolism prevention for hospitalized medical patients. Trial Registration ClinicalTrials.gov NCT01212393 PMID:27227406

  15. Honey Bee Swarms Aboard the USNS Comfort: Recommendations for Sting Prevention, Swarm Removal, and Medical Readiness on Military Ships.

    PubMed

    Dunford, James C; Kronmann, Karl C; Peet, Luke R; Stancil, Jeffrey D

    2016-01-01

    The article provides observations of multiple honey bee (Apis mellifera) swarms aboard the USNS Comfort (TAH-20) during the Continuing Promise 2015 mission. A brief overview of swarming biology is given along with control/removal recommendations to reduce sting exposures. The observations suggest that preventive medicine personnel should provide adequate risk communications about the potential occurrence of bee swarms aboard military ships, and medical department personnel should be prepared for the possibility of treating of multiple sting exposures, especially in the Southern Command Area of Operations where the Africanized genotype of A mellifera is common. PMID:27613207

  16. Peer-led Stress Prevention Seminars in the First Year of Medical School – A Project Report

    PubMed Central

    Bugaj, Till Johannes; Mücksch, Christine; Schmid, Carolin; Junne, Florian; Erschens, Rebecca; Herzog, Wolfgang; Nikendei, Christoph

    2016-01-01

    Introduction: From the beginning of the first year of medical studies, increased psychological stress and elevated burnout prevalence rates can be registered compared to sample populations. Characterized by learning “on an equal footing”, the principle of peer-assisted learning (PAL) is widely used in medical education. This report aims to showcase the development and evaluation of peer-led stress prevention seminars for first year medical students after one year of implementation. Project description: With each of the three sessions lasting 90 min., the stress prevention seminars took place in small groups (6-10 students) in the period from November 2013 to January 2014 and from November 2014 to December 2014 at the Medical Faculty of Heidelberg. Led by trained peers, the seminar content ranged from psycho-educational elements, i.e. time management strategy development and test anxiety assistance, to relaxation techniques. All seminar sessions were evaluated via questionnaire. All questions were answered on a Likert scale ranging from 1 to 7 (1=strongly agree; 7=strongly disagree). Results: 75 students consented to participate in seminars (65% female; aged 20.5±3.3 years). The series of seminars was averagely given the school grade of 1.2±0.4 (1=very good to 6=unsatisfactory) in WS 2013/14 and 1.5±0.5 in the following year and the peer tutors’ competence was evaluated as very high (1.4 to 1.5 approval rate on the Likert scale). Discussion: The seminar sessions’ importance to the students is underlined by their very positive evaluations. This offer seems to have benefited students especially during the demanding transitional phase at the start of their studies. Both the implementation of the preventive measure at an early stage as well as the use of PAL seem to have proven effective. Conclusion: PAL seems to be effective in the field of stress prevention. However, specific efficacy studies are still lacking. PMID:26958651

  17. Novel Approaches to the Diagnosis, Prevention and Treatment of Medical Device-Associated Infections

    PubMed Central

    Vergidis, Paschalis; Patel, Robin

    2011-01-01

    Synopsis The pathogenesis of device-associated infections is related to biofilm bacteria that exhibit distinct characteristics with respect to growth rate, structural features, and protection from host immune mechanisms when compared to planktonic counterparts. Biofilm-associated infections are prevented, diagnosed and treated differently than infections not associated with biofilms. This article reviews innovative concepts for the prevention of biofilm formation, such as use of antisense molecules, quorum-sensing inhibitors, and bacteriophages, and novel approaches for treatment, such as enhancement of antimicrobial activity against biofilm bacteria by use of electric current or ultrasound. Specific approaches for the diagnosis and prevention of catheter-associated urinary tract and bloodstream infections, infections associated with orthopedic implants, and cardiovascular implantable electronic devices, are also discussed. PMID:22284383

  18. Improving Breast Cancer Preventive Behavior among Female Medical Staff: The Use of Educational Intervention based on Health Belief Model

    PubMed Central

    TORBAGHAN, Ameneh Eskandari-; FARMANFARMA, Khadijah Kalan-; MOGHADDAM, Alireza Ansari-; ZAREI, Zahra

    2014-01-01

    Background: Breast cancer is one of the most common types of cancer prevalent among women worldwide. Preventive behaviors such as early diagnosis through screening tests play an important role in prevention and control of the disease. This study aimed to determine the effects of educational intervention using a health belief model on breast cancer preventive behaviors. Methods: This interventional study was conducted on 130 female employees of Zahedan University of Medical Sciences who were randomly divided into intervention and control groups. A questionnaire, made and validated by the researcher, was completed before and one month after training by the study subjects. Data were analysed using regression analysis, independent sample T-test, chi-square and Pearson’s correlation coefficient using the SPSS software 18. Results: There were significant changes in the training group, following educational intervention in the awareness construct and in some constructs of the model including perceived susceptibility, perceived benefits, and perceived barriers, as well as in practice compared to the control group (P < 0.05). Nevertheless, perceived barriers remained as the only predictor in the model, such that for every unit increase in this variable, the behavior score increased by 18%. Conclusion: The use of educational intervention based on Health Belief Model had positive effect on knowledge of breast cancer preventive behaviors among participants. PMID:25977633

  19. A Cognitive Approach to Child Mistreatment Prevention among Medically At-Risk Infants

    ERIC Educational Resources Information Center

    Bugental, Daphne Blunt; Schwartz, Alex

    2009-01-01

    The authors assessed the effectiveness of a home visitation program in enhancing the early parenting history of infants born at medical risk--a population that is at risk for mistreatment. A randomized clinical trial design was used to compare the effects of a cognitively based extension of the Healthy Start home visitation program (HV+) with a…

  20. Similar Secondary Stroke Prevention and Medication Persistence Rates among Rural and Urban Patients

    ERIC Educational Resources Information Center

    Rodriguez, Daniel; Cox, Margueritte; Zimmer, Louise O.; Olson, DaiWai M.; Goldstein, Larry B.; Drew, Laura; Peterson, Eric D.; Bushnell, Cheryl D.

    2011-01-01

    Purpose: Rural residents are less likely to obtain optimal care for many serious conditions and have poorer health outcomes than those residing in more urban areas. We determined whether rural vs urban residence affected postdischarge medication persistence and 1 year outcomes after stroke. Methods: The Adherence eValuation After Ischemic…

  1. Applying Medical Anthropology: Developing Diabetes Education and Prevention Programs in American Indian Cultures.

    ERIC Educational Resources Information Center

    Olson, Brooke

    1999-01-01

    Medical anthropology provides a broader contextual framework for understanding complex causal factors associated with diabetes among American Indians and how to minimize these factors in education/treatment programs. Discusses historical, epidemiological, and genetic considerations in American Indian diabetes; cultural factors related to foods,…

  2. Cigarette Smoking among Medical Students in China and Modifiable Risk Factors for Smoking Prevention

    ERIC Educational Resources Information Center

    Chen, Xinguang; Tang, Xiaolan; Stanton, Bonita; Li, Hanwu; Chen, Weiqing

    2012-01-01

    Purpose: The reduction of tobacco use among medical students is a potentially powerful strategy to reduce tobacco use among future health professionals, who in turn, can have significant impact on tobacco use among patients as well as the general population in China. The goal of this study is to update information on the prevalence of cigarette…

  3. [Medical and biological assessment of preventive drinks use among workers exposed to adverse working conditions].

    PubMed

    Nikanov, A N; Markova, O L; Frolova, N M; Kulikova, K S

    2013-01-01

    Studies on the assessment of the effect of treatment-and-preventive drinks, i.e. "Leovit" dietary kissels, and "Zosterin-Ultra" biologically active food additive, on copper, nickel and cobalt ion concentrations in urine and on lead blood concentrations in workers employed at the "Kola Mining Company" limited liability joint-stock company and exposed to long-term metal aerosol effects, were carried out. Dependence of ion concentrations of these metals in biological media on exposure duration was reported. The study findings reveal the advisability of use of the above-mentioned food additives, having detoxication properties, while carrying out preventive measures among workers exposed to heavy metals. PMID:24340762

  4. A Quantitative Analysis of the Effect of Simulation on Medication Administration in Nursing Students

    ERIC Educational Resources Information Center

    Scudmore, Casey

    2013-01-01

    Medication errors are a leading cause of injury and death in health care, and nurses are the last line of defense for patient safety. Nursing educators must develop curriculum to effectively teach nursing students to prevent medication errors and protect the public. The purpose of this quantitative, quasi-experimental study was to determine if…

  5. Integrating Prevention Education into the Medical School Curriculum: The Role of Departments of Family Medicine.

    ERIC Educational Resources Information Center

    Stine, Curtis; Kohrs, Francis P.; Little, David N.; Kaprielian, Victoria; Gatipon, Betty B.; Haq, Cynthia

    2000-01-01

    Discusses the role of departments of family medicine in teaching preventive medicine through required clinical experiences, required nonclinical courses, electives, collaborative interdisciplinary clerkships, and interdisciplinary nonclinical courses. Offers examples of innovative programs at the Universities of Michigan, Wisconsin, Vermont,…

  6. Scope and Limits of Medical Discourse Concerning AIDS Prevention--Rationale and Preliminary Findings.

    ERIC Educational Resources Information Center

    Singy, Pascal; Guex, Patrice

    1997-01-01

    Reports on a preliminary stage of a project funded by the Federal Office of Public Health in Switzerland to gain insights into physician-patient communication regarding Acquired Immune Deficiency Syndrome (AIDS) and apply findings to their teaching programs. Particular focus is on aspects of communication relating to primary prevention of HIV and…

  7. Preventing Healthcare-Associated Infections by Monitoring the Cleanliness of Medical Devices and Other Critical Points in a Sterilization Service.

    PubMed

    Veiga-Malta, Isabel

    2016-04-01

    It is well known that the common goal of all central sterile supply departments (CSSDs) is to prevent healthcare-associated infections. Such infections entail high costs to society, not only economic but also social. Therefore, delivering safe medical devices and guaranteeing a positive contribution to the control of healthcare-associated infections form the main responsibilities of a CSSD. The monitoring of the effectiveness of medical device cleaning processes is highly recommended. However, ensuring a flawless environment for the preparation, assembly, and packaging of medical devices and clean handling of sterilized items is crucial to achieving the goal of safe medical devices. This study analyzed not only the cleanliness of surgical instruments but also two critical aspects of the surrounding environment: the cleanliness of work surfaces and the cleanliness of workers' hands. To evaluate the cleanliness of surgical instruments, two methods were used: the adenosine triphosphate (ATP) detection method and a residual protein test. It was not the intention of this work to make an exhaustive comparison of these methods. The ATP bioluminescence method was also used for monitoring the cleanliness of work surfaces and workers' hands. The aims of this study were to establish the most suitable method of evaluating the cleanliness of reusable medical devices in the CSSD and to assess the quality of the environment. Assessing the surgical instruments, work surfaces, and staff hands for cleanliness allowed the identification of possible contamination sources and to correct them by improving cleaning/disinfection protocols. Furthermore, the use of ATP monitoring tests of workers' hands highlighted the importance of staff compliance with good practice guidelines. Thus, these results have a positive impact on the CSSD quality system and, consequently, on patient safety. PMID:27100075

  8. Preventing Drug Errors in Children

    MedlinePlus

    ... can help you protect your child from potential harm. The links below provide some of ISMP’s expert ... Newsletter for Consumers Consumer Alerts Home | Contact Us | Employment | Legal Notices | Privacy Policy | Help Support ISMP Med- ...

  9. Partnerships between the faith-based and medical sectors: Implications for preventive medicine and public health.

    PubMed

    Levin, Jeff

    2016-12-01

    Interconnections between the faith-based and medical sectors are multifaceted and have existed for centuries, including partnerships that have evolved over the past several decades in the U.S. This paper outlines ten points of intersection that have engaged medical and healthcare professionals and institutions across specialties, focusing especially on primary care, global health, and community-based outreach to underserved populations. In a time of healthcare resource scarcity, such partnerships-involving religious congregations, denominations, and communal and philanthropic agencies-are useful complements to the work of private-sector medical care providers and of federal, state, and local public health institutions in their efforts to protect and maintain the health of the population. At the same time, challenges and obstacles remain, mostly related to negotiating the complex and contentious relations between these two sectors. This paper identifies pressing legal/constitutional, political/policy, professional/jurisdictional, ethical, and research and evaluation issues that need to be better addressed before this work can realize its full potential. PMID:27512649

  10. The design and rationale for the Acute Medically Ill Venous Thromboembolism Prevention with Extended Duration Betrixaban (APEX) study.

    PubMed

    Cohen, Alexander T; Harrington, Robert; Goldhaber, Samuel Z; Hull, Russell; Gibson, C Michael; Hernandez, Adrian F; Kitt, Michael M; Lorenz, Todd J

    2014-03-01

    Randomized clinical trials have identified a population of acute medically ill patients who remain at risk for venous thromboembolism (VTE) beyond the standard duration of therapy and hospital discharge. The aim of the APEX study is to determine whether extended administration of oral betrixaban (35-42 days) is superior to a standard short course of prophylaxis with subcutaneous enoxaparin (10 ± 4 days followed by placebo) in patients with known risk factors for post-discharge VTE. Patients initially are randomized to receive either betrixaban or enoxaparin (and matching placebo) in a double dummy design. Following a standard duration period of enoxaparin treatment (with placebo tablets) or betrixaban (with placebo injections), patients receive only betrixaban (or alternative matching placebo). Patients are considered for enrollment if they are older than 40 years, have a specified medical illness, and restricted mobility. They must also meet the APEX criteria for increased VTE risk (aged ≥75 years, baseline D-Dimer ≥2× upper the limit of "normal", or 2 additional ancillary risk factors for VTE). The primary efficacy end point is the composite of asymptomatic proximal deep venous thrombosis, symptomatic deep venous thrombosis, non-fatal (pulmonary embolus) pulmonary embolism, or VTE-related death through day 35. The primary safety outcome is the occurrence of major bleeding. We hypothesize that extended duration betrixaban VTE prophylaxis will be safe and more effective than standard short duration enoxaparin in preventing VTE in acute medically ill patients with known risk factors for post hospital discharge VTE. PMID:24576517

  11. Reducing stillbirths: prevention and management of medical disorders and infections during pregnancy

    PubMed Central

    Menezes, Esme V; Yakoob, Mohammad Yawar; Soomro, Tanya; Haws, Rachel A; Darmstadt, Gary L; Bhutta, Zulfiqar A

    2009-01-01

    Background An estimated two-thirds of the world's 3.2 million stillbirths occur antenatally, prior to labour, and are often overlooked in policy and programs. Poorly recognised, untreated or inadequately treated maternal infections such as syphilis and malaria, and maternal conditions including hypertensive disorders, are known risk factors for stillbirth. Methods We undertook a systematic review of the evidence for 16 antenatal interventions with the potential to prevent stillbirths. We searched a range of sources including PubMed and the Cochrane Library. For interventions with prior Cochrane reviews, we conducted additional meta-analyses including eligible newer randomised controlled trials following the Cochrane protocol. We focused on interventions deliverable at the community level in low-/middle-income countries, where the burden of stillbirths is greatest. Results Few of the studies we included reported stillbirth as an outcome; most that did were underpowered to assess this outcome. While Cochrane reviews or meta-analyses were available for many interventions, few focused on stillbirth or perinatal mortality as outcomes, and evidence was frequently conflicting. Several interventions showed clear evidence of impact on stillbirths, including heparin therapy for certain maternal indications; syphilis screening and treatment; and insecticide-treated bed nets for prevention of malaria. Other interventions, such as management of obstetric intrahepatic cholestasis, maternal anti-helminthic treatment, and intermittent preventive treatment of malaria, showed promising impact on stillbirth rates but require confirmatory studies. Several interventions reduced known risk factors for stillbirth (e.g., anti-hypertensive drugs for chronic hypertension), yet failed to show statistically significant impact on stillbirth or perinatal mortality rates. Periodontal disease emerged as a clear risk factor for stillbirth but no interventions have reduced stillbirth rates

  12. 20th-Century “medical Marco Polos” in the origins of preventive cardiology and cardiovascular disease epidemiology.

    PubMed

    Blackburn, Henry

    2012-03-01

    In mid-20th century, several streams of knowledge converged to create the new academic discipline of cardiovascular disease epidemiology and the new practice of preventive cardiology. One stream was modern cardiology, with the ability to diagnose myocardial infarction, to characterize and count its victims, and to report vital statistics on cardiovascular causes of death. Another stream came from burgeoning clinical and laboratory research and greater understanding of the underlying processes of atherosclerosis and hypertension. A third stream came from the observations of intellectually curious "medical Marco Polos," who brought back from travels their tales of unusual population frequencies of heart attacks, along with ideas about sociocultural causes. This led to more formal research about cardiovascular disease risk and causes among populations and about mechanisms in the clinic and laboratory. The broad river of investigation thus formed produced a risk paradigm of the multiple biologic, behavioral, and societal factors in causal pathways to the common cardiovascular diseases. An evidence base was built for sound clinical and public health approaches to prevention. Here, the author tells brief stories about 5 early and particularly observant world travelers and their influence on knowledge and thinking about prevention. PMID:22470931

  13. Using intervention mapping to develop and adapt a secondary stroke prevention program in Veterans Health Administration medical centers

    PubMed Central

    2010-01-01

    Secondary stroke prevention is championed by the stroke guidelines; however, it is rarely systematically delivered. We sought to develop a locally tailored, evidence-based secondary stroke prevention program. The purpose of this paper was to apply intervention mapping (IM) to develop our locally tailored stroke prevention program and implementation plan. We completed a needs assessment and the five Steps of IM. The needs assessment included semi-structured interviews of 45 providers; 26 in Indianapolis and 19 in Houston. We queried frontline clinical providers of stroke care using structured interviews on the following topics: current provider practices in secondary stroke risk factor management; barriers and needs to support risk factor management; and suggestions on how to enhance secondary stroke risk factor management throughout the continuum of care. We then describe how we incorporated each of the five Steps of IM to develop locally tailored programs at two sites that will be evaluated through surveys for patient outcomes, and medical records chart abstraction for processes of care. PMID:21159171

  14. Maternal Medication and Herbal Use and Risk for Hypospadias: Data from the National Birth Defects Prevention Study, 1997--2007

    PubMed Central

    Lind, Jennifer N.; Tinker, Sarah C.; Broussard, Cheryl S.; Reefhuis, Jennita; Carmichael, Suzan L.; Honein, Margaret A.; Olney, Richard S.; Parker, Samantha E.; Werler, Martha M.

    2014-01-01

    Purpose Investigate associations between maternal use of common medications and herbals during early pregnancy and risk for hypospadias in male infants. Methods We used data from the National Birth Defects Prevention Study, a multi-site, population-based, case-control study. We analyzed data from 1,537 infants with second-or third-degree isolated hypospadias and 4,314 liveborn male control infants without major birth defects, with estimated dates of delivery from 1997–2007. Exposure was reported use of prescription or over-the-counter medications or herbal products, from 1 month before to 4 months after conception. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were estimated using multivariable logistic regression, adjusting for maternal age, race/ethnicity, education, pre-pregnancy BMI, previous live births, maternal sub-fertility, study site, and year. Results We assessed 64 medication and 24 herbal components. Maternal uses of most components were not associated with an increased risk of hypospadias. Two new associations were observed for venlafaxine (aOR 2.4; 95% CI 1.0, 6.0) and progestin only oral contraceptives (aOR 1.9, 95% CI 1.1, 3.2). The previously reported association for clomiphene citrate was confirmed (aOR 1.9, 95% CI 1.2, 3.0). Numbers were relatively small for exposure to other specific patterns of fertility agents, but elevated aORs were observed for the most common of them. Conclusions Overall, findings were reassuring that hypospadias is not associated with most medication components examined in this analysis. New associations will need to be confirmed in other studies. Increased risks for hypospadias associated with various fertility agents raises the possibility of confounding by underlying subfertility. PMID:23620412

  15. [A plan for the medical prevention of pneumoconiosis in coal mining].

    PubMed

    Marek, K; Kujawska, A; Stasiów, A

    1987-01-01

    Some assumptions of a system of pneumoconiosis prevention for coal miners have been presented. An essential element of the system consists in replacing fluororadiograms with full-size X-ray pictures, as a method of primary selection. Provisions have been also made for promotion of the detection and treatment of chronic bronchitis and some other respiratory system diseases, along with obligatory spirometric tests. It is planned that the examinations will also involve pensioners. The current analysis of the collected information will be made using the electronic data processing. PMID:3695937

  16. [Exists an Obligation to be Healthy? Ethical Limits of Medical Prevention].

    PubMed

    Arntz, K

    2016-02-01

    An obligation to be healthy in the sauce of a categorical imperative "You shall change your life!" (P. Sloterdijk) does not exist. There is however a moral responsibility to shape ones own life in such a way that the resulting potentials for development can be realized within one owns possibilities (I. Kant). The example of predictive medicine illustrates, why the right not to know can be a responsible way of self governance when dealing with the knowledge of modern biomedicine. This allows the setting of limits within prevention, which preserve the quality of life of the exposed as well as enabling the individual the "acceptance of self" (R. Guardini). PMID:26906530

  17. Prevention of medication-related osteonecrosis of the jaws secondary to tooth extractions. A systematic review

    PubMed Central

    Limeres, Jacobo

    2016-01-01

    Background A study was made to identify the most effective protocol for reducing the risk of osteonecrosis of the jaws (ONJ) following tooth extraction in patients subjected to treatment with antiresorptive or antiangiogenic drugs. Material and Methods A MEDLINE and SCOPUS search (January 2003 - March 2015) was made with the purpose of conducting a systematic literature review based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. All articles contributing information on tooth extractions in patients treated with oral or intravenous antiresorptive or antiangiogenic drugs were included. Results Only 13 of the 380 selected articles were finally included in the review: 11 and 5 of them offered data on patients treated with intravenous and oral bisphosphonates, respectively. No randomized controlled trials were found – all publications corresponding to case series or cohort studies. The prevalence of ONJ in the patients treated with intravenous and oral bisphosphonates was 6,9% (range 0-34.7%) and 0.47% (range 0-2.5%), respectively. The main preventive measures comprised local and systemic infection control. Conclusions No conclusive scientific evidence is available to date on the efficacy of ONJ prevention protocols in patients treated with antiresorptive or antiangiogenic drugs subjected to tooth extraction. Key words:Bisphosphonates, angiogenesis inhibitors, antiresorptive drugs, extraction, osteonecrosis. PMID:26827065

  18. Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns: A Randomized Controlled Trial

    PubMed Central

    Guille, Constance; Zhao, Zhuo; Krystal, John; Nichols, Breck; Brady, Kathleen; Sen, Srijan

    2016-01-01

    Importance In the United States, approximately one physician dies by suicide every day. Training physicians are at particularly high risk, with suicidal ideation increasing over four-fold during the first three months of internship year. Despite this dramatic increase, very few efforts have been made to prevent the escalation of suicidal thoughts among training physicians. Objective To assess the effectiveness of a Web-based Cognitive Behavioral Therapy (wCBT) program delivered prior to the start of internship year in the prevention of suicidal ideation in medical interns. Design, Setting and Participants A randomized controlled trial conducted at two university hospitals with 199 interns from multiple specialties during academic years 2009-10 or 2011-12. Interventions Interns were randomly assigned to study groups (wCBT, n=100; attention-control group (ACG), n=99), and completed study activities lasting 30-minutes each week for four weeks prior to starting internship year. Subjects assigned to wCBT completed online-CBT modules and subjects assigned to ACG received emails with general information about depression, suicidal thinking and local mental health providers. Main Outcome Measure The Patient Health Questionnaire (PHQ-9) was employed to assess suicidal ideation (i.e., “thoughts that you would be better off dead, or hurting yourself in some way”) prior to the start of intern year and at 3-month intervals throughout the year. Results 62.2% (199/320) of individuals agreed to take part in the study. During at least one time point over the course of internship year 12% (12/100) of interns assigned to wCBT endorsed suicidal ideation, compared to 21%(21/99) of interns assigned to ACG. After adjusting for covariates identified a priori that have previously shown to increase the risk for suicidal ideation, interns assigned to wCBT were 60% less likely to endorse suicidal ideation during internship year (RR: 0.40, 95% CI 0.17-0.91; p=0.03), compared to those

  19. One strategy to reduce medication errors: the effect of an online continuing education module on nurses' use of the Lexi-Comp feature of the Pyxis MedStation 2000.

    PubMed

    Straight, Maureen

    2008-01-01

    This study sought to evaluate the impact of an online self-learning module on nurse knowledge and use of the Lexi-Comp feature of the Pyxis MedStation Rx 2000 system, a point-of-care medication delivery system. Data were collected among nurse-users at a community-based healthcare organization (N = 41). Pre- and post-training surveys were used to evaluate training effects. After training, completion of the tutorial and knowledge and use of the Lexi-Comp feature increased by 23% and 56%, respectively. One month after training, a drop in medication errors on administration at the healthcare organization was observed. These findings suggest that use of evaluative and instructional tools would improve integration of technology and clinical practice and improve patient outcomes in medication error reduction. PMID:18091618

  20. A cognitive approach to child mistreatment prevention among medically at-risk infants.

    PubMed

    Bugental, Daphne Blunt; Schwartz, Alex

    2009-01-01

    The authors assessed the effectiveness of a home visitation program in enhancing the early parenting history of infants born at medical risk--a population that is at risk for mistreatment. A randomized clinical trial design was used to compare the effects of a cognitively based extension of the Healthy Start home visitation program (HV+) with a visitation condition that did not include this component (HV). In the HV+ condition, they observed (a) a lower use of corporal punishment, (b) greater safety maintenance in the home, and (c) fewer reported child injuries. The sample (N = 102) was primarily Latino; however, the effects of the intervention were not qualified by ethnicity, maternal education, or immigration status. PMID:19210009

  1. Preventive strategies in chronic liver disease: part I. Alcohol, vaccines, toxic medications and supplements, diet and exercise.

    PubMed

    Riley, T R; Bhatti, A M

    2001-11-01

    Chronic liver disease is the 10th leading cause of death in the United States. Hepatitis C virus infection is the most frequent cause of chronic liver disease and the most common indication for liver transplantation. Preventive care can significantly reduce the progression of liver disease. Alcohol and hepatitis C virus are synergistic in hastening the development of cirrhosis; therefore, patients with hepatitis C infection should abstain from alcohol use. Because superinfection with hepatitis A or B virus can lead to liver failure, vaccination is recommended. Potentially hepatotoxic medications should be used with caution in patients with chronic liver disease. In general, nonsteroidal anti-inflammatory drugs should be avoided; acetaminophen in a dosage below 2 g per day is the safest choice. Many herbal remedies are potentially hepatotoxic, and only milk thistle can be used safely in patients who have chronic liver disease. Weight reduction and exercise can improve liver function in patients with fatty liver. PMID:11730310

  2. The Landing Error Scoring System as a Screening Tool for an Anterior Cruciate Ligament Injury–Prevention Program in Elite-Youth Soccer Athletes

    PubMed Central

    Padua, Darin A.; DiStefano, Lindsay J.; Beutler, Anthony I.; de la Motte, Sarah J.; DiStefano, Michael J.; Marshall, Steven W.

    2015-01-01

    Context Identifying neuromuscular screening factors for anterior cruciate ligament (ACL) injury is a critical step toward large-scale deployment of effective ACL injury-prevention programs. The Landing Error Scoring System (LESS) is a valid and reliable clinical assessment of jump-landing biomechanics. Objective To investigate the ability of the LESS to identify individuals at risk for ACL injury in an elite-youth soccer population. Design Cohort study. Setting Field-based functional movement screening performed at soccer practice facilities. Patients or Other Participants A total of 829 elite-youth soccer athletes (348 boys, 481 girls; age = 13.9 ± 1.8 years, age range = 11 to 18 years), of whom 25% (n = 207) were less than 13 years of age. Intervention(s) Baseline preseason testing for all participants consisted of a jump-landing task (3 trials). Participants were followed prospectively throughout their soccer seasons for diagnosis of ACL injuries (1217 athlete-seasons of follow-up). Main Outcome Measure(s) Landings were scored for “errors” in technique using the LESS. We used receiver operator characteristic curves to determine a cutpoint on the LESS. Sensitivity and specificity of the LESS in predicting ACL injury were assessed. Results Seven participants sustained ACL injuries during the follow-up period; the mechanism of injury was noncontact or indirect contact for all injuries. Uninjured participants had lower LESS scores (4.43 ± 1.71) than injured participants (6.24 ± 1.75; t1215 = −2.784, P = .005). The receiver operator characteristic curve analyses suggested that 5 was the optimal cutpoint for the LESS, generating a sensitivity of 86% and a specificity of 64%. Conclusions Despite sample-size limitations, the LESS showed potential as a screening tool to determine ACL injury risk in elite-youth soccer athletes. PMID:25811846

  3. Voluntary medical male circumcision for HIV prevention and early resumption of sexual activity: a literature review.

    PubMed

    Kamath, Veena; Limaye, Rupali J

    2015-01-01

    A number of programs have focused on scale-up and implementation research regarding voluntary medical male circumcision; however, there is limited research with regard to factors and strategies related to abstinence compliance and the effects of resuming sex during the wound healing period (42-day post-circumcision). We searched the literature for peer-reviewed articles examining early resumption of sex during this period. This review identifies factors that may predispose a client to engage in sex during the 42-day postoperative period, examines how early resumption of sex can inhibit wound healing and increase seroconversion, and reviews strategies that may increase adherence to abstinence during the wound healing period. We found that the most common factor that may predispose a client to engage in sex before the end of the postoperative period is marriage or cohabitation with a sexual partner. With regard to the effect of sex during the postoperative period on wound healing and seroconversion, we found that adverse events incurred were mild, and there was an increased risk of seroconversion. The only strategy studied to increase compliance to abstinence during the postoperative period utilized text messaging, and the trial results indicate that text messaging did not increase abstinence compliance. PMID:25738780

  4. Malaria prevention and treatment in pregnancy: survey of current practice among private medical practitioners in Lagos, Nigeria.

    PubMed

    Rabiu, Kabiru Afolarin; Davies, Nosimot Omolola; Nzeribe-Abangwu, Ugochi O; Adewunmi, Adeniyi Abiodun; Akinlusi, Fatimat Motunrayo; Akinola, Oluwarotimi Ireti; Ogundele, Sunday O

    2015-01-01

    We studied the practice of malaria prevention and treatment in pregnancy of 394 private medical practitioners in Lagos State, Nigeria using a self-administered pre-tested structured questionnaire. Only 39 (9.9%) respondents had correct knowledge of the World Health Organization (WHO) strategies. Malaria prophylaxis in pregnancy was offered by 336 (85.3%), but only 98 (24.9%) had correct knowledge of recommended chemoprophylaxis. Of these, 68 (17.3%) had correct knowledge of first trimester treatment, while only 41 (10.4%) had knowledge of second and third trimester treatment. Only 64 (16.2%) of respondents routinely recommended use of insecticide-treated bed nets. The most common anti-malarial drug prescribed for chemoprophylaxis was pyrimethamine (43.7%); chloroquine was the most common anti-malarial prescribed for both first trimester treatment (81.5%) and second and third trimester treatment (55.3%). The study showed that private medical practitioners have poor knowledge of malaria prophylaxis and treatment in pregnancy, and the practice of most do not conform to recommended guidelines. PMID:25253668

  5. Medically important venomous animals: biology, prevention, first aid, and clinical management.

    PubMed

    Junghanss, Thomas; Bodio, Mauro

    2006-11-15

    Venomous animals are a significant health problem for rural populations in many parts of the world. Given the current level of the international mobility of individuals and the inquisitiveness of travelers, clinicians and travel clinics need to be able to give advice on the prevention, first aid, and clinical management of envenoming. Health professionals often feel overwhelmed by the taxonomy of venomous animals; however, venomous animals can be grouped, using a simple set of criteria, into cnidarians, venomous fish, sea snakes, scorpions, spiders, hymenoterans, and venomous terrestrial snakes. Geographic distribution, habitats, and circumstances of accidents further reduce the range of culprits that need to be considered in any single event. Clinical management of envenomed patients relies on supportive therapy and, if available, specific antivenoms. Supplies of life-saving antivenoms are scarce, and this scarcity particularly affects rural populations in resource-poor settings. Travel clinics and hospitals in highly industrialized areas predominantly see patients with injuries caused by accidents involving marine animals: in particular, stings by venomous fish and skin damage caused by jellyfish. However, globally, terrestrial venomous snakes are the most important group of venomous animals. PMID:17051499

  6. The properties of weft knitted fabric medical and preventive treatment action using eco-raw materials

    NASA Astrophysics Data System (ADS)

    Halavska, L.; Batrak, O.

    2016-07-01

    A new trend in the world is the clothing production using the new types of ecological raw materials application - milk, pineapple, coconut, hemp, banana, eucalyptus, clams, corn, bamboo, soya, nettle yarn. This makes it possible to create textile materials of new generation with unique antibacterial and antiseptic properties. Such materials have a positive preventive and sometimes therapeutic effect on people, and their health. Eco-raw materials clothing is able to protect the human body from the environment harmful effects: cold, heat, rain, dust, opportunely remove from underclothing layer the steam and gases, sweat; maintain in underclothing layer the necessary microclimate for normal organism functioning. Study of knitwear consumer properties, produced with eco-materials, is an urgent task of the world vector, directed on ecological environmental protection. This paper presents the research results of hygroscopicity and capillarity weft knitted fabrics, what knitted from different types of eco-raw materials: bamboo yarn, yarn containing soybean and nettle yarn. Character of influence of the liquid raising level changes depending on the experiment time and the knitting structure is revealed.

  7. Refractive Errors

    MedlinePlus

    ... and lens of your eye helps you focus. Refractive errors are vision problems that happen when the ... cornea, or aging of the lens. Four common refractive errors are Myopia, or nearsightedness - clear vision close ...

  8. The Limits of Medical Interventions for the Elimination of Preventable Blindness

    PubMed Central

    Goldschmidt, Pablo; Einterz, Ellen

    2014-01-01

    Background: Health authorities are working toward the global elimination of trachoma by the year 2020 with actions focused on the World Health Organization SAFE strategy (surgery of trichiasis, antibiotics, face washing and environmental changes) with emphasis on hygienist approaches for education. Objectives: The present survey was performed to assess the sustainability of the SAFE strategy 3 years after trachoma was eliminated from 6 villages. Methods: In February 2013 a rapid trachoma assessment was conducted in 6 villages of Kolofata’s district, Extreme north Region, Cameroon, where trachoma was eliminated in 2010. A total of 300 children (1–10 years) from 6 villages were examined by trained staff. Results: The prevalence of active trachoma (children aged > 1 and < 10 years) in 2013 was 15% and in at least 25% was observed absence of face washing and flies in their eyes and nose. Income level, quality of roads, hygiene, and illiteracy were similar in all the villages; they did not change between 2010 and 2013 and could not be analyzed as independent risk factors. Discussion: The heterogeneity of methods described for clinical trials makes it inappropriate to conduct meta-analysis for the present and for other SAFE-related trials. The results obtained after implementation the SAFE strategy (recurrence) reveal that the causes (infectious agents and dirtiness) and effects (illness) were not connected by illiterate people living under conditions of extreme poverty. So far, antibiotics, surgery and hygiene education are insufficient for the sustainability of trachoma elimination and highlight that hypothetic-deductive processes seem not operational after implementing the awareness campaigns. Trachoma recurrence detected in 2013 in sedentary populations of Kolofata receiving efficacious treatments against Chlamydia sp. suggest that the elimination goals will be delayed if strategies are limited to medical actions. Restricting efforts to repeated pharmacological

  9. A Brief Motivational Intervention for Preventing Medication-Associated Weight Gain Among Youth with Bipolar Disorder: Treatment Development and Case Report

    PubMed Central

    Goldstein, Benjamin I.; Mantz, Michael B.; Bailey, Bridget; Douaihy, Antoine

    2011-01-01

    Abstract Bipolar disorder (BP) in youth is an impairing psychiatric disorder associated with high rates of relapse and recurrence. High rates of psychiatric and medical co-morbidities account for additional illness burden in pediatric BP. The elevated risk of overweight and obesity in this population is of particular concern. One of the likely etiologies for weight gain in youth with BP is use of mood-stabilizing medications. Although these medications can be effective for mood stabilization, excessive weight gain is a common side effect. Obesity is associated with a host of medical problems and is also correlated with worse psychiatric outcomes in BP, rendering the prevention of weight gain in this population particularly clinically relevant. In this article, we describe the rationale and development of a brief motivational intervention for preventing weight gain among youth with BP initiating mood-stabilizing pharmacological treatment and then present a case example illustrating the principles of the intervention. PMID:21663430

  10. [Food for health: primary-care prevention and public health--relevance of the medical role].

    PubMed

    Ravasco, Paula; Ferreira, Catarina; Camilo, Maria Ermelinda

    2011-12-01

    . These are the interventions and attitudes that make a difference and that are actually effective in preventing and/or treating many chronic diseases. Hence it is possible to improve health and quality of health services provided to the population (public health scope) and that of patients (clinical practice scope) as well as to optimize costs in health. PMID:22863485

  11. How do Community Pharmacies Recover from E-prescription Errors?

    PubMed Central

    Odukoya, Olufunmilola K.; Stone, Jamie A.; Chui, Michelle A.

    2014-01-01

    Background The use of e-prescribing is increasing annually, with over 788 million e-prescriptions received in US pharmacies in 2012. Approximately 9% of e-prescriptions have medication errors. Objective To describe the process used by community pharmacy staff to detect, explain, and correct e-prescription errors. Methods The error recovery conceptual framework was employed for data collection and analysis. 13 pharmacists and 14 technicians from five community pharmacies in Wisconsin participated in the study. A combination of data collection methods were utilized, including direct observations, interviews, and focus groups. The transcription and content analysis of recordings were guided by the three-step error recovery model. Results Most of the e-prescription errors were detected during the entering of information into the pharmacy system. These errors were detected by both pharmacists and technicians using a variety of strategies which included: (1) performing double checks of e-prescription information; (2) printing the e-prescription to paper and confirming the information on the computer screen with information from the paper printout; and (3) using colored pens to highlight important information. Strategies used for explaining errors included: (1) careful review of patient’ medication history; (2) pharmacist consultation with patients; (3) consultation with another pharmacy team member; and (4) use of online resources. In order to correct e-prescription errors, participants made educated guesses of the prescriber’s intent or contacted the prescriber via telephone or fax. When e-prescription errors were encountered in the community pharmacies, the primary goal of participants was to get the order right for patients by verifying the prescriber’s intent. Conclusion Pharmacists and technicians play an important role in preventing e-prescription errors through the detection of errors and the verification of prescribers’ intent. Future studies are needed

  12. Fermented milk containing Lactobacillus casei strain Shirota prevents the onset of physical symptoms in medical students under academic examination stress.

    PubMed

    Kato-Kataoka, A; Nishida, K; Takada, M; Suda, K; Kawai, M; Shimizu, K; Kushiro, A; Hoshi, R; Watanabe, O; Igarashi, T; Miyazaki, K; Kuwano, Y; Rokutan, K

    2016-01-01

    This pilot study investigated the effects of the probiotic Lactobacillus casei strain Shirota (LcS) on psychological, physiological, and physical stress responses in medical students undertaking an authorised nationwide examination for promotion. In a double-blind, placebo-controlled trial, 24 and 23 healthy medical students consumed a fermented milk containing LcS and a placebo milk, respectively, once a day for 8 weeks until the day before the examination. Psychophysical state, salivary cortisol, faecal serotonin, and plasma L-tryptophan were analysed on 5 different sampling days (8 weeks before, 2 weeks before, 1 day before, immediately after, and 2 weeks after the examination). Physical symptoms were also recorded in a diary by subjects during the intervention period for 8 weeks. In association with a significant elevation of anxiety at 1 day before the examination, salivary cortisol and plasma L-tryptophan levels were significantly increased in only the placebo group (P<0.05). Two weeks after the examination, the LcS group had significantly higher faecal serotonin levels (P<0.05) than the placebo group. Moreover, the rate of subjects experiencing common abdominal and cold symptoms and total number of days experiencing these physical symptoms per subject were significantly lower in the LcS group than in the placebo group during the pre-examination period at 5-6 weeks (each P<0.05) and 7-8 weeks (each P<0.01) during the intervention period. Our results suggest that the daily consumption of fermented milk containing LcS may exert beneficial effects preventing the onset of physical symptoms in healthy subjects exposed to stressful situations. PMID:26689231

  13. Medication reconciliation: passing phase or real need?

    PubMed

    Durán-García, Esther; Fernandez-Llamazares, Cecilia M; Calleja-Hernández, Miguel A

    2012-12-01

    Medication reconciliation errors occur across transitions in patient care. Of all medication errors in a hospital, 25 % in hospitalised patients are caused by a failure to reconcile new prescriptions with ongoing home treatments. These errors are more common at discharge, but the critical moment for detecting and resolving them is at the time of admission. This commentary reviews the different ways in which reconciliation errors can be prevented. The reconciliation process should be standardised and implemented in daily practice as a routine part of healthcare provision. To achieve this, professional development of hospital pharmacists is of paramount importance. The commentary goes on to describe the factors that affect the reconciliation process and the stages involved in its implementation. Finally, we discuss the use of information technology as a means to help integrating medication reconciliation into clinical practice. PMID:23054139

  14. Brief Training of HIV Medical Providers Increases Their Frequency of Delivering Prevention Counselling to Patients at Risk of Transmitting HIV to Others

    ERIC Educational Resources Information Center

    Patel, Shilpa N.; Marks, Gary; Gardner, Lytt; Golin, Carol E.; Shinde, Sanjyot; O'Daniels, Christine; Wilson, Tracey E.; Quinlivan, E. Byrd; Banderas, Julie W.

    2013-01-01

    Objective: The aim of this study was to examine whether brief training of human immunodeficiency virus (HIV) medical providers increased the frequency with which they routinely delivered prevention counselling to patients, and whether patient characteristics were associated with receipt of that counselling. Design: Longitudinal. Setting: Seven HIV…

  15. Treatment-Specific Changes in Decentering Following Mindfulness-Based Cognitive Therapy versus Antidepressant Medication or Placebo for Prevention of Depressive Relapse

    ERIC Educational Resources Information Center

    Bieling, Peter J.; Hawley, Lance L.; Bloch, Richard T.; Corcoran, Kathleen M.; Levitan, Robert D.; Young, L. Trevor; MacQueen, Glenda M.; Segal, Zindel V.

    2012-01-01

    Objective: To examine whether metacognitive psychological skills, acquired in mindfulness-based cognitive therapy (MBCT), are also present in patients receiving medication treatments for prevention of depressive relapse and whether these skills mediate MBCT's effectiveness. Method: This study, embedded within a randomized efficacy trial of MBCT,…

  16. Physical examination. Frequently observed errors.

    PubMed

    Wiener, S; Nathanson, M

    1976-08-16

    A method allowing for direct observation of intern and resident physicians while interviewing and examining patients has been in use on our medical wards for the last five years. A large number of errors in the performance of the medical examination by young physicians were noted and a classification of these errors into those of technique, omission, detection, interpretation, and recording was made. An approach to detection and correction of each of these kinds of errors is presented, as well as a discussion of possible reasons for the occurrence of these errors in physician performance. PMID:947266

  17. Medical and health economic evaluation of prevention- and control measures related to MRSA infections or -colonisations at hospitals

    PubMed Central

    Korczak, Dieter; Schöffmann, Christine

    2010-01-01

    Introduction Methicillin-resistant Staphylococcus aureus (MRSA) are dangerous agents of nosocomial infections. In 2007 the prevalence of MRSA is 20.3% in Germany (Oxacilline-resistance according to EUCAST-criteria [EUCAST = European Committee on Antimicrobial Susceptibility Testing]). Objectives Which measurements are effective in the prevention and control of MRSA-infections in the hospital? How effective are contact precautions, screening, decolonisation, education and surveillance? Which recommendations can be given to health care politics on the basis of cost-effectiveness studies? Have there been any adverse effects on patients and clinical staff? What kind of liability problems exist? Methods Based on a systematic review of the literature studies are included which have been published in German or English language since 2004. Results 1,508 articles have been found. After having surveyed the full text, 33 medical, eight economic and four ethical/juridical studies are included for the Health Technology Assessment (HTA) report. The key result of the HTA report is that different measurements are effective in the prevention and control of MRSA-infections in hospitals, though the majority of the studies has a low quality. Effective are the conduction of differentiated screening measurements if they take into account the specific endemic situation, the use of antibiotic-control programs and the introduction and control of hygienic measurements. The break even point of preventive and control measurements cannot be defined because the study results differ too much. In the future it has to be more considered that MRSA-infections and contact precautions lead to a psycho-social strain for patients. Discussion It is hardly possible to describe causal efficacies because in the majority of the studies confounders are not sufficiently considered. In many cases bundles of measurements have been established but not analyzed individually. The internal and external validity of

  18. Electronic medication ordering with integrated drug database and clinical decision support system.

    PubMed

    Cufar, Andreja; Droljc, Anže; Orel, Andrej

    2012-01-01

    Medication errors have been identified as one of the most important causes of adverse drug events. Computerized physician order-entry (CPOE) systems, coupled with decision support (Medication allergy checking, drug interactions, and dose calculations), are considered to be appropriate solutions for reducing medication errors and standardizing care. It is quite useful if clinical information system (CIS) supports order sets, which help with standardizing care, preventing omission errors, and expediting the ordering process. Order sets are predefined groups of orders pertinent to one or more specific clinical conditions or diagnoses. The article describes how a clinical information system can be used to support medication process (prescribing, ordering, dispensing, administration and monitoring) and offer participating medical teams real time warnings and key information regarding medications and patient status, thus reducing medication errors. Integrated electronic prescribing support system benefits for total parenteral nutrition (TPN) are discussed at the end. PMID:22874280

  19. Intervention strategies for the management of human error

    NASA Technical Reports Server (NTRS)

    Wiener, Earl L.

    1993-01-01

    This report examines the management of human error in the cockpit. The principles probably apply as well to other applications in the aviation realm (e.g. air traffic control, dispatch, weather, etc.) as well as other high-risk systems outside of aviation (e.g. shipping, high-technology medical procedures, military operations, nuclear power production). Management of human error is distinguished from error prevention. It is a more encompassing term, which includes not only the prevention of error, but also a means of disallowing an error, once made, from adversely affecting system output. Such techniques include: traditional human factors engineering, improvement of feedback and feedforward of information from system to crew, 'error-evident' displays which make erroneous input more obvious to the crew, trapping of errors within a system, goal-sharing between humans and machines (also called 'intent-driven' systems), paperwork management, and behaviorally based approaches, including procedures, standardization, checklist design, training, cockpit resource management, etc. Fifteen guidelines for the design and implementation of intervention strategies are included.

  20. Errors in prenatal diagnosis.

    PubMed

    Anumba, Dilly O C

    2013-08-01

    Prenatal screening and diagnosis are integral to antenatal care worldwide. Prospective parents are offered screening for common fetal chromosomal and structural congenital malformations. In most developed countries, prenatal screening is routinely offered in a package that includes ultrasound scan of the fetus and the assay in maternal blood of biochemical markers of aneuploidy. Mistakes can arise at any point of the care pathway for fetal screening and diagnosis, and may involve individual or corporate systemic or latent errors. Special clinical circumstances, such as maternal size, fetal position, and multiple pregnancy, contribute to the complexities of prenatal diagnosis and to the chance of error. Clinical interventions may lead to adverse outcomes not caused by operator error. In this review I discuss the scope of the errors in prenatal diagnosis, and highlight strategies for their prevention and diagnosis, as well as identify areas for further research and study to enhance patient safety. PMID:23725900

  1. Medication Use during Pregnancy

    MedlinePlus

    ... medications that are necessary. What Medications Can Cause Birth Defects? We know that taking certain medications during pregnancy ... may visit the FDA Pregnancy Registry website. National Birth Defects Prevention Study: Medications and Birth Defects The Centers ...

  2. Current Status of Infection Prevention and Control Programs for Emergency Medical Personnel in the Republic of Korea

    PubMed Central

    Oh, Hyang Soon; Uhm, Dong Choon

    2015-01-01

    Objectives: Emergency medical personnel (EMPs) are pre-hospital emergency responders who are at risk of exposure to infections and may also serve as a source for the transmission of infections. However, few studies of infection control have specifically addressed EMPs in the Republic of Korea (hereafter Korea). The goal of this study was to assess the current status of infection prevention and control programs (IPCPs) for EMPs in Korea. Methods: A cross-sectional survey was conducted to quantitatively assess the resources and activities of IPCPs. A total of 907 EMPs in five metropolitan cities completed a structured questionnaire from September 2014 to January 2015. The data were analyzed using descriptive statistics, multi-response analysis, and the chi-square test. Results: The mean age of the participants was 34.8±15.1 years. IPCPs were found to have weaknesses with regard to the following resources: the assignment of infection control personnel (ICP) (79.5%), hand hygiene resources such as waterless antiseptics (79.3%), the use of paper towels (38.9%), personal protective equipment such as face shields (46.9%), and safety containers for sharps and a separated space for the disposal of infectious waste (10.1%). Likewise, the following activities were found to be inadequately incorporated into the workflow of EMPs: education about infection control (77.5%), post-exposure management (35.9%), and the decontamination of items and spaces after use (88.4%). ICP were found to have a significant effect on the resources and activities of IPCPs (p<0.001). The resources and activities of IPCPs were found to be significantly different among the five cities (p<0.001). Conclusions: IPCPs for EMPs showed some limitations in their resources and activities. IPCPs should be actively supported, and specific IPCP activities for EMPs should be developed. PMID:26639747

  3. OCCUPATIONAL EXPOSURES TO BODY FLUIDS AND BEHAVIORS REGARDING THEIR PREVENTION AND POST-EXPOSURE AMONG MEDICAL AND NURSING STUDENTS AT A BRAZILIAN PUBLIC UNIVERSITY

    PubMed Central

    de Souza-Borges, Fernanda Ribeiro Fagundes; Ribeiro, Larissa Araújo; de Oliveira, Luiz Carlos Marques

    2014-01-01

    A cross-sectional study was conducted to assess the frequencies and characteristics of occupational exposures among medical and nursing students at a Brazilian public university, in addition to their prevention and post-exposure behavior. During the second semester of 2010, a self-administered semi-structured questionnaire was completed by 253/320 (79.1%) medical students of the clinical course and 149/200 (74.5%) nursing students who were already performing practical activities. Among medical students, 53 (20.9%) suffered 73 injuries, which mainly occurred while performing extra-curricular activities (32.9%), with cutting and piercing objects (56.2%), in the emergency room (39.7%), and as a result of lack of technical preparation or distraction (54.8%). Among nursing students, 27 (18.1%) suffered 37 injuries, which mainly occurred with hollow needles (67.6%) in the operating room or wards (72.2%), and as a result of lack of technical preparation or distraction (62.1%). Among medical and nursing students, respectively, 96.4% and 48% were dissatisfied with the instructions on previously received exposure prevention; 48% and 18% did not always use personal protective equipment; 67.6% and 16.8% recapped used needles; 49.3% and 35.1% did not bother to find out the source patient's serological results post-exposure; and 1.4% and 18.9% officially reported injuries. In conclusion, this study found high frequencies of exposures among the assessed students, inadequate practices in prevention and post-exposure, and, consequently, the need for training in “standard precautions” to prevent such exposures. PMID:24626419

  4. Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Prevention of Relapse and Recurrence in Major Depression

    ERIC Educational Resources Information Center

    Dobson, Keith S.; Hollon, Steven D.; Dimidjian, Sona; Schmaling, Karen B.; Kohlenberg, Robert J.; Gallop, Robert J.; Rizvi, Shireen L.; Gollan, Jackie K.; Dunner, David L.; Jacobson, Neil S.

    2008-01-01

    This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior…

  5. Learning from adverse incidents involving medical devices.

    PubMed

    Amoore, John; Ingram, Paula

    While an adverse event involving a medical device is often ascribed to either user error or device failure, the causes are typically multifactorial. A number of incidents involving medical devices are explored using this approach to investigate the various causes of the incident and the protective barriers that minimised or prevented adverse consequences. User factors, including mistakes, omissions and lack of training, conspired with background factors--device controls and device design, storage conditions, hidden device damage and physical layout of equipment when in use--to cause the adverse events. Protective barriers that prevented or minimised the consequences included staff vigilance, operating procedures and alarms. PMID:12715578

  6. Errors in administration of parenteral drugs in intensive care units: multinational prospective study

    PubMed Central

    Capuzzo, Maurizia; Guidet, Bertrand; Moreno, Rui; Metnitz, Barbara; Bauer, Peter; Metnitz, Philipp

    2009-01-01

    Objective To assess on a multinational level the frequency, characteristics, contributing factors, and preventive measures of administration errors in parenteral medication in intensive care units. Design Observational, prospective, 24 hour cross sectional study with self reporting by staff. Setting 113 intensive care units in 27 countries. Participants 1328 adults in intensive care. Main outcome measures Number of errors; impact of errors; distribution of error characteristics; distribution of contributing and preventive factors. Results 861 errors affecting 441 patients were reported: 74.5 (95% confidence interval 69.5 to 79.4) events per 100 patient days. Three quarters of the errors were classified as errors of omission. Twelve patients (0.9% of the study population) experienced permanent harm or died because of medication errors at the administration stage. In a multiple logistic regression with patients as the unit of analysis, odds ratios for the occurrence of at least one parenteral medication error were raised for number of organ failures (odds ratio per increase of one organ failure: 1.19, 95% confidence interval 1.05 to 1.34); use of any intravenous medication (yes v no: 2.73, 1.39 to 5.36); number of parenteral administrations (per increase of one parenteral administration: 1.06, 1.04 to 1.08); typical interventions in patients in intensive care (yes v no: 1.50, 1.14 to 1.96); larger intensive care unit (per increase of one bed: 1.01, 1.00 to 1.02); number of patients per nurse (per increase of one patient: 1.30, 1.03 to 1.64); and occupancy rate (per 10% increase: 1.03, 1.00 to 1.05). Odds ratios for the occurrence of parenteral medication errors were decreased for presence of basic monitoring (yes v no: 0.19, 0.07 to 0.49); an existing critical incident reporting system (yes v no: 0.69, 0.53 to 0.90); an established routine of checks at nurses’ shift change (yes v no: 0.68, 0.52 to 0.90); and an increased ratio of patient turnover to the size of the

  7. Medication Safety Systems and the Important Role of Pharmacists.

    PubMed

    Mansur, Jeannell M

    2016-03-01

    Preventable medication-related adverse events continue to occur in the healthcare setting. While the Institute of Medicine's To Err is Human, published in 2000, highlighted the prevalence of medical and medication-related errors in patient morbidity and mortality, there has not been significant documented progress in addressing system contributors to medication errors. The lack of progress may be related to the myriad of pharmaceutical options now available and the nuances of optimizing drug therapy to achieve desired outcomes and prevent undesirable outcomes. However, on a broader scale, there may be opportunities to focus on the design and performance of the many processes that are part of the medication system. Errors may occur in the storage, prescribing, transcription, preparation and dispensing, or administration and monitoring of medications. Each of these nodes of the medication system, with its many components, is prone to failure, resulting in harm to patients. The pharmacist is uniquely trained to be able to impact medication safety at the individual patient level through medication management skills that are part of the clinical pharmacist's role, but also to analyze the performance of medication processes and to lead redesign efforts to mitigate drug-related outcomes that may cause harm. One population that can benefit from a focus on medication safety through clinical pharmacy services and medication safety programs is the elderly, who are at risk for adverse drug events due to their many co-morbidities and the number of medications often used. This article describes the medication safety systems and provides a blueprint for creating a foundation for medication safety programs within healthcare organizations. The specific role of pharmacists and clinical pharmacy services in medication safety is also discussed here and in other articles in this Theme Issue. PMID:26932714

  8. Prevention of and response to inadvertent exposure of embryo/fetus to ionizing radiation, due to medical exposure of the mother. The Greek regulatory authority initiatives.

    PubMed

    Economides, Sotirios; Boziari, Argiro; Vogiatzi, Stavroula; Hourdakis, Konstantinos J; Kamenopoulou, Vassiliki; Dimitriou, Panagiotis

    2014-03-01

    Embryo/fetus (E/F) irradiation as a result of medical exposure of the mother should be avoided, unless there are strong clinical indications. Medical practitioners are assigned the primary task and obligation of ensuring overall patient protection and safety in the prescription of and during the delivery of medical exposure. In cases of unintended exposure of embryo/fetus (E/F), the risk analysis and communication is conducted by or under the supervision of medical physicists at local level. National competent authorities can contribute to the prevention, risk analysis and communication of inadvertent E/F exposure to ionizing radiation by recording, analyzing and disseminating the relevant information. Since 2001, Greek Atomic Energy Commission has established a committee with the mandate to provide advice, to keep records, to analyze and disseminate the experience gained in cases of unintended E/F exposure. During the period 2001-2011, the committee was consulted by 269 pregnant women undergone medical exposures. The conclusions from the relevant data analysis, as well as the experience gained are herein presented and discussed. PMID:23697885

  9. Quality and Safety in Health Care, Part XI: Introduction to Diagnostic Errors.

    PubMed

    Harolds, Jay A

    2016-06-01

    The process of reaching a diagnosis in health care has not been emphasized in safety programs carried out by health care organizations as much as many other aspects of care such as handoffs, medication errors, patient falls, wrong-side surgery, and decreasing hospital-acquired infections. However, diagnostic errors are a fairly frequent cause of harm that can contribute to serious injury or death. This article is the first in a series discussing the diagnostic process and how to define, measure, and prevent errors in diagnosis. PMID:26975016

  10. Using a web-based game to prevent posttraumatic stress in children following medical events: design of a randomized controlled trial

    PubMed Central

    Marsac, Meghan L.; Kohser, Kristen L.; Winston, Flaura K.; Kenardy, Justin; March, Sonja; Kassam-Adams, Nancy

    2013-01-01

    Background Medical events including acute illness and injury are among the most common potentially traumatic experiences for children. Despite the scope of the problem, only limited resources are available for prevention of posttraumatic stress symptoms (PTSS) after pediatric medical events. Web-based programs provide a low-cost, accessible means to reach a wide range of families and show promise in related areas of child mental health. Objectives To describe the design of a randomized controlled trial that will evaluate feasibility and estimate preliminary efficacy of Coping Coach, a web-based preventive intervention to prevent or reduce PTSS after acute pediatric medical events. Method Seventy children and their parents will be randomly assigned to either an intervention or a waitlist control condition. Inclusion criteria require that children are aged 8–12 years, have experienced a medical event, have access to Internet and telephone, and have sufficient competency in the English language to complete measures and understand the intervention. Participants will complete baseline measures and will then be randomized to the intervention or waitlist control condition. Children in the intervention condition will complete module 1 (Feelings Identification) in the hospital and will be instructed on how to complete modules 2 (Appraisals) and 3 (Avoidance) online. Follow-up assessments will be conducted via telephone at 6, 12, and 18 weeks after the baseline assessment. Following the 12-week assessment, children in the waitlist control condition will receive instructions for completing the intervention. Results Primary study outcomes include data on intervention feasibility and outcomes (child appraisals, coping, PTSS and health-related quality of life). Discussion Results will provide data on the feasibility of the implementation of the Coping Coach intervention and study procedures as well as estimations of efficacy to determine sample size for a larger study

  11. Computerized medication administration records decrease medication occurrences.

    PubMed

    Wilson, A L; Hill, J J; Wilson, R G; Nipper, K; Kwon, I W

    1997-04-01

    Studies have demonstrated that medication errors occur at a number of locations in the continuum between ordering of drug therapy and administration of the medication. Computer management of patient medication profiles offers the opportunity to enhance communication between pharmacists and nurses, and to decrease medication errors and delays in delivery of therapy. A number of authors have postulated that computerization of medication profiles would enhance medication delivery accuracy and timeliness, but no study has demonstrated this improvement. We report the results of a retrospective analysis undertaken to assess the improvements resulting from sharing a computerized medication record. We used a broader definition of medication occurrences that includes the more traditional definition, and averted errors, delays in delivery of medications and information, and disagreements between pharmacy and nursing medication profiles. We compared medication occurrences reported through an existing internal system between two periods; the first when separate pharmacy and nursing medication records were used, and the second period when a shared medication record was used by pharmacy and nursing. Average medication occurrences per admission decreased from 0.1084 to 0.0658 (p < 0.01). Medication occurrences per dose decreased from 0.0005 to 0.0003 (p < 0.01). The use of a shared medication record by pharmacy and nursing led to a statistically significant decrease in medication occurrences. Information shared between the two professions allowed timely resolution of discrepancies in medication orders, leading to better execution of drug therapy, decreased medication occurrences, and increased efficiency. PMID:10166241

  12. A two-phased screening paradigm for evaluating candidate medications for cocaine cessation or relapse prevention: Modafinil, levodopa-carbidopa, naltrexone

    PubMed Central

    Schmitz, Joy M.; Green, Charles E.; Stotts, Angela L.; Lindsay, Jan A.; Rathnayaka, Nuvan S.; Grabowski, John; Moeller, F. G.

    2014-01-01

    Background Cocaine pharmacotherapy trials are often confounded by considerable variability in baseline cocaine-use levels, obscuring possible medication efficacy. Testing the feasibility of using a prerandomization, abstinence-induction protocol, we screened three candidate medications to explore treatment response in patients who did, or did not, achieve abstinence during an extended baseline phase. Method Eligible treatment-seeking, cocaine-dependent subjects entered a 4-week baseline period (Phase I) with high-value abstinence contingent vouchers and two motivational interviewing sessions, followed by a 12-week medication trial (Phase II) with random assignment stratified on Phase I abstinence status to (1) modafinil (400mg/d), (2) levodopa/carbidopa (800/200mg/d), (3) naltrexone (50mg/d), or (4) placebo. Treatment consisted of thrice-weekly clinic visits for urine benzoylecgonine testing and weekly cognitive behavioral therapy with contingency management targeting medication compliance. Results Of the 118 subjects enrolled, 81 (80%) completed Phase I, with 33 (41%) achieving abstinence, defined a priori as 6 consecutive cocaine-negative urines. Tests of the interaction of each medication (active vs. placebo) by baseline status (abstinent vs. nonabstinent) permitted moderator effect analysis. Overall, baseline abstinence predicted better outcome. Cocaine-use outcomes for levodopa and naltrexone treatment differed as a function of Phase I abstinence status, with both medications producing benefit in nonabstinent but not baseline-abstinent subjects. There was no evidence of a moderator effect for modafinil. Conclusions The two-phase screening trial demonstrated that subgrouping of patients with respect to baseline abstinence status is feasible and clinically useful for exploring cocaine cessation and relapse-prevention effects of candidate medications. PMID:24424425

  13. Methods to reduce prescribing errors in elderly patients with multimorbidity.

    PubMed

    Lavan, Amanda H; Gallagher, Paul F; O'Mahony, Denis

    2016-01-01

    The global population of multimorbid older people is growing steadily. Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events. Those who prescribe for older frailer multimorbid people are particularly prone to committing prescribing errors of various kinds. The causes of prescribing errors in this patient population are multifaceted and complex, including prescribers' lack of knowledge of aging physiology, geriatric medicine, and geriatric pharmacotherapy, overprescribing that frequently leads to major polypharmacy, inappropriate prescribing, and inappropriate drug omission. This review examines the various ways of minimizing prescribing errors in multimorbid older people. The role of education in physician prescribers and clinical pharmacists, the use of implicit and explicit prescribing criteria designed to improve medication appropriateness in older people, and the application of information and communication-technology systems to minimize errors are discussed in detail. Although evidence to support any single intervention to prevent prescribing errors in multimorbid elderly people is inconclusive or lacking, published data support focused prescriber education in geriatric pharmacotherapy, routine application of STOPP/START (screening tool of older people's prescriptions/screening tool to alert to right treatment) criteria for potentially inappropriate prescribing, electronic prescribing, and close liaison between clinical pharmacists and physicians in relation to structured medication review and reconciliation. Carrying out a structured medication review aimed at optimizing pharmacotherapy in this vulnerable patient population presents a major challenge. Another challenge is to design, build, validate, and test by clinical trials suitably versatile and efficient software engines that can reliably and swiftly perform complex medication reviews in

  14. Methods to reduce prescribing errors in elderly patients with multimorbidity

    PubMed Central

    Lavan, Amanda H; Gallagher, Paul F; O’Mahony, Denis

    2016-01-01

    The global population of multimorbid older people is growing steadily. Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events. Those who prescribe for older frailer multimorbid people are particularly prone to committing prescribing errors of various kinds. The causes of prescribing errors in this patient population are multifaceted and complex, including prescribers’ lack of knowledge of aging physiology, geriatric medicine, and geriatric pharmacotherapy, overprescribing that frequently leads to major polypharmacy, inappropriate prescribing, and inappropriate drug omission. This review examines the various ways of minimizing prescribing errors in multimorbid older people. The role of education in physician prescribers and clinical pharmacists, the use of implicit and explicit prescribing criteria designed to improve medication appropriateness in older people, and the application of information and communication-technology systems to minimize errors are discussed in detail. Although evidence to support any single intervention to prevent prescribing errors in multimorbid elderly people is inconclusive or lacking, published data support focused prescriber education in geriatric pharmacotherapy, routine application of STOPP/START (screening tool of older people’s prescriptions/screening tool to alert to right treatment) criteria for potentially inappropriate prescribing, electronic prescribing, and close liaison between clinical pharmacists and physicians in relation to structured medication review and reconciliation. Carrying out a structured medication review aimed at optimizing pharmacotherapy in this vulnerable patient population presents a major challenge. Another challenge is to design, build, validate, and test by clinical trials suitably versatile and efficient software engines that can reliably and swiftly perform complex medication reviews

  15. Analysis of an electronic medication reconciliation and information at discharge programme for frail elderly patients.

    PubMed

    Moro Agud, Marta; Menéndez Colino, Rocío; Mauleón Ladrero, María Del Coro; Ruano Encinar, Margarita; Díez Sebastián, Jesús; Villamañán Bueno, Elena; Herrero Ambrosio, Alicia; González Montalvo, Juan Ignacio

    2016-08-01

    Background During care transitions, discrepancies and medication errors often occur, putting patients at risk, especially older patients with polypharmacy. Objective To assess the results of a medication reconciliation and information programme for discharge of geriatric patients conducted through hospital information systems. Setting A 1300-bed university hospital in Madrid, Spain. Method A prospective observational study. Geriatricians selected candidates for medication reconciliation at discharge, and sent an electronic inter-consultation request to the pharmacy department. Pharmacists reviewed the medication list, comparing it with electronic prescriptions, medication previously prescribed by primary care physicians and other medical records, and resolved any discrepancies. An individualized and tailored drug information at discharge sheet was sent to geriatricians and made available to primary care physicians. Main outcome measure The number and type of discrepancies, the number, type and severity of errors, and the main pharmacological groups involved. Results Medication reconciliation was performed for 118 patients with a mean age of 87 years (SD 5.9), involving a total of 2054 medications, or 17.4 per patient. Discrepancies were found in 723 (35 %) drugs, 105 of which were considered medication errors (15 %); 66 patients (56 %) had at least one error. This gave 0.9 reconciliation errors per patient reviewed and 1.6 per patient with errors. Of the 105 errors, 14 (13 %) were considered serious. The most frequent errors were incomplete prescriptions (40 %) and omissions (35 %). Conclusion An electronic medication reconciliation programme helps pharmacists detect serious medication errors in frail elderly patients and provides complete and up-to-date written information to prevent additional errors at home. PMID:27306652

  16. Factors associated with reporting nursing errors in Iran: a qualitative study

    PubMed Central

    2012-01-01

    Background Reporting the professional errors for improving patient safety is considered essential not only in hospitals, but also in ambulatory care centers. Unfortunately, a great number of nurses, similar to most clinicians, do not report their errors. Therefore, the present study aimed to clarify the factors associated with reporting the nursing errors through the experiences of clinical nurses and nursing managers. Methods A total of 115 nurses working in the hospitals and specialized clinics affiliated to Tehran and Shiraz Universities of Medical Sciences, Iran participated in this qualitative study. The study data were collected through a semi-structured group discussion conducted in 17 sessions and analyzed by inductive content analysis approach. Results The main categories emerged in this study were: a) general approaches of the nurses towards errors, b) barriers in reporting the nursing errors, and c) motivators in error reporting. Conclusion Error reporting provides extremely valuable information for preventing future errors and improving the patient safety. Overall, regarding motivators and barriers in reporting the nursing errors, it is necessary to enact regulations in which the ways of reporting the error and its constituent elements, such as the notion of the error, are clearly identified. PMID:23078517

  17. Prescribing errors and other problems reported by community pharmacists

    PubMed Central

    Chen, Yen-Fu; Neil, Karen E; Avery, Anthony J; Dewey, Michael E; Johnson, Christine

    2005-01-01

    Introduction: Prevention of medication errors is a priority for health services worldwide. Pharmacists routinely screen prescriptions for potential problems, including prescribing errors. This study describes prescribing problems reported by community pharmacists and discusses them from an error prevention perspective. Method For one month, nine community pharmacists documented prescribing problems, interventions made, and the proximal causes of the problems. The results were presented to local GPs and pharmacists at a meeting and feedback was invited. Results For 32 403 items dispensed, pharmacists reported 196 prescribing problems (0.6%). The reporting rates ranged from 0.2%–1.9% between pharmacists and were inversely correlated to dispensing volume. Prescriptions containing incomplete or incorrect information accounted for two-thirds of the problems. Lack of information on the prescriptions and transcribing/typing errors were the most frequently cited proximal causes. A few pitfalls of computerized prescribing were observed. Conclusion Although rates of prescribing problems reported were relatively low, community pharmacists and patients remain important safeguards. This study identified potential causes of prescribing errors, and illustrated areas which could be improved in the design of computerized prescribing systems, and the communication and sharing of information between GPs and pharmacists. PMID:18360575

  18. Depressive symptoms, antidepressant medication use and new onset of diabetes in participants of the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study

    PubMed Central

    Marrero, David G.; Ma, Yong; de Groot, Mary; Horton, Edward S.; Price, David W.; Barrett-Connor, Elizabeth; Carnethon, Mercedes R.; Knowler, William C.

    2015-01-01

    Objective To assess in participants in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study (DPP/DPPOS) whether diagnosis of diabetes predicted: elevated depressive symptoms (DS) or antidepressant medicine (ADM) use after diagnosis; diabetes status or duration had significant effect on DS or ADM use; and associations between A1C, fasting plasma glucose (FPG), normalization of FPG and DS or ADM use post diagnosis. Methods DPP participants in 3 treatment arms [intensive lifestyle (ILS), metformin (MET), placebo (PLC)] were assessed semiannually or annually for diabetes, glucose control, ADM use, and DS. DS was measured using Beck Depression Inventory (BDI) questionnaire. Among the total 3234 enrolled participants, 1285 developed diabetes whose levels of depression were measured before and after their diabetes diagnosis. Results Neither DS nor ADM use increased significantly following diabetes diagnosis. After diabetes diagnosis, higher FPG was associated with greater ADM use in the ILS arm independent of potential confounders; a 10 mg/dl higher in FPG is associated with 8.8% more odds of ADM use. Higher FPG, and higher A1C were associated with higher BDI scores in all three arms. On average, a participant with 10 mg/dl higher rise in FPG had a 0.07 increase in BDI score. Similarly, 1% higher A1c was associated with a 0.21 point increase in BDI score. On contrary, normalization of FPG was associated with lower BDI scores. In participants with FPG that had normalized, there was a decrease of 0.30 points in the BDI score compared to those whose FPG had not normalized. Conclusions Contrary to clinical attributions, the diagnosis of diabetes did not show an immediate impact on BDI scores or ADM use. However, higher glucose levels after diagnosis were associated with small but significant higher BDI score and more ADM use. PMID:25775165

  19. UNDERSTANDING OR NURSES' REACTIONS TO ERRORS AND USING THIS UNDERSTANDING TO IMPROVE PATIENT SAFETY.

    PubMed

    Taifoori, Ladan; Valiee, Sina

    2015-09-01

    The operating room can be home to many different types of nursing errors due to the invasiveness of OR procedures. The nurses' reactions towards errors can be a key factor in patient safety. This article is based on a study, with the aim of investigating nurses' reactions toward nursing errors and the various contributing and resulting factors, conducted at Kurdistan University of Medical Sciences in Sanandaj, Iran in 2014. The goal of the study was to determine how OR nurses' reacted to nursing errors with the goal of having this information used to improve patient safety. Research was conducted as a cross-sectional descriptive study. The participants were all nurses employed in the operating rooms of the teaching hospitals of Kurdistan University of Medical Sciences, which was selected by a consensus method (170 persons). The information was gathered through questionnaires that focused on demographic information, error definition, reasons for error occurrence, and emotional reactions for error occurrence, and emotional reactions toward the errors. 153 questionnaires were completed and analyzed by SPSS software version 16.0. "Not following sterile technique" (82.4 percent) was the most reported nursing error, "tiredness" (92.8 percent) was the most reported reason for the error occurrence, "being upset at having harmed the patient" (85.6 percent) was the most reported emotional reaction after error occurrence", with "decision making for a better approach to tasks the next time" (97.7 percent) as the most common goal and "paying more attention to details" (98 percent) was the most reported planned strategy for future improved outcomes. While healthcare facilities are focused on planning for the prevention and elimination of errors it was shown that nurses can also benefit from support after error occurrence. Their reactions, and coping strategies, need guidance and, with both individual and organizational support, can be a factor in improving patient safety. PMID

  20. Guideline Implementation: Prevention of Retained Surgical Items.

    PubMed

    Fencl, Jennifer L

    2016-07-01

    A surgical item unintentionally retained in a patient after an operative or other invasive procedure is a serious, preventable medical error with the potential to cause the patient great harm. Perioperative RNs play a key role in preventing retained surgical items (RSIs). The updated AORN "Guideline for prevention of retained surgical items" provides guidance for implementing a consistent, multidisciplinary approach to RSI prevention; accounting for surgical items; preventing retention of device fragments; reconciling count discrepancies; and using adjunct technologies to supplement manual count procedures. This article focuses on key points of the guideline to help perioperative personnel provide optimal care during a procedure. Key points addressed include taking responsibility for RSI prevention as a team; minimizing distractions, noise, and interruptions during counts; using consistent counting methods; reconciling discrepancies; and participating in performance-improvement activities. Perioperative RNs should review the complete guideline for additional information and for guidance in writing and updating policies and procedures. PMID:27350354

  1. Role of Computerized Physician Order Entry Usability in the Reduction of Prescribing Errors

    PubMed Central

    Zakaria, Mohamad Shanudin; Yasin, Norjaya M.; Shah, Mahmood Hussain; Elhissi, Abdelbary

    2013-01-01

    Objectives Some hospitals have implemented computerized physician order entry (CPOE) systems to reduce the medical error rates. However, research in this area has been very limited, especially regarding the impact of CPOE use on the reduction of prescribing errors. Moreover, the past studies have dealt with the overall impact of CPOE on the reduction of broadly termed "medical errors", and they have not specified which medical errors have been reduced by CPOE. Furthermore, the majority of the past research in this field has been either qualitative or has not used robust empirical techniques. This research examined the impacts of usability of CPOE systems on the reduction of doctors' prescribing errors. Methods One hundred and sixty-six questionnaires were used for quantitative data analyses. Since the data was not normally distributed, partial least square path modelling-as the second generation of multivariate data analyses-was applied to analyze data. Results It was found that the ease of use of the system and information quality can significantly reduce prescribing errors. Moreover, the user interface consistency and system error prevention have a significant positive impact on the perceived ease of use. More than 50% of the respondents believed that CPOE reduces the likelihood of drug allergy, drug interaction, and drug dosing errors thus improving patient safety. Conclusions Prescribing errors in terms of drug allergy, drug interaction, and drug dosing errors are reduced if the CPOE is not error-prone and easy to use, if the user interface is consistent, and if it provides quality information to doctors. PMID:23882414

  2. Non-Medical Use of Prescription Drugs among Youth in an Appalachian Population: Prevalence, Predictors, and Implications for Prevention

    ERIC Educational Resources Information Center

    Collins, David; Abadi, Melissa Harris; Johnson, Knowlton; Shamblen, Steve; Thompson, Kirsten

    2011-01-01

    This article examines prevalence of non-medical use of prescription drugs (NMUPD) in a sample of elementary and high school students in an Appalachian Tennessee county. We found that lifetime prevalence of NMUPD (35%) was higher than prevalence of cigarette use (28%) and marijuana use (17%), but lower than lifetime prevalence of alcohol use (46%).…

  3. Personalised, predictive and preventive medication process in hospitals—still rather missing: professional opinion survey on medication safety in Czech hospitals (based on professional opinions of recognised Czech health care experts)

    PubMed Central

    2014-01-01

    The survey had the following aims: (1) to rationalise the hypothesis that risks and losses relating to medication process' errors in Czech hospitals are at least comparable with the other developed countries and EU countries especially, (2) to get a valid professional opinion/estimate on the rate of adverse drug events happening in Czech hospitals, (3) to point out that medication errors represent real and serious risks and (4) to induce the hospital management readiness to execute fundamental changes and improvements to medication processes. We read through a lot of studies inquiring into hospitals' medication safety. Then, we selected the studies which brought reliable findings and formulated credible conclusions. Finally, we addressed reputable Czech experts in health care and asked them structured questions whether the studies' findings and conclusions corresponded with our respondents' own experience in the Czech hospital clinical practice and what their own estimates of adverse drug events' consequences were like. Based on the reputable Czech health care expert opinions/estimates, the rate of a false drug administration may exceed 5%, and over 7% of those cause serious health complications to Czech hospital inpatients. Measured by an average length of stay (ALOS), the Czech inpatients, harmed by a false drug administration, stay in hospital for more than 2.6 days longer than necessary. Any positive changes to a currently used, traditional, ways of drug dispensing and administration, along with computerisation, automation, electronic traceability, validation, or verification, must well pay off. Referring to the above results, it seems to be wise to follow the EU priorities in health and health care improvements. Thus, a right usage of the financial means provided by the EC—in terms of its new health programmes for the period 2014–2020 (e.g. Horizon 2020)—has a good chance of a good result in doing the right things right, at the right time and in the

  4. Error analysis in laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Gantert, Walter A.; Tendick, Frank; Bhoyrul, Sunil; Tyrrell, Dana; Fujino, Yukio; Rangel, Shawn; Patti, Marco G.; Way, Lawrence W.

    1998-06-01

    Iatrogenic complications in laparoscopic surgery, as in any field, stem from human error. In recent years, cognitive psychologists have developed theories for understanding and analyzing human error, and the application of these principles has decreased error rates in the aviation and nuclear power industries. The purpose of this study was to apply error analysis to laparoscopic surgery and evaluate its potential for preventing complications. Our approach is based on James Reason's framework using a classification of errors according to three performance levels: at the skill- based performance level, slips are caused by attention failures, and lapses result form memory failures. Rule-based mistakes constitute the second level. Knowledge-based mistakes occur at the highest performance level and are caused by shortcomings in conscious processing. These errors committed by the performer 'at the sharp end' occur in typical situations which often times are brought about by already built-in latent system failures. We present a series of case studies in laparoscopic surgery in which errors are classified and the influence of intrinsic failures and extrinsic system flaws are evaluated. Most serious technical errors in lap surgery stem from a rule-based or knowledge- based mistake triggered by cognitive underspecification due to incomplete or illusory visual input information. Error analysis in laparoscopic surgery should be able to improve human performance, and it should detect and help eliminate system flaws. Complication rates in laparoscopic surgery due to technical errors can thus be considerably reduced.

  5. Diagnosis errors are a system problem, not just doctor's fault.

    PubMed

    2015-11-01

    The Institute of Medicine has issued a report calling on the medical community to more effectively address diagnostic errors. Reducing these errors will require a collaborative approach. Diagnostic errors are not typically caused by only a physician's error. Radiologists and pathologists should be more involved with diagnoses. Risk managers should treat diagnostic errors as a system problem. PMID:26565056

  6. Cardiac Medications

    MedlinePlus

    ... Diovan) What the Medication Does Rather than lowering levels of angiotensin II (as ACE inhibitors do) angiotensin II receptor blockers prevent this chemical from having any effects on the heart and blood vessels. This keeps blood pressure from rising. Reason for Medication Used to treat or improve ...

  7. Chronic inflammatory diseases are stimulated by current lifestyle: how diet, stress levels and medication prevent our body from recovering

    PubMed Central

    2012-01-01

    Serhan and colleagues introduced the term "Resoleomics" in 1996 as the process of inflammation resolution. The major discovery of Serhan's work is that onset to conclusion of an inflammation is a controlled process of the immune system (IS) and not simply the consequence of an extinguished or "exhausted" immune reaction. Resoleomics can be considered as the evolutionary mechanism of restoring homeostatic balances after injury, inflammation and infection. Under normal circumstances, Resoleomics should be able to conclude inflammatory responses. Considering the modern pandemic increase of chronic medical and psychiatric illnesses involving chronic inflammation, it has become apparent that Resoleomics is not fulfilling its potential resolving capacity. We suggest that recent drastic changes in lifestyle, including diet and psycho-emotional stress, are responsible for inflammation and for disturbances in Resoleomics. In addition, current interventions, like chronic use of anti-inflammatory medication, suppress Resoleomics. These new lifestyle factors, including the use of medication, should be considered health hazards, as they are capable of long-term or chronic activation of the central stress axes. The IS is designed to produce solutions for fast, intensive hazards, not to cope with long-term, chronic stimulation. The never-ending stress factors of recent lifestyle changes have pushed the IS and the central stress system into a constant state of activity, leading to chronically unresolved inflammation and increased vulnerability for chronic disease. Our hypothesis is that modern diet, increased psycho-emotional stress and chronic use of anti-inflammatory medication disrupt the natural process of inflammation resolution ie Resoleomics. PMID:22510431

  8. Recommendations on the use of folic acid supplementation to prevent the recurrence of neural tube defects. Clinical Teratology Committee, Canadian College of Medical Geneticists.

    PubMed Central

    Van Allen, M I; Fraser, F C; Dallaire, L; Allanson, J; McLeod, D R; Andermann, E; Friedman, J M

    1993-01-01

    OBJECTIVE: To prevent the recurrence of neural tube defects (NTDs) in families at increased risk of having offspring with NTDs with the use of periconceptional folic acid supplementation. OPTIONS: Genetic counselling and prenatal diagnosis of NTDs. OUTCOMES: NTDs cause stillbirth, neonatal death and severe disabilities. The cost for medical care and rehabilitation in the first 10 years of life of a child with spina bifida cystica was estimated to be $42,507 in 1987. EVIDENCE: The authors reviewed the medical literature, communicated with investigators from key studies, reviewed policy recommendations from other organizations and drew on their own expertise. A recent multicentre randomized controlled trial showed that among women at high risk of having a child with an NTD those who received 4 mg/d of folic acid had 72% fewer cases of NTD-affected offspring than nonsupplemented women. Two previous intervention studies also demonstrated that folic acid supplementation was effective in reducing the rate of NTD recurrence. Several retrospective studies support this conclusion. VALUES: Recommendations are the consensus of the Clinical Teratology Committee of the Canadian College of Medical Geneticists (CCMG) and have been approved by the CCMG Board. The committee believes that primary prevention of NTDs is preferable to treatment or to prenatal detection and abortion. BENEFITS, HARMS AND COSTS: Folic acid supplementation should result in fewer NTDs among infants in Canada and ancillary savings in medical costs. The recommended dosage of folic acid is not known to be associated with adverse effects. Higher dosages of folic acid may make vitamin B12 deficiency difficult to diagnose and may alter seizure frequency in patients with epilepsy due to drug interactions with anticonvulsants. RECOMMENDATIONS: A minimum dosage of folic acid of 0.8 mg/d, not to exceed 5.0 mg/d, is recommended along with a well-balanced, nutritious diet for all women who are at increased risk of

  9. The role of the physician and the medical profession in the prevention of international torture and in the treatment of its survivors. American College of Physicians.

    PubMed

    1995-04-15

    The prevention of torture and the treatment of survivors are issues that concern an increasing number of physicians in their daily work. Every day, thousands of men, women, and children are subjected to violence and are forced to flee their homelands. There are more than 18 million refugees in the world and hundreds of thousands of persons seeking asylum, many of them in the United States. Physicians are often the first to interview these victims of abuse. Torture has serious and long-lasting health consequences. Thus, physicians can play a key role in documenting and preventing many forms of abuse and in treating survivors. In some areas, physicians may become the targets of arrest because of their work as clinicians or as influential members of their communities. They may also face disturbing ethical dilemmas as they witness torture or its results. As members of the medical profession, physicians have an obligation to their peers around the world. This report reviews the current state of physicians' involvement in the prevention of international torture and in the treatment of its victims. We propose ways in which physicians can become involved by caring for survivors of torture and by providing expert testimony on behalf of victims who seek asylum. We discuss how the medical profession complements the efforts of individual physicians by providing an infrastructure to support and guide their work. Medical organizations can adopt and disseminate ethical principles that specifically address human rights and their violation. They can coordinate letter-writing networks for human rights, organize or sponsor fact-finding missions, and develop continuing medical education courses on topics such as the identification and treatment of victims of torture. We conclude that physicians can make a difference, both as clinicians and as advocates for the health of the public and the protection of the human rights. The American College of Physicians will continue to advocate for

  10. Optimal medical therapy for secondary prevention after an acute coronary syndrome: 18-month follow-up results at a tertiary teaching hospital in South Korea

    PubMed Central

    Byeon, Hee Ja; Yang, Young-Mo; Choi, Eun Joo

    2016-01-01

    Background Acute coronary syndrome (ACS) is a fatal cardiovascular disease caused by atherosclerotic plaque erosion or rupture and formation of coronary thrombus. The latest guidelines for ACS recommend the combined drug regimen, comprising aspirin, P2Y12 inhibitor, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, β-blocker, and statin, at discharge after ACS treatment to reduce recurrent ischemic cardiovascular events. This study aimed to examine prescription patterns of secondary prevention drugs in Korean patients with ACS after hospital discharge, to access the appropriateness of secondary prevention drug therapy for ACS, and to evaluate whether to persistently use discharge medications for 18 months. Methods This study was retrospectively conducted with the patients who were discharged from the tertiary hospital, located in South Korea, after ACS treatment between September 2009 and August 2013. Data were collected through electronic medical record. Results Among 3,676 patients during the study period, 494 were selected based on inclusion and exclusion criteria. The regimen of aspirin + clopidogrel + β-blocker + angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker + statin was prescribed to 374 (75.71%) patients with ACS at discharge. Specifically, this regimen was used in 177 (69.69%) unstable angina patients, 44 (70.97%) non-ST-segment elevation myocardial infarction patients, and 153 (85.96%) ST-segment elevation myocardial infarction patients. Compared with the number of ACS patients with all five guideline-recommended drugs at discharge, the number of ACS patients using them 12 (n=169, 34.21%) and 18 (n=105, 21.26%) months after discharge tended to be gradually decreased. Conclusion The majority of ACS patients in this study received all five guideline-recommended medications at discharge from the hospital. However, the frequency of using all of them had been gradually decreased 3, 6, 12, and 18 months after

  11. Preventable mortality in geriatric hip fracture inpatients

    PubMed Central

    Tarrant, S. M.; Hardy, B. M.; Byth, P. L.; Brown, T. L.; Attia, J.; Balogh, Z. J.

    2014-01-01

    There is a high rate of mortality in elderly patients who sustain a fracture of the hip. We aimed to determine the rate of preventable mortality and errors during the management of these patients. A 12 month prospective study was performed on patients aged > 65 years who had sustained a fracture of the hip. This was conducted at a Level 1 Trauma Centre with no orthogeriatric service. A multidisciplinary review of the medical records by four specialists was performed to analyse errors of management and elements of preventable mortality. During 2011, there were 437 patients aged > 65 years admitted with a fracture of the hip (85 years (66 to 99)) and 20 died while in hospital (86.3 years (67 to 96)). A total of 152 errors were identified in the 80 individual reviews of the 20 deaths. A total of 99 errors (65%) were thought to have at least a moderate effect on death; 45 reviews considering death (57%) were thought to have potentially been preventable. Agreement between the panel of reviewers on the preventability of death was fair. A larger-scale assessment of preventable mortality in elderly patients who sustain a fracture of the hip is required. Multidisciplinary review panels could be considered as part of the quality assurance process in the management of these patients. Cite this article: Bone Joint J 2014;96-B:1178–84. PMID:25183587

  12. [Errors in medicine. Causes, impact and improvement measures to improve patient safety].

    PubMed

    Waeschle, R M; Bauer, M; Schmidt, C E

    2015-09-01

    The guarantee of quality of care and patient safety is of major importance in hospitals even though increased economic pressure and work intensification are ubiquitously present. Nevertheless, adverse events still occur in 3-4 % of hospital stays and of these 25-50 % are estimated to be avoidable. The identification of possible causes of error and the development of measures for the prevention of medical errors are essential for patient safety. The implementation and continuous development of a constructive culture of error tolerance are fundamental.The origins of errors can be differentiated into systemic latent and individual active causes and components of both categories are typically involved when an error occurs. Systemic causes are, for example out of date structural environments, lack of clinical standards and low personnel density. These causes arise far away from the patient, e.g. management decisions and can remain unrecognized for a long time. Individual causes involve, e.g. confirmation bias, error of fixation and prospective memory failure. These causes have a direct impact on patient care and can result in immediate injury to patients. Stress, unclear information, complex systems and a lack of professional experience can promote individual causes. Awareness of possible causes of error is a fundamental precondition to establishing appropriate countermeasures.Error prevention should include actions directly affecting the causes of error and includes checklists and standard operating procedures (SOP) to avoid fixation and prospective memory failure and team resource management to improve communication and the generation of collective mental models. Critical incident reporting systems (CIRS) provide the opportunity to learn from previous incidents without resulting in injury to patients. Information technology (IT) support systems, such as the computerized physician order entry system, assist in the prevention of medication errors by providing

  13. Helping Clinicians Prevent Pregnancy among Sexually Active Adolescents: U.S. Medical Eligibility Criteria for Contraceptive Use and U.S. Selected Practice Recommendations for Contraceptive Use.

    PubMed

    Godfrey, Emily M

    2015-08-01

    The United States has made substantial progress in reducing teenage birth rates in recent decades, but rates remain high. Teen pregnancy can increase the risk of poor health outcomes and lead to decreased educational attainment, increased poverty, and welfare use, as well as increased cost to taxpayers. One of the most effective ways to prevent teenage pregnancy is through the use of effective birth control methods. The Centers for Disease Control (CDC) and Prevention has made the prevention of teenage pregnancy 1 of its 10 winnable battles. The CDC has released 2 evidence-based clinical guideline documents regarding contraceptive use for adolescents and adults. The first guideline, US Medical Eligibility Criteria for Contraceptive Use, 2010, helps clinicians recognize when a contraceptive method may not be safe to use for a particular adolescent but also when not to withhold a contraceptive method that is safe to use. The second document, US Selected Practice Recommendations for Contraceptive Use, 2013, provides guidance for how to use contraceptive methods safely and effectively once they are deemed safe. Health care providers are encouraged to use these documents to provide safe and effective contraceptive care to patients seeking family planning, including adolescents. PMID:26026219

  14. Medical prevention of space motion sickness—animal model of therapeutic effect of a new medicine on motion sickness

    NASA Astrophysics Data System (ADS)

    Yang, T. D.; Pei, J. S.; Yang, S. L.; Liu, Z. Q.; Sun, R. L.

    Space motion sickness (MS) is one of the most important problems in the field of space medicine. In order to prevent space MS, a new medicine, PMPA, has been prepared by means of synthesizing in our laboratory. The purposes of this study were to set up animal models of PMPA against MS, and to observe its effects on anti-MS, and to prove its function of antagonism to choline. Eight cats, forty rabbits and two hundred and ten rats were selected as animal subjects. The parallel swing stimulus, a method causing the reversal syndromes and tests of anti-choline function were used in our experiments. The results are as follows: (1) The score of MS symptoms in cats with PMPA or scopolamine (SCOP) is significantly lower than that in cats with placebo (p<0.01), while the incidences of efficiency and prevention of PMPA (87.5%, 75%) are higher than those of SCOP (75.0%, 50%) in cats. (2) PMPA of 1.6 mg/kg or 0.8 mg/kg could antagonize the reversal syndromes and repress reversal rotation significantly in rabbits like SCOP in comparison with placebo (p<0.01). (3) PMPA could inhibit tremor evoked by oxotremorine or by nicotine-procaine in rats like SCOP, and play an important role in the antagonism to central M-choline and N-choline receptors. The animal experiments demonstrate that PMPA is an effective medicine against MS with antagonism function to choline.

  15. Error detection and reduction in blood banking.

    PubMed

    Motschman, T L; Moore, S B

    1996-12-01

    Error management plays a major role in facility process improvement efforts. By detecting and reducing errors, quality and, therefore, patient care improve. It begins with a strong organizational foundation of management attitude with clear, consistent employee direction and appropriate physical facilities. Clearly defined critical processes, critical activities, and SOPs act as the framework for operations as well as active quality monitoring. To assure that personnel can detect an report errors they must be trained in both operational duties and error management practices. Use of simulated/intentional errors and incorporation of error detection into competency assessment keeps employees practiced, confident, and diminishes fear of the unknown. Personnel can clearly see that errors are indeed used as opportunities for process improvement and not for punishment. The facility must have a clearly defined and consistently used definition for reportable errors. Reportable errors should include those errors with potentially harmful outcomes as well as those errors that are "upstream," and thus further away from the outcome. A well-written error report consists of who, what, when, where, why/how, and follow-up to the error. Before correction can occur, an investigation to determine the underlying cause of the error should be undertaken. Obviously, the best corrective action is prevention. Correction can occur at five different levels; however, only three of these levels are directed at prevention. Prevention requires a method to collect and analyze data concerning errors. In the authors' facility a functional error classification method and a quality system-based classification have been useful. An active method to search for problems uncovers them further upstream, before they can have disastrous outcomes. In the continual quest for improving processes, an error management program is itself a process that needs improvement, and we must strive to always close the circle

  16. [The reliable and plausible conclusions in the decisions of the forensic medical experts].

    PubMed

    Kovalev, A V; Shmarov, L A; Ten'kov, A A

    2016-01-01

    The authors characterize in brief the conclusions drawn by the forensic medical experts in the course of their professional activities with special reference to their reliability and plausibility. The most common errors creeping into the conclusions are discussed together with the approaches to their prevention and/or correction. This article continues a series of publications of the same authors concerning the main logical errors encountered in the conclusions of the forensic medical experts. The results of a deeper analysis of such errors will be published elsewhere. PMID:27030098

  17. Automatic Errors: A Case Series on the Errors Inherent in Electronic Prescribing.

    PubMed

    Lourenco, Laura M; Bursua, Adam; Groo, Vicki L

    2016-07-01

    The adoption of electronic prescribing is on the rise, as it reduces medication errors compared to handwritten orders. The inadvertent dispensing of discontinued medications is a type of medication error that is less well described, but one that can lead to adverse events. Software for electronic prescriptions transmits orders for refills or new prescriptions, but not discontinuations, to the pharmacy. Medications that have been stopped are displayed only at the prescribing facility's electronic medical record (EMR). This report describes five cases in which the pharmacy dispensed electronically discontinued medications, two of which contributed to adverse outcomes. PMID:26883522

  18. Medication Use in the Transition from Hospital to Home

    PubMed Central

    Cua, Yvette M.; Kripalani, Sunil

    2013-01-01

    After hospital discharge, correct understanding and use of medications are key components of patient safety. The current discharge process does not provide adequate fail-safes to ensure quality post-discharge care. This often leads to preventable medication errors as well as non-adherence. Several barriers to successful discharge counseling, including use of medical jargon, lack of educational and administrative resources, time constraints, and low health literacy, contribute to ineffective communication between hospital physicians and patients. Other obstacles include inaccurate or incomplete documentation of the medication history, lack of social support, financial constraints, and poor transfer of information to outpatient physicians. Solutions to improve medication use in the transition period after hospital discharge require effective communication with patients through the use of easily understood language, highlighting key information, and ensuring patient comprehension through the “teach back” technique. More timely communication with outpatient physicians in addition to a more comprehensive transfer of information further facilitate the transition home. Finally, a systematic process of medication reconciliation also aids in decreasing the incidence of medication errors. Hospital-based physicians who attend to key details in the process of discharging patients can have a profound impact on improving medication adherence, avoiding medication errors, and decreasing adverse outcomes in the post-discharge period. PMID:18327350

  19. Treating dental caries as an infectious disease. Applying the medical model in practice to prevent dental caries.

    PubMed

    Limeback, H

    1996-01-01

    The above diagnostic and treatment principles may be self evident to most dental practitioners. To many, however, this treatment philosophy is a new one. Continuing dental education and quality assurance programs will play a significant role in helping dentists make the philosophical shift from a highly technical restorative approach to one that uses the medical model and treats dental caries as an infectious disease. While a total cure in humans suffering from dental disease may never be attainable, dental practitioners should soon be better able to direct more of their attention to the patients who already demonstrate a high incidence of dental decay and to those who are clearly at risk to develop future dental decay. PMID:9470624

  20. Prospective, multidisciplinary recording of perioperative errors in cerebrovascular surgery: is error in the eye of the beholder?

    PubMed

    Michalak, Suzanne M; Rolston, John D; Lawton, Michael T

    2016-06-01

    .001 and p = 0.028, respectively). CONCLUSIONS This study is the only of its kind to elicit error reporting from multiple members of the operating team, and it demonstrates error is truly in the eye of the beholder-the types and timing of perioperative errors vary based on whom you ask. The authors estimate that previous studies surveying only the attending physician missed up to 75% of perioperative errors. By finding significant correlations between technical DOCs and prolonged hospital stays and reported and actual delays, this study shows that these surveys provide relevant and useful information for improving clinical practice. Overall, the results of this study emphasize that research on medical error must include input from all members of the operating team; it is only by understanding every perspective that surgical staff can begin to efficiently prevent errors, improve patient care and safety, and decrease delays. PMID:26636377

  1. The prevalence and nature of prescribing and monitoring errors in English general practice: a retrospective case note review

    PubMed Central

    Avery, Anthony J; Ghaleb, Maisoon; Barber, Nick; Dean Franklin, Bryony; Armstrong, Sarah J; Serumaga, Brian; Dhillon, Soraya; Freyer, Anette; Howard, Rachel; Talabi, Olanrewaju; Mehta, Rajnikant L

    2013-01-01

    Background Relatively little is known about prescribing errors in general practice, or the factors associated with error. Aim To determine the prevalence and nature of prescribing and monitoring errors in general practices in England. Design and setting Retrospective case-note review of unique medication items prescribed over a 12-month period to a 2% random sample of patients. Fifteen general practices across three primary care trusts in England. Method A total of 6048 unique prescription items prescribed over the previous 12 months for 1777 patients were examined. The data were analysed by mixed effects logistic regression. The main outcome measures were prevalence of prescribing and monitoring errors, and severity of errors, using validated definitions. Results Prescribing and/or monitoring errors were detected in 4.9% (296/6048) of all prescription items (95% confidence interval [CI] = 4.4% to 5.5%). The vast majority of errors were of mild to moderate severity, with 0.2% (11/6048) of items having a severe error. After adjusting for covariates, patient-related factors associated with an increased risk of prescribing and/or monitoring errors were: age <15 years (odds ratio [OR] = 1.87, 95% CI = 1.19 to 2.94, P = 0.006) or >64 years (OR = 1.68, 95% CI = 1.04 to 2.73, P = 0.035), and higher numbers of unique medication items prescribed (OR = 1.16, 95% CI = 1.12 to 1.19, P<0.001). Conclusion Prescribing and monitoring errors are common in English general practice, although severe errors are unusual. Many factors increase the risk of error. Having identified the most common and important errors, and the factors associated with these, strategies to prevent future errors should be developed, based on the study findings. PMID:23972195

  2. Quality initiatives: anatomy and pathophysiology of errors occurring in clinical radiology practice.

    PubMed

    Brook, Olga R; O'Connell, Anna Marie; Thornton, Eavan; Eisenberg, Ronald L; Mendiratta-Lala, Mishal; Kruskal, Jonathan B

    2010-09-01

    The Joint Commission requires development of comprehensive error detection systems that incorporate root cause analyses for all sentinel events. To prevent medical errors from occurring, there is a need for a readily available and easy-to-implement system for detecting, classifying, and managing mistakes. The wide spectrum of interrelated contributing factors makes the classification of errors difficult. Contributors to and causes of radiologic errors can be classified under latent and active failures. Latent failures include technical and system-related failures, with a radiology-specific subgroup of communication failures that includes documentation, inaccurate or incomplete information, and communication loop failures. Active failures may be ascribed to human failures (more specifically failure of execution of a task, inadequate planning, or behavior-related failures), patient-based failures, and external failures. Classification of an error should also include the impact of the error on the patient, staff, other customers, and radiology practice. Further considerations should include nonmedical impact of the error, including legal, social, and economic effects on both the patient and the system. Rather than focusing the investigation on blaming individuals for active failures, the primary effort should be to discover latent system failures that can be remedied at a departmental level. Such an error classification system will decrease the likelihood of future errors and diminish their adverse impact. PMID:20622192

  3. A Review of Medical and Substance Use Co-Morbidities in Central Asian Prisons: Implications for HIV Prevention and Treatment

    PubMed Central

    Polonsky, Maxim; Kerimi, Nina; Mamyrov, Mirlan; Dvoryak, Sergey; Altice, Frederick L.

    2013-01-01

    Background HIV incidence in Central Asia is rising rapidly. People who inject drugs (PWIDs) contribute greatest to the epidemic, with more than a quarter of all HIV cases being in the criminal justice system (CJS). This review assembled and aggregated recent data on drug-related health problems and respective healthcare services in the CJS of Central Asia and the Republic of Azerbaijan. Methods Online databases and published literature (peer-reviewed and grey) were reviewed. Additionally, prison officials in the 6 countries were invited to participate in a survey and prison administrators from Kazakhstan, Kyrgyzstan and Tajikistan completed it. Results The data on conditions and healthcare in Central Asian prisons are inconsistent and lack unbiased details. Reporting is primarily based on “official” disease registries, which markedly underestimate prevalence. Even these limited data, however, indicate that HIV prevalence and drug-related health problems are high, concentrated and, in some countries, rising rapidly. Only some of the range of HIV prevention interventions recommended by international organizations have been implemented in the region with two of the crucial interventions, needle and syringe exchange programs (NSP) and opioid substitution therapy (OST), only available in Kyrgyzstan prisons, with Tajikistan implementing a pilot NSP and contemplating introduction of prison-based OST. Conclusions Despite deficiencies in routine health reporting and insufficient HIV sentinel surveillance undertaken in prisons, the data available on the concentration of HIV within at-risk populations in prisons indicate a necessity to broaden the range and increase the scale the scale of HIV prevention and treatment services. PMID:23932844

  4. Human Error: A Concept Analysis

    NASA Technical Reports Server (NTRS)

    Hansen, Frederick D.

    2007-01-01

    Human error is the subject of research in almost every industry and profession of our times. This term is part of our daily language and intuitively understood by most people however, it would be premature to assume that everyone's understanding of human error s the same. For example, human error is used to describe the outcome or consequence of human action, the causal factor of an accident, deliberate violations,a nd the actual action taken by a human being. As a result, researchers rarely agree on the either a specific definition or how to prevent human error. The purpose of this article is to explore the specific concept of human error using Concept Analysis as described by Walker and Avant (1995). The concept of human error is examined as currently used in the literature of a variety of industries and professions. Defining attributes and examples of model, borderline, and contrary cases are described. The antecedents and consequences of human error are also discussed and a definition of human error is offered.

  5. [Diagnostic Errors in Medicine].

    PubMed

    Buser, Claudia; Bankova, Andriyana

    2015-12-01

    The recognition of diagnostic errors in everyday practice can help improve patient safety. The most common diagnostic errors are the cognitive errors, followed by system-related errors and no fault errors. The cognitive errors often result from mental shortcuts, known as heuristics. The rate of cognitive errors can be reduced by a better understanding of heuristics and the use of checklists. The autopsy as a retrospective quality assessment of clinical diagnosis has a crucial role in learning from diagnostic errors. Diagnostic errors occur more often in primary care in comparison to hospital settings. On the other hand, the inpatient errors are more severe than the outpatient errors. PMID:26649954

  6. Acceptability and Correlates of Primary and Secondary Prevention of Cervical Cancer among Medical Students in Southwest China: Implications for Cancer Education

    PubMed Central

    Pan, Xiong-Fei; Zhao, Zhi-Mei; Sun, Jing; Chen, Feng; Wen, Qing-Lian; Liu, Kang; Song, Gui-Qin; Zhang, Jing-Jing; Wen, Ying; Fu, Chun-Jing; Yang, Chun-Xia

    2014-01-01

    Objectives To understand knowledge about, and acceptability of, cervical cancer screening and HPV vaccines among medical students; and to explore potential factors that influence their acceptability in China. Methods We conducted a survey among medical students at six universities across southwest China using a 58-item questionnaire regarding knowledge and perceptions of HPV, cervical cancer, and HPV vaccines. Results We surveyed 1878 medical students with a mean age of 20.8 years (standard deviation: 1.3 years). Of these, 48.8% and 80.1% believed cervical cancer can be prevented by HPV vaccines and screening respectively, while 60.2% and 71.2% would like to receive or recommend HPV vaccines and screening. 35.4% thought HPV vaccines ought to be given to adolescents aged 13–18 years. 32% stated that women should start to undergo screening from the age of 25. 49.2% felt that women should receive screening every year. Concern about side effects (38.3% and 39.8%), and inadequate information (42.4% and 35.0%) were the most cited barriers to receiving or recommending HPV vaccination and cervical cancer screening. Females were more likely to accept HPV vaccines (OR, 1.86; 95% CI: 1.47–2.35) or cervical cancer screening (OR, 3.69; 95% CI: 2.88–4.74). Students with a higher level of related knowledge were much more willing to receive or recommend vaccines (P<0.001) or screening (P<0.001). Students who showed negative or uncertain attitudes towards premarital sex were less likely to accept either HPV vaccines (OR, 0.67; 95% CI: 0.47–0.96), or screening (OR, 0.68; 0.47–0.10). Non-clinical students showed lower acceptability of cervical screening compared to students in clinical medicine (OR, 0.74; 95% CI: 0.56–0.96). Conclusions The acceptability of HPV vaccines and cervical cancer screening is relatively low among medical students in southwest China. Measures should be taken to improve knowledge about cervical cancer and awareness of HPV vaccines and screening

  7. Error management in blood establishments: results of eight years of experience (2003–2010) at the Croatian Institute of Transfusion Medicine

    PubMed Central

    Vuk, Tomislav; Barišić, Marijan; Očić, Tihomir; Mihaljević, Ivanka; Šarlija, Dorotea; Jukić, Irena

    2012-01-01

    Background. Continuous and efficient error management, including procedures from error detection to their resolution and prevention, is an important part of quality management in blood establishments. At the Croatian Institute of Transfusion Medicine (CITM), error management has been systematically performed since 2003. Materials and methods. Data derived from error management at the CITM during an 8-year period (2003–2010) formed the basis of this study. Throughout the study period, errors were reported to the Department of Quality Assurance. In addition to surveys and the necessary corrective activities, errors were analysed and classified according to the Medical Event Reporting System for Transfusion Medicine (MERS-TM). Results. During the study period, a total of 2,068 errors were recorded, including 1,778 (86.0%) in blood bank activities and 290 (14.0%) in blood transfusion services. As many as 1,744 (84.3%) errors were detected before issue of the product or service. Among the 324 errors identified upon release from the CITM, 163 (50.3%) errors were detected by customers and reported as complaints. In only five cases was an error detected after blood product transfusion however without any harmful consequences for the patients. All errors were, therefore, evaluated as “near miss” and “no harm” events. Fifty-two (2.5%) errors were evaluated as high-risk events. With regards to blood bank activities, the highest proportion of errors occurred in the processes of labelling (27.1%) and blood collection (23.7%). With regards to blood transfusion services, errors related to blood product issuing prevailed (24.5%). Conclusion. This study shows that comprehensive management of errors, including near miss errors, can generate data on the functioning of transfusion services, which is a precondition for implementation of efficient corrective and preventive actions that will ensure further improvement of the quality and safety of transfusion treatment. PMID

  8. Sensitivity and specificity of dosing alerts for dosing errors among hospitalized pediatric patients

    PubMed Central

    Stultz, Jeremy S; Porter, Kyle; Nahata, Milap C

    2014-01-01

    Objectives To determine the sensitivity and specificity of a dosing alert system for dosing errors and to compare the sensitivity of a proprietary system with and without institutional customization at a pediatric hospital. Methods A retrospective analysis of medication orders, orders causing dosing alerts, reported adverse drug events, and dosing errors during July, 2011 was conducted. Dosing errors with and without alerts were identified and the sensitivity of the system with and without customization was compared. Results There were 47 181 inpatient pediatric orders during the studied period; 257 dosing errors were identified (0.54%). The sensitivity of the system for identifying dosing errors was 54.1% (95% CI 47.8% to 60.3%) if customization had not occurred and increased to 60.3% (CI 54.0% to 66.3%) with customization (p=0.02). The sensitivity of the system for underdoses was 49.6% without customization and 60.3% with customization (p=0.01). Specificity of the customized system for dosing errors was 96.2% (CI 96.0% to 96.3%) with a positive predictive value of 8.0% (CI 6.8% to 9.3). All dosing errors had an alert over-ridden by the prescriber and 40.6% of dosing errors with alerts were administered to the patient. The lack of indication-specific dose ranges was the most common reason why an alert did not occur for a dosing error. Discussion Advances in dosing alert systems should aim to improve the sensitivity and positive predictive value of the system for dosing errors. Conclusions The dosing alert system had a low sensitivity and positive predictive value for dosing errors, but might have prevented dosing errors from reaching patients. Customization increased the sensitivity of the system for dosing errors. PMID:24496386

  9. Error Prevention as Developed in Airlines

    SciTech Connect

    Logan, Timothy J.

    2008-05-01

    The airline industry is a high-risk endeavor. Tens of thousands of flights depart each day carrying millions of passengers with the potential for catastrophic consequences. To manage and mitigate this risk, airline operators, labor unions, and the Federal Aviation Administration have developed a partnership approach to improving safety. This partnership includes cooperative programs such as the Aviation Safety Action Partnership and the Flight Operational Quality Assurance. It also involves concentrating on the key aspects of aircraft maintenance reliability and employee training. This report discusses recent enhancements within the airline industry in the areas of proactive safety programs and the move toward safety management systems that will drive improvements in the future.

  10. Error prevention as developed in airlines.

    PubMed

    Logan, Timothy J

    2008-01-01

    The airline industry is a high-risk endeavor. Tens of thousands of flights depart each day carrying millions of passengers with the potential for catastrophic consequences. To manage and mitigate this risk, airline operators, labor unions, and the Federal Aviation Administration have developed a partnership approach to improving safety. This partnership includes cooperative programs such as the Aviation Safety Action Partnership and the Flight Operational Quality Assurance. It also involves concentrating on the key aspects of aircraft maintenance reliability and employee training. This report discusses recent enhancements within the airline industry in the areas of proactive safety programs and the move toward safety management systems that will drive improvements in the future. PMID:18406922

  11. Knowledge, Beliefs and Practices Regarding Antiretroviral Medications for HIV Prevention: Results from a Survey of Healthcare Providers in New England

    PubMed Central

    Krakower, Douglas S.; Oldenburg, Catherine E.; Mitty, Jennifer A.; Wilson, Ira B.; Kurth, Ann E.; Maloney, Kevin M.; Gallagher, Donna; Mayer, Kenneth H.

    2015-01-01

    Background Antiretroviral treatment for HIV-infection before immunologic decline (early ART) and pre-exposure chemoprophylaxis (PrEP) can prevent HIV transmission, but routine adoption of these practices by clinicians has been limited. Methods Between September and December 2013, healthcare practitioners affiliated with a regional AIDS Education and Training Center in New England were invited to complete online surveys assessing knowledge, beliefs and practices regarding early ART and PrEP. Multivariable models were utilized to determine characteristics associated with prescribing intentions and practices. Results Surveys were completed by 184 practitioners. Respondent median age was 44 years, 58% were female, and 82% were white. Among ART-prescribing clinicians (61% of the entire sample), 64% were aware that HIV treatment guidelines from the Department of Health and Human Services recommended early ART, and 69% indicated they would prescribe ART to all HIV-infected patients irrespective of immunologic status. However, 77% of ART-prescribing clinicians would defer ART for patients not ready to initiate treatment. Three-fourths of all respondents were aware of guidance from the U.S. Centers for Disease Control and Prevention recommending PrEP provision, 19% had prescribed PrEP, and 58% of clinicians who had not prescribed PrEP anticipated future prescribing. Practitioners expressed theoretical concerns and perceived practical barriers to prescribing early ART and PrEP. Clinicians with higher percentages of HIV-infected patients (aOR 1.16 per 10% increase in proportion of patients with HIV-infection, 95% CI 1.01–1.34) and infectious diseases specialists (versus primary care physicians; aOR 3.32, 95% CI 0.98–11.2) were more likely to report intentions to prescribe early ART. Higher percentage of HIV-infected patients was also associated with having prescribed PrEP (aOR 1.19, 95% CI 1.06–1.34), whereas female gender (aOR 0.26, 95% CI 0.10–0.71) was associated

  12. Conventional and alternative medical advice for cold and flu prevention: what should be recommended and what should be avoided?

    PubMed

    Moyad, Mark A

    2009-01-01

    H1N1, seasonal flu, and upper respiratory infection over-the-counter (OTC) prevention recommendations seem daunting, but in reality, only several diverse lifestyle changes, supplements, and prescriptions have adequate evidence that should be discussed with patients. In addition, numerous other recommendations contain little to no evidence. For example, most heart-healthy behavioral changes, such as reducing visceral adipose tissue, simultaneously improve immune health, and this needs to be emphasized. Ethyl alcohol hand gel and plain soap and water should be encouraged, and antimicrobial soaps should be discouraged. Gargling with water and using nasal saline spray are also cost effective and supported with clinical evidence. Vitamins C and D have the largest benefit-to-risk ratio for patients and may reduce the risk of pneumonia from a recent meta-analysis. Other supplements, such has echinacea, vitamin E, and zinc, have some clinical data, but also have potential long-term safety issues. High-calorie antioxidant beverages only encourage weight and waist gain, but a teaspoon or two of honey has antimicrobial activity and may suppress cough. Finally, vaccine compliance as early as possible should be promoted as a selfless act that reduces viral transmission that could cause morbidity and mortality in the most immune vulnerable individuals, and simply promotes herd immunity, rather than a self-centered act whose individual result and response (n = 1) currently and unfortunately seems to mirror the perceived personal effectiveness or lack of effectiveness of the vaccine. PMID:20088240

  13. [Guideline to prevent claims due to medical malpractice, on how to act when they do occur and how to defend oneself through the courts].

    PubMed

    Bruguera, M; Arimany, J; Bruguera, R; Barberia, E; Ferrer, F; Sala, J; Pujol Robinat, A; Medallo Muñiz, J

    2012-04-01

    Claims due to presumed medical malpractice are increasing in all developed countries and many of them have no basis. To prevent legal complaints, the physicians should know the reasons why complaints are made by their patients and adopt the adequate preventive measures. In the case of a complaint, it is essential to follow the guidelines that allow for adequate legal defense and the action of the physician before the judge that inspires confidence and credibility. The risk of the claims can be reduced with adequate information to the patient, the following of the clinical guidelines, control of the risk factors and adoption of verification lists in each invasive procedure. In case of complication or serious adverse effect, explanations should be given to the patient and family and it should be reported to the facility where one works and to the insurance company. If the physician received a claim, he/she should report it to the insurance compare so that it can name a lawyer responsible for the legal defense who will advise the physician regarding the appearance in court before the judge. PMID:22397887

  14. A New Cure for Medical Errors

    NASA Technical Reports Server (NTRS)

    2002-01-01

    In May 2000, senior officials of the U.S. Department of Veterans Affairs (VA) and NASA signed an agreement that would commit the two agencies to create the Patient Safety Reporting System (PSRS) to report: events or situations that could have resulted in accident, injury, or illness, but did not, either by chance or through timely intervention (close-calls); unexpected serious occurrences that involved a patient or employee's death, physical injury, or psychological injury; lessens learned; and safety ideas. The VA provided NASA with funding for the initial development of the new system, which automatically removes all personal names, facility names and locations, and other potentially identifying information before entering reports into its database. Designed to complement the VA's current internal reporting systems, the PSRS is modeled after NASA's Aviation Safety Reporting System, which was established in 1975 under a Memorandum of Agreement between the Federal Aviation Administration and NASA and began operation in 1976.

  15. Drug errors: consequences, mechanisms, and avoidance.

    PubMed

    Glavin, R J

    2010-07-01

    Medication errors are common throughout healthcare and result in significant human and financial cost. Prospective studies suggest that the error rate in anaesthesia is around one error in every 133 anaesthetics. There are several categories of medication error ranging from slips and lapses to fixation errors and deliberate violations. Violations may be more likely in organizations with a tendency to blame front-line workers, a tendency to deny the existence of latent conditions, and a blinkered pursuit of productivity indicators. In these organizations, borderline-tolerated conditions of use may occur which blur the distinction between safe and unsafe practice. Latent conditions will also make the error at the 'sharp end' more likely to result in actual patient harm. Several complementary strategies are proposed which may result in fewer medication errors. At the organizational level, developing a safety culture and promoting robust error reporting systems is key. The individual anaesthetist can play a part in this, setting an example to other members of the team in vigilance for errors, creating a safety climate with psychological safety, and reporting and learning from errors. PMID:20507858

  16. Pharmaceutical interventions in medications prescribed for administration via enteral tubes in a teaching hospital

    PubMed Central

    Ferreira, Carolina Justus Buhrer; Plodek, Caroline Koga; Soares, Franciny Kossemba; de Andrade, Rayza Assis; Teleginski, Fernanda; da Rocha, Maria Dagmar

    2016-01-01

    Abstract Objective: to analyze the impact of guidelines regarding errors in medications prescribed for administration through enteral tubes. Method: quantitative study, in three phases, undertaken in internal medicine, neurology and an intensive care unit in a general teaching hospital. In Phase 1, the following was undertaken: a protocol for dilution and unit-dose repackaging and administration for 294 medications via enteral tubes; a decision flowchart; operational-standard procedures for dilution and unit-dose repackaging of oral pharmaceutical forms and for administration of medications through enteral tubes. In phase 2, errors in 872 medications prescribed through enteral tubes, in 293 prescriptions for patients receiving inpatient treatment between March and June, were investigated. This was followed by training of the teams in relation to the guidelines established. In Phase 3, pharmaceutical errors and interventions in 945 medications prescribed through enteral tubes, in 292 prescriptions of patients receiving inpatient treatment between August and September, were investigated prospectively. The data collected, in a structured questionnaire, were compiled in the Microsoft Office Excel(r) program, and frequencies were calculated. Results: 786 errors were observed, 63.9% (502) in Phase 2, and 36.1% (284) in Phase 3. In Phase 3, a reduction was ascertained in the frequency of prescription of medications delivered via enteral tubes, medications which were contraindicated, and those for which information was not available. Conclusion: guidelines and pharmaceutical interventions were determined in the prevention of errors involving medications delivered through enteral tubes. PMID:27276019

  17. Impact of Patients’ Communication with the Medical Practitioners, on Their Adherence Declared to Preventive Behaviours, Five Years after a Coronary Angiography, in Luxembourg

    PubMed Central

    Baumann, Michèle; Tchicaya, Anastase; Lorentz, Nathalie; Le Bihan, Etienne

    2016-01-01

    Background Patients of the National Institute of Cardiac Surgery and Interventional Cardiology in Luxembourg who underwent coronary angiography were surveyed for hypertension, hypercholesterolemia, diabetes and overweight/obesity between 2008/9 and 2013/4. For each cardiovascular risk factor (CVRFs), we analysed the associations between the quality of the patients' communication with the medical practitioner and their adherence declared to preventive behaviours. Methods 1,289 completed a self-administered questionnaire on communication with the medical practitioner (P’Com-5 items scale; Cronbach 0.87). 61.8% stopped smoking, 57.9% reduced or stopped their consumption of salt, 71.9% of fat, and 62.8% of sugar, and whereas 65% increased their consumption of fruit and vegetables and 19.8% increased their physical activity. Around 37% reported having made changes following their doctor's advice. 90% were followed by a cardiologist and 95.9% by an attending physician. Results No link was observed between declaration of physical activity, smoking, fats, and quality of communication. Significant associations: for increased consumption of fruit and vegetables was linked with the quality of doctor-patient communication when patients were overweight (OR = 1.081), obese (OR = 1.130), hypercholesterolemic (OR = 1.102), hypertensive (OR = 1.084) or diabetic (OR = 1.103). Reduction in salt intake was linked only to patients with hypertension (OR = 1.102), whereas reduction or cessation of sugar consumption was linked to overweight (OR = 1.093), and more so obese, (OR = 1.106), hypercholesterolemics (OR = 1.103) and diabetics (OR = 1.173). Conclusions Good doctor-patient communication was related to nutrition, particularly increased consumption of fresh fruits and vegetables. Accurate perception of CVRFs by both patients and medical practitioners is essential for CV protection. The aim of instructing patients is to encourage them to make informed decisions about how to change

  18. Sun compass error model

    NASA Technical Reports Server (NTRS)

    Blucker, T. J.; Ferry, W. W.

    1971-01-01

    An error model is described for the Apollo 15 sun compass, a contingency navigational device. Field test data are presented along with significant results of the test. The errors reported include a random error resulting from tilt in leveling the sun compass, a random error because of observer sighting inaccuracies, a bias error because of mean tilt in compass leveling, a bias error in the sun compass itself, and a bias error because the device is leveled to the local terrain slope.

  19. A Secure ECC-based RFID Mutual Authentication Protocol to Enhance Patient Medication Safety.

    PubMed

    Jin, Chunhua; Xu, Chunxiang; Zhang, Xiaojun; Li, Fagen

    2016-01-01

    Patient medication safety is an important issue in patient medication systems. In order to prevent medication errors, integrating Radio Frequency Identification (RFID) technology into automated patient medication systems is required in hospitals. Based on RFID technology, such systems can provide medical evidence for patients' prescriptions and medicine doses, etc. Due to the mutual authentication between the medication server and the tag, RFID authentication scheme is the best choice for automated patient medication systems. In this paper, we present a RFID mutual authentication scheme based on elliptic curve cryptography (ECC) to enhance patient medication safety. Our scheme can achieve security requirements and overcome various attacks existing in other schemes. In addition, our scheme has better performance in terms of computational cost and communication overhead. Therefore, the proposed scheme is well suitable for patient medication systems. PMID:26573649

  20. Structured methods for identifying and correcting potential human errors in space operations.

    PubMed

    Nelson, W R; Haney, L N; Ostrom, L T; Richards, R E

    1998-01-01

    Human performance plays a significant role in the development and operation of any complex system, and human errors are significant contributors to degraded performance, incidents, and accidents for technologies as diverse as medical systems, commercial aircraft, offshore oil platforms, nuclear power plants, and space systems. To date, serious accidents attributed to human error have fortunately been rare in space operations. However, as flight rates go up and the duration of space missions increases, the accident rate could increase unless proactive action is taken to identity and correct potential human errors in space operations. The Idaho National Engineering and Environmental Laboratory (INEEL) has developed and applied structured methods of human error analysis to identify potential human errors, assess their effects on system performance, and develop strategies to prevent the errors or mitigate their consequences. These methods are being applied in NASA-sponsored programs to the domain of commercial aviation, focusing on airplane maintenance and air traffic management. The application of human error analysis to space operations could contribute to minimize the risks associated with human error in the design and operation of future space systems. PMID:11541925

  1. Structured methods for identifying and correcting potential human errors in space operations

    NASA Astrophysics Data System (ADS)

    Nelson, William R.; Haney, Lon N.; Ostrom, Lee T.; Richards, Robert E.

    Human performance plays a significant role in the development and operation of any complex system, and human errors are significant contributors to degraded performance, incidents, and accidents for technologies as diverse as medical systems, commercial aircraft, offshore oil platforms, nuclear power plants, and space systems. To date, serious accidents attributed to human error have fortunately been rare in space operations. However, as flight rates go up and the duration of space missions increases, the accident rate could increase unless proactive action is taken to identify and correct potential human errors in space operations. The Idaho National Engineering and Environmental Laboratory (INEEL) has developed and applied structured methods of human error analysis to identify potential human errors, assess their effects on system performance, and develop strategies to prevent the errors or mitigate their consequences. These methods are being applied in NASA-sponsored programs to the domain of commercial aviation, focusing on airplane maintenance and air traffic management. The application of human error analysis to space operations could contribute to minimize the risks associated with human error in the design and operation of future space systems.

  2. Medical Device Safety

    MedlinePlus

    A medical device is any product used to diagnose, cure, or treat a condition, or to prevent disease. They range ... may need one in a hospital. To use medical devices safely Know how your device works. Keep instructions ...