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Medication errors pose a significant threat to patients. The results of medication errors vary from mild to deadly. No facility is immune from the possibility to drug errors, either through a fault of their own, or from suppliers or pharmacists that supply them. All medication errors must be reported to the Food and Drug Administration. This agency keeps records of the types of drug errors that occur, with the intention of using them as a tool to improve patient safety on all levels (U.S. FDA). This study will explore many facets of medication errors and will present a review of a video on medication errors from the ISMP website. The purpose of this study is to gain a better understanding of medication errors and ways to minimize them in any medical setting.
Medication Errors Including Look-Alike Sound-Alike Drugs in an ICU
People mistakes. This is true in every field and in every job. But in certain areas, mistakes can be costly, even deadly. Medication errors happen because sometimes staff at the medical facility or hospital see drug names that not just look alike, but also sound alike. Statistics point to only 0-2% detection rate of medication errors and prescribing errors. Although over 34% of adverse events happen when it comes to medication errors and over a half for prescribing errors, the very low detection rate presents problems. Medication safety, patient safety should be paramount especially in ICU conditions where the health of patients is at best stable, at worst at the brink of death.
To prevent things like accidental overdose, allergic reactions, or other complications resulting from medication errors, a possible solution is renaming drugs, especially those that have to be injected.…
Emmerton, L., & Rizk, M. (2011). Look-alike and sound-alike medicines: risks and 'solutions'.International Journal of Clinical Pharmacy, 34(1), 4-8. Doi: 10.1007/s11096-011-9595-x
Irwin, A., Mearns, K., Watson, M., & Urquhart, J. (2012). The Effect of Proximity, Tall Man Lettering, and Time Pressure on Accurate Visual Perception of Drug Names. Human Factors: The Journal of the Human Factors and Ergonomics Society, 55(2), 253-266. Doi: 10.1177/0018720812457565
Pak, J., & Park, K. (2012). Construction of a Smart Medication Dispenser with High Degree of Scalability and Remote Manageability. Journal of Biomedicine and Biotechnology, 2012, 1-10. doi:10.1155/2012/381493
Pape, T. (2013). The Effect of a Five-Part Intervention to Decrease Omitted Medications. Nurse Forum, 48(3), 211-222. doi:10.1111/nuf.12025
Overmedication can be described as an inappropriate medical treatment that occurs when a patient takes unnecessary or excessive medications. This may happen because the prescriber is unaware of other medications the patient is already taking, because of drug interactions with another chemical or target population, because of human error, or because of undiagnosed medical conditions. Sometimes, the extra prescription is intentional (and sometimes illegal), as in the case of the use of excessive psychoactive medications as "chemical restraints" for elderly patients in nursing homes. The purpose of the research paper is to identify the root causes of overmedication and its effect on healthcare. It then goes on to identify the role that a nurse can play in elimination medication errors.
oot causes of Overmedication:
Overmedication is the misuse or prescription of medication in situations where less medication would be more beneficial to the patient. Patients are…
Barber, C. (2008). "Comfortably Numb: How Psychiatry Is Medicating a Nation"
Deene, L. (2009) "Journal of Continuing Education in Nursing" Is This the Right Patient?
Siri C. (2008). "The epidemic of overmedication Use of multiple drugs, especially in older adults, can exacerbate ailments"
One proven solution to decrease medication errors is use of medication software such as CPOE. It has significantly reduced errors in prescribing, transcription, and dispensing of medications (Hidle). It also has the potential to decrease errors in administration due to unfamiliarity with a drug, drugs with similar names, or incorrect dose calculations since the software performs the calculations. So, why are these systems not used more often in the administration of medications? In general, there has been reluctance on the part of nurses to use software programs. It is not known why this is, but it is thought that unfamiliarity with the technology, lack of training, and lack of involvement in the design of the software has caused this reluctance. Studies have shown that when used medical software has reduced medication errors due to administration (King). One major drawback is the lack of willingness to use the software. This could…
Dickens, G. Inpatient psychiatry: Three methods to detect medication errors. Nurse Prescribing 5(4) (2007): 167-171. Web. 5 May 2010.
Drach-Zahavy, a., Pud, D. Learning mechanisms to limit medication administration errors. Journal of Advanced Nursing 66(4) (2010): 794-805. Web. 7 May 2010.
Hidle, U. Implementing technology to improve medication safety in healthcare facilities: A literature review. Journal of the New York State Nurses Association 38(2) (2007): 4-9. Web. 6 May 2010.
King, W.J., Paice, N., Rangrej, J., Forestell, G.J., Swartz, R. The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients. Pediatrics 112 (2003): 506-509. Web. 6 May 2010.
Medication errors have serious direct and indirect results, and are usually the consequence of breakdowns in a system of care…Ten to 18% of all reported hospital injuries have been attributed to medication errors" (Mayo & Duncan 2004: 209). One of the most common reasons that errors in medical administration transpire is miscommunication. On a staff level, errors may occur in terms of the paperwork associated with the patient. The hospital pharmacist may misread the strength or even the name of the pill or the frequency of the dose and release the patient with an incorrect pill or orders. Or, within the hospital a nurse may misread the patient's orders and administer treatment incorrectly. If a nurse, within the environment of the hospital, is pressed for time or overtired, risks of medication errors increase.
When a patient is discharged with orders, miscommunication can also occur if the nurse does not stress…
Bullock, S., & Manias, E. (2011). Fundamentals of pharmacology. Frenchs Forest, Australia:
Pearson Education (6th ed). Australia.
Clinical Rounds: How nurses perceive mistakes. (2004). Nursing. 34 (11): 34. Retrieved
September 5, 2011 at http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=531200
The anger that eventually and inevitably spills out is far more hurtful than any truth I could have told before, and the damage I have done to my self-esteem is too great. My opinions, right or wrong, are part of who I am.
Honesty does not mean tactlessness. In fact, one of the important lessons about learning to be honest is to know that honesty does not mean being too brutal, or sarcastic, or cruel, which is just the same thing as lying. Cruelty is a lie because it is a one-sided tale. Nothing is all bad or all good. Honesty is a balanced and upfront perspective of the truth, even if it is only your subjective, perceived truth. Everyone's truth, after all, will be influenced by their personal biases and perspectives on life. But that does not excuse telling falsehoods about that perspective.
Being honest is important to me,…
Clinical Application Paper
Medication errors are a serious public health problem and they pose a serious threat to patient safety. Medication errors are costly from an economic, human, and social viewpoint since all patients are potentially vulnerable to these errors. It is estimated that in the United States more than 250,000 deaths per year are attributed to medication errors (Dirik, Samur, Seren Intepeler, & Hewison, 2019). Nurses work in a fast-paced healthcare environment which makes administering medication to be a high-risk nursing task. Medication errors can occur at any phase of medication from prescribing, dispensing, transcribing, administering, monitoring, and reporting. When a nurse makes a medication error they are emotionally traumatized since most of them beat themselves up for making such an error and this might undermine their self-esteem and confidence. Medication errors can be caused by any member of the healthcare team, but nurses account for the majority since…
Cho, S.-D., Heo, S.-E., & Moon, D. H. (2016). A convergence study on the hospital nurse\\'s perception of patient safety culture and safety nursing activity. Journal of the Korea Convergence Society, 7(1), 125-136.
Dirik, H. F., Samur, M., Seren Intepeler, S., & Hewison, A. (2019). Nurses’ identification and reporting of medication errors. Journal of clinical nursing, 28(5-6), 931-938.
Kelly, K., Harrington, L., Matos, P., Turner, B., & Johnson, C. (2016). Creating a culture of safety around bar-code medication administration: An evidence-based evaluation framework. JONA: The Journal of Nursing Administration, 46(1), 30-37.
Lee, S. E., Scott, L. D., Dahinten, V. S., Vincent, C., Lopez, K. D., & Park, C. G. (2019). Safety culture, patient safety, and quality of care outcomes: A literature review. Western journal of nursing research, 41(2), 279-304.
Tong, E. Y., Roman, C. P., Mitra, B., Yip, G. S., Gibbs, H., Newnham, H. H., . . . Dooley, M. J. (2017). Reducing medication errors in hospital discharge summaries: a randomised controlled trial. Medical Journal of Australia, 206(1), 36-39.
Genetics/Genomics and Medication in Public Health Care
Contemporary health care has experienced significant changes in the recent past because of several factors like technology and advances in genetics or genomics. Actually, nurses in the modern health care system are well positioned to include genetic and genomic information in nearly every aspect of public health. This is primarily because advances in genetics and genomics are applicable to the whole spectrum of health care and every health care profession. The use of genetics and genomics in the current health care system is influenced by the fact that nearly every health condition, disease risk, and therapies used to treat the conditions have a genomic and/or genetic component (Calzone et. al., 2010, p.26).
Some of the most significant public health related advances in genomics and genetics include genetic testing, gene therapy, and genotyping and genetic sequencing. These advances have and are expected to continue…
Calzone et. al. (2010, January). Nurses Transforming Health Care Using Genetics and Genomics. Nursing Outlook, 58(1), 26-35.
Huston, C. (2013, May 31). The Impact of Emerging Technology on Nursing Care: Warp Speed Ahead. The Online Journal of Issues in Nursing, 18(2). Retrieved September 2, 2015, from http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Emerging-Technology.html
"The Safety of Medicines in Public Health Programmes: Pharmacovigilance An Essential Tool." (2006). World Health Organization. Retrieved September 2, 2015, from http://www.who.int/medicines/areas/quality_safety/safety_efficacy/Pharmacovigilance_B.pdf
Velo, G.P. & Minuz, P. (2009, June). Medication Errors: Prescribing Faults and Prescription Errors. British Journal of Clinical Pharmacology, 67(6), 624-628.
Medication Errors in an ICU Unit
Medication Errors -- Including Look-Alike and Sound-Alike Drugs -- in an ICU Unit
Medication errors can and do occur in the ICU unit, and they often come from look-alike and sound-alike medications that can easily get mixed up. When a nurse or other health care professional gives a medication to a patient, that professional should be absolutely certain the medication is the right one, and in the right dosage (Helmons, Dalton, & Daniels, 2012). Unfortunately, that due diligence does not always take place, and people who want and need the proper medications do not always get them (Helmons, Dalton, & Daniels, 2012). Especially in an ICU, when patients are dealing with critical injuries or sicknesses, an incorrect, missing, or wrongly added medication could result in the worsening of a patient's condition or even the death of that patient (Athanasakis, 2012). In addition to medications…
Athanasakis, E. (2012). Prevention of medication errors made by nurses in clinical practice. Health Science Journal, 6(4): 773-783.
Crigger, N., & Godfrey, N.S. (2014). Professional wrongdoing: Reconciliation and recovery. Journal of Nursing Regulation, 4(4): 40-45.
Elliott, M., Page, K., & Worrall-Carter, L. (2012). Reason's accident causation model: Application to adverse events in acute care. Contemporary Nurse, 43(1): 22-28.
Frith, K.H., Anderson, E.F., Tseng, F., & Fong, E.A. (2012). Nurse staffing is an important strategy to prevent medication errors in community hospitals. Nursing Economics, 30(5): 288-294.
First of all, there must be a paradigm shift in the patient-provider relationship, one being to "allow and encourage patients to take a more active role in their own medical care" via some type of partnership between a patient and his/her physician. This could be accomplished by better communication via physicians "fully informing their patients about the risks, contraindications and possible side effects" of all medications ("Preventing Medication Errors," 2006, 2).
Second, physicians, nurses and other health care professionals must utilize information technologies to reduce medication errors. One way is to use "point-of-care reference information typically accessed over the Internet" which provides highly-detailed information about the specifics of a certain drug and how it interacts with other medications ("Preventing Medication Errors," 2006, 3). Of course, many hospitals are now using computers instead of paper to track and account for all medications and to ensure that the patient receives the right…
Glanze, Walter D. (2001). Medication errors: a serious medical problem and its consequences. Journal of Nursing, 4(2), 134-36.
"Preventing Medication Errors." (2006). Report Brief. Institute of Medicine of the National Academies, 1-4.
(Institute for Safe Medication Practices)
Many medication errors by the patient occur because they do not know about the drugs they are taking. Nurses can help to identify these gaps and provide education and written materials for the patient.
Medication errors could be greatly reduced if the patient was taught to:
1. Inform doctors of all allergies and any previous reactions to drugs
2. Ask the doctors and pharmacist about prescribed medications in layman terms
3. If English is not the first language always take an interpreter
4. Most important is to be active participant in the health care team. (Woolston, Chris)
Patients in the hospital can help avoid medication errors by:
1. When receiving a new medication, ask what it is and what is for, who ordered it and how often it is given.
2. Always make sure your ID bracelet is checked and state your name to the…
According to Daughton, a researcher at the U.S. Environmental Protection Agency, "Indeed, deaths from medication errors occurring both in and out of hospitals exceed 7,000 annually in the United States -- exceeding those from workplace injuries" (2003, p. 757).
Tertiary healthcare facilities and other healthcare providers have identified some effective methods for reducing the number of medication errors through the use of technology, improving processes, targeting those types of specific medication errors that result in harm to patients, and promoting an organizational culture of safety (Meadows, 2003). One approach that has been shown to be particularly effective has been the use of bar codes and scanners together with computerized patient information systems; in these settings, bar code technology can help to prevent a number of different types of medication errors, including administering the wrong drug or dose, or administering a drug to a patient with a known allergy (Meadows, 2003).…
Anson, B.R. (2000). Taking charge of change in a volatile healthcare marketplace. Human Resource Planning, 23(4), 21.
Daughton, C.G. (2003). Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. Environmental Health
Perspectives, 111(5), 757-758.
Meadows, M. (2003, May-June). Strategies to reduce medication errors: How the FDA is working to improve medication safety and what you can do to help. FDA Consumer,
The right route
Likewise, this clinician advises, "The administrator must give the medication via the right route. In preparing the medication, the triple check will identify the route to be given on the medication order."
The right time
Penultimately, double-checking the time is required: "The administrator will check the medication order to ensure that the medication is given at the right time. The prescriber will identify the times that the medication is to be given."
Finally, clinicians administering medication are responsible for recording the client's status prior to the medication administration as well as the medication given, the time it was given, the dose given, and the route administered. In addition, "Then the administrator will follow up and record the client's response to the medication given."
Source: Adapted from Six ights to educing Medication Errors, 2012
The project will consist of a series of custom-designed posters,…
Bomba, D. & Land, T. (2006, August). The feasibility of implementing an electronic prescribing decision support system: A case study of an Australian public hospital. Australian Health
Review, (30)3, 3-5.
Evans, J. (2009, February). Prevalence, risk factors, consequences and strategies for reducing medication errors in Australian hospitals: A literature review. Contemporary Nurse: a Journal for the Australian Nursing Profession, 31(2), 19-20.
Mahmood, a., Chaudhury, H. & Gaumont, a. (2009, Winter). Environmental issues related to medication errors in long-term care: Lessons from the literature. HERD: Health
Quality and Sustainability Paper Part Two - Identifying Opportunities to Reduce Medication Error Rates by Nursing Staff
As reported previously, medication errors can occur in virtually any treatment setting, including patients’ homes, but the problem is especially pronounced in hospitals where the adverse reactions caused by medication errors can result in extended inpatient stays or even death. As also reported previously, nurses account for the largest percentage of medication errors, and these errors affect more than 7 million patients, cost nearly $21 billion and cause more than one million emergency room visits and three-and-a-half million visits to doctors’ offices each year. The purpose of part two of this study is to provide an overview of a selected nationwide health care organization and a description of its successes and failures in reducing medication error rates. In addition, this part of the study identifies a quality area in which nursing science can…
About XYZ. (2018). XYZ Health Care Organization. Retrieved from https://www.va.gov/health/ findcare.asp.
Bellum, P. (2018). New study shows quality improvement initiative working. XYZ Health Care Organization. Retrieved from https://www.va.gov/health/NewsFeatures/20110825a.asp.
Incident reporting. (2015). XYZ Health Care Organization. Retrieved from https://www.va.gov/ vdl/documents/financial_admin/incident_reporting/irum.doc.
Stoppler, M. C. & Marks, J. W. (2018) The most common medication errors. MedicineNet. Retrieved from https://www.medicinenet.com/drugs_the_most_common_ medication_errors/views.htm.
The origin of the XYZ motto. (2018). XYZ Health Care Organization. Retrieved from https://www.va.gov/opa/publications/celebrate/vamotto.pdf.
DACH-ZAHAVY A. & PUD D. (2010) Learning mechanisms to limit medication administration errors. Journal of Advanced Nursing 66(4), 794 -- 805.
In this paper, the learning mechanism used in the limiting of medication errors of studied. The paper is a report of a study the was carried out to identify as well as test the learning mechanism's effectiveness in the context of nursing staff in hospital wards as a way of limiting the errors associated with medication administration.
The background of the paper is the influential report titled 'To Err Is Human' and has a deep emphasis on the role of effective team playing in the reduction of the level of medication errors.
The study involved the random recruitment of 32 hospital wards where data were collected in Israel via a multi-method as well as multisource approach. The medication administration errors were effectively defined as any form of…
Benner P, Sheets V, Uris P, Malloch K, Schwed K, Jamison D.Individual, practice, and system causes of errors in nursing: a taxonomy. J Nurs Adm. 2002 Oct;32(10):509-23.
DRACH-ZAHAVY A. & PUD D. (2010) Learning mechanisms to limit medication administration errors. Journal of Advanced Nursing 66(4), 794 -- 805.
Evans J.(2009).Prevalence, risk factors, consequences and strategies for reducing medication errors in Australian hospitals: a literature review. Contemp Nurse. 2009 Feb;31(2):176-89.
isk Management Within a Healthcare Environment
Medication errors and falls are among the top events that can cause harm to patients, and consequently, increase the costs of hospitalization. In a healthcare environment, a professional nurse can be liable for damages if her conduct is below the standard of care, which cause injuries to patients. This paper explores the concept of falls, medication errors, and nursing liability. The study recommends how nurses can promote a culture safety within a healthcare environment.
A fall is an unintentional, and sudden slip that leads to a change in position. A fall is one of the common adverse effects in a hospital setting where more than 37.3 million of the case globally occurs annually. WHO (2012) reveals falls result to more than 424,000 deaths globally each year, and over 80% of the case are in developing countries. In the United States, the fall rates…
The Joint Commission (2016).2016 National Patient Safety Goals. USA.
Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., et al. (2013). Types and causes of medication error from nurse's viewpoint. Iranian Journal of Nursing and Midwifery Research, 18(3), 228-231.
Currie, L. (2008). Fall and Injury Prevention. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (U.S.).
Douglas, M.K. Pierce, J.U. Rosenkoetter, M. et al. (2011). Standards of Practice for Culturally Competent Nursing Care: Update. J Transcult Nurs. 22(4): 317-333.
Medication Administration Entails Six ights, Namely:
ight time, and ight documentation (Six ights of Medication Administration, n.d; Perry, Potter & Ostendorf, 2015).
For ensuring that one administers medicine to the correct person, one must firstly know the person, and remain focused on the job to avoid giving that medication to the wrong person (Six ights of Medication Administration, n.d).
For ensuring that the medication is right, one should carefully read the label on the drug/medicine, and triple check it. It should be borne in mind that some of the medications possess two or more names: brand name, along with no less than one generic name (Six ights of Medication Administration, n.d).
This refers to amount of the particular medication an individual can consume at a time. For dosage determination, one must be aware of each individual…
How to Prevent Needle stick and Sharps Injuries. (2012, February 1). Retrieved October 19, 2015, from http://www.cdc.gov/niosh/docs/2012-123/pdfs/2012-123.pdf
Krucik, G. (2013, May 20). Intramuscular Injection. Retrieved October 19, 2015, from http://www.healthline.com/health/intramuscular-injection#Procedure3
Krucik, G. (2013, May 22). Administration of Medication. Retrieved October 19, 2015, from http://www.healthline.com/health/administration-of-medication#Problems5
Patient Rights & Responsibilities. (n.d.). Retrieved October 19, 2015, from http://www.umchealthsystem.com/index.php/for-patients/patient-rights
Identifying Effective Strategies to Reduce Medication Errors
Nurses are responsible for the largest percentage of medication errors. Medication errors adversely affect more than 7 million patients, cost almost $21 billion and result in excess of one million emergency room visits and 3.5 million additional visits to doctors’ offices each year (Stoppler & Marks, 2018).
Problem: Medication errors remain the leading cause of adverse incidents for inpatients in the United States.
Intervention: Develop and disseminate an attractive and informative poster that underscores the severity of the problem and its causes, and provides nursing staff with the mnemonic five “rights” of medication administration (i.e., right patient, the right drug, the right dose, the right route and the right time). Nursing supervisors were requested to hang The posters in a prominent location at all nursing stations (see below).
Comparison: A comparison of medication error rates following the dissemination of the…
One of the major challenges impact healthcare providers is medical errors. These issues are challenging, as they will have an adverse impact on quality and safety. In the case of the ICU, these challenges are becoming more pronounced. This is because of the different conditions and large number of patients they are working with. A good example of this can be seen with insights from Orgeas (2010) who said, "Although intensive care units (ICUs) were created for patients with life-threatening illnesses, the ICU environment generates a high risk of iatrogenic events. Identifying medical errors (MEs) that serve as indicators for iatrogenic risk is crucial for purposes of reporting and prevention. We describe the selection of indicator MEs, the incidence of such MEs, and their relationship with mortality. We selected indicator MEs using Delphi techniques. An observational prospective multicenter cohort study of these MEs was conducted from March 27…
Data and Statistics. (2014). CDC. Retrieved from: http://www.cdc.gov/hai/surveillance/
Marcucci, L. (2012). Avoiding Common ICU Errors. Hoboken, NJ: Wiley.
Marino, P. (2012). ICU Book. Thousand Oaks, CA: Sage.
McClean, S. (2011). Intelligent Patient Management. New York, NY: Springer.
According to the BWH study, in some cases an increase of potential adverse drug events was possible, especially when every dose of medications was not scanned. For barcode scanning technology to work as designed, every medication dose would have to be scanned before it reached the patient (BWH, 2002). Given the current shortage of nurses available to perform routine tasks in hospital care settings, it is likely that multiple errors might occur from a nurse not having time to or forgetting to scan every dose a patient would take before medicating the patient.
Some reports acknowledge that technological systems as barcode scanning are "cumbersome" and may "cause an unreasonable increase in time needed to administer medications" with some hospitals reporting an 8-second delay in medication recognition when nurses used a database instead of manual methods (Cipriano, 2002).
The use of barcode scanning for medication processing and administration is not…
Bayley, C. & Berlinger, N. Who is responsible? The Hastings Center Report, 36(3): 11.
BWH. (2005). BWH study finds using bar code technology in a hospital pharmacy dramatically reduces dispensing errors and potential adverse drug events." Brigham and Women's Hospital. February, 2005. Accessed 7, May 2007: http://www.hms.harvard.edu/news/pressreleases/bwh/1006barcodes.html
Cipriano, P.F. "Statement of the American Academy of Nursing and the American
Organization of Nurse Executives regarding barcode labeling." July 26, 2002. Accessed 7, May, 2007:
EXPEIENCE OF NUSES WITH MEDICATIONS
The Lived Experiences of Nurses with Medication
Nurses are tasked with the proper distribution of medications. Unfortunately, they sometimes are unable to perform that task properly due to various factors. This paper presents five separate studies, two qualitative and three quantitative or mixed, which researched how nurses commit medication error, what the antecedents are, and how they can be avoided. The studies are examined according to research design, sample size and whether the study could be extrapolated to the broader population.
The Lived Experiences of Nurses with Medication
This is a literature review which focuses on nurses who make medication errors and what importance is placed on those errors in relation to patient safety. Five studies were examined with the express purpose of determining what types of studies are being conducted to alleviate this issue, what research designs they are using, and whether…
Hofmann, D.A., & Mark, B. (2006). An investigation of the relationship between safety climate and medication errors as well as other nurse and patient outcomes. Personnel Psychology, 59(4). 238-249.
Kim, J., An, K., Kim, M.K., & Yoon, S.H. (2007). Nurses' perception of error reporting and patient safety culture in Korea. Western Journal of Nursing Research, 29(7). 827-844.
Jones, J.H., & Treiber, L. (2010). When the 5 rights go wrong: Medication errors from the nursing perspective. Journal of Nursing Care Quality, 25(3). 240-247.
Schelbred, A.-B., & Nord, R. (2007). Nurses experiences of drug administration errors. Journal of Advanced Nursing, 60(3). 317-324.
Poor medical safety practices result in over 40,000 deaths per year, of that 7,000 deaths are attributed to medication-related medical errors. There is no excuse for negligence when it comes to human lives. It is imperative that the medical community introduce sound medication safety best practices to eliminate adverse outcomes related to medication prescriptions. Best practices include the implementation of standardization and protocols in addition to the use of technology to reduce errors.
Medical Safety Practices
Medical practitioners are relied upon to provide solutions, acting as the first and many times, last hope of those in dire need. But despite this great responsibility to patients whose lives are entrusted in medical staff studies show that out of every 100 patients admitted to a medical facility 2 patients will experience a medical error due to incorrectly prescribed or administered medication. The results can be mild but can also be…
Bates, David W.; Spell, Nathan; Cullen, David J., et al. (1997).The Costs of Adverse Drug Events in Hospitalized Patients. JAMA. 277:307 -- 311.
Centers for Disease Control and Prevention (National Center for Health Statistics). (1999). Births and deaths: Preliminary data for 1997. National Vital Statistics Reports.
Grissinger, M., Globus, N.J. (2004). How Technology Affects Your Risk of Medication Errors. Nursing2004. 34(1), 36-41.
Institute of Medicine. (2000). To Err Is Human: Building A Safer Healthcare System.
Nurses' Practice Environments, Error Interception Practices and Inpatient Medication Errors (2012)
Null hypothesis: There is no significant relationship between nurses' error interception practices and their practice environment.
Alternative hypothesis: There is a significant relationship between nurses' error interception practices and their practice environment.
Two frameworks were used in developing the theoretical foundation of the study: Error Theory and Nursing Organization and Outcomes Model.
Error Theory is a framework developed to explain errors that occur in different organizational settings. In the hospital/medical setting, errors are identified as medical errors, defined as "any preventable event that may lead to inappropriate medication use or patient harm" (Flynn et al., 2012, p. 181). In essence, error theory posits that in preventing errors from occurring within an organization, there must be a system established and implemented that could detect, determine, and deter any preventable errors/events. Further, the theory's proponent, J. eason, posited that within the…
Flynn, L., Y. Liang, G. Dickson, M. Xie, and D. Suh. (2012). "Nurses' Practice Environments, Error Interception Practices and Inpatient Medication Errors." Journal of Nursing Scholarship, Vol. 44, No. 2.
Role of Nursing Staff in Eliminating Medical Errors
The article focuses on the role that nurses play in eliminating errors in various medical situations. The research focused on the relationship between the number of nurses and the prevalence of medical errors. The study unveiled many reasons why medical errors occur. Some medical errors are caused by interruption of the nurses while working or understaffing in various healthcare facilities. The study reveals that the nurses play an important role in reducing the medical errors because they are responsible for administering the medication and monitoring the progress of the patients. Major medical errors are common when few nurses are made to handle many patients. The study shows that when the workload is high, the nurses tend to take short cuts to ensure they deliver the service. As a result, medical errors result from omission of some steps, missing the proper order of…
Bar code medication administration (BCMA) is one of the keys to minimizing medical errors in a manner consistent with evidence-based practice (Poon et al., 2010). However, universal embrace and utilization of BCMA remains stagnant. easons for resisting the transition to BCMA include nurse perceptions. Holden, Brown, Scanlon, & Tzion-Karsh (2012), for instance, found nurses reporting low perceived usefulness of BCMA in spite of the wealth of evidence supporting the technology. Perceived ease of use of BCMA was moderate, suggesting that it is mainly attitude factors preventing nurses from implementing BCMA in their institutions. When perceptions of the usefulness of BCMA increase, then compliance with BCMA standards can become more widespread. Any program that attempts to increase the utilization of BCMA must focus first on human factors including attitudes. This requires that all nurse leaders, as well as nurse educators, prepare advance practice nurses for using BCMA as a matter…
Duffield, C.M., Roche, M.A., Blay, N., & Stasa, H. (2011). Nursing unit managers, staff retention and the work environment. Journal of Clinical Nursing, 20(1-2), 23-33.
Roberts, B.R. (2013). Doctor of nursing practice: Integrating theory, research, and evidence-based practice. Clinical Scholars Review, 6(1), 4-8. doi: http://dx.doi.org/10.1891/1939-2095.6.1.4
Health Care Situation: Medical Error Due to Doctors' Bad Handwriting
Identify a health care news situation that affects a health care organization such as a hospital, clinic or insurance company.
I have identified the following health care news situation as the topic of my paper: "Poor Handwriting of Doctors and its implied risks for the Patient, Hospital and Medical Malpractice Insurance." Poor handwriting of physicians resulting in poor legibility of entries into patients' medical records carries very dramatic risks for all above-mentioned interest bearers. It can result in severe health danger for the patient and - in extreme situations - even cause a patient's death. Doctors' bad penmanship has long been seen a problem within organized medicine and the patient safety movement. Three American Medical Association (AMA) policies dating back to 1992, urge doctors to "improve the legibility of handwritten orders for medications" and review all orders for accuracy and…
Berwick, Donald M. & Winickoff, David E. (1996). The truth about doctors' handwriting: a prospective study. BMJ Vol. 313 (21-28 December 1996). 1657-1658. www.bmj.com/content/313/7072/1657.full, accessed 21 August 2011.
Bruner, Anne & Kasdan, Morton.L. Handwriting Errors: Harmful, Wasteful and Preventable.
1-4. www.kyma.org/uploads/file/.../Harmful_wasteful_and_preventable.pdfSimilar, accessed 22 August 2011.
Gallant, Al. (22 November 2009). For a secure electronic health record implementation, user authentication is key. 1-2). searchhealthit.techtarget.com/.../User-authentication-is-critical-for-pl.., accessed 24 August 2011.
Medication Administration Tech
Policy and Procedure Change Bar Code eader System for Medication Administration
Though the Utah State Hospital has an integrated electronic prescription system there is no evidence that the institution utilizes bar code reading technology either on the unit or in the pharmacy itself. This is evidenced by the lack of such information in the institutions policies and procedures manual, and specifically in their policies and procedures associated with controlled drugs, which is an area where inventory controls, accountability and patient safety are particularly important. Such a system would serve the patient population well, helping to ensure that fewer errors were made and more observation of possible conflicts between medications as well as other issues could be more closely monitored. This work will describe in detail from the literature both the types of systems available, their use and the research effects associated with them to aide in the…
"ASHP statement on bar-code verification during inventory, preparation, and dispensing of medications: developed through the ASHP Section of Pharmacy Informatics and Technology and approved by the ASHP Board of Directors on April 15, 2010, and by the ASHP House of Delegates on June 6, 2010." (2011) American Journal of Health-System Pharmacy 68(5), 442. Gale Power Search. Web. 24 Oct. 2011.
Agrawal, A. (2009). Medication errors: prevention using information technology systems. British Journal Of Clinical Pharmacology, 67(6), 681-686. doi:10.1111/j.1365-2125.2009.03427.x
Fowler, S.B., Sohler, P., & Zarillo, D.F. (2009). Bar-Code Technology for Medication Administration: Medication Errors and Nurse Satisfaction. MEDSURG Nursing, 18(2), 103-109.
Prusch, A.E., Suess, T.M., Paoletti, R.D., Olin, S.T., & Watts, S.D. (2011). Integrating technology to improve medication administration. American Journal Of Health-System Pharmacy, 68(9), 835-842. doi:10.2146/ajhp100211
Statistics in Healthcare
The author of this report has been presented with a case study scenario that involves one Ben Davis and another man named Juan de Pacotilla. The former is a young student who has just completed a Statistical Thinking for Business Improvement course and the latter is a pharmacy manager who is ostensibly about to lose his job due to a glut of errors relating to the dispensing of medications that are either the wrong drug or the wrong dosage of the right drug. Juan has spoken to another statistician but the person has been less than helpful in relation to this problem and Juan is now desperate. He sees Ben as a closer ally because Ben actually works in the pharmacy and thus sees thing first-hand. The ostensible task that Ben has been given is to nail down precisely what is going wrong using statistical data and…
HRSA. (2015). How does e-prescribing work?. Hrsa.gov. Retrieved 31 October 2015, from http://www.hrsa.gov/healthit/toolbox/HealthITAdoptiontoolbox/ElectronicPrescribing/epreswork.html
THA. (2015). Prescription Verification Tips for the NEW Pharmacist or Student -- The Honest Apothecary -- . Thehonestapothecary.com. Retrieved 31 October 2015, from http://www.thehonestapothecary.com/2015/01/22/prescription-verification-tips-for-the-new-pharmacist-or-student/
Appendix -- Process Map
job aid that reduces human error and lack of attention to detail by providing a list of policies, procedures, or items that are needed to produce a consistent job or product. There are checklists used in transportation to ensure the vehicles are ready, in clinical medical practice to organize charting and patient history, in software engineering to check process compliance and code, in litigation to deal with the complexity of discovery, in biology/science to list standardized practices and names, and even in everyday hobbies and life to organize materials, shopping, or contents. This tool of organization and operation may seem simple, but it provides a template and framework for innumerable tasks in almost endless ways (Gawande, 2007). It is interesting to note that this simple tool -- so logical and valuable, has saved so many lives in medical care (e.g. surgery, medication, etc.) by simply trying to understand a multistage…
Felder, K. (1996). One of these things is not like the other. NCSU.edu. Retrieved from:
Gawande, A. (December 10, 2007). The Checklist. The New Yorker. Retrieved from: http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande
Gopalan, P. (April 29, 2011). Avoiding the checklist monkey. On Product Management. Retrieved from: http://onproductmanagement.net/2011/04/29/avoiding-the-checklist-monkey/
Stated to be barriers in the current environment and responsible for the reporting that is inadequate in relation to medical errors are:
Lack of a common understanding about errors among health care professionals
Physicians generally think of errors as individual that resulted from patient morbidity or mortality.
Physicians report errors in medical records that have in turn been ignored by researchers.
Interestingly errors in medication occur in almost 1 of every 5 doses provided to patients in hospitals. It was stated by Kaushal, et al., (2001) that "the rate of medication errors per 100 admission was 55 in pediatric inpatients. Using their figure, we estimated that the sensitivity of using a keyword search on explicit error reports to detect medication errors in inpatients is about 0.7%. They also reported the 37.4% of medication errors were caused by wrong dose or frequency, which is not far away from our result of…
Discussion Paper on Adverse Event and Error Reporting In Healthcare: Institute for Safe Medication Practices Jan 24, 2000
Patient Safety/Medical Errors Online at the Premiere Inc. page located at: http://www.premierinc.com/all/safety/resources/patient_safety/downloads/patient_safety_policy_position_2001.doc
Medstat / Shortell, S. Assessing the Impact of Continuous Quality Improvement on Clinical Practice: What It Will Take to Accelerate Progress.
Health Policy Monitor (2001) A Publication of the Council of State Governments Vol. 6, No. 1 Winter/Spring 2001 PO18-0101
Chang Proposal - Milestone #4
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N 451- Capstone Project Milestone #4: Design for Change Proposal
N 451 Capstone Course
Quality of patient care is a paramount concern of healthcare professionals. When nurses experience interruptions while they are working, the quality of care patients receive can be negatively impacted. Interruptions have been shown to disrupt working memory, disrupt on-duty focus, induce frustration and stress, contribute to accidents, and lead to patient care errors (Bennet, et al., 2010). Interruptions that occur when nurses administer medication to patients are a particular concern. The incidence of interruptions is higher than might be surmised; according to Day (2010), 19.8% of all procedures did not have any disruptions or clinical errors. Biron, et al. (2009) reviewed 14 observational studies of nurses providing patient care, in which they found that 6.7 interruptions occurred each hour during mediation administration. This…
Bennett, J. (2006). Effects of interruptions to nurses during medication administration.
Nursing Management (Harrow), 16(9), 22-3.
PMID: 20222227 [PubMed - indexed for MEDLINE]
Biron, A., Lavoie-Tremblay, N., and Loiselle, C.G. (2009). Characteristics of work interruptions during medication administration. Journal of Nursing Scholarship, 41(4), 330-336. doi: 10.1111/j.1547-5069.20009.01300.x
The second purpose was to explore the association of demographic variables and nurses' perceptions of pump implementation to ratings of the management team and job satisfaction. Data was collected via a survey given to 1056 nurses at a tertiary Magnet hospital. The first section of the questionnaire pertained to demographic characteristics, while the second section consisted of thirty questions on a 5-point Likert scale based on both STS Theory and the Life Patterns Model conceptual framework.
The researchers conclude that generalizations cannot be made based on just one study. They did state however that the findings of this study give credence to the importance of technological changes in clinical nursing practice. ecommendations were made for future studies in that there is a need to analyze the degree to which technology affects the environment, patient acuity as well as overall nursing satisfaction. Carrying out this study in more that one hospital…
Advantages and Disadvantages of the Survey Method. (2011). Retrieved from http://writing.colostate.edu/guides/research/survey/com2d1.cfm
Bowcutt, Marilyn, Rosenkoetter, Marlene M., Chernecky, Cynthia C., Wall, Jane, Wynn, Donald
and Serrano, Christina. (2008). Journal of Nursing Management, 16(2), p.188-197.
An estimated 1.5 million “preventable adverse drug events” occur each year in the United States alone; the number of medication errors that did not lead to adverse effects but remained undisclosed is unknown (Jenkins & Vaida, 2007, p. 41). The scenario is this: You are working as an advanced practice nurse at a community health clinic. You make an error when prescribing a drug to a patient. You do not think the patient would know that you made the error, and it certainly was not intentional.
Disclosure is an ethical and legal prerogative, showing respect for the patient and a willingness to accept professional responsibility. Consequentialist ethics do not apply to situations like these, because the broader issue is about changing advanced nursing practice and ensuring a culture of safety for all patients. Likewise, disclosure empowers the patient to make informed choices about reactions to the medical error while…
448). However, due to the recent introduction of the CPOE system (Computerized Physician Order Entry), the authors surmise that this system will help to eliminate up to 80% of all medication errors (Tang, Sheu, Yu, Wei and Chen, 2007, p. 448).
Third, the authors make it abundantly clear that nurses themselves must accept the bulk of the responsibility when it comes to transcribing, dispensing and administering medications to patients. Of course, if the prescription itself, almost always filled out by a physician, is inaccurate, then the responsibility falls upon the prescribing physician, a situation which then leads to nurses dispensing and administering the wrong medication. In addition, the authors provide an analysis related to nurses failing to report their medication mistakes to the proper hospital/clinic authorities, due perhaps to "shame, guilt and the fear of punishment" from their superiors when informed of medication errors on the part of nurses (Tang,…
Tang, Fu-in, Sheu, Shuh-Jen, Yu, Shu, Wei, Ien-Lan, and Ching-Huey Chen. (2007).
Nurses relate the contributing factors involved in medication errors. Journal of Clinical Nursing, 16, 447-457.
eports from medical center services and committees concerning patient incidents are used to develop appropriate interventions.
Trended data of patient incidents can point to shift and date where most incidents occur.
A 50% reduction in the number medication errors of all types over the next 12 months.
Goals and Objectives to Facilitate Outcome
The overarching goal of this program would be to reduce the number of medication errors in general and among those wards/shifts with the highest numbers of medication errors over the past 12 months. The objectives in support of this goal include:
1. Developing awareness campaign materials such as locally prepared newsletter articles, posters and brochures concerning the goal to reduce medication errors.
2. Conduct a medication error theme seminar that provides basic guidelines for avoiding medication errors (the "5 Ps").
Translation of Goals and Objectives into Policies and Procedures
The above-described goals and objectives would…
Jorm, C.M. & Dunbar, N. (2009, August). Should patient safety be more patient centered?
Australian Health Review, 33(3), 390-395.
Tillman, P. (2013, January 7). U.S. Department of Veterans Affairs. Retrieved from http://www.
Flexible medication times were the norm amongst these nurses. Even experienced nurses felt that late medications were not critical during busy times, stressing the need to prioritize when giving care (Stetina, Groves & afford 2005:4). Nursing judgment was another justification for flexible medication time, as noted by one "relatively new labor and delivery nurse" who described two situations arising on a specialty unit. The first situation related to purposely omitting a drug because of possible harm to the patient: 'Like with itocin[R] we have an (pause) orders to increase it by so much every 20 minutes, but if the baby's not tolerating it, we don't do it. And that's nursing judgment [not an error]" (Stetina, Groves & afford 2005:4). A perhaps more candid experienced ER nurse admitted that the risk of error increases when emergences occur" as a fact of hospital life (Stetina, Groves & afford 2005:4).
A medical-surgical nurse…
Previous studies suggested that the top three causes of medication errors were failure to check the patient identification band with the prescription, nurse fatigue and illegible doctor handwriting. Another study suggested that nurses did not identify what most would call a medication error, such as giving medicine late. It was "discovered that nurses believed it was not an error if the nurse could correct the situation safely, if the patient status required a change, or in emergency situations" it did not 'count' as an error if the medication was given late (Stetina, Groves & Pafford 2005:1).
The authors embarked upon a new phenomenological study of nurses working in wide variety of clinical settings and levels and types of experience reporting (Stetina, Groves & Pafford 2005:3). Flexible medication times were the norm amongst these nurses. Even experienced nurses felt that late medications were not critical during busy times, stressing the need to prioritize when giving care (Stetina, Groves & Pafford 2005:4). Nursing judgment was another justification for flexible medication time, as noted by one "relatively new labor and delivery nurse" who described two situations arising on a specialty unit. The first situation related to purposely omitting a drug because of possible harm to the patient: 'Like with Pitocin[R] we have an (pause) orders to increase it by so much every 20 minutes, but if the baby's not tolerating it, we don't do it. And that's nursing judgment [not an error]" (Stetina, Groves & Pafford 2005:4). A perhaps more candid experienced ER nurse admitted that the risk of error increases when emergences occur" as a fact of hospital life (Stetina, Groves & Pafford 2005:4).
A medical-surgical nurse provided a different perspective, saying that her hospital's methodology of double-checking charts was helpful in preventing errors. However, reliance upon hospital-imposed assistive system, including medication administration records (MARs) and automated medication dispensing machines (AMDMs) can also increase the risk of errors, if patient allergies and drug interactions are not recorded in the system. In addition to variance from standard practices, "nurses showed an increased reliance upon computerized and systematic checks put into place in health care systems. Nurses viewed the systems as infallible and as a relief from the duty of systematic checking against error" (Stetina, Groves & Pafford 2005:4). However, the author's studies express considerable concern about the nurses' willingness to suspend their own judgment and leave themselves and their patients at the mercy of automated systems, as well as the nurses' lack of concern about correct dosage times when busy or fatigued.
Pitocin Induction and Postpartum Hemorrhage
THE SEARCH CONTINUES
Is Pitocin Induction a Factor in Postpartum Hemorrhage?
The induction of oxytocin injection has been a bane of contention in the medical community not only because it has been listed as a high-alert medication, which incurs serious risks to the patient, the fetus and the institution. It is also used frequently to manage postpartum hemorrhage. This quantitative correlational study analyzes and presents the findings of five updated and authoritative sources on the subject and answers the questions surrounding the induction of oxytocin in postpartum hemorrhage and its appropriateness, efficacy and safety.
Postpartum hemorrhage occurs when there is blood loss greater than 500 ml during spontaneous vaginal delivery or 1,000 ml during a cesarean section delivery (Yiadom, 2010). Fortunately, in most cases, healthy females can tolerate much blood loss of more than 500 ml without incurring adverse conditions. The two types are early…
Balci, O. et al. (2011). Comparison of induction of labor with vaginal misoprostol plus
Oxytocin vs. oxytocin alone in term primigravidae. Vol. 2 # 9, Journal of Maternal
and Neonatal Medicine: Informa Healthcare Publishing Technology. Retrieved on January 12, 2014 from http://www.ingenta.connect.com/content/apl/mfn/2011/00000024/00000009/art00002
Clayworth, S. (2000). The nurse's role during Oxytocin administration. Vol. 25 # 2, The
B. This study used cross-sectional design and may tend to under-select individuals who have been exposed. This is known as "late-look bias." The possibility of nurses recalling MAEs over their careers may result in reporting of, or remembering information that is not accurate.
C. The instrument developed by authors used expert validity, but more research is needed to determine the construction validity and use the appropriate interventions to decrease MAEs (Lin & Ma).
ather than a hypothesis, the Lin and Ma (2009) study was guided by the following research questions:
A. What is the self-reported incidence of MAEs throughout a nurse's career in Taiwan?
B. What is the willingness of nurses to report MAEs?
C. What factors are related to nurses' willingness to report MAEs?
The first research question, though, differs from the authors' stated purpose which was to "explore the prevalence of MAEs and the willingness…
Gebhart, F. (2008, May 12). N.C. hospital loses CMS certification over drug and other errors.
Drug Topics, 152(6), 12.
Lin, Y-H & Ma, S-n. (2009). Willingness of nurses to report medication administration errors in southern Taiwan: A cross-sectional survey.
Wakefield, B.J., Uden-Holman, T. & Wakefield, D.S. (2005). Development and validation of the medication administration error reporting survey. In Advances in patient safety: From research to implementation. Henriksen, K., Battles, J.B., Marks E.S., et al. (eds).
Workflow is a term that is utilized to refer to processes or steps undertaken to complete a specific task (Mastrian & McGonigle, 2015). In a healthcare organization, this concept refers to initiatives undertaken to provide patient care services. This essentially means that workflow is crucial towards the achievement of organizational goals since it plays a critical role in the accomplishment of desired tasks/activities. Given its significance to realization of organizational objectives, organizations conduct workflow analysis to help identify workflow patterns that maximize effective resource utilization and reduce those that do not add value. Workflow analysis process is carried out using several tools to examine workflow processes and shed light on potential areas for removing waste. This paper provides a workflow analysis through flowcharts of medication administration in a community health center.
Common Event in My Organization
The organization I work for is a community health center that provides…
Design Considerations and Workarounds
Implementation of an informatics system in nursing
The nursing profession continues to evolve with the advancing technology, ensuring that it maintains standards of quality in service. In the endeavor to facilitate quality healthcare, the profession endorsed the use of medical informatics systems. The nursing informatics integrates the three subjects of nursing science, computer science and information science. The practice employs these facilities in managing and communicating data and information while in line of duty. The informatics in nursing facilitates integration of information and knowledge to support the patients, nurses and doctors in decision making roles and administering of care (McGonigle & Mastrian, 2012). Information technology is essentially the significant aspect of the informatics; thus, it is necessary for hospitals to consider the quality of the technology they employ.
Medical informatics systems
The medical informatics systems support a variety of activities in the hospital or clinic…
Australian National Health Informatics Conference, Maeder, A., & Martin-Sanchez, F.J.
(2012). Health Informatics: Building a healthcare future through trusted information;
selected papers from the 20th Australian National Health Informatics Conference (HIC
2012). Amsterdam: IOS Press Inc.
" (MediLexicon International, Ltd., 2006).
The PCIP was formed from the recognition that high costs and low quality inherent in the Healthcare system of the U.S. is largely due to a system that is antiquated and fragmented (DOHMH, 2006a). The inability to properly collect and use health information is one of the primary problems associated with proper health care maintenance. The PCIP. was formed in response to this need. The primary care physician acts as the conduit between the patient and the healthcare system. However, the physician often has no means to effectively transmit the information that they collect to other entities within the system. The PCIP grew out of a need for the primary health care Physician to be able to transmit the needed information to others in the Healthcare system.
There are three essential parts to the PCIP. The first is the Primary Care Health Information Consortium (PCHIC).…
Department of Health and Mental Hygiene. (DOHMH) 2006. PCIP. Retrieved August 30 at http://www.nyc.gov/html/doh/html/pcip/pcip.shtml
DOHMH 2006b. Primary Care Health Information Consortium (PCHIC). Retrieved August 30 at http://www.nyc.gov/html/doh/html/pcip/pcip-pchic.shtml.
MediLexicon International, Ltd. (2006). 1,000 New York City Doctors Will Get Electronic Health Records Systems. Retrieved August 30 at http://www.medicalnewstoday.com/medicalnews.php?newsid=42483
The American Health Quality Foundation (AHQF)(2006). Quality Improvement Organizations and Health Information Exchange. March 6, 2006. Retrieved August 30 at http://www.ehealthinitiative.org/assets/documents/QIOHIEFinalReportMarch62006.pdf#search=%22Health%20care%20information%20management%20PCIP%22
This is exactly where the problem usually starts.
There are a number of reports published which revealed that even the physicians are not so keen into attending more seminars and trainings to learn the new systems (Ball, 1992). Physicians are expectedly always busy. They sometimes work from hospital to hospital. They are always on call hence they really find it hard to squeeze in their thigh schedule the time for further training and semi-are regarding the system. At some point in time, physicians will also worry about their income that will be affected if they will get a time off just to attend the training.
In the same manner, most of the administrators, who will manage the new systems for the hospitals, also show signs of hesitance regarding the training. It must be noted that the being considered as a 'wired hospital' the institution must have uniform data standards (Aspden…
Aspden, P., J.M. Corrigan, J. Wolcott, and S.M. Erickson. 2003. Patient Safety: Achieving a New Standard for Care. Washington, DC: National Academies Press.
Ball, M. 1992. "Computer-Based Patient Records: The Push Gains Momentum." Health Informatics 9 (1): 36-38.
Bates, D.W., J.M. Teich, J. Lee, D. Seger, G.J. Kuperman, N. Ma'Luf, D. Boyle, and L. Leape. 1999. "The Impact of Computerized Physician Order Entry on Medication Error Prevention." Journal of the American Medical Informatics Association 6 (4): 313-21.
Benefits of it to Medical Profession http://www.cica.org.uk/bre-cica_survey/ranking_of_it_benefits.htm . September 25, 2006
Smart Card Health Role in Rational Use of Medicines
The objective of this study is to examine the role of smart cared in health and their role in the rational use of medicines. Smart cards are very small and very secure and serve to protect patient privacy. Smart cards contain digital logs with location, date, time, and the individual's stamp to record every transaction. Smart cards also may contain digital prescriptions therefore mistakes made with prescriptions that are handwritten are eliminated and specifically as to the "quantity or quality of medications." (HealthOne, 2011)
How the Smart Card Works
The smart card uses technology that stores a patient's personal health information on a microprocessor chip embedded in the card that is the size of a credit card but that has a "small metal contact plate on the front which is how the reader accesses the medical information stored on the chip"…
Benjamin, DM (2003) Reducing Medication Errors and Increasing Patient Safety: Case Studies in Clinical Pharmacology. J Clin Pharmacol 2003 Jul;43(7):768-83.
Hsu, MH (2011) Online detection of potential duplicate medications and changes of physician behavior for outpatients visiting multiple hospitals using national health insurance smart cards in Taiwan. Int J. Med Inform. 2011 Mar;80(3):181-9. Epub 2010 Dec 22.
Hsu, MH, Li, YC, and Liu, CT (2006) ADRs and Smart Health Cards. CMAJ Aug 15, 2006 Vol. 175 No. 4. Retrieved from: http://www.cmaj.ca/content/175/4/385.1.full
Runciman, WB et al. (2003) Adverse Drug Events and Medication Errors in Australia. Int J. Qual Health Care 2003, Dec;15 Suppl 1:i49-59.
The most common cause of pancreatic cancer is smoking which accounts for 25 -- 30% of cases (urveillance, Epidemiology and End Results Program). Other factors include hereditary pancreatic cancers, adults with diabetes of minimum duration two years, hereditary pancreatic, and a history of other family cancers (GUT. Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas). The Consensus Guidelines of the International Association of Pancreatology advises that patients with a genetic history of pancreatic cancer should be referred to specialist centers where they can receive diagnosis of pancreatic diseases, genetic counseling, and advice on secondary screening (Ulrich et al., 2001).
Most pancreatic cancers (about 90%) originate in the ductal region and are usually discovered when they are locally advanced. They are called ductal adenocarcinoma. Others (80-90%) occur in the head of the gland (GUT). Lymph node metastasis is common as well as…
Doheny, K ( July 2, 2012) Medication Errors Affect Half of Heart Patients WebMD http://www.webmd.com/heart/news/20120702/half-of-heart-patients-make-medication-errors
GUT. Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas http://gut.bmj.com/content/54/suppl_5/v1.full
Surveillance, Epidemiology and End Results Program. http://seer.cancer.gov/faststats/html/inc_pancreas.html
Neoptolemos JP, Dunn JA, Stocken DD, et al. (2001) Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet;358:1576-85
worked a number years office a family physician retired. You a position a busy surgical floor a local, acute-care hospital. You frequently hear references JCAHO requirements documenting a patient's pain assessment treatment, documenting medication administration, documenting verbal telephone orders.
Documenting patient's pain assessment and treatment
Pain assessment is the first step in managing pain. The suggested method of improving pain care essentially requires that the following procedures are followed properly and meticulously.
a) The pain and its intensity must be measured using an appropriate tool. There are many tools but the best is self reporting by the patient for the pain.
b) The second important thing to be followed is to repeat the assessment consistently and record the same at varying intervals to record the process of the progress of pain. The tool or format for this must be chosen before hand and the same record structure must be maintained…
Aspden, Philip; Institute of Medicine (U.S.) Committee on Identifying and Preventing
Medication Errors. (2007) "Preventing Medication Errors" The National Academies Press.
Joint Commission Resources. (2004) "A guide to JCAHO's medication management
standards" Joint Commission Resources.
Studies suggest that more computerized order entry of medications helps reduce errors by limiting interpretation errors due to handwriting (Meadows, 2003). Thus more order entry is involving computers to protect patients. A culture that supports safety and safe practices has also been adopted to provide nursing staff and patients information about drug therapy and medication to ensure that everyone is aware of the need for safe practices when utilizing and dispensing medications.
Describe the strategies used to ensure nursing practice is performed within legal requirements and ethical frameworks
Nurses now "live and work in a world where there is no single reality but many coexisting realities among which they must choose" (Johnston, 1999:1). Given that through more and more nurses are forced to make legal and ethical decisions and take steps that will determine the best processes to adopt to ensure that moral and legal processes are adopted and followed.…
Campbell, D.W. & Sigsby, L.M. (1995). "Nursing interventions classification: A content analysis of nursing activities in public schools." Journal of Community Health Nursing, 12(4): 229.
Caretto, V.A. & McCormick, C.S. (1991). "Community as Client: A Hand's on experience for baccalaureate nursing students." Journal of Community Health Nursing, 8(3): 179.
Johnston, M.J. (1999). Bioethics: A nursing perspective. Sydney: Harcourt Saunders.
Lumby, J. & Picone, D. (2000). Clinical challenges: Focus on nursing. St. Leanords:
Furthermore, one of the pillars of collaborative care that will need to be firmly established is the fostering of clear dialogue and a means for strong communication within the care management planning. For instance, there needs to be a clear decision and communication of all tests ordered and when the test results will be available. One of the most important aspects of this collaborative care will be the nursing interventions which can have significant impact on the patient's health and stabilization (Allen, 2010). In fact, strategic nursing care can even minimize readmission rates of Margaret and other patients with comparable conditions (Chen et al., 2012).
Prioritize the Nursing Care Needs of Margaret
The prioritization of nursing interventions is essential, and the way in which a nurse determines this priority is going to be something unique and distinct. "Trials reviewed demonstrated a beneficial impact of nursing interventions for secondary prevention in…
Adler, H.M. (n.d.). Toward a biopsychosocial understanding of the patient -- physician relationship: An emerging dialogue. (2007). J Gen Intern Med,22(2), 280 -- 285.
Afilala, J. (n.d.). Frailty in patients with cardiovascular disease: Why, when, and how to measure. (2011). Curr Cardiovasc Risk Rep, 5(5), 467 -- 472.
Allen, J.K. (2010). Randomized trials of nursing interventions for secondary prevention in patients with coronary artery disease and heart failure: Systematic review.
Journal of Cardiovascular Nursing,25(3), 207-220.
Nurses are considered the backbone of the medical care-giver community. Good quality patient care centers on having a competent educated nursing labor force. There is a wealth of empirical evidence that has demonstrated Baccalaureate (BSN) nurses are associated with fewer medication errors, lower mortality rates, and greater overall positive patient outcomes than nurses at lower levels of educational achievement. For example, Brady, Malone, and Fleming (2009) performed an extensive literature review and found that BSN nurses made fewer medication errors than their less educated counterparts. Aiken and associates (2003) found a strong link between N education level and patient outcomes. Their findings indicated that for every ten percent increase in the proportion of BSN nurses in a surgical unit there was a four percent decrease in the risk of death to patients. In a large study of nearly 47,000 patients conducted at the University Toronto it was found that hospital…
Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., & Silber, J.H. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290, 1617-1623.
Brady, A.M., Malone, A.M., & Fleming, S. (2009). A literature review of the individual and systems factors that contribute to medication errors in nursing practice. Journal of Nursing Management, 17(6), 679-697.
Friese, C.R, Lake, E.T., Aiken, L.H., Silber, J.H. & Sochalski, J. (2008). Hospital nurse practice environments and outcomes for surgical oncology patients. Health Services Research, 43(4), 1145-1163.
Profetto-McGrath, J. (2003). The relationship of critical thinking skills and critical thinking dispositions of baccalaureate nursing students. Journal of Advanced Nursing, 43(6), 569- 577.
He or she is also entitled to proper medication to deal with the disease.
It's not just the responsibility of medics to offer health care but the family members of the sick too play a very important role in caring about health. y accompanying the sick person to hospital and administering the prescribed medicine at home. As well, family members offer support by praying and giving the sick member company. Did you know that even loneliness is a health hazard.
Quality health care is individual responsibility. Every individual is supposed to make sure they have the best health always. Contagious diseases should be avoided at all costs, however, should we contact them then we should care for ourselves. A sick person should maintain bodily cleanliness and eat the right foods. Ones health should not also cause harm to neighbors at home and in public. Global concerns are also rising quickly…
Baum F (1998).The new public health: an Australian perspective, Oxford University Press,
Mannion R, Konteh F, Davies H (2008) Measuring culture for quality and safety improvement: a national survey of tools and tool use, Quality and Safety in Health Care (in press).
Mannion R, Davies H, Marshall M (2005) Cultural attributes of 'high' and 'low' performing hospitals. Journal of Health Organization and Management 19(6):431-9.
A reflection on the case shows me that ethical and moral guidelines must be instilled in pharmacy as a profession. It is therefore necessary for the pharmacies to collaborate with other key stakeholders in ensuring that proper guidelines are put in place together with polices aimed at ensuring an ethical and moral pharmaceutical practice. Case esolution Model (CM) (Brincat & Wike,1999) is therefore an important model since it has taken me through all the necessary steps that can allow me to effective conclude this case amicably.
World Health Organization (2001). The ole of the Pharmacist in Self-Care and Self-Medication.Available online at http://apps.who.int/medicinedocs/pdf/whozip32e/whozip32e.pdf
Brincat, C.,Wike, vs (1999). Morality and the Professional Life: Values at Work. Pearson; 1st ed.
Passmore P, Kailis SG (1994).In pursuit of rational drug use and effective drug management: clinical and public health pharmacy viewpoint. Asia Pac J. Public Health. 1994;7(4):236-41.
outledge, PA., O'Mahony, MS., WoodhouseKW…
World Health Organization (2001). The Role of the Pharmacist in Self-Care and Self-Medication.Available online at http://apps.who.int/medicinedocs/pdf/whozip32e/whozip32e.pdf
Brincat, C.,Wike, vs (1999). Morality and the Professional Life: Values at Work. Pearson; 1st ed.
Passmore PR, Kailis SG (1994).In pursuit of rational drug use and effective drug management: clinical and public health pharmacy viewpoint. Asia Pac J. Public Health. 1994;7(4):236-41.
Routledge, PA., O'Mahony, MS., WoodhouseKW (2003).Adverse drug reactions in elderly patients. Br J. Clin Pharmacol. 2004 February; 57(2): 121 -- 126. doi: 10.1046/j.1365-2125.2003.01875.x PMCID: PMC1884428
There are certain interactions that may cause toxicity
The drug may be administered orally without regard to meals.
The seriousness of an overdose of Lamictal depends on the ingested amount. There are however several non-life threatening symptoms of overdosing Lamictal with symptoms raging from ataxia, dizziness, somnolence and headache. However, in certain cases of overdose, the patient would experience renal and liver failure, delirium, rash as well as coma. The lethal dosage is lower for children. All suspected cases of Lamictal overdose should be treated as a medical emergency and the patient should be taken for immediate medical attention.
Lamictal has been very effective in the treatment and management of epilepsy and depression. A review of literature however suggests that it has certain risks in its administration. It is therefore necessary to be careful when taking or prescribing this medication. There are reports that the drug Seroquel…
GlaxoSmithKline (2004). LAMICTAL®(lamotrigine) Tablets
Goa KL, Ross SR, Chrisp P. Lamotrigine.(1993)A review of its pharmacological properties and clinical efficacy in epilepsy. Drugs 1993;46:152-76
Keck, P., and McElroy, S (2003) New Approaches in Managing Bipolar Depression. J Clin Psychiatry 2003;64 (suppl 1).
In order to implement these new techniques, an understanding of where handoffs occur is also crucial. Knowing where handoffs are frequent enables the healthcare facility to expect and enable these techniques effectively.
Handoffs as mentioned previously, occur in high traffic units of the health care facility, when specialists are needed, and in large facilities such as hospitals. Handoffs generally occur under these circumstances: shift-to-shift handoff, nursing unit-to-nursing unit handoff, nursing unit to diagnostic area, special settings (operating room, emergency department), discharge and interfacility transfer handoff, and physician-to-physician handoffs. In 2011, stricter national regulations, offered to minimize the continuous-duty hours of first-year resident physicians from 30 to 16 to help decrease incidences of ineffective handoffs. Some argue this will be ineffective, but considering how many residents and interns make mistakes because of their fatigue from long work hours, it seems to help more than hurt.
Ultimately it takes a lot to…
Aarts, J., & Nohr, C. (2010). Information Technology in Health Care: Socio-technical Approaches 2010: from Safe Systems to Patient Safety. IOS Press.
Clinical Handover and Patient Safety: Literature Review Report. (2005). Darlinghurst, N.S.W.: The Commission.
Handoff Communications: Toolkit for Implementing the National Patient Safety Goal. (2008). Oak Brook, IL: Joint Commission Resources.
Lippincott Williams & Wilkins (1989). Academic Medicine: Journal of the Association of American Medical Colleges. Philadelphia, Pa: Hanley & Belfus.
Workflow Analysis Of A Selected Nursing Activity
The Tele-Management System
Medication errors have resulted to numerous injuries, which has led to some healthcare providers adopting IT systems such as electronic records and information systems as a measure to minimize the errors. The adoption of these technologies involves several stakeholders, but most importantly, the informatics nurses. These nurses play an important role in optimization by representing the needs of clinicians. In addition, they also assist in improving technological solutions in case of technological hitches with the IT systems. When hospitals adopt technology solutions, it will influence their workflow process (McGonigle and Mastrian, 2012).
The informatics nurses come in to redesign the workflow to accommodate the solution, through evaluation of tasks that will require the utilization of technology. However, the solutions adopted should allow for exchange of information across different hospitals to improve or eliminate dependence on one…
Hussain, A.A. (2011). Meaningful use of information technology: A local perspective. Ann Intern Med, 154, 690-692.
Logan, G.A. et al. (2007).Mobile Phone -- Based Remote Patient Monitoring System for Management of Hypertension in Diabetic Patients. AJH, 20, 942-948.
McGonigle, D., & Mastrian, K.G. (2012). Nursing informatics and the foundation of nursing (2nd ed.). Burlington, MA: Jones and Barlett Learning.
Pickering, T.G., Gerin, W., Holland, J.K. (1999). Home blood pressure teletransmission for better diagnosis and treatment. Curr Hypertension Rep, 1, 489 -- 494.
Secured real time protocol (STP) is also being identified to enhance the security parameter of WAN and LAN network elements. "STP provides protection with encryption keys for wired and wireless networks including bandwidth limited channels." (Guillen and Chacon 2009 P. 690). There is also a growing use of IP secure to protect organization from the interception of data over the LAN and WAN environment.
To enhance network security, Chen, Horng, & Yang (2008) postulate the use of public key cryptography. While there is a growing use of public key cryptography, there is still a shortcoming identified with the use of public key cryptography in the LAN and WAN environment. Since the public key is being kept in a public file, it is possible for an active intruder to forge the contents of the public key and use it to get access onto the data kept within the network system. To…
Chen, T. Horng, G. & Yang, C. (2008).Public Key Authentication Schemes for Local Area. Informaticia.19 (1):3-16.
Fetterolf, P.C. & Anandalinga, G. (1992). Optimal design of LAN-WAN internetworks:
an approach using simulated annealing. Annals of Operations Research. 36: 275-298.
Guillen, P.E. & Chacon, D. A (2009). VoIP Networks Performance Analysis with Encryption Systems. World Academy of Science, Engineering & Technology. 58: 688-695.
challenging environment that the world faces has placed much strain and stress on the health care industry and their many institutions. Despite the rapid advances in technology, nutrition and fitness, the world is in constant need of medical treatment and assistance. The role of the nurse and the professional duties that accompany this experience has also changed rapidly along with technology and medical advancement. It is important to investigate how nurses can take advantage of these newly developed systems to perform at a higher level and eventually ease the suffering and pain that accompanies medical procedures in today's day and age.
Informatics is a newly formed discipline that provides some of the solutions to the many problems that nurses are faced with. The purpose of this essay is to discuss and highlight the importance of informatics and its synthesis into the nursing profession. The essay will first give some background…
Healthcare Information and Management Systems Society (2008). Nursing Informatics: Scope and Standards of Practice, ANA 2008. Retrieved from http://www.himss.org/resourcelibrary/TopicList.aspx?MetaDataID=767
Oroviogoicoechea, Cristina, Barbara Elliott, and Roger Watson. "Review: evaluating information systems in nursing." Journal of clinical nursing 17.5 (2008): 567-575.
Thede, L., Schwiran, P., (February 25, 2011) "Informatics: The Standardized Nursing Terminologies: A National Survey of Nurses' Experiences and Attitudes - Survey I*" OJIN: The Online Journal of Issues in Nursing Vol. 16 No. 2.
Camouflaged Killer: The Shocking Double Life of Colonel ussell Williams offers a thorough treatment of a disturbing story from both criminal psychology and criminal justice perspectives. Gibb does far more than offer a biography and overview of the facts, but also analyzes the key issues of the case and offers suggestions for how to deal with similar situations that may arise in the future. What makes Camouflaged Killer a remarkable work on Colonel ussell Williams is the author's stance that Williams is not "evil," but rather, "plainly, simply, and tragically human," (Introduction p. 1). William's behavior was part of an overarching pattern, which, if it were detected and dealt with sooner, might never have erupted into tragic assaults. Medication error and doctor complicity is a part of the Williams problem few have been courageous enough to address.
Gibb does not avoid the gruesome nature of the crimes William commits, and…
California Penal Code. Retrieved online: http://www.leginfo.ca.gov/cgi-bin/calawquery?codesection=pen
Gibb, D.A. (2011). Camouflaged Killer. New York: Penguin.
(2010). Learning mechanisms to limit medication administration errors. Journal of Advanced Nursing, 66(4), 794-
Kaushal, R., Kern, L., Barron, Y., Quaresimo, J., & Abramson, E. (2010). Electronic
Prescribing Improves Medication Safety in Community-Based Office Practices.
JGIM: Journal of General Internal Medicine, 25(6), 530-536. doi:10.1007/s11606-
Kliger, J. (2010). Giving Medication Administration the Respect it Is Due. Archives of Internal Medicine, 170(8), 690-692. Retrieved from Academic Search Premier database.
Lambert, B., Dickey, L., Fisher, ., Gibbons, R., Lin, S., Luce, P., et al. (2010). Listen
carefully: The risk of error in spoken medication orders. Social Science & Medicine, 70(10), 1599-1608. doi:10.1016/j.socscimed.2010.01.042.
Poon, E., Keohane, C., Yoon, C., Ditmore, M., Bane, a., Levtzion-Korach, O., et al.
(2010). Effect of Bar-Code Technology on the Safety of Medication
Administration. New England Journal of Medicine, 362(18), 1698-1707.
Siew Siang, C., Hui Ming, C., & Omar, a. (2010). Drug administration errors in paediatric wards:…
Bohomol, E., Ramos, L., & D'Innocenzo, M. (2009). Medication errors in an intensive care unit. Journal of Advanced Nursing, p1259-1267.
Carayon, P., Hundt, a., & Wetterneck, T. (2010). Nurses' acceptance of Smart IV pump technology. International Journal of Medical Informatics, 79(6), 401-411.
Drach-Zahavy, a., & Pud, D. (2010). Learning mechanisms to limit medication administration errors. Journal of Advanced Nursing, 66(4), 794-
Others include delays in data accessibility, albeit shorter delays and the continued need for source data verification (Donovan, 2007).
Other obstacles have occurred in the developing of mobile healthcare applications. These have included mobile device limitations, wireless networking problems, infrastructure constraints, security concerns, and user distrust (Keng and Shen, 2006).
A third problem that has been encountered is that of a lack of education on not only the importance of the information technology but also training on how to use the specific pieces of equipment. The tools that are provided to people are only as good as the training that is provided on how to use them. The tools may be able to do wonderful things, but if those that are using them do not know how to get the best use out of them they will in the end be less efficient.
According to an Institute of…
Al-Assaf, Al F., Bumpus, Lisa J., Carter, Dana, and Dixon, Stephen B. (2003). Preventing Errors
in Healthcare: A Call for Action. Hospital Topics. 81(3), 5-12.
Brommeyer, Mark. (2005). e-nursing and e-patients. Nursing Management -- UK. 11(9), 12-13.
Damberg, Cheryl L., Ridgely, M. Susan, Shaw, Rebecca, Meili, Robin C., Sorbero, Melony E.,
The Importance of Patient Identifiers
Adverse events as a consequence of medical treatment are now recognized to be a significant source of morbidity and mortality around the world (World Health Organization [WHO], 2005). Somewhere between 3 and 5% of all hospital admissions in the United States result in an adverse event, and in 1999 it was estimated that the majority of the 44,000 to 98,000 deaths caused annually by medical mistakes could have been prevented (reviewed by Leape, 2000, and WHO, 2005).
The sources of adverse events can be divided into clinical practice, defective or poorly maintained products, improper procedures, or an organizational system. The World Health Organization (2005) concluded that systemic failures are the primary source of adverse events, and can be attributed to a particular organization's patient care strategy, culture, attitudes toward managing quality of care and risk prevention, and the ability to learn from mistakes.…
Resources. When taught in-house, hospital PHI guidelines will be included as course material. A formal 2-hour lecture will be presented, followed by a specified period for home study of the course material. A 1-hour supervised exam will then be administered to test the student's comprehension of the HIPAA Privacy and Security Rules, and the significance of PSQIA.
Association of Surgical Technologists. (2006). Recommended Standards of Practice for Patient Identification. Retrieved March 16, 2011 from http://www.ast.org/pdf/Standards_of_Practice/RSOP_Patient_Identification.pdf
Brady, Anne-Marie, Malone, Anne-Marie, and Fleming, Sandra. (2009). A literature review of the individual and systems factors that contribute to medication errors in nursing practice. Journal of Nursing Management, 17, 679-697.
Brady, Anne-Marie, Redmond, Richard, Curtis, Elizabeth, Fleming, Sandra, Keenan, Paul, Malone, Anne-Marie et al. (2009). Adverse events in health care: a literature review. Journal of Nursing Management, 17, 155-164.
Patient Safety in the Medical Environment
Medicines cure various infectious conditions, avert chronic diseases issues, and alleviate pain. However, an incorrect dosage and usage of drugs could invite negative effects. Errors from incorrect medicine usage are unavoidable and can happen at home, doctor's place, pharmacies, or even at hospitals. Such erroneous activities are one of the prime triggers behind paediatric patients experiencing iatrogenic injuries. Triggers of such medication errors, as put forward by studies, include lack of adequate knowledge, work pressure, lack of awareness that such errors exist, and insufficient training. Avoiding such errors is a clinical and government necessity. Some strategies that have been employed to lower recurrences of such errors include better input from clinical pharmacists, changes in system by using critical incident analysis and using information technology (Simpson, Lynch, Grant, & Alroomi, 2004). This paper looks into two major healthcare system failures, how to lower and avoid…
Diamond, C.L., & Jacobs, A.E. (2010). Let's Not Contribute to Disparities: The Best Methods for Teaching Clinicians How to Overcome Language Barriers to Health Care. Journal of General Internal Medicine, 189 -- 193.
Quan, K., & Lynch, J. (2010). The High Costs of Language Barriers in Medical Malpractice. California: The National Health Law Program.
Simpson, J.H., Lynch, R., Grant, J., & Alroomi, L. (2004). Reducing medication errors in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed, F480-F482.
The Academy of Managed Care Pharmacy's. (2010). Concepts in Managed Care Pharmacy: Medication Errors? The Academy of Managed Care Pharmacy's.