Medication error reporting in Tehran: a survey.

AIM: The purpose of this study was to evaluate nurses' reporting of medication errors. BACKGROUND: Improvement in medication error reporting is one of the major challenges in today's health care environments. METHODS: This was a descriptive survey of nurses working in medical, surgery, orthopaedic, gynaecology and obstetric wards in hospitals affiliated to Iran University of Medical Sciences, using stratified multistage sampling. Data were collected between November 2008 and May 2009 using a researcher-designed questionnaire. Data were described and explored using Kruskal-Wallis, one-way analysis of variance and Mann-Whitney's test. RESULTS: The response rate was 93% (n = 286).The mean number of medication errors 'reported' per nurse during 3 months was 1.33 [standard deviation (SD) = 4.18, median = 0, interquartile range (IQR) = 0-0, range = 70-0]. The mean number of errors made was 19.5 (SD = 30.27, median = 10, IQR = 1-25, range = 181-0). None of the individual and organisational characteristics reported were significantly related to reporting of medication errors. Failure to record vital signs (e.g. pulse, blood pressure etc.) before and after administering certain medicines was the most frequently reported medication error. CONCLUSION: More errors were made than were reported and this requires further investigation. IMPLICATIONS FOR NURSING MANAGEMENT: The reporting of medication errors is a problem in health care systems worldwide, including Iran. Considering the significant difference between the nurses' actual and reported medication errors, managers should monitor medication errors. Educational initiatives are needed to improve understanding of the importance of medication administration.

Trucut biopsy of breast lesions: the first step toward international standards in developing countries.

UNLABELLED: The new concept in breast cancer diagnosis and treatment is based on a less invasive, more accurate and effective strategy, with a multidisciplinary approach in a specialised breast unit. When indicated, conservative surgery has replaced mastectomy with sentinel-node biopsy substituting routine axillary dissection. But the key factor in respect of these new standards is to confirm the cancer before going to the operating room. Trucut biopsy is performed instead of incisional or excisional biopsy and frozen section. The technique is reliable, simple, and reproducible, and not at all expensive; it can be adapted even for low-income developing countries. MATERIALS AND METHODS: Between March 2006 and June 2010, 764 patients under clinical suspicion of cancer and/or with BIRADS (Breast Imaging Reporting and Data System) III-V in imaging in one university and one private hospital in Tehran, Iran underwent trucut biopsy (60% palpable and 40% non-palpable lesions). Cancer was found in 30.8% of the cases. In benign pathology, in concordance with clinical and imaging suspicion, surgery was omitted with short-term follow-up. For palpable symptomatic benign lesions surgery was performed to relieve the patient's symptoms. When the pathology report was not in concordance with clinical/imaging suspicion (1.8%), and in the presence of moderate and severe hyperplasia with or without atypia, in lobular and papillary lesions (4.9%) open biopsy was done to rule out cancer (10 added cancers, 1.3%; total cancers 32.1%). Cancer surgery was done as a single procedure in 89.8% of cases. CONCLUSION: Trucut biopsy for breast lesion assessment is the first step toward a new concept in breast cancer care. It is simple, reduces the number of surgeries (no surgery for non-symptomatic benign lesions and one surgery for cancer), and avoids diagnostic errors with full respect for the patient's rights. We insist on its routine use to extend international guidelines while decreasing the total cost of this common disease in all low-resource countries.

The relationship between incidence and report of medication errors and working conditions.

BACKGROUND: Medication errors are considered to be a serious threat to patients' safety. Efforts to detect and prevent these errors have increased considerably in recent years. AIM: To determine the incidence and reporting rate of medication errors as reported by Iranian nurses and their relationship with work conditions in hospitals under the authority of Iran University of Medical Sciences. METHODS: This descriptive-analytical study was carried out in six hospitals. Through a stratified multiple stage sampling, 300 nurses were selected. A researcher-constructed, three-part, self-report questionnaire was used to collect data regarding the nurses' medication errors, medication error reports and their perceived working conditions during the previous 3 months. The data were processed using descriptive statistics and Kruskal-Wallis one-way analysis of variance. FINDINGS: The mean of medication errors that nurses recalled was 19.5, and the mean of error reporting was 1.3 cases during the previous 3 months. The relationship between error incidence and work conditions as perceived by nurses was statistically significant (df = 3, P ≤ 0.0001); however, there was no significant relationship between reporting the occurred error and nurses' perceived work conditions (df = 3, P ≤ 0.255). CONCLUSION AND IMPLICATIONS: The establishment of an efficient reporting system, documentation of errors and removal of obstacles to reporting may result in reduced frequency of medication errors. Considering the relationship between medication error incidence and working conditions, it seems that creating a work condition in which nurses feel more comfortable and decreasing work tensions may pave the way to preventing nursing errors.

Caring relationship: the core component of patients' rights practice as experienced by patients and their companions.

The aim of this article is to describe how Iranian patients and their companions explain their lived experiences with caring relationships in a central teaching hospital in Tehran, Iran. Despite a large number of theoretical articles on this topic, the meaning of caring is still ambiguous, particularly in specific cultures. In Iran, there is not enough qualitative evidence on this topic to indicate what patients actually mean when they refer to caring relationship. This article explores how Iranian patients and their companions perceive and describe caring relationships as an element of patients' rights practice. This is part of a phenomenological research on patients' rights practice in Iran conducted during 2003-2006. Semi-structured interviews were conducted with 16 patients/companions, and van Mannen's approach was used for thematic analysis. The ethics committee of Tehran University of Medical Sciences approved the study. Patient-centered care, compassion, effective communication, support/advocacy, informed participation and meeting patients' basic needs were found to be the key elements in defining caring relationships. These themes were all described as elements of patients' rights practice issues. The results indicated that it is necessary for care givers/nurses to understand the person who will receive care in order to provide zealous and authentic care, because feeling "to be cared for" is even more important than providing the "care" itself.