A model for medication safety event detection.

BACKGROUND: Hospital medication safety event detection predominantly emphasizes the identification of preventable adverse drug events (ADEs) through self-reports. These relatively rare events only provide insight into patient harm and self-reports identify only a small portion of ADEs. A broader system-focused approach to medication safety event detection that uses an array of event detection methods is recommended. This approach illuminates medication system deficits and supports improvement strategies that can prevent future patient risk. OBJECTIVE: To: (i) describe a system-focused approach to hospital medication safety event detection, and (ii) present a case illustration of approach application. SYSTEM-FOCUSED MODEL AND METHODOLOGY: A three-level medication safety event detection model that ranges from a narrow harm-focused to broader system-focused approach is described. A standardized cross-level methodology to detect medication safety events is presented. CASE ILLUSTRATION: A Level 3 system-focused methodology that incorporated both voluntary and non-voluntary event detection strategies was used in 17 critical care (n = 4), intermediate care (n = 7) and medical-surgical units (n = 6) across two hospitals. A total of 431 events were detected: 78 (18.1%) ADEs and 353 (81.9%) potential ADEs. Of the 353 PADEs, 302 (70.0%) were non-intercepted events. Non-voluntary detection methods yielded the majority of events (367, 85.1%). CONCLUSIONS: The incidence of ADEs was low when compared with non-intercepted PADEs. This was indicative of medication safety system failures that placed patients at risk for potential harm. Non-voluntary detection methods were much more effective at detecting events than traditional self-report methods.

Reliability evaluation of the adapted national coordinating council medication error reporting and prevention (NCC MERP) index.

PURPOSE: Adapted National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index criteria were used in a study undertaken to evaluate commercial computerized provider order entry (CPOE) system impact on community hospital medication errors. This article describes: (1) adaptation of the Index, (2) classification criteria and processes used to assess the adapted Index, and (3) inter-rater reliability results. METHODS: A random sample of 130 (17%) of 2251 medication safety events (MSEs) were classified based on event type, that is, adverse drug event (ADE) or potential ADE (PADE); preventability, that is, 'yes' or 'no,' and outcome severity. Event outcome severity was categorized using adapted Index categories E-I (ADEs) and B-D (PADEs). Decision rules were used for rule-based classification, while an MSE Case Review Panel used judgment-based classification when decision rules did not apply. Inter-rater reliability for both classification approaches was assessed with kappa coefficients, percentage agreement, and confidence intervals (CI). RESULTS: Level of agreement was substantial for both rule-based and judgment-based MSE classification for event type (6 = 0.70-0.90), preventability (6 = 0.67-0.82), and decision rule application (6 = 0.79). Rule-based agreement for ADE and PADE severity was almost perfect for discrete (6 = 0.83-0.84) and combined (6 = 0.87-0.90) Index categories. Judgment-based agreement was substantial for discrete (6 = 0.63-0.67) and combined (6 = 0.66-0.84) Index categories. CONCLUSIONS: The adapted Index yielded substantial agreement for event type, preventability, and severity. Adaptation of the Index to support classification of non-preventable ADEs was an important improvement.

Measuring hospital readiness for information technology (IT) innovation: A multisite study of the Organizational Information Technology Innovation Readiness Scale.

The Institute of Medicine has stressed the need for health care organizations to increase their use of information technology (IT) to create safer health care environments, particularly in the area of medication safety. However, the rate of successful organizational IT innovation remains low and this is primarily attributed to a lack of organizational IT innovation readiness. The reported study completes the fourth phase in the development of the 48-item Organizational Information Technology Innovation Readiness Scale (OI-TIRS). The aim of this study was to re-examine the psychometric adequacy of the OITIRS to determine the readiness of three community hospitals to implement a commercial computerized provider order entry (CPOE) medication safety system. Findings supported internal consistency reliability with alpha coefficients from .78 to .92, and mean interitem correlations for the eight subscales ranging from .38 to .65 with a significance level of .01. Construct validity was supported with an overall factor loading range of .49 to .92 across the eight subscales and an explained variance ranged from 33% to 66%. The study findings supported the use of the OITIRS to assess hospital readiness for computer provider order entry system innovation.