Identifying and preventing drug-drug interactions (DDI) is critical to patient safety, but the usual method of detecting DDI and other errors - manual chart review - is resource intensive. This study describes the use of an e-trigger to pre-select charts for review that are more likely to include one of three DDIs, thus reducing the overall number of charts needing review. Two of the DDI e-triggers had high positive predictive values (0.76 and 0.57), demonstrating that e-triggers can be a useful method to pre-selecting charts for manual review.

Using data from four hospitals in the Netherlands that use barcode-assisted medication administration, the authors of this study sought to identify potential risk factors associated with workarounds performed by nurses. Potential risk factors identified include the timing of medication rounds, the route of administration, drug classification, and the nurse-to-patient ratio. Future quality improvement measures could focus on modifiable risk factors including nurse workload and nurse staffing.

… J Am Med Inform Assoc … J Am Med Inform Assoc … Workarounds occur frequently in … about two-thirds of medication administrations. They found a significant association between workarounds and medication …

Emergency department triage systems are designed to prioritize patients based on the level of illness. Inappropriate triage can lead to delays in care and adverse events. In Europe, the Manchester Triage System is a widely used algorithm that classifies patients based on five levels of urgency with a corresponding maximum waiting time. This study sought to assess the effectiveness of the Manchester Triage System in children requiring admission to the intensive care unit (ICU). Analyzing more than 50,000 consecutive emergency department visits of children younger than 16, the authors determined that almost one third of children admitted to the ICU were undertriaged. Risk factors identified for undertriage included age younger than 3 months, type of medical presenting problem, presence of underlying chronic conditions, referral by a specialist or emergency medical services, and arrival during the evening or at night. These findings suggest that the Manchester Triage System inappropriately triages a significant proportion of children requiring ICU admission and that modifications should be made to improve safety in pediatric emergency care. A previous WebM&M commentary discussed the challenges of triage in the emergency department.

… of the American Medical Informatics Association : JAMIA … J Am Med Inform Assoc … Numerous studies have identified … the hospital setting. This study, which analyzed data from a national database of medication errors in the Netherlands, … poorly designed screens and displays, were at the root of a large proportion of these errors. Dr. Donald Norman, a …

… Br J Surg … Br J Surg … This study noted a 6% error rate for … of near miss events as key learning opportunities. … Bosma E, Veen EJ, Roukema JA. Incidence, nature and impact of …

… International Journal of Nursing Studies … Int J Nurs Stud … This study explored whether nurses and … More than three-fourths had not, but those who did cited a recognized lack of expertise or disagreement regarding the …