Non-intercepted dose errors in prescribing anti-neoplastic treatment: a prospective, comparative cohort study.

BACKGROUND: The incidence of non-intercepted prescription errors and the risk factors involved, including the impact of computerised order entry (CPOE) systems on such errors, are unknown. Our objective was to determine the incidence, type, severity, and related risk factors of non-intercepted prescription dose errors. PATIENTS AND METHODS: A prospective, comparative cohort study in two clinical oncology units. One institution used a CPOE system with no connection to the electronic patient record system, while the other used paper-based prescription forms. All standard prescriptions were included and reviewed. Doses were recalculated according to the guidelines of each institution, using the patient data as documented in the patient record, the paper-based prescription form, or the CPOE system. A non-intercepted prescription dose error was defined as ≥10% difference between the administered and the recalculated dose. RESULTS: Data were collected from 1 November 2012 to 15 January 2013. A total of 5767 prescriptions were evaluated, 2677 from the institution using CPOE and 3090 from the institution with paper-based prescription. Crude analysis showed an overall risk of a prescription dose error of 1.73 per 100 prescriptions. CPOE resulted in 1.60 and paper-based prescription forms in 1.84 errors per 100 prescriptions, i.e. odds ratio (OR) = 0.87 [95% confidence interval (CI) 0.59-1.29, P = 0.49]. Fifteen different types of errors and four potential risk factors were identified. None of the dose errors resulted in the death of the patient. CONCLUSIONS: Non-intercepted prescribing dose errors occurred in <2% of the prescriptions. The parallel CPOE system did not significantly reduce the overall risk of dose errors, and although it reduced the risk of calculation errors, it introduced other errors. Strategies to prevent future prescription errors could usefully focus on integrated computerised systems that can aid dose calculations and reduce transcription errors between databases.

A new virtual reality approach for planning of cardiac interventions.

A novel approach to three-dimensional (3D) visualization of high quality, respiratory compensated cardiac magnetic resonance (MR) data is presented with the purpose of assisting the cardiovascular surgeon and the invasive cardiologist in the pre-operative planning. Developments included: (1) optimization of 3D, MR scan protocols; (2) dedicated segmentation software; (3) optimization of model generation algorithms; (4) interactive, virtual reality visualization. The approach is based on a tool for interactive, real-time visualization of 3D cardiac MR datasets in the form of 3D heart models displayed on virtual reality equipment. This allows the cardiac surgeon and the cardiologist to examine the model as if they were actually holding it in their hands. To secure relevant examination of all details related to cardiac morphology, the model can be re-scaled and the viewpoint can be set to any point inside the heart. Finally, the original, raw MR images can be examined on line as textures in cut-planes through the heart models.

[Monitoring quality of health care using indicators]. / Overvågning af kvaliteten af sundhedsvaesenets ydelser ved hjaelp af indikatorer.

In a modern health care system continuing measurement and monitoring of relevant clinical data comprise the base of documentation for the quality of care. Internationally there has been increasing focus on monitoring and measuring the quality of care using principals from clinical epidemiology, including quality monitoring using clinical indicators. Indicators can be derived with regard to structure, process and outcome. The indicators should be in a form which can be used within the individual department and for comparison between hospitals nationally and internationally. The idea of professional indicators is to be able to track developments over time, as well to be able to respond at relevant times. The work with quality indicators will support continuing work with quality development in the medical specialities as well as giving a possibility for dialogue between politicians, the management system and the medical specialities about priority of resources and the structure of the hospital system, which extend further than the simpler issues of finance, which have been dominating until now.

[Patients and attitudes to a palliative unit in H:S--a questionnaire study]. / Patientunderlag og holdninger til en palliativ enhed i H:S--en spørgeskemaundersøgelse.

A questionnaire was mailed to 42 representative in-patient departments of hospitals in the City of Copenhagen asking the medical staff to state what number of their patients could possibly be referred to a future hospital--associated palliative care unit. All-together 215 answers were returned from two questionnaire dates two weeks apart, comprising more than 1750 patients each day. Furthermore, 42 of 60 general practitioners answered another questionnaire on the same topic. From the hospital questionnaire it was concluded that approximately 8% of all patients were admitted for palliative care reasons, 75% suffering from incurable cancer. More than 50% of patients admitted for palliative care reasons were assessed to be suitable candidates for a palliative care unit. The general practitioners recognised at least 50 patients treated only for palliative reasons. In the same month the general practitioners referred more than 20 patients to hospital wards, but two-thirds of the practitioners would have preferred that these patients could have had the option of staying at home for terminal care. In general, more than 50% of the medical staff opted for establishing a palliative care unit.

[Neonatal pediatrics in Denmark. Referral and capacity, 1990]. / Neonatal paediatri i Danmark. Visitation og beredskab, 1990.

A investigation on neonatal intensive care in Denmark was carried out in October 1990 based on a questionnaire. The eighteen paediatric departments in the country with neonatal intensive care units all answered the questionnaire. The neonatal capacity and its distribution in different parts of Denmark, the level of medical qualifications, the routines for transferral to departments with higher specialization and for certain treatment procedures are described. Several variations in diagnostic and therapeutic routines were found between departments with the same level of specialization. The results are compared to the findings of a similar investigation in 1984. It was found that the neonatal bed-capacity has been reduced since 1984. It was also found that this capacity is relatively smaller in the eastern part of Denmark than in the western part, and that neonatal intensive care is centralized in the eastern part and decentralized in the western part of Denmark. Compared to 1984 better access to radiological and biochemical service has been achieved, and neonatal care is to a greater degree performed by a specialist in paediatrics.

[Neonatal pediatrics in Denmark. Therapeutic routines in care of very low birth weight infants and very premature infants, 1990]. / Neonatal paediatri i Danmark. Rutiner i behandling af meget lavvoegtige og meget for tidligt fødte børn, 1990.

A questionnaire on neonatal carried intensive care in Denmark was carried out in October 1990. The eighteen paediatric departments in the country with neonatal intensive care units all answered the questionnaire. The routines concerning transferral to a higher level of specialization, and the treatment procedures for children with a birthweight below 1500 grams and/or a gestational age under 32 weeks are described. Major regional variations were found in the degree of centralization of treatment, especially between the eastern and western part of Denmark. In an international perspective to neonatal intensive care Denmark seems to be modest with respect to initiation of treatment and the use of technology.

[Planning of prenatal care in hospital districts in 1988/1989]. / Sygehuskommunernes planlaegning af svangreprofylaksen 1988/1989.

In this investigation, the planning of antenatal care in the Danish hospital districts was compared with the directives for antenatal and maternity care issued by the Danish Ministry of Health in 1985. Information about planning was obtained by means of a questionnaire sent to the authorities responsible. The results reveal that, in the hospital districts, there is a tendency to emphasize routine measures at the expense of services based more on requirements. In addition, the investigation reveals that planning differs in the various hospital districts, and that in many hospital districts, local conditions in maternity clinics and midwives' centres may be decisive for planning. The health services which are offered to pregnant women with the same requirements are thus characterized by geographic variations. Finally, the investigation reveals that the hospital districts deviate from the directives issued by the Ministry of Health in their planning of antenatal care. The possible reasons for this are discussed.