[Critical Incident Reporting on medication errors regarding units of measurement and calculations]. / Critical Incident Reporting zu Medikationsfehlern mit Masseinheiten und Berechnungen.

INTRODUCTION: Medication safety is an important hot spot of patient safety. This fact prompted the Swiss Patient Safety Foundation to conduct its annual CIRRNET (Critical Incident Reporting & Reacting NETwork) reporting month on the topic of "Units of measurement of medicines and calculation errors in prescription/dispensing (mg, g, mmol etc.)". METHODS: During the CIRRNET reporting month 2018, the CIRS (Critical Incident Reporting System) managers of the health institutions participating in CIRRNET forwarded all incident reports on the topic to the CIRRNET database. The archive was also searched for usable reports on the same topic. The reports were analysed according to the type of medication involved (type of application and medication class according to ATC codes), the process stage affected (prescription, preparation, administration and documentation) and the error category. RESULTS: Of the 110 reports analysed, 27 reports originated directly from the reporting month, 83 reports were additionally extracted from the archive. 67 reports (60 %) concerned intravenously administered medications and analgesics (opioids and non-opioids, such as NSAIDs) were the most frequently affected/involved medication class with 21 reports (18 %). The process step preparation/calculation was the one where most of the errors analysed occurred. With a total of 48 reports (44 %), most of the errors analysed were classified here. Regarding error categories, it becomes apparent that the categories "Derivation of the amount to be administered (volume/number of single doses) from strength or concentration" with 33 (30 %), "Unit of measurement ml - mg" with 20 (18 %) and "Dose/volume per time" with 14 reports (13 %) were reported most frequently. CONCLUSION: Errors concerning units of measurement or the calculation of medication have been numerously reported by the CIRRNET institutions. Often, these were cases in which, for example, the volume of a drug to be administered was derived incorrectly. Such calculations are demanding, prone to error and represent a system problem. Therefore, good solution strategies need to be implemented in order to sustainably improve medication safety and thus patient safety.

[Specimen labelling: A complex process with a high error rate]. / Etikettierung von Laborröhrchen: ein komplexer Prozess mit hoher Fehleranfälligkeit.

Errors associated with the labelling of laboratory specimens repeatedly occur in health facilities and are often described in Critical Incident Reporting Systems (CIRS). The analysis of these error reports and the complexity of the specimen collection process pose major challenges for responsible health care professionals. To examine which errors occur in the labelling of laboratory specimens, and what leads to their detection, the error reports of 42 Swiss hospitals within the Critical Incident Reporting & Reaching NETwork (CIRRNET) were systematically analysed. METHOD: Within the scope of a reporting month in the year 2016, 42 hospitals were asked to pay particular attention to the issue of mislabelled laboratory specimens, to report these errors in the local CIRS system, and to forward the information to the CIRRNET database. In addition, using a systematic keyword search, a search for old error reports on the mislabelling of laboratory specimens was conducted in the CIRRNET database and the results extracted. 227 error reports were finally included in the analysis. All these error reports were analysed systematically and by content, and the problem areas described in these reports allocated to newly defined categories. The systematic analysis included: the time of error detection, the problem area described, the length of time between error occurrence and error detection, as well as possible safety barriers. RESULTS: The majority (52 %) of labelling errors of laboratory specimens are detected in the laboratory, 21.1 % on the hospital ward before the specimens are sent to the laboratory to be processed, and a further 24.7 % at a very late stage when test results are associated with the patient on the ward. The analysis of the problem areas described showed that patient identification (7.9 %) was a key issue. The most frequent errors occurred in connection with the labelling of laboratory test tubes (45.4 %) and analysis forms or requisition slips (33 %). Numerous errors went undetected throughout the entire process, i.e. right up until the moment when the test result was finally assigned to the patient. The analysis also provided information about possible safety barriers for future prevention of laboratory specimen mislabelling. CONCLUSIONS: A content-analysis approach is essential to the evaluation of error reports as it is the only way to identify all the problems of laboratory specimen mislabelling described. Furthermore, a deductive approach also facilitates the identification of possible safety barriers. The findings provide valuable information for mislabelling prevention approaches that is not otherwise available. Further analysis of error reports from Critical Incident Reporting Systems is necessary in order to gain more experience with the methodical approach and to draw conclusions as to whether the complex process of analysing each individual error report yields information that is more useful than the analysis of the error reports of an identified problem area.

[Quality of advanced practice nurse counseling in home care settings (APN-BQ): psychometric testing of the instrument]. / Beratungsqualität von Pflegeexpertinnen-APN im spitalexternen Bereich (APN-BQ) - Psychometrische Testung des Instruments.

BACKGROUND: Patient centred and individually-tailored counselling of older people with a chronic condition who live at home is a useful intervention to support their independence. AIM: The paper presents the development and psychometric testing of the APN-BQ Instrument, to measure patient-centeredness. METHOD: To measure the quality of an in-home counselling intervention, a 23-item questionnaire was developed and tested with 206 people 80 years and older. Principal component analysis with Varimax Rotation was conducted (n = 206). RESULTS: Analysis revealed a four factor (fs = 0.91) model scoring in 19 items. All factors loaded > 0.45. Cronbach's alpha was 0.86. The utility and acceptance of the instrument was confirmed by the high response rate (100 %) and the fact that participants answered 98.8 % of all questions. CONCLUSIONS: The APN-BQ has shown to be a reliable Instrument with good content and construct validity. It is a tool for APNs to measure structure, process, and outcome quality of a patient-centred and individually-tailored counselling program, including the degree of patient participation, and patient empowerment.