The Crossroads between Workforce and Education.

Concern is growing among industry leaders that students may not be obtaining the necessary skills for entry into the labor market. To gain an understanding of the perceived disconnect in the skill set of graduates entering the health information workforce, a survey was developed to examine the opinions of educators and employers related to graduate preparedness. The concern related to graduate preparedness is supported by findings in this research study, in which those working in industry and those in academia noted a disconnect between academic training and preparedness to enter the labor market. A statistically significant difference was found between labor leaders and academics in their assessment of graduates' preparation in the areas of technical, communication, and leadership skills. Educators noted higher levels of preparedness of students with regard to professional and technical skills and leadership skills, while both educators and industry respondents noted a need for improved employability skills (e.g., communication skills and workplace etiquette). No difference was found between the two groups with regard to the need to increase apprenticeships and professional practice experience to cover this gap in formal training. Finally, when asked how the federal government might assist with preparing students, more than half of the respondents noted the importance of apprenticeships and funding for these opportunities.

The pharmacist-physician relationship in the detection of ambulatory medication errors.

BACKGROUND: Expenditures on outpatient prescription drugs have increased enormously in the last decade. Despite this growth in expenditures, prescription medication safety in the ambulatory setting is lacking. Prior research in outpatient care has centered around the physician-patient encounter. What remains unexamined in the ambulatory care literature is the pharmacist's role as interceptor, detector, and reporter of medication errors to the physician. METHODS: Data about the role, responsibilities, and expectations to inform physicians about this subject were collected from pharmacist (N = 30) and patient (N = 31) focus groups conducted between July 2002 and July 2003. Pharmacists in outpatient practices and patients were randomly selected from the state licensure database and the Jackson Metropolitan phonebook, respectively. ANALYSIS: Grounded theory provided the perspective on which data were interpreted. Data patterns were linked using key words and phrases for theme analysis. Arbitration between coders resulted in an inter-rater reliability of 0.85. RESULTS: : Three complementary patterns were identified from the data: 1) patients likely see multiple physicians and only one pharmacist; 2) patients are more likely to report medication errors to the pharmacist than to the physician; and 3) pharmacists are the final interceptors, detecting medication errors before they reach patients. CONCLUSIONS: Ambulatory pharmacists are in a privileged position to gather data regarding adverse responses to prescribed medication or incidents of medication mishaps. The failure of pharmacists to report information back to physicians is a missed opportunity to improve patient safety.

Identifying barriers to the adoption of new technology in rural hospitals: a case report.

The purpose of this study is to identify barriers to the adoption of new technology in rural settings. Specifically, this paper focuses on identifying and overcoming barriers to the adoption of a medication error reporting system in eight rural hospitals. Prior research has generally focused on barriers to the adoption of new technology in urban areas, medical centers, or large hospitals. The literature has identified six primary barriers to the adoption of new technology: cost, legality, time, fear, usefulness, and complexity. Although our research recognizes these same barriers, the means through which these barriers may be mitigated are different in rural settings. Our research identified three additional barriers to the adoption of new technology that may be specific to rural areas: personnel, physical space, and Internet access. Our outcome variable, in order to demonstrate our success, is the number of reported medication errors.

Improving patient safety through information technology.

Health information technology (HIT) is generally accepted as the solution for the nation's medical error crisis. Although limited studies suggest the importance of using HIT in the process of medication management, research has failed to adequately describe how HIT actually works in capturing medication error data and improving patient safety within a healthcare system.1-3 The aim of our study is to identify essential elements in the adoption of technology within the broader context of system change and workflow modification. Using the adoption of an electronic reporting system to improve patient safety, we examine the role of this technology within process improvement, culture, and workflow.

Fixing broken bones and broken homes: domestic violence as a patient safety issue.

BACKGROUND: Domestic violence (DV) is a significant problem in terms of both patient harm and cost. To better address this problem, the diagnosis and treatment of DV are considered within the emerging model of patient safety and medical error reduction. The case of a female patient who presents in the clinical setting following an incident of DV shows how medical errors can be analyzed as they are in medical cases not involving DV, such as when a person with abdominal pain is sent away from the emergency department with instructions to take an acid reducer and later suffers a burst appendix. ROOT CAUSE ANALYSIS: A number of factors inhibit the correct diagnosis and treatment of DV victims seeking additional treatment. Physicians often fail to screen for DV, misidentify symptoms, or deny the possibility of underlying DV, and patients often hide the symptoms and refuse to admit the problem. However, human factor errors related to knowledge, cultural norms, and individual biases; organizational factors, including lack of training and reimbursement; and technology factors related to information accessibility appear to play significant roles. CONCLUSION: Failure to diagnose or adequately address DV can be interpreted as medical errors. Addressing DV requires a systemic response, which might begin with integrating education and training about DV into the clinical setting, ensuring the use of existing screening tools, and providing adequate and appropriate reimbursement levels.