Reasons for medication errors in nursing,type 1 diabetes insulin dependent glut,diabete de type 2 anglais pdf - You Shoud Know

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This article was written on 21 Sep 2015, and is filled under Volume 10 2015, Volume 10 No 1 & 2. Purpose: Wrong-time medication administration error (WTMAE) is a high risk to patient safety. Setting: Data was gathered from a private tertiary care university hospital in Karachi, Pakistan. Implications: Medication administration is a complex process, and WTMAE is a major area to focus for improving the accuracy of medication administration recording. Value: Technology used innovatively in the form of eMAR can significantly help in identifying medication administration errors (MAE). Patient safety issues related to medication administration are critical on a day by day basis.
Studies have been conducted to identify MAEs and wrong-time medication administration error (WTMAE) as high risk to patient safety. The purpose of this study was to investigate the prevalence of WTMAE with the help of technology and to explore factors contributing to WTMAE. A literature review was done using different search engines such as Pub-Med, EBSCO host CINAHL Plus and Cochrane Database of Systematic Reviews. The study was conducted at a private tertiary care university hospital in Karachi, Pakistan.
A universal sampling technique was used to capture all the medication doses prescribed for the 3-month period from February 10, 2012 to May 9, 2012. Data received from the eMAR was coded for different variables and analyzed in SPSS version 19. The results illustrate that, overall 250,213 doses were prescribed for all of the five selected inpatient locations during the study period of 90 days. Figure 2 summarizes the percentage of on-time and wrong-time medication administration record by locations. Data was also analyzed to measure WTMAEs in different shifts to identify the impact of shifts on WT errors.
The eMAR system was programed to allow nurses to administer a medication dose 60 minutes prior or later to its scheduled time only after giving a short reason.
The data on WT medication administration errors illustrates that error identification from electronic system helps to give accurate number of errors and avoid any Hawthorne effects on the study; whereas the literature search revealed that most of the previous studies used observational methods to gather medication administration error data (Bates,.
As a System Analyst, I am involved in the planning, development and implementation of different clinical systems to enhance technology in nurses. Problem: For almost a decade, practitioners have been reporting concerns with illegible labeling of unit-dose respiratory therapy medications packaged in low-density polyethylene (LDPE) plastic containers.
The often indecipherable labeling is evident to practitioners such as nurses and respiratory therapists, as well as to patients and caregivers, who administer these medications. Many inhalation products intended for use by nebulization are packaged in LDPE plastic containers. The embossing method of labeling is used because the FDA no longer permits paper labels or printed ink on these containers. In 2004, the FDA’s Drug Safety and Risk Management Advisory Committee met to discuss how to prevent errors with drug products marketed in unit-dose plastic containers composed of LDPE.
Some practitioners and patients have considered using marking pens on individual containers to color-code or mark a letter indicating the drug name or to affix labels to the containers as a means of easily identifying these medications.
Individual plastic ampules should not be kept with others in a single location because many products look alike and might be inadvertently mixed together. Manufacturers of many products that are packaged in protective foil pouches because of their sensitivity to light recommend storing unopened containers in the pouch until they are ready to use. In most cases, containers that are removed from the foil pouch should be used within one week. In an effort to keep medications in their original packaging, pharmacists should avoid dispensing partial boxes. Patients should be counseled about the proper use and storage of medications, and they should be alerted to the ease with which these products can be misidentified.
Pharmacists should advise patients about the need to store the medications in their original, clearly labeled packaging. Patients may want to know how to identify the plastic containers or what to do if the wrong medication or too much of one medication is taken. In the first installment of this series of posts by Umanick about patient security in the world of health care, we singled out correct patient identification as one of the health care sector’s major challenges for the 21st century. The same study cites failing to correctly identify patients as the fundamental cause of erroneous diagnoses of patients’ health, administering the wrong medication, performing unsolicited transfusions, procedures and treatments, or carrying out unnecessary invasive and non-invasive tests, among other mistakes. Incorrect patient identification is therefore the cause that contributes to the emergence of a whole host of adverse events that can cause serious harm to patients’ health and, in some extreme cases, even death. A study published in 1998 by the Institute of Medicine (IOM), places the death toll in the USA as a result of medical error at 98 000, 60% of which were the result of errors in patient identification.
More recent reports state that harm to patients as the result of medical errors has become the third largest cause of death in the US health care system. One in seven patients on the Medicare social security health insurance program, which is run by the US government and provides health care to over 65s, has suffered from some kind of medical error. Two thirds of the errors in transfusions are related to the incorrect bedside identification of patientswhile they are on the ward. These figures are shocking and are a major concern for governments, and public and private health care organizations alike. The second argument in support of improving patient identification methods is of a financial nature, as the cost of maintaining an inefficient patient identification system year after year is overwhelming. Currently, hospitals allocate a large part of their budget, time and manpower to correcting errors and mitigating the effects of problems for the patient. Hospitals spend an estimated 3.5 billion dollars each year on treating illnesses related to incorrectly administered medication, which represents a totally unnecessary cost for the health care system. According to the Joint Commission on Accreditation of Healthcare Organizations, 116 instances of wrong-site surgery, including surgery performed on the wrong patient, were committed during operations in 2008 (the year of the most recent available data). Although the occurrence of adverse events is the most serious issue because it directly threatens patient safety, it is by no means the only problem caused by the ineffectiveness of the current patient identification methods.
By definition, medical identity theft occurs when an individual uses the personal information of another to commit an act of fraud related to the provision of health care services or products. One of the most famous cases of fraud is that of a man from Ohio (USA) who was accused of identity theft. The Coalition Against Insurance Fraud claims that year after year medical insurance fraud remains one of the primary causes of arrest and conviction for acts of fraud committed against medical insurance companies. The same institute estimates that medical identity fraud, as a means of accessing the services of the US health care system, costs tax payers between 70 and 255 billion dollars each year.


Roughly half of the victims of medical identity theft have lost their insurance policies, and only 10% of cases have been fully resolved.
In all of these cases, repairing the damage caused to the patient’s reputation and his or her bank balance is difficult, but identity fraud may yet have more drastic consequences. Without doubt, the health care system is in need of a method that unequivocally, safely and securely identifies each and every patient. One thing is for sure: we cannot keep on relying on traditional identification credentials and methods.
If you would like to know how biometrics can resolve the problems caused by incorrect patient identification, keep an eye out for the next post on the Umanick blog, which will be the last in thisthree-article series of entries on this issue. And, if you want to find out about Umanick’s value proposition for health care, click to download a FREE version of “BIOMETRICS IN HEALTH CARE”. This entry was posted in biometrics, health care and tagged biometric patient identification, biometrics, health care, patient identification, Umanick by Inaki Fernandez Sanz. The study found that mistaking the drug for another medication, packaging errors at pharmacies or misunderstandings between patients and doctors or pharmacists were common reasons behind accidental overdoses.'These mistakes are quite easy to make.
Dr Cairns said that symptoms of accidental overdoses can often be delayed and so many people will feel no symptoms at first.'If taken daily, methotrexate can suppress the immune system. Research by the Medical Journal of Australia found twenty-two deaths linked with the drug methotrexate. The views expressed in the contents above are those of our users and do not necessarily reflect the views of MailOnline. Share176 Tweet1 Pin24 Reddit EmailPrescription writing is something that I used to worry so much about in my 3rd year of medical school. While these are just estimates from various studies and statistical models, the numbers are staggering.
A prescription is an order that is written by you, the physician (or medical student with signature by a physician) to tell the pharmacist what medication you want your patient to take. According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) national patient safety goals, at least two patient identifiers should be used in various clinical situations. The last instruction on the prescription informs the pharmacist how many times the patient will be allowed to use the same exact prescription, i.e. This example shows a common way to write prescriptions for liquids, especially for children.
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Each downloadable resource packet includes an instructor guide, learner workbook, inservice attendance roster, certificate of completion, quiz, and quiz key. We offer continuing education classes, webinars, online education, staff training, video training, and compliance tools. The study highlights the frequency of WTMAEs and provides opportunities for improvement in nursing practices by elaborating multiple reasons for WTMAEs. Among all types of clinical errors, medication administration errors (MAEs) are reported as the second most frequent cause of injury.
The National Patient Safety Agency (NPSA) News (2007) reported that WTMAE is the second largest category of medication error reported worldwide and has resulted in death or serious harm to patients. This study compared actual versus expected medication administration time, captured from an electronic medication administration recording system (eMAR).
Attempts were made to find the literature from the primary source library and some of the literature was explored through secondary sources (University of Sheffield) library.All electronic databases were searched for references with key terms such as medication error, medication administration error and wrong-time medication administration errors.
Data for this study was gathered through the eMAR system, which identified the dose timing (actual verses expected) with reasons for early or late administration. This activity was initiated only after getting approval from hospital departmental heads and the ERC. Additionally Chi-square test was used to analyze data for differences between wrong-time administration verses on-time administration at different locations and shifts, to identify any significance difference.
The finding indicates that out of 250,213 prescribed doses 231,380 doses were administered whereas 18,833 doses were not administered (see Table 2). The data showed 17% prevalence of WTMAEs at the tertiary care university hospital in Karachi, Pakistan.
This systemic intervention helped us to identify many reasons for early or late medication administration errors.
The most important contribution of this study was the focus on wrong-time medication administration errors and their contributing factors. International studies conducted on wrong time error were reported using observational and chat review methods via manual medication administration record. Currently work as a Lead Analyst Nurse working with EHR Core Committee for selection of suitable software for Electronic Health Record for all the Aga Khan Hospitals in Asia & Africa. The poor legibility of these product labels has repeatedly been brought to the attention of the USP-ISMP Medication Errors Reporting Program (MERP).
Unfortunately, pharmacists might not be aware of the extent of the problem because they do not usually see the individual unit-dose containers. Examples include albuterol (Schering), ipratropium bromide (Atrovent canadian, Boeh-ringer Ingelheim), an albuterol-ipratropium combination (Duoneb®, Dey), levalbuterol (Xopenex®, Sepracor), cromolyn sodium [Intal®, Aventis), and budesonide (Pulmicort® Respules). LDPE plastic is permeable to the volatile chemicals used in label adhesives, paper, and ink, and the inhalation solutions can become contaminated, resulting in potential harm to patients. Although the committee did not determine a solution to the labeling problem, a number of alternative measures were considered. However, because other substances can permeate the plastic containers, it seems reasonable that the ink from a marker and volatile ingredients from the label adhesives would do the same. Elderly patients and those with visual difficulty should be taught how to properly identify their respiratory medications, especially if they are using more than one product.
In this second entry, we elaborate on this issue and examine three of the fundamental reasons that support this statement. According to a study of the US Veterans Administration (VA) health care system, incorrect identification was the major cause of 72% of the adverse events that occurred to members of this groupin 2010. One example of such an organization is the Joint Commission on Accreditation of Healthcare Organizations, which, since 2003, has cited correct patient identification as one of its targets for improving patient safety. Another considerable sum of money is set aside to ensure that the information in electronic medical records is accurate and up to date.
There is also a serious problem in protecting patients’ personal data and preventing the theft of their medical identities.
A fraudster can use the stolen identity to receive treatment, including surgery, or to defraud medical insurance companies by making false claims.
He is believed to have used another individual’s identity to obtain more than 300 000 dollars in medical treatments.
The Ponemon Institute (USA), which carries out studies into privacy, data protection and information security, has also published data that shows the severity of this issue. More than half of the people interviewed for the study admitted to having experienced at least one incident of medical identity theft, and 45% reported more than five violations of data in the last two years.
These figures represent between 3 and 10% of the government’s total annual health care bill.
If a fraudster receives treatment in someone else’s name, these health problems appear in the victim’s medical records. The goal is clear: to improve patient safety throughout the entire healthcare system, while simultaneously protecting patients’ medical identity, preventing fraud and reducing the overall costs of health care.
Despite many of these methods such as date of birth, address, name and surname or car license plate being used with total confidence in many other sectors, in the case of health care,using this information to identify patients is, unfortunately, highly unreliable.


In other words, using some physical trait or behavior that unequivocally, safely and securely identifies someone as a unique individual.
Methotrexate is considered safe and effective if taken as prescribed, however if it is accidentally taken daily for as little as three consecutive days this can result in life-threatening toxicity,' Dr Cairns told Daily Mail Australia.A There were 14 deaths in the study attributed to causes other than accidental overdoses of methotrexate .
Even though I don’t think I caused any major harm to any of my patients with prescription errors, I wish that I had read something like this when I first started writing prescriptions when I was in my 3rd year of medical school. The basic format of a prescription includes the patient’s name and another patient identifier, usually the date of birth. Unfortunately when you are in a hurry and scribbling these prescriptions, (there is a truth behind never being able to read a physician’s hand writing) many of these abbreviations can look similar. This can be anywhere from once a day, once a night, twice a day or even once every other week. If you there is a question that you have that isn’t answered yet, contact us and tell us what it is.
Through this study we investigated the prevalence of WTMAEs via electronic medical administration record (eMAR) and explore the contributing factors associated with WTMAEs. Therefore research needs to be done to identify different types of medication administration errors such as, wrong patient, wrong dose, wrong route, wrong drug, wrong-time and many others. The study was conducted at a tertiary care hospital in Pakistan where the electronic medication administration record (eMAR) was used at all inpatient locations.
These reasons were further grouped to list 35 reasons (Table 3) for late administration and eight reasons (Table 4) for early administration. Our study results showed a total of (n=39,386; 17%) doses in error due to WT administration in a three month period.
The study shows that innovative technology and its role in identification of MAE and WTMAE are imperative and well supported by the literature.
In fact, the Food and Drug Administration (FDA) has received more than 100 error reports through the MERP and the FDA Med-Watch programs combined.
These medications are usually dispensed in boxes that contain foil pouches, with each pouch holding multiple unit-dose containers.
These products carry the same risk of error because of their similarly sized and shaped containers as well as their nearly invisible labels. In fact, FDA studies have shown that 29 of 37 samples tested positive for volatile chemicals. However, compared with the prior paper labels used on some products, embossed labels are almost impossible to read (Figure 2), often leading to medication errors.
Because correctly identifying patients is the first step to protecting patients’ safety, reducing health care spending and eradicating medical fraud. This may affect the victim’s chances of receiving medical treatment and medical insurance benefits, and may even influence doctors’ decisions when treating this patient. It also includes the meat of the prescription, which contains the medication and strength, the amount to be taken, the route by which it is to be taken and the frequency. It generally does not matter if you write the generic or the brand name here, unless you specifically want to prescribe the brand name. A NOTE: it is often suggested that to help reduce the number of medication errors, prescription writing should be 100% English, with no Latin abbreviations.
Upon further exploration of WTMAEs multiple reasons for late and early medication administration were identified. Identification and analysis of MAEs are highly important for process improvement and patient safety.
The study findings provide an opportunity to decrease patient care risk and assist in development of different strategies for system improvement to ensure safe practices. Pub-Med search revealed 1642 articles, EBSCO host CINAHL Plus provided 220 and the Cochrane database revealed 1551 full text articles with search term: “medication error”. These units were chosen to cover most of the specialty areas for adult and pediatric patients with medical and surgical conditions. Figures 4 and 5 depict the top five reasons for late and top three reasons of early administration. The data also displayed how timing errors are not considered a major issue and have been given less attention.
Electronic medication administration record systems act as a great tool to capture the administration record in a timely manner and to help to correctly estimate the prevalence of WTMAE and the reasons behind the wrong-time administration.
This study’s finding suggest that staff members ought to be sensitized to the importance of on-time medication administration, which requires strong enforcement by management in the form of institutional policy. Transparent, raised letters, which include the drug name, concentration, lot number, and expiration date, are embossed into the plastic container, making the labeling virtually impossible to read (Figure 1). The presumed source of these chemicals was the packaging and labeling materials used, such as adhesives, varnishes, inks, and solvents. Often times, the exact strength you want is not available, so the pharmacist will substitute an appropriate alternative for you.
A physician may prescribe 1 pack of an oral contraceptive with 11 refills, which would last the patient a full year.
According to Koppel, Wetterneck, Telles, and Karsh (2008) “The Institute of Medicine (IOM) estimates that, on average, a hospitalized patient is subject to one medication administration error (MAEs) per day… In hospitals, the medication administration stage accounts for 26% to 32% of adult patient’s medication errors” (p.
The search was narrowed to search term “wrong-time medication administration error” which revealed limited full text articles. Approval for data collection was requested from relevant departmental heads and the hospital Ethical Review cCmmittee (ERC). It has been mentioned by Fitzhenry et al., (2007) that“the effects of timing errors and errors of omission were rarely recognized clinically” (p. Also regular audits of medication administration records in the eMAR should be done to check for WTMAE. And with the amount of material that needs to be covered in those 4 years, I’m sure writing prescriptions is not that well covered at any medical school.
For example, if you write prednisone (a corticosteroid) 50 mg, and the pharmacy only carries 10 mg tablets, the pharmacist will dispense the 10 mg tabs and adjust the amount the patient should take by a multiple of 5.
Pharmacists make these changes all the time, often without any input needed from the physician. This is convenient for both the patient and physician for any medications that will be used long term. When the patient complains of nausea, the nurse can give this medication because it has been prescribed.
The senior management must also be apprised of the fact that to create a culture of patient safety, correct nurse-patient ratios are important to curtail WTMAE.
Once completed with a signature and any other physician identifiers like NPI number or DEA number, the prescription is taken to the pharmacist who interprets what is written and prepares the medication for the patient. This way you don’t write a signed prescription without a patient name on it that accidentally falls out of your white coat and onto the floor in the cafeteria.
Allan and Barker (1990) suggested that wrong-time errors were defined as deviations from hospital policy.



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