Medication safety improves after implementation of positive patient identification.

OBJECTIVE: To report the incidence and severity of medication safety events before and after initiation of barcode scanning for positive patient identification (PPID) in a large teaching hospital. METHODS: Retrospective analysis of data from an existing safety reporting system with anonymous and non-punitive self-reporting. Medication safety events were categorized as "near-miss" (unsafe conditions or caught before reaching the patient) or reaching the patient, with requisite additional monitoring or treatment. Baseline and post-PPID implementation data on events per 1,000,000 drug administrations were compared by chi-square with p<0.05 considered significant. RESULTS: An average of 510,541 doses were dispensed each month in 2008. Total self-reported medication errors initially increased from 20 per million doses dispensed pre-barcoding (first quarter 2008) to 38 per million doses dispensed immediately post-intervention (last quarter 2008), but errors reaching the patient decreased from 3.26 per million to 0.8 per million despite the increase in "near-misses". A number of process issues were identified and improved, including additional training and equipment, instituting ParX scanning when filling Pyxis machines, and lobbying for a manufacturing change in how bar codes were printed on bags of intravenous solutions to reduce scanning failures. CONCLUSION: Introduction of barcoding of medications and patient wristbands reduced serious medication dispensing errors reaching the patient, but temporarily increased the number of "near-miss" situations reported. Overall patient safety improved with the barcoding and positive patient identification initiative. These results have been sustained during the 18 months following full implementation.

Evaluation of the interferon-gamma release assay in healthcare workers.

OBJECTIVES: An in vitro test for the diagnosis of latent TB-infection (LTBI) is now available that has the potential to replace the tuberculin skin test (TST). The new test measures the cell-mediated immune response to TB antigens. Little experience is currently available on the performance of the IGRA when testing HCW for LTBI. Therefore the aim of the study was to compare the IGRA with the TST in testing HCW for LTBI. METHODS: The medical staffs of three hospitals were simultaneously tested with TST (RT23) and IGRA (QFT). The study comprises 261 HCW, all exposed to active TB-patients. Information on gender, age, workplace, BCG vaccination and history of both TB and TST were collected using a standardised questionnaire. RESULTS: The TST was positive in 24.1% and the IGRA in 9.6% of the participants. Agreement between the tests was low in HCW with a BCG-vaccination. A history of an earlier TST was a risk factor for a positive TST but not for a positive IGRA. Out of 48 results positive in the TST but negative in the IGRA 97.8% might be explained by BCG vaccination or an earlier TST. A positive association between age and LTBI was observed for the IGRA but not for the TST results. Out of 25 positive results in the IGRA only 60% were recognized by the TST, too. The HCW with a positive IGRA and a negative TST had the same age (mean 49.1) as the HCW positive in both tests (mean 50.9), which was higher than the age of those negative in both tests (mean 38.8). CONCLUSIONS: The data indicate that the IGRA should replace the TST in serial testing of HCW in high income, low incidence countries. The recommendations to use the IGRA in order to verify a positive TST only should be reconsidered.

Cuddler Program provides soothing answers.

Volunteer cuddler programs have the potential to enhance the human caring aspects of complex technological nursing care provided premature infants. Nurse researchers have identified the value of human touch and stimulation to the development of premature infants. Although the fragile premature infant may not always appear to respond overtly, the weight gain, and social and mental development of the cuddled babies give testimony to the effectiveness of human attention. The infants' improved well-being and subsequent earlier hospital discharge as a result of cuddling are convincing rationale to implement a cuddler program. A well administered hospital volunteer program is an excellent resource for cuddlers. Volunteers tend to be readily attracted to a neonatal nursery and their services have proven to be safe and therapeutic. After determining the type of service needed, nurse administrators and directors of volunteer programs may team together to develop their strategy. A literature review about cuddler programs and the development of the premature infant contain valuable information of research findings and experience of other nurses. Staff nurse and physician involvement in the program are essential for overall success as well as identifying an effective person to coordinate the plan. The team of planners need a program development and implementation schedule, a volunteer job description and a training plan. Orientation of all nursing staff to the program may occur simultaneously with volunteer recruitment. Evaluation of a cuddler program utilizing predetermined criteria should occur at scheduled intervals.(ABSTRACT TRUNCATED AT 250 WORDS)