Development and Interrater Agreement of a Novel Classification System Combining Medical and Surgical Adverse Event Reporting.

Importance: Categorization systems for adverse events are not standardized across care settings and specialties and do not always include near miss events (events where there was potential for patient harm, but where no actual harm occurred), making it difficult to effectively assess patient safety for quality improvement. Objective: To develop and assess interrater agreement on a classification system for adverse events reporting that incorporates events in both inpatient and outpatient settings across medical and surgical subspecialties including near miss events. Design, Setting, and Participants: A cross-sectional study in a tertiary care center including 174 patient cases occurring from 2018 to 2020 was carried out. Data were abstracted from a Department of Otorhinolaryngology-Head and Neck Surgery Quality Assurance database. The cases were comprised of near miss and adverse events occurring in adult and pediatric patients in inpatient, outpatient, and emergency department settings. The ratings took place in March and April of 2022. Exposures: Four raters (2 attending physicians and 2 senior resident physicians) were recruited to classify these cases according to 3 classification systems: the National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP), Clavien-Dindo, and our novel Quality Improvement Classification System (QICS). Main Outcomes and Measures: The primary outcome was overall interrater agreements using Fleiss κ. Results: Across all 4 raters grading 174 cases, the NCC-MERP, Clavien-Dindo, and QICS received a κ score. Fair-to-moderate interrater reliability was observed between the resident and attending physician groups across the 3 classification systems: NCC-MERP (κ = 0.33; 95% CI, 0.30-0.35), Clavien-Dindo (κ = 0.47; 95% CI, 0.43-0.50), and QICS (κ = 0.42; 95% CI, 0.39-0.44). Strong interrater concordance was observed for complications across all scenarios. Conclusion and Relevance: This cross-sectional study found that the new QICS classification scheme was applicable to wide-ranging clinical scenarios with a focus on patient-centered outcomes including near miss events. In addition, QICS allowed for the comparison of patient outcome data in a multitude of settings.

[Medication errors in pediatrics]. / Errores de medicación en pediatría.

INTRODUCTION: Medication errors (ME) are preventable incidents of inappropriate use of medications by health per sonnel or by the patient. These events can occur at any stage of drug use generating significant costs to the health system and, in some cases, these can even lead to death. The pediatric population is con sidered susceptible to ME with a prevalence 3 times higher than adult patients. OBJECTIVE: To identify the prevalence of medication errors in hospitalized pediatric patients, as well as their classification according to the stage of use of the medication when they occurred. METHOD: A literature review of ME in pediatrics was carried out through a Pubmed / Medline search using Mesh terms ("Medication Errors" and "Pediatrics") in the last 10 years. Three investigators reviewed independently the identi fied articles considering the STROBE checklist for observational studies. RESULTS: 192 bibliographic references were identified, 22 of them were eligible for review and data collection. Studies reported an error rate between 1% and 58% of the evaluated medication indications, with errors reported in different processes of drug use. 9 articles (41%) described errors related only to prescription, mainly associated with incorrect dosage, 6 (27%) errors related to prescription, administration, and other processes, 3 (14%) related to prescription and administration, 2 (9%) related only to administra tion, 1 (4%) article reported errors related to conciliation, and 1 (4%) described errors related to preparation and administration. CONCLUSION: The studies reported different medication errors in the pediatric population. Most of them reported ME related to prescription followed by ME in the administration. Knowing the proportion of ME allows focusing interventions aimed at reducing their prevalence.

Construction and analysis of a database for medication errors in a pharmacovigilance centre-the Moroccan experience.

PURPOSE: The study aimed to describe the epidemiological profile of medication errors (MEs) reported to the Moroccan Pharmacovigilance Center (MPVC), to determine factors associated with serious MEs, and to describe signals related to them. METHODS: We carried out a retrospective descriptive analysis of MEs reported to the MPVC from 2006 to 2016 and a secondary analysis of the seriousness of MEs with adverse drug reactions (ADRs). The reports were sorted by demographic profile and by ME and ADR characteristics. For signal detection, a quantitative approach was adopted, and the root cause analysis was completed. Epi info 7 software was used to perform descriptive and analytical statistics. The statistical significance level was set at p < 0.05. RESULTS: A total of 1618 ME reports were retrieved. The proportion of MEs associated with serious ADRs was 23.9%. The factors statistically associated with serious MEs were as follows: (i) the age group 16 years old and less (p < 0.001), (ii) the gender (p = 0.01), (iii) the administration and the prescription stages (p < 0.001), and (iv) the ME types related to inappropriate schedule of drug administration, drug prescribing error (p < 0.001), and incorrect drug administration dosage form (p = 0.04). Fourteen signals related to MEs were detected, for which risk minimization actions were implemented. CONCLUSION: The establishment of a ME unit within the MPVC was an opportunity to further improve the pharmacovigilance centre performance and consequently its contribution to medication safety. The lessons learned from MEs should be shared through pharmacovigilance networks and with institutions involved in medication safety for synergistic results to achieve patient safety worldwide.

Incidence of paediatric 10-fold medication errors in Wales.

OBJECTIVES: To estimate the incidence, characteristics and outcomes of 10-fold or greater or a tenth or less medication errors in children aged <16 years in Wales. DESIGN: Population-based surveillance study July 2017 to June 2019. Cases were identified by paediatricians and hospital pharmacists using monthly electronic Welsh Paediatric Surveillance Unit (WPSU) reporting system. PATIENTS: 'Definite' incident occurred when children received all or any of the incorrect dose of medication. 'Near miss' was where the prescribed, prepared or dispensed medication was not administered to the child. MAIN OUTCOME MEASURES: Incidence, patient characteristics, setting, drug characteristics, outcome, harm and enabling or preventive factors. RESULTS: In total, 50 10-fold errors were reported; 20 definite and 30 near miss cases. This yields a minimum annual incidence of 1 per 3797 admissions, or 4.6/100 000 children. Of these, 43 were overdoses and 7 underdoses. 33 incidents occurred in children <5 years of age. Overall, 37 different medications were involved with the majority, 31 cases, being administered enterally. Of these 31 enteral medication errors, all definite cases (10) had received liquid preparations. Temporary harm occurred in 5/20 (25%) definite cases with one requiring intensive care; all fully recovered. CONCLUSIONS: In this first ever population surveillance study in a high-resource healthcare system, 10-fold errors in children were rare, sometimes prevented and uncommonly caused harm. We recommend country-wide improvements be made to reduce iatrogenic harm. Understanding the enabling and preventive factors may help national improvement strategies to reduce these errors.

Sobrecarga, equivocación, falta de capacitación: factores contribuyentes en errores de medicación en hospital público chileno / Overload, mistake, lack of training: contributing factors in medication errors in a Chilean public hospital

OBJETIVO: Analizar errores de medicación notificados en 2018 en un hospital público de alta complejidad chileno. METODOLOGÍA: Estudio cuantitativo, retrospectivo, descriptivo y correlacional. Se analizaron las variables sexo y edad del paciente, mes del incidente, tipo de error, servicio, etapa del proceso de medicación y factores contribuyentes. RESULTADOS: Los incidentes fueron más frecuentes en meses estivales, en pacientes mayores de 60 años y de sexo femenino. Los errores más notificados fueron dosis, medicamento y paciente incorrecto. En farmacia se registraron el mayor número de notificaciones. Los errores ocurrieron con mayor frecuencia en las etapas de administración y dispensación. Entre los factores contribuyentes destacan chequeo ineficiente, desgaste o sobrecarga laboral, exceso de confianza, falta de capacitación y confusión del paciente. CONCLUSIÓN: Los periodos vacacionales concentran el mayor número de errores de medicación, asociados a la sobrecarga laboral y falta de capacitación de los profesionales de reemplazo, cuya formación debe ser reforzada

OBJECTIVE: To analyze medication errors reported in 2018 in a highly complex Chilean public hospital. METHODOLOGY: Quantitative, retrospective, descriptive and correlational study. The variables sex and age of the patient, month of the incident, type of error, service, stage of the medication process and contributing factors were analyzed. RESULTS: The incidents were more frequent in summer months, in female patients over 60 years of age. The most commonly reported errors were incorrect dose, medication and patient. The highest number of notifications were registered in the pharmacy. Errors occurred more frequently in the administration and dispensing stages. Among the contributing factors are inefficient check-up, attrition or work overload, overconfidence, lack of training, and patient confusion. CONCLUSION: Vacation periods concentrate the highest number of medication errors, associated with work overload and lack of training for replacement professionals, whose training must be reinforced

Gravedad de los errores de conciliación producidos en el servicio de urgencias en pacientes ancianos / Seriousness of medication reconciliation errors in patients of advanced agein the emergency department

OBJETIVOS: Analizar la gravedad de los errores de conciliación (EC) producidos en el servicio de urgencias (SU) en pacientes que ingresan en una unidad de agudos de geriatría. Cuantificar y describir las discrepancias y los EC. Analizar los grupos farmacológicos y los factores de riesgo. MÉTODO: Estudio observacional prospectivo. Un farmacéutico realizó la historia farmacoterapéutica y comparó el tratamiento habitual con el prescrito en el SU, identificó discrepancias y posibles EC y un geriatra evaluó su gravedad. RESULTADOS: Se incluyeron 351 pacientes, de los que 328 (93,8%) presentaron discrepancias, 151 pacientes (43,02%) presentaron al menos 1 EC. Se observaron 300 EC de los que 248 (82,7%) alcanzaron al paciente, y 27 EC (9%) produjeron daño reversible. No hubo ningún error que causase daño prolongado o mortal. CONCLUSIONES: Los EC fueron frecuentes pero de escasa gravedad, y los daños que ocasionaron fueron reversibles

OBJECTIVES: To analyze the seriousness of medication reconciliation errors (MREs) in the treatment of older patients admitted to an emergency department's acute geriatric unit. To identify and describe discrepancies, including the drug groups involved, and to explore risk factors. METHODS: Prospective, observational 6-month study. A pharmacist recorded medications in each patient's history and compared the patient's usual treatment to the regimen prescribed in the emergency department; discrepancies were flagged for evaluation as possible MREs. A geriatric medicine specialist evaluated MRE seriousness. RESULTS: Three hundred twenty-eight discrepancies were detected (93.8% of the total of 351 patients); 151 patients (43.02%) had at least 1 MRE. Three hundred MREs were identified, 248 (82.7%) reached the patient, and 27 (9%) caused reversible injury. No errors led to prolonged injury or death. CONCLUSIONS: MREs were common but not serious, and the injuries caused were reversible

PRIME study: Prescription review to impede medication errors.

BACKGROUND: Medication errors may account up to one-third of all medical errors in hospitals, thereby leading to adverse outcomes such as higher mortality rate and longer hospital stay. OBJECTIVES: The primary objective of the study was to determine whether patient safety can be improved by clinical pharmacy services. The study also aimed to reveal whether medication errors can be prevented by any means. METHODS: A prospective, observational study was conducted in a multispecialty hospital in India. Prescription audit was performed for patients followed by necessary intervention by the concerned physician. Chi-squared test, paired t-test and ANOVA were performed to test statistical significance. RESULTS: A total of 699 errors were encountered by 501 of 1149 patients enrolled. Prescription errors accounted for the majority (87.1%) of errors followed by administration (7.4%), transcription (4.3%) and dispensing (1.2%) errors. Average error per patient showed a significant gradual decline from baseline (2.08) to the final follow-up (1.06). ICU patients encountered a higher rate (52.8%) of errors than general ward group (42.8%), while geriatric population witnessed a low error rate (18.8%) compared to adults (72%). CONCLUSIONS: The study was not only successful in highlighting the impact of medication error assessment on patient safety, but it also demonstrated that medication errors can be lowered with the help of clinical pharmacy services. Findings from the study conclude that medication errors can be prevented if healthcare professionals are educated appropriately to avoid recurrence of past mistakes.

[Descriptive analysis of medication errors notified by Primary Health Care: Learning from errors]. / Análisis descriptivo de los errores de medicación notificados en atención primaria: aprendiendo de nuestros errores.

INTRODUCTION AND OBJECTIVES: Aim of this study is to determine the setting, causes, and the harm of medication errors (ME) which are notified by Primary Health Care. MATERIAL AND METHODS: Setting: Primary Care Regional Health Service of Madrid. 2016. DESIGN: Descriptive and cross-sectional study. PARTICIPANTS: All ME (1,839) which were notified by Primary Care Centres by notification system of safety incidents between January 1st 2016 and November 17th 2016. MAIN MEASUREMENTS: Setting, real harm, potential harm, and cause of error. These items were classified by one researcher. Concordance was checked with another researcher. RESULTS: Just under half (47%) (95% CI: 44.8%-49.3%) of ME occurred in Primary Care Centre, 26.5% (95% CI: 24.5%-28.6%) of ME were patient medication errors, and 27.5% (95% CI: 24.1%-30.8%) of ME were potential severe harm errors. Prescribing errors were the cause of most ME in Primary Care Centre [27.4% (95% CI: 24.4%-30.4%)]. Communication between patients and doctors were the cause of most patient medication errors [66% (95% CI: 61.8%-70.2%)]. Patient mistakes and forgetfulness were also causes of patient medication errors. CONCLUSIONS: Half of all mediation errors hppened at Primary Care Center while one quarter of them were patient medication errors. One quarter of all ME were potential severe harm errors. The main causes were prescribing errors, failure of communication between patients and doctors, and patient mistakes and forgetfulness. Prescribing aid systems, communication improvements and patients aids should be implemented.

The medication discrepancy taxonomy (MedTax): The development and validation of a classification system for medication discrepancies identified through medication reconciliation.

BACKGROUND: Medication discrepancies directly impact patient safety and can adversely impact quality of care and resource utilization at transitions of care. OBJECTIVES: To develop a common nomenclature and taxonomy for classifying and reporting medication discrepancies and to assess the content validity and reliability of the taxonomy. METHODS: The taxonomy was developed following a multi-stage process. The content of the taxonomy was then assessed using expert opinion through a two-round modified Delphi process. The expert panel comprised 10 experts who were selected based on pre-defined selection criteria. Six experienced pharmacists were then invited to classify medication discrepancies from a number of fictitious cases (adapted from authentic cases) using the taxonomy. RESULTS: The medication discrepancy taxonomy (MedTax) comprises 12 main types and 28 sub-types of discrepancies. A set of operational instructions and definitions to aid the use of the taxonomy was formulated. The overall Average content validity index (Ave-CVI) was 0.93 and interrater reliability was 0.67 (multirater κfree), indicating substantial agreement. An excellent internal consistency of the taxonomy was established (Kuder-Richardson Formula 20 (KR-20) = 0.92). CONCLUSIONS: A content valid and reliable taxonomy for classifying medication discrepancies was developed. The MedTax may be used to classify medication discrepancies identified following medication reconciliation services. The clear and consistent reporting of medication discrepancies arising from medication reconciliation services may be of value to policy makers, healthcare professionals and researchers, when evaluating such services. The MedTax was designed to fill an essential void in global endeavors to reinforce standardization of medication reconciliation practices and to improve medication safety across transitions of care.

Evaluation of a method for drug-related problems identification and classification in hospital setting: applicability and reliability.

Background Prescription evaluation by pharmacists has potential to improve pharmacotherapy management. It requires the use of robust methods to identify drug-related problems (DRP), which are important issues in pharmacotherapy. Objective To evaluate the applicability and reliability of Grupo de Investigação em Cuidados Farmacêuticos (GIGUF) method for prescription analysis, identification and classification of drug-related problems in inpatients prescriptions. Setting Department of Medical Clinic of a tertiary and teaching Brazilian hospital. Method An observational and retrospective study of identification and classification of drug-related problems. GIGUF method was used to evaluate prescriptions of hematological patients hospitalized between August and October 2015. The problems were categorized using GICUF-method classification. Three pharmacists performed inter-rater agreement analysis of the method using Kappa. Differences in prevalence of DRP was calculated by age, sex, pharmacotherapy complexity, length of stay and number of drugs. Main outcome measure (a) frequency and characteristics and (b) inter-rater agreement in identification and classification of the drug-related problems. Results A total of 211 problems were identified and 'inadequate dosing' was the most common problem. There was an association between the occurence of a drug-reklated problem and complexity of pharmacotherapy (p = 0.001) and number of drugs used (p = 0.010). The overall inter-rater agreement was moderate (k = 0.44 IC 95% 0.34-0.55) and the problem 'not suitable drug' (k = 0.55 IC 95% 0.44-0.66) had greater inter-rater agreement. Conclusion The method "Evaluation Drug Use Process" was useful for prescription analysis since it made the identification and classification of DRPs possible. The method demonstrated a moderate inter-rater agreement, and can contribute to pharmacotherapy management by hospital pharmacists.

Conciliación de la medicación en las transiciones asistenciales de pacientes previamente ingresados / Medication reconciliation in inpatient transfers

OBJETIVOS: Valorar la efectividad de la intervención farmacéutica y caracterizar los tipos de discrepancias y errores de conciliación de la medicación, en el contexto de un programa de conciliación de la medicación durante el ingreso hospitalario de pacientes sometidos a una transición asistencial interna, cuya procedencia ha sido otro centro hospitalario o la unidad de cuidados intensivos. MÉTODOS: Estudio prospectivo realizado en un hospital de especialidades. La población objeto de estudio han sido los pacientes que generaron estancia en nuestro centro durante un periodo de 8 meses, y cuya procedencia fue otro centro hospitalario o la unidad de cuidados intensivos (UCI). Diariamente se revisaron todos aquellos pacientes procedentes de una transición asistencial y posteriormente, se elaboró la mejor historia farmacoterapéutica posible revisando la información disponible sobre la medicación que podía estar recibiendo el paciente de forma previa a la transición asistencial y completando el proceso mediante una entrevista clínica. Las discrepancias que requerían aclaración fueron comunicadas al médico. RESULTADOS: Se conciliaron un total de 350 medicamentos en 136 pacientes (una media de 2,6 fármacos por paciente). Se realizaron 139 actos de conciliación, de los cuales, en 68 se encontraron discrepancias justificadas, en 53 no se encontraron discrepancias y en los 18 restantes se encontraron discrepancias que requerían aclaración, siendo la más habitual entre ellas la omisión de un medicamento seguida de la prescripción incompleta y modificación de posología o vía sin justificación. De esas discrepancias, 15 fueron aceptadas por parte del médico prescriptor, modificando posteriormente la prescripción. La mayoría de los fármacos con esas discrepancias pertenecían a los grupos anatomoterapéuticos: tracto alimentario y metabolismo, sistema cardiovascular, sistema nervioso y sistema respiratorio. CONCLUSIONES: La conciliación de la medicación durante las transiciones asistenciales llevada a cabo por un farmacéutico mostró ser útil en la identificación y prevención de errores de medicación con potenciales consecuencias clínicas para los pacientes

OBJECTIVE: To assess the effectiveness of the pharmaceutical intervention and characterize the types of discrepancies and errors of medication reconciliation, in the context of a program of medication reconciliation during inpatient transfers, whose origin has been other hospital or the intensive care unit. METHODS: An eight months prospective, observational study was carried out in a secondary hospital. Patients were selected when they were transferred to a medical unit of our hospital from an intensive care unit (ICU), a coronary intensive care unit (CICU) or other hospitals. Daily, in order to conduct the reconciliation process, the Pharmacist prepared the best pharmacotherapeutical history possible, reviewing all available information about the medication the patient could be taking before, and completing the process with a clinical interview. The discrepancies requiring clarification were reported to the physician. RESULTS: 350 medications were reconciled in 136 patients, with a mean of 2,6 drugs per patient.139 reconciliations were made: 68 were considered as justified discrepancies, 53 as no discrepancies and the remaining 18 as discrepancies that required clarification; the most frequent was the omission of a medication, followed by incomplete prescription and unjustified modification of dosing or way of administration. Among these 18 discrepancies, 15 were accepted by the hospital physician and prescriptions were modified. Most of the drugs with these discrepancies belonged to the anatomical-therapeutic groups: alimentary tract and metabolism, cardiovascular system, nervous system and respiratory system. CONCLUSIONS: The medication reconciliation process conducted by a pharmacist has proven to be useful in the identification and prevention of medication errors with potential clinical consequences for patients

Factors, influencing medication errors in prehospital care: A retrospective observational study.

To determine the frequency of medication errors in prehospital care and to investigate the influencing factors - diagnostic agreement (DA), the medical educational status, the specialty, the approval for emergency medicine of the prehospital emergency physician, the patient age and sex and the time of deployment.We retrospectively reviewed 708 patients from 2013 to 2015, treated by the prehospital emergency physicians of the emergency medical service center Bad Belzig, Germany. The medication appropriateness was determined by a systematic comparison of the administered medication in prehospital deployments with the discharge diagnosis, according to current guidelines. The influencing factors were examined by univariate analysis of medication appropriateness (MA), using the χ, the Mann-Whtiney U and the Welch tests. We calculated a cut-off value with the Youden index to predict absent MA, according to patients age. The significance level was P = .05.MA was absent in 220 of 708 patients (31.1%). In the case of present DA, MA was absent in 103 of 491 patients (20.9%). In the case of absent DA, MA was absent in 117 of 217 patients (53.9%) (P = .01). MA was absent in 82 of 227 patients (36.1%), treated by specialist and in 138 of 481 patients (28.7%), treated by resident physicians (P = .04). The calculated cut-off value to predict absent MA was 75.5 years. MA was absent in 100 of 375 patients (26.7%) of the younger patient age group (≤75.5 years), MA was absent 120 of 333 patients (36.0%) of the older patient age group (>75.5 years) (P = .01). Absent MA showed peak values (46.7%-60%) at night from 3 to 6 AM (P = .01) The other investigated factors had no influence on MA.The correctness of medication as a quality feature in prehospital care shows a necessity for improvement with a proportion of 31.1% medication errors. The correct diagnosis by the prehospital emergency physician and his rapid accumulation of experience had an impact on the correctness of medication in prehospital care. Elderly patients (75+ years) and nighttime prehospital deployments (3-6 AM) were identified as high risk for medication errors by the emergency physicians.

Where are we in patient safety in the ED in Turkey?

Near misses and unsafe conditions have become more serious for patients in emergency departments (EDs). We aimed to search the near misses and unsafe conditions that occurred in an ED to improve patient safety.This was a retrospective analysis of a 10-year observational period from January 1, 2007 to December 31, 2016. We gained access to the adverse event notification forms (AENFs) sent to the hospital quality department from the ED. Patient age, sex, and date of presentation were recorded. The near misses and unsafe conditions were classified into 7 types: medication errors, falls, management errors, penetrative-sharp tool injuries, incidents due to institution security, incidents due to medical equipment, and forensic events. The outcome of these events was recorded.A total of 220 AENF were reported from 294,673 ED visits. The median age of the 166 patients was 60 (21-95) years. Of these, 57.1% of the patients were females and 47.9% were males. The most commonly reported events were medication errors (32.7%) and management errors (27.3%). The median age of falling patients was 67.5 years. The nurse-patient ratio between 2007 to 2011 and 2011 to 2016 were 1/10 and 1/7, respectively. We found that when this ratio increased, the adverse events results were less significant (P < .003).This was the 1st study investigating the adverse events in ED in Turkey. The reporting ratio of 0.07% for the total ED visits was too low. This showed that adverse events were under-reported.

Identifying medication errors in neonatal intensive care units: a two-center study.

BACKGROUND: This study aimed to assess the types and frequency of medication errors in our NICUs (neonatal intensive care units). METHODS: This descriptive cross-sectional study was conducted on two neonatal intensive care units of two hospitals over 3 months. Demographic information, drug information and total number of prescriptions for each neonate were extracted from medical records and assessed. RESULTS: A total of 688 prescriptions for 44 types of drugs were checked for the assessment of medical records of 155 neonates. There were 509 medication errors, averaging (SD) 3.38 (+/- 5.49) errors per patient. Collectively, 116 neonates (74.8%) experienced at least one medication error. Term neonates and preterm neonates experienced 125 and 384 medication errors, respectively. The most frequent medication errors were wrong dosage by physicians in prescription phase [WU1] (142 errors; 28%) and not administering medication by nurse in administration phase (146 errors; 29%). Of total 688 prescriptions, 127 errors were recorded. In this regard, lack of time and/or date of order were the most common errors. CONCLUSIONS: The most frequent medication errors were wrong dosage and not administering the medication to patient, and on the quality of prescribing, lack of time and/or date of order was the most frequent one. Medication errors happened more frequently in preterm neonates (P < 0.001). We think that using computerized physician order entry (CPOE) system and increasing the nurse-to-patient ratio can reduce the possibility of medication errors.

Combined SNA and LDA methods to understand adverse medical events.

OBJECTIVE: To compare primary medical adverse event keywords from reporters (e.g. physicians and nurses) and harm level perspectives to explore the underlying behaviors of medical adverse events using social network analysis (SNA) and latent Dirichlet allocation (LDA) leading to process improvements. DESIGN: Used SNA methods to explore primary keywords used to describe the medical adverse events reported by physicians and nurses. Used LDA methods to investigate topics used for various harm levels. Combined the SNA and LDA methods to discover common shared topic keywords to better understand underlying behaviors of physicians and nurses in different harm level medical adverse events. SETTING: Maccabi Healthcare Community is the second largest healthcare organization in Israel. DATA: 17,868 medical adverse event data records collected between 2000 and 2017. METHODS: Big data analysis techniques using social network analysis (SNA) and latent Dirichlet allocation (LDA). RESULTS: Shared topic keywords used by both physicians and nurses were determined. The study revealed that communication, information transfer, and inattentiveness were the most common problems reported in the medical adverse events data. CONCLUSIONS: Communication and inattentiveness were the most common problems reported in medical adverse events regardless of healthcare professional reporting or harm levels. Findings suggested that an information-sharing and feedback mechanism should be implemented to eliminate preventable medical adverse events. Healthcare institutions managers and government officials should take targeted actions to decrease these preventable medical adverse events through quality improvement efforts.

Medication errors in emergency departments: is electronic medical record an effective barrier?

OBJECTIVE: To compare medication errors in two emergency departments with electronic medical record, to two departments that had conventional handwritten records at the same organization. METHODS: A cross-sectional, retrospective, descriptive, comparative study of medication errors and their classification, according to the National Coordinating Council for Medication Error Reporting and Prevention, associated with the use of electronic and conventional medical records, in emergency departments of the same organization, during one year. RESULTS: There were 88 events per million opportunities in the departments with electronic medical record and 164 events per million opportunities in the units with conventional medical records. There were more medication errors when using conventional medical record - in 9 of 14 categories of the National Coordinating Council for Medication Error Reporting and Prevention. CONCLUSION: The emergency departments using electronic medical records presented lower levels of medication errors, and contributed to a continuous improvement in patients´ safety.

Closed-Loop Medication System: Leveraging Technology to Elevate Safety.

BACKGROUND: Healthcare organizations have long been dependent on the vigilance of nurses to identify and intercept medication errors before they can adversely affect patients. New technologies have been implemented in an effort to reduce medication errors; however, few studies have evaluated the long-term effects of technology-based interventions in reducing medication errors. AIM: The aim of this study was to evaluate the effects of barcode medication administration (BCMA) and the closed-loop medication system (CLMS) interventions on medication errors and adverse drug event (ADE) rates. METHODS: An autoregressive integrated moving average model for interrupted time series design was used to evaluate the impact of the BCMA and CLMS interventions on the monthly reported medication error and ADE rates at Humber River Hospital between September 2013 and August 2018. Descriptive statistics were generated to evaluate the types of error and their gravity. RESULTS: A total of 1,712 medication errors and ADEs were reported in the five-year study period. The results of the interrupted time series indicated that the introduction of the BCMA intervention was associated with a statistically significant gradual decrease in reported medication error and ADE rates at 0.002 percentage points per month (p = 0.003). The introduction of the CLMS intervention was associated with an immediate absolute decrease in reported medication error and ADE rates of 0.010% (p = 0.020). CONCLUSIONS: The findings from this study support the adoption of both BCMA and CLMS interventions to prevent medication errors. Staged implementation of CLMS allows time for learning and incorporating barcode scanning. Interprofessional and cross-functional collaboration is necessary to successfully integrate the requirements of each respective discipline and service in the CLMS.

Standardising the Classification of Harm Associated with Medication Errors: The Harm Associated with Medication Error Classification (HAMEC).

Classifying harm associated with a medication error can be time consuming and labour intensive and limited studies undertake this step. There is no standardised process, and few studies that report harm assessment provide adequate methods to allow for study replication. Studies typically mention that a clinical review panel classified patient harm and provide a reference to a classification tool. Moreover, in many studies it is unclear whether potential or actual harm was classified as studies refer only to 'error severity'. The tools used to categorise the severity of patient harm vary widely across studies and few have been assessed for inter-rater reliability and criterion validity. In this paper, we describe the systematic process we undertook to synthesise the defining elements and strengths, while mitigating the limitations, of existing harm classification tools to derive the Harm Associated with Medication Error Classification (HAMEC). This new tool provides a harm classification for use across clinical and research settings. The provision of an explicit process for its application and guiding category descriptors are designed to reduce the risk of misclassification and produce results that are comparable across studies. As the World Health Organisation embarks on its international safety challenge of reducing medication-related harm by 50%, accompanying methodological advances are required to measure progress.

Prospective survey-based study on the categorization quality of hospital pharmacists' interventions using DokuPIK.

Background There is a growing need to categorize pharmacists' interventions (PIs) in Germany to document their impact on solving or avoiding drug-related problems. Objective To validate the categorization of drug-related problems-one aspect of the categorical internet database DokuPIK, designed for recording routinely PIs. To identify case-specific predictive values. Setting German hospitals. Methods Within a prospective, nationwide survey-based study, 37 of 498 registered database users volunteered to evaluate 24 standardized case reports independently. Case evaluation was restricted to classify problems, based on 26 given categories with no limit on the number of item choices. Ratings were conducted electronically and anonymously. A gold standard of one or more problems per case was developed by majority consensus of five senior clinical pharmacists. Agreement of raters' case classification with the gold standard was assessed by calculating sensitivity, specificity and positive and negative predictive value and was reported as median and range. Main outcome Level of agreement. Results Independent assessment yielded a median agreement of 90% [79-94%]. Sensitivity and specificity were 37% [21-57%] and 99% [97-100%], respectively. Median positive and negative predicted value were both 90% [60-100%] and 90% [78-95%]. Mean case-specific agreement was robust (≥ 79%) with respect to a majority and maximum consensus (three and five out of five raters). Conclusion DokuPIK seems to have a high level of agreement and a good specificity according to the majority of clinical pharmacists in a panel of assessors. Despite the allowance of multiple choices, predictive values were high and indicated a well-constructed classification by pharmacists.